Meeting documents

Shadow Health and Wellbeing Board
Friday 8 February 2013 2.00 pm



i


Royal Borough of Windsor and Maidenhead
Document Title: Minutes of the Shadow Health and Wellbeing Board – 8 February 2013
Author: Liz Hornby
Creation Date: February 2013
SHADOW HEALTH AND WELLBEING BOARD
COUNCIL CHAMBER AT 2.00PM

8 FEBRUARY 2013

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

Seona Douglas, Dr Adrian Hayter, Dr Lise Llewellyn, Dr Jackie McGlynn and Angela Wellings.

Also present: Councillors Sue Evans, George Fussey, Angela Cole, Sheila Holmes, Rutuja Kulkarni, Barbara Story, Reece Weaver and Dan Whiteway.

Officers: Liz Hornby and Catherine Mullins.
PART I

28/12 APOLOGIES FOR ABSENCE

Apologies were received from Christabel Shawcross, Brian Huggett and Councillor Lynda Yong.

29/12 DECLARATIONS OF INTEREST

None

30/12 MINUTES
    RESOLVED: That the minutes of the meeting of the Panel held on 7 December 2012 be approved

31/12 PUBLIC HEALTH TRANSFER OF RESPONSIBILITIES AND NATIONAL UPDATE

The Board considered the regular report on the Public Health Transfer of Responsibilities and National Update and noted the progress of the transfer of Public Health responsibilities from NHS Berkshire to RBWM from April 2013 which was being managed through the Berkshire-wide transition board, which, in turn, was being led by Bracknell Council. The recommendations in the report were being made because it was a statutory requirement to take on new duties and to meet the Department of Health (DOH) timescales. The overarching project implementation had been co-ordinated through the Berkshire-wide group through Bracknell. The Board noted that the paper brought attention to the management of contracts as some services needed to be commissioned to deliver to residents. The Royal Borough would ‘inherit’ some contracts although the 2 year ring-fenced financial allocation to determine the budget envelope for meeting public health commitments and expectations had been received quite late. However, the SHADOW HEALTH AND WELLBEING BOARD – 08.02.13
transition board made the decision to roll over all contracts and throughout the coming year all will be given notice. It was noted that some contracts would be impossible to identify in terms of which Boroughs’ residents were being assisted so it was agreed that all six unitaries contribute to contracts for a minimum of two years. The Board raised some concern that if the Borough decided to end contributions after two years, if it was found not to be working, was there a break clause? It was noted that governance quoted a 12-month notice period should be given because if funding were to be withdrawn immediately this would have a significant impact on services being delivered to residents. The Board agreed that the share of financial risk should be for a minimum of two years followed by a 12 month notice period.

The Board also noted that strong emergency plans were in place. They noted that work would take place alongside Oxfordshire (Oxon) and Buckinghamshire (Bucks) and that Oxon would take the lead. It was also noted that strong plans were in place across all six unitary authorities.

The Board noted that the Berkshire-wide organisation structure was being looked at currently on whether it would be a standalone organisation or would outsource of be a shared resource in the future and that discussions were ongoing. However, any direction the Board might wish to give would be welcomed. It was requested that guidance on the future role of the Health and Wellbeing Board would also be welcomed but that Cabinet would ultimately decide.

The Chairman requested an update at each future meeting of the Board.
      RESOLVED UNANIMOUSLY: that the Board endorsed the recommendations within the report but that the financial risk should be for a minimum of two years followed by a 12-month notice period.

32/12 UPDATE ON THE ADULT SOCIAL CARE TRANSFORMATION AND EFFICIENCIES PROJECTS

The Board considered the Update report on the Adult Social Care Transformation and Efficiencies Projects and noted that there were a number of issues. It had been reported to Cabinet that a saving of over £1 million had been achieved. Cabinet agreed on a programme for ambitious improvements and efficiencies based on measures to prevent people from requiring institutional care and achieving greater independence. The report outlined the programme to be undertaken to deliver the challenging efficiency agenda for 2013-14 whilst ensuring that service user outcomes, service quality and safeguarding were maintained or even enhanced in accordance with government encouragement.

The Board noted that even in the current challenging economic climate there were positive signs. It was important that residents receive care as soon as possible which should also be sustainable. It was understood that the population was living longer and that as a consequence the projections of the population who will have dementia is increasing. The Board noted that a short term rehabilitation team, jointly funded, gave a range of professionals who could deliver a range of care to target at the earliest point possible especially for the physical aspects of a social care need. .

