Agenda and minutes

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

Apologies for absence were received from the following:

·         Kim Wright (Chief Executive, Brent Council)

·         Councillor Donnelly-Jackson (Brent Council)

·         Dr Mohammad Haidar (Vice Chair)

·         Dr Melanie Smith (Director of Public Health, Brent Council)

·         Simon Crawford (Deputy CEO, LNWT), substituted by Mark Titcombe (Managing Director EOC, CMH & Ealing, LNWT)

·         Jackie Allain (Director of Operations, CLCH), substituted by Patrick Laffey (Deputy Director of Operations, CLCH)

·         Cleo Chalk (HealthWatch Manager)

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 15 April 2024, be approved as an accurate record of the meeting.

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

None.

To outline the development of the mental health strategy for adult residents of North West London (NWL).

Toby Lambert (Director of Strategy and Population Health, NWL ICB) introduced the paper which presented the NWL Mental Health Strategy for adults. In introducing the report, he highlighted the following key points:

·         The strategy focused solely on the needs of adult residents in NWL. A parallel piece of work looking at the needs of children and young people and transition into adult services would be picked up in September 2024. The strategy also did not expressly focus on promoting resilience and overall wellbeing as there had been a clear view, following strong engagement with the strategy working group which included all NWL trusts and local authorities, that each individual local authority had their own Health and Wellbeing Strategy focused on those areas and therefore it would not be helpful to have a NWL-wide view on that. As such, the strategy focused on an individual’s first contact with mental health services onwards.

·         The engagement and participation process that the ICB went through to arrive at the strategy was detailed. Through the engagement process, the ICB had learned that there had been considerable progress in the mental health services on offer but not enough. Extra investment had been put in and access had been expanded but there was still further work to do. The strategy set out the collective ambition for further improved services, which were encapsulated into 3 main areas.

·         The first area of the strategy was raising awareness and promoting wellbeing. Whilst this was not a wellbeing strategy, it was clear people who came into contact with mental health services needed to be signposted and supported in their wellbeing. There was a degree of hesitancy amongst those of the NWL population who most needed to access services to come forward, which was a major driver of the inequity in outcomes and access that NWL saw, hence the need for promoting awareness of where help was available and how to access services.

·         The second area of the strategy was around increasing the equity and quality of access to mental health services. The Board heard that there was an ongoing programme to develop a common offer across NWL, as currently the services available did vary depending on their resident borough in both practice and access. A common offer meant setting a clear shared specification of what was expected to be available no matter where a patient was in NWL. It was highlighted that there was no significant extra funding coming into the system, although there was a need to increase the productivity of services in NWL because, where mental health services had been expanded, the number of people accessing those services had not yet caught up with the extra resources put in. As such, he highlighted the importance of making the best use of resource in terms of levelling up across NWL to the highest specification of service using the resources already in the system.

·         The third area was around patients receiving right care in the right place and ensuring residents found  ...  view the full minutes text for item 5.

To present new proposed commitments for the Joint Health and Wellbeing Strategy for approval by the Health and Wellbeing Board.

Agnieszka Spruds (Strategy Lead – Policy, Brent Council) introduced the report, which provided a refresh of the Brent Joint Health and Wellbeing Strategy. In introducing the report, she highlighted the following key points:

• The Board were reminded that a fundamental re-write of the Joint Health and Wellbeing Board had been agreed in October 2020 in the context of the issues exposed by the covid-19 pandemic. The Board had agreed at that time that the focus should be a whole systems approach to tackling health inequalities and the wider social determinants of health as exposed by covid-19. There was clear instruction that the strategy must be developed with strong involvement of communities.
• Following the Board’s agreement to re-write the strategy, an extensive 3-stage consultation had taken place which led to establishing five main priorities; healthy lives, healthy places, staying healthy, understanding, listening and improving, and healthy ways of working. In January 2024, the Board reaffirmed its commitment to those priorities and accepted the proposal to refresh the strategy. During that meeting, it was noted that the initial comments made had been narrative based, which was appropriate at the time, but the refresh would ensure that there were strong Key Performance Indicators (KPIs) alongside those priorities.
• In refreshing the strategy, officers had collaborated with ICP exec groups, Brent Children’s Trust, and Council Leadership Teams to collate new commitments. These new commitments included clear KPIs, a solid baseline for measurements and a clear focus on addressing health inequalities, with 49 diverse commitments all focused on tackling health inequalities and allocated to the themes approved by the Board.
• Officers highlighted the positive experience in preparing the strategy and refresh and hoped the Board shared their enthusiasm and endorsed publication of the Joint Health and Wellbeing Strategy refresh.

