HOUNSLOW HEALTH & WELLBEING BOARD MEETING: 2 FEBRUARY 2021 - Council Meetings

 
HOUNSLOW HEALTH & WELLBEING BOARD MEETING: 2 FEBRUARY 2021 - Council Meetings
HOUNSLOW HEALTH & WELLBEING BOARD

                  MEETING: 2 FEBRUARY 2021

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HOUNSLOW HEALTH & WELLBEING BOARD MEETING: 2 FEBRUARY 2021 - Council Meetings
AGENDA

1.   WELCOME

2.   NOTES FROM MEETING: 4 NOVEMBER 2020

3.   IMPACT OF COVID-19 ON HEALTH & WELLBEING IN THE BOROUGH

4.   WHAT HAVE WE LEARNT? HOW DO WE APPLY TO OUR CURRENT PRIORITIES?

5.   REVIEW OF THE BOARD’S GOVERNANCE ARRANGEMENTS

6.   ANY OTHER BUSINESS

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HOUNSLOW HEALTH & WELLBEING BOARD MEETING: 2 FEBRUARY 2021 - Council Meetings
IMPACT OF COVID-19 ON HEALTH & WELLBEING

•   What does the data tell us?
•   Big Picture – London
•   Local Picture - Hounslow
•   Variation across the Borough – geography and communities
•   Health and social inequalities
•   Communications and Engagement
•   Current Priorities – system leadership/ demand management/ testing and vaccination

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HOUNSLOW HEALTH & WELLBEING BOARD MEETING: 2 FEBRUARY 2021 - Council Meetings
InfectionInfection
           Rates inRates
                    London    – 1 February
                         in London          2021
                                   27th January

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HOUNSLOW HEALTH & WELLBEING BOARD MEETING: 2 FEBRUARY 2021 - Council Meetings
Data Dashboard:

                                                   12 January 2021:
                    12/1 – 1141 /100k
                                                   Rate: 1141 / 100,000
         28/12 – 645 /100k                         No. Cases: 3098
                                                   Over 60 cases: 445
    21/12 – 460 /100k                              Case Positivity: 23%
                                26/1 – 645 /100k

12/12 – 171 /100k                                  1 February 2021:
                              27/1 – 596 /100k

                                                   Rate: 432 / 100,000
                                                   No. Cases: 1172
                                                   Over 60 cases: 170
                                                   Case Positivity: 9.4%

                                                   December v January

                                                   No. Cases: 53
                                                   Deaths:
                                                               5
HOUNSLOW HEALTH & WELLBEING BOARD MEETING: 2 FEBRUARY 2021 - Council Meetings
COVID-19 Surveillance in Hounslow – Total Case Numbers/ Ward

                                    Total number of cases LBH:
                                    •     8373 (20th Dec)
                                    •     21,643 (29th Jan)
                                    •     158% increase since 20/12/20

                                    Age profile of cases:
                                    •    Under-19 – 15%
                                    •    Aged 20-59 – 70%
                                    •    Over-60 – 15%                   6
HOUNSLOW HEALTH & WELLBEING BOARD MEETING: 2 FEBRUARY 2021 - Council Meetings
Ward                        Rate per 10,000
                                  Heston West                           1038.6
COVID RATE/ WARD                  Heston East                           1026.3
                                  Cranford                               925.2
                                  Heston Central                         908.4
                                  Hounslow West                          880.4
                                  Feltham North                          852.2
 Highest COVID rates per
                                  Hounslow South                         836.9
10,000 are seen in Heston West,   Hounslow Central                       823.9
Heston East and Cranford (Data    Bedfont                                808.3
from March 2020 to January        Hounslow Heath                         782.2
2021). These wards are based in   Hanworth Park                          737.5
the central part of Hounslow.     Hanworth                               732.3
Rates were calculated using ONS   Brentford                              731.9
2019 mid-year estimates.          Osterley and Spring Grove              723.1
                                  Isleworth                              713.7
                                  Syon                                   700.2
                                  Feltham West                           656.2
                                  Chiswick Homefields                    499.9   7

                                  Turnham Green                          483.2
                                  Chiswick Riverside                     451.7
HOUNSLOW HEALTH & WELLBEING BOARD MEETING: 2 FEBRUARY 2021 - Council Meetings
Data rec’d on 1st February : 7-day period: 23 Jan - 29 Jan 2021