In relation to Telecare and Telehealth, it was noted that further savings could be achieved whilst being confident that care could be taken forward to offer more personalised care to Borough residents.

Extensive work around placements of people into residential care was being undertaken particularly where costs were high. It was noted that some placements were ‘out of Borough’ placements which was challenging for families involved. Work with health colleagues to repatriate residents so they could be local to their families was being undertaken.

People with high / severe disabilities was also a challenge particularly those who had been schooled outside the Borough who were ‘coming back’ to live with their families on a full-time basis as they would transfer from Children’s Services to Adult Services and agencies would work together to ensure a seamless transition.

The Board noted that positive results in customers receiving value for money around Homecare had been achieved – this had been reduced by £1 per hour. It was acknowledged that the year ahead would be challenging for all those concerned and that steam-lining services would continue.

The Board was assured that while savings would achieved, quality would not compromised due to having a robust team in place to ensure quality.

The Board requested that a presentation on Telecare be presented at a future meeting.

The Board noted that a Stroke Co-ordinator had been employed and had started in January 2013.
      RESOLVED UNANIMOUSLY: that the recommendations be noted and endorsed. That a presentation on Telecare be presented at a future meeting.

33/12 TERMS OF REFERENCE FOR THE SHWB AND NATIONAL UPDATES THAT IMPACT ON THE HWB

The Board noted that no detail from the DOH had been received and therefore would this item would be deferred for a future meeting.

34/12 WINDSOR, ASCOT AND MAIDENHEAD CCG AUTHOISATION UPDATE

The Board noted the update on the Windsor, Ascot and Maidenhead CCG Authorisation. It was noted that in comparison to the two neighbouring Local Authorities (LAs) the Royal Borough had the greater challenge as residents had a lower allocation per resident compared to the other two by £117. This therefore meant that the Royal Borough had to be better equipped to deal with the financial implications. The CCG also had the task to create further savings over the next few months. A meeting with the Commissioning Board had taken place and they had been reassured by the plans put forward. However, the plan had to be taken to regional level and then signed off at national level. It was noted that this should all have taken place and be authorised by the end of March 2013 with the first public meeting being held in early April.

The Board noted that four priorities had been identified and put forward, they were –
    1. Proportion of people feeling supported to manage their condition.
    2. Emergency admissions for children with LRTI (Lower Respiratory Tract Infections).
    3. Patient experience of GP services.
    4. Nursing and residential homes patients.

It was noted that there was a need to ensure good care with joint responsibility and more work would take place in the coming weeks.

The Board also noted that some CCGs who had submitted their plans early did not have clear plans to be judged on as they kept their plans moderate. The Board learned that the CCG was in a good position as time had been taken over what to submit and should therefore come through the authorisation process without any conditions attached.

The Board noted that the £117 per resident was set at national level but was a formula that was constantly under review. The basic assumption was that the sicker the population in an area, the more money would be allocated. Therefore it was agreed that residents in the Royal Borough were, on the whole, healthier than in a lot of areas in the UK.

The Board noted that a Nurse Practitioner had been employed who was a nurse with a strong nursing background. She was to be Nurse Director of three CCGs and she had already started to make connections.

35/12 BRACKNELL AND ASCOT CCG AUTHORISATION UPDATE

The Board received a presentation on the update on the Bracknell and Ascot CCG Authorisation and noted that projects needed to be prioritised. These had been agreed and would be worked with the other CCGs. It was also noted that a Constitution needed to be agreed. It was also agreed that quality of care needed to preserved, that as a provider of CIPs all areas presented would need to be looked at further. The Board noted that three acute providers were involved, including Royal Berks.

Like the Royal Borough, Bracknell had an ageing population and there was an aim for higher diagnostics.

The CCG had identified four priorities which were still the subject of debate. It was agreed that the area had strong GP practices. Further information on depression was being sought as there were many levels of depression to explore. The CCG agreed that they will deal with every challenge particularly in relation to quality assurance as it was believed that was very important.

It was noted that in relation to dementia it was known not everyone was receiving a diagnosis and that figures were low and therefore the prevalence target was a key priority and would be addressed.

