Agenda item

A presentation will also be given by Dr Helen Taylor on progress with respect to the Wellbeing Partnership’s work-stream on frailty.

The Board received a presentation from Dr Helen Taylor on the frailty workstream of the Wellbeing Partnership. Following the presentation the Board discussed its findings.

The Board considered that in addition to age, there were a number of factors that determined health needs such as; social housing, possessing long term conditions, reduced mobility and mental health issues. In determining how to care for these people it was evident that there was a cohort of patients who received a high level of care and were know to the system. Dr Taylor advised that in developing the frailty workstream it was hoped that the partnership could intervene in cases where people may be developing long term conditions or have reduced mobility but only became known to the system once they had suffered a crisis and were admitted to an A&E department. The Board was advised that the proposal was to mirror schemes undertaken by south west academic health science networks and in places like Humberside in which frailty was considered as a long term condition. Frailty was described as a loss of reserve, due to factors such as a loss of mobility and the presence of other long term conditions etcetera, which would result in a period of hospitalisation following a crisis.

Using this definition, a cohort of service users had been identified through workshops and pathways were sought to reduce their level of potential vulnerability and to intervene before they reached a crisis point. In determining what was already in place, the Board was advised that there were already a significant amount of interventions available but the challenge was to connect these together and think strategically at a population level. Dr Taylor also advised that the task was to deliver the correct outcomes, that the patient wanted, and to do so before they suffered a health crisis. An e-frailty index had been developed to that effect which provided a way of indentifying frailty across a range of factors and categorising them in terms of mild, moderate and severe frailty which would then be linked to GP records. The Board was advised that the proposal was due to be taken to the sponsor board and Dr Taylor invited the Board to provide comments and consider what the next steps were. In response to a request for clarification, Dr Taylor advised that a key consideration was how to take the work been done by the Wellbeing Partnership and get it to the point where this could work at a population level. The Chair commented that there were some interesting pilot schemes involved, and the question was at what point was there enough of an evidence base to incorporate into them into mainstream service provision.

The Board also received a report from Tim Deeprose, Programme Director for the Wellbeing Partnership which sought views on the extent of the collaboration involved in the establishment of the Wellbeing Partnership Agreement, which was to be presented to Council Cabinets, Trust Boards and CCG Governing Bodies in April and May 2017. Support was given to establish a Haringey & Islington Wellbeing Partnership at the 3^rd October meeting in common and the Board was asked to consider areas for greater joint working.

The Deputy Chief Executive, LB Haringey commented that some of the questions raised in the report were easier to answer than others and that having a joint health & wellbeing strategy should be easy to agree as without a strategy it would be difficult to join up any of the other aspects that would sit underneath it.  The Deputy Chief Executive suggested that the Board might want to consider whether to include all health and care services or whether there were some services that would be best placed to be delivered outside of the Wellbeing partnership, at a very local level. The Board considered the need to develop the management & leadership capability in order to facilitate greater joint working across the proposed workstreams and that in reference to the point raised by Dr Taylor about next steps; it was likely that the Wellbeing Partnership would need to move towards joint management structures. The Deputy Chief Executive suggested that joint performance management would likely follow on from the development of a joint health and wellbeing strategy.

The Chair echoed the comments of the Deputy Chief Executive, LB Haringey and suggested that this seemed like a sensible approach. The Chair proposed that the assumption was for joint working whilst protecting the principle of subsidiarity and that partners should be able to their own due diligence and consider their own legal responsibilities.

The Chief Executive, LB Islington echoed the comments of the Deputy Chief Executive, LB Haringey around the need for a joint health and wellbeing strategy and that areas of greater joint working would flow from there, along with the principles already agreed by the Wellbeing Partnership such as the need for subsidiarity. The Chief Executive advocated being selective in the areas of joint working and focusing on getting those right before broadening the approach. The Board considered that agreement had already been secured through the CCG for a joint local CCG type arrangement across the two boroughs with shared commissioning post and that this would help develop a joint management structure.  The Chief Executive, LB Islington advised that adopting a ‘big bang approach’ would likely scare people and generate concerns about budgets and where they would sit in future, instead the Wellbeing partnership should build confidence by focusing on a joint strategy and clear areas of focus around particular workstreams. 

The Programme Director for the Wellbeing Partnership presented a draft governance structure to the Board which was included at page 27 of the agenda pack. The Board considered that the Wellbeing Partnership Board would have oversight of the system as a whole, deal with strategic issues and have sight of all of the funding being used in the area. Whereas the delivery group would be operationally focused and clinically driven, involving professionals from each of the services involved. The Board was advised that it was felt necessary to include a community reference group in the proposed governance structure in order to ensure there was enough community/service user influence across the system. The Programme Director for the Wellbeing Partnership advised that the work groups across the bottom of the structure clustered activities being undertaken by the programme and reflected the same groupings as set out in the STP. The Board where asked to provide comments on governance arrangements and the draft governance structure.

The Haringey Cabinet Member for Finance & Health commented that he felt that the proposed governance structure looked sensible but that an interim governance structure was selected for the wellbeing programme when it was adopted last year and challenged whether there was enough evidence from that period of informal collaboration to justify formalising the structures as proposed. The Programme Director for the Wellbeing Partnership acknowledged these concerns and advised that the sponsor board were meeting later that week to discuss the barriers that were being faced by each of the working groups as they have tried to establish how new services could be put in place. The Programme Director for the Wellbeing Partnership suggested that the governance structure needed to be nudged along in order to stay ahead of where the working groups had got to so that they were in a position to remove barriers as and when they arose.

The Cabinet Member sought clarification on what some of those barriers had been to date. In response, the Board was advised that a key barrier was around the need to get information governance in place in order to be able to share information across a large population base. The Programme Director for the Wellbeing Partnership also advised that workstreams to help people self manage their conditions needed to be established at a local level to support the STP, and that having a formalised governance structure facilitated this through encouraging greater interaction between constituent parts of the system.

Cllr Kober enquired where democratic accountability would sit within the proposed governance structure. The Board was advised that this would depend upon the type of partnership arrangement that was sought and what it was that the Wellbeing Partnership Board needed to do. It was envisaged that if there was a significant element of budgetary responsibility transferred over then this would likely necessitate greater political oversight. The Programme Director for the Wellbeing Partnership suggested that ultimately a very different accountability might be required but that over the next 12 to 18 months democratic accountability would remain with the individual statutory organisations that made up the Wellbeing Partnership Board.

The Chief Executive, LB Islington commented that she had assumed that the Wellbeing Partnership Board was an evolution of the two Haringey and Islington Health & Wellbeing Boards meeting jointly, reflecting a formalisation of existing arrangements. In doing so, it was assumed that there would continue to be a mix of democratically elected members and professional officers.

The Chief Executive of the Bridge Renewal Trust queried whether the community reference group referred to in the draft governance structure would be one group, combining voluntary and community sector groups across Haringey and Islington or whether there would be two groups. The Board also considered the need to ensure that local organisations were included in any future commissioning arrangements.

The Chair advised of the need to set some fairly short timescales to resolve some of the queries raised. The Board agreed for a proposal setting out the governance arrangements and a resolution to some answers to some of the questions raised, to come back to the next meeting of the Board.

Action: Tim Deeprose/Clerk