Present:-

Devon County Council

Councillors Davis (Chairman), Clatworthy, McInnes and Dr V Pearson (Director of Public Health)

District Council Representative

Councillor Sanders

South Devon and Torbay Devon Clinical Commissioning Group (CCG)

Dr D Greatorex

Police and Crime Commissioner

Mr T Hogg

Apologies:

Mr R Norley (Environmental Health)

Carol Williams (NHS England)

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

Ms J Stephens (Strategic Director, People) Devon County Council

Mr R Menary (Probation Service)

Dr H Ackland (Health Watch)

Ms C Brown (Joint Engagement Board)

Councillor Barker (Devon County Council)

*147 Minutes

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

RESOLVED that the minutes of the meeting held on 15 January 2015 be signed as a correct record.

*148 Items Requiring Urgent Attention

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

The Chairman had decided that the Board should consider this item as a matter of urgency, in order that Members may be made aware that she had made a bid to the Health Wellbeing Regional Network funding pot for Individual Board Development Offers.

This bid had been successful and details were awaited from the appointed consultant.

PERFORMANCE AND THEME MONITORING

*149 Devon Joint Health and Wellbeing Strategy: Priorities and Outcomes Monitoring

The Board received 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 indicators relating to Teenage Conception Rate (2013), Alcohol-Related Admissions (Q2 2014-15), Dementia Diagnosis Rate (December 2014), Feel Supported to Manage Own Condition (Q1-Q2 2014-15), Male Life Expectancy Gap (2011-2013) and Female Life Expectancy Gap (2011-2013) 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 (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, in discussion, noted the work that had been undertaken in trying to identify ways of developing an indicator to monitor outcomes in relation to tackling and preventing Child Sexual Exploitation. Mr Chant advised that at present there were no available overarching indicators which could be effectively compared with other areas locally, regionally or nationally, which related to outcomes rather than processes, or were suitably robust. It was, however, an area of development and the Devon Safeguarding Childrens Board was currently working with partners to produce a scorecard which tracked local progress in relation to Child Sexual Exploitation.

The Board further noted the changing parameters in respect of dementia diagnosis rates and the impact on the figures when the target would be recalculated (from April 2015) and also the excellent performance of this indicator in the Newton Abbot area.

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

RESOLVED that

(a) in lieu of an appropriate overarching indicator for Child Sexual Exploitation, future versions of the performance report would provide a short summary of the latest scorecard, drawing out relevant issues for attention, and providing a link to the scorecard (once available);

(b) that when the dashboard was available, Mr D Taylor (Chair of the Devon Childrens Safeguarding Board) be invited to attend a future Board meeting; and

(c) that the Strategic Director (People) be asked bring a report to the Board on the ongoing multi-agency work being undertaken in respect of preventing Child Sexual Exploitation.

*150 Theme Based Report Healthy LifeStyle Choices

The Board considered a discussion paper from the Director of Public Health which focused upon the Healthy LifeStyle Choices priority area from the Joint Health and Wellbeing Strategy, centering on supporting people to take responsibility for their own health, the health of their families and people in their care, by helping them to address aspects of their lifestyle which were likely to be detrimental to their current and future health.

The Board noted that non-communicable diseases such as coronary heart disease, lung cancer, stroke and liver disease were the leading cause of premature mortality and ill-health so individual, community and service provided preventive action was important.

The report further highlighted the relationship between health-related behaviours and deprivation. Analysis of the Joint Strategic Needs Assessment identified priorities of alcohol misuse, contraception and sexual health, screening, physical activity, healthy eating and smoking cessation and high blood pressure (hypertension) for this overarching objective. The report gave some further examples of local developments for each of the priorities.

Lastly the report gave an analysis of relevant outcomes measures from the Devon Health and Wellbeing Outcomes Report.

The report also emphasised 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.

Carol McOrmack-Hole, on behalf of Health Watch Devon and the Devon Joint Engagement Board, presented the public, service user and carer perspective drawn from the experience of people in Devon, with good practice examples, to illustrate the Healthy Lifestyle Choices theme and promote Board discussion.