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HOUNSLOW HEALTH & WELLBEING BOARD MEETING: 2 FEBRUARY 2021 - Council Meetings
Data rec’d on 1st February : 7-day period: 23 Jan - 29 Jan 2021

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HOUNSLOW HEALTH & WELLBEING BOARD MEETING: 2 FEBRUARY 2021 - Council Meetings
Data rec’d on 26th January : Infection Rate/ Ward: 7-day period: 23 Jan – 29 Jan 2021

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Demographic Differences and Risk

Using ‘available*’ data we have profiled factors that increase risk of catching Covid-19 – PHE Report identified these factors:
• Where you live, population density* in that area and deprivation levels
• Your Age
• Your Ethnicity
• Your ability to speak English
• Your reported health status pre-covid
• Whether your home is over-crowded and you live in a multi-generational home
• You are of working age:
• Exposure: Your job**
• Health and Social Inequalities will be affected by wider determinants of health – education, employment, financial stability

*Data can often be incomplete
**The number of jobs in retail is highest in Feltham West at 19%, followed by Heston West (15%) and Isleworth (14%)/ The number of
jobs in transport and storage is 78% in Hounslow Central, followed by 38% in Feltham North and 34% in Hounslow Heath

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CORRELATIONS – POPULATION DENSITY

                                    Wards with a higher
                                    population density generally
                                    have a higher rate of covid
                                    cases. However, the
                                    correlation is weak.

                                                              12
NUMBER OF COVID
CASES BY AGE GROUP

 Highest number of COVID cases
by age group in Hounslow are
seen in 31-45 age category (data
from March 2020 to Jan 2021).
Age band 31-45 contributes to
31% of COVID cases in Hounslow.
This is consistent with age profile
in Hounslow, where 31-45 age
group have the highest population
in Hounslow.
 When looking at individual
wards, this is also consistent, 31-
45 age groups have the highest
proportion of COVID cases in all
wards.
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DEPRIVATION – INDICES OF MULTIPLE DEPRIVATION (2019)

                                             Wards in less deprived areas have a
                                             lower rate of COVID cases,
                                             whereas those living in more deprived
                                             wards have an increased rate of COVID
                                             cases.
                                             The chart shows a moderate
                                             negative correlation, because the y-
                                             axis takes us from higher deprivation
                                             on the left-hand side to lower
                                             deprivation on the right-hand side

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Hounslow: IMPACT: Social and Economic Differences?
•   Furlough (data to 31 October): 18,100 jobs still furloughed in the borough (from a peak of 56k - end July 2020)
•   Expectation based on elapsed time/ observations indicate remaining furloughs will correlate strongly to increased unemployment when the scheme
    ends.
•   Most of the unemployed and furloughed will have been linked to Heathrow, the hospitality and leisure sectors that have been effectively shut down
    since March 2020.
•   Universal Credit applications (DWP monthly data): increase by 9,200 unemployed in Hounslow (December 2020 compared to March 2020)
      – Variation by wards: West of the Borough greater impact compared to more East of Borough
      – Households also claim UC if ‘in work but on a low income’ (low/reduced hours or pay/ sick/acting as carers and therefore unavailable for work)
          – additional 8,200 with reduced earnings forcing them to claim UC; PLUS an extra 1,200 unable to work;
      – Total unemployed, low income and unable to work - additional 19,100 claimants
      – In excess of 22% of residents are now in receipt of UC; varies geographically - dominated by Heathrow employment status – some wards have
          around 30% of working age adults claiming UC – e.g. Hounslow Heath and Cranford – approx. 30% total UC claimants as a percentage of the
          working age population.
•   The increase in people who are not expected to find work: Increased by one fifth over December; suggests increasing mental health and physical ill-
    heath;
•   Impact likely to lead to poorer mental health, substance misuse, social problems such as DV, and eventually physical health issues secondary to all of the
    above – health and social inequalities
•   Recovery will be linked to the future recovery of the aviation sector/ what may arise to replace it, should this not materialise.

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CORRELATIONS - BAME COMPARED WITH WHITE POPULATION

                                               Wards with a higher proportion
                                               of BAME have a higher
                                               proportion of positive cases.
                                               This shows a strong positive
                                               correlation. In contrast, wards
                                               with a higher proportion of
                                               White populations have a lower
                                               proportion of covid cases and
                                               shows a negative correlation.

