Agenda item

To inform the Panel about a plan for a ‘place-based approach’ in North Tottenham which aims to develop more integrated public services.  

Rachel Lissauer, Director of Commissioning and Integration at Haringey CCG, introduced the first part of this item speaking about the practical partnership work around integration and prevention. The context had been signalled in advance by the NHS Long Term Plan published in January 2019 which set the direction through the mandate that all areas are to be become integrated care systems by April 2021. Within each integrated care system there is an expectation that there will be a single CCG which would be at a much higher level than currently so this is likely to require a merger of existing CCGs. The Long Term Plan also signalled that GPs should work as part of primary care networks with more contractually based partnerships and these networks, each covering around 30,000 to 50,000 populations, have now been signed off in Haringey. There has also been a focus on developing integration at Borough level as well as the NCL level and, in addition, a series of workshops have been held which proposed a greater degree of localised working.

Charlotte Pomery, Assistant Director for Commissioning, said that the response from the Health and Wellbeing Board about the Borough partnership had been based on the wider governance arrangements and key outcomes such as reducing health inequalities, ensuring that health and wellbeing outcomes are improved for all residents. The existing joint working across the NCL area, including through the Sustainability and Transformation Plan means that Haringey is starting from a strong position. They were also keen to emphasise that the integrated care system should not just include health and care services but should also include factors that impact on health and wellbeing such as housing and the environment. There is currently an intention to build a broad, inclusive and collaborative approach. There was also some specific feedback about ensuring that there is sufficient capacity at Borough level, that there is enough time to work through the key issues and that the views of local residents are built into the work.

In response to questions from the Panel, Rachel Lissauer said that the signal of the CCGs of their intention to form a single CCG is likely to happen in September. Staff for the existing CCGs will remain in their Boroughs as the governance structures integrate into the single CCG. Charlotte Pomery said that in terms of IT there is already a large digital programme in place across the NCL area including a strand on sharing health and care records. Rachel Lissauer said that the leadership would be shared and emphasised that a lot of joint working had already been established in NCL before the Long Term Plan was published. Beverley Tarka, Director of Adults and Health, added that the NCL has put together a co-design group and has called for nominations from all stakeholders so this is very much a shared endeavour.

Jonathan Gardner, Director of Strategy at Whittington Health NHS Trust, introduced the next part of the presentation. The area of biggest need where the greatest impact could be achieved had been identified as North Tottenham. In October/November 2018 there was a community engagement event led by Bridge Renewal Trust followed by a launch event in December 2018. Various meetings were held from January to March 2019 which aimed to establish a framework and vision for the project. A day discussion with the whole Borough partnership was then held in May 2019 to look at localities and integrated care.

It had been established that there was a need for low-level mental health support and for help with housing, employment and benefits with intervention at an early stage to prevent problems from arising. The public health data showed a higher prevalence of diabetes and hypertension. These and the other factors identified have led to the draft vision statement which emphasises the need to “create a step forward in how well we prevent issues arising and nip them in the bud early, through more integrated public services and more resilient local communities.” This requires more joined up local systems, integrated multi-disciplinary teams that tackle issues holistically and a new system partnership with the voluntary sector. This will be enabled by a joint approach to the shared public estate, integrated data and systems, a more mature approach to finance and more joined-up governance with the Council and NHS. The principles that have been identified are a) a preventative approach, b) partnerships based in local communities, c) a learning approach and d) a strength-based approach. The approach is aimed at all ages and focuses on early intervention, prevention and building strong and resilient communities to shift more people away from specialist care. The Community First work is a key pillar of this and the connection of IT infrastructure, estates and workforces are important enablers. In response to a question from the Panel, Jonathan Gardner said that they were still working on the best model to help people navigate community-based services as this could involve Community First, Local Area Coordinators or the existing knowledge of front-line staff. Will Maimaris, Director of Public Health, emphasised the importance of social prescribing, local area coordinators and building a strengths-based approach through all services. 

In response to further questions from the Panel, Viv Acharya, Programme Lead for Community First, said that:

• Community First currently operates from Wood Green Library on Mondays and Tuesdays. The plan is to roll this model out to Marcus Garvey Library and then extend out to work collaboratively with the primary care networks, GP practices and North Middlesex Hospital A&E.
• In practical terms for residents, the previous pathways for something like depression may be more medical but with a more integrated approach the residents could also get access to other help and support such as debt or housing advice that might help to address some of the underlying causes.
• On housing problems he said that the issues could be wide ranging but that Community First can often act as advocates for people while acknowledging that they can only use the pathways available to them within the context of a wider housing crisis. The Homelessness Prevention Team are part of their service offer and Community First is seen as part of their outreach work.
• Community First has 3.5 FTEs on a multi-disciplinary team which includes Citizens Advice Bureau colleagues.

Geoffrey Ocen, Chief Executive of the Bridge Renewal Trust, informed the Panel about their community engagement work in the summer of 2018 which involved speaking to 369 residents, of which around 20% were from the North Tottenham area. This involved focus groups and one-to-one interviews and often involved people with the sort of employment, housing or other problems that this work was targeted at improving. People understand the pressures on public services in recent years and are also keen to see support at an early stage. Digital engagement worked for some but others want access to face-to-face support.

On a comment from the Panel that more detail on how this will work in practice could be provided, Beverley Tarka said that they are working on the principle that solutions need to evolve from the bottom-up from residents and the workforce, which is why there is such an emphasis on engagement. It is also important to note that in terms of investment, this has been made a high priority for the future of how early intervention and prevention is supported and by bringing partners together resources are being multiplied. Completing the presentation, Beverly Tarka showed slides that mapped out all the different services in Haringey and the resources that are available. The top three risks that had been identified were limited staff engagement with the new way of working, IT systems and estates limiting the speed/scale of change and outcomes not being met.

Asked whether NHS funding could be cut if outcomes are not achieved, Beverley Tarka said that some initial investment would be required but much of the work was about how existing resources are used better, improving knowledge of the existing resources and integrating pathways. Will Maimaris gave an example of a recent initiative on reducing strokes by addressing risk factors and with the number of strokes coming down the Council spend on care is reduced.

Beverley Tarka confirmed that the initiative is due to be reviewed at the end of the financial year so it should be possible to come back to the panel with an update in April/May 2020. (ACTION) Asked whether site visits for Members would be possible, Beverley Tarka said that it would but only from April 2020 onwards as it was currently still at the planning stage. Viv Acharya added that a business case for a more sustainable version of Community First is due to be developed by December 2019.