1

Item Health & Wellbeing Board

Date 9th July 2013

Title: Health & Wellbeing Board – Governance Issues

Report of: Clive Morton, Head of Health Integration

Phone: 020 8496 3506

Email: clive.morton@walthamforest.gov.uk

Appendices: Appendix A: HWBB Priorities Appendix B : Structure Chart Appendix C: Draft Terms of Reference of Strategic Health and Wellbeing Forum

Public Access: Open

1 PURPOSE OF REPORT / SUMMARY

1.1 This report describes the outcome of a series of discussions concerning the future governance of the Health and Wellbeing Board (HWBB) including those held at the Shadow Health and Wellbeing Board on 27th February 2013 and the HWBB Workshop held on 31st May 2013.

1.2 The report recommends amendments to the existing HWBB membership, the

further consideration of a new set of priorities and a structure that outlines the relationship between the Board and its subgroups and the rationale for these.

2. RECOMMENDATIONS

2.1 The Board is asked to:

2.1.1 Recommend to Council the changes in Health and Wellbeing Board

membership outlined at 6.2 of this report and listed as follows:

Addition of the LBWF Deputy Chief Executive, Environment &

Regeneration

Addition of the Waltham Forest Clinical Commissioning Group

Chief Officer

Removal of LBWF Divisional Directors of Adult Social care and Children and Families.

2.1.2 Discuss the new priorities outlined in Appendix A and agree any further

work required to finalise them

2.1.3 Agree the sub-groups outlined at Appendix B

2

2.1.4 Agree that each year three wider informal Strategic Health and

Wellbeing Forums will be held to inform the work of the Board and that

these Forums will take place immediately prior to each alternate

HWBB.

2.1.5 Agree that the membership of the Strategic Health and Wellbeing

Forum will be reviewed following its first year of operation.

2.1.6 Agree the Terms of Reference for the Strategic Health and Wellbeing

Forum attached at Appendix C to this report.

3. BACKGROUND

3.1 At its 27th February meeting the Shadow Health and Wellbeing Board

considered a report outlining the necessary changes to the structure and

governance of the Board and recommended actions to ensure that the Board

complies with its statutory obligations.

3.2 At is 21st March meeting Council agreed to establish the Health and Wellbeing Board as a full committee of the Council from 1st April 2013 with the membership outlined at para 6.1 of this report.

3.3 On 31st May the Health and Wellbeing Board met, along with members of the

Shadow HWBB, to consider the wider governance issues to be addressed to ensure the efficient operation of the HWBB.

4. Establishment of Sub-Committees, working parties or task and

finish groups and operation of meetings

4.1 The Health and Wellbeing Board will develop an approach to planning and

conducting its work that ensures an effective strategic approach to meeting

the Health and Wellbeing needs of local residents.

4.2 The effective use of smaller groups conducting work on behalf of and

reporting back to the HWBB will achieve the statutory and operational

obligations and aspirations of the Board whilst allowing it to maintain its

strategic leadership role.

4.3 Appendix B proposes a number of groups and their relationship to the Health

and Wellbeing Board and it’s priorities. The HWBB will formally establish such

groups at public meetings, and agree their remit, membership and terms of

reference at the time of establishment, although these may be amended from

time to time by the HWBB at a later meeting. The nature of each group will

depend on the task allocated and include the following models:

3

4.3.1 Sub Committees. A Sub Committee of the HWBB may be appropriate

when a workstream may be lengthy and requires continued attention at

a senior level, for example a performance sub-committee, and where it

is appropriate for the HWBB to delegate some of its statutory powers to

such a body. A sub-committee would in effect be a formal committee

of the council, possibly with decision-making powers, and its meetings

and members would be subject to formal statutory procedures and

responsibilities. Membership would be drawn from the full HWBB

membership. Its terms of reference will include a description of its

powers and when they were delegated by the HWBB.

4.3.2 Task & Finish Groups. A Task and Finish Group will be less formal

and more flexible, addressing an issue in depth with a predetermined

timescale and reporting its findings to the HWBB. It would not have any

decision-making powers but would make recommendations to the

HWBB. Its terms of reference will include its membership, work

programme, frequency and type of meetings, and a fixed end date.

Membership may be drawn from the HWBB and beyond.

4.3.3 Virtual Groups. A Virtual Group will carry out their work without

necessarily meeting as a group on a regular basis. Typically a member

of the group will be tasked with producing a report for HWBB

consideration with each group member contributing ‘remotely’. They

will not have decision-making powers and membership may be drawn

from the HWBB and beyond.