                                               Hounslow has a BAME
                                               population of 52% and a White
                                               population of 48% (ONS Annual
                                               Population Survey, 2018).
                                               However, proportion of positive
                                               cases are 55% BAME and 29%
                                               White with 16% Unknown.  16
CORRELATIONS – ASIAN GROUP
                             Wards with a higher proportion of Asian
                             groups have a higher rate of positive
                             cases. Comparing different ethnic groups,
                             Asians (R2 = 0.64) have the strongest
                             positive correlation with rate of cases.
                             Followed by Mixed, Other and Black
                             ethnic groups.

                             Highest proportion of positive cases
                             by Asian group is seen in Indian
                             subgroup and Pakistani subgroup.
                             According to the 2011 census, Indians
                             make up 19% of Hounslow's population
                             and Pakistani population make up 5.4% of
                             Hounslow's population. However,
                             proportion of Indian cases are 22% and
                             proportion of Pakistani cases are 5%
                             (including unknown ethnicities).

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MULTI-
GENERATIONAL
HOUSING

 Hounslow Central has the
 highest number of people in
 multi-generational housing
 and the majority of people
 living in them are of Asian
 ethnicity

                               18
OVERCROWDING

                                        Overcrowding is highest in
                                        Hounslow Central at 36% of
                                        households, followed by
                                        Hounslow Heath at 34% and
                                        Hounslow West at 31%

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Source: Census 2011, Hounslow Insight
ENGLISH NOT 1ST LANGUAGE (%)

                               Wards with a higher
                               proportion of English not
                               their 1st language have a
                               higher rate of COVID cases.
                               This shows a strong
                               positive correlation.

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CORRELATIONS – POOR HEALTH GROUPS BY ETHNICITY (%)

                                              Wards with higher white
                                              populations with poor health have a
                                              lower rate of COVID cases. This is
                                              shown as a strong negative
                                              correlation (See chart). This
                                              relationship is also observed when
                                              looking at rate of COVID cases and
                                              White populations.

                                              In contrast, there is a positive
                                              correlation with Asian, Black and
                                              Other groups in poor health and
                                              rate of COVID cases. However,
                                              Black and Other ethnic group had a
                                              very weak correlation. Strongest
                                              correlation is seen in Asian group21
                                              (R2 =0.69),
DEATHS FROM COVID: DATA UP TO 30/11 – 245 CASES

Ethnicity       Population est’ (ONS 2019) Deaths   Rate per 100,000    From January - Nov there were a
                                                                          total of 245 Covid deaths in
Asian
                          93,964             91           96.8            Hounslow
Mixed                                                                   In the data set there were 36
                          13,471             11           81.7
                                                                          patients with an unknown ethnicity
Black
                          19,543             15           76.8          From the patients with known
                                                                          ethnicity the highest rate of covid-
White British
                         103,145             75           72.7            19 deaths were seen in Asians with
                                                                          a rate of 96.8 per 100,000
Other
                          9,942               4           40.2
White other
                         134,603             13            9.7
                                                                                                           22
Daily Covid deaths in Hounslow: within 28 days of positive test* Total Deaths

  Rate of death from CV-19 Comparison:

  •   UK: 159/100,000
  •   England: 166/100,000
  •   London: 150/100,000
  •   Hounslow: 168/100,000

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DEATHS FROM COVID

                                                % premature deaths from                    Rate of pop with premature
Ethnicity
DEATHS FROM COVID-19 (NO. WITH A PRE-COVID LONG TERM HEALTH CONDITION)

Ethnicity       Number of deaths   Number of those who had a LTC % who had a LTC    The ethnicity with the highest % of
                                                                                      those who had a LTC out of those
Asian                                                                                 who had died from covid was seen
                91                 50                           55%
                                                                                      in white British and then second
Black                                                                                 highest in Asians
                15                 3                            20%
White British
                75                 57                           76%
White other
                13                 5                            38%
Mixed
                11                 3                            27%
Other
                4                  0                            0%
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CO-MORBIDITIES ASSOCIATED WITH DEATHS

