Agenda and minutes

To approve as a correct record the Minutes of the meeting of the Board held on 30 May 2019.

Councillor Rick Jones welcomed two new members to the Board; Superintendent Nick John, who had replaced Jim Weems as representative for Thames Valley Police, and Charlotte Hall who represented the arts and culture sector.

The Minutes of the meeting held on 30 May 2019 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 agreed the following additions to the Forward Plan:

·         Council Strategy Delivery Plan

·         Joint Health and Wellbeing Strategy Development Updates

·         Winter Plan for Rough Sleepers

·         Summer Plan for Rough Sleepers

·         Progress on the recommendations in the Voice of Disability Report

·         End of Life Conference report

·         The Wigan Deal; how can West Berkshire be more like Wigan?

·         Inequalities in West Berkshire (report on the Overview and Scrutiny Management Committee work programme)

To consider outstanding actions from previous meeting(s).

The list of actions arising from previous meetings was noted and updated accordingly.

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.

Dr Bal Bahia declared an interest in all matters pertaining to Primary Care, by virtue of the fact that he was a General Practitioner, to Secondary Care by virtue of the fact that he was a Director for Royal Berkshire NHS Foundation Trust and also that he was a Director for Recovery in Mind, but reported that as his interests were personal and not disclosable pecuniary or other registrable interests, he determined to remain to take part in the debate and vote on the matters where appropriate.

Councillor Owen Jeffrey declared an interest by virtue of the fact that his daughter was employed by Frimley Health Foundation Trust and reported that, as his interest was personal and not a disclosable pecuniary or other registrable interest, he determined to remain to take part in the debate and vote on the matters where appropriate.

Councillor Lynne Doherty declared an interest by virtue of the fact that she was employed by a disability charity and reported that, as her interest was personal and not a disclosable pecuniary or other registrable interest, she determined to remain to take part in the debate and vote on the matters where appropriate.

Councillor Steve Masters declared an interest by virtue of the fact that he was the Chair of Trustees for Eight Bells for Mental Health and reported that, as his interest was personal and not a disclosable pecuniary or other registrable 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 a disclosable pecuniary or other registrable interest, he determined to remain to take part in the debate and vote on the matters where appropriate.

No public questions were submitted.

There were no petitions presented to the Board.

To update of the progress to establish Primary Care Networks in West Berkshire.

The Board considered a report (Agenda Item 8) to provide an update on the work to establish Primary Care Networks (PCNs) in West Berkshire. Kamal Bahia tabled a leaflet which included a map of the four PCNs named West Berkshire Rural, A34, Kennet and West Reading Villages. Unfortunately Chapel Row Surgery had decided to align with a PCN in Reading but this was not anticipated to impact on development of PCNs in West Berkshire.

Kamal explained that PCNs would build on the already strong joint working in Primary Care to deliver enhanced access to appointments in evenings and weekends. Locally, the focus was on recruiting the additional staff such as Physician’s Associates and the recruitment of social prescribers would be aligned with local aspirations for community wellbeing.

Work was ongoing to set up governance boards for each PCN and the chair was rotating between the 14 PCNs in Berkshire West. A ‘Design your Neighbourhood’ was held on 19 September 2019 to share information with the public.

It was proposed to provide a further report to the Board when the next major stage on the PCN checklist (included in the report) was reached.

Tandra Forster confirmed that the Clinical Directors of each PCN were invited to the Locality Integration Board, a sub-group of the Health and Wellbeing Board which oversaw integration between health and social care in West Berkshire. She reported that their enthusiasm was inspiring.

Councillor Lynne Doherty requested that a leaflet be drafted to be shared at the upcoming District Parish Conference on 22 October 2019. (Action)

Luke Bingham asked whether visiting services were involved in PCNs; Kamal advised that they were not at present.

Andrew Sharp asked whether there was any scope for Patient Participation Groups to mirror PCNs. Kamal advised that the approach to engagement was still in development.

Councillor Owen Jeffrey reported that he had been pleased to learn that additional funding had been made available to support the recruitment of the additional posts.

Dr Bal Bahia commented that the development of PCNs was in part to ensure that Primary Care had a sustainable workforce and it would be important to make sure patients were on board.

Councillor Rick Jones, to summarise, stated that the checklist included in the report was helpful and noted that the Board had been calling for updates faster than progress was being made. He confirmed that there needed to be more content before the public would be ready to learn about the changes.

RESOLVED that the Board noted the report.

To confirm the decision made at the Informal Meeting on 11 July 2019 to produce a Joint Health and Wellbeing Strategy with Reading and Wokingham’s Health and Wellbeing Boards.

