Meeting documents

Shadow Health and Wellbeing Board
Friday, 4th November, 2011 2.00 pm



Present: Councillors Dudley (Chairman) and Mrs Quick.

Brian Huggett, Dr Pat Riordan, Cliff Turner, Dr Adrian Hayter, Bev Searle (Co-opted for the duration of the meeting), and Christabel Shawcross.

Also Present: Councillors Mrs Bateson, Fussey, Mrs Luxton and Hilton. Rutuja Kulkarni.

Officers: Lisa Duncan, Michael Kiely, Catherine Mullins, John Scaife, Keith Skerman, Andrew Scott, David Scott, Chris Targowski and Genny Webb.


Apologies were received from Dr Judith Kinder and David Williams.


In noting the receipt of apologies from David Williams, the Board resolved to co-opt Bev Searle for the duration of the meeting, to ensure representation from the area of PCT commissioning was maintained.
    RESOLVED: That Bev Searle be co-opted to the Board for the duration of the meeting.


There were no declarations of interest.

    RESOLVED: That the minutes of the meeting of the Panel held on 15 July 2011 be approved.

    RESOLVED: That the order of business be amended.


In relation to the Board’s Terms of Reference it was agreed that these would be reviewed again. This was likely to take place in February 2012. The review would, amongst other things, take account of substitutions, should a member be absent.

The Health and Social Care Bill continued to progress through Parliament. Once this had been completed the full role of the Health and Wellbeing Board would be clarified. A key issue for the Borough was the transfer of health responsibilities. It was noted that further details on this matter would be considered by Cabinet at its meeting in December 2011.

In the ensuing discussion the following comments were made:
    Ø An area of concern for the Borough would be to receive an appropriate level of funding for the Public Health services it was expected to commission. It was explained that a report for the Department of Health had been prepared based on actual spend in 2010/11. This included the commissioning of specific services such as sexual health. It had proved difficult to break down these total spends into individual local authority areas due to block contracts and across locality working.
    Ø It was explained that the Borough’s Public Health budget would be based on an agreed national formula. The formula, which was to be based on demographics and established health needs, would be announced prior to Christmas 2011. It was expected that the Secretary of State for Health would set targets for each local authority based on their current pace of change.
    Ø The Chairman wished it noted that the Borough was concerned to obtain a fair share of funding when it took on the responsibilities in 2013. To achieve this it was suggested that the Borough should be very clear in its objective setting, and should use all available data to ensure funding was targeted at those areas and individuals with most demonstrable need.
    Ø It was agreed that the funding formula should be the subject of a report to the February 2012 Board meeting.
    RESOLVED: Unanimously that:
a) The content of the report be noted.
b) The Terms of Reference be redrafted as appropriate and reported back to the 3rd February 2012 meeting.
c) Details of the funding formula be reported to the 3rd February 2012 meeting.


The Board welcomed Charles Waddicor, Chief Executive of NHS Berkshire, who along with Dr Adrian Hayter, presented the report on the ‘Shaping the Future’ programme which was a joint commitment by all elements of the NHS in East Berkshire to find a long term solution for hospital and community health services to meet the key challenges facing the NHS.

During the presentation the following comments were made:
    Ø It was explained that the guiding principles of the programme were quality, safety, best evidence care and affordability.
    Ø There was an emerging ‘clinical voice’ where health practitioners were getting together to challenge themselves to enhance patient care at a time when the local population and its health needs were changing.
    Ø The Department of Health was developing a model where competition between hospitals was encouraged as it was considered that this drove quality up and ensured best value.
    Ø Concern was expressed about the Bracknell HealthSpace which would become operational in 2013. It was suggested that ownership of equity in that HealthSpace could be inequitous and lead to potential conflicts of interest. In response it was explained that a private contractor was delivering the building, having competed in a tender process. The PCT and GPs had guaranteed to fund 40% of the space provided. GPs would have no interest in the assets of the building and would not derive any share of future profits. They would only act as commissioners of healthcare for their local populations. The 40% ‘risk’ held by the PCT would eventually transfer to the Clinical Commissioning Groups. The 60% of the space held by the developer would need to be ‘sold’ elsewhere. It was explained that the developer was enthusiastic about the model.
    Ø A query was raised as to why such a HealthSpace could not be constructed at Heatherwood.
    Ø Four groups of options for the future were presented to the Board. It was explained that these were ‘work in progress’ and that some options or some parts of them may not eventually form part of the public consultation.
    Ø Concern was expressed that further development of Wexham Park Hospital would require significant traffic and parking related investment.
    Ø Certain elements of the proposals involved working with private providers. Discussions would take place at an early stage to establish their appetite for such proposals.
    Ø It could not be guaranteed that any capital receipts would be fully reinvested in healthcare. It was acknowledged that the debts that the Trust currently faced would have to be taken account of.
    Ø Disappointment was expressed that the presentation made no reference to the contribution made by social care. In response it was explained that the contribution of social care was valued and would form part of the conversation about how to develop ‘wrap around’ care.
    Ø It was expected that the options would be considered at NHS Berkshire Board level in January 2012 and by the Strategic Health Authority in February. Formal public consultation would be launched in March 2011.
    RESOLVED: Unanimously that content of the report and the presentation and general concerns be noted. Particularly the concerns regarding the Heatherwood site.


