Agenda item

To present the NWL ICB Joint Forward Plan to Brent Health and Wellbeing Board.

The Chair informed the Board that the NWL ICB was visiting all Health and Wellbeing Boards in the timeline available to present the Joint Forward Plan, which had now been submitted to NHSE, as the presentation of the Forward Plan to Health and Wellbeing Boards had been impacted by the pre-election period. In inviting Toby Lambert (Director of Strategy and Population Health, NWL ICB) to present the Forward Plan, the Chair highlighted the concern amongst Health and Wellbeing Boards that the document was very health focused, with local Councils unsure how the work of local authorities would fit in with the document.

Toby Lambert introduced the item, highlighting that the Plan was a joint document defined in statute as ‘joint’ between the ICB and NHS trust, which was why it was health focused, although he acknowledged that did not mean the document could not look at partner organisations. The document built on the NWL ICB Health and Care Strategy which was signed off in November 2023 by all 8 NWL local authorities. In presenting the document, Toby Lambert highlighted the following key points:

• There were 9 themes laid out in the Plan with actions underneath each of those. NWL’s acute providers had offered to take up 2 of those themes which had expanded them further and there was commonality between those themes.
• The health service was working on a 3-step process. First was to develop a common offer across NWL to standardise inconsistencies in the offer and develop a shared offer so that no matter where someone lived in NWL there were shared core services available. In order to do that, a levelling up process would be needed with consideration needed in relation to resource and productivity levels.
• The second step was around more fully understanding the needs of residents to tailor the core common offer to different groups with different needs in a culturally competent and appropriate way, building trust with communities so that they were confident to come forward for services and knew where to go. This would draw on the experience and good work each borough had been doing in their own neighbourhoods on health inequalities.
• There would be a need to evaluate where the greatest need was presenting and ensure resource shifted towards that need. Toby Lambert highlighted the importance of doing that in a balanced way, because if resource was moved too quickly it could result in spare capacity and an underuse of services, but if resource was moved too slowly then the demand could overwhelm the system and create waiting lists, leaving people dispirited from coming forward.
• The third step was around bespoke offers for certain groups of the population, such as Asylum Seekers.
• The statutory role of the Health and Wellbeing Board was to respond to the ICB on whether the content of the Forward Plan met the needs of residents as expressed in the Joint Strategic Needs Assessment (JSNA). Due to 2 pre-election periods, it had not been possible to present the Forward Plan to Health and Wellbeing Boards before the statutory deadline, therefore the Plan had needed to be finalised prior to consideration at Health and Wellbeing Boards. Members were reassured that this would become an annual process so there would be an opportunity to propose improvements to the plan and the process in preparing and approving the plan in the future.

The Chair thanked Toby Lambert for his presentation and invited comments and questions from those present, with the following issues raised:

• The Board welcomed the intention to transform maternity care and address inequalities in maternal health. They raised concerns that the document stated there were no plans to consolidate maternity units when there was a proposal being considered to shut either the Whittington or Royal Free Maternity Units. Toby Lambert explained that the reference to there being no plans to consolidate units referred to those maternity units within the boundaries of NWL. There was a proposal to consolidate units in the neighbouring boundary, so the purpose of the statement was to reassure residents that while there were proposals in North Central London ICB to consolidate units there were no parallel plans in NWL. He added that the NWL ICB had more work to do on the maternity strategy, particularly in relation to variation in care.
• The Board noted that a key priority of the plan was reducing the amount of time people were waiting for procedures, which was highlighted to be a national problem. There were systemic problems in addressing the waiting lists including lack of funding and staffing levels, and the Plan outlined some ambitious targets to improve waiting times. The Board asked how much of those targets would rely on those national issues being addressed and how much could be done to address the issues locally. Toby Lambert was of the view that there was a lot that could be done locally to address planned care waiting lists. The NWL ICB had opened an Elective Orthopaedic Centre which had been instrumental in increasing productivity and reducing the waiting list. The biggest dependency in NWL ICB was relating to the ongoing strike action in acute units, which disrupted elective lists and the number of people going through to surgery. The waiting list data for NWL compared favourably to most other parts of the country, but there was still room for improvement.
• It was agreed that the suggested improvements for the next Plan were sound, such as putting in a shared needs assessment, better co-ordination and engagement with local authority colleagues and a strengthening in the KPIs against the actions identified in the plan. Local authority colleagues highlighted September time as the most effective for the Council to plan for the year ahead, but recognised that annual guidance and settlement information would not yet be available. It was highlighted that having Senior Council Teams and Senior Health Teams around the table proved effective in terms of moving actions forward.
• The Board raised concerns regarding the level of governance outlined in the plan. For example, for Integrated Neighbourhood Team plans there was the suggestion of borough governance, an executive group, and oversight group and the local care board, which the Board felt would not help deliver the plans. They highlighted the need to ensure governance processes were helping and not impeding processes so that improvements could be made at a swift pace.

As no further issues were raised, the Chair drew the item to a close, asking members to note the report and emphasise the opportunity for collaboration in the future between the ICB and local government around key common issues.