Agenda and minutes

In accordance with the Council’s Constitution and the ICB Sub-Committee’s Terms of Reference, Members of the Committees in Common are asked to declare any interest they may have in any matter which is to be considered at this meeting.

The minutes of the Health and Wellbeing Board and ICB Sub-Committee meeting held on 19 September 2023 were confirmed as correct.

Councillor Worby presented the Barking and Dagenham Safeguarding Adults Board (SAB) Annual Report for 2022/23 on behalf of the Independent Chair of the SAB who was unable to attend the meeting.

Councillor Worby referred to the role of the SAB, its close relationship with the three statutory partners of the Council - the NHS North East London Integrated Care Board (NEL ICB) and the Police - and the key achievements of the SAB and its three committees during 2022/23.  The SAB had established the following six main priorities for 2022/23, which were each supported by a range of actions:

1)  Support for Hoarding and Self Neglect;

2)  Implement a Learning and Development Committee to deliver joint multi agency learning;

3)  Preparing for CQC regulation;

4)  Joining up with children’s social care on key cross cutting themes;

5)  Develop governances, safeguarding and quality interfaces with NEL ICB;

6)  Develop a community safeguarding offer and preventative offer for adults.

The Annual Report included data on enquiries under Section 42 of the Care Act 2014 relating to individuals experiencing, or at risk of, abuse and neglect.  The data showed that Barking and Dagenham received 1,511 adult safeguarding concerns in 2022/23, 252 of which (17%) led to a Section 42 enquiry.  Councillor Worby welcomed the relatively low level of referrals that resulted in a Section 42 enquiry, which also compared favourably with the overall national rate of 30%.  However, she did express a slight concern at the low level of referrals from agencies such as the Police and also remarked upon a disproportionate level of white adults being referred in comparison to other ethnic groups, which suggested that more targeted information was needed to raise awareness amongst minority ethnic groups.  A further observation was made relating to the low level (3%) of domestic abuse-related referrals.

In response to a question regarding the Police’s priorities around safeguarding, Councillor Worby confirmed that the local Police were an active member of the Borough’s Community Safety Partnership (CSP) and took shared responsibility for safeguarding.  It was acknowledged, however, that the recent position taken by the Metropolitan Police regarding responses to mental health-related ‘crisis’ incidents was a cause for concern, particularly in terms of the added pressure that may have on other parts of the overall system, such as health providers and local authorities.  Other issues raised during the discussions included:

·  The increasing number of hunger-related cases being experienced;

·  The need for robust transitional arrangements for young people turning 19 years of age who move from children’s social care services onto adult social care;

·  The importance of using meaningful language when communicating on ‘safeguarding’ issues, so that the entire local community, including minority ethnic groups, can understand what safeguarding means for them and their families, the various types of abuse that can be experienced such as financial abuse and ‘cuckooing’, the support services available and the experience that they can expect;

·  The particular vulnerabilities amongst the 18-25 year old group, many of whom were not known previously known to  ...  view the full minutes text for item 24.

Sharon Morrow, Director of Partnership, Impact and Delivery, NEL ICB, introduced a report on the refreshing of the Joint Forward Plan (JFP) for 2024/25, which incorporated local plans in the areas of (1) long term conditions; (2) obesity and smoking; (3) the best start in life; (4) ageing well; and (5) estates.

The JFP acted as a delivery plan for the integrated care strategy of the local Integrated Care Partnership (ICP) and relevant joint local health and wellbeing strategies (JLHWSs), whilst addressing universal NHS commitments.  It had been developed by the B&D ICB together with the Barking, Havering and Redbridge University Trust (BHRUT) and the North East London NHS Foundation Trust (NELFT).

Ms Morrow acknowledged that more work was needed to align the planning process with the financial recovery plan, to understand and mitigate risk and to develop a system approach to prioritisation.  Various measures had already been put in place and a new partnership Planning Steering Group had been established to guide partners through the process, linking to current strategies and the priorities of the various organisations.  The approach to refreshing the plans for 2024/25 would focus on three key areas of reflection, local insight and resource requirements and a further report would be brough back to the Committees in Common early in the New Year.

Members spoke in support of the approach but it was stressed that a fundamental role of the Committees in Common was to assess the impact of plans and strategies.  To that end, understanding how all of the plans and strategies interacted with each other was crucial and Members discussed how that could be achieved and the various factors that would need to be taken into account to deliver at the ‘Place’ level.  It was noted that the February 2024 Committees in Common development session would focus on what had been delivered in 2023/24 for the local plans, the lessons that had been learnt and the key deliverables and targets going forward.

The Health and Wellbeing Board and ICB Sub-Committee resolved to:

(i)  Endorse the approach to reviewing local plans; and

(ii)  Note the reporting and governance timelines.

