Agenda item

The Board received a presentation, from Ms. Zina Etheridge and Ms. Sarah Price, the Chief Operating Officer of Haringey Clinical Commissioning Group, giving an overview of key developments related to Health & Wellbeing in Haringey. Ms. Etheridge noted that the Mental Health and Wellbeing Framework was tabled as an appendix to the report in the agenda pack. Following the presentation the Board discussed the findings.

The Board noted that the Care Act 2014 involved the biggest change to adult social care since the foundation of the Welfare State in 1948.  Included in the Act was a provision that the Council had a duty to promote an individual’s wellbeing. It was noted that the Care Act 2014 made the principle of wellbeing a cross-Council, cross-partner and cross-third sector concern; which created a community based definition of wellbeing.

Ms. Etheridge outlined the key elements of the Children and Families Act 2014. The Board noted that the Act involved changes to adoption and reforms to the way Looked after Children were cared for. It was also noted that the act integrated educational training provision with health care and social care provision in the context of promoting wellbeing. This duty provided a much greater emphasis of health care and social care providers to work in a more joined-up fashion and, as a result, engendered joint commissioning arrangements between the Council and the CCG in relation to children and young people with those needs.

Ms. Price noted that the Five Year Forward View for the NHS was set out in October last year and this document brought together all of the health care organisations such as NHS England, Public Health England and the Trust Development Agency to jointly set out what those organisations wanted to achieve over the next five years. The document showed how the transformation of services was to be delivered, in order to make it both affordable and also improve the quality and ensure sustainability going forward.  The key consideration was noted of changing health demographics, with a rise in long term conditions and associated costs involved. The Board noted that Haringey CCG was awarded an additional £5m (including £1.7m to assist with additional demand pressures during winter) from the £1.95B announced in the Autumn Statement to support the changes set out in the Five Year Forward View. Additionally, £200m was allocated for pump priming the new models of care set out in the report and £250m a year, for a four year period, was set aside to improve primary care. Ms Price advised that the local outcome of those two bids would be known around Easter time.

Ms. Price outlined the main elements of the Haringey CCG Five Year Plan, which was coming to the end of the first year of its planning cycle. The plan had been developed locally and discussions had also been undertaken with Camden, Islington, Barnet and Enfield to ascertain what their plans were and what could be achieved through a collaborative plan. The CCG was looking to explore and commission some the alternative models of care through this plan. The overall mission of the plan was to make primary care and care closer to home really work for all Haringey’s residents, and in doing so reduce the pressures on hospitals. The plan also set out how models of primary care might be set out more innovatively bringing GP’s, Trusts, community and voluntary organisations into the new ways of working.

Ms. Etheridge commented that in Priority 2 of the Council’s Corporate Plan 2015-2018, the Council was committed to “empowering all adults to live healthy, long and fulfilling lives”. Ms. Etheridge also commented that the Council was consulting on Haringey’s new Health and Wellbeing Strategy for 2015-2018, but that the three main priorities for the strategy were:

• Reducing obesity;
• Increasing healthy life expectancy; and
• Improving mental health and wellbeing

Ms. Etheridge introduced Tamara Djuretic, Assistant Director of Public Health, and Tim Deeprose, Interim Assistant Director for Mental Health Commissioning, and they presented the Mental Health and Wellbeing Framework to the Board. Dr. Djuretic commented that the Mental Health and Wellbeing Framework was jointly produced by the CCG and LBH andarticulated joint vision and strategic commissioning intentions for the next three years. It was noted that dementia was excluded from the framework as it had a different set of strategies required to deliver it. The framework takes a life course approach and reflected the shifting current model of care from acute and residential care towards community care, focused on prevention and early health. The vision for the framework was: “All residents in Haringey are able to fulfil their mental health and wellbeing potential.” The Board noted that this focused on the population as a whole not just high risk cases and identified wellbeing, as defined in the Care Act 2015, as a key element.

Mr. Deeprose outlined the four priorities of the framework to the board. The Board noted that each of the four priorities was to have a task and finish group established to assist in the implementation of the framework.

The priorities were noted as:

• Promoting mental health and wellbeing and preventing mental ill health across all ages.
• Improving the mental health outcomes of children and young people by commissioning and delivering effective, integrated interventions and treatments and by focusing on transition into adulthood.
• Improving mental health outcomes of adults and older people by focusing on the three main areas: meeting the needs of those most at risk; improving care for people in mental health crisis; improving the physical health of those with mental-ill health and vice versa.
• Commissioning and delivering an integrated enablement model which used individuals, families and communities’ assets as an approach to support those living with mental illness to lead fulfilling lives.

Ms. Etheridge noted that there was a considerable amount of change outlined in the paper. The paper and the Mental Health Wellbeing Framework in particular, contained a number of key principles and outcomes:

Principles:

• Wellbeing at the core of all we do.
• Prevention and early help – including supporting children to get the best start in life.
• Strong, collaborative partnership.
• Promoting independence, underpinned with the right support.
• Working with communities.
• A holistic approach, putting individuals, not institutions, in control.
• Reducing health inequalities.

Outcomes:

• Better wellbeing.
• Better health, for longer, for everyone.
• Independence and self managed support – enabling people to be in control of their lives.
• High quality services that are joined up around individuals, and community needs, not those of the institutions providing services.
• Resilient communities.
• Safety.

