Agenda and minutes

The minutes of the meeting held on 5 May were taken as read, confirmed and signed.

There were no urgent items presented for consideration. However Chairman did make reference to breaking news of NHS England’s intention to cease the commissioning of children’s heart surgery at Glenfield Hospital and the significant concerns this news had generated locally. The Chairman noted that John Adler had been unable to attend the meeting as he was dealing with the associated media enquiries about this.

The Chairman invited members who wished to do so to declare any interest in respect of items on the agenda for the meeting.

Mr. I. D. Ould CC declared a personal interest in respect of Item 13  as the Cabinet Lead Member for Children and Family Services (Minute 300 refers).

The Chairman gave a position statement on the following matters:-

·       Engagement events for Non-emergency Patient Transport Services;

·       Two LPT projects shortlisted for national awards;

·       Education’s “power” to prevent Type 2 diabetes;

·       A range of national publications.

A copy of the position statement is filed with these minutes.

The Board considered a report of the Director of Public Health concerning one of the key actions arising from the Board’s development session held in February 2016, which aimed to take a more systematic approach to the wider determinants of health and wellbeing within the agenda of the Board, including ensuring the Board’s strategy and work plan provides more prominence to these matters in 2016/17. A copy of the report marked ‘Agenda Item 5’ is filed with these minutes.

Arising from discussion the following points were raised:-

·                The positive engagement of district council colleagues was welcomed;

·                It was felt that more needed to be done as part of the planning application process for new housing developments to ensure that adequate provision was made for GP surgeries. The impact of new care homes on local health services was also raised, as these developments often happened rapidly and without adequate engagement of primary care, with local surgeries faced with putting in place support a short notice. This was felt to be of particular relevance to medium to large-sized developments. In response to a request, officers indicated that partners would be engaged with a view to considering how best this issue could be addressed.

RESOLVED:

(a)       That the proposed arrangements for Board Members to receive targeted updates from other bodies delivering work relating to the wider determinants of health be noted;

(b)       That the proposed approach to health in all policies be approved;

(c)       That the Board will ensure that the refreshed Joint Health and Wellbeing Strategy presents a systematic approach to the wider determinants of health and wellbeing, in accordance with the proposals set out in the report;

(d)       That it be noted that the recommendations from the report will support the implementation of the Better Care Together Programme and Sustainability and Transformation Plan in Leicester, Leicestershire and Rutland.

The Board considered a report of the Director of Adults and Communities advising the Board on the forthcoming consultation on the draft Adult Social Care Accommodation Strategy for Older People and to present the annual review of progress in relation to extra care housing in the County. A copy of the report marked ‘Agenda Item 6’ is filed with these minutes.

RESOLVED:

That Board members be invited to seek comments from their respective organisations as part of the consultation process, and that the actions arising from the Extra Care Annual Review as highlighted in paragraph 15 (a) to (f) be noted.

The Board considered a report of Director of Public Health concerning the proposed new Outcomes framework for the strategy and the scope of the draft Health and Wellbeing Strategy 2017-2020. The report included feedback from the discussions that had taken place with Board members and stakeholders about the Joint Health and Wellbeing Strategy (JHWS) including the Health and Wellbeing Board Development Session of 21st June 2016. A copy of the report marked ‘Agenda Item 7’ is filed with these minutes.

Arising from discussion the following points were raised:-

·         The focus on outcomes was welcomed, though a suggestion was made that Outcome Four should have an increased focus on “end of life” care. A further suggestion was made for some regard to be given to dementia within this Outcome. In response, officers indicated that suggestions such as these would be a focus of the associated Delivery Plans;

·         A view was expressed at the high number of closely linked strategies now coming before the Board and the need to avoid duplication and demonstrate alignment. It was noted that work was underway as part of this Strategy to identify any gaps and interrelationships across existing work streams, for example in the context of BCT and the STP;

·         A single mission statement for health and care across Leicester, Leicestershire and Rutland was being developed as part of the Sustainability and Transformation Plan.  The Joint Health and Wellbeing Strategy would have regard to this;

·         It was felt that there may be some duplication between Outcome Three and the work of the Safeguarding Board. A suggestion was made to include reference to the statutory obligations of the Director of Children and Family Services and the Cabinet Lead Member for this area;

·         It was suggested that paragraph 47(b) of the report should amended in light of the Board’s decision today to adopt the “Health in all policies” approach when planning and commissioning services.

