Agenda item
The single CCG and the Quartet
To update the Health and Wellbeing Board on the single CCG and ICS, including the Health and Social Care White Paper, and introduce the Quartet.
Reports published on 31 March 2021
Minutes:
Phil Porter (Strategic Director Community Wellbeing, Brent Council) introduced the item on the single CCG and the quartet. The Health and Wellbeing Board had been receiving six-monthly update reports on the Health and Care Transformation Board, which had now formally came to an end and been subsumed within the “quartet” to take forward the agenda for adult care integration. The quartet would build on that work that had been done, for example the work done together to ensure hospitals were freed up as much as possible during the pandemic to support those who really needed them. Care homes were a key part of the work with a multi-agency approach led by care homes and Basu Lamichaane as the Chair. At the time of the meeting 87% of care home residents had been vaccinated in Brent and 75% of care home staff had been vaccinated. The care home support scheme had been introduced which provided a dedicated team working with care homes requiring improvement to improve their quality of care and CQC rating. Basu Lamichaane (Brent Nursing and Residential Care Sector) strongly agreed that vaccination uptake was going up, and there were lots of support initiatives from Brent including funding, webinars, leaflets and information cascading. In general care homes in Brent had managed the last wave well, he felt, and the weekly meetings had enabled care homes to share letters, policies, protocol, guidance and opportunities with each other. Care homes had resumed visiting with one designated visitor and the following Monday this would increase to 2 designated visitors.
In relation to rehabilitation and re-ablement, Phil Porter advised that an integrated approach was being taken and the rehabilitation beds in Birchwood Grove through wave 2 of the pandemic were very successful. This was tied together with a range of other projects as part of the Better Care Fund Bid (BCF), which was spoken about at the previous Board meeting and which the Board was asked to formally ratify at this meeting.
Robyn Doran (Chief Operating Officer, CNWL) introduced herself as the new health lead working in the quartet with other colleagues. In relation to the quartet, Robyn Doran advised that there were actually 5 members as part of the new structure and the idea behind it was to bring together all of the health and social care work and pull resources to have a very focused approach. It included herself and Phil Porter as co-Chairs, Dr MC Patel, Simon Crawford (LNWUHT) for acute services, Janet Lewis as the lead director from new community provider CLCH, and was well support by Jonathan Turner (Brent CCG) and Tom Shakespeare (Brent Council). The quartet would oversee and co-ordinate health care in particular and she felt the input from the Council had been incredible bringing services together. The quartet would build on the work around health inequalities, which was a number one priority alongside the vaccination programme. The second priority was Primary Care Network (PCN) development and reduction in practice variation. The third priority was to improve community and intermediary healthcare services and wrap services around individuals, and the final priority was mental health and wellbeing. The quartet met regularly with the “sectet”, made up of 9 members, which in turn reported to the Integrated Care System (ICS).
The Chair thanked Phil Porter and Robyn Doran for introducing the item, and invited comments and questions from those present, with the following raised:
· In relation to 4.4.2 of the report in relation to levelling up the Board were pleased that resource was going towards diabetes in Brent and asked what specifically was being considered. Dr MC Patel (CCG) explained that there would be a large investment towards diabetes with clear priorities; the “rewind” project, which supported those on medication to work towards coming off medication; preventing people getting diabetes including picking up high risk patients early on and working with them; and working with those who have had diabetes and high blood sugar for a long time alongside the health inequalities team. They would also target cohorts with HBO1 to encourage them to take more control and help those not already on the maximum therapies or who may not have access to all the interventions they could possibly have. There would also be management of cholesterol and blood pressure in diabetes. Sheik Auladin (CCG) added that as part of the merger into 1 CCG across 8 NWL Boroughs there was a promise made to Brent CCG around inequalities. An issue faced in Brent was the levelling up of investment in community and primary care, and as a result the ICS had looked at issues pertaining to diabetes in the community and Brent had received an investment of around £1.9m for diabetes. This would complement community services and primary care regarding diabetes management for the future. Jonathan Turner (CCG) added that there was a series of workshops in the design phase looking to increase the standards at primary care level through General Practice, tiers of care, and looking at investment in hubs to support General Practice and be a seamless interface between General Practice and Hospital, so that those with hyperglycaemic episodes would be able to seek the help of the hub. Other areas of focus for the CCG were obesity, cardiovascular issues and hypertension, and Long Term Conditions, and determining why there was low uptake in certain populations for bowel and cervical cancer screenings and childhood immunisations.
