Agenda and minutes

For Members of the Board to note any apologies for absence.

Apologies for absence were received from the following:

·         Robyn Doran (Director of Transformation and Brent ICP Director)

·         Dr Mohammad Haidar (Vice Chair)

·         Simon Crawford (Deputy Chief Executive, LNWUHT), substituted by Trish Winn

·         Dr Ketana Halai (NWL ICS)

·         Janet Lewis (Director of Operations, CLCH), substituted by Jackie Allain

Members are invited to declare at this stage of the meeting, the nature and existence of any relevant disclosable pecuniary or personal interests in the items on this agenda and to specify the item(s) to which they relate.

None declared.

To approve the minutes of the previous meeting as a correct record.

RESOLVED: That the minutes of the meeting, held on 16 March 2022, be approved as an accurate record of the meeting.

To consider any matters arising from the minutes of the previous meeting.

None.

To provide members of the Health and Wellbeing Board with an update on progress in the development of the Healthwatch Brent work service.

Jo Kay (HealthWatch Brent) introduced the report, which asked the Health and Wellbeing Board to note and recognise the key themes and achievements in the development of the HealthWatch service over the past year. In introducing the report, she advised the Board that she felt HealthWatch had been successful in laying the foundations of the service and had worked hard to raise its profile in Brent through engagement with various community groups, including in deprived wards and with voluntary sector organisations. She highlighted that HealthWatch took community views and concerns into consideration and amplified those voices at various meetings to various partners and statutory bodies. In addition, HealthWatch had partnered on a few consultations and strategies through the year and communicated the need for improvements where services should be engaging with the public to either co-design services or be part of the consultation process. In her introduction, Jo Kay highlighted the following key points:

·         Within the report, sample sizes were very small and HealthWatch were working hard to increase the number of people who were engaged through their engagement strategy. Although sample sizes were small, feedback helped HealthWatch ensure providers were assessing and addressing existing concerns.

·         Local health and care services should be returning to pre-pandemic activity, but HealthWatch saw residual and potentially long term problems due to lack of funding and staff shortages.

·         Paragraphs 3.7 and 3.8 of the report detailed the work HealthWatch were prioritising on access to GP services, which remained a top priority for Brent residents, particularly those who faced barriers to care such as those with disabilities. HealthWatch welcomed the investment put into primary care to address these issues, particularly the renewed focus on personalised care, however recognised that many patients were still unable to access their GP practice in a timely or efficient way.

·         Over the coming months, HealthWatch hoped to see that primary care systems were understanding communities and addressing disparities in access. GPs were a vital first point of contact, so it was important general practice worked for everyone.

·         HealthWatch were currently independently evaluating the alternate Saturday inequality clinics being held across Brent which were offering routine services such as health screenings, checks and immunisations. They had heard good feedback from patients regarding Saturday appointments and seen excellent approaches from certain GP practices to ensure they were meeting the individual needs of vulnerable and elderly patients. The evaluation report would be submitted to primary care in late August 2022 with the final outcomes.

·         HealthWatch welcomed NHS England’s focus on ensuring better dental support for people with complex problems and improvements in information for those trying to find an NHS dentist. They hoped the focus would improve the issues they heard about in Brent in relation to dentist access and information. As oral health was one of the priorities for children and young people’s health, HealthWatch queried what was being done to address concerns around lack of dentists signing up new patients in Brent.

·         In relation to Child and Adolescent Mental Health Services  ...  view the full minutes text for item 5.

For the Health and Wellbeing Board to be updated on the mental health workstream.

