Agenda and minutes

The minutes of the meeting held on 5 January 2017 were taken as read, confirmed and signed.

The Board also noted the Action Log, which provided an update on actions agreed by the Board at its previous meetings.

There were no urgent items for consideration.

The Chairman invited members who wished to do so to declare any interest in respect of items on the agenda for the meeting.

No declarations were made.

The Chairman presented a position statement on the following matters:-

·       Focus on improving end of life care across Leicester, Leicestershire and Rutland;

·       A selection of national publications.

The difficulties in meeting patients’ wishes for end of life care were recognised. A discussion had taken place at a meeting of the System Leadership Team earlier that day regarding proposals for a more integrated approach in this area, building on good work which had already taken place.

A copy of the position statement is filed with these minutes.

The Chairman sought and obtained the consent of the Board to vary the order of business from that set out on the agenda.

The Board considered a report of the Director of Health and Care Integration which provided an overview of the progress to refresh and submit the Leicestershire Better Care Fund (BCF) Plan, including an update on the refreshed spending plan and outcome metrics for 2017/18 and 2018/19 as at 7 March 2017.  A copy of the report marked ‘Agenda Item 7’ is filed with these mintues.

The target for permanent admissions of older people to residential and nursing care homes had been set on the basis that the Help to Live at Home procurement was not yet completed and there were other developments linked to the Home First workstream of the Sustainability and Transformation Plan (STP) that would be implemented over the next 12 months and support improvements later in the year.  It would not be appropriate to have a more challenging target in this area until stability had been achieved and the emerging improvements to be led by the Home First workstream were scoped and delivered.

It was clarified that the Home First workstream was intended to provide services for people in crisis who needed additional support to prevent them from going into hospital or to support discharge (e.g. step up services, as well as step down services on hospital discharge).  This workstream would not address general capacity issues within the social care workforce.  However, a workforce strategy would be implemented during the next financial year to support social care providers to develop capacity.  It was intended that this would be funded through the additional adult social care grant allocation.

RESOLVED:

(a)  That the Better Care Fund Plan for 2017/18 – 2018/19 be approved for submission to NHS England in line with the national timetable, and subject to the publication of the national BCF guidance and any further amendments required;

(b)  That the Chief Executive of Leicestershire County Council, following consultation with the Chairman of the Health and Wellbeing Board be authorised to make any amendments to the Better Care Fund Plan 2017/18 – 2019/20 in the light of the national guidance, prior to its submission to NHS England;

(c)  That the final Better Care Fund Plan for 2017/18 – 2019/20 be submitted to the next meeting of the Health and Wellbeing Board for assurance, along with a progress update on the process and timescale for national assurance via NHS England.

The Board considered a report of Better Care Together which provided an update on the progress of the Leicester, Leicestershire and Rutland Sustainability and Transformation Plan (STP).  A copy of the report marked ‘Agenda Item 5’ is filed with these minutes.

It was noted that the national decision regarding the capital funding required to deliver the STP had been deferred until the Autumn Statement.  In the meantime, it would be important to continue work which did not require capital funding, such as Home First and the Integrated Locality Teams.  This would ensure that sustainable community services were in place.

RESOLVED:

That the update on the progress of the Leicester, Leicestershire and Rutland Sustainability and Transformation Plan be noted.

The Board considered a report from the Independent Chair of the Safeguarding Boards which set out the draft proposed Business Plan priorities for the Leicestershire and Rutland Local Safeguarding Children Board and the Leicestershire and Rutland Safeguarding Adults Board for 2017/18.  A copy of the report marked ‘Agenda Item 12’ is filed with these minutes.

RESOLVED:

(a)  That the Business Plan priorities 2017/18 for the Leicestershire and Rutland Safeguarding Children Board and Safeguarding Adults Board be noted;

(b)  That the Board thank Paul Burnett for his work as Chairman of the Safeguarding Board and wish him well in his retirement.

