Agenda item

An item of Urgent Business may only be considered under this heading, where, by reason of special circumstances to be recorded in the minutes, the Chair of the meeting is of the opinion that the item should be considered at the meeting as a matter of urgency.  Wherever possible, the Chief Executive should be given advance warning of any Members' intention to raise a matter under this heading.

Developing the Lancashire Place – Our Proposition for Aligned Governance

The item of Urgent Business had been received and agreed by the Chair as there was a need to agree governance arrangements for the recently established Place Based Partnership in relation to the Health and Wellbeing Board.

Louise Taylor, Adult Services and Health and Wellbeing, Lancashire County Council and Sarah James, Health and Care Integration, NHS provided the context along with the attached presentation which outlines the proposal for new governance and requested the views of the Health and Wellbeing Board.

The Board noted that as a result of the major reform of the NHS, there has been some changes in the architecture of Lancashire and South Cumbria that has introduced an Integrated Care Board which manages the NHS spend and performance and has established an Integrated Care Partnership which is mainly between local government and the NHS and must involve and engage a whole range of other key partners on collaborative working to make a difference in Lancashire to Lancashire people.

The Board were asked as to whether the Health and Wellbeing Board could play a more prominent role in the new arrangements given that the Board exists and has a statutory responsibility to the Better Care Fund which was introduced to encourage the NHS and Lancashire County Council to pool its funds to decide where to collaborate and spend and particularly to support people in the community.  The Board were asked whether it could capitalise on that and produce a Joint Strategic Needs Assessment (JSNA) to make the Lancashire Health and Wellbeing Board the Place Based Partnership.  It would be the main collaborative space for agreeing its' strategic direction, priorities and assurance on delivery whilst delivery itself would take place through Central, East and North localities across Lancashire as well as at district and community level.

If taken forward, the Health and Wellbeing Board in its new role would have strategic direction around the Better Care Fund, the Health and Wellbeing Strategy and the delivery will be done within the localities due to the size, range and scope of the services within Lancashire and would need the strong delivery units to carry out the work.

Further detail was highlighted in the presentation attached to these minutes, which set out the timeframe for the proposed aligned governance as to how a move from the Health and Wellbeing Board to a Place Board discharging the functions of the Health and Wellbeing Board, to a full Joint Committee with delegated decision making.

Following the presentation, the following comments were made:

·  The focus needs to be on outcomes and there needs to be proportionate governance in place.

·  It will bring additional responsibilities to the Health and Wellbeing Board, which could mean additional time commitments and the willingness to take on these responsibilities and drive it forwards.

·  A review of membership would need to take place, however keeping it streamlined with key partners playing an integral part in order to set a strategic direction of travel with a degree of oversight and assurance with the key being the delivery units.

·  To look at the perception of locality working and ensure that everything is not brough back to the "centre".

·  Healthwatch are looking to establish a Citizen Ambassador model which is a group of citizens who are supported, trained and encouraged by Healthwatch, who have lived experience of using services and can help shape, design and run services and ask them to attend meetings.  It does, however, require resources and a small amount of money to reward people for their involvement and giving their time and need to consider involving people with lived experience.

·  Brief discussions with the Integrated Care Board regarding the proposals have taken place, however, dependant on the views of the Health and Wellbeing Board and their agreement to the proposals at this meeting, then further discussions would take place with the Integrated Care Board prior to the next Health and Wellbeing Board.

·  There needs to be a differentiation between what the role of the Board/Committee is and the role of what the teams are being asked and are able to do.

·  Discussions have taken place with other areas, eg Cheshire and Merseyside with some areas discounting the proposals however, it was reinforced that all Health and Wellbeing Boards operate differently, and Lancashire is larger than some Integrated Care Systems, therefore it cannot be compared to most other areas.

·  The proposals should be embraced as the intent of the Board.

·  It was felt that membership needed to reflect more of the public voice.

·  It is unclear currently, what is going to be delegated and this is something that needs to be very clear as to what the Board will be responsible for.

·  There is a difference between Health Care and Health and also Health and Social Care and Health and Wellbeing.  20% of Health and Wellbeing outcomes are influenced by Health and Care Services with the remaining 80% around the wider determinants of health.

·  The Health and Wellbeing Board has a wider strategic role around improving outcomes and reducing inequalities.

·  Noted how the new role of the Board would embed itself in the wider manifestation of public sector collaboration for Lancashire's places and communities.

·  That it is around proportionate governance and to focus on the outcomes.

·  The Board would need to set the strategic context for the local delivery and operate as an enabler.

·  If Lancashire is the first Board to become a Place Based Partnership, it should be embraced.

Resolved:  That the Health and Wellbeing Board:

(i)  Considered the proposal in principal and approved further work to be undertaken.

(ii)  If further work was approved, requested the development and more detail on the potential new arrangement and that a fuller proposal be received at its next meeting on 24 January 2023.