RESOLVED:

(a)       That the proposed outcomes set out at paragraph 34 of the report be approved, subject to the comments of the Board and that further regard be given to “end of life” care and dementia as part of Outcome Four;

(b)       That it be noted that Board will be required to provide a clear steer regarding the content of the priority objectives and actions which will underpin the Joint Health and Wellbeing Strategy;

(c)       That the mission statement and principles to enable the Board to work in a more proactive and collaborative way be approved;

(d)       That the timetable for completion of the Joint Health and Wellbeing Strategy outlined in Paragraphs 48 to 52 of the report be approved;

(e)       That members of the Board be asked to consult their own organisations on the content of the Joint Health and Wellbeing Strategy in order to approve the final strategy at the Board meeting in November.

The Board considered a report of the Director of Public Health concerning the medium term strategy for early help and prevention services within Leicestershire County Council and the associated review of current delivery, and the governance proposal and outline programme approach to deliver the recommendations of the Strategy. A copy of the report marked ‘Agenda Item 8’ is filed with these minutes.

The Director reported that the principal aim of the project was to provide a consistent offer in respect of early help and prevention services, as these services had previously been operated across multiple Council departments. £48.3 million was currently spent by the Council on prevention services. It was hoped the project would deliver some £3 million in savings.

It was noted that the Director would act as the project sponsor, with Mr. White CC acting as the Lead Member for the project. Update reports on the progress of the project would be provided to future Board meetings.

RESOLVED:

(a)       That the Medium Term Strategy for Early Help and Prevention services within Leicestershire County Council and the associated review of current delivery be noted;

(b)       That the governance proposal and outline programme approach to deliver the recommendations of the Strategy as approved by Leicestershire County Council’s Cabinet on the 17th June 2016 be noted.

The Board considered a report of the Director of Children and Family Services concerning an update on progress made by the Better Care Together programme for improving the mental health and wellbeing of children and young people. A copy of the report marked ‘Agenda Item 9’ is filed with these minutes.

Arising from a discussion, the following points were noted:

·                Tributes were paid to the former Director of Children and Family Services in leading this work across LLR, and who had recently taken up an equivalent post at Northamptonshire County Council. An emphasis had been placed on improving CAMHS and this had already resulted in reduced waiting times and the reduction of a large backlog of cases;

·                It was felt that more could be done to bring the various sectors together to tackle CAMHS issues on a more collaborative basis and improve integration;

·                School nurses now fell within the responsibility of Public Health and there was a need to manage expectation and tackle bureaucracy given a transformation plan to tackle CAMHS issues was being implemented over the next 4-5 years.

RESOLVED:

That the update on progress made by the Better Care Together programme for improving the mental health and wellbeing of children and young people be noted.

The Board considered a report and supporting presentation of Healthwatch Leicestershire concerning the findings of Healthwatch Leicestershire’s (HWL) ‘The Listen to me: #YoungVoicesMatter report’ that saw HWL listen to the views, opinions and experiences of young people. A copy of the report marked ‘Agenda Item 10’ and the slides forming the supporting presentation is filed with these minutes.

