Agenda item

A report was included in the agenda pack at page 47. Zina Etheridge introduced the report to the Board which provided information about a partnership that was being formed between NHS organisations and local authorities in Haringey and Islington. Ms Etheridge introduced Anni Hartley-Walder, Programme Director for the Wellbeing Partnership to the Board. Following the presentation the Board discussed the findings.

The Board were advised that the partnership was made up of representatives of Haringey & Islington Councils, Haringey & Islington CCGs, Whittington Hospital and Camden and Islington Mental Health Trust and built upon some work that had been undertaken around bidding for NHS innovation funding. The Wellbeing Partnership looked at whether there were ways for the organisations to work together more effectively; to make sure that they were reshaping the health and social care economy across Haringey and Islington to support better quality outcomes for service users and to do so in a more financially stable way. 

The Deputy Chief Executive advised that the report was brought to the Board to outline the proposed governance arrangements, reflect on next steps and to highlight that there were significant benefits for residents in both boroughs to continue to work in a more joined up way. It was proposed that the Haringey & Islington Health and Wellbeing Boards would provide the overall governance for the programme and that on occasion the two Health and Wellbeing Boards would come together and meet as a joint body to provide high level governance. The Board noted that the constitutional arrangements for any joint meetings would need to be determined.

The Deputy Chief Executive advised that the Wellbeing Partnership was a really important part of the overall NCL Sustainability & Transformation Plan and formed a key platform for governing and taking forward the reshaping of the health and social care economy locally. The Chief Officer Haringey CCG suggested that the Wellbeing Partnership would be an obvious home for some of the work being undertaken around outcomes based commissioning. The Board were advised that the themes of frailty in older people and diabetes care would benefit from being aligned together and then pulling them in to the value based commissioning work to ensure an alignment of incentives for all the organisations involved, to provide the desired outcomes such as keeping patients at home.

The Chair advised the Board that she had met with Richard Watts, the Chair of the Islington Health and Wellbeing Board along with the Wellbeing Partnership Sponsor Board on two occasions recently. The Chair fed back that the progress made in those two meetings was fairly heartening and that there was a significant improvement in coherence from the first meeting to the second. The Chair advised that at the last meeting it was agreed that the next step was to arrange a joint meeting of the two Health and Wellbeing Boards, ideally before the summer holidays to give the impetus and oversight that the project required. Clerk to look into holding a joint Health and Wellbeing Boards and possible dates prior to summer recess. (Action: Clerk).

The Lay Member Haringey CCG commented on the increasing focus on shared working between the Council and various partners and welcomed the impact of this on improving services for patients and residents. The Lay Member Haringey CCG also advised that the Board needed to be cognisant of what these proposals meant for the east of the borough and that the Board needed to acknowledge that would be a key question. The Lay Member Haringey CCG also commented on the significant number of governance structures involved in the process and advocated that this would need to be simplified in the future. The Deputy Chief Executive acknowledged the complex governance arrangements and suggested that these would only become sustainable when they became the way that the Board worked in its day-to-day functions. It was noted that the workstreams chosen were because they were absolute priorities for the authority and the Board would have to look at merging some of the governance strands to facilitate progress.

Sharon Grant, Chair Healthwatch Haringey, acknowledged the administrative benefits and financial drivers behind the Wellbeing Partnership but raised concerns about how the Board would ensure that patients and residents continued to have an input into the decision making process if decisions were increasingly taken by centralised bodies. Ms Grant also raised concerns about what would happen in the event of differing priorities and questioned how different needs across parts of the two authorities would be managed. The Board acknowledged the need for transparency and suggested that it was part of the reason behind the desire to bring the two Health and Wellbeing Boards together. The Chair advised that this would not require the merging of Haringey and Islington Healthwatch due to an acknowledgement that the two bodies would have different interests. The Chair also commented that through being very clear about the four initial priorities for the partnership, 2 of which were more population based and 2 of which were of a clinical nature, the Board should be able to target the groups and individuals it wanted to regardless of location. 

