Agenda and minutes

(a)  To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health & Wellbeing Board held on Monday, 14^th November 2016.

(b)  To note the outstanding actions.

The minutes of the meeting held on Monday, 14^th November 2016, were agreed as a correct record.

Apologies for absence were received from Liz Bruce, Clare Chamberlain, Steve Miley, Rachel Wright-Turner, Mike Robinson, Councillor Sharon Holder and Councillor Sue Macmillan.  Apologies for lateness were received from Vanessa Andreae.

None.

This report provides an update on the current JSNA work programme and outlines proposals for future projects. The paper presents two JSNA products for consideration and approval by the Health and Wellbeing Board.

Councillor Vivienne Lukey, Chair and Cabinet Member for Health and Adult Social Care welcomed Jessica Nyman, JSNA Manager, and Thilina Jayatilleke, Senior Public Health Analyst, for this item, which provided an update on the current programme of work and outlined future proposals for the work programme.  Toby Hyde, Head of Strategy, H&F CCG introduced the Young Adults JSNA, which highlighted the collaborative process that was followed.  A key aspect of the JSNA had been the identification of the needs of the local population, allowing invaluable correlations to be drawn from key data sets.  It was noted that the Online JSNA in particular offered the opportunity to extrapolate data and allow for deep dive analysis, which had been particularly useful for the report on Young Adults (18-25) JSNA. 

Jessica Nyman reported that the one of the key priorities in the JSNA forward plan was a deep dive JSNA on the needs of children and young people with Special Educational Needs and complex health needs, a key priority area for Children’s Services, giving the forthcoming inspection.  A mental health JSNA was also factored into the forward plan, to be undertaken in the next two years.  

Toby Hyde commented that the process in examining this particular cohort of the population was interesting, given its transient nature and higher rates of migration.  Young adults transitioning from 18-25 comprised 12.5% of the population, with historically very little evidence collected as to their needs.  It was explained that this cohort had shown the least improvement medically in the previous 50 years, with evidence suggesting that this was the point at which poor health choices became rooted in risky behaviour, manifesting themselves in later life in form of long term conditions.  More detailed evidence would help identify trends and formulate a broad pattern, to help pinpoint risk taking behaviour particularly in respect of substance misuse and mental health.  Social isolation amongst young adults was also known to be increasing significantly. 

From a health perspective, Toby Hyde continued that 45% of patients surveyed would not feel comfortable in talking to a GP, with a disproportionate percentage of 18 - 25-year-olds preferring to use urgent care centres.  There was evidence to suggest that improvements such as accessible digital platforms utilising smart technology might be more in line with expectations.  Key findings and themes were set out in paragraph 4.6 of the report.  Paragraph 4.7 of the report included summarised recommendations which included piloting an integrated primary care model at one or more GP surgeries and offering additional GP training. 

Councillor Rory Vaughan commented that the preference to attend urgent care centres by young adults was not a revelation, but it would be helpful to identify what evidence that was already known in terms of achieving a better understanding of risky behaviour patterns, post 18+.  Keith Mallinson, Healthwatch, suggested that drop-in sessions might be a better, more informal alternative, given that the traditional access to GP appointments was problematic for some groups, particularly in terms of addressing the needs  ...  view the full minutes text for item 84.

This report outlines the responsibility of the Health and Wellbeing Board to publish a Pharmaceutical Needs Assessment (PNA) for Hammersmith and Fulham.  The report also describes the purpose and requirements for the PNA and outlines local arrangements to produce the PNA.    

