Meeting documents

Shadow Health and Wellbeing Board
Friday 3 February 2012 2.00 pm



i
SHADOW HEALTH AND WELLBEING BOARD

3 FEBRUARY 2012

Present: Councillor Eileen Quick.

Dr Adrian Hayter, Brian Huggett, Dr Pat Riordan, Christabel Shawcross, Cliff Turner and David Williams.

Also Present: Angela Snowling.

Officers: Debbie Dickenson, Liz Hornby, Catherine Mullins, John Scaife, David Scott and Genny Webb.
PART I

26/11 APOLOGIES FOR ABSENCE

Apologies were received from Councillor Dudley and Dr Judith Kinder.

27/11 DECLARATIONS OF INTEREST

There were no declarations of interest.

28/11 MINUTES
    RESOLVED: That the minutes of the meeting of the Panel held on 4 November 2011 be approved.

Updates from previous Minutes:

17/11 Shaping the Future – Healthcare in East Berkshire – it was noted that different options would be available in July therefore giving more time to consider the future.

19/11 NHS Berkshire Commissioning of Mental Health Services at St Marks Hospital – it was noted that a decision had been taken by the NHS and Trust that the services would move to Prospect Park and that £100,000 had been allocated for transport of patients to and from the site although discussions were still to be held. It was also noted that the intention was to care for patients within the community therefore there would be increased home treatment.

20/1 Information on Speech and Language Therapy Services for Stroke Survivors – it was noted that a work programme to review pathways would be undertaken and that there were representatives on the Childrens Overview and Scrutiny Panel Task and Finish group.

21/11 Department of Health Transfer of Funds Progress Report – it was noted that positive discussions had been held in relation to the allocation of funding.


29/11 TERMS OF REFERENCE AGREEMENT AND GOVERNANCE ARRANGEMENTS FOR SHWB

The Board was reminded that it was still in ‘Shadow’ form due to the Health and Social Care Bill not having been made law as yet and it was not known when this might happen. They also noted the recommendation to appoint the Deputy Lead Member for Health to the Board as a Vice-Chairman and agreed to the proposal. The Terms of Reference would therefore be amended accordingly and taken to Council for approval and ratification. For information, it was noted that the Deputy Lead Member for Health was a member of the Adult Services and Health Overview and Scrutiny Panel, and once appointed to this Board she would resign from the Scrutiny Panel.

The Board noted the recommendation to agree to delegate development of a working protocol for the HWB and the Bracknell and Ascot Clinical Commissioning Group (BA CCG) to the Strategic Director of Adult and Community Services to work in partnership with WAM CCG and that, if agreed, this would be reflected in the Terms of Reference. It was noted that three Clinical Commissioning Groups (CCGs) of East Berkshire were adopting a federated approach for some commissioning functions to maximise effectiveness...They meet once a month and had recognised differences which they were addressing. Residents should not be affected during the transformation process. Each practice was involved in a series of meetings which had led to survey’s being carried out by the individual practice as people interpreted the concept in different ways.
    RESOLVED: Unanimously that:
a) The content of the report be noted;
b) The Recommendations be noted and actioned as appropriate.

30/11 DEMENTIA ACTION PLAN (BASED ON THE NATIONAL DEMENTIA STRATEGY)

The Board received the report on the Dementia Action Plan (based on the National Dementia Strategy) and noted the contents and recommendation. The Board noted that the Joint Strategic Needs Assessment (JSNA) had indicated that dementia was a key priority for the Royal Borough and predicted a 71% increase by 2030.

The Board noted that there were seventeen key objectives which had been identified within four key themes which were –
    1. Raising Awareness
    2. Early Diagnosis and Support
    3. Living Well with Dementia
    4. Strategy Implementation

These four key themes are from the National Dementia Strategy and have been supported by the attendees at an RBWM hosted conference in 2009 where some gaps were also identified. The Board noted the recommendation in the report that a specific grant of £25,000 from the Department of Health be allocated from the PCT to the Council to enable continued funding for the Dementia Care Advisor (DCA). It was noted that the DCA would receive referrals and remain with the patient until they received other assistance. It was believed this support was crucial at a frightening time for the patient and their families. The Board noted that the funding was available for the DCA and that the matter was the only agreement they could make as the money had to be spent on the Memory Services and recommended an advisory person as an ideal service for the funding. The Board noted that the funding was non-recurrent and lasted for one year.