· The Board queried how the work of the quartet on priority one (reducing health inequalities and increasing vaccination uptake) would relate to that of the new vaccination hesitancy task force set up by North West London CCG. In relation to vaccination, Dr MC Patel advised that there had been a lot of effort from the Council, CCG, Health Inequalities Team and NWL trying to get those patients to come forward who had not yet had the vaccination within the relevant cohorts. A call centre was being set up to look at the top 10 practices with the highest decline rates and those listed as having contraindications to the vaccination, as a lot of practices had coded allergy as a contraindication to the vaccine and it was believed some practices may not have coded that correctly. The health inequalities team in the Council would provide additional resource to work with practices on reaching those patients who had not yet came forward. Pop up clinics were also proving successful at the Mosque so there was hope to continue with that, and a process had now been agreed with the Council was for those pop-ups to take place. In relation to queries on certain vaccination centres being closed for vaccination on certain days Dr MC Patel advised that all PCNs had a list of groups of people they could call upon to deceive the vaccine but were being mandated to work within the priority cohorts. He advised however that Brent had very minimal vaccination wastage. Jonathan Turner added that the Hive Centre was based in Harrow so something the quartet was not directly responsible for but that some clinics had never run every day in order to be as efficient as possible.
· The Board requested that an action plan for priority 2, PCN development, was brought back to the next Health and Wellbeing Board explaining exactly what was going to be done to reduce variation in practice across the Borough. Dr MC Patel advised that the quartet had set a goal for itself that in 3 years’ time all practices would be functioning at the average of North West London practice. In Brent there was considerable variation in terms of outcomes and expected incidence of some chronic diseases, so the plan was to look at practices individually very carefully, with 10 identified to start with that had been particularly hard hit by COVID-19, looking at why the variance may be occurring and address it by offering support and assistance. This work would be underway once the second round of vaccinations had been done as that was the current priority.
· It was noted that an executive subgroup was proposed to be established for each priority and queried who decided who sat on those groups. Robyn Doran advised that there were 4 groups and subgroups within those and at the moment the proposal was that at least 2 of the quartet co-chaired the various subgroups. For example, Robyn Doran and Dr MC Patel had just chaired the first meeting of the reducing health inequalities sub group, and they had brought in Shazia Hussain (Assistant Chief Executive, Brent Council) and other officers in the Council to ensure the work being done in the Council was not lost as part of the overall health inequalities work. Partner agencies had agreed to have senior representation from each of those agencies on the sub groups to ensure all agencies were well represented. Full membership of those subgroups was being worked on at the time of the meeting.
· Regarding the 4 care homes homes that were part of the care home peer support programme, the Board asked whether what had been put in place would be sustainable long term. Phil Porter advised that of the 4 homes that had been worked with 2 had gone from requires improvement to good. While he did not believe he could promise sustainability as it depended on the registered manager of the home, they were looking at how the team could be sustained as an ongoing project.
· A question was raised in relation to long covid and its impact on those with cardiovascular and respiratory diseases and whether there was any resources that would cover that. Robyn Doran advised that all health agencies had pulled together some long covid connects, but there was a piece of work across London looking at all the resources coming in.
· The Board asked how services for young people were being included in the work of the quartet. Robyn Doran explained that it would be part of the priority around community services and in discussion with Gail Tolley (Strategic Director Children and Young People, Brent Council). Young people and children would also be looked at by the quartet in relation to CAMHS, transition and mental health under the mental health priority. Gail Tolley confirmed that the sectet, which had 9 members, did include the Strategic Director for Children and Young People role as part of its structure.
· The Board queried what the relationship of the Brent locality to the wider NWL health system was regarding health investment and levelling up. Robyn Doran advised that the relationship between the quartet, the wider ICS and the health inequalities team was forming. There was a group which she sat on with Dr MC Patel looking at health inequalities at system level but there was yet to be a discussion on levelling up which was something she would be advocating. The metrics for the inequalities work were being formed. Phil Porter added that it was very new, and the quartet (made up of 5 members) and sectet (made up of 9 members) had a purpose of accountability.
RESOLVED:
i) To note progress against the plan agreed in 2020 / 21 and the transition to new governance arrangements.
ii) To provide a strategic steer and advice to support the delivery of the updated priorities and approach.
Supporting documents: