Agenda item

The committee is required to consider and comment on the NHS 10 Year Plan and Neighbourhood Health Delivery and the impact on future service provision.

Richard Dale, Chief Strategy Officer, NWL & NCL ICB briefed the committee that the presentation provided a summary of current progress and that they would Richard Dale, Chief Strategy Officer, NWL & NCL ICB briefed the committee that the presentation provided a summary of current progress and that they would be finalising broader plans over the summer. There have been ongoing conversations about moving care from hospitals to communities, whilst ensuring that diverse needs are met. The neighbourhood health approach focusses on the involvement of carers and families as part of the process all whilst considering the concerns about recruitment and retaining community-based staff.

 

The objective is for technology to enhance and support care whilst also retaining the offline option. Key for digital services is to use data to better understand those with greater needs and inequalities and in view of this, tailor services This will be delivered through Neighbourhood Health focussing on adults with complexities and long-term conditions. Data will be used for early diagnosis and proactive treatment. The shared patient record is important and key to seamless care. In terms of preventing ill heath, this is the priority and working better with the voluntary and community sector will support this. The conversations with the public will continue throughout.

 

Richard Dale also highlighted the changing role of the ICB, as part of the merger of NCL and NWL ICB which is driven by the need to deliver a 50% reduction in running costs. At the centre of the Neighbourhood Health model is multi-disciplinary teams that work alongside existing health services and to move into this space they are now working with Integrators in each borough building on the work on the Inequalities Fund and how it can be scaled up.

 

The Chair expressed the importance of a joined-up conversation with regards to this and hence the importance of having Jo Baty, Director of Adult Social Care, Haringey Council and Sara Suttun, Corporate Director for Adults, Housing and Health, Haringey Council involved in the discussions relating to the10 Year Plan. The Chair enquired about the neighbourhood offer which residents reported as being confused by what was on offer and who was doing what. She further sought to know what will change in the light of the merger and how will local focus be retained. The Chief Strategy Officer, NWL & NCL ICB expressed the need to have a clear road map and working with Integrators to understand all the community assets, primary care has specialist social prescribers will help with some of the navigation. Corporate Director for Adults, Housing and Health, Haringey Council explained that we are in the process of developing the Neighbourhood Plan which would be signed off by the Health and Wellbeing Board and as part of this work the voluntary and community sector is already integrated into the planning work.

 

The Chief Strategy Officer explained that a communication subgroup had been set up where all the organisations are represented in order to be able to pick up how we ensure consistent communication, knowing who is taking the lead and how the information gets out to the community. In Haringey, the capacity building a strong offer through the voluntary and community sector organisations. There is a need to strengthen the direct communication with residents and using other organisations to facilitate it.

 

The plan is to develop alongside ICB infographics exploring ‘what are neighbourhoods and what changes will be seen on the ground. In Haringey there is already a Multi-Agency Care Coordination Team (MAC) who are working on identifying target cohorts and how to work and co-produce with residents. There is also a community prevention strand to the work to co-produce priorities and the communications sub-group is ultimately working closely with the workforce who will deliver.

 

Councillor Connor enquired that if the right messaging is going to the workforce, from strategic position what will be done to ensure the information is seamless across all the boroughs to ensure everyone is getting the correct information. The Chief Strategy Officer explained that each borough has a communications programme and they are now reviewing their commissioning processes and developing a shared understanding of who is the most vulnerable in the community through partners and neighbourhood working.

 

Councillor Revah enquired over how they will we ensure that some people don’t get left behind as they were during covid and it was explained that the gaps in the data have been closed and so there is a better understanding of the more isolated members of the community. Work was also carried out with the London Care Record regarding the definition of a care team. Councillor Revah expressed scepticism about whether people would really be reached.

 

The Chief Strategy Officer emphasised that as things come together well Neighbourhood Health Plans will actually be better at reaching people who are harder to reach. On enquiry about how information will be shared with social care within the new model, the Director of Adult Social Care, Haringey Council explained we come together in different forums already and this will be more efficient way of doing this e.g. MARAC, opportunity to work better with community activists who work with the most vulnerable community members. The new way of working has come together due to depleted resources, but it means that all agencies will now be working more efficiently.

