Agenda and minutes

To approve as a correct record the Minutes of the meeting of the Board held on 28 January 2016.

The Minutes of the meeting held on 28^th January 2016 were approved as a true and correct record and signed by the Chairman.

An opportunity for Board Members to suggest items to go on to the Forward Plan.

The Health and Wellbeing Board noted the forward plan.

Dr Bal Bahia asked that a report on pharmaceutical provision plans for West Berkshire, in the context of changes initiated by the government and the NHS, be added to the forward plan for the July meeting.

Lesley Wyman reported that Dr Lise Llewellyn that the West Berkshire Prevention Working Group Consultation Paper be added to the forward plan for the July meeting.

(Councillor Hilary Cole joined the meeting at 9.32am)

To consider outstanding actions from previous meeting(s).

The Board noted the actions arising from previous meetings.

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.

Dr Bal Bahia declared an interest in all matters pertaining to Primary Care, by virtue of the fact that he was a General Practitioner, but reported that as his interest was not personal, prejudicial or a disclosable pecuniary interest, he determined to remain to take part in the debate and vote on the matters where appropriate.

Dr Barbara Barrie declared an interest in all matters pertaining to Primary Care, by virtue of the fact that she was a General Practitioner, but reported that as her interest was not personal, prejudicial or a disclosable pecuniary interest, she determined to remain to take part in the debate and vote on the matters where appropriate.

Councillor Graham Jones declared an interest in all agenda items by virtue of the fact that he was a Pharmaceutical Director in Lambourn but reported that, as his interest was personal and not prejudicial or a disclosable pecuniary interest, he determined to remain to take part in the debate and vote on the matters where appropriate.

Andrew Sharp declared an interest in any items that might refer to South Central Ambulance Service due to the fact that he was the Chair of Trustees of the West Berks Rapid Response Cars (WBRRC), a local charity that supplied blue light cars for ambulance drivers to use in their spare time to help SCAS respond with 999 calls in West Berkshire, and reported that, as his interest was personal and not prejudicial or a disclosable pecuniary interest, he determined to remain to take part in the debate and vote on the matters where appropriate.

Councillor Gordon Lundie declared an interest by virtue of the fact that he worked for a pharmaceutical company which sought to influence public health policy. The company was not currently offering medical treatments and was still at the research stage. He reported that, as his interest was personal and not prejudicial or a disclosable pecuniary interest, he determined to remain to take part in the debate and vote on the matters where appropriate.

Councillor Lundie also declared during the discussion on Item 13, that he was a member of the Board of Governors for the Royal Berkshire Hospital. He reported that, as his interest was personal and not prejudicial or a disclosable pecuniary interest, he determined to remain to take part in the debate and vote on the matters where appropriate.

There were no public questions submitted.

There were no petitions presented to the Board.

Purpose: To present the Annual Report from the Director of Public Health

The Board considered a report and presentation (Agenda Item 8) from the Director of Public Health (DPH). Section 31 of the Health and Social Care Act 2012 placed a duty on the local authority to publish the DPH’s annual report, while the Act required the DPH to write one.

This year’s annual report focused on children’s health in its broader sense. Each organisation was charged with improving the health of local residents and to reduce health inequalities. Giving children the best start in life was evidenced to be the most effective way to do this.

Lesley Wyman gave a presentation on Lise Llewellyn’s behalf, summarising the presentation included in the agenda for the meeting.

Infant mortality had decreased over the last 20 years from 12.0 deaths per 1,000 live births in 1980 to 3.8 in 2013. This was the lowest level recorded in England and Wales. Councillor Hilary Cole questioned how there could be .8 of a death. Lesley Wyman answered that the figure presented was a rate not an absolute figure. Councillor Gordon Lundie commented that he would like to see the numbers, noting that there was a higher infant mortality rate in the 10% most deprived areas in West Berkshire.

