Agenda and minutes

There were none received.

The first names of Dr Paddy Hannigan, Dean Stevens and Helen Coombes should have been included in the minutes. It was noted that Paula Furnival, Programme Director and Amanda Stringer, Programme Manager were in attendance at the meeting held on the 10 September 2015.

It was RESOLVED that subject to the above amendments the minutes of the meeting held on the 10 September 2015 be confirmed and signed by the Chairman.

The following questions from Sandra Payne, Operations Manager South, Support Staffordshire, on behalf of Action on Hearing Loss, were tabled at the meeting;

What action will the Health and Wellbeing Board take following the 8 October county council motion against hearing aid cuts, which came about after nearly 6,000 Staffordshire residents signed a petition opposing cuts? What discussions have been had with the Healthy Staffordshire Select Committee following its hearing aid working group held on 25 November?

In the discussion that followed it was confirmed that;

·         The hearing aid consultation was in abeyance.

·         North Staffordshire CCG had been implementing their Hearing Aid policy from the 1 September 2015.

·         The CCG Prioritisation Process was being reviewed.

It was confirmed that the second question had been shared with the Chair of the Healthy Staffordshire Select Committee for a response.

It was RESOLVED that the Board would receive information regarding the CCGs Prioritisation Process after consideration by the Collaborative Commissioning Congress.  

Chair

Dr Charles Pidsley (Chair) introduced the report and noted the personnel changes on the Board and suggested that inviting Rita Symons, Staffordshire Transformation Director to become a Member of the Board would be positive as she would provide clear insight into the work of the Collaborative Commissioning Congress.

In the discussion that followed it was suggested that NHS England be contacted regarding their attendance at Board meetings as there had been a change of personnel and the regional representative could now be in a position to attend.

It was RESOLVED that the Board;

·         Approve the appointment of Rita Symons as the Staffordshire Transformation Director to the Staffordshire Health and Wellbeing Board.

·         Note the changes to the titles and responsibilities of the County Council senior officer representatives on the Board.

·         Write to Ken Deacon, NHS England, to ensure a representative attend the Board from NHS England in his absence. 

Shelia Crosbie, North Staffs CCG Commissioning Manager and Roger Graham, CCG Commissioning Manager,Children, Young People (Non-acute services), East Staffordshire

Sheila Crosbie, Commissioning Lead for Children, North Staffordshire Clinical Commissioning Group welcomed the opportunity to discuss the Local Transformation Plan for Child and Adolescent Mental Health (CAMH). She referred to national concerns, with a Mental Health Taskforce and a Parliamentary Inquiry focussed on CAMH. Pressures on Tier 4 in-patient services, which were the responsibility of NHS England were recognised. CAMH was now a government priority and resources had been made available. Allocations had been based on weighted populations but to secure this funding a Local Transformation Plan had had to be provided. Guidance was published in August 2015 and by the end of October 2015 the Plan had to be submitted to NHS England Specialised Commissioning. Prior to this, the plan required sign off from the CCG Accountable Officers and the Stoke on Trent and the Staffordshire Health and Wellbeing Boards. Due to time constraints it was agreed that this would be done via Chairs Action and Dr Charles Pidsley has signed the plan on behalf of the Board. The focus of the plan was around reducing pressure on in-patient access. On the 26 October 2015 confirmation was received that the plan had been approved and that funding would be released to the individual CCGs. Feedback was that some minor modifications/clarifications were required to the narrative. The Plan was based on national priorities, as listed in the report. Across Staffordshire £1.5 million of funding had been received for 2016/17. This would be received recurrently for five years and included in CCG baselines. In terms of governance the intension was to build on existing groups rather than create a new structure but a pan Staffordshire Strategic Board for Child and Adolescent Mental Health Services (CAMHS) had not existed previously. An implementation group including commissioners and providers would also meet. It was a pan-Staffordshire Plan, aligned to the existing strategies for Stoke on Trent and Staffordshire. A central referral hub had been introduced in the summer of 2015 and capacity would be increased. The target was to ensure access to an initial appointment within four weeks by June 2016. This would be a considerable improvement on the current position. In the north of Staffordshire schemes would be provided by North Staffordshire Combined Healthcare Trust and in the south, South Staffordshire and Shropshire Healthcare NHS Foundation Trust.

