Amy's Monthly Briefing - September 2022

September’s THT Board was the first time we also met formally as the new Place Sub-Committee of the North East London (NEL) Integrated Care Board (ICB). As part of the transition, we welcomed some new members to the Board – Roberto Tamsanguan – Place Clinical Care Director, Neil Ashman – new CEO of the Royal London and Mile End Hospitals, Matthew Adrien – new Service Director of Healthwatch Tower Hamlets, and Mark Gilbey-Cross – Director of Nursing at NEL. We also said goodbye to Julia Slay, who has been the Associate Lay Member for THT and previously the borough’s CCG, for the past six years and done huge amounts to champion and challenge our approach to citizen voice, patient engagement and co-production. We will miss Julia’s wisdom and expertise greatly but wish her the best for the future!

The first item was a stock take of our engagement work across the partnership with recommendations for the future to strengthen citizen voice at the executive board, through the engagement leads group, and within the life course workstreams and local delivery board. While the borough Associate Lay Member roles have ended at NEL-level, the Board restated our commitment to locally invest in a Patient and Community Representative as a formal member of both THT and of the Place Sub-Committee, which we will move to recruit asap. In the meantime, as Chair of THT I will oversee the engagement work at Board level once Julia finishes at the end of September, to ensure continued momentum and visibility. We agreed the recommendations, which will come to back to the October Board as a detailed action plan for sign off. Partners also proposed developing a stronger ‘critical friend’ function that enables the public to challenge how THT does business, meaningfully interrogate workstreams and projects, and hold the Board to account – e.g. via a stakeholder committee that could function like a Council of Governors for a mental health trust, or similar independent scrutineer roles. 

We heard the quarterly integrated finance report which presented a very bleak financial picture across both the ICB and local authority commissioning budgets, with major gaps in government funding compared to growing complexity and demand. Providers reported significant recruitment challenges resulting in higher agency and locum costs, on top of increased numbers of people needing care, hyperinflationary pressures, and failure to deliver efficiency plans. The Board requested a deep dive session as a priority ahead of Winter, to share and compare savings plans from all partners, identify system-wide gaps and potential solutions, and upskill partners in each other’s budget processes.

The SEND annual report was presented for discussion and Board members praised how strongly the voices of children, young people and parents shone through every chapter. Successes highlighted in the report were: improved engagement of children, young people and parents; delivering a wider approach to inclusion e.g. through new playground equipment; quality auditing of education, health and care plans for the first time; inspection feedback that the leadership is across the weaknesses in SEND provision and there were ‘no surprises’ inspectors uncovered; new investment across the SEND programme. Areas for further work include: timeliness and delays in referrals, assessments and EHCPs; improving communications with all parents; workforce gaps especially specialists e.g. in speech and language therapy; a stronger early help offer so that EHCPs are no longer seen as the only route or ‘ticket’ to support; post-16 opportunities for young people with SEND.

We then had an update on the THT Equity Programme, which will use £460k of funding from NEL for quality improvement projects that identify and address areas of inequity in health and wellbeing. The programme will run from October 2022 for 16-18 months, any teams, organisations or groups across the borough will be able to apply, and we are putting additional funding in place to support community and voluntary sector organisations to take part. This is set to be a really exciting and important programme, with the core principles we aim to support being:

• Improved education, training and tools to better understand where inequalities exist and how to address them, including understanding and tackling racism;
• Inclusive leadership and representation, including workforce equity;
• Achieving equity in service provision, from design to delivery, including patient experience and access;
• Building community resilience and participation, including codesigning services. 

Finally, we discussed and approved new Terms of Reference for both THT Board and the Place Sub-Committee of NEL ICB, with some amendments to make more explicit our commitment to anti-racism and citizen voice at the heart of our partnership. We also discussed options for vice-chairing arrangements, and partners were keen to explore a ‘triumvirate’ model which balances professional, clinical and lived experience leadership through the Independent Chair (me) plus two Vice-Chairs – the Clinical Care Director (Roberto) and the new Patient and Community Representative (to be recruited). I’ll be able to share more about this next month. We are also keen, now Covid permits, to get back out into the borough more, holding THT Board meetings in community buildings, doing exec visits and walk arounds, and re-starting the THT workforce events. On that note, I hope to see many of you at the THT awards (albeit online) on 29 September to celebrate the amazing work happening across our partnership!