Related Documents:
agenda for these minutes
Present:-
Devon County Council
Councillors Barker, Davis (Chairman), Clatworthy, McInnes.
Ms J Stephens (Strategic Director, People) and Dr V Pearson (Director of Public Health)
District Council Representative
Councillor Sanders
Police and Crime Commissioner
Mr T Hogg
Environmental Health
Mr R Norley
Northern, Eastern Western (NEW) Devon Clinical Commissioning Group (CCG)
Dr Tim Burke
Probation Service
Mr R Menary
Health Watch
Dr H Ackland
Joint Engagement Board
Ms C Brown
Apologies:
Dr D Greatorex (South Devon and Torbay Devon Clinical Commissioning Group (CCG) (Dr Charlie Daniels attended to present the reports)
*164 Minutes
It was MOVED by Councillor Clatworthy, SECONDED by Councillor, and
RESOLVED that the minutes of the meeting held on 12 March 2015 be signed as a correct record.
*165 Announcements
The Chairman welcomed Dr Katherine Rake, Chief Executive of Healthwatch England, who was attending to observe the Health and Wellbeing Board meeting and also Mr Sullivan who was attending in his capacity as a Co-opted Member of the Council's Standards Committee to observe and monitor compliance with the Council s ethical governance framework.
PERFORMANCE AND THEME MONITORING
*166 Devon Joint Health and Wellbeing Strategy: Priorities and Outcomes Monitoring
The Board considered a report from the Director of Public Health, presented by Simon Chant (Public Health Specialist Intelligence), on the performance for the Board, which monitored the priorities identified in the Joint Health and Wellbeing Strategy for Devon 2013-2016.
The Board received an updates only version of the Health and Wellbeing Outcomes Report. The report was themed around the four Joint Health and Wellbeing Strategy 2013-16 priorities and included breakdowns by local authority, district, clinical commissioning group, inequalities characteristics and trends over time. The indicator relating to the Dementia diagnosis rate had been updated since the last report to the Board
The Board noted that in March 2015, 7,838 people in Devon were on a GP register for dementia, compared with an expected prevalence of 13,864, a diagnosis rate of 56.5%. Rates in Devon were below the South West (58.3%) and England (60.8%) and mirrored the local authority comparator group rate (56.5%). Diagnosis rates had improved in recent years, increasing from 28.0% in 2006/07 and 44.9% in March 2014, and the gap had narrowed significantly.
Following approval at the November 2013 Board meeting, a Red, Amber, Green (RAG) rating had been added to the indicator list and a performance summary on page 2 of the full report. Areas with a red rating included hospital admissions for self-harm, aged 10-24.
The Board further noted the intention to report a summary of emerging themes from the Devon Child Sexual Exploitation scorecard. The scorecard was being developed by the Devon Safeguarding Children Board s Child Sexual Exploitation sub-group and would be made available in due course.
The indicator list and performance summary within the full report set out the priorities, indicators and indicator types, and included a trend line, highlighting change over time, and a Devon, South West and England comparison chart for benchmarking purposes.
The outcomes report was also available on the Devon Health and Wellbeing website www.devonhealthandwellbeing.org.uk/jsna/health-and-wellbeing-outcomes-report
The Board, in discussion, welcomed the ongoing work to identify ways of developing an indicator to monitor outcomes in relation to tackling and preventing Child Sexual Exploitation, as outlined in the report and also the intention of Government to introduce eight local profiles, one of which would be Child Sexual Exploitation.
It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and
RESOLVED that the report be noted and the ongoing work in relation to the Child Sexual Exploitation Scorecard be commended.
*167 Theme Based Report Review of Joint Health and Wellbeing Strategy and Joint Strategic Needs Assessment
The Board considered a number of reports from the Director of Public Health which focused upon the refresh of the Devon Joint Health and Wellbeing Strategy and the Joint Strategic Needs Assessment.
