Agenda and minutes

Minutes of the meeting held on 15 December 2016.

It was MOVED by Councillor Clatworthy, SECONDED by Councillor Croad, and

RESOLVED that the minutes of the meeting held on 15 December 2016 be signed as a correct record.

Items which in the opinion of the Chairman should be considered at the meeting as matters of urgency.

The Chairman placed on record her thanks to Mr Robert Norley (Chief Environmental Health Officer), who had been a Board Member since its inception, for his valued contributions and commitment to the work to the Board.

RESOLVED that the Board write to the Chief Environmental Officers Group for confirmation of the new representative.

Report of the Chief Officer for Communities, Public Health, Environment and Prosperity, which reviews progress against the overarching priorities identified in the Joint Health and Wellbeing Strategy for Devon 2016-2019.

The appendix is available at http://www.devonhealthandwellbeing.org.uk/jsna/health-and-wellbeing-outcomes-report/ and is attached separately for Board Members.

The Board received a report from the Chief Officer for Communities, Public Health, Environment and Prosperity on the performance for the Board, which monitored the priorities identified in the Joint Health and Wellbeing Strategy for Devon 2016-2019.

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.

The Board received an ‘updates only’ version of the Health and Wellbeing Outcomes Report.  The report was themed around the five Joint Health and Wellbeing Strategy 2016-19 priorities and included breakdowns by South West benchmarking, local authority district and local authority comparator group, clinical commissioning group, and locality comparison, trend and future trajectories and inequalities characteristics. The indicators below had all been updated since the last report to the Board in December 2016;

GCSE Attainment 2015-16, Alcohol-Related Admissions 2015-16, Healthy Life Expectancy (Male) 2013 to 2015, Healthy Life Expectancy (Female) 2013 to 2015, Re-offending Rate 2014, Rough Sleeping Rate 2016, Emotional Wellbeing of Looked After Children 2015-16 and Self-reported Wellbeing (low happiness score) 2015-16.

Following approval at a previous meeting, a Red, Amber, Green (RAG) rating was included in the indicator list and a performance summary on page 12 of the reports pack. Areas with a red rating included Fuel Poverty and Hospital Admissions for Self-harm, aged 10 - 24.

The report also featured a summary of the priority areas (March 2017):

Children, Young People & Families - Teenage conception rates were falling and levels of development at school entry were improving, although variations in excess weight, poverty, GCSE attainment and alcohol harm persisted.

Living Well - Smoking rates and deaths from preventable causes were falling, and levels of excess weight, physically activity and fruit and vegetable consumption compared favourably with similar areas.

Good Health and Wellbeing in Older Age - Deaths at home, healthy life expectancy, falls and GP support compared well in Devon, but whilst the service was effective, the coverage of re-ablement services was lower.

Strong and Supportive Communities - Housing-related measures, including fuel poverty, dwelling hazards and rough sleeping levels were a cause of concern in Devon.

Life Long Mental Health - Whilst general wellbeing was better, poorer outcomes were evident for those with mental health problems.

Table 5 of the report showed how Devon compared with the Local Authority Comparator Group (LACG) for all Health and Wellbeing outcome measures (March 2017). This included how Devon compared / performed against both the LACG and England and their rank position.

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, highlighted and asked questions on;

·         Why Exeter was reporting a particularly high number of rough sleepers and the links between high housing costs;

·         The new processes and links with CAMHS in respect of young people entering the care system;

·         The attainment statistics for GCSE’s in the North Devon and Torridge areas and the concern that the inequalities graph appeared to show a widening rather than  ...  view the full minutes text for item 33.

A themed discussion will take place on the theme of ‘Living Well’, as outlined as a priority in the Joint Health and Wellbeing Strategy. This includes a Panel of representatives from Public Health, Devon County Council, Active Devon and Natural Devon and a biography of those attendees is attached.

The Board held a round table discussion on the ‘Living Well’ priority, as detailed in the Joint Health and Wellbeing Strategy, which included attendance of representatives who formed an ‘expert panel’. A biography of each attendee was appended to the agenda and included Mr S Brown Deputy Director of Public Health (Devon County Council), Mr J Hulland Transport Planning and Road Safety Manager (Devon County Council), James Bogue Senior Development Manager (Active Devon) and Sue Goodfellow (Chair of Natural Devon).

