Venue: Trentham and Rudyard Suites - Staffordshire Place 1, Tipping Street, Stafford, ST16 2DH
Contact: Jon Topham Email: StaffsHWBB@staffordshire.gov.uk
Declarations of Interest
There were none at this meeting.
RESOLVED- That the minutes of the Health and Wellbeing Board (H&WB) meeting held on 6 June 2019 be confirmed and signed by the Chairman.
Co-Chair Cllr Alan White shared the letter he had received from Action on Hearing Loss outlining their concerns at possible changes to the provision of hearing aids across Staffordshire and Stoke-on-Trent. Several Board Members had received letters from this organisation. Cllr White had previously met with the Group. It was proposed that the response from Cllr White inform them that their letter had been shared with the Board.
RESOLVED – That the letter to Cllr Alan White (Co-Chair) from Action on Hearing Loss and his agreed response be noted.
Questions from the public
There were none at this meeting.
Jon Topham, Senior Commissioning Manager
The revised H&WB Terms of Reference had been agreed at their meeting of 6 September 2018. At that meeting Members also agreed to review these annually.
Members received the 2019 review, and noted the following amendments:
· Paragraph 21: Agenda: removal of the three categories to simplify agenda setting;
· Paragraph 23: removal of Physical Activity Sub Group. Members had agreed at their 6 June 2019 meeting that the sub group would cease and that Sport Across Staffordshire & Stoke-on-Trent (SASSOT) was recognised as the lead agency for physical activity. Members agreed that, in future, Tim Clegg would act as the link between the H&WB and the SASSOT.
RESOLVED – That the amendments to the Terms of Reference be agreed.
Jon Topham, Senior Commissioning Manager
Members had received a presentation on the Director of Public Health’s (DPH) Annual Report “Live long and Prosper: digital technologies for health and wellbeing” at their June meeting. At that meeting it had been agreed that consideration would be given to how the Board would support the implementation of the 17 recommendations. Members now received details of proposed actions to enable each recommendation to be taken forward.
Several recommendations included the action to request a short report from the STP digital lead. The intention was for these to be included in one report to the Board outlining how using digital initiatives was changing health and care.
A report would also be brought to the December Board meeting to update Members on progress and give timescales for any outstanding actions.
RESOLVED – That the recommendations be endorsed and the proposed actions be agreed.
H&WB Strategy Delivery Plan
Joanna Robinson, Senior Commissioning Manager, Public Health
[Joanna Robinson, Senior Commissioning Manager, Public Health, in attendance for this item.]
The H&WB Strategy delivery plan included implementing public conversation campaigns to help raise awareness and support individuals to take more control of their health and wellbeing. The DPH’s Annual Report also recommended that the H&WB:
· take a lead role in increasing public awareness of health and care digital technologies to help them improve health and wellbeing or better self-manage their conditions; and
· promote telecare and assistive technology and signpost people to useful devices.
With this in mind Staffordshire County Council (SCC) would be running four communication campaigns during 2019/2020 which: educated people on actions to improve or maintain their health and wellbeing; worked to persuade and/or motivate them to take action; and, signposted as appropriate to trusted information sources, advice, guidance, digital tools and assistive technologies.
The four campaigns were:
· sexual health – to reduce the number of residents aged 35+ who contract sexually transmitted diseases (STIs);
· NHS health checks – to increase uptake rates of NHS health checks for residents, particularly around heart health,
· supportive communities – to reduce demand on health and social care by encouraging support for family members, friends and/or neighbours to help individuals live more independently for longer as part of the #DoingOurBit campaign; and
· suicide prevention – to reduce the number of people taking their own lives in Staffordshire.
The campaigns would use social media, local media, email and other no-cost forms of digital communication, underpinned by a trusted source of information, advice and guidance. Support from other stakeholder organisations would also be sought and Members emphasised that campaigns were most effective where there was co-ordination between organisations to ensure the message reached the target audience. Packaging the message appropriately was also key to ensure the campaign reached the most appropriate department/sector within each organisation.
RESOLVED – That:
a) this approach, as part of the Joint Health and Wellbeing Board Delivery Plan, be endorsed;
b) the communication campaigns be supported by Board Members through their own organisations; and
c) ensure information is targeted at the most appropriate department/ sector of each organisation to enable effective reach of the target audience for each campaign.
Dave Sugden, Commissioning Manager, Strategy and Policy
[Dave Sugden, Commissioning Manager, Strategy and Policy, in attendance for this item.]
In March 2017 the H&WB had agreed to embrace the Health in All Polices (HiAP) agenda, including becoming champions of HiAP across their respective organisations. In September 2018 a workstream was developed with District and Borough Councils, which included production of data packs to facilitate the definition and development of local priorities, resulting in four District/Borough Councils producing definitive HiAP strategies or plans as well as joint cross-directorate planning within SCC.
