Agenda and minutes

RESOLVED:

That the appointment of Mrs P Posnett CC as Chairman of the Health and Wellbeing Board be noted.

Mrs P Posnett CC – in the Chair

The Chairman paid tribute to Mr Ernie White CC, who had passed away on 2 January 2018.  Mr White had been Chairman of the Health and Wellbeing Board since it was created.  Members of the Board joined the Chairman in silent tribute to Mr White.

The minutes of the meeting held on 16 November 2017 were taken as read, confirmed and signed.

The Board also noted the Action Log, which provided an update on action 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:

·         Self-Care Campaign

·         STOP Suicide Campaign and Pledge

·         All GP practices in East Leicestershire and Rutland were now rated ‘good’ by CQC

·         Mental health crisis house moving to a new central location in Leicester

·         Glenfield Children’s Heart Unit

·         Patients being encouraged to share more information to help improve care

·         Antimicrobial Resistance: Preparing for winter

·         A selection of regional, national and international publications

Particular reference was made to the STOP suicide campaign.  Following a report which had been considered by the County Council’s Cabinet on 9 January, members of the Health and Wellbeing Board were asked to pledge to support the campaign.

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 Healthwatch Leicestershire presenting the findings of a survey of expecting mothers, mothers and healthcare professionals.  A copy of the report, marked ‘Agenda Item 13’, is filed with these minutes.

Responses to the survey had been received from 136 expectant mothers and mothers and 54 healthcare professionals.  It was noted that just over half the mothers had given birth at Leicester General Hospital or the Leicester Royal Infirmary.  UHL acknowledged that some of the findings in the report were difficult to hear and noted that the report was less positive than UHL’s internal polling for maternity services.  UHL would reflect on the report with its obstetricians and midwives to identify what changes could be made.  It was expected that any changes would result from the proposed reconfiguration of maternity services set out in the draft Sustainability and Transformation Plan.

Attention was drawn to the ‘Top Tips for New Mothers’ section of the report.  It had not yet been confirmed whether this would be used as a separate document, but those who had taken part in the survey would be sent a copy of the report so it would be possible for participants to disseminate the information.

Caution was expressed in relation to the comments in the report around breast feeding, as it was felt that these could be construed as slightly negative.  There was also some concern regarding the continuity of care once the mother had transferred to community services.  Discussions regarding these issues would take place with the Public Health Commissioning Team for 0-19 services. 

RESOLVED:

That the findings be noted and health and social care partners be urged to consider actions to improve services, systems and processes outlined in the report.

The Board considered a report of the Director of Public Health which provided an update on the work of the Unified Prevention Board (UPB) in delivering the prevention approach for Leicestershire and how this flowed into the work of each partner organisation.  A copy of the report, marked ‘Agenda Item 6’, is filed with these minutes.

The UPB had agreed four outcome pillars that it was felt all partners could contribute to – keep well, keep safe, stay independent, enjoy life.  Three cross-cutting programmes of work had been identified as the focus in developing the unified prevention offer and an update on the achievements to date was reported.  Work had also been taking place to develop a social prescribing model as the wrap-around prevention offer.

RESOLVED:

That the contents of the report and progress to date be noted.

There will be a Powerpoint presentation for this item.

The Board received a presentation from the Director of Children and Family Services which provided a briefing on the work around the Early Help Review.  A copy of the presentation is filed with these minutes.

Arising from discussion the following points were raised:-

(i)            There were currently 40 buildings across the Early Help Service; the review proposed that the new service would operate from five key hub buildings and ten supporting spoke buildings.  It was acknowledged that this would have implications for partners who currently provided services from the children’s centres and these partners were encouraged to respond to the consultation.

(ii)          The new service would be in place from April 2019; the intervening period would be used to develop it.  This would involve consideration of the boundaries for the two area based localities and five hubs proposed in the review.  The Health and Wellbeing Board would support the alignment of localities to the Integrated Locality Teams, especially as this would enable development of a whole life prevention model.

