Agenda item

Mr Toby Lambert, Director of Strategy and Population Health at North West London Integrated Care Board (NWL ICB), advised that the Health and Care Strategy for NWL had been prepared by NWL Integrated Care Partnership to bring local authorities and the NHS together.  The document had been based on the Joint Strategic Needs Assessments (JSNAs) of each of the eight local authorities in NWL and needed to be jointly owned by them and the NHS (who also had to 'have regard' to it). 

The report stated that there were some areas of concern in NWL, with some improvement in health status that now appeared to have stalled.  These concerns included the measure of Disability-Adjusted Life Years per 100,000 population, an almost record number of people on out of work benefits and the continuation of the cost-of-living crisis.  The health and care systems had been struggling to respond to challenges in relation to things like workforce / recruitment, access to mental health care and managing the waiting lists for elective care. 

Mr Lambert advised that the document set out a number of shared outcomes which had been worked up with the local authorities' Directors of Public Health.  These outcomes had not been an attempt to collate all of the work that was being undertaken in the eight local authority areas but set out a number of example priorities including: a focus on employment; addressing priorities and differentiating the offer to residents; improving access to urgent and emergency care; developing and rolling out integrated neighbourhood teams; and developing core models of care for children and young people. 

NHS NWL started the consultation on the Health and Care Strategy for NWL at the end of May 2023 and it would close towards the end of July 2023.  Over 400 responses had already been received in relation to the consultation. 

Mr Lambert suggested that the Health and Care Strategy for NWL provided an opportunity to liberate funds to support other areas.  Appendix A of the report set out a number of actions that NHS NWL would like to embark on. 

It was agreed that the Executive Director for Adult Services and Health be asked to put together a formal response to the NWL ICB on its Health and Care Strategy for NWL, in consultation with the Board's Co-Chairmen, the Chairman of Healthwatch Hillingdon and the NHS North West London Borough Director.  This response would be based on the comments received from members of the Board at this meeting. 

Mr Tony Zaman, the Council's Chief Executive, noted that the document appeared to be full of truisms that everyone was already aware of.  At a strategic level, this was fine, but the notion of place being a borough needed to be more visible as it was about achieving the best outcomes for the neighbourhoods.  The Strategy provided a very high level view of NWL but did not reflect the view that Hillingdon had achieved best value for money or that a range of actions could be undertaken by different means.  It was important that those individuals that were heavy users of services needed to be engaged to try to manage the impact of their needs.  It was important that how issues would be addressed was identified but this would be known at a neighbourhood level, not at a NWL level. 

Mr Richard Ellis, Joint Lead Borough Director at NWL ICB, recognised the roots of the strategy in the work that had been done in the JSNA and Joint Health and Wellbeing Strategy.  He suggested that the Health and Care Strategy for NWL needed to identify how local partners would know when they had achieved the objectives that were set out therein.  What were the enablers and the expected outcomes / results? 

Hillingdon had been a high achiever because the separate elements of place had been working well together on things like discharge.  It would be useful if the ICB devised a graded set of milestones and provided partners with an action plan.  It would also be useful to have a set of financial milestones. 

Mr Keith Spencer, Co-Chairman and Managing Director of Hillingdon Health and Care Partners, advised that there needed to be a mindset shift amongst partners as it was about how the ICS supported place but also vice versa. 

Professor Ian Goodman, NWL ICS, advised that the data and digital aspects of the Strategy needed to be redrafted.  The document referred to "all our hospital systems" when it should really be referring to "all systems".  With regard to the Strategy's desire to reduce the need for patients to repeat themselves, Professor Goodman advised that this could be very dangerous.  Although clinicians would have read a patient's files, it was important that the patient repeated their story as the details might have been recorded incorrectly or there may be information of importance that the patient included on a subsequent explanation that provided a fuller picture.  Although Mr Lambert advised that seemingly unnecessary repetition of their story was one of the issues most frequently raised by patients, Professor Goodman stated that there was a need to educate them of the reasoning and importance behind it.  Councillor Jane Palmer, Co-Chairman, advised that communication was important.  Residents needed to be encouraged and enabled to understand why they were being asked to repeat themselves as well as how the system worked.

Ms Sandra Taylor, the Council's Executive Director of Adult Services and Health, advised that she wanted social care / place to feel part of the Strategy and see where it fitted in.  The Strategy currently included blanket priorities but they needed to suit the place.  It needed to be recognised that each borough had its own demands and needs which would direct its priorities and that this should not become a capacity competition. 

Ms Lynn Hill, Chair of Healthwatch Hillingdon, felt that the Strategy was trying to be everywhere and everything all at once.  The ICB needed to prioritise its priorities and provide a timeframe for the implementation of each.

Mr Lambert noted that the Health and Wellbeing Board was keen to ensure that health literacy / resident empowerment was prioritised and wanted clarity and further information included on how the Strategy was going to support this.  He understood partners' feelings on the importance of explaining "why". 

In terms of next steps, Mr Lambert would await Hillingdon's formal response and collate the feedback from the Health and Wellbeing Boards in NWL.  He would then work with officers (including Ms Taylor) to incorporate comments into the Strategy and a five-year plan would be drafted (a statutory requirement) which set out and prioritised the actions on a year-by-year basis. 

RESOLVED:  That the Health and Wellbeing Board delegates authority to the Executive Director for Adult Services and Health, in consultation with the Board's Co-Chairmen, the Chairman of Healthwatch Hillingdon and the NHS North West London Borough Director, to formulate and submit a formal response to NWL ICB on its Health and Care Strategy for NWL.