Agenda item

Jess McGregor, Service Director – Strategy & Commissioning, Clare Henderson, Director of Commissioning and Integration at Islington CCG, and Julie Billett, Director of Public Health, introduced Items B1 and B2 on partnership working and integration of the local health and care system.

The following main points were noted in the discussion:

·         Partnership working was crucial to improvement of local services. Services for those with learning disabilities were cited as a successful example of joint commissioning by the clinical commissioning group and the local authority, and joint delivery by the local authority and the local mental health trust. The procurement of supported accommodation was also cited as a good example of joint working which ensured that the needs of local people were met.

·         It was commented that commissioning of Child and Adolescent Mental Health Services was another example of effective joint working between the local authority and clinical commission group. The use of pooled resources across the health and care system ensured that services were able to meet the needs of local people in an efficient and comprehensive way. 

·         Islington Public Health led on the commissioning of sexual health services across North Central London. The successful rollout of PrEP was an example of effective joint working across the partnership.

·         Members of the Health and Wellbeing Board welcomed successful joint working initiatives and commented on areas that would benefit from further joint working across the local health and care system.

·         In response to a question, it was advised that the Royal Free provided patient transport services on behalf of various local hospitals and Barnet CCG was the lead commissioner at NCL level. It was advised that any issues associated with the service should be communicated to the Provider Board.

·         Following a question, it was advised that a carers’ needs analysis would be carried out and this would help to inform the commissioning and delivery of future services. To date services for carers had primarily focused on meeting the needs of particular groups, including young carers, BME carers, and challenging the stigma faced by residents who care for people with substance misuse or mental health issues.

·         There were many “hidden carers” and carers often only became known to local services when they reached a crisis point. It was commented that carers could be better supported if they were known to local services before they reached this point.

·         It was reported that services for young carers were well received and the local authority was confident of their offer to young people with caring responsibilities; however young carers had reported to the local authority that they thought young carers were significantly under identified. It was suggested that further work with schools would help to identify young carers and ensure that they were able to access support services. 

·         The Board queried what actions were being taken to reduce delayed transfers of care. In response, it was advised that work was underway to improve performance in this area, including further collaboration with local hospitals, weekly multidisciplinary calls to resolve delays, the implementation of a Trusted Assessor role to support the timely discharge of patients into care homes, improving communication with care homes, and work to support the care home market across North Central London. It was commented that some families reject the onward care arrangements made for their relatives. The reasons for this were often complex and specific to the case and further work was needed to understand and resolve such issues.

·         It was queried why Islington had a higher number of delayed transfers of care in comparison to other London boroughs. In response, it was suggested that the reasons were complex, and the relatively higher proportion of patients with mental health needs could be a contributing factor. It was also commented that the accuracy of the data would need to be reviewed before drawing conclusions on this issue. It was suggested that this issue could be reviewed at a future meeting.

·         A member commented on the importance of gathering feedback on the patient experience, particularly over winter, as this would help to inform future improvements to care pathways.

·         The Board reviewed the high level road map to the integration of services detailed in the meeting papers and agreed that it was a sound basis for the development of a borough-wide integrated health and care system.

·         It was commented that the integration of health and care services would need to develop coherently alongside the local authority Localities Programme. It was noted that further discussions on this alignment would take place outside of the meeting.

·         The Board agreed the recommendations in the reports.

RESOLVED:

(i)           That the progress made since March 2019 towards the development of an Islington Borough Partnership be noted;

(ii)          That the progress in 2018/19 between health and social care under Section 75 arrangements including key achievements be noted;

(iii)         That the priorities for 2019/20 be noted, and the receipt of future annual reports on these arrangements be agreed;

(iv)         That the Better Care Fund 2019/20 Islington plan be ratified.