Present:-

Devon County Council

Councillors Davis (Chairman), Barker and Clatworthy, Ms J Stephens (Strategic Director, People) and Dr V Pearson (Director of Public Health)

District Council Representative

Councillor Sanders

Health Watch

Dr H Ackland

Probation Service

Mr R Menary

Northern, Eastern Western (NEW) Devon Clinical Commissioning Group (CCG)

Dr T Burke

South Devon and Torbay Devon Clinical Commissioning Group (CCG)

Dr D Greatorex

Environmental Health

Mr R Norley

Apologies:

Councillor McInnes (Devon County Council)

Mr T Hogg (Police and Crime Commissioner)

Ms C Williams (NHS England)

Ms C Brown (Joint Engagement Board)

*116 Minutes

RESOLVED that the minutes of the meeting held on 11 September 2014 be signed as a correct record.

*117 Items Requiring Urgent Attention South West Integrated Personal Commissioning Programme

(An item taken under Section 100B(4) of the Local Government Act 1972).

The Chairman had decided that the Board consider this item as a matter of urgency, in order that the timescales for submission of the bid might be met.

The Board noted the aims of the South West Integrated Personal Commissioning programme, which had been circulated, and NHS England s South West regional application for demonstrator status. This bid was being developed collaboratively and co-ordinated via the South West Strategic Clinical Network.

Initial endorsements from the Chair of the Board, Statutory Officer for Children and Adults Services and accountable officers in the CCG s had been made in order for a joint application for demonstrator status to be considered. These endorsements had been submitted by the required partners on 7^th November 2014).

The next stage was that support needed to be obtained from Health and Wellbeing Boards.

It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and

RESOLVED that the South West IPC networks programme, relating to the design and Implementation of the IPC, be welcomed and endorsed.

PERFORMANCE AND THEME MONITORING

*118 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 Alcohol-Related Admissions (Q1 2014-15), Dementia Diagnosis Rate (September 2014) and Self-Reported Wellbeing, Low Happiness Score (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.

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 need for alcohol issues to remain a high priority for the Board;

whether there was any known link between hospital admissions for alcohol and deprivation indices and also licensing regimes;

the impacts of a high student population;

the initiatives underway to improve hospital related admissions and also the links between other services such as domestic violence and mental health services;

that the campaign in Torridge Stop the Strength had been very successful in tackling street drinking by banning the sale of super-strength alcohol; and

the importance of looking at wider societal issues related to alcohol such as pricing, local licensing, impacts on families and the support available for families.

It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and

RESOLVED

(a) that the Health and Wellbeing Outcomes Report, in particular the focus on alcohol as a priority, be welcomed;

(b) that the Board receive a more detailed report, aligned to the Healthy Lifestyle Choices themed report , on alcohol issues, which should include information on current activities, repeat admissions, Assaults Related Injuries Database (Arid data) and the links between other services such as mental health and domestic violence services and impacts on blue light services; and

(c) that the Police and Crime Commissioner be asked to attend the Board on 12 March 2015 to contribute to this debate.

*119 Strong and Supportive Communities

Overview Report - Strong and Supportive Communities

The Board considered a discussion paper from the Director of Public Health. This outlined that the capacity of communities (both geographical and of shared interests) to support themselves had become an increasing focus of national policy. The emerging impact of reduced public sector funding was challenging the relationship between commissioners, providers and local people and the role the community could play.

The Council s Better Together vision for 2020 reflected that changing expectation of both citizens and communities, in that people wanted personalised services that provided flexibility and choice and communities expected services that were tailored to meet local needs. It was important to create the right environment for community, voluntary and private enterprises to innovate and thrive, intervening directly only where was necessary.

The report gave an analysis of the Joint Strategic Needs Assessment and identified the following priorities for this overarching objective. It further outlined examples of local developments within the priorities of Mental Health and Emotional Wellbeing, Improving Living Environments, Housing and Homelessness, Social isolation, Offender Health and Protected Characteristics included in the Joint Strategic Needs Assessment, with dedicated Health Needs Assessments.

