Agenda item

To provide a presentation to the Panel on ‘locality working’, a community-based approach that aims to better address need in local neighbourhoods, reduce inequalities and build better outcomes with and for residents.

Charlotte Pomery, Assistant Director for Commissioning, introduced a presentation on Locality Working in North Tottenham, supported by a number of colleagues from partner agencies.

Background to Locality Working

Jonathan Gardner, Director of Strategy at Whittington Health, introduced the background section of the presentation, beginning with setting out what local partners were trying to achieve with residents. This vision had been defined as “We want to work alongside residents to prevent issues arising and nip them in the bud early, through more integrated public services and more resilient local communities.”

This vision required a simpler, more joined up system and integrated, multi-disciplinary teams tackling issues holistically by building relationships and looking at the root causes of problems such as debt or ill-health. This needed a workforce who feel connected to each other and able to work flexibly across organisations along with a partnership with the voluntary sector. The approach would be enabled by a person-centred approach to care and joined-up governance with a mature approach to finance across the local system.

Rachel Lissauer, Director of Integration at NCL CCG, said that the approach involved encouraging difference groups of people who work with residents and patients to feel that they are part of the same team and recognise when they are working with the same residents and patients. It was important to recognise that GP surgeries were often doing the care navigation for a patient and so the locality approach had been built around the geography that made sense to GPs. The shape of the three localities of west, central and east Haringey had therefore been drawn to fit around the existing Primary Care Networks (PCNs). This also enables the identification of issues and priorities in different areas of the borough. In the west this included a higher proportion of older people and a risk of social isolation, the central area has higher levels of disability and food insecurity and the east has the highest level of deprivation.

Charlotte Pomery explained that a successful “test and learn” had been held in North Tottenham and would be used as a blueprint to roll out the localities model across Haringey. This was underpinned by being accessible and open to residents, being located within communities, working with people as early as possible and a commitment from the Borough Partnership to support frontline staff to work differently.

The approach would be supported by a number of Community Locality Hubs which would provide physical spaces to enable locality-based working and an Integrated Locality Centre within each locality which would focus on the integration of health and care services. Connected Communities would be part of the model, providing a bridge between residents and statutory services when issues are identified.

Responses were then provided to questions from the Panel:

• Helena Kania noted that a Locality Centre in the west was located at Hornsey neighbourhood health centre, though it had been acknowledged in the slides that transport links were poor. Charlotte Pomery acknowledge that the issue of transport links was a challenge but said that the presence of Community Locality Hubs helped to complement the Locality Centres by providing alternative spaces in different parts of each locality. Rachel Lissauer said the Hornsey centre had the most available space, so had the most potential uses. She added that there was no one place in the west locality that could easily serve everyone and the Hornsey centre was not intended to be the exclusive hub for the west of the borough.
• In response to a question from Helena Kania who commented that patient transport was becoming more difficult due to Low Traffic Neighbourhoods, Charlotte Pomery said that officers would take this point away to consider and provide a response at a later date. (ACTION)
• In response to a question from Cllr Connor, Rachel Lissauer said that a proposal was currently being worked up for the Locality Centre for the central locality in Wood Green but it was not yet confirmed. There wasn’t currently an alternative site to be used but other aspects of the localities approach could be rolled out without the Locality Centre in the meantime. Cllr Connor requested that some further clarity be provided about how people in the central locality would be served until a Locality Centre was established. (ACTION)
• Asked by Helena Kania about the impact of crime and business viability on these areas, Charlotte Pomery said that they had tried to use the broadest sweep of demographic data that affect health and wellbeing including crime and employment.

Connected Communities

Florence Guppy, Strategic Lead for Community Enablement, introduced this section of the presentation with a map illustrating the areas covered by the eight Local Area Coordinators (LACs) that were now working in the borough and the hubs that they were operating from where different services work together. Due to the current Covid restrictions, the only premises currently being used for this were Wood Green and Marcus Garvey Libraries, Hornsey Health Centre, Northumberland Park Resource Centre and Commerce Road Resident Centre. It was hoped that further locations would be opened up from April onwards.