The Child Death Overview Panel (CDOP) reviewed information on all unexpected child deaths, recorded preventable child deaths and made recommendations to ensure that similar deaths were prevented in the future. The Berkshire CDOP reviewed cases across the county and reported into each Local Safeguarding Board. In West Berkshire in 2015 the main cause of death in infants was genetic or chromosomal abnormalities. Councillor Lynne Doherty asked whether screening could identify such abnormalities. Rachael Wardell advised that she was the Deputy Chair of the CDOP and explained that as a result she was aware that many were identified during pregnancy and were carried to term with significant medical intervention but unfortunately lost their life.

In 2014/15, 11.4% of mothers in England were smokers at the time of delivery. All of the Berkshire local authorities had a significantly lower level of smokers, from 6.3% in Wokingham to 9.2% in Reading. In West Berkshire, the level was 8.7%. Councillor Doherty commented that while the whole of Berkshire had low levels, West Berkshire had the second highest level of smoking and asked whether this was cause for concern. Lesley Wyman responded that Wokingham had an exceptionally low level of smoking in its population generally. West Berkshire’s smoking cessation service was paid additionally for supporting expectant mothers to quit smoking. Councillor Doherty asked if there were any lessons to be learnt from Wokingham’s low smoking rate. Lesley Wyman responded that Wokingham had reported low  levels of smoking since records on the measure began and could not be connected to any particular initiative.

Rachael Wardell indicated that the level of smoking amongst mothers at the time of delivery for Slough was an outlier when, based on other demographic factors it might be anticipated that it would have similar levels to Reading. It was interesting  ...  view the full minutes text for item 91.

Purpose: To present the Dashboard and highlight any emerging issues.

The Board considered a report (Agenda Item 9) concerning the Health and Social Care Dashboard.

ASC1: Proportion of older people (65+) who were still at home 91 days after discharge from hospital to reablement/rehabilitation service: Tandra Forster was disappointed to report that latest data indicated that this measure would remain ‘red’ at year-end as the measure related to a small number of people and it would not  take a lot of change to effect performance against the measure. There would be continued work to provide reablement support as the majority of people admitted to hospital wanted to be able to return home.

ASC3: Proportion of clients with Long Term Service receiving a review in the past 12 months: Latest data now indicated that performance was at 90% against the measure and officers were confident that by year-end 100% of reviews would be achieved.

Rachael Wardell commented that some of the RAG rating in the Children’s Social Care section was incorrect.

CSC1: The number of looked after children per 10,000 population: Rachael Wardell advised that 46 looked after children per 10,000 would make this indicator ‘green’ as it was within normal range and since submitting the data for inclusion in the dashboard there were 45.

CSC2: The number of child protection plans per 10,000 population: This measure should not be reported as ‘green’ as the number was outside normal range, however Rachael Wardell reported that she was not currently concerned about this measure as the length of time children were staying on a plan was reducing thanks to effective interventions or timely escalation.

CSC3: The number of Section 47 enquiries per 10,000 population: numbers of Section 47 enquiries were still increasing. They were a significant intervention and might be seen as heavy-handed if they did not result in a Child Protection Plan. Conversely, children might be at a safeguarding risk if concerns were not progressed under a Section 47 enquiry. This indicator was ‘red” and was a cause for concern.

CSC4: To maintain a high percentage of (single) assessments being completed within 45 working days: Performance was reported at 79% so should not be ‘red’. Although recent performance was much higher than 79% at 93% and 96%, YTD performance is negatively impacted by poor performance earlier in the year.

CSC6: Child Protection cases which were reviewed within required timescales: Although performance of 99% met the suggested target and could be flagged as ‘green’ Rachael Wardell was satisfied to leave this measure as ‘amber’ as in her view 100% should be being achieved.

CSC7: Percentage of LAC with Health Assessments completed on time: Q3 reporting had demonstrated that performance was at 93% and above target. As at the end of February, performance against this measure was now 98% and expected to be achieved by year-end.

AS1: 4-hour A&E target - total time spent in the A&E Department: Although this measure should be green as it was showing performance of 95.1% against a target of 95%. However Q4 reporting was  ...  view the full minutes text for item 92.

