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 25 June 2019; and

(b)  To note the outstanding actions.

RESOLVED

That the minutes of the meeting held on 25 June 2019 were agreed as an accurate record.

ACTIONS AND MATTERS ARISING

Janet Cree provided a brief update on the CCG Governing Body consideration of the decision of the CCGs to merge.  A paper would be considered by the Council’s Health, Inclusion and Social Care Policy and Accountability Committee (HISPAC) at their meeting on 11 September 2019.  The recommendation was to defer the merger and aim to work towards implementation in April 2021.  The transition year would be used to plan and ensure that the requirements of the NHS LTP were met.

Councillor Coleman welcomed and supported the recommendation but sought further clarification about the specific details. The decision had been deferred and he enquired what the outcome would be if the CCGs were not ready to merge in April 2021. Janet Cree outlined that the deferred merger reflected an aspiration to merge and was optimistic that it would go ahead although she acknowledged that she did not know what would happen if the CCGs decided against a merger. An assurance framework would be established with agreed measures to identify the relevant issues to be considered. Vanessa Andreae added that there were clear governance structures to be put in place and that would need to be agreed by a membership vote throughout the North West London CGGs.  It was noted that this would be further discussed at HISPAC.

Apologies for absence were received from Councillors Patricia Quigley and Larry Culhane; and Dr James Cavanagh, Steve Miley, Glendine Shepherd and Nadia Taylor.

None.

This report provides a progress update 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. The Better Care Fund was announced in June 2013 “to drive the transformation of local services to ensure that people receive better and more integrated care and support.

Linda Jackson and Sue Roostan outlined the background work undertaken on the Better Care Fund (BCF).  There were several things that the CCG and the Council were keen to deliver in partnership with primary care preventing people from going into hospital. Paragraph 1.3 was clarified as referring to a “draft” local proposal.  Work had commenced on the developing the range of services deliverable by working in partnership.  The spend on this would be further monitored and a paper provided to a future Board meeting. A large piece of work on co-production would be undertaken, together with a review of carers, understanding the evaluation of carers in the context of the spend.  Winter funding had also been received and Linda Jackson explained that they would be working with colleagues on how this would be applied. 

ACTON: Paper on the BCG to be provided to a future Board meeting

Sue Spiller enquired what had been funded and utilised in the past two years.  Prakash Daryanani explained that the plan was divided into three sections and supported a range of services.  There were CCG delivered services such as the Community Independent Service. The CCG also was the lead commissioner with the local authority, for example, the joint equipment contract (accommodation). 

Sue Spiller asked whether a trend in demand for care services could be identified and Lisa Redfern agreed to provide available data. Sue Roostan added that it had been possible to identify co-production outcomes in terms of what could be delivered for residents.  Lisa Redfern explained that due to the late provision of guidance in July (it had been expected in May) had prevented more timely consideration by the Board. Sue Roostan explained that the requirements to be satisfied formed part of four national conditions generated by the Department of Health (the metrics of which were set out in page 6 of the Supplementary Agenda).

Keith Mallinson commented that there was no reference to mental health and enquired if any work on this was planned. It was clarified that there was reference to delayed discharges on mental health which was included within the metrics, together with mental health services as part of the BCF and that the Council was performance measured on this. The next deadline to be aware of was 27 September 2019 and it was noted that some decisions would have to be taken outside the Board.  The response template was to be completed by 20 September 2019 and the Chair of the Board and H&F CCG will be invited to sign off.

ACTION: BCF Plan was agreed. Chair of the Board and H&F CCG may sign off final template outside the meeting

RESOLVED

That the report was noted by the Board.

This report provides an overview of Primary Care Networks and explains how they will be organised in Hammersmith and Fulham.

Janet Cree, a colleague from H&F CCG and Dr McLaren provided a brief overview of primary care networks (PCN) and how five PCNs would be configured in Hammersmith and Fulham. The concept of PCNs was described as a group of GP practices working together to provide population healthcare. This was not a new concept but offered formalised, structured and developed links within the context of wider changes to GP contracts. 

The five-year NHS LTP was issued in January 2019 and the direct enhanced service (DES) timeline extended to March 2019. Considerable work had been undertaken with GP practices to obtain the best provision to meet the needs of residents.  The PCN structure had been formally agreed and PCNs practices had signed up to it in addition to their core GP contracts and the DES. This was envisaged as a group of practices delivering a group of services for a portion of the population.  The network DES would receive funding to appoint directors and offer extended healthcare access across the population from 1^st July.

Details had not yet been provided and in April 2020 there would also be a requirement for each of the PCNs to deliver on the specifications.  The PCNs would deliver a range of services provided by health professionals working alongside the GP Federation.  The services would be wide ranging with a significant impact and would be mobilised as quickly as possible.