The Board first considered the Devon Overview for 2015 in relation to the Joint Strategic Needs Assessment (JSNA). The Devon Overview looked at the overall pattern of health and care needs in the County, including the impact of population change, deprivation and economic conditions. It sat alongside other elements of the JSNA including area profiles, topic based information, outcomes reports, and a library of supporting health needs assessments and other documents. The report contained an executive summary (as an appendix to the report) of the JSNA Devon Overview, but could be viewed in full at www.devonhealthandwellbeing.org.uk/draft-jsna-devon-overview-2015)
The Board also received a detailed presentation to accompany the JSNA report which highlighted its development areas which included long term conditions, qualitative information, protected characteristics and development of the website. It also outlined the forthcoming work programme and important trends in relation to population, equality and diversity, economy, community and environment, deprivation, starting well (children), living well (adults) and aging well (older people) which all identified where resources might be targeted and the direction of the Strategy. The presentation concluded with outlining the main challenges in Devon which included, inter alia, ageing populations, rurality, financial pressure, mental health, below average earnings and long term conditions.
The Board noted that it had a statutory duty to produce the Devon Joint Health and Wellbeing Strategy and update it. This was the second update of the 2013-16 strategy, and would be the last pending refresh of the strategy for 2016 onwards.
The update reflected new membership, governance, changing landscapes and the importance of using the JHWBS, JSNA, Health Needs Assessments and outcomes reporting in commissioning decisions. The update consolidated the relevance of the existing priorities and suggested an increased focus on mental and emotional health and wellbeing for all ages, an increased focus on prevention and renewed effort to reduce health inequalities that persisted for certain groups and certain areas.
A draft of the refreshed Health and Wellbeing Strategy was made available to Board Members for comments. They noted that the on-going analysis of the joint strategic needs assessment confirmed that the four strategic priorities remained relevant and were helpful in framing activity focused around the life course approach.
The Board noted that the needs of people and communities, particularly those most vulnerable or disadvantaged, would be made explicit in the Devon Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy and that it was important for the Board to consider all individuals in shaping policy and have due regard to the need to eliminate discrimination, advance equality of opportunity, and foster good relations between different people when carrying out its activities. The JSNA had specific sections on the Protected Characteristics and an equality impact assessment had been completed for the JHWBS update.
The Board discussed the following in terms of
the strengthening of the inequalities theme and that this was a focus in the forthcoming Public Health Annual Report;
the welcome news that the CCG s had just commissioned a 24/7 coverage service for CAMHS;
the importance of considering both long term and neurological conditions, especially in light of an aging population and the cost of appropriate medication;
the significant impact of loneliness and isolation as a factor in poor health and wellbeing and that it should be reflected in the health risks already identified;
clarification of how the Board established links with commissioning activities and commissioning bodies; and
the need for all publically funded services to be the responsibility of a larger commissioning Board.
It was MOVED by Councillor Davis, SECONDED by Councillor Clatworthy, and
RESOLVED
(a) that the draft Joint Strategic Needs Assessment Devon Overview be approved[1] and
(b) that the revised Health and Wellbeing Strategy[2] update be endorsed and used as the basis for the engagement for the new Strategy development alongside the Joint Strategic Needs Assessment (JSNA) update for 2015.
BOARD BUSINESS - MATTERS FOR DECISION
*168 Joint Commissioning in Devon, the Better Care Fund (BCF) and Governance Arrangements)
The Board considered a joint report from Mr T Golby (Head of Social Care Commissioning, Devon County Council) and Mr P O Sullivan (Director of Partnerships, NEW Devon CCG) on current progress with the Better Care Fund.
The purpose of this fund was a drive towards integration and a seamless service user / patient experience being at the forefront of developments around health and social care. The key areas of focus were prevention and independence, crisis response and regaining independence.
The report outlined that the Board were required to track the high level metrics contained within the agreed Better Care Fund Plan. They were further required (quarterly) to formally report, using the template supplied by the central Better Care Fund Programme support team.
The BCF First Quarter Return was attached to the papers and included the allocation information, budget arrangements and national conditions. The data collection also required the Board to submit a written narrative that contained any additional appropriate information, for example explanations of any material variances against the plan.
