Chairs Update

v  Better Care Fund (bcf)– Noted the planning requirements were published at the end of September 2021 with the submission date on the 16th of November 2021. The expectation is that regional assurance will then take place between the 16th of November 2021 and the 7th of December 2021. The outcome of regional assurance will then be shared on the 7th of December, 2021 with formal approval letters issued from the 11th of January, 2022 the Board had quite an extensive discussion about this at the last meeting and Members all recognised that the Better Care Fund is a real is an opportunity for the Health and Well-Being Board Partners and the Towerhamlets Together  Partnership to really drive integration there is an expectation that the Section 75 agreements will be signed and in place by the 31st of January, 2022. The biggest change for this year is the metrics which now focus on avoidable admissions; length of stay; discharged to normal place of residence and residential admissions.

v  The Board was reminded that it had undertaken a review the local BCF scheme earlier in the year and the Section 75 proposals do reflect this. It was noted that whilst there is a requirement for the local Health and Well-Being Boards to sign off local plans, as the next Board meeting is not now scheduled until the 1^{st of} February 2022 the current approach is for there to be a delegated signed off by Denise Radley Corporate Director Health, Adults and Community and Deputy Chief Executive and Siobhan Harper from Northeast London (NEL) CCG. Although the Chair will review the BCF proposals before they are submitted on the 16^{th of} November 2021 this is as mentioned above a delegated submission by the Corporate Director Health, Adults and Community and Deputy Chief Executive on behalf of the Board.

v  Adult Social Care Strategy 2021 – It was noted that the Board is developing a new strategy in adult social care that will set out the plans over the next 3-5 years, outlining what will be done differently and what difference it will make. The Strategy has gone through a very extensive engagement and co-production process in the run up to publication and this strategy is now being finalised and will be launched in the coming weeks. The Chair stated that she hoped that everybody present had, had a chance to feed into the process, but she will ensure that the Board will see the consultation proposals and if Members have not yet read the draft that when they review the document they will agree that all the issues are covered although if Members wish to raise any issues then they should get in touch immediately.

v  Board Terms of Reference – Noted that due to changes in NHS structures and ways of working within the current pandemic has warranted an interim review of the current Health and Wellbeing Boards Terms of Reference. With a view to  ...  view the full minutes text for item 1.1

To note any declarations of interest made by members of the Board. (See attached note of Monitoring Officer).

There were no declarations of disclosable pecuniary interests received at the meeting.

To confirm as a correct record the minutes of the meeting of the Tower Hamlets Health and Wellbeing Board held on. Also to consider matters arising.

That the unrestricted minutes of the meeting of the Board held on 6^th April, 2021 be approved as a correct record of the proceedings and the Chair was authorised to sign them accordingly.

That the unrestricted minutes of the meeting of the Board held on 29^th June, 2021 be approved as a correct record of the proceedings and the Chair was authorised to sign them accordingly.

That the unrestricted minutes of the meeting of the Board held on 21^st September, 2021 be approved as a correct record of the proceedings and the Chair was authorised to sign them accordingly.

Noted that the Health and Social Care Act 2012 had helped establish statutory health and Wellbeing Boards in April 2013. Since its inception, the ambition has always remained that health and wellbeing boards will build strong and effective partnerships, which improve the commissioning and delivery of services across NHS and local government, leading to better health and wellbeing outcomes for local people. The Board operates according to the Council’s Constitution and according to the Terms of Reference for the Board itself. The main points of the discussion have been summarised as follows.

The Board:

Noted that a few changes in NHS structures and ways of working within the current pandemic has warranted a quick review of the current Health and Wellbeing Boards Terms of Reference resulting in two proposed amendments to the current Terms of Reference.

