Agenda and minutes

The minutes of the meeting held on 22 January 2020 were confirmed as correct.

Presentation by Tony Chambers, Interim Chief Executive BHRUT and Nick Swift, Chief Financial Officer BHRUT

The Board received a presentation from the BHRUT Chief Medical Officer (CMO) who provided an overview of the current position in developing its Clinical Strategy, including future developments and the next steps to improve patient care, setting out the details of the emerging priorities and themes which followed recent public and stakeholder engagement.

The presentation covered the local context, the reasons and case for change, the key principles and objectives as well as details of the three priorities that have emerged to improve patient care namely:

-  Work to improve a number of services that can begin immediately as detailed

-  Potential consolidation of some services onto fewer sites to make services more sustainable, and

-  Work to build partnerships with other organisations to provide the best possible specialised services for the local population

The CMO stressed that this was not a standalone strategy and that for it to be successful it had to work with the wider BHR system as well as the Boroughs and local communities. That said she recognised that Barking and Dagenham does not have a local hospital and that this compounded matters.

Given the current coronavirus crisis the Director of Public Health asked what opportunities might arise to take things forward more quickly?  The CMO explained that there were already discussions about using digital technology for patient appointments as well as online and telephone consultations, all of which had been planned but which was now coming forward more quickly.

The Chair stated that the strategy provides a clear pathway to influence outcomes and consequently she asked Board Members to review the strategy as presented and to feedback any comments direct to the CMO.

In recognition of its focus in the Joint Health and Wellbeing Strategy 2019-2023 the Board noted a report and presentation by Commissioning Managers  on key developments around Barking & Dagenham’s approach to tackling Domestic Abuse (DA) including the launch at City Hall on 4 February of a new DA Commission made up of 12  commissioners who reflect the areas which interlink with the issue, and which will operate until October 2020 with a view presenting a series recommendations on how to tackle the issue in the Borough. Working alongside the Commission providing local expertise and connections is a Borough Expert Panel.

There are 7 workstreams which the Commission will focus on, updates on what has been achieved so far against each were provided covering:

-  Quantitative data

-  Understanding residents’ experiences and attitudes

-  Cultures and history

-  Funding proofing

-  National best practice

-  Staff

-  Creating a national methodology 

Following a competitive tender process Refuge Charity had been appointed from October 2019 for initially three years, as a strategic partner to operate a new domestic and sexual violence service in the Borough replacing the existing refuge accommodation service and independent advocacy delivered by Hestia and Victim Support respectively. A summary of the Refuge remit and objectives were outlined.

Finally, an update was provided of the wide range of work happening across the system in relation to DA.

In response to the presentation the Deputy Chair expressed concern about the low levels of referrals from GP’s (2 only to date) and that his worry was that patients are reluctant to report sexual health issues as it potentially exposes possible domestic violence in the home. He asked whether there were any educational programmes for children around domestic violence with a view to flagging up possible issues at home.

The Commissioning Manager explained that a lot of targeted work was taking place in schools. She also referenced a programme designed to support and train GP’s to develop advocate skills.

The Chair concluded that once the quantitative data was available and analysed, she was hopeful that it would lead to identifying different ways and methods to tackle what has proved a very difficult problem to solve for many years in Barking and Dagenham. 

Presentation by Jill Williams, Shared Coordinator, Public Health 

Following the tragic death of a young woman in the Borough in September 2018 by suicide, officers from Public Health presented the Board with an update on the progress made against the aims and objectives and six priority actions of the BHR Suicide Prevention Strategy 2018-22 with specific reference to Barking and Dagenham which has the lowest rate of suicide in London which itself has the lowest rate in the UK.

The aims of the Strategy seek to reduce the rates of suicide across BHR by 10% by 2021 (in line with national targets) and to ensure people affected by suicide receive timely help and support. 3 objectives underpin these aims, namely:

-  Prevention

-  Support at times of crisis, and

-  Support and help for those affected by suicide

The presentation summarised the progress against the six priorities which was mixed and at this stage too early to say whether the 10% reduction in suicides will be achieved, given that the relevant data has still to come through. Nationally however rates are increasing. Since May 2019 suicide is now concluded on the civil rather than the criminal standard of evidence i.e. on the balance of probability and not beyond reasonable doubt. This is expected to lead to an increase in deaths recorded as suicide.

The key messages from the presentation were that suicides are preventable, that it is everybody’s responsibility and should be the focus of an integrated approach across commission, service delivery, workplaces and schools. Furthermore, suicide prevention sits within the wider framework of mental health and wellbeing for both adults and young people and the Council’s vision for the Borough.

In response to the presentation it was enquired as to why action had not yet commenced on Priority 5- ‘Reviewing Care of People who self-harm’ and what evidence there was about the statement that there is a stronger bias against  suicide in different communities?

The Shared Care Coordinator stated that given that the process of reviewing the care of people who self-harm is very complicated is the reason why the work requires tackling at the STP level rather than locally. As for the different communities the evidence which extends back over many years shows particular in respect of religious beliefs that there is a stigma around suicide although the recent change in the legal definition by decriminalising suicide will hopefully help. It was noted that Pride London do provide an excellent on-line training resource.

Healthwatch led a very successful Suicide Prevention day recently although it was disappointing that the Council choose not to take part, something the Chair will take up.   

Finally the Board  noted that NELFT will be attending Health Scrutiny Committee on 24 March to report on a small number of deaths by suicide in the Borough which has led to the issue of a Regulation 28 report, with a view to discussing lessons learnt etc. 