Councillor Lukey welcomed Colin Brodie, Public Health Knowledge Manager, who presented a report that outlined the responsibility of the Board to publish a Pharmaceutical Needs Assessment (PNA) for Hammersmith and Fulham.  It was explained that the PNA was essentially a statement of need for pharmaceutical services in the Borough and was most recently submitted in 2015.  When a provider offered pharmacy services in an area, it was required to apply to NHS England and demonstrate that it responded to the level of need in the area, as set out in the PNA, in order to be included on a pharmaceutical list for that area.  The PNA was required to be refreshed every three years and the 2013 regulations also set a legal requirement for the Board to undertake consultation.  The updated PNA would need to be in place for 2018

Additionally, it was explained that this was useful evidence for local commissioning.  The work by colleagues on the Online JSNA had helped source a map of local pharmacies and it was noted that the update of the PNA would be included in the JSNA work programme.  Section 7 of the report set out further issues for the Board to consider, noting in particular, the role of pharmacies. The convenient location of pharmacies had long been recognised as an important feature of local high streets, and further, understanding the role of community pharmacies was helpful in offering context for the JHWB Strategy and the STP, to shape strategy and to prioritise.

The update of the PNA was being undertaken during a time when the financial challenges for community pharmacies were difficult but the impact of the October 2016 decision by the Department of Health to reduce funding in 2016/17 and 2017/18 for NHS contractors providing services under the contract, was not yet known, although it was likely that there might be some pharmacy closures.  A further challenge to the PNA assessment was the access to data held by a number of organisations which included PH England, NHS England and local CCGs, for which access would have to be requested. 

Keith Mallinson reported Healthwatch concerns regarding the issue of funding for community pharmacies, highlighting the point that appropriate provision should be in place prior to any decision was made to reduce funding.  Councillor Lukey observed that the update to the PNA provided a good opportunity to highlight the work of community pharmacies and the range of pharmaceutical businesses that existed.  There were many examples of good practice, and Councillor Lukey commented on the campaigns to support the retention of good, local pharmacies, which conducted home visits and took a personal approach, offering practical, confidential advice and support. 

Colin Brodie confirmed that the specific requirements of the scope of the PNA

were precise but it would be possible to look at trying to capture examples of good practice.  Stuart Lines suggested that community pharmacies be considered as an item at the next Board meeting on 20^th March.  Janet Cree, Managing Director, H  ...  view the full minutes text for item 85.

This report provides an update on progress to date in relation to the development of a Delivery Plan for the Hammersmith and Fulham Joint Health and Wellbeing Strategy 2016-21. The Board is asked to endorse the proposed approach in taking this work forward. 

Harley Collins, Health and Wellbeing Manager, presented the report which provided an update on the development of a Delivery Plan for the Hammersmith and Fulham Joint Health and Wellbeing Strategy 2016-21 (JHWB), and invited the Board to endorse the selected approach in progressing the work.  It was explained that the Board and the Council, had considered and endorsed the strategy. 

While the JHWB strategy was a high level report, it had identified four key priority areas, but did not provide the necessary detail about the projects that would underpin the strategy.  Further work would be required to complete this, integrating information about the projects, service provision and key milestones.  A small partnership group had been established which consisted of Children’s Services, Adult Social Care and the CCG, to develop the Delivery Plan.  The group would also assist with preparations for the Health and Wellbeing Board development day, to be held on Tuesday, 14^th February.  Board members on the development day will consider action plans, leadership and ownership of priorities, governance mechanisms, identify partner providers and establish how the work will be delivered.  The aim was to present the draft delivery plan in spring 2017, for approval.

Councillor Vaughan enquired what the outcome had been to the suggestion from the Health, Adult Social Care and Social Inclusion, Policy and Accountability Committee, of whether to include a fifth priority, specifically addressing the needs of older people.  It was explained that the references to older people within the strategy would be made more obvious and phrased with greater clarity.  The strategy would shortly be published on the Council website and a press release would also be issued. 

RESOLVED

1.      That the progress made with the development of the Delivery Plan to date, be noted;

2.      That the comments of the Board members during the discussion of the report, be noted; and

3.      That the programme of engagement with stakeholders to develop the Delivery Plan, taking place over the coming 6-8 weeks, be noted.

This report provides an update to the Health and Wellbeing Board on progress towards developing the Better Care Fund arrangements for 2017/18.

