The Health & Wellbeing Board and ICB Sub-Committee met on Tuesday 16 January 2024 to discuss winter planning, the NEL Joint Forward Plan, financial updates, and the Director of Public Health's annual report. Key decisions included noting the winter planning update, endorsing the draft NEL Joint Forward Plan Refresh 2024/25, noting the financial position for 2023/24, and noting the Director of Public Health's draft Annual Report for 2022/23. The committee also agreed to proceed with the procurement of integrated adult and young people's substance misuse services.

Barking and Dagenham Winter Planning Update

The committee received an update on the progress of this year's winter planning arrangements. Kelvin Hankins, Deputy Director and Lead for Ageing Well for the Barking and Dagenham Place Team at NHS NEL ICB, presented the report. Despite pressures from industrial action, significant improvements were noted in four-hour waiting times at King George's Hospital (KGH) and Queen's Hospital (QH), with both facilities nearing the revised national standard. Barking Urgent Treatment Centre (UTC) also reported a high achievement level. Category 2 response times for the London Ambulance Service (LAS) in North East London had improved, and schemes like REACH were helping to reduce hospital admissions.

Winter Plan actions and priorities were discussed, with no significant risks identified. Winter hubs were available for support, though national funding for respiratory hubs was absent. Additional funding for a reablement service in the Borough and a well-received winter communications and engagement plan were highlighted. Councillor Maureen Worby, Cabinet Member for Adult Social Care, Health and Housing, emphasised the need for clear communication about free services, particularly for the elderly, and discussed 'risk of falling' mitigation. Concerns were raised about plans for continuous improvement given the growing population, with Mr Hankins explaining that the ICB sustainability case model accounted for this. The handover time from ambulance services within the Borough, currently 30-45 minutes against a 15-minute national standard, was noted as an area for continued work. The committee also discussed residents attending hospitals outside the Borough, such as Newham Hospital or the Royal London Hospital, potentially due to perceived shorter wait times or better transport links. Mr Hankins clarified that most local residents continued to use KGH and QH. Dr Kanika Rai, Place based Partnership Primary Care Development Clinical Lead, noted a disparity in automatic booking into specialist outpatient clinics between BHRUT and other areas, suggesting this could contribute to patients moving around the system and should be factored into modelling to reduce health inequalities.

The Health and Wellbeing Board and ICB Sub-Committee resolved to note the report.

NEL Joint Forward Plan Refresh 2024/25

Sharon Morrow, Director of Partnership, Impact and Delivery at NHS NEL, presented the NEL Joint Forward Plan Refresh (JFPR) 2024/25. The report included a Barking and Dagenham Local Plan (BDLP) and would be updated to reflect discussions from a December workshop. The annual NHS Planning Guidance was delayed, but many priorities from the previous year were expected to remain. ICBs are also required to produce a Capital Plan by April.

The draft JFPR and BDLP share priorities with the Joint Health and Wellbeing Strategy. A planning group will identify key priorities to improve health outcomes within available resources, with prevention being a key aspect. Members discussed re-prioritising schemes that promote levelling-up over easing financial difficulties, ensuring the JFPR reflects local priorities, and challenging data to accurately represent achievements within current resources. The need for new healthcare provision and buildings to accommodate the growing population was highlighted, alongside learning from best practices, the importance of prevention and intervention, and celebrating achievements such as GP pop-ups and increased GP appointments. Integrating new ways of working into business as usual and a greater emphasis on workforce issues in Barking and Dagenham were also discussed, with a Workforce Strategy in development.

The Health and Wellbeing Board and ICB Sub-Committee resolved to note the planning update and endorse the draft NEL Joint Forward Plan Refresh 2024/25.

ICB Finance Overview - Month 7 2023/24

Sunil Thakker, Director of Finance at NHS NEL, provided an update on the financial positions of the NEL ICS and ICB at period 7 of the 2023/24 financial year, including delegated budgets for Barking and Dagenham Place. The ICB reported an adverse variance to plan of £16.5m, contributing to a £87.2m adverse variance for the ICS. Key drivers for the overspend included inflation, failure to deliver efficiencies, ongoing industrial action, operational pressures, and lost income for providers. Mitigations and a formal recovery plan (FRP) are being implemented.

