Venue: North West Surrey Clinical Commissioning Group. 58 Church St, Weybridge KT13 8DP
Contact: Amelia Christopher
Items
No.
Item
1/20
APOLOGIES FOR ABSENCE
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To receive any apologies for absence and
substitutions.
Minutes:
Apologies were received from Siobhan Kennedy -
Catherine Butler acted as
substitute, Caroline Reeves, Joanna Killian, Dr Russell Hills,
Simon White - Liz Uliasz acted as substitute, David Munro, Dr
Elango Vijaykumar, Robin Brennan, Carl Hall - Cynthia Allen acted
as substitute, John Ward and Jason Gaskell.
The minutes were agreed as a true record of
the meetings.
3/20
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 none.
4/20
QUESTIONS AND PETITIONS
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4/20a
Members' Questions
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The deadline for
Member’s questions is 12pm four working days before the
meeting (28 February 2020).
Minutes:
None received.
5/20
Public Questions
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The deadline for public questions is seven
days before the meeting (27 February 2020).
Minutes:
None received.
6/20
Petitions
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The deadline for petitions was 14 days before
the meeting. No petitions have been received.
The
Joint Strategic Needs Assessment (JSNA) needed to be refreshed
following publication of the new Joint Health and Wellbeing
Strategy (JHWS) in 2019. The JSNA is a core part of the
intelligence system capability.
Minutes:
Liz
Uliasz arrived at 1.14pm
Helen Griffiths arrived at 1.14pm
Rod Brown
arrived at 1.20pm
Frances
Rutter arrived at 1.20pm
Witnesses:
Lucy Lynch - Public Health Registrar (SCC)
Key
points raised in the discussion:
The
Public Health Registrar introduced the report and noted
that:
·it was a statutory requirement to maintain the Joint
Strategic Needs Assessment (JSNA), so a refresh following the
publication of the new Joint Health and Wellbeing Strategy (JHWS)
in 2019 was needed.
·the refresh proposed using the 12 focus areas
identified in the JHWS to frame the JSNA and support detailed
action plans that address local needs.
·central to renewing the governance of the JSNA was
the avoidance of duplication - to be achieved by ensuring ownership
of specific chapters by the relevant JHWS governance group with a
coordinating operational oversight group - to meet in April 2020.
That group would include representatives from the Council and other
key organisations.
The Chief Constable of Surrey Police stated that the
force were happy to engage with the project particularly from a
mental health aspect which formed a significant part of the
force’s duty.
Board members urged
caution in the approach to prevent the formation of blind spots if
the focus areas were too narrow, noting that it was important to
recognise potential gaps in commissioning as issues change over
time. The Public Health Registrar commented that while each chapter
would include a horizon-scanning section within their focus area,
the operational oversight group would also have a role in
identifying new and emerging issues.
A Member of the Board was concerned that vulnerable
groups such as Looked After Children (LAC) and Care Leavers were
scattered across various JSNA chapters which did not support the
partnership in meeting their responsibilities for Corporate
Parenting. In response, the Public Health Registrar explained that
the four target population groups included one of ‘deprived
and vulnerable communities’ but this was broad and not yet
delineated. She added that a list of such groups was being
developed and would be shared with population group champions for
discussion. The developing list included LAC and care leavers. The
intention was to develop infographic summaries of each population
group/sub-group as required.
A Member of the Board raised a concern regarding the
difficulty in cross-system data collection on vulnerability and
health inequality as many organisations held pockets of information
and were not good at sharing it centrally. In response, the Public
Health Registrar replied that in light of the Chairman’s
earlier comment that the Health and Wellbeing Board would reaffirm
itself as a ‘doing’ board, there were opportunities to
improve the collation of data, across partners.
In response to the Deputy Chairman’s query,
the Public Health Registrar commented that the public health team
were considering how the intelligence within the JSNA refresh would
align with and complement the NHS England’s Population Health
Management (PHM) system across Surrey Heartlands.
