Related Documents:
agenda for these minutes
Present:-
Devon County Council
Councillors Davis (Chairman), Clatworthy and McInnes, Ms J Stephens (Strategic Director, People) and Dr V Pearson (Director of Public Health)
District Council Representative
Councillor Sanders
Health Watch
Dr H Ackland
Joint Engagement Board
Ms C Brown
NHS England
Ms C Williams
Apologies:
Mr R Menary (Probation Service)
Dr T Burke (Northern, Eastern Western (NEW) Devon Clinical Commissioning Group (CCG)
Dr D Greatorex (South Devon and Torbay Devon Clinical Commissioning Group (CCG))
Mr R Norley (Environmental Health)
Mr T Hogg (Police and Crime Commissioner)
Councillor Barker (Devon County Council)
*103 Minutes
RESOLVED that the minutes of the meeting held on 12 June 2014 be signed as a correct record.
PERFORMANCE AND THEME MONITORING
*104 Devon Joint Health and Wellbeing Strategy: Priorities and Outcomes Monitoring
The Board considered a report 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 indicators relating to Teenage Conception Rate (2013 Q2), Proportion of Physically Active Adults (2013), Alcohol-Related Admissions (2013-14), Incidence of Clostridium Difficile (2013-14), Feeling Supported to Manage Own Conditions (2013-14), Re-ablement Services Effectiveness (2013-14), Re-ablement Services Coverage (2013-14), Social Connectedness (2013-14), Stable and Appropriate Accommodation Learning Disability (2013-14), Stable and Appropriate Accommodation Mental Health (2013-14) had all been updated since the last report to the Board.
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 and dementia diagnoses rates.
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 discussed the following;
the indicators in relation to dementia diagnoses rates and why these were below national averages (although the most recent statistics showed an improvement); and
that the re-ablement indicators should be applauded and whilst there was no room for complacency, including additional support for people coming out of hospital, some very positive outcomes were being witnessed.
It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and
RESOLVED that the Health and Wellbeing Outcomes Report, in particular the positive results in relation to Re-ablement and Teenage Conception indicators, be welcomed.
*105 Good Health and Wellbeing in Older Age
(a) Overview Report - Good Health and Wellbeing in Older Age
The Board considered a report from the Director of Public Health which outlined the context and importance of promoting good health and wellbeing in older age within the County. This was reinforced by a number of factors including the proportion of older people living and working in Devon, the evidence base to the benefits of maintaining good health and wellbeing and inclusion of the issue as an overarching priority in Joint Health and Wellbeing Strategy 2013/16.
The report highlighted the relative size of the 85 years and over population and the year in which the national population profile would match the local population profile for selected areas. Analysis of the joint strategic needs assessment identified priorities of reducing falls and fractures in older people, raising awareness of dementia in communities, identifying hidden carers and producing an end-of-life care integrated pathway. The report further provided an analysis of relevant outcomes measures from the Devon Health and Wellbeing Outcomes Report including Incidence of Clostridium Difficile, Injuries Due to Falls, Dementia Diagnosis Rate, Feeling Supported to Manage Own Condition(s), Re-ablement Services (Effectiveness), Re-ablement Services (Coverage) and Re-admissions to Hospital within 30 Days.
The report also stressed 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. Integrated Impact Assessments would be undertaken on specific thematic, condition or population based health and wellbeing related strategies and 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.
It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and
RESOLVED that the contents of the report be noted and form the basis for the Frail Older People discussion paper and the public, service user and carer perspective involvement by Healthwatch and the Joint Engagement Board.
(b) A Focus on Frailty
The Board considered a discussion paper from the Director of Public Health related to good health and wellbeing in older people, with a focus on frailty issues. The purpose of the report was to assist the Board in holding a round table discussion on the priority, with input from all Board partners on how they were contributing, and for the Board to assess any potential gaps in provision and identify any improved joint working opportunities.
The report provided an overview on frailty and how it might be identified. It was noted that an increased risk of adverse health outcomes could be predicted by early identification of frailty, and adverse outcomes prevented by appropriate multidisciplinary interventions. The position in Devon was outlined in terms of the percentage of total population who were classified as frail or pre-frail and aged 65 and over. The longer term projections (to 2037) showed that the numbers were expected to rise considerably.
In January 2014, NHS England published Safe, Compassionate Care for Frail Older People using an Integrated Care Pathway . This pathway contained nine stages which included, healthy active ageing and supporting independence, living well with simple or stable long-term conditions, living well with complex comorbidities, dementia and frailty, rapid support close to home in a crisis, good acute hospital care when (and only when) needed, good discharge planning and post-discharge support, good rehabilitation and re-ablement after acute illness or injury, high quality nursing and residential care for those who truly need it and choice, control and support towards the end-of-life.
