Agenda and minutes

Health and Wellbeing Board - Thursday, 5 April 2018 1.00 pm

Venue: Committee Room C,, County Hall, Kingston-Upon-Thames, KT1 2DN

Contact: Richard Plummer 

Note: MEETING RESCHEDULED FROM 1 MARCH 

Items
No. Item

118.

APOLOGIES FOR ABSENCE

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    To receive any apologies for absence and substitutions.

    Minutes:

    Apologies were received from Dr Charlotte Canniff, Dr Russell Hills, Dr Andy Whitfield and Peter Gordon.

     

    Dr Richard Barnett substituted for Dr Charlotte Canniff and Kate Scribbins substituted for Peter Gordon.

     

    The Chairman informed the Board that Dr Andy Whitfield, Chair of North East Hampshire and Farnham Clinical Commissioning Group (CCG) had stepped down and a replacement would be confirmed after a new chair is appointed. Members expressed gratitude towards Dr Andy Whitfield for his contribution and work on the Board.

     

    It was noted that the CCG Co-Chair will change effective from after this meeting, Co-Chair Helyn Clack thanked Dr Andy Brooks for his professionalism and expertise as Co-Chair and presented him with a departing gift.

     

218.

MINUTES OF PREVIOUS MEETING: 7 DECEMBER 2017 pdf icon PDF 158 KB

    To agree the minutes of the previous meeting.

    Minutes:

    The minutes were agreed as a true record of the meeting.

     

    The Board agreed that it would be useful going forward to reference the asterix beside members in attendance to indicate that it represents members who were present at the meeting.

     

318.

DECLARATIONS OF INTEREST

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    All Members present are required to declare, at this point in the meeting or as soon as possible thereafter

     

    (i)      Any disclosable pecuniary interests and / or

    (ii)      Other interests arising under the Code of Conduct in respect of any item(s) of business being considered at this meeting

     

    NOTES:

     

    •        Members are reminded that they must not participate in any item where they have a disclosable pecuniary interest

    •        As well as an interest of the Member, this includes any interest, of which the Member is aware, that relates to the Member’s spouse or civil partner (or any person with whom the Member is living as a spouse or civil partner)

    •        Members with a significant personal interest may participate in the discussion and vote on that matter unless that interest could be reasonably regarded as prejudicial.

     

    Minutes:

    There were no declarations of interest received.

     

    The Board agreed to do a refresh on members’ interests at its next meeting to accommodate the changes to the Board’s membership.

418.

QUESTIONS AND PETITIONS

    There were none.

    Minutes:

    There were no questions and petitions received.

518.

Public Questions

    The deadline for public questions is seven days before the meeting (29 March 2018).

     

    Minutes:

    There were none.

618.

BOARD BUSINESS pdf icon PDF 129 KB

    To update the Board on any key issues relevant to its areas of work, membership and terms of reference.

     

    The Health and Wellbeing Strategy (2018) is attached for reference and final approval.

    Additional documents:

    Minutes:

    Declarations of interest:

     

    None

     

    Witnesses:

     

    None

     

    Key points raised during the discussion:

     

    1. It was highlighted that the updated Joint Health and Wellbeing Strategy was now available online and a link to the document had been circulated to Members.

     

    1. It was noted to meet annual requirements of the Health and Social Act (2012) the Health and Wellbeing Board must be consulted as part of the CCGs annual report process as to their contribution to the delivery of the Surrey Joint Health and Wellbeing Strategy.

     

    1. It was further noted that each CCG had completed a self-assessment template, demonstrating how they have contributed to the Surrey Joint Health and Wellbeing Strategy and these were circulated to the Board on Friday 23 February.

     

    1. Members were reminded that the deadline for any feedback was 6 April 2018.

     

    1. The Board were informed that the informal meeting on 26 April 2018 was cancelled due to low availability and Victoria Heald would organise items into the forward plan and circulate to the Board.