Despite some improvements since the report was written, ongoing costs from industrial action are expected to negatively impact the year-end position. Discussions with NHS England regarding potential additional funding are underway. Charlotte Pomery, Executive Director at NHS North East London, highlighted the value of a medium-term financial plan and aspirations for more integrated finance reporting across health and local authority sectors.

The Health and Wellbeing Board and ICB Sub-Committee resolved to note the updated financial position for 2023/24.

Draft Annual Report of the Director of Public Health 2022/23

Matthew Cole, LBBD Director of Public Health, presented his draft Annual Report for 2022/23. The report addresses the lasting impacts of Covid-19, including on life expectancy and its determinants, noting that Barking and Dagenham experienced disproportionately higher demand for health and social care services due to economic difficulties. The report connects with the Borough Manifesto, the Council's Corporate Plan, and the ICS Joint Local Forward Plan, and will feed into the 2024 Joint Strategic Needs Assessment.

Key messages include the need to improve healthy life expectancy through place-based partnerships, address contributing factors to overall health and independence in later life, and tackle long-term conditions, behavioural risk factors, and wider determinants of health. The report stresses the importance of actions affecting both short-term adult health and the entire life course, breaking down barriers to health inequalities for hard to reach groups, aligning strategic and delivery plans, and reprioritising the Public Health Grant. The impact of Covid-19 on mental health and the role of early intervention through a place-based approach were highlighted. An health in all policies approach is advocated to understand the role of health inequalities in driving community priorities like employment. The report also emphasises driving forward vaccination and immunisation programmes, with the Chair encouraging promotion of the MMR jab.

Elspeth Paisley, Health Lead at BD Collective, welcomed the focus on healthy life expectancy and suggested short and longer-term targets for progress assessment. Other observations included recognising communities as assets, addressing social isolation and loneliness, understanding patient needs for better referral pathways, the effectiveness of social prescribing in Barking and Dagenham, the long-term impact of consistent health checks, and the disparity in central funding received by Barking and Dagenham compared to neighbouring boroughs. Nathan Singleton, Chief Executive of Healthwatch - Lifeline Projects Ltd, referred to a Healthwatch report on Education Health and Care Plans (EHCPs) and the projected increase in cases, highlighting the need for early intervention. Councillor Worby mentioned the Council's work on localities and seamless service integration. A peer review of the local public health approach led by the Local Government Authority (LGA) is scheduled for February 2024.

The Health and Wellbeing Board and ICB Sub-Committee resolved to note the Director of Public Health's draft Annual Report for 2022/23.

Barking and Dagenham Partnership Risk Register

Sharon Morrow presented the partnership risk register, which identifies key risks to achieving strategic objectives. Identified risks for 2023/24 include capacity within management and clinical teams, capacity in children and young people's therapy services to meet increasing demand for SEND, the High Intensity Service not adequately supporting Barking and Dagenham residents, and the current proactive care model not meeting best practice guidance. Ms Morrow confirmed the register is continually monitored and updated.

The Health and Wellbeing Board and ICB Sub-Committee resolved to note the current partnership risk register.

B&D GP Federation - CQC Inspection

Craig Nikolic, Chief Operating Officer of B&D GP Federation, announced that the Federation had received an overall 'Good' rating from the Care Quality Commission (CQC), with an 'Outstanding' rating for how patients and residents are listened to. The CQC report is expected to be published soon. The Chair suggested that the Committees in Common would benefit from regular reports on CQC inspection outcomes.

Procurement of Integrated Adult and Young People Substance Misuse (Drug and Alcohol) Services

Matthew Cole introduced a report on proposals to procure an Integrated Substance Misuse Service, divided into two lots: Adults and Young People. The contracts, commencing 31 March 2024, will be for up to seven years with a combined annual value of approximately £2.5m, funded from core grant via the Office of Health Improvement and Disparities (OHID).

The Health and Wellbeing Board resolved to:

• Agree that the Council proceeds with the procurement of a contract for Adult and Young People's Integrated Substance Misuse (Drug and Alcohol) Services in accordance with the strategy set out in the report.
• Delegate authority to the Strategic Director, Children and Adults, in consultation with the Cabinet Member for Adult Social Care and Health Integration and the Head of Legal, to conduct the procurement and award and enter into the contracts and all other necessary or ancillary agreements, including extension periods, to fully implement and effect the proposals.