The Board considered a report of the Director of Children and Family Services which advised of the outcome of the recent Ofsted inspection of children’s social care services in Leicestershire and presented the Action Plan which had been developed to address the recommendations in the Ofsted Report and to set out the way forward for the development of the Council’s Children and Families Service.  A copy of the report marked ‘Agenda Item 13’ is filed with these minutes.

It was noted that the inspection findings were in line with the Council’s own self-assessment and that work had therefore already started on a number of the development areas identified by Ofsted.

Partnership engagement had been identified as a strength although areas such as access to the Child and Adolescent Mental Health Service (CAMHS) and services for children with disabilities required improvement.

RESOLVED:

(a)      That the content, grades and recommendations of the Ofsted inspection report on children’s social care services in Leicestershire be noted;

(b)      That the Children and Family Services Improvement Plan which was developed in preparation for the inspection and charts progress made be noted;

(c)      That the Action Plan which has been prepared in response to the recommendations in the Ofsted Report and includes proposals for the future development and improvement of services to children and families be noted.

The final draft of the document submitted to NHS England is attached.

The Board considered a report from Better Care Together which set out how the development and resilience of general practice would be ensured and would assist in bringing about the system-wide transformation required to focus on prevention and the moderation of demand growth.  A copy of the report marked ‘Agenda Item 6’ is filed with these minutes.

GPs were facing an increase in workloads due to both rising demand and a requirement for surgeries to be open for longer hours.  The GP Five Year Forward View could not require GPs to change how they worked but it was intended to support GPs and to find ways of working with them to deliver sustainable change.

The workforce evidence highlighted risks for Leicester, Leicestershire and Rutland (LLR), such as the fact that 60 percent of nurses were aged over 50 and recruitment and retention issues across primary care.  It was intended that the GP Five Year Forward View would help to make Leicestershire an attractive place to work and would offer GPs new ways of working such as portfolio careers.

Work already undertaken in LLR provided a good foundation for the GP Five Year Forward View.  The STP model was developing place based services around localities, for example through Integrated Locality Teams.  GPs were at the centre of this model.  A preventative approach was also being developed through the STP to promote self-care and self-referral into services such as the Stop Smoking Service.  It was hope that this would reduce the number of GP appointments needed in the future.

RESOLVED:

That the Blueprint for General Practice: Delivering the General Practice Five Year Forward View, be noted.

The Board considered a report of the Director of Adults and Communities which provided information on the proposals for the future joint commissioning of a dementia community and hospital inreach support service and sought agreement for the use of Better Care Fund monies for this purpose.  A copy of the report marked ‘Agenda Item 8’ is filed with these minutes.

RESOLVED:

(a)  That the proposal for joint commissioning of a Dementia Community and Hospital Inreach Service, to support the ambitions of the Leicester, Leicestershire and Rutland Sustainability and Transformation Plan and improve the support pathway for people affected by dementia, be approved;

(b)  That the proposal for a 10% efficiency saving against the current allocation of Better Care Fund resources, resulting in a contribution of £287,000 per annum, be approved.

The Board considered a report of the Director of Public Health which outlined the emerging Leicestershire bid to be a Sport England Local Delivery Pilot site and sought the Board’s support for the bid.  A copy of the report marked ‘Agenda Item 9’ is filed with these minutes.

Arising from discussion the following points were raised:-

(i)    The bid and its focus on walking were welcomed as walking was an accessible form of physical activity and also had a positive effect on mental health and reducing social isolation.  A range of approaches would be used to promote walking programmes, details of which would be confirmed later in the bidding process.

(ii)   It would be important to ensure that motivational techniques were used to encourage inactive people to walk and for people to not use the car for short journeys.  Other barriers which prevented people from walking would also need to be addressed.  It was hoped that Loughborough University would have insight to support this part of the scheme.

An announcement was expected in May regarding which bids had successfully progressed to the next stage.

RESOLVED:

That the Local Delivery Pilot Bid to Sport England and initial expression of interest be supported.