     

    1. The Board welcomed Dr Sian Jones who replaces Dr David Eyre-Brook who has now retired.

     

    1. The Board agreed to write a letter of thanks to Dr David Eyre-Brook thanking him for his hard work and contribution.

     

    1. It was highlighted that Councillor Vivienne Michael from Mole Valley District Council has been appointed to the Health and Wellbeing Board as a replacement to Councillor Clive Smitheram and would join Councillor Paul Spooner representing the Borough and District Councils in Surrey.

     

    1. It was noted that Dr Elango Vijaykumar would be the new CCG Co-Chair effective from after this meeting.

     

    1. Members were informed that the Council had recently welcomed a new Chief Executive, Joanna Killian.

     

    Actions/ further information to be provided:

     

    a)    Officers to update the membership page of the Joint Health and Wellbeing Strategy.

     

    b)    Officers to write to a letter of thanks to Dr David Eyre-Brooks from the Board.

     

     

718.

LETTERS CIRCULATED BY THE BOARD pdf icon PDF 88 KB

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    To review letters sent by the co-chairman of the Board between the date of the last meeting and the current date.

     

    Additional documents:

    Minutes:

    Declarations of interest:

     

    None

     

     

    Witnesses:

     

    None

     

    Key points raised during the discussion:

     

    1. The Board noted a letter received from the Sussex and East Surrey STP Suicide Prevention Workstream and a subsequent response letter from the Chairmen.

     

    1. The Strategic Director of Adult Social and Public Health clarified that the police would be involved with the development of the strategy and the Police and Crime Commissioner signposted Amy McLoud as the respective officer in this area.

     

    Actions/ further information to be provided:

     

    None

     

    RESOLVED:     

     

    The Board reviewed the letters sent by the Co-Chairmen of the Board.

     

818.

FORWARD PLAN AND ACTION REVIEW pdf icon PDF 88 KB

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    To review and agree the Board forward work program and actions tracker.

     

    Additional documents:

    Minutes:

    Declarations of interest:

     

    None

     

    Witnesses:

    Victoria Heald, Health and Wellbeing Programme Manager

     

    Key points raised during the discussion:

     

    1. The Health and Wellbeing Programme Manager informed the Board that the forward plan would be re-organised and updated to reflect the cancellation of the Board meeting on 26 April 2018.

     

    1. It was noted that there was one outstanding action on the action tracker, A34/17, CCGs to publish the updated CAMHS transformation Plan on their websites.

     

    Actions/ further information to be provided:

     

    a)    Officers to update the forward work programme and actions tracker.

     

    b)    CCGs to publish the updated CAMHS transformation Plan on their websites and inform officers once complete.

     

    c)    Officers to contact the University of Surrey’s Medical School following the unsuccessful bid to confirm the case study item on the forward plan in October.

     

    RESOLVED:

     

    The Board reviewed the forward work programme and noted the actions tracker.

     

918.

PHARMACEUTICAL NEEDS ASSESSMENT pdf icon PDF 159 KB

    Purpose of report:

    a)    To present the Surrey Pharmaceutical Needs Assessment (PNA), highlighting key aspects of the PNA including its recommendations to the Health and Wellbeing Board (HWB)

    b)    To ask the HWB to ratify the PNA following the Chair’s Action to approve publication on 1st April 2018 in accordance with the requirements of the NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013.

    Additional documents:

    Minutes:

    Declarations of interest:

     

    None

     

    Witnesses:

     

    Julie George, Public Health Consultant

     

    Key points raised during the discussion:

     

    1. The board noted a change to the running order of the agenda, upon officers request the Chairman agreed to review item 11 before the STP update.

     

    1. It was highlighted that the Pharmaceutical Needs Assessment (PNA) was a statutory responsibility of the Health & Wellbeing Board (H&WB) and was due to be published on 1 April 2018. 

