Agenda and minutes

To approve as a correct record the Minutes of the meeting of the Board held on 27^th March 2014.

The Minutes of the meeting held on 27^th March were approved as a true and correct record and signed by the Chairman.

To remind Members of the need to record the existence and nature of any Personal, Disclosable Pecuniary or other interests in items on the agenda, in accordance with the Members’ Code of Conduct.

There were no declarations of interest received.

Members of the Executive to answer questions submitted by members of the public in accordance with the Executive Procedure Rules contained in the Council’s Constitution. (Note: There were no questions submitted relating to items not included on this Agenda.)

No public questions were received.

Councillors or Members of the public may present any petition which they have received. These will normally be referred to the appropriate Committee without discussion.

There were no petitions presented to the Board.

Purpose: The Federation of Clinical Commissioning Groups to present a summary of their comments and statement of inclusion.

Phil McNamara introduced his item, which aimed to assure the Health and Wellbeing Board as to the quality of services provided by the Royal Berkshire NHS Foundation Trust (RBFT) and Berkshire Healthcare NHS Foundation Trust (BHFT).

Phil McNamara reported that the Foundation Trusts were duty bound to provide the Quality Account documents. Both RBHT and BHFT were inviting comments from stakeholders as part of the consultation process.

The Clinical Commissioning Groups (CCG) took keen interest in the Quality Account Documents and Debbie Davy (Nurse Director) had studied the documents closey and was satisfied they covered what they were required to.

Phil McNamara drew the Board’s attention to the BHFT Quality Account document and stated that the priorities were for 2014/15 (rather than 2013/14 as stated in the document). Areas included within the document were those the CCG would expect to be included.

Regarding RBFT, Phil McNamara reported that the Quality Account document was at a slightly different level as they were slightly further on in the draft process. The CCG were satisfied with the areas focused upon with the document.

The CCG was satisfied with the level of consultation which had taken place on both documents and the Nurse Director had been fully involved in the early stages. Phil McNamara then asked if there was anything specific in either of the two Quality Account documents the Health and Wellbeing Board would like to comment on.

Councillor Marcus Franks explained that the Health and Wellbeing Board had requested the CCG provide comments on the Quality Account documents. West Berkshire was served by several hospital trusts, whose Quality Account timeframes did not coincide with that of the Health and Wellbeing Board. A further development session for the Board was being set up and would be used to host discussions on how other planning timescales could be incorporated into the work programme for the Board.

Rachael Wardell asked for confirmation on deadlines for both documents and Phil McNamara stated he would check and report back. Councillor Franks stated that one of the consultation deadlines had passed and this illustrated how timeframes were not yet aligned to enable the Board time to comment.

Rachael Wardell highlighted the importance of engaging stakeholders moving forward.

Adrian Barker reported that Healthwatch had commented on the RBFT Quality Account document and had raised numerous questions including why hard copy records were being used rather than moving to an electronic system and also relating to Accident and Emergency Services.

Phil McNamara reiterated the need to move towards a more consistent method of responding in future.

Purpose: Where the Board is now and where it is going next.

(Appendix to the report attached will follow)

(The decision was taken to discuss item 8 before item 7 on the agenda, due to the references to the performance framework under item 8)

Rachael Wardell updated the Health and Wellbeing Board on the development session that took place on 30^th April 2014 and was facilitated by the Local Government Association (LGA). The main body of the report that was circulated with the agenda ‘The West Berkshire Health and Wellbeing Board – Three Years On – A Review’ (on page 25) formed the basis for the development session. It reviewed the progress that had been made over the past three years, drawing on national research conducted by the Kings Fund.

The report reflected on the West Berkshire Health and Wellbeing Board’s position in comparison to other Health and Wellbeing Boards nationally. It found that the West Berkshire Board was in a similar position to that of many Boards nationally and was still on a journey. 

Rachael Wardell reported that the report had been written with the expectation that the Board would move to an Executive Decision Making Model.

