London's devolution deal to benefit the people of Havering

16 November 2017

Today’s landmark devolution deal to improve health and care in London, signed by the Mayor of London and the Secretary of State for Health as well as health and care leaders across the capital, is a key step forward for greater health and care integration in Barking and Dagenham, Havering and Redbridge,” said Councillor Maureen Worby, Chair of the Barking and Dagenham, Havering and Redbridge Integrated Care Partnership Board (BHR ICPB). “It will support our planned pooling of budgets to enable joint planning and delivery of services, starting from April 2018 with selected services.”

“We also welcome the news that devolution will allow money from the sale of London’s NHS-owned assets to be reinvested in the capital’s health and care system, and look forward to working with partners across London to ensure these new opportunities benefit local people.”

Since December 2015, health and care leaders in Barking and Dagenham, Havering and Redbridge, as one of five London devolution pilots, have been working together to develop an accountable care system – led and delivered by NHS and council partners - to improve patient care by keeping people out of hospital and in their own homes, reduce the costs of unnecessary hospital care and then spend that money to support improving health and wellbeing in other ways. Alongside this, we have been working together to change and streamline patient pathways where possible, to benefit patients by greatly speeding up the process.

In 2016, we carried out an extensive engagement programme, surveying thousands of local people about their attitudes and views on health and social care. We held a series of workshops with voluntary sector colleagues to explore news ways of mutually-beneficial ways of working. For the first time, we collectively surveyed all staff working for NHS organisations and GPs and in local authority care services across BHR to help us understand the barriers between services that impede the delivery of high-quality care and what our staff feel they need to help local people lead longer, healthier lives. All groups showed wide-spread support for closer working between services. We used this rich information to describe the challenges and set out our integration ambitions in our strategic business case.

Councillor Worby said: “We are working to fundamentally change the way in which the health and care system works across Barking and Dagenham, Havering and Redbridge. We believe that pooling budgets and sharing resources will enable us to work more efficiently and sustainably and produce better health wellbeing outcomes for local people.”

Local authority and health commissioners (from the CCGs) will be jointly accountable for the health and wellbeing of the local population, setting the high-level strategic outcomes for their defined population.

Local authority and NHS providers of services, including hospital, community and GP services, will work together in an alliance to provide health and care services in the most appropriate way for their population (which could expand over time to include other providers such as the voluntary sector and care homes).

Commissioners will pass the budget to the provider alliance, who will then decide the best way of using it to meet the high-level strategic outcomes. The experience worldwide from areas that have introduced similar models is that this leads to a greater focus on prevention, with more resources used to improve population health and wellbeing.

The provider alliance is establishing locality teams consisting of health and care professionals from across the system, co-located and working together to provide holistic treatment for individuals. They will provide primary, community and social care and local authority services - such as housing, employment, diet and lifestyle – that support better health and wellbeing. Each team will support a population of at least 50,000 residents, with primary care at its heart (in networks of 8-15 GP practices).

The locality teams will understand and be tailored to their specific population (for example in terms of the staff mix), identifying people who are likely to develop serious health problems and offering early support and intervention. They will be flexible, responding to changes in the population. We expect there to be a single point of access to advice, assessment, support and treatment.

This model should result in a shift in resource from acute hospital services to services in the community which are proactively supporting individuals to take control of their own health and wellbeing and stay as well as possible, in their own homes, for as long as they can.

Councillor Worby said: “We will know we have succeeded in our aim when local people tell us it feels different - their care and treatment is seamless and most of their needs are met near their home. They will say that accessing care is simple and they feel the local health and care system responds to them as an individual.”

Working together, commissioners and the provider alliance have agreed to pilot this approach, ideally in several service areas, from April 2018. Commissioners are developing joint commissioning plans for three services - intermediate care; diabetes; and children’s special educational needs and disabilities - to share with the provider alliance this month for them to consider how they can provide better, more joined-up services to the local population.

Councillor Worby added: “Our ambition is to learn from the pilot areas and introduce the new approach, with fully pooled budgets, across all NHS-led health and local authority care services from April 2019. Today’s announcement will help us to move forward together.”