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

the impacts of health inequality and the huge strain placed on both health and social care systems;

the social science research that highlighted some of the social benefits achieved from activities such as smoking and drinking, further demonstrating the complexities of health prevention and health inequality issues;

the importance of keeping the brain active in later life;

the concerns around childhood obesity figures and the need to tackle this early in life, with particular reference to the new child weight management services recently launched by Public Health;

the massive impact that social isolation and loneliness could have on a persons physical health and general wellbeing;

the impact of the Care Act and;

that making healthy lifestyle choices could be fun, for example health walks.

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

RESOLVED that the initiatives outlined in the discussion be noted and welcomed.

*151 Alcohol Topic Report

The Board considered a discussion paper from the Director of Public Health which focused upon the risk and type of alcohol-related harm. The included the changing patterns of alcohol consumption, noting that the volume of alcohol consumed per person in the UK had been decreasing since 2004.

The report outlined many issues associated with alcohol-related harm including alcohol-related hospital admissions (admission rates by Devon local authority district, by Devon towns, by age and type) and that chronic long-term conditions made up the largest group of alcohol-related hospital admissions. It considered the impact of deprivation and crime levels with alcohol related harm.

The amount of alcohol people drank was related to both the availability and affordability (price) of alcohol, which is why strategies to prevent alcohol-related harm focussed on these two factors. The report finally considered the role of marketing, screening, diagnosis and assessment and how partnership working could, in collaboration, reduce alcohol-related harm with initiatives such as influencing where and when alcohol was sold, enforcing laws on underage sales, promoting sensible drinking, work in schools and data sharing partnerships to name but a few.

The Board discussed and asked questions on the following issues;

the importance of alignment with some of the local marketing initiatives, with wider strategic priorities;

the work of the Police and Crime Commissioner at a national level (Home Office Alcohol Forum) and a local Alcohol Focus Group considering issues such as minimum pricing, late night levies and media campaigns;

the importance of using the licensing laws, already in existence, to their full potential; and

the welcome reduction in binge drinking among young people.

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

RESOLVED that the comprehensive nature of the report be welcomed.

BOARD BUSINESS - MATTERS FOR DECISION

*152 (i) Joint Commissioning in Devon, the Better Care Fund (BCF) and Governance Arrangements)

The Board received a verbal update 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.

(ii) Devon Better Care Fund Governance and Risk Sharing Arrangements

The Board then considered a joint report of the Director of Partnerships, NEW Devon CCG; Director of Commissioning, South Devon and Torbay CCG; Head of Social Care Commissioning, Devon County Council on the governance and risk sharing arrangements in relation to the Better Care Fund.

The Board noted that the BCF was a pooled budget between the above partners and in 2015/16 the fund would be 59,865k (although the Board noted this was not new money). Robust governance and risk sharing arrangements were required, to be agreed by all partners and put in place by 1st April 2015.

In line with NHS England requirements the partner organisations were fulfilling their statutory duties by pooling funds under a section 75 (s75) agreement. The pooled fund would be managed by Devon County Council who had assumed the role of Pooled Fund Manager . Whilst the Board was required to sign off the BCF, accountability for delivery of the BCF rested with the Joint Coordinating Commissioning Group (JCCG). The report further outlined the role of the BCF delivery group, its membership and how it also contributed and supported delivery of schemes, both locally at Systems Resilience Group level and also county wide levels.

The report further explained the risk share and the use of risk pools as well as the performance related element of the BCF pooled fund to achieve a 3.5% reduction in emergency hospital admissions and also how any underspends or overspends would be managed.

The Board noted that each organisation would have to sign or seal the s75 agreement in line with its own scheme of delegation.

The Board discussed and asked questions on the following;

the timescale for completion of the draft s75 agreement and whether the deadline would be achieved;

confirmation of what engagement had taken place / would take place with the District Councils in relation to the Disabled Facilities Grant; and

clarification of the Boards relationship with the Joint Coordinating Commissioning Group (JCCG).

The Board further noted that NHS England had asked that a self assessment be completed, which would be undertaken, in the first instance, by the Joint Coordinating Commissioning Group (JCCG) and then shared with the Board for their endorsement and comment (via email).

It was MOVED by Councillor McInnes, SECONDED by Councillor Sanders, and

RESOLVED that the Governance and Risk Sharing arrangements, as outlined in the report, be endorsed.

