Agenda item

To receive an overview of the development of the Haringey Borough Partnership for Health and Care and how it fits in with the wider Integrated Care System for North Central London.

Will Maimaris, Director for Public Health at Haringey Council, and Rachel Lissauer, Director of Integration for Haringey at North Central London ICB, introduced slides providing an overview of the integration of health and care services in Haringey and how this would fit within the wider Integrated Care System (ICS) for North Central London:

• The Haringey Borough Partnership (HBP), which had been in operation for several years, brought together the Council, NHS organisations and voluntary/community organisations.
• The new North Central London (NCL) Integrated Care System (ICS) brought together partners across Barnet, Camden, Enfield, Haringey and Islington.
• Within the ICS there were other bodies including the NCL Integrated Care Board (ICB) which has the statutory responsibility for allocating the NHS budget and commissioning services, effectively replacing the Clinical Commissioning Group (CCG). The first Board meeting took place on 4^th July 2022.
• The NCL Health and Care Partnership would be a joint committee with Councils across the five boroughs which would be responsible for strategic planning on health and social care needs.
• A provider collaborative, known as the UCL Health Alliance, would bring together NHS trusts and primary care to work together across NCL to develop more systematic joint working. There would also be place-based partnerships and multidisciplinary working in neighbourhood areas to further development integrated working at local level.

Rachel Lissauer and Will Maimaris then responded to questions from Panel Members:

• Asked by Cllr Gourtsoyannis about the budget available to the ICB, Rachel Lissauer said that the Board had a responsibility to present a balanced budget to NHS England. Whereas under the old system there could often be negotiation between the NHS Trusts and the CCG on where deficits should sit, this was now the collective responsibility of an integrated board. Cllr das Neves added that an important challenge would be around balancing differing priorities across the NCL area.
• Asked by Cllr Connor about the membership of the ICB, Rachel Lissauer said that it had one local authority partner member and did not have a patient representative. She added that the governance structure was for the ICB to be complemented by the NCL Health and Care Partnership which had not been formed yet but would include wider local authority and voluntary/community sector representation. The Community Partnership Forum would also provide engagement opportunities for patient representatives and the voluntary/community sector.
• Asked by Cllr Gourtsoyannis about the process for organisations to gain membership of the Haringey Borough Partnership, Rachel Lissauer said that the voluntary organisations were represented by the Bridge Renewal Trust and that she regularly spoke with networks of voluntary organisations about live issues along with the Chief Executive of the Bridge Renewal Trust.

Further slides were presented with the following key points:

• National government policy was that, by Spring 2023, all ‘Places’ should adopt a leadership and governance model with a single point of accountability across health and social care. This single accountable person for Haringey had not yet been determined. A shared plan with outcomes should be underpinned by pooled or aligned resources by 2026. Further guidance was expected from the government later in the year, but preparations were being made locally in the meantime.
• The ambitions for Place in the NCL area included reducing health inequalities, embedding prevention and early help into local partnership working and co-designing integrated neighbourhood/place services with residents.
• Functions at Borough level would include statutory responsibilities such as safeguarding and delivery of transformation work as well as publishing a local partnership plan which would include a core set of action and deliverables. The Borough Partnership delivery role would involve bringing together senior leaders with local delivery responsibility. While there were no specific changes to scrutiny arrangements required, there was a potential opportunity for a more joined up approach to public scrutiny and accountability.
• The Haringey Borough Partnership Executive was co-chaired by Andy Donald, (Chief Executive of Haringey Council) and Helen Brown (Chief Executive of Whittington Health). Beneath this were four partnership boards (Start Well, Live Well, Age Well and Place).

Cllr Gourtsoyannis asked for further details about the expected co-production process. Rachel Lissauer said that a scheme had been developed with HealthWatch which could potentially be adopted by the Borough Partnership. There had also been some good examples of co-production and co-design locally which would be taken in account as well. Cllr das Neves added that she defined co-production as begin where a service is designed for and with residents and where there was a focus on lived experience about what works. While co-production may not necessarily work for every aspect of a service, she felt that there was scope to have lived experience input for many services. This could help to deliver better outcomes for residents and to address objectives such as reducing health inequalities.

