Agenda and minutes

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

Apologies for absence were received from the following:

·         Carolyn Downs (Chief Executive, Brent Council)

·         Gail Tolley (Strategic Director Children and Young People, Brent Council) from 7pm

·         Simon Crawford (Deputy Chief Executive, LNWUHT) substituted by James Walters

·         Janet Lewis (Director of Operations, CLCH) substituted by Jahan Mahmoodi

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 19 October 2021, be approved as an accurate record of the meeting, subject to ratification at the next quorate meeting.

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

None.

To receive a verbal update regarding Covid-19.

The Board received a verbal update from Dr Melanie Smith (Director of Public Health, Brent Council) detailing the most recent information about the Covid-19 pandemic, with the following points highlighted:

·         Rates in London had now peaked. During Omicron, Brent had been behind some other London Boroughs, and those who had higher numbers early on were now falling, so Brent’s position in comparison had worsened as the rates in Brent increased. Brent had moved up the London average and the 7 day instance rate per 100k was 1,800, above the London average of 1,500.

·         There had been an impact from the testing constraints experienced the previous week when there were limited tests available. The testing numbers had since picked up again and the positivity rate had fallen to under 30%, compared to 34% the previous week, suggesting there was a better handle on infection rates, although they were still high.

·         The infection rate for over 60 year olds was high, which was a concern, as those age groups were more likely to become ill.

·         The infection rates had not peaked in children and were still rising, which was likely to continue as children returned to schools following the winter break. There were lower levels than desired of vaccination uptake for 12-15 year olds and while there were many who now could receive a second dose, there were still a lot of children who had not yet had their first dose. The Board heard it was important those age groups were vaccinated not only to protect children but also because children were a driver for infection in the community.

·         It had been shown that the Omicron variant was much more transmissible, reflected in the very high infection rates and the rapidity in which those rates increased. The variant was introduced to a population in the UK with high levels of immunity as a result of vaccination or previous infection, which had meant those very high levels of infection had not translated to high levels of hospital admissions, serious illness or death. Dr Melanie Smith attributed the vaccination programme for the reason morbidity and mortality had been weathered and expressed that receiving a booster was critically important.

·         Inequalities in vaccination uptake persisted, and Dr Melanie Smith advised that vaccination rates were lower in members of Black communities, those with Learning Disabilities, and those with a Mental Illness. Dr Melanie Smith advised that while there was a national drive for boosters, it was important locally to ensure focus and to continue with targeted efforts.

The Chair thanked Dr Melanie Smith for her update and invited comments and questions from those present, with the following raised:

·         The Board discussed the need for more pharmacies in the South of the Borough to be vaccinating the Brent population. Robyn Doran (Chief Operating Officer, CNWL / Brent ICP Director) advised that she had wrote about this issue on behalf of Brent to NWL NHS. Fana Hussain (Borough Lead Director for Brent, NWL CCG) had also followed up with  ...  view the full minutes text for item 5.

To receive an update regarding winter pressures on the health and care system, as well as the system response.

Phil Porter (Strategic Director Community Wellbeing, Brent Council) introduced the report, which provided information on the system response during winter and winter pressures. He advised that the system was fortunate in Brent that there were very good working relationships and a strong commitment to support the residents of Brent to stay out of hospital and get the appropriate care at the right time, working with the acute trust. Phil Porter and Robyn Doran (Chief Operating Officer, CNWL / Brent ICP Director), as co-chairs of the Integrated Care Partnership (ICP), had focused on winter planning for the past 3 ICP Exec meetings and would continue to throughout winter to ensure the system was working. He reassured the Board there were daily calls with the hospital to discuss discharge as needed, as well as daily calls at a NWL level for Directors of Adult Social Care (DAS) and ICP directors. He advised that the report set out the support Adult Social Care had put in place to help with the discharge process, with a lot of work put in to support residential and nursing homes and supported living and extra care, particularly with the closure of 9 nursing homes in Brent. A range of services in social care had been maintained through the hard work of all in the department as well as those in care homes and home care providers, and Phil Porter extended a special thanks to all those individuals.

Robyn Doran agreed that they were very conscious of the need for all agencies to work together at a local level, as well as feed in to the system as a whole. Daily calls with DAS and ICP directors allowed the NWL system to pick up issues across the patch. For example, many care homes were closed, including in Brent and particularly in Ealing, with both boroughs used by London North West University Healthcare NHS Trust (LNWUHT) to move patients down. The arrangements allowed for the system to use other capacity, such as community rehabilitation beds, to plug those gaps and move patients.

James Walters (Chief Operating Officer, LNWUHT) agreed that he had felt the partnership over the holiday period, where it would have been challenging for the hospital had it not had the support of the ICP through the winter schemes delivered locally. The hospital had been ensuring a business as usual approach, including accident and emergency for those attending with urgent care needs not limited to Covid-19, and maintaining a focus on elective services. The hospital was moving towards achieving the levels of activity it had seen prior to Covid-19. Throughout the period the hospital had focused on keeping patients and staff safe through ensuring good infection control and prevention measures across all wards and supported staff with equipment, vaccination and PPE.

In relation to care homes, Basu Lamichhane (Chair of Brent Care Home Forum) advised that care homes had support from the local authority, CCG and a good network that helped each other. For example, one care  ...  view the full minutes text for item 6.

To receive an update on the Joint Brent Health and Wellbeing Strategy (JHWS).