                                        The most common LTC found
                                        in covid deaths are shown in
                                        the funnel chart Hypertension
                                        is the most common LTC
                                        found in patients died from
                                        covid19

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MORTALITY: 3 MAIN LTC BY ETHNICITY

                                     Looking at the top 3 LTC found in
                                     patients who have died from covid
                                     they are most commonly seen in
                                     Asian and white British patients
                                     who have died from COVID-19

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System Management: Shared strategy, agenda and priorities
1.     Prevention, Early intervention:
               - Use of Data and Intelligence to Inform action – target communities
               - Warning and informing – Universal v Targeted messaging and intervention
               - Engaging Community/ Partners/ Community Champions
2.   Partnerships to respond to escalation of cases/ outbreaks – care home, schools, businesses – strategy to protect the vulnerable
3.   Identifying cases and supporting families:
               - Testing sites: Symptomatic and Asymptomatic – working with DHSC
               - Enhanced Contact Tracing
               - Community Hub
               - Financial support – Grant payments
               - Enforcement: Council enforcement and Police – working with Businesses/ dealing with individuals
4.     Managing demand for hospital care: system leadership across health and social care
               - Partnerships between commissioners and social care providers
               - Established forums for increasing support: PPE/ care home nurse and GP service
               - Hot Hubs led by Primary Care
               - Discharge Planning Team
               - Hospital and community NHS services flexing to meet demand
5.   Mobilising to roll out the vaccination plan

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WARNING AND INFORMING:
Hounslow: Data Driven Community Engagement & Communications
 Launched Community Champions programme
                                                                          Everyone does it their way: some will spread
    Understanding that familiar faces can often be more effective in      to their family; others to every mosque in
                                                                          Hounslow– we support you in what ever way
    delivering messages and affecting behaviour change than               we can
    government or official bodies, we developed a champions model to
    spread messages to hard to reach communities.

    110 champions from across the borough representing various groups
    and ethnicities who share messages with their communities.

    Evidence of effectiveness:
    •   surveys sent only to champions result in over 200 responses.
    •   Promotion via pop-up testing site led to high uptake after data
        showed high rates of infection in Heston
                                                                                             Everyone sharing –
                                                                                             we want to hear from
                                                                                             the champions too:
 Used data to understand where engagement is                                                 what info do they
                                                                                             need? what are the
 needed                                                                                      issues in the
                                                                                             community?
    Used data of hotspots of cases and understanding of borough
    characteristics to inform work
    • Targeted testing and messaging in areas of high case
    • Engagement with HMO tenants, Heathrow, etc.
    • Testing messages to understand which might be effective
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Last updated at 1pm Monday 1st
                      February 2021

               Please note that information is
              subject to change at short notice

Hounslow COVID-19 Vaccination Programme Update
               Health & Wellbeing Board
              Tuesday 2nd February 2021

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Overview

Hounslow Vaccination Settings
Vaccines are being administered through a range of settings:
•   In Hounslow, roving vaccination teams from practices are administering to all care homes residents and staff, including extra care, and the
    housebound (with district nurse support)
•   We have 4 approved primary care vaccination sites based on our primary care network (PCN) footprints. Each of the sites have the
    capacity to deliver approximately 350 vaccines per day and are focussing on the cohorts outlined by the JCVI.
•   Hounslow’s mass vaccination centre will be in Brentford planned to open in February. It will have the capacity to administer 1,000 doses per
    day. Hounslow residents will also have access to slots at an alternative site near Heathrow, with the capacity to administer 5,000 doses per
    day.
•   A number of community pharmacies are due to come on stream in the coming weeks to assist with the vaccination of those in the priority
    groups.
•   Hospital vaccination hubs will support with the vaccination of frontline health and care staff

Hounslow Target
The order in which residents are vaccinated is determined by the JCVI (Joint Committee on Vaccination and Immunisation).
•   45,830 first doses to be administered to priority groups 2-4 by 15th Feb (via all vaccination routes). This will require 1,478 vaccinations per
    day 7 days a week on average.

