Richmond Place Committee Meeting: 17 May 2023

Attendees

Cllr Piers Allen, Richmond Health and Wellbeing Board and South West London Integrated Care Partnership Local Authority Member

Shannon Katiyo, Public Health Lead

Mike Derry, Healthwatch Richmond Lead

Melissa Wilks, Carers Lead

Nick Grundy, Primary Care Development Lead

Ian Dodds, Children’s Lead

Tara Ferguson-Jones, Communications and Engagement Lead

Kathryn Williamson, Voluntary Sector Lead

Heather Bryan, Primary Care Provider Lead

Jen Allan, Mental Health Lead

Anne Stratton, Community Lead

Denise Madden, Place Development Programme Lead

Sheena Basnayake, Divisional Director of Operations at Chelsea and Westminster Hospital NHS Foundation Trust

Jummy Dawodu, Director of Operations, Central London Community Healthcare NHS Trust

Lynn Wild, Associate Director Health and Care at Richmond and Wandsworth Councils

Fergus Keegan, Director of Quality, Kingston and Richmond, NHS SWL ICB

Vicki Harvey-Piper, Director of Strategy and Partnership, K&R, NHS SWL ICB

Yarlini Roberts, Chief Financial Officer, HRCH

Thom Lafferty, Deputy Chief Executive and Director of Strategy, KHFT and HRCH

Dugald Millar, Trustee, Healthwatch Richmond

Brian Roberts, Lead Transformation Manager, Kingston and Richmond, NHS SWL ICB

Transformation

Mental health services in Kingston and Richmond

South West London & St George’s Estates Transformation

A new model for the delivery of Adult Mental Health is being delivered in Kingston and Richmond in line with the principles of the Adult Community Mental Health Framework and the Long Term Plan. New operational structures for both the boroughs, launched in April this year, which include the integration of primary care mental health services having been transferred to SWL & St George’s Mental Health NHS Trust (SWLSTG).

Local Healthwatch organisations are leading independent evaluations for both Richmond and Kingston adult mental health services to ensure it is delivering high quality care for local people.

The services will move from 01 April 2024, with a period of transition this year as the services move from Camden and Islington to South West London and St George’s NHS Trust.

Richmond Wellbeing Services (RWS)

The committee were informed that Richmond wellbeing services has been delivered by SWLSTG since 5^th December 2022.The service is now settling post-transition and performance has improved. The wellbeing service is now in the process of becoming fully integrated into the Richmond mental health pathway through community transformation. Over the next year the Introducing access to psychological therapy services (IAPT) will become known as Richmond NHS talking therapies in line with national recommendations.

Barnes Hospital

Following consultations with patients, service users, staff, and community stakeholders over several years, Barnes Hospital is currently being redeveloped, with construction due to begin shortly. We anticipate completion in the summer of 2024. Once final approvals are confirmed, construction works will start on the development of a brand-new mental health facility for adult outpatients at Barnes Hospital. This represents an investment of £11m in local NHS services and has been designed in partnership with staff, carers, patients, and service users.

Services at Barnes Hospital have temporarily relocated to a newly refurbished facility called Livingston House in Teddington, with all appointments previously based at Barnes Hospital now held there. Work is also progressing on the refurbishment of a new facility at the former site of Richmond Royal, which will be home to Richmond Child & Adolescent Mental Health Services (CAMHS) later this year.

Richmond Better Care Fund (BCF)

There was an update on the Better Care Fund programme which is in place to support local systems to successfully deliver the integration of health and social care.

The committee were asked to note the changes from previous better care fund processes. Which are:

Funding allocations have been released on a national level. There has been an additional £600m in 2023-24 and £1bn in 2024-25 to support discharge from hospital and reduce delays allocated across Integrated Care Boards (£300m) and Local Authority (£300m). The NHS minimum contributions for social care and NHS commissioned out of hospital spend for all Health and Wellbeing areas is uplifted by 5.66% for each year.