The report gave a more detailed analysis of indicators such as Suicide Rate, Life Expectancy Gap, Self-Reported Wellbeing, Social Contentedness, Carer Reported Quality of Life, Stable and Appropriate Accommodation (Learning Disability) and Stable and Appropriate Accommodation (Mental Health).

The Board noted that the Better Together vision provided a useful focus as to how partners could be encouraged to develop local services through activities such as supporting voluntary and community groups, making Council facilities available, introducing new ways to help local people to organise, help communities to develop local emergency plans and making information about self-help and community support readily available.

They also considered the importance of the Board to consider all individuals in shaping policy and having due regard to the need to eliminate discrimination, advance equality of opportunity, and foster good relations between different people when carrying out its activities.

Hilary Ackland, on behalf of Health Watch Devon and the Devon Joint Engagement Board, presented the public, service user and carer perspective using the case study of Jackie to illustrate the Stronger and Supportive Communities theme and promote Board member discussion on what community support should have been in place to prevent the situation from reaching crisis point.

The Board discussed the following in terms of what the data and case study presentation highlighted for future learning;

the current situation with the offender population and ex-service personnel, whether the figures in Devon were typical when compared to the rest of the country and support for those dishonourably discharged;

the importance of living environments, including housing for those with disabilities or learning difficulties and the role (and influence) of planning processes and regulation;

the current work of the County Council with planning authorities in provision of social / affordable housing which included extra care housing;

the implications of the Care Act 2014 and the additional responsibilities placed on Local Authorities;

the links between employment, suicide and mental health;

the many ongoing pilots and whether there was more to be done to communicate these initiatives; and

the high quality of staff and assistance from the voluntary sector and whether a stronger strategic direction was required, particularly around social investment and the cohesiveness of various strategies.

It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and

RESOLVED

(a) that the report and case study be welcomed as highlighting some highly pertinent issues; and

(b) that consideration be given to better promotion and communication of some of the current pilots and initiatives that contributed to the stronger communities theme.

BOARD BUSINESS - MATTERS FOR DECISION

*120 Joint Commissioning in Devon and the Better Care Fund (BCF) (formally the Integration and Transformation Fund)

The Board received a presentation from Dr Derek Greatorex, Clinical Chair, South Devon Torbay CCG and Dr Tim Burke, Clinical Chair, 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 outlined the outcome of Devon BCF Submission which, in line with the Nationally Consistent Assurance Review (NCAR) process, classified the Devon plan as Approved with Support . This meant the review process had identified a number of areas for improvement which, once addressed, would enable the plan to move to a fully approved status.

In terms of other plans, only 6 areas had their plans approved , 90 were approved with support , 48 were approved subject to conditions and 5 currently not approved .

The presentation outlined the next steps. Those areas rated as assured with support would be required to submit evidence against areas of risk identified through the NCAR process. The key areas that required an action plan were further identified (these included an action plan for 7 day services, how protection of social care money would be used to ensure new duties were met, ensuring parity for people with mental health issues, details of on-going engagement with service providers, development of specific measurable outcomes on which to assess the schemes, how carer support would impact on patient level outcomes and finalising risk sharing arrangements).

The Board asked for clarification of the role of the relationship manager from NHS England who would be tracking agreed actions and assessing evidence.

It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and

RESOLVED

(a) that the areas for improvement be addressed, as outlined in the presentation, and a final version of the BCF Plan be brought to the January Board meeting; and

(b) that a copy of the presentation be emailed to all Board members.

*121 Effective Engagement between Health and Wellbeing Boards and Major Providers

The Board received a report from the Director of Public Health on levels of engagement with major providers of health services. This stemmed from a letter from the Secretary of State for Health, the Rt Hon Jeremy Hunt MP, who wrote to Health and Wellbeing Board Chairs reflecting on the varying level of engagement with major providers of health services as part of the Better Care Fund process.

