The Committee considered the following report:
“1.0 Purpose of Report or Summary of main Issues
1.1 The purpose of this report is to update members on the outcome of the Value for Money Review that has recently been completed by Copius Advisory Services/Consulting of partnership funding provided annually by Belfast City Council, Belfast Health and Social Care Trust, Northern Ireland Housing Executive and the Public Health Agency to Belfast Healthy Cities. It was previously agreed that this review would be undertaken separate to the broader Partnership Funding Evaluation Review given the 4-way partnership funding and monitoring arrangements.
2.1 Given the conclusions of the review outlined in section 3, alongside the recent redesignation of Healthy Cities status for Belfast to 2026, it is recommended that Committee:
· Agree in principle to fund Belfast Healthy Cities at the same level for the 2022/23 financial year (£81,294), subject to the completion of the 2022/23 revenue estimates process;
· Agree for council officers and partner organisation representatives to undertake a series of facilitated discussions between Nov 21-Mar 2022 namely with BHDU staff, BHC staff and Board alongside key health and community planning leads to develop and agree health priorities for Belfast to be progressed as part of the Belfast Agenda Refresh, Belfast’s Phase VII plan and the emerging ICP structure and planning process for Belfast;
· Note that this process will include agreeing the governance structure and resources anticipated/required to progress the priority actions and will therefore take account of, and incorporate, the review’s recommendations in relation to BHC in terms of being one of the key resources/delivery agents;
· Note a further report to be brought to Committee, as well as via the Belfast Community Planning Partnership structures, for consideration and approval.
3.0 Main report
Belfast’s membership to the WHO European Healthy Cities Network is facilitated by Belfast Healthy Cities (BHC), an independent partnership organisation, recognised as having charitable status by The Charity Commission for Northern Ireland. Belfast Healthy Cities is governed by a Board of Directors, elected annually and representing the public, university, voluntary and community sectors.
Members approved the completion of an Expression of Interest for Belfast to re-designate as a WHO Healthy City and participate in Phase VII of the WHO European Healthy Cities Network at the meeting of the Strategic Policy and Resources Committee on 17th August 2018. Members then approved the application for submission in September 2020. On 21st May 2021 Belfast Healthy Cities confirmed that the City of Belfast had been successful in its application, has been designated in Phase VII, and thereby extended to April 2026.
Council are one of four core funders to Belfast Healthy Cities, along with the Public Health Agency (PHA), Belfast Health and Social Care Trust (BHSCT) and Northern Ireland Housing Executive (NIHE). Annual funding amounts to over 300k of which BCC contributes £89,586.
Officers engaged with the other funding organisations to outline the decision of Council and in the spirit of ‘collaborative gain’ as set within the Belfast Agenda, it was then agreed to widen the scope of the review of Council’s partnership agreement with Belfast Healthy Cities, to also include the agreements of the other core funders.
A collective specification was agreed and, following a quotation exercise led by BCC, and Copius Advisory Services/Consulting was appointed to undertake a ‘value for money’ review of the partnership agreements with Belfast Healthy Cities, taking account of the direct and indirect benefits brought to the city.
Due to Covid the value for money review exercise was significantly delayed and as a result there have been several submissions to committee in 20/21 and 21/22 to extend the current funding arrangements with BHC (each partner organisation has also extended via their approval processes) – the most recent request was approved at the P&C committee’s June 21 meeting and ensures funding is in place until end of March 2022. BHC has continued to provide services throughout the review period albeit the provider did raise concerns that ongoing uncertainty around funding and future intentions did have a negative impact on staffing levels/retention at times.
3.2 Partnership Funding Review Terms of Reference
As per the agreed TORS, Copius were tasked with undertaking a value for money review based on the Challenge, Compare and Consult components of the 4 C’s of Best Value.
1. Challenge – to challenge the need for continuing the contracted services;
2. Compare – to compare the levels of contracted services being provided against the best available, from public, private, voluntary and community sectors;
3. Consult – to consult with local partners, in order to give them a voice in determining the quality and type of services required.
The contractor consulted with a wide range of stakeholders including each of the funding partners, the Board of BHC, members of external partnerships where BHC are represented, providers BHC had worked in partnership with or provided services to, elected members and providers offering similar services across other cities in the UK and Ireland.
The contractor reviewed existing funding agreements and monitoring arrangements including progress monitoring returns submitted during the review period.
3.3 Summary findings following Challenge, Compare and Consult analysis
Challenge – ‘In summary therefore BHC is found to comfortably clear the ‘challenge’ tests, demonstrating that it operates in an area of growing importance, extends rather than duplicates and informs rather than copies, and does not fail any mandatory requirements. Its future alignment with those strategic drivers [Programme for Government, Belfast Agenda, Making Life Better, etc.] is considered later within considerations as to the way forward.’