4.3.4 Sub Groups. Sub Groups will meet on a regular basis, will usually

have their own terms of reference and work programme and will report

regularly to the HWBB. They will not have decision-making powers.

Membership may be drawn from the HWBB and beyond.

5 HWBB Priorities

5.1 The priorities outlined in Appendix A are structured to reflect the main

areas where LBWF children’s and adults services, working with the

Waltham Forest Clinical Commissioning Group, can make the highest

impact through integrated working. They also identify the priorities that

health commissioners in the borough believe to be the most urgent

priorities for providers to enable them to make maximum impact on the

Health and Wellbeing of borough residents.

5.2 These priorities will be reviewed regularly by the Board.

4

6 Board Membership

6.1 Board Members

Council on 21st March 2013 appointed the following HWBB Membership:

• Councillors Angie Bean, Clare Coghill and Ahsan Khan (nominated by the Leader); • Alan Adams, Deputy Chief Executive and Executive Director, Families; • Glynnis Joffe, Interim Executive Director, Adult Social Care; • Alison Murphy, Interim Deputy Director, Children’s Services; • Vicky Hobart, Director of Public Health; • Jaime Walsh, Healthwatch Manager; • Dr Anwar Khan, Chair of the Clinical Commissioning Group.

6.2 Proposed Changes to Board Membership

6.2.1 It is proposed to add the Deputy Chief Executive Environment & Regeneration of Waltham Forest to ensure HWBB outcomes receive the full benefit of regenerative initiatives towards achieving significant improvement in residents’ Health and Wellbeing 6.2.2 It is also proposed to add the Clinical Commissioning Group (CCG) Accountable Officer to ensure that the CCG is fully engaged with and able to contribute to HWBB strategic initiatives including the statutory responsibility to promote integration 6.2.3 The inclusion of the Deputy Chief Executive of the Waltham Forest Families Directorate in the membership of the Board satisfies the statutory requirement to include the Directors of Children’s Services and the Director of Adults Social Services in the membership. Therefore to avoid duplication of responsibilities and to ensure that the membership numbers remain at a functional level it is proposed to remove the posts of Divisional Director of Adult Social Care &

Divisional Director of Children and Families.

6.3 Proposed Additional Standing Invitees and Formal Advisors to the Board

6.3.1 Arising from the statutory requirement for the Board to promote integrated working across Health and Social care Services it is proposed to issue a standing invitation to the Head of LBWF Strategic Commissioning and the Waltham Forest CCG Director of Strategic Commissioning to ensure the commissioning strategies and services of the major commissioners of health services within Waltham Forest are fully aligned.

5

6.3.2 The Chairs of the Children’s and Adults Safeguarding Boards

have agreed to act as formal advisors to the HWBB on relevant

safeguarding issues and can choose either to attend meetings or to

send comments on agenda items to be considered by the Board .

7 Creation of a Strategic Health and Wellbeing Forum

7.1 The HWB Board would benefit from alternating its agenda between meetings

that address only formal business and meetings that, while still focusing on

formal business, also allow the opportunity to consider strategic matters in-

depth. Including a wider range of invitees in strategic discussions will lead to

Board decisions being both stronger, and more likely to be delivered.

7.2 It is proposed that a Strategic Health and Wellbeing Forum be established

and that HWBB Members, Standing Invitees and Formal Advisors are invited

to both Business and Strategic meetings. Further additional invitees will be

encouraged to attend the wider Strategic Health and Wellbeing Forums. The

Strategic Health and Wellbeing Forums will take place immediately prior to

alternate formal Board meetings.

7.3 Meetings of the Forum will be themed and will focus on specific issues of

strategic importance leading to recommendations to the Health and Wellbeing

Board.

7.4 Draft Terms of Reference for the Strategic Health and Wellbeing Forum are

attached at Appendix C. It is recommended that the Board review the

membership of the Forum following its first year of operation.

7.5 Proposed Membership of the Strategic Health and Wellbeing Forum.

HWBB Board Members, its standing invitees and advisors will be members of the Forum. In addition the following will also be members of the Strategic Health and Wellbeing Forum:

7.5.1 The Chief Executive of Ascham Homes in recognition of the strategic

and operational part that housing will play in improving the future

health and wellbeing of borough residents and in delivering the

regeneration of the Borough.

