Agenda item

Will Holt introduced the report, which provided an update on progress and next steps to develop Integrated Neighbourhood Teams (INTs) as well as ongoing work to develop a Radical Place Leadership (RPL) approach in Brent. He began his introduction by explaining that RPL focused on shifting power away from organisations towards communities and encouraged consideration of how services could be redesigned with residents as the clear focus so that services were being built around residents’ multiple interconnected needs. The RPL approach aimed to empower partner organisations, neighbourhood groups and communities to take greater ownership of decision making and saw residents as collaborative partners in the process. To take the work forward, the Council had established an RPL Steering Group which brought together a range of colleagues across the local authority, health, education, police and VCS. The steering group had now agreed a model for RPL and agreed to initially start testing the approach in Harlesden, which was chosen due to the health outcomes, employment outcomes and deprivation levels there as well as the strong VCS presence in the area and willingness and energy of partner organisations. The steering group had identified 3 key pillars which were seen as fundamental to the vision which were; Health INTs; establishment of INT pilots in Harlesden on the wider determinants of health; and community power to empower communities to take ownership of local placemaking.

Josefa Baylon then provided information on the neighbourhood health aspect of INTs, reminding the Board of the extensive resident engagement that had been done with residents from 2022 and presented to the Board regularly. She emphasised that the priority areas identified had been done in collaboration with communities through face-to-face neighbourhood forums, online ‘have your say’ surveys and virtual forums. She added that, due to the nature of the localised approach, there would be differences in terms of specific neighbourhood hyperlocal priorities. Of the 5 neighbourhood areas, the programme was very active within Harlesden and Willesden, where Harlesden aligned closely with the RPL vision focusing on the wider determinants of health such as homelessness, financial hardship and housing. She explained that the aim was for all 3 elements to eventually come together as one, i.e. the health INT and wider determinants of health INT through an RPL approach.

In relation to the INT for the wider social determinants of health, some initial key priorities specific to Harlesden had been established around financial hardship, homelessness risk and increasing school readiness. The INT would bring together colleagues from a range of Council services and partner organisations in a co-located collaborative space in Harlesden to work with residents in need and prevent escalations to crises. The team would operate on a case worker model with one member of an INT being the primary point of contact for a specific resident, and the INT may involve children’s and adult’s social workers, representatives from the VCS including Crisis and Sufra, debt advisors, employment support workers, colleagues from CNWL and social prescribers. The team should be strongly informed and supported by robust data and insight about the locality.

Will Holt added that community power would underpin the work being done, building on the co-ordinated work across the INTs to bring them closer together and develop a strong community power offer with ways to co-produce services. Officers were starting to look at how the approach would work in practice, offering the opportunity to devolve some decision-making powers to local communities and ensure ownership of what was happening in local areas. He added the importance of ensuring work was not being duplicated.

The Chair thanked presenters for the introduction and invited contributions from those present, with the following points raised:

