Agenda item

The paper sets out the governance review of the Health and Wellbeing Board and Surrey Heartlands Integrated Care Partnership/Integrated Care Board; noting that as the focus on achieving greater alignment at all levels of delivery and strategic oversight increases, it is imperative to review and assess how the component parts are working to enable this. Reviewing governance functions so they are efficient and effective, reduce duplication and maintain focus on delivery for residents, particularly those experiencing health inequalities, will ensure that Surrey is well positioned to deliver against its clear strategic aims and implement its delivery plans.

Witnesses:

Phill Austen-Reed, Principal Lead - Health and Wellbeing, Surrey County Council

Key points raised in the discussion:

1.    The Chair explained that the proposals in the report sought to rationalise the membership and way the Health and Wellbeing Board (HWB), Surrey Heartlands Integrated Care Partnership (SHICP) and Integrated Care Board (SHICB) operate to avoid repetition. Noted that the proposals were sensible, however the representation of the organisations on the HWB needed to be addressed.

2.    The Principal Lead - Health and Wellbeing (SCC) noted that:

·         the Health and Social Care Act 2012 established HWBs; ICPs and ICBs were established in 2022.

·         there had been an opportunity to align the ICP and HWB in coterminous areas however that route was not chosen due to Surrey’s unique geography with two Integrated Care Systems (ICSs), Surrey Heartlands ICS had a one-to-one relationship with the HWB whilst Frimley ICS cut across five HWBs.

·         following the establishment of the ICP and ICB over the past eighteen months, it had been recognised that the agendas of those bodies and the HWB contained similar topics and memberships.

·         the Chairs of the HWB, SHICP and SHICB had discussed how to make those bodies more efficient and the proposals sought to address that through the HWB and SHICP to meet on the same day in three parts: business ‘in common’, HWB specific business such as community safety, and SHICP specific business; and the SHICB to meet that same day. 

·         it was proposed that the HWB and SHICP membership be streamlined addressing the issue of the same organisations being represented on both bodies by different people; the level of representation would be protected.

·         officers were working more closely together to align agendas.

·         the aim of the proposals was around improving the oversight and assurance of the delivery of the Health and Well-Being Strategy and Integrated Care Strategy, and other strategies/areas, enabling more collaborative strategic direction setting and collective decision making, better alignment around the governance, and ensuring more efficient communication.

3.    A Board member noted that the number of places given to the VCSE Alliance had improved partnership working, the VCSE Alliance had benefited from having that closer relationship to decision-making; the addition of a Carers System Representative had also been crucial. Stressed the need to maintain the diversity of perspectives through the membership.

4.    A Board member noted the alignment between the Integrated Care Strategy’s three ambitions - particular the first ambition around prevention - with the Health and Well-Being Strategy. Noted that despite the complexity of the five HWBs within Frimley ICS’s geography, there was a good working relationship between those directors of public health to cross-reference. For example, Frimley ICP’s membership and key themes were cross-referenced with SHICP.

5.    A Board member welcomed the deduplication, however noted that it was important to have clarity in the governance arrangements of how Frimley ICS fits into the equation, offered support in understanding that.

6.    A Board member welcomed the reduction in the number of meetings and aligning agendas, however noted a concern in losing certain aspects, for example the VCSE Alliance representatives. Regarding the future structure, asked whether there would still be opportunities for public questions and petitions. The Chair noted that public questions and petitions would remain for the HWB, and would ensure the right representation going forward.

Graham Wareham, Helen Coombes and Rachael Wardell left the meeting at 4.00 pm.

7.    A Board member noted the need for clarity around the membership in terms of the separation of strategy (ICP) and operational delivery (ICB) in the ICS, as the ICP and the ICB were set up to have minimal overlap between them. Regarding health representatives, a consideration was needed about whether the combining of memberships would blur that separation; so as not to weaken the voice of non-health representatives. The Chair acknowledged that it was important to protect key areas of business that work in the current framework. 

8.    A Board member highlighted the challenge around the review of membership which might lead to less individuals participating with ‘specialised knowledge or expertise in specific areas relevant to healthcare, social care and population health’. Sought additional detail to understand what specialised knowledge or expertise might be lost or not discussed in the new structure. The Principal Lead - Health and Wellbeing (SCC) noted that it was the first time the proposals have been shared with the three bodies, the concern around the balance of representation would be reflected on as the detail is developed. Emphasised that the streamlining of membership was around reducing the duplication, not about reducing the range of input. The Chair noted feedback that whilst some people were involved in sub-committees/groups, having the opportunity to raise issues directly with partners at the HWB was important.

9.    A Board member noted that most HWB members were represented on the SHICP in terms of their organisation or sector. The ICP was not solely about health but the care and wellbeing of Surrey’s residents, whilst some expertise might be lost; that could be addressed by bringing in representatives as needed.

Professor Helen Rostill left the meeting at 4.05 pm.

RESOLVED:

Approved that:

1.    The HWB and the SHICP operates with one streamlined, membership, with agendas of business designed so they run concurrently in one meeting.

2.    The respective membership of the SHICP and HWB are reviewed - to reduce any duplication of organisational representation, whilst retaining existing representation from a wide range of stakeholders, including Frimley ICS.

3.    This regular meeting take place on the same day and in the same location as the SHICB to be as efficient as possible for any shared membership between HWB/SHICP and the SHICB.

4.    The agendas across the combined HWB/SHICP meetings and the SHICB are planned and coordinated to eliminate duplication.

5.    These updated arrangements are considered for possible implementation from May 2024 prior to steps to incorporate changes in relevant Terms of Reference and constitutions by September 2024.

6.    The respective boards undertake in the interim to ensure that agenda items are clear in purpose in order to provide assurance, make decisions or seek direction/commitment on key strategic issues related to the respective strategies/plans they are responsible for.

7.    Items coming to the respective boards will have been previously discussed at sub-committee level.

Actions/further information to be provided:

1.    The Principal Lead - Health and Wellbeing (SCC) and Chair will reflect on the comments raised by Board members particularly around the balance of representation regarding the streamlined membership, as the detail around the proposals is developed.