     

    1. It was noted as the March H&WB meeting was cancelled the chairs approved the publication as a chairs action and sought the Board’s ratification of this decision in public in its meeting today.

     

    1. The Board received a presentation (attached as Annex 1) on the Surrey Pharmaceutical Needs Assessment (PNA), highlighting key aspects of the PNA including its recommendations to the Health and Wellbeing Board.

     

    1. There was a discussion around pharmacy opening hours and how this impacted the discharge of patients, the Board were assured that pharmacy opening hours did not affect patients being transferred out of hospital as opening hours only applied to the public.

     

    1. It was explained that delays in discharging patients was mainly due to the process and not the dispensing of medicines. CCG’s noted this concern and agreed to consider advising departments to communicate better.

     

    1. The Board also agreed that improved signposting could relieve GP surgeries and hospitals with patients as treatments were more commonly available at pharmacies. The Board noted that they would like a future item relating to pharmacies and the health and social care system at a future meeting.

     

    1. It was noted that Martin Mandelbaum has now retired as Chief Executive of the Surrey Local Pharmaceutical Committee after many years of service and was commended for providing constructive challenge and insight to the Health and Wellbeing Board and his contribution on the two Pharmaceutical Needs Assessments for Surrey.

     

    Actions/ further information to be provided:

     

    Officers to include an item on pharmacies and the health and social care system on the Board’s forward plan.

     

    RESOLVED:

     

    The Board approved the PNA publications on 1 April 2018 and supported the following recommendations;

     

    Recommendations 1

     

    a)    Recognise the potential for population growth with large scale housing developments

    b)    Partners to consider how to improve access to enhanced services in rural and deprived areas

    c)    Improve signposting to existing pharmaceutical services

    d)    Improve inter-professional contact

     

    Recommendation 2

     

    Local Clinical Commissioning Groups and the STPs should consider the findings and recommendations of this PNA in the course of their on-going work to improve the health of the local population, implement the GPFV and improve urgent and unplanned care services.

     

1018.

SUSTAINABILITY AND TRANSFORMATION PARTNERSHIPS UPDATE pdf icon PDF 134 KB

    Purpose of the report: To update the Health and Wellbeing Board on progress on the Sustainability and Transformation Partnerships affecting Surrey.

    Minutes:

    Declarations of interest:

     

    None

     

    Witnesses:

     

    Dr Andy Brooks, Frimley Health STP
    Dr Sian Jones, Surrey Heartlands STP
    Dr Elango Vijaykumar, Sussex and East Surrey STP

     

    Key points raised during the discussion:

     

    1. The Board received a presentation for the Frimley Health System Transformation Partnership (STP) and Integrated Care System update (ICS) attached as Annex 2.

     

    1. The Surrey Heartlands STP representative reported that progress was being made through the process of devolution. In addition a joint committee had been formed, focused on improving services for residents and mapping out current priorities.

     

    1. It was further reported that Surrey Heartlands STP was progressing well particularly in areas of engagement and were encouraging digital ways of working.

     

    1. It was noted that within the Sussex and East Surrey STP footprint, a commissioning alliance of five CCGs was formed on 1 April 2018.  This links East Surrey CCG with four additional CCGs in Central Sussex, under one executive team.  The alliance brings challenges and complexities, particularly due to the geographical make up and the individual five systems. However despite the challenges it was reported that the integration aspect has been effective.

     

    1. The Cabinet Member for Health commended the progress made across the STPs and the results produced to date, however raised concerns with the lack of elected member oversight in all three STPs, highlighting a missed opportunity to make representation.

     

    1. The Board noted it would be useful to have member engagement in STP work and would consider this going forward.

     

    1. There was a discussion around financial challenges and it was noted that STPs focused on resources that were available to meet the needs of the population and by integrating services there was a reduction in duplication allowing saving efficiencies to be made.

