v  Councillor Rachel Blake (Deputy Mayor and Cabinet Member for Adults, Health and Wellbeing) welcomed everybody to the meeting.

v  Welcomed Detective Chief Inspector Yasmin Lalani (Public Protection Team) to this her first Board meeting which she was attending on behalf of Detective Chief Superintendent Marcus Barnett - BCU Commander.

v  Advised the Board that due to exceptionally busy demands the primary care partners are joining online which means that according to the current formal terms of reference the meeting is not formally quorate and as a result the status of this meeting will be recorded as advisory.

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 29^th June 2021. Also to consider matters arising.

In addition, as advised the last Board meeting was not formally quorate (See Items 1.1 and 1.3) and as a result the unrestricted minutes of the meeting of the Board held on 6^th April 2021 (See Appendix One) require formal ratification.

The Chair Moved and it was:-

RESOLVED

That the unrestricted minutes of the meeting of the Board held on 6^th April and 21^st June, 2021 be formally ratified at the next formal Board meeting subject to the inclusion of Councillor Gabriela Salva Macallan in the list of those present.

Matters Arising

Item 1.5 Home Care Transformation and Re-procurement

It was suggested that there should be a further report on the Home Care Transformation and Re-procurement programme to a future meeting of the Board.

The Chair:

v  Stated that there has been considerable discussion about NHS reorganisation and integration between the NHS and local authority services and that the decision has been taken not to have in-depth discussions about this at the Health and Wellbeing Board due to there being quite a lot of uncertainty about the way forward as there has now been quite extensive change in terms of the organisation of the former CCG and we are only now beginning to get clarity of around national guidance for the reorganisation. Therefore, the Chair suggested that the Board discusses this issue at the November meeting alongside a refresh about the Boards own membership and terms of reference.

v  Indicated that she was happy to take a couple of questions on that topic now or reflections if that is felt to be helpful. However, the Chair stated that she  wanted to give the Board the “Heads Up” that that really is quite a substantial piece of work to ensure that there is a there is a relentless focus on health inequalities on outcomes for people in terms of this NHS restructure and at the same time making sure that NHS and local authority bodies are integrating.

v  Indicated that she increasingly had been contacted by constituents about access to GP appointments and there had been some media coverage as well about the new protocol for accessing GP appointments. It was noted that the Chair and Vice-Chair had been discussing the experience of accessing GP appointments and that Board should keep a watching brief on the establishment of the new access arrangements.

The Vice-Chair:

v  Stated that he was very concerned about the media’s criticism of family doctors following government demands for them to increase face-to-face appointments. This idea to improve general practice would it was noted would do little to relieve the intense pressure on surgeries and could exacerbate the chronic shortage of family doctors by prompting more to quit the profession.

v  It was important to understand that (i) the workload in primary care is overwhelming as research now shows that primary care is managing a third all the patients on the waiting list which is 20% to 30% increase when compared to previous years (ii) this is still the Summer period (iii) staff are still off with COVID or have been in close to someone who has tested positive for COVID-19 (iv) staff are trying to catch up on leave which they have not had for year (v) whilst some people prefer online contact as it is so much more convenient for them not having to come in to a surgery but there is always challenges and situations whenever you change the way a service is provided. Accordingly, there needs that there is a sensible debate about how we can work together on ameliorating the situation with regard to access in primary care.

The Chair:

v  Reminded the Board that within (i) the Health and Wellbeing Strategy;  and (ii) the Black and  ...  view the full minutes text for item 2.

The Board will receive a presentation on coping with Mental Health – To follow.

The Board received a presentation on coping with Mental Health, the main points arising from the consideration of this may be summarised as follows:

The Board

The Board received a presentation from Lloyd Lennox on coping with Mental Health and as member of the Black Community, the main points arising from the consideration of this may be summarised as follows:

The Board

v  Received a very informative, honest and a really powerful story of the experiences that had punctuated his journey when learning to cope with Mental Health e.g. his first counsellor had gone missing and he had, had to persist to get a new counsellor to help him address his mental health issues.

v  Indicated that there was a need for a concerted effort by services to target social needs more systematically and to share power through partnership working to reduce the apparent disempowerment and wariness that some service users feel and in turn reduce potential inequalities.

v  Agreed on the importance of listening to and engaging with such patient experience, sharing information, and seeking to incorporate patient preferences within the care provided. This is one approach that may help to counter the wariness that some people feel when entering mental health services.

v  Observed that there was a need for culturally appropriate advocacy services that recognise the distinct needs of the Boroughs diverse communities. Which should contribute to breaking the cycle of social disadvantage and alienation from services that may underpin many of the entrenched ethnic disparities in access to and experiences of mental health care.

v  Was pleased to note that Lloyd had been invited by MIND to become a Peer Leader as having lived experience of mental illness he was very well placed to support others through challenging times. The training and support for this role had been provided by Mind in Tower Hamlet & Newham and had meant that he has helped others and helped himself through increasing his own skill sets, self-esteem, and confidence.

In conclusion the Chair said that she was very grateful for Lloyd having attended the Board; sharing his experiences (e.g. benefits of the Peer Leadership Programme) and his insights about local mental health services as set out in his testimony.

The Board received a presentation and a report providing an update on the work being carried out on the Mental Health Strategy.