The Board discussed and asked questions on the following;
the impact of the Care Act and that further guidance was expected in the Autumn which might impact on the BCF and work undertaken to date;
the lack of clarity on how the submitted returns would be collated, analysed and presented to partners; and
clarification of the success regime and confirmation that further guidance was awaited on this.
It was MOVED by Councillor Sanders, SECONDED by Councillor Clatworthy, and
RESOLVED
(a) that the first quarter return, as submitted with the report, be endorsed;
(b) that, due to the timescales for submitting the quarterly returns, the Board give delegated Authority to the Chair of the Board to sign these on its behalf; and
(c) that a further report on the Care Act and its implications be brought to the Board in the Autumn.
*169 Joint Draft Commissioning Strategy for Prevention
The Board considered a joint report from the Head of Social Care Commissioning, Managing Director (Partnerships) NEW Devon CCG and Director of Commissioning, South Devon and Torbay CCG, which presented a draft joint commissioning strategy for prevention which had been developed by the two Clinical Commissioning Groups, Devon County Council, Public Health and District Councils.
The strategy had been developed by the prevention work stream which formed part of the Care Act implementation programme in Devon. The Care Act 2014 aimed to help improve people s independence and wellbeing and made clear that Local Authorities must arrange services that help prevent or delay people from deteriorating to the point they would need on-going care and support. For this to work, Local Authorities needed to work with communities to obtain relevant support to keep people well and independent.
The draft strategy was presented as part of the papers and was aligned with Devon County Council s strategy, Better Together , the I Plan and the Better Care Fund. It was people, rather than organisation focused and was underpinned by integrated and preventive approaches and would look for innovative solutions to the challenges faced. The Board noted the shift towards prevention activity at an earlier stage and the adoption of a living well and ageing well approach.
Further consultation on the Strategy was planned and the report outlined that the draft strategy had been prepared in line with the partners Public Sector Equality Duty, recognising where positive action needed to be taken to address the needs of underrepresented groups and those with protected characteristics.
The Board discussed and asked questions on the following;
the new duties of prevention contained within the Care Act;
the current work in mapping investments;
clarification of the prevention definitions (primary, secondary and tertiary) and the need to intervene more at the primary and secondary stages;
the possibility that some services might need to be decommissioned, in order to re-commission in line with the strategy;
that all public services needed to be jointly commissioning in preventive services; and
the role of the new website my care, my life , which, in due course, would be updated by communities to provide relevant information and support.
It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and
RESOLVED
(a) that the Joint Commissioning Strategy for Prevention, and the themes contained within, be endorsed as the basis for commissioning delivery plans; and
(b) that a progress report on the Strategy be received at the Board meeting in November 2015.
*170 Children, Young People and Families
(a) Ofsted Report
The Board considered the recent inspection report from Ofsted on their inspection of services for children in need of help and protection, children looked after and care leavers. The report was available at http://reports.ofsted.gov.uk/local-authorities/devon
The Ofsted review had also considered the effectiveness of the Local Safeguarding Children Board.
The overall outcome was that the service required improvement . The review headings included Quality of work with children and young people , Management of service quality and provision and Leadership, Governance and Partnerships and the improvements that were required in these areas.
The report also went on the highlight some of the Authorities strengths that had been demonstrated during the review.
The Board asked for clarification of Ofsted s comments, which had been made in relation to care leavers and the care leavers service and they also noted that an action plan was being progressed.
It was MOVED by Councillor Davis, SECONDED by Councillor McInnes, and
RESOLVED that the contents of the Ofsted Inspection Report be noted.
(b) Proposals for Partnerships and Governance Arrangements
The Board considered a report from the Strategic Director (People) on governance and planning arrangements between the Local Authority, the Devon Health and Wellbeing Board, Devon s Childrens and Families Alliance and the Devon Safeguarding Children Board. This was a recommendation from the Ofsted report to ensure the Governance arrangements were clear.
