Present:-

Devon County Council

Councillors Barker (items 7-14), Davis (Chairman) and McInnes

Dr V Pearson (Director of Public Health) and Mr T Golby (representing Ms J Stephens)

Environmental Health

Mr R Norley

South Devon and Torbay Devon Clinical Commissioning Group (CCG)

Dr D Greatorex

NHS England

Ms L Scott

Joint Engagement Board

Mrs C McCormack Hole (representing Mrs C Brown)

Health Watch Devon

Mr D Rogers

District Council Representative

Councillor Sanders

Apologies:

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

Mrs C Brown (Joint Engagement Board)

Ms J Stephens (Devon County Council)

Mr J Wiseman (Probation Service)

Councillor Clatworthy (Devon County Council)

*216 Minutes

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

RESOLVED that the minutes of the meeting held on 12 November 2015 be signed as a correct record.

PERFORMANCE AND THEME MONITORING

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

The Board considered a report from the Director of Public Health on the performance for the Board, which monitored the priorities identified in the Joint Health and Wellbeing Strategy for Devon 2013-2016.

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. In terms of benchmarking, the local authority comparator group had been updated to reflect the latest designations, with Cambridgeshire and Hampshire being removed and Staffordshire and Suffolk added.

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 below had all been updated since the last report to the Board;

Early Years Foundation Score 2014-15 which had improved significantly as 71.6% of children achieved a good level of development at school entry;

Smoking at Time of Delivery 2014-15 was an area to be improved upon with 11.2% of mothers in the wider Devon area smoking at time of delivery;

Teenage Conception Rate Q3 2014 was a good news story with rates dropping significantly in recent years;

Excess Weight in Four / Five Year Olds 2014-15;

Excess Weight in 10 / 11 Year Olds 2014-15;

Adult Smoking Prevalence 2014 was an excellent achievement, linked to the work of the Smokefree Devon Alliance with 13.8% of the adult population in Devon smoking, compared to the South West average (16.9%), local authority comparator group (16.8%) and England rate (18.0%);

Under 75 Mortality Rate (All Cancers 2012 to 2014) mortality rates continued to fall;

Under 75 Mortality Rate (Circulatory Diseases 2012 to 2014) where the rate was 59.1 per 100,000 (below the South West (65.3), local authority comparator group (65.4) and England (75.7) rates) showing falling rates and narrowing inequalities; and

Suicide Rate 2012 to 2014 where rates in Devon had typically remained around or slightly above the national rate. This demonstrated the importance of good access to mental health services.

Following approval at a previous meeting, a Red, Amber, Green (RAG) rating was included in 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, again demonstrating the importance of investing in services that supported emotional wellbeing.

The report also featured a table showing how Devon compared with the Local Authority Comparator Group (LACG) for all Health and Wellbeing outcome measures (January 2016). This included how Devon compared / performed against both the LACG and England and their rank position.

The report also highlighted that a Child Sexual Exploitation (CSE) Scorecard had been introduced with indicators being developed by partners, including the roll out of the CSE assessment tool within Children s Social Care and the addition of a CSE marker in Police crime recording. The scorecard was being shared with the Devon Safeguarding Children Board (DSCB) subgroup on a quarterly basis.

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;

whether any data was collated on teenage smoking figures;

the self harm figures, whether this was the tip of the iceberg, the recording of self harm data at A E departments, links to suicide rates and the complexities of determining the causes of self harm and as such, the correct pathway to help and support;

obesity and what work was being done, including the school environment and its influence over obesity levels in children;

clarification on the numbers of male suicides, the peak that seemed to coincide with recessions and whether any analysis was undertaken on high risk groups and professions;

the importance of a successful alcohol strategy, especially any links to emotional wellbeing; and

the recent film, to be shortly published by Healthwatch, produced by young people on issues affecting them (eating disorders, grief, mental health issues etc), the link would be shared with the Board in due course.

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

RESOLVED that the performance report be noted and accepted.

*218 Theme Based Report A Focus on Families

The Board considered a report from the Director of Public Health on the Focus on Families priority, as detailed in the Joint Health and Wellbeing Strategy, which was centred on giving children the best possible start in life, with early family intervention and support where needed.

