Harrow’s population is growing and ageing; it has one of the highest proportions of those aged 65 and over amongst the boroughs that form the North West London cluster.
- London North West Healthcare NHS Trust and Imperial College Healthcare NHS Trust are the main providers of acute services.
- London North West also provides community services
- Central and North West London NHS Foundation Trust provides mental health services in and out of hospital.
The chair of Harrow CCG:
Dr Amol Kelshiker
- Harrow’s population is estimated to grow over the next 10–15 years, particularly amongst the 0–15 age group, and the over 65s. There will also be a decline in the number of residents aged 15– 44. Currently, the north of the borough has a greater proportion of older people than the south.
- The population is ageing: Harrow has one of the highest proportions of those aged 65 and over compared to the other boroughs in North West London.
- More than 50% of Harrow’s population is from black and minority ethnic (BAME) groups. The biggest of these is the Indian ethnic group who make up over a quarter of the Harrow population.
- Less than half of the children speak English as a first language. The second most commonly spoken language is Gujarati.
*based on 2013 ONS figures
- Cardiovascular disease is the highest cause of death in Harrow, followed by cancer and respiratory disease.
- Harrow has particular challenges around circulatory disease and if mortality rates from coronary heart disease in the most deprived parts of Harrow were to reduce to the rate seen in the most affluent, life expectancy would increase by over one year in males and over nine months in females. Tackling chronic obstructive pulmonary disease (COPD) in both sexes would make a significant difference to life expectancy.
- Short Term Assessment Rehabilitation and Re-ablement service (STARRS): by providing care in the community and in patients’ homes, this service helps avoid stays in hospital. If you do need a hospital stay, it will also help you get safely back home sooner. In 2014/15, STARRS helped over 3,000 patients.
- Ambulatory care: currently helping 50 patients a week, this service helps reduce unplanned short stays in hospital.
- Integrated Care Planning: patients with long-term conditions get care that brings together all their health and social care needs so they stay healthy for longer and don’t need to go to hospital. So far, we have agreed 6,000 care plans with patients in order to deliver better more coordinated care.
- Piloted weekly virtual ward meetings in one area to provide better care for patients considered at high risk of hospital admission.
Community and GP services
- Urgent care centre enhancements: we have improved the service offering minor injuries and illness management which runs alongside the A&E service and is open 24 hours a day, seven days a week. The service now treats more than 300 patients per day from an initially commissioned 190 patients per day.
- Gynaecology, cardiology and ophthalmology services have been redesigned so that more care is available in the community rather than hospital-based settings. This should help reduce waiting times and provide a more responsive and accessible service.
- Community walk-in centres / hubs: our two walk-in centres will become out-of-hospital hubs offering a wider range of community-based services. A third hub is to be developed to serve the east and north east of the borough. The aim is to offer up to 36,000 walk-in appointments from an existing baseline of 22,000 contracted appointments.
- End of life care: with our three key providers of end of life care, we are developing an integrated care model for end of life care, with a shared palliative care single point of access pilot so patients get an agreed care plans that supports them to die in dignified settings.
- Prime Ministers Challenge Fund (PMCF) is helping all 34 GP practices in Harrow to deliver better support to patients for urgent, continuous and convenient care.
- Six GP Peer Groups established to provide clinical leadership and drive up the quality of GP services available to all patients by sharing best practice.
- Weekend and evening GP appointments: two practices offer weekend and bank holiday access to patients across Harrow. The Pinn Medical Centre offers 8:00am-8:00 pm access seven days a week and Alexandra Avenue offers weekend access to patients from 9:00am-4:00pm. Twenty practices also offer extended access during the week.
- Efficient appointments: 28 practices offer telephone consultations and one practice is offering email consultations. Twenty-five practices offer online appointment booking and 24 offer longer appointments to those that need them.
Mental health and wellbeing
- Psychiatric liaison service supported by a single point of access and a supported discharge service providing better care for people with mental health illnesses at the right time in the right care settings.
- Harrow Dementia Action Alliance: a partnership of local organisations established to plan and improve dementia services.
- Integrating Mental Health: ensuring people receive the most appropriate care, that is more responsive to people’s needs, improves wellbeing and is delivered closer to home.
- 0% of Community Mental Health services shifting to general practice (excluding Child & Adolescent Mental Health Services, Mother & Baby community services, specialist teams and memory services).
- Harrow 20% of mental health appointments will be provided by GP surgeries.
- Memory Assessment Service in primary care has reduced waiting times from 37 to 13 weeks and improved the diagnosis of dementia.
Our future plans
Whilst we have made significant improvements, there is still more we want to do to improve care in Harrow.
- We have worked with our partners to submit our Better Care Fund Plan, which has now been approved. We aim to transform community services, integrate carefully and support social services so people can stay healthy and in their own homes for longer, only go to hospital if they need to and, if they do need a stay in hospital, get the right support when they leave.
- We are working as part of the North West London CCG collaboration to develop innovative approaches to whole systems integrated care as one of the National Integrated Care Pioneer Partnerships.
- We are continuing to roll out and develop our successful Whole Systems Integrated Care Programme to provide better services for people over 65 with one or more long term condition.
- Roll out weekly virtual ward meetings across the borough over the course of 2015/16 to provide better care for patients considered at high risk of hospital admission. Consultants will be available to assess patients and provide expert advice, as well as carrying out home visits if necessary.
- We will re-commission and reconfigure our community nursing services. Six multi-disciplinary teams – bringing together staff from the NHS and social care – will work across the borough so patients get more joined up care between GP, hospital, community and social care.
Mental health and wellbeing
- We have commissioned, reconfigured and expanded the Memory Assessment Services (MAS) so that it is community-based, located within practices. All investigations are completed prior to first attendance at the MAS. Access to specialist services by multi-disciplinary teams is also provided.
- As part of Improving Access to Psychological Therapies (IAPT), Harrow is one of the pilot sites for the “Big White Wall” initiative where people can self refer, or be referred from a relevant service, for IAPT support so Harrow residents can get help early to maintain their psychological wellbeing.
- We have established the Harrow Primary Care Mental Health Service (PCMHS) providing screening, assessment, comprehensive and evidence based interventions, advice and signposting for people aged 18 years and above who are experiencing a range of mental health problems.
- Harrow has re-configured the Roxbourne Service which provides active mental health rehabilitation to Harrow residents, reducing delayed discharges, and length of stay.
Community and GP services
- Improving primary care and access to it: we are supporting our 34 GP practices to work in a network to deliver integrated care services and work more closely with community and acute services. This means more appointments will be available at more convenient times. Patients will also be able to contact their GP in new ways such as via email.
- We will continue to make it easier to see a GP with three walk-in centre GP practices providing appointments 8:00am–8pm, seven days per week, so all patients can access both urgent (within four hours) and non-urgent (within 48 hours) appointments. In time, the walk-in centres will be expanded to form community hubs.
- Increasing Outpatient and Elective Services in the Community: we intend to continue our work moving of services into community settings where safe and in the best interests of patients.
- Through our Primary Care Transformation Plan, Whole Systems work and the reconfiguration of community services, we will continue to deliver our vision of establishing three Community Hubs across the borough.
- We will re-commission and reconfigure our community nursing services. Six multi-disciplinary teams – bringing in staff from community, primary, hospital and social care – will work across the borough so patients get a more responsive service.
- We are investing in an Enhanced Nurse Pilot Project to increase nursing capacity within the community and provide better care management and coordination for our most vulnerable patients.