     

    1. A member of the public expressed the view that further progress can be made by linking in Parish Councils and the Voluntary Sector who have fundraising potential and the ability to contribute financially. The Board assured that this was a working progress and that communications were improving to promote positive ways of working.

     

    Actions/Further information to be provided:

     

    The Board to consider member oversight and engagement within STPs.

     

1118.

PRIORITY STATUS UPDATE: IMPROVING OLDER ADULT'S HEALTH AND WELLBEING pdf icon PDF 290 KB

    Purpose of the report:  Performance Management/Policy Development and Review 

    Minutes:

    Witnesses:

    Dr Andy Brooks, Clinical Chair, Surrey Heath CCG

    Helen Atkinson, Strategic Director for Adults and Health

     

    Key points raised during the discussion:

     

    1. The Surrey Heath CCG introduced the report by highlighting the journey since the Joint Health and Wellbeing Strategy was published in 2013, reporting how there is a shared system of understanding, a shared vision and action to work together to improve the health and wellbeing of older adults in Surrey.

     

    1. The Board noted a number of outcomes that have made a difference to residents over the period 2013-2018 since the strategy took effect, this includes;

     

    a)    A 5% increase in the proportion of older adults still at home 91 days after discharge from hospital (from 2012/13 – 2016/17).

    b)    A 12% reduction in permanent admissions to care homes (from 2014/15 to 2016/17).

    c)    The proportion of Surrey adults (all ages who had an inpatient experience of health services that would recommend to friends and family increased from 92% to 97% from 2014 to 2017.

    d)    Dementia diagnosis have improved by 14% across Surrey from 2014 to 2017.

    e)    Surrey has maintained a non-elective admission rate consistently below that of England overall,

    f)     Delayed Transfer of Care (DTOC) from hospital have reduced by 17% in Surrey compared to a 62% increase across England.

    g)    An 8.8% rise in the number of carers registered with GP practices in 2017/18.

     

    1. The Chairman highlighted a list of achievements demonstrating the system was working together by reporting that new integrated models of care across Surrey have been developed by embedding social care teams at hospital sites.

     

    1. It was further highlighted that Surrey had been identified as an exemplar area working with NHS England on embedding carers within STPs.

     

    1. It was noted that Surrey had also received a Health Service Journal Award for Commissioning for Carers.

     

    1. The Board acknowledged that District and Boroughs had funded home adaptations and community equipment supporting older adults to live more independently. 

     

    1. The Chairman shared the view that the Health and Wellbeing Board was fundamental to building the work around whole systems partnership working and has proved invaluable at strengthening relationships and understanding between local government and NHS partners.

     

    1. The Board were assured that there will be a continued focus on improving the health and wellbeing of older adults in Surrey with the development of an action plan and dashboard to deliver and track progress of the outcomes in the updated strategy.

     

    1. Members were informed that Surrey had achieved a great deal over the life-course of the previous strategy, however, noted that there was further improvement to be made particularly to deliver the new strategy to ensure the health and wellbeing of older adults was at the forefront in Surrey’s priorities.

     

    1. A Member asked the Board to consider delayed discharging of adults due to the lack of places in the Market and as a result adults were being kept in hospitals for longer periods of time.

     

    1. It was explained that Surrey had the capacity however it was faced  ...  view the full minutes text for item 1118.

1218.

PRIORITY STATUS UPDATE: IMPROVING CHILDREN'S HEALTH AND WELLBEING pdf icon PDF 207 KB

    Purpose of the report:  Performance Management/Policy Development

     

    The purpose of this report is to update the Health and Wellbeing Board on progress against the outcomes under the ‘improving children’s health and wellbeing’ priority within the Joint Health and Wellbeing Strategy. An update is provided to the Board every six months with the last in September 2017.