The report set out an analysis of relevant outcomes measures from the Devon Health and Wellbeing Outcomes Report, covering all the relevant indicators under the priority a focus on families and the two excess weight in childhood indicators under the healthy lifestyle choices priority.

The report gave a more detailed analysis of those indicators highlighting;

Children in Poverty 15,215 children (12.4%) in Devon lived in households dependent on benefits or tax credits, compared with 14.8% in the South West and 18.6% nationally;

Early Years Foundation Score In 2015, 71.6% of children in Devon achieved a good level of development at school entry, which was significantly above the South West (67.2%), local authority comparator group (67.1%) and England (66.3%) rates;

Smoking at Time of Delivery In the year 2014-15, 11.2% of mothers were smoking at time of delivery in Devon. This compared with 11.9% in the South West, and 11.4% in England. Nationally data are no longer reported on a local authority basis but on a CCG basis;

Teenage Conception Rates There were 201 conceptions in Devon between October 2013 and September 2014 for females aged under 18, with around half leading to a birth. The latest rate (16.3 per 1,000 females) was significantly below South West (19.4), local authority comparator group (20.4) and England (23.3) rates;

Hospital Admissions for Self-Harm, aged 10 to 24 There were 653 hospital admissions for self-harm in persons aged 10 to 24 in Devon in 2013-14. The rate per 100,000 in Devon was 501.8, which was below the South West rate (520.8), but above the local authority comparator group (463.1) and England (412.1) rates;

Excess Weight in Children aged 4 or 5 ('excess weight' covered children classified as overweight or very overweight) in reception year, 22.4% of pupils in Devon were recorded in the excess weight category, compared to 22.3% for the South West, 21.8% for the local authority comparator group, and 21.9% for England; and

Excess Weight in Children aged 10 or 11 In year six (aged 10 or 11) 28.7% of pupils in Devon were recorded in the excess weight category, which was below the South West (30.5%), local authority comparator group (31.0%), and England (33.2%) rates.

In summary, the report outlined there had been a marked improvement in areas such as smoking at time of delivery and the teenage conception rate but areas such as children in poverty (the figures showing 1 in 6 children in poverty in Devon) and excess weight in children remained a challenge.

The Board discussed and asked questions on the following;

that poverty was not always just a monetary issue, but aspiration was also a significant factor;

the new Early Help for Mental Health service and health and wellbeing survey data from schools would provide improved intelligence on the prevalence of mental health issues in young people and issues such as self harm;

the recent report sent to the JEB from the mental health service user representative on the work of the multiagency acute care pathway group for Devon who highlighted the need to focus on children in crisis and access to CAMHS services; and

the ongoing work on investing in early intervention and support services.

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

RESOLVED that the report be noted and that, given the current gap in data, further information be brought back to the Board, as a result of the survey and new service, about the prevalence of mental health and emotional wellbeing issues in young people.

*219 Children and Young Persons Alliance Plan

The Board considered a joint report from the Strategic Director (People) and Cabinet Member for Children, Schools and Skills on the Children, Young People and Families Alliance Plan.

The report outlined that the Alliance was a partnership of all organisations and services that worked with and for children, young people and families in Devon. The aim of which was to work better together to improve things for all children and young people in Devon.

An Executive group (with representatives from the Council, Police, CCG s, Voluntary Sector, Schools, District Councils and Department of Work and Pensions) had been established to provide a formalised structure and was responsible for taking forward the work with strategic leadership, direction and driving change.

The report outlined that a five year strategy had been developed My Life, My Journey , and this had been circulated to Board members. The document was also available on the web at http://www.devonchildrensalliance.org.uk/wp-content/uploads/2015/10/CYPF-Plan-Final.pdf.

The Alliance Plan had six priorities for the next five years which were Safe, Resilient, Thrive, Active, Connect and Give.

During the first year of implementation (2015-2016) the Executive chose the following outcomes as the priorities, with a view to improving those outcomes:

Resilient; Children in Devon enjoying good mental health emotional wellbeing;

Thrive; Young people (and parents) having excellent economic prospects; and

Connect; Young people influencing the decisions that affect them.