 

The Chair commented that Baroness Casey is currently looking into the independent commissioning of adult social care where she is concerned about the separate health and social care services and funding and impact on equalities. The Chair enquired if work was underway exploring adult social care and NHS funding and how they could be funded together. The Chair enquired over what would be done once Barness Casey’s report proposes and aligns with joint commissioning. The Chief Strategy Officer expressed that interface between social care and health is critical including the Better Care Funding and there is already joint support and that more joined up work was something that they were looking into. The committee heard that as part of the joint review process, conversations will take place with all the local authorities about how to increase joint work in advance of the publication of the outcomes.

 

The Chair explained the governance structure needed clarity in terms of where the Adult Social Care Directors amongst the boroughs would sit on the board and whether it would be one borough representing all the 13 boroughs amongst NCL and NWL. Richard Dale explained that one of the Leaders and a Chief Executive is on the board presently and discussions are ongoing about how things will work.

 

The Corporate Director for Adults, Housing and Health explained that the Haringey Team is Better Care Funded (BCF) already so this will now be expanded into Neighbourhood teams. The committee heard that in2027/28 there will be a piece on borough partnerships and there may need to change the local decision routes and Health and Wellbeing boards will be strengthened as where Neighbourhood Plans and decisions on funding will take place with then. Action: The Chair expressed that a follow up piece on the strengthened role of the Health and Wellbeing Board and pooled budgets would be helpful.

 

Councillor Seargent informed the committee about a neighbourhood approach in Graham Park in Barnet where residents were unaware of social prescribing and the benefits and lacked clarity regarding if they should go to GPs or hospitals at any given time Councillor Sergeant also asked about Integrators. The Chief Strategy Officer explained that Integrators are existing organisations in each borough taking on additional responsibilities to draw people together. There will be funding invested in the neighbourhood delivery process but not directly to the organisations.

Recommendation: Given that there is no further funding, further information on how they are progressing and how they are delivering more for less though Integrators will be something that the Committee needs to consider in more detail as they progress.

 

The Corporate Director for Adults, Housing and Health explained that there aren’t additional contracts but there are memorandums of understanding to formalise and strengthen the way of working. It was also highlighted that not all authorities are taking the lead. Action: What is the impact on the developing relationship where there are authorities not taking the lead? The chair expressed that this could be explored with two authorities with opposing approaches, one which is heavily involved and one with a more hands off approach.

 

Councillor Atolagbe enquired which other ICBs they were working with due to data concerns and GDPR and what was being done for hard-to-reach groups. The Chief Strategy Officer responded that extensive work across all the London ICB’s takes place in terms of data sharing and hence why the London Care Record was put in place and there is a data sharing agreement as Londoners are mobile and may need to access services away from home etc. In terms of working with communities that don’t always access services and the approach, the are no longer saying the individuals are ‘hard to reach’ but that some services are not designed appropriately.   Neighbourhood health will be looking at how we provide better tailored services and do things differently in future. For example, the longest waiters in terms of elective care are those from deprived communities on zero hours contracts so this is something that needs to be addressed.

 

The Chair of the Joint Partnership Board responded that in terms of bringing local communities and the voluntary sector is brilliant at supporting the interests of people, however she raised concerns in respect of training and particularly when looking at things from an intersectional perspective. It was enquired over what was being done in respect of unconscious bias so that the voluntary and community sector and the Integrators have a sense of how to see things from another person’s perspective and this is particularly key for the Integrators. The Chief Strategy Officer explained that some work had been carried out with the voluntary and community sector about viewing people as individuals and health equity is at the core of the strategy and it needs to be further refined into polices and in turn training and development. Action: ICB colleagues to seek advice about how to include the expertise of the Joint Partnership Board.

 

The Chair expressed her concerns about the idea of virtual wards and ultimately the impact on the carer and explained that an audit was requested to look at how they are coping in this role as they are unpaid careers, picking up the burden. The Chief Strategy Officer explained that work is currently underway monitoring the impact on carers and explained that the terminology ‘virtual wards’ is also unhelpful as it enraptures acute care being delivered by professionals in people’s homes. Action: work carried out to come back on virtual wards.

 

The Chair asked colleagues in social care if they were aware of an additional ask to carers in a rehabilitation route. The Director of Adult Social Care, Haringey Council explained the Carers Strategy was being implemented aware of concerns with discharge and big ask to do more. The Chair of the Joint Partnership Board explained that they were trying to make sure carers were actively involved and in the room in terms of developing governance around strategy. Involving various sectors of the local authority and linking in with unpaid carers, GPs, social care, housing and other key services to ensure a holistic approach was also important.

