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 February 2018.

(b)  To note the outstanding actions.

The minutes of the previous meeting held on 20 February 2018 were agreed as an accurate record.

Apologies for absence were received from Councillors Rory Vaughan and Sue Macmillan; and Janet Cree.

None.

This report outlines progress on the Integration and Better Care Fund Plan for 2017-19 submitted on 11 September to NHS England and the Department of Communities and Local Government.

Graham Terry presented the Better Care Fund (BCF) report which provided a high-level Quarter 3 information, delayed by guidance being issued.  This was a precursor to Quarter 4 data available in May/June.  The report was being considered by HWB as it was responsible for signing off the BCF plan and review the progress made since submission.  The Community Independence Service (CIS) continued to be a priority across all three HWB areas with very good performance on delayed transfers of care.  The current contract was due to expire in July 2018, with agreement by senior health and social care leads to roll this forward until end of March 2019, to enable a full quality and financial review of the service has been undertaken. As CIS continued to play a strong role in parallel with other services.

Previously low performance on Delayed Transfers of Care (DToC) had been improved, largely due to focus and dedicated leadership from Lisa Redfern and her team to reduce DToC.  There was now an upwards trajectory achieving above what was expected and this would meet the cumulative target in July, despite winter figures.  The Integrated Care Partnership had been formally signed off with a two-year agreement, operating as committees in common.  This provided agreement for a group of partners focused on integrated care to improve care pathways for LBHF residents.  A seven-day social work team had been established to provide continuity of care throughout the week. Financial implications meant that both partners faced cost pressures, with a section 75 health funded services shortfall of £9.8 million (covered in report to the September 2017 HWB). 

Keith Mallinson expressed concern regarding the introduction of Accountable Care Organisations (ACOs) in the context of Sustainable Transformation Partnerships (STPs) and the fact that LBHF had not agreed to the STP. Graham Terry reported that general concerns about this had been recently discussed at a Kings Fund meeting and no assurances had been offered. Surrey Borders Partnerships NHS Foundation Trust had delivered without an ACO or an integrated partnership.  There had been some evidence of frontline working and the benefit to residents and how this had developed, questioning the arguments in support of an ACO, a view which was in line with the LBHF approach. 

Councillor Ben Coleman confirmed that there were concerns about ACOs, and unsubstantiated claims about the benefits.  Integration was more a term about centralised control. Councillor Coleman said that more robust action might necessary but that they would be happy to continue with local projects such as diabetes if they continued to provide proven health benefits for LBHF residents.

Councillor Coleman commended Lisa Redfern, Graham Terry, and colleagues for their work on DToC, together with CIS. He recognised that failure to deliver the required targets would jeopardise funding.  This was a significant achievement given the low numbers from last year and he acknowledged the hard work undertaken to achieve this. Councillor Coleman suggested that residents should  ...  view the full minutes text for item 137.

This report presents the final version of the Pharmaceutical Needs Assessment (PNA) for the London Borough of Hammersmith & Fulham for approval, to ensure that the Health and Wellbeing Board meets its statutory requirement to publish a PNA by 1 April 2018. In addition, it reports on the proposed changes to the PNA following the mandatory 60-day consultation undertaken between December 2017 to Feb 2018.

Colin Brodie and Dr Ashlee Mulimba presented a report on the Pharmaceutical Needs Assessment (PNA).  The draft PNA was in the final stages of completion, following an earlier draft prepared in November 2017, Consultation had been undertaken from December to February 2018. With feedback from CCG, NHS England (NHSE) and pharmacies.  The HWB was statutorily responsible for the PNA statement of need for pharmaceutical services, with a requirement to categorise services. LBHF had a good network of pharmacy with no gaps in necessary services. 

In response to a query from Vanessa Andreae, Colin Brodie explained that the only key change was the perceived gap in terms of opening hours, particularly in the northern part of the Borough.  The only time that a person might need a prescription urgently during out of hours was if they received palliative care.  The draft PNA had introduced a recommendation that this was an area that should be looked at.  NHSE was reviewing palliative care, out of hours prescriptions and what this might will look like. They had also recommended that NHSE commissioners consider out of hours consultation.  There were plans for piloting an out of hours service in LBHF and a trial process would be helpful in terms of identifying long term need.

Lisa Redfern welcomed the report.  Referring to page 97 of the pack, care home advice service, she asked how care homes were advised.  Colin Brodie explained that currently, advice was largely given by private providers.  It was important to understand this aspect and how out of hours service linked to provision for rough sleepers.  It was understood that there was also a lack of provision for sexual health screening treatment. Vanessa Andreae explained that this was privately commissioned, and was like the provision of weight management services. 

Colin Brodie explained that one of the purposes of the PNA was to identify areas where services could be commissioned in future and potentially identify missed provision. Once the PNA was submitted it would be reviewed by NHSE. NSHE recommendations were looking to expand on the provision of health campaigns. Pharmacy funding conditions included a provision that they participate in up to 6 public health campaigns per year.  Colin Brodie was unclear as to how this provision worked in practice and agreed to report back.

ACTION: Public Health

NHSE monitored health campaigns, with some being monitored privately.  Colin Brodie explained that there were four categories of service. This included those that were essential and advanced services, which commissioned by NHSE (e.g. smoking cessation). The new Director of Public Health would be responsible for monitoring the take up of services, which would allow them to better understand commissioning needs.

Keith Mallinson referenced paragraph 6.21 and the purchase of medication, expressing concern about the implementation of the policy. The lack of communication had caused confusion and some patients had misunderstood the changes. Vanessa Andreae explained that GP’s should ask patients if they were prepared to buy medication that was available without prescription. If not, then it  ...  view the full minutes text for item 138.

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.

To be agreed.

The Board is asked to note the provisional date of the next meeting, as Tuesday, 19^th June 2018, to be confirmed.

To be confirmed.