Agenda item

To provide a briefing note summarising the recently published Darzi report and any next steps for Brent in response to the report.

Jonathan Turner (Borough Director, Brent Integrated Care Partnership) introduced the report, which had been commissioned by the new government to review the current ‘state of play’ of the NHS and looked at patient access, quality of care and the overall performance of the health system. The final report identified some themes on how to ‘repair’ the NHS but did not provide a plan or set of recommendations. The report aimed to set the context and tone for the coming NHS 10 Year Plan, due to be published in Spring 2025. In presenting the document, he highlighted the following key points:

• The report looked at the context of where the NHS was currently, such as the aging population, increase in demand, and deterioration of the access targets and national targets that had been in the system for some time including A & E waits, 62 day cancer waits, and increased waiting times for ADHD and ASD assessments.
• The report suggested that some aspects had improved and the NHS had taken advantage of some of the improvements in technology over the years, but there were also areas for concern, including maternal deaths and the deterioration in children and young people’s mental health.
• The report looked at the finances of the NHS and proportion of income from across the different parts of the system and noted that, whilst there had been discussions about shifting more funding into community and preventative services, the acute system was still taking up more of a proportion of the NHS budget. A theme of the report was to make that shift to more preventative work in the community, which supported the direction of travel Brent had already been attempting.
• The report looked at the per capita spend in England compared to the EU 15 countries, which England was broadly on par with, but which included countries that less economically affluent than the UK.
• One of the features of the report was the capital investment on buildings and technology and the report suggested this should be a key area for investment in future.
• Darzi had looked at the impact of the pandemic on staff mental health and wellbeing and the resilience of the system, noting that England had gone into Covid with much lower bed capacity than a lot of countries and had higher excess mortality.
• The report looked at structures of the NHS and internal reorganisations and showed a want for stability in those structures to focus on planning in coming years. The report did not suggest major changes in organisational structures but referred to the need to clarify the purpose and remit of Integrated Care Boards (ICBs).
• The report focused on shifting care closer to home, re-engaging with staff and patients about the future of the NHS, increasing productivity in hospitals and reducing waiting lists, getting people back into work and making better use of technology. 
• Officers had then outlined in the Health and Wellbeing Board report what some of these findings meant for Brent. It was thought that the report confirmed the importance of Brent’s approach to health inequalities and working with communities with preventative approaches, which had already been done collectively with Brent Health Matters. It was likely there would be a continued focus on Integrated Neighbourhood Teams (INTs) and Brent partnership had done some work around those areas both on the health side and looking at the social determinants of health. The partnership was now looking at Radical Place Leadership not just focused on health services but wider wellbeing including services for homeless people, housing and employment.

The Chair thanked Jonathan Turner for his overview and invited comments and questions from those present, with the following issues raised:

• The Board welcomed the inclusion of the Darzi report in the Health and Wellbeing Board papers and felt it was a significant and far-reaching report concerned with challenges at a national level. They thanked officers for the time they had taken to reflect on what the report meant for Brent.
• Noting that much of the report looked at access to services, specifically access to GPs, cancer waiting times and A & E waiting times, the Board asked how Brent was doing compared to nationally. They were advised that A & E waiting times were reported at a provider level rather than a borough level so the figures available covered wider NWL boroughs where trusts crossed borders. They heard that, in general, the NWL acute system was performing better than the national average, but officers highlighted there were still large problems within the system and there was further work needed around GP access and satisfaction. Northwick Park Hospital was the most pressured point in the system with the largest number of A & E attendances in London, emphasising the need to invest further in the community to reduce A & E attendances and waiting times. The ICP was looking collectively with LNWT to identify what more could be done to reduce those emergency admissions.
• The Board asked whether there were insights in terms of the extent the Darzi report might influence future policy making. Dr Melanie Smith (Director of Public Health, Brent Council) highlighted that there were no indications of the influence the report would yet have but the focus on prevention was welcome as was the recognition in the report of the consistent de-prioritisation of public health.
• Dr Melanie Smith drew the Board’s attention to the fact that, whilst the Darzi report reflected childhood obesity was a national problem and getting worse, there had been a downward trend in Brent which was stable and she asked the Board to recognise this as a system achievement locally. The key drivers of the improvements were the joined-up action being taken through Family Wellbeing Centres, multi-agency training for partners enabling a consistent message that was age appropriate, and significant investment through CLCH’s ‘Busy Bodies’ programme introducing an effective treatment service with significant prevention initiatives.
• Rachel Crossley (Corporate Director Community Health and Wellbeing, Brent Council) challenged the Board to take the opportunity to influence the 10-year NHS plan now through the consultation that was currently open. She suggested that partner organisations committed to complete the organisational questionnaire with support from the Board and for the ICP Exec to consider how they would undertake local engagement, particularly for under-represented groups, to encourage them to participate in the consultation. She would take back an action for the ICP to look at how that engagement piece was co-ordinated across Brent to bring the voice of the community in.

As no further issues were raised, the Chair drew the item to a close, asking members to note the information in paragraph 3.1 of the report which provided a framework for service development and resource allocation at a local level. Members acknowledged the need to maximise opportunities in Brent for the local authority and NHS to contribute to the national conversation around the NHS and take a collective view when feeding back.