Agenda item

Mr Kevin Byrne, the Council’s Head of Health and Strategic Partnerships, noted that a new approach to the operation of the Board had been agreed at the workshop held on 18 May 2021.  The Board had set our its aspirations to be the leader of ‘place’ and the report set out the key live issues across the health and care economy.

The Health and Care Bill was currently at committee stage in the Commons and would give effect to a number of changes that had been set out in the NHS Long Term Plan and the White Paper, a lot of which would be helpful to the Borough.  Although not hugely prescriptive, the Bill did give a clear direction for centralisation which could take away local discretion to act in the best interests of Hillingdon residents and patients. 

The North West London (NWL) System Development Plan (SDP) had been submitted by the interim NWL Integrated Care System (ICS) and set out the ICS’s vision and ambitions.  Issues that arose from the plan included the significant £460m underlying deficit across the system.  In addition, it had been proposed that one CEO representative would be on the NWL ICS Board to represent all eight local authorities in NWL and that borough delivery leads would only be represented on a much wider NWL ICS Health and Care Partnership Council. 

Dr Fran Beasley, the Council’s Chief Executive, advised that she and Councillor Palmer attended a range of fora where they had been continuously reiterating the need for Hillingdon to have representation on the NWL ICS Board.  It would be impossible for the Borough’s voice to be heard if it didn’t have representation around the table.  To this end, it would be important for Hillingdon to be clear about its mandate.  Other NWL boroughs didn’t seem to be quite as passionate about this issue which might be because they did not have the same coterminosity or have made as much progress as had been made in Hillingdon. 

The Chief Executive of NWL ICS had written to all local authority Leaders confirming the intention to appoint a single Chair across the four acute trusts in NWL including The Hillingdon Hospitals NHS Foundation Trust (THH).  Hillingdon’s Council Leader had responded to advise that this move raised issues of concern at a Borough level and he had highlighted the key part that THH had played in developing a place based approach to health and care in Hillingdon. 

Ms Caroline Morison, Co-Chairman and Managing Director at Hillingdon Health and Care Partners (HHCP), advised that Hillingdon had been going through a period of transition during the pandemic which had helped partners to collectively sharpen their aspirations for Hillingdon.  Further work was needed to align strategic priorities so that these could be fed into the ICS priorities to present a clear and aligned local voice to the ICS. 

Work was ongoing in relation to the balance between local and system accountability.  Overall, things had been positive with HHCP acting as a well developed delivery vehicle and providing enablers for delivery. 

Mr Tony Zaman, the Council’s Corporate Director of Social Care and Health, advised that the current situation was evolving.  Hillingdon partners wanted to set themselves up as a local system but there seemed to be a NWL push towards a superstructure rather than a series of local systems coming together.  Currently, the Hillingdon Health and Wellbeing Board was the only place with senior representation to develop the strategic direction of travel.  As such, it was important that the Board could demonstrate that it had the right people round the table.  The membership changes that had been implemented would ensure that all partners benefited equally from attendance at Board meetings.  The Co-Chairmen would need to discuss the issue of non attendance to determine how this should be addressed. 

The ICS was new and had not yet had the opportunity to acclimatise to the culture of NWL.  Hillingdon had had the confidence to think outside the box and had made significant progress but all NWL boroughs were being treated as though they were currently starting from the same place.  Hillingdon would need to ensure that it positioned itself so that it was seen as being different to the other boroughs.

Mr Nick Hunt, Director of Service Development at Royal Brompton and Harefield NHS Foundation Trust, noted that the report had not mentioned the devolution of specialist commissioning which had been overspent by hundreds of millions of pounds.  The issues around devolution of these services would need to be resolved as it was possible that the ICS would be required to find a local solution and fund it in the future. 

In addition to the issues around specialist commissioning, there would already be a significant financial challenge in NWL.  It would be important to ensure that Hillingdon had an understanding of the challenges that it faced as well as a clear plan on how these would be addressed.  Hillingdon would need to articulate its ambition regularly and consistently across all fora. 

RESOLVED:  That:

1.    the issues set out in the report be noted and the Board’s position on behalf of the health and care system in Hillingdon be confirmed; and

2.    the new approach to governance and membership be noted.