Agenda and minutes

The minutes of the meeting held on 24 January 2019 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:

·         Drop in sessions to discuss NHS improvements plans;

·         ‘Within Your Gift to Give’ social media campaign;

·         The new Integrated Care (Reablement) Team;

·         ‘Start A Conversation’ Suicide Prevention Campaign;

·         Radiographers at Leicester’s Hospitals national award;  

·         ‘Cervical Screening Saves Lives’ campaign.

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

A PowerPoint presentation will be considered for this item.

The Board considered a presentation of the Chief Executive which provided an update on the delivery of the Leicester and Leicestershire Strategic Growth Plan (SGP) which had been jointly prepared and subsequently approved by the eight local planning authorities (the district councils), the County Council as the highway authority and Leicester City Council in late 2018.  A copy of the presentation slides are filed with these minutes.

The Chief Executive reported that the SGP set out a strategy for the growth and development of Leicester and Leicestershire in the period to 2050, enabling partners to consider the longer term needs of the area and opportunities which extend beyond the conventional timeframe of a Local Plan.

Arising from discussion the following points were noted;

·         The growth and development of the County would have considerable impact on Health and Care partners and it was therefore important for them to be able to have an input into the development process. It had been acknowledged that there was a need for greater engagement at a strategic level with such partners: it was expected that this would be improved in time for the next revisions to district-level Local Plans, which should reflect the strategic direction of the SGP;

·         As well as ensuring new developments had the appropriate health infrastructure in place, it was important that planners considered the wider determinants of health as a fundamental part of the process, rather than a re-active afterthought. The recent development of New Lubbesthorpe, for which Blaby District Council had won a Local Government Chronical Award,  was a good example of where this approach had been taken;

·         The recently published Chief Medical Officer’s report promoted putting health and wellbeing at the forefront of policy making and prioritising investment to create active environments which enhanced health and helped prevent disease;

·         Strategic Planning Groups were an ideal forum in which to discuss the importance of health considerations and ensure planning authorities and developers understood the benefits of active design;

·         The Health and Wellbeing Board could play a significant role in the promotion of active design principles within new developments and it would consider at a future meeting the types of health considerations it wished for development plans to have regard for.

RESOLVED:

That a report concerning the promotion of active design within new county housing developments be considered at a future meeting of the Health and Wellbeing Board.

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The Board considered a joint report of the Chief Executive and Director of Public Health which detailed the work of the Leicester, Leicestershire and Rutland Civil and Military Partnership Board (LLRCMPB) and the delivery of the Armed Forces Covenant (AFC) in Leicestershire. A copy of the report and accompanying presentation is filed with these minutes marked ‘Agenda item 6’.

Following a commitment to support those who serve or had served in the armed forces and their families better, the LLRCMPB was formed in 2017 to help deliver the initiative locally. In addition, some local organisations had signed covenants which set out their commitment to support the Armed Forces community.

There was a lack of data nationally as to the numbers of veterans in the community which it was hoped would be partially addressed by the introduction of a new veterans category in the census from 2021. In the meantime there was an opportunity locally to support and encourage veterans to make their status known when accessing services, particularly in health settings such as GP surgeries. It was noted that Leicestershire Partnership Trust had amended its patient template to include a military field.

GP surgeries were encouraged to register for the Armed Forces Veteran Friendly Accreditation which promoted improved medical care and treatment for former members of the armed services. Practices could qualify for veteran friendly status by offering extra support for ex-military personnel who might face additional challenges when they return to civilian life. It was noted that practice staff could benefit from additional veteran specific educational training, similar to that offered by some CCGs in other areas.

It was noted that a number of local organisations had been recognised as part of the Ministry of Defence’s employer recognition scheme for actively supporting their employees who were members of the armed forces family. Leicestershire County Council had attained the silver award and had expressed an interest in achieving the gold standard.

RESOLVED:

a)    That the Health and Wellbeing Board seek to establish and maintain a link with the work of the Civil and Military Partnership Board through the Director of Public Health,  to be aware of it and the purpose it has and seek its involvement in relevant areas of work;

b)    That the Health and Wellbeing Board endorse and support the Armed Forces Covenant in relation to primary care particularly the promotion of the veteran friendly GP accreditation scheme;

c)    That partners be encouraged to collectively continue to work on addressing the gaps in knowledge and data and encourage Armed Forces personnel, particularly veterans to identify themselves.

The Board considered a report of the Director of Public Health which detailed progress made to strengthen links between community safety and health and wellbeing. A copy of the report marked ‘Agenda item 7’ is filed with these minutes.

The Director reported that work led by the Office of the Police and Crime Commissioner was ongoing to develop and implement ‘People Zones’ (geographically defined areas wherein public services work collaboratively to address the key social problems across the county) across the County. The outcomes of this project would help steer the work of partnership bodies such as the Unified Prevention Board and the Strategic Partnership Board.

