Agenda and minutes

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

Apologies for absence were received from the following:

·         Councillor Donnelly-Jackson (Brent Council)

·         Basu Lamichane (Nursing and Residential Care Sector)

·         Judith Davey (CEO, Brent HealthWatch)

·         Simon Crawford (Deputy Chief Executive, LNWUHT), substituted by Lisa Knight (Chief Nurse, LNWUHT)

·         Robyn Doran (CNWL)

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 12 January 2023, be approved as an accurate record of the meeting.

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

None.

For the Health and Wellbeing Board to receive an update from the Integrated Care Partnership (ICP) on primary health care.

Fana Hussain (Assistant Director Primary Care, NHS NWL) introduced the report, which provided an update on the actions taken to improve GP and primary care access in Brent. She highlighted that access to primary care remained on the agenda as a priority area for all boroughs in NWL. NWL had been working alongside GP practices after the ‘no-one left alone’ report and recommendations. In updating the Board, she highlighted the following key points:

·         The Primary Care Team had been looking at how to improve access to appointments, including online consultations, as well as how to improve the number of staff working in GP practices and how primary care worked with partner organisations. A lot of work on this had been undertaken in the past year and members’ attention was drawn to Table 1a of the report, which showed the number of GP appointments offered in NWL. In the month of December 2022, Brent had been the borough with the second highest number of GP appointments, and in January 2023 had moved to joint second position alongside other boroughs. The graphs showed appointments at GP practice level but did not include appointments held at the Access Hubs.

·         The main focus areas had been:

o    Increasing appointments outside of core hours (8:00am – 6:30pm, Monday to Friday), looking at how appointment options could be expanded up to 8pm and on weekends

o   Offering additional appointments in health inequality clinics and promoting uptake.

·         As such, GPs were seeing more patients who were diabetic, had long term conditions, and were offering screenings and immunisations. Enhanced Access Services were now providing double the number of appointments they had previously, with 135,000 appointments now being provided in hubs where patients could get an appointment outside of core hours. Booking for those remained through GP practices and calling 111, but the aim was to enable direct booking into those slots once IT barriers had been resolved.

·         Face to face appointments had remained a focus, as primary care were aware patients wanted to be seen face to face. Two thirds of appointments in most GP practices were provided face to face with one third online. It was understood that there was also a demand for online consultation, particularly from the younger generation and those with IT skills, so that hybrid model was available.

·         The focus on improving access to primary care had also concentrated on access to registration. Primary care understood that patients were experiencing issues registering with GPs, and so this had been highlighted and taken forward, working with an organisation called Doctors of the World. As part of this, surgeries were being offered accredited training on ‘safe surgery’, which looked at barriers to registering. 40 GP practices had now been accredited as safe surgeries and the remainder would go to the next programme. Registration was now much easier and more fluent with documentation no longer required and, going forward, the NHS app would allow patients to change GP practice at the click of a button.

·         Additional  ...  view the full minutes text for item 5.

To provide the Health and Wellbeing Board with an update on HealthWatch Brent’s progress throughout 2022-23 and the development of the HealthWatch Brent workplan for 2023-24.

Cleo Chalk (Manager, HealthWatch Brent) introduced the report, which asked Board members to note the outcomes achieved over the past year, as well as HealthWatch’s plan to build on existing priorities and develop the service. In introducing the report, she highlighted the following key points:

·         HealthWatch had experienced challenges over the past 12 months due to staffing challenges but were now in a stronger position with Cleo Chalk as Manager and an overarching Service Manager from the Advocacy Project.

·         HealthWatch were pleased to have made progress in the past 12 months despite staffing challenges, particularly the project work with Brent’s communities facing multiple health inequalities including strengthening links with Romanian and Somali communities. HealthWatch looked forward to continuing that targeted work in 2023-24. It had been found that the experiences of these groups echoed the broader lack of access affecting many communities in Brent.

·         A series of highly insightful ‘enter and view’ visits had been conducted at the Park Royal Centre for Mental Health, which resulted in several key findings, notably the lack of information patients had about their care plans and the need for more information about the complaints process. HealthWatch were now working closely with that service to implement the changes from those recommendations.

