Agenda and minutes

Apologies for inability to attend the meeting were received from Dr Lise Lewellyn and Lady Emma Stevens. Lesley Wyman represented Public Health on behalf of Lise Llewellyn and Adrian Barker represented Healthwatch on behalf of Emma Stevens.

The Minutes of the meeting held on 25April 2013 were approved as a true record and signed by the Chairman.

There were no public questions submitted relating to items on this agenda.

Councillor Graham Jones welcomed Jo Hawthorne to the meeting, who would give a presentation to the Board on the Joint Strategic Needs Assessment (JSNA). Jo Hawthorne reported that she was leading on the development of the JSNA and the new proposed model for Berkshire.

JSNAs became a strategic requirement in 2007 and one had first been introduced in West Berkshire in 2011/12. West Berkshire now had the opportunity to refresh and restyle their JSNA. . It was reported that the current document was not user friendly. It was clinically focused and in areas very complex.

The Vision for West Berkshire was to scope a JSNA that had the ability to:

•          Be accessible and web based

•          Provide relevant, easy to disseminate data

•          Tell the local story

•          Use Ward data as a tool to plan for localised services, and:

•          Provide key stakeholders with data for commissioning intentions.

Jo Hawthorne had viewed numerous examples of JSNAs around the country when undergoing her research and although she had viewed some excellent ones, many of these had been costly to produce. One particular style of JSNA which was very clear and user friendly was the Bedford Model. Jo Hawthorne encouraged Board Members to view the model online and feed their thoughts back to her. In her opinion the Bedford Model was excellent at portraying the local story to the reader, by listing the wards and then giving a snapshot of information which pertaining to areas including health and wellbeing, housing, children and young people and transport. The script was supported by data. Jo Hawthorne explained that she particularly liked that the Bedford Model focused on particular conditions such as sexual health, providing information on what the current situation was and what needed to happen next including links to the Health and Wellbeing Strategy.

Jo Hawthorne confirmed that agreement by the Board was required on the Vision for the new JSNA, so that she could move forward with the redesign process for Berkshire.

Dr Catherine Kelly asked whether the new version would allow data to be broken down by area so that each CCG in a sense could have their own JSNA. Jo Hawthorne confirmed that it was difficult to give an answer to this, as this was something the data team were currently working on. Dr Kelly stressed how important this was.

Councillor Graham Pask asked if the information could be broken down by ward and if this information was currently available. Jo Hawthorne confirmed that this was available for some data, however, added the caveat that the more data was broken down the less statistically reliable it became because of smaller numbers. Councillor Pask also stated that it was important to ensure there were links from the JSNA to relevant websites and to refrain from using too much jargon. Jo Hawthorne confirmed that language was a challenge and her team aimed to make it as user friendly as possible.

Rachael Wardell highlighted that this was an excellent  ...  view the full minutes text for item 15.

Sean Murphy reported that his presentation to the Board would look at how closely Trading Standards and Public Health linked together. Trading Standards had worked very closely with Public Health over the past five years.

Trading Standards worked to the National Intelligence model of delivery. Its Service Plan was broken down into areas of prevention, intelligence and enforcement. There were specific areas of work which fell within the Public Health remit and would contribute towards targets within the Health and Wellbeing Strategy.

Trading Standards were responsible for many areas of the food chain, for example they had recently been included in activity pertaining to the horse meat scandal.

The service carried out much work to ensure high quality standards were met on food however, work still needed to take place to ensure people fully understood food labels.

Trading Standards supported numerous healthy eating programmes within schools, which helped to tackle childhood obesity in the district. A popular programme involved helping young people to prepare nutritious snacks. Many of the health eating initiatives targeted those in need such as low income families and were well received by the Food Standards Agency.

Trading Standards worked with retailers to help ensure healthy options were offered as part of menus through offering training and an award incentive scheme. A food hygiene course had been run for many years, however, Sean Murphy reported that the damage caused through unhealthy food was much more significant.

The approach to healthy eating was changing. The Government were pushing for the food industry to change as a whole and for this to be initiated at a local level by Local Authorities in order to improve standards.

