To receive apologies for absence.

Apologies for absence were received from Councillor Stuart Carroll, Alison Alexander and Dr Lise Llewellyn.

To receive any Declarations of Interest.

None received.

To confirm the Part I minutes of the previous meeting.

RESOLVED UNANIMOUSLY: That the minutes of the meeting held on 15 February 2017 were signed as a true and accurate record.

Mark Sanders, Healthwatch wanted to reassure the Board and the public that Healthwatch had been commissioned as a service and therefore, nothing would change. All email addresses and phone numbers had not changed; it was just a more efficient way of doing things.

·         Confirming the workstreams

·         The NHS 5 year forward view update  

·         What the workstreams are delivering that is different for residents

Hilary Turner, Dr Adrian Hater and Angela Morris gave the Board a presentation on the latest update on the Sustainability and Transformation Plan. The main points of the presentation included the following key points:

Priorities for the next five years:

Ø  Priority one: making a substantial step change to improve wellbeing. Increase prevention, self-care and early detection.

Ø  Priority two: Action to improved long term condition outcomes including greater self management and proactive management across all providers for people with single long term conditions.

Ø  Priority three: frailty management – proactive management of frail patients with multiple complex physical and mental health long term conditions, reducing crises and prolonged hospital stays.

Ø  Priority four: redesigning urgent and emergency care, including integrated working and primary care models providing timely care in the most appropriate place.

Ø  Priority five: reducing variation and health inequalities across pathways to improve outcomes and maximise value for citizens across the population, supported by evidence.

Ø  Many residents had the skills, confidence and support to take responsibility for their own health and wellbeing.

Ø  The Frimley Health & Care STP could do more to assist them and were committed to developing integrated decision making hubs with phased implementation across the area by 2018.

Ø  Integrated hubs provided a foundation for a new model of general practice provided at scale.

Ø  An underpinning programme of transformational enablers included:

o   Becoming a system with a collective focus on the whole population.

o   Developing communities and social networks so that people had the skills and confidence to take responsibility for their own health and care in their communities.

o   Developing the workforce across the system so that is is able to deliver new models of care.

o   Using technology to enable patients and the workforce to improve wellbeing, care, outcomes and efficiency.

o   Developing the estate.

Next steps for the NHS Five Year Forward View:

Ø  The Five Year Forward View (5YFV) set out why the NHS needed to change; the 5YFV next steps set out what changes the public would see in the next two years.

Ø  The STP now stood for ‘Sustainability and transformation Partnerships’, better reflecting the purpose.

Ø  The plan addressed the top five issues citizens wanted to see improved:

o   Mental Health services

o   Convenient access to GPs

o   Easier hospital discharge

o   Better social care

o   Reduced cancer waits

Ø  The plan recognised access and the way GP services were run needed to change.

Ø  The STP enabled the NHS to work more closely with local authorities.

Ø  There would be more investment in primary care which would also look at extra places for talking therapies.

Mental Health and what would be different:

Ø  60,000 extra places for talking therapies meaning more residents could benefit from the service

Ø  Better care for expectant and new mothers

Ø  Improved CAMHS and increase in patient in-beds meaning residents could receive specialist care closer to home

Ø  Specialist mental health care in A&E with a four hour  ...  view the full minutes text for item 92/15

To receive the above presentation.

Dr Hayter gave Members a brief presentation on the changing face of General Practice. Members noted the following key points:

Ø  Things were changing while services continued to be provided, the situation was fluid and ever changing.

Ø  The GP Forward View came after the Five Year Forward View.

Ø  GPs were part of the community looking after patients.

Ø  GPs recognised the historical model was not fit for the future so they were talking about joining up services to provide wraparound care.

Ø  GPs needed to think about how care was redesigned.

Ø  GPs were less well funded and more investment had gone into hospitals instead of GP practices. GP investment would now be increased.

Ø  GPs were starting to think as providers and were coming up with solutions such as having Clinical pharmacists being resident in GP surgeries; that would help patients manage conditions such as diabetes.

Ø  Federation WAM was helping smaller practices to survive as they were doing things more to scale.

Ø  GP practices were also working more collaboratively with staff being shared across surgeries.

Ø  In Dr Hayter’s Practice, Runnymede Medical Practice, the CQC said some things could be done differently, the practice saw triple the number of people with sever frailty compared with other practices in other areas.