The report outlined some suggested accountability mechanisms to ensure the work of the Alliance and the Health and Wellbeing Board was aligned. These included;

The Joint Strategic Needs Assessment (JSNA) being a key input for the Alliances Plan and the yearly refresh of that Plan;

The Board being informed of activities / strategy of the Alliance by the Chair of the Alliance annually presenting to the Board; and

The Alliance to stay informed of the activities / strategy of the Board by inviting the chair of the Board to present to the Alliance Executive annually.

The Board noted that Equality was one of the four vital principals that underpinned the entire Alliance Plan and that the Alliance was committed to closing the gap between vulnerable children and others. The Executive Group would work to ensure equality considerations were mainstreamed into the work of the Alliance.

The Board also received a supporting presentation which outlined the reasons why an Alliance was required, for example the statutory Duty to Cooperate , the outcomes of the Ofsted Inspection regarding governance and also the challenges for Devon such as rates of mental health problems, health inequalities and rising numbers of children at risk of harm.

The presentation supported the report, outlining the membership of the Alliance and also the lead officers for the various priorities as well as current work streams and sub-groups.

The presentation further highlighted the relevant Strategic Bodies in Devon, including the Health and Wellbeing Board, and how they might create synergies avoid overlap, whilst also jointly listening to children and young people.

There was a dedicated website for the Alliance which could be found at http://www.devonchildrensalliance.org.uk

The Board discussed and asked questions on the following;

the comments made by Ofsted in relation to better alignment between various Strategic Boards and the Alliance;

the need to ensure there was no additional bureaucracy arising from the Alliance structures;

clarification of any powers afforded to the Alliance; and

the role of the Joint Commissioning Board, that was working effectively with high level representation, ensuring that commissioning decisions were appropriate and in alignment with strategy and priorities;

It was MOVED by Councillor Sanders, SECONDED by Mr Norley, and

RESOLVED

(a) that the Children, Young People and Families Alliance Plan be welcomed;

(b) that the suggested accountability mechanisms between the Health and Wellbeing Board and the Children, Young People and Families Alliance, as outlined in the report also be endorsed.

BOARD BUSINESS - MATTERS FOR DECISION

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

The Board considered a joint report from Mr T Golby (Head of Social Care Commissioning, Devon County Council) and Mr P O Sullivan (Director of Partnerships, NEW Devon CCG).

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 Coordinating Commissioning Group through the high level metrics reports and progress overview. The BCF 2015 /16 Second Quarter Return had been submitted on 27th November 2015 and there was an action plan for its completion. The JCCG was monitoring progress, which was currently on track. The Quarter 3 submission plan had been drafted and would be reported to the March 2016 Board meeting.

The performance narrative highlighted that all partners continue to work collaboratively on the BCF Plan as part of an ambition to achieve the commissioning and provision of joined up Health and Social Care services. Furthermore, the work on the National Conditions continued as well as Joint Assessment and Care Planning, the Board noting that Devon had well established Joint Health and Social Care Community Teams (CCTs) that demonstrated integrated working on a daily basis.

A detailed analysis of Non Elective Admissions had yielded greater insight to the reasons for entry into the system to enable more targeted action. The frailty work (part of the Frailty and Community Care scheme) continued to perform well and Devon benchmarks favourably for 75+ years Non Elective Admissions. However admissions were not decreasing in line with the ambition (at this stage). The local metric was Dementia Diagnosis with an emphasis on improving identification and access to appropriate support services. The rate had steadily been increasing throughout the year, although delays in the agreement around the national indicator had impacted on the reporting.

A full performance report was also circulated to Board Members and included an overview and indicator summary, dashboard showing current monthly in-year performance, detailed indicator reports providing breakdowns comparing Devon to other South West local authorities and similar local authorities, as well as comparisons with the South West and England rates over time and supplementary monthly dashboards for localities.

The Board asked questions on delayed transfers of care and any correlations with re-ablement services and were also asked to consider the reporting mechanisms for the Better Care Fund, noting that the timings of the quarterly returns and dates of Board meetings were not always in alignment and as such, data was not timely.

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

RESOLVED

(a) that, in view of the timescales for BCF returns, delegated authority be given to the Chairman to sign off future quarterly returns by the required deadlines;

(b) that further analysis be undertaken on the relationship between delayed transfers of care and re-ablement indicators; and

(c) that a further discussion be held at the Boards Development Day on future reporting on the Better Care Fund, notwithstanding the Boards responsibility to maintain an overview of the Better Care Fund.

