Agenda and minutes

There were none at this meeting.

RESOLVED – That the minutes of the Health and Wellbeing Board meeting held on 7 September 2017 be confirmed and signed by the Chairman.

The following question has been submitted by Mr Ashok Kumar:

How many people can science and medicine keep alive on a planet which has only a limited amount of resources and time? Moreover, is science and medicine also part of the limited amount of resources and time?

One question had been received by the Board from Mr A Kumar:

“How many people can science and medicine keep alive on a planet which has only a limited amount of resources and time? Moreover, is science and medicine also part of the limited amount of resources and time?”

Mr Kumar went on to share his views with the Board that there was a need to accept death as positive and that medicine was not the answer to all.

The Board explained to Mr Kumar their work around End of Life, including the recent Director of Public Health’s Annual Report and the Public Conversation which was due to be held in the New Year. The issues were around ensuring a quality of life in good health and enabling a good death. The Board agreed that the world had finite resources and that the best way to reduce the birth rate was through education. They also acknowledged the moral question concerning many developed countries in continuing life through medical intervention.

Richard Harling, Director for Health and Care

Suicide prevention is a key public health issue. The Staffordshire Suicide Prevention Strategy had been developed in 2015 and focused on a number of issues, including: reducing the risk of suicide in key high risk groups; tailored approaches to improve mental health; reducing the means of suicide; supporting the bereaved ; and research, data collection and monitoring.

A new suicide prevention action plan for Staffordshire and Stoke-on-Trent was being developed and the Board received details of planned activities within this.

Board Members asked for clarification on the following:

·         the report referred to the “myths” around suicide and Board Members asked what these were;

·         the percentage of those who self harm who then go on to commit suicide as opposed to those who successfully commit suicide who have self harmed (anecdotally the figure for those who were successful in committing suicide and had self harmed was very high); and

·         the percentage of successful suicides victims who had been receiving mental health services (this data was not currently available from the Coroner, however work was being undertaken through Staffordshire and Shropshire Prevent to access this information).

Members also asked that the triggers for suicide should be identified as well as the impact suicides had on the individual’s family, friends and community. Whilst acknowledging the limited resources available the Board suggested that a review of support should be undertaken where a successful suicide has taken place, in a similar way to the review undertaken in cases of domestic homicide.

RESOLVED – That:

a)    the current planned activity set out in the report be supported and endorsed;

b)    the further areas for consideration listed above be included in the action plan;

c)    Board Members champion the importance of suicide prevention and support the “zero tolerance” approach across Staffordshire.

Jane Tipping, Head of Mental Health Commissioning and Roger Graham, CAMHS Commissioner, South Staffs CCGs

NHS England required Clinical Commissioning Groups (CCGs) to submit a refreshed version of the Local Transformation Plan (LTP) for the development of Child and Adolescent Mental Health Services (CAMHS) within their localities. This was undertaken annually and had to include verification that the H&WB had signed-off the final submission.

Members felt they would like further detail on the Plan to ensure it was outcome rather than services focused and asked that it be brought to the March meeting to enable this clarification.

RESOLVED – That the updated Local Transformation Plan be brought to the March 2018 H&WB meeting.

Jon Topham, Senior Commissioning Manager

In accordance with the 2012 Health and Social Care Act the H&WB has a duty to produce a Health and Wellbeing Strategy which takes account of the Joint Strategic Needs Assessment. The current Strategy would end in 2018 and the Board now considered the new Strategy for 2018-2023.

The new Strategy reflected on what had been achieved through the 2013-2018 Living Well Strategy, reiterated the role of the H&WB, gave a summary of the key health and care issues that affect Staffordshire and set out the new approach, which focused on extending healthy life.

The Board felt that the Strategy should have a strategic rather than a tactical approach so that it would have greater influence over the health and wellbeing of Staffordshire residents. Members also noted the work of the Families Strategic Partnership which had been established two years ago to address the Board’s concerns in moving work forward with partners around children and young people.

Members felt there was a need to reflect on the Board’s constitution, and in particular consider whether providers should be included on the Board Membership. Whilst this had been a consideration previously no change had been made as it had been hoped that the Stoke-on-Trent H&WB would merge with the Staffordshire H&WB to prevent duplication and ensure closer working with partners across the two authorities.

Members also discussed the role of the Staffordshire Transformation Plan (STP), whether there was too much duplication and overlap with the H&WB and if the two bodies should be brought together. Whilst there was much overlap there was also a role for both, with the H&WB having a more holistic and preventative approach which considered a broader range of factors influencing health and wellbeing, including employment, housing and education (wider than health determinants). NHS England directed the STP around a medical agenda which could dilute the preventative work that is sees as the core H&WB role.

There was a need for greater alignment across strategies and organisations such as the STP, LEP and the two Staffordshire based H&WB. It was noted that the recent CQC report on the Stoke on Trent H&WB highlighted the need for closer and more collaborative working. Members suggested that a recommendation be made to request the Stoke on Trent and Staffordshire STP strive towards closer working between the two H&WBs and the STP.

RESOLVED – That:

a)    the Staffordshire H&WB strive for closer working with the Stoke on Trent H&WB and the Staffordshire STP, and that this is discussed further at a joint workshop;

b)    the focus of the new Strategy be on extending healthy life expectancy; and,

c)    CCGs and partners be written to as part of the new Strategy consultation, and that this consultation also be used to promote closer working between the STP and the two H&WBs.

