Agenda and minutes

Minutes of the meeting held on 10 March 2016.

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

RESOLVED that the minutes of the meeting held on 8 September 2016 be signed as a correct record.

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

There were no items requiring urgent attention.

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

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

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

The report reflected the new and updated priorities in the Joint Health and Wellbeing Strategy for Devon 2016-2019, and had been comprehensively revised. The eight existing indicators from the 2013-2016 outcomes report had been removed and 16 new indicators introduced, organised around the five priorities in the Joint Health and Wellbeing Strategy (children, young people and families, living well, good health and wellbeing in older age, strong and supportive communities and life-long mental health).

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. There were breakdowns by local authority, district, clinical commissioning group, inequalities characteristics and trends over time.

The report described 16 new indicators for GCSE attainment,  alcohol-specific admissions in under 18s, excess weight in adults, proportion of adults meeting 5-a-day in their diet, mortality rate from preventable causes, healthy life expectancy (male), healthy life expectancy (female), percentage dying at home or usual place of residence, domestic abuse incidents per 1,000 population, re-offending rate, rough sleeping rate per 1,000 households, dwellings with serious (category one) hazards, private sector dwellings made free of serious (category one) hazards, fuel poverty, emotional difficulties in looked after children and gap in employment rate for those in contact with mental health services.

There were a further 11 indicators which had been updated with new data since the September 2016 report, including, children in poverty, early years foundation score, excess weight in four/five and 10/11 year olds, teenage conception rate, re-ablement services (effectiveness and coverage), stable and appropriate accommodation (learning disabilities and mental health), suicide rate and social contentedness.

Whilst the full detail for all of the above the indicators was included in the separate report and was also available on the Devon Health and Wellbeing website at www.devonhealthandwellbeing.org.uk/jsna/health-and-wellbeing-outcomes-report, the tables in the covering report provided a quick summary of overall findings, including a summary of the indicators, the latest available rate, an indication of trend and a quick comparison between Devon, the South West and England, short textual summary covering the five priority areas and comparison of the indicators with Devon’s local authority comparator group, a group of similar local authorities, ordered according to Devon’s ranking.

Following approval at a previous meeting, a Red, Amber, Green (RAG) rating was included in the indicator list and a performance summary. Areas with a red rating included hospital admissions for self-harm aged 10-24 and fuel poverty.

The Board, in discussion, highlighted and asked questions on;

• the challenge of housing stock and clarification of ‘category 1 hazards’, the impact of poor housing on both mental health and emotional wellbeing and the role of the Strategic Housing Group;
• the welcome  ...  view the full minutes text for item 16.

A themed discussion will take place on ‘Mental Health Services’, including attendance of representatives involved in a new project around mental health in conjunction with the Dartington Social Research Unit. A biography of attendees is attached.

The Board received a presentation and held a themed discussion on ‘Mental Health Services’, which included attendance of representatives involved in a new project around mental health in conjunction with the Dartington Social Research Unit. A biography of the attendees was appended to the agenda.

The presentation highlighted the Mental Health Commissioning Strategy for Devon, Torbay and Plymouth for 2014-2017, including its themes of Prevention, Personalisation, Integration, Improving health and wellbeing, Supporting recovery and Access to services. It also looked at the Transformation Priorities which included ensuring safe and sustainable services and addressing gaps in service provision, making acute and crisis care more resilient; 24 hours a day, seven days a week, a life course approach to care, achieving equity of access and national standards, treating people with complex care needs in Devon, recruiting and retaining staff and also increasing access to mental health support and services for children and young people.

It also reflected on the Pathway and Infrastructure Development, which aligned with NICE guidelines and quality standards and wanted to ensure people had co-produced care plans that were recovery and outcomes-focused.

The panel also reflected on what was meant by ‘public mental health’, including the importance of happiness and social connectedness for mentally healthy communities.

In terms of setting the scene for the future, Dartington had been engaged to provide robust evidence for application to practical (actual) services, hence the use of system dynamic modelling to mental health provision so that behaviours drove changes within the system.