Roger Graham, CCG Commissioning Manager Children and Young People, South Staffordshire Clinical Commissioning Groups, referred to the specific allocation for eating disorder. Intensive outreach was a priority area with the ambition of reducing Tier 4 admissions. The focus was on supporting people at home. Tier 3 Plus would be strengthened. A Participation Officer in the South would work with young people to find out how they wanted to be communicated with. A proportion of funding would be used to add to capacity at Tier 2, which had been commissioned by local authorities and provided by third sector providers. It was acknowledged that the momentum around early intervention had been lost in 2010 with reductions in CAMHS  ...  view the full minutes text for item 102.

Chris Weiner, Interim Director of Health and Care and Kate Waterhouse, Head of Insight, Planning and Performance

Chris Weiner, Interim Director for Health and Care, introduced the Intelligence Group Update which included a summary of the quarterly performance and outcomes report, detailed analysis on outcomes that were initially identified by the prioritisation process, the focus of the first deep dive - healthy lifestyles and diabetes prevention, evaluation of the CCG commissioning intensions and assessment of the mental health and alcohol and drugs strategies.

It was RESOLVED that the Board note and approve the recommendations within the reports presented as part of the Health and Wellbeing Board Intelligence Group update.

Chris Weiner introduced the performance and outcomes report which brought together key outcome measures from the national outcomes frameworks for the NHS, adult social care and public health.

In the discussion that followed;

·         It was commented that the shift to the left and patient and user experience was not included. It was confirmed that some financial modelling had been undertaken for the Collaborative Commissioning Congress and that patient experience could be used to bring information to life although there was not one way to measure this.

·         It was acknowledged that the Feel the Difference survey asked a number of questions about people’s views on health and social care in Staffordshire and there was not one performance measure that could be provided. Information gathered was fed to relevant services.

·         It was suggested that where information on user experience was gathered this could be mapped to develop measures to inform the Health and Wellbeing Board.

·         It was put forward that the Board should focus on areas that it could influence and drive improvement where performance was getting worse, for example breast feeding rates.

·         It was suggested that Board Members take the data away from the meeting and ask what their organisation was doing to address areas of worsening performance.

·         It was identified that in some areas interventions had not made a big difference and that sometimes one professional, for example a pro-active midwife, could make all the difference.

·         It was suggested that performance in relation eating disorders and waiting times for CAMHS could be included in future reporting to the Board and confirmed that this would be picked up for the next meeting.

It was RESOLVED that the Board note the information contained within the health and wellbeing outcomes and performance summary report for Staffordshire – November 2015.

Chris Weiner introduced the report which focussed on diabetes prevention. Performance against healthy lifestyle indicators such as excess weight, inactivity and healthy eating was not going in the right direction and although there had been a decline in mortality rates there had not been a decline in the levels of ill health. Ninety four percent of people in Staffordshire had at least one lifestyle risk indicator. Smoking remained a significant risk factor but an unhealthy diet had now taken the lead. There remained a gap between what was known and what was known about what works. Over two thirds of people were over weight or obese and only half of people took sufficient exercise. To make a one percent improvement, services would need to reach out to thirty seven thousand people. Intervention would have to be delivered on a sufficient scale to have an impact.  Performance data indicated inequalities in the care and treatment for diabetic patients across Staffordshire and Stoke on Trent. Children were starting school overweight. The system was highly complex and whole system change was required. There was a need to align policies, decide where to focus attention and consider how to implement policies that would be effective at scale. Some groups remained at higher risk of diabetes and it was important to engage with them. It was essential to recognise the scale of the problem and if this was addressed it would have a huge impact on the people of Staffordshire by improving health and wellbeing outcomes and creating a system which could drive down future cost.

In the conversation that followed;

·         It was confirmed that Type 2 diabetes was reversible in some circumstances. For example diabetes could ne reversed in certain patients with high levels of obesity who had bariatric surgery. In less severe Type 2 cases, a better diet and exercise could reverse the situation.

·         It was suggested that £200m would be better spent on diets and gym membership than on drugs.

·         It was emphasised that the environment had to change to force people to take more exercise and to make access to unhealthy foods more difficult.

·         The important role of education programmes in schools and in the community was referred to.

·         It was agreed that local authorities had a role to play but that central government also had a responsibility. It was suggested that the District and Borough Councils make representations that the Licensing Act should be amended to include health and wellbeing considerations, as in Scotland. It was later clarified that District and Boroughs had raised this issue in the past and there was the option to consult Public Health in licensing discussions.