Sean Murphy moved onto the next priority under the Health and Wellbeing Strategy ‘Supporting those over 40 years old to address lifestyle choices detrimental to health’, which also fell within the remit of Trading Standards. Much work was carried out around the smuggling of tobacco, as schemes to reduce smoking by increasing the price of cigarettes were undermined by this. A lot of smuggled alcohol had also been seized in the past. The main issue currently being tackled by Trading Standards was ‘legal highs’ (drugs that could be obtained from the internet for example), these were regularly banned however, new ones were created as quickly as the bans were implemented.

Sean Murphy reported that debt had huge implications on a person’s mental health and Trading Standards were currently undertaking a large project with the credit union which included identifying organisations which were miss selling loans.

Sean Murphy reported that Trading Standards worked to promote independence. It was important that care homes provided the correct nutritional standards so that elderly people were not receiving too little or alternatively too high a level of salt and calories. Crime was considered a major barrier to independence. Trends supported that there was an ageing population and it was the elderly who often became isolated and primarily the victims of crime.

Sean Murphy referred to the Trading Standards  ...  view the full minutes text for item 16.

Rachael Wardell reported that she had received a letter asking that the Health and Wellbeing Board sign up to a Charter in the respect of disabled children.

The Board supported the aspirations of the Disabled Children’s Charter. If the Board signed up to the Charter it would have to adhere to its reporting cycle. With this in mind Rachael Wardell asked to what extent the Board would want to evidence it was complying with the Charter, as it was highly unlikely that this would be the last letter it would receive requesting its sign up.

Councillor Graham Jones stated that he could see no problem with the Board signing up to the principle of the Charter, however, was concerned the Board would receive more letters of similar nature. A protocol was required to deal with similar documents in the future

Adrian Barker agreed with Councillor Jones and fully supported the principles of the document but could see the possible risk in signing up to it. He proposed that they look at a range of vulnerable groups and then assess how the Board would take their needs into account. He suggested that Healthwatch put a paper together and bring it back to a future meeting of the Board.

Councillor Jones supported Adrian Barkers suggestion that Healthwatch lead on producing a paper which detailed how to address the needs of vulnerable groups collectively.

RESOLVED that: Healthwatch liaise with colleagues in Strategic Support and Councillor Jones to create a protocol on behalf of the Board, detailing how to deal with vulnerable groups in the future.

Lesley Wyman introduced her presentation to the Board on tackling type two diabetes in West Berkshire. Joint working was taking place between the Local Authority and the Clinical Commissioning Groups however, areas of work were needed to promote this. Lesley Wyman proposed that type two diabetes was an area where the Board could positively demonstrate joint working and was aligned to the Health and Wellbeing Strategy. A piece of work was required which established how large an issue type two diabetes was in West Berkshire.

The priority within the Health and Wellbeing Board Strategy which gave focus to type two diabetes was:

Supporting those over 40 years old to address lifestyle choices detrimental to health

In order to help prevent diabetes and assist early identification of the disease there were a number of areas that could be focused on such as increasing health checks to help identify early cases of diabetes; promoting healthy eating to reduce obesity, one of the largest risk factors in developing diabetes; promoting and supporting work places supported healthy lifestyles and ensuring services were accessible to those living in rural locations as people with diabetes as well as the elderly were at risk of becoming isolated.

Lesley Wyman referred to a slide which illustrated the estimated total (diagnosed and undiagnosed) diabetes prevalence in adults in WB (PHE). Much work had been carried out with the Public Health Observatories and Public Health England in studying the prevalence of diabetes in different areas. Figures showed that in 2012 the estimated prevalence of diabetes in West Berkshire was 6.5%. Lesley Wyman highlighted that these were just estimates and therefore were adjusted by age, sex, ethnic group and deprivation pattern of the local population

Although figures in West Berkshire were lower that the England average, they were still predicted to rise and could be as high as 7.5% by 2025.

Lesley Wyman continued to the next slide which looked at the Quality Outcomes Framework figures (QOF) for 2011/12. She reported that the number of patients on the diabetes register had risen to just below 5000 from 4829 (2011/12) across the 14 GP practices. Prevalence ranged from 3.1% to 4.9% with an average of 4.1%. It was suspected that there were also many people who had developed type two diabetes, but not yet been diagnosed.