The report proposed that a Devon Public Services Board be constituted to hold an overview of the strategic links and opportunities between key public sector partnerships across the Devon footprint. Such a Board would provide an opportunity to coordinate responsibilities across key partnership boards/groups which currently existed and to clarify responsibility, where required. The appendix of the report outlined the links between and remits of structures such as the Children, Young People and Families (CYPF) Alliance (and the potential consideration of an Adults Alliance), the Devon Safeguarding Children Board (DSCB), the Devon Safeguarding Adults Board (DSAB), the Safer Devon Partnership, the Local Nature Partnership, the Local Transport Board and the Devon Education Forum.
The Board discussed the proposals in terms of bringing together a number of senior accountable officers and also focusing on delivering a smaller number of key services.
It was MOVED by Councillor Davis, SECONDED by Councillor Clatworthy, and
RESOLVED that proposals outlined in the report, for multi-agency partnership and governance arrangements, be endorsed.
*171 0-5 Public Health Nursing Transition
The Board received a report from the Director of Public Health on the transfer of commissioning responsibilities (on 1st October 2015) for the Healthy Child Programme for 0-5 year olds. This service, included the health visiting service and the Family Nurse Partnership (or equivalent), would transfer from NHS England to Local Authorities.
The responsibilities would include undertaking five statutory universal reviews, including antenatal health promoting visits (which included beginning maternal mental health screening), new baby review, 6-8 week check, 1 year assessment and the 2 to 2 year review.
The report included data on the current position of the 0-5 public health commissioning transfer, including the Devon resident 0-5 child population. The Board noted that attention was being given to the quality of service as well as reaching the target trajectory numbers and, as such, a large amount of training and upskilling had been undertaken. Furthermore, work was underway to ensure that information governance, clinical governance, communication and local finance arrangements were in place ready for the transfer.
The report further outlined the challenges and opportunities presented by this transfer.
*172 Quality Premium Measures
The Board considered a report from the South Devon and Torbay CCG on the Quality Premium Measures. The quality premium was intended to monitor CCGs for improvements in the quality of the services commissioned. The CCG were required to select preferred indicators within the Quality Premium Return, across 3 Domains, with a weighted value assigned to each indicator. The Board was asked to review the proposed list, as presented in the report, in relation to;
Urgent and Emergency Care (Delayed transfers of care which were NHS responsibility (10%), increase in number of patients admitted for non-elective reasons, who were discharged at weekends or bank holidays (10%) and reduction in avoidable emergency admissions (composite measure) (10%));
Mental Health (reduction in the number of patients attending AE for a mental health related need who wait more than four hours to be treated and discharged, or admitted, together with a defined improvement in the coding of patients attending AE (30%)); and
Local Measures (reduction in the number of breaches of the 6 Week standard for diagnosis tests - Targeted Value 1% and 10% of quality premium, Dementia Diagnosis Rate for the over 65 - Targeted Value: 66.7% and 10% of quality premium.
The Board clarified that the mental health indicator applied to both adults and children.
It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and
RESOLVED that the Quality Premium Indicators, as outlined above, be endorsed.
*173 Integrated Care Organisation (ICO), Consultation on Community Health Services and Senior Staffing
The Board received a report, for information, from the South Devon and Torbay CCG giving a progress update on the Integrated Care Organisation (ICO), Consultation on Community Health Services in Dawlish and Teignmouth and Senior Staffing within the CCG.
The Board heard that the CCG had supported the concept of the ICO as its outline business case included an improved care model and efficiencies deliverable within CCG recurrent budgets. The CCG continued to work closely with South Devon Healthcare NHS Foundation Trust and Torbay and Southern Devon Health and Care Trust, towards an implementation date of 1st August 2015.
The had been a formal 14-week consultation on future community services in the Teignmouth and Dawlish area, with 6 public meetings and more than 40 other meetings (including staff groups, Leagues of Friends, town councils, interested groups and voluntary organisations). Healthwatch Devon used all consultation responses to formalise a report and the suggestions would be evaluated using the criteria of meeting demand in the future population, providing services locally, improving the quality of care provided, meeting the standards/guidelines of care provision and being affordable and financially sustainable. The outcomes would be presented to the County Councils Health and Wellbeing Scrutiny Committee in June and a decision on whether to implement any of the options would be taken later in the Summer.