Purpose: To provide an update for the Board.

The Board considered a report (Agenda Item 10) concerning a briefing report on Mental Health Street Triage.

The Berkshire West Street Triage One Year Pilot Project was part of collaborative funding arrangements between Berkshire West Clinical Commissioning Groups, three Local authorities and NHS England at a total cost of £150k. This service was based on the Oxford Street Triage Model of care to support the reduction of mental health patients being detained inappropriately in police custody, reduce the use of Section 136 and also to support the Local Crisis Care Concordat Action Plan Commitment from CCGs & LAs.

Street triage referred to a service where clinical mental health professionals (MHPs) accompanied and/or assisted police at incidents where the possible mental ill health of an individual gave rise to concern. The MHPs would assist in ensuring the best option for the individuals in crisis. They would do this by offering professional advice on the spot, accessing health information systems, and helping to liaise with other care services to identify the right kind of support required.

Between 1 April 2014 to 31st March 2015, there was a total of 216 Section 136 applied by Thames Valley Police officers in Berkshire West (136- Reading, 47- West Berkshire and 33- Wokingham). This was an increase of 23% on the previous year for Berkshire West. Mental Health incidents as reported by TVP, during the same period of time were reported (per 1000 population) Reading- 6.4, West Berkshire- 2.9 and Wokingham- 2.1. Reading had the third highest in the Thames Valley area, whilst West Berkshire and Wokingham were below the TVP average of 4.5.

The project sought to achieve the following outcomes:

·         To reduce the number of Section 136’s applied by Thames Valley Police (TVP) across Berkshire West.

·         To provide alternative mental health outcomes to persons found in crisis by TVP officers in Berkshire West.

·         Provide support to TVP regarding mental Health Welfare/ calls of concern calls received by TVP control room.

·         Release/ free up TVP officer’s time/ earlier return to non- Mental Health related duties.

·         To prevent mental health patient being detained in police custody

An evaluation of this project took place in January 2016 to share the impact of this service in Berkshire West. The draft report had demonstrated positive outcomes and the case was strong.

The plan was to develop a business case to seek recurrent funding of £133k for the Berkshire West Street Triage Service for 2016/17 from the CCGs & LAs. Jason Jongali reported that he was confident that the business case was strong and recurrent funding would be received.

Councillor Jones asked that the report be circulated to the Board once it had been finished. He further enquired what mechanisms were in place to review the business case for continued funding of the street triage service. Jason Jongali replied that Reading Borough Council were the lead Local Authority for the pilot and Wendy Fabbro, Head of Adult Social Care at Reading Borough Council would coordinate with her counterparts at Wokingham and West  ...  view the full minutes text for item 93.

Purpose: to keep the Board up to date on the BCF and wider integration programme and to inform the Board of the process for 2016.

(Councillor(s) * declared a personal and prejudicial interest in Agenda item 4(*) by virtue of the fact that *. As his/her/their interest was personal and prejudicial he/she/they left the meeting and took no part in the debate or voting on the matter).

(Councillor(s) * declared a personal interest in Agenda item 4(*) by virtue of the fact that *. As his/her/their interest was personal and not prejudicial he/she/they was/were permitted to take part in the debate and vote on the matter).

The Board considered a report (Agenda Item 11) concerning the Better Care Fund arrangements for 2016/17.

Despite delays within the Department of Health in confirming the timeline and the technical guidance the Council and the CCGs were able to commence negotiation of the 2016/17 financial plan; details of the initial proposals were discussed at Operations Board on the 14th January.

Subsequent to this meeting, allocations for localities were published. These confirmed the CCG minimum contribution at £8.807m, an increase of £279k and an increase in the  capital grant to the Council (routed through the BCF) from £1.005m to £1,4m. The main element of the capital funding was for Disabled Facilities Grants.

