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 Tuesday, 20^th June 2017

(b)  To note the outstanding actions.

The minutes of the previous meeting held on 20^th June were amended to included apologies for absence from Councillor Rory Vaughan and agreed.

There were no actions arising.

Keith Mallinson declared an interest regarding his employment with MIND.  Dr Tim Spicer declared an interest as practicing GP working within LBHF.

This report provides the Health and Wellbeing Board with details of the Integration and Better Care Fund Plan for 2017-19 submitted on the 11^th September to NHS England.

Note:  The documents included in the Supplementary 2 Agenda are appendices to Appendix 1, the Better Care Plan 2017/19.

The report provided details of the Better Care Fund Plan for 2017/19 (BCF).  The government issued late guidance in July, setting a submission date of 11^th September, within a short timeframe.  This meant that much of the considerable collaborative work undertaken to prepare the plan had been undertaken before the meeting.  Councillor Coleman commended officers for the highly detailed and comprehensive report, which had been put together in a very short time period, developed through extensive dialogue and agreement with partner organisations.

Davey Thompson, Associate Director, BCF Lead, explained that this was the third BCF submitted in two years and had been amended to align with other local authorities and the CCG.  The number of schemes taken forward had been reduced to 7, after a number of previous schemes were now operating as business as usual. It was confirmed that collaboration throughout the process had been a key factor to facilitate formal signing off. 

Referring to section four, the Board noted progress built throughout 2016-17, translating the vision for integration into a strategy and delivery plan that was both assured and demonstrated confidence in the partnership between local authorities and CCGs.  Section five set out high level figures, indicating a jointly agreed budget of £43.708 million.  This included a minimum £5.782 million, to be transferred to Adult Social Care, in order to protect frontline services and to meet a condition of the BCF.

Keith Mallinson expressed concern about the provision of podiatry service being withdrawn from people with long term conditions such as diabetes.  Janet Cree explained that podiatry services did not form part of the service provision covered by the BCF.  Councillor Vaughan confirmed that this had been highlighted at the previous evening’s Health, Adult Social Care and Social Inclusion, Policy and Accountability (HASCSIPAC).  It was intended that that this be considered at its next meeting in November. 

Ian Lawry commented that the voluntary and community sector in Hammersmith and Fulham was broadly supportive and welcomed the BCF view on integration but felt this could go further and encompass the voluntary and community sector as a collective, ensuring a more devolved process of delivering care in the community.  He cited the examples of MIND and the White City Enterprise, recognising the need to consider the social determinants of ill-health. 

Commenting further, Keith Mallinson, highlighted further concerns regarding a lack of consultation, making the point that many viable projects were delivered short term, the result being a negative impact on recruitment and job security, with insufficient resources to meet need. Graham Terry responded that it was important that ASC continued to work closely with the CCG, delivering greater integrated care, and, help build more resilient and robust communities.  ASC was well positioned to be able to help individuals make the most of community assets, eventually reducing the cost to the service. Graham Terry agreed with the views expressed and supported a socially inclusive approach which would more proactively involve the voluntary sector.  Councillor Coleman acknowledged the work of White  ...  view the full minutes text for item 115.

This paper provides an update to the Health and Wellbeing Board on the key aspects of the Primary Care Strategy, ahead of its publication in mid-September 2017.

Janet Cree explained that the report provided an update on the current position of the Like Minded Strategy, covering specifically, locally deliverable actions within Hammersmith & Fulham.  The final strategy, which had been agreed at the CCG’s AGM the previous evening, had not been included in the papers but was made available following agreement at the AGM meeting.

Janet Cree commented that while access to primary care had improved, for example out of hospital services such as diabetes or the Community Independence Service, there was more that could be done to integrate care across the system, while ensuring a more sustainable primary care structure. She added that primary care networks (PCNs) in the strategy would enable GP practices and wider services to collaborate.  PCNs would be unified and collectively deliver community services through a platform of a Multispeciality Community Provider (MCP).  Referencing Appendix 1 to the report, Janet Cree explained that local engagement events had been held throughout July and the response from participants had been incorporated into the final strategy, which included adapting technical language and patient case studies. 

Section 4.6 of the report identified a number of workstreams to support the implementation of the strategy.  The transformation journey would involve the development of links with providers as this moves towards a more accountable care partnership (ACP).  It was notable that this already existed in Hammersmith & Fulham but that the links would need further development. 

Lisa Redfern welcomed the report and suggested that a transformation board or group would be helpful to facilitate the ACP, or similar mechanism to capture multi-faceted, on-going work.  Dr Tim Spicer commented that while he welcomed the suggestion to form a transformation sub-group, he observed that this a hugely complex and non-static of work, which required an overarching level of expertise that could not be provided by a single individual.  Councillor Vaughan added that it was important for the Board to have oversight in order to evaluate the impact.  Vanessa Andreae confirmed that the timetable for implementation would commence in October.  She added that there were two fundamental issues, the first, that patients needed access to services.  A second issue was the need to secure GP practices, without causing disruption to existing networks. 

Moving the discussion forward, Councillor Coleman asked about the underlying reasons for the work and what would be the outcome for residents (patients).  Dr Spicer explained that it was important for patients / residents with complex needs, being cared for by a multi-disciplinary team, to feel that care was being provided seamlessly.  Currently, 13% of patients held this view, which could be improved.  Janet Cree concurred, adding that the aim would be to remove from ASC those with long term complex needs, to care delivered through MCPs.  Councillor Coleman emphasised the importance understanding the resident experience and identify their expectations.  Vanessa Andreae confirmed that the patient experience had been included, so the patient’s voice was embedded within the development of the strategy.