An addendum update report had been circulated following the Board’s development session on 30^th April with a purpose of summarising the debate and to agree the next steps. The update report highlighted what had been identified as going well and what had gone less well.

Using the King’s Fund three scenarios, the conclusion reached at the development session was that the West Berkshire Health and Wellbeing Board should be positioned between options one (continue on the current trajectory) and three (an executive decision making body).  Ambitions should move the Board towards option three, without damaging what had been developed so far.

Rachael Wardell asked if the Board were in agreement with the next steps outlined in the update report.

Councillor Graham Pask commended the development session and stated that it had been a very useful event. The West Berkshire Health and Wellbeing Board had been set up with the best intentions and the way forward for the West Berkshire Board was what was important. It needed to be an executive decision making board. It was acknowledged that there had been predominant emphasis on health to date however, wellbeing required further focus. Councillor Pask stated that the Board also needed consider how it should move forward with regards to other bodies such as the Local Strategic Partnership (LSP). Some places in the country had merged their Health and Wellbeing Board and LSPs. The question of whether this approach diluted issues needed to be asked and this needed further discussion with a certain degree of urgency.

Adrian Barker stated that one option that had only been lightly touched on was an option for the Board outside the King’s Fund three scenarios. This could involve the Board being strategic without an executive decision making power. This as an option had not yet been discussed.

Adrian Barker stated that he was hopeful that Healthwatch could be involved in the proposed Management Group that  ...  view the full minutes text for item 6.

Purpose: To agree the 13/14 performance framework and take note of how Health and Wellbeing partners worked to address the five Health and Wellbeing priorities.

Marcus Franks introduced the report to Members on behalf of Lesley Wyman, which was recommending a finalised Health and Wellbeing Performance Framework for 2013/14 for approval.

Councillor Franks reported that the performance framework for 2014/15 would look very similar however, would include the Better Care Fund (BCF).

Section two of the report detailed the five priorities in the Health and Wellbeing Strategy.

Councillor Franks referred to page 17 of the agenda pack, which was the Performance Framework for the Health and Wellbeing Board for 2013/14. There were overarching indicators and then below this local indicators for each priority area. Councillor Franks stressed that Lesley Wyman had experienced difficulties obtaining information from both internal and external colleagues, particularly around agreeing what information needed to be included within the framework.

Councillor Franks went on to talk through each priority area, highlighting some of the local indicators for each.

Reducing Childhood Obesity in Primary School Children

Regarding the number of additional physical activity initiatives commissioned in school and community settings for children - more work was needed in order to map which schools would be involved next.

Supporting those over 40 to change lifestyle behaviours detrimental to health and wellbeing

Councillor Franks reported that the health checks and been a great success. The number of people offered this service had been in line with the benchmark however, there was ambition to do more.

Promoting independence and supporting older people to manage their long term conditions

Councillor Franks remarked that this section was particularly empty due to lack of cooperation in providing information. Figures and local indicators were the responsibility of General Practitioners and Adult Social Care. Councillor Franks questioned if members felt the indicators were the right ones and if not the strategy needed refreshing as soon as possible. If they were the correct indicators, consideration needed to be given to how the indicators were going to be met.

Giving every child and young person the best start in life

More local indicators were required in this section.

Supporting and Vibrant District

This was considered the most difficult priority to measure.

Decreasing statutory homelessness, homelessness acceptances and households in temporary accommodation was currently an indicator however, the Housing Team had suggested that this should not be included due to the low numbers in West Berkshire. Local indicators around fuel poverty were still required.

Rachael Wardell wanted to make it clear that any individual presenting as homeless was always a priority for the Housing Team, but agreed that including it in the performance framework for the Board might be over prioritising an area given that actual numbers were low.

Rachael Wardell suggested that the Board could learn lessons from the Local Safeguarding Children’s Board (LSCB) and how it managed performance management across a group of diverse partner organisations. Membership organisations of the LSCB gave a lot of attention to their performance information and were held accountable for this information if the LSCB had particular concerns.