In the local plan it had been agreed with the CCG that £4.367m would now be provided in the 2016/17 BCF to maintain provision of social care services. This reflected a real terms increase on last year’s amount, £4.021m, and fulfilled the guidance that ‘As a minimum, it should maintain in real terms the level of protection as provided through the mandated minimum element of local Better Care Fund agreements of 2015-16.’

The amount includes the £408k invested in the Joint Care Provider scheme. This was considered as our local flagship scheme; it had seen much closer working between the Council and BFHT resulting in less duplication and good performance levels despite unprecedented challenges for the acute Trusts. The £408k would allow the existing capacity of the reablement service to be maintained.

£500k had also been included to help to continue to deliver 7 Day Week Services. The council had made a number of changes to ensure a social work presence in hospitals at the weekend to ensure discharge was not now limited to weekdays. The intention was to build on this good work with other hospitals we work with and to extend our focus into the community to address non elective admissions.

The amount also included funding for West of Berkshire projects. These  include ‘Connected Care’, an ICT project that aimed to support more effective information sharing across health and social care, a key requirement of any integration programme and ‘Care Homes’ which focused on reducing the disproportionately high number of non elective admissions from care homes.

Investment related to the contract held with BFHT had also been agreed with the CCG, totalling £1,889,000.  This covered a range of services including intermediate care, speech and language therapy and the community geriatrician.

Whilst the financial plan had been agreed with the CCG the accompanying narrative was still in  ...  view the full minutes text for item 94.

Purpose: To present a snapshot of the JSNA, which includes any changes the Board needs to be aware of.

The Board considered a report and presentation (Agenda Item 12) concerning updates to the Joint Strategic Needs Assessment (JSNA).

Lesley Wyman asked the Board whether they felt it was helpful to present updates to the JSNA as she had used updated information from the Public Health Shared Team, however the JSNA actually contained more in-depth data from a number of sources which, when layered, gave a better picture of the needs of the district.

Councillor Jones expressed the view that it was useful to look at data in-depth but acknowledged that there might not be enough time in this meeting to go into detail. Lesley Wyman suggested that she sent out updates to all Board members as they were received and members could identify areas for more in-depth discussion. Rachael Wardell agreed with this approach and asked that Lesley Wyman drew Board members’ attention to data changes which were significant or surprising.

Councillor Lundie, referring to the data on page 72 of the agenda pack regarding oral health, asked for the reason that the number of five-year-olds and twelve-year-olds had the same number of decayed teeth. Lesley Wyman advised that the data was confusing and came from a Public Health England dental health sample survey using different cohorts. The key piece of information to draw from this data was that older children had more problems with decayed teeth.

Councillor Lundie commented that when he had visited care homes there was an issue with the dental health of older people as it effected their eating and appetite which could lead to a downward spiral for their overall health and wellbeing; he asked whether there was any data on the dental health of older people. Tandra Forster advised that although it wasn’t reported, officers were sighted on this information and worked with older people in care homes and dental surgeries to help them attend dental appointments.

RESOLVED that the updates to the JSNA be noted. Lesley Wyman would circulate JSNA updates to Board members outside of meetings in the future and would identify areas of focus based on comments received, for more formal reporting to the Board.

Purpose: To inform the Board where commissioning alignment is already taking place; what plans are for the coming year; where efforts could be improved; what the challenges are and how the Health and Wellbeing Board can help influence this work.

(Councillor Gordon Lundie declared a personal and prejudicial interest in Agenda item 13 by virtue of the fact that he was a member of the Board of Governors for Royal Berkshire Hospital. As his interest was personal and not prejudicial or a disclosable pecuniary interest, he determined to remain to take part in the debate and vote on the matters where appropriate.)

The Board considered a presentation (Agenda Item 13) concerning the alignment of commissioning plans.

Shairoz Claridge and Tandra Forster gave the presentation as attached on the agenda and invited the Board to comment of how they would like to see alignment of commissioning work progress in the future and whether there were any areas that officers had not already considered.

Councillor Hilary Cole commented that very good work had taken place around aligning commissioning plans. She further added that in a time of diminishing financial resources, no stone should be left unturned when it came to achieving economies of scale by better joint commissioning.

