Hammersmith and Fulham: local authority assessment

The local authority was part of the Northwest London Integrated Care System which includes 8 London boroughs, 7 NHS trusts and 2 specialist care providers. Within the Integrated Care System, there was a local health partnership board which was attended by the Cabinet Member for Adult Social Care. Part of the Integrated Care System Vision 2023 was to create neighbourhood teams in the 7 borough-based partnerships, across the Integrated Care System. All partners agreed relationships at the borough level needed to be developed, and the local health and social care system did not have a shared vision for health and social care support in Hammersmith the Fulham.

Work had begun to build trusting relationships to support a neighbourhood team; the Integrated Care Board (ICB), Central London Community Health and the local authority had jointly appointed a managing director to develop the integrated model of care. This was in its early stages, but all parties were committed to building these relationships and were hoping the model would be functioning in 12-18 months. Key development areas were joint pathways for people living with dementia, adult mental health and community empowerment in the north of the borough. Governance arrangements for how current joint work would fit into the neighbourhood model, and the role the Health and Wellbeing Strategy and the board would have in setting the agenda, were part of building shared priorities within the neighbourhood model.

Outside of these local arrangements, there were initiatives the local authority was directing in response to its priorities. Public health has funded several programmes to improve health outcomes; for people leaving prison, people at risk of suicide, provider staff reluctant to take up vaccination and social care support for homeless people in hostel accommodation.

There were also shared initiatives with health including the dementia partnership board and the building trust engagement with Black communities but work implementing change was slow. For example, the Dementia strategy 2021- 2025 had been developed in co-production with residents. A Dementia Partnership Board had been established to oversee an implementation plan, with representation from the NHS, Hammersmith and Fulham Council, the Voluntary and Community Sector and people with dementia, their carers and families. In March 2023 the group reported on its first year of progress to the Health and Wellbeing Board and they showed that they had an impact in developing a range of dementia-friendly activities and raising awareness of dementia across the borough. However, they reported that despite multiple meetings about data among partners, no progress was made meaning the board was unable to set key performance indicators for the strategy. Also, work was needed to understand how the priorities of the dementia partnership board sat within the governance framework and priorities within the borough partnership.

The local authority had limited systems arrangements with health partner agencies. In the past there had been a lack of power sharing and maturity in the decisions by partners and the local authority, which meant adult social care was a separate system from health, and all partners were keen to protect their resources. However new leadership is proactively engaged in strengthening the partnership work. This is reflected in a new Director of Commissioning, Transformation and Health Partnerships Role. A recent Health and Care Partnership Strategic Planning Away Day saw the agreement of new shared priorities and commitments for joint working.

The local authority had Better Care Fund (BCF) arrangements with the Northwest London Integrated Care Board (ICB) but there were limited funds spent on joining up health, social care and housing services. The ICB was reviewing the Better Care Fund arrangements across Northwest London as they wanted to better understand how this funding was spent to support the system. The local authority spent a considerable proportion of the BCF supporting their home care provision and had recently commissioned Aston University to review the impact that home care without charge had on the health and social care system.

As the borough partnership was in its early stages there were no performance indicators agreed at this level to define what success looked like in the local systems leadership, however the Health and Wellbeing Board did manage the statutory responsibility of reviewing Better Care Funding.

The Better Care Fund (BCF) was overseen by the Health and Wellbeing Board which had oversight of how money was spent and how effective this was. The Health and Wellbeing board evaluated how funding had been used and the effectiveness of this. In 2023-2024 the way that the BCF was being spent was reviewed. The bridging service for people who needed to go home from the hospital with a care package was a success. In the bridging service, contracts were put out to the open market for spot contracting when the local authority could not meet the needs under contract within targeted timescales. This meant people were not delayed in hospital waiting for care provision if it was available on the open market. Step-down beds in care homes had a limited impact; people did not like moving twice and it could take time to move people out of a step-down bed, so a decision was made not to commission this again. Information about how the Better Care Fund was used was sent to NHS England and the Northwest London Integrated Care Board.

The local authority worked collaboratively with voluntary and charity organisations to understand and meet local social care needs, some were unsettled by short-term contracting that had taken place. However, there was still a strong commitment among community partners to support positive progress in adult social care, and there was representation of the voluntary and community sectors on strategic boards, like the Health and Wellbeing Board.

There was an open culture in the voluntary community sector, and they were happy to talk to the local authorities about challenges and deeper inequalities that groups were facing, this showed a large amount of trust in the local authority. For example, in the building trust exercise completed with Black and Asian communities, the voluntary sector supported people to share their very personal experiences of inequality.

The local authority and health provided funding to a community development organisation that supported the voluntary and community sector and issued grants on its behalf to improve mental health in ethnic groups and health and social care outcomes in communities. For example, the mental health grant programme gave grants to 15 community organisations during 2022/23. This supported a range of community groups to deliver mental health input to their communities in a creative way. Like support to the Iranian community to deliver holistic therapies, which supported 45 refugees to improve their wellbeing. Health and social care partners were committed to providing these grants on an annual basis.

The voluntary and community sector felt further improvements could be made if the local authority was clearer about its priorities and gave more feedback on progress after co-production activities. The local authority had identified that the work on some of its strategies had slowed like the Autism strategy, Carers strategy and the Building Trust work and were working to get these back on track.