 

Councillor Revah expressed that disabilities haven’t been mentioned in the paper and it is important. Councillor Revah further emphasised that given carers don’t have formal training and enquired how it was being monitored. Sarah Morgan, Chief People Officer, NCL & NWL ICB as part of the People Strategy for NCL, they had identified one hundred thousand unpaid carers and work was done through the five councils looking at supporting unpaid carers and in NWL they are currently looking at unpaid workers packages. Action: Look at where this work has now got to from the Peoples Strategy and pick up on the work undertaken in NWL and whether it can be implemented in NCL.

 

Councillor Sergeant raised the point that although there are unpaid carers, there are also people who don’t have unpaid carers as well, socially isolated people and enquired whether there was any work being carried out for identifying people who may fall through the net before they are left with caring role. Richard Dale agreed and that neighbourhood teams will address these first in terms of the neighbourhood work. The Chair expressed that there seemed to have been some excellent work from the MAC and it would be useful to know if it was sustainable financially and could be rolled out across the five boroughs.

 

The Chair of the Joint Partnership Board briefed that there were also isolated people without carers and whether any work has been done in terms of people with unfit and abusive careers? The Chief Strategy Officer expressed that if the work with partners comes together well then this will give greater insight into the more complex type of relationships. The closest model is the MAC team although its presently more clinical than what they envisage, it is the closest thing to the neighbourhood model that they plan for. The plan over the summer is looking at how to scale the model across all the boroughs. Action.

Richard Dale, Chief Strategy Officer, NWL & NCL ICB briefed the committee that the presentation provided a summary of current progress and that they would be finalising broader plans over the summer. There have been ongoing conversations about moving care from hospitals to communities, whilst ensuring that diverse needs are met. The neighbourhood health approach focusses on the involvement of carers and families as part of the process all whilst considering the concerns about recruitment and retaining community-based staff.

 

The objective is for technology to enhance and support care whilst also retaining the offline option. Key for digital services is to use data to better understand those with greater needs and inequalities and in view of this, tailor services This will be delivered through Neighbourhood Health focussing on adults with complexities and long-term conditions. Data will be used for early diagnosis and proactive treatment. The shared patient record is important and key to seamless care. In terms of preventing ill heath, this is the priority and working better with the voluntary and community sector will support this. The conversations with the public will continue throughout.

 

Richard Dale also highlighted the changing role of the ICB, as part of the merger of NCL and NWL ICB which is driven by the need to deliver a 50% reduction in running costs. At the centre of the Neighbourhood Health model is multi-disciplinary teams that work alongside existing health services and to move into this space they are now working with Integrators in each borough building on the work on the Inequalities Fund and how it can be scaled up.

 

The Chair expressed the importance of a joined-up conversation with regards to this and hence the importance of having Jo Baty, Director of Adult Social Care, Haringey Council and Sara Suttun, Corporate Director for Adults, Housing and Health, Haringey Council involved in the discussions relating to the10 Year Plan. The Chair enquired about the neighbourhood offer which residents reported as being confused by what was on offer and who was doing what. She further sought to know what will change in the light of the merger and how will local focus be retained. The Chief Strategy Officer, NWL & NCL ICB expressed the need to have a clear road map and working with Integrators to understand all the community assets, primary care has specialist social prescribers will help with some of the navigation. Corporate Director for Adults, Housing and Health, Haringey Council explained that we are in the process of developing the Neighbourhood Plan which would be signed off by the Health and Wellbeing Board and as part of this work the voluntary and community sector is already integrated into the planning work.

 

The Chief Strategy Officer explained that a communication subgroup had been set up where all the organisations are represented in order to be able to pick up how we ensure consistent communication, knowing who is taking the lead and how the information gets out to the community. In Haringey, the capacity building a strong offer through the voluntary and community sector organisations. There is a need to strengthen the direct communication with residents and using other organisations to facilitate it.

 

The plan is to develop alongside ICB infographics exploring ‘what are neighbourhoods and what changes will be seen on the ground. In Haringey there is already a Multi-Agency Care Coordination Team (MAC) who are working on identifying target cohorts and how to work and co-produce with residents. There is also a community prevention strand to the work to co-produce priorities and the communications sub-group is ultimately working closely with the workforce who will deliver.