·         Priorities for 2023-24 had now been agreed for the Annual Work Programme, which had been informed by a detailed piece of work evaluating what HealthWatch knew about health inequalities in Brent and its relationship with key stakeholders.

·         The first priority was mental health in key communities and geographical hotspots, building on existing work with the Somali community and developing a new project working specifically with the Pakistani community. The Pakistani community had been chosen following conversations with CNWL which suggested that group was underrepresented.

·         The second priority would be around translation and additional support to access services. From the work HealthWatch had done with the Romanian community, they knew that there was a lack of access to translated materials and HealthWatch were looking to investigate that further, including in relation to key services such as maternity. It was hoped this would lead to more opportunities for co-production work in that community to develop those translated resources.

·         The final priority was to ensure HealthWatch was focusing on residents in the most deprived wards. Engagement work had always been concentrated in Harlesden and Stonebridge and this would be expanded to include Kensal Rise. The work in those areas would focus on delivering HealthWatch’s advice and information service, crucially in face-to-face and pop-up services and not solely online or telephone. That work would also focus on the delivery of health information, and was looking at cancer screening workshops to be delivered specifically in those wards.

·         Now that the service was close to being fully staffed and there was a larger pool of volunteers, HealthWatch were looking at service development and wanted to expand the advice and signposting service, which was felt to be a really important way HealthWatch reached residents most struggling to access services.

In considering  ...  view the full minutes text for item 6.

To update the Health and Wellbeing Board on winter planning.

Steve Vo (Assistant Director of Integration and Delivery, NHS NWL) introduced the report, which detailed the winter planning journey that had started in July 2022. He highlighted the following key points:

·         A total of £3.35m had been secured across the system, which he felt demonstrated good collaborative working across health and social care partners to structurally come together to create schemes and commit to a reporting regime.

·         Positive feedback had been received from service managers across the Council, NHS NWL, CLCH and CNWL.

·         February data showed a rise in A&E and non-elective attendances and so the data was being looked into to understand the spikes in particular months.

·         Service leads and teams were assessing the current schemes, evaluating data to learn lessons from the past few years in order to plan ahead, and the outcome of that assessment would give a steer on which schemes would need to be prioritised locally and identify appropriate funding to continue schemes going forward.

In considering the report, the following points were raised:

·         The Board asked whether there was any data regarding readmittance to hospital and if that was an area of concern. Lisa Knight (Chief Nurse, LNWUHT) advised that readmission data was collated and could be shared with Steve Vo to be used as part of the evaluation process. She believed readmission to be 8% across the entire organisation, and there would be a need to look at that by borough for the Health and Wellbeing Board. LNWUHT had a requirement to audit readmissions, so they could undertake and share the reasons for readmission, as readmission data could include patients who were readmitted for a reason not related to their original diagnosis or health concern.

·         The Board asked if there was any significant system learning that had been taken from the winter planning schemes over the year. Tom Shakespeare (Director, Integrated Care Partnership (ICP)) advised the Board that they were currently going through the process of reporting back to the ICP the impact of specific winter pressure schemes which they could bring back to the Board at a future date. Each of the NWL hospitals were currently undertaking a peer review and Adult Social Care would be looking to be part of that process in terms of learning what the experiences had been.

·         Lisa Knight added that LNWUHT had been thankful for the support, but irrespective of the winter support schemes put in place it had been a very difficult winter. Emergency activity continued to increase at Northwick Park Hospital in particular, and there were significant diverts in place with the London Ambulance Service, with that activity being increased through Ealing as more ambulances were being sent through Ealing due to ambulance queues. She wanted the Board to be aware that some of the experiences in emergency departments continued to be not what they should be, and LNWUHT were in a position where they were ‘plus one-ing’, where patients were moved to wards without a bed on every ward every  ...  view the full minutes text for item 7.

To provide information to the Health and Wellbeing Board on the newly launched five year strategy at London North West University Healthcare NHS Trust.

Lisa Knight (Chief Nurse, LNWUHT) introduced the report, which presented the 5-year strategy for LNWUHT, which had been ratified by the Trust Board. She advised the Board that the strategy had been developed over the last year with patients, staff, and local organisations. The document was a statement of where the Trust was now and how it wanted to develop and engage with partners over the next 5 years. There had been good engagement on the strategy, and she requested that LNWUHT came back to the Board for a future update.