Councillor Franks stated that at the next development session  ...  view the full minutes text for item 7.

Purpose: To give a follow up report on the work which is now complete.

Alison Love introduced her report to Members of the Health and Wellbeing Board, which aimed to give a follow up report on the Joint Health and Social Care Self Assessment Framework (JH&SCAF), which was now complete.

The JH&SCAF was a required annual report on local health and social care services for people with learning disabilities. In 2013 the responsibility for requesting and collating this information transferred from the Government Office for South East England to Public Health England. The requirement to collect and monitor this information was part of the Valuing People Now objectives.

There was much evidence to indicate that people with learning disabilities suffered from poorer health than the general population.

The local Joint Health and Social Care Self Assessment approach was developed in conjunction with colleagues from the Commissioning Support Unit of the Clinical Commissioning Groups (CCGs) and Berkshire Healthcare Trust.

The format of the report had changed considerably from previous years and some colleagues struggled to obtain the information required. Therefore there were significant gaps and inaccuracies in the health information. The local Community Team, for People with Learning Disabilities had some information that gave evidence of better local health services than was portrayed in the report however, the report format clearly stipulated how and where the evidence should be gathered. 

Dr Barbara Barrie stated that there should be information from areas such as Mortimer and Theale, where the CCGs overlapped. Alison Love reported that all GP practices were approached and then the relevant information sent back to each Local Authority.

Adrian Barker stated that he had read the report however, struggled to see how the Board itself could assist. He also acknowledged that the numbers of those with learning disabilities did seem very low and queried what the definition was for someone with a learning disability. Alison Love reported that the definition was those people who had an IQ less than 70 however, those with milder forms of a learning disability were also welcomed to have a health check.

Rachael Wardell reported that much of the Board’s contribution would be around the ground work. It was incomplete baseline information and it was being flagged that further work was required.

Adrian Barker questioned what work needed to be done to get to where they needed to be. Alison Love confirmed that the JH&SCAF formed part of the work carried out by the Joint Commissioning Group for the West of Berkshire. Locally there was contact with GPs, so health check information was being requested. Other screening information from the NHS was also required. Under reporting had taken place across the board and not just in Newbury. There would be a push for better information gathering next year.

Alison Love reported that there was a dedicated Learning Disability Nurse and she was particularly good at helping to access the right services.

Councillor Franks questioned how people requiring learning disability support were flagged to GPs, particularly if joining a new practice. Dr Barbara  ...  view the full minutes text for item 8.

Purpose: To raise awareness of the SEND Reforms.

Jane Seymour introduced her report to Members of the Health and Wellbeing Board, which aimed to raise awareness of the Special Educational Needs (SEN) and Disability reforms. It also sought to inform Members regarding the work undertaken so far towards implementation of the reforms and seek their approval and finally to request that the Board consider how the specific implications of the reforms for health would be address.

Section two of the report outlined the main changes as a result of the SEN Disability Reforms and section three looked at the next steps towards implementing the changes.

The existing statutory assessment and statementing process would be replaced by a much more holistic, person centred Education Health and Care (EHC) Assessment process. There would be a new timescale in that EHC assessments must be carried out within 20 weeks, compared to the previous 26 weeks.

The process would be much more person centred and every family whose child had an EHC Plan would be able to request a Personal Budget for the education, health and/or care aspects of the EHC Plan. As a result the process would be much more resource intensive.

Three Assessment Coordinators would be recruited. Interviews were taking place the week commencing 19^th May 2014.

Local Authorities’ responsibilities would extend potentially up to the age of 25, whereas they currently lapsed at age 19.

There were specific requirements for joint commissioning. These included the development of clear arrangements between Local Authorities and partner commissioning bodies for commissioning services for children with SEND, the integration of education, health and care provision for SEND where it was beneficial and the agreement of shared outcomes including joint analysis of intelligence about needs of the local population.