Councillor Lynne Doherty enquired upon the timelines for further commissioning work as the end of the current financial year was fast approaching. Shairoz Claridge responded that the work was ongoing and work to align the Voluntary Sector Prospectus would be undertaken in the following twelve months in anticipation of the 2017/18 financial year. Other timelines would be agreed by other commissioning groups.

Cathy Winfield sought to raise the same point as Councillor Cole regarding financial pressures and asked how this could link to the three local authorities (Reading, West Berkshire and Wokingham) in their joint commissioning. Tandra Forster described the example of the reprocurement of the NHS 111 and explained that the contract would allow for an extension in order to allow a new approach to be initiated. Rachael Wardell added that the business case had been completed and it was deemed that better value for money could not be achieved from a standalone commissioning unit but there was a case for a more collaborative approach. No contract would be renewed without consultation with the other two local authorities (Reading and Wokingham) and the Director for Adult Social Services would keep this under review.

Councillor Lundie advised that he was a member on the Board of Governors for Royal Berkshire Hospital and at its strategy board meeting had discussed integration funding for providers. In the context of accountable care organisations, he asked what the role of the Board was in these organisations as providers had signed letters of intent regarding integration with the Clinical Commissioning Groups. Cathy Winfield explained that discussion on this matter had been held at the Berkshire West 10 Integration Board which took a view that there was an Accountable Care System rather than organisation. There was a two year plan with integration in the CCGs the focus of year one and the plan was for local authorities and adult social care to have more involvement in year two of the integration project. Providers had received large amounts of funding towards  ...  view the full minutes text for item 96.

Purpose: To update the Board on the community engagement event with the voluntary sector that took place in December.

The Board considered a report (Agenda Item 14) concerning the Community Engagement Event facilitated by the South, Central and West Commissioning Support Unit.

In December 2015, 36 colleagues from across the health, social and voluntary sector service in West Berkshire met for the first time to discuss better partnership and cooperation between organisations in the system. The impetus for the meeting came from a Community Engagement Strategy commissioned by the West Berkshire Health and Wellbeing Board earlier in 2015.

The event identified a number of quick wins such as more ‘sharing’ and ‘liking’ of each other’s content on social media and establishing a common events calendar.

RESOLVED that the actions from the Community Engagement Event be noted.

Purpose: To inform the Board on the Joint Agreement between the Berkshire West CCG Federation, the Berkshire Healthcare Foundation Trust, the Royal Berkshire Hospital Trust, West Berkshire Council, Reading Borough Council and Wokingham Borough Council, in respect of operational arrangements for children and young people with Special Educational Needs and Disabilities (SEND) aged 0 to 25 years

This item had been provided for information only and was not discussed.

This item had been provided for information only and was not discussed.

This item had been provided for information only and was not discussed.

“Is there any assessment of the demand and the suitability of West Berkshire Community Hospital to provide expanded oncology services that would allow patients currently treated in the Royal Berkshire Hospital to be cared for close to home?”

A question standing in the name of Councillor Gordon Lundie was answered by the Executive Member for Health and Wellbeing, Devolution.

“Was there a plan to use the upper floor of West Berkshire Community Hospital (I understand it has been recently refurbished) to provide extra remote oncology care for patients normally treated at the Royal Berkshire Hospital?”

A question standing in the name of Councillor Gordon Lundie was answered by the Executive Member for Health and Wellbeing, Devolution.

“Who would own the commissioning of additional remote oncology service if we wanted to further investigate this development?”

A question standing in the name of Councillor Gordon Lundie was answered by the Executive Member for Health and Wellbeing, Devolution.

26^th May 2016 (private)

7^th July 2016

29^th September 2016 (private)

24^th November 2016

27^th January 2017 (private)

30^th March 2017

25^th May 2017 (private)

The list of future meeting dates was noted as follows:

Jo Reeves also reminded Members that there would be a Special Health and Wellbeing Board on 14^th April 2016 to approve the Better Care Fund 2016/17.