The Health & Wellbeing Board and ICB Sub-Committee (Committees in Common) met on Tuesday, 16 January 2024, to discuss the winter planning update, the NEL Joint Forward Plan refresh, the ICB finance overview, and the draft Annual Report of the Director of Public Health. Key decisions included noting the winter planning update, endorsing the draft NEL Joint Forward Plan Refresh 2024/25, and noting the updated financial position for 2023/24.

Barking and Dagenham Winter Planning Update

Kelvin Hankins, Deputy Director and Lead for Ageing Well for the Barking and Dagenham Place Team at NHS NEL ICB, presented an update on the progress of the winter planning arrangements. He highlighted improvements in four-hour waiting times at King George's Hospital (KGH) and Queen's Hospital (QH), as well as at the Borough's Urgent Treatment Centres (UTCs). Category 2 response times for the London Ambulance Service (LAS) had also improved, with schemes like REACH helping to reduce unnecessary hospital conveyances.

The Winter Plan actions and priorities were discussed, with no significant risks identified. Additional funding had been secured for a reablement service, and the winter communications plan had been launched. Councillor Maureen Worby, Cabinet Member for Adult Social Care, Health and Integration, emphasised the need for clear, easy-to-understand communications about free services, particularly for the elderly. Concerns were raised about plans for continuous improvement in light of a growing population, and the handover times from ambulance services to hospitals, which were noted as being longer than the national standard. Members also discussed local residents attending Newham Hospital or the Royal London Hospital instead of KGH or QH, potentially due to perceived shorter wait times or better public transport access. Dr Kanika Rai, Place-based Partnership Primary Care Development Clinical Lead, noted that inpatients at the Royal London Hospital and Newham Hospital were generally automatically booked into specialist outpatient clinics, unlike in the Barking, Havering and Redbridge University Hospitals (BHRUT) area, suggesting this could be a factor in patients moving around the system and contributing to 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 for NHS NEL, presented the NEL Joint Forward Plan Refresh (JFPR) 2024/25. The first draft of the JFPR, including a Barking and Dagenham Local Plan (BDLP), was appended to the report. Ms Morrow explained that the plan would be continually updated, incorporating feedback from a recent workshop where portfolio leads shared their draft system programme plans and identified health inequalities and gaps. The annual NHS Planning Guidance had been delayed, but many priorities from the 2023/24 guidance were expected to remain. ICBs are also required to produce a Capital Plan by April.

The draft JFPR and its BDLP share common 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 the draft JFPR, raising points about re-prioritising schemes that promote levelling-up, ensuring local priorities are reflected, challenging data commentary, the need for new healthcare provision for a growing population, learning from best practice, the importance of prevention and intervention, lobbying for additional healthcare facilities and capital funding, celebrating achievements, integrating new ways of working, and the need for greater emphasis on workforce issues. A Workforce Strategy is in development, and details of ongoing initiatives will be shared.

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 for NHS NEL, presented 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. The ICB had an adverse variance to plan of £16.5m, contributing to a £87.2m adverse variance for the ICS. Mr Thakker outlined the main drivers for the overspend, including inflation, non-delivery of efficiencies, industrial action, operational pressures, and lost income for providers. Mitigations are being put in place as part of a formal recovery plan (FRP). Discussions are ongoing with NHS England regarding potential additional funding.

Charlotte Pomery, Executive Director at NHS North East London, highlighted the value of a medium-term financial plan and aspirations for more joined-up 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 covers the legacy of Covid-19 and its lasting impacts on life expectancy and its determinants in Barking and Dagenham. The borough has been disproportionately affected by economic difficulties and faces high demand for health and social care services. Key messages from the report include the need to leverage opportunities within the Place-based Partnership to improve healthy life expectancy, focus on addressing contributing factors to health, and break down barriers causing health inequalities. A 'health in all policies' approach is recommended to understand the role of health inequalities in driving community priorities. The report also emphasises the importance of driving forward vaccination programmes, with the Chair suggesting bus stop advertising for the MMR jab.

Elspeth Paisley, Health Lead at BD Collective, welcomed the focus on healthy life expectancy and suggested setting short and longer-term targets for assessment and accountability. Observations included recognising communities as assets, addressing social isolation and loneliness, understanding referral pathways for prevention and early intervention, and the disparity between central funding received in 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. Councillor Worby noted the work being undertaken within the Council regarding localities and seamless service integration. Mr Cole advised that a peer review of the local public health approach would take place in 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 captures 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 model for proactive care 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 for 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. Colleagues congratulated the Federation, and it was noted that the CQC report would be published shortly. 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 under two contracts (Lot 1 - Adults and Lot 2 - Young People). The contracts would be for up to seven years, commencing 31 March 2024, with a combined annual value of approximately £2.5 million, funded from core grant via the Office of Health Improvement and Disparities (OHID). Members were invited to provide comments on the proposals after the meeting due to the late publication of the report.

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.