·         It was acknowledged that there was not one way to address the problem but to make an impact collective action was required. An example of an entire US city going on a diet was referred to.

·         An example of work being undertaken in the East Midlands where by employers had signed a responsibility deal with Public Health was referred  ...  view the full minutes text for item 103b

Paula Furnival, Health and Wellbeing Board Programme Director introduced the report which provided a collective summary of the assessment of CCG Commissioning/Operational Plans 2015. It was confirmed that each CCG had received individual feedback and strengths and opportunities had been identified. The authors of strategies and plans had been offered pointers around greater alignment for future action/development. Use of the evidence contained in the Joint Strategic Needs Assessment and alignment with the Living Well in Staffordshire Strategy had been considered. It was commented that all CCGs were facing massive challenge and noted that since the plans were written a number of changes had taken place with greater collaborative working between the CCGs through the Collaborative Commissioning Congress. Plans going forward would have a greater focus on prevention and care closer to the person and the Board would wish to see evaluation by patients, user feedback and models of care shaped by stakeholders.

In the conversation that followed, it was commented that;

·         There was a lot of learning from the assessment and it was hoped that the CCGs would take this into account.

·         Learning needed to be included in the system and reported back to the Collaborative Commissioning Congress and demonstrated in the Case for Change

It was RESOLVED that the Board;

• Note the plans that had been reviewed and endorse the improvements required and outlined as opportunities.
• That the draft Case for Change be considered by the Board. 

A report on the review of the Drug and Alcohol strategy as part of the alignment of commissioning strategies to the Living Well in Staffordshire was referred to.

It was commented that;

·         There was a good level of evidence of how the Joint Strategic Needs Assessment fed into the strategy but less evidence of patient engagement. 

·         There was a clearly outlined approach to recovery and asset based community development.

·         The strategy was clear in its intent with a focus on shifting to prevention, early help and recovery (after treatment).

·         There was an opportunity to share learning with other strategic leads.

·         Whilst there was strong integrated working with the CCGs and the local authority there was an opportunity to further align the strategy with the police.

·         Overall the strategy was positive.

It was RESOLVED that the Board;

·         Commend the development of the Strategy and the work involved in taking an approach across the whole system.

·         Further evaluate the progress of the development of the strategy and its delivery plans in a cycle of outcomes reporting to the Board.

·         Endorse the approach to the evaluation taken by the Intelligence Group. 

The Board received a report detailing the assessment of the alignment of the Mental Health is Everybody’s Business strategy to the Living Well Strategy.

In the discussion it was commented that;

·         Having a separate strategy and stand alone delivery for adult mental health was an opportunity.

·         There was a lot of alignment and co-working but budgets were not yet pooled, although there was a joint commissioning team for mental health.

·         Engaging Communities had undertaken community engagement to feed into the Mental Health Strategy. A report could be provided to the Health and Wellbeing Board if requested.

·         Nervousness was expressed about whether or not the opportunities that had been identified would be taken forward and it was commented that the Collaborative Commissioning Congress could support this process.

It was RESOLVED that the Board;

·         Commend the development of the Mental Health Is Everybody’s Business strategy and the work involved in gaining sign up and ownership of the approach across the whole system.

·         Monitor and evaluate the opportunities achieved in the regular performance oversight, with a detailed progress report to be reported in six months time.

·         Endorse the approach to evaluation by the Intelligence Hub. 

REPORT TO FOLLOW

Alan White, Co-Chair and Cabinet Member for Health, Care and Wellbeing, Helen Coombes, Head of Care and Interim Head of DASS and Marcus Warnes, Accountable Officer, North Staffordshire CCG

Alan White, Co-Chair of the Board and Cabinet Member for Health, Care and Wellbeing introduced the item, highlighting that there was more work to be undertaken and that the Better Care Fund (BCF) would continue for future years.

