Agenda item

This report presents the LGA peer review report and action plan in response to the findings and recommendations.

Councillor Liz Dixon (as Cabinet Member for Community Safety and Public Health) introduced the item, which presented the LGA independent review of Brent Health Matters (BHM), and Brent’s response to the review. In introducing the report, she commended the work of BHM and was pleased that the review had recognised the success of the programme and what it had achieved in practice. The health checks in factories and health events in community spaces such as the Pakistani Community Centre were particularly emphasised as good practice in community engagement and tackling health inequalities. She provided a brief history of the establishment of BHM in response to COVID-19 and its now ongoing programme tackling health inequalities and thanked all who contributed to the review. She then invited Dr Debbie Frost to present further information who highlighted the following points:

·       Dr Debbie Frost had been asked to facilitate reviews by the LGA as a retired Deputy Medical Director at NHSE, a Barnet GP and Chair of the then Barnet CCG, and she had been facilitating reviews for around 10 years. The LGA attended reviews as a group of multiple professionals to discuss the delivery of health programmes with local stakeholders. The feedback that the LGA gave came from local people.  

·       In Brent, the LGA spoke to over 30 people and then presented the report at a workshop of senior stakeholders in April. She presented the positive comments heard about BHM which was treasured within the community and did well in reaching communities that were often not engaging with services.

·       Within the feedback received from the review, respondents felt that BHM was running alongside the system rather than within it and it was clear that not enough integration between mainstream primary care and BHM was happening. There was also a feeling that some of the activity was already being commissioned in primary and community care. She advised that a relationship was essential between BHM and primary care so that when BHM made successful interventions the practical steps, such as booking an appointment for a vaccination at the GP, could be undertaken quickly and seamlessly.

·       Feedback also highlighted that the real impact of BHM’s work was not being captured and it was not clear that some of the outcomes, which were very clinical in nature, were as the result of BHM interventions. For Dr Debbie Frost, the most compelling narrative was successful individual stories, such as when the BHM team visited a family who needed help for asthma and also supported that family in applying for benefits and school places for three children who were not in school and arranged a dentist appointment all within the same visit, which was not possible to quantify but which made a big difference to that family. She felt that some of this community working could be better communicated when reporting the impact of BHM.

·       Further feedback suggested that upstream prevention ambition was unfinished and that the programme had focused too much on health access and clinical interventions instead of the wider determinants of health, such as housing, employment, poverty, education and place.

·       There was no shared infrastructure enabling organisations to collaborate. Several interviewees pointed to organisations already functioning as neighbourhood anchors such as the Jason Roberts Foundation, Ashford Place and Harlesden Collaborative as examples of what was possible when community energy was properly resourced and connected, and the report advocated for putting people at the centre of what BHM was doing instead of statistics.

·       BHM had no dedicated Programme Board to achieve a common vision from all partners, with no obvious body that brought together the stakeholders to own the outcomes framework for BHM.

·       The recommendations from the workshop were then presented and focused on moving towards prevention, moving care into the community, and moving from analogue to digital. The LGA recommended BHM supported more community-based or community-led actions, repurposed the BHM grant programme, ensured a stronger focus on children, young people and families for early support and prevention, aligned relationships to Integrated Neighbourhood Teams, introduced a small flexible budget that could be drawn on, made links to the wider enablers for neighbourhood working and integrated BHM with primary care.

Dan Shurlock then presented Brent’s responses to the review, highlighting the following key points:

• The work to align BHM closer to the wider neighbourhoods agenda was underway with a detailed action plan.
• There was now a Joint Partnership Leadership Group established with key stakeholders, including two GPs, to help link BHM with primary care. That group was 100% committed to taking forward the recommendations and actions from the review.
• He felt that the review provided a balanced view of BHM that celebrated the successes and achievements of the team and identified ways BHM could develop further.
• Following the outcome of the review, BHM had looked to reprioritise the resource available based on the learning, putting it towards the areas that would make the most difference and deliver the biggest impact.

Ruth du Plessis summed up the presentation by quoting the review which had found that BHM had achieved something genuinely hard to replicate. She thanked the Programme Director, Nipa Shah, for the work she had done with BHM over the years since it had been established and thanked the LGA for producing their peer review. She felt that the programme had built real trust in communities above and beyond what statutory services had previously been able to do.

The Chair thanked officers for their presentation and invited comments and questions from Board members, with the following points raised:

·       The Board echoed the compliments for BHM which they felt was an asset to Brent and truly valued in the community. They thanked the LGA for conducting the review and were pleased to receive external validation for what was being done and how that could be improved.

·       Noting that there were recommendations to further develop work with children and families, the Board asked what partners thought would make the most impact there, particularly in relation to immunisations and oral health. Ruth du Plessis advised that BHM had agreed it would shift resource to ensure a bigger focus on children and families, linked with Brent hubs and wider teams such as the 0-19 service. She agreed that there was a need to focus on dentistry and immunisations and added that mental health was also a top priority she would want to see resource go towards. She advised that BHM could do more in that preventative space for children and young people on mental health. Partners were also looking to shift clinical resource into those areas as well. Robyn Doran highlighted childhood asthma as another area to focus on, and she had seen a shift with BHM working with GPs delivering children’s hubs which had made a big difference in identifying the social determinants of health.

·       In response to whether BHM worked with housing colleagues, officers confirmed this was the case.

·       The Board asked whether BHM delivered any work specifically related to addiction. Ruth du Plessis confirmed work was delivered through VIA New Beginnings, Brent’s service user-led drug and alcohol service, who had used the opportunity through BHM to break down some of the stigma towards addiction and raise awareness of the services available to help and support those experiencing addiction. She added that often services may see someone with a mental health issue who did not then get treated by the drugs and alcohol service and vice versa, so the mental health and addiction team was trying to invest in those services by creating some combined posts across mental health and addiction. Slightly wider, better links with housing were being made in relation to mental health with a dedicated housing post within the service and bringing in community connectors who could relate to different communities and the different understandings of mental health from different cultural backgrounds.

·       The Board was pleased that one of the recommendations was to focus on community grants and ensuring more trusted voices around the table.

·       Noting the comments around the lack of demonstrable outcomes using the current reporting mechanisms, the Board asked what data collection would need to take place in order to capture the work and outcomes in more detail. Robyn Doran responded that one of the questions being asked was how the programme could measure social value and the difference it was making. There were measures out there to capture that and the level of community engagement which BHM was now looking at. Dan Shurlock responded that it was an important challenge to the team. Going forward, the ICP was going to support BHM with more practical next steps to work with individuals and families to navigate their individual situations which would have some measures of the positive impact by helping those families avoid a crisis or a cost avoidance in the system. The methods of capturing that were not straightforward but were possible. As a practical example, Ruth du Plessis advised that BHM had recently attended a factory night shift where they learned that the factory catering system had been changed as a result of the education from BHM, showing the wider impacts that had not been measured or reported. As such, BHM was looking to understand some of those wider impacts further. Radhika Balu added that it would be useful for the ICB to receive feedback when BHM and Brent ICP measured social value so that could be fed into the overall WNL strategy.

As no further issues were raised, the Board thanked BHM for all the work they do, particularly the work around early detection of bowel cancer which had saved lives.