(iii) Effective Engagement between Health Wellbeing Board and Major Providers

The Board also considered a report from the NEW Devon CCG and South Devon and Torbay CCG on the potential options for the Board regarding the engagement of main providers of services. This followed consideration of the item at the Boards meeting on 13th November 2014, where a letter from the Secretary of State asked Health and Wellbeing Boards to consider the matter. The Board 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

The Joint Health Social Care Development Group met on 10^th February 2015 and felt it was necessary to optimise existing forums to enhance the engagement of the main providers whilst also improving on current arrangements. They noted that all main providers were already engaged in each of the 4 System Resilience Groups (SRG s) or Urgent Care Boards which covered each of the acute trust geographical areas. It was felt the Board could use these forums to disseminate or share information and to support feedback from these groups. It was further felt that, quarterly, it would be beneficial to bring the main providers together into one county wide planning forum to enable a two way dialogue regarding the Health and Wellbeing Boards plans and the work in each SRG area, particularly when considering the Joint Strategic Needs Assessment and the Joint Health and Wellbeing Strategy.

The Board also heard that the Systems Resilience Groups would welcome sight of the topic based reports seen by the Board.

It was MOVED by Councillor Sanders, SECONDED by Councillor McInnes, and

RESOLVED that the Board support the proposals for engagement with providers, as outlined above and set out in the report).

*153 Devon Pharmaceutical Needs Assessment (PNA)

The Board considered a report from the Director of Public Health on the Board s statutory duty to ensure the production of a Pharmaceutical Needs Assessment (PNA) for Devon by April 2015.

The PNA was a comprehensive assessment of the current and future pharmaceutical needs of the local population for community pharmacy, dispensing appliance contractors, and dispensing doctors in rural areas (where relevant). The PNA for Devon 2015-2018 presented a picture of community pharmacy need and provision in Devon, and linked to Devon s Joint Strategic Needs Assessment.

The draft PNA underwent a comprehensive consultation exercise for a 60-day period in compliance with the statutory regulations. The Steering Group reviewed all the responses and took decisions on the necessary amendments to be made to the document. The report further outlined the consultation responses that had been received and considered.

The Board noted that the needs of people and communities, particularly those most vulnerable or disadvantaged were made explicit in the Devon Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy and there were no specific equality issues relating to the Pharmaceutical Needs Assessment.

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

RESOLVED that the Pharmaceutical Needs Assessment (PNA) for Devon be endorsed

http://www.devonhealthandwellbeing.org.uk/board/pharmaceutical-need-assessment/

*154 EIA s / Consideration of the Public Sector Equality Duty for the Board

The Board considered a report from the Director of Public Health on the Boards responsibilities in respect of the public sector equality duty. This duty required public bodies to give due regard to the need to;

eliminate discrimination, victimisation and harassment;

advance equality by encouraging participation in public life, removing disadvantage, taking account of disabilities and meeting people s needs; and

foster good relations by tackling prejudice and promoting understanding.

This was in relation to nine protected characteristics of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex (gender) and sexual orientation.

The Board noted it was important that both the JHWBS and JSNA provided an overall picture of the health needs of the protected characteristic groups so that individual decisions could be based on the need and impact on health inequalities. Board members needed to reflect on whether organisational decisions considered partner impacts and the overall effect on the protected characteristic groups when making decisions.

The updated JHWBS would have a full Equality Impact Assessment undertaken and there would be a continued commitment to address health inequalities on a geographical and population group basis.

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

RESOLVED that the work undertaken to ensure that the Board addressed its public sector equality duty, especially in relation to the Joint Health and Wellbeing Strategy and Joint Strategic Needs Assessment, be welcomed.

*155 Joint Commissioning Strategies.

The Board considered a report from the Head of Service Social Care Commissioning, The Managing Director (Partnerships) NEW Devon CCG and The Director of Commissioning (South Devon and Torbay CCG) on a suite of Joint Commissioning strategies, developed by the two Clinical Commissioning Groups, Devon County Council, Plymouth City Council and Torbay Council.

The first of these, the Dementia Strategy, was endorsed by the Health and Well Being Board early in 2014, and three further strategies had now been prepared in relation to Learning Disability, Mental Health and Carers. The Board noted that the Strategies had been extensively consulted on with service users, carers and a wide range of stakeholders and were available on the web at;

https://new.devon.gov.uk/adultsocialcareandhealth/policies-and-procedures/

Furthermore, they aligned with the Council s strategy, Better Together , the I Plan and the Better Care Fund and were people-focused, rather than organisation-focused. They were also underpinned by integrated, preventative approaches that focussed on promoting independence, reablement and recovery.