Phil Porter (Strategic Director Community Wellbeing, Brent Council) introduced the report which set out the progress being made on the Integrated Care Partnership’s (ICP) mental health and wellbeing workstream, as one of the four ICP priority areas. He advised the Board that the workstream was split into 4 areas. The first area was around improved access to employment, which began with an outcome based review before the pandemic and focused on ensuring pathways into employment services were clear and easy to access. That part of the workstream also worked to support employers to become disability confident, which would help people access the skills and opportunities needed to get jobs and ensure employers were confident in supporting people in those roles. Mental health and housing formed the second area of the workstream, looking at those people struggling with housing need or who were already homeless and how they could be better supported and how tenancies could be sustained, working with Network Homes and Brent Housing Management. The third area was Children & Young People, including Specialist Child and Adolescent Mental Health Services (CAMHS), which was set up as a reaction to the issues in accessing CAMHS. A meeting of that particular subgroup had took place during that week, where the Director for Safeguarding, Partnerships and Strategy had been positive about having all providers in the room which gave a shared sense of the challenge for Brent. It was hoped the Council, ICP and other providers would continue to work together to reduce waiting lists and give a clear voice back to NWL about what the funding shortfall was. The final area was access to adult mental health services, including IAPT and improving access to health checks. All areas of the workstream were difficult to evidence impact, therefore the ICP were having to define and set up measurements for those, including the social determinants of health.

The Chair thanked Phil Porter for introducing the report and invited comments and questions, with the following issues raised:

• The Board queried whether the ICP were working with ‘Project Search’ as part of their cohort of stakeholders for this workstream, who set up supported internships and worked closely with the NHS. Phil Porter confirmed that Project Search were working with employers in Brent, and there was a long list of operational providers and community groups working with the ICP that had not been included in the report. A lot of the work done on skills and employment was done jointly with the West London Alliance (WLA).
• The Board asked where the ICP hoped to be in six months’ time with the CAMHS waiting lists. Gail Tolley (Strategic Director Children and Young People, Brent Council) confirmed that the ICP anticipated significant progress on that particular workstream. She highlighted that CAMHS was not a Council provision but a health provision, but there was significant strength in the additional provisions of support on offer. Gail Tolley highlighted that CAMHS was a very specialist service and there  ...  view the full minutes text for item 6.

To receive an update on the Brent Placed Partnership.

Tom Shakespeare (Integrated Care Partnership Director) introduced the report, providing an update on the Partnership Development work to date, including the key achievements and outcomes so far. The partnership development had been strengthened through an away day bringing together all relevant stakeholders, which reinforced the importance of relationships and joint working. He drew the Board’s attention to the information in the report which detailed progress so far, priorities going forward, work done to date, and the next phase of partnership development. In particular, the Board’s attention was drawn to the following key points:

• Significant progress had been made on the clinical leadership across the borough with PCN clinical directors in place and clinical leads across the 4 ICP areas.
• Work with Brent Health Matters (BHM) continued to expand with a large number of outreach events which had resulted in a material impact, particularly on diabetes and the number of health checks that had been happening in the community.
• Within community services, there had been good work with Central London Community Healthcare (CLCH), piloting a rehabilitation and reablement expansion to support people more intensively at home in partnership with Adult Social Care.
• There would be a focus on the development of neighbourhood teams going forward to support wraparound services in the community, and a post had been recruited to in order to take that forward with Primary Care Networks (PCNs).

RESOLVED: To approve the direction of travel of the Partnership Development work.

For the Health and Wellbeing Board to receive a GP access update.

Fana Hussain (Assistant Director Primary Care, NWL ICS) introduced the report, highlighting the challenges in relation to GP access that the NHS were trying to address. She advised that, while the NHS were trying to manage and increase GP access to the population, the demand continued to increase. For example, there was a backlog within the acute trust, and the acute trust had been directing more activity into GP practices to support the management of those patients waiting for their operations. In some cases, there had been a 30% increase in demand for GP appointments since the pandemic. There had also been another wave of Covid-19 which had resulted in stack sicknesses, and GPs were finding it difficult to recruit locums and salaried GPs due to the rate of pay increase. Brent also had difficulties with retaining staff due to being outside of the inner London weighting, which attracted more staff. NWL NHS were tracking the number of appointments being offered using a national system, which was available publicly for people to see the number of appointments being offered in each ICP area.

