Agenda item

Rachel Lissauer, Director of the Wellbeing Partnership for Haringey and Islington CCGs, introduced this report and presentation to the JHWBSC. This report provided a summary of the NHS Long Term Plan with a particular focus on its implications for the development of integrated Care Systems in both boroughs.

The following was highlighted:

• The report set out the expectations of what would happen at integrated care systems level. There were a set of expectations surrounding health and care budget alignment. This was permissive in its approach and outlined a range of options.
• There was an expectation that integrated care systems would provide a plan of their approach for NHSE by April 2019.
• It was expected that the boroughs would be approached regarding how they saw their integrated care systems developing. Across the different boroughs in North London, a simulation event was held which considered what it meant for the boroughs to work in an integrated care system.
• The JHWBSC was asked to note the long-term plan and discuss the ways in which to use the learning from the integrate events and learning from the work already done in formulating a response to the NCL.

The following was noted in discussion:

• As it was not known at what level the integrated care system would be set, it was questioned how a response could be provided given that lack of certainty.
• Regarding budget alignment, it was queried whether the Council had any choice in the matter, and what would be the extent of the budget alignment.
• It was queried what the role of the public and democratically elected representatives would be in the integrated care systems.
• There was disappointment that social care was not mentioned within the NHS Long Term Plan.
• Whilst the NHS was seeking to increase its contribution to addressing the causes of ill health such as smoking, it was noted Council efforts in reducing smoking had been hampered by budget cuts.
• Cllr Watts stated decisions should be taken at the lowest possible level or closest to where they would have an effect in order to maximise the potential of the integrated care system. The JHWBSC felt strongly that any plan needed to be clear regarding what was being done and where. In regards to taking decisions at the earliest available level, Cllr Weston questioned where that level was set for different services and what was the process to decide where and how those decisions should be taken if the system was to be redesigned. 
• The differences in the political visions of the different North London boroughs was highlighted in making it unlikely there would be a single shared approach to an integrated care system. It was recognised that boroughs in North London had differing needs and requirements across their services and therefore it would be difficult to create a single system to accommodate those.

• The change in the GP contract, which enabled them to formally work in primary care networks, was highlighted as a positive step. An issue for GPs before was that money in general practice was not recurring but with the change of GP contract, the money was now recurring to support their role in the primary care network.
• With the increasing digitalisation of the service, such as the option for patients to receive advice and care on the NHS App, there was a concern that residents who could not or did not have the ability to use these, might be left behind. Members were satisfied that the move towards digitalisation was a positive direction which would free up much needed resources.
• Regarding consultation on the Plan, partners were encouraged to consider what was useful in addressing with residents, such as programmes and services that were currently working for residents and what needed to be improved.
• The JHWBSC were encouraged to use this opportunity to create a bespoke system that fitted the needs of their residents, or have a system imposed on them. It would be up to the partners to establish solutions to the problems and obstacles.
• The Chief Executive of the Bridge Renewal Trust welcomed the emphasis and inclusion of social prescribing. However, he was concerned that primary care networks were seen in terms of its clinical leadership and not its other elements such as the voluntary sector. It was therefore important to increase the inclusivity of all the different services within the primary care network.
• It noted that the Long Term Plan was encouraging in that it had many elements that the NCL already had in practice but the extensive scope of the Plan was a potential positive and negative. There was concern that Primary Care Networks were not seen as part of the system as much as it needed to be.
• It was important that providers were encouraged to work together in sensible ways. There had been attempts to create momentum around new roles, such as the nursing associate role, which had been positively received.
• Financial issues was highlighted as being a potential concern. The JHWBSC was referred to the NHS confederation’s campaign ‘Health for Care – Demanding a Future for Social Care’ which was a multiagency group looking at the funding surrounding social care.
• The Chair of Healthwatch Haringey raised concern that it was not clear what was able to be consulted with the public during the consultation as the parameters had not yet been set. There also needed to be work informing the public about the potential positive impact on them when the proposed system came into effect. Publicising case studies on the positive impact on individuals was encouraged. The Lay Member for the CCG Haringey concurred and stated the public had to be told clearly what they were being consulted on and what they were being informed of. It was also questioned what ‘local’ looked like and how local would be determined.
• Regarding the implications locally, it was important the board and similar bodies carefully considered the principles, values and behaviours that would be embedded in the new care systems moving forward. For example, increasing the engagement of the residents and patients in contributing to the formulation of any new care system.
• It would be difficult to prepare for a system where there was a degree of uncertainty in how that system might take form.
• Merging North London CCG’s had been discussed as a possible option.

RESOLVED

1.    To discuss responses to the Long Term Plan and to consider learning and insights from the InterGreat events.

2.    To note that Haringey and Islington would be continuing to work ‘on the ground’ through their prototypes and would also be starting to set out at borough level, their proposed and preferred models for integration. These can then contribute towards an NCL response. The joint board approved that those responses should be developed collaboratively and brought to a future joint board meeting for consideration.