*221 Cranbrook Health Wellbeing Strategy

The Board received a presentation from Ms J McNeil (NEW Devon CCG) which outlined the ongoing work in developing a health, care and wellbeing Strategy for the new community of Cranbrook. The Strategy was focussed on maintaining and improving health and used a systematic approach that placed individuals and the population at the centre of imaginative 21st century planning.

The Strategy was about early thinking (shared with partners) to enable planning, alignment with health and wellbeing priorities, connected planning of the various elements of healthcare and involvement and engagement. The Strategy development work was underway and included a task and finish group.

The presentation outlined that the Strategy took a placed based approach using the best of both national and local thinking as well as innovative and fresh new ideas. The core purpose of the Strategy was, inter alia, to use the environment as an enabler to wellbeing, adding life to years, staying well and independent for longer, improved health outcomes, innovative services and connected planning.

The slides showed the population structure of Cranbrook and also the predicted growth, the needs assessment 2015 with a comparison to the rest of Exeter.

The Integrated care model highlighted co-ordinated services, joined up front doors, services wrapped around individuals, effective integrated responses and models relevant to the population. In respect of individual care management, this should be pro-active, effective with crisis responses, be tailored to population need and be simplified and streamlined.

In summary, the Strategy was about Healthcare and Wellbeing in the context of the bigger picture, supporting planning and galvanising change and having a positive approach to community engagement.

The Board further noted that Cranbrook had reached the shortlist in the NHS England and Public Health England Healthy New Towns initiative.

OTHER MATTERS

*222 References from Committees

Nil

*223 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.

*224 Forward Plan

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

Date	Matter for Consideration
Thursday 10 March 2016 @ 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 Delivering Integrated Care Exeter (ICE) Project Annual Update Integrated Personal Care (Jon Taylor / Frances Tippett) Success Regime CCG Updates Other Matters Scrutiny Work Programme / References / Board Forward Plan / Briefing Papers, Updates Matters for Information
Thursday 9 June 2016 @ 2.00pm	Performance / Themed Reporting Health Wellbeing Strategy Priorities and Outcomes Monitoring Theme Based Report (Review / Refresh of Joint 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 8 September 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 November 2016 @ 2.00pm	Performance / Themed Reporting Health Wellbeing Strategy Priorities and Outcomes Monitoring Theme Based Report (TBC) Mental Health and Young People (Min 218) 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 12 January 2017 @ 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 9 March 2017 @ 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
Annual Reporting	Delivering Integrated Care Exeter (ICE) Project Annual Update (March) Children s Safeguarding annual report (September / November) Adults Safeguarding annual report (September / November) Joint Commissioning Strategies Actions Plans (Annual Report - November)
Other Issues	Equality protected characteristics outcomes framework Winterbourne View (Exception reporting)

RESOLVED that the Forward Plan be approved, including the items approved at the meeting and an update on the Success Regime at the March Board meeting.

*225 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/

No items of correspondence had been received since the last meeting.

*226 Dates of Future Meetings

RESOLVED that future meetings of the Board will be held on

Thursday 10^th March 2016 @ 2.00pm

Thursday 9^th June 2016 @ 2.00pm

Thursday 8^th September 2016 @ 2.00pm

Thursday 10^th November 2016 @ 2.00pm

Thursday 12^th January 2017 @ 2.00pm

Thursday 9^th March 2017 @ 2.00pm

*227 Dates of Future Seminars

Thursday 11^th February 2016 @ 10.00am 4.00pm

Thursday 13^th October 2016 @ 10.30am 4.00pm

Thursday 9^th February 2017 @ 10.30am 4.00pm

*DENOTES DELEGATED MATTER WITH POWER TO ACT

The meeting started at 2.00pm and finished at 4.04pm.

NOTES: 1. Minutes should be read in association with any Reports or documents referred to therein, for a complete record. 2.The Minutes of the Board are published on the County Council s website at http://www.devon.gov.uk/index/councildemocracy/decision_making/cma/index_hwb.htm 3. A recording of the webcast of this meeting will also available to view for up to six months from the date of the meeting, at http://www.devoncc.public-i.tv/core/portal/home