(iii)         The County Council’s financial position meant that services would need to be more targeted.  The number of looked after children had increased significantly over the last four years and this was putting pressure on the Council’s ability to meet its statutory obligations.  This could have an adverse impact on families with less complex needs.  It was hoped that through closer working with partners such as schools, a partnership approach could be developed which would mitigate a potential review on these families.

(iv)         A proportion of the buildings that would cease to be used as children’s centres were attached to schools and community centres.  It was hoped that ownership of a number of these would be transferred to alternative public services so that they could continue to operate in a different format.  There was some disappointment that the focus appeared to be around the loss of buildings rather than on ensuring that the provision of services was focused on those who were most in need.

RESOLVED:

That the presentation be noted.

The Board considered a report from Better Care Together seeking approval of the draft of the next stage of the local Future in Mind transformation plan for submission to NHS England and describing the next phase of the transformation journey and direction of travel for the next year.  A copy of the report, marked ‘Agenda Item 8’, is filed with these minutes.

There was a requirement for the next stage of the local transformation plan to be signed off by the Leicester, Leicestershire and Rutland Health and Wellbeing Boards and the CCGs prior to its submission to NHS England.  The plan would then be published on the three CCG websites. 

A query was raised around the ownership of the plan and governance arrangements for the Future in Mind programme.  It was confirmed that the Plan had been developed by the Future in Mind Steering Group which had representation from all commissioning partners, including the Local Authorities.  Providers had not been included due to conflict of interest.  A partnership group was being established to consider pathways, joint working and outcomes.  Providers would be engaged with the work of this partnership group.

The increase in workforce referred to in the Plan related to nurses and professional counsellors, not just specialist Child and Adolescent Mental Health Service (CAMHS) staff.  An increased skill mix would improve access to interventions for lower level mental health needs such as therapeutic services.  Quality of interaction was also important and it was suggested that there should be a metric to measure feedback in this regard.  Although there would be links to the County Council’s Early Help Review, it was important to note that Future in Mind would focus on individual children rather than working with families.

The Plan saw CAMHS in the context of the emotional health and wellbeing of children and young people and this was welcomed.  It was also positive that the Plan focused on young offenders and looked after children more than had previously been the case.  It was hoped that working in partnership would ensure that there was less duplication as the programme was now more inclusive of all services.

The funding arrangements for the consultation/engagement around the plan were queried and it was noted that the CCGs had provided some funding for an engagement event.  The voluntary sector had helped in the process and participation groups had been utilised.  The issue of finding further funding had been raised at the Future in Mind Steering Group.

RESOLVED:

(a)  That the draft local transformation plan be approved for submission to NHS England;

(b)  That it be noted that the draft local transformation plan will be published on the three CCG websites.

The Board considered a report of the Director of Adults and Communities outlining details of two Government consultations around housing costs for sheltered and extra care accommodation and housing costs for short-term supported accommodation.  The deadline for responses to the consultations was 23 January 2018.  A copy of the report, marked ‘Agenda Item 9’, is filed with these minutes along with the County Council’s consultation response.

The Board agreed that consideration should be given to developing a joint approach to supported housing services and the related strategic needs assessment across the Leicester, Leicestershire and Rutland health and social care system.  Work was ongoing around how to shape the offer to those with issues that could lead to homelessness and it was felt that this could form part of a bigger piece of work.  The role of the housing services partnership was key to helping shape future services.

RESOLVED:

a)    That the Government consultation documents be noted;

b)    That the implications for housing and support services within Leicestershire be noted.

The Board considered a report of the Interim Director of Health and Care Integration which provided a progress update on delayed transfers of care (DTOC), a key outcome metric of the Better Care Fund (BCF).  The report detailed performance against the DTOC targets along with current progress locally across health and care to reduce delays.  A copy of the report, marked ‘Agenda Item 10’ is filed with these minutes.

In November, the average number of days delayed per day, per 100,000 adult population had been 8.0 against a local target of 6.84.  Despite significant improvements and effort, the nationally mandated November target for Leicestershire had not been achieved.  However, the level achieved was better than the national target for delayed transfers of care of no more than 9.4 days delayed per day, per 100,000 adult population.  Further improvement activity continued to be coordinated by the Discharge Working Group.