7.5.2 The Chief Executive of North East London Foundation Trust (NELFT)

to ensure the Board benefits from the expertise available from NELFT

as a major local service provider.

6

7.5.3 The Borough Commander of the Metropolitan Police to advise and

engage on the required application of resources to improve community

safety to achieve the necessary improvements in residents’ H&WB

7.5.4 A senior representative of Barts Health Trust to represent the Trust and

in particular Whipps Cross University Hospital to ensure that, as the

largest local provider, the Trust’s plans, views and experience

contribute effectively to the HWBb’s approach to strategic initiatives.

7.5.5 A voluntary sector representative to represent the users of local adults’

health and social care services and to inform the strategic approach of

the Board

7.5.6 A voluntary sector representative to represent the users of local

childrens’ health and social care services and to inform the

strategic approach of the Board

7.5.7 The Director of Delivery North, Central and East London of the NHS

National Commissioning Board to ensure that the HWBB’s direction is

fully informed by national and sub-regional commissioning intentions

and priorities.

7

8

Health and Wellbeing Board Cross-Cutting Themes

Adopting an integrated approach to health and social care based on prevention,

personalisation, safeguarding, promoting independence, control and choice and reducing

inequalities. This will ensure the best possible outcomes for residents underpinned by

service user involvement and emphasising the child’s voice throughout

HWBB will ensure that the central part that Regeneration plays in improving the health and

wellbeing of borough residents is reflected in the Board’s priorities.

9

Health & Wellbeing

Board

Safeguarding

Children Board

Safeguarding

Adults Board

Improvement &

Development

Board for

Childrens

Services

Sub-Group

Educational

Improvement

Partnership Board

Sub-Group

Child Poverty

Board

Sub-Group

Reducing Health

Inequalities Board

Sub-Group

Full Council Cabinet (For Executive

Matters)

CCG Board

Joint

Commissioning

Board

Sub-Group

SafetyNet

Board

Sub-Group

CCG

Development

Group

Virtual

Group

Health

Integration

Virtual

Group

Appendix B Proposed Structure

10

The proposed structure includes the following groups. The summary below

outlines the functions of these groups and their relationship to the HWBB

priorities:

1 Reducing Health Inequalities Board (Sub-Group)

This Board will ensure the development and delivery of the Health and

Wellbeing Strategy Action Plan and will report to the HWBB on progress against key actions and indicators.

Link to HWBB Priorities:

Maximise employment opportunities for local residents

Work with commissioners to ensure residents can access the right healthcare in the right place

Establish effective NHS Healthchecks programme

2 Educational Improvement Partnership Board (Sub-Group)

The EIPB Board will focus on achieving shared ambitions for education

in Waltham Forest, supported by 3-4 Working groups. This will

complement, support and encourage bottom-up collaboration, while

ensuring that all partners are constructively involved in working

together in the interests of all of Waltham Forest’s children and young

people.

Link to HWBB Priorities:

Developing a systematic approach to embedding the child’s voice in our strategies and service delivery

Healthy Child Programme

Maximise employment opportunities for local residents Educational improvement is a key factor in the regeneration of the Borough

11

3 SafetyNet (Sub Group)

The SafetyNet Executive is the principal collective decision-making and co-ordinating body for strategic crime and disorder work in Waltham Forest. It is the programme board with oversight of implementation and evaluation of project initiatives and activities. Link to HWBB Priorities:

• Ending violence against women and girls

4 Joint Commissioning Board (Sub Group)

The primary aim of the Joint Commissioning Board is to promote integration and partnership working in commissioning, strategy development and resource allocation between the NHS and social care for children’s and adults services. Link to HWBB Priorities:

• Develop and implement a joint commissioning function across health and social care

• Review intermediate care services across health and social

care and deliver an effective model

• Effective partnership working in the delivery of care to older people

• Work with commissioners to ensure residents can access the

right healthcare in the right place

• Develop a Public Health Commissioning Strategy

• Ensure NHS commissioning responsibilities are delivered effectively including

5 Child Poverty Board (Sub Group)

The Child Poverty Board oversees the development and implementation of the boroughs Child Poverty Strategy and monitors child poverty work by services and organisations. It will develop, monitor and performance manage the implementation of the action plan to reduce child poverty and evaluates the impact.