• The Board welcomed what they saw as a compelling vision of the potential for INTs and RPL.
• The Board noted the information in the slide pack circulated with the agenda showing that Diabetes Virtual MDT had saved approximately £252,000 in potential hospital bed days and that personalised asthma action plans for children had increased from 23% to 100% resulting in reductions in A&E visits, and asked for an understanding of what the investment had been to achieve those outcomes. Josefa Baylon explained that there was no upfront investment for the diabetes workstream, so the INTs used investment already allocated through the specifications of NWL ICB. As such, MDT and diabetes services were compelled to work together to deliver what was best for diabetes patients with existing resources, and an impact analysis had shown that reduction in admissions. In relation to asthma, there had been an investment of £135k from the health inequalities fund for a period of 18-24 months to do that work. There was learning in relation to that workstream, for example the clinic had not started from day 1 of the pilot due to recruitment issues and information governance issues, meaning the pilot only ran for 6 months. The intention was to develop a toolkit of learning from that work. The Board recognised that the work had been done within existing contracts but highlighted that resource had needed to be moved around to deliver them, therefore having an evaluation of the impact on current services was crucial.
• Josefa Baylon advised members that a deep dive of the diabetes INT in Harlesden would be done in 6 months and the findings of that could be shared. That would include involvement from CLCH, primary care, ARRS staff and a diabetologist. One learning from early implementation was the importance of mental health on diabetes care as people may lose motivation to continue with their medication, and since that had been flagged there was now a dedicated IAPT Talking Therapy Lead for the neighbourhood who attended MDT to provide expert advice, and was a good case study demonstrating the importance of the non-medical model of intervention.
• The Board asked how officers undertaking this work had engaged housing colleagues within the Council and wider housing sector. Will Holt advised that since January 2025 a steering group had been established with membership across the whole council which included the Director of Housing Need and a Director from Crisis. Officers were conscious of ensuring there was strong housing representation within those decision making groups and had identified a gap in terms of how Housing Associations were represented so the team was exploring how to get them involved.
• Noting that Brent Council’s Hubs were based around co-location, co-production and the wider determinants of health and tackled issues around housing advice, debt advice and immigration advice, the Board asked how this work would ensure it was not duplicating services already in place. Will Holt confirmed that the aim was to avoid duplication. Rachel Crossley added that the hub model and Family Wellbeing Centres (FWCs) were good examples of where support services were working, but often feedback received was that once service users reached a certain point there was a tendency to focus on eligibility criteria, so those working in hubs were still needing to navigate Adult Social Care or Children’s Social Care. By bringing professionals closer to the community in one footprint, that took away some of the criteria so that professionals could genuinely work in the prevention space to help someone not end up in crisis, and the model being presented aimed to connect that all together as well as understand the assets already available in the community. Once that was understood there would be consideration of whether assets were being utilised to their full abilities, whether there were any that could be invested in, and how they might connect.
• In response to how ward members would be engaged on this work, Will Holt advised that there were plans to do some sessions over the next few weeks including a briefing seminar for all councillors to provide an overview of RPL. There was a need to work with ward councillors in Harlesden who would be good critical friends about how the model was being received on the ground.
• The Board asked about the scalability of the pilots being undertaken and how that might be done across all the Connect areas. Rachel Crossley responded that this depended on how successful the pilots in Harlesden were and whether the outcomes showed that it could be sustainable. If the pilot showed a model that worked then the team would look to scale that up. Officers were also working with the VCS for capacity building and trying to bring in funding through different routes.
• In terms of timescales, the Board heard that the steering group had agreed the model and the resource needed within that team, and officers were now reaching out to services in the Council to identify the individuals needed. It was hoped that some of the new approaches would be piloted from early May with an initial 1 day a week pilot, with a view to scaling that up over the next 2 years based on what worked well. The work being done in Harlesden was an initial 6 month piece of work that would feed into the budget conversations. If at that point it was not actively showing it would help with alleviating budget and demand pressures then a decision would need to be made on continuation of the scheme quickly.
• In relation to moving funding up the system, it was felt that by utilising the 3 key pillars identified this would help shift resource as less would be spent in that complex care area, so funding could come downstream to at-risk groups. As and when the INTs showed an impact, officers would build capacity within the local VCS so that they were better able to support themselves without intervention. Tom Shakespeare supported that shift from complex care to prevention from a health perspective and highlighted a national focus on this. He highlighted that as much as possible would be done within the existing resources available and where the approaches were most successful, they would be built into business as usual. He highlighted the need to await the NHSE and ICB reforms to see where the opportunities were for integration and alignment and joint incentives to drive sustained focus on this longer term.
• Given the significance of the approach for residents and wider public services, the Board asked how the programme would be evaluated. In terms of RPL, Rachel Crossley advised that there was consideration of appointing a learning partner to help. The steering group was considering the availability of data and insight resources and allocating resource there to do some modelling.
• The Board highlighted the risk of partners not buying into the programmes and asked whether the Board’s commitment was shared by partners. Will Holt acknowledged the challenge in getting partner buy-in but felt that the team was at a point now where there was clarity on what was meant by RPL and INTs which was helping to get partners on Board. Officers were being clear about the aims for Harlesden and buy-in had improved.
• The Board noted the report references to required culture changes and asked for further information. Rachel Crossley explained that, in the past, services had been trained in different ways to gatekeep, so there was a need to unlearn some of that behaviour. In terms of culture change for partners, the Council had been building trust with the VCS and spending time in each others’ spaces and the next step would be to have clear conversations with VCS partners that whilst the Council may invest and help build capacity, not every project with Council involvement would be a funded opportunity. CNWL were also providing some capacity for this with some innovative leadership programmes, of which the VCS had strongly requested. Dr Melanie Smith added that there were 2 phases to the culture change, as it would be easier in Harlesden where there was a coalition of willing participants, and when the scheme moved to business as usual that may prove more difficult.
• The Board asked to what degree the cohort of people being supported through the model had a disability, and whether that was data that was being captured. They also asked whether other contextual data would be captured, such as housing need. Rachel Crossley advised that it was not yet clear whether the model would capture that information but it was something that would be considered as this would help inform patterns creating longer term conditions. The model should be capturing all protected characteristics in that space.
• The Board highlighted that there had always been barriers in terms of data sharing and collaboration with partners and asked how the scheme would capture the right data to ensure that work targeted the right support to the right people. They asked whether the new Social Progress Index (SPI) would help towards data monitoring. Rachel Crossley advised that the SPI would not achieve the particular aims of the model, but would help to track impact for longitudinal research. There had been a need to move the Council’s mosaic systems so it would not be until the end of the year that the Council would be in a good position for data sharing, but in the meantime it could move fast on the sharing agreements.

As no further issues were raised the Board noted the report and approved the next steps. In drawing the discussion to a close, the Chair highlighted the importance of funding streams, timelines, partner buy-in, evaluation, culture change, information sharing and IT in order to ensure success for the model. It was agreed that a further update would be provided in 6 months.