The Brent Health and Wellbeing Board met on Wednesday 2 April 2025 to discuss a range of critical health and social care initiatives. Key decisions included noting the status of the Better Care Fund planning process for 2025-26, which is facing challenges due to a significant reduction in additional Integrated Care Board (ICB) funding. The Board also approved the strategic approach for developing Integrated Neighbourhood Teams (INTs) and a Radical Place Leadership (RPL) model, aiming to shift power towards communities and redesign services around residents' needs.

Better Care Fund Planning Process 2025-26

The Board received an update on the Better Care Fund (BCF) planning process for 2025-26. The national deadline for submission to NHS England (NHSE) was 31 March, but Brent received an extension to 4 April due to ongoing discussions with the North West London (NWL) ICB regarding a reduction in the Additional ICB Funding. This reduction amounts to £864,925, which will impact winter planning and the Brent Borough Based Partnership's ability to balance its budget.

As a consequence of the funding reduction, the Discharge to Assess physiotherapy service, a pilot programme offering fast-tracked physiotherapy access, has been removed. Officers are working with Central London Community Healthcare NHS Trust (CLCH) to manage the risks associated with these changes. Rachel Crossley, Corporate Director of Community Health and Wellbeing, confirmed she had delegated authority to sign off the BCF plan by the new deadline.

Board members expressed concern about the impact of the funding reduction and how decisions would be made regarding which schemes to prioritise. Steve Vo, Assistant Director of Place for Brent Borough at NWL ICB, explained that three additional schemes impacting hospital discharges and step-down beds were under review, with the reablement service identified as having the least impact due to its pilot status and lack of established funding. Tom Shakespeare, Director of Brent Integrated Care Partnership (ICP), stated that a comprehensive review of rehabilitation and reablement services would be undertaken to maximise the impact of remaining resources.

The Board also discussed the importance of prevention and community services, with Rachel Crossley highlighting the misalignment between NHS and local government planning timelines and financial settlements. The ICP advocated for longer-term, multi-year planning for the BCF and local government funding to enable strategic planning and recruitment.

Going Local - Integrated Neighbourhood Team and Radical Place Leadership

The Board received an update on the progress and next steps for developing Integrated Neighbourhood Teams (INTs) and the Radical Place Leadership (RPL) approach in Brent. Will Holt, Change and Improvement Programme Lead at Brent Council, explained that RPL aims to shift power from organisations to communities, redesigning services around residents' interconnected needs. The initial pilot for RPL will be in Harlesden, chosen for its health outcomes, employment levels, deprivation, and strong voluntary and community sector (VCS) presence.

Josefa Baylon, Head of Integration for INT Development, detailed the neighbourhood health aspect of INTs, emphasising extensive resident engagement and the identification of priority areas such as homelessness, financial hardship, and school readiness in Harlesden. The INT will co-locate professionals from various council services and partner organisations to work with residents and prevent crises.

The Board welcomed the vision for INTs and RPL, noting positive outcomes from existing initiatives such as the Diabetes Virtual MDT, which reportedly saved £252,000 in potential hospital bed days, and personalised asthma action plans for children, which increased from 23% to 100% and led to reduced A&E visits. The investment for these initiatives was primarily from existing allocated resources and a health inequalities fund.

Concerns were raised about engaging the housing sector and avoiding duplication with existing services like Brent Council's Hubs. Will Holt confirmed that housing representation was being sought, and Rachel Crossley explained that the INT model aims to move beyond eligibility criteria to focus on prevention and connect existing community assets. Plans are in place to brief councillors on RPL and engage ward councillors in Harlesden. The scalability of the pilots will depend on their success, with a phased approach planned from May.

The Board also discussed the importance of culture change, moving from siloed to collaborative working and from reactive to preventative approaches. The need for leadership commitment and effective data sharing was highlighted, with the Council working to improve its mosaic systems for better data sharing. A further update on the INTs and RPL programme is expected in six months.

Adult Mental Health Workstream Update

Sarah Nyandoro provided an update on the adult mental health programme in Brent, highlighting performance data, delivery progress, and proposed priorities for 2025-26. Matt Henshaw, Borough Director for Mental Health and Learning Disability Services, noted the link between the NW2, NW10, and HA9 pilots and the INT work.

The Board discussed the use of online services like Kooth for children and young people, with Brent residents showing the highest engagement and outcomes. Concerns were raised about the lack of data on mental health patients in the private rented sector, with challenges in data sharing and regulation acknowledged. Nigel Chapman, Corporate Director for Children and Young People, highlighted the ongoing waiting times for specialist mental health services for young people with neurodiversity needs and the commitment from NWL ICB and Central North West London NHS Foundation Trust (CNWL) to address this.

The Board commended the work on employment support and the need to consider the impact of welfare benefit changes. Matt Henshaw confirmed that CNWL routinely captures employment status and provides specific support within community mental health teams. The Vice Chair requested that the children and young people's mental health transformation plan be presented at a future meeting.

Brent Children's Trust Progress Report

Nigel Chapman presented the progress report from the Brent Children's Trust (BCT), outlining its role in coordinating strategic direction for integrated services for children and young people. He highlighted the BCT's priority areas, including vaccinations, the THRIVE programme, early help, services for looked-after children and care leavers, and services for children with Special Educational Needs and Disabilities (SEND).

Key updates included the revised Care Leaver Local Offer and Charter, which includes enhanced digital support, expanded mentorship programmes, and increased allowances. The Board noted the minimal financial implications of these revisions. The progress on the SEND Strategy was also detailed, with advancements in opening Additional Resourced Provision (ARP) and the planned opening of Wembley Manor School. The report also covered the Brent Carers Strategy, focusing on young carers, and the ongoing analysis of data and intelligence to improve services.

The Board asked about the co-production of the new Autism Strategy and the development of the Welsh Harp Skills Resource Centre, with confirmation that strategies are co-produced with the Parent and Carer Forum and the centre is in its design stages. A new Travel Policy and Travel Training Policy, co-produced with parents and carers, was also highlighted.

Healthwatch Brent 2025/26 Work Programme (draft)

Patricia Zebiri, Healthwatch Manager, presented the draft work programme for Healthwatch Brent for 2025-26, seeking feedback and strategic input. She emphasised the need for Healthwatch to be precise in its focus due to limited resources and its commitment to driving the agenda based on community feedback.

Key focus areas for the upcoming year include community engagement, adult social care, community pharmacies and the Pharmaceutical Needs Assessment (PNA), and GP access and complaints processes. Healthwatch will continue to monitor resident feedback, participate in key health and care meetings, and support Healthwatch England's national projects.

The Board acknowledged the improved response to the PNA consultation due to Healthwatch's support. While Adult Social Care has been responsive to Healthwatch findings, the Board noted that initial pushback can occur when difficult information is presented. The Board also inquired about how Brent partners could help improve Healthwatch's capacity, with the suggestion that free or low-rent accommodation would allow for increased staffing.

Health and Wellbeing Board Forward Look - Future Agenda Items

The Board discussed potential future agenda items, including the Children and Young People's Mental Health Transformation Programme, an update on Integrated Neighbourhood Teams, a review of the impacts of welfare benefits reforms, and a care home sector update.