Agenda item

a.    Update on the Wellbeing Partnership (verbal)

b.    Developing an Accountable Care Partnership Across Haringey and Islington

c.    Discussion – Work stream on Cardiovascular Disease and Diabetes in Haringey and Islington

Item 8a. Update on the Wellbeing Partnership

Sarah Price, Chief Officer of Haringey CCG, provided a verbal update on the Haringey and Islington Wellbeing Partnership.

It was advised that Haringey and Islington had consolidated their position in relation to the other North Central London boroughs and the work of the Wellbeing Partnership was being recognised as a key component of the North Central London Sustainability and Transformation Plan.

Work around cardiovascular disease and diabetes was underway and would be key in helping to deliver sustainability. Work undertaken around mental health would also be very important. Work around musculoskeletal conditions was due to start following the appointment of a lead officer. A children’s and young people project was also being developed under the Wellbeing Partnership, in response to feedback from staff that they wanted to see its inclusion as one of the initial workstreams. It was noted that Tim Deeprose had recently been appointed as the Interim Programme Director for the Wellbeing Partnership, and that establishing a team to support the work was a key task to help drive the project forward.

Following a request for clarification, it was advised that the musculoskeletal work had not progressed at the same pace as other workstreams due to capacity and the need to identify resources and officers to lead on delivery of the project.

The Board noted that representatives from both Islington and Haringey CCGs, local authorities and the Whittington and North Middlesex hospitals had met the previous week to consider the children and young people workstream. It was thought that the workstream would review the demands of children and young people on A&E, as well as the pathways for children with long term conditions, and childhood obesity. Whittington Health had volunteered to draft a plan for the proposed work.

In response to a question on the pressures on A&E services at the Whittington, Simon Pleydell advised that the issue was around what was the most suitable setting to receive care and whether that was in a community setting or whether this was at an emergency department. This was a key challenge faced across the health sector. 

Item 8b. Developing and Accountable Care Partnership

Zina Etheridge, Deputy Chief Executive of LB Haringey, and Charlotte Pomery, Assistant Director of Commissioning at LB Haringey, presented the report which proposed the establishment of an Accountable Care Partnership. 

The following main points were noted in the discussion:

·         The Wellbeing Partnership was working well and it was thought that consideration should be given to developing formal governance arrangements. It was commented that a formal governance structure would assist partner organisations in making the transition to a more integrated model. The need for system-wide partnership working was recognised, however it was suggested that at present there was not the system-wide responses available to tackle them effectively.

·         Whilst work was underway to rationalise services through the partnership, it was commented that duplication and inefficiencies existed in the system. For example, each organisation had its own contracting and commissioning arrangements. The result of this was that Haringey and Islington residents were entitled to different services from providers such as the Whittington.

·         It was noted that commissioners and providers were increasingly moving towards pooled budget arrangements. It was suggested that this should be explored for the Wellbeing Partnership, however it was recognised that shared budgets presented challenges which would need to be carefully considered. 

·         The Wellbeing Partnership had created a partnership at two levels; a top-down strategic layer, and a bottom-up operational layer. It was thought that an Accountable Care Partnership could facilitate the scaling up of areas of good practice by adopting an operational form that encouraged innovation in planning, resourcing and delivering services.

·         Whilst there were other Accountable Care Partnerships operating across the country, it was thought that these did not offer a ready-made model suitable for the particularly complex health and care landscape in Islington and Haringey. Further thought on governance arrangements and how to engage clinicians, social care organisations and other professionals was required. It was important for any Accountable Care Partnership to able to work effectively with local communities and the wider health and care system. 

·         A recent Joint Health Overview and Scrutiny Committee meeting had found that there was an appetite from local people to engage in the development of health and care services.  It was thought that that the STP felt far removed from local people and the process of co-production should be embedded early in the development of any Accountable Care Partnership.

Cllr Caluori entered the meeting.

·         It was thought that a formal governance arrangement would give partner organisations greater influence, particularly in regards to the STP process. It was commented that financial stability could be best achieved through a structural approach. 

·         The Board noted concerns that service users could not keep up to date with the number of changes to the health and care system. It was important for service users to understand how and where decisions were made, and how to influence those decisions.

·         There would be both costs and savings associated with establishing an Accountable Care Partnership, however these would not be known until the form of the Partnership was decided. A business case would need to be developed and reviewed before any changes were agreed. 

·         The Board acknowledged that clarity around governance arrangements was required and it was important to ensure that any organisation established was transparent and accountable to the local community. The Wellbeing Partnership Sponsor Board was reviewing accountability issues in tandem with work underway on governance and its findings would be reported to a future meeting. 