12

• Link to HWBB Priorities:

• Developing good quality management Information

• Maximise employment opportunities for local residents

• Ensure NHS commissioning responsibilities are delivered

effectively including: Healthy Child Programme

6 Improvement and Development Board for Children’s Services (Sub-Group)

The purpose of the Improvement and Development Board is to ensure that: • the Council and its partners share a clear and ambitious vision

for children’s services in Waltham Forest; • strategic governance arrangements provide children’s services

with strong leadership and challenge; and • safeguarding and looked after children services continue to

improve and meet the standard required for an Ofsted rating of at least good.

Link to HWBB Priorities:

• Ending violence against women and girls

• Aspire to excellence in service delivery

• Recruiting and Developing a Skilled workforce

• Developing good quality management Information

• Developing a systematic approach to embedding the child’s voice in our strategies and service delivery

• Ensure NHS commissioning responsibilities are delivered

effectively including: Healthy Child Programme

7 Health Integration Group (Virtual)

The Deputy Chief Executive, Families Directorate will update the Board

on progress as we continue to develop integration opportunities

13

between LBWF and WFCCG. Health Integration will be a standing item

on the HWBB agenda

• Link to HWBB Priorities:

• Develop and implement a joint commissioning function across health and social care

• Effective partnership working in the delivery of care to older

people

• Effective GP led commissioning network

• Work with commissioners to ensure residents can access the right healthcare in the right place

• Develop a commissioning strategy for public health services

8 CCG Development Group (Virtual/Task & Finish)

The Chief Officer of the CCG will report on progress to ensure that

WFCCG structure and governance is optimised to allow the delivery of effective commissioning of Health Services. Link to HWBB Priorities:

• CCG to achieve authorisation

• Effective GP led commissioning network

14

Strategic Health & Wellbeing Forum Terms of Reference

Background

The Forum will play a key part in supporting the Health and Wellbeing Board in delivering both its local priorities and its statutory duties. The statutory role of the Board is outlined below:

The Health and Social Care Act 2012 gives Health and Wellbeing Boards specific functions. These are a statutory minimum and legislation permits further functions to be delegated to the Board ‘in line with local circumstances.’ The statutory functions are:

1 To prepare Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs), which is a duty of local authorities and clinical commissioning groups (CCGs). 2 A duty to encourage integrated working between health and

social care commissioners, including providing advice, assistance or other support to encourage arrangements under section 75 of the National Health Service Act 2006 (ie lead commissioning, pooled budgets and/or integrated provision) in connection with the provision of health and social care services.

3 A power to encourage close working between commissioners of health-related services and the board itself.

4 A power to encourage close working between commissioners of health-related services (such as housing and many other local government services) and commissioners of health and social care services

5 Any other functions that may be delegated by the council under section 196(2) of the Health and Social Care Act 2012

Role and Responsibilities The Forum will :

Be themed and will focus on specific issues of strategic importance leading to recommendations to the Health and Wellbeing Board.

Undertake in-depth partnership work on agreed aspects of the HWBB’s priorities

Provide the HWBB with the views of a range of provider organisations

Provide the HWBB with the views of the wider voluntary sector

Appendix C

15

Inform the HWBB Forward Plan by identifying key issues likely to arise over the next 12 months

Offer the HWBB its views on a range of strategic issues

Contribute to the work of task and finish and other sub groups of the HWBB as appropriate

Frequency of Meetings:

Meetings will take place three times a year and will take place immediately prior to meetings of the HWBB

Meetings will last no more than 90 minutes

Membership

Portfolio Lead Member for Health & Wellbeing Portfolio Lead Member for Adult Services Portfolio Lead Member for Children and Young People Deputy Chief Executive and Executive Director, Families Joint Director of Public Health Healthwatch Manager Chair of the WF Clinical Commissioning Group. Deputy Chief Executive Environment & Regeneration Clinical Commissioning Group Chief Officer LBWF Head of Strategic Commissioning CCG Director of Strategic Commissioning Chair of the Childrens Safeguarding Board Chair of the Adults Safeguarding Board Chief Executive of Ascham Homes Chief Executive of North East London Foundation Trust (NELFT) Borough Commander of the Metropolitan Police Senior representative of Barts Health Trust Voluntary sector representative to represent the users of local adults health and social care services Voluntary sector representative to represent the users of local childrens health and social care services The Director of Delivery North, Central and East London of the NHS National Commissioning Board Named substitutes will be allowed for meetings of the Strategic Health & Wellbeing Forum

The Chair of the Health and Wellbeing Board will chair the Forum. If the HWBB Chair is unable to be present a chair for the meeting will be agreed from amongst attendees.