The Board discussed and asked questions on the following;

·         the movement of focus from crisis to prevention was welcomed;

·         the role of the ‘educators’ within the relevant professions and the engagement of these people;

·         an explanation of how ‘success’ might be measured;

·         the use of self-help tools and talking therapies as opposed to the prescription of ante-depressant medication;

·         the data collected by Healthwatch of patient experiences of mental health services and provision; and

·         whether any attention was being given to dementia and any plans for the future

·         the Early Help for Mental Health (EH4MH) programme which was developed through collaborative work with schools and enabled school and academy training on promoting mental health and providing access to online and face-to-face counselling.

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

RESOLVED

(a) that the Panel be thanked for their attendance and the format of using an expert panel be used for future meetings; and

(b) that Members of the Board receive a copy of the annual activity report in relation to the Early Help and Mental Health Access online project with schools (EH4MH).

Reports from both the South Devon and Torbay CCG and the NEW Devon CCG on their Child and Adolescent Mental Health Services (CAMHS) Transformation Plans, attached.

The Board considered Reports from South Devon and Torbay CCG on their 2016/17 Refresh of the Five Year Child and Adolescent Mental Health Services Local Transformation Plan 2015-2021 and also from NEW Devon CCG on the Transformation Plan 2015/2016 – 2020/2021 in relation to Child and Adolescent Mental Health Services (CAMHS)

NHS England required CCGs to refresh and republish their original plans which were previously considered by the Health and Wellbeing Board.

In terms of South Devon and Torbay CCG, their refreshed Local Transformation Plan (LTP) provided a review of progress to date, challenges and next steps. It reflected the working together ethos in the whole system to achieve a consistent vision and strategic priorities whilst recognising the different points and stages of development of services; different geography; diversity of needs and alignment with key local priorities.

The refreshed LTP, was to adopt a twin track approach to ensure that vulnerable children / young people had access to specialist and expert help within Child and Adolescent Mental Health Services (CAMHS) and also an emphasis on earlier help and intervention to reduce the need to access specialist, expert help from CAMHS.

It was noted that the refreshed Plan was consistent with the CCG’s Sustainability and Transformation Plan.

NEW Devon CCG’s refresh reflected on their position and planning as of 31^st October 2016. With partners, strategic priorities and commissioning intentions for children’s services (including CAMHS is an integral part) were being reviewed. There was planned engagement and consultation on the developments (November 2016), which would have the voice of children and their families embedded in the plans.

The Plan set out the CCG’s commissioning strategy, priorities and plans to transform the support and services offered over a five year period.  It had been developed with partners and

providers, taking into account on-going engagement and consultation with children and young people and their families. It also provided a summary of what had been achieved over the last twelve months and an overview of priorities for 2016/17 and beyond.

The Board further noted that the refreshed plan was consistent with Sustainability and Transformation Plans.  The evidence base underpinning a place-based approach highlighted the relationship between quality of health services, health outcomes and educational attainment. The CCG also reported they were committed to an all age approach, ensuring that local services were integrated and coordinated, in line with research and guidance indicating the importance of this ‘all age’ approach.

The Board asked questions about the take up of schools in relation to the early help and mental health support offer.

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

RESOLVED that the Board continue to receive the yearly refresh of CAHMS Local Transformation Plans.

Joint report of the Head of Adult Commissioning and Health, NEW Devon CCG and South Devon & Torbay CCG, on the BCF, Quarter Return, Performance Report and Performance Summary.

The Board received a joint report from Mr T Golby (Head of Social Care Commissioning, Devon County Council), Caroline Dawe (NEW Devon CCG) and Simon Tapley (South Devon and Torbay 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 Board noted that the BCF 2016/2017 Second Quarter Return was submitted on 25th November 2016 and copies could be made available if required.

The report summarised the BCF activity in terms of the work towards the National Conditions.

