Alison Blair introduced the report which provided an update on proposals for greater integration between Islington Council, Islington Clinical Commission Group, their counterparts in Haringey, Whittington Health NHS Trust and Camden and Islington NHS Foundation Trust.
The following main points were noted during the discussion:
· The overall objective of integration was to improve health and care services for residents. It was thought that further integration of services would contribute to residents feeling supported and listened to and would mean that service users would only have to provide information once.
· In considering integration matters, partners would need to review how they communicate with each other and the public, the information they hold, how systems are managed and the changes required to achieve the best outcomes for residents. It was considered that further integration would improve efficiencies and the financial sustainability of services.
· The Board considered local services and initiatives which had benefitted from further integration, including the Integrated Community Ageing Team, iHub, locality networks and the integrated digital care record project. It was noted that there was national support for further integration of local services and, following small-scale successes, local agencies had to consider how services could be integrated further and at a greater pace.
· It was reported that discussions with Haringey had continued following the NHS Vanguard application in early 2015. Whilst there was a local and national appetite for integration, further consideration was required on how integration would impact on service providers, financial resources and the sustainability of services. The Board noted that it was crucial for local needs and priorities to be reflected in any integration arrangements.
· It was agreed that the Health and Wellbeing Boards of Islington and Haringey were best placed to lead on the integration of services and infrastructure. There was a need to move from integration on initiatives to integration at a strategic and governance level, although it was recognised that this was a greater challenge. The Board requested a further report on how integration with Haringey at a governance level could be achieved.
· To ensure integration achieved the desired outcomes, integration would need to be approached in a careful and targeted manner. All partners needed to further consider what was to be integrated and why. In addition, Islington Council would need to consider how integration with Haringey would interact with joint-working with Camden on Public Health functions. It was reported that CCG Chairs across London had recently discussed the benefits of collaboration and opportunities for shared learning.
· Although the Board recognised the potential efficiencies and benefits of integration, it was agreed that a detailed vision was required to shape the integration of local services. It was thought that once this vision was agreed the governance arrangements would follow. Partners would need to address the spatial scale of services; determining which services were best delivered at a sub-borough, borough, cross-borough, and cross-London scale.
· The importance of involving local people in developing integrated services was emphasised. In particular, it was commented that services had to reflect the differing levels of independence of service users; the level of professional involvement should be flexible to service user needs.
· It was suggested that naming the integration project would make it more tangible.
· It was hoped that integrated services would ease referral processes. It was emphasised that the focus of integration should be on securing the best outcomes for patients and services and achieving economic benefits over a given timescale, as opposed to secondary concerns such as the management of buildings and facilities.
· It was suggested that integration could be assisted by mapping health and care pathways across boroughs; as although local agencies had similar processes to their counterparts in Haringey, these were not identical and integrated services would need to either resolve or recognise local differences.
· The Board requested that detailed proposals for integration, including an assessment of the optimal spatial scale of services and legal implications, be prepared and reported to the Board for discussion as soon as possible.
1) That the principle of further integration of local agencies in Islington and Haringey be supported;
2) That a further report on integration at a governance level be received to a future meeting; and
3) That detailed proposals for integration be prepared and reported to the Board for discussion as soon as possible.