Royal Borough of Windsor and Maidenhead
Document Title: Minutes of the Shadow Health and Wellbeing Board – 7 December 2012
Author: Liz Hornby
Creation Date: December 2012

Present: Councillors David Coppinger (Chairman – Cabinet Lead Member for Adult and Community Services), Phill Bicknell (Cabinet Lead Member for Children’s Services) and Lynda Yong (Deputy Lead Member for Health).

Dr Adrian Hayter, Brian Huggett, Rutuja Kulkarni, Mary Purnell, Christabel Shawcross and Angela Wellings.

Officers: Dawn Cannon, Julia Cole, Nick Davies, Seona Douglas, Katie Dover, Christina Gradowski, Sebnam Guhertas, Sheila Holmes, Liz Hornby, Catherine Mullins and Viki Wadd.
15/12 APOLOGIES FOR ABSENCE

Apologies were received from Dr Jackie McGlynn.

16/12 DECLARATIONS OF INTEREST

None

17/12 MINUTES

RESOLVED: That the minutes of the meeting of the Panel held on 28 September 2012 be approved

18/12 PUBLIC HEALTH TRANSFER OF RESPONSIBILITIES AND NATIONAL UPDATE

The Board considered the report on the Public Health Transfer of Responsibilities and National Update and noted that this was a regular report to the Board. It was noted that the recommendations of the report were being made because it was a statutory requirement to take on the new duties which would meet the Department of Health (DOH) timescales. The overarching project implementation had been co-ordinated through the Berkshire-wide group and the team will be hosted through Bracknell. Rutuja Kulkarni had been appointed as the Consultant in Public Health within the Royal Borough and she would liaise with the other Berkshire Unitaries and the Strategic Director of Public Health for Berkshire. It was also noted that the local team was being put together and interviews were also being undertaken.

The Board also noted that the public health functions were being looked at along with CCGs roles in public health. Key areas of concern were around funding as it was not yet known how much funding would be allocated, although it was hoped that this figure would be confirmed by the end of the calendar year. It was hoped that budgets could be pooled SHADOW HEALTH AND WELLBEING BOARD – 07.12.12
so that the contract could be commissioned together with other unitaries offering a risk sharing incentive.

RESOLVED UNANIMOUSLY: that the recommendations be noted.

19/12 THE AUTISM STRATEGY

The Board considered the report on the Autism Strategy and welcomed Debbie Dickenson, Mental Health Service Development Officer. It was noted that in 2009 a groundbreaking piece of legislation in the Autism Act had signalled a new commitment across government to transform the way public services support adults with autism. The national autism strategy ‘Fulfilling and Rewarding Lives’, the first ever created in England, was another landmark in the process and represented a shared approach towards a society that not only accepted and understood autism, but provided real opportunities for adults with autistic spectrum conditions to live fulfilling and rewarding lives.

A consultation was launched in July 2011 at an event in the Town Hall which was attended by seventy two people to inform people about the strategy and give support in completing a questionnaire that had been distributed to individuals with autism and their carers and families along with teams jointly staffed by social care and health, GPs and health professionals as well as voluntary groups. Thirty two questionnaires were received as a result of the consultation and the low response was indicative of how difficult it was to engage with people with autism. Three key priorities were identified by people in the Royal Borough –

1. Help with finding employment
2. More information about what support and services were available
3. More opportunities for social inclusion and befriending

The Board noted that the Royal Borough had established an Autism Partnership Board engaged with various agencies with targets for delivery and which was chaired by an independent person. Awareness training for professionals was underway in some areas but there was still room for improvement particularly in GP training due to GPs being in the front line when it came to helping people with Asperger Syndrome (AS). Following a government survey, it was noted that 80% of GPs who responded said they would not know how to recognise and effectively deal with an individual with AS.

To address the issue of lack of social contact, the Borough jointly financed with BAS a very successful pub group who met at The Bear in Maidenhead. This group met every week and had a membership of over one hundred. To address the issue of employment, people with AS often had difficulty getting a job and holding on to it. According to NAS figures, only 15% of adults with autism were in full-time employment. The APB wanted employment to be theme of a strategy launch to take the opportunity to increase awareness of the problems and hopefully provide some help and advice through the event.

During the ensuing discussion, the following points were raised –

Ø That a joint strategy had been started to be written with a lot of involvement from the PCT and that this would be constantly reviewed.
Ø It was acknowledged that the budget would be challenging as there was no certainty that there would be any. The report identified current spending with a view to looking at how the money could be better allocated. Prevention support was being sought, probably through other voluntary organisations.
Ø The Interim Director of Children’s Services confirmed that Children’s Services was looking at totality of support early on. She had met with a potential free school near Reading which the National Autistic Society was proposing to run. This was considered a real bonus for Berkshire as currently a number of families with children with autism were schooled further out of the area. Children’s Services would be a large part of the planning and Manor Green would be involved as well.