1.    In April 2021, Tower Hamlets Clinical Commissioning Group (CCG) along with the six other Northeast London (NEL) CCGs – City and Hackney, Newham, Waltham Forest, Barking and Dagenham, Havering, and Redbridge started working together as a commissioning alliance to develop an aligned approach to collaborating with providers to ensure long term sustainability. As a result of these changes in NHs structures, the position of independent chair of Tower Hamlets CCG no longer exists. It is proposed that a suitable clinical representation from the NHS Northeast London CCG is identified.

2.    Due to the pandemic, the Government made allowances to local Authorities to host committee meetings until end of May 2021. Since then, Tower Hamlets has been operating a hybrid model providing a quarter of the membership attend the meeting physically as per Terms of Reference. Health and Wellbeing Board Terms of Reference holds an additional premise that the quarter of the membership ‘includes at least one representative from the NHS Tower Hamlets Clinical Commissioning Group.’ There is no legal precedent for this requirement and to ensure that meetings are quorate the proposal is to remove the additional premise from the Terms of Reference with boards agreement.

Noted that a further review of the Terms of Reference would be undertaken in the coming months following development of Integrated Care System and NHS reorganisation in April 2022.

Noted that some existing aspects of the Board’s current Terms of Reference had been accidentally omitted from Appendix 1 to the report and thus changes to be considered should be restricted to those specified in paragraph 3.3 of the report. 

Accordingly, the Board RESOLVED to:

     I.        Agree to amend the Board’s Terms of Reference as follows.

a.    Replace the current Vice Chair role description with ‘Clinical representative of NHS North East London Clinical Commissioning Group (NEL CCG).

b.    Replace the current wording under the Quorum heading with “The quorum of the Board in the Terms of Reference is a quarter of the membership”.

    II.        Agree that a further review of the Terms of Reference will take place in the coming months following development of Integrated Care System and NHS reorganisation in April 2022.

The Board received a presentation that outlined the information, advice, and advocacy offer, across health and care, in Tower Hamlets. The main points of the discussion and questions raised are summarised as follows.

The Board

v  Noted that the Council leads on the transformation and redesign of a joined-up approach to information and advice across health, social care and social welfare and is a key driver in empowering residents with making more informed choices and control. The new and integrated Tower Hamlets Connect Service went live on 19^th of July 2021 and takes a strengths-based approach to information and advice, supporting people to help themselves and achieve their goals.

v  Understood that Tower Hamlets Connects supports the Council to manage demand on its adult social care front door and those of health partners by providing free, quality-assured information, advice and advocacy across health, social care, and social welfare.

v  Observed that Tower Hamlets Connects is equipping residents with the correct information and advice support at the right time to enable residents to support themselves, live fulfilling lives and to be as independent as possible.

v  Was advised that the service offers early help and support to residents and carers through a digital portal, a help/advice telephone line service and face-to-face support in community and primary care settings.

v  Noted that a key element of the information and advice offer is the Tower Hamlets Together Digital Portal. This website provides the digital front door for all residents with or without health or care needs. It provides residents with a suite of information and advice pages, a service directory, and an events calendar.

v  Noted the Compassionate Neighbours project that supports people in Hackney and Tower Hamlets who are living with chronic life-limiting illness and those that are feeling isolated from their local community.

v  Observed that Compassionate Neighbours support people in the local community by (i) Visiting regularly; (ii) Offering friendship and a listening ear; (iii) Telephone support; (iv) Supporting people to do the things they like and enjoy; and (v) Supporting people to stay connected to their community, family, and friends.

v  Noted with interest the “Love Your Neighbour” project that is East London Cares' friendship matching scheme, which brings older and younger neighbours together to spend time one-to-one. Older and younger neighbours are matched up based on location, interests, and personality. They get together once a week and build friendships that help bring a little of the outside world in for neighbours who can struggle to get out. Younger neighbours can also support their older neighbours to get and about and enjoy all that Tower Hamlets have to offer – whether that is the cinema, the theatre, or parks and museums.

v  Noted that the programme aims to bridge divides that can make London an isolating and lonely place for younger and older neighbours alike. Through conversation, company and companionship, younger and older neighbours can support one another to stay vibrant, visible, and connected. It is mutually  ...  view the full minutes text for item 3.2

The Board received a presentation that outlined how residents accessing the Tower Hamlets Connect service are be supported online, on the phone, and in person. Noted that the Service has been commissioned to be the front door for adult social care and to support residents as far as possible in the community. The main points of the discussion and questions raised have been summarised as follows.