In summary, the recommendations contained within the document could be condensed into 4 principles:
prevention was key;
Care decisions should be based on functionality, not age alone;
promotion of integrated care; and
improvements to the quality of care
Dr Ackland, on behalf of Health Watch Devon and the Devon Joint Engagement Board, presented the public, service user and carer perspective through the experience of Oscar and Agnes Fairweather case study. Whilst not real life couple, the data gathered by Health Watch formed the basis of the case study to show the reality for people of strategic decisions made by the interested parties that formed the Health and Wellbeing Board.
The Board discussed the following in terms of what the data and case study presentation highlighted for future learning;
the value of the case study in bringing a reality and personal touch to the decision making process;
the importance of information control, prevention and early intervention;
the role of the community in looking out for people and providing a support network;
a perception by family and friends (and even GP s) that ageing is simply that, masking potential problems and conditions;
the role of a more personalised approach and personal budgets to support that;
further work / evidence would be welcomed on the potential for people being treated at home (particularly for diagnostics) and only when safe to do so;
the role of carers health checks and that these should be an additional Health and Wellbeing Board indicator;
a lack of understanding amongst service users about the options available to them. Better communication was required to enable them to ask the right questions to obtain the best pathway of treatment;
It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and
RESOLVED
(a) that the data and case study be welcomed as providing an excellent basis for identifying future directions of travel and options for health and social care delivery; and
(b) that the key messages to be communicated from the Board were user focus, information empowerment, personalised approaches to health and care, advocacy, clear care navigation and co-ordination, identifying gaps in carers health checks, early support, the notion of no bed like your own bed and ensuring fairness in access to services.
BOARD BUSINESS - MATTERS FOR DECISION
*106 Joint Commissioning in Devon and the Better Care Fund (formally the Integration and Transformation Fund)
The Board received a presentation from the Head of Social Care Commissioning (Devon County Council) and Managing Director 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 presentation further outlined what had changed in BCF planning (particularly in relation to the quantified reduction in total emergency admissions with schemes to support the reductions) and the steps of assessment, improvement and approval process. In terms of approval, plans had to be submitted by 19 September 2014 and then a nationally consistent review and approval process would commence. By the end of October 2014, all BCF plans would be approved or approved with support or conditions or not approved .
The presentation further outlined the governance arrangements, an overview of schemes including section 256 schemes for 2014/2015 (increasing social care capacity, admissions avoidance, re-ablement, rehabilitation and recovery, improved delayed discharge and prevention) and some suggested scheme groupings for 2015/2016 (which included targeted prevention and maintenance, support when crises occurred and recovery and independence), the metrics for the Better Care Fund including a summary of the benefits / outcomes, pooled funding risk sharing arrangements, the project timeline including the next steps and sign off of the project plan.
The latest version of the plan had been circulated to Board members and the Head of Social Care Commissioning highlighted that comments on the Plan were welcomed.
He further explained that the planned assumptions in relation to the protection of adult social care funding in 2015/16 (highlighted on page 41) were in dispute, therefore the assumption of 10m within the Plan to support the protection of adult social care services commissioned by the Council was not agreed and the issue had yet to be resolved.
The Board discussed the following;
the need to recognise the pressures on adult social care, notwithstanding the massive shift in working practices that had already taken place;
the role of geriatricians in the health and social care arena;
the proposed priorities for 2015/16 could be reworded to reflect the Boards earlier discussion on empowerment, personalisation, care navigation, early interventions and user focus;
the risks and contingency section (page 30) didn t adequately explain the extent to which the mitigating actions reduced the highlighted risks;
the role of the voluntary and community sectors in the governance structures and associated levels of decision making;
the need to recognise the scale of the challenge of the transformation programme including the importance of signposting and the role of the private sector;
any double running costs in the transitional period should be addressed and highlighted in the documentation as one of the risks; and
the consequences of the Plan not being agreed or signed off by the stipulated deadline.
The Board expressed a grave concern over their agreement to the Plan when the social care funding assumptions within it had not been fully addressed.
It was MOVED by Councillor Clatworthy, SECONDED by Dr Pearson, and
RESOLVED that should the social care funding assumptions, as outlined at page 41 of the Plan, be agreed and form part of the final BCF Plan, then the Chairman be authorised to sign off the Plan to meet the timescale of 19 September 2014; should agreement not be reached and an alternative Plan be proposed, a Special meeting of the Board be convened to discuss and consider that revised plan.