 

Councillor Connor enquired that if the right messaging is going to the workforce, from strategic position what will be done to ensure the information is seamless across all the boroughs to ensure everyone is getting the correct information. The Chief Strategy Officer explained that each borough has a communications programme and they are now reviewing their commissioning processes and developing a shared understanding of who is the most vulnerable in the community through partners and neighbourhood working.

 

Councillor Revah enquired over how they will we ensure that some people don’t get left behind as they were during covid and it was explained that the gaps in the data have been closed and so there is a better understanding of the more isolated members of the community. Work was also carried out with the London Care Record regarding the definition of a care team. Councillor Revah expressed scepticism about whether people would really be reached.

 

The Chief Strategy Officer emphasised that as things come together well Neighbourhood Health Plans will actually be better at reaching people who are harder to reach. On enquiry about how information will be shared with social care within the new model, the Director of Adult Social Care, Haringey Council explained we come together in different forums already and this will be more efficient way of doing this e.g. MARAC, opportunity to work better with community activists who work with the most vulnerable community members. The new way of working has come together due to depleted resources, but it means that all agencies will now be working more efficiently.

 

The Chair commented that Baroness Casey is currently looking into the independent commissioning of adult social care where she is concerned about the separate health and social care services and funding and impact on equalities. The Chair enquired if work was underway exploring adult social care and NHS funding and how they could be funded together. The Chair enquired over what would be done once Barness Casey’s report proposes and aligns with joint commissioning. The Chief Strategy Officer expressed that interface between social care and health is critical including the Better Care Funding and there is already joint support and that more joined up work was something that they were looking into. The committee heard that as part of the joint review process, conversations will take place with all the local authorities about how to increase joint work in advance of the publication of the outcomes.

 

The Chair explained the governance structure needed clarity in terms of where the Adult Social Care Directors amongst the boroughs would sit on the board and whether it would be one borough representing all the 13 boroughs amongst NCL and NWL. Richard Dale explained that one of the Leaders and a Chief Executive is on the board presently and discussions are ongoing about how things will work.

 

The Corporate Director for Adults, Housing and Health explained that the Haringey Team is Better Care Funded (BCF) already so this will now be expanded into Neighbourhood teams. The committee heard that in2027/28 there will be a piece on borough partnerships and there may need to change the local decision routes and Health and Wellbeing boards will be strengthened as where Neighbourhood Plans and decisions on funding will take place with then. Action: The Chair expressed that a follow up piece on the strengthened role of the Health and Wellbeing Board and pooled budgets would be helpful.

 

Councillor Seargent informed the committee about a neighbourhood approach in Graham Park in Barnet where residents were unaware of social prescribing and the benefits and lacked clarity regarding if they should go to GPs or hospitals at any given time Councillor Sergeant also asked about Integrators. The Chief Strategy Officer explained that Integrators are existing organisations in each borough taking on additional responsibilities to draw people together. There will be funding invested in the neighbourhood delivery process but not directly to the organisations.

Recommendation: Given that there is no further funding, further information on how they are progressing and how they are delivering more for less though Integrators will be something that the Committee needs to consider in more detail as they progress.

 

The Corporate Director for Adults, Housing and Health explained that there aren’t additional contracts but there are memorandums of understanding to formalise and strengthen the way of working. It was also highlighted that not all authorities are taking the lead. Action: What is the impact on the developing relationship where there are authorities not taking the lead? The chair expressed that this could be explored with two authorities with opposing approaches, one which is heavily involved and one with a more hands off approach.

 

Councillor Atolagbe enquired which other ICBs they were working with due to data concerns and GDPR and what was being done for hard-to-reach groups. The Chief Strategy Officer responded that extensive work across all the London ICB’s takes place in terms of data sharing and hence why the London Care Record was put in place and there is a data sharing agreement as Londoners are mobile and may need to access services away from home etc. In terms of working with communities that don’t always access services and the approach, the are no longer saying the individuals are ‘hard to reach’ but that some services are not designed appropriately.   Neighbourhood health will be looking at how we provide better tailored services and do things differently in future. For example, the longest waiters in terms of elective care are those from deprived communities on zero hours contracts so this is something that needs to be addressed.

