To receive apologies for absence.

Apologies were received from Alison Alexander and Dr William Tong.

To receive any Declarations of Interest.

Cllr Carroll – Declared a personal interest as he works for a pharmaceutical company, Sanofi Pasteur. Cllr Carroll declared his employment in the interests of full transparency and to highlight that should for any reason during any point of the meeting, or indeed during future meetings, the HWB discussed anything directly related to Sanofi Pastuer’s business he would abstain from the discussion and leave the room as required. Cllr Carrol confirmed he had no pecuniary interests or conflicts of interests for any of the agenda items under discussion.

Dr Adrian Hayter – Declared a personal interest as he is a member of a GP practice that is part of the Sustainability and Transformation Team affected by the Sustainability and Transformation Plan.

To confirm the Part I minutes of the previous meeting.

RESOLVED That: the minutes of the meeting held on 30 November 2016 were agreed and signed as a true and accurate record.

To receive the above paper and presentation from Cllr Stuart Carroll, Hilary Hall and Darrell Gale.

a)    Context and Overview – Cllr Carroll

b)    The Year of Mental Health Action Plan – Hilary Hall

c)    The DRAFT Berkshire Suicide Prevention and Self Harm Strategy / Action Plan – Darrell Gale / Hilary Hall

As part of the Borough’s Year of Mental Health, the Chairman agreed to amend the agenda slightly to allow a question from the public to be asked as it fit within the remit of the Year of Mental Health.

Dr Hayter responded to the question from a member of the public regarding Dementia and how treating and looking after those affected was being paid for and if funding was to be made available. Dr Hayter stated that the CCGs had been doing a lot of work around Dementia and had been looking at it as an initiative with partner agencies. Funding proposals were being worked on and the local authority and the CCG were working together. The initiatives included having two Dementia Advisors which compliment other services and means the borough was in a better position than ever when it came to looking after those with Dementia. He added that they were also working with providers in the Borough and had launched a programme for carers of those with Dementia.

Dr Hayter stated that the Borough was leading on developing programmes in 17 practices and had been working on diagnosing Dementia, they had also implemented tests to help identify those with dementia. Dr Hayter confirmed that the CCG was looking to work across the sphere for Dementia and also working on education in homes on Dementia to support nurses. He continued that it was not about one individual and that nurses were on the ground supporting programmes.

Dr Hayter confirmed that the CCG and the Borough were planning to work sustainably and long term on proposals to see how Admiral Nurses could offer wider support. He added that the CCG had also been working with younger people with a diagnosis of Dementia.

Context and overview

Cllr Carroll introduced the item on the Year of Mental Health and highlighted the following main points:

Ø  Context – the Health and Wellbeing Board had already placed mental health as a priority within the JHWS. The priority this year was to build on initiatives.

Ø  Local Authorities had signed up to Priority Berkshire which was designed to create awareness and best practice.

Ø  It was a dynamic campaign and the Borough was planning to take on an active role within the initiative.

Ø  The initiative would use a communications platform to share ideas.

Ø  An action plan was being implemented.

The Year of Mental Health action plan

Hilary Hall, Head of Commissioning for Adult, Children and Health stated that the Borough had put together the Year of Mental Health Plan and it was not a plan that was restricted to just one year of activity; it would be an ongoing strategy. There was three pillars to the action plan which were listed within paragraph 2.6 on page 18 of the agenda pack.

The Head of Commissioning for Adult, Children and Health stated that there was a whole series of activities undertaken and all Borough managers had taken on mental health awareness training including suicide  ...  view the full minutes text for item 81/15

Partnership discussion regarding the letter from David Mowat MP – Discussion led by Hilary Hall

Councillor Carroll explained to the Board that the Borough received a letter from David Mowat MP,  Parliamentary Under Secretary of State for Community Health and Care on 14 December 2016 regarding end of life care and he had brought the letter to the Health and Wellbeing Board for a broader discussion.