*107 Integrated Digital Fund Bid
The Board received a report from the NEW Devon CCG on the recent integrated digital fund bid. The report outlined that, in June 2014, NHS England had announced the availability of funding for technology through the Integrated Digital Care Fund.
A total of six bids were submitted in accordance with the deadline from both hospitals and local authorities across the NEW Devon CCG area. One of the bids was a joint bid across North Devon District Hospital and NEW Devon CCG and one of the criteria for the bidding process was that any joint bid should have the support of the local Health and Wellbeing Board. In order to support the bidding process timescale the Chair of the Health and Wellbeing Board had provided a letter of support, subject to the Board ratifying this.
The paper therefore summarised the bid in order that the Board had sufficient information to provide its support. It outlined that the bid would enable the purchase of a system that allowed the sharing of appropriate patient information between clinicians, thereby improving the information flow and supporting more effective clinical decision making.
A cost/benefit analysis was also provided with the report.
It was MOVED by Councillor Clatworthy, SECONDED by Councillor Sanders, and
RESOLVED that the integrated digital care fund bid, made by North Devon District Hospital in partnership with the NEW Devon CCG to NHS England, be endorsed.
*108 NEW Devon CCG Quality Premium Indicators
The Board received a report from the NEW Devon CCG on the quality premium which was a scheme intended to reward clinical commissioning groups (CCGs) for improvements in the quality of the services they commissioned and for associated improvements in health outcomes and reducing inequalities.
The quality premium paid to CCGs in 2015/16 (to reflect the quality of the health services commissioned in 2014/15) would be based on six measures that covered a combination of national and local priorities. These were:
reducing potential years of lives lost through causes considered amenable to healthcare and addressing locally agreed priorities for reducing premature mortality (15% of quality premium);
improving access to psychological therapies (15% of quality premium);
reducing avoidable emergency admissions (25% of quality premium);
addressing issues identified in the 2013/14 Friends and Family Test (FFT), supporting roll out of FFT in 2014/15 and showing improvement in a locally selected patient experience indicator (15% of quality premium);
improving the reporting of medication-related safety incidents based on a locally selected measure (15% of quality premium); and
a further local measure that should be based on local priorities such as those identified in joint health and wellbeing strategies (15% of quality premium).
The total quality premium payment for a CCG would be reduced if its providers did not meet the NHS Constitution rights or pledges for patients.
It was MOVED by Councillor Sanders, SECONDED by Councillor Clatworthy, and
RESOLVED that the quality premium indicators as outlined in the report be endorsed.
*109 Devon Children s Safeguarding Board Annual Report
The Board considered the annual report of the Devon Safeguarding Childrens Board presented by Mr D Taylor (Chair of the Board). This outlined a summary of progress against the priorities identified for 2013/14, of which there were four.
These included a quality assurance framework and regular performance information that enabled the DSCB to understand multi-agency operational practice and to provide effective challenge where appropriate, a clear and coherent Early Help offer that enabled timely and effective services to vulnerable children and young people (well supported and linked to more specialist services), a training and workforce development programme that enabled effective multi agency working and supported the priorities and key developments of the Board and, last, a DSCB that was fit for purpose with a structure that enabled it to exercise clear leadership in improving multi professional working to safeguard children and young people.
The report also outlined, inter-alia, structures for 2014/15, financial arrangements, quality assurance and evaluation, multi agency case audits, compliance with section 11, (Childrens Act 2004), serious case reviews, child death overview panel, workforce development and safeguarding training, early help, multi-agency safeguarding hub, protecting children that go missing, sexual exploitation and protection from abuse using information technology, parents / carers and children and young people with harmful behaviours (substance misuse, emotional health and wellbeing, domestic abuse), public protection and governance arrangements.
The challenges for 2014/15 were also identified as part of the annual report.
The Board questioned whether the Plan and its Priorities adequately reflected child exploitation issues and appropriate safeguards in light of the dreadful events in Rotherham and they were assured that it did.
It was MOVED by Councillor McInnes, SECONDED by Dr Pearson, and
RESOLVED that the areas and priorities identified within the Annual Report 2013/14 to improve the safeguarding children practice of staff in Devon be supported and endorsed.
*110 Devon Adults Safeguarding Board Annual Report 2013/2014
The Board considered the annual report of the Devon Adults Safeguarding Board, presented by Mr B Spencer (Chair of the Board.)
The Safeguarding Board provided multi agency strategic coordination and oversight of safeguarding adults in Devon. The Board s governance structure was outlined in the annual report and this included its connection with the Health and Wellbeing Board.
