Present: Councillors Simon Dudley (Chairman – Cabinet Lead Member for Adult and Community Services), Eileen Quick (Cabinet Lead Member for Children’s Services) and Lynda Yong (Deputy Lead Member for Health).

Dr Adrian Hayter, Mr Mike Holness (substituting for Brian Huggett), Dr Pat Riordan, Christabel Shawcross, Cliff Turner and David Williams.

Also Present: Councillor George Fussey, Dr Jackie McGlynn and Bev Searle

Officers: Helene Green, Michaela Helman, Liz Hornby, Naveed Mohammed, Catherine Mullins and David Scott

37/11 APOLOGIES FOR ABSENCE

Apologies were received from Brian Huggett, Dr Judith Kinder and David Williams.

38/11 DECLARATIONS OF INTEREST

There were no declarations of interest.

39/11 MINUTES

RESOLVED: That the minutes of the meeting of the Panel held on 3 February 2011 be approved.

40/11 TERMS OF REFERENCE AGREEMENT

The Board considered the report on the Terms of Reference Agreement and noted the recommendation that the Terms of Reference were agreed and signed off by the Shadow Health & Wellbeing Board (SHWB) members and that they are to be reviewed before April 2013. The Board noted that the final Terms of Reference would be reviewed once the final guidelines from the Department of Health (DoH) had been issued.

RESOLVED Unanimously: The Panel noted the recommendations that the Terms of Reference were agreed and signed off by the SHWB members and that the Terms of Reference were reviewed before April 2013.

41/11 PUBLIC HEALTH – TRANSFER OF RESPONSIBILITIES FROM NHS TO LOCAL AUTHORITIES

The Board considered the report on the Public Health – Transfer of Responsibilities from NHS to Local Authorities and noted the contents. They noted that the report dealt with the impact of public health becoming a function of councils from April 2013 and the preparations for the transfer. RBWM was participating in the Berkshire wide project group to determine best alignment of public health functions. The proposal was for one DPH and an AD and staff in each unitary. RBWM was still considering alternatives. Both CCG reps stressed the need for continuity and consistency in advice from one DPH as they would work on afdertaed basis. Using another DPh would be problematic and their preference was for the one model. This would be noted and reported to Cabinet in June. The Board also noted that the report proposed that in order to meet the DoH timescales for confirming transfer arrangements with NHS Berkshire that authority was delegated to the Leader, Lead Member and Chief Executive for final decision on Public Health arrangements in the Royal Borough. The Board also noted that Berkshire unitaries had made representation to the Department of Health (DH) over concern about the allocation and potential gap in funding. Discussions were ongoing with the GP Clinical Commissioning Groups (CCG’s) in relation to funding and commissioning services. Board members noted the following points:-

Ø that £21 per head capita was allocated
Ø representations to the DoH had been made
Ø the question of who was using the service

The Board noted that lots of work had been carried out locally and agreement across the Local Authorities (LA’s) had been reached in respect of the model. A presentation of the Public Health Transition Plan was to be made to the Transition Board on the 31 May 2012. It was noted that there was a time limit in relation to circulating job descriptions to staff.

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. The Board noted also that there was one small strategic team. The model should be designed around what each Local Authority (LA) needed and that duplication should not occur between East and West Berkshire.

It as noted that integration was key because individual organisations would not be able to exist in isolation. Public Health in the Local Authority was the best to deliver services for residents with the resources available. The Board noted that there were in the region of 860,000 residents in Berkshire and that each Berkshire unitary was fairly evenly spread in respect of resident numbers, although different in land mass.

RESOLVED UNANIMOUSLY: that the content of the report be noted along with the Recommendation.

42/11 UPDATE ON THE NHS CHANGES INCLUDING THE JOINT HEALTH AND WELLBEING STRATEGY

The Board received the report on the Update on the NHS Changes including the Joint Health and Wellbeing Strategy (JHWS) and noted the report dealt with the national changes that impacted the Royal Borough through the Health and Social Care Act 2012. The report also recommended that the Joint Health and Wellbeing Strategy was designed around the Marmot strategic priorities for the reduction of health inequalities, and that the recommendations were being made due to there being a statutory requirement to produce a JHWS that needed to be structured in a way that was most effective for addressing local health inequalities. The Board also noted that there was a duty to have public engagement in the process of the development of the JHWS.

The Board noted that the report outlined a proposal that a sub-group of the SHWB be formed to design the draft JHWS and that it should include officers from NHS Berkshire and the Royal Borough and other key stakeholders as required. Once agreement had been reached a report would be taken to the NHS and to the Royal Borough Cabinet for final approval. The Board agreed that they wished to see the report before it went before the NHS and Cabinet and noted that it would be brought to the September meeting. The Board noted that guidance was due to be produced in the summer with the draft strategy produced by September. They also noted that this would be a joint document.

The Board noted that this work was important as it joined up Health with Social Care and that it was in the gift of the LA’s to deliver jointly.

RESOLVED UNANIMOUSLY: that the recommendations be noted and that a sub-group of the SHWB be formed to design the draft JHWS, including officers from NHS Berkshire and RBWM and other key stakeholders as required; and that the JHWS was designed around the Marmot strategic objectives for reducing health inequalities.