James Biggin-Lamming (Director of Strategy and Transformation, LNWUHT) spoke in more detail about how the strategy had been developed, highlighting the following key points:

·         Almost 900 patients had responded to the multi-lingual survey about their care and their aspirations for their care, which had been translated into several local languages. 2,400 staff had input at various points what their hopes for the organisation were and what could be done together to improve, and there had been significant engagement from partner organisations.

·         The new vision was to have quality at the heart of the Trust. Central to the Strategy was the ambition to have consistent, best practice quality in the care provided, and as an employer and partner. Four objectives underpinned that vision;

o   Objective 1 was to provide high quality, timely and equitable care in a sustainable way.

o   Objective 2 was to be a high-quality employer where staff felt like they belonged and were empowered to provide excellent services and grow their careers.

o   Objective 3 focused on basing care on high quality, responsive and seamless non-clinical and administration services. James Biggin-Lamming informed the Board he was proud to have an objective in the strategy around admin support services as clinical care did not rely solely on clinical staff but also those working ‘behind the scenes’ such as procurement, HR, and finance. If their work was done effectively this freed up time for clinicians to do more with patients. This workstream was also in response to patient interactions with admin staff not always being constructive such as booking appointments and so the Trust was determined to do that in a much better way.

o   Objective 4 was to build high quality, trusted ways of working with local people and partners to improve the health outcomes of communities together. This included working with primary care, social care, mental health, the voluntary sector and patients, with the Trust as an anchor organisation within that partnership.

·         The details of the strategy were available on the Trust website and included measures and actions to track the strategy. The Health and Wellbeing Board were invited to support the strategy.

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

·         The Board welcomed the strategy and asked whether there were any specific asks of the wider health and wellbeing system. They were advised that under the partnership workstream there were opportunities to work on how the Trust trained and recruited  ...  view the full minutes text for item 8.

To provide an update to the Health and Wellbeing Board on local governance in the context of the NWL relationship.

Tom Shakespeare (Director, Integrated Care Partnership) introduced the report, which aimed to get a steer from the Board on three main areas the Integrated Care Partnership (ICP) wanted to work more closely with the Integrated Care Board (ICB) on, where it was felt there was a unique need for ICB support.

Area 1: Action on workforce, specifically how the ICP and ICB could work to counteract the inequity of pay between inner and outer London, particularly in harder to recruit areas such as Occupational Therapists, Health Visitors and Mental Health Practitioners, as well as the broader workforce issues.

Area 2: Support to continue lobbying for levelling up funding. The ICP had made good progress with funding to primary care over the past year but had been told a decision regarding mental health funding had been made which it was yet to hear the outcome of. The ICP were undertaking further work to get a clear position around finances relative to other areas to make a case for levelling up, as well as looking at opportunities to improve efficiency, joint working and integration so that the system was in a robust position to respond to challenges.

Area 3: Action around inequalities. The ICP had received significant investment for Brent Health Matters (BHM) from the ICB and a recurrent share of £7m funding (£780,000). This was welcomed by the ICP, but it was looking for support and investment into the development of services across acute, secondary and primary care in order to embed addressing health inequalities in all services from a disability, ethnicity and deprivation lens.

RESOLVED:

i)              To note the report and endorse the approach taken by the ICP.

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.

Dr Melanie Smith (Director of Public Health, Brent Council) highlighted that the new Polio vaccination campaign was not a response to any new finding of Polio in sewage and was simply a reflection that there were low levels of immunisation locally. The MMR vaccination would also be offered as part of that campaign. The campaign would be school based, but work was ongoing with providers to try to accommodate some vaccinations in community settings as had been done previously.

The Board were advised that this was David Petrie’s (Strategy and Partnerships Manager, Brent Council) final meeting, and thanked him for all the work he had done to support the Board.

The Board were advised that this was also Carolyn Downs’s (Chief Executive, Brent Council) final meeting, and thanked her for her input in ensuring a good, effective partnership. Her input had been valued at the Health and Wellbeing Board.