Agenda and minutes

Please note this meeting may be filmed or recorded by the Council for live or subsequent broadcast via the Council’s internet site or by anyone attending the meeting using any communication method.  Although we ask members of the public recording, filming or reporting on the meeting not to include the public seating areas, members of the public attending the meeting should be aware that we cannot guarantee that they will not be filmed or recorded by others attending the meeting.  Members of the public participating in the meeting (e.g. making deputations, asking questions, making oral protests) should be aware that they are likely to be filmed, recorded or reported on.  By entering the meeting room and using the public seating area, you are consenting to being filmed and to the possible use of those images and sound recordings.

The Chair of the meeting has the discretion to terminate or suspend filming or recording, if in his or her opinion continuation of the filming, recording or reporting would disrupt or prejudice the proceedings, infringe the rights of any individual, or may lead to the breach of a legal obligation by the Council.

The Chair referred those present to Agenda Item 1 as shown on the agenda in respect of filming at this meeting and asked that those present reviewed and noted the information contained therein.

The Co-Chairs will welcome those present to the meeting and introductions will be given.

The Chair welcomed those present to the meeting and the Board introduced themselves.

To receive any apologies for absence.

The following apologies were noted:

·         Jon Abbey, Director of Children’s Services, London Borough of Haringey (substitute Sarah Alexander).

·         Sir Paul Ennals, Chair of Haringey’s LSCB

·         Dr Jeanelle de Gruchy, Director of Public Health, London Borough of Haringey (substitute Susan Otiti)

·         Dr Dina Dhorajiwala, Vice Chair Haringey CCG

·         Sorrel Brookes, Lay Member, Islington CCG (substitute: Lucy de Groot)

·         Emma Whitby, Chief Executive, Healthwatch Islington

·         Angela McNab, Chief Executive, Camden and Islington NHS Foundation Trust (representative: Andy Stopher)

·         Carmel Littleton, Corporate Director of Children’s Services, London Borough of Islington

In addition, apologies for lateness were received from Cllr Joe Caluori, Executive Member for Children, Young People and Families, London Borough of Islington)

There were no items of urgent business.

A Member with a disclosable pecuniary interest or a prejudicial interest in a matter who attends a meeting of the authority at which the matter is considered:

(i) must disclose the interest at the start of the meeting or when the interest becomes apparent, and

(ii) may not participate in any discussion or vote on the matter and must withdraw from the meeting room.

A Member who discloses at a meeting a disclosable pecuniary interest which is not registered in the Register of Members’ Interests or the subject of a pending notification must notify the Monitoring Officer of the interest within 28 days of the disclosure.

Disclosable pecuniary interests, personal interests and prejudicial interests are defined in the Members’ Code of Conduct.

No Declarations of Interest.

To consider any requests received.

No Questions, Deputations or Petitions were tabled.

An overview will be given of key health and care data across Haringey and Islington.

The Board received a presentation which set out the key health challenges faced by Haringey and Islington. The presentation slides were included in the agenda pack at pages 5-20 and the presentation was given by Julie Billet, Director of Public Health Camden and Islington. Some of the key points raised in the presentation were:

·         Life expectancy was a really good indicator of overall health outcomes across the two boroughs. Life expectancy at birth had increased in both Islington and Haringey over the past decade and Haringey was now comparable to London and England for both males and females. Male life expectancy in Islington remained significantly lower than London and England. In both boroughs residents spent on average the last 20 years of their life in poor health. A key challenge going forward was to address the gap in life expectancy between the less affluent and more affluent areas of the population of both boroughs.

·         Resident population was close to 500k across the two boroughs with a projected growth of 8% by 2016. Population growth would be concentrated amongst older age groups, which had particular consequences for health and social care services in the future.

·          Deprivation was a key influence on Health and Wellbeing and overall both boroughs had similar levels of deprivation.

