Agenda item

This report sets out the goals and expectations of the NHS Neighbourhood Health Framework and how it will be delivered as part of Brent’s overall approach to ‘Working in Neighbourhoods’ (WIN), highlights progress to date in Brent, outlines the role of the Health and Wellbeing Board in shaping, overseeing and championing neighbourhood working, and provides timelines and next steps.

The Board received a report from the Brent Integrated Care Partnership (ICP) Executive setting out the goals and expectations of the NHS Neighbourhood Health Framework and how it will be delivered as part of Brent’s overall approach to ‘Working in Neighbourhoods’ (WIN), highlighting progress to date in neighbourhood working in Brent and outlining the role of the Health and Wellbeing Board in shaping, overseeing and championing neighbourhood working. Robyn Doran began the presentation and highlighted the following key points:

·       She highlighted the importance of neighbourhood work both because Brent had been passionately working towards this for several years and because it was now part of a framework in terms of the NHS 10-Year Plan which cited the importance of Health and Wellbeing Boards in the shaping of neighbourhood geographies and overseeing how the work was implemented locally.

·       The framework set out how local areas should move away from the hospital-based treatment that had been traditionally delivered for many years to a community-based model, towards prevention and away from treatment, and towards a digital approach, away from analogue. The principle should be care as close to home as possible, wrapping services for health and social care, and the voluntary sector, around where people lived.

·       In recognising those aims, the ICP also acknowledged the differences across neighbourhoods in Brent. Neighbourhood working had been piloted in Harlesden for the past 18 months which she had advised had been a successful way of working, asking the community what mattered most to them.

·       As the ICP had tested and learned from that model, it would look to roll it out wider across the whole borough, with a programme overseeing that and neighbourhoods agreed by the Health and Wellbeing Board. The ICP would report regularly to the Board on the progress of the programme.

Dan Shurlock then outlined the Health and Wellbeing Board’s role in supporting working in neighbourhoods, highlighting the following key points:

·       There were some significant decisions and roles for the Health and Wellbeing Board in supporting the implementation of Working in Neighbourhoods, including to confirm the neighbourhood geographies.

·       There was an expectation for an action plan to be signed off for each of the agreed neighbourhood areas in Brent, with those action plans aiming to deliver some of the key NHS targets around health services going forward. Brent should identify the local priorities specific to Brent communities that the system wanted to work together on and identify opportunities to bring in additional funding and resources to deliver those priorities.

·       The ICP was opening up a conversation with key stakeholders to ask for their views on geographies. That evidence would be gathered for the Board and the ICP would return to the Board in September 2026 outlining that engagement work, the findings and recommending a way forward for neighbourhood geographies.

Subash Jayakumar then provided further details of the pilot work conducted in Harlesden, highlighting the following key points:

• Subash Jayakumar began by introducing himself as a GP based at the Stonebridge practice and the PCN Clinical Director and Clinical Lead for the Harlesden neighbourhood, supporting 10 practices within the Harlesden and Stonebridge area and covering a population of around 60,000 patients.
• The PCN had found that, for an increasing amount of time, many residents had been finding health organisations difficult to manoeuvre. Residents reported having to repeat their stories multiple times on a practical basis due to being moved around the system, which he highlighted was despite some important work going on within each organisation.
• As a GP, whilst his focus was on health, he could see that residents had challenges much wider than health and struggled with housing, benefits, financial strain, crime, violence and alcohol and drugs on top of their health. As such, much of what was happening for residents was intersectional and multi-faceted, resulting in residents reaching a crisis stage.
• Looking to address that, the Harlesden pilot looked to build new models and ways of working that broke down some of the organisational barriers residents were experiencing, with a strong Neighbourhood Team in place involving health, Council services, and community and voluntary sector organisations.
• The work over the last 18 months had been strong in identifying the key pressures and priorities within organisations and what residents were attending those organisations for, and the relationships that had been built during that time were equally powerful.
• He was pleased to have worked with Crisis Skylight during the pilot phase who he would not normally have worked with if it had not been for this workstream, and that relationship was equally powerful.
• The work had confirmed that many residents and service users had the same overlapping problems, and from that learning a Harlesden neighbourhood action plan had been established focusing on priorities intentionally addressing community challenges such as safety, housing, finance and employment, recognising that wellbeing was much wider than health alone. These priorities would be delivered across partners collaboratively, avoiding the need to send residents back to another front door. Social Prescribing Link Workers from Brent Mencap had helped to facilitate that as well as Care Co-Ordinators and other multi-disciplinary colleagues who were not traditionally health focused.
• The pilot had also looked to develop strong IT tools and tools for communication and officers were looking to develop that further.
• The main areas of focus were; tackling complex needs; communicating between providers; working towards opportunities for earlier intervention and proactive care within the community and; working collaboratively across organisations to move forward the aims and objectives of neighbourhood working.