It provided ‘Outcome’ measures which included agreement on a local action plan to  reduce delayed transfers of care, a summary of BCF schemes focused on reduction of non-elective admissions, monitoring the support for people with dementia, including assessing the length of stay for people with dementia admitted to hospital rather than diagnosis rates, the permanent admissions to residential and nursing care homes (the rate being significantly below the South West average) and effectiveness of re-ablement services.

Members of the Board noted that Delayed Transfers of Care was still a challenging target.

Report of the NEW Devon CCG on the Governance arrangements for the Integrated Personal Care Programme.

The Board considered a report from NEW Devon CCG, presented by Jon Taylor (Commissioning Transformation Manager) and Paul O’Sullivan (Partnerships Manager) on the Integrated Personal Commissioning (IPC) programme, following changes that had been made by NHS England for the year 2016-2017 and beyond.

The Board had previously received an overview, in March 2016 (Minute 231) and whilst had supported the key aims and ambitions of the project, felt further work was required on the role of the Board in the governance structures proposed.

The report therefore sought to clarify the local governance arrangements for IPC, including how the IPC programme would be incorporated into the governance framework being developed to support delivery of the Sustainability and Transformation Plan (STP).

By way of a background, the IPC programme was first outlined in June 2014 and provided a delivery vehicle for integration and personalisation, sitting alongside new models of care vanguards amongst other change programmes (e.g. Transforming Care, Special Education Needs) that the Five Year Forward View introduced.

The goals of the programme were;

• people with complex needs and their carers to have a better quality of life, allowing them to achieve outcomes important to them / their families through greater involvement in their care, designed around their needs;
• prevention of crises (that led to unplanned hospital visits and institutional care) by keeping people well and supporting self-management; and
• better integration and quality of care, including better user and family experiences of care.

The report highlighted the Memorandum of Understanding agreed between Devon Clinical Commissioning Groups (CCGs) and NHS England to support the delivery of integrated personal commissioning (IPC) in Devon and also the proposed governance structure to support local delivery of the integrated personal commissioning model.

The Board satisfied themselves that the Overview Steering Group would provide NHS England with the relevant assurances.

It was MOVED by Councillor Davis, SECONDED by J Olsson, and

RESOLVED that the update be welcomed, in particular, the revised and proposed Governance structures.

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Covering Report of the NEW Devon CCG, on the Wider Devon Sustainability and Transformation Plan (STP), attached.

The actual Sustainability and Transformation Plan (STP) can be found at: http://www.newdevonccg.nhs.uk/about-us/sustainability-and-transformation-plan-stp/102099

A hard copy is attached separately for Board Members.

The Board considered a covering report which outlined the recent publication of the Wider Devon Sustainability and Transformation Plan, asking the Board how it could be best engaged in the Plan going forward.

The report outlined that the Sustainability and Transformation Plan (STP) was a strategic framework developed by NHS organisations in Devon working in partnership with County, Plymouth and Torbay Councils and covered the whole population of wider Devon.

The STP was the Plan to achieve the NHS ‘Five Year Forward View’ and address the challenges faced locally particularly those set out in the Case for Change. The STP was published on 4th November 2016 and was available online at:

http://www.newdevonccg.nhs.uk/about-us/sustainability-and-transformation-planstp/102099  and was meant to be the overarching strategic framework within which detailed proposals for how services across Devon would develop between now and 2020/2021. Whilst there was a focus on preventing ill health and promoting people’s independence through more joined up services in or closer to people’s homes, it was also focused on closing the financial gap that existed.

The Board noted there had been work in 2016/2017 on early improvements and efficiencies that could be made and the STP also confirmed plans to review acute and specialist services.

The next steps were for the STP to be considered by the Boards of all organisations involved and also the need, in any programme of transformation, for ongoing dialogue with patients, volunteers, carers, clinicians, public, local voluntary and community sector, local authorities and political representatives.

The Board also received a supporting presentation, from Ms L Nicholas (Director of Strategy NEW Devon CCG) outlining the STP footprint and ambition, the triple aim of the STP regarding improving population health and wellbeing, experience of care and also cost effectiveness per head of population. It outlined the STP priorities and also the challenges of achieving those.