The Board:

v  Noted that access to adult social care is underpinned by a digital portal developed by Tower Hamlets together partners with a key focus of the services to reduce duplication.

v  Noted that the main objectives of the project are to make sure that residents are getting the help that they need when they need it in the way that they need it and to ensure that agencies are coordinating their resources.

v  Noted that the priority for Tower Hamlets Connect in 2022 is to establish these pathways; understand the available wider support services; collaborating with partners to identify where there are gaps and capacity issues; and really understanding accessibility.

v  Understood that Tower Hamlets Connect are providing people with the support and information they need to access and to keep the help that they need and to retain their independence, and if possible before they need intervention from adult social services.

v  Was informed that residents can access the service by visiting the portal; the helpline; email enquiry@towerhamletsconnect.org or by texting information and advice service.

v  Noted that the Partnership includes a number of agencies such as the Council, the NHS, Metropolitan Police, London Fire Brigade, Tower Hamlets Council for Voluntary Service, Queen Mary University, Tower Hamlets College, East London Business Alliance, Tower Hamlets Housing Forum, Canary Wharf Group. However, it was important to note the longer-term ambition is to strengthen relationships across the entire system with the wider voluntary sector, community health and emergency services.

v  Agreed that (i) those who could benefit from social prescribing schemes include people with mild or long-term mental health problems, vulnerable groups, people who are socially isolated, and those who frequently attend either primary or secondary health care; and (ii) the core principles of social prescribing are to promote health and wellbeing and to reduce health inequalities in a community setting, using non-clinical methods addresses barriers to engagement and enable people to play an active part in their care.

v  Noted that social prescribing is a move away from the drug description method which is fundamentally only 20% of what people need, it is about accessing a whole raft of services within the Borough and not necessarily from the partner agencies. Therefore, this method aims to deliver such a service in an integrated fashion that means that there must be a spreading of the load within the system.

v  Recognised that some people are more able to be signposted than others and the agencies need to be proactive in taking the lead on identifying what  residents accessing the Tower Hamlets Connect service need and  ...  view the full minutes text for item 3.3

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.

The Board noted that the Tower Hamlets Black, Asian and Minority Ethnic Inequalities Commission health recommendations and action plan had been considered by the Health and Wellbeing Board on the 21st of September 2021. The main points of the discussion and questions raised summarised as follows.

v  Noted that nine of the twenty-three recommendations made by the Commission relate to health and wellbeing.

v  Noted that the report sets out the progress and immediate priorities for delivery against the Health Theme of the action plan.

v  Indicated that it would wish to see some hypothesis to be developed now about addressing people's lives within structural, social, and contexts, and social change. e.g., the list of 10 things for the next 9 months to 5 years, 5 to 18, adulthood, people living with long term conditions; complex care and driving out inequalities.

v  Agreed things that such research must involve people in the community and must build on the work that has been undertaken since the start of the pandemic e.g., through the delivery of services in which residents participate in the creation, design, steering, and management of services.

v  Indicated that with vaccine hesitancy continuing to present significant obstacles partners need to have programmes to maintain the public’s trust in the partnership, based on local needs with data broken down for agencies to find out better ways to manage the challenges and situations presented by Covid.

v  Noted the work being taken forward at London level by Kevin Fenton the Regional Director of Public Health, NHS London that has indicated that stakeholders have expressed deep concern and anxiety that if lessons are not learnt from this initial phase of the epidemic, future waves of the disease could again have severe and disproportionate impacts. Accordingly, agencies need to be united in the commitment that urgent, collaborative, and decisive action is required to avoid a repeat of this in the future i.e., the members of the Health and Well-Being Board will continue to gather insights on the experience of Black, Asian, and Minority Ethnic communities in relation to the Covid.

