The Tower Hamlets Health and Wellbeing Board met on Tuesday 21 September 2021 to discuss a range of critical health and wellbeing issues facing the borough. Key topics included the ongoing challenges with GP access, the progress of the Mental Health Strategy, and the development of the Health and Wellbeing Strategy and the Black and Asian Minority Ethnic Inequalities Action Plan. The Board also reviewed the Better Care Fund and its role in integrating health and social care services.

GP Access and Primary Care Pressures

The Board discussed the significant pressures on GP access, with concerns raised about the impact of media coverage and increased patient demand. Dr. Sam Everington, Chief Medical Officer at East London Foundation Trust, highlighted that primary care is now managing a substantial portion of hospital waiting lists, with workloads up 20-30% compared to previous years. He expressed worry about the impact on staff morale and the potential for GPs to resign due to the current situation. Councillor Rachel Blake, Deputy Mayor and Lead Member for Adults Health and Wellbeing, acknowledged the mixed personal experiences of accessing GP appointments and proposed roundtables with service users to understand how to raise awareness and support people in navigating new access arrangements, such as e-consultations. Jackie Sullivan, Chief Executive Officer of Royal London & Mile End Hospitals, noted that the acute sector is also overwhelmed, with a significant percentage of cases potentially originating from primary care. Randal Smith suggested revisiting a previous study on patient flows to identify inefficiencies and ensure people are directed to the right services first time.

Mental Health Strategy Update

Carrie Kirkpatrick, Deputy Director of Mental Health and Joint Commissioning, presented an update on the delivery of the 2019-2024 Mental Health Strategy. She highlighted that the strategy's implementation has been significantly impacted by the COVID-19 pandemic, which has both accelerated and hindered progress. Key areas of work over the past 18 months have included responding to the pandemic, expanding crisis pathways, transforming community mental health services, and tackling stigma through awareness campaigns. Future priorities include work on the mental health accommodation pathway, redesigning accommodation within the borough, developing autism diagnosis services, and rolling out trauma-informed approaches. Fran Pearson, who chairs the Safeguarding Adults Board, noted the strong commitment to mental health within adult safeguarding and highlighted the interface between mental health, accommodation issues, poverty, and substance misuse. James Thomas raised questions about the integration of the adult mental health strategy with strategies for children and young people, particularly concerning the transition from CAMHS support to adult services. Councillor Blake also sought further detail on actions being taken to improve access to talking therapies for older people and Black, Asian, and minority ethnic communities, as outlined in the strategy. Dr. Paul Gilluley, Chief Medical Officer at North East London Integrated Care Board, emphasised the importance of co-production and the use of peer support workers, particularly for individuals from Black, Asian, and minority ethnic backgrounds, to ensure services are reflective of the communities they serve.

Better Care Fund (BCF) Review

Warwick Tomsett, Suki, and Phil Carr provided an overview of the Better Care Fund (BCF) in Tower Hamlets. The BCF aims to integrate health and social care services and is comprised of approximately 39 schemes, funded by contributions from the CCG and the local authority. The primary objectives of the BCF are to reduce delayed transfers of care, reduce non-elective admissions, ensure effective rehabilitation services, and reduce permanent admissions to care homes. The total BCF spend in 2021 was £55.2 million. The Board discussed the ongoing review of the BCF, including efforts to improve transparency and ensure schemes reflect current needs. A proposal was made to transition from a single incentive scheme to a Locality Development Fund to support integration at a local level, with a focus on primary care networks, the voluntary sector, social care, and housing. Amy, a representative from Tower Hamlets Together (THT), highlighted the opportunity for deeper integration and budget pooling, emphasizing that the criteria for such initiatives must be based on outcomes, experience, and efficiency. Gabby Salva Macallan raised concerns about the timing of these discussions in light of the emerging Integrated Care System (ICS) framework and the need for clarity on the council's funding and voice within the new system. The Board agreed to take the detail of potential BCF pilots offline for further discussion and to bring this back to the Board in November, alongside a discussion on ICS proposals.

Health and Wellbeing Strategy and Black and Asian Minority Ethnic Inequalities Action Plan

Councillor Rachel Blake introduced the new Health and Wellbeing Strategy, which has been developed over a long period, incorporating learning from the pandemic and a commitment to tackling health inequalities and taking anti-racist action. Joanne Starkey, Head of Strategy and Policy for Health, Adult and Community, outlined the extensive consultation and engagement process that informed the strategy, including input from residents, community groups, and various boards. Key themes emerging from the consultation included the uneven and unequal experience of health and wellbeing, the importance of connection and community, the desire for joined-up and accessible support, and pride in the borough's assets. The strategy's principles focus on targeted resource allocation, stronger networks, equalities and anti-racism, better communication, community-led approaches, and making the best use of assets.

Councillor Asma Begum provided an update on the Black and Asian Minority Ethnic Inequalities Action Plan, which responds to 23 recommendations from the BAME Inequality Commission. The plan addresses areas including community leadership, health, education, and employment. A key development is the Tower Hamlets Anti-Racist Pledge, encouraging organisations to commit to becoming anti-racist. The Board discussed the need for clear resource allocation and timelines for the actions within the plan. Jackie Sullivan confirmed that the Royal London and Mile End Hospitals are actively working on inclusion agendas and will ensure the action plan remains a living document. Ellie raised a point about engaging with growth and economic development teams regarding employment initiatives within the action plan. The Board agreed to bring the action plan back for a monitoring and challenge session in November, following its submission to Cabinet.

Any Other Business (AOB)

Several items were flagged for future discussion at the next meeting in November:

• GP Access and Digital Inclusion: A more detailed discussion on the operational impact of new GP access arrangements and digital inclusion initiatives.
• BCF Pilots: Consideration of potential pilot schemes for the Better Care Fund.
• Winter Preparedness and Vaccination Programmes: Review of plans for the upcoming winter season.
• Integrated Care System (ICS) Proposals: Further discussion on the evolving ICS framework.
• Health and Wellbeing Impacts of Cost of Living Increases: Consideration of the potential impacts of the reduction in Universal Credit, the end of furlough, and rising energy costs on residents' health and wellbeing.

The meeting concluded with thanks to officers for their extensive preparation and to all attendees for their contributions.