·         Both boroughs had ethnically diverse populations seeing an increase in that diversity between 2001-2011. Both boroughs would see a reduction in the Black Caribbean and Bangladeshi populations, according to population projections.

·         Both boroughs had similar prevalence of health behavioural risk factors, although Islington had significantly more alcohol-related hospital admissions compared to Haringey. Prevalence of smoking in Islington and Haringey was significantly higher than the London average.

·         Both boroughs had a similar prevalence of diagnosed and undiagnosed long term conditions.

·         Islington had the second highest prevalence of serious mental health conditions in London (1.5%) and Haringey had the 10th highest. Both boroughs were significantly above the England and London average.

·         Both boroughs had amongst the highest numbers residents of working age claiming out of work benefits.

·         Both Haringey and Islington had significantly higher proportion of their working age population claiming sickness/disability benefits due to physical and/or mental ill health.

In summary, Director of Public Health Camden and Islington advised that the key challenges were:

• The complexity in provider landscape and patient flows and a lack of neat system boundaries.
• Different organisational cultures and ways of working across the partners
• The need to balance continued focus and work at a local level with work across the Wellbeing Partnership and at a sub-regional level.

The key opportunities were identified as:

·         Similar population health and care needs

·         The shared challenge of improving population health outcomes, care quality and system sustainability in the face of significant financial constraints.

·         Possessing shared ambitions for the residents of the boroughs, along with shared values and a commitment to working in partnership. 

a.    Update on the Wellbeing Partnership (verbal)

b.    Developing an Accountable Care Partnership Across Haringey and Islington

c.    Discussion – Workstream on Cardiovascular Disease and Diabetes in Haringey and Islington

8A. Update on the Wellbeing partnership.

The Board received a verbal update on the Haringey and Islington Wellbeing Partnership by Sarah Price, Chief Officer Haringey CCG. The Chief Officer, Haringey CCG advised that over the summer, Haringey and Islington had consolidated their position in relation to the other boroughs within NCL; the work that was occurring across the two boroughs was widely recognised as being a key component of the sustainability and transformation of health and care in the five boroughs. A lot of work had been undertaken behind the scenes to clarify what the partnership was trying to achieve, and to set out its principles and objectives.

The Board was advised that the work that was being undertaken around Cardiovascular Disease and Diabetes would be significant in helping to deliver sustainable health and care services, both across the two boroughs and more broadly. The Board was also advised that the work being undertaken around mental health was also important and that work on MSK was due to start in earnest following the appointment of an MSK lead. A children’s and young people project was also being developed under the partnership, in response to feedback from staff that they wanted to see its inclusion as one of the initial workstreams. It was noted that Tim Deeprose had recently been appointed as the Interim Programme Director for the Wellbeing Partnership, and that establishing a team to support the work was a key task to help drive the project forwards.

In response to a request for clarification, the Chief Officer Haringey CCG gave some further background information on the reasons why it had taken longer to get the work around MSK going. The Board was informed that part of the reason was due to capacity and the need to identify resources to lead on delivery of the project, particularly in terms of coordination across the different organisations involved. A lead had been appointed and work was underway to develop this work stream.  The Assistant Director of Public Health LBOH, outlined some of the main factors behind why the MSK piece of work was so important. The Board noted that representatives from CCGs, local authorities and the Whittington and North Middlesex hospitals had met the previous week to look at the agenda around children and young people. The Board also noted that the work plan for children and young people would be reviewed to support the wider work of the STP around the demands on acute care and A&E, as well as to look at the pathways for children with long term conditions with community support needs. As a result of these discussions, Whittington Health agreed to lead on putting together a proposed work plan and this would be presented to the next Haringey Health and Wellbeing Board. The Assistant Director of Public Health reiterated that there were clear links between the children and young people workstream and acute community services.

Simon Pleydell; Chief Executive, the Whittington Hospital NHS Trust commented that  ...  view the full minutes text for item 8.

