Agenda and minutes

        The Minutes of the meeting held on 4 November 2014 having been printed and circulated were signed as a correct record.

        The Board was advised that no public questions had been received.

The Minutes of the Health and Wellbeing Board of its meeting held on 12 November 2014 were submitted to the Board for information.

RESOLVED: That the minutes be received.

(Note: Councillor M Lloyd-Jones declared a Disclosable Other Interest in the following item of business as her husband is a Governor of Warrington & Halton Hospitals Board).

            The Board considered a report of the Strategic Director, Communities, which outlined Warrington and Halton Hospitals NHS Foundation Trust five years Strategy, ‘Creating Tomorrow’s Heathcare Today’.  The Chief Executive of the Trust attended the meeting to present the report and a presentation.

The Board was advised that over the last five years massive changes had been made to NHS services at Warrington and Halton Hospitals - modernising hospitals, investing in staff and, most importantly, delivering quality and safety improvements for our local population.  Creating tomorrow’s healthcare today was a way of setting out the strategy for the next five years. It set out the overall vision for the hospitals. It detailed the plans that would be delivered and other improvements in line with the local and national picture and changes taking place in the wider NHS.

It was reported that it was the result of work with NHS governors, Members and the public over the last few months as well as being informed by commissioning intentions and national mapping work across the health and social care sector.

The presentation Creating tomorrow’s healthcare today:-

·              outlined the national and local forces affecting healthcare and the commissioner response;

·              set out the Vision;

·              detailed the route to sustainability over five years;

·              gave details of the transformational and modernisation programmes;

·               highlighted that quality would be improved today to ensure they were here tomorrow;

·             Explained the estate and facilities, creating a new environment for tomorrow’s healthcare needs;

·             Highlighted the technology was being developed to support future healthcare requirements;

·             Gave details of the workforce – investing in staff and skills to enable the workforce to be ready for the future; and

·             Set out a summary of tomorrows healthcare today in respect of quality, people and sustainability.

The following comments arose from the discussion:-

·             Members raised concern at the proposals for car parking charges at the Urgent Care Centre on the hospital site which would be used by Runcorn residents.  It was reported there was no car parking charges in Halton and Members requested that this matter be reconsidered with a view to removing the charges.  It was also suggested that if removing the charges was not an option on this particular site then alternative sites should be considered i.e Halton Lea Shopping Centre.  It was also highlighted that charges would result in cars being parked in residential areas to avoid the charges. In reply, it was reported that negotiations were taking place and a meeting had been arranged next week to find a solution to this issue;

·             It was noted that the Strategy would bring care closer to home for patients by supporting the local health community in providing care closer to home for the patients of Warrington, Halton and neighbouring areas by looking at different models of provision and technology enabling the capitalisation of knowledge and skills of staff;

·             It was noted that the vision was to develop a health delivery model which would keep people in their environment, mobilising expertise so that they would  ...  view the full minutes text for item 36.

The Board considered a report of the Strategic Director, Communities, which detailed the Healthwatch report on GP Access and Out of Hours Provision.

The Board was advised that Healthwatch Halton was the consumer champion for health and social care in Halton. Its purpose was to understand the needs, experiences and concerns of people who use health and social care services and to ensure their voices are heard and responded to.

The Board was further advised that from the launch of Healthwatch in April 2013 one of the main issues raised by local people was the difficulties accessing local GP services. Having made a note of the findings from the local feedback and from national surveys it had been decided that a Healthwatch Task and Finish group should be set up to look at ‘Access to GP Services and Out of Hours GP Provision’ across Halton. 

A public survey had been launched by Healthwatch Halton at the end of March 2014 the end June 2014. In total 491 surveys had been completed with received responses covering all GP practices in Halton. A number of recommendations had been put forward in the report produced by the Healthwatch Halton Task & Finish group. The report attached as Appendix 1, had been sent to Halton CCG for a formal response to the recommendations, and the response was due in January 2015.

          Mr Paul Cooke, Mr Roy Page, Mr Dave Wilson and Ms Susan Ellison, Healthwatch attended the meeting and presented the report and the recommendations.

          It was reported that the Clinical Commissioning Group (CCG) had endorse the recommendations and an action plan had been developed.  It was also reported that Healthwatch would be working with the CCG on this matter. In addition, The Healthwatch Halton “Have your voice heard today” leaflet was circulated at the meeting.  

The Board welcomed the report, supported the recommendations and thanked Healthwatch for the excellent work they had undertaken to date.

The following comments arose from the discussion:-

·             It was suggested that an information campaign be established to raise awareness of the numerous services that were