The report outlined the definitions and reporting arrangements for concerns about vulnerable adults who might be experiencing or be at risk of abuse or neglect. It further described the new legal requirements of the Care Act in relation to safeguarding adults. The new requirements had not required any substantial changes to how the Safeguarding Board worked, but they did reinforce the important nature of the work.
The annual report was available on the website at https://new.devon.gov.uk/devonsafeguardingadultsboard/safeguarding-adults-board-information and included an update on progress with the Board s Business Plan and on the work of the Boards 5 sub-groups, which included a group for people with care needs and carers.
Mr Spencer highlighted that a review of mental health services had been commissioned and the results of the review would be shared with the Board later in the year. Second, they would be undertaking a review of the Winterbourne actions, assessing the impact and undertaking a health check of where agencies were in the process.
It was MOVED by Councillor Sanders, SECONDED by Ms J Stephens, and
RESOLVED that the work of the Adults Safeguarding Board and the annual report for 2013/2014 be endorsed, subject to a review of the Governance structure diagram to include the role of Scrutiny and remove the reference to the internal Safeguarding Board.
OTHER MATTERS
*111 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.
*112 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 13th November 2014 @ 2.00pm | Performance / Themed Reporting Health Wellbeing Strategy Priorities and Outcomes Monitoring Theme Based Report (Strong and Supportive Communities) Business / Matters for Decision Better Care Fund CCG Updates NEW Devon TCS next steps endorsement CQC Patient Survey Action Plans (min 88(d)(a) Other Matters Scrutiny Work Programme / References Board Forward Plan Briefing Papers, Updates Matters for Information |
|
Thursday 15th January 2015 @ 2.00pm | Performance / Themed Reporting Health Wellbeing Strategy Priorities and Outcomes Monitoring Theme Based Report (A focus on Children and Families)
Business / Matters for Decision Better Care Fund CCG Updates Devon Pharmaceutical Needs Assessment Adult Safeguarding Review of Mental Health Services
Other Matters Scrutiny Work Programme / References Board Forward Plan Briefing Papers, Updates Matters for Information |
|
Thursday 12th March 2015 @ 2.00pm | Performance / Themed Reporting Health Wellbeing Strategy Priorities and Outcomes Monitoring Theme Based Report (Healthy Lifestyle Choices) Business / Matters for Decision Better Care Fund CCG Updates Other Matters Scrutiny Work Programme / References Board Forward Plan Briefing Papers, Updates Matters for Information |
| Thursday 11 June 2015 @ 2.00pm | Performance / Themed Reporting Health Wellbeing Strategy Priorities and Outcomes Monitoring Theme Based Report (Review of Health and Wellbeing Strategy / JSNA) Business / Matters for Decision Better Care Fund CCG Updates Other Matters Scrutiny Work Programme / References Board Forward Plan Briefing Papers, Updates Matters for Information |
| 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 CCG Updates Children s Safeguarding annual report (annually in September) Adult Safeguarding annual report (annually in September)
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 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 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
|
|
Items to Add | Equality protected characteristics outcomes framework Winterbourne View (Exception reporting) |
RESOLVED that the Forward Plan be approved.
*113 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 and events and consultations. Details were available at;
http://www.devonhealthandwellbeing.org.uk/
Items of interest included;
Local Nature Partnership update including State of Environment and Naturally Healthy;http://www.devonhealthandwellbeing.org.uk/wp-content/uploads/downloads/2014/06/local-nature-partnership-june-2014.pdf
European Antibiotic Awareness Day: letters to NHS and local authority health and wellbeing boards; https://www.gov.uk/government/publications/european-antibiotic-awareness-day-letters-to-nhs-and-local-authority-health-and-wellbeing-boards
Financially Challenged Health Communities / Strategic Priorities .. a Briefing Paper outlining the nature of scope of this project was at; http://devon.cc/gs669
*114 Dates of Future Meetings
RESOLVED that future meetings of the Board will be held on
Thursday 13th November 2014 @ 2.00pm
Thursday 15th January 2015 @ 2.00pm
Thursday 12th March 2015 @ 2.00pm
Thursday 11th June 2015 @ 2.00pm
Thursday 10th September 2015 @ 2.00pm
Thursday 12th November 2015 @ 2.00pm
Thursday 14th January 2016 @ 2.00pm
Thursday 10th March 2016 @ 2.00pm
*115 Dates of Future Seminars
Thursday 12th February 2015 @ 10.30am 4.00pm
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 4.05pm.