The Board considered a report of the Director of Public Health which provided an update on the work of the Leicester, Leicestershire and Rutland (LLR) Suicide Audit and Prevention Group and sought approval for the LLR Suicide Prevention Strategy and draft action plan for 2017-20.  A copy of the report marked ‘Agenda Item 10’ is filed with these minutes.

Arising from discussion the following points were raised:-

(i)    Concern was expressed that the Strategy did not make an explicit link to schools or children in care.  The Board was assured that a lot of work, including anti-bullying initiatives, was undertaken in schools to support the mental health of children and young people.

(ii)   There were no significant differences between the national picture and local statistics for Leicestershire.  Audits were undertaken each year to consider local practice and prevention.  It might also be useful to identify local suicide hotspots.

(iii)  It was suggested that the Strategy could be more ambitious and aim for a target of zero suicides.  However, it was acknowledged that this would be challenging.

(iv) Leicestershire Partnership Trust had developed an e-learning package for its staff, based on the experiences of people who had survived a suicide attempt.  The Trust was currently considering the procurement of an app called ‘Stay Alive’ which helped people to form strategies to keep themselves safe.

RESOLVED:

(a)  That the purpose and work of the Leicester, Leicestershire and Rutland Suicide Audit and Prevention Group be noted;

(b)  That the draft Leicester, Leicestershire and Rutland Suicide Prevention Strategy and Action Plans (2017 – 2020) be approved;

(c)  That the Unified Prevention Board be requested to take forward Leicestershire specific work actions and report back to the Health and Wellbeing Board when appropriate.

The Board considered a report of the Director of Public Health which highlighted its responsibility to publish a Pharmaceutical Needs Assessment (PNA), the timescale to do so and the proposed governance structure to enable the production of the PNA.  A copy of the report marked ‘Agenda Item 11’ is filed with these minutes.

RESOLVED:

(a)  That the report be noted;

(b)  That the delegation of the assurance role to the Integration Executive be approved;

(c)  That the proposal to form a project team and an interagency Leicester, Leicestershire and Rutland wide reference group and the draft terms of reference for the project team be approved;

(d)  That further reports on progress be submitted to the Health and Wellbeing Board and that the final Pharmaceutical Needs Assessment be submitted to the Board for approval in March 2018.

The Board considered a report from Leicester City CCG which presented the refresh of the Mental Health and Wellbeing Transformational Plan delivered through the Future in Mind – Children and Young People’s Mental Health and Wellbeing Transformation Programme.  A copy of the report marked ‘Agenda Item 14’ is filed with these minutes.

Arising from discussion the following points were raised:-

(i)    Members of the Board welcomed the progress that had been made in this area, in particular with the eating disorder service which was now in place.  It was acknowledged that the CAMHS service was still under a lot of pressure as referral rates had increased.  More early help services were needed to help address this issue, although difficulties with procurement had led to delay in implementing the early help offer.

(ii)   It was clarified that home visiting referred to the crisis home response service.  A phased approach was being taken to the implementation of this service.  Phase 1, employing and training staff, had been completed.  Phase 2 was expected to be implemented in April or May.  This phase would see the service up and running.

(iii)  It would be important to ensure that the performance dashboard did not just rely on process data.  It would also need to reflect the impact that the Programme was having on the child’s journey and progress being made towards wellbeing.

(iv) Funding for the programme during 2017/18 was in the CCGs baseline budget.  It was earmarked for Future in Mind, although not a ring-fenced grant.  It would be spent on the workstreams as planned.  The allocation for 2016/17 had been omitted from the report.

(v)  It was requested that more consideration be given to identifying priority areas for development.  For example, looked after children were the group with the highest risk of mental health issues and also the group that had the most difficulty accessing services.  It might be appropriate to take a more innovative approach in this area, such as through joint commissioning.

RESOLVED:

That the content of the refreshed transformation plan be noted and that the document be approved prior to publication on the CCG and Local Authority websites.

The Board considered a report of the Director of Public Health which provided details of the role that the LLR Health Protection Board and more recently the LLR Health Protection System Assurance Group was carrying out to provide assurance for whole system health protection across LLR.  The report also provided an update on health protection performance, key incidents and risks that had emerged from October 2015 to the end of December 2016.  A copy of the report marked ‘Agenda Item 15’ is filed with these minutes.

