London's Health and Care Vision Presented By

Date of meeting: 10 July 2019 Agenda item: 5 Title: London’s Health and Care Vision Presented by: Will Tuckley, Chief Executive, Tower Hamlets and SPB Co-Chair Sir David Sloman, London Regional Director, NHS England and Improvement Author: Dick Sorabji, Corporate Director of Policy and Public Affairs, London Councils Dr Vin Diwakar, London NHS Regional Medical Director Paul Plant, Interim Regional Director, PHE London Cleared by Dr Tom Coffey, Mayoral Health Advisor Status: For discussion Classification Public 1 Purpose of this paper 1.1 Partners have described a shared ambition to make London the healthiest global city. This paper reports progress on the development of a Health and Care Vision for London in support of that aim, and it shares an emerging description of the vital purpose of our partnership in delivering that shared ambition. 1.2 Since the meeting of the London Health Board (LHB) in April a process of professional engagement and co-development has been undertaken to help focus our Vision on a set of ambitious and impactful proposals that will animate and energise our work together. This covers 10 priority areas requiring strong London-wide collaboration, and it also considers the importance of London-level support to enable greater integration and collaboration at borough and neighbourhood levels. This paper presents some of the early outputs of that work in order to test the content before a more detailed process of engagement, policy development and planning. 1.3 Moving from aspiration to action will require increasing detail about the practical changes that need to be enacted across our partnership in the coming three, five and 10 years. To undertake that work in advance of the launch of the Vision will require effective engagement. This includes active involvement of organisational leaders across the partnership, as well as incorporating outputs of the extensive public engagement that health and care partnerships are undertaking for example in response to the NHS Long Term Plan. The paper sets out a high- level proposal to enable purposeful institutional and public engagement within the short timeframe, and without duplication of existing local processes. 2 Recommendation(s) 2.1 This report seeks the views of LHB members to guide and refine further development work. In particular, the Board is asked: a) to comment on the emerging narrative, highlighting points of strength and areas for refinement, as the basis for further development; b) to consider the 10 priority areas and the ideas emerging from professional engagement, and to give a view about whether these are the right areas upon which to focus; and c) to comment on the proposed approach to engagement, highlighting any further specific activities that are necessary and feasible within the timeframe. 3 Context and progress 3.1 Building on the Better Health for London report (2014), London’s NHS, Public Health England, Health Education England, London Councils (representing London’s Boroughs), local borough partnerships and the Mayor of London have been working together to devise a set of shared commitments to make London the healthiest global city. To further these goals and build on our collective work London’s health and care partners entered into Health Devolution Agreement with national bodies. 3.2 In July 2018, a progress report was presented to the Strategic Partnership Board (SPB) which assessed the improvements made and outstanding challenges faced by the partnership. In response to that review – and in anticipation of the likely changes in context created by the NHS Long Term Plan, the Social Care Green Paper, and the Prevention Green Paper – the SPB initiated work to renew the partnership’s Vision, and to establish a set of actions to refocus the work of the partnership in order to move ever closer to becoming the healthiest global city. 3.3 Since the initiation of the work we have established guiding principles and we are continuing to refine an emerging narrative that helps to frame our purpose, priorities and practical actions. Significant engagement has taken place in the early development of the Vision involving over 300 health and care professionals across multiple forums. 3.4 Following the April LHB meeting, professional expertise has been engaged to further define priority London wide population health commitments, measures and delivery plans. Over 100 experts have been involved in this process including London’s Directors of Children’s Services, Directors of Adult Services, Directors of Public Health and clinical leaders across the capital. Professional expert panels have also developed evidence compendiums bringing together data analysis, research and case studies from other global cities to support each priority. Figure 1: Summary of the process and progress in developing our Vision 4 Emerging themes, priorities and potential actions 4.1 Outline narrative themes 4.1.1 Healthy cities enhance quality of life, improve productivity, increase capacity for learning, strengthen families and communities, support sustainable habitats and environments and contribute to security, poverty reduction and social inclusion. Our partnership has a shared ambition for London to be the healthiest global city, and the best global city in which to receive health and care. 4.1.2 Our shared ambition is underpinned by our organisations’ respective and collective responsibilities to make a difference to: the health of Londoners; the health and care services in London; and how we collaborate. Our shared partnership is underpinned by a recognition that no single organisation alone can effectively address the opportunities and challenges we face: shared action makes us greater than the sum of our parts and better able to address priority issues that require pan-London solutions, and to support pan-London actions that enable closer and more effective partnerships at system, borough and neighbourhood levels. 4.1.3 Our shared commitment to improving health is framed using a life course approach, with the aim to ensure that all Londoners can start well, live well and age well. Our shared understanding of improving health and care services in London is to support primary prevention, community action, and self-care; to engender integrated community models; and to support effective specialist services and networks. And our shared commitment to collaborate effectively is based on recognising that we need aligned and reciprocal support across the partnership to address the real and urgent challenges we face in establishing sustainable services, whilst ensuring that decisions about health and care are devolved to the most appropriate level. Figure 2: Emerging framework for our Vision 4.2 Potential priorities and practical actions 4.2.1 There are some issues that demand collective action at a London level to improve health outcomes, either because they are by nature less constrained by local geography – for example air quality – or because there are significant scope or scale benefits that emerge from acting collectively. Our work to date has highlighted ten priority areas for pan-London action, which are listed below. These are explored in more detail in the Appendix, which provides a summary of the emerging output of our professional engagement. These emerging outputs could be further developed into a set of ambitious and more granular proposals for inclusion within the Vision. Figure 3: Outputs from professional engagement: for consideration when developing partnership commitments and plans – N.B. early stage draft for discussion Priority area and Possible local actions Possible city-wide actions possible commitments Reduce childhood • All London hospitals adopting • Support for all London primary obesity the new version of hospital schools to adopt a ‘water only’ food standards. policy. Commit to achieving a • Local areas taking up the • Expanding the junk food 10% reduction in Healthy Early Years London, advertising ban in boroughs proportion of children and the Healthy Schools. and on NHS sites. obese in year 6 and London across their borough • Partnering with TfL to increase reverse the trend in • Traffic light labelling for child the proportion of Londoners those who are friendly food retailers. achieving two ten-minute overweight. • Create more self-management periods of walking or cycling opportunities to support each day. children and families with • Introduce a network of water maintaining a healthy weight. fountains, refill cafes and restaurants to improve access to water. Improve the emotional • London’s local authorities • Youth mental health first aid wellbeing of children establishing Thrive LDN hubs. instructors in every London and young Londoners • Enhanced CAMHS pathways borough to ensure that every across STP footprints. London state school has London is a city with • NHS Trailblazer pilots, access to a Youth Mental environments that establishing mental health Health First Aid trainer by support children teams servicing schools in 2021. reaching a good level of London boroughs. • ThriveLDN ‘Are we OK development • Partner with the Mental Health London?’ campaign to open a cognitively, socially and Foundation to deliver three conversation with Londoners emotionally; and when ‘Thriving Community about inequality, mental health needed effective child prevention pilots. and wellbeing. and adolescent mental • ‘Perfectly Norman’ storytelling • Establish a suicide prevention health services are sessions designed to get multi-agency information available

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