Responding to a Member of the Board’s
question, the Public Health Registrar explained that veterans were
currently included one of ...
view the full minutes text for item 7/20
The
Children’s Safeguarding Partnership in Surrey is a statutory
body, which replaced the previous Safeguarding Board in October
2019. The Annual Report is being reported to the Health and
Wellbeing board and sets out the final part of the old Board and
the beginning of the new Partnership. Therefore, the attached
report covers an 18 month transitionary period from April 2018 to
October 2019. Simon Hart was appointed as the Independent Chair of
the Board/Partnership in December 2018 and has overseen the
transition.
Simon
Hart- Independent Chair of the Surrey Children’s Safeguarding
Partnership
Key points raised in the discussion:
A Member
of the Board highlighted that 2018/2019 was a year of national
change towards local improvement in children’s safeguarding
with the move away fromLocal Safeguarding
Children’s Boards towards the new Local Safeguarding
Partnerships. She recognised the key work of the previous
Independent Chair of the Surrey Safeguarding Children Board who put
in place development arrangements for the Board and praised the
work of the current Independent Chair.
The
Independent Chair of the Surrey Children’s
Safeguarding Partnership summarised that the new local safeguarding
Partnership was operational from October 2019.Unlike the
Surrey Safeguarding Children Board (SSCB) which was
convened solely by Surrey County Council, the Partnership was
convened more widely with Surrey Police and the NHS, as it
was important that safeguarding was underpinned by various
agencies.
He
explained that the SSCB’s annual report
unusually covered an 18 month period from April 2018 in order to
give a full account of the Board’s activities over that
extended period including the transition to the new Partnership
arrangements. The key focus of the Partnership would
be the Children’s Services Improvement Programme with
oversight to embedding the new arrangements moving away from the
Ofsted Priority Action Board towards the Partnership.
He
highlighted the following key strategic priorities of the SSCB
which would serve as the foundation for the new Partnership:
·the remodelling of theEarly
Help Services delivered and commissioned by Surrey County Council,
with the new Early Help Hub established through a Children’s
Single Point of Access (C-SPA).
·reducing harm to children and young people from
exploitation through contextual safeguarding which was an approach
to safeguarding using children and young peoples’ experiences
of harm outside of their homes.
·children’s exposure to domestic abuse, which
was a key issue underlying many of the serious case reviews.
Following on from the SSCB, the Partnership was working closely
with Surrey Police, social services andother
key partnership groups such as the Community Safety Strategy
to allow the escalation of concerns where
necessary.
The
Independent Chair noted that the new governance structure from the
SSCB to the new Partnership received strong agreement from partners
who in the past felt as though the SSCB considered large agendas
too quickly. Whereas the Partnership had more focused agendas and
was steered by the Executive Group. There would also be a reduction
in the number of sub-groups in order to consider the commissioning
approach more effectively.
He
stated that a core value for the Partnership was a child-centred
approach and ensuring thatchildren’s
voices and lived experiences were heard as they were integral to
the decision-making process.
He noted
that the strong lead from the Council was vital to aid the
Partnership’s focus on supporting children, families and
young people to reduce the likelihood of them needing statutory
services. As well as supporting the Partnership’s
commissioning of serious case ...
view the full minutes text for item 8/20
Following discussions at the Health and Wellbeing Board and the
Community Safety Board, this paper seeks approval for the merger of
the Community Safety Board and the Health and Wellbeing
Board.
Amy
Morgan - Policy and Programme Manager for Health & Social Care
Integration (H&Sci) (SCC)
Key points raised in the discussion:
The
Policy and Programme Manager noted that the merger was based upon
developing a longer term approach to improving health outcomes and
inequality across Surrey, after close working with the Office of
the Police and Crime Commissioner and key stakeholders represented
through the four new Members of the Board.