The Board received the report which presented the Department of Health 2011 Health profile Indicator 9 – Physically Active Children (percentage of 5-9 year olds attending local authority schools who participated in at least 3 hours high quality PE and sport at school). The data had shown that the Borough was 7.8% points below national average for this indicator. However, it was considered that the data was based on a quite a narrow judgement and Section 3 of the report provided a broader, more positive context. Physical activity in children and young people in the Borough was at a reasonable level.

During the discussion the following comments were made:
    Ø On the expiry of current contracts the Borough’s leisure centres would cease to sell crisps and sweets.
    Ø It was noted that child obesity at Year 6 was lower than the national average but that obesity was rising in the Borough, particularly amongst those reaching school age.
    Ø The new school meal contracts focused on nutritional value, and there were no tuck shops in Borough schools.
    Ø Work continued to maximise the participation in sport within schools and there was ongoing development of competitive programmes outside of schools and between schools.
    Ø Efforts would be made to ‘catch the Olympic wave’.
    Ø The Borough continued to protect playing fields.
    RESOLVED: Unanimously that content of the report be noted.


The Board received the report which dealt with the future provision of mental health inpatient services for East Berkshire. It summarised the current service provision, key findings of the additional engagement and consultation work undertaken during the Summer, and described the current status of work in progress.

The additional work had been carried out as a result of concerns expressed. Attention was drawn to the data in Section 3 of the report, Key Implications. This estimated that at any one time 6-8 inpatients at St Marks were older adults from the Royal Borough. The report also stated that the accommodation in East Berkshire in which some services were provided were not at the standard required to achieve the best outcomes.

In the ensuing discussion, the following comments were made:
    Ø Efficient use of resources would allow more funding to be invested in services for patients with personality disorders. Good treatments at an early stage benefited the patients and their families.
    Ø Around £100k could be allocated to transport funding to support visits by families and friends, but these proposals did require further work. Transport services could include community transport providers, public transport vouchers and contributions towards petrol costs.
    Ø The experience of service users was a crucial part of the consultation. Lead GPs were surveyed, wards were visited and patients and their carers were all spoken to. Key outcomes of this work were the need for quality accommodation. Patients required dignity and respect, and this was not always achieved if they had to share bedrooms and/or toilets.
    Ø There had been an established clinical need for more investment in community based treatments. This had been shown to reduce the demand for inpatient care.
    Ø The Clinical Executive Committee would consider the options week commencing 7th November 2011 and the matter would be discussed at NHS Berkshire Board level on 22nd November.
    Ø The Panel requested that NHS Berkshire continued to engage fully with the press to ensure patients and their families were kept fully informed of progress.
    RESOLVED: Unanimously that content of the report be noted and that the planned additional work be supported.


The Board welcomed Christina Gradowski and Penny Ascough. The report provided an overview of stroke services available to Berkshire East residents with a focus on community services, in particular speech and language services within the Royal Borough.

During the discussion, the following comments were made:
    Ø It was noted that the Borough had received a three-year grant for provision of specialist community based services for Stroke Survivors. This funding had expired in March 2011 and had five main service areas, one of which was a Community Speech and Language Therapy (SALT) Assistant and the post ceased to be filled in the Autumn of 2011 due to the funding being ceased.
    Ø A best practice model had been developed in West Berkshire for the Stroke Care Pathway. It was agreed that this should be reviewed and adapted to the Royal Borough’s own needs.
    Ø The Speech and Language Therapy Services were based at St Marks Hospital with some additional provision at Wexham Park Hospital. Stroke patients were a core part of their work. Borough stroke patients did get to see qualified specialists, at a very early stage. Early intervention was medically proven to deliver the best outcomes.
    Ø Funding had ceased for movement and mobility sessions. Service users continued to attend the sessions, but they paid for them themselves a nominal amount as the setting up of the service had been covered by the grant.
    Ø It was agreed that the Head of Adult Services would review with the NHS the potential for application of the West Berkshire model and that the Adult and Community Services Overview and Scrutiny Panel would be recommended to take the matter up as a Task and Finish project. Mr Huggett requested that his involvement in such a project be considered. The Clinical Commissioning Group could also be involved. It was agreed that Cllr Derek Wilson should be kept informed of developments. A progress update would be provided to the next meeting.
    RESOLVED: Unanimously that:

    a) The content of the report be noted.
    b) The Head of Adult Services with the NHS to review the potential for application of the West Berkshire model.
    c) The Chairman of the Adult Services and Health Overview and Scrutiny Panel be notified of the Panel’s recommendation that Speech and Language Therapy services be the subject of a Task and Finish group.