The Panel also gave a supporting presentation which considered the proportional contributions to premature death, including behaviours, genetics, social circumstances and environments. The 20 leading risk factors relating to ill health in adults were explained as well as the challenges when looking at the number of adults who smoked (79,000), were obese (141,200), physically inactive (163,900) and were drinking at harmful levels (120,600).

The presentation outlined the One Small Step service, the new ‘are you sitting comfortably’ campaign, the challenges (and opportunities) with transport issues and the definitions of an inactive lifestyle. Lastly, the target to help at least 125k people to get more active and the campaign of ‘Natural Devon’ (Devon Local Nature Partnership) to take forward a ‘Naturally Healthy Campaign’ (funding had been applied for) to help inactive people aged 55+ become more active by connecting them with nature.

The Devon Local Nature Partnership also outlined their vision, which was about everyone in Devon having the opportunity and confidence to be ‘naturally active’ in order to improve their health and well-being. They also highlighted the 77 varied events that took place in Devon in May 2016 for Naturally Healthy Month, reiterating that access to green space was one of the few health interventions which reduced health inequalities. For May 2017, the naturally healthy month was being extended into Somerset. More information was available at www.naturaldevon.org.uk.

The Board discussed and asked questions on the following;

·         That the ‘natural health service’ was crucial in supporting general health and wellbeing;

·         How the partners were engaging with schools, to ensure healthy habits and lifestyles from an early age;

·         The importance of linking green spaces with new developments, particularly urban development, the role of public transport and innovative uses for S106 monies, for example to improve Public Rights of Way;

·         The impact of the sugar tax and the revenue that might be raised from that and potential uses;

·         Clarification of how the initiatives target the most vulnerable, including links with disabilities;

·         And the importance of evaluation and how success might be measured.

Joint report of the Head of Adult Commissioning and Health, NEW Devon CCG and South Devon and Torbay CCG) on the BCF Performance (Report and Summary), attached.

The Board considered a joint report from the Head of Adult Commissioning and Health, NEW Devon CCG and South Devon and Torbay CCG on the BCF, Quarter Return, Performance Report and Performance Summary. The Board noted that the 3^rd quarter return had been submitted on 3 March 2017.

Regular reports were provided on the progress of the Devon Better Care Fund Plan to enable monitoring by the Health and Wellbeing Board. Performance and progress was reviewed monthly by the Joint Co-ordinating Commissioning Group through the high level metrics reports and progress overview.

The report summarised the BCF activity in terms of the work towards the National Conditions, and outlined all the conditions had been met. 

It also provided ‘Outcome’ measures which included agreement on a system wide action plan to  reduce delayed transfers of care (developed with providers and owned by the multi-agency A & E Delivery Boards), a summary of BCF schemes focused on reduction of non-elective admissions, monitoring the support for people with dementia, including assessing the length of stay for people with dementia admitted to hospital rather than diagnosis rates, the permanent admissions to residential and nursing care homes (the rate being significantly below the South West average) and effectiveness of re-ablement services (which were effective for around 88% of older people).

Members of the Board noted that Delayed Transfers of Care was still a challenging target and that coverage (rather than effectiveness) of re-ablement services was still benchmarking lower than desired.

RESOLVED that the 3^rd quarter return be endorsed.

Annual Report for 2015/2016 of the Chair of the Safeguarding Adults Board, attached. The Chair of the Board, Siân Walker, will attend to present.

The Board considered the Devon Adults Safeguarding Board Annual Report for 2015/16, presented by Sian Walker, Independent Chair of the Devon Adults Safeguarding Board.

The report highlighted the role of the Executive Board and other subgroups such as the Mental Capacity Act (MCA) Sub-Group, Operational Sub-Group, Safeguarding Adults Review Group, the Learning and Improvement Group and also the benefits of the themed workshops.

The Business Plan for 2016-19 would focus on improving people’s experience of safeguarding, the prevention of harm and neglect in care and health services, improving awareness and application of MCA, protecting people from harm, identifying people at risk, reducing financial abuse / scams, reducing the prevalence of modern slavery and the PREVENT agenda.