The Chair commented that a huge body of work had gone in to the paper and underlined that the report made clear that the delivery of these changes required a significant change in the way organisations worked, including greater cooperation between the public and voluntary sector. The Chair requested clarification on what some of the key challenges would be in that regard. Ms. Etheridge responded that there were some very significant challenges involved, but at the centre of this was placing early intervention and prevention at the core of everything that Council and partners undertook. Significant resources were tied up in acute provision and resources focused on people in beds as appose to enabling people to live in the community, so transitioning would be a key challenge including the work force transformation required to support this. Officers also responded that a further key challenge was ensuring that community and voluntary sector organisations were involved and operated as strong partners with the Council and CCG. Doing so would involve a level of support to those organisations to enable them take on those opportunities. Furthermore, the Care Act 2015 outlines a duty to ensure that there was a sustainable market available for delivering the goals of the Care Act.

Ms. Price noted that from the NHS’ perspective, the workforce issues would require some further joint work; particularly as both the Council and NHS would be looking to recruit from the same pool of resources. In addition, reduced duplication through the better alignment of resources was also identified as a challenge. Officers also noted that people being helped to understand what the vision was across Haringey as a whole, was also a key challenge.

Jon Abbey, Interim Director of Children’s Services, commented that the Care Act 2015 and the Children and Families Act 2014 should not be seen in isolation and that there were substantial crossovers, particularly in terms of the transitionary period between when a young person becomes an adult. Possible concerns were noted in terms of the negotiation of Education Health and Care Plan and also Child Needs Assessment. The link between the two was highlighted and consideration would be required on with how best to utilise resources to ensure best outcomes. Joint commissioning was central to the overlap being tackled. 

Beverley Tarka, Interim Director Adult Social Care, commented that health and social care integration was key to transformation of the health and social care economy. Ms. Tarka reiterated that significant resources were trapped in the acute sector and emphasised the need to shift activity to prevention and early intervention. Ms. Tarka also identified a number cross-cutting themes and enablers such as staff, IT and interoperability. The centrality of the communities’ theme was highlighted particularly in relation to the Care Act 2015, Children and Families Act 2014 and the NHS Five Year Forward View. In order to develop the shift required the Council and partners would need to facilitate the community to self manage, which would be a huge task. The commitment to develop a diverse and sustainable market was identified as one of the key challenges in the Care Act 2015 and it was noted that this would necessitate close cooperation between the Council and its partners.   

Dr. Djuretic commented that the increasing population and the effects of an ageing population were also an important consideration as this would place an increasing strain on health and social care providers.

Sir Paul Ennals, Chair of Haringey LSCB, commented that the work that had been done so far including the Mental Health & Wellbeing Framework in Haringey was a very impressive body of work, particularly in terms of its scope and the fact that all of the different stands had been brought together. Sir Paul advised that whilst the pace of change had been swift in the previous three years, the next three years would be even more difficult. Sir Paul noted that the theme of integration including integrated planning, commissioning and delivery of services would only be increased over time. Sir Paul enquired what the overall arching strategy document was, given the number of strategic documents being developed by the Board. Sir Paul also queried what the role of the draft Health and Wellbeing Strategy was in relation to these other documents. The Board needed a central strategy to bind all of the other strategies together. The Health and Wellbeing Strategy should be the central strategy, which pulled together the outcomes and principles from which all of the strategies of the Health and Wellbeing Board flowed.

Sharon Grant, Chair of Healthwatch Haringey, reiterated Sir Paul’s comments about the need to have a central strategic document that outlined all of the changes that are being brought about in health and wellbeing. Ms. Grant also commented that she would like to see some indication in the document of how our strategies had been informed by the particular problems in Haringey, including our engagement with communities.

The Leader, Cllr Kober, also agreed with Sir Paul’s and Ms. Grant’s comments about the need for an overarching strategy document. The Chair stated that there was a great deal of worth in the draft Health and Wellbeing Strategy and that the challenge over the next three months was to refine some of the issues and to make clear the Haringey specific elements. Mr Abbey commented that in terms of the tabled report, the draft Health & Wellbeing Strategy and the recent Overview & Scrutiny review of Mental Health and Wellbeing, there was a strong Haringey specific flavour to the work that was being undertaken. Ms. Etheridge advised that the Joint Strategic Needs Assessment was the place where the specific information that related to Haringey was brought together. Ms. Etheridge also commented that perhaps the report needed to better reflect the JSNA.

Ms. Grant fed back that Healthwatch Haringey felt that the Mental Health and Wellbeing Framework in Haringey lacked sufficient emphasis on drugs and alcohol related issues. Ms Djuretic agreed to take these comments on board and agreed that this would be incorporated into the delivery plan developed through the task & finish groups.

It was

RESOLVED:

I). That the impact of the Care Act 2014 and the Children and Families Act 2015 be noted; and

II). That the Council, NHS England and Haringey CCG Strategic Plans and Priorities referred to in the report be noted; and

III). That the progress on the consultation for the Health and Wellbeing Strategy be noted; and

IV). That the Mental Health and Wellbeing Framework in Haringey be agreed.