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

• Robyn Doran (Director of Transformation, CNWL, and Brent ICP Director) endorsed the strategy as a Brent resident and as someone who had been part of the process. She confirmed to the Board that she recognised the dialogues the team had with stakeholders within the strategy and felt the refresh represented a more up to date picture of what Brent’s needs were now.
• The Board asked officers to include some of the health offer available for looked after children and care leavers within the strategy, which contributed to addressing health inequalities which were highlighted to be deep-rooted for many looked after children and care leavers.
• Board members asked about the link between housing insecurity and mental and physical health problems and whether the outreach work being done in hotels and temporary accommodation could be incorporated into the strategy. Rachel Crossley (Corporate Director Community Health and Wellbeing, Brent Council) detailed the work being done in relation to mental health and housing, which was one of the sub-groups within the Mental Health Executive Sub-Group of the Integrated Care Partnership (ICP). The group had been particularly focused on temporary accommodation, with a big focus on where it was  ...  view the full minutes text for item 6.

To set out the Council’s responsibilities to carers, demographic information on carers in Brent, and information on the engagement work that has taken place to inform and develop the Carers’ strategy for unpaid carers.

Claudia Brown (Director Adult Social Care, Brent Council) introduced the strategy which had been co-produced with carers over the last 2 years. The strategy was now at a stage where it could be launched and therefore was being presented to the Health and Wellbeing Board for comments and endorsement. She introduced Star Pswarayi (Head of Access – Information, Safeguarding and Wellbeing Services, Brent Council), Ann-Marie Morris (CEO, Brent Carers Centre) and Hasmita Patel and invited them to introduce the strategy. Some of the key points were highlighted as follows:

• Brent had never had a Carers Strategy before, so officers were pleased to be bringing this piece of work, which had been co-produced with informal carers.
• Star Pswarayi had project-led the preparation of the carers’ strategy alongside carers in Brent. She highlighted that there were currently 22,000 known carers in Brent, and the Census 2021 and Carers UK research had found that carers were contributing approximately £160 billion into the nation’s Health and Social Care budget.
• Anne-Marie Morris added described the strategy as an integrated strategy with health and social care working together to bring it together, including partners such as the local authority, CNWL, and CLCH, as well as voluntary and community sector organisations.
• A lot of planning had taken place to ensure the right people were around the table and officers had been thorough in the way they had implemented engagement with carers and key stakeholders, taking time to listen and have challenging discussions with carers about their experiences. It was believed that, through that collaborative consultation, carers had felt listened to, appreciated and valued and officers were keen to progress the strategy to show carers the ways services had incorporated what they had asked for.
• One of the key elements of the strategy was the commitment to ‘no wrong doors’, particularly for young carers, which ensured carers were not being passed around to different services without knowing who they were and what support they could offer.
• Hasmita Patel highlighted one of the main concerns from carers had been the amount of information in different formats. Carers had asked for all information to be available in one place that was easy to access, and so a carers booklet had been created which would be shared with all partners to use so that every partner was giving the same information to carers. That booklet would be reviewed on a regular basis to include any changes.
• Another objective of the strategy was partnership working. The carers forum was well established with health partners and different types of carers involved, and officers were looking to widen that to have other organisations involved, including social care. As carers were seen as partners in the strategy, officers were getting them involved in reviewing contracts that affected them so that services were relevant to them.
• A third objective was supporting the wellbeing of carers, as it was recognised that caring could be a stressful role. A document was being pulled together with information about where  ...  view the full minutes text for item 7.

To present the first Brent Health Matters (BHM) Annual Report which summarises the BHM programme approach, achievements between April 2023 and March 2024, and priorities for 2024-25.

Nipa Shah (Programme Director, Brent Health Matters) introduced the Brent Health Matters Annual Report for 2023-24, which was the first annual report of the programme since its launch in 2020. She provided an introduction to Brent Health Matters, which was launched following the first wave of the covid-19 pandemic after the spotlight was shown on the health inequalities that had always existed but been made more apparent during the pandemic. The programme had shown a commitment from all organisations to come together to work with Brent’s communities through an iterative process to continue to understand the barriers faced in accessing and experiencing health and care services. She highlighted that it had been a positive journey in understanding and realising how powerful working with the community could be in informing the work of the system. In presenting the annual report, she highlighted the following key points:

• Attention was drawn to the large variance between different groups of people in terms of their health. For example, there was a difference in life expectancy for women and men in different parts of the borough. Brent was very diverse, with 1 in 3 residents in Brent using a language other than English as their main language, whereas all of the work done in health and social care was conducted in the English language. There was also disparity in long term conditions such as diabetes, cardiovascular disease and mental health depending on ethnicity, where a person lived, employment status and other social determinants.
• BHM was a model and a programme supporting work with Brent communities, accepting that communities were not hard to reach but instead experienced barriers in accessing services. There were various workstreams within BHM working with diverse communities, specifically BAME communities, emerging communities, those experiencing homelessness, people with learning disabilities and mental health conditions, and shift workers.
• The demand for BHM services was growing as the programme became more visible and communities were now trusting BHM more, coming forward and willing to help in co-producing solutions.
• BHM worked with voluntary and local community organisations and to date had worked with around 428 organisations. The aim was to get the voluntary and community sector to a point where they were empowered to find solutions and BHM supported them to do it, which took time.
• BHM was working to co-produce outreach events where health and care services were taken out into the community at a time and place that suited different communities such as faith centres, community centres, factories, high streets, schools and colleges and even a barber’s shop. BHM had also produced assets and messaging in different languages and through various means such as social media, WhatsApp and local celebrities.
• Community grants had helped to empower organisations to support this work and in 2023-24 community grants had been given to 27 organisations to support them to become sustainable. Part of that package included support in monitoring the outcomes of their programmes so that they could apply for larger grants. One organisation that had been  ...  view the full minutes text for item 8.

