Agenda and minutes

Apologies for absence had been received from Carole Cumino, Lee Davenport, Anthony Kelly, and Karen May the new North Worcestershire District Councils Representative.

Jonathan Sutton attended for Carole Cumino.

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 Members of the public wishing to take part should notify Legal and Democratic Services in writing or by e-mail indicating the nature and content of their proposed participation on items relevant to the agenda, no later than 9.00am on the day before the meeting (in this case 9.00am on 12 September 2016). Enquiries can be made through the telephone number/e-mail address below.

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To confirm the minutes of the meetings held on 10 May 2016 and 14 June 2016.

The minutes of the meetings held on 10 May 2016 and 14 June 2016 were agreed to be a correct record of the meeting and were signed by the Chairman.

Sarah Dugan summarised presented information regarding the Sustainability and Transformation Plan. Board members were familiar with the concept of addressing the triple aim gap of Health and Well-being, Care and Quality and Finance and Efficiency; but following meetings with the national team the Programme Board was particularly focussing on what money would be available in 5 years' time – what future allocations would be given to CCGs rather than what would be done differently with the current spend.

Under the structured budget prioritisation work, 14 different work programmes had been identified, each one led by a Chief Executive Officer – but prevention and children and young people were themes which ran through all the different programmes. Analysis was taking place to find benchmarks which could be compared to other STP areas. The analysis would help to ensure that Herefordshire and Worcestershire were being as efficient as possible. Help was being received from the Commissioning Support Agency who had supported Board members in a programme budgeting exercise.

All areas of investment should show a decrease in costs elsewhere. For example investment in care at home should see a decrease in acute care costs. Back office and infrastructure efficiencies were also being sought across the public sector.

All local STPs had an allocation which could be invested in areas of national priority such as the digital agenda, 7 day services and parity for mental health services. The requirement for provider efficiencies was not yet included in the plans but once the plans had been worked up they would be brought back to the HWB and also to scrutiny.

Engagement with Healthwatch and the VCS was on-going and once draft plans had been completed engagement would occur with a wider group of stakeholders. Sue Harris had been working on an engagement strategy which would include public, patients and staff.

The next submission would be made on 21 October and as there would be a very tight turnaround it was proposed that proposals would be emailed to members of the HWB for comment. A full report would then be brought to the meeting on 1 November.

During the discussion, Board members queried how the consultation would be approached:

·         The plan was the beginning of the process and then specific consultation would occur and inform some of the detail before various parts of the plan were implemented;

·         The strategic plan being submitted on 21 October would outline the series of changes that would need to happen and then consultation would occur on those proposals as appropriate. Cabinet Office guidelines suggested best practice should be for consultations to be for 12 weeks but it depended on the size of the changes;

·         Board members felt that although consultation would happen prior to the implementation of certain proposals, they felt that general issues such as prevention, self- care and back office efficiencies should be communicated to the public straight away. Also the STP should be discussed at each HWB so that all members could take details back to  ...  view the full minutes text for item 383.

The Future of Acute Hospital Services programme had been looking at the sustainability of acute services for 5 years and that work had contributed to the STP.

The programme needed to go through 2 tests. Firstly that it was clinically sound and the West Midlands Clinical Senate had provided independent clinical endorsement of the plan in early summer.  The second test was the financial and business viability of the plan. The pre-consultation business plan would be signed off by the CCG Governing Bodies and then NHS England would be testing the plan on 19 October. Once the plan was agreed there would be a 12 week consultation period before the outcomes could be implemented and it was expected the process would be concluded by the end of the financial year.

The programme was needed due to concerns about sustainability. However, safety issues had emerged which had necessitated emergency changes to some maternity and paediatric services in recent months, which had been centralised at Worcester Acute.

