Agenda and minutes

To elect the Chairman and appoint the Vice-Chairman for the 2016/17 municipal year.

Councillor Graham Jones was voted as Chairman of the Health and Wellbeing Board and Dr Bal Bahia was voted as Vice-Chairman for the 2016/17 Municipal Year.

Councillor Jones announced that he had unexpectedly been called away on urgent business and would have to now leave the meeting.

(Councillor Jones left the meeting at 9.35am)

To approve as a correct record the Minutes of the meeting of the Board held on 23 March 2016 and the special meetings held on 14 April 2016 and 12 May 2016.

The Minutes of the meetings held on 24 March 2016, 14 April 2016 and 12 May 2016 were approved as a true and correct record and signed by the Leader, subject to the following amendment to the minutes from the meeting held on 24 March 2016:

Page 13, Item 94: the first two paragraphs to be removed.

Page 17, Item 103: the following to be inserted after “the list of future meeting dates was noted as follows:”

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)

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

The Health and Wellbeing Board noted the forward plan.

To consider outstanding actions from previous meetings.

The Health and Wellbeing Board noted actions arising from the previous meeting.

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 and Dr Barbara Barrie declared an interest in all matters pertaining to Primary Care, by virtue of the fact that they were General Practitioners, but reported that as their interest was not personal, prejudicial or a disclosable pecuniary interest, they 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 and he was also a member of the Board of Governors for the Royal Berkshire Hospital. 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.

The Chairman of the Health and Wellbeing Board 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.)

There were no public questions submitted.

There were no petitions presented to the Board.

To inform the Board of the work of the Children’s Delivery Group, including activity undertaken since the Hot Focus Session and learning from the LSCB Exclusions Audit.

The Board considered a report (Agenda Item 9) which summarised the Terms of Reference, the strategic priorities and workplan for the Children’s Delivery Group.

Andrea King introduced the item by informing the Board that she was the Chair of the Children’s Delivery Group which oversaw the strategic priorities around safeguarding children but did not replicate the statutory role of the West Berkshire Local Children’s Safeguarding Board.

The Board was asked to note that following the establishment of the inter-agency Emotional Health Triage functions and the Emotional Health Academy (EHA), the number of children and young people waiting for Tier 2 Emotional Health support had reduced from 120 children in August 2015 to 0 children in April 16.

The Children’s Delivery Group was also responsible for the co-design of one shared partnership vision for Targeted Prevention services (ie. to provide strategic coherence in a time of staffing and resource reductions across early help and targeted prevention services).

The report highlighted the recent learning from West Berkshire Local Safeguarding Children Board (LSCB) analysis of local children and young people excluded from school; and the significant number of children and young people within this cohort who were waiting for Autism Spectrum Disorder (ASD) or Attention Deficit Hyperactivity Disorder (ADHD) diagnosis. It was found that schools had a perverse incentive to exclude children in order to access additional help and this caused increased safeguarding risk for children and young people; this was a  strategic challenge for the H&WBB.

Sally Murray explained that an audit of exclusions between September and December 2015 had shown that the majority of children who were excluded had challenging behaviour which built up over time. Emotional health and wellbeing of these children needed to be a priority for all partners.

A number of improvements had been made since September 2015, including increased capacity within tier 3 of the Child and Adolescent Mental Health Service (CAMHS).

Staff on the Berkshire Healthcare Foundation Trust (BHTF) Autism Spectrum Disorder (ASD) pathway had worked with Autism Berkshire and Parenting Special Children to develop workshops for families waiting for an ASD assessment. These workshops were piloted in 2015 and had been offered to all families waiting for an ASD assessment. These workshops continued through 16/17, funded by Future In Mind investment and delivered at venues across Berkshire West. Autism Berkshire had been commissioned to provide additional support for families whose teenage children had ASD as this could be a particularly challenging period of time. Autism Berkshire was commissioned to provide telephone helpline. BHFT were to launch additional telephone and online support for families who were awaiting ASD diagnosis.

Councillor Lynne Doherty commended the work of the Children’s Delivery Group. Referring to the terms of reference, she expressed the view that more consideration to schools representation be given. She also noted that there had been a reduction in the waiting list on the ASD pathway but asked for the figures to gain a better understanding of the facts.

Councillor Doherty further suggested that  ...  view the full minutes text for item 8.

To present the Dashboard and highlight any emerging issues.

The Board considered a report (Agenda Item 10) concerning the health and social care dashboard.

Ian Dawe presented the data for the adult social care indicators particularly drawing attention to ASC2 - Number of assessments completed in last 12 months leading to a provision of a Long Term Service: highlighting that the outturn showed that while there had been an increase in the number of people approaching the Council in need of help and an increase in prevention work many people could be supported without the need for a long term service.

Ian Dawe also referred to the New Ways of Working model which came into effect on 24 May 2016. A Review Team was focussing on planned work and was achieving 95% against ASC3 - Proportion of clients with Long Term Service receiving a review in the past 12 months.

Jo Reeves explained that due to staff capacity issues, the data against the Children’s Social Care indicators were the same as those presented to the last ordinary meeting of the Board in March 2016.

AS1 - 4-hour A&E target - total time spent in the A&E Department: Shairoz Claridge advised that performance against this indicator continued to be a challenge because there had been a ‘late winter’ whereby admissions has risen during March, April and May 2016. At quarter one for 2016/17, the outturn was 92.6% for the Royal Berkshire Hospital (RBH) which demonstrated a deteriorating picture. The RBH was however the third best in the Thames Valley so declining performance against this indicator was an indication of a national issue. Healthwatch had been involved in undertaking a patient survey which had revealed that patients being admitted to Accident and Emergency departments had higher needs, so the right patients were being seen by A&E. The Board’s Steering Group had been examining in closer detail the reasons for non-elective admissions. The narrative provided for AS6 - A&E attendances revealed that there had been an average of 300 attendances per day.

