The Integrated Meeting of the Waltham Forest Health & Wellbeing and Health & Care Partnership Boards included discussions on partnership governance, promoting wellbeing, population health, integrated neighbourhood working, and adult ADHD services. Councillor Louise Mitchell, Health and Wellbeing Board (Portfolio Lead Member - Adults and Health) was scheduled to chair the meeting. The boards were expected to look at ways to maximise the value of integrated meetings and to establish clear, measurable priorities for the period 2025-2027.

Adult ADHD Assessment and Treatment Service

The Waltham Forest Health and Care Partnership Board was expected to discuss the challenges faced by the adult ADHD assessment and treatment service in Waltham Forest, which is managed by North East London NHS Foundation Trust (NELFT).

According to the report pack, the service has experienced a steep rise in demand, leading to increasing waiting lists and delays for assessment. The report pack stated that in 2024, NELFT boroughs received 2,532 referrals, compared to 155 in 2020. In Waltham Forest, the waiting list has grown to approximately 2,000 people, with assessment waits of several years.

The report pack noted that NELFT has attempted to meet the demand, but this has had a detrimental impact on other services. It also stated that an increasing number of GPs in the borough are declining shared care arrangements for ADHD patients.

The report pack stated that a clinical interface meeting across North East London identified the following key issues:

• Overwhelming demand and capacity constraints
• Shared care agreement challenges
• Private provider integration issues
• Patient expectations and communication
• Thresholds for referral

Given these pressures, the report pack stated that NELFT proposed to prioritise existing resources for three groups:

1. Adults already initiated on treatment who require ongoing review
2. Children and young people transitioning from CAMHS who have already been diagnosed and initiated on treatment
3. Adults with complex needs and presentations comorbid with other mental health conditions who are already under the care of secondary care mental health services

As a result, the report pack stated that NELFT would need to close its waiting list to new referrals. The report pack also anticipated that these changes could result in further delays for those currently on the waiting list but not from the three priority groups.

The report pack stated that NELFT intended to inform referring partners, including all GP practices in the borough, of these changes. The report pack also stated that it anticipated that the closure of the NELFT waiting list may lead to an increase in referrals to private sector providers funded through Right to Choose, and that further consideration is needed across the partnership to mitigate this risk.

Integrated Neighbourhood Working

The boards were scheduled to discuss a report providing an overview of the national context, North East London Integrated Care Board, the proposed Waltham Forest vision and implementation plan for Integrated Neighbourhood working.

The report pack stated that national and government direction calls for the improvement of the nation’s health by delivering better and more preventative care closer to where people live their lives, and that investing in integration at place is key to deliver the government’s plans.

The report pack referenced Lord Darzi's 2024 review, which stated the need to simplify and innovate care delivery for a neighbourhood NHS, showing that the best way to do this was to work as a team and embrace new multidisciplinary models of care that bring together primary, community and mental health services.

The report pack stated that the North East London Integrated Care Board have also launched their vision for neighbourhood working where ‘Everyone in North East London lives in a neighbourhood which supports and actively contributes to their physical and mental health and wellbeing’.

The report pack outlined four key goals of neighbourhood working:

• Working with and for local communities
• Work in a proactive and preventative way, addressing rising need
• Deliver integrated, accessible care
• Support service sustainability

The report pack stated that work has already taken place locally to look at the development of locality hubs that will support an integrated neighbourhood approach, and that this has been recently supported by Carnall Farrer with a framework approach and recommendations for next steps to support Waltham Forest.

The report pack also stated that a large-scale transformation programme will require new ways of working across many teams, and that key enablers, including organisational development, population health management approach and programme resource will be critical to delivery.

The report pack stated that Integrated Neighbourhood working in Waltham Forest should be an enabler and underpinning model that aligns with the four strategic priorities of North East London Integrated Commissioning Board and also with the priorities of the Waltham Forest Joint Health and Wellbeing Board, and to adopt SEND as an additional priority area.