43/11 SHAPING THE FUTURE – HEALTHCARE IN EAST BERKSHIRE

The Board received a presentation on Shaping the Future – Healthcare in East Berkshire and noted the following –

Ø The current position was that the plan for Heatherwood & Wexham Park (HWWP) had been accepted by the Board and the HWWP Board; that the CCG’s and SHA supported the plan as well as Monitor. The DoH had been kept in the picture and was to be asked to sign it off at the end of May 2012.
Ø This therefore meant that the new DTC on the Heatherwood site would do elective surgery only. Consultation on the future of the Minor Injuries Unit (MIU), Birthing unit and rehabilitation wards currently at Heatherwood would take place in September. There would also be a review of community services to support changes, for example early Supported Discharge Team to replace some beds.
Ø The timetable was that pre-consultation would take place in late June and July with consultation in September. A decision by the PCT Board was due in January 2013 and procurement of a partner to develop Heatherwood would begin now and conclude in February 2013.

The Board noted that there was no plan to close St Mark’s although discussions would take place with colleagues on what was the best use for each site. The Board also noted that there was a link to all updates on the PCT website.

The Board noted the large amount of work that had been undertaken as the work was considered complex and agreed that the situation was not sustainable if everything stayed the same and that changes would have to be made. It was noted that much joint clinical working and redesign of clinical pathways.

The Board heard that a partner for Heatherwood was being procured who would provide expertise and costs on elective surgery. It was noted that private healthcare centres were being run successfully and it was hoped to integrate that expertise with the NHS expertise. The Board was assured that the sites would be used in the best possible way. Heatherwood was not completely fit for purpose, and that future investment would help with this in bringing the facilities up-to-date. It was also agreed that patient choice was important.

In response to a query in relation to the King Edward VII hospital in Windsor, it was noted that there were plans being drawn up in relation to the current empty wards issue although duplication with other sites across the Borough was hoped to be avoided.

44/11 HEALTHY MINDS REPORT ON SERVICE – presented by Helene Green

The Board considered the report on Healthy Minds and noted that the recommendation was for the SHWB to consider the information contained in the appendix report and kept a watching brief of the future of the service. The recommendations were made due to the service undergoing a significant amount of change at this time and the SHWB would be able to give clear direction for the service once the Board had full statutory powers from April 2013.

Some concern was voiced in relation to the service trading with schools as the LA provided a core service and there was no confidence that the LA would continue funding although schools would buy-back services. It was noted that this would create a postcode lottery. However, this issue was complex with a difference between doctors commissioning compared to the schools and LA. The Board noted that early intervention was valuable as it could reduce more long-term suffering and any consequences related to that suffering into adulthood. It was noted that the graph in the appendix related to terms dates and not annual dates.

The Board received a presentation and noted the following –

Ø that 1 in 10 children between 5 and 16 suffered from a diagnosable mental health disorder; 3 children in every class or 3350 of the 33,500 children in the Royal Borough.
Ø Typically in secondary schools, of the 1000 students 200 would experience mental health problems over a year.
Ø Risk factors included family conflict, poverty, divorce, abuse, trauma, parental mental health and that unaddressed problems were more likely to persist into adulthood which could then be linked to crime as well as adult mental health problems.
Ø Protective factors included responsive institutions that promoted good relationships and autonomy and early identification and management.
Ø There was training for those working with children who were violent, troubled, anxious or depressed.
Ø There was access to a telephone consultation one afternoon per week, which some children had described as a ‘lifeline’.
Ø The currently there were 2.4 therapists and an assistant Psychologist who were led by a Senior Educational Psychologist. Supervise therapists in training were based with the team and the small team worked closely with Behaviour Support and the Educational Psychology services.
Ø The outcomes included 34% of consultations enabled others to sustain and develop their work with vulnerable children while training was provided which in turn enabled other to provide effective support. The Hun panel process had improved co-ordination and communication.
Ø 187 children and young people had received direct therapeutic interventions, all with abnormal screening scores at the outset.
Ø The future included key commissioners in 2011-12 were schools, the LA for those children with more complex needs and proposals were being prepared to support commissioning of children’s mental health services appropriate to the level of need; the development of a social enterprise for children with more complex needs and the consolidation of services for schools.

RESOLVED: Unanimously that the contents of the report and recommendations were noted that the SHWB kept a watching brief on changes that were taking place to the healthy minds service so that the benefits to residents could be maximised through the most effective way of operating the service.

45/11 HEALTHWATCH DEVELOPMENT – UPDATE ON PROGRESS

The Board considered the report on Healthwatch Development – Update on Progress and noted that the Health and Social Care Act 2012 made provision for establishment of Healthwatch. Healthwatch England (HWE) was being established as a statutory committee of the Care Quality Commission to act as the national consumer champion for people, families and carers who used health and social care services. The HWE committee would be established in October 2012 and LHW would be introduced in April 2013. The report recommended the business model and form of legal entity of LHW.

The Board noted that this would help people by signposting them on which service to choose; this included Complaints Advocacy. The Director of Adult and Community Services would seek Cabinet approval in September 2012 to issue an Invitation To Tender for the professional support service to LHW to be effective from 1 April 2013.

RESOLVED: Unanimously that the contents of the report be noted.

46/11 DATES OF FUTURE MEETINGS AND PLANNED AGENDA ITEMS FOR FUTURE MEETINGS

The following dates were proposed:

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 Public Health Update
Ø Safeguarding Children and OSTED Inspection Report
Ø Suicide and Self Harm Prevention
Ø Commissioning for Equality (December)
Ø Telecare and Telehealth Care (December)
Ø Shaping the Future (September)

47/11 MEETING

The meeting, which began at 2.00pm, ended at 4.02pm.