36/12 UPDATE ON THE PUBLIC CONSULTATION OF THE JOINT HEALTH AND WELLBEING STRATEGY

The Board received a presentation on the Update on the Public Consultation of the Joint Health and Wellbeing Strategy and noted that every LA had do undertaken this consultation through the Shadow Health and Wellbeing Board (SHWB). It was noted that the DOH had run a consultation but had been overwhelmed by the response and had therefore undertaken a further consultation in the autumn of 2012; following the results of the consultation guidance was awaited from the DOH, this was due at the end of March. It was noted that carers were specifically mentioned as a population of interst, as well as people who lived outside the Royal Borough but worked or received services within the Borough. There was a statutory duty to consult with Fire, Police, Community and Voluntary Sector as well as taking into account the current and future health and wellbeing needs within the Royal Borough.

The Board noted that a sub-group of the SHWB had been set up to understand what was needed and four documents had been produced – The JHWS; the Consultation Questions; The Appendix with the details behind the priorities and a Communication Plan. There was a duty under the Act to involve the public with the development of the Strategy.

A consultation which took place between 19 November 2012 and 20 January 2013 had elicited 114 responses. Most responders were between the ages of 55-64 and no responses had been received from people aged 24 years or less. It was noted that 64.9% of responders were a member of the public. Cox Green had the most responders and 12 of the responders did not live in the Royal Borough. 86% were White British.

It was realised that the period was a particularly difficult one due to Christmas and New Year but the consultation did last seven weeks in all. The top three priorities classed as “very appropriate” were –
    Ø Support the ageing population and the impact of long-term conditions, support older adults to live at home and prevent ill-health (68.2%)
    Ø Ensure that all children had a healthy start which supported long-term benefits into adulthood (67.4%)
    Ø Safeguarding children and vulnerable adults from abuse, promotion of dignity and respect and increased awareness of signs of abuse and how to report it (61.1%).

Combined results for those classed as “very appropriate” or “appropriate” were as follows –
    Ø Support people to live safely in their homes for as long as possible and have happy, healthy lives. Improvements to the infrastructure and neighbourhoods planned with residents’ needs and healthy considered (88.2%)
    Ø Improve health and reduction of health inequalities by the prevention, detection and early treatment of Dementia (87.1%)
    Ø Support the ageing population and the impact of long-term conditions, support of older adults to live at home and prevent ill-health (87%)

There was to be further in-depth analysis of the results which would include free-text questions, comments and suggestions. The results would also need to be considered by the HWB members and partner organisations.

Some concern was raised as to why no under 24-year olds had not responded and requested that some work be done to correct this. It was noted that there were targeted promotions of the JHWS for children and young people about how best to take this forward.

37/12 THE PREVENTION STRATEGY

The Board received a presentation on The Prevention Strategy by Angela Cole and noted that it was about what organisations could do to help maintain their health and independence and thus reducing their need for support from health and social care services, and what the CCG and LA could do together. However, it needed the community in that early intervention, prevention and enablement was not just about statutory services.

The Board noted that the Prevention Strategy fitted well with the JHWS as it was supporting self-care and family focussed support.

Five intervention points had been recognised but these depended on the help from the community particularly for those who wished to cope independently for as long as possible. This did require investment as there was a large theme around isolation so networks would need to be built on. There was no easy formula and financial projections would be produced. A particular focus will centre on mobility. It was agreed that Telecare and Telehealth were important.

It was noted that community asset mapping was already taking place and the one things residents had particularly commented upon was the SMILE club which was focussing on keeping the ageing population healthy and was therefore a positive feature in the Royal Borough. The Board agreed that the JSNA was a negative document and that in future a positive approach should be taken. They also agreed that Family Friends, a voluntary organisation within the local area was a very positive organisation. The suggestion of involving younger people to help older people as a part of inter-generational projects was put to the Board.

38/12 DATES OF FUTURE MEETINGS AND PLANNED AGENDA ITEMS FOR FUTURE MEETINGS

The following dates were proposed:

    Ø 2 May 2013

The following items for future meetings were proposed:
    Ø Commissioning for Quality
    Ø Delivery Planning for the Joint Health and Wellbeing Strategy
    Ø Shaping the Future
    Ø Telecare presentation
    Ø HealthWatch
    Ø Structuring the JSNA

39/12 MEETING

The meeting, which began at 2.05pm, ended at 4.15pm.

CHAIRMAN ………………………………….
DATE …………………………………..