Meeting Details

Mr Nick Chilvers addressed the Panel, pursuant to the provisions of Meetings General Procedure Rule 5(1), to question the need for a Health and Wellbeing Board in Colchester, how it would work and from where the necessary resources would come.

Rory Doyle, Associate Director - Integrated Strategic Partnerships, laid out that this item and the following item were a package, with the Health and Wellbeing Alliance documents developed as part of the Alliance’s approach. These had been agreed by the Alliance and were now due to go to Cabinet for endorsement. The Panel was asked to examine these and consider whether it wished to make any recommendations.

Laura Taylor-Green, Director of North-East Essex Alliance, explained that integrated health systems had been introduced in 2022, with integrated care partnerships and boards. The boards planned healthcare services for local areas. A flexible approach was used, as each area was different. Many elements went into health and wellbeing work, including some handled by councils. These included green spaces, education, income, planning and work around increasing population levels. The wider area was subdivided into areas with around 1m population as being about the right level of division. The Director explained her role, bringing together organisations providing health and wellbeing services, including the Police and Fire Services and the University. It was recognised that ‘Place’ would be important as part of local government reorganisation [LGR], and having a local health partnership could ensure key service provision.

The Associate Director explained that the documentation under consideration was not designed to be community-facing, so didn’t address the questions asked by Mr Chilvers. Instead, it was designed to give the understanding and methodology agreed between the partners as to how they would work. The Council had a role to play in health and wellbeing and had worked with the other partners such as the Integrated Care Board, County Council, and Tendring District Council. This Memorandum now needed endorsement from the partners, such as from the Cabinets of Colchester and Tendring Councils.

The next stage would be to provide the details on what work would then be done between partners and with wider stakeholders and communities, bringing together details and content. Short-, medium- and long-term actions would all need to be laid out. The approach had previously been reactive, whereas this document reflected the need to address root causes and drivers of bad health. Current work was to be brought together under this in order to increase its impact. The approach document showed the wider agreement with the partnership. The Memorandum of Understanding [MoU] laid out the details of the working arrangements under the Alliance, and how this would help meet the Council’s strategic priorities. Data had shown rising inequalities and deprivations.

The Alliance was seen as an exemplar, and as a strength for the Council. It brought skills and resources together to address strategic priorities. Working separately had caused challenges and barriers, and the proposed approach sought to integrate operations and resources. A future unitary local authority would bring upper and lower tier council services together into one organisation.

A Panel member welcomed the proposals, giving the One Colchester Partnership as an example as to how partnership working could be a strength. The Associate Director agreed that there were similarities to One Colchester but explained that the Health and Wellbeing Board would have a narrower focus on health and wellbeing.

The officers were asked how the agreement translated into actions to improve outcomes, how key performance indicators would be measured, and what extra resources the Council might need to contribute. The Associate Director highlighted that the approach document specified an outcomes-based methodology which would work on wider health determinants. An example given was partner work on socio-economics and built environment, addressing these as drivers on health and wellbeing outcomes and identifying where interventions were possible, such as in provision of education, skills and work opportunities.

The Director answered questions on the need for the proposed approach, stating that it would improve coordination and visibility of options. There were pockets of great work currently being done, but a full picture had not been possible, and it was impossible to identify where more could be done. The proposed approach brought all organisations together and set shared KPIs. The shared approach helped the partners hold each other to account and aligned to the Government’s 10-year plan for neighbourhood health. The Associate Director addressed the questions about resourcing, stating that this was about making best use of existing resources, rather than adding extra. Resource reallocations may come should data show that this would boost outcomes.

A Panel member raised the benefits that had been found to arise from multi-year funding agreements, whilst another voiced concern that this partnership working would create an additional ‘silo’ on top of existing ones. The Chairman read out content from Section 12 of the Memorandum, stating that this encapsulated the spirit. The Associate Director stated that if this work created a new silo, then it would be judged a failure. He outlined his joint role with the Care Board and Council, and the opportunity presented to bring together and influence two organisations. Michelle Tarbun was likewise now in a joint role, providing better value by linking between the two organisations. Local statistics would be used and reflected in the services provided in communities. Data showed that cardiac, pulmonary and mental health conditions were the major health issues in this area. A Panel member asked whether it was necessary to look at statistics at the local level.

Officers were asked, given the content covering the identifying of areas where more support was required, how it would be ensured that Colchester residents would not see any cuts in the services to which they currently had access. The Director gave assurances that there would be no removal of services for anyone and that the aim would be to identify areas where additional support was necessary. The Associate Director drew attention to the 15-year disparity in life expectancy between Wivenhoe and Greenstead, from very specific local reasons. The challenges and opportunities would both need to be assessed. There were likely to be efficiency savings to be found from aligning resources. The Integrated Care Board commissioned health services and could bring in other partners to maximise the use of resources.

After being askes if lessons had been taken from other Health and Wellbeing Boards, the Director confirmed that the Alliance was always looking to learn and improve progress. The Neighbourhood Health Team had looked at work in North-West London, Leeds, Manchester, Essex and Suffolk for learning and ideas. Lessons then need to be applied to local needs and assets. 

A Panel member argued that the MoU should be endorsed, and that the proposals would help prepare the area for devolution and would strengthen partnership working. This would help address disparities in local life expectancies and health outcomes. Specific organisations would continue their work, but together with others and would benefit from a wider support network.