Progress to date
 Hounslow has administered more than 22,000 vaccinations since 15th December 2020 to those in priority groups 1-4
 System capacity continues to increase; over the past three days across Hounslow’s primary care sites alone they have administered on
   average 2,000 vaccines per day.
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Please note this
North West London/ National Commitments & Modelling                                                          is first dose only

How do these translate to Hounslow? How are we doing?
               Priority Area               Number of people in      Deadline for      Delivery model                Status
                                                cohort               Delivery
Priority 1: Residents in a care home for   1,250                 17/01/2021        PCN Hubs- roving         Initial phase completed-
older adults and staff                                                             teams                    mop up sessions
                                                                                                            planned
Priority 2: Over 80s                       8,700                 24/01/2021        PCN Hubs & roving        76% completed as of
                                                                                   teams for housebound     02/02/2021

Priority 2: Frontline Health and care      691                   15/02/2021        PCN Hubs                 Complete
workers (primary care)

Priority 2: Frontline health and care      Approx. 4,000         15/02/2021        Mass vaccination sites   In progress
workers (social care)                                                              Hospital hubs

Priority 3: Over 75s                       6,573                 15/02/2021        Mass vaccination sites   In progress
                                                                                   PCN hubs

Priority 4: Over 70s                       9,735                 15/02/2021        Mass vaccination sites   In progress
                                                                                   PCN Hubs

Priority 4: CEV individuals (aged 17-69)   13,508                15/02/2021        Mass vaccination sites   In progress
                                                                                   PCN hubs
                                                                                                                                  32
NW London additional identified priority groups (not specified within JCVI)

         Priority Area             Number of people in    Deadline for    Delivery model          Status
                                        cohort             Delivery
Extra Care Staff and Residents   302                     22/01/2021       PCN Hubs-        Completed
                                                                          roving teams
Remaining CQC Care Homes-        447                     15/02/2021       PCN Hubs-        Initial phase
Staff & Residents                                                         roving teams     completed- mop up
                                                                                           sessions planned
                                                                                           (75% residents, 51%
                                                                                           staff)
Housebound                       1,423                   80+ 27/01/2021   PCN Hubs-        In progress; over 80s
                                                                          roving teams     completed by
                                                         Under 80                          27/01/2021 with mop
                                                         15/02/2021                        ups planned; under
Please note this                                                                           80s now underway
is first dose only

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Tackling Health Inequalities
Clear there are Health Inequalities in our Borough – Data and PHE Report on impact of Covid on BAME communities
Covid-19 – One Borough Population – with different health needs in geographical areas – based on the communities that
live there
Current Drivers to address this:
• ICP Vision, workplan and work-streams
• Corporate Plan 2021
• Recovery Plan – Led by the H&WBB and Children’s Delivery Group

November 2020: Agreed to review the Board and Health and Wellbeing Strategy

Next Stage: For information and discussion
• Recovery Plan
• Focus of ICP
• Role of the Board in delivery of a revised strategy – consultation on Terms of Reference

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Recovery Plan – November 2020
Outcome 1: System-wide action to address health inequalities, reduce disparities in risk and outcomes of covid-19 and respond to subsequent wave(s):
Targeted action to reduce disparities in risk and outcomes for groups and communities impacted adversely by COVID-19: outcome focused lifestyle services,
primary care prioritisation of people with diabetes and at risk of avoidable ill-health during winter. Implement new model for healthy lifestyle services that
targets the Rising Risk Group (people with co-morbidities) most at risk of adverse health impacts of COVID-19

Outcome 2: Our services are outcome-focused, we invest in prevention and early intervention, health educate and support to empower our residents to
self care.
Educate our residents with co-morbidities to take responsibility for their health. Target offer for BAME communities planned, starting with developing the
relationship with faith leaders and improving translation of information targeted at specific communities
In response to Public Health England’s report on disparities and risk associated with COVID-19, the HWB Board holds as its principal focus for 2020-21 the
work which has been started on tacking health inequalities, through:
    *Effective use of local data to define the health inequalities in the borough and identify groups who are most vulnerable
    *Targeting of interventions towards those most in need and where the greatest gains in population health are likely to be made
    *Greater engagement of those most likely to benefit from interventions via new approaches in communication and intervention
    *Evaluating the effectiveness of our interventions in reducing health inequalities in the borough
    *Provide ongoing challenge/ scrutiny to ensure that tackling the inequity and inequality exposed through COVID-19 is central to our work.

