Agenda item

To provide an update to the Health and Wellbeing Board on key community transformation work streams.

Jackie Allain (Director of Operations, CLCH) introduced the report, which provided an overview of the progress and activity of the community services workstream. In introducing the report, she highlighted the following points:

• The Community Services Executive was one of 4 priority Executives within the Integrated Care Partnership (ICP), and its aim was to look at ways to help reduce admissions into hospital and keep people out of hospital post discharge. The group was chaired by Jackie Allain and Simon Crawford (Deputy Chief Executive, LNWUHT) to ensure both community and acute representation.
• The Community Services priority had been split into 6 main priorities – respiratory, care homes, heart failure, frailty, rehab and reablement, and integrated neighbourhood teams, and more recently a 7^th priority had been added looking at children’s services, including special schools. The report showed a breakdown of each of those workstreams.
• On respiratory, work had been done to look at new oxygen assessments and review the specification to ensure the requirements were being delivered locally. Officers were also looking at a new pulmonary rehab offer at the Willesden Centre to help reduce waiting lists within the acute sector.
• Officers were working closely on the Integrated Neighbourhood Teams Project to deliver services locally, joining with Primary Care and the Council to ensure services were delivered in the heart of communities.
• Officers were looking at making a business case for a strong children’s continence service within the borough.

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

·         The Board noted the priority around continence services for children, but asked where continence services for adults featured, as this was something that could particularly affect the elderly and women. Some residents were reporting waiting over 22 weeks for a referral to the Bladder and Bowel Service, with GPs not providing continence pads during that waiting period. The Board was advised that there was an adult Bladder and Bowel Service in Brent and it was very much under pressure. Central London Community Healthcare (CLCH) were looking at how that service could be enhanced, working with commissioning colleagues. The reason children’s continence was deemed a priority was because it was felt there was no strong or robust children’s continence service at all, and a lot of support for children with incontinence was referred to the Bladder and Bowel Service, which was an adult service without the right expertise for children’s incontinence. As such, this had been recognised as a joint priority with CLCH and the Children’s Commissioning Team.

·         Nigel Chapman (Corporate Director Children and Young People, Brent Council) welcomed the priority on special school places and the need over the coming years, but highlighted that the situation was unlikely to resolve itself quickly. Brent continued to see a year on year growth of at least 5% in children with Education Health and Care Plans (EHCPs), and would need to look at extra capacity above and beyond the additional 427 places that had been committed to. There would need to be a continued focus on the health element that supported that additional capacity for children with needs in Brent.  

·         In terms of how the priorities had been determined, Simon Crawford advised the Board that they had been in place for a while, and many were linked to the key admission factors into acute care. The biggest admission group was the frail elderly due to issues such as heart failure and respiratory conditions, and those were the types of conditions that could be managed through joint pathways across acute and community services. Tom Shakespeare (Managing Director, Brent ICP) added that through the Community Services Executive and ICP Executive, priorities were reviewed and refreshed on a regularly basis and there would be a review of governance for all Executive Groups going forward to ensure the risks and issues were being escalated through the relevant governance routes.

·         As the document was public facing, members felt it missed the link to communities, outcomes, and the JSNA, including why issues were made a priority from a person perspective. The Board also asked for the document to show what organisations had learned, including from Brent Health Matters, in terms of health issues and feedback from residents in future reports.

·         The Board heard that clinicians across primary care, community services and the acute sector were working together to have a single point of access under the frailty model. This should make the journey of the patient much smoother and easier.

RESOLVED:

i)              To note the report and highlight the need for metrics, outcomes and learning from residents to be included in future reports.