RECOMMENDATION to CABINET that Cabinet endorses the adoption of a Memorandum of Understanding with the North-East Essex Health and Wellbeing Alliance and the adoption of the Place Partnership

The Chairman enquired as to whether the relevant Portfolio Holder would report back to the Scrutiny Panel each year, as Chair of the Health and Wellbeing Board. Rory Doyle, Associate Director - Integrated Strategic Partnerships, stated that this would be a good idea. The Associate Director explained that Colchester was currently the only area in Essex without a Health and Wellbeing Board, but that not many areas had a formalised Memorandum of Understanding [MoU], so this was seen as an exemplar in putting such an MoU in place. The plans would need oversight. The Board’s work could come to Scrutiny Panel for oversight before going on for Cabinet oversight. The Board’s work would be strategic, rather than operational.

Panel comments showed an expectation that a series of metrics would be developed to show expected results, set time frames, and lay out responsibilities as to who would take on which actions. One Panel member asked if the Board would link with the Safer Colchester Partnership. The Associate Director explained that there would be some crossovers, but that the Monitoring Officer’s advice had been to keep this Board separate, to focus on health and wellbeing.

Michelle Tarbun, Head of Health Partnerships & Wellbeing, informed the Panel that there had been much research into different models. Some were combined models and others were separate. The Safer Colchester Partnership carried out a statutory function, whilst the Health and Wellbeing Board would not, so the concern had been that linking the two would divert focus from the Board’s area of work. The Board was however expected to dovetail some of its work with the Partnership, where appropriate. It was confirmed that the Board would not hold decision-making powers but would make recommendations to partners for actions.

A Panel member expressed surprise that a summary of the data on needs had not been provided. Evidence was expected to show that proposals would reduce local disparities, and the Panel required evidence to ensure that decisions were taken on good principles. There were worse areas in Tendring, but no evidence was given as to how deprivations were increasing, and to quantify the public perceptions as to deprivation increasing. These would be expected, if organisations were to approve the proposed partnership arrangements.

Continuing, the Panel member highlighted the stretching of local government, agreed that the aims given were worthy, but set out that the proposals would need to show how they would service those aims, and how measurements would be taken of the staff resources put into the proposed activities. Accountability for inputs and effectiveness in achieving the Board’s objectives was necessary. Information could be provided to the Panel as to any shifts in deprivations within the local area, with it being highlighted that there existed local micro pockets of deprivation, for which there was currently no information given. Concern was raised that no alternative options had been laid out in the report, as to how to address drivers of poor health and wellbeing. The officers were asked for justification as to why the proposal set out was the best way to address the issue in question.

The Director highlighted the data pack which had been provided with the report. Without a Board, there would be no hyper local coordination, with any coordination happening at the higher Alliance level, which covered all of Tendring and Colchester. The proposals were about localising on matters within the boundaries of Colchester. There were many bad health outcomes involving cardiac, pulmonary and mental health issues being contributory factors to poor health. Without a Board, there would be no forum to discuss issues local to Colchester.

With permission of the Chairman, Mr Chilver addressed the Panel as a follow-up to his earlier statement made at the start of the meeting. Mr Chilvers argued that the Council needed to be a ‘slim’ operator and to avoid trying to micromanage people’s lives. Mr Chilvers warned that voluntary organisations were often sensitive to interventions from above, and that the Board could be a talking shop when, in his view, most of the issues at play were obvious. This was described as a nannying approach.

The Associate Director laid out that the key would be to address the increase in people presenting to Council and its partners at point of crises, which was costly to those organisations involved. If preventative action was not taken, costs would be higher, with poorer results for the individuals concerned. Causes must be addressed where preventable issues arose. Poor health outcomes led to increased demand on pressured service.

The Associate Director was asked why this proposal would be more effective than the Council operating alone to use its resources to encourage people to stop smoking, drink less, eat healthy food, take more exercise and find employment. It was queried whether better outcomes would come from focussing on direct action and delivery. The Associate Director clarified that the proposed Board was not intended to replace direct actions and interventions by each partner, but sought to provide a forum to answer the kind of questions being asked by Scrutiny Panel, to seek assurances that the Council’s assets were having the desired effects, identify where this wasn’t the case and to recommend changes.

A suggestion from the Panel was that, instead of an advisory Board, an alternative option would be for the Board to take an executive ‘action’ role, giving it a degree of control. A further suggestion was that such a Board could contribute to the Local Plan process, laying out views as to types of businesses or development which were considered to be injurious to public health and wellbeing, or advising on matters such as refuse collection services. A Panel member asked if a purely advisory Board would be able to achieve its aims.

The Associate Director went over best practice, with the majority of such boards being without decision-making powers. There was an Essex level Strategic Board. Some work was already being carried out, such as providing evidence to planning colleagues, to help develop the local planning policy base addressing matters such as fast food outlet planning applications, proximity to schools and other issues. The view had been taken that Cabinet carried out the Council’s executive functions, and the relevant Portfolio Holder would chair the Board, with recommendations going from the Board to Cabinet for decisions.

A Panel member asked if AI could be used to assess dispersed data in order to learn and predict outcomes. The Associate Director agreed that there were hugs opportunities with this, and with care technology developments. Further investment options would be in health and care technology, and there were possibilities for use of predictive modelling.

A Panel member suggested that the Panel could recommend that the Council dedicate resources to this initiative, positing that funds would need to be put behind it. A request was made for ward breakdowns of the relevant data to be provided to the Scrutiny Panel going forward.

RECOMMENDATION to CABINET that Cabinet: -

a) Considers the resourcing implications of the Health and Wellbeing Board

b) Explores any resourcing responsibilities for the Health and Wellbeing Board

c) Ensures that Portfolio Holder reports on the work of the Health and Wellbeing Board are provided to the Scrutiny Panel on a regular basis

Owen Howell, Democratic Services Officer, informed the Panel that a date was being sought for an additional meeting to allow the Panel to consider items on Northern Gateway, C360, and Middle Mill Weir. This was being sought in early April, and a date would be confirmed as soon as possible.

RESOLVED that the SCRUTINY PANEL approve its work programme for 2024-25.