·         It was noted that not all health providers in Islington and Haringey were engaged in the Wellbeing Partnership and consideration would need to be given to how these organisations would interact with any Accountable Care Partnership.

RESOLVED:

 (1)          That the principles and high level outcomes as developed by the Sponsor Board of the Haringey and Islington Wellbeing Partnership be adopted;

(2)        That the development of a form of accountable care partnership which best supports the outcomes sought by the Haringey and Islington Wellbeing Partnership be agreed in principle; 

(3)        That further work to develop the detail of such a partnership, with the aim of gaining agreement on the final structure and form from constituent decision making bodies by April 2017, be endorsed;

(4)        That the Sponsor Board report back on progress in developing and implementing a project plan; 

(5)        That the Sponsor Board be requested to consider as a matter of priority how community and stakeholder engagement will be undertaken and involve key stakeholders including Healthwatch.

Item 8c. Workstream on Cardiovascular Disease and Diabetes in Haringey and Islington

Dr Will Maimaris, Consultant in Public Health, and Claire Davidson, lead on self-management support and behaviour change at Whittington Health, made a presentation to the Committee on health and care needs relating to diabetes and cardiovascular disease.

The following main points were noted in the discussion:

·         Haringey had the 2^nd highest rate of early death from stroke in the country. There were 23,000 people diagnosed with diabetes in Haringey and Islington and 1 in 5 of these people was likely to have depression.

• 1 in 5 people had high blood pressure in Haringey and Islington. People living in the most deprived parts of Haringey and Islington were more than 3 times more likely to die young from cardiovascular disease than people living in the most affluent areas.
• There was a high level of spending on those who had already developed diabetes, CVD and complex health needs. Dr Maimaris suggested that the biggest impact could be made by targeting interventions at the wider population, through initiatives such as Healthy High Streets, as these would support the health of everyone, including those with existing conditions.

• The self-management support approach at the Whittington involved patient programmes which focused on building knowledge skills and confidence so that patients could effectively manage their own health conditions. Support for clinicians was also involved, to build knowledge, skills and confidence to support self-management and build coaching and communication skills.  The approach also included providing support to services to embed the approach into their way of working.
• It could often take a significant amount of time for people to build up to being able to self-manage their conditions. At present services were structured so that patients received short interventions and consideration needed to be given to think about how the system as a whole could operate to facilitate self-management in an integrated way.
• The diabetes self-management programme could achieve a reduction in HbA1c (blood sugar control) of 0.6% which was equivalent to the reduction achieved through anti-diabetic drugs but was considerably cheaper. There were currently 200 places available per annum on the programme.

·         Dr Maimaris advised that engagement with clinicians and partners to find the main opportunities for improving outcomes and value for money was already underway and that the Wellbeing Partnership was had the potential to be a vehicle to help drive improvements in CVD and diabetes. 

• Dr Maimaris advised that gaps identified locally were also highlighted within the NCL STP case for change: challenges in primary care provision; a lack of focus on prevention across North Central London; gaps in early detection of disease; and lack of integrated care and support for people with long-term conditions. Whilst the NCL STP would provide a framework to tackle some of the challenges identified, many of the solutions would need to be implemented at a more local level.

·         The Board recognised the potential benefits of collaborative working on diabetes and cardiovascular disease, and emphasised the need to engage local communities in preventative work. Initiatives such as Healthy High Streets and the Daily Mile were considered to have a positive impact on population health, but required coordinated support from local services and organisations; including schools, voluntary and community groups, and others. Preventative work in Haringey was supported through the Haringey Obesity Alliance and it was suggested that a cross-borough alliance could be developed.

·         Members of the Board were aware of several disparate, small initiatives focusing on obesity and suggested that these needed to be coordinated and scaled up to have a larger impact. It was commented that effective work on diabetes and cardiovascular disease would have a positive effect on the whole health of the population, and a significant impact could be made by targeting interventions on school children. Collaborative working on such initiatives provided the opportunity to tackle broader issues of inequality and social justice. 

·         The Board noted that the Adult Social Services departments of Islington and Haringey were intending to carry out a reciprocal peer review, with a particular focus on prevention. It was suggested that this would create a number of opportunities for joint working and the outcomes of the review could be presented to a future meeting of the Board.

RESOLVED:

 (1)             That the issues raised in the submitted report and presentation be noted;

 (2)             That the opportunities for improving population health outcomes and value for money for cardiovascular disease and diabetes prevention and care through the Haringey and Islington Wellbeing Partnership be noted.