A letter had been received from the Secretaries of State for the Department of Communities and Local Government and the Department of Health confirming that, due to the improved DTOC performance in Leicestershire, there would be no impact on the IBCF allocation in 2018/19. 

It was noted that the DTOC measurement included people on an end of life care pathway who were delayed in hospital awaiting discharge.  In West Leicestershire, a new End of Life pathway had been put in place to prevent DTOC for this particular group of patients.

RESOLVED:

a)    That the progress report be received and noted;

b)    That it be noted that the report has been forwarded to the Discharge Working Group and the Director of Urgent Care for Leicester, Leicestershire and Rutland in support of their oversight of DTOC performance on an LLR-wide basis.

The Board considered a report of the Director of Public Health which highlighted the responsibility of the Health and Wellbeing Board to publish a Joint Strategic Needs Assessment (JSNA), the timescale and the proposed governance structure to enable production.  The last JSNA for Leicestershire had been produced in 2015.  A copy of the report, marked ‘Agenda Item 11’, is filed with these minutes.

It was proposed to publish the JSNA in subject-specific chapters throughout a three year period in line with CCG and local authority commissioning cycles.  The chapters would be aligned to the County Council’s Strategic Outcomes Framework.  A JSNA Reference Group was to be established which would support JSNA work across Leicestershire, and would provide a status report to the Integration Executive on a quarterly basis.

Support was given for the JSNA to be delivered in chapters.  The publication timeline was based on when plans were due to be refreshed and would be reviewed at the first meeting of the reference group.  It was requested that consideration be given to prioritising the chapters on End of Life Care and frail older people.  The intention was to make the JSNA more commissioner friendly and to align the work required more with Leicester City so there would be greater consistency and that the output could be used in planning processes across LLR.  The annual Health and Wellbeing Board Development Session would consider how commissioning intentions for the forthcoming year were informed by the JSNA.

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 JSNA reference group and the draft terms of reference for the JSNA reference group be approved;

d)    That the Health and Wellbeing Board receives further reports on progress of the JSNA.

The Board considered a report of the Director of Public Health which provided an overview of the achievements and outcomes that had been delivered by the Health and Wellbeing Board during 2017 and an update on the progress that had been made to meet the needs of the people of Leicestershire.  The report also contained a look ahead to 2018.  A copy of the report, marked ‘Agenda Item 12’, is filed with these minutes.

RESOLVED:

a)    That the Health and Wellbeing Board Annual Report be approved for publication;

b)    That the progress that has been made by the Board in 2017 be noted;

c)    That the key work streams that have been identified to further progress the impact of the Health and Wellbeing Board in 2018 be supported.

The Board considered a report of the Interim Director of Health and Care Integration which provided assurance that the Leicestershire Better Care Fund Section 75 agreement had been refreshed and updated for 2017-19.  Approval was also sought from the Health and Wellbeing Board to continue with pooled budget arrangements for 2017/18 and 2018/19.  A copy of the report, marked ‘Agenda Item 14’ is filed with these minutes.

Formal confirmation had been received from NHS England on 20 December 2017 that the Leicestershire BCF Plan for 2017-19 had been approved.  This confirmed that the BCF funding could now be released and transferred into pooled funds under the Section 75 agreement.  It was noted that the BCF expenditure plan was being reviewed during Q4 2017/18 for 2018/19 to ensure that it met planned commissioning intentions.

RESOLVED:

a)    That the Health and Wellbeing Board receives assurance on the work undertaken to refresh the Section 75 pooled budget agreement for the BCF;

b)    That the continuation of the Section 75 pooled budget arrangements between Leicestershire County Council, East Leicestershire and Rutland and West Leicestershire Clinical Commissioning Groups be approved.

The next meeting of the Health and Wellbeing Board will be held on 22 March 2018 at 2.00pm.

It was noted that the next meeting of the Board would take place on 22 March 2018 at 2.00pm.