The areas covered and the hub placements had been designed to broadly correlate with the West, Central and East localities, though residents were free to access any hub of their choice irrespective of where they lived in the borough.

The response to the Covid pandemic had led to engagement with residents over issues such as claiming Statutory Sick Pay, self-isolation payments or connecting people with loneliness or well-being support.

Connected Communities had run a proactive campaign in the summer to identify people eligible for Pension Credit but not claiming it. This had increased residents’ income by almost £90,000 a year overall. More proactive campaigns would be launched over the next year based on data and insight to identify areas where further support could be offered to residents and then measuring the impact and Social Return on Investment.

A case study was provided of a resident who had recently been discharged from the North Middlesex Hospital following treatment for Covid-19. While the regular follow up happened, such as an occupational therapy assessment, some financial challenges that the resident was experiencing were flagged to Connected Communities which was able to assist with their rent arrears and an attendance allowance claim. The resident was an army veteran and had also been a miner and so Connected Communities referred them to the Royal British Legion and a coal mining charity which had provided access to some grants and also social activities.

Richard Gourlay, Director of Strategic Development at North Middlesex Hospital, reported that Connected Communities had been working in the A&E unit at the hospital for around 18 months. While pick up had been slow to begin with, the pandemic had provided an opportunity to review what was provided and they had gradually been linked to other services, including the paediatric team and the oncology team, to provide support to those individuals as well as their families and carers when there may be social care or other problems. Connected Communities was recognised as an important facet of moving forward, were part of the hospital’s Keeping Healthy Board and the aim was to increase the number of referrals.

Responses were then provided to questions from the Panel:

• Cllr da Costa commented that he had received positive feedback about Connected Communities as a ward councillor. He asked if further data could be provided on the number of people engaged with, a breakdown on the type of issue and what support was provided as this would be more reliable than case studies. Florence Guppy said that this data was available and could be provided to the Panel. (ACTION) Cllr Carlin requested that any available social return on investment assessment data also be provided to the Panel. (ACTION)
• Cllr Carlin expressed concerns about the potential problem of LACs becoming overloaded. Charlotte Pomery said that part of the approach was about changing how existing workforces work together and so LACs were there to help provide connections rather than being responsible for everything. Florence Guppy added that LACs have different specialisms and are encouraged to consider whether they are the best person to help with a specific query or whether they need to refer them to another colleague or another part of the workforce.
• Asked by Cllr das Neves how best to enable people across the borough to benefit from the thematic specialisms in each hub area, Florence Guppy said the hope was that by being part of the wider Connected Communities team and the wider network of services across the borough, connections could be made and people could be introduced to the opportunities most relevant to them. She acknowledged that transport issues could be an obstacle and said that there would be scope to change things in future if they weren’t working.
• Asked by Helena Kania about how the Mutual Aid groups fit in with the approach, Charlotte Pomery said that strong connections had been made and fortnightly meetings held with the Mutual Aid groups which was providing a strong resource. Cllr Connor commented that at a future update it would be useful to receive further details about how other community navigators (apart from the LACs) fit into the wider approach. Charlotte Pomery said that this was mapped out and could be presented to a future meeting if required. (ACTION)
• Asked by Cllr Connor about the financing of the locality approach, Charlotte Pomery confirmed that there were contributions from the CCG as well as North Middlesex and the Whittington acting as hosts. In terms of governance, a lot of work was being done to understand how money moves across the system. Cllr Connor suggested that more information could also be provided about the financial arrangement at the next update. (ACTION)

Localities working in practice and Leadership teams

Andrew Wright, Director of Planning & Partnerships at Barnet, Enfield and Haringey Mental Health Trust, presented slides on how the localities approach works in practice. He described localities as the unit where integration and the delivery of joined-up services comes together and can support residents more holistically instead of separately addressing different aspects of their lives in silos. At every level this was about building relationships, bringing down boundaries and joint problem solving.

Chris Atherton, Principal Social Worker, spoke about the three Locality Leadership Teams which had been set up to ensure that the strategic vision of localities could be operationalised. The focus of the initial meetings was on the identification of appropriate estates from which to operate the hubs and also on the mobilisation of the workforce within communities. A decision had been made to merge the three leadership teams into one team in order to avoid things becoming disjointed and to ensure alignment and coordination during implementation. The team had an ambition aim to open a physical hub in each locality by August 2021.