Dr Hayter stated the letter outlined the context  of commissioning plans. CCGs in East Berkshire were involved in working through end of life care plans and work was ongoing to change and provide better access to advice for end of life care decisions and make services available seven days a week. He added the CCGs were working with community trusts to deliver the work and in terms of Sustainability and Transformation, there were initiatives looking at shared care and that was bedded in to the vision of care work. Dr Hayter stated that with shared care work, there were better choices at the end of life and a better provision of care. However, his CCG needed to work with other CCGs and partners so people could have a death in a place of choice.

Dr McGlynn stated there had been a significant programme of work to increase education of professionals across the three CCGs and that Frimley Health had been doing a lot of work on end of life care, including a care home package so that those in care homes did not get admitted to hospital when it was not in the best interests of the patient. Dr Llewellyn stated there was a challenge and it was the promotion of conversation between families and carers. Cancer patients often got to have those conversations but, they were less common for those with heart failure or diabetes complications. She added that families needed to have those conversations with older family members to encourage people to find out what they want at the end of their lives. Elder people might bot be able to have those conversations when the time came so it was necessary to have them much earlier.

The Chairman stated he would respond to the Minister setting out the work the Borough and CCGs were doing regarding end of life care.

To receive the above verbal update from Dr Adrian Hayter.

Dr Hayter stated that the plan was submitted to NHS England and received positive feedback. The CCG had been doing a lot of work on how organisations worked together on all aspects of care. There were leaders all across the Sustainability and Transformation Plan looking at how to develop and improve together on a local basis. Dr Hayter said it was a good news story and he wanted to think about governance and working relations that could be embedded in the Plan. He added that work had started on each of the seven work streams, and he would be reporting back to the Board on progress in the future.

The Chairman stated that from residents’ perspectives, Frimley STP was in the top five and that was great news. There had been investment into a new hospital and investment in A&E also. He added he was pleased with progress and looked forward to the next update.

To receive a verbal update on Delivering Differently from Hilary Hall.

Hilary Hall, Head of Commissioning for Adult, Children and Health stated the Borough had transferred Children’s Services into Achieving for Children and Adults Services had been transferred into Optalis. The target date for transfer was April 2017 and the Borough was on schedule with the transfers. The Borough wanted to ensure there was no impact on service delivery and a lot of work had been done to ensure a smooth transfer. The Head of Commissioning for Adult, Children and Health added that all the Human Resources implications were being worked on and there would be further information on that aspect in March 2017. An information leaflet on the changes to the service were being sent out to all residents with their council tax letters.

Angela Morris, Deputy Director Health and Adult Social Care stated the project team was looking at key elements to ensure the services transfer safely. It was very much a partnership with CCGS and the police, ensuring continuation of services and work was being done to ensure customers were reassured of the changes and that service levels were not going to dip.

Councillor Airey stated it was just to improve service delivery as the Borough was a small authority and it wanted to grow and deliver a better service. Nothing was changing as staff would still be there and questions from residents were welcomed.

The Head of Commissioning for Adult, Children and Health confirmed there were very minimal staff turnover as staff had been very engaged with the transfer. There was only a single figure of staff not wanting to transfer over to the new service delivery model. The Chairman commented that he had attended drop-in sessions for staff and had seen the benefits for them and for residents.

To receive the following update from Hilary Hall:

·         Update on progress

·         Integrated Carers Strategy Delivery Plan

Hilary Hall, Head of Commissioning for Adult, Children and Health stated that Non-elective Admissions were very close to target but, the target had not been achieved. Against the national backdrop, the BCF was not working. However, it had been of huge benefit in the Borough. The BCF meant that the Borough could do campaigns that it would not have been able to do were it not for the BCF being in place.

Other key points noted by the Board included:

Ø  0 – 4 year old non-elective admissions – not done as well as last year (2016).

Ø  Continuing with same campaigns and proactive work – that had paid dividends previously but not as much this year (2017).

Ø  Delayed transfer of care – the Borough was a midway performer, local care homes had a number of issues and was an area of focus:

o   Residents at home 90 days after discharge from hospital

o   Residents moving into care homes was positive

o   Integrated carers delivery plan – the strategy was being reviewed and needed to understand the definition of a carer.