The Cabinet Member for Finance and Health enquired about the wider prevention piece and the extent to which determining factors such as housing, environment and education were fed into the governance structure.  The Chief Officer Haringey CCG commented that the name Wellbeing Partnership was selected because of a desire to start with a much more preventative approach. The Chief Officer Haringey CCG advised that there was currently no incentive in the health system to tackle determining factors at a preventative level and that by aligning the two boards together it was hoped that levels of need could be driven down and risk factors tackled before they developed into more severe issues. The Deputy Chief Executive commented that a significant amount of work had been done as part of the cross-cutting mental health strand, looking at accommodation and employment pathways for people with severe and enduring mental illnesses which resulted in commissioning a support package to get those people into employment in a targeted way. The Board was advised that the partnership enabled them to understand some of the issues around determinants and the tensions contained therein, precipitating a wider conversation about what the earliest stage was that prevention measures could be in place collectively as a system. The Deputy Chief Executive acknowledged that the current work strands did not necessarily reflect  these proposed developments due to it being at a an early stage but reflected that work was being undertaken to determine the pathways or population groups that required focus.

The Cabinet Member for Finance and Health further enquired whether, in feeding those issues into discussions, it would be primarily the Council that would be responsible for achieving this or whether the Board would look to bring specialists in, such as community sector representatives. In response, the Deputy Chief executive suggested that other Health and Wellbeing Boards regularly involved outside organisations and that hopefully this process would afford the Board more scope in determining whether it needed to involve specific groups for specific programmes.

The Chief Executive BRT commented that the BEHMHT did not seem to be included in the partnership and suggested that it seemed as though mental health did not appear as prominent in the work streams as physical health. The Chief Executive BRT also sought clarification on the stakeholder forum and how that might work. Clarification was sought how the process would link into the community and voluntary sectors.

The Chief Officer Haringey CCG responded that the officers were in discussions with mental health providers including BEHMHT about how they would tie into the process. The Board was given assurances that mental health would be at the heart of each of the areas looked at and that initial discussions had suggested that because it was so fundamental and overlapping to each area it was felt that having it as a specific work stream would have been unsuitable. The Chief Officer Haringey CCG agreed to ask Dr Maimaris’ team to look at better reflecting the crucial role that mental health would play in the partnership’s priority setting process. (Action: Sarah Price). In relation to the stakeholder forum, the Chief Officer Haringey CCG advised the Board that a lot of groups had already been involved in the forum, particularly the disease based groups. The Chief Officer Haringey CCG acknowledged the ongoing need to develop a robust forum in which ideas could be tested out and a broad array of opinions included.

The Chair of Healthwatch Haringey sought clarification around the integrated model of care for people with learning disabilities proposed as an immediate area of work, and how that would interact with the existing work being done in the borough and the role of the current steering group. Dr Maimaris advised that over the coming weeks and months partners would be looking to more detailed scoping of each of these proposals to try and build on what was happening in the borough. Dr Maimaris argued that in terms of mental health, they would consider which areas of work could really benefit from the added value of working on a shared Haringey and Islington footprint. Dr Maimaris also reassured the Board that mental health and wellbeing would be a key work stream undertaken. The Deputy Chief Executive commented that the physical health outcomes for people with learning disabilities were really poor and the partnership would be looking at the pathway as a whole, such as the transition from children to adulthood and the connection to physical health.

The Vice-Chair, Haringey CCG enquired about the extent to which links to schools had been considered, given the importance of promoting health and wellbeing from a young age.  The Director of Children’s Services responded that prevention was a key priority within the early help arena and acknowledged the need to work with partners to reach out to school children at a fairly early age. The DCS also commented on the need to capitalise on some of the existing work that was already being done in local schools and within the wider community.

The Programme Director for the Wellbeing Partnership commented that the wellbeing partnership gave partners the opportunity to upscale projects to make them transformational, utilising the combined focus of the local authority and health organisations. The Programme Director for the Wellbeing Partnership highlighted that the timing of this piece of work also seemed to be right given the clear links with the NCL STP and the need to have a repertoire of well developed schemes, on a transformational footprint, in place in order to access funding once it becomes available in April 2017.

RESOLVED:

I). That the Board note the immediate areas of work:

-   Developing care that supports independence in older people with health and social care needs

-   A re-designed pathway for people needing musculoskeletal care (ranging from physiotherapy to treatment for chronic pain and rheumatology)

-   An integrated model of care for people with learning disabilities

-   A model of care that improves the prevention, identification and management of diabetes and cardiovascular disease.

The cross-cutting themes across all these four areas will include: sustaining good mental health, prevention, action on the wider determinants of health (including housing and the environment), early identification of illness and maintaining independence.

II). That the Board support the approach being taken by the Haringey

and Islington Health and Wellbeing Partnership, noting the principles

underpinning the joint work and recognising the value in working

across organisations in Islington where this offers scope for

increased impact and pace of change for people in Haringey.