Agenda item

A cover report was included in the agenda pack (pages 21-22), which  updated the board on the work being undertaken at a local level around health and social care within Haringey; jointly between Haringey and Islington through the Wellbeing Partnership and, across North Central London through the Sustainable Transformation Plan.  Zina Etheridge, Deputy Chief Executive introduced the report. A presentation was also given jointly to the Board by the Deputy Chief Executive and Sarah Price, Chair Haringey CCG. Hard copies of the presentation were tabled at the meeting.

The Board were advised that together, Haringey & Islington were best placed to tackle local issues and lead transformational change at pace. However, the Board needed to start considering next steps to ensure the right structures were in place to work with communities to deliver better health and care over the long term. Some of the key considerations outlined in the presentation included: Whether there was a need for a more formal, shared governance structure with shared accountabilities, risks and incentives; should there be a more radical approach to pooling financial resources; how to improve the commissioner/provider relationships; and how to embed incentive structures aligned to outcomes rather than processes.

The Board considered that any new approach would need to enable the Wellbeing Partnership to deliver improvements for residents, front-line change and financial efficiencies faster and more effectively. In summary, the Deputy Chief Executive advised that development of the STP for North Central London led to a series of questions about how best to deliver ongoing improvements to health and care in Haringey. The Board was informed that the next step was to start exploring whether a more formal arrangement for the Wellbeing Partnership could help achieve these improvements. The Deputy Chief Executive acknowledged that there was a significant amount of information to consider and suggested that the Board might want to consider and discuss its initial findings, and that subsequent conversations could be held either on a one-to-one basis or potentially at the next Joint Health and Wellbeing Board with Islington.

Cllr Weston, Cabinet Member for Children and Families commented that the increasingly formalised nature of joint working with both Islington and across NCL created the need for an overarching structure in place in order to ensure successful delivery. This was especially apparent given the resources already invested and the risks involved. The Chief Officer, Haringey CCG agreed that the process needed to be embedded and become more formalised, and advised that the focus was very much on the population as opposed to the organisations that sat within them. It was advocated that that this was crucial in making sure the services delivered met local needs.

The Deputy Chief Executive outlined that the initial emphasis for forming the Wellbeing Partnership was the application to become a vanguard organisation for the NHS’s New Models of Care programme which, whilst unsuccessful, elicited further discussions around developing a new model of care that brought in Islington and a host of new providers and led to the establishment of the Wellbeing Partnership. The Deputy Chief Executive suggested to the Board that there was a spectrum of different models that could be used; from developing an Accountable Care Partnership to a much looser coalition governed by a Memorandum of Understanding. The Board noted that an Accountable Care Partnership tended to have budgets based on a per-head of population basis and that as a system, there would be a focus on what was the best way of spending that money to achieve the objectives required. Separate arrangements were likely to be required for specialist commissioning. 

The Chair suggested that it was probable that there could be a significant devolution deal for London on the table around the time of the Autumn Statement, which would include aspects on fiscal devolution and also aspects of public service reform to make it more accountable and responsive. The Chair advised that part of the process would involve scaling up from working on a borough wide basis to a sub-regional or regional basis, and that there were clear synergies between this and the work being undertaken around further integrating health and care in Haringey. The Chief Officer, Haringey CCG suggested that there would also likely be further opportunities to apply for vanguard status and some of the pump priming funds to help get some of these new models up and running. 

The Chair requested that members of the Board give further consideration to whether a more formal arrangement for the Wellbeing Partnership should be developed and also consider the potential models involved. Further consideration to be given outside of the meeting and in the run up to the joint Health and Wellbeing Board meeting on 3^rd October.

Geoffrey Ocen, Chief Executive of the Bridge Renewal Trust emphasised the need to agree a governance structure going forward, particularly in terms of the need to safeguard localised decision making. The Deputy Chief Executive acknowledged that there would be certain aspects that were best suited to being undertaken on pan-London or regional basis, some on an NCL basis and those that would be much more suited to a local basis. The Cabinet Member for Children and Families urged that an agreement would also need to contain the flexibility to allow other partners to come in when required. The Cabinet Member elaborated that as well as facilitating localised decision making, the agreement would also need to support further integration of health and care across the NCL region.

Sharon Grant, Chair Healthwatch Haringey raised concerns about accountability and advocated the need to continue to make it clear to user groups where decisions were made. The Chair of Healthwatch Haringey also raised concerns around the potential for further broadening of collaborative working to harden the inequalities around the north-east of the borough and urged focusing on collaboration that tackled some of the significant health inequalities in this area. The Chief Officer, Haringey CCG agreed that a key challenge was to find how to broaden work with other partners, commissioning services together in order to deliver the range of services required for the population, including working with Enfield.

The Chair advised that there had been a great deal of partnership working undertaken in recent months with Enfield around North Middlesex Hospital, which had also led to a number of discussions around the underpinning issues relating to primary care and the clear similarities between north Tottenham and Edmonton. The Chair noted the point about accountability and commented that this would be particularly important given that the STP process seemed to have taken place across the country with very little political oversight and suggested there was a clear need for transparency.

RESOLVED:

I). That the HWB notes developments on health and social care locally, with Islington and across North Central London.