She
emphasised that greater connectivity across priority areas was
vital to improving the lives of those with severe disadvantages and
to address the wider determinants of health. Over the last three
months, officers in the OPCC and SCC had worked with stakeholders,
including the Community Safety Partnerships, to map the current
work and statutory responsibilities of both the Community Safety
Board and the Health and Wellbeing Board. Officers were able to
provide assurance that the four major priorities of the Community
Safety Board would be aligned with those of the Health and
Wellbeing Board, which would ensure the delivery of the Surrey
Community Safety Agreement (CCSA).
The
Health and Wellbeing Board was also developing stronger links to
the Adult Safeguarding and Children Safeguarding Partnerships. The
Surrey Adults Matter programme was a good example of how the Health
and Wellbeing Strategy was responding directly to community
safety-related concerns raised by the Adult Safeguarding
Board.
The
Chief Constable of Surrey Police, was very supportive of the merger
noting the national policing and health consensus on the importance
of wellbeing which was exemplified at the 2019 Fifth International
Law Enforcement and Public Health Conference.
He
summarised that: policing was more closely coupled with health -
70% demand of policing - than justice, that case work was
increasingly complex, focusing on a range of issues to work out why
someone committed a crime rather than simply who did it, active
research to understand the causes of safety and wellbeing rather
than the symptoms - personal resilience and control were key, that
different and earlier intervention was required such as trauma
informed policing and adverse childhood experiences, collective
action across agencies was essential as there was a move away from
individual territorial leadership.
The
Cabinet Member for Community Safety, Fire and Resilience positively
reported that she had seen tangible progress on the ground through
the use of Trading Standards community safety departments to
identify hotspots of priority offenders to manage crime more
intelligently and from a wellbeing perspective addressing the
causes of criminal activity.
The
substitute for the Assistant Chief Officer of the Community
Rehabilitation Company noted that it was important that probation
and community rehabilitation remained represented on the Board, as
reoffending and health were closely linked.
Members
were in agreement with the merger and noted that it was the first
of its kind in the United Kingdom.
RESOLVED:
The
Health and Wellbeing Board:
Approved
the merger of the Community Safety Board and the Health and
Wellbeing Board.
The
Surrey Health and Wellbeing Board (HWB) has a statutory
responsibility to deliver a Pharmaceutical Needs Assessment (PNA)
every three years. The Surrey PNA was last published in March 2018,
but the PNA Steering Group reviews changes to the local population
and local services annually to ensure no substantive changes to the
PNA are required.
The
Public Health Consultant provided a summary of the report,
highlighting that the Board had a statutory responsibility to
deliver a Pharmaceutical Needs Assessment (PNA) every three
years.
The last
PNA was in March 2018 to which no substantive changes to the
findings of that PNA were required on the advice of the PNA
Steering Group which annually reviews changes to the local
population and pharmaceutical services. The steering group
identified gap in the provision. There have been four closures of
community pharmacies in 2019, with alternative provision nearby.
The large housing developments and rate of pharmacists per 100,000
were also considered evaluated.
Future
pharmacy provision would be reviewed through the 2021 PNA which
would be brought to the Board in March 2021. That PNA would include
the evaluation of the future requirements of large new housing
developments and travel time using public transport - if possible -
recognising the inequality in transport provision across
communities.
The
Deputy Chairman was concerned as three out of the four closures in
community pharmacies were in North West Surrey - the area in which
she was Clinical Chair - and asked what other measurements were
used to assess provision other than large housing developments and
population size. Especially as in 2019/20 community pharmacies
would be expected to commission two new services: the Community
Pharmacist Consultation Service (CPCS) with community pharmacies as
a first port of call for minor illnesses and Hepatitis C testing.
In response, the Public Health Consultant commented that at present
no other measurements were used, but explained that her team was
working closely with the Surrey and Sussex Local Pharmaceutical
Committee and other health colleagues to incorporate consideration
of the requirements of the new pharmaceutical contract in the 2021
PNA.
Responding to a Member of the Board’s query on the
disparity in access between populations to community pharmacies,
the Public Health Consultant replied that it was a challenge as a
PNA Steering Group could only make recommendations on the
acceptable level provision. Its remit did not include the way in
which services were paid which can also affect pharmaceutical
service provision. A recent judicial review concluded that drive
time to a community pharmacy greater than thirty minutes was not
good access.