The Board considered a report (Agenda Item 9) to confirm the decision made at the Informal Meeting to pursue the development of a Joint Health and Wellbeing Strategy with Reading and Wokingham’s Health and Wellbeing Boards. The Strategy would continue to include a localised action plan. A new Prevention Board had been created under the Integrated Care Partnership (ICP) which would oversee the strategy development. Updates would be brought back to the Board as they arose.

Councillor Lynne Doherty stated that she supported the approach but questioned whether the proposed timescales were realistic. Matt Pearce agreed that it might be necessary to slip the proposed timescales to ensure that the strategy was properly coproduced with the public.

Andrew Sharp agreed with the proposal and pressed the need to collaborate with the public. Matt confirmed that the ‘Design your Neighbourhood’ events were already helping to engage with the public on health and wellbeing priorities.

Cathy Winfield highlighted that the Board would not need to start from scratch to develop the new strategy so would encourage the strategy to be developed with some pace. The strategy would be important to inform the ICP’s work.

Councillor Rick Jones concluded that the timescales could not be controlled by West Berkshire alone and the timescales would need to be realistic.

RESOLVED that  the Board:

(1)  Support the concept of a Shared JHWS

(2)  Agree the timeline for the strategy development

(3)  Agree to identify dedicated capacity for strategy development

(4)  Agree to delegate the development of the strategy to a Strategy Development Group

To receive assurance that an improvement plan is in place in response to the Improvement and Assessment Framework Rating 2018/19.

The Board considered the report (Agenda Item 10) which reported the outcome of the 2018/19 CCG Improvement and Assessment Framework evaluation of Berkshire West CCG’s performance. Cathy Winfield explained that the CCG had been given the judgment of ‘requires improvement’ because it had ended the year with a financial deficit. The decision had been taken to support Royal Berkshire Hospital to balance their position in order to enable them to access a further £9m. Unfortunately the funding element trumped all other criteria in the Framework. It was likely that the CCG would be judged ‘requires improvement’ for 2019/20 as there was a £4m pressure on the budget which the CCG would be unable to mitigate.

Councillor Owen Jeffrey stated that he had read the report with horror because it was ridiculous that finances trumped the quality of care under the Framework. He asked whether the Board would be willing to write to the Secretary of State for Health and Social Care to seek an explanation why a deficit of 0.4% of the total CCG budget had led to the judgement.

Andrew Sharp expressed the view that the judgment was tantamount to corporate vandalism. He stated that it was irresponsible to conflate language used by the Care Quality Commission. Healthwatch had already contacted NHS England and he encouraged the Board to do the same.

Councillor Dominic Boeck asked whether a risk assessment had been undertaken on the judgement and if there were any financial implications. Cathy Winfield advised that the CCG management knew the financial position but had considered the benefits of the additional £9m to support the RBH to be the right thing for the Berkshire West health economy. They had not realised there would be an impact on the rating. The assurance framework had not kept pace with system working. There was no financial penalty associated with the rating. In terms of a formal response by the Board, Cathy advised that the CCG had taken the decision to accept the rating and move forward.

Councillor Lynne Doherty stated that she would like to have more information on the other 58 areas included in the assessment framework before considering whether to submit a formal response. Cathy Winfield agreed to circulate a briefing on those areas and the CCG’s performance report (Action: Cathy Winfield)

Andrew Sharp declared that Healthwatch would be writing to the Secretary of State to challenge the transparency of the rating and make the point that it gave the wrong message to patients.

RESOLVED that the report be noted.

To approve the Better Care Fund Plan 2019/20.

The Board considered a report (Agenda Item 11) to gain formal sign off for the Better Care Fund (BCF) Plan for 2019/20.

Shairoz Claridge introduced the report and explained that the four key metrics (non-elective admissions, admissions to residential and care homes, effectiveness of reablement; and Delayed Transfers of Care (DTOC)) were being maintained and the system had either ‘mature’ or ‘established’ progress against the high-impact areas identified by the Local Government Association.

The BCF was monitored by the Locality Integration Board who moving forward would also monitor Primary Care Networks and a new approach to Population Health Management.

The Plan has already been submitted to NHS England as the guidance was received later than anticipated.

RESOLVED that the Better Care Fund Plan 2019/20 be approved.

To consult the Board on the objectives which will be published for consultation for the Culture Strategy.

The Board received a presentation (Agenda Item 12) by Paul James, Culture and Libraries Manager (West Berkshire Council), regarding the development of a Cultural Strategy. It was planned that the strategy would set out a broad, strategic vision for West Berkshire, the Council and partner organisations, to promote and develop culture and cultural heritage as a valuable resource which  made a significant contribution to the economy, improved the health and wellbeing of communities, and which was a unique asset in its own right.