Helen Coombes, Head of Care and Interim Director of Adult Social Services, Staffordshire County Council, explained that a stocktake exercise was being undertaken to ensure that the lessons learnt from the current year could be taken forward into the plan for 2016/17. Data showed that performance around non elective admissions was within the plan’s expectations. Twenty percent of the fund was dependent on this. In terms of Accident and Emergency attendances, there had been a slight reduction over the summer months however this was to be expected. Although the rate of social care assessments of new clients had fallen, the level of reduction required to achieve the planned figure had not been met as a result of the implementation of the Care Act 2014, which had broadened the criteria for assessment of needs. Admissions of older people (aged 65 and over) to residential and nursing care remained low compared to elsewhere in the West Midlands however seasonal fluctuations would lead to increases later in the year. Work was being undertaken to ensure consistent reporting of delayed discharge from hospital to reablement/rehabilitation services, with two workshops being held. The BCF would continue going forward and national guidance was awaited. It was anticipated that the BCF would need to become less bureaucratic and that the Health and Wellbeing Board would have a pivotal role in driving forward integration. Final sign off would take place on 11 April 2016.

In the discussion that followed that following points were made;

·         The process had commenced in November 2013. It was hoped that the Department of Communities and Local Government and the Department of Health would align.

·         The announcement of an additional £500m was referred to and it was confirmed that a small amount would be available in 2017/18 and that this would scale up in 2019/20.

·         It was queried if the District and Borough Councils would be allocated the same Disabled Facilities Grant as the previous year as there were concerns that potentially there could be an increase in the number of delayed discharges of care as adaptations could not be made. It was acknowledged that as soon as the allocations were known the District/Borough would be informed.

·         The outcomes of the BCF were queried and work to develop Staffordshire Cares was referred to.

·         It was suggested that if there were seasonal variations in performance that were anticipated then these should be included in the BCF.

In was RESOLVED that the Board consider the future direction of the Better Care Fund in more detail.

REPORT TO BE TABLED

Alan White, Co-Chair and Cabinet Member for Health, Care and Wellbeing

Alan White provided an update to the Committee and explained that Health and Social Care was a key part of the Autumn Statement with £10 billion allocated over a five year period with £6 billion to be provided in the first year. £22 billion in efficiency savings was expected from the NHS. An additional £600 million would be available for mental health and £1.5 billion through the BCF. Local authorities had been given permission to raise and additional 2 percent in Council Tax, which would be ring fenced to support health and social care. There were efficiency savings to be made of 6.2 percent in public health each year which could make the shift to the left more challenging. Services had to work more creatively and do things differently to make the savings required. £1 billion would be invested in technological improvements and £5 billion in health research and development. Patients would have to be referred or given the all clear from cancer within four weeks and there would have to be investment in diagnosis. £1.5 billion would need to be achieved by the BCF by 2019 however overall there would be a real term decrease. The government would not determine what health and social care integration should look like but would highlight models that worked. Plans had to be submitted by April 2017, however Staffordshire was already underway with this and ahead of other areas, with the development of the Collaborative Commissioning Congress. In response to questioning it was confirmed that the Council’s medium term financial strategy had been published and a decision would be made in February 2015.

TO BE TABLED

Paula Furnival, Health and Wellbeing Programme Director and Amanda Stringer, Health and Wellbeing Programme Manager

Paula Furnival provided an update to the Board on future items. It was confirmed that workshop sessions would be held in January and February. The next public meeting of the Board would take place on the 10 March and include consideration of the BCF submission and the Staffordshire Families Strategic Partnership Update.

John Wood, Independent Chair of Staffordshire and Stoke on Trent Adult Safeguarding Partnership Board took the opportunity to introduce himself to the Health and Wellbeing Board.

In the discussion that followed;

·         It was confirmed that the number of referrals had increased and it was thought that this was a result of greater awareness raising and training which had encouraged reporting. He undertook to consider this in more detail.

·         The Multi Agency Safeguarding Hub (MASH) in Staffordshire was an example of best practice and was visited by local authorities from elsewhere, however representatives from the Staffordshire MASH were also in regular liaison with colleagues outside the area, enabling learning from elsewhere to be shared. If an issue arose information could be shared very quickly.

·         Current issues included problems with Care Homes as some did not have the best business models and the introduction of the National Living Wage would create pressures. There had also been an increase in the number of the Deprivations of Liberty referrals as the definition had changed which had resulted in a backlog.

·         It was confirmed that the Cabinet Member for Health, Care and Wellbeing was in regular dialogue with the Association of Care Home Providers and was keen to see the evidence behind the concerns raised.

·         Nationally there was no evidence to demonstrate the link between the cost of care and the quality of care. The vast amount of issues were in relation to quality rather than safeguarding.

·         There were increasing amounts of family abuse.

·         Modern slavery was taking place in Staffordshire. This included forced labour and adult exploitation and there were signs that this could be an issue going forward.