The letter requested that Health and Wellbeing Boards considered how best to optimise engagement given the importance of the integration agenda for health and social care. The report, therefore, outlined four options in this respect, including the advantages and disadvantages of each approach.

option 1 no change;

option 2a meet with major providers on an ad hoc basis;

option 2b establish a major provider forum to meet annually;

option 3 create a major provider subcommittee of the Health and Wellbeing Board; and

option 4 add major providers to Health and Wellbeing Board membership

The Board discussed the following;

the timescale for decision on the matter, as there were other interested parties who should be consulted on the proposals;

the need to clarify the providers as referred to in the letter, as this could be a wide ranging group (for example mental health services, social care providers, voluntary sector etc);

the role of the joint health and social care commissioning group and their role in considering the proposals, given their current engagement with providers;

the role of the newly established systems resilience groups and how this currently enabled a provider voice ; and

that option 4 was felt to be unworkable, especially given the potential numbers that could be involved.

It was MOVED by Councillor Barker, SECONDED by Councillor Davis, and

RESOLVED that the joint health and social care commissioning group (chaired by Dr T Burke) be asked to consider the matter further and report back to the Board in due course.

*122 Health Protection Assurance Report

The Board received a report from the Director of Public Health which provided a summary of the assurance functions of the Health Protection Committee (of the three Boards) and the significant matters considered since its inaugural meeting on 15th October 2013.

The aim of the Health Protection Committee was to provide assurance to the Health and Wellbeing Boards of Devon County Council, Plymouth City Council and Torbay Council that adequate arrangements were in place for the prevention, surveillance, planning and response required to protect the public s health.

The report further considered the following domains of health protection:

communicable disease control and environmental hazards;

immunisation and screening; and

health care associated infections

and also summarised the action taken to date against the programme of health protection work priorities established by the committee for the period 2014 to 2015.

The report outlined those assurance arrangements, work on the prevention and control of infectious Diseases (tuberculosis, scarlet fever and norovirus), including organisational responsibilities and surveillance arrangements, Immunisation and Screening activities including changes to the National Immunisation Programme, Health Care Associated Infections including the work of the Health Care Associated Infection Programme Group and the programme of works for 2014/2015 (Seasonal Influenza, Hepatitis C Strategy and Implementation, TB Service Review and Health Social Care).

It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and

RESOLVED that the assurance report be welcomed.

*123 Pharmaceutical Needs Assessment

The Board received a report from the Director of Public Health which provided an update on the paper received by the Board in June 2014 which described the Board s statutory duty to ensure the production of a Pharmaceutical Needs Assessment for Devon.

Part of that statutory requirement was the undertaking of a consultation process and the report outlined how this would be carried out.

The statutory requirement was for a minimum of a 60 day consultation period. A link to the draft Pharmaceutical Needs Assessment would be placed on the Devon Health and Wellbeing website with a link to a consultation feedback form. The consultation would run from 17^th November 2014 to 16^th January 2015 and the final version would be presented to the Board in March 2015.

The Department of Health had specified a number of statutory consultees, which were outlined in the report, notwithstanding the views of a wider range of partners would also be sought. The proposed approach complied with national regulations and the timescales for sign off.

It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and

RESOLVED

(a) that the consultation process being undertaken for the Pharmaceutical Needs Assessment (PNA) for Devon be noted; and

(b) that the final version of the Pharmaceutical Needs Assessment (PNA) for Devon be presented to the Board in March 2014.

*124 NEW Devon CCG Transforming Community Services

The Board considered the report of the Northern, Eastern and Western (NEW) Devon Clinical Commissioning Group on the Transforming Community Services Programme, the purpose of which was to set the strategic direction, delivery and design for community services in the area covered by the CCG.

There had been extensive engagement, including presenting the draft to the Board in June 2014, and taking national policy and local health needs into account and as such, the Strategic Framework Integrated, personal and sustainable: Community Services for the 21st Century had been finalised. This had been circulated to Board members but could also be found online at; http://www.newdevonccg.nhs.uk/get-involved/get-involved/community-services/community-services-strategic-framework/101239

The document recognised the increasing numbers of people with complex health needs, the desire to improve quality and outcomes for people and the resource challenges ahead. In this context it described the key role of community services in shifting the emphasis towards greater prevention and pro-active care and support in people s homes and nearby care settings.