RESOLVED UNANIMOUSLY: that the recommendations be noted and endorsed.

20/12 WINDSOR, ASCOT AND MAIDENHEAD CCG AUTHOISATION UPDATE

The Board noted the update on the Windsor, Ascot and Maidenhead CCG Authorisation. It was noted that the three East Berkshire CCGs had been very busy recently with site visits and a successful visit in WAM from which some reports had been produced. The federation arrangements were particularly highlighted.

The Board noted that there were a only a few issues that needed to be addressed and work with the local area team and the commissioning board would take place to address the final few conditions.

21/12 BRACKNELL AND ASCOT CCG AUTHORISATION UPDATE

The Board received a presentation on the update on the Bracknell and Ascot CCG Authorisation and noted that there were now 18 premises in use which represented the way the population behaved in that area. It was also noted that residents in that area were choosing Frimley Park hospital rather than Wexham Park hospital to attend. The Board also noted that the CCG Board was taking shape with Dr McGlynn a Clinical Director and Sally Kemp a Lay Member. The Nurse Governor was not yet in post. It was noted that the JSNA covered Ascot and Bracknell and that Ascot residents tended to be older than Bracknell residents.

Some of the commissioning priorities were to promote healthy lives and self care; better management of Urgent Care and Long Term Conditions; reducing inappropriate clinical variation and getting performance to top decile – it was noted that there was still a lot of work to achieve this.

In terms of Managing Variation, it was noted that all GP practices received get the Managing Variation report on a monthly basis. Some practices had specialists in various fields working which made it easier and quicker to refer a patient to secondary care.

The Board noted that there were currently no community hospital beds in the area. There had been some in Wokingham but these had been decommissioned with an increase in beds at Bridgewell which was closer to Bracknell. Going forward there would be an Urgent Care Centre which was part of the Shaping the Future consultation; better management of children with illness, particularly self-limiting illness; prevention of avoidable A&E attendance; case management for Long Term Conditions (LTC) and managing demand differently through integrated teams. Some concern was raised in relation to Urgent Care and whether any work was being carried out around other units called Urgent Care. It was noted that the population was increasing rapidly and there was concern that the number of referrals was dropping. It was not known whether this was a general trend of whether GPs were not in a position to make a diagnosis which would lead to a referral. It was noted however, that often a patient believed they needed to be referred but sometimes it would not be necessary and in this instance there was a huge variation which would be investigated.

There was a need to understand secondary services to ensure that they do what they were designed to do, for instance at King Edward VII hospital in Windsor, there were two physiotherapists who were good at diagnosing patients and it was noted that through these techniques there could be better diagnosis and better use of community pathways. It hoped to implement a full pathway which would not delay referrals. There was a need for people to understand issues such as weight management and how to prevent it, for instance, taking exercise would help prevent as well as reduce weight issues. It was noted that the whole system was being investigated and how to improve on areas that needed it.

22/12 SHAPING THE FUTURE OF HEALTHCARE IN EAST BERKSHIRE – UPDATE ON PROGRESS OF CONSULTATION

The Board received a presentation by Dr Adrian Hayter on Shaping the Future of Healthcare in East Berkshire – Update on Progress of Consultation and noted the following that the consultation started on 15 October 2012 and would end on 31 January 2013 and that submissions could be made in person at a consultation event, by post or online.

The Board noted that the vision for healthcare in East Berkshire was to give better care closer to home, for patients to recover their independence faster, for fewer people to attend A&E, for pregnant women to have a wider choice of safe, high-quality birth options and better value for money. The commitment laid down was to listen to residents so that it can be understood what is important and why. Final decisions would be made public in March 2013 and that change would occur where there were clear patient benefits.

Some concern was raised that some residents had not been able to access the consultation although it was noted that hard copies had been placed in GPs surgeries, libraries, at the Town Hall etc., as well as being available online. However it was noted that many of the older population did not have the facility to access the consultation online and that therefore a large proportion had been missed. The Board was assured that notices had been placed in the local newspapers as well as a leaflet drop through properties.

It was noted that in September 2008, the maternity services at Heatherwood hospital changed to a stand-alone midwife-led birth centre but that it had failed to attract enough births to be clinically or financially viable. In the nine months to September 2012 fewer than 170 women have given birth at Heatherwood, with only 239 births in the whole of 2010. This equated to just 5% of Windsor and Maidenhead births and 7% of Bracknell births.