The report pack stated that findings from The Good Care Conversation will be used to guide the strategy and implementation of integrated neighbourhood working, and that some engagement has already taken place around locality hubs and ongoing engagement by VCSE colleagues is in place, to allow residents feedback is used.

Promoting Wellbeing Workstream

The boards were scheduled to receive an update on the Promoting Wellbeing workstream, which aims to advance a preventative approach and reduce health inequalities. The report pack stated that the workstream has brought together partners from the local authority, the NHS, and the voluntary and community sector.

The report pack included a status report with updates from the five priority areas within the workstream:

• Strengthening the partnership with the voluntary and community sector and faith groups, to promote health
• Mental Health Promotion
• Locality Hub and Primary Care Spaces
• Maximising Employment Support
• Housing and Health

The report pack also included a draft indicator set for a proposed dashboard for this workstream, and an update on the Healthy Weight Strategy.

Strengthening the partnership with the voluntary and community sector and faith groups, to promote health

This area focuses on increasing voluntary and community sector (VCS) representation across the system, including on boards and in special interest groups. The goal is to work with system partners to support innovative and sustainable efforts to improve health outcomes for local communities. These goals are guided by the Council's VCS Strategy, with a specific health and social care VCS strategy in development.

The report pack stated that the VCS Leadership Group (LG) is currently undergoing a transformative phase, shifting from a primary focus on representation, influence and involvement to prioritising alliance-building and joint delivery.

The report pack also stated that progress has been made in supporting migrant and refugee communities through improved access to healthcare under the Borough of Sanctuary workstream.

Mental Health Promotion

The report pack stated that the Mental Health Promotion work builds on the previous Better Mental Health for All work, which supports the mental health promotion strategy published in December 2023. Four priority groups for action were identified in the strategy; Black and South Asian men, People with Long Term Health Conditions, unpaid carers and expectant and new families and in November 2024 it was agreed to continue with these four groups for a further year until March 2026.

The report pack noted significant progress has been made on many of the strategy objectives including:

• The Kings Fund supported delivery of a series of workshops at the end of 2024 and plans are now advancing to take forward a significant programme of work to improve the mental health of Black boys and young men.
• The Parent and Baby Emotional Wellbeing service (PBEW), has now been delivering for one year, with a comprehensive evaluation underway and funding recently confirmed until March 2026.
• Funding has been secured to extend the Making Every Contact Count (MECC) training contract for another year until March 2026, with a programme of face-to-face and online sessions to be delivered to frontline staff across statutory and voluntary services. To date around 750 staff have now been trained.
• Small grants have been provided to grassroots organisations to deliver activity in line with the strategy including via the Make It Happen grants and Social Prescribing Community Chest.

Locality Hub and Primary Care Spaces

The report pack stated that there are three focus areas for this priority: locality hubs, primary care spaces for wellbeing services, and improving primary care access, and that these three areas are progressing through the planning and development phase.

The report pack noted that progress has been made particularly around the frailty model and community dermatology requirements, whilst the significant resident engagement work conducted over the past 6 months draws to a close with outcomes due to be published shortly.

The report pack also stated that work is well underway in the development of the Expressions of Interest (EOI) toolkit and data pack for the Primary Care Network (PCN) health inequalities projects, supported by the Waltham Forest Health Equity Alliance.

Maximising Employment Support

The priority of this workstream is to maximise employment opportunities for residents, focussing particularly on helping those with long term health conditions.

The report pack stated that roll out of the Connect to Work programme has begun, and work is ongoing to raise awareness with partners, and that there has been some progress in enhancing existing referral pathways, with NELFT taking a proactive approach.

Housing and Health

The report pack stated that there has been significant progress in this priority area, including the central importance of housing in the Council’s Marmot response. Work in this area continues to ensure that health is recognised in key housing strategies, and more operational work is being done to align and deliver health and housing priorities jointly for Q2 2025.