 

The Chair of the Joint Partnership Board responded that in terms of bringing local communities and the voluntary sector is brilliant at supporting the interests of people, however she raised concerns in respect of training and particularly when looking at things from an intersectional perspective. It was enquired over what was being done in respect of unconscious bias so that the voluntary and community sector and the Integrators have a sense of how to see things from another person’s perspective and this is particularly key for the Integrators. The Chief Strategy Officer explained that some work had been carried out with the voluntary and community sector about viewing people as individuals and health equity is at the core of the strategy and it needs to be further refined into polices and in turn training and development. Action: ICB colleagues to seek advice about how to include the expertise of the Joint Partnership Board.

 

The Chair expressed her concerns about the idea of virtual wards and ultimately the impact on the carer and explained that an audit was requested to look at how they are coping in this role as they are unpaid careers, picking up the burden. The Chief Strategy Officer explained that work is currently underway monitoring the impact on carers and explained that the terminology ‘virtual wards’ is also unhelpful as it enraptures acute care being delivered by professionals in people’s homes. Action: work carried out to come back on virtual wards.

 

The Chair asked colleagues in social care if they were aware of an additional ask to carers in a rehabilitation route. The Director of Adult Social Care, Haringey Council explained the Carers Strategy was being implemented aware of concerns with discharge and big ask to do more. The Chair of the Joint Partnership Board explained that they were trying to make sure carers were actively involved and in the room in terms of developing governance around strategy. Involving various sectors of the local authority and linking in with unpaid carers, GPs, social care, housing and other key services to ensure a holistic approach was also important.

 

Councillor Revah expressed that disabilities haven’t been mentioned in the paper and it is important. Councillor Revah further emphasised that given carers don’t have formal training and enquired how it was being monitored. Sarah Morgan, Chief People Officer, NCL & NWL ICB as part of the People Strategy for NCL, they had identified one hundred thousand unpaid carers and work was done through the five councils looking at supporting unpaid carers and in NWL they are currently looking at unpaid workers packages. Action: Look at where this work has now got to from the Peoples Strategy and pick up on the work undertaken in NWL and whether it can be implemented in NCL.

 

Councillor Sergeant raised the point that although there are unpaid carers, there are also people who don’t have unpaid carers as well, socially isolated people and enquired whether there was any work being carried out for identifying people who may fall through the net before they are left with caring role. Richard Dale agreed and that neighbourhood teams will address these first in terms of the neighbourhood work. The Chair expressed that there seemed to have been some excellent work from the MAC and it would be useful to know if it was sustainable financially and could be rolled out across the five boroughs.

 

The Chair of the Joint Partnership Board briefed that there were also isolated people without carers and whether any work has been done in terms of people with unfit and abusive careers? The Chief Strategy Officer expressed that if the work with partners comes together well then this will give greater insight into the more complex type of relationships. The closest model is the MAC team although its presently more clinical than what they envisage, it is the closest thing to the neighbourhood model that they plan for. The plan over the summer is looking at how to scale the model across all the boroughs. Action.

e finalising broader plans over the summer. There have been ongoing conversations about moving care from hospitals to communities, whilst ensuring that diverse needs are met. The neighbourhood health approach focusses on the involvement of carers and families as part of the process all whilst considering the concerns about recruitment and retaining community-based staff.

 

The objective is for technology to enhance and support care whilst also retaining the offline option. Key for digital services is to use data to better understand those with greater needs and inequalities and in view of this, tailor services This will be delivered through Neighbourhood Health focussing on adults with complexities and long-term conditions. Data will be used for early diagnosis and proactive treatment. The shared patient record is important and key to seamless care. In terms of preventing ill heath, this is the priority and working better with the voluntary and community sector will support this. The conversations with the public will continue throughout.

 

Richard Dale also highlighted the changing role of the ICB, as part of the merger of NCL and NWL ICB which is driven by the need to deliver a 50% reduction in running costs. At the centre of the Neighbourhood Health model is multi-disciplinary teams that work alongside existing health services and to move into this space they are now working with Integrators in each borough building on the work on the Inequalities Fund and how it can be scaled up.