Accordingly, the Board formally:

1. Noted current progress and plans for delivery against recommendations in 2021/22.
2. Considered the equalities considerations as set out in Paragraph 4.1 of the report.
3. Indicated how agencies should be taking forward research on causes of inequalities in Black Asian and Minority Ethnic Communities.

The Board received a briefing that provided the Health and Wellbeing Board with an update on current work to strengthen research collaborations in Tower Hamlets. The main points of the discussion and questions raised are summarised as follows.

The Board:

v  Noted that this work is to provide the underlying infrastructure, collaborations, and processes to enable research on several ‘wider determinants’ of health, as set out in the priorities of Tower Hamlets Partnership and the Boards Strategy.

v  Noted that as part of this work agencies are developing a bid for the National Institute for Health Research (NIHR)-funded ‘Health Determinants Research Collaborations’ to develop underlying infrastructure to support research (rather than to do research)

v  Welcomed the offers by Barts Health, Northeast London Foundation Trust, Tower Hamlets Housing Forum (THHF) and Healthwatch to help with a Black, Asian and minority ethnic inequalities research. In addition, Health Watch have the Community Insights Repository that primarily enables the processing of vast quantities of information, qualitative and quantitative, resulting in a large, robust evidence base of user and resident views.

Accordingly, the Board formally noted the current work to strengthen research collaborations in Tower Hamlets and the offers by Board Members to help with Black, Asian and minority ethnic inequalities research

The Board:

v  Noted that the improvement work is directly concerned with equalities and by driving improvement work will improve outcomes for children and young people with Special Educational Needs and Disabilities e.g. importance of attainment in terms of both socialization and the ability to engage with education and development.
Noted that with regard to Education and Health Care Plans (EHCP) the inspectors were impressed with the progress that had been made in terms of completing assessments in a timely way e.g. that quality of all EHCP’s was consistent in all assessments and the resulting plans. 

v  Noted that as part of the improvement planning (i) there was a need within the next 12 months to strengthen the systematic completion and the quality of annual reviews of EHCP’s; and (ii) there was a commitment to significant additional resourcing, focused on those annual reviews.

v  Noted that work is being undertaken to develop the holistic pathways that would provide supportive therapies to help maintain good health and wellbeing for children and families

v  Noted that the CCG has invested additional funds over the next two years to help clear the backlog and address the waiting times regarding EHCP’s.

v  Noted that with regards to communication and engagement with parents there are plans that are being developed and produced with parents and carers around (i) better communication, in particular to ensure that every parent is clear about the support services that they are entitled to; (ii) better engagement with parents and carers through a program of listening events as well as building on the existing strengths for parent representatives such as the Parent Care Forum and the SEND parent champions; (iii) every parent or carer with a young person who has special educational needs or disability feel that they are co-producing the educational health and care plan; and (iv) parents and carers feeling that they are deeply engaged in the annual review of their services to meet their child’s needs.

v  Noted that the Service would welcome the continued support and challenge that the Board has provided over the past 12 months on SEND e.g., a six-monthly review with the Board to see what measures have been taken to demonstrate the kind of momentum of improvement against all the priority areas.

v  Agreed that it was immensely helpful to have such detailed contributions from all the relevant partner agencies at the Board.

The Board:

v  Noted the continued access problems in general practice and that patients have reported finding it difficult to book appointments and access treatment and that councillors are to receive a briefing on access to general practitioners to help them understand and be able to advocate for the issue. However, it was agreed that the Board needed to continue to maintain a watching brief on this issue.

v  Noted that a letter should be sent to the Department of Health and Social Care prepared and signed by the Chair setting out that the Board’s Membership collectively supports the need to resolve the current access problems in general practice.

Finally with no other business to discuss, the Chair called the meeting to a close, and thanked scrutiny members for their attendance and participation tonight.