November 2020: Agreed to review the Board and Health and Wellbeing Strategy in light of COVID-19 and the findings of the Recovery Board

                                                                                                                                                        35
Hounslow Integrated
      Care Partnership

Delivering our Vision
                           36
Our Shared Vision
        “Our communities are healthy, happy, connected and
               enabled to realise their full potential”
  We will do this by providing care and support based on people’s needs and preferences. By working together we will ensure
                this is simple for residents to access and navigate and will take into account a persons whole life.

 Our design principles                        Our key behaviours
 1.                  2.
                                                                                              Constructive and
       Engage             Empower                 Behave with           Support each            appreciative,
                                                                                                                   We act in the spirit
                                                                                                                    of our shared
                                                empathy towards       other and ask for
      residents           residents
                                                                                                  celebrating
                                                                                                                      goals and
                                                 all colleagues              help              successes and
                                                                                                                       purpose
                                                                                               giving feedback

 3.                  4.
                                                                       We are resilient,
   Invest in             Work                  Share challenges      learning and building   We trust each other

  prevention            across                 and take collective     the conditions for     and work on our
                                                 responsibility       working together as      relationships
                      boundaries                                             we go
                                                                                                                            37
The difference we will make

                                        To our residents

       I AM SUPPORTED                        I AM LISTENED TO                      I AM CONNECTED
       BEFORE A CRISIS
                                          • My personal needs, behaviours,      • I will be connected to people in
   • I will be able to access support       experiences or goals will be          my community and support from
     when things start to become            listened to by people who want to     the voluntary sector, and where
     challenging for me.                    help me. I will not be judged or      possible to other with shared
                                            channeled into a narrow service       experience.
   • Early signs of need will be            response. My strengths will be
     identified by staff, or friends,       part the solution.                  • They will help me address
     family or neighbours, and I will                                             underlying issues and meet my
     talk to professionals whose goal     • Together we will create a             personal goals.
     is to understand what is               common understanding of our
     happening in my life and see how       shared goals, at level and pace I
     they can help.                         feel comfortable with.
                                                                                                                     38
The difference we will make

                                          To our staff

      I AM CONNECTED                           I AM INFORMED                       I AM EMPOWERED

   I know other professionals and         I will be equipped to engage local    I am empowered to intervene early
   stakeholders in the community who      residents.                            an to coordinate and collaborate
   can help tackle a problem.                                                   with partners to address common
                                          I will know who leads on issues in    challenges.
   I can access information and data      partner organisations.
   that other professionals in Hounslow                                         My relationships with peers act as a
   have.                                  Working together, I will be able to   support network for in my work.
                                          build a comprehensive
                                          understanding of an issue and who
                                          can help address it.

                                                                                                                    39
The health challenge
                        Population challenges
                                                      More
                    A steady      Around 3,000                                         Growing
                                                   residents      High rate of
  High levels      increase in    older people                                        number of
                                                  living with    death due to
  of smoking       unplanned       experience                                        falls-related
                                                    complex      cardiovascul
  and obesity        hospital        chronic                                           hospital
                                                  health and      ar disease
                   admissions      loneliness                                        admissions
                                                  care needs

                          Shared challenges across partners

      Varied and
                       Duplication of     Misaligned        Workforce            Financial
     Fragmented
                         services         incentives          gaps               pressures
         Care

                                                                                             40
The Hounslow Recovery Plan

             Recovery efforts focus on
                  four key areas

      Renewing        Tackling local     Supporting      Reimagining
         local         inequalities    local residents   local places
      economies

      The Integrated Care Partnership is the vehicle to achieve our
           vision and help deliver Hounslow’s Recovery Plan

                                                                        41
ICP Recovery Board
                                                 The Council and NHS Hounslow partners are working hand-in-hand to rise to the
                                                 unique Hounslow recovery challenge. The ICP Recovery Board drives this work.

            PRIMARY CARE                                                                                                                                              CHILDREN
               NETWORKS                                                                                                                                        AND YOUNG PEOPLE
      Improving population health                                                                                                                          Children receive a start in life to
    and wellbeing at neighbourhood
      level. Resources directed at                                                  OUR OFFER                                                               place them on a level playing
                                                                                                                                                              field; reducing inequality,
       reducing any unwarranted
        variation in primary care.
                                                                                    AS A PLACE                                                              maximising opportunity from
                                                                                                                                                                      early years.