In relation to General Rehabilitation and Stroke admissions, it was explained that because of the stroke unit at Heatherwood, there were a number of admissions from all over East Berkshire although it was noted that there were a high number in the Slough area. Patients were transferred to Heatherwood hospital following their initial stay at other hospitals, notably Wexham Park and Frimley Park. It was agreed that patients recovered better and faster in their own home environment and therefore gain independence quicker.

23/12 COMMUNICATION STRATEGY FOR THE HEALTH AND WELLBEING BOARD

The Board considered the report on the Communication Strategy for the Health and Wellbeing Board and noted that part of the strategy of the Board was to have a strategy with patients in the Royal Borough particularly around Health and Wellbeing. The paper outlined proposals to take this forward. It was noted that a temporary NHS post had been extended and the wish was to continue with this person in post with joint funding from the NHS.

The Chairman was concerned that the Board met every three months which was not necessarily the best way. He explained that he would like to explore whether activities could run in parallel with Board meetings, for instance running a workshop within the meeting. However, the possibility would be explored for future meetings.

The Board noted that the final guidance would end in January and that the current governance report would be taken to Cabinet. It was suggested that this would be a good time to look at the work programme especially now that the CCG was established.

RESOLVED UNANIMOUSLY: that the recommendations be noted and endorsed.

24/12 UPDATE ON THE STROKE CARE PATHWAY AND EARLY SUPPORTED DISCHARGE OF PATIENTS

The Board received a presentation on the Update on the Stroke Care Pathway and Early Supported Discharge of Patients and noted that there were two types on stroke, Ischaemic Stroke (the most common form) and Haemorrhagic Stroke. There were approximately 110,000 strokes and around 20,000 TIAs per year in England and that there were approximately 300,000 people living with moderate to severe disabilities as a result of a stroke. The impact of strokes locally was that Berkshire East stroke was the third leading cause of death at 403 deaths and in Windsor, Ascot and Maidenhead a total of 527 males and 597 females resident in the Borough died in the calendar year of 2010. Stroke was the third leading cause of death at 36 males and 43 females.

It was noted that patients were admitted to a Hyper-acute facility at first diagnosis and then after 72-hours they could be moved somewhere else. This was assuming that they could in fact be moved. Early Supported Discharge (ESD) was up to 40% and it was clear that not all patients were eligible for ESD as it depended on the severity of the stroke as the patient would need to be medically stable before being transferred. At the request of the Board, a lobby would take place along with the consultation on moving the service to Wexham Park hospital when 8 beds will move over. The Board noted that an average length of stay was 27 days, although those eligible for ESD would bring that figure down to 15 days.

For information, ESD enabled appropriate stroke survivors to leave hospital ‘early’ through the provision o intense rehabilitation in the community which corresponded to a similar level of care provided in hospital. An ESD team of nurses, therapists, psychologists and doctors worked collaboratively as a team and with the patient and their family providing intensive rehabilitation at home for a period of up to 6 weeks. This reduced the risk of re-admission into hospital for stroke related problems and increased independence and quality of life. The ESD service provided support to the carer(s) and family of the stroke survivor.

25/12 SUICIDE AND SELF HARM PREVENTION – INITIAL UPDATE ON DEVELOPMENTS

The Board received a presentation on Suicide and Self Harm Prevention – Initial Update on Developments and noted that work towards developing a strategy across Berkshire and multi-agency group approach was being undertaken. Berkshire is now below the national suicide rate which has been decreasing since 1993. The Royal Borough has one of the lowest levels. Part of JSNA was a priority identified in West Berkshire, particularly the Newbury area. The initial draft of a report was due in February 2013 with an intended final strategy being produced in April 2013.

It was confirmed that the Samaritans were involved in the strategy as they were key in assisting with data etc. It was also noted that if children were identified as being at risk, then they could be referred to CAHMS and adults were identified and referred on by their GPs although patients were not always willing to seek help from their GP.

It was agreed that the new strategy be included in an edition of Around the Royal Borough so get the message over to as many residents as possible.

13/12 DATES OF FUTURE MEETINGS AND PLANNED AGENDA ITEMS FOR FUTURE MEETINGS

The following dates were proposed:

Ø 8 February 2013

The following items for future meetings were proposed:

Ø Housing Needs and Status
Ø Public Health Update
Ø TOR Review of Board
Ø Endorsing Priorities
Ø Prevention Strategy.

14/12 MEETING

The meeting, which began at 2.05pm, ended at 4.05pm.