An implementation plan was being developed for each strategy and progress would be reported annually.

The Board welcomed this excellent example of collaboration between three different Local Authorities and two CCG s.

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

RESOLVED that

(a) the Joint Commissioning Strategies for Learning Disability, Mental Health and Carers, be welcomed;

(b) that the common themes identified at Appendix 1 of the report, be noted;

(c) the delivery of the strategies, as outlined in the implementation plans, be welcomed; and

(d) the intention to report progress annually to the Board be welcomed and be added to the Boards forward plan for the Autumn.

*156 NEW Devon Primary Care Co-commissioning Group

The Board considered a report from NEW Devon CCG on the Primary Care Co-commissioning agenda.

The Board had previously considered a copy of a letter received from NHS England that explained they had recently invited Clinical Commissioning Groups (CCGs) to take on an increased role in the commissioning of primary care services. The intention was to empower and enable CCGs to improve primary care services locally for the benefit of patients and local communities.

This was linked to the publication of Next Steps Towards Primary Care Co-Commissioning which set out three possible models for primary care co-commissioning (greater involvement, joint commissioning and delegated commissioning) and the next steps towards implementation. As part of this there was encouragement for Health and Wellbeing Boards to engage with their local commissioners of primary care, both CCGs and NHS England.

The Board noted that NEW Devon CCG was moving forward with primary care co-commissioning at level 1 greater involvement in primary care decisions making. This was working well as the NEW Devon CCG was a member of the Primary Care Oversight Group (PCOG) and through this the CCG could ensure its priorities were taken into account in relation to the commissioning of primary care in the CCG area. Longer term, the CCG envisaged further involvement in the commissioning of primary care and when this happened they would look to invite a member of the Board to whatever CCG decision making forum was formed. Currently, the Primary Care Commissioning and Development Group had been formed to fully utilise clinical input in the development of primary care.

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

RESOLVED that the update be noted.

*157 South Devon and Torbay Clinical Commissioning Group Operating Plan

The Board considered a report from the South Devon and Torbay Clinical Commissioning Group (CCG) on its Operating Plan for 2015/2016.

The Board noted that it was the second year of the CCG s five year Strategic Plan and the long-term vision continued to be Excellent, joined up care for everyone , which focussed on prevention and self-care, joined up services closer to home and sustainable local services.

The CCG highlighted that 2014/2015 had been a challenging year, therefore the focus for 2015/16 was firstly, achieving the NHS Constitution standards and secondly, delivering their Quality, Innovation, Prevention and Productivity (QIPP) plan, which would enable the CCG to achieve financial balance.

In terms of delivery, the CCG aimed to meet the NHS Constitution standards and reduce health inequality, convenient access for everyone (with examples of initiatives in, and with, mental health, primary care, community services, minority groups and cancer).

The Board discussed the importance of considering the role of the community and community help and care should be taken not to overload, what was sometimes, a small group of volunteers.

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

RESOLVED that the Operating Plan for 2015/2016 be endorsed.

OTHER MATTERS

*158 References from Committees

Nil

*159 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.

*160 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 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 Prevention Offer / Care Act Adult Safeguarding Review of Mental Health Services (Deferred from March) 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) Child Sexual Exploitation Multi-Agency Working David Taylor - Child Sexual Exploitation DashBoard (Performance) 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) 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
Items to Add	Equality protected characteristics outcomes framework Winterbourne View (Exception reporting)

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

*161 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;

Community Services Hub in Bideford Pilot Project (offer of visit);

Charter for Homeless Health invitation for the Board to sign up;

St Mungo s Broadway Charter for Homeless Health - http://www.devonhealthandwellbeing.org.uk/board/archives/

The Police and Crime Commissioner had also circulated a letter on mutual interests and shared ambitions, which included updates on the refreshed Police and Crime Plan (which included new / increased tasks such as Child Sexual Exploitation and Cybercrime, and also priorities such as Safeguarding, Mental Health, Substance Misuse, Victims and Domestic and Sexual Violence).

The Board were pleased to hear about a new service for victims that had just been launched, the details of which could be found at http://www.devonandcornwall-pcc.gov.uk/victims-information/victim-services-directory/

*162 Dates of Future Meetings

RESOLVED that future meetings of the Board will be held on

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

*163 Dates of Future Seminars

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 3.55pm.