AS2 - Average number of Delayed Transfers of Care: Shairoz Claridge explained that performance against this indicator continued to pose a challenge because increased A&E attendances led to increased discharges. Ian Dawe advised that systems resilience phone calls occurred several times per week and the Council was using therapy assistants and the reablement team to support getting people out of hospital. Shairoz Claridge added that the Urgent Care Programme Board was working on the ‘front door’ side of the system to understand why people were being admitted to hospital.

AS5 - Ambulance Clinical Quality - Category A 8 Minute Response Time - Red 2: During February there was a further deterioration in the Thames Valley wide performance. This deterioration was as a result of increased activity levels in the month (13.8% above plan and 16.8% above previous year). Thames Valley performance was therefore not on plan with the recovery trajectory, although the majority of actions within the action plan had been delivered by SCAS. Dr  ...  view the full minutes text for item 9.

To inform the Board about the work being undertaken around the Accountable Care System and Sustainability and Transformation Plans

The Board considered a presentation (Agenda Item 11) to provide information about the Accountable Care System (ACS) and Sustainability and Transformation Plans (STP).

Shairoz Claridge gave the presentation as laid out in the agenda, particularly noting that the Berkshire West 10 group, whose membership included representatives from councils and clinical commissioning groups, was furthering the integration agenda. Health partners had however had to expedite this work separately to respond to national directives from the National Health Service.

Andrew Sharp queried whether the primary driver for this change was for financial purposes or for improved outcomes. Shairoz Claridge responded that the NHS was aware of the pressures on the system and was of the view that further integration would both drive down costs and achieve better outcomes.

Andrew Sharp further questioned whether the engagement on the STP was a process of informing or seeking input. Dr Lise Llewellyn advised that information was being provided so that a local response could be formulated.

Councillor Gordon Lundie asked whether the West Berkshire Oxfordshire Buckinghamshire footprint of the STP would be too big and if it was likely to be broken down. Dr Lise Llewellyn advised that the STP had been built up from Health and Wellbeing Strategies and Berkshire wide strategies. The focus would be on things that could not be achieved locally.

Councillor Lundie enquired how the STP would work. Dr Llewellyn reported that there would be three areas of focus: health and wellbeing, care and outcomes, and financial stability. The STP would still allow for local solutions for local priorities and would identify major improvements to achieve financial stability.

Councillor Lundie noted that sometimes the money and patients were in the wrong parts of the system and enquired whether any savings achieved in social care would be used to offset budget pressures in Accident and Emergency services. Dr Llewellyn responded that the ACS would explore how to spend resources in a way which addressed risks and drove change.

Councillor Lundie asked what model the ACS was based on. Shairoz Claridge answered that it was based on the Accountable Care Organisation model, but for Berkshire West ‘system’ was being used as there was no inclination to merge into one organisation. Instead work would be undertaken with a Memorandum of Understanding, using money in the system to address the needs of the system.

Councillor Lundie asked why councils were not included in the Memorandum of Understanding. Shairoz Claridge responded that work was continuing with local authorities to align the values and vision of the ACS. Health services have had to expedite the process but would be bringing in councils as part of a second phase to the process.

RESOLVED that the presentation be noted.

To feedback on the Falls Prevention Hot Focus session and suggested further action in relation to falls prevention.

The Board considered a report (Agenda Item 12) which provided feedback on the work undertaken on falls prevention following the Hot Focus Session held in April 2016.

The session was run to help the Health and Wellbeing Board have a greater understanding of what services were available in West Berkshire around falls prevention and how the Board could achieve the priority within the Health and Wellbeing Strategy: “We will maximise independence in older people by preventing falls, reducing preventable hospital admissions due to falls and improving rehabilitation services”

The aims of the session were to bring together relevant stakeholders with members of the Health and Wellbeing Board to inform them of Falls Prevention services that were available within West Berkshire across a continuum from prevention to treatment and rehabilitation and to identify successes, gaps and barriers within the system and suggest solutions that would inform the Health and Wellbeing Strategy delivery plan.

There was a great deal of positivity about the opportunity for partners to work more closely together particularly in setting up an older peoples group and a mapping processes.

Dr Lise Llewellyn expressed the view that a task group would be useful to ensure a joined-up approach to the work being undertaken in the system to support falls prevention and the frail elderly pathway.

Councillor Hilary Cole also expressed support for a group and asked for further information. April Peberdy advised that a discussion was held at the Steering Group which was of the view that direction to set up the group needed to come from the Board but that she would set up the group and set the terms of reference. Dr Llewellyn advised that Councillor Cole would be consulted on the terms of reference.

Councillor Mollie Lock commented that there was a leaflet regarding fall prevention services which was very useful and clear. April Peberdy advised that it detailed a lot of ongoing work but more work was needed on prevention.

Dr Bal Bahia made reference to the preceding presentation about the Accountable Care System and Sustainability and Transformation Plans and noted that duplication of work should be avoided and the terms of reference for the new group should be clear on how it fit into other groups in the local health and social care system.

RESOLVED that an Older Peoples Task Group be established.

To inform the Board about the changes to pharmaceutical regulations and the potential impact on West Berkshire.

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

The Chairman of the Health and Wellbeing Board 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 Member Questions submitted to the Board.

29^th September 2016

25^th November 2016

26^th January 2017 (Development Session)

30^th March 2017

25^th May 2017 (Development Session)

The next meetings of the Board would take place on:

29^th September 2016

25^th November 2016

26^th January 2017 (Development Session)

30^th March 2017

25^th May 2017 (Development Session)