Agenda item

This report provides the Health and Wellbeing Board with an update on the implementation of Integrated Neighbourhood Teams.

The Board received a report from Josefa Baylon (Head of Integration – Brent, NWL NHS) which provided an update on the progress made and the overall strategic approach taken in the continued development of Integrated Neighbour Teams (INTs) in Brent. The approach focused on 3 key enabling pieces of work; workforce and organisational development; estates; and ICT data, digitisation, and connectivity. The Board was asked to approve the next steps and comment on how best INTs could ensure the next phase of work involved meaningful input from communities and best ways to measure and track impact.

In introducing the report, Josefa Baylon reiterated that INTs were a large scale, long term development approach which followed guidance on what integration should look like. It focused on co-production, engagement, and working collaboratively with partners and residents to discover, design, develop, implement, evaluate and sustain models of integrated working. Some of the achievements of the work so far included some neighbourhood deep dives with visioning days, which had fostered an environment of continuous learning and engagement. The Board heard that, collectively, those engagement events had engaged over 200 residents between June – November 2023 on in Willesden, Wembley, and Stonebridge, Harlesden, Kensal Green & Roundwood. Those neighbourhoods were now ready to fulfil their delivery plans within their areas. There was still work to do on the remaining 2 neighbourhoods in Brent, which were Kenton & Kingsbury and Kilburn.

Next steps would include looking at understanding workforce training and development needs across all key delivery partners, and estate optimisation. A local estates strategy had been drafted which was being shared with stakeholders for review. The report provided further details on initiatives which included the opening of a new site for Wembley Medical Practice. As part of the new site, it was hoped it would be possible to integrate it with nearby services, such as Brent Civic Centre, to act as integrated care hubs, meaning residents would not need to repeat their stories more than once. This would look to integrate and connect information, with work was being done with London Care Records, Care Information Exchange, Universal Care Plans, Pharmacy First and Optica to ensure this was done appropriately. The work would look to establish a defined theory of change that would enable INTs to measure and track the impact of delivery.

The Chair then invited contributions from those present, with the following points raised:

• Within the report there was a section on population health needs analysis, which showed a life expectancy and deprivation map outlining that the highest areas of deprivation had less life expectancy. The Board asked, as a result of that information, whether the approach should be more targeted with more resource put behind those areas. Tom Shakespeare (Director of Integrated Care Partnership) felt this was an important point. He stressed that this particular programme was about enabling and did not come with significant additional resource in itself, but looked at aligning existing resources within the system to achieve outcomes. In other areas of work, the ICP was making the case for levelling up, with business cases submitted for additional resource in all parts of the system.
• The Chair queried how each locality would ensure equity operated within their hyperlocal areas where some parts might be more affluent or engaged in processes than others. Officers acknowledged that challenge, and highlighted that they were aware of those areas. For example, there were parts of South Kilburn that might be hard to reach, suggesting it might be easier to work with certain groups in South Kilburn, and that there was a need to ensure all partners in Kilburn were part of the design and development of the Neighbourhood Team. The approach being taken was around co-production with a bottom-up approach and, when delivery plans were designed, officers ensured engagement with those hard to reach communities within a neighbourhood. 
• Dr Haidar explained that the purpose of this work was to bring all partners, stakeholders and residents together with a single approach to work towards ‘One Brent’. For example, if there was a service in the South of Brent for respiratory services, a person with a similar problem travelling from the North of the borough all the way to the South proved difficult, particularly for people with chronic respiratory conditions who may need to take several buses, so the INTs aimed to provide services as close to home as possible for all Brent residents.
• Board members thought the report could be clearer in helping members and residents to understand what stage the INTs were in their development, as there was some confusion over whether there were any integrated hubs operating already. Josefa Baylon confirmed that no Integrated Care Hubs had been opened yet and officers were still at the scoping and design phase with residents and frontline staff. She highlighted that there was no specific pot of funding for this work, but officers were preparing a strategy that would inform the next phase of options appraisals where it was hoped they would be able to bid for funding. This would prioritise optimising what was already available, so rather than building a new physical space without funding, officers would be looking to maximise community assets with short term, medium term and long-term plans to get to a stage where there were campus style hubs with services within walking distance for residents.
• The Board highlighted that some Council services already operated within a hubs model, such as for debt relief and advice. They queried how linked Integrated Care Hubs would be with existing hub models, highlighting that health was often impacted by other factors in people’s lives such as debt and stress. Josefa Baylon explained that the INTs would want to link in with those existing Council ran hubs which was why campus style hubs were proposed to enable health, NHS primary care, social care, and voluntary and community sector care to be located together. For example, the new Wembley Park hub scheduled to open in March 2024 would be made up of the Wembley Park Medical Centre with the Brent Civic Centre located opposite that site, where residents could access health advice and across the road advice and guidance and access to frontline staff regarding housing and Adult Social Care.
• In terms of the approach to the different health needs of different localities, the Board asked how INTs would respond to barriers different groups faced using data such as Census data to better understand that. For example, Census data showed that there were over 100 languages spoken in Brent, with several communities where English was not a first language. The Board wanted to know how INTs would access those communities and how they would link with faith communities who already did outreach work. Josefa Baylon responded that accessibility and language was very important for the INTs, and in order to address health inequalities there was a need to ensure INTs had tools available to break down barriers, such as access to interpreters. Officers had already been using interpreters for co-production and engagement stages of the INT work. There had also been work with the Deaf Parents Forum for Children and Families and work with faith communities. For example, officers were working with Kingsbury Temple who were offering use of their large space to host some of the hubs. Another example highlighted that the vaccination programme was being expanded in the Willesden Central Mosque to target hard to reach communities.
• HealthWatch Brent was excited to see progression with this work and agreed that it aligned with what residents were telling HealthWatch they wanted to see. They hoped that residents would be involved in the process of monitoring and measuring impact to ensure long term transformation and not just short-term outcomes. Josefa Baylon confirmed that the work was committed to the values and principles of co-production and had been agile in first reporting findings to residents before they were reported to the Board and ICP Executive. In Harlesden and Stonebridge, a free venue had been offered for quarterly meetings to ensure residents remained part of the process.

In bringing the discussion to close, the Chair asked the Board to note the report and approve the next steps for development of INTs. For the next presentation to the Board, the following asks were made:

• To include information about the significance of PCN alignment with the geography of Brent localities.
• To include information on the need for health improvement targets for each locality that seek to overcome local health inequalities.
• To include practical examples of the work that has been undertaken so far and an ‘easy read’ report developed for better public accessibility.
• To develop links with the work of Brent’s already established hubs and learn from them.
• To ensure the valued contribution of faith communities is not lost.
• To ensure the Health and Wellbeing Board is made aware of resource issues, including for One Public Estate, and to have a view of the timeline, showing the move from development phase into implementation.