Anita Silberbaur then presented the work Crisis was doing in Skylight in Harlesden, highlighting the following key points:

• Crisis was commissioned to provide support to people who were homeless or at risk of homelessness who were owed the prevention or relief duty by the local authority. Through non-commissioned work which took place at Skylight in Harlesden, work took place with rough sleepers and people with multiple exclusion with complex needs.
• Through the work in Skylight, links had been made with health, social care and other providers and the work in neighbourhoods had enabled Skylight to use its experience and knowledge to work together to develop preventative solutions.
• Working in neighbourhoods presented the opportunity to look at neighbourhood planning and health planning together, with one plan for tackling those range of issues. Pride in Place was also a new opportunity that could contribute to this workstream.
• It was clear through the pilot in Harlesden that it was best to work in a joined-up way which improved the customer experience, and those involved were trying to find creative ways to do that and avoid working in siloes or duplicating work.
• To do that, effort was required and there was a need to have backing and commitment from senior levels which trickled through all levels, which she thought was the case in Brent. There had been shared learning opportunities and impactful results already from that approach.
• There was now more connectedness between different teams, statutory services, voluntary sector organisations and health partners, and the multidisciplinary team helped to pull together the various knowledge and resource across partners with one person holding onto a case and feeding back.
• One of the key successes to the pilot had been co-locating services in Skylight, which had made services available and accessible, bringing services outside of their teams and comfort zones into different places and working with different people to develop new ways of working and a new culture with more streamlining and less isolation of services and teams.

The Chair thanked colleagues for their presentation and invited contributions from those present. The following points were made:

·       The Chair recognised that bringing healthcare back into the community from hospitals had been a mainstay of the work between the Council and NHS for many years and acknowledged the level of demand on services. She asked to what extent it was believed that the reorientation of services would deliver results and whether it would be limited by that demand. Robyn Doran responded that there had been too long a focus on having people in hospitals, which cost money and was resource intensive. By shifting the focus and co-designing services with the community, such as with the work that had been done in Harlesden recognising there was an overrepresentation of young Black men subject to a Section under the Mental Health Act as their first interaction with services, CNWL had been able to reduce admissions and had already started to see that shift in demand. There was a need to put resource behind the work in order for that shift to work, and she encouraged senior officers to do that. Jackie Allain advised that CLCH were investing in the Urgent Community Response Teams providing hospital at home to prevent people going into the hospital in the first place, providing more complex care in the community. There was a lot of work being done to keep patients at home where possible including with the London Ambulance Service. As such, neighbourhood work was recognised as a solution to the increased acute demand.

·       Radhika Balu confirmed that the WNL Strategy was presented to the Integrated Care Board (ICB) the previous week. That Strategy looked to shift 1% of funding into neighbourhoods across the 13 boroughs. The Strategy also looked at how to make a difference at the front door through more preventative and proactive approaches. The Strategy focused on the communities with the most complex health conditions in the most deprived boroughs and preventative measures.

·       Noting that neighbourhoods had different population volumes, the Board asked how that might be resourced. Ruth du Plessis advised that, together, partners had put a lot of thought into neighbourhoods, such as whether having a different make-up of teams for each neighbourhood depending on need would work, or different weightings. For example, where there was a younger population with families, the focus would be ensuring services around housing, family support and debt advice were available. Where there were older populations, the approach would look to have more input from Adult Social Care and services for the elderly. Some services would need to be provided in every borough, such as mental health services. Partners were working hard to develop datasets in order to ensure the work was data led and consulting with residents to ensure it was community led. Dan Shurlock confirmed that population size would be factored into the development of neighbourhood teams.

·       David Crawley advised that Healthwatch was awaiting guidance on how the patient experience would be improved in the neighbourhood team model, as the mechanisms that had existed through Healthwatch were now being centralised and abolished. He asked whether any thought had been given into the new model of patient data. Ruth du Plessis thanked Healthwatch for the work it had done across Brent in highlighting areas for improvement and areas of good practice. Brent had been building a skill base around community engagement and were training neighbourhood managers to do that quality engagement. She added that having community leaders as part of the infrastructure for engagement would be key to enable co-design. Brent was trying to move to an approach where community leaders were taking the lead in implementing improvements. It was important to work with community leaders and keep those conversations going to ensure that Brent was getting it right.

