Agenda item

To present the draft Integrated Care System Strategy consultation, including Brent’s response to the draft consultation.

Dr Charlotte Benjamin (Chief Medical Officer, NWL ICS) and Olivia Clymer (Head of Community Engagement and Partnerships, NWL ICS) delivered a presentation to detail the work done so far in relation to the current draft of the Integrated Care System (ICS) Strategy. They recalled that many members of the Health and Wellbeing Board had taken part in some of the strategy sessions and that Brent ICP had submitted a response to the draft strategy which was included in the pack. In presenting the item, they highlighted the following key points:

·         The strategy presented had drawn information from across all 8 NWL boroughs looking at individual Joint Strategic Needs Assessments (JSNA) and Health and Wellbeing Strategies.

·         The NWL Integrated Care Board (ICB) were in the engagement phase of the draft strategy. This had included publishing one-page summaries online, strategy chapters, and asking for feedback and considerations that may have been missed or not emphasised enough to help with the next iteration of the strategy. The seven other NWL boroughs had already provided feedback through their Health and Wellbeing Boards with Brent’s Health and Wellbeing Board being the final one.

·         Different modes of engagement had involved a residents’ forum, which had received over 100 attendees at its most recent event, and a citizens panel with around 4,000 members from a diverse range of the population. Overall, the strategy had received feedback from over 1,000 residents. It was highlighted that the engagement had managed to obtained views from a broad age range, with 47% of respondents aged between 26-35 years old which had been a surprise. In addition, there were slightly more men responding than women which was not usually the case.

·         Some of the headlines from survey analysis, which would be triangulated with feedback from the 8 ICPs and other community outreach work, were outlined. 73% of residents agreed that they thought the strategy captured the right areas for the ICS to work on, and 67% agreed that the strategy was meaningful.

·         One of NWL ICS’s main challenges was workforce, which lead to variation in access and service provision, particularly mental health provision at a time when mental health needs had gone up across NWL and nationally since the Covid-19 pandemic. The ICS was aware from surveys and insight reports that those challenges continued to concern residents.

·         In relation to outcomes, the ICS was using ‘marmot’ principles, focusing on measures that would be shared across the ICB on the 6 priority areas. Those priority areas were employment, inequalities, integrated neighbourhood teams, streamlining primary care and community access, focusing on children and young people, and productivity and quality of services, which should support the other priorities referenced.

In considering the presentation, the Board raised the following points:

·         The Board asked what the timeline was for signing off the strategy and moving into the delivery and workplan phase. Olivia Clymer explained that a crunch of the data and the draft would be shared with the Association of Directors of Adult Social Services and Directors of Public Health over the next few weeks, with the aim of a final draft to be presented to the next ICB meeting on 26 September 2023.

·         The Board asked for assurance that disabled people were consulted appropriately and that the various engagement techniques used were accessible, including the citizens panel. Olivia Clymer advised the Board that she had a small team dedicated to challenging themselves on whether protected characteristics were being appropriately addressed in the work they did. Engagement did focus on particular groups and the team had gone the extra mile, with an easy read version to support summary documents and an offer in place stating that if it was helpful for the engagement team to visit groups to talk about the strategy then this could be done. The citizen’s panel was an online forum and was accessible in that sense but there might be more that could be done to improve accessibility there.

·         The Board felt that the information on slide 6 of the presentation could be construed as ableist where mental health, learning disability and autism were included only in the delivery column as potential service users and not also in the networks column as part of the networks that the ICS consulted with. Olivia Clymer felt this was a valid point and she was happy to take that on board, agreeing that people with disabilities were not passive recipients but active members of the community.

·         The Board highlighted they would be interested to see further details on the number of people on out of work benefits that related to disability. Presenting officers agreed to look into that.

·         The Board were advised that outreach work with deaf families and deaf parents and carers had been done.

·         In relation to the slide in the presentation which detailed the gap in employment rate between those with a physical or mental health condition, members of the Board highlighted that for people without a disability the employment rate was around 80-90%. In comparison, for those with a physical disability the employment rate was around 50%, and for those with autism the employment rate was only around 6%. They asked for those figures to be highlighted in future iterations.

·         The Board asked how the citizens panel was recruited to and diversity was ensured. Olivia Clymer explained that recruitment to the citizens panel took a representative sample of NWL communities. NWL ICS were doing some specific recruitment for people with disabilities and young people to join the panel where they felt there was a gap. It was highlighted that the citizens panel was a very valuable resource, and the tool was available for partners to use.

·         The Board would like more detail about health inequalities included in the strategy, including what data analysis would be involved and how deep community links could be made in tackling health inequalities. Olivia Clymer agreed that there were further examples that could be used for how health inequalities were being tackled and specific examples for Brent.

·         The Board asked for further emphasis to be made regarding informal carers.

·         The Board were pleased that the strategy focused on the experience of Black women in childbirth. They asked for this topic to return to the Health and Wellbeing Board to see how the priorities were progressing.

·         Dr Charlotte Benjamin agreed to provide some information around continuity of care for patients more at risk of having adverse events in pregnancy.

·         The Board asked whether gambling as a risk for health had been considered when developing the strategy. This had been raised at the most recent Full Council meeting on behalf of residents’ concerns. Dr Charlotte Benjamin agreed that gambling was recognised as a health risk and featured in some of the mental health strategies being developed. The Chair felt this would be useful to take forward as a joint piece of work.

·         The Board highlighted the findings from the survey that 19% of respondents had felt they had not been treated equally by the NHS. They asked whether any further follow up had taken place with those people. Olivia Clymer explained that 19% of respondents feeling excluded was challenging and there was further work going on internally about how to address that. Those in the survey who answered as such had not been followed up specifically but that would be seen in the strategy and the work of population health and equalities colleagues.

·         In relation to 45% of respondents finding it difficult to book an appointment, Olivia Clymer advised the Board it was hoped that would now start to improve. The insights report gathered monthly was showing that there was movement in this statistic because of the work being done around access and the primary care campaign that was helping people navigate the health system and understand the different roles within primary care. One of the major pieces of work being done across NWL was around GP access. The ICS recognised that electronic communications and online consultation was a benefit for people who could use those systems but they were not intended for everybody, and so the aim was to get those who were able to use online systems to do that, thus freeing up phone lines for those who could not.

·         The Board asked whether there were any standouts in terms of variation in response from different trusts or boroughs regarding resident experience of services. Olivia Clymer explained that when the early analysis was undertaken there were some issues coming through more in some areas than others, particularly around the wider determinants of health such as housing. She agreed to see whether there had been any change as further engagement work took place.

·         In response to what the meaning of proportionate universalism was, Dr Charlotte Benjamin explained it was a broad approach looking at everybody across the spectrum to improve health across the board.

·         In response to what DALYs were, Dr Charlotte Benjamin explained this was disability adjusted life years and was a public health measure of the impact of illness on someone’s life. 

RESOLVED: to agree Brent ICP’s response to the ICS Strategy and highlight the addition of informal carers within the strategy and the need to elevate the third sector as a strength in NWL, and to receive further granular information about residents’ experience of services, particularly in relation to the wider determinants of health.