Matt Pearce stated that he recognised the value of culture and asked that closer work with the NHS was undertaken to embed culture in clinical pathways. Dr Bal Bahia supported the view that links should be made and highlighted an example of Poetry on Prescription in Shropshire.

Charlotte Hall reported that she saw the benefits of arts and culture on wellbeing daily through initiatives such as Dance for Parkinson’s. The sector was keen to step up and support communities. She welcomed the opportunity to connect culture and wellbeing through the strategy.

Councillor Rick Jones concluded that he welcomed the proposed new Strategy and wanted to ensure the Board’s new strategy included culture.

RESOLVED that the Board supported the commencement of a public consultation.

To present a list of existing and emerging strategies which support the delivery of the West Berkshire Vision 2036.

The Board considered a report (Agenda Item 13) which reported on the alignment of current and emerging strategies with the aspirations outlined in West Berkshire Vision 2036. The Steering Group had recommended that emerging Strategies were added to the Board’s Forward Plan so that the Board could ensure it had oversight.

Matt Pearce suggested the addition of the forthcoming Leisure Strategy to the list. Cathy Winfield highlighted that the CCG Operational Plan should be added and more documents would be produced by the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System.

Councillor Steve Masters asked whether it was intended to invite the Portfolio Holder for Environment to present the Environment Strategy. Councillor Rick Jones advised that he would discuss with him how best to engage with the Health and Wellbeing Board.

RESOLVED that  the report be noted and the emerging strategies be added to the Board’s Forward Plan.

To present the outcome and recommendations arising from a self-assessment exercise.

The Board considered a report (Agenda Item 14) which presented the key findings from self-assessment exercise conducted over the summer.

Councillor Rick Jones stated that he recognised the findings and would ask the Steering Group to consider how best to take them forward.

Cathy Winfield noted a theme arising from the feedback that health partners were not considered to be sufficiently involved and asked for any further information.

Tandra Forster recognised that there was always more to do but praised the significant improvement achieved since the Peer Review in 2016.

A discussion was held regarding the recommendation to consider how the Board’s public engagement was resourced and it was recognised that while the public did not need to know what the Health and Wellbeing Board was, they needed to know its work. Dr Bal Bahia reminded members that the Board and Steering Group were not responsible for any resource and individual member organisaions needed to identify anything additional they could offer to support public engagement.

RESOLVED that the report be noted.

(Cathy Winfield left the meeting at 11am)

To present an update on the plan to develop a five year strategy for the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System.

Councillor Rick Jones announced that this item would be discussed, although it had been marked on the agenda as for information only.

The Board considered a report (Agenda Item 15) which set out plans to develop priorities for the next five years. Nick Carter introduced the report and stated that the document would be followed by a large technical submission which he recommended Board members to read and provide comments on.

Nick expressed the view that there was very little content on the impact on local government and the NHS Long Term Plan did not include any information on social care. He expressed concern that funding would be allocated to the system (Buckinghamshire, Oxfordshire and Berkshire West(BOB)) instead of the place (Berkshire West). He awaited the technical submission for more information.

Further, it was likely that Berkshire West CCG would be required to merge with its Buckinghamshire and Oxfordshire counterparts which was highly relevant to the Board.

Nick concluded that the Board should make comment on the document and the technical submission to express any concerns.

Andrew Sharp stated that Healthwatch West Berkshire had been invited to attend BOB meetings which were undertaking projects at very large scale. It was unrealistic to expect the Board to sign off the plans with such short deadlines and he stated the Board should be concerned. 30% of patients in the area used services outside the BOB system and he was concerned that there was not sufficient clarity on arrangements for those patients. Andrew expressed the view that prevention was an after thought and at a recent conference the NHS had recognised that only 25% of health outcomes were linked to the provision of care; the remaining 75% of factors were about the wider determinants of health.

It was agreed that any comments would be returned to Jo Reeves to collate and if necessary a small working group would be established. Councillor Rick Jones encouraged all in the public gallery to also provide their comments. (Action: All)

RESOLVED that  the report be noted.

To present an update on the work to make West Berkshire dementia friendly.

The Board noted the report.

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).

A question submitted by Andrew Sharp on the subject of West Berkshire residents using services outside the Integrated Care System area was answered by the Chairman.

Health and Wellbeing Informal Meeting (private) - 28 November 2019

Health and Wellbeing Board (public) - 30 January 2020

The Board wished Ian Mundy a happy retirement and noted that Reva Stewart would replace him as the representative for Berkshire Healthcare NHS Foundation Trust.