In response to questions it was clarified that:

·         Two aspects of the plan still needed to be implemented – Emergency surgery to be centralised to Worcester and A&E in Redditch to become Adult only but with an urgent care centre alongside,

·         Communicating with the public was very important and although some of the changes had already been implemented on an emergency basis, the consultation period was important to engage with the public and explain why the changes were happening;

·         The number of beds at the acute hospital assumed a level of efficiency which was not being delivered. Better discharge systems and prevention services were needed but uncertainty over the future of the services was part of the problem. Patient feedback was being sought and an A&E Delivery Board was being set up to help with issues such as waiting times in A&E.

RESOLVED that the Health and Well-being Board noted the update on the Future of Acute Hospital Services in Worcestershire.

The Chairman congratulated Dr Frances Howie on becoming Director of Public Health. Dr Howie then presented her Annual Report.

The report was in two parts – Part one: Ageing in Worcestershire and Part Two: Compendium of Health Indicators. There were larger numbers of older people in Worcestershire than in many areas of the Country. There was a difference between life expectancy and healthy life expectancy, and system leaders had a part to play in encouraging healthy lifestyles.

The numbers of older people were increasing but there was a difference between the people living in disadvantaged circumstances who were more likely to have a lower life expectancy and a longer period of ill health, compared to those who were advantaged.

The report compared some outcomes around the Country and internationally and lessons should be learnt. It was realistic to have the ambition to close the gap between Worcestershire and the best performing areas.

 There were five recommendations:

1.    System leaders giving higher priority to reducing the gap between life expectancy and healthy life expectancy. People should expect good health till the end of life,

2.    Building for a healthy old age. Worcestershire planners and decision makers should give more focus to the health impact of the planned environment, increasing the chances of a healthy old age,

3.    Enabling people to help themselves, scaling up training to create a public health army, building inclusive digital assets and systematising social prescribing,

4.    Developing targeted and evidence based prevention services, such as falls prevention, vaccination and lifestyle change,

5.    Shifting attitudes towards celebrating later life.

The compendium of Health Indicators summarised that overall Worcestershire had good health outcomes.  Some areas of concern were around smoking in pregnancy, levels of breastfeeding, child obesity and children living in poverty where the figures were not improving.

In the discussion it was noted that:

·         District Councils could do a lot to support these issues without additional funding, such as awareness raising and all District Councils should be aware of the health implications of their work;

·         Screening programmes were nationally set but local effort was needed to make sure that they reached the relevant population, and not only the most advantaged,

·         Volunteering was an asset for Worcestershire as well as for the people who took part, but it should be recognised that people could organise volunteering themselves in their community,

·         Public health was an important part of the STP, with prevention being embedded in each of the 14 programmes;

·         Board Members would appreciate partners reporting back on the actions they were taking. The Health Improvement Group would report back on various action plans and actions on health inequality would be highlighted;

RESOLVED that the Health and Well-being Board:

a)    Noted and discussed the content of the Annual Report  of the Director of Public health;

b)    Discussed how the organisations represented on the Board might best respond to the recommendations of the report, and resolved to take this discussion into different organisations; and

c)    Agreed that Member bodies should use  ...  view the full minutes text for item 385.

A Joint Health and Well-being Stakeholder Event took place on 9 June and was attended by more than 100 people. The event looked at Developing Action Plans around the three priorities from the Joint Health and Well-being Strategy 2016-21, which were:

·         Good mental health and well-being throughout life,

·         Being active at every age, and

·         Reducing harm from alcohol at all ages.

The various action plans would be reported to the Health Improvement Group and then back to the HWB.

RESOLVED that the Health and Well-being Board:

a)    Noted the summary of the 'Developing Action Plans' stakeholder event held on 9 June 2016,

b)    Noted the on-going and further development of the priority area action plans,

c)    Would ensure that delivering the action plans was given priority in the Member organisations, bringing a refreshed and joined up approach to tackling the three priority areas.

Lucy Hancock, an expert by experience gave some details of her experience which included problems with being weighed and not receiving any physiotherapy in the last five years. She believed that the liaison nurses did a great job but it was important that people had some choices about where they lived and with whom, although people with learning disabilities may not be able to afford to move. Lucy left copies of a letter from her mother for Board Members which detailed the lack of physiotherapy for adults with disabilities.