In order to address the challenges, additional inequalities clinics had been arranged on alternate Saturdays and GP practices and access hubs were opening during evenings and longer hours, attempting to see new and more patients and opening in new locations. Fana Hussain highlighted that there was innovation and ideas around improving access. NWL were committed to ensuring easy digital access for patients, making it easy for patients to complete online consultation, including for patients whose first language was not English. In the new system that had been commissioned, patients would be able to change to their language preference at the click of a button and in future would be able to enable speech to text. Patients using the new system had offered feedback that it was a lot more user friendly. With that digital innovation came a focus on digital poverty and work was ongoing there. From 1 October 2022, access hubs would transform into ‘Enhanced Service Hubs’ where they would provide a service particularly focused on seeing residents face to face, and residents would be able to obtain an appointment for urgent care on the day of demand, as well as pre-book appointments available 2 weeks in advance. To ensure those appointments were used for their intended purpose, patients would be triaged. NWL were creating an environment focused on cohesive partnership working.

In relation to children and young people, Fana Hussain advised that NWL NHS were conscious that the younger generation needed dedicated services, and there had been a focus on expanding the number of paediatric GPs from 2 to 4, dedicated to looking at pathways and supporting GPs to manage complex patients and improving care for younger patients.

Fana Hussain advised that it was important that patients understood how they could access appointments. This could be done online, via the NHS app, over the telephone, directly by providers or directly by 111. Community pharmacy schemes  ...  view the full minutes text for item 8.

To receive a thematic update on the Joint Health and Wellbeing Strategy.

Melanie Smith (Director of Public Health, Brent Council) explained that this report was being presented as one of the 5 key themes of the Joint Health and Wellbeing Strategy (JHWS) following its approval in March 2022. She hoped the Board would note the progress made against the commitments in the 2022-23 action plan and the breadth of that commitment in terms of key stakeholders such as the ICS, provider organisations, Adult Social Care, Children and Young People, and Public Health. She felt that the breadth of the commitment reflected the ambition the Health and Wellbeing Board had expressed in refreshing the JHWS.

In introducing the report, Melanie Smith advised that this was the first time the JHWS progress had been presented in this way and welcomed any feedback for future update presentations. In future, officers were working to quantify some of the achievements and impacts of this particular theme, and commit to having a more explicit focus on action to address health inequalities in order to demonstrate the difference the Strategy was having.

The Chair invited contributions from those present, with the following issues raised:

• In relation to paragraph 3.27, Gail Tolley (Strategic Director Children and Young People, Brent Council) advised that the meetings being referenced were professionals meetings, with learning from parents and carers through the parent and carers forum and parent and carer representation.

• The Board felt that the content of the report on ‘staying healthy’ was focused on staying healthy in a medical way, and noted there were much broader ways people stayed healthy including through social prescribing. Melanie Smith felt this was a fair assessment and when the update on the ‘healthy lives’ theme was brought to the Board she hoped that the attention to health in its wider sense was more evident.

• Board members requested further details be brought back to the Board on how the strategy would robustly address health inequalities.

RESOLVED: to note the Joint Health and Wellbeing Strategy (JHWS) thematic update.

To update the Health and Wellbeing Board’s Terms of Reference and provide a proposed work programme for 2022-23.

Councillor Nerva introduced the item to the Board, explaining that, since there was a new Council administration and new arrangements operating within the NHS, work had been undertaken to review the Terms of Reference (ToR) and membership. Phil Porter (Strategic Director Community Wellbeing, Brent Council) added that the ToR had been updated to take into account the changes in the Integrated Care System (ICS) to recognise their role in Health and Wellbeing. The final appendix within the report set out the indicative Forward Plan for the year, which would adapt throughout the year as needed.

In considering the report, the Chair requested that disability was added into point 6 of the ToR.

RESOLVED: To agree the Terms of Reference and Work Programme, subject to the minor amendment to the Terms of Reference.

Notice of items to be raised under this heading must be given in writing to the Head of Executive and Member Services or her representative before the meeting in accordance with Standing Order 60.

The Board noted that this would be Gail Tolley’s final Health and Wellbeing Board meeting as the Strategic Director Children and Young People, and thanked her for her work with the Board.