The also report outlined some senior staff changes which included the appointment of Chief Clinical Officer, Dr Nick Roberts.
*174 NEW Devon Clinical Commissioning Group Operating Plan
The Board considered a report from the NEW Devon Clinical Commissioning Group (CCG) on its Operating Plan for 2015/2016. This was the organisations workplan for the year ahead, outlining the priorities, challenges and commissioning intentions for 2015/16 and the delivery model for this work.
The plan outlined the National context, including Everyone Counts: Planning for Patients 2014/15 to 2018/19 which clearly set the priorities, results and outcomes that healthcare commissioners and providers were expected to deliver. It also described the five year forward view (5YFV), which explained how the health service needed to change to ensure a more engaged relationship with patients, carers and the public to promote wellbeing and prevent ill health.
The plan also considered the local context, where the CCG had been facing a growing financial challenge since it had been formed and, as such, had entered a turnaround regime in late November 2014.
The report highlighted the focus for 2015/2016 on delivering the turnaround plan and developing the system-wide strategic and financial framework within which the health economy would work.
The Board discussed and asked questions on the following;
the appointment of a turnaround director to address some of the issues currently faced by the CCG;
that the operating plan was based on the previous years information so could not fully reflect the strategic direction outlined in the Joint Strategic Needs Assessment, the Joint Health and Wellbeing Strategy and the Prevention Strategy; and
why there was no detail in the BCF funding arrangements for 2016/17 and 2017/18 in the draft financial plan.
. It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and
RESOLVED that the Operating Plan for 2015/2016 be noted.
OTHER MATTERS
*175 References from Committees
Nil
*176 Scrutiny Work Programme
The Board received a copy of Council s Scrutiny Committee work programme in order that it could review the items being considered and avoid any potential duplications.
*177 Forward Plan
The Board considered the contents of the Forward Plan, as outlined below (which included the additional items agreed at the meeting).
| Date | Matter for Consideration |
| Thursday 10 September 2015 @ 2.00pm | Performance / Themed Reporting Health Wellbeing Strategy Priorities and Outcomes Monitoring Theme Based Report (TBC) Business / Matters for Decision Better Care Fund Care Act Implications CCG Updates Children s Safeguarding annual report (annually in September) Adult Safeguarding annual report (annually in September) Child Sexual Exploitation Multi-Agency Working David Taylor - Child Sexual Exploitation Dashboard (Performance) Adult Safeguarding Review of Mental Health Services Other Matters Scrutiny Work Programme / References Board Forward Plan Briefing Papers, Updates Matters for Information
|
| Thursday 12 November 2015 @ 2.00pm | Performance / Themed Reporting Health Wellbeing Strategy Priorities and Outcomes Monitoring Theme Based Report (TBC) Business / Matters for Decision Better Care Fund CCG Updates Joint Commissioning Strategies Actions Plans (Annual Report) Prevention Strategy Update (Minute 169) Other Matters Scrutiny Work Programme / References Board Forward Plan Briefing Papers, Updates Matters for Information |
| Thursday 14 January 2016 @ 2.00pm | Performance / Themed Reporting Health Wellbeing Strategy Priorities and Outcomes Monitoring Theme Based Report (TBC) Business / Matters for Decision Better Care Fund CCG Updates Delivering Integrated Care Exeter (ICE) Project Annual Update Other Matters Scrutiny Work Programme / References Board Forward Plan Briefing Papers, Updates Matters for Information |
| Thursday 10 March 2016 @ 2.00pm | Performance / Themed Reporting Health Wellbeing Strategy Priorities and Outcomes Monitoring Theme Based Report (TBC)
Business / Matters for Decision Better Care Fund CCG Updates
Other Matters Scrutiny Work Programme / References Board Forward Plan Briefing Papers, Updates Matters for Information
|
RESOLVED that the Forward Plan be approved, including the items approved at the meeting.
