The Board received a report that provided an overview of the upcoming changes via the forming of the NEL Integrated Care System (ICS) and the impact of this at a borough level - the Tower Hamlets Together (THT) Partnership. The main points of the discussion and questions raised maybe summarised as follows.

The Board

v  Understood that the system has undergone a meaningful change recently, especially at the Clinical Commissioning Groups (CCGs) and system levels, due to implementation of requirements set out in the NHS Long Term Plan.

v  Noted the focus on the direction and ambitions of the NEL Integrated care systems (ICSs) changes and the potential form and functions options that are available to Borough’s partnerships as part of the wider changes.

v  Agreed that it is important that the structures and processes ensure accountability, transparency, inclusiveness reflecting what the objectives are in terms of reducing health inequalities and making sure that services are as integrated as they can be.

v  Agreed that it was important to understand the CCG’s functions; how these will transfer to the ICS and moving the responsibility of population management system management to the provider side.

v  Acknowledged that you could look at this transition as considering lean and mean as one of the options or partners might look at it as setting up another commissioning body. However, that risks the establishment of a body that is much bigger and is extraordinarily complex and risks reinventing the CCG; damaging the existing relationships within the Borough and creating a body for unproductive talk rather than action with endless papers and briefings and not addressing the disengagement of doctors and nurses in the system that will come at a massive cost. The focus needs to be kept the existing experienced team focused on advising the ICB on how to help residents including self-management, of long-term conditions, a swift response to acute illness, the provision of reablement, and improved community health provision to residents may help reduce the numbers of hospital admissions.

v  Noted that the Councils own scrutiny function is keen to understand what is being done to prepare for these changes e.g., what conversations are being had with the NHS locally about the changes; what expectations the local NHS might have about health scrutiny’s involvement; the impact the health scrutiny functions.

v  Agreed that (i) the timetable for adoption needs to include consultation with the Tower Hamlets Healthy Adults Scrutiny Sub Committee; (ii) residents and partner agencies are engaged in a meaningful way; and (iii) we use the strengths and established structure’s that we have of as a Health and Well-Being Board to really make this work.

The Board:

1. Noted the proposed opportunities of integration from April 2022; and
2. Agreed that there should be a standing item on the Board’s agenda on the development of the Integrated Care System in the Borough.

Councillor Amina Ali, Cabinet Member for Health and Wellbeing introduced the item and set out the context of the health and social care integration plan.  This plan aimed to enable service users to access joined up health and social care services when needed.  The outcomes not only concerned care of service users but also the wider well-being of the individual. Councillor Ali highlighted that delivery was required not only in the context of individuals’ needs but also that of structural changes to  health and social care services and financial challenges.

The Joint Director of Integrated Commissioning then gave a presentation on the health and social care integration plan for the borough; outlining the context, the current arrangements and the proposed Tower Hamlets Together Integrated Plan which will deliver further transformation.

Arising from the presentation, the Board noted that:

·         In 2020 Clinical Commissioning Group (CCG) arrangements would change resulting in one CCG for East London.

·         There was a £60M funding gap between the NHS and CCG in Tower Hamlets.  The Board was informed that, in the context of this financial challenge, an integrated system known as ‘Tower Hamlets Together’ had been devised which was intended to address the challenges around use of resources, pooling and aligning budgets and governance around health and social care while retaining local decision-making.

·         It was necessary that Tower Hamlets consider its present local JSNA in relation to other boroughs and assess if averaged below or above these in its provision.  A key area was good communications between the NHS and the local authority.  The Board was informed that Tower Hamlets had broad relationships with other elements of the Tower Hamlets Partnership and at a London-wide level.

·         There was a risk that the Tower Hamlets Together integrated structure might disempower the Health and Well-Being Board and create tension around governance. Additionally there was risk of diluting community outcomes because of the professionalisation of the Tower Hamlets Together framework.  The Board was informed that the Council intended to ensure engagement was retained within the Tower Hamlets Together framework and work was being undertaken to establish how the future Tower Hamlets Together structure would fit in with other existing bodies.  Other authorities around the country were looking at how decision-making bodies might bring decision-making together in the form of a joint board with delegates from the participating health and well-being points.

The following information was then provided in response to Members’ questions:

• Officers had sought to mitigate the funding gap by assessing how the Council used community related resources and then to reshape what resources were spent on and/or reduced duplication.
• Borough services would be safeguarded because the integrated scheme would support more embedded and sustainable partnerships.
• The integrated arrangements would permit the overarching East London CCG to establish different plans with each of the seven boroughs within each borough partnership.  However, at present, the NHS wished to explore how to achieve consistency and how boroughs could work together. 
• To mitigate potential negative impacts or a risk of failure  ...  view the full minutes text for item 5