Keith Mallinson queried the level  ...  view the full minutes text for item 116.

This is report provides an update to the Health and Wellbeing Board on the current position with the Like Minded strategy.  The report provides both a general overview of the key elements of the strategy together with specific details of the actions that have been/are being taken within Hammersmith and Fulham.

Councillor Coleman welcomed, Carolyn Regan Chief Executive of West London Mental Health Trust (WLMHT).  The report provided an update to the Board on the key elements of the strategy, which fell within Delivery Area 4 of the Sustainability and Transformation Plan (STP), improving mental health services.  With emphasis on delivering community health care, the aim was to ensure the right support was in place to treat mental health conditions.  To illustrate, Community Perinatal Mental Health commenced at WLMHT in April 2016, providing targeted, community based support for women, and their families, with pregnancy related mild-to-severe mental illness. 

It was noted that the distribution of services for long term conditions and mental health needs across the Borough was good.  There was a new enhanced GP service offering extended appointments and work was on-going with practices to ensure a good uptake of services on enhanced GPs “offers”.    The Transforming Care Partnership (TCP), for people with learning disabilities and complex long term conditions, recognised the importance of a safe and seamless transfer into a community setting, rather than in a specialist learning disabilities hospital. 

With reference to the TCP, Keith Mallinson welcomed the report but observed that the lack of a joined up approach between departments contributed to a deterioration of long term conditions, acknowledging the link between housing issues and mental illness. 

Lisa Redfern queried the impact of implementing the strategy on resources and sought assurances that this would not result in the loss of beds.  In response, Carolyn Regan explained that mental health was a priority area and that there would not be any proposals to reduce beds in LBHF.  Ealing had more acute beds for longer stays but there were also vacant beds, indicating a need to look at the overall allocation of resources.  Acknowledging that LBHF residents were also placed in Ealing facilities, it was explained that each borough predominantly provided for its own residents and that the use of the bed changed on a weekly basis.

Following further discussion, the Board received an assurance that WLMHT would inform them of any proposed bed closures.  It was explained that there was a joint mental health transformation board consisting of the three boroughs and that considerable work was being undertaken with residents to facilitate early intervention.  Mike Robinson commented that encouraging residents to be more proactive about their own care will help alleviate pressure on services, and the impact of long term mental health conditions.

Steve Miley referred to the suicide awareness training being rolled out to 700 frontline staff across the three boroughs and enquired if this could be extended.  It was also noted that there was embedded support through CAMHs (Children and Adolescents Mental Health Services) and statutory cover for looked after children aged 21-25 years.  Support for this small cohort of care leavers mental health conditions was important, particularly in terms of ensuring access to services.  Given this and the recent Transitions report from the policy and accountability task and finish group,  ...  view the full minutes text for item 117.

Members of the Board considered items listed provisionally in the Work Programme (Appendix 1 to the report).   Commenting on the item on “one public sector estate”, Janet Cree agreed that this could be a joint report but did not necessarily need to come to the Board.  Commenting on the “social isolation item”, Mike Robinson referred to development of the Tackling Social Isolation and Loneliness Strategy.  Ian Lawry suggested that Sobus could invite interested groups to the next meeting of the Board to help identify key issues. The suggestion was welcomed by members. 

While it was accepted that there were mechanisms in place to avoid duplication of grant allocations, Vanessa Andreae suggested a report which mapped out grant allocations made by both the CCG and the local authority.  Joint co-ordination to explore this would be helpful to ensure a joined up approach.  This could also be mapped to the priority areas of the Joint HWB Strategy.

Mike Robinson commented on the “healthy lifestyle” item.  He explained that Public Health was considering the consolidation of large numbers of small contracts. This was an issue for the Board to consider, particularly in terms of how this aligned with the PCS and grant allocations. 

Harley Collins referred to the draft pharmaceutical needs assessment, which would need to be published by April 2018 and would require a 60-day consultation period, taking place between November 2017 and January 2018.  It was agreed that this could be addressed outside of the current cycle of meetings.

Councillor Holder suggested that further discussions were required around the way in which consultation and engagement with residents was conducted with residents on health matters.

Lisa Redfern highlighted the local authority’s statutory responsibility to consider the annual report of the Safeguarding Adults Executive Board and it was accepted that this would need to be considered by both the Board and HASCSIPAC. 

Following detailed discussion, it was agreed that the following changes would be made:

• Delete STP updates;
• HWB Priority Area 1 – Integrated Services for Children and Young People, to be rescheduled for a later meeting;
• Whole Systems Commissioning Intentions – Remove, as covered under STP;
• One Public sector estate – CCG to further explore, as noted.

There were three items agreed for the November meeting:

• Healthy Lifestyle service (LBHF)
• Mapping exercise of CCG and local authority grant allocations
• Social Isolation and Loneliness – invite Councillor Fennimore, interested residents and stakeholders.

It was agreed that the January meeting would look at transitions work and consider the findings of the Disabled Peoples Commission.  The Board also noted that a view would be required on when to programme a workshop style discussion on the Joint HWB Strategy, provisionally planned for January.

RESOLVED

That the Work Programme be amended to reflect the discussion and agreed changes, set out as minuted. 

The Board is asked to note that the dates of the meetings scheduled for the municipal year 2017/2018 are as follows:

Tuesday, 21^st November 2017

Wednesday, 31^st January 2018

Wednesday, 21^st March 2018

The date of the next meeting of the Board was noted as Tuesday, 21^st November 2017.