Haringey was using a strengths-based working approach in its work with people across the borough called Head, Hands, Heart to focus on the strengths that people have rather than focusing on the problems and limitations that they have. A Champions Programme had been developed to promote the work across the borough. ‘Champions’ had been identified across the borough partnership including from the Locality Leadership Team.

Rachel Lissauer said that, in terms of the estate development in the east of the borough, Lordship Lane was being worked towards as the main Integrated Locality Centre but, as they were conscious about the need for good access and transport links, a multi-site model was also being considered. Sites could include the Northumberland Park Resource Centre, the Selby Centre and Broadwater Farm which already has a GP surgery on-site.

Responses were then provided to questions from the Panel:

• Cllr da Costa asked about the governance required to bring many different organisations together. Charlotte Pomery responded that, from the beginning, the aim was for the governance culture to be empowering and enabling one that would not block a bottom-up approach. Beverley Tarka added that this concept had been introduced to senior executive group of the Borough Partnership some time ago and they received training from Research In Practice. This had been important to enable buy-in for the bottom-up approach. Andrew Wright stressed that the leadership and commitment of all of the partner organisations was clearly important to make it stick and that all had explicitly supported this approach. Chris Atherton said that the experience of the pandemic had demonstrated that local partners can work together incredibly well and the support for this approach had been very positive. Cllr Connor said that it would be useful for the Panel to receive more information in future about the detail of the governance structure. (ACTION)
• Asked by Cllr Connor about Research In Practice, Chris Atherton said that the Council had starting working with them a few years ago when the Chief Social Worker visited the Borough and had recommended them as a way of implementing change. This had built momentum and they had recently been working with the Borough Partnership. Cllr Connor said that it would be useful for the Panel to receive more information in future about the work that Research In Practice had been doing in Haringey. (ACTION)
• Asked by Cllr Connor about the Champions Programme, Chris Atherton said that these were drawn from across the workforce including DWP, social services, Whittington Health, North Middlesex and Connected Communities.

Working in North Tottenham

Charlotte Pomery presented some details about the locality approach in North Tottenham where the Locality Hub was based at the Northumberland Park Neighbourhood Resource Centre. The Centre was a large building with office space for hire that had previously been occupied by various local services but was currently underutilised so there was potential for the space to be used to bring local partners together. The hub would have three primary functions:

• As a Locality Centre to deliver a range of services from the Council and partners with both office space and an area to meet clients.
• As a Community Hub with space available for local groups and organisations.
• For office space available with for rent or as in-kind support.

Geoffrey Ocen, Chief Executive of the Bridge Renewal Trust, set out the background to this, noting that the need for multi-agency centres had been identified a couple of years previously. Hassan Bala, a senior practitioner within the Tottenham strength-based team, explained how the six practitioners in the team worked with residents with a focus on what outcomes people want to achieve and enabling them to find the best solution drawing on their own strengths and the community resources. The assets in the local community had been mapped, enabling people to access resources through one place and help to build more independent lives. Juliet Chard, a community connector with Reach and Connect, explained that she and a colleague had been attending the hub since it opened last December. The benefits of this had included being able to build relationships with other partner organisations in a quicker way, on a regular consistent basis, space to develop ideas and solve problems together and better engagement with residents.

Responses were then provided to questions from the Panel:

• Asked by Cllr Connor how this could be rolled out elsewhere in the Borough, Charlotte Pomery said that there was both a strategic vision and an aim to build from the bottom-up and to help spread this practice across the borough. The Champions network would also help in developing this elsewhere in the borough.
• Cllr Connor suggested that arranging a site visit would be useful when Covid restrictions were lifted. (ACTION)
• Asked by Cllr Connor whether capital funding would be made available to enhance the facilities at the Centre, Charlotte Pomery said that a feasibility study was underway and some capital money had been set aside but the outcome of this was being awaited. 

Cllr Connor thanked officers and external partners for their presentations and all the information that had been provided and suggested that the Panel consider this and the additional information requested in order to provide comments and feedback in due course.