More recently a King’s Fund report had highlighted improvements were stalling in national life expectancy for the first time in 150 years, with their analysis indicating this being driven by health inequalities arising from social determinants.
The NHS Long Term Plan (2019) placed great emphasis on the role of social determinants in NHS planning and outlined new requirements for local NHS systems to set out how health equalities would be reduced, including joint planning with the local authority.
To take this forward it was suggested that:
· Board Members signed up to a minimum standard for the development of HiAP activity within and across member organisations, with a view to establishing a baseline for a developmental and incrementally ambitious programme for HiAP;
· using these standards to develop specific priorities for HiAP action within and across organisations (in the first instance writing to the CCG Accountable Officer suggesting a joint planning session on HiAP and Social Determinants in line with NHS long-term planning);
· the development of initial HiAP action plans for Board Member organisations, with these being discussed at a future Board meeting;
· further supporting public health work, which drove and facilitated the HiAP agenda across organisations; and
· development of a contextual broader HiAP narrative.
Members suggested it would be beneficial to share good practice across District and Borough Councils as well as learning from areas nationally and internationally, such as Manchester, Coventry and Australia. They also considered the long and short term benefits from HiAP, including the impact on attainment and the variety of work undertaken by schools. Members were referred to the Stafford Borough Council’s Supporting Schools Project website which was designed to complement and enhance the PSHE curriculum and gave an example of HiAP working successfully.
RESOLVED – That:
a) Members commit to their role as “Champions for Change” for HiAP; and
b) the proposed activity to take HiAP forward be agreed.
Kerry Dove, Strategic Insight Manager, and Divya Patel, Senior Public Health Epidemiologist
[Wendy Tompson, Operational Insight Manager, in attendance for this item.]
The Board received the second deep dive Joint Strategic Needs Assessment (JSNA) for 2019 which focused on a better understanding of communities and people on the cusp of care. The JSNA enabled a better understanding of current and likely demand in the context of community and asset-based approaches and would help to inform current prevention and earlier intervention strategies.
The report considered current demand and the drivers for demand. An evidence base was being developed for groups and individuals at risk of requiring health and care services. Members also received details of a number of existing or developing products that would support understanding of the at-risk individuals/groups.
Members noted the opportunity to explore a more predictive approach to health and care using data to better understand individuals/specific populations that were more likely to benefit from NHS and/or adult social care support whilst also presenting an opportunity to shape appropriate responses from communities as part of the rising prevention agenda. To enable this, it was intended to take a population health management approach over the next six months. This would allow better understanding of how existing and integrated care record data could support the development of an early warning system approach to predicting future demand and targeting prevention at the earliest opportunity.
Close working and information sharing was discussed between Member organisations to help support early identification, exploring other data sets to help provide a clearer picture, such as missing persons and victims of crime data. A pilot for this information sharing was suggested to help predict the at risk groups. It was also important to ensure that data was gathered around risks where interventions were possible to ameliorate them, so appropriate actions and interventions could be taken.
RESOLVED – That:
a) focus for the next JSNAs be around population health and social isolation and the the DPH Annual Report;
b) the JSNA on understanding communities and people on the cusp of care be supported; and
c) the “next steps” population health management approach to better understanding how existing and integrated care record data could support the development of an early warning system approach to predicting future demand be agreed.
Presentation by Sally Young, Director of Corporate Governance, Communications and Engagement, and Jenny Fullard, Senior Communications and Engagement Manager
[Sharon Young, Governor, NHS Stafford and Surrounds CCG.]
The Board was aware that the six Clinical Commissioning Groups (CCGs) across Staffordshire and Stoke-on-Trent had undertaken a consultation process on proposals to form a single Strategic Commissioning Organisation. The proposal recognised the opportunities for better planning, buying and delivery of health care for local people through one organisation. The proposal also linked well with the NHS’s long term plan to work effectively without barriers.
Assurances had been given that the single organisation would:
· remain clinically led and break down barriers in the interests of patients;
· retain strong, local clinical and patient voices to ensure local control;
· respect that different areas of the county may have particular healthcare needs that are different to others and that these particular needs must be considered;
· ensure that no CCG lost out financially as a result of a single Strategic Commissioning Organisation.
Members understood that the CCGs had been working more closely over recent years, including having a single leadership team and staffing structure, and Governing Body meetings held “in common”. In December 2018 the CCGs wrote to NHS England informing them of their wish to explore the development of a single organisation.
Two options were considered:
· Option 1 – to keep the current arrangements of six separate CCGS under a single leadership team;
· Option 2 – to develop a single CCG.
Following the consultation feedback a decision was expected in September 2019. Should there be agreement to forming a single organisation the next step would be for the Governing Bodies to make a formal application to NHS England.
RESOLVED – That the progress made to form a single Strategic Commissioning Organisation be noted.
