Agenda and draft minutes
Venue: Second Floor Meeting Area Council Offices Market Street Newbury. View directions
Contact: Gordon Oliver
To approve as a correct record the Minutes of the meeting of the Board held on 9 December 2021.
It was noted that Councillor Rick Jones should have been recorded as attending remotely rather than in person. Subject to this amendment, the Minutes of the meeting held on 9 December 2021 were approved as a true and correct record and signed by the Chairman.
To consider outstanding actions from previous meeting(s).
Progress on actions from the previous meetings was noted. Observations were made in relation to the following actions:
· 153 – Work was ongoing in relation to the Peer Review - the main challenge would be scheduling meetings with the Peer Review Team, with a minimum lead time of 6 months.
· 180 to 183 – These would be picked up as part of the Forward Plan item.
Councillor Dominic Boeck noted that at the Board had endorsed the recommendations in the Healthwatch report on CAMHS with key partners asked to act on the report’s recommendations. Matt Pearce had indicated that the Children’s Delivery Group (CDG) would lead on this. However, there was no action identified and the CDG was not aware that they had been allocated this piece of work.
Andy Sharp indicated that the Integrated Care Partnership’s Delivery Group for Children’s Services, was taking forward a project on CAMHS and Mental Health and Wellbeing.
Action: Councillor Boeck, Andy Sharp, Matt Pearce and Gordon Oliver to agree who will progress matters in relation to the Healthwatch CAMHS report.
To remind Members of the need to record the existence and nature of any personal, disclosable pecuniary or other registrable interests in items on the agenda, in accordance with the Members’ Code of Conduct.
There were no declarations over and above the standing declarations of interest from Councillor Graham Bridgman and Andrew Sharp.
Members 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.
There were no public questions submitted to the meeting.
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: To provide the Board with an update on capacity and performance over the winter period and how this has been affected by Covid.
Councillor Graham Bridgman declared a personal interest in Agenda Item 11 by virtue of the fact that he was a governor of the Royal Berkshire Hospital NHS Foundation Trust. As his interest was personal and not prejudicial or a disclosable pecuniary interest, he determined to remain to take part in the debate.)
Dr Alex Evans gave a presentation on the current situation at the Royal Berkshire Hospital and the challenges they faced. Key points from the presentation were as follows:
· There were 109 inpatients with Covid, with three patients in the intensive care unit, one of whom was on mechanical ventilation.
· 40 Covid patients were being treated on a virtual ward and received daily contact from physicians and remote monitoring of blood oxygen levels.
· These numbers were much less than in the second wave, when there had been 280 Covid inpatients.
· The main challenge was in keeping Covid patients separate from other patients. The Trust was amongst the top performers in England in avoiding nosocomial infections.
· A disproportionate number of Covid inpatients had not been fully vaccinated.
· 96.3% of the Trust’s staff had received at least one jab – the Trust was ranked 13 out of 126 in England for uptake.
· Approximately 150 out of more than 6,000 staff were off work with Covid – this was an improving situation.
· Teams had been working well to meet elective waiting lists.
· There were very high pressures on the Emergency Department (ED, with 400+ patients per day (up from 300 on a bad day pre-Covid).
· Mitigating measures put in place included:
o A new discharge lounge
o A Complex Discharge Liaison Team and Patient Flow Co-ordinators assigned to bring expert knowledge to complex discharge cases
o Same day emergency care unit that assessed and treated more than 100 patients per week
o A Covid Medicines Delivery Unit had been set up to provide high-risk patients with new Covid anti-viral treatments
o Additional Point of Care Testing had been brought into the ED to provide rapid testing of patients for Covid, flu, norovirus, etc.
· It was one the few Trusts to continue diagnostic work and elective procedures through Covid and 92.7% of suspected cancer patients were being seen within two weeks.
· Efforts were being made to bring performance back to standard for all patients to be seen within six weeks of referral.
· There were challenges in diagnostics (MRI, CT and endoscopy) and plans were in place to improve capacity, with a new diagnostic hub created at West Berkshire Community Hospital.
Activity at West Berkshire Community Hospital:
· Day surgery unit running 3-4 Saturday endoscopy lists every month
· All services resumed with mix of face-to-face and telephone services
· Additional outpatient clinics being run to clear backlogs
· Clinic space provided at weekends to support the Covid vaccine programme for 12-15 year olds
· WBCH was one of the first Community Diagnostic Centres in the country to open – a new MRI and PET-CT scanning facility will open later this year
· Two MRI scanners purchased ... view the full minutes text for item 81.
Purpose: To update the Board on progress with the establishment of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System.
Matt Tait gave an update on the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (ICS) (Agenda Item 10). Key points from the presentation were as follows:
· The date for establishing the Integrated Care Board had been pushed back from April to July 2022.
· There was a need to ensure appropriate governance architecture and capacity to maintain the CCGs for another three months and the ICS was satisfied that the statutory responsibilities could be maintained.
