Agenda item

a)    Presentation on the Frailty Workstream

Dr Helen Taylor provided an update on progress with the Wellbeing Partnership’s frailty workstream.

The following main points were noted in the discussion:

·         The level of frailty in Islington and Haringey was increasing as the population aged. However, the needs of frail people were exacerbated by factors such as deprivation and unsuitable housing. It was suggested that addressing these factors could significantly increase patient wellbeing.

·         Whilst high-dependency patients were already known to the health system, it was thought that there were a number of people living with long term conditions who would only be identified as being frail once they had a health crisis and presented to A&E. It was commented that frailty usually worsened after health crises and vulnerable people often did not regain their full independence. As a result the patient’s demand for health and social care, particularly emergency care, tended to increase after a crisis. Frailty therefore had considerable costs to the individual and the health and care system as a whole. It was considered that treating frailty itself as a long term condition and intervening earlier would improve outcomes for vulnerable people and achieve savings for health and care services.

·         A frailty index had been developed through the Wellbeing Partnership which allowed a person’s frailty to be measured against 32 deficits. This was intended to be used as a pop-up system for GPs when assessing a vulnerable person’s needs. The system would allow local agencies to assess levels of frailty and ensure that vulnerable people received appropriate support before they reached a crisis point.

·         It was thought that there were 10,000 people across Islington and Haringey who were either mild, moderately or severely frail. Local services needed to consider what could be done to stop those who were mild or moderately frail from becoming severely frail. For example, it was suggested that there could be a case for providing specialist care or services to frail people if they were just below eligibility thresholds if it would stop their frailty increasing.

b)    Discussion on the Wellbeing Partnership

Tim Deeprose, Programme Director, Haringey and Islington Wellbeing Partnership, led a discussion on how to further develop the wellbeing partnership.

·         It was thought that agreeing data sharing arrangements would be essential to providing targeted and joined-up services.

·         It was thought that agreeing system-wide objectives and performance indicators would promote integration and collaboration between services. 

·         It was thought that joint procurement and pooling budgets would help to achieve efficiencies and service integration; however it was acknowledged that there were technical difficulties associated with financial matters.

·         It was suggested that a shared health and wellbeing strategy would be useful in establishing a joint vision for health and care across Islington and Haringey.

·         It was suggested that some services could be joined and operate across organisational boundaries, or could operate with shared management structures, however each organisation would need to consider the implications of this diligently.

·         It was suggested that risks and concerns associated with joining services across organisational boundaries could be minimised by taking a cautious approach, focused on making one or two joint services work effectively and then expanding to other areas, rather than immediately integrating several services.

·         The Board noted that agreement had already been secured through the CCG for a joint local arrangement across the two boroughs with a shared commissioning post. 

·         The Board considered the proposed governance structure of the Wellbeing Partnership, as set out in the agenda pack. The proposed structure was considered sensible, however it was commented that the Wellbeing Partnership was still relatively new and revision may be required as arrangements developed.

·         The Board considered the barriers faced by the Wellbeing Partnership to date, which included information sharing and communication between different parts of the health and care system. It was commented that agreeing a governance structure would assist with resolving such barriers. 

·         The Board considered how democratic accountability could be ensured in the Wellbeing Partnership. In response, it was suggested that a light-touch partnership model requiring decisions to be made by its constituent organisations would not require additional democratic oversight, however a more developed partnership with budgetary responsibility would require democratic representation on decision-making bodies. It was thought that over the next 12 to 18 months democratic accountability would remain with the individual statutory organisations that made up the Wellbeing Partnership Board.

·         It was thought that developing joint Health and Wellbeing Board arrangements between Islington and Haringey would ensure that the Wellbeing Partnership received oversight from both elected members and professional officers.

·         It was queried whether the community reference group referred to in the draft governance structure would be one group, combining voluntary and community sector groups across Haringey and Islington or whether there would be two groups. The Board also considered the need to ensure that local organisations were included in any future commissioning arrangements.

·         It was emphasised that partnership arrangements needed to develop within a relatively short timescale to ensure that benefits would be realised and to enable organisations to respond to the STP effectively. It was noted that the governing bodies of partner organisations would be asked to approve the Partnership Agreement in the spring. It was requested that a more detailed proposal for governance arrangements be reported to a future meeting of the Board.

RESOLVED:

That the report be noted.