The Health and Wellbeing Board and ICB Sub-Committee met on 16 January 2024 to discuss winter planning, the NEL Joint Forward Plan, ICB finances, and the Director of Public Health's annual report. Key decisions included noting the winter planning update, endorsing the draft NEL Joint Forward Plan, and noting the ICB's financial position.

Barking and Dagenham Winter Planning Update

Kelvin Hankins, Deputy Director and Lead for Ageing Well for the Barking and Dagenham Place Team at NHS North East London ICB, presented an update on the winter planning arrangements. He highlighted improvements in emergency care response times at Queen's Hospital and King George Hospital, with urgent treatment centres also showing strong performance. While Category 2 ambulance response times for North East London had improved to 43 minutes, further work is needed to meet the national target of 30 minutes. Schemes like REACH, which provide senior clinical advice to ambulance crews, are helping to reduce unnecessary hospital conveyances. The winter plan's actions are largely on track, with highlights including efforts to optimise MMR and flu vaccine uptake, the funding of respiratory hubs, and the upcoming launch of a reablement service. Councillor Maureen Worby emphasised the need for clear, accessible communications about available services, particularly for the elderly. Concerns were raised about continued improvement in waiting times given population growth, and Mr Hankins noted that the ICB's sustainability case model addresses increasing population needs. Dr Kanika Rai pointed out a discrepancy in how specialist outpatient clinic appointments are booked between Newham Hospital/Royal London Hospital and BHRUT, suggesting this could influence patient choice and contribute to health inequalities. The 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 an update on the refresh of the North East London (NEL) Joint Forward Plan (JFP) for 2024/25. The first draft of the JFP, including a Barking and Dagenham Local Plan, was appended to the report. Ms Morrow explained that the plan is continually being updated based on feedback and discussions, with a workshop held in December to identify gaps, duplication, and synergies. The annual NHS Planning Guidance, which influences the JFP, has been delayed until late January. New national guidance requires ICBs to produce a Capital Plan by April, aligned with the JFP. Members discussed the re-prioritisation of the Integrated Care Partnership's three priorities, placing schemes and projects that promote levelling-up above easing financial difficulties. Concerns were raised about not becoming bogged down in national requirements and ensuring the JFP reflects local priorities. Councillor Craig Nikolic recommended a more awkward approach to challenging data and advocating for increased resources, particularly for estates and workforce. Ms Morrow acknowledged the constraints but highlighted the ongoing work on a manifesto for North East London to lobby for capital and estate funding. Councillor Sharon Morrow noted the need for clarity on now programmes concerning long-term conditions, babies, children, and young people, and how these align with place level work to avoid duplication. The 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, presented the financial overview for the NEL Integrated Care System (ICS) and ICB at Month 7 of the 2023/24 financial year. The ICS reported an adverse variance of £87.2 million, with the ICB having an adverse variance of £16.5 million. Key drivers for the overspend included inflation, under-delivery of efficiency targets, staffing costs (including agency use), industrial action, and operational pressures. A formal Financial Recovery Plan (FRP) is in place to mitigate these pressures. Since the report's drafting, there have been some financial improvements, but ongoing costs from industrial action are expected to negatively impact the year-end position. Discussions with NHS England are ongoing regarding potential additional funding. Charlotte Pomery highlighted the importance of a medium-term financial plan and aspirations for more integrated financial reporting across health and local authorities. The committee resolved to note the updated financial position.

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

Matthew Cole, Barking and Dagenham's Director of Public Health, presented his draft Annual Report for 2022/23. The report highlights the lasting impacts of COVID-19 on life expectancy and health determinants, compounded by economic difficulties and increased demand for health and social care services. Mr Cole connected his report to the Borough Manifesto, Council's Corporate Plan, and the ICS Joint Local Forward Plan. Key messages included the need to exploit place-based partnership opportunities to improve healthy life expectancy, focus on early diagnosis and management of long-term conditions, address behavioural risk factors like smoking and obesity, and tackle wider determinants of health. The report also emphasised the impact of COVID-19 on mental health and the importance of a place-based approach for early intervention. Councillor Worby asked for clearer targets and timelines for improving healthy life expectancy and linking wider determinants of health. Ms Elspeth Paisley welcomed the focus on healthy life expectancy and suggested recognising communities as assets. Councillor Craig Nikolic highlighted the need for more explicit focus on neurodiversity and social isolation. The committee resolved to note the draft Annual Report and support a discussion on taking forward the advice once published.

Barking and Dagenham Partnership Risk Register

Sharon Morrow, Director of Partnership, Impact and Delivery at NEL ICB, introduced the partnership risk register, which identifies key risks to achieving strategic objectives. Current risks include capacity issues within management and clinical teams, insufficient capacity in children and young people's therapy services for those with Special Educational Needs and Disabilities (SEND), the High Intensity Service not adequately supporting Barking and Dagenham residents, and the lack of a consistent proactive care model and case-finding tool. The register is a work in progress, with delivery groups updating it and escalating significant risks to the committee. The committee resolved to note the current partnership risk register.

B&D GP Federation - CQC Inspection

Craig Nikolic, Chief Operating Officer for the 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 listening to residents. The committee congratulated the Federation and noted that the full report would be published soon. The Chair suggested that regular reports on CQC inspections would be beneficial for the committee.

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

Matthew Cole presented a report on proposals to procure an Integrated Substance Misuse Service, covering both adults and young people, under two lots. The contracts, commencing 31 March 2024, have a combined annual value of approximately £2.5 million, funded by the Office of Health Improvement and Disparities (OHID). Due to the late publication of the report, members were invited to provide any comments after the meeting. The committee resolved to agree the procurement of the service and 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 the contracts. Dr Ramneek Hara and Councillor Syed Ghani raised concerns about pathways for dual diagnosis (mental health and drug/alcohol abuse) and housebound patients, which Mr Cole confirmed were addressed in the contract specification. Dr Hara also highlighted the need for clarity on prescribing responsibilities and joint working to avoid gaps in service provision.