The Board further noted that each of the localities (Northern, Eastern and Western) were distinct in terms of geography, health needs, projections etc, therefore, each locality had developed proposed commissioning intentions for community services. Consultation was still underway, until 12^th December 2014 and the Board s engagement, particularly in the context of the Health and Wellbeing Strategy, would be welcomed.

The proposed locality commissioning intentions documents were available at: http://www.newdevonccg.nhs.uk/get-involved/get-involved/community-services/101039

It was MOVED by Councillor Davis, SECONDED by Councillor Barker, and

RESOLVED that the final strategic framework be endorsed and the Board continue to engage in the programme (through the locality commissioning intentions).

*125 CQC Patient Survey Action Plans (Minute 88(d)(a) 12/6/14)

The Board received an update report, for information only, from Dr Derek Greatorex, Clinical Chair, South Devon Torbay CCG and Dr Tim Burke, Clinical Chair, NEW Devon CCG on the national adult inpatient services survey.

This included an overview of key findings and remedial action plans for the Northern Devon Healthcare NHS Trust, Royal Devon and Exeter NHS Foundation Trust, Plymouth Hospitals NHS Trust, Patient Experience Network and South Devon Healthcare NHS Foundation Trust.

OTHER MATTERS

*126 References from Committees Health and Wellbeing Scrutiny Committee (18 September 2014 Minute *63)

At its meeting on 18 September 2014, the Health and Wellbeing Scrutiny Committee received a report from the Devon Partnership NHS Trust (PH/14/19 - text only | pdf PH/14/19) outlining key challenges around significant levels of demand for services. The Committee discussed a lack of funding available in Devon to resource Psychological Therapy services compared to other parts of the county and RESOLVED;

that a recommendation to Cabinet and the Health Wellbeing Board be made to lobby the Department of Health over the lack of funding for Psychological Therapies in Devon .

The Board discussed the spending priorities of the CCG s, who both confirmed that mental health services were a priority and work was underway with the provider to improve current provision and service.

The Board felt the reference from the Health and Wellbeing Scrutiny Committee was a little unclear as to whether a lack of funding was the key issue or whether it was access to services or a lack of targeted support (for example, long waiting lists were referred to in the original report).

It was MOVED by Councillor Davis, SECONDED by Dr Pearson, and

RESOLVED that the CCG s be thanked for their response and subsequent offer to take the issue back and check current provision.

*127 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.

*128 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 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 final submission CCG Updates Adult Safeguarding Review of Mental Health Services NEW Devon CCG - Mental Health Strategy Exeter ICE project Effective Engagement between Health and Wellbeing Boards and Major Providers report back from Joint Health and Social Care Commissioning Group. 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); to include alcohol issues / links with other initiatives (Minute 118b). Business / Matters for Decision Better Care Fund CCG Updates Devon Pharmaceutical Needs Assessment (final) 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

RESOLVED that the Forward Plan be approved.

*129 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;

The launch of the Get Ready for Winter campaign which had cross-government input and outlined elements of winter preparedness for the health and care system

http://www.devonhealthandwellbeing.org.uk/?p=4409

NHS Futures Discussion Paper (NEW Devon CCG) (5/11/14). https://www.newdevonccg.nhs.uk/who-we-are/governing-body/public-papers-for-governing-body-meetings/100198

*130 Dates of Future Meetings

RESOLVED that future meetings of the Board will be held on

Thursday 15^th January 2015 @ 2.00pm

Thursday 12^th March 2015 @ 2.00pm

Thursday 11^th June 2015 @ 2.00pm

Thursday 10^th September 2015 @ 2.00pm

Thursday 12^th November 2015 @ 2.00pm

Thursday 14^th January 2016 @ 2.00pm

Thursday 10^th March 2016 @ 2.00pm

*131 Dates of Future Seminars

Thursday 12^th February 2015 @ 10.30am 4.00pm

Thursday 8^th October 2015 @ 10.30am 4.00pm

Thursday 11^th February 2016 @ 10.30am 4.00pm

*DENOTES DELEGATED MATTER WITH POWER TO ACT

The meeting started at 2.00pm and finished at 3.44pm.