·       Noting that work had previously been done with Somalian communities around vaccine hesitancy, the Board asked whether any other work had been done specifically with the Somali community. Robyn Doran advised that there had been multiple workstreams working alongside the Somali community, including mental health, which she advised was not something that was talked about amongst the community. Brent had done a lot of listening, bringing in people from the Somali community who were mental health professionals and trusted to help educate people about mental health. There was also the current project being delivered for young Black men sectioned under the Mental Health Act who were overrepresented and of Somali heritage, which had led to good relationship building and trust. The next area of work would be around vaccination and dispelling certain myths around vaccination and the false claim it caused autism, using the community to impart those messages alongside health colleagues. Funding had now been agreed for the next stage of that project, with clear targets to improve vaccination rates for that community.

·       The Board asked if officers were confident that they could match the target timelines and progress the work to achieve positive outcomes within that time, highlighting that some areas would not be in place until 2029. Dan Shurlock advised that Brent had undertaken a self-assessment with a long set of requirements and expectations to fill, and having reviewed with all relevant stakeholders where Brent was currently, felt that this presented a realistic progress chart. Overall, the NHS Plan was over 10-years, and 2029 was a staging post within that time. As Brent was still at the start of the journey, 2029 was felt to be fair and accurate. He advised he was ‘cautiously optimistic’ about the delivery of the programme, advising that some priorities might shift based on what was learned over the coming years and any further national directives. With the investment set aside for the work, he felt that gave a better chance at success than simply good will and collaborative working, with all people around the table committed to the work and making the case for additional investment to support these targets wherever possible. He made a request that the Board asked how partners were progressing against targets as a standing question. Robyn Doran added that the fact this work was being done in an integrated way alongside communities, including the community and voluntary sector, was another reason it was more likely to be sustainable and make a difference.

·       The Board asked for assurance that the funding for this work would come through from the ICB, highlighting that Brent now sat within a much larger ICB spanning 13 boroughs and there would be much more demand for that resource. If priorities changed or the ICB wanted to move in a different direction, the Board asked what that would mean for Working in Neighbourhoods. Radhika Balu explained that the ICB’s role had moved back into strategic commissioning, no longer delivering services in each borough. The model of delivery going forward would be based around neighbourhoods, based on the NHS 10-Year Plan. She provided assurance that the ICB would do a 1% left shift of about £120m to each of the boroughs depending on the population and needs of each borough. The focus of those allocations would be addressing health inequalities and addressing the life expectancy gap between the different ICB boroughs. It was recognised that there were also life expectancy gaps within individual boroughs as well, and she felt that the only way to address that was by focusing on the wider determinants of health. As such, she assured Board members that the ICB was working towards this, recognising that health outcomes were determined by a multitude of factors not limited to a GP consultation.

·       The WNL ICB Strategy was due to be shared with all members of the Board and she asked that everyone commented on the draft when they received it. The Integrated Health Needs Assessment for Brent would be included in that strategy, identifying Brent as having the highest asthma admission rates for childhood asthma, promoting the MMR vaccination, and reflecting on poverty in the borough.

·       In terms of how this would be different from previous commitments made around joint and neighbourhood working, Rachel Crossley highlighted that the contributions from stakeholders and the new ICB already felt different with very mature conversations around the 1% left shift. She confirmed that Brent officers were at the table in those conversations and she could feel that relationship changing.

·       The Board requested that the ambitions of Brent Health Matters (BHM) were considered and incorporated both into neighbourhood working and the ICB Strategy to ensure that tackling health inequalities remained a central part of the work being done in neighbourhoods.

·       The Board asked what the plans were for data sharing and IT systems for neighbourhood working. Rachel Crossley highlighted the intention to have one care record across the NHS, bringing together one full picture of a patient and allowing Adult Social Care to have read-only access to those records. There was still work needed on the Council side to ensure the right toolkits were in place and information governance training had been delivered to do that, but there was a commitment there, and in particular she was keen to do the work at scale across services where possible to ensure systems were talking to each other.

·       Simon Crawford provided a perspective from acute services, welcoming any community initiatives designed to prevent admissions and support patients in the community. He recognised the work that had taken place in Brent over the last 18 months to test a range of different initiatives. He also welcomed the intention for the 1% left shift, and hoped for more clarity around how much would be coming in and when, as well as what specifically it would target to help prevent admissions, as at the present moment he was still seeing a rising demand in acute services with a record summer period in terms of ambulance attendances and admissions. 

In concluding the discussion, the Chair thanked representatives for their presentation and for responding to the Board’s questions, and the Board approved the recommendations set out in the report.