Compare – ‘The review considers regional, national and international best practice around evaluation and assesses the performance in Belfast, concluding that innovation and learning from the wider network is clearly demonstrated, that the quality of planning, operation and communication is very high and staff are exceptionally highly regarded. Particular strengths were noted in working at the community level and in developing effective partnerships.’
‘A number of commentators, familiar with the working of the wider HC network, have identified Belfast as a leader amongst its peers and one that acts as a role model to others. There is no directly comparable alternative, the HC network being global and backed by the World Health Organisation (WHO), an entity brought into being by the United Nations and the prime international body concerned with developing health across the world, working with a range of stakeholders from governments to NGOs.’
Consult – ‘From a governance perspective there was a sense that whilst flexible and agile the service level agreements which provide a framework for performance and delivery between the funders and BHC could be strengthened with the introduction of a dedicated consistent jointly managed process to agree annual activity and resulting reporting.’
‘At times, with multiple ‘touch points’ at various organisational levels between BHC and the funders created challenges to ensure consistent messaging and communication. Given the size and sometimes complex internal operations of the organisations involved this would require some consideration to resolve.’
‘Overall then the review strongly endorses the role that Belfast Healthy Cities can play in fostering a community wide and holistic approach to health promotion in Belfast. There is strong evidence of its ability to deliver practical impacts for Belfast residents across many priority issues, including for example, Health Literacy, Health Equity, Healthy Urban Environments, Older People / Healthy Ageing, etc.
The formative aspect of this review points at areas where development is likely to further increase effectiveness:
· Greater clarity and accountability embedded into the process by which funders and BHC agree annual delivery targets and activity.
· The continued ability of BHC to introduce best practice health delivery from elsewhere and implement effectively within the Belfast context in conjunction with the funding organisations – underpinned by good governance.
· Clarity and agreement regarding the role and involvement of BHC within the Community Planning structure / any other health improvement / public health arena / structure
· Wider consultation and engagement of stakeholders, including in particular, political representatives.
· Greater geographical spread across the Belfast area.
These insights should be shared beyond the funder group, facilitating a dialogue with all relevant parties to enhance future operation within a Belfast context and contributing to the global literature on best practice in health promotion.’
3.5 Partnership Funding Review Conclusions
Ultimately the review concluded that the funding provided to BHC by each of the partner organisations represented good value for money based on return for investment. Chapter 5 outlines the Summary, Conclusions and Recommendations and is included in its entirety at Appendix 1 for Members information. Within this section several work areas have been identified for the funding bodies to consider and progress, namely:
1. Ensuring BHC investment is strategically aligned to policy drivers including the Programme for Government, Making Life Better and the Belfast Agenda.
2. Moving performance analysis to an outcomes focused / based approach (away from output measures).
3. Establishing a clearly defined role for Belfast Healthy Cities with consistency of service across Belfast.
4. The removal of duplication in planning and reporting between Belfast Healthy Cities and the various funders involved in this process.
The funders, particularly BCC, BHSCT and PHA (who also provide joint funding to the Belfast Health Development Unit (BHDU) based within Council) have been having ongoing discussions over the past two years in relation to how the population health/health inequalities agenda could be better coordinated and resourced in light of the Belfast Agenda Refresh and taking account of the emerging Integrated Care Planning model. Preliminary discussions have also taken place with staff within the BHDU, with the Board and CEO of BHC and with community planning leads.
Leads within each of the funding bodies are proposing to have a number of facilitated sessions between now and the end of March 2022 to inform how we identify and agree our health-focussed priorities, to agree the structure (linked to the Community Planning Partnership at a city level and to the local structures already in existence or planned), the resources (staffing & financial) that we need to have in place to take these actions forward over the next 5-year period.
Better alignment of existing resources and streamlining of oversight and accountability processes to include addressing the governance concerns and duplication issues identified within this review will form a key part of this exercise. It is hoped that we will have a new proposed operating model for approval which will then be initiated as early as possible in 2022/23.
Financial and Resource Implications
3.6 The total financial allocation from Belfast City Council to Belfast Healthy City is £81,294 which has been included in the planned budget for 2022/23, however remains subject to agreement through the 2022/23 estimates process.
Equality or Good Relations Implications/
Rural Needs Assessment
3.7 None identified at this stage but kept under continuous review. It should be noted that much of the work undertaken by BHC is to address, or promote awareness of, health inequalities and best practice whole population of targeted approaches to mitigate or prevent these.”
The Committee adopted the recommendations.