Spending plans should now cover two years, with plans for 2024-25 provisionally set. The BCF plans now incorporate the adult social care discharge funding, now referred to as the discharge funding element of the BCF.
The discharge element of the BCF (comprising both local authority and ICB contributions) will be c£838k for the period April 2023 – March 2024, compared to the 2022-23 Adult Social Care Discharge fund, which was c£1,280k for the period 16th December 2022 – 31st March 2023.

Kingston Hospital / Hounslow Richmond Community Healthcare (HRCH) and Your Healthcare emerging strategy

The developing strategy for HRCH, Your Healthcare and Kingston Hospital was shared with committee members for discussion. The committee were informed that the ambition set out in the strategy is to support our places, our services, and people to thrive.

Both organisations have held around 70 meetings with teams of staff to inform development of the strategy, ensuring that staff were fully informed.

It was explained that by working together with partners THRIVE will enable the organisations to provide holistic health and care services aimed at improving the health and wellbeing of the local population and provide a range of more specialised services across south west London and beyond. The committee were told that the below points are the strategic principles that will guide the work forward:

Provide high quality care and strive for excellence in everything we do
Our workforce will operate at the top of its licence –making the best use of everyone’s skills
We will be a key provider in the delivery of integrated services across our places
We will work in a digitally mature system. Our digital tools will ensure all relevant information is available to decision makers at the point of care, so there are no delays in the provision of care.
We are committed to the Greener NHS Strategy, and we will do all we can to become carbon neutral by 2040 for the emissions we are in control of and by 2045 for those we can influence.
We will be recognised as an exemplar provider focusing on the prevention of ill-health, whilst working to reduce health inequalities in local populations.

Place partners felt that the Thrive Strategy resonated well and welcomed an opportunity to join a further engagement session for partners on this.

Regarding the digital aspect of the strategy, it was discussed by the committee that there is a need to integrate the digital strategy work already ongoing at place and at south west London together to inform the overall strategy.

Quality and Performance

Richmond Partnership agreement

The committee were informed that the purpose of the partnership delivery agreement is to set out the joint expectations between South West London Integrated Care Board (ICB) and Richmond place for delivering shared outcomes for the local population in line with the core purposes identified for each place.

The agreement also details the responsibility of place in supporting the delivery of south west London ICB’s delegated responsibilities as appropriate.

The committee was informed of the feedback received to date on the draft partnership agreement by partners. Feedback was also received from the place committee members and discussed at the meeting:

Success of Richmond Place performance hinges on provision for our population that sits outside of south west London (e.g. “discharge from hospital to usual place of residence”) is important to recognise this within the agreement and how the relationship works both within Place and between the SWL Integrated Care System (ICS) and neighbouring ICS, e.g. West Middlesex
Strong NHS focus on much of the reporting, which seems at odds with the narrative about what the ICS and Place are supposed to achieve in partnership around prevention and reducing health inequalities
Helpful that the agreement connects to the local health and care plan
Several corrections re grammar, language used and suggestions to add links to referenced documents
Finance, there was a query regarding adhering to Integrated Care Board Standing Financial Instructions and procurement policies and what it means in relation to delegation.

Communications and Engagement

The committee was presented with a series of slides that describe the engagement work that has be done in Richmond between January – March 2023

The slides describe how the team group their engagement work into areas e.g., health inequalities & community outreach, primary care and PCNs and prevention/early intervention, and gives examples of the work they have done and are doing under each area
The slides provide detail through worked examples of the engagement work that has been done in Richmond, demonstrating the impact and difference made for local people and communities
The team presented a case study of a local example of the engagement work that was done recently with RUILs to tackle health inequalities.
These slides are part of the Q4 report covering all 6 SWL boroughs that will be presented to the SWL People Communities Engagement Assurance Group (PCEAG) in early June for assurance purposes, to ensure the ICS is meeting its legal duty to involve
This is only the second time the report has been produced and it is a developing model – for this quarter PCEAG are keen for place committees to review the report and give comments and these will be included in the final PCEAG report

The committee was given information aboutthe Winter outreach programme which has been running since October last year and were informed of the areas and groups the team have heard from between January – March this year.