The Board also noted that a sub group of the Dementia Action Plan (DAP) had been formed and consisted of a good group from across the voluntary and statutory sectors. Due to the DAP being a living document, the Berkshire Healthcare Foundation Trust was holding information courses on a regular basis as it was noted that the Borough had not been very successful in diagnosing patients early. However, GPs were being educated in understanding that services were available and where they can ‘signpost’ patients and carers for support.

The Board noted that the Borough was in the lowest quartile nationally for early diagnosis and intervention. It was noted that Dr Chris Allen had bid for funding but had been rejected. There was the ongoing managing of patients and awareness among GPs was being raised.
    RESOLVED: Unanimously the content of the report along with the Recommendation.

31/11 UPDATE ON THE NHS CHANGES (INCLUDING PUBLIC HEALTH)

The Board received the report on the Update on the NHS Changes and noted that the Health and Social Care Bill had still not received Royal Assent. It was noted that the NHS had hosted a workshop on the subject of the transfer of the public health function and regarding public health commissioning, contracts and financial information at the end of January 2012. The Berkshire CEO’s had formed a Programme Board to look at the most effective ways of managing/commissioning the public health functions once the key information was issued in regard to finances available. An event for Scrutiny and SHWB Members was to be held on 8 February 2012. It was also noted that the Chairs of all Scrutiny’s had been invited.

The Board noted that a funded Project Manager had been appointed in West Berkshire and it was hoped to appoint the same in East Berkshire although this had not yet been agreed between the local Unitary Authorities. It was deemed that Berkshire was a special case due to the complexity of the Authorities involved.

The Board also noted the outcomes from the recent Table Discussions event when the Marmot themes were considered. It was agreed that this item would be brought to the next meeting of the Board. It was noted that Healthwatch was due to be implemented by April 2013 although guidance was still to be published. The Health and Wellbeing Strategy was seen as important as it was the ‘glue’ in the system and which could have a significant impact on the process.

The Board agreed that a sub-group should be formed to discuss with the Director of Public Health, NHS Berkshire how to take forward the Joint Health and Wellbeing Strategy, which will most likely be based on the Marmot Key strategic objectives.

The Board noted that team support for CCGs was being taken forward and that lay representation was being encouraged. Workshops would be held for people who expressed an interest. It was noted that four CCGs in West Berkshire who met regularly and it was agreed that with the three CCGs from East Berkshire that all seven should recognise they should work together.
    RESOLVED: Unanimously that content of the report be noted.

31/11 NHS BERKSHIRE EAST QIPP PRIORITIES FOR 2012/13

The Board received a presentation on the NHS Berkshire East Operating Plan Review 2012/13 and noted the following –
    Ø That the NHS had to make £20bn efficiency savings by 2014/15.
    Ø That the local NHS was the seventh lowest funded PCT in the country which therefore made the challenge more difficult as the PCT would receive around 20% more if it received the average funding per head.
    Ø Total QIPP savings plan of £14.1m from a budget of £600m.
    Ø That the quality of services at HWPFT showed a mixed set of findings for the first five months of 2012 particularly noting that they were national leads in cleanliness and that in relation to Dignity and Nutrition National Hospital Survey did very well.
    Ø Most Trusts were achieving an 18-week target but it was noted that HWPFT currently was not. However, the Outpatient target had been achieved.
    Ø In relation to HWP performance, it was noted that there was a 100% improvement in the area of Stroke performance.
    Ø The figure of 1:32 across the Birth to Midwife ratios was achieved across the service, achieving 99% for 12-weeks booked target, and a C-section rate at 26.70% for November 2011. This figure included both elective and emergency C-sections.
    Ø A&E performance was still struggling, but there was an improvement.
    Ø In relation to Staying Healthy it was noted that this was an area where nearly £800,000 was being invested, particularly in relation to areas such as Alcohol Harm Reduction, Breast Screening Age Extension, NHS Health Checks. Expert Patient and Physical Activity.
    Ø In relation to Access to Services, it was noted in particular that in Outpatient Care GPs were working with colleagues to enable patients to be seen locally which in turn would reduce referrals to hospital. The programme would ensure that drugs are suitable prescribed. Surgical Care – to ensure best practice with clinicians.
    Ø Preventing Crisis, providing support. It was noted that £1m had been invested on emergency care.
    Ø Joint Commissioning saw investment in Children’s Services.
    Ø Better Value Contracts and Performance Management. It was noted that delivery of better value could be achieved.
    Ø Shaping the Future for Berkshire East. The programme was long-term and had led to enhanced focus on clinical engagement across primary and secondary care; new programme architecture; further work with HOSC’s to update on developments and work on criteria by which final proposed options would be assessed and development of rigorously tested options to ensure high quality, safe and affordable care.