There was a growing awareness of air quality and its impact on health.  Evidence linked premature mortality to air quality.  The Board was assured that Public Health was represented on an LLR-wide air quality group and also developing a health impact assessment for large developments which would address issues including active travel and measures for improving air quality.

RESOLVED:

(a)  That the Health Protection Board Report October 2015 – December 2016 be received;

(b)  That the specific health protection issues that have arisen locally and steps taken to deal with these be noted.

The Board considered a joint report from the County Council Chief Executive and the Arden/GEM Commissioning Support Performance Service which presented an update on overall health and wellbeing system performance issues using a number of locally and nationally agreed metrics and standards.  A copy of the report marked ‘Agenda Item 16’ is filed with these minutes.

It was suggested that consideration be given to how performance data was presented to the Board in future, to ensure that it was meaningful and focused on key issues affecting the local health and care system.

With regard to urgent care performance, it was noted that there had been an improvement in ambulance handover times during February but referral to treatment performance had declined because elective care had been suspended for a short period as a result of the challenging emergency care position.  Demand and capacity continued to present a challenge.

RESOLVED:

That the performance summary, issues identified this quarter and actions planned in response to improve performance be noted.

The Board considered a report which presented the findings of Healthwatch Leicestershire’s visit to four Urgent Care Centres/Walk-in Centres across Leicestershire.  A copy of the report marked ‘Agenda Item 17’ is filed with these minutes.

It was noted that a more consistent Urgent Care offer across Leicester, Leicestershire and Rutland formed part of the Vanguard Programme and was therefore being overseen by the A&E Delivery Board.  It was recognised that there was work to do and a procurement exercise was planned as part of the development of Urgent Care.

RESOLVED:

(a)  That the findings from the visits be noted;

(b)  That it be noted that there are four separate sets of recommendations from each Urgent Care Centre for commissioners and providers to address.

The Board considered a report of Healthwatch Leicestershire which presented the findings of a survey of patients, carers and staff members on the issue of hospital discharge.  A copy of the report marked ‘Agenda Item 18’ is filed with these minutes.

A response to the recommendations set out in the report had been produced by the University Hospitals of Leicester NHS Trust (UHL) and was circulated to members of the Board.  A copy of the response is also filed with these minutes.

UHL had found the report helpful and insightful and felt that the recommendations were practical and were being acted upon.

RESOLVED:

(a)  That the findings be noted and that health and social care partners be urged to consider actions to improve services, systems and processes outlined in the findings report;

(b)  That the response from the University Hospitals of Leicester NHS Trust be welcomed.

The Board considered a report of the Director of Health and Care Integration which provided assurance regarding the national quarterly reporting requirements for the Better Care Fund.  A copy of the report marked ‘Agenda Item 19’ is filed with these minutes.

RESOLVED:

That it be noted that the quarter three 2016/17 BCF return was approved by representatives on the Integration Executive by 2 March and submitted to NHS England on 3 March.

The Board considered a report of the Director of Health and Care Integration which provided an update on the actions that had been taken following the Board Development Session on 15 December 2016.  A copy of the report marked ‘Agenda Item 20’ is filed with this agenda.

It was suggested that the communications plan should reflect local work as well as national campaigns.

RESOLVED:

(a)  That the progress that has been made with the actions arising from the Board Development Session held in December be noted;

(b)  That the updated Code of Conduct for Co-opted Members of the Health and Wellbeing Board, attached as Appendix A to this report, be approved;

(c)  That the actions outlined at paragraph 11 of this report be agreed for discussion at the Board Development Session on 18 April.

The next meeting of the Health and Wellbeing Board will be held on 1 June 2017 at 2.00pm

It was noted that the next meeting of the Board would take place on 1 June 2017 at 2.00pm.

[The meeting was subsequently rearranged for 22 June 2017 at 2.00pm].