Jane Seymour reported that section four power phrased the report by the Commissioning Support Unit Officer and outlined specific implications for health commissioners and providers. Section 4.2 of the report gave additional recommendations for consideration by CCGs including all EHC Plans needing to be outcome focused and reiteration of the new 20 week deadline for the publication of final EHC Plans.

Councillor Graham Pask asked Philip McNamara if this was innovative work for the CCG and what steps the CCG would need to take. Phil McNamara reported that the pooling of budgets was not new to them as this had also taken place within the previous Primary Care Trusts. The recent approach taken to the BCF illustrated how the CCG would operate moving forward. Phil McNamara support the suggested way forward.

Jane Seymour confirmed that there was an external organisation commissioned to hold personal budgets if individuals did not feel confident to do so.

Councillor Franks referred to the ‘Local Offer’ and queried if there was a case for extending the voluntary prospectus. Tandra Forster was leading on a piece of work looking at what was being commissioned with the voluntary sector and quality assessment. Jane Seymour confirmed that she was unaware of this would however, would ensure she linked to it moving forward.  ...  view the full minutes text for item 9.

Purpose: To present the Healthwatch Q4 report.

Adrian Barker gave a quarterly update to the Health and Wellbeing Board on behalf of Healthwatch for quarter four.

It was reported that most of the work in quarter four had focused on outreach work. This would be built on in the coming year. There had also been a lot of activity around online communication and referring to the advocacy service SEAP if required.

Councillor Marcus Franks referred to page 107 of the agenda pack and asked what ‘enter and view’ was. Adrian Barker reported that this was a power that had once belonged to LiNKS and enabled them to enter premises in the form of unexpected visits. This power now belonged to Healthwatch.

Councillor Franks further questioned how many people were reached through social networks and what was the age profile of these people.

RESOLVED that Adrian Barker would find out the number and age profile of people accessed through social networking.

Phil McNamara asked for an update on the Champions network. Adrian Barker reported that the champion board had met and it brought together people involved with particular areas to look at priorities. The next step was to involve other organisations.

Rachael Wardell queried the value of the ‘free text’ views because they were insufficiently specific as to what problems or issues were. As a director responsible for delivery she found the outputs from this difficult to use to improve services. Rachael Wardell felt that they needed to identify the next steps for Healthwatch and how the information it was gathering from the public could be used to better shape services.  Adrian Barker concurred and stated that the same point had been made by the Champions Board.

It was felt that it would be interesting for the Board to receive reports and findings from the Champions Board.

Adrian Barker stated Heather Hunter was due to report to the Board in July and would cover the items raised.

Purpose: For information and an opportunity for Members of the Board to place items on the Forward Plan.

All noted the Forward Plan for the Health and Wellbeing Board. Adrian Barker suggested that there was further opportunity to tie in progress with the JSNA and development of the Health and Wellbeing Strategy. It was important that Healthwatch were involved at an early stage in both of these areas of work.

Rachael Wardell referred to the forward plan item coming to the next meeting of the Board regarding the protocol on the working arrangements between West Berkshire LSCB, the Health and Wellbeing Board and the Munro Implementation Board. She reported that it was likely that this item would be expanded to inform the Board about recent revisions to the Children and Young People’s Partnership.

Councillor Marcus Franks stressed the importance of ensuring the right reports were coming to the Board. It was possible that meetings would take on a themed nature in future to ensure the right topics were being considered.  

Members of the Executive to answer questions submitted by Councillors in accordance with the Executive Procedure Rules contained in the Council’s Constitution. (Note: There were no questions submitted relating to items not included on this Agenda.)

There were no Members’ questions received.

24 July 2014

25 September 2014

27 November 2014

22 January 2015

28 May 2015

It was confirmed that the next meeting of the Health and Wellbeing Board would take place on 24^th July 2014.