    Minutes:

    Declarations of interest:

     

    None

     

    Witnesses:

     

    Rose Durban, Interim Director for Children, Schools and Families

    Garath Symonds, Strategic Director for Commissioning and Prevention

    Diane McCormack, Director of Commissioning, Guildford and Waverley CCG

     

    Key points raised during the discussion:

     

    1. The Interim Strategic Director for children updated the Board on the progress against the outcomes under the ‘improving children’s health and wellbeing’ priority within the Joint Health and Wellbeing Strategy and outlined particular concerns with CAMHS.

     

    1. It was noted that although there were ongoing challenges with CAMHS, the commissioners and providers were working together to solve these.

     

    1. There was a discussion around the performance issues in CAMHS and officers assured a problem solving approach would be undertaken as well as an independent commission review of the contract to determine a sustainable solution long term.

     

    1. It was reported that a Health Summit would be taking place in the week commencing 9 April 2018 to address and discuss current issues and the Board agreed it would be useful for officers to provide a report on this at its meeting in May.

     

    1. Member expressed disappointment with the CAMHS contract and the Board agreed it would be useful to write a letter to the Commissioners to express their views.

     

    1. It was clarified to the Board that the Community Health Contract follow up report would be provided in the annual report.

     

    Actions/ further information to be provided:

     

    The Board to receive an update report in relation to the Health Summit at its meeting in May 2018.

     

    For a letter to be written to the Commissioners in relation to the CAMHS contract expressing the Boards views.

     

    RESOLVED:

     

    The Board noted and approved the following recommendations;

     

    1)    Note areas where progress has been made against the 'improving children's health and wellbeing' priority, specifically in relation to DfE recognition of the substantial progress in SEND services to date.

     

    2)    Note areas where progress has been more limited or where we are yet to see the impact of work for children, such as childhood immunisation rates, tier 3 perinatal mental health services and breastfeeding at 6-8 weeks.

     

    3)    Note areas where better data and analysis has highlighted more stubborn challenges, specifically in relation to initial and review health assessments for looked after children and waiting times for paediatric and therapy services for vulnerable children, where we will need to develop a different approach to improve timely access to these services for children.

    4)    Note the significant concerns in relation to demand and clinical risk within the jointly commissioned child and adolescent mental health service (CAMHS) and the proposed next steps.

     

    5)    Receive a further update in relation to progress to clinical risk within the CAMHS service at the next board meeting.

     

    6)    Receive a further update for the 'improving children's health and wellbeing' priority against the new set of outcomes, in six months' time.

     

1318.

COMMUNICATING INFORMATION THROUGH THE HOSPITAL DISCHARGE JOURNEY pdf icon PDF 195 KB

    Purpose of the report: To highlight patient experience of hospital discharge.

    Additional documents:

    Minutes:

    Declarations of interest:

     

    None

     

    Witnesses:

     

    Kate Scribbins, CEO Healthwatch

     

    Key points raised during the discussion:

     

    1. The Healthwatch CEO introduced the report by highlighting that good initiatives had taken place to capture patient experiences of hospital discharge in Surrey.

     

    1. It was reported that findings suggested that good practice was being delivered however there were areas that could be improved.

     

    1. It was noted Healthwatch Surrey were looking at ways in which older people could be supported and empowered to find out information about leaving hospital and their follow up care.

     

    1. The Healthwatch CEO introduced the creation of a checklist/conversation record that can be utilised by patients, next of kin, and hospital staff had the potential to aid communication during an individual’s hospital stay, and this is currently being considered.

     

    1. Members suggested the distribution of this checklist to be provided to Surrey libraries, community buildings and amongst the voluntary sector.

     

    1. The Board recognised the difficulty in promoting the checklist to isolated individuals and supported the view that volunteers could support the initiative in this area.

     

    Actions/further information to be provided:

     

    None

     

    RESOLVED:

     

    The Board noted the content of the report.

     

1418.

DATE OF THE NEXT MEETING

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    The next public meeting of the Health and Wellbeing Board will be on 7 June 2018.

    Minutes:

    The next meeting of the Health and Wellbeing Board will be held on 7 June 2018.