· There were some challenges around financial planning for an additional quarter year but the ICS was confident that this could be managed.
· The delay allowed more time for engagement and discussion on structures and working practices, which was welcomed.
· Javed Khan had been appointed as Chair Designate and James Kent had been appointed as Chief Executive Designate.
· Interviews were being held to appoint the non-executive members of the Integrated Care Board (ICB).
· Adverts would be going out shortly for the three statutory executive roles – chief financial officer, chief nurse and chief medical director.
· The processes were being developed for the partner member nomination, assessment and appointment, taking account of the emerging legislation.
· The working assumption was that the ICB would have the minimum membership, with just one local authority partner member, who would bring sector expertise rather than being a representative of a particular council.
· It was noted that local authority members were no longer disqualified from sitting on the ICB, but the recommendation was that the role should be an executive member.
· The Integrated Care Partnership (ICP) would need to be established on 1 July 2022 by its founder members – the Chair of the ICB and a representative from each of the five local authorities.
· Place based sub-committees would need to be set up for each of the three ‘places’ within the ICS – this would be more complex within Berkshire West as it spanned three local authorities.
· Consideration was being given to the process for developing the ICP Strategy, which would in turn inform the ICB Strategy – this was expected to take 9-12 months and steering groups would be set up in due course.
The Chairman asked for further details about the proposal for the ICP to contain the ICB Chair and five local authority representatives. Discussions had already taken place between the Leaders and Health and Wellbeing Portfolio Holders of the Berkshire West local authorities about how they would interact with the ICP. The Chairman also indicated that the Berkshire West local authorities had just approved a 10 year Health and Wellbeing Strategy and asked how the strategies for each place would interact with the system level strategy. In addition, the Chairman noted that current legislation required a member of the CCG to be appointed to the Health and Wellbeing Board and the West Berkshire Constitution required a CCG representative to be present in order for meetings to be quorate. He asked what would be proposed in terms of future Health and Wellbeing Board representation.
Matt Tait indicated that ... view the full minutes text for item 82.
The agree additions to the Health and Wellbeing Board membership.
The Board was asked to note the changes to the Membership and Substitutes as outlined in the agenda pack.
To agree any changes to Health and Wellbeing Board membership.
It was noted that Raghuv Bhasin and Matt Pearce would be leaving their respective positions and standing down from the Health and Wellbeing Board.
The Chairman congratulated Matt Pearce on his new role as Director of Public Health at Herefordshire County Council and thanked him for his contribution during the Covid pandemic.
Purpose: To consider the impacts of the Government's adult social care reforms and what they mean for West Berkshire.
Paul Coe gave a presentation on adult social care reforms (Agenda Item 9). Key points from the presentation were as follows:
· The Government’s proposals were initially set out in ‘Build Back Better’ with further detail added in the White Paper ‘People at the Heart of Care’ and the Policy Paper ‘Market Sustainability and Fair Cost of Care Fund: purpose and conditions 2022 to 2023’
· The Dilnot report had looked at charging for care costs, while the Care Act 2014 set out the legal foundations for changes, but this was not progressed in 2015 when the rest of the Care Act was implemented.
· The focus was on ensuring that arrangements would be affordable and sustainable in the long-term.
· Specific areas had been identified for investment.
· The White Papers identified best practice around choice, control, independence, accessibility, timeliness, etc.
· Key changes included:
o New Health and Social Care Levy based on National Insurance contributions
o A cap on care costs of £86,000 from October 2023 for new people
o New capital limits (upper limit of £100,000 and a lower limit of £20,000)
o An intent to shrink the gap between private funder fees and local authority fees
· Priorities for investment included:
o Support for staff (training, occupational health, recruitment, etc)
o Better health and care integration
o Investment to integrate housing into local health and care strategies, with a focus on supported housing
o Greater adoption of technology and digitisation in social care
o Support the social care workforce to access training and to feel recognised and valued, with a focus on workforce wellbeing
o Digital tools to support independent living/improved quality of care
o New practical support service to help people remain independent and safe in their homes, and an increased upper limit on the Disabled Facilities Grant for home adaptations
o Improved services to support unpaid carers
o Funding to help local areas innovate and provide more options that suit people’s needs and individual circumstances
· Key issues and risks were:
o The cap on care and proposed changes to thresholds would result in a loss of income for the Council and lead to a substantial funding shortfall
o West Berkshire had a large number of self-funders who currently organised their own care, either with or without advice
o Everyone who might need care would require assessment from the local authority in order to arrive at an Independent Personal Budget and to ensure best value
o Because the cap only applied to ‘new people’, individuals may wait and put their own health at risk
o There would be an additional burden on providers to account for the different elements of their costs.
The Chairman asked if the cap related to the care costs rather than ‘hotel services’.