Presentation by Mark Scott (ELHCP) and Sharon Morrow

At the last meeting the Board received an update from the East London Health Care Partnership (ELHCP) on its response to the NHS England Long Term Plan(LTP) setting out a 5 year strategic delivery plan known as the System Operating Plan (SOP) as published in January 2019, showing how the Partnership intended to work with partners to known challenges and deliver improvements to health and care services. Given the theme of the last  meeting the update focussed on those aspects addressing the health needs of children.

Mark Scott, Deputy Director of Transformation presented the Board with an update on the other elements of the Plan including the development of an integrated care system for NE London and how it will support the Partnership’s deliver of the LTP (see Minute 57 below), the role of the acute collaborative group, delivery and the next steps. 

The basic principle underpinning the LTP for NE London is that decisions about health and care should take place locally at borough level and only at NEL level when there is a good reason to do so. The presentation highlighted what has been achieved so far through collaborative working as well as a reminder of the challenges faced by ELHCP. 

Presentation by Henry Black, Chief Finance Officer - NELCA

Following on from the previous presentation from the ELHCP the Board received a briefing from Henry Black, Chief Finance Officer, North-East London Commissioning Alliance (NELCA) on the development of the Integrated Care System for NEL.

The plan is that by April 2021 the ICS will be supported by a single CCG, three local systems (BHR, City and Hackney and WEL) and seven place-based partnerships to maintain focus at a local level. The CFO explained that the streamlining of the CCG’s should result in a reduction in the overall management structures and costs with a target saving of 20%. Some specialist services will be devolved down to the regions (NEL).

The Board, whilst acknowledging that the government is committed to these structural changes, expressed its concerns that it will make decision making more problematic, given the difficulties of reaching consensus under the current CCG arrangements, let alone moving to a regional structure.

Dr John, Deputy Chair and in his new capacity as Chair of the ICS stated that there had been a number of positives for the Borough operating under the current arrangements, adding that whilst the ICS will hold the overall budgets they will be channelled locally and in that respect Barking and Dagenham will have a voice through representation at Board level.  He had also received assurances that under the new structural arrangements the Borough would not lose out financially and that recognising the good work already achieved through the BHRCCG, he was confident that local residents will not lose out.

The Independent Chair of the Local Safeguarding Adults Board asked that given the new body will hold all the funds allocated for adult and children safeguarding, how will they get access to monies?  The CFO understands that up to 95% of allocated monies will be devolved locally and it was his understanding that the Chair of this Board and the Council’s Chief Executive are pushing for the Borough Partnership to be made responsible. 

Finally, it appeared to the Board that the new structures would be moving away from the current commissioner/provider financial split, and how would this operate?  The CFO responded that he did not support the commissioner/provider split to deliver health and care services as in his view it did not encourage collaborative working. 

Presentation by Alison Blair and Matthew Cole

The Director of Public Health and the Director of Transition, BHR System provided an update on the programme of work and direction of travel being progressed through the BHR Integrated Care Partnership Board (ICPB) to create more coordinated health and care services. The objective was to make significant changes in the way care was planned from April 2021 in order to improve outcomes for residents. It was noted that this report was also being presented to Board and Partnerships in Havering and Redbridge.

The Board noted as part of the development of the System Strategy a workshop of the ICPB was held in January 2020 to discuss the case for change, a vision for the future and a set of strategic objectives and from which three priorities were focused on to take forward for immediate action, namely:

-  Embrace a population health management approach with a focus on children and young people,

-  Enhancing the retention of local staff, attracting new job roles and driving forward recruitment, and

-  A more coherent approach to communication and engagement. 

The Board supported both the direction of travel as outlined and the further development of the BHR system and noted that further details of the operating model would be developed for approval in Autumn 2020. 

Presentation by Wassim Fattahi-Negro, Principle Manager Performance & Intelligence  

Further to presenting a report in September 2019 on the revisions to the Health and Wellbeing Outcomes Framework, to align with the Joint Health and Wellbeing Strategy (JHWS), the Board received an update from the Council’s Principle Performance Manager in Public Health on the development of the Framework. He highlighted the agreed three priority themes, seven key health and wellbeing outcomes as well as the shortlist of measures presented in the JHWS and the tri-borough Joint Strategic Needs Assessment 2020. 

The Chair explained that the Council at the next Cabinet meeting would be reviewing as part of the Corporate Plan a range of social care and health integration key performance indicators and would feedback which ones will form measures in the Framework. She encouraged Partners to do the same.

Going forward it was agreed that the performance reporting of the measures once confirmed should be submitted to the Board by-annually, notwithstanding that any particular ones which under-perform would be reported as and when necessary. 

The Board received an update from the Council’s Head of Insight and Innovation (HI&I) around the work of App health’s Innovation UK funded pilot which is running in the Borough until Autumn 2021, and which focuses on a two-way text booking service for health checks with local GP’s with a view to increasing the take up, which is both nationally and locally underperforming against targets. He was confident that this system would in time lead to uptake in the rates of health checks.

The Deputy Chair in supporting this work stated that new technology was playing an increasing part in healthcare and supporting the work of GP’s. In that respect he would like to see it used to submit blood pressure results and issue routine blood test requests, thus reducing pressure on practices. The HI&I acknowledged that this was something to consider longer term hopefully as the project development evolves.

The Board were pleased to note that the early results of the pilot were very encouraging with a higher take up in the Borough and which would lead to a range of long-term population health benefits. 

The Director of Public Health updated the Board with the latest developments on the spread and management of the Coronavirus in the Borough and London as a whole.