Dr Hayter welcomed the confidence around the STSTR work and added that could be a good opportunity to get the Health and Wellbeing Board to highlight the work of people being supported in their own homes. That could be something for a future Board meeting.

Angela Morris, Deputy Director Health and Adult Social Care said she was going to organise a team meeting to what else could be done about potential discharges and then weekly meetings would follow to facilitate discharges by identifying spaces and by looking at how independent a person was. She stated they constantly had to see if there were any spaces available on a daily basis. She stated that the team met every Thursday where there could be three delayed discharges, and by the Friday, that would go down to one delay but then early the following week, the delays start climbing up again. The Deputy Director Health and Adult Social Care said it was a fluctuating picture and they were always looking to increase capacity and work with CCGs and care home providers so they can increase the right capacity but, nationally, it was a very challenging situation.

To discuss any other business.

Mike Copeland, Healthwatch stated that the Head of Healthwatch had held an emergency meeting that morning as his local branch in Windsor and Maidenhead was being merged with Bracknell Healthwatch. They had received good representations from the public but no one from the Royal Borough attended. Following the merge, it was decided that any residual funding should be used for charitable causes. Mike Copeland said there had been a lack of consultation to wind up Windsor and Maidenhead Healthwatch and residents were not too happy. He added he had not been given an option to carry on valuable work and he did not feel Bracknell could serve the needs of Windsor, Maidenhead and Ascot in the way Healthwatch did when based in the area.

The Chairman stated he was not sure where any residual funding could go and he took on board Mike Copeland’s points and would respond in due course.

To receive any questions from the public.

The Chairman opened the item referring to an article on the front page of the Maidenhead Advertiser which might have been of concern to residents. The statement said there was a £13m black hole in the finances to run vital services. He confirmed that headline was incorrect and that budget monitoring took place for every service area and was a necessary document required to ensure there was funding for every service area. The Chairman added that there was no need for any of the Borough’s residents to be concerned. There was no issue and the Council had to balance the budget by law.

Sheila Holmes of the Older Persons Partnership Board stated she found it interesting how the Health and Wellbeing Board never targeted older people specifically. She felt very strongly that older people don’t have a role within the Older Persons Partnership Board (OPPB) to report back and inform the Health and Wellbeing Board. Sheila stated the OPPB had a very good publication on end of life care which was informative and encouraged people to speak to family members on the issue. The OPPB had a lot of input from other services and they, as a group, wanted to contribute. The Chairman stated the Board would discuss it and look at ways the Board could include the OPPB.

Sheila Holmes stated the members of the OPPB had no idea about Windsor and Maidenhead Healthwatch being merged with the Bracknell branch and they were not asked opinions on plans for Healthwatch.

George Fussey asked if there was any room for the voluntary sector to clear a role in families realising burdens placed on the system in Accident and Emergency Departments. Dr Llewellyn replied that yes, there were roles in explaining what to expect, how long things could take and filling those roles by volunteers would be very helpful. Dr Hayter stated there was a role in supporting mental health and wellbeing within the NHS.

The Chairman said he had received a query on social media asking why all the Health and Wellbeing Board meetings took place during the day. He asked the Board for a view on that and asked if they wanted to consider holding the occasional meeting in the evening. Dr Llewellyn stated that the evening meetings of the Health and Wellbeing Board in Wokingham were the least attended by members of the public. The Chairman stated he would check across Berkshire and see how well other authorities Board meetings were attended in the evenings and consider a response. Dr Hayter stated the Council used Periscope regularly and suggested that could be a solution. Councillor Carroll said he was happy to take that back and see what could be done to arrange Periscope at Health and Wellbeing Board meetings.

A member of the public said that Royal Berks Hospital had a disability liaison nurse and asked if there would be one within the Frimley Trust. Dr Llewellyn confirmed there would be a disability liaison nurse or the  ...  view the full minutes text for item 87/15

To note that the schedule of meetings for 2017 – 2018 are to be confirmed.

Members noted the following dates of future Health and Wellbeing Board meetings:

Ø  25 April 2017

Ø  8 August 2017

Ø  7 November 2017

Ø  13 March 2018