 

The Chair expressed the importance of a joined-up conversation with regards to this and hence the importance of having Jo Baty, Director of Adult Social Care, Haringey Council and Sara Suttun, Corporate Director for Adults, Housing and Health, Haringey Council involved in the discussions relating to the10 Year Plan. The Chair enquired about the neighbourhood offer which residents reported as being confused by what was on offer and who was doing what. She further sought to know what will change in the light of the merger and how will local focus be retained. The Chief Strategy Officer, NWL & NCL ICB expressed the need to have a clear road map and working with Integrators to understand all the community assets, primary care has specialist social prescribers will help with some of the navigation. Corporate Director for Adults, Housing and Health, Haringey Council explained that we are in the process of developing the Neighbourhood Plan which would be signed off by the Health and Wellbeing Board and as part of this work the voluntary and community sector is already integrated into the planning work.

 

The Chief Strategy Officer explained that a communication subgroup had been set up where all the organisations are represented in order to be able to pick up how we ensure consistent communication, knowing who is taking the lead and how the information gets out to the community. In Haringey, the capacity building a strong offer through the voluntary and community sector organisations. There is a need to strengthen the direct communication with residents and using other organisations to facilitate it.

 

The plan is to develop alongside ICB infographics exploring ‘what are neighbourhoods and what changes will be seen on the ground. In Haringey there is already a Multi-Agency Care Coordination Team (MAC) who are working on identifying target cohorts and how to work and co-produce with residents. There is also a community prevention strand to the work to co-produce priorities and the communications sub-group is ultimately working closely with the workforce who will deliver.

 

Councillor Connor enquired that if the right messaging is going to the workforce, from strategic position what will be done to ensure the information is seamless across all the boroughs to ensure everyone is getting the correct information. The Chief Strategy Officer explained that each borough has a communications programme and they are now reviewing their commissioning processes and developing a shared understanding of who is the most vulnerable in the community through partners and neighbourhood working.

 

Councillor Revah enquired over how they will we ensure that some people don’t get left behind as they were during covid and it was explained that the gaps in the data have been closed and so there is a better understanding of the more isolated members of the community. Work was also carried out with the London Care Record regarding the definition of a care team. Councillor Revah expressed scepticism about whether people would really be reached.

 

The Chief Strategy Officer emphasised that as things come together well Neighbourhood Health Plans will actually be better at reaching people who are harder to reach. On enquiry about how information will be shared with social care within the new model, the Director of Adult Social Care, Haringey Council explained we come together in different forums already and this will be more efficient way of doing this e.g. MARAC, opportunity to work better with community activists who work with the most vulnerable community members. The new way of working has come together due to depleted resources, but it means that all agencies will now be working more efficiently.

 

The Chair commented that Baroness Casey is currently looking into the independent commissioning of adult social care where she is concerned about the separate health and social care services and funding and impact on equalities. The Chair enquired if work was underway exploring adult social care and NHS funding and how they could be funded together. The Chair enquired over what would be done once Barness Casey’s report proposes and aligns with joint commissioning. The Chief Strategy Officer expressed that interface between social care and health is critical including the Better Care Funding and there is already joint support and that more joined up work was something that they were looking into. The committee heard that as part of the joint review process, conversations will take place with all the local authorities about how to increase joint work in advance of the publication of the outcomes.

 

The Chair explained the governance structure needed clarity in terms of where the Adult Social Care Directors amongst the boroughs would sit on the board and whether it would be one borough representing all the 13 boroughs amongst NCL and NWL. Richard Dale explained that one of the Leaders and a Chief Executive is on the board presently and discussions are ongoing about how things will work.

 

The Corporate Director for Adults, Housing and Health explained that the Haringey Team is Better Care Funded (BCF) already so this will now be expanded into Neighbourhood teams. The committee heard that in2027/28 there will be a piece on borough partnerships and there may need to change the local decision routes and Health and Wellbeing boards will be strengthened as where Neighbourhood Plans and decisions on funding will take place with then. Action: The Chair expressed that a follow up piece on the strengthened role of the Health and Wellbeing Board and pooled budgets would be helpful.

 

Councillor Seargent informed the committee about a neighbourhood approach in Graham Park in Barnet where residents were unaware of social prescribing and the benefits and lacked clarity regarding if they should go to GPs or hospitals at any given time Councillor Sergeant also asked about Integrators. The Chief Strategy Officer explained that Integrators are existing organisations in each borough taking on additional responsibilities to draw people together. There will be funding invested in the neighbourhood delivery process but not directly to the organisations.