                                            MENTAL HEALTH                                                                       COMMUNITY SOLUTIONS
                                       Support good mental health                                                              Community-led solutions with
                                        with integrated community                                                               VCSE to develop integrated
                                      mental health teams wrapped                                                             local offers to residents. Better
                                      around PCNs. Develop wider                                                              opportunities for VCSE groups
                                        mental health offer for the                                                              and volunteers to shape
                                           people of Hounslow.                       HOME FIRST MODEL                            priorities and outcomes.
                                                                                 People with frailty, dementia
                                                                                and receiving end of life care
                                                                                will live healthier lives at home
                                                                                and in the community through
                                                                                 our redesigned ‘Home First’
                                                                                             model.

    POOLING OUR RESOURCES                                                        TACKLING INEQUALITIES                                                             WORKFORCE
We will identify opportunities to meet service         Use one systematic population health management approach to target interventions                               DIGITAL
  need and maximise our collective cash              appropriately and reduce health and care inequalities in our population, with a particular
   envelope by pooling our resources.                                          focus on our BAME communities.                                       COMMUNICATIONS AND ENGAGEMENT
                                                                                                                                                                              42
ICP Governance
   North West London
 Integrated Care System                 Health and Wellbeing Board
                                                                                      West London
                                                                                                                 HRCH Board            Chelwest Board
                                                                                         Trust

                                                                                    LB Hounslow CLT             Hounslow CCG           GP Consortium
 Chief Financial                Integrated Care Recovery Board
 Officers Group                 Chief Executive Officers Meeting

                                                                   Workstreams
Impact on the Borough and Residents        Access to Hospital Services              Public Health and Prevention Lead:          Digital
Lead: Niall Bolger, CEX, LBH               Lead: Mark Titcomb, West Mid Hospital    Kelly O’Neill, Director of Public Health,   Lead: Mark Lumley, Director of IT,
                                           Director                                 LBH                                         LBH

                                           Hospital Prevention and Discharge
Our Mental Health Offer                                                             Communications and Engagement               Voluntary and Community Sector
                                           Leads: Anne Stratton, ED, HRCH
Lead: Jo Manley Deputy Director, West                                               Lead: Ben Knowles, Assistant                Lead: Mandy Skinner, Assistant CEX,
                                           Steven Forbes, ED Children and Adults,
London Trust                                                                        Director of Comms, LBH                      LBH
                                           LBH                                                                                                          43
HEALTH & WELLBEING BOARD - WHAT NEXT?

DISCUSSION WITH THE BOARD

                                        44
INTRODUCTION
• Health & Wellbeing Boards were established under the Health and Social Care Act 2012 to act as a forum in which key leaders and
  partners from the local health and care system could work together to improve the health and wellbeing of their local population
• Across the country, there has been discussion about the role and purpose of these boards within the new Integrated Care Systems.
  NHS England suggests some guidance will be developed.
• The Covid pandemic has changed the health landscape and emphasised the importance of the wider determinants of health
  (Marmot, 10 years on)
• The ICS has changed our operating context, with different structures and relationships established
• In response to these changes, the Board might review its purpose, work and membership (as part of the annual review of the TOR)
• As part of the Recovery Planning, it was also suggest that the Board refresh the Health & Wellbeing Strategy and ensure that the
  Board is well-placed to deliver on the strategy and realise impact
• The Council is reviewing it Corporate Plan and Constitution so this is an opportune time to do this work and also assess our
  relationships with our partnership boards (ICP Board, Safeguarding boards, Community Safety Partnerships etc)
• There is also opportunity to think about the role of HWB in better enabling engagement and consultations around health, wellbeing
  and the broader determinants of health and effectively reach into communities to promote self-care and create a social movement
  for health

            This presentation sets out a process for discussions and review of the Board’s Terms of Reference and
            Strategy with the view to making the Board as effective and purposeful as possible within this new context

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BACK TO BASICS – THE PURPOSE OF HWB
• The Health and Social Care Act 2012 made HWBs responsible for encouraging place-based integrated working
  between health and social care commissioners, including partnership arrangements such as pooled budgets, lead
  commissioning and integrated provision

