Agenda item

To receive an overview of local healthcare resource.

Councillor Neil Nerva (Cabinet Member for Public Health and Adult Social Care, Brent Council) introduced the report, which detailed how local health service resources were allocated. He highlighted that Brent NHS was now part of the Brent Integrated Care System (ICS) and that the formal statutory body for managing health resources was the NWL Integrated Care Board (ICB) within the ICS. He explained that the paper highlighted the challenges within the system regarding how Brent ensured community services were reaching people as early as possible and how that could be maximised, and that there was some equity in the way those services were delivered and the way residents experienced services across NWL. He highlighted that there were no colleagues from the ICS present at the meeting, and it may be a good opportunity for the Committee to invite colleagues from the ICS to a future meeting.

Tom Shakespeare (Managing Director, Brent ICP) continued the introduction, informing the Committee that the starting position in Brent was challenging both in terms of workforce and funding relative to other NWL boroughs. Having said that, there was positive news with the publication of the new National Workforce Strategy, which gave the ICP an opportunity to develop further work around that and the response locally. Brent ICP was using every opportunity to maximise workforce, such as establishing a training hub, which was an important foundation for primary care ensuring significant capacity across a range of professional levels. The ICP provider partners, Central London Community Healthcare (CLCH) and Central and North West London University NHS Foundation Trust (CNWL) had also been looking at a range of initiatives around recruitment and retention, including ‘golden hellos’.

Robyn Doran (Director of Transformation, CNWL, and Brent ICP Director) expanded on some of the work CNWL was doing on recruitment and retention. She highlighted that one of Brent’s challenges was that the NHS had an inner and outer London weighting in terms of NHS salaries, where inner London employees received approximately £2k more per year than outer London. Brent was classed as an outer London borough, compared to Kensington and Chelsea which was a neighbouring borough. This meant that if someone was working in Park Royal Hospital they would only have to move across to St Charles’ Hospital, less than 5 miles away, to receive the inner London weighting. The inner and outer London weighting formed part of the national pay award which Brent ICP found challenging due to the impact it had in Brent. CNWL had used ‘golden hellos’ in the past, giving newly recruited staff £5,000 upfront to bring them in, but had found this had not retained staff. For that reason, there had been a big focus on retention at CNWL, focused on training, further education and personal development plans for all staff members as well as ensuring staff felt valued. The NHS workforce strategy recommended apprenticeships, and CNWL was already doing some of that work, with Occupational Therapist, Nurse Associate and Social Work apprenticeships in Brent. In addition, CNWL was recruiting directly from the Brent community into entry level jobs which were graded at a higher band for their lived experience in the community. Finally, CNWL was running a ‘volunteers to careers’ scheme, bringing volunteers in and creating a pathway for them to get jobs with CNWL.

In relation to funding, Tom Shakespeare explained that the starting position in Brent was also significantly further behind other NWL boroughs and there were significant historical issues regarding how that had came to pass. The ICP was undertaking some extensive work to build a case for allocating resources on the basis of need, working very closely with the ICB to build that case across a range of focus areas. Alongside that, Brent ICP was taking a pragmatic approach to address resources. For example, where there were new beds coming in for mental health, Brent ICP was supporting the case for those coming to Brent and looking at every other opportunity to make a strong case for provision coming to Brent. There had been some significant levelling up funding for primary care which was good news, but he felt there was further work to do around mental health and some community service areas.

Councillor Nerva concluded the introduction by highlighting that central government was now taking a greater look into health inequalities and it was important for NWL to look at what was happening in Brent in order to radically improve on health inequalities.

The Chair thanked colleagues for their introduction and invited comments and questions from those present, with the following issues raised:

The Committee noted that the graph in section 3.4.7 of the report was from 2019-2020, and queried whether that investment from various different providers had now improved in 2023. Presenting officers highlighted that funding had not improved significantly and the disparity for Brent still existed. One of the things Brent ICP was doing to respond to some of those challenges was to look at performance data comparatively, to make a case to show where Brent would target investment and how it was using existing capacity within the system. Detailed work with clinical leads and partners was also looking at maximising that capacity in the system to continue to deliver the value of services whilst making the case for further significant investment. Robyn Doran agreed that it was important to look at what could be done locally to fill the gaps where funding was not where it should be and move funding around within local trusts where that was possible. For example, in 2022 the waiting lists for CAMHS had been brought down because CNWL was able to move some one-off money away from Westminster and towards Brent to deal with those waiting lists. She advised the Committee to invite Brent ICP back together with NWL ICB to talk about the levelling up strategy.