RESOLVED:

a)    That the progress made to date in strengthening links between community safety and health and wellbeing be noted;

b)    That a report detailing the work of the Strategic Partnership Board and the People Zones Project be considered at a future meeting of the Health and wellbeing Board.

A PowerPoint presentation will be considered for this item.

The Board received a presentation from Leicestershire Partnership NHS Trust (LPT) which provided information on the five year transformation programme to re-design its mental health services.  A copy of the presentation is filed with these minutes.

It was noted that the transformation exercise which was still at a development stage would address the increasing demand and capacity issues currently experienced by the service to improve the quality, efficiency and overall experience of mental health services.

Arising from discussion the following points were raised:-

·         Direct patient access to services would form an important part of the transformation project, including the development of a single point of access for mental health services and improvements to the way in which previously discharged patients could re-access support;

·         GPs welcomed the ability to refer patients to urgent mental health care through the crisis team. However, there were limited options for patients who were assessed as not requiring urgent care, but requiring support within a fairly short timeframe;

·         Patient engagement throughout the transformation exercise was essential. The consultation stage would include further co-design workshops and the opportunity for a draft model to be tested ahead of final implementation;

·         With regard to social prescribing, it was confirmed that LPT had made links with the existing Leicestershire offer developed by the Unified Prevention Board and in particular the First Contact Plus provision. There was however an opportunity to improve the system further; for example an LLR-wide offer had not yet been developed;

·         It was noted that the recent CQC inspection of LPT had identified concerns in a number of areas, including the Bradgate Unit. The Board was assured that this topic would be addressed through the Joint Health Overview and Scrutiny Committee.

RESOLVED:

That the presentation be noted.

The Board considered a report of the Director of Care and Integration which provided an update on the delivery of the actions agreed following the Health and Wellbeing Board Development session held in November 2018. A copy of the report marked ‘Agenda item 9’ is filed with these minutes.

The Director reported that the action plan would be revised in order to take into account the recent changes to the governance arrangements of mental health services across Leicester, Leicestershire and Rutland.

RESOLVED:

That the action log and the initial progress made be noted.

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 2019/20 as at 1 March 2019.  A copy of the report marked ‘Agenda Item 10’ is filed with these minutes.

In response to questions concerning the proportion of the proposed BCF spend on acute services, and seeking confirmation optimum use was being achieved from the BCF, the Director confirmed the refreshed plan commissioning intentions and expenditure plan for 2019/20 had been consulted upon through multi agency workshops and individual partner governance structures, which included University Hospitals of Leicester (UHL) representation. Whilst the BCF spend totalled just short of £60m, BCF national policy requirements and conditions on expenditure types/amounts were fairly prescriptive giving limited scope for flexible spending within the Plan. It was noted that the total was considerably less than that spent overall on health across the County.

It was noted that whilst the proposals for 2019/20 were not fundamentally different from the 2018/19 Plan (as 2019/20 is seen as a continuation, with the BCF policy framework is expected to operate in a similar basis as 2018/19), it was possible that future national guidance could lead to considerably different BCF policy framework affecting local plans from 2020 onwards. This was anticipated to respond to the new integrated care system requirements per the NHS Plan, driven both locally and through the Better Care Together (LLR) programme Plans. The revisions would lead to wider discussions amongst partner agencies as to the future approach to overall spend on Health and Social Care.    

RESOLVED:

a)    That the draft BCF Plan for 2019/20, as summarised in Appendix A and B, be approved for submission to BCF National Team in line with the national timetable, 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 BCF plan 2019/20 in light of the national guidance, prior to its submission to NHS England;

c)    That the final submitted version BCF plan for 2019/20 be submitted to the next possible meeting of the Health and Wellbeing Board for assurance, along with a progress update on the process and timescales for national assurance via the BCF National Team;

d)     That the Board notes that the members of the Integration Executive (a subgroup of the Health and Wellbeing Board responsible for the day to day delivery of the BCF Plan), will be asked to confirm their agreement to the final version of the plan to be submitted to NHS England.

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 2018 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 2019.  A copy of the report, marked ‘Agenda Item 11’, is filed with these minutes.

The Director encouraged partner representatives of the Board to share the Annual Report with their own management teams and consider the content when producing their own annual summaries.

RESOLVED:

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

b)    That partners be encouraged to share the report with their own management teams;  

c)    That the progress made by the Board in 2018 be noted;

d)    That the key workstreams that have been identified to further progress the impact of the Health and Wellbeing Board in 2019 be supported.

The next meeting of the Health and Wellbeing Board will be held on 30 May at 2.00pm.

It was noted that the next meeting of the Health and Wellbeing Board would be held on Thursday 30 May 2019.