Richard Harling, Director for Health and Care

The Board received details of the Director of Public Health (DPH) report for 2017/18 considering the use of technology to improve health, well-being and care. The Board supported this as the topic for the DPH report, however they asked that consideration be given to the following:

·         how to avoid a two tier system of care/opportunities between those who had access to and were IT literate and those who were not;

·         how to avoid self diagnosis and the possible build up of symptoms that may not be picked up appropriately;

·         adequate record keeping and how to build in regulation;

·         identifying issues and how IT could help tackle these rather than looking at the IT available and finding a use for it; and

·         the breadth of opportunities available and not limiting the vehicles by which technology can now be accessed, eg through the television.

RESOLVED – That:

a)    the use of technology to improve health and wellbeing and care  be endorsed as the topic for the DPH report 2017/18; and

b)     the areas highlighted above be considered as part of the report.

Richard Harling, Director for Health and Care

The Health in All Policies (HiAP) had previously been considered by the H&WB at their meetings of 9 March and 8 June 2017. The Board now received an update on the development of HiAP.

Members heard that the HiAP workshop had been well received with each authority now developing their own HiAP Strategy. These Strategies would be shared at a future date to help maintain momentum. A HiAP Steering Group was being established to develop this work.

RESOLVED- That:

a)    the developments within the HiAP agenda be noted;

b)    the Board continues to support and endorse HiAP in Staffordshire; and

c)    the Board continue to engage with the developing HiAP programme of work.

Richard Harling, Director for Health and Care

Following the Government’s publication of the Clean Air Strategy an initial appraisal of Staffordshire air quality was undertaken. The H&WB received a summary of options for activity to help support the Clean Air Strategy and considered four recommendations:

Recommendation 1 – Develop a partnership agreement between Staffordshire County Council, Stoke-on-Trent City Council and the eight District/Borough Councils across Staffordshire to improve air quality.

·         the Board agreed to send a letter to all Chief Executives asking all authorities work in partnership to deliver the best possible outcomes across Staffordshire and Stoke-on-Trent; and

·         each Board member will consider their own organisation’s responsibilities towards air quality.

Members noted that the Pollution Control Officer would also be working towards this in each local authority.

Recommendation 2 – Develop a strategy/action plan for local implementation from October 2018 (informed by a detailed options appraisal)

·         the Board will assist in prioritising actions following details of the option appraisal which was expected to be brought to the Board in Spring 2018;

·         air quality will be considered as part of the HiAP agenda; and

·         each local authority to develop and implement their own Air Quality Strategy.

Members noted that some local authorities had already developed a strategy.

Recommendation 3 – Develop a communications plan for engaging and communicating with the public on air pollution across Staffordshire and Stoke-on-Trent. In addition the communications plan should include business and commerce.

·         once the Air Quality Communications Plan had been developed H&WB Members would be asked to use this within their own organisations.

Recommendation 4 – Bid for any appropriate Air Quality Grants as they became available. For example Defra Air Quality Grant 2017/18 announced in November 2017.

·         a partnership bid was being developed with the additional support of the Staffordshire Air Quality Forum for submission by the December 2017 deadlines;

·         any grant submissions to have H&WB delegated authority from the joint Chairmen for sign off.

The Board accepted the recommendations.

RESOLVED- That:

a)    an Air Quality partnership agreement be developed between Staffordshire County Council, Stoke-on-Trent City Council and the eight District Councils across Staffordshire;

b)    an action plan for local implementation from October 2018 be developed, being informed by the options appraisal;

c)    a communications plan be developed for engaging both the general public and business and commerce around issues of air pollution;  and,

d)    that bids be made for any appropriate Air Quality Grants as they become available with delegated authority to sign bids off on behalf of the Board being given to the joint Chairmen.

The following items were included on the H&WB agenda for information only:

·         Staffordshire Better Care Fund – this had been approved with conditions and the Co-Chair, Alan White, wished to record his gratitude for the hard work and close working relationships which had enabled approval to be reached, and specifically to Dr Ricard Harling, Director of Care and Health and Dr Marcus Warnes, North Staffs CCG.

·         OFSTED – Report on Children’s Services  - which had been commended good overall with areas for improvement.

·         Anti-Microbial Resistance (AMR)

·         Staffordshire & Stoke-on-Trent Adult Safeguarding Partnership Board Annual Report

·         JSNA Outcomes Report – Members asked that in future this paper clearly highlights the areas of new information included in the report.

·         Update on Burton/Derby Merger and Plans for the Community Hospitals

In considering the Forward Plan the Board noted the following items scheduled for their December meeting:

Items for Decision:-

·         HWBB Strategy

·         Local Transformation Plan for Children and Young People’s Mental Health Services

Items for Debate:-

·         CCG/SCC Commissioning Intentions

·         District Delivery Plans

·         SCC Strategy

·         STP/BCF

·         Annual Report of the Director of Public Health

·         Place Based Approach

Items for Information:-

·         JSNA

It was agreed not to include an item on the Burton/Derby proposed merger at the March meeting.

RESOLVED – That the Forward Plan be agreed.