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the update, explaining that, as a result of Omicron, the consultation had not happened to the extent they would have wished. Engagement had been slower than hoped and the consultation was continuing. Useful work had been done talking with people working with and experiencing mental illness and changes to the strategy had been made as a result of that. She requested members of the Board to encourage people to respond to the consultation before it closed at the end of January.

The Chair thanked Dr Melanie Smith for the update and invited members to comment, with the following issues raised:

·         Jo Kay (Healthwatch Brent) advised Healthwatch had several focus group sessions booked for December 2021 but due to community groups putting a stop to face to face they were not able to go ahead. Things were now starting back up and Healthwatch had met a few groups that week to feed back on the draft strategy. She highlighted that community groups and more vulnerable communities were being heard and influencing the strategy. The Disability Forum had been pleased their ideas had been considered and included in the Strategy.

·         Councillor Nerva (Lead Member for Public Health, Leisure and Culture) felt there was space for the NHS to make its views known on air quality and its impact on health, as there were a number of things he felt public services could collectively do to improve air quality and opportunities for people to engage in active travel. He hoped those discussions could take place between now and the final documentation in March 2022.

·         The Board were advised that officers had reached out through the Community and Voluntary Sector to ask for views and would remind people they had the opportunity to comment by the end of the month. The consultation was being supported to go through the Black Community Action Plan Youth Advisory Group and officers would look to see if they could arrange a specific session with them.

·         The Board agreed that more time was needed for further engagement for the strategy to be meaningful and include the views of as many people as possible.

RESOLVED: To note the Brent Health and Wellbeing Strategy Update.

To receive an update on the Integrated Care Partnership (ICP) Governance arrangements.

Phil Porter (Strategic Director Community Wellbeing, Brent Council) introduced the update, outlining the draft structure for the Integrated Care Partnership (ICP) governance in Appendix 1 of the report. He advised the Board that it was being presented in order to be as transparent as possible. The ICP arrangements focused on building on what already existed based on national guidance, such as the Brent Children’s Trust, and had enhanced what was previously known as the Health and Care Transformation Board into the ICP Exec. The main change presented to Board with this iteration was the creation of an ICP Board which brought those two children and adult streams together. The ICP Board had been meeting informally as a cohort and it needed to be formalised. The Terms of Reference, included in Appendix 2 of the report, detailed that membership. He advised the Board that different legislation meant slightly different requirements on memberships for ICP and Health and Wellbeing Boards, and there may be a need to review the membership of the Health and Wellbeing Board once the ICS was in place. The ICP Board would meet 6 weeks before Health and Wellbeing Board meaning anything coming through the ICP Board could be reported to the Health and Wellbeing Board. Robyn Doran (Chief Operating Officer, CNWL / Brent ICP Director) added that the ICP understood the importance of having councillors in the room to ensure good governance. In her role as ICP director she had met, alongside other ICP directors, the new Accountable Officer, and would invite him to meet locally with relevant partners.

The Chair invited comments and questions from those present, with the following issues raised:

·         The Board welcomed the recreation of a significant joint planning arrangement.

·         The Board queried how investment decisions would be made in the future with the new arrangements. Robyn Doran recalled that at a previous meeting Lesley Watts (Chief Executive, NWL CCG) had spoken about a commitment from North West London (NWL) to move money into areas that had been underfunded for some time, including Brent. Robyn Doran advised that a significant amount of money had come into the system both nationally and locally. There was a commitment from NWL CCG and central government, through the Department of Health, to look at a population health approach to funding and there was a recognition that places such as Brent and other areas had been underfunded for a long time. Any new money into the system would go to those boroughs and some of that was already happening. Robyn Doran agreed to conduct a retrospective piece of work outlining what had been invested on in the past year in all of the key areas, including information on where there was large underfunding or unmet need.

·         The Board agreed that it was important to factor in the voice of voluntary and community organisations and the voice of people with lived experience. That conversation had taken place within the subgroups of the ICP and the ICP exec had met  ...  view the full minutes text for item 8.

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.

9a. Better Care Fund Plan 2021-2022

Phil Porter (Strategic Director Community Wellbeing, Brent Council) advised that the Board had received the Better Care Fund (BCF) proposals with a large appendix detailing significant amounts of money. There was a national reporting regime for BCF money and all partners had been engaged on the plan. The plan had also been signed off at the ICP Exec and submitted to the relevant NHSE and LGA bodies with initial feedback that the plan was strong and confidence it was well worked up as a partnership. Part of the process was to ensure the BCF was brought to the Health and Wellbeing Board as part of transparency and there was a Chair’s action to take forward before the Strategic Director Community and Wellbeing signed it off.

In considering the BCF, the following comments were raised:

·         In relation to whether there was any evaluation system for the BCF as a whole, Phil Porter advised that there was no single evaluation system, but for individual schemes, particularly pilots, the partnership would look to understand their impact and make a decision as a system whether a scheme should continue. Discussions around investment and project appraisal would take place at an ICP Exec level with subgroups taking forward some projects. For example, the Community Services Subgroup was taking a lead on reablement and continued to expand all forms of rehabilitation and reablement integration.

The Board were happy to note the BCF Plan for 2021 – 2022 and were happy with the proposed projects and funding set out in section 4 of the report.

9b. Flu vaccination

Dr M C Patel (NWL CCG) reminded partners that it was important for people to come forward to receive their flu vaccinations.

As previously detailed on the agenda, attached is a report which asks the board to note and comment on the Better Care Fund proposals.

To consider any items that have been identified during the meeting that will require the exclusion of the press or public.

The next scheduled meeting of the Health and Wellbeing Board is on