Andy Marriot, Lead Commissioner (All Aged Disabilities and Mental Health) and Gill Smith, Commissioning Manager
[Taryn Poole, Commissioning Officer, in attendance for this item.]
A Staffordshire Carers Strategy “All together for Carers” was being developed by SCC and the five Staffordshire CCGs. The Strategy set out the statutory duties for both SCC and the NHS under the Care Act 2014, Children and Families Act 2014 and the NHS Constitution.
The Strategy set out seven priorities:
· identifying carers
· improving information, advice and guidance
· staying healthy
· a life outside caring
· assessment and support
· crisis management
· recognition and value
The draft strategy had previously been considered by the H&WB at their meeting of 6 June 2019. A 12 week consultation had been undertaken, with feedback from this process having overwhelmingly supported the seven priorities as sensible, laudable and exactly what SCC and the CCGs should be doing to further enhance the lives of carers across Staffordshire. Comments received from the consultation process had been reflected in the final version of the Strategy, including:
· a review of the carers pathway to ensure a single gateway and an equitable approach;
· a review of the commissioned services for carers to ensure they are able to deliver ambitions set out in the Strategy;
· how to strengthen relationships and joint working with the voluntary and community sector to improve collaborative working.
RESOLVED – That:
a) the Staffordshire Strategy for Carers be endorsed; and
b) the current review of the Carers Pathway and services arrangements be noted.
Jenny Pierpoint, Portfolio Manager
[Becky Wilkinson, Health and Care Partnership Manager, West Midlands Better Care Fund Lead, in attendance for this item.]
In March 2019 the H&WB had noted progress of the Staffordshire BCF during 2017-2019 and had agreed an extension of the current BCF schemes into 2019-2020. At their 6 June 2019 meeting the Board had noted publication of the 2019-2020 BCF Policy Framework and the financial risk presented by the delay in publication of the BCF Planning Requirements. These Requirements were published on 18 July 2019 and gave details of the submission and approvals process, confirming the uplift to the CCG cash transfers, which for Staffordshire would be 5.3%. As this represented an additional pressure to CCG budgets, additional funding was being made available to CCGs.
The Board received details of the 2019-2020 BCF Pooled Fund and inclusions in the Plan which, in line with national and regional guidance, would largely be a rollover of the 2017-2019 Staffordshire BCF Plan.
The 2019-2020 Plan had been agreed by the Joint Commissioning Board and would be approved by the CCG Governing Bodies. At their 2019 March meeting the H&WB had delegated sign off for the BCF Plan to the Co-Chairs. Members now heard that the Plan would be submitted no later than 27 September. A simplified assurance process was now in place, with regional moderation through a joint NHS and local government process.
The Board was made aware of continued difficulties in gaining agreement over the pooled funding. However, assurances were given that agreement with the CCGs was expected within the week. As such the Board would be unable to confirm the funding for 2019/20 as set out in recommendation a).
RESOLVED – That:
a) confirmation of funding for the 2019-2020 Staffordshire BCF (as set out in paragraph 5 of the report) be delegated to the Co-Chairs once agreement with the CCGs and NHS England has been achieved, and that the Board be notified once this has been achieved;
b) content of the 2019-2020 Staffordshire BCF Plan be noted;
c) delegated authority to sign off and submit the BCF Plan to the Co-Chairs be confirmed; and
d) the submission and assurance timescales for 2019-2020 (as set out in paragraph 14 of the report) be noted.
Simon Whitehouse, STP Director
A 12 week listening exercise had been undertaken by the Together We’re Better Partnership seeking views on health and care services in Staffordshire and Stoke-on-Trent. This was the start of a formal involvement process to gather local experiences and views, particularly focused on areas highlighted in the Case for Change that may require significant transformation. Healthwatch had also undertaken engagement work.
Feedback from both exercises would be reported during Autumn 2019. Key themes were already being shared with the partnership’s work programmes to help inform the development of the Pre-Consultation Business Care and the Five Year Plan. It was anticipated that work programmes would produce their long list of options by the Autumn, based on data analysis, clinical feedback and information gathered during the listening exercise. Programmes would then follow a best practice approach to develop a short list of options to be included in the Pre Consultation Business Case.
This was a system plan which required commitment from all organisations in the health and care system to act as one, unifying systems to become more efficient, nimble and responsive, focusing on a preventative agenda.
RESOLVED – That the approach to developing the Five Year System Plan be supported.
The H&WB noted their Forward Plan, and the addition of the following items for their December meeting:
· Commissioning intensions;
· Population health management;
· Early Years Strategy;
· Staffordshire and Stoke-on-Trent Local Transformation Plan;
· Adult Safeguarding Annual report;
· SEND Strategy;
· Supportive Communities Delivery Plan; and,
· End of Life Public Conversation Progress report.
RESOLVED – That the additions to the work programme be noted.