The team have focused their engagement on the groups they hear from the least and those experiencing health inequalities e.g., men, those experiencing mental health issues, the Korean community, young people, and people living in areas of deprivation
The team highlighted to the committee the emerging themes from the insight that has been gather from these groups:
- People rely on their community, the community leaders and voluntary and community organisations that support them for trusted health advice and information – so it’s key we engage with these organisations to deliver healthcare messages and use these trusted voices to help us have conversations with communities about local health and care services
- Primary care – all groups we spoke to have views on their GP practices and common themes were– online and triage services are a barrier to those who don’t speak English as a first language, difficulties getting urgent or same day appointments and big variations in how practices work across Kingston
- The impact of rising cost of living on the cost of medication, food, and heating
- Hospitals – people are experiencing long wait times and more people than usual, mentioned routine outpatient appointments being cancelled
- Mental health services – especially young people are struggling to access them due to long wait times and lack of knowledge or support available.

Assurance Reports for Information

Finance Delivery Group

The place committee was asked to confirm support for the approach outlined in the paper. The update summarised the aims of the Integrated financial performance group IFPG. The paper outlines that there is agreement to work together and to non-recurrently support the establishment of investment that has an overall benefit for the Kingston & Richmond (K&R) System.

The achievements over the last year were highlighted in the paper, including the fostering of closer relationships across system partners and the establishment of an innovation fund, followed by the ambition for 2023/24 and beyond. The paper indicated that there is recognition that Kingston place will need to work differently together to achieve the required financial and workforce sustainability. The process will be to support the priorities emerging through the Transformation Delivery Group / A&E Delivery Board.

To date the IFPG has achieved:

Engagement from system finance partners across Kingston and Richmond: Social Care, Integrated Care Board, place, Hounslow Richmond Community Healthcare, Your Healthcare and Kingston Healthcare Foundation Trust.
Establishment of a K&R place investment fund to provide non-recurrent pump priming support for proposals which will go on to be self-sufficient. All proposals are overseen by the transformation delivery group to ensure alignment with the 5 agreed strategic priorities. To date four proposals have been approved for support:
Heart failure nurses
Patienteer
Admiral nurses for dementia
Falls
An open book approach has been established which is expected to deepen over time. It has been agreed that any efficiency savings achieved from pump primed investment should be reinvested to the level of original investment; to support maintenance of the fund.
The ambition for the future is to continue working together in partnership to achieve future financial and workforce sustainability. As partners there is a need to work differently together if we are to achieve optimal benefits across Kingston and Richmond Place and beyond.

Quality Delivery Group

The Quality Delivery Group (QDG) is established to provide assurance and oversight to the Place Partnerships on the quality of services and programmes delivered across the Kingston and Richmond Places. An additional reporting line exists from the Chief Nursing Officer (CNO) through to SWL CNO through the SWL System Quality Council which meets monthly.

The committee were informed via the paper about key matters to date that the QDC have received –

Quality place delivery plan – either completed or in development that delivers on quality improvement at Place, which draws together quality planning, quality control, quality improvement and assurance functions to deliver care that is high-quality, personalised, and equitable

An understanding of current Integrated Care System governance arrangements

Measuring quality: An agreed way to measure quality, including safety, using key quality indicators triangulated with intelligence and professional insight, which is reported publicly and transparently at Board-level to inform decision-making and effective management of quality risks.

The committee were informed that a forward plan is in place which covers the areas identified in the recently revised Place Partnership Delivery Agreement including:

• Primary Care

• Safeguarding – adults and children

• Children Looked After

• SEND

• Patient safety and learning

• Continuing Health Care

• Infection and prevention control

Next steps for the QDC are to:

Continue to provide high degree of focus and leadership on emergency services – this remains a priority as the increased waiting times could have a negative impact on both patient experience and length of stay