Paul Coe agreed, but indicated that details were still emerging. Also, there were some other grey areas where clarification was required. For example, where an unpaid carers had previously received support, but the person they cared for had not received support, it was ... view the full minutes text for item 85.
Purpose: To review the Health and Wellbeing Board Conference that took place on 21 January 2022.
Councillor Graham Bridgman presented the report on the Health and Wellbeing Conference (Agenda Item 12).
The Conference was held on 21 January. The event was open to all and 98 people attended, with 87 staying to the end. After the event, the introductory video had been made available on the Council’s website. The Chairman felt that a remote conference worked well, because it allowed residents to engage without having to travel, but a physical event would have facilitated conversations and exchanges. There had been five breakout sessions, which related to the priorities of the Health and Wellbeing Strategy and the outputs from these would be used to inform the Delivery Plan.
Councillor Martha Vickers thought that it had been a good event, but she would have liked to know whether people were attending in a personal capacity or on behalf of a group or organisation. She felt that the breakout sessions were too short, with time for discussion further limited by presentations from the facilitators. She also suggested that there could be an additional event organised just for young people. She agreed that people would get more out of a face-to-face event.
Councillor Lynne Doherty acknowledged that it was important to listen to people and stressed the importance of communicating how the Board was responding to the feedback received. She highlighted an example where someone had highlighted the need to help people fill out online forms, and noted that this support was already available.
The Chairman agreed that Steering Group would review the workshop discussions and report back to the Board, with actions incorporated into the Communications Strategy.
Action: Steering Group to review the workshop feedback and report back to the Board.
Purpose: To present the West of Berkshire Safeguarding Adults Board Annual Report for 2020/2021.
The Chairman noted that due to a clash of meetings, there was no-one from the Safeguarding Adults Board available to present its Annual Report (Agenda Item 13). Some case studies were cited in the report, where incidents had required full reports or practice learning notes. Members were encouraged to visit the Partnership’s website if they wished to know more about these case studies, which were drawn from the whole of Berkshire. If Members felt that there was anything within the report that merited further discussion, then a representative from the Board could be invited to attend a future meeting.
Councillor Lynne Doherty highlighted the 50% increase in safeguarding concerns across the partnership, but noted that the increase in West Berkshire was much less at 13%. She expressed concern that issues in West Berkshire would not receive as much attention as those in other local authorities that had higher incidences. She suggested that the Board should consider the West Berkshire situation in more detail.
Councillor Martha Vickers raised two issues:
i. On page 61 the report said that the Performance and Quality Subgroup investigated the increase in no support reason in 2019/20, which was attributed to West Berkshire Council and confirmed that the increase was correct, and that Reading Borough Council and Wokingham Council had reviewed their recording practices to ensure that they were consistent with NHS digital guidance. She asked whether West Berkshire Council needed to review its processes, or if it was already compliant with NHS Digital Guidance.
ii. On page 62 she noted a comment that the Safeguarding Board was not complying with its Quality Assurance Framework due to a lack of capacity.
The Chairman proposed that a paper be brought to the next meeting to consider the West Berkshire implications arising from the Annual Report and for a member of the Partnership to be invited to attend the meeting.
Garry Poulson stated that he was the voluntary sector representative on the Safeguarding Adults Board. He noted that reporting mechanisms had been greatly improved, which would have affected the numbers. This was a good thing, as it meant that there was awareness of issues that needed to be resolved. He explained that the Safeguarding Adults Board had just appointed Professor Keith Brown as the new Independent Chair. He was also Chairman of the NHS England Adults Network. He suggested that it would be a good time to raise any areas of concern that needed further investigation.
Emily Evans stated that that she had previously been the Detective Chief Inspector for Protecting Vulnerable People and had worked in safeguarding for most of her career right across Berkshire. She indicated that the reason for this being a Berkshire West document was that most of the partners worked across the three local authorities of West Berkshire, Reading and Wokingham, and in order to understand the West Berkshire situation, this would need input from West Berkshire people. She explained that a conscious decision had been made to share learning from serious case ... view the full minutes text for item 87.
Members of the Executive to answer questions submitted by Councillors in accordance with the Executive Procedure Rules contained in the Council’s Constitution.
There were no questions submitted to the meeting.
Purpose: An opportunity for Board Members to suggest items to go on to the Forward Plan.
The Chairman noted that there would be an item on Joint Funding of Health and Social Care at the May meeting. He also noted that the terms of reference for the Board, its Steering Group and Sub-Groups were being considered as part of a review of all committees across the Council. It was felt to be useful to review the terms of reference since activities would feed into the Health and Wellbeing Strategy and Delivery Plan.
Future meeting dates
· 19 May 2022
· 21 July 2022
· 29 September 2022
· 8 December 2022
· 23 February 2023
(All meetings to start at 09:30)
Board Members were invited to note the dates of future meetings and were advised that the July meeting would need to be rearranged due to a clash of meetings.