Ø  The Runnymede Medical Practice began to think about doing things differently and put a bid in for funding to help support carers.

Ø  Support for carers included things such as providing training or information to keep them well, offering annual health checks for carers and informing them on how to receive practical support as a carer.

Ø  A carers event was held in March with the Runnymede Medical Centre working hard to identify young carers; they carried out their own young carers week, worked with local schools and held a coffee morning. The work went well and 10 young carers were identified and now receiving support.

Ø  Overall, there were 320 carers identified across all groups which was up from 40.

To receive the above case study presented by the Dementia Care Advisor.

Jeanette Bailey, Team Manager for the Short Term Support and Rehabilitation Service gave a brief presentation on Dementia Care Advisers. Members note the following key points:

Ø  The role was originally established in 2014 to provide supportive advice and signposting for all newly diagnosed residents. This was linked to Memory Clinics and third sector dementia support services.

Ø  The role was well established and valued by all stakeholders over two years.

Ø  2014-2016 saw a period of growth and change such as:

o   As dementia diagnosis rates increased, there was an increased demand for services.

o   The profile of dementia raised as a specific condition and as part of complex needs with other long term needs.

o   Care Act implementation – there was more focus on carers needs.

o   Additional network of supportive services and liaison – through older person as Mental Health Sub-Group.

o   Launch of Each Step Together programme.

Ø  Maternity leave offered an opportunity to take stock, review and absorb learning from other models of DCA support – nationally and across Berkshire.

Ø  Activities from September 2016 – to date have included:

o   Increased staffing to 1.2 WTE – two DCAs with complementary and different skills and experience to widen scope of the role.

o   One nurse and one specialist in Cognitive Stimulation therapy

o   136 new referrals in seven months with a wide spectrum of neurological conditions.

o   Refresh all promotional information and proactive engagement with all contact points across wider H&SC systems i.e. practice nurses, public Daily Living Made Easy event in October 2016.

o   Speedy response and onward referral to targeted community support – EST approach.

o   Proactive relationship with the Memory Clinic – DCAs involved in last week of introductory course for better client/carer face to face contact.

o   Holistic and sustained support to dementia patient and family – better carer identification and support.

o   Targeted advice on acquisition of relevant equipment and use of assistive technology (with demonstrable impact on falls related NEL admissions), telephone triaging to identify those near crisis and offer immediate pre-emptive support with immediate access to other health and social care specialist advice.

Ø  Impact – Resident stories:

o   More joined up information sharing – reinforces the ‘tell your story once’ objectives for residents and targeted support without repeating historical information.

o   More timely and creative interventions to promote independence and reduce risk of crisis.

o   Tailored support for different types of dementia diagnosis – and links to other long term conditions.

o   Shorter waiting times for referral implementation e.g. reduced six week waiting time for Day Centre referrals to one week – EST

o   Whole person – lifelong support – not just at initial diagnosis – gateway to ongoing advice and support throughout patient journey.

o   Patient and carer – supported individually and together – multigenerational households.

o   Better/increased use of other dementia related services.

Ø  Dementia Care Advisors tried to personalise the service based on need

Ø  DCAs acted as key workers; they tried to  ...  view the full minutes text for item 94/15

To receive the above presentation from Fiona Slevin Brown.

The Berkshire Transforming Care Partnership Board held a shared vision and commitment to support the implementation of the national service model to ensure that children, young people and adults with learning disabilities, behaviour that challenges and those with mental health and autism receive services to lead meaningful lives through tailored care plans and subsequent bespoke services to meet individuals needs.

The Berkshire Transforming Care Plan had four big aims:

1.    Making sure less people were in hospitals by having better services in the community.

2.    Making sure people did not stay in hospital longer than they needed to.

3.    Making sure people got good quality care and the right support in hospital and the community.

4.    To avoid admissions to and support discharge from hospital, people would receive and be involved in a Care Treatment review (CTR).

There were the following work streams and project groups:

Ø  Works Streams (Themes)

o   Demand and Capacity

o   Market Shaping – Housing and care Providers

o   Inpatients

o   Intensive Support Team

o   Communities and engagement

o   Communications and engagement

o   Children and Young people

o   Workforce Development and Culture

o   Co-production

o   Joint Commissioning and Integration

o   Risk Management

o   Programme Management

o   High Impact Actions.

