Agenda item

Professor Chris Ham (King’s Fund) has kindly agreed to attend the meeting and the Board is requested to discuss place based systems of care and the solution they potentially offer to the challenges facing the local health and care system.

Professor Chris Ham gave a presentation to the board on ‘Place-based systems of care’. The full presentation can be found on pages 61-75 of the agenda. Chris Ham talked about three versions of place based systems and how the NHS was taking the idea forward. He also explained health and social care integration under the aegis of the health and wellbeing boards (HWBs) and outlined the purpose and scope of the sustainability and transformation plans (STPs). He then identified the emerging issues which included the size and complexity of the task and the deadlines, as well as, leadership, management capacity and the role of the local authority. 

He outlined the local government version of place based systems and gave the examples of Greater Manchester’s devolution plan and the integrated care pioneering which had taken place in Leeds. He explained that the focus was on whole populations and public service and community budgets. He also talked about the bold vision for the ‘northern powerhouse’. 

Chris Ham then summarised health and social care integration and talked about the Isle of Wight, Torbay and West London and new care models under the NHS. With regard to the Isle of Wight he explained that working under the health and wellbeing board had already been established and provided overall leadership for the transformation programme. He went on to talk about relationships with STP’s and the behaviours of leaders and concluded that system leadership was needed at all levels to realise the benefits; and, that HWB’s had a role in providing that leadership. 

Chris Ham moved onto the implications for Hammersmith and Fultham and across NW London in specialised health services. He talked further on local acute services across the Borough and about community, primary and social care as well as population health at all levels. He explained that there was a broader shift in the focus for individuals and populations and that improving population health and outcomes was the overall goal. He then talked through the challenges and how to ensure progress in Hammersmith and Fulham and posed four questions for the Board which were;

1. What part should the Board play in providing place based leadership?
2. Were the right people sitting around the table?
3. Did the board have the support it needed?
4. Was there an appetite for taking on the role that was emerging for the HWB in the Isle of Wight and was under discussion elsewhere?

Steve Miley asked how the Isle of Wight model worked and Chris Ham stated that they had a broad vision and an overarching board. That they had split provision and partnering enabled them to provide services effectively. 

Keith Mallinson commented that public input was important and that he would like to see more members of the public involved in the future governance arrangements. He also felt it would be useful to have the health unions support for future plans. 

Stuart Lines asked if there were any examples of public health input into population health improvement systems and Chris Ham stated that in Manchester the public health had been used as a common research tool for interested parties and that they had retained their statutory responsibilities. 

Councillor Lukey expressed concern that existing structures and the complexity of arrangements could be a barrier to effectiveness, as well as, the size and make up of NW London. In response Chris Ham confirmed that in areas where the place based systems of care were happening it was due to the leadership of the local authorities. He added that there were examples of smaller and larger areas where it was working. 

Vanessa Andreae commented that it was important for the CCG and local authority to work together and that there was a need to overcome the current issue of Charing Cross hospital. Councillor Vaughan added that the majority of local authorities were opposed to the strategic plans and agreed it was primarily about leadership. He gave the example of the flu immunisation roll out and the fragmentation of the approach. He also reiterated the need to work together and added that personal relationships were more difficult to maintain without workforce sustainability. He also asked how success would be measured. Chris Ham confirmed that it was the role of the commissioners to define success and that his expectation was that there would need to be a huge amount of consensus. 

Vanessa Andreae commented that in order the HWB to accept responsibility for overall decisions they would need to be able to influence outcomes. Dr Tim Spicer added that NW London had a more transient population with less predictable needs than some of the example areas. He also noted that the Imperial which had specialised equipment was an asset for the area. He further commented that community ownership was an important issue where residents were more powerful and had greater levels of responsibility; and, he made reference to Baltimore where such a scheme was in place with 51% of residents sitting on a similar decision-making board.  

Keith Mallinson asked why there was no one from the Mental Health Trust on the board and Chris Neil explained that the next item on the agenda covered the membership of the board. He then asked members for comments on the best practice criteria for the board which was detailed on pages 81-82 of the report. Councillor Lukey stated that some blocks were in place but that the pace was moving too slowly. She also felt that children should be included more in the planning. Councillor Macmillan added that OFSTED had recently criticised the HWB for not covering children sufficiently. 

Councillor Lukey proposed a half a day session for the board to discuss the issues more fully. This was agreed by Members. 

ACTION CHRIS NEIL

Councillor Holder stated that it was also important to establish as much information around patient communication as possible going forward. 

Chris Ham concluded by stating that the Audit Commission had found that not enough attention was given to decision making and membership in partnership working. He also stated that it was about going back to basics to avoid competitive behaviours between partners and to identify where constituent organisations were willing to give up power. 

RESOLVED

That the report be noted.