• Theme 1 To raise awareness and understanding of the importance of mental health and wellbeing
• Theme 2 To ensure early help is available particularly in time of crisis
• Theme 3 To ensure the provision of high-quality mental health care and treatment

It was noted that a significant amount of work has been undertaken against these three themes in the last year and more is planned however due to the nature of the pandemic not all proposed actions have been taken forward in the way initially proposed. The presentation provided an update against these themes and their associated actions / outcomes with a particular focus on recovery from Covid-19. A summary of the questions and comments from the Board is set out below:

The Board

v  Noted that the Safeguarding Adult Board agrees that the consideration of mental capacity is crucial at all stages of the safeguarding adults process as it provides a framework for decision making to balance independence and protection. Especially the interface between (i) mental health accommodation issues; (ii) poverty and related difficulties on road to recovery from Covid-19; (iii) substance misuse; and (iv) the layers of vulnerability that any vulnerable adult could have, not just those diagnosed with mental health conditions.

v  Noted that the Safeguarding Adult Board was keen to collaborate with colleagues on the development of the Mental Health Strategy.

v  Noted that in regard to talking therapies there is a specific programme of work being undertaken over the next few months to look at the particular barriers to access and under representation from older adults and individuals from the BAME communities and how the offer can be adjusted to address accessibility and representation (e.g. Bringing in organisations or individuals that can better represent people from those community groups). In addition, the public health response to the pandemic, will be the subject of continued analysis and commentary over the next 12 to 18 months especially addressing (i) inequalities and population health; (ii) reshaping the relationship between communities and public services (e.g. Talking Therapies); and (iii) co-production with local communities (e.g. Addressing the barriers for community elders and how to reach into communities and to facilitate discussions).

v  Noted the development of Community Connectors (e.g. in the Somali and Bengali Communities) to help people in the Borough and their families or carers, to access community-level services and activities that will help them maintain independent lives and which help prevent their circumstances deteriorating to a point where they might need higher level health or social care services. The Community Connectors can also help support people when they return to home from hospital by helping other Third Sector services identify additional local services that may be needed.

v  Noted that the East London NHS Foundation Trustin recognising that Covid has further exacerbated existing social,  ...  view the full minutes text for item 3.2

The Board received a presentation that provided an update of recent actions including (i) an overview of the considerations and outcome of the internal review of the local Better Care Fund (BCF) plans; (ii) an update on proposed and future changes to the BCF (including areas for future integration); and (iii) an update on changes expected at a national level and anticipated assurance dates for the BCF plan sign-off for 2021-22. The discussions arising from the presentation including questions and comments regarding the BCF may be summarised as follows:

The Board

v  Asked about the benefits of pooled and aligned budgets to deliver more efficient and effective services that can lead to better outcomes for local people.

v  Noted that there a number of good examples of pooled budgets working in a smaller scale through the BCF and it is a real opportunity to think much more radically about how agencies join up their collective resources and to think about shifting investment to avoid some of these issues getting worse before they land in the Acute Sector. That is what partners want to and to challenge themselves about getting serious with regard to the pooling of budgets

v  Noted that the partnersas a group of system leaders recognise that they have to have that conversation now or lose that opportunity especially regarding delegations to Borough and the local areas. Also to be very clear as to their shared ambition and to make sure that their goals both politically and within the wider public health agenda are harmonised.

v  Noted that potentially there are opportunities (i) around supporting multi-disciplinary teams in the network of GP practices; and (ii) around how do we get some voluntary sector organisations involved.

v  Agreed that these developments need to be in line with the Integrated Care System (ICS) changes and that this will be worked on in the coming weeks

v  Agreed that partner agencies need to look at the total resource for a particular area e.g. learning disability and to be willing to (i) put those resources together in pooled or an aligned budget; (ii) consider what are the outcomes they want to achieve with a particular cohort of people; (iii) think about all the potential challenges and situation; and (iv) agree where any pilots for pooled or an aligned budget should take place.

v  Agreed that this has been a really good start a conversation about the BCF but it would be helpful for an ongoing discussion about the development of pooled or aligned budgets and where to pilot those at the next meeting together with the introduction of the Integrated Care System (ICS).

As a result of considerations on the report the Board:

1.    Noted the report on the proposed areas of integration from 2022-23; and

2.    Agreed for a further discussion on the development of pooled or aligned budgets at the next meeting together with the introduction of the Integrated Care System (ICS)

The Board received a report that presented the refreshed 2021 Tower Hamlets Joint Health and Wellbeing Strategy and it was noted that:

1. The primary aim of the Strategy is to explain what priorities the Health and Wellbeing Board has set in order to tackle the needs of the local population, setting a small number of key strategic priorities for action that will make a real impact on people’s lives.
2. The refreshed strategy recognises both the long-standing health needs and inequalities in Tower Hamlets, and the emerging longer-term impacts of the pandemic; and
3. This strategy has been driven by what local people have told the Board what is important to them. The findings have driven the principles and ambitions of the Strategy and therefore the work of the Health and Wellbeing Board going forward.

The Board noted that as according to the current formal terms of reference the meeting is not quorate and as a result the Health and Wellbeing Strategy will be formally ratified at the next formal Board meeting.

In conclusion the Chair (i) expressed her thanks to everybody who had contributed this evening; and (ii) noted the following future items of business (a) GP access; (b) digital inclusion; (c) BCF Pilots; (d) Winter preparedness; (e) the vaccine programmes; and (f) the impact of the increase in gas and electric prices; (g) the integrated care systems ; and (h) impact of Universal Credit cuts across LBTH.

Finally, the Board noted that Healthwatch Tower Hamlets o 17^th November 2021 would be holding a conference on the lessons that has been learnt from Covid in terms of delivering better services and outcomes.