Elaine Allegretti, LBBD Strategic Director, Children and Adults, presented the proposed business case that had been developed to support the enhancement of therapy services for children and young people within Barking and Dagenham.

NELFT undertook a therapy demand and capacity review in Barking and Dagenham in 2022/23, initially focused on speech and language therapy (SLT) and then expanded to include occupational therapy and physiotherapy.  The Strategic Director explained that improving access to therapy support had been identified as a priority due to the significant increase in the number of children and young people on Education, Health and Care plans (EHCP), which was exacerbated in Barking and Dagenham due to it having the fastest growing child population in the country at approx. 30%, a high 18-25 year old cohort and the levels of deprivation.  The combined impact of those factors meant that there was a significant deficit in therapy capacity to meet current and future demand, resulting in high caseloads and long waiting times for therapy support, particularly speech and language therapy.

The outputs of the SLT demand and capacity review fed into the ICB financial planning process for 2023/24 and growth funding of up to £500,000 was ear-marked, subject to the approval of the NHS North East London Investment Committee.  The business case identified a capacity gap of 10 SLT therapists and four occupational health practitioners and physiotherapists, requiring recurrent additional funding of £923,797.

Members discussed the problems associated with recruiting to posts with high caseloads, the disparity between inner and outer London pay rates and the need for early intervention to help reduce future demand pressures.  It was also suggested that the service could be enhanced by having greater links with other activities taking place in the local community to improve accessibility and support the likely success of the business case application.  Tom Ellis, Director of Strategy at Newham University Hospital, referred to past experience of successful business case submissions and suggested that the demand and capacity model used in the business case should be supported with greater insight into the assumptions used and the anticipated reduction to wait times etc..

Officers were also asked to present information to a future meeting on current waiting times for therapeutic services, to assess the effectiveness of the additional resources and the impact on waiting times.

The Health and Wellbeing Board and ICB Sub-Committee resolved to endorse the Additional Capacity in Children and Young Peoples Therapy Services business case at Appendix A to the report, subject to the issues raised at the meeting, and recommend its approval to the NHS North East London Investment Committee.

Sarah Carter, LBBD Head of Borough Partnerships, provided a summary of the discussions at the Committees in Common Development Session held on 26 October 2023, which focussed on the issue of “Localities Working – Developing the Footprints”.

At present, there were three recognised localities across Barking and Dagenham relating to the organisation of health and wellbeing services, roughly divided into East, West and North.  It had previously been recognised that the scale of residential development in the Borough, particularly the southern part, would necessitate a review of those locality arrangements and the recent Development Session discussed some of the practical arrangements for creating that fourth locality.  The session was well attended by partners and six main principles were agreed:

1)  To be people-centred, ensuring that the local community was at the heart of what we do;

2)  To base decisions on data and insights;

3)  To provide an equity of offer, driving out unwanted variations but recognising that one size would not fit all;

4)  To be efficient, ensuring that we are working as close as possible to the population to make change;

5)  To be collaborative, develop trustful relationships and seek to understand one another’s challenges;

6)  To have a positive attitude to change.

The Head of Borough Partnerships added that, to take those discussions forward, it was also proposed to the establish a time-limited task and finish group to determine whether it was now appropriate to create a fourth locality footprint in the south of the Borough. 

Arising from the discussions on the issue, a number of observations were made which included:

·  The potential need to readdress which Council wards sat in each locality if we were to move from three to four localities, acknowledging that Primary Care and GP practices would not sit neatly into localities;

·  Community-based localities should be factored into the discussions;

·  The need to continue to lobby for additional funding and resources to support the Borough-wide growth;

·  That partner organisations may need to split current teams to co-locate into a logical area;

·  That the locality discussions represented one of the early stages of meeting expectations for locally-based services over the next few years;

·  The need to take account of cross-borough issues, workforce challenges and high caseloads when considering how to bring services ‘closer to home’.

The Chair encouraged attendees to contact Fiona Russell, LBBD Director of Care, Community and Health Integration, to register their interest in participating in the proposed task and finish group.

The Health and Wellbeing Board and the ICB Sub-Committee resolved to agree the establishment of a time-limited task and finish group to determine whether to create a fourth locality footprint in the south of the borough.

There were no additional questions from the public.

The Chair referred to a flyer that had been circulated at the meeting relating to free training workshops aimed at helping identify ‘hidden’ carers, how to support them and accessibility to the Carers’ Hub, and encouraged attendees to share the information within their organisations.

The Chair also asked officers to report to the next meeting on the challenges currently being faced by the London Ambulance Service and their impact on response times across Barking and Dagenham and other knock-on effects.