Lesley Wyman briefly talked about the complications of diabetes. Those over 45 with type two diabetes were more likely to be admitted to hospital as it was associated with a whole host of other health problems.

It was vital that the JSNA was used to assess what services needed commissioning. Then once commissioned they needed to be monitored and evaluated. In essence three steps needed to be followed:

·         Step 1 – understand the health needs of the population with diabetes.

·         Step 2 – understand what needed to be commissioned as an integrated service.

·         Step 3 – implementation of key services across the care pathway from prevention and early identification through to treatment  ...  view the full minutes text for item 18.

Rachael Wardell introduced a paper which had been circulated with the agenda by Capita on demand and capacity modelling for the Berkshire West health and social care economy. She informed the Board that this work was being carried out by Capita on behalf of West of Berkshire. The aim was to look at the demand on the health system and then look at how this should be managed in future.

Rachael Wardell drew the Boards’ attention to the 17 options which had been suggested by Capita to address the current pressures’ (page 69 of the agenda).

Leila Ferguson referred to option no. 15 which stated ‘Use of third and Voluntary Sector to provide a place of safety in peoples own homes’. Empowering West Berkshire represented over 500 Voluntary and Community Sector (VCS) organisation of various sizes and she asked if this would be a new expectation on each of them. Rachael Wardell confirmed that not every VCS organisation would be involved. Dr Catherine Kelly noted that it showed that those living near West Berkshire Hospital (minor injuries) were more likely to visit this facility than go to A&E however, figures indicated that this service was no more cost effective. It was confirmed that there was not a similar unit to West Berkshire Hospital on the other side of the M4.

Dr Catherine Kelly noted that it showed that those living near West Berkshire Hospital (minor injuries) were more likely to visit this facility than go to A&E however, figures indicated that this service was no more cost effective. It was confirmed that there was not a similar unit to West Berkshire Hospital on the other side of the M4.

Rachael Wardell confirmed that a pioneer programme was being launched as part of the work and areas with pioneer status would be given a lot of assistance. The deadline date for bids to be involved in the Pioneer Programme closed on 28^th June 2013. She felt that West Berkshire could not become a Pioneer area alone however, the West of Berkshire as a whole could bid for the pioneer status.

Councillor Graham Jones noted that this was a fast moving agenda and felt West Berkshire needed to be at the forefront of the work.

Resolved that Councillor Jones and Dr Alex Anderson take the issue forward in consultation with the Board.

Dr Alex Anderson stated that he has asked to have this item on the agenda as it was an opportunity for a piece of work to be carried out in partnership between Health and Social Care. 

The value of carers was estimated of £190 billion per year nationally. Dr Anderson proposed that a Joint Carers Strategy be developed and overseen by the Health and Wellbeing Board.

Rachael Wardell supported the proposal but stated that she would like to investigate what work was already taking place.

Dr Anderson confirmed that a meeting would take place on 4^th July 2013 to discuss taking this going forward. Leila Ferguson felt that it was important that other Carer forums and groups were not reinvented.

RESOLVED that the Health and Wellbeing Board supported the proposal of a Joint Carers Strategy.

Dr Catherine Kelly reported that the 111 Service had been launched and was going well. In Berkshire a phased approach was being taken to implementing the new service to avoid the problems being experienced nationally. The service was being publicly launched in June/July time and NHS would remain in place until then.

Clarification was sought regarding where out of hour calls were directed. Dr Alex Anderson confirmed that the public would now be asked to call the 111 Service when calling the surgery out of hours. When somebody then called the 111 Service they would receive an assessment which would direct them to the most suitable care or advice. The 111 Team were physically located in Bicester.

The Service was monitored daily and so far had reduced the number of contacts with Out of Hours GPs.

Adrian Barker gave the Board an update on Healthwatch in Lady Emma Steven’s Absence.

Healthwatch was still in the early stages however, reasonable progress was being made.  There were five executive directors in place and the first board meeting had recently taken place.

Healthwatch were in the process of setting up their website and social media, including Face Book and Twitter.

It was requested that the following item be added to the work plan for the next meeting in July:

·         Integrated Health and Social Care Management (Rachael Wardell).