The Committee noted the unique pressures on staff within Brent and patients in the borough, but asked how other boroughs falling within the same pay bracket as Brent was performing with recruitment and retention in comparison. Robyn Doran advised the Committee that both CLCH and CNWL had shared all information together between the boroughs of Harrow, Brent and Hillingdon because the trusts crossed borders, so a lot of what was being done in Brent was being done in those outer boroughs too. She highlighted that outer London boroughs were doing a large amount of work on recruitment and retention due to the salary weighting, and added that Brent had the added pressure of workload. For example, in Brent the CAMHS service had one third of the number of CAMHS workers that Westminster had, with significantly more demand, which had a huge impact on staff. Another way the partnership was focused on recruitment and retention was through schools, with local health and social care professionals visiting schools to talk about the work they did and offer apprenticeships and volunteering placements as a means to get people into the workforce. Those staff were very passionate about their work which proved hugely motivating.

Continuing to discuss staff retention, the Committee highlighted that the NHS National Retention Programme had pointed out that the two key factors for staff retention was targeted interventions at different career stages and people feeling valued, and within that, people feeling stable and safe in their role, leading to people staying. They asked what Brent was doing with regard to targeting interventions at different career stages, making staff feel valued, and routing out instability. Robyn Doran explained that CNWL had developed a Leadership Programme called ‘21^st Century Leadership’ where one of the core elements was compassionate based leadership, talking very openly about staff feeling safe and stable in the workplace. She highlighted that in large London organisations that had a higher number of BAME staff those staff did not feel safe that their career was progressing, felt their leaders were not compassionate and thought instability was part of the culture, so CNWL was having honest conversations with Leaders about that. 100 leaders had now completed that training programme and a further 100 were due to complete it.

The Committee further queried what techniques were being employed to prepare people for what it was like to work in Brent so that they were made to feel at home and understood the communities they worked with and served. Tom Shakespeare advised the Committee that the ICP was developing a common induction process so that any member of staff working in the health and care sector in Brent, regardless of the organisation, would receive this induction. This would look at what it meant to work in Brent, what the vision was, what was being done around health inequalities and why Brent was an exciting place to work, and would be tailored differently for different types of staff.

The Committee asked for further details regarding the £2,500 one-off bonus payment for health visitors detailed in the report and questioned what impact Brent ICP expected from that. Robyn Doran highlighted that, from her experience, one-off bonus payments worked for a time but did not tie people into a role long-term unless the organisation also took various other approaches to retain people, such as ensuring staff were managed well, supported, given development opportunities, and felt their jobs were doable. Both CNWL and CLCH was working on those additional steps to retention, but Robyn Doran highlighted the pressure, demand and lack of resources that was specific to Brent. Dr Melanie Smith added that, as the commissioners of the Health Visiting Service alongside CLCH, different service models were being reviewed, because another reason people stayed in Brent was satisfaction from working in a service that delivered. She highlighted that Brent was proud of the MESH service, the targeted health visiting service which worked with the most vulnerable families in Brent with children under 2 years old, and was pleased to be one of the first places in the country that would introduce the successor to MESH, visiting children who continued to need support from ages 2 – 5 years old. As such, she felt that by creating those more fulfilling professional roles then there was a better chance of retaining health visitors.

The Committee asked how the partnership would escalate the issue around the London weighting and whether there was any concrete outcomes they hoped for. Tom Shakespeare highlighted how difficult it was to influence the London weighting due to it being a national decision. Most of the approaches the partnership had taken were what was available to the partnership as a system, through golden hellos, building the workforce from within Brent, and opportunities to work in different ways. The question for the partnership was how to scale up that work and build it in to everything the partnership did. He highlighted the need to recognise it was a complex system with multiple providers working across different geographical footprints and boroughs and within a national context where the gifts were not entirely within the Brent partnerships’ control. However, he did feel that there were opportunities within the context of the new national NHS workforce plan. Councillor Nerva highlighted that the health service consisted of single trusts which covered both inner and outer London, where someone could still be working in the same trust but earn significantly more money depending on where they were based, which was the challenge the new NWL ICS, which covered both inner and outer London, would need to cope with.