The next steps were to continue with delivery of the 2016/2017 work streams and build operational plans for 2017/2018, including detailed plans across the 7 STP priorities and also large scale community consultation events.

Councillor Davis reported on a letter which had been received on 12 December 2016 from Simon Stevens, Chief Executive of NHS England,  which referred to the first phase of STP’s as ‘developing proposals for discussion’, and then referring to a next phase of ‘turning proposals into plans’.

The Board asked questions on and discussed the following:

• the status of the plan, as to whether it was a final version or living document to be further amended;
• concern over the lack of reference to and implications for social care;
• clarification of the funding position with rural and urban areas, particularly those described as ‘deprived’, and whether funds were likely to be shifted from one area to another, specifically from Devon to Plymouth;
• the importance of ensuring the strategic direction was appropriate, before launching formal and individual service reviews and consultations;
• the need for an open and transparent engagement process with all affected stakeholders and partners, on proposed future operational plans and service reconfigurations;  ...  view the full minutes text for item 21.

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

This item was deferred to a future meeting.

Report of the South Devon and Torbay CCG on their Community Services Transformation Consultation, attached.

The Board considered the report of South Devon and Torbay CCG on their Community Services Transformation Consultation, which ran from 1 September to 23 November 2016.

The proposals for change resulted from a recognition that the current NHS provision in the area was unsustainable and unable to cope with rising demand for services.

The consultation proposals would see a switch of spend from bed based to community based care with the number of community hospital beds being reduced, further investment in the local services which most people used and minor injuries units being concentrated in three locations. The report outlined the main changes which included the closure of Ashburton and Buckfastleigh, Bovey Tracey (beds currently temporarily relocated to Newton Abbot Hospital due to safe staffing issues), Dartmouth and Paignton Hospitals. Also Totnes and Newton Abbot would become the location of enhanced MIU services. MIUs in Ashburton, Dartmouth (both currently suspended), Brixham and Paignton would close. There would be the establishment of clinical hubs in Newton Abbot, Totnes and Brixham, establishment of health and wellbeing centres in Ashburton or Buckfastleigh, Bovey Tracy or Chudleigh, Dartmouth, Newton Abbot, Totnes, Brixham, Paignton and Torquay and the expansion of intermediate care across the CCG area.

The consultation process was fully outlined including 14,000 consultation documents, 2,000 posters, 23 public meetings, more than 60 other meetings with community based groups and staff, sharing with community groups, website promotion, 1,700 people attended public meetings, adverts in local newpapers, social media advertising and reporting, presentations to Scrutiny Committees and 1,400 questionnaires completed.

A number of themes were heard across the consultation and the report outlined these in detail.

In terms of the next steps, the CCG governing body would meet on 26 January 2017 to consider a Healthwatch report, evaluation of alternative ideas and make decisions on the future of community services.

The Board asked about the proposals and locations for the clinical hubs and health and wellbeing centres and also future reporting procedures on this transformation programme.

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

RESOLVED that the decisions of the Governing body and proposals regarding implementation plans be brought to the March meeting of the Health and Wellbeing Board.

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Verbal updates from Clinical Commissioning Groups on matters of importance or pertinence to the Board.

The Board received a verbal update from NEW Devon CCG on the launch of the Budleigh Health and Wellbeing Hub. Work would begin in January on refurbishment of part of the hospital and the Board would be kept briefed on developments.

Report of the Chief Officer for Communities, Public Health, Environment and Proposperity, attached.

The Board received the Health Protection Report of the Chief Officer for Communities, Public Health, Environment and Prosperity for the Health and Wellbeing Boards of Devon County Council, Plymouth City Council, Torbay Council and Cornwall Council and the Isles of Scilly Council.

It provided a summary of the assurance functions of the Health Protection Committee (of the five Health and Wellbeing Boards) on behalf of the five local authorities and significant matters considered for the period from 1st April 2015 to the 31st March 2016, including the domains of health protection, including communicable disease control and environmental hazards, immunisation and screening and health care associated infections.