32/11 UPDATE ON THE OUTCOMES FRAMEWORKS AND IMPACT ON JOINT STRATEGIC NEEDS ASSESSMENT (JSNA) AND THE JHWS

The Board welcomed Genny Webb, Performance and Information Officer, RBWM who stated that the report dealt with the progress of national performance frameworks since the withdrawal of the National Indicator Set (NIS) in October 2010. A revised Appendix A was circulated to Board members. It was noted that the Department of Education (DfE) were currently consulting on a set of local performance indicators based on the recommendations of the recent Munro report.

The Board noted the three Recommendations in the report and particular the third recommendation – incorporating Public Health information into current Council performance monitoring, which would start once the JHWS had been agreed.

The Board noted that progress against measures would be taken into account as more trend analysis would be looked at. They also noted that the LAA targets were not localised and that there was a need to be more strategic.
    RESOLVED: Unanimously that the contents of the report and recommendations were noted.

33/11 ENDORSEMENT OF THE JSNA

The Board received a presentation and noted the following –
    Ø In relation to child poverty areas within the Borough that in July 2012 up to date information would be published and number who were claiming Working Tax Credits.
    Ø That there were large gaps in the Early Years Foundation state communication and language – a Marmot Indicator.
    Ø The Shelter database was online which enabled viewers to see all indicators in relation to Housing in the Royal Borough. The Board noted that at the end of March 2011 there were 2168 on the waiting lists. There were 6160 claiming housing benefits. In March 2011, the Supporting People data showed support was provided for 1233 older people.
    Ø In respect of Domestic Abuse work was ongoing with victims although risk factors were still to be understood.
    Ø Significant work had been carried out on long term conditions in local practices with extracts from hospital and other surgery data available. This enabled specific areas to be looked at where support was most needed.
    Ø There were 17,000 admissions compared to what was expected for mental health patients.

The Board received the report which dealt with future health and well being needs of the population in light of the existing services. The Board wished to thank the Assistant Director and Consultant for Public Health and her team for the very detailed work produced as well as the working group from RBWM who have also provided a lot of the information. The Board noted that a link to the site where the report was held would be made available on the Borough’s website, and work would take place to find out the best way of ensuring the functionality of the JSNA is compatible with available IT systems. A series of workshops were proposed which would demonstrate how to work through the JSNA. Public engagement was important and this would be taken forward in attempting to engage residents. It would take time to fit in with the guidance and it was considered that this would be a rolling programme.

The Board queried whether information on numbers of children being given universal vaccinations could be made available and they were informed that access in ‘real-time’ from practices was already in place. It was noted that such information would be uploaded to the website, but there were issues to be overcome, particularly so that figures could not be altered. The Board agreed that a dedicated IT lead from the Borough should be sought.

In respect of ‘flu vaccinations, it was noted that in the Over 65’s group numbers were up on previous years. However, numbers from ‘At Risk’ groups were down on previous years, although increased numbers of frontline Borough staff had taken the opportunity of a vaccination.

    RESOLVED: Unanimously that the contents of the report be noted.
34/11 PROPOSAL OF FUTURE ITEMS

See 35/11 below.

35/11 DATES OF FUTURE MEETINGS AND PLANNED AGENDA ITEMS FOR FUTURE MEETINGS

The following dates were proposed:
    Ø 18 May 2012
    Ø 29 September 2012
    Ø 7 December 2012
    Ø 8 February 2013

The following items for future meetings were proposed:
    Ø Update on unallocated funds for the LAA Reward monies
    Ø Update on Stroke Care Pathway
    Ø Transfer of Department of Health Funds
    Ø NHS Changes Update
    Ø Shaping the Future – Healthcare in East Berkshire
    Ø HealthWatch Development of Business Models
    Ø Development of the Joint Health and Wellbeing Strategy

36/11 MEETING

The meeting, which began at 2.00pm, ended at 4.10pm.

CHAIRMAN ………………………………….

DATE …………………………………..