The Board received a report which was included at pages 37-40, copies of the NCL STP progress report and the case for change were also included in the agenda pack at pages 41 and 69 respectively. The report provided an update to the Board on the development of the STP, which was a five year, strategic plan for the health and care system across the five boroughs of North Central London. The report was introduced by Julie Billet, Joint Director of Public Health Camden and Islington.

The Chair commented that they welcomed that the Board had the opportunity to put some of the information involved with the STP into the public domain and expressed frustration with the level of transparency around the process to date. The Chair also commented that it was clearly in the interests of both populations that the two Health and Wellbeing Boards were engaged and sat round a table discussing the STP, as the impact would be very significant. The Chair furthered that whilst the Board was happy to engage, they would reserve judgement until more concrete proposals were in place and the outcomes were known.

The Joint Director of Public Health Camden and Islington identified that as part of the STP process, officers were developing a plan on how to improve outcomes and financial sustainability across the health and care system. An initial high level STP plan was submitted in June 2016.  Over the summer, further work was undertaken to further develop the STP and a final plan would be submitted to NHS England on 21^st October. Following submission on the initial plan in June, partners across the health and care system continued to develop the ‘case for change’ and to develop plans across the following key workstreams:

• Population health and prevention
• transforming primary care
• mental health
• urgent and emergency care
• optimising planned care pathways
• consolidation of specialties
• organisational-level and system-level efficiencies

Discussions around transitioning to an accountable care partnership model were also being discussed through the NCL STP process. The Joint Director of Public Health Camden and Islington advised that there had been an initial engagement process around the STP, with a series of public events taking place in September. Although the final plan was due to be submitted in October, this version would not have been formally endorsed by any of the statutory constituent bodies of the STPs and would need to be approved by the individual Health and Wellbeing Boards.

Lesley Seary, Chief Executive, Islington Council commented that it was important to get the relationship right between the work involved in the Wellbeing Partnership, and the work involved in the STP process and the change of commissioning arrangements across NCL. The Chief Executive emphasised the need for subsidiary in the process to be able to deliver at a local level where it was most appropriate. It was considered that one of the important messages that needed to be conveyed as part of the STP process was about the need for  ...  view the full minutes text for item 9.

To consider a paper setting out the process for establishing a joint Health and Wellbeing Board between Haringey and Islington. 

The Board received a report which set out a number of considerations relating to future joint meetings of the Haringey and Islington Health and Wellbeing Boards, including the frequency of joint meetings and the possibility of formalising joint arrangements. The report was included in the agenda pack at pages 119-122, and was introduced by Stephen Lawrence-Orumwense. The Chair advised that, having discussed this with their counterpart, the sense was that the two Health & Wellbeing Boards should meet around three or four times a year. The Chair also advised that if the Board agreed to formalise joint arrangements then further consideration should be given to the frequency of individual Health and Wellbeing Board meetings. The Board agreed that further work would be undertaken around formalising arrangements and that a follow up report would be brought to the next meeting in common of the Haringey and Islington Health and Wellbeing Boards (Action: Stephen Lawrence-Orumwense).

RESOLVED

         I.        That the frequency of joint meetings be agreed at three or four meetings per year

       II.        That further work be undertaken with a view to potentially establishing a Joint Committee.

Members of each Health and Wellbeing Board to agree a date for next joint meeting.  

The Boards agreed that the Clerks would email round future meeting dates to the two Boards. (Action: joint-Clerks).

To consider any new items of urgent business admitted at Item 4 above.

None

To consider whether, in view of the nature of the remaining items on the agenda, any of them are likely to involve the disclosure of exempt or confidential information within the terms of  Schedule 12A of the Local Government Act 1972 and, if so, whether to exclude the press and public during discussion thereof.

N/A

Any exempt items which the Chair agrees should be considered urgently by reason of special circumstances. The reasons for urgency will be agreed by the Chair and recorded in the minutes.

N/A