• As set out in 2013 ‘Statutory Guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing
  Strategies, each is charged with producing
     • a joint strategic needs assessment (information and data for health, care and wellbeing planning and
       commissioning, customised to the needs of the area and developing over time),
     • a joint health and wellbeing strategy (a vision, priorities and action agreed at the HWB to improve the health,
       care and wellbeing of local communities and reduce inequalities for all ages) and
     • a Pharmaceutical Needs Assessment’

• HWBs should address the wider social, environmental and economic factors that impact on health and should work
  closely with other partners, such as youth justice, police and crime commissioners, the voluntary and community
  sector and others

• Statutory membership requires representation from at least one local authority elected member, from all CCGs within
  area, local Healthwatch, and directors of adult social services, children’s services and public health
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CURRENT HWB Terms of Reference
• TOR: ‘bringing together the leadership of key organisations to plan and work in partnership, identify local needs and
  inequalities, monitor performance and develop effective plans and services’
    • JSNA, JHWB & PNA
    • Oversight commissioning
    • Encourage integrated working
    • Communication and engagement strategy
    • Appoint such sub-groups or sub-committees
    • Work with scrutiny and HT Board
    • Submit an annual plan
• Membership: Councillors and five staff side members. Chair to be a Councillor, vice-chair is an officer. (note:
  proportionality rules do not formally apply to this body)
    • The right people?
    • The right mix?
• Children’s Delivery Sub-Group (replaces Children’s Trust Board and sits under the Hounslow Health and Wellbeing
  Board. The wider duty to cooperate to improve children’s wellbeing, as set out in section 10 of the Children Act 2004,
  remains in force
• Health Integration Sub-group: Develop the vision for health integration in Hounslow and oversee progress towards
  that vision                                                                                                   47
BUT! OUR BOROUGH HAS CHANGED
“ The local effects of a global pandemic and a national lockdown hit Hounslow
hard. The clinical impact of COVID-19 has, rightly, been to the fore. …As serious as
this clinical picture is, the indirect impacts of COVID-19 will have a greater effect
still on the borough- Hounslow Recovery Plan

                                                                                        …’the virus does not affect us equally. National
                                                                                        studies show that older age, ethnicity, male sex
                                                                                        and geography, for example, are associated with a
                                                                                        greater chance of getting the infection, of
                                                                                        experiencing more severe symptoms, and of dying
                                                                                        with COVID-19. Locally we know that the wider
                                                                                        factors underpinning good health – such as
                                                                                        quality housing, decent work, regular income, and
                                                                                        a good education – are not available to everyone

                Figures 8 October 22020
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AND WE ARE OPERATING IN A NEW SYSTEM- THE ICS and ICP

                                                         June 2019 Designing integrated care systems (ICSs) in
                                                          England sets out the different levels of working within
                                                          the ICS, describing their core functions, the rationale
                                                          and how they work together.
                                                         Nov 2020, Integrating Care – The next steps to building
                                                          strong and effective integrated care systems across
                                                          England, set out proposals for legislative reform and
                                                          operational direction of travel.
                                                         There is a lack of clarity of the role of HWB in the
                                                          system. Apparently guidance may come

  ICS in North West London and the ICP in Hounslow (Our place-based committee)
  • We have a new Hounslow ICP Board (co- chaired by CEX) for commissioning local services, addressing
    local issues and escalating to the issues beyond its authority
  • It’ s relationship to the HWB needs to be defined and our TOR amended to show this
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Recommended Process

                               Opportunity to                                                    New TOR &
                                                                Workshops/                        refreshed
   Different Context           refine role and
                                                               engagements                         Strategic
                                    focus
                                                                                                    Focus

                             • Role:                     What works?
  • NWL Integrated Care
                               What is the best, most    What doesn’t work?                 • Revised Terms of
    System
                               purposeful role for the   What are the opportunities           Reference
  • Hounslow ICP Board         Board                     available for effective action?
  • Covid Impact on health                                                                  • Refreshed strategic
                             • Purpose:                  Where should we focus?               focus
  • The importance of the      What should our focus
    wider determinants of                                What are the alternatives?
                               be in this new context?
    health (Marmot 10                                    Where are we seeing effective
    years on)                                            board action
  • Our Recovery Plan                                    Is there a role for HWB as a key
  • Other Boards work                                    engagement forum?

    February                                                                                        May
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ANY OTHER BUSINESS

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