Arising from a discussion, the following points were noted:

·             Though some of the issues brought out in the report would be impacted by the work around improving access to CAMHS(see Minute 296), there were some concerns around the results of the survey where the views expressed by the young people showed their levels of concern about self-esteem, for example many young people (both male and female) worried constantly about their personal appearance. It was noted that elements of support available to address these types of concerns fall outside of the CAMHS service and are part of wider service provision within mental health services (e.g. work on mental health resilience);

·             While the results around the number of young people who said they had self-harmed were concerning, the context of the small sample size used for the report was discussed, along with the fact that the local results appeared to be in line with proportions reporting self harm in larger surveys. For some, the high number of those who said that had self-harmed was also reflective of wider “health literacy” issues, where increased support on a family basis would be needed;

·             Those young people that had participated in the survey would be issued with a copy of the full report by way of feedback and the Board asked that this feedback include action taken as a result of the survey It was hoped that those who had contributed would also form a cohort which could be consulted on future Healthwatch proposals;

·             Confidentiality was viewed by young people as being an important factor in accessing support services, such as school nurses. In this case, it was noted that some young people might be put off making use of this facility if it was apparent fellow students to see that they had visited the school nurse’s office. The use of the chat health confidential texting service was noted as a positive development in support of this issue;

·             It was suggested that the report be sent to GP surgeries, libraries and schools and its findings be publicised to youth groups, such as the County Youth Council for Leicestershire (CYCLe), the Children in Care Council and the LPT’s “Evolving Minds” Group. In the case of the youth groups, it was suggested that any actions arising from the discussions that took place should be fed back to the Board with a view to establishing whether any further action was required.

RESOLVED:

(a)        That Healthwatch Leicestershire’s “Listen to me: #YoungVoicesMatter” report and the supporting presentation setting out key findings and themes be noted;

(b)        That the Board’s comments on the recommendations (a) – (g) of the report be noted;

(c)        That the findings of the report be presented to the Children in Care Council, the County Youth Council for Leicestershire (CYCLe) and the LPT’s “Evolving Minds” Group;

(d)        That, arising from (c) above, the Director of Health and Care Integration would follow up with members of the Board to consider if further actions should be taken to address the Healthwatch survey findings relating to young people’s self-esteem and anxieties around their personal appearance;

(e)        That the report be circulated widely to GP surgeries, libraries and schools.

The Board considered a report of Healthwatch Leicestershire concerning the findings of Healthwatch Leicestershire’s Enter & View visit to the Child and Adolescent Mental Health Services (CAMHS) Unit at Coalville Community Hospital (Ward 3) on the 23 February 2016. A copy of the report marked ‘Agenda Item 11’ is filed with these minutes.

RESOVED:

(a)       That the findings of the report and actions for improvement of the service and the system as a whole as outlined in the report be noted;

(b)       That it be noted that this report is to be presented at the West Leicestershire Clinical Commissioning Group Quality & Performance Committee on 19 July 2016 and Voluntary Action Leicestershire’s Children, Young People & Families Forum on 16 August 2016.

The Board considered a report of the Director of Health and Care Integration concerning assurance on the quarterly reporting requirements for the Better Care Fund (BCF) including the pay for performance element of the fund, which is linked to achieving reductions in emergency admissions. A copy of the report marked ‘Agenda Item 12’ is filed with these minutes.

RESOLVED:

That it be noted that the final 2015/16 quarterly return was approved by the Integration Executive on 24th May and submitted to NHS England on 27th May.

The Board considered a report of the Director of Children and Family Services presenting the terms of reference for the Supporting Leicestershire Families Executive for the Board’s approval. A copy of the report marked ‘Agenda Item 13’ is filed with these minutes.

Mr Ould, having declared a personal interest in this matter, chose to leave the room during discussion of this item.

RESOLVED:

(a)       That the Terms of Reference for the Supporting Leicestershire Families Executive be approved;

(b)       That those partner organisations which have not yet nominated a representative to serve on the Supporting Leicestershire Families Executive be asked to do so as soon as is reasonably practicable.

The next meeting of the Health and Wellbeing Board will be held on 15^th September at 2.00pm.

The next meeting of the Board would take place on Thursday 15 September at 2.00pm.