Amy's Monthly Briefing - September 2020

I hope everyone is staying safe and managed to get some kind of a break over the summer. During August, I met with the Deputy Mayor for Adults, Health and Wellbeing, Cllr Rachel Blake, to talk all things partnership and integrated care, and had further conversations with partners to finalise the revised THT governance, which will be circulated very soon.

September’s Executive Board had a packed agenda as ever. We started by reviewing the 12 week plan, which reflects the existing THT borough plan and focuses on preparing for a future wave of Covid-19 and winter pressures, while laying the foundations for longer term recovery and transformation. The plan’s objectives are:

1. Prevent and control Covid-19 infection

2. Recommence delivery of services that were suppressed in the initial peak

3. Meet new or changing needs of our population due to Covid-19

4. Ensure services are capable of responding to surging demand and local outbreaks

5. Operate within capacity and resources so everyone who needs care can receive it

We agreed to delegate oversight, development and delivery of this work to the new Local Delivery Board, which sits underneath the THT Exec Board to drive operational change. We reflected on how to embed the Covid-19 response in day-to-day delivery across the system, including normalising testing, local contact tracing through existing routes e.g. social prescribers and care navigators, and the ongoing shielding work.

Next up was a joint financial report from the CCG and Council. The CCG reported a £2.6m overspend to the end of July, of which £1.6m was due to Covid-19. NHS England has approved retrospective top-up funding to achieve a break even position and we await the prospective financial envelope for October onwards from NEL. The biggest drivers of Covid-19 costs are in primary care and community health services. In adult social care, the council forecasts a £5m overspend, made up of Covid-19 expenditure and ongoing pressures from previous years. With 4,000 users being supported, there are high costs within nursing / residential placements and home care, with high numbers of small care packages. Overall, the council faces a major financial gap of £30m, having spent an additional £60m during the first four full months of lockdown, with the government only committing £30m of extra funding so far.

Board members raised the need for future financial reports to include children’s services and other relevant areas of council spending and flagged overspends within both learning disabilities and mental health services, where we have integrated teams, and forthcoming cuts to council services, due to the £30m gap. We reflected on the system challenge that the NHS has been covered for Covid-19 costs while the council has not fully and also bears the legacy of previous austerity measures. The Exec Board agreed to a closed session ahead of budget and savings proposals, to share plans early and develop a partnership response. This fits with ongoing work to explore the scope for greater alignment of NHS and council budgets to unlock transformation and spend funds most effectively across the whole system.

Our next focus was on the local response to Public Health England’s Covid-19 disparities report, which highlighted significant inequalities, including that people of Bangladeshi ethnicity, once diagnosed, have twice the risk of death than the White British ethnic group. The Public Health team presented an analysis of where we are against PHE’s 7 recommendations, highlighting progress, actions and urgent gaps to address. We also had an update on the Mayor’s Inequalities Commission which plans to cover employment, health and community leadership. Board members highlighted the weight of responsibility local young people are bearing during Covid-19 when informally interpreting for their family members, the work we all need to do within our organisations to address bias and racism, and the need to prioritise community engagement and workforce as we take this agenda forward. We agreed to task the life-course workstreams and enabler groups to review and commit to relevant local recommendations, to embed a focus on racial inequalities across the system.

Last but certainly not least, we welcomed Tahima and Tuwahid, two SEND parent ambassadors, to our user voice slot. They spoke with such passion about their voluntary work to promote parental participation in the community, schools and services, and their goal to broaden outreach and foster relationships with mainstream settings to promote inclusion and support early intervention for children with no diagnosis. The major challenges families raise with them include barriers to approaching professionals who can be dismissive of parents' concerns, lack of diagnosis or identification of needs, lengthy delays in getting Education, Health and Care Plans, and fears about safety of SEND transport during Covid-19.

As ever, it was a breath of fresh air to have local people in the room (well, on the Teams call) speaking directly to system leaders about their experiences and what needs to change.