It summarised the action taken to date against the programme of health protection work priorities established by the committee for the period 2015 to 2016.

Nil

There were no matters referred.

In order to prevent duplication, the Board will review the Council’s Scrutiny Committee’s Work Programmes, attached. The latest round of Scrutiny Committees confirmed their work programmes and the plans can be accessed at;

http://new.devon.gov.uk/democracy/committee-meetings/scrutiny-committees/scrutiny-work-programme/.

The Board received a copy of Council’s Scrutiny Committee work programme in order that it could review the items being considered and avoid any potential duplications.

Councillor Barker referred the Board to the recent Scrutiny Spotlight Review on Models of Care. Members from the Councils Health Scrutiny Committee, People’s Scrutiny Committee, Torbay Community Services Review Panel and the Plymouth Wellbeing Scrutiny Committee undertaken to form part of the on-going work to understand and scrutinise the activities in localities that followed the Sustainability and Transformation Plan. The report could be viewed on the website.

To review and agree the Boards Forward Plan.

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

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

·         Better Care Fund (BCF) Plan Submission – Members are asked to note the attached letter, stating that following the regional assurance process, the Plan had been classified as ‘Approved’, meaning it meets all requirements.

·         Letter received from Northam Town Council, attached, relating to the proposals for cuts at North Devon Hospital and wishing to express their concern.

·         Letter received from West Devon Borough Council, attached, on NEW Devon CCG Consultation and the concerns of the Borough Council regarding the loss of beds at Okehampton hospital. The Board are asked to consider this in any forthcoming debate.

·         Letter from David Mowat MP Parliamentary Under Secretary of State for Community Health and Care regarding the General Practice Forward View and the relationship of primary care with the delivery of local health and wellbeing strategies. Boards were being asked to, through their work and Health and Wellbeing Strategies, to encourage action to develop and strengthen relationships with general practice services in local areas, in order to generate benefits for the whole system and better outcomes for patients.

·         Letter from Jeremy Hunt MP and Amber Rudd MP about pressures on health and care services and police forces and asking Health and Wellbeing Boards and PCCs to consider how they can better work together by ensuring appropriate representation from both sectors on Health and Wellbeing Boards.

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.

• The Board received a letter regarding the Better Care Fund (BCF) Plan and that following the regional assurance process, it had been classified as ‘Approved’, therefore had met all requirements and focus should now be on delivery.
• Board Members noted the contents of the letter received from Northam Town Council, relating to proposals for cuts at North Devon Hospital and wishing to express their concern.
• A letter from West Devon Borough Council, on NEW Devon CCG Consultation and the concerns of the Borough Council regarding loss of beds at Okehampton hospital. The Board noted the request to consider their concerns in any debate.
• The Board received the letter from David Mowat MP Parliamentary Under Secretary of State for Community Health and Care regarding the General Practice Forward View and the relationship of primary care with the delivery of local health and wellbeing strategies. Boards had been asked to, through their work and Health and Wellbeing Strategies, to encourage action to develop and strengthen relationships with general practice services in local areas, in order to generate benefits for the whole system and better outcomes for patients. The Devon Board had already taking action in this regard.
• Members noted a letter from Jeremy Hunt MP and Amber Rudd MP about pressures on health and care services and police forces, asking Health and Wellbeing Boards and PCCs to consider how they can better work together by ensuring appropriate representation from both sectors on Health and Wellbeing Boards. The Devon Board had already taking action in this regard.

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

Meetings

Thursday 9^th March 2017 @ 2.00pm

Thursday 8^th June 2017 @ 2.15pm

Thursday 7^th September @2.15pm

Thursday 14^th December @ 2.15pm

Annual Conference

Thursday 8^th June 2017 @ 10.00am

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

Meetings

Thursday 9^th March 2017 @ 2.00pm

Thursday 8^th June 2017 @ 2.15pm

Thursday 7^th September @2.15pm

Thursday 14^th December @ 2.15pm

Annual Conference

Thursday 8^th June 2017 @ 10.00am