Sandra Rohan Kickham who was a carer for her son with complex health needs then spoke about the resource centre her son attended in Bromsgrove. She felt that the new model was working well although some attendees had not received their annual user support plan reviews for 15 months. She queried what was going to happen when carers required a break and mentioned that it would be useful to have a transition plan for older carers. She felt that there was inconsistency in the service being offered to the LD community from GPs and social workers and felt that generally people with complex needs received inferior healthcare. The Your Life Your Choice website had had a poor start but more recently carers had reported it contained useful information. It was felt that carers assessments were inconsistent with the advice they offered and finally that the range of housing options that was now available for people with Learning Disabilities was good.

Elaine Carolan explained that the agenda report gave an overview of the Learning Disability Strategy one year on. The LA was required to complete a Framework Assessment and had completed a self-assessment with 30-40 partners. Mainly improvements had been seen but there were concerns in a few areas such as transitions to adult services.

Up to March 2016, 1124 individuals with LD had received services. It was pointed out that there were significant health inequalities with regards to people with LD and their life expectancy was 10 – 12 years lower than average.

Updated copies of the Learning Disability Strategy were left for Board Members.

Board members made the following comments:

·         They were pleased to hear of the improvements in services and that the Connect day centre was doing well,

·         The County Council supported employment for people with disabilities and were ambitious to get other employers interested in employment for people with disabilities,

·         The commissioning of LD services had a higher profile than it had in the previous 10 years which was good, however,

·         The presentations had brought up some concerns that needed to be picked up by the Staying Healthy Group and health representatives were keen to address these.

RESOLVED that the Health and Well-being Board noted the progress made on the Learning Disability Strategy.

The Transforming Care Plan was a nationally mandated programme concerning people with a learning disability, autism, mental illness and presenting with challenging behaviour. The plan had been submitted in June after being signed off by ICEOG and now needed to be ratified by the HWB.

The number of people in locked or secure hospitals needed to be decreased by 50% and Worcestershire started in a good position as it already had low numbers in secure hospitals.

NHS England would be providing match funding but that was only for one year so it was difficult to plan for services after that date. When people were discharged from hospitals the costs would fall to CCGs and Local Authorities and it was not yet certain that the funding would be transferred from NHS England to local areas.

Rachel Barrett, an expert by experience, explained that she had been involved with Speak Easy Now Healthcheckers team since 2010 since the Winterbourne View case had been highlighted. She had learnt about abuse and how to spot it and had been involved in making recommendations. Healthcheckers had been involved in care and treatment reviews. She was pleased that the person being reviewed was now central to the process and it was being recognised that moving people back to their community to be near family and friends was important.

Board members supported the Transforming Care Plan and supporting people to live in their communities where it was safe for them to do so, but they were concerned about the future funding burden and felt it was important for dowries to be transferred to local areas.

RESOLVED that the Health and Well-being Board:

a)    Agreed to ratify the Worcestershire Transforming Care Plan (TCP),

b)    Noted that the Plan had already been submitted to NHS England with an accompanying letter stating that Worcestershire expects the cost of meeting TCP to be cost neutral;

c)    Agreed that any financial pressure arising from the discharge of patients should be met by NHS England as set out in paragraphs 18 to 21, and

d)    Supported writing to the Government to reiterate the importance of NHS England dowries being paid to local areas.

·         Including the Child Death Review Process for Worcestershire.

Derek Benson, appointed Chairman of the Worcestershire Safeguarding Children Board in April 2016 presented the findings from the Safeguarding Boards Annual Report 2015/16.

At the September 2015 meeting the previous Chairman said she could not be assured about the safety of Children in Worcestershire. As of March 2016 the situation remained the same and the Chairman and Board could not be assured of the robustness of the child protection system.

This view had been established from a range of data and although there was commitment to safeguarding in the County, and arrangements were in place, they needed to be better and more co-ordinated. The pace of change was not sufficient and although strategies were in place, oversight was needed to ensure delivery. It was recognised that improvement was needed against a backdrop of reducing resources and increasing demand.