RESOLVED:
The
Board approved the 2020 PNA Supplementary Statement, on the advice
of the PNA Steering Group.
The
Board would publish the approved Supplementary Statement on
surrey-i.gov.uk and surreycc.gov.uk by 31 March 2020.
Actions/further information to be
provided:
The
Board will publish the approved Supplementary Statement on
surrey-i.gov.uk and surreycc.gov.uk by 31 March 2020.
The
report gives an overview of progress, risks and issues relating to
the Health and Wellbeing Strategy implementation plans, including
areas where progress is being made, as well as highlighting several
projects which require a Senior Project Lead to progress. The
report also includes the outcomes dashboard, which is now public
and is due an annual refresh in June to review any changes to
outcomes.
Rod
Brown - Head of Housing and Community at Epsom and Ewell District
Council (Priority 1)
Giles Mahoney - Director of Integrated Care Partnerships at
Guildford and Waverley Clinical Commissioning Group (CCG) (Priority
2)
Rob Moran - Chief Executive of
Elmbridge Borough Council (Priority 3)
Ruth
Hutchinson -Interim Director of Public
Health (SCC)
Witnesses:
Amy
Morgan - Policy and Programme Manager for Health & Social Care
Integration (H&Sci) (SCC)
Key points
raised in the discussion:
The Priority 1 sponsoroutlined the key
issue across all three priorities as included in the annex on
project diagnosis highlighting several projects which were missing
a Senior Responsible Owner (SRO) to progress. One Red rated area
without an SRO was Surrey-wide cardio-vascular diseases (CVD)
prevention and the overall CVD prevention approach had not been
agreed across partners.
The project diagnosis was a vital health check on various key
projects and successes in Priority 1included:
-increasing the local uptake of childhood
immunisations to 95% of the population which wasreached in two
weeks.
-a Planning and Health Forum was established in which
health and planning officers met to help embed health and wellbeing
into planning policies.
-regarding Surrey Adults Matter, an approach had been agreed with all key system partners and
work was beginning with frontline agencies. A newly recruited
Senior Partnership Manager would aid that area.
He
noted that although there were many professionals working hard
across all three priorities, it was difficult to identify SROs to
take on specific projects and the priority sponsors were working
closely with the Policy and Programme Manager
(H&Sci) on the matter.
The Priority 2 sponsorsimilarly stated
that it was difficult to identify SROs in some areas within that
priority.He summarised the current progress
on:
-therecent Surrey Mental Health Planning meeting composed of system
partners across Surrey Heartlands and Frimley Health ICS aligning
mental health with the Surrey Health and Wellbeing Strategy.
-the draft First 1000 Days
Strategy was being finalised and would shortly be shared with
system partners for feedback.
-theDynamic System Purchasing
Arrangements were established for Supported
Accommodation aiding supported living for people with a
mental health problem.
-Pocket Parks which weresmall
plots of land often in urban spaces which provide green spaces to
aid wellbeing physical and mental health of the communities using
them, supported by the Royal Horticultural Society Garden Wisley
and initiatives in Epsom and Ewell.
He
explained that a key risk within the priority was developing
community resources to support a consistent
Surrey-wide approach to social isolation. Projects
included work on social isolation in Surrey Downs, a mental health
centre of excellence in Woking and Social Prescribing
intergenerational mentoring pilots in Guildford and Waverley which
secured a funding of £750,000. Those pilots were volunteer
led in which volunteers spent time with those over 65 who sought
company.The Priority 3 sponsor and Chief Executive of Elmbridge
Borough Council indicated that he would be ...
view the full minutes text for item 11/20
At the September
Health and Wellbeing Board, Members agreed to develop a Social
Progress Index (SPI) for Surrey to measure real lived experience of
residents, focusing on social and environmental outcomes only. This
will provide a helpful measure of ‘fulfilling
potential’ in Surrey to help understand how individuals are
living and progressing within District and Borough Wards and who is
being left behind.