Recommendation: Given that there is no further funding, further information on how they are progressing and how they are delivering more for less though Integrators will be something that the Committee needs to consider in more detail as they progress.

 

The Corporate Director for Adults, Housing and Health explained that there aren’t additional contracts but there are memorandums of understanding to formalise and strengthen the way of working. It was also highlighted that not all authorities are taking the lead. Action: What is the impact on the developing relationship where there are authorities not taking the lead? The chair expressed that this could be explored with two authorities with opposing approaches, one which is heavily involved and one with a more hands off approach.

 

Councillor Atolagbe enquired which other ICBs they were working with due to data concerns and GDPR and what was being done for hard-to-reach groups. The Chief Strategy Officer responded that extensive work across all the London ICB’s takes place in terms of data sharing and hence why the London Care Record was put in place and there is a data sharing agreement as Londoners are mobile and may need to access services away from home etc. In terms of working with communities that don’t always access services and the approach, the are no longer saying the individuals are ‘hard to reach’ but that some services are not designed appropriately.   Neighbourhood health will be looking at how we provide better tailored services and do things differently in future. For example, the longest waiters in terms of elective care are those from deprived communities on zero hours contracts so this is something that needs to be addressed.

 

The Chair of the Joint Partnership Board responded that in terms of bringing local communities and the voluntary sector is brilliant at supporting the interests of people, however she raised concerns in respect of training and particularly when looking at things from an intersectional perspective. It was enquired over what was being done in respect of unconscious bias so that the voluntary and community sector and the Integrators have a sense of how to see things from another person’s perspective and this is particularly key for the Integrators. The Chief Strategy Officer explained that some work had been carried out with the voluntary and community sector about viewing people as individuals and health equity is at the core of the strategy and it needs to be further refined into polices and in turn training and development. Action: ICB colleagues to seek advice about how to include the expertise of the Joint Partnership Board.

 

The Chair expressed her concerns about the idea of virtual wards and ultimately the impact on the carer and explained that an audit was requested to look at how they are coping in this role as they are unpaid careers, picking up the burden. The Chief Strategy Officer explained that work is currently underway monitoring the impact on carers and explained that the terminology ‘virtual wards’ is also unhelpful as it enraptures acute care being delivered by professionals in people’s homes. Action: work carried out to come back on virtual wards.

 

The Chair asked colleagues in social care if they were aware of an additional ask to carers in a rehabilitation route. The Director of Adult Social Care, Haringey Council explained the Carers Strategy was being implemented aware of concerns with discharge and big ask to do more. The Chair of the Joint Partnership Board explained that they were trying to make sure carers were actively involved and in the room in terms of developing governance around strategy. Involving various sectors of the local authority and linking in with unpaid carers, GPs, social care, housing and other key services to ensure a holistic approach was also important.

 

Councillor Revah expressed that disabilities haven’t been mentioned in the paper and it is important. Councillor Revah further emphasised that given carers don’t have formal training and enquired how it was being monitored. Sarah Morgan, Chief People Officer, NCL & NWL ICB as part of the People Strategy for NCL, they had identified one hundred thousand unpaid carers and work was done through the five councils looking at supporting unpaid carers and in NWL they are currently looking at unpaid workers packages. Action: Look at where this work has now got to from the Peoples Strategy and pick up on the work undertaken in NWL and whether it can be implemented in NCL.

 

Councillor Sergeant raised the point that although there are unpaid carers, there are also people who don’t have unpaid carers as well, socially isolated people and enquired whether there was any work being carried out for identifying people who may fall through the net before they are left with caring role. Richard Dale agreed and that neighbourhood teams will address these first in terms of the neighbourhood work. The Chair expressed that there seemed to have been some excellent work from the MAC and it would be useful to know if it was sustainable financially and could be rolled out across the five boroughs.

 

The Chair of the Joint Partnership Board briefed that there were also isolated people without carers and whether any work has been done in terms of people with unfit and abusive careers? The Chief Strategy Officer expressed that if the work with partners comes together well then this will give greater insight into the more complex type of relationships. The closest model is the MAC team although its presently more clinical than what they envisage, it is the closest thing to the neighbourhood model that they plan for. The plan over the summer is looking at how to scale the model across all the boroughs. Action.