Agenda and minutes

          The Minutes of the meeting held on 18 September 2018 were signed as a correct record.

The minutes of the Health and Wellbeing Board from its meeting on 4 July 2018 were presented to the Board for information.

HWB3 – One Member requested an update be brought to the Board on the progression of the One Halton Programme.

RESOLVED:  That the minutes and comments made be noted.

The Board received a report from the Strategic Director – People, and accompanying presentation, which provided an awareness of dementia and its impact on people’s lives and the provision provided by the Alzheimer’s Society in Halton. 

It was reported that people in Halton with a diagnosis of dementia were supported by the Post Diagnosis Dementia Community Pathway; the key features of the pathway were discussed in the report.

The Board was advised that the Alzheimer’s Society was the UK’s leading support and research charity for people with dementia, their families and carers.  In Halton, the Alzheimer’s Society provided a comprehensive dementia support service for patients who were referred into the service by Memory Assessment Centres and other referral routes.  The costs associated with dementia care were outlined in the presentation together with the Society’s new strategy, the New Deal on Dementia. 

As the representatives from the Alzheimer’s Society were unfortunately unable to attend the Board meeting, Officers would investigate queries made by Members in relation to: the difficulties people diagnosed with Alzheimer’s experienced in getting medication for the illness; details requested on the numbers of paid staff and volunteers involved in the delivery of the Halton post diagnostic community pathway; and the times from referral to diagnosis of dementia.

RESOLVED:  That the report and presentation be noted.

The Board welcomed Catherine Nicholson, Sara Pimblett and Stephen Sweeney from Fortunatus Housing Solutions, who gave a presentation to the Board on the Company’s work in Halton.

They introduced Fortunatus Housing Solutions as a North West based registered charity providing supported accommodation for vulnerable adults with mental health problems and/or learning disabilities who were unable to access social housing.  Fortunatus currently accommodated and supported 41 people in tenancies in Halton, and had a further 6 people on their waiting list.

The Board was advised that Fortunatus had a robust referral assessment process, with all referrals coming from health and social care services.   As part of their assessment, a number of factors were taken into consideration, as outlined in the report.  It was noted that all tenants received person centred support and received weekly visits from their designated support worker.  They also benefitted from good quality accommodation; designated maintenance officers; the services of a professional property and lettings manager; and an out of hours service.

Outlined in the presentation were details of how the Charity was funded and the work carried out with 8 local authorities in the North West.  Details were also provided on the potential for savings to be made by local authorities who used the service.  Further to the Board’s request, further information on this would be sent to them following the meeting.

In response to Members’ queries, it was noted that the Charity did not own the properties on their books, they were leased from private owners; and that clients were housed in their local authority areas.

RESOLVED:  That the Board notes the report and presentation.

The Board received a report from the Strategic Director – People, which provided an update on the status of the realignment of Stroke Services across the Mid-Mersey health economy.

It was reported that Phase 1 of the reconfiguration had been implemented and all patients who were still within the window of opportunity for thrombolysis, within 4 hours of onset, were conveyed to St Helens and Knowsley Hospital for treatment.  Patients who were post 4 hours from onset and not suitable for thrombolysis, would be conveyed to their local hospital.

It was noted that the clinical teams had agreed four elements of the clinical pathways and these were described in the report.

Members were advised that the Phase 2 element of the service had been delayed, as the requirements for additional capacity was confirmed for both units and the ambulance service.  The Mid Mersey CCG Joint Committee would present a case for investment in capacity.

RESOLVED:  That the Board notes that

1)    Phase 1 of the service reconfiguration had been implemented successfully; and

2)    Phase 2, to transfer all stroke cases to St Helens and Knowsley Hospital had been delayed, until capacity had been confirmed to ensure patients could be managed effectively. 

The Board received an update from the Chief Commissioner, NHS Halton CCG, on the status of the delivery and performance of NHS Halton IAPT Service/Think Wellbeing Service.

It was reported that there was considerable evidence for the use of psychological therapies as an effective treatment for many mental health problems.  Improving Access to Psychological Therapies (IAPT) was a national NHS Programme, being rolled out across England.  Members were advised that the aim of the Programme was to develop local talking therapy services that offered treatments for depression and anxiety disorders, as per the guidance from the National Institute for Health and Clinical Excellence (NICE).  It was noted that nationally there was a requirement to increase the numbers of people accessing IAPT compliant therapies year on year, to reach an eventual target of 25% of the eligible population in 2021; so one in four.