Ø  Project Groups

o   Finance and Activity

o   Housing and Accommodation

o   Autism

o   Intensive Intervention service

o   Occupation and Employment

o   Berks East Capital ‘Home’ Project

o   Co-productions (People’s Voice Service)

o   Experts by experience Steering Group

o   Communications and Engagement.

Ø  2016 TCP Achievements

o   Regular TCP briefings to all partners and communication teams to keep them up to date with national and local news

o   Secured:

§  2016-2017 funding from NHS England for Shared Housing Provision in RBWM for up to three individuals from across Berkshire with complex LD and challenging behaviours

§  2016-2018from the DfH for 10 x Hold Ownership Schemes for people with long term disability

§  2017-2018 national funding for interim intensive support service and respite

o   Co-opted carer and family experts by experience into the programme on voluntary appointment contracts, as members of the finance and activity project group, capital ‘home’ project group, and TCP Board, with further appointments planned in 2017

o   Commenced experience based co-design project with Point of Care Foundation – weekly BHFT led group with service users

o   Undertaken a desk top gap analysis of local authority LD and ASD strategies and, reviewed capacity and demand projections until 2019, to inform prioritising of the work plan for 2017/18

o   Started to map local authority and CCG work streams already in place for Children and Young People, to avoid duplication in work

o   Developed a repatriation timetable for NHS England specialist commissioned patients and Clinical Commissioning Group out of area placements.

o   Will be linked into STP funding

o   Autism was a key part with agencies working much more collaboratively

Ø  Intensive Support Team:

o   All TCPs nationally were looking to commission a new service model in the community called an Intensive Support Team (IST) or Intensive  ...  view the full minutes text for item 95/15

To receive the above presentation by Hillary Hall.

Hilary Hall, Head of Commissioning - Adult, Children and Health gave a brief presentation and Members noted the following key points:

Ø  National context – Admissions and delayed transfers of care

o   A&E attendances in 2016 had been 5% higher than in 2015

o   The number of emergency admissions rose by 4.5%. the rate was currently 10% higher than raw population increase

o   In 2016, each month’s total admissions had been higher than the same month in each previous year

Ø  Build up of pressure in the national ‘system’

o   21% of patients spent more than four hours in major A&E departments in December 2016, compared with 13% in December 2015 and 6% in December 2011

o   Long waits for emergency admission were 58% higher in 2016 than in 2015, and five times higher than 2011

o   However, the Borough was not performing as badly nationally

Ø  Emphasises the need for integrated approach to managing front and back door in acute rusts reflected in BCF targets

o   Delayed transfers of care had increased substantially over the past three years

o   There were 23% more delayed transfers of care in 2016 than in 2016

o   Compared with 2015, delays where NHS was at least partially responsible rose by 17% whereas social care delays rose by 37%

o   There were lots of ongoing actions to try and keep on top of the figures and the situation was being reviewed weekly.

Ø  Local actions to address Delayed Transfers of Care (DTC)

o   Integrated weekly meetings with Wexham, Royal Borough Hospital team, Short Term Support and Rehabilitation Team and Carewatch to review individual cases and agree packages of support

o   Support from GP practices to identify and support frail patients using new electronic frailty index

o   Pilot in Old Windsor with support of parish council to identify those who live alone or are vulnerable – and offer them proactive support and advice

o   Focus on choice – proactive support for carers via SIGNAL and Dementia Advisors to enable residents to continue to live at home where possible

o   Review of third sector support from Red Cross to ensure that Royal Borough residents had access to the home from hospital service, e.g. milk in the fridge, settling in, prescriptions etc.

o   Proactive engagement with wider East Berkshire programme, including:

§  Monitoring patient flow – daily telephone calls with Wexham and partners to identify patients ‘fit for discharge’ and use of Alamac data set

§  Pilot of Discharge to Assess model in new Windsor Care Home for East Berkshire residents

§  Review/mapping of service pathways between Optalis and Berkshire Healthcare Foundation Trust to meet resident needs – June 2017

Ø  Non-elective admissions – average stay post non-elective admission was decreasing as lots of work was ongoing with partners.

Ø  Proportion of adults (65+) who were home 91 days after discharge from hospital –

o   The data showed the proportion of people who were at home 91 days after discharge from hospital from April  ...  view the full minutes text for item 96/15

To receive and answer questions from the public.

The Chairman regretted that there was no time left to take questions from the public.

·         8 August 2017

·         7 November 2017

·         13 March 2017

Members noted the future meeting dates.