Cllr Connor suggested that, while this process was being put together, further information could be shared with the Panel on the principles of co-design and co-production that would be applied through integrated working. Beverley Tarka emphasised that co-design principles needed to be developed with residents. However, details could be shared about what had worked well so far and how the learning on the ways of working in this area had progressed. Cllr Connor added that an understanding of how the process would be developed with residents would also be useful. (ACTION)

Cllr Brennan observed that, as a new Councillor, she felt that communication from the Council on services and projects could often be lacking or would focus too heavily on jargon or buzzwords that were often unclear to residents. Cllr das Neves agreed that the Council needed to do more to improve on this, particularly through using more straightforward language, communicating through formats such as digital newsletters and establishing models of co-production that involve clear and easily understood outcomes. Cllr Connor suggested that information about the communications and engagement process for a specific project could be brought to the Panel at the next time that a suitable new project was in development. (ACTION)

Cllr Peacock asked about co-optees and resident representation on the partnership boards. Rachel Lissauer said that there was a representative of Haringey Over-50s on the Aging Well partnership board. Cllr Peacock referred to other pensioner groups in the borough that would also be in a position to contribute. Will Maimaris agreed that there could be conversations with other groups about how they might most appropriately contribute through the new governance structures. This wouldn’t necessarily have to involve direct partnership board representation. Rachel Lissauer added that there was a resident and voluntary/community sector group (the Community Health Advisory Board) that meets in parallel to the Health and Wellbeing to discuss the same items on the agenda. Cllr das Neves agreed that it would be worth communicating with voluntary/community groups that are not currently involved in order to understand whether they would be interested in contributing. It was agreed that this should be explored further. (ACTION)

Will Maimaris then spoke about efforts to improve population health outcomes at Borough level. There had been challenges regarding this since 2010 and overall life expectancies had been reducing, particularly in the most deprived areas and amongst men. The Covid pandemic had then reduced life expectancies further. The Covid vaccination programme had proved to be successful in systematically working on a population outcome. This approach could now be taken forward through the Borough Partnership in other areas to reduce health inequalities and improve health outcomes. A range of population health measures were used to track these outcomes.

Cllr Gourtsoyannis suggested that further detail on the policies to support these outcomes would be useful. Will Maimaris noted that the framework illustrated in the slide was relatively new but that details on specific policies could be provided to future meetings in any areas that the Panel wished to explore further. Cllr Connor added that it would be important to understand what had changed under the new system compared to the public health approach used in the past and how this was expected to improve outcomes. Will Maimaris said that the NCL outcomes framework itself was new and allowed a more systematic approach to specific health outcomes. Cllr Connor suggested that it would be useful to see the progress with regular updates on the new data, perhaps through the finance and performance briefings, so that specific areas could be scrutinised. (ACTION)

Asked by Cllr Brennan about the national requirements for integrated working, Rachel Lissauer said that there were fairly fixed expectations of what had to be done included a balanced budget, an outcomes framework and performance on health quality. What was less fixed was the role of Place and Borough in relation to the integrated care system.

Asked by Cllr Connor about the implications of integrated working for budget scrutiny and how Councillors could fully understand how budgets were being used, Beverley Tarka said that she recognised the challenge and that some of the practical issues were still being worked through so this was all still at an early stage. Rachel Lissauer added that, as the Borough Partnership evolved, it would be possible to consider under which areas joint budgets and oversight would help in better using finite resources. Cllr Connor suggested that this issue should be monitored as arrangements were put into place with further details provided to the Panel when available. (ACTION)

The Panel agreed to continue to monitor progress on the implementation of integrated working and noted that the Chair and Scrutiny Officer would liaise with officers over expected timescales for this. (ACTION)