The report also outlined partner key achievements which included, inter alia, increased resources in Sexual Offences and Domestic Abuse Investigation Teams (Police), training for care management staff and improved approaches to quality assurance of safeguarding practice (DCC), a street triage service, information sharing and place of safety suites with Devon Partnership Trust as well as other initiatives and projects with NEW Devon CCG, North Devon Health Care NHS Trust, South Devon and Torbay CCG, the South Western Ambulance Service NHS Foundation Trust and Torbay and South Devon NHS Foundation Trust.

Finally, the vision for the future was ‘making safeguarding personal’, so ensuring that services to vulnerable people were person-centred, easy to access and promoted independence as well as ensuring people were supported to keep themselves safe and were able to express what outcomes they wished to achieve.

The Board further questioned how adult’s services and children’s services could work together to either strengthen links or share successes.

RESOLVED that the report be welcomed and the Chair of the Board be thanked for her presentation.

Report of the South Devon & Torbay CCG on Transforming Community Services, attached.

The Board considered the report of the South Devon and Torbay Clinical Commissioning Group (CCG) on their Transforming Community Services Programme and the outcomes of recent consultations, including decisions made by the CCG governing body at its meeting on 26 January 2017 and the subsequent implementation process.

The consultation reflected proposals to switching funding from bed based to community based care and 12 weeks of formal public consultation ran from 1 September to 23 November 2016. The report outlined the key concerns raised during that consultation and also the Governing Body meeting which considered the feedback, alternative proposals and the proposed model of care.

It had been agreed that changes would not be made to existing services until new provision was in place and operating at a level where demand could be met. The CCG Board had outlined a set of parameters in relation to this including, contracts for intermediate care placements, medical leadership, medical contracts, referral systems, capacity and community clinics appropriate to need.

The report outlined what needed to happen before the MIU’s could be removed from the community hospitals and also a summary of changes town by town, including Ashburton/Buckfastleigh, Newton Abbot, Bovey Tracey/Chudleigh, Brixham, Dartmouth, Totnes, Newton Abbot, Paignton, Totnes and Torquay.

It was recognised that achieving change in the NHS was not easy and it caused concern for local people. The new model of care was expected to reduce demand for hospital admissions, provide viable alternatives to A&E and put greater focus on prevention, health promotion and self-care.

The Board checked that the aims of the reconfiguration reflected other strategic plans, including that of the children’s alliance.

Verbal updates from CCG’s on issues or matters pertinent to the Boards Business.

The Board received a verbal update from Dr Greatoex (South Devon & Torbay CCG) that it would be his last meeting of the Board.

He further updated Board Members that whilst the Sustainability and Transformation Plan (STP) was being developed for a wider Devon, work was continuing on place based commissioning to develop a more localised agenda, reflecting community need at either CCG level or even town / locality level.

RESOLVED that Dr Greatorex be thanked for his contributions and commitment to the Board, having been a member since its inception, and the Board note that Dr Johnson had been appointed as the Clinical Chair for South Devon and Torbay CCG, thereby replacing Dr Greatorex on the Board.

Nil

There were no references from Committees.

In order to prevent duplication, the Board will review the Council’s Scrutiny Committee’s Work Programmes. The latest round of Scrutiny Committees confirmed their work programmes and the plan can be accessed at; http://new.devon.gov.uk/democracy/committee-meetings/scrutiny-committees/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.

To review and agree the Boards Forward Plan.

The Board considered the contents of the Forward Plan, as outlined below (which included the additional items agreed at the meeting).

RESOLVED that the Forward Plan be approved, including the items approved at the meeting.

There had been no items of correspondence received.

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/

However, no items of correspondence had been received since the last meeting.

Please note that dates of future meetings and conferences will be included in the Devon County Council meetings calendar. All will take place at County Hall, unless otherwise stated.

Meetings

Thursday 8th June 2017 @ 2.15pm

Thursday 7th September 2017 @2.15pm

Thursday 14th December 2017 @ 2.15pm

Annual Conference

Thursday 8th June 2017 @ 10.00am

RESOLVED that future meetings and conferences of the Board will be held on:

Meetings

Thursday 8th June 2017 @ 2.15pm

Thursday 7th September 2017 @2.15pm

Thursday 14th December 2017 @ 2.15pm

Annual Conference

Thursday 8th June 2017 @ 10.00am