The report pack also stated that Housing are also working with public health colleagues and officers who commission supported housing to define the scope of a new Supported Housing strategy to be developed over 2025 with the overall goal to improve supported housing provision across Waltham Forest.

Population Health

The boards were scheduled to discuss population health management in Waltham Forest.

The report pack included a presentation on population health management in Waltham Forest, which outlined the developing approach to population segmentation and population health management across NEL.

The presentation stated that almost 30% of the Waltham Forest population have a diagnosed health condition, and that all 323,897 people registered with a Waltham Forest GP practice are each assigned exclusively to a single main segment.

The presentation also included data on the age profiles across each segment, the ethnic composition of each segment, and health life expectancy across deprivation quintiles.

The presentation also included data on activity and cost by segment, and examples of analysis available to PCNs.

Updated health and care system partnership governance, ways of working, priorities for 2025/26

The boards were scheduled to discuss a report on the updated health and care system partnership governance, ways of working, and priorities for 2025/26.

The report pack stated that this report follows the January 2025 aligned boards business planning session which aimed to identify how to maximise the value of integrated meetings and establish clear, measurable priorities for the period 2025 - 2027.

The report pack presented an updated, simplified governance structure to show how the Health and Well Being Board (HWBB) and the Health and Care Partnership Board work in an aligned way to form the Waltham Forest Health and Care System Partnership.

The report pack also set out the agreed approach to health and care system partnership working and proposes the work programme priorities for the partnership for 2025/26.

The report pack stated that the partners have agreed the following principles for how it will operate in practice as follows:

The Waltham Forest Health and Care System Partnership will:

• Set the strategic priorities for the WF system
• Use partnership meetings to problem – solve, design and shape rather than oversee and monitor programmes of delivery
• Respond to data led insights shaping and changing programmes accordingly
• Use the partnership to understand organisational financial challenges and how the system comes together to support delivery and avoid unintended consequences of unilateral implementation.
• Ensure resident engagement and co production is central to decision making.
• Use the partnership as an opportunity to strengthen our VCS role and involvement in the delivery of our priorities
• Focus on key themes, eg BCYP, MHLDA/ Integrated care/ neighbourhood health working to support connectivity and engagement

The report pack listed the following partnership priorities for 2025/26:

• Health Inequality and Wellbeing
  • Mental health and wellbeing of Black boys and young Black men
  • Childhood obesity and the path to diabetes, especially among children from the global majority
  • Early onset of complexity and frailty early prevention
• SEND
  • Deliver the SEND improvement plan focussing on PFA, improving EHCPs, coproduction and waiting times for specialist services.
• Babies Children and Young People Programme
  • Delivery the 25/26 BCYP programme priorities including: Hospital at Home service, development of a Community Dietetics Enteral Feeding service, Development of the Asthma programme to include improved diagnosis, Development of a community MSK model for BCYP, and to coproduce a map of CAMHs offer in the borough
• Community Service Transformation Programme
  • Evidence impact of programme through cashable savings to sustain programme
  • Develop Transfer of Care Hubs, reablement offer, step down beds and the use of assistive technology to further improve hospital flow and discharge to home first principles.
  • Establish our approach to neighbourhood health working and teams in Waltham Forest
  • To implement a new integrated community model for End-of-Life Services and reduce unplanned, unnecessary admissions to hospital for residents at the end of their lives
  • Homeless health
• MH/LDA Programme
  • Relaunch a LDA Board, co led and produced with residents with LDA to develop a system strategy for LDA identify priority programmes
  • To utilise mental health accommodation options more effectively to improve flow
  • To deliver mental health crisis alternative models to prevent ED attendance
  • To improve service outcomes and access (primary care secondary care interface/ demand and capacity in wellbeing teams)

Approval of prior minutes

The minutes from the meeting on 24 March 2025 were included in the report pack.¹