Councillor Coleman enquired about social prescribing and it was explained that work was ongoing to recruit social prescribing link workers for each of the three PCNs.  The CCG would also be providing training to Patient and Public Involvement (PPI) groups.  Meetings with groups would be held at network level and working with them was a priority for the CCG.  This was a big change in the way in which things were organised but there was a requirement to produce plans in a very short time.  It was important to understand what it was that PCNs were required to deliver and the anticipated journey.  Some additional investment was to be provided to enable clinical delivery going forward. 

The role of clinical directors and their specific role would be key in developing the foundations of PCNs.  The five PCNs for Hammersmith and Fulham would include GP At Hand, each covering between 30,000 and 70, 000 patients.  With reference to GP At Hand, it was stated that from the CCG perspective, the aim was to respond and support patients that were part of the GP At Hand network (approximately 71,000), even though they did not all meet criteria of placed based commissioning. This would have to be further considered going forward as it involved a significant number of patients of which only 17, 000 were resident within the Borough.

Councillor Richardson enquired what would be different following the introductions of PCNs and the potential impact on the day to day provision of health services.  Dr McLaren was unsure if he could explain this fully.  There were huge  ...  view the full minutes text for item 14.

In accordance with the statutory duties and powers given to the Health and Wellbeing Board by the Health and Social Care Act 2012, the Board’s terms of reference in Hammersmith & Fulham’s constitution this report provides oversight of the development and use of the Joint Strategic Needs Assessment (JSNA) by the Council and the H&F Clinical Commissioning Group (CCG).

Jo Baty presented the report on behalf of Mandy Lawson, Assistant Director of SEND. The JNSA (Joint Strategic Needs Assessment) was formulated and published in 2017, just as the Council left the shared services arrangement.    It was reported that the outline data was broadly the same with 16% of the population with special educational needs (SEN). It was difficult to capture data due to missing information and difficulties in drawing comparisons due to the differences in cohorts. 

In terms of speech, language and communication needs it was important to note that the way in which schools captured SEN data was based on presented need. For example, a child with SEN may be autistic, with mental health issues and physical disabilities, so the data was one-dimensional.  62%* of EHC (educational health care plans) were conducted in 2018, with only 8 not carried out.  The data was significant and one that the service was very proud of.  This was highlighted in the inspection report and indicated a huge improvement. 

ACTION: *Exact data about ECH plans to be circulated.

It was explained that the relationship with the CCG was not as well embedded as it could have been at the time, but the inspection report identified a strong working relationship with the CCG and parents, so this was also welcome news.  There was also an improved local offer accessible on the Council website for 0-25-years SEND.  A young person had just been appointed to lead work on co-production to co-produce a SEND pathway.  There was a large transition team in place, appointed in line with the transition report recommendations.  This had been in place for one year but there was considerable progress to be made.  In terms of post 16 pathways, it was reported that they were working with West London College to develop these in more detail. 

There was a focus on early intervention and prevention, mental health wellbeing and joint working with CCG colleagues.  They were also considering how to fund mental health pathways and how this work could properly support young people at risk.  The speech and language SEND team was well established and further information about this was available. There were some excellent special schools in the Borough, and it would be interesting to identify if SEND arose within the local cohort or was imported, with many those with SEND moving into the area attracted by the local offer. On transitioning to a sovereign service, Jo Baty highlighted the need for more data and research, and they were fortunate to now have in place a team that offered a high standard of business intelligence. 

Keith Mallinson asked how it would be possible to identify those with SEND in main stream schools as it was difficult to do this.  Jo Baty explained that they worked with teachers and the wider education service.  It was anticipated that a child may not meet the EHC threshold but may still have SEND requirements.  It was confirmed that they were working to develop this  ...  view the full minutes text for item 15.

The Board is requested to consider the items for its work programme and suggest any amendments or additional topics to be included in the future.

Councillor Coleman referred Board members to a piece reported in the Guardian newspaper regarding the CCG merger and how this had been postponed and delayed to April 2021.  He expressed concern that the recommendation to merge would be rushed without full consideration and more information was required in order to understand the changes being sought.

Vanessa Andreae commented that this was within the remit of the JHOSC (Joint Health Overview and Scrutiny Committee) and that it was reasonable for the NWL Collaboration of CCGs to be called to account so that the output can then be locally driven.  She also suggested that it would be helpful to identify how the social inclusion and loneliness (SIL) strategy linked in with the evolution of PCNs.  Councillor Coleman welcomed this and asked that officers identify how SIL could be addressed in all future reports, to be included at the beginning of each report.

ACTION: Vanessa Andreae to seek further details about the merger recommendation

The Board is asked to note the date of the next meeting of the Board which will be on Wednesday, 6 November 2019.

The date of the next meeting was noted as Wednesday, 11 November 2019.