To present the NWL ICB Joint Forward Plan to Brent Health and Wellbeing Board.

The Chair informed the Board that the NWL ICB was visiting all Health and Wellbeing Boards in the timeline available to present the Joint Forward Plan, which had now been submitted to NHSE, as the presentation of the Forward Plan to Health and Wellbeing Boards had been impacted by the pre-election period. In inviting Toby Lambert (Director of Strategy and Population Health, NWL ICB) to present the Forward Plan, the Chair highlighted the concern amongst Health and Wellbeing Boards that the document was very health focused, with local Councils unsure how the work of local authorities would fit in with the document.

Toby Lambert introduced the item, highlighting that the Plan was a joint document defined in statute as ‘joint’ between the ICB and NHS trust, which was why it was health focused, although he acknowledged that did not mean the document could not look at partner organisations. The document built on the NWL ICB Health and Care Strategy which was signed off in November 2023 by all 8 NWL local authorities. In presenting the document, Toby Lambert highlighted the following key points:

• There were 9 themes laid out in the Plan with actions underneath each of those. NWL’s acute providers had offered to take up 2 of those themes which had expanded them further and there was commonality between those themes.
• The health service was working on a 3-step process. First was to develop a common offer across NWL to standardise inconsistencies in the offer and develop a shared offer so that no matter where someone lived in NWL there were shared core services available. In order to do that, a levelling up process would be needed with consideration needed in relation to resource and productivity levels.
• The second step was around more fully understanding the needs of residents to tailor the core common offer to different groups with different needs in a culturally competent and appropriate way, building trust with communities so that they were confident to come forward for services and knew where to go. This would draw on the experience and good work each borough had been doing in their own neighbourhoods on health inequalities.
• There would be a need to evaluate where the greatest need was presenting and ensure resource shifted towards that need. Toby Lambert highlighted the importance of doing that in a balanced way, because if resource was moved too quickly it could result in spare capacity and an underuse of services, but if resource was moved too slowly then the demand could overwhelm the system and create waiting lists, leaving people dispirited from coming forward.
• The third step was around bespoke offers for certain groups of the population, such as Asylum Seekers.
• The statutory role of the Health and Wellbeing Board was to respond to the ICB on whether the content of the Forward Plan met the needs of residents as expressed in the Joint Strategic Needs Assessment (JSNA). Due to 2 pre-election periods, it had not been possible to present the  ...  view the full minutes text for item 9.

To present and seek formal ratification for the end of year report for the Better Care Fund (BCF) 2023-24, and seek formal ratification from the Health and Wellbeing Board for the Better Care Fund Plan for 2024-25.

Steve Vo (Assistant Director Integration and Deliver, Brent Borough – Brent ICP) and Eleanor Maxwell (Senior Programme Officer and Better Care Fund Lead, Brent Council) introduced the item, which presented the end of year report for the Better Care Fund (BCF) 2023-24 for ratification and the report for the 2024-25 BCF plan submission. Members were asked to ratify the 2023-24 BCF end of year report and formally approve the proposed metrics and spend for the 2024-25 BCF plan.

The Chair thanked officers for introducing the item and invited comments from those present, with the following issues raised:

·         The Board highlighted the signing of the Section 75 in February 2024 for the period 2023-24 was too late in governance terms and there was now a commitment for completing that in an earlier timeframe. The aim for 2024-25 was to sign the Section 75 Agreement in September 2024.

As no further issues were raised, the Board noted the assurance regarding governance arrangements for BCF and Section 75 and the clear desire of the Board to sign off plans as soon as possible, and RESOLVED:

i)              To ratify the end of year report for BCF 2023-24.

ii)             To approve the proposed metrics and spend for the 2024-25 BCF plan.

To consider refreshing the membership of the Health and Wellbeing Board. Members attention is drawn to the government guidance regarding Health and Wellbeing Boards - Health and wellbeing boards – guidance - GOV.UK (www.gov.uk).

The Chair asked the Board to note that a review would be undertaken of arrangements of the Board which would include a refresh of the membership and terms of reference in order to formalise membership and confirm voting rights.

To discuss and agree any future agenda items for the Health and Wellbeing Board.

The Chair gave members the opportunity to highlight any items they would like to see the Health and Wellbeing Board consider in the future. Some of the suggested topics for future discussion were for the Health and Wellbeing Board to have sight of the NWL Maternity Strategy when that was produced, to receive information relating to Family Wellbeing Centres and their impact across public health and children and young people, and to receive an overview of the work of the ICP Community Collaborative, looking at lessons learnt from admissions avoidance work.

Notice of items to be raised under this heading must be given in writing to the Deputy Director – Democratic Services or their representative before the meeting in accordance with Standing Order 60.

None.