Minutes:
Witnesses:
Satyam Bhagwanani - Head of Analytics and Insight
(SCC)
Amy
Morgan - Policy and Programme Manager for Health & Social Care
Integration (H&Sci) (SCC)
Simon Hart - Independent Chair of the Surrey Children’s
Safeguarding Partnership
Key points raised in the discussion:
The Head
of Analytics and Insight introduced the report and explained that
the Social Progress Index (SPI) aligned to the Board’s third
priority of all fulfilling their potential.
Fundamental to the SPI was the collaboration between the SPI
Working Group with the Social Index Imperative, to which there
would be a workshop in March bringing together multi-agency data
owners across the county. With the aim to agree Surrey’s
choice of indicators for the SPI, providing a holistic view of
Surrey and the wider determinants of health inequality.
An early
version of the SPI would be shared with the Board in June and the
full SPI would be completed by summer. The Head of Analytics and
Insight noted that it was an ambitious timeline and the main risk
was data collection from many partners, urging Board members to
support the quick signoff on data where possible.
Responding to Board members’ queries on the purpose of
data collection, the Head of Analytics and Insight replied that the
SPI would be outcomes focused by evaluating where populations were
at across the county and at ward level, economically, socially and
environmentally. The Chairman added that the SPI ensured the
objective identification of the top ten areas of deprivation within
the county, with multidisciplinary teams to provide a range of
solutions for different areas - which would overlap and develop
some of the Board’s KPIs.
A Member
of the Board noted that the SPI was piloted in Elmbridge which
identified regional solutions there but was concerned that ward
level data collection would be more complex. In response, the
Chairman noted that obtaining ward level data was crucial as he
cited the example of the difference in life expectancy between
certain wards in Waverley. A Member of the Board added that despite
a very high percentage of good GCSEs results in Surrey schools,
schooling in deprived wards was comparably poor and he stated that
schools should be a beacon of opportunity and not a mirror of
deprivation.
The
Policy and Programme Manager discussed that from a public health
perspective, the SPI would be an important step in mapping out
health inequality, highlighting areas where there was good or bad
access to community facilities.
The
Chairman commented that one important initiative of the Council was
the £100 million Community Investment Fund to support key
initiatives, recognising the shifting narrative of public health
being community led.
The
Independent Chair of the Surrey Children’s
Safeguarding Partnership took a proactive interest in
assisting the SPI, noting the importance of including
safeguarding.
RESOLVED:
The
Board members would:
Emphasise the SPI ambition within partner
organisations.
Secure
executive level agreement/support to share data.
The next public meeting of the Health and
Wellbeing Board will be on 4 June 2020.
Minutes:
The Board noted that its next
meeting would be held on 4 June 2020.
Any
other business:
The Interim Director of Public Health, provided the Board with
an update on Coronavirus (COVID-19) noting the recent cluster of
four positive cases in Surrey and West Sussex. Public Health
England (PHE) had madegood progress in contacting anyone who had been in close
contact with the individuals to provide them with necessary advice.
She noted that the country was still in the ‘contain’
phase of the outbreak but likely to move to ‘delay’
soon.
Board membersadded that:
they were seeing
frequent suspected cases in their GP surgeries but swabbing all
patients was not current policy.
councils in Surrey
were actively working through emergency planning
procedures.
three schools in
Surrey had been closed recently for a brief time for deep
cleaning.
Members
were provided with a handout detailing the Board’s response
to the survey on Surrey CCGs regarding the delivery of the joint
health and wellbeing strategy which was developed across key
organisations within Surrey. It signalled an important shift to a
more preventative approach, addressing root causes of poor health
and wellbeing and not simply focusing on treating the symptoms,
setting targets for the next ten years. NHS East Surrey CCG, North
West CCG, Surrey Downs CCG and Guildford & Waverley CCG were
all part of Surrey Heartlands Integrated Care System and as of 1
April 2020, would become one CCG, named Surrey Heartlands
CCG.
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