Agenda item

This item presents the Integrated Care System (ICS) Health and Care Strategy for North West London for challenge and comment.

Toby Lambert (Northwest London ICB) introduced the item which presented the Integrated Care System (ICS) Health and Care Strategy for Northwest London for challenge and comment.He noted that the strategy built off the existing work of the JSNA and Health & Wellbeing Strategies. They were gathering feedback from all Health & Wellbeing Boards and would incorporate them into the final strategy.

Toby Lambert noted that the engagement period would run to the end of July. There was a form on their website for residents to provide feedback. Councils could provide feedback through Health & Wellbeing Board meetings and could also provide longer written responses. The Chair noted H&F may share the minutes of the meeting or provide a written submission at the right time.

ACTION: Linda Jackson / David Abbott

Councillor Natalia Perez asked if there were groups that the ICS wanted more engagement from. Toby Lambert said each section of the strategy had its own engagement process, but engagement had taken place with partners, the residents forum, and colleagues in communications had been working to build links with each group and community.

Merril Hammer commented that the strategy presented was not specific enough. She said the strategy should clearly articulate the current position, have baseline figures to measure progress against, and outline the plan to get to the desired end point. She highlighted the maternity and children and young people sections as a good example. But she felt it was wrong to put palliative care as something that was being done well, noting they were 10 months late to report. She also felt the mental health section was seriously lacking, with little or no detail about baseline provision, need, demand, measures of inequality, productivity, or staffing.

Toby Lambert said he agreed some sections were more detailed than others, explaining that it was partly an artefact of how the document was produced. He noted there was supporting data available in the needs assessment on their website, but it was not as comprehensive as he would like.

Jim Grealy discussed the need for a clear articulation of what success and failure in each area. He also said there needed to be a realistic look at what could be staffed with the expected resources. Toby Lambert said the strategy would feed into a joint forward plan, which would have more detail about finances and workforce. He noted that while there were shortages in some key professions, overall, they had more staff than ever before. The challenge was how best to deploy that workforce.

The Chair asked if the joint forward plan would contain detailed targets and outcomes. Toby Lambert said it would.

Jacqui McShannon highlighted transitions from Children’s Services into Adult Social Care, mental health, and autism as areas that needed more focus. She warned there was a growing cohort of people whose needs were not being met. The Chair also said the strategy did not include enough on autism. Toby Lambert said there had been similar feedback from others and he would feed it back to the ICP.

Jacqui McShannon said she would also like more focus on the group of children and young people that were considerable risk but low incidence. The Chair suggested it would be more impactful if all the Children’s Services Directors from across Northwest London coordinated and produced a joint response to the strategy.

ACTION: Jacqui McShannon

Nadia Taylor asked if there was scope to extend the engagement period to ensure a wide range of responses. She also noted the strategy covered a lengthy period and asked if artificial intelligence (AI) and its application in healthcare part of the discussion had been. Toby Lambert said he was personally keen to move from the strategy phase to hard targets and actions. Regarding AI, he said it was part of their research and innovation strategy – and in some areas like population health around hypertension it was already being used to identify people at risk.

Councillor Natalia Perez, regarding mental health services, asked if there would be more investment in alternatives to A&E. she also asked if there would be what plans there were to incorporate the feedback and incorporate it in a meaningful way. Toby Lambert said, regarding A&E, there was a new crisis service which took people out of A&E and into an assessment bed where they could be stabilised and moved back into the community with support. They were looking at the most impactful investments. Regarding the feedback he said they would produce a response to the engagement document, summarising the feedback received and report back to the ICP with recommendations about what to include in the final strategy.

Linda Jackson said one of the key issues was that people needed to be able to see the resources that will enable these outcomes to happen. She said the overarching plans needed to be shown to residents. She also asked if there was a public risk register.

Toby Lambert assured the Board that details plans would follow the strategy in the form of the joint forward plan which would bring together estates, the workforce, and finances. He added that a risk register was also being put together and it included capital funding as a risk.

The Chair asked if the Board should have a meeting on the joint forward plan. Toby Lambert said there was a decision to be made about whether to try and do it all in one piece or have more detailed discussions about each section i.e., mental health.

The Chair asked what was meant by an ‘integrated approach to housing’ in the strategy and asked if that would entail the ICP putting money into housing to tackle mould and damp. Toby Lambert said it was unlikely that the NHS could put money directly into housing repairs, but he said they could release land for new housing.

The Chair said children with asthma were costing the NHS a lot of money across their lifetime and suggested that it would be a better use of funding to collaborate with the Council to fix the problem at an early stage. Toby Lambert said there were things the NHS could do, and they would think about innovative approaches, but could not make a commitment at the meeting.

Jacqui McShannon said there was some anxiety in Children’s Services about the joint forward plan imposing services for local authorities to deliver but without any additional funding. She also raised an issue about engagement on boards, noting that there should be more representation from staff working directly with children, rather than it always being Director-level. She said it would be useful to see a list of all boards and who was represented on them. The Chair agreed and asked Toby Lambert to provide a list. He added that it would be a good step in helping improve understanding and noted the importance of having a constructive relationship.

ACTION: Toby Lambert

Jo Baty raised the importance of having a scalable core offer, noting that a lot of children and young people move across boroughs. Previously there were reciprocal agreements in place but those had been lost. She said an integrated early help service and reciprocal arrangements would be welcomed.

Jim Grealy objected to phrasing in the document suggesting that ethnicity was one of the main social determinants of health. Toby Lambert said he would ask for it to be rewritten.

ACTION: Toby Lambert

Merril Hammer asked if the joint forward plan was amendable. She also asked if the engagement phase for the strategy could be extended beyond the end of July. Toby Lambert said he would prefer to move on to the planning stage but if groups wanted to come back after the end of July with further input, they would take that on board. Regarding the joint forward plan, he said it would be amendable.

The Chair thanked Toby Lambert for attending.

RESOLVED

1. The report was noted.