Sarah McBride, Director of Partnerships presented the report, which set out for the Board progress towards developing Better Care Fund arrangements for 2017/18.  Guidance was expected to be issued in November 2016 and had been delayed, and as a consequence, there may be a reduced timeframe in which to complete plans. The Board was asked to note the possibility that an extraordinary meeting of the Board might be required to ratify the plans.  The Board noted that learning from the previous year would be rolled over and set in the context of the Health and Wellbeing Strategy.  The intention was to have a smaller number of projects with a more manageable, embedded approach. 

ACTION: Adult Social Care / CCG

RESOLVED

1.      That progress towards the development of arrangements for the Better Care Fund 2017/18, be noted; and

2.      That the Board note that officers anticipate that an extraordinary meeting of the Board may be required to ratify the final Better Care Fund 2017/18 plan, should the required timescale fall outside the timetabled meetings of the Board for 2017/18.

This report provides an update to the Health and Wellbeing Board on primary care delegation.  Members of the Health and Wellbeing Board are asked to note the paper

Councillor Lukey invited Janet Cree, Managing Director of the H&F CCG to present the report, which informed the Board of the CCG’s application for fully delegated (level 3) commissioning arrangements for primary care medical services, commencing from 1^st April 2017.  Under the current co-commissioning, NHS England retained responsibility for existing primary care arrangements, and discharged in conjunction with the CCG.  The CCG Governing Body had in November 2016, discussed the process of submitting the application to NHS England, which would now be considered and voted on, by members of the CCG.  If the feedback from members did not support the application to fully delegate services, the application would be withdrawn.  The Board were informed that the CCG were currently undertaking engagement work with members across the Borough, in addition to progressing governance work streams, so that the CCG was fully cognisant of what was going on.  Janet Cree explained that this was a substantial piece of work, being undertaken at the same time along with the seven other North West London CCGs, going through the same process.   The consultation would take place between 1-14^th February, through an online voting process with a single vote for each practice, and validated an external invigilator.  The outcome of the voting process was to be determined by members and not the Governing Body of the CCG. 

Keith Mallinson reiterated the previously communicated concerns of Healthwatch, regarding the implementation of the STP, and invited the CCG to reconsider proposals for it. 

RESOLVED

1.      That the voting outcome of the H&F CCG membership as to whether to progress the application for fully delegated primary care commissioning, be reported to the Board in due course; and

2.      That the report be noted.

The Quality premium is intended to reward CCGs on the basis of achieving a number of key improvements and is paid to CCGs annually, based on performance against measures that incorporate a combination of national and local priorities.  The submission date for the 2017/18 Quality Premium the date is to be confirmed but expected to be February or March.

Janet Cree, Managing Director, H&F CCG, presented the report which provided an update on the Quality Premium for 2016/17, and, planning arrangements for 2017/18.  It was noted that the premium was intended to reward CCGs to improve the quality of commissioned services, health outcomes and reduce health inequalities in access to services.  Janet Cree explained that there was a common theme around the guidance and that each CCG was required to select a set of Quality Premium indicators.  It was noted that the premium paid was based on CCG performance against measures that incorporated a range of national and local priorities, according to the CCG constituted standards. 

Janet Cree explained the outline for 2017/18 and confirmed that a review of baseline information and related measures will most likely be agreed at CCG operational group meetings but that the Board will be kept informed.  The two likely areas of focus across the NWL CCGs will be diabetes and hypotension.

RESOLVED

That the Health and Wellbeing Board note the performance against the 2016/17 Quality Premium indicators and requirements for the 2017/18 submission.

The Board is requested to consider the items within the proposed work

programme and suggest any amendments or additional topics to be

included in the future.

The Board briefly discussed and noted the work programme as set out in Appendix 1 of the report.  It was agreed that the item on Accountable Care Partnerships be postponed to a later meeting and that the federation be invited to present a report on their collaborative work.  Keith Mallinson asked that an item around the new mental health initiatives implemented by MIND be added to the work programme. 

RESOLVED

That the forward work programme be noted.

The Board is asked to note that the final meeting date scheduled for the municipal year 2016/2017 is as follows:

Monday, 20 March 2017

It was noted that the meetings for the new municipal year 2017/18 would be agreed at Council on 22 February 2017.  The final meeting of the current municipal year will be held on Monday, 20^th March 2017.