The focus of the Safeguarding Board in 2015/16 was:

a)    Implementing the child sexual health strategy,

b)    Early Help,

c)    The Integrated Family Front Door,

d)    Children's Social care 'Back to Basics' improvement programme.

There were no serious case reviews in 2015/16 and following audits, compliance was found to be good.  The Board fulfilled all its statutory functions and commitment was strong. The Police had confirmed that funding for the Board would be sustained for next year.

When asked what had been achieved since April and what assurance was needed from partners, the Safeguarding Board Chairman replied that:

·         He had attended the CSE Strategy Board but they had not yet got a full picture of the situation. With regard to missing children, there had been an improvement in the return interviews but the quality needed to be maintained,

·         He supported the ethos of the Family Front Door but they now needed to see if their ambitions could be achieved,

·         Back to basics needed to be scrutinised more as improvement was not at the necessary level, and

·         He felt he still needed to understand what Partners commitment would be and they were looking to introduce a process so that Partners assessed how any changes to their processes would impact on safeguarding.

Felix Borchardt Chairman of the Child Death Review Panel reported that there had been 38 notifications in the last year. 35 case reviews were conducted and modifiable factors had been found in 31% which was slightly higher than the national average, although it was noted that definitions of modifiable were locally determined and Worcestershire had a relatively broad definition.

Smoking and obesity remained as the main modifiable factors and the Panel were concerned about the proposed changes to health visitors who played a key part in the health of under-fives.

The Panel played a role in informing parents of the consequences of an unhealthy lifestyle such as with the safer sleeping initiative which had been delivered through health visiting, with significant Public Health input. They would also work closely with Public Health on pre-pregnancy planning. A safety book was being produced for parents and advice packs for schools. Good health was important  ...  view the full minutes text for item 389.

Anne Clarke confirmed that the BCF had been approved through the NHS England assurance process after it had been submitted on 22 July. The quarter 1 report had then been submitted on 9 September as required.

In 2014/15 there had been a £141,000 underspend which had been transferred to 2015/16. It was expected that there would be a £50,000 underspend this year due to the lower use of client schemes concerning avoidable admissions and discharge plans. Last summer it had been expected that the client schemes would result in an overspend so the weekly panel which had been set up to assess the use of the schemes and the length of stay of people in the schemes would continue.

On 30 September Better Care Funding for Howbury would cease and there were presently no new admissions.

There would be increased funding for intermediate care support which was being developed with South Worcestershire CCG. This was based on the principle of 'home first' and used increased night support and medical support to allow people to stay at home while going through assessments.

Guidance for 2017/18 BCF was currently awaited.

It was clarified that spending on client schemes was falling due to the better use of community beds and resources.

RESOLVED that the Health and Well-being Board:

a)    Noted the "Approved" status of the 2016/17 Better Care Fund plan

b)    Noted the current plans for the use of the reserve created by the 2015/16 underspend;

c)    Noted the financial position for 2016/17, as reported to the Integrated Commissioning Executive Officers Group on 5 September 2016;

d)    Noted the ending of BCF Funding for Howbury from 30 September 2016; and

e)    Noted the information on the planning process for 2017/18.

2016

Public meetings (All at 2pm)

·         13 September 2016

·         1 November 2016

Private Development meetings (All at 2pm)

·         11 October 2016

·         6 December 2016

2017

Public meetings (All at 2pm)

·         14 February 2017

·         25 April 2017

·         11 July 2017

·         10 October 2017

Private Development meetings (All at 2pm)

·         25 January 2017

·         14 March 2017

·         13 June 2017

·         12 September 2017

·         7 November 2017

·         5 December 2017

The Chairman announced that the next public meeting would be held on

1 November.

There were also private development meetings on 11 October and 6 December.

Meeting Dates 2017

Public meetings (All at 2pm)

·         14 February 2017

·         25 April 2017

·         11 July 2017

·         10 October 2017

Private Development meetings (All at 2pm)

·         25 January 2017

·         14 March 2017

·         13 June 2017

·         12 September 2017

·         7 November 2017

·         5 December 2017