The Committee felt that staff must find it difficult to stay resilient at work due to the mental health crisis, where mental health patients were being discharged before they should be due to the number of beds and then returning in crisis again. Tom Shakespeare agreed there was a need to make a case for moving away from dependency on beds, which were a symptom of a problem, and moving downstream towards preventing crisis in the first place by managing people in the community. The timeline for this was being revised currently and the ICP was building its case for investment and transformation for September 2023, with the delivery phase being much longer term. In relation to mental health, Councillor Nerva added that all 8 NWL boroughs had agreed that the first deep dive to take place towards getting a high-level ICS Strategy would centre around mental health. He highlighted there would be evidence gathering around mental health spend and use across the whole of NWL.

The Committee asked how Brent ICP was addressing the £2m funding gap for children’s mental health service. Tom Shakespeare explained that the ICP was trying to make a case for further investment from NWL. There had been some successful attempts where the ICP had managed to secure some funding shifted from CNWL to invest in partnership work with the voluntary and community sector, which had seen a significant impact on the CAMHS waiting list. The ICP would like to expand that further, working with clinical leads over the next few months to find what further interventions could be put in place with the resources that were already there whilst lobbying for levelling up. The ICP had very constructive positive engagement from CNWL at a senior level, who were supportive of the ICP making that case, and he felt positive the ICP would come up with some creative solutions with their partners.

The Committee felt that some health areas affecting minorities in Brent were not spoken about prominently, such as Sickle Cell. They queried whether any funding was being allocated to research these types of health issues. Dr Melanie Smith agreed that there were entrenched inequalities within the topics chosen for research and who was included within research. There was some good news that some big national research funders, such as the National Institute for Health and Care Research (NHIR), were now more interested in funding research carried out in conjunction with the wider system, so Brent was being approached by a number of academic institutions looking for its support. One of the criteria Brent had set in agreeing who to partner with was whether that research was relevant to the diversity of Brent’s population.

The Committee asked what was being done to maximise the limited pot of funding Brent received and what reassurance could be given to residents that the ICP was doing the best it could to ensure residents were looked after. Tom Shakespeare expressed that he could say with confidence that the ICP was doing everything it possibly could to maximise the resources available in Brent. The impact Brent was having for the resources it had was significantly above other areas. However, he acknowledged there were always areas for improvement. The ICP was aware there was significant underutilisation of crisis response centres in Brent, and there were significant opportunities for better aligning and increasing awareness of that resource and its referral routes, as well as the ongoing work developing neighbourhood teams. He felt there was an opportunity for the ICP to consider how services could be brought together much more effectively, where services could promote other services. Robyn Doran added that the model of BHM focused on getting all agencies to work together as one team, to make it easier for residents to only have to tell their story once.

The Chair thanked those present for their contributions and drew the item to a close. He invited the Committee to make recommendations, with the following RESOLVED:

i)              To recommend that North West London Integrated Care Board (NWL ICB) colleagues are invited for further discussions relating to funding settlements for Brent in relation to NWL.

ii)             To recommend that work to address the inner and outer London pay gap is further escalated and that bolder solutions are utilised.

iii)           To recommend that Brent Integrated Care Partnership (ICP) advocates for further levelling up for children’s mental health services in the borough.

iv)           To recommend that NWL ICB commits to a timescale to address the historical underfunding compared with other NWL boroughs and to equalise levels of expenditure.

v)            To recommend that a collaborative approach is taken with staff, the community and managers to co-produce solutions for retention.

vi)           To recommend that the proposed induction for all staff working in Brent should include attending a Brent Health Matters (BHM) community event.

vii)          To recommend that Brent continues to advocate for healthcare funding that is allocated based on need, rather than population.

A number of information requests were made throughout the course of the discussion, recorded as follows:

i)              For the Community and Wellbeing Scrutiny Committee to receive information on how outreach work in schools to promote roles in Brent’s health and care sector is aligned with the Greater London Authority (GLA) Academy.