The Main targets of the service were outlined in the report and Members were provided with an update on the status of the service delivery and its performance so far.

Members discussed the reasons for the possibility of the stretched target failing due to clients missing appointments, particularly at this time of year.  The Healthwatch co-optee requested the figures for self-referrals; these were not immediately at hand so would be sent following the meeting.  It was commented that Healthwatch Halton would be happy to promote the IAPT service in the community.

RESOLVED:  That the Board notes the report and comments made.

The Board received a report from the Strategic Director – People, which provided an update on the key issues with regards to safeguarding and the work of Halton’s Safeguarding Adults Board (HSAB).

Highlighted within the report and discussed was:

·       The Integrated Anti-Stalking Unit (IASU);

·       HSAB provision of a free multi agency training programme to all partners across Halton working or caring for adults;

·       The Cheshire Anti-Slavery Network (CASN);

·       Making Safeguarding Personal (MSP); and

·       The Mental Capacity (Amendment) Bill.

Further to Members’ queries the following was noted:

·       The number of safeguarding referrals for the 85+ age group was considered high in comparison with the populations within the younger groups.  The Safeguarding Adults Board (SAB) had agreed for the free  training for staff on the vulnerabilities of the elderly; and were working with key stakeholders including Age UK to raise awareness of this via the new marketing campaign ‘Ever Wondered Why?’;

·       There was no additional funding expected for the running of the DoLS: and

·       That the proposed new Liberty Protection Safeguards (LPS) recommended that a registered manager of a care home would undertake assessments for the LPS.  Members were advised that there had been a challenge in respect of this and the House of Lords had rejected the latest Bill for further amendments.

RESOLVED:  That the report be noted.

The Chair, Councillor J. Lowe declared a Disclosable Other Interest in the following item, as her daughter-in-law worked for the domiciliary care provider.  She did not take part in any discussion and handed the Chair to Councillor Baker for the duration of the item.

A report was presented from the Strategic Director – People, which highlighted the key issues with respect to quality in local Care Homes and Domiciliary Care Services.

The report provided commentary with regards to the Council’s priority to ensure the provision of a range of good quality services to support adults requiring commissioned care in the Borough; in line with the Care Act 2014.  It was noted that Halton had 25 registered care homes with a total of 757 beds, operated by 14 providers.  With regards to domiciliary care, this was commissioned by one lead provider who worked closely with the Council to transform provision using a Re-ablement First model. 

The responsibilities of the Care Quality Commission (CQC) and its assessment processes for all registered providers were described in the report.  Further, the work of the Council’s Quality Assurance Team was outlined.  The quarter 2 ratings given to care homes by the CQC and the Quality Assurance Team were presented in the report.  It was noted that the rating for the domiciliary care provider was not available for quarter 2, as the development of a range of performance metrics by the Quality Assurance Team was still in progress and the CQC had not yet rated the provider.

Members were referred to the North West ADASS Monthly CQC Data Update (October 2018 Edition), which was appended to the report.  With reference to this, Members highlighted that the ‘safe’ and ‘well-led’ elements of the care home ratings were poor in many cases.  It was suggested that this could be due to underfunding.  Officers advised that Halton had developed a care home working group which would include the monitoring of these ratings as part of their role.  It was also commented that registered managers were crucial to the success of a care home; the Council was planning to do some work around this to professionalise the role, so it was more recognised within the care home field.

RESOLVED:  That the Board notes the report.

The Board received the Performance Management Reports for quarter 2 of 2018/19. 

Members were advised that the report introduced, through the submission of a structured thematic performance report, the progress of key performance indicators, milestones and targets relating to health in quarter 2, which included a description of factors which were affecting the service.

The Board was requested to consider the progress and performance information and raise any questions or points for clarification and highlight any areas of interest or concern for reporting at future meetings of the Board. 

Members were pleased to note that the proportion of adults with learning disabilities who were in employment had already exceeded the yearly target at quarter 2; and that the proportion of adults with learning disabilities who lived in their own home or with their family had met the yearly target at quarter 2.  One member requested more details on the use of ‘Bed and Breakfast’ accommodation for people classed as homeless recently; this would be shared with the Board after the meeting.

RESOLVED:  That the quarter 2 performance management reports for 2018/19 be received.