The Board received the report which dealt with the allocation of additional, non-recurrent funding by the Department of Health through Primary Care Trusts (PCTs) in 2011-12 (and in 2012-13) to support adult social care services that result in health and social care gains. The report recommended that the Board noted the uses of the money as agreed between officers of the Berkshire East PCT (Berkshire NHS Cluster) and the Council as an excellent example of joint commissioning of integrated health and social care services, and noted the regular reporting of the use of the funds between the Council and the PCT.

During the discussion the following comments were made:
    Ø A budget pressure of £950k for 2011/12 was noted.
    Ø A 10% growth bid had been submitted for 2012/13 to reflect the growing demand.
    Ø Detailed discussion took place on telehealth and telecare. Both Tunstall Telehealth and Housing Solutions had operatives trained in the installation of telehealth / telecare equipment. Housing Solutions had agreed to visit health clinics to raise awareness of the effectiveness of such services. The PCT was in discussion with the Clinical Commissioning Groups. Caution was expressed that innovative new services would need to be the subject of robust evaluation to ensure they were effective and delivered medical benefits. The national evidence suggested that more evaluation was required.
    Ø There had been a sharp rise locally in the population who are older people, especially aged 85 and over. There was a need for innovative services but these needed to be evidence and care-based. The Head of Adult Services advised that the Borough was proceeding with caution and that his Supporting People Co-ordinator was collecting data for evaluation.
    Ø A query was raised as to whether telecare and the first responders could be linked to the Project CareBank.
    Ø It was noted that the Borough and WRVS would jointly pilot Project CareBank in 2012.
    RESOLVED: Unanimously that:

    a) The use of funds transferred from the Berkshire East PCT to the Council; for use in adult social care services for health gain in 2012-13 be noted.
    b) The support of the strategic focus on preventative services and the transformation of adult social care programme be noted.


The Board received an update from Dr Hayter. The report to the July meeting outlined the principles and structures that had been developed by the WAM CCG, which had resulted from discussions with partner organisations. The report described subsequent progress, with a particular emphasis on the governance arrangements and the emerging priorities for WAM CCG.

During the presentation the following comments were made:
    Ø Concern had been expressed that three surgeries in Ascot had chosen to be part of the Ascot CCG.
    Ø There was a need for WAM CCG to formalise links to CCGs in Bracknell, Surrey and Buckinghamshire. This was because cross boundary issues were inevitable.
    Ø Practice managers were fully engaged in the development of the CCG.
    Ø The independent consultant to the CCG was working to involve patients and service users.
    Ø There was a need to utilise the clinical estate to its best advantage, despite its condition in parts.
    Ø The CCG had a small management budget at present. This was expected to be increased.
    Ø Details about the CCG had been published in Around the Royal Borough. The NHS Changes Programme Project Manager (Catherine Mullins) was thanked for her assistance in this regard.
    Ø The structure of the CCG had been developed further. Dr Hayter had been appointed Chairman of the CCG and Dr Kinder had been appointed as the Vice-Chairman.

In the ensuing discussion the following comments were made:
    Ø Members welcomed the news that the structure was developing well and that the Chairmanship had been confirmed.
    Ø The CCG would be held to account by the commissioning boards and the Borough. It was also expected that the Borough’s Adult Services and Health Overview and Scrutiny Panel would take a role in monitoring the work of the CCG. The Scrutiny Panel would also scrutinise the work of the Health and Wellbeing Board, once it was fully established.
    Ø A view was expressed that there needed to be more communication with the public. In response it was confirmed that a communication strategy was under development.
    RESOLVED: Unanimously that the progress reported be noted.


The Board received a presentation by Dr Riordan and Rutuja Kulkarni. The report outlined the progress made by the PCT against the 2011/12 JSNA. It outlined the process of engagement and described the structure of the JSNA. The first draft of the Berkshire East JSNA for the Borough was expected to be completed by mid November and a final draft would be completed by the end of November 2011.

During the discussion the following comments were made:
    Ø Clear benefits had arisen from the development of the JSNA. It looked at existing and future needs. It engaged with key partners, voluntary organisations and interested residents.
    Ø The JSNA would feed into the Health and Wellbeing Strategy.
    Ø There is an evaluation form being developed for the JSNA to identify how it has been used and the influence it has on service development for all stakeholders.
    Ø Detailed use of IT and GIS would identify issues and areas of need.
    Ø The Borough’s assistance in the development of the JSNA was greatly appreciated.
    Ø It was noted that some of the Borough’s Partnership Boards had expressed a wish to feed in their views and explain what they wanted to see in the JSNA. In response it was confirmed that there would be further consultation workshops.
    RESOLVED: Unanimously that the progress reported be noted.


The following items for future meetings were proposed:

3 February 2012
Dementia Action Plan and Dementia Advisor Post
Update on Unallocated Funds of the LAA Reward Monies
NHS Changes Including the Transfer of Public Health Responsibilities
Update on the Joint Health and Wellbeing Strategy
Information on the Outcomes Framework for Health and Social Care
Shaping the Future Update


The meeting, which began at 2.00pm, ended at 4.45pm.

CHAIRMAN …………………………..

DATE …………………………………..