*178 Briefing Papers, Updates and Matters for Information
Members of the Board received regular email bulletins directing them to items of interest, including research reports, policy documents, details of national / regional meetings, events, consultations, campaigns and other correspondence. Details were available at;
http://www.devonhealthandwellbeing.org.uk/
Items of interest included;
(a) The formal response from Healthwatch Devon to the County Council s Public Transport Review. The response highlighted that the Council took soundings on the proposals from both CCGs and the Health and Wellbeing Board. The full response could be viewed at http://www.healthwatchdevon.co.uk/public-transport-review/
(b) Stick With It A review of the second year of the health and wellbeing improvement programme (LGA Publication);
(c) Conquering the Twin Peaks (Research on how London's Health and Wellbeing Boards were doing two years after they took up their statutory roles); http://www.londoncouncils.gov.uk/node/25543
(d) South West Sexual Health Board Annual Report 2014/15; http://www.southglos.gov.uk//documents/Sexual-Health-Annual-Report-2015.pdf
(e) Childhood Obesity Conference 3 asks of the Health and Wellbeing Board. A report had been prepared by the Director of Public Health outlining the context for Obesity issues, the associated health problems and the attributable costs to the NHS. The report highlighted the data in relation to childhood obesity and that analysis demonstrated a link with socioeconomic status.
The South West Health and Wellbeing Board Chairs Network hosted a Conference on Childhood Obesity and asked three things of Boards, which included;
raising public awareness of childhood obesity (lifestyle changes could make a big difference);
Health-in-all local policies (e.g. all new housing developments to enable healthy lifestyles as the norm); and
Schools (influence Local Authorities, Schools and teacher training organisations to develop / evaluate physical activity and healthy eating sessions in schools)
The report highlighted what the County was doing in relation to Childhood Obesity in respect of the three areas and highlighted the complexity of the issue. Devon had adopted a life-course approach, seeking to tackle inequality through the targeting of resources and aiming to strike a balance between prevention and management. Devon also worked in partnership with a wide range of stakeholders and linked into local and national networks to evaluate programmes and learn from best practice.
(f) Campaign to End Loneliness The Board were asked a number of questions in response to the campaign, in particular how the Health Wellbeing Strategy addressed issues such as loneliness and / or isolation. The Chair of the Board had responded according, the response being outlined in the agenda papers.
(g) The End Fuel Poverty Coalition (EFPC) Letter was circulated with the agenda. This highlighted it welcomed the NICE guidance on Excess Winter Deaths and Morbidity and Health Risks of Cold Homes with recommendations aimed at Health and Wellbeing Boards and / or its Partners https://www.nice.org.uk/guidance/ng6
RESOLVED
(a) that the areas highlighted by the recent conference on childhood obesity and the actions delivered across the County to achieve them, be noted; and
(b) that the publications, outlined above, be noted.
*179 Dates of Future Meetings
RESOLVED that future meetings of the Board will be held on
Thursday 10th September 2015 @ 2.00pm
Thursday 12th November 2015 @ 2.00pm
Thursday 14th January 2016 @ 2.00pm
Thursday 10th March 2016 @ 2.00pm
*180 Dates of Future Seminars
Thursday 8th October 2015 @ 10.30am 4.00pm
Thursday 11th February 2016 @ 10.30am 4.00pm
*DENOTES DELEGATED MATTER WITH POWER TO ACT
The meeting started at 2.00pm and finished at 4.32pm.
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NOTES: 1. Minutes should be read in association with any Reports or documents referred to therein, for a complete record. 2.The Minutes of the Board are published on the County Council s website at http://www.devon.gov.uk/index/councildemocracy/decision_making/cma/index_hwb.htm 3. A recording of the webcast of this meeting will also available to view for up to six months from the date of the meeting, at http://www.devoncc.public-i.tv/core/portal/home |
[1] Final version can be found here JSNA Devon Overview 2015
[2] Final version can be found here Joint Health and Wellbeing Strategy Update, June 2015