Present: Councillor Lynda Yong (Deputy Lead for Member Health Services).

Dr Adrian Hayter, Alison Alexander, Christabel Shawcross, Dr Lise Llewellyn

Carrol Crowe, Nick Davies, Hilary Hall, Marianne Hiley, Rutuja Kulkarni, David Mason.

Officers: Wendy Binmore and Catherine Mullins.

27/14 APOLOGIES FOR ABSENCE

Apologies were received from Councillor Coppinger, Councillor Bicknell, Mike Copeland, Dr Jackie McGlynn, and Mary Purnell.

28/14 DECLARATIONS OF INTEREST

None.

29/14 MINUTES

RESOLVED: That the minutes of the meeting of the Panel held on 11 September 2014 be approved.

30/14 CHILD SEXUAL EXPLOITATION – THE CSE STRATEGY AND PROTECTING YOUNG PEOPLE FROM HARM

The Strategic Director of Children's Services and the Service Leader for Strategic Commissioning and Practice Improvement gave a presentation on Child Sexual Exploitation which included the following main points:

Child Sexual Exploitation was not new but there was now a renewed focus.
Education carried out in schools and GP surgeries all played a part in drawing children’s attention to what constituted an abusive relationship.
There were historical cases of CSE in the Borough that went back to the 1960s and 1970s.
A new Ofsted inspection was to be used with the Borough, Police and other partners working together in a joined up approach.
CSE definition:
o ‘Sexual exploitation of children and young people under 18 involves exploitative situations, contexts and relationships where young people (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities.
o Child sexual exploitation can occur through the use of technology without the child’s immediate recognition; for example being persuaded to post sexual images on the internet/mobile phones without immediate payment or gain.
o In all cases, those exploiting the child/young person have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources. Violence, coercion and intimidation are economic or other resources. Violence, coercion and intimidation are common, involvement in exploitative relationships being characterised in the main by the child or young person’s limited availability of choice resulting from their social/economic and/or emotional vulnerability’.
Context:
o High profile nationally.
o In the Rochdale and Oxford court cases, resources were deployed to deal with incidents.
o The Jay Report was about institutions not recognising and ignoring incidents of CSE.
o Ofsted thematic immediate inspections of 8 local authorities – the report said organisations had started to develop strategies but they were not yet imbedded in in seeking to identify incidents.
o Office of the Children’s Commissioner Report into child sexual exploitation in gangs was carried out two years ago; the Jay Report was now in circulation and it was discovered that abuse took place in many areas.
o The Local Authority had a statutory responsibility to identify risks, such as licenced taxi’s and looking at houses of multiple occupation .
o Hostels and B & B’s would undergo inspections.
o The Council agreed to undertake an audit on how the Borough used all its safeguarding powers to establish how to identify those most at risk.
o The Council was also undertaking a review on how all agencies were responding to CSE cases.
o A report would be submitted to Cabinet in March 2015 and Thames Valley Police and the local CCG’s would be taking the report to their boards for consideration.
RBWM Response:
o The operational focus was looking at missing children groups and CSE groups who would meet once per month and had representation from all statutory and voluntary organisations to identify young people and children at risk.
o Those statutory and voluntary groups made up the RBWM Combined Strategic Operational Children Sexual Exploitation and Missing Persons Panel.
Operational Group:
o Jointly chaired by the Borough and Thames Valley Police.
o Cases were tracked monthly through the group.
o Risk was assessed against three levels prescribed by the Police:
Level one: Children/young people where there was no current information that they were at risk of CSE but who had previously been linked to CSE and/or were displaying the warning signs.
Level two: Children and young people where there was information that suggested a current risk of CSE but no disclosures or evidence of CSE.
Level three: Children/young people where there had been a disclosure of sexual offences perpetrated against them or where an active investigation was taking place due to corroborated intelligence or evidence regarding CSE.
CSE Indicator Tool:
o Berkshire LSCB Child Protection Procedures:
Key details including any disclosure of CSE/abuse.
Domains – what was known/not known
Health
Behaviours
Grooming
Family and Social
Safety
The tool looked at different domains and looked to address all those areas that the information brought to the group.
Current levels of risk:
o The Strategic Director of Children's Services had a cross Borough conference and she wanted all Members of the Health and Wellbeing Board to be involved and to take the information back to their boards.
o There were cases the Borough knew about but there could also be issues of under reporting.
o An audit was carried out on all level three cases that had been flagged up, there were children in the system where their cases were robustly managed.
o It was necessary to strengthen the response at levels one and two.
o By November 2014, there was one case at level one; 10 cases at level two and three cases at level three.
Strategic Focus:
o Strategic Group – Sub-Group of the Local Safeguarding Children Board: Director of Children’s Services and Local Police Area Commander.
o Child Sexual Exploitation Strategy – final approved by the LSCB in January 2015 for ratification – would be bought back to the Health and Wellbeing Board after the review was completed.
o Strategic Lead within the Borough – Hilary Hall, Service Leader for Strategy, Commissioning and Performance.
o There might be a need to include Adult Services.
o A one year post was being made available to appoint a CSE and Missing Co-Ordinator. It was hoped the Co-Ordinator would undertake a lot of the work and then following a review at the end of the first year of the post’s existence, look to see if it was possible to make the post a longer term role.
Principles behind strategy, 1
o Sexual exploitation includes sexual, physical and emotional abuse, as well as, in some cases, neglect.
o Children do not make informed choices to enter or remain in sexual exploitation, but do so from coercion, enticement, manipulation or desperation – there were a range of reasons.
o Children under 16 years of age could not consent to sexual activity – it was illegal.
o Sexual activity with children under 13 was statutory rape.
o Sexually exploited children should be treated as victims of abuse and not as offenders – this was highlighted in the Jay Report.
o Between the ages of 16 and 18, consideration might be given, in very limited circumstances and where all other options had failed, to the use of criminal justice action.
o There was a need to be clear on how to deal with vulnerable adults.
Principles behind strategy, 2:
o Many sexually exploited children had difficulty distinguishing between their own choices around sex and sexuality and the sexual activities they were coerced into.
o The primary law enforcement effort must be against the coercers and sex abusers, who may be adult, but could also be the child’s peers or young people who were older than the child.
o Sexually exploited children were children in need of services under the Children Act 1989 and 2004. They were also children in need of protection.
o A multi-agency network or planning meeting/discussion should take place for all children considered at risk of sexual exploitation.
o Engage with wardens to help identify children at risk.
o There was a need to focus on the abusers.
Ofsted inspection criteria:
o Ofsted thematic inspections of eight local authorities carried out in September and October 2014.
o Inspection criteria:
Strategic leadership.
Compliance with the 2009 statutory guidance.
Information sharing – using that to enable us to be better.
Quality assurance of practice.
Effectiveness of prevention work.
Early identification.
Effective safeguarding and protection of those who are, or have been, sexually exploited.
Commissioning arrangements - would be closely looked at.
Effectiveness of disruption activities – how the Borough was responding to perpetrators.
There was a need to upskill staff to respond to incidents.
Key findings from eight inspections, 1:
o Local Authorities and their partners not meeting their full responsibilities in relation to child sexual exploitation.
o Poor information in relation to local issues and lack of information sharing – able to share with partners now. Operation Group did well in sharing information regarding known cases.
o Good quality training in place.
o Lack of robust quality assurance of practice – started the audit.
o Rang of innovative and creative awareness raising campaigns in place – doing campaigning currently: cards for young people and parents were being distributed, cards for professionals and cue cards had been introduced.
Key findings from eight inspections, 2:
o Inconsistent use of screening and assessment tools – there was now an assessment tool in place and it was being used.
o Lack of disruption activities in place – how the Borough used its rights to look at Licensing – are those who drive taxi’s licenced; Police now doing checks on B&B’s and hostels.
o Low number of prosecutions – evidence and cooperation was needed to prosecute.
o Not all young people that went missing had a formal return interview: - there was a robust response when they were missing from education and care but those missing from home were not as robustly followed up. Parents that chose to home educate their children were not so easily investigated either.
o Lack of cross referencing of information and soft intelligence to identify children at risk of sexual exploitation.
RBWM activities, to May 2015, 1
o Deep dive audit of all Level 3 cases completed in October 2014.
o Internal audit of the Borough’s use of regulatory powers, report due in February 2015.
o External review of statutory partners’ use powers and working together to address the risk of child sexual exploitation, report due in February 2015.
o Reports to go to Health and Wellbeing Board and Community Safety Partnership in December 2014.

The Strategic Director of Adult & Community Services stated there was a huge amount of information in the presentation and there was a lot to learn from identifying what should be referred and the expectations of organisations being audited. The Service Leader – Strategic Commissioning and Practice Improvement confirmed there was not a specific tool to help with identification but, that was something to be developed. The Strategic Director of Children's Services stated an internal audit could be shared with all organisations. That would help identify what to look out for when using powers to intervene. That could be used with partner organisations. She confirmed that schools had gone through the cycle of being inspected against education criteria. The inspections were now being carried out in a holistic way; the Strategic Director of Children's Services stated she had spoken to Borough educationalists and agreed a joint inset day across both primary and secondary schools so they could discover how to share information and focus on resilience and that would help them to become robust.

Councillor Yong commented there were private schools in the area and they could fall through the net. The Strategic Director of Children's Services confirmed those schools could be included in the inset day training or, they could carry out a separate exercise for them. The Strategic Director of Children's Services stated she would bring the paper back to the Board in March 2015 with the outcomes from the audit.

31/14 PROTOCOL AGREEMENT

The Service Leader – Strategic Commissioning and Practice Improvement introduced the report and summarised the main points of the report:
The Protocol had been developed through the young people and children partnership.
The Protocol ensured the agencies used a joined up approach.
The Protocol tried to articulate the principles of working together.
It was a work in progress and would be refined and developed further.
It was about active engagement across the Boards.
The Protocol was about having a strategic approach, minimising duplication of work and having a joined up approach.
The Protocol had been through the Children and Young People and Safeguarding Board and it was going to be presented to Adults Services too.

Dr Lise Llewelyn confirmed the Health and Wellbeing Board’s duty was to reduce inequalities and also to undertake the JSNA so that could join up on the delivery of needs assessment and then pool all the information together. The Strategic Director of Adult & Community Services commented that adult safeguarding was a different issue to safeguarding children. Dr Hayter confirmed the Chair of the Safeguarding Board of both adults and children had been co-opted onto the Health and Wellbeing Board to be present as and when appropriate.

32/14 PUBLIC HEALTH ACTIONS UPDATE

Dr Lise Llewelyn gave a brief update on the public health actions which included the following main points:

Pharmaceutical Needs Assessment – report to be presented to the next Health and Wellbeing Board.
Joint Strategic Needs Assessment – refresh due in the coming weeks.
Strategic intentions for suicide would be updated once results pooled.
Flu Plan – there were low levels of flu; therefore, the plan was working well.
Ebola – there were two planning events looking at responses should a case in Berkshire be confirmed.

Members noted that there was a slight increase in people attending A&E with flu. The increase was measured at 6% but the national average for admissions with flu symptoms was around 8% so the Borough’s position was better than the Thames Valley average.

Dr Lise Llewelyn confirmed the suicide plan was adult focused but, a Suicide Audit Group had been organised and any recommendations would go to adult groups and then onto CAMHS and Safeguarding groups.


33/14 JOINT HEALTH AND WELLBEING STRATEGY

Catherine Mullins, Health and Wellbeing Development Officer gave a brief presentation on the Joint Health and Wellbeing Strategy. The main points of the presentation included:

The Joint Health and Wellbeing Strategy applied to:

o The whole population.
o Across the life course.
o Vulnerable people, excluded or hard to reach groups.
o Carers and their families.
o People who lived outside of the area but received services in the Local Authority area.
o People who worked in the area.

The JHWS and Public Involvement:

o There was a requirement for lots of public input.
o The JHWS needed to identify what the priorities were for collective action and what the local outcomes are that needed to be achieved, and how they could be achieved together. That then identified the priorities for the commissioning (purchasing and provision) of services through large scale public consultation.
o Duty under the Act to have involvement of the public with the development of the Strategy.
o There was a consultation on the high-level priorities needed to meet local needs.
o Confident strategy did take residents views into account. The Strategy was made with and for residents.

Priorities of the JHWS Public Consultation:

o From the public consultation there were three overarching themes that came through the responses.
Supporting a Health Population – help residents to improve their health and wellbeing.
Prevention and early Intervention – give help to residents early to prevent a possible crisis or a situation getting worse.
Enabling Residents to Maximise their Capabilities and Life Chances – improve education, employment opportunities and access to housing that improve health and wellbeing.

The strategy was launched in 2013 and was a fluid document as things changed.
There were 707 downloads of the strategy per month of unique IP addresses.
The public were aware of the strategy.


Stakeholder Event:

o On 4 November 2014 over 80 attendees heard about the latest developments across Health and Social Care and gave their views on areas to consider with the JHWS refresh.
o The input came from a variety of different age groups.
o There was support with what the Borough and CCG’s were doing with the strategy.
o The three areas covered by the strategy were still relevant.

Next Steps:
o Proposed Format of the JHWS Refresh –
Retain the JHWS format as it is.
Have a progress against indicators performance table as a separate document, so that residents and stakeholders can see the progress against the indicators.
Create an addendum document that supplements the JHWS identifying the changing policy context of health and social care, including BCF, 5 Year Plans, Care Act and Children’s Outcomes.
Potential for a further refresh/rewrite during 2015 with the embedding of the changes and further resident feedback – this should be revisited once per year to keep it relevant.
Considerations from the HWB on this proposal are sought.
Full agreement on the format and contents of the current refresh March 2015 meeting.
Sign off the refresh in March 2015 with HWB Members to help.

Dr Lise Llewelyn stated she supported the idea of an addendum being included but requested other agencies to be included so the context for all partners is included. The Strategic Director of Adult & Community Services stated it should show what had been achieved and what needed more work over the following 18 months.

Dr Adrian Hayter stated Healthwatch had a significant role in the original strategy. The NHS Changes and Project Manager responded being involved and engaged in giving was giving a strong residential voice to the strategy. Healthwatch also gave the strategy viability and added value. Healthwatch were also on the Board of the JSNA so residents know their voices would be heard. There was an element of awareness raising with posters and leaflets; working with Healthwatch to get the message of the refresh out there. Dr Adrian Hayter stated he accepted the way things were moving forward.

34/14 CARE AND SUPPORT ACT

The Strategic Director of Adult & Community Services stated she had a report going to Cabinet on 17 December 2014 regarding financial changes and key outcomes of the Act on promoting them to the local population. The key change was in terms of who was eligible for care and support and whether or not their needs were to be met by Adult Services. There was lots of work going on in training staff and the legal framework had to be assessed on a critical basis. There was also a duty to assess carers and that covered domestic support to help with their caring roles. Work was ongoing with local Berkshire carers to help with the development of forms and accessibility. All work would begin in April 2015.

Other areas covered in the report included:

Dilnot reforms: people would not have to sell their homes in their lifetimes to pay for care.
Consultation on reforms ongoing from January/February 2015.
Ability of nursing care to provide services at the same rate as the Council.
Council now responsible to provide self payers with information on how much care costs the Council so they could make informed decisions.

Dr Adrian Hayter commented there was a lot of work going on between December 2014 and April 2015.

35/14 BETTER CARE FUND

The following main points of the presentation included:

The report updated the Health and Wellbeing Board on the progress of the assurance process of the Better Care Fund agreement between RBWM and Windsor and Maidenhead (WAM) and Bracknell and Ascot Clinical Commissioning Groups (CCGs). It was submitted to NHS England in October 2014.
The report provided an update on the progress of the projects that were focused on delivering the Non Elective Admission target of a 3.5% reduction by December 2015.
The report noted the potential for the transformational expansion of the Better Care fund to achieve integration in 2016-17 and beyond.
The report notes the progress and timetable for agreeing the pooled budget and the risk share for the financial elements of the Better Care Fund in 2015-16. This will form part of a Section 75 agreement.

Adult Social Care was focusing on working with accurate data.
Up to date data indicated Care Homes Programme was still going ahead and was on target.
Admissions were being avoided.
Added new dashboard for Sheltered Accommodation.
Able to start using monitored data.
Positive response from Health Authorities in reducing non-elective admissions.
Help to set up training in falls prevention – ongoing.
Family Friends had been supportive and shared information.
Paediatrics groups were also supporting the project in advising on childhood illness to reduce non-elective admissions.
Two GP practices were sharing their best practices with other GP surgeries.
Falls prevention – positive role across the area.
Integrated care teams focusing on those with long term conditions.
Ambulatory care was an issue at end of life care – ended having people in hospital at the end of their life inappropriately.
Community IV Service was going forward and there was a meeting planned for 17 December 2014.
In terms of the paper on the Care Act itself, it outlined and noted the progress of assurance from the BCF approved and a letter of national approval was expected imminently.
The recommendations of the report also highlighted projects on non-elective admissions – a lot of work was ongoing in areas, such as falls prevention.
Transformational transfer of budget – there were challenges in how the Borough and CCGs moved forward with the process.
Table 75 Agreement – progressing on timetable; it was very specific around projects that delivered and transformed services moving forward.
The paper would be brought back to the Health and wellbeing Board in March 2015 for verification.
Figures for reduction on non-elective admissions KPI were not going to be determined till the end of January 2015.
BCF requirement – asked to provide a service user measure – wanted one to combine Health and Wellbeing.
There had been a lot of Public Health input.

39/14 COMMISSIONING INTENTIONS


Commissioning was seen as the route to implement strategies.
Local Authority or Public Health did not deliver the Borough’s strategies, they were commissioned.
Commissioning intentions were in the draft stage.
National focus was mental health and integration of the five year plan.
Identified a variation in health care provider delivery teams so required a standardisation exercise.
Integration pathway reviews – delivering BCF Matrix, seven day working five days a week did not work.
Completed mental health intentions commissioning and a hand out showed how aspects had been prioritised.
There would be a service specification for tier four services and it would have to proven the bed days required.
There was a national shortage of beds and NHS England wanted to do an exercise on funding.
NHS England would be responsible for services within a 50 mile radius.
There were factors to be added on physical health impacts in the BHFT Commissioning.
Needed to link physical and mental health services.
Specification was required on where the CCGs and Borough needed to be and that would need to be reviewed at the end of June 2015.
Contractual penalties if service provider did not provide their service as specified, such as smoking cessation, to be implemented.

40/14 THE LOCAL QUALITY ACCOUNT FOR 2013/14

The report reflected the quality of services delivered around four outcomes.
Fourth QA and it was important to provide feedback on what had been achieved.
Members were directed to page two as Healthwatch had now signed the document off.
The main points were highlighted on page nine of the report on four areas which enhanced quality of life using qualitative measures.
One area to focus on was people saying they wanted services that gave them control.
Outcome two on page 15 of the report showed how being joined up was indicated.
Page 16 showed performance targets which avoided permanent admissions. Showed work being done in maintaining independence.
Page 21, outcome three – positive experience of services in care and support – 2013/14 dropped on previous years. Work was needed to address the drop and Task and Finish Groups were being organised on particular areas.
Page 31, outcome four – safeguarding: there was lots of work done but there was still more to do to make sure processes were robust. Levels of reporting of safeguarding issues were being maintained.
Endorsement of the recommendations were required from the Board.

42/14 ANY OTHER BUSINESS

The Strategic Director of Adult & Community Services said a workshop was being organised to review how the Borough had been doing and it was agreed to invite the Kings Fund. Richard Humphries was available to help and a date had been set for 12 February 2015. The key areas were – there was a big gap in service providers. It was not possible to deliver services if service providers did not engage. The workshop on 12 February was to help providers become more engaged.

Heatherwood and Wexham Park had issues with quality of care so it was necessary to think about how to help them provide a better service. The Strategic Director of Adult & Community Services hopes to see a lot of the Members there. Dr Hayter commented there was a real positive point in the Health and Wellbeing Board cycle to stand back and reflect.

Letters to the Health and Wellbeing Board Chair

A summary of all letters received was circulated to Members and were just for Members to note. Any questions were to be directed to the Strategic Director of Adult & Community Services. The following letters had been received:

Assistant Chief Constable, Thames Valley Police – Mental Health Crisis Care Concordat.
Dept. of Health, Effective Working with Major Providers.
Thames Valley Police and Crime Panel – Female Genital Mutilation.
Thames Valley Clinical Networks, End of Life Care.
Getting Ready for Winter.
Request for data from Children’s Commissioner.

41/14 POTENTIAL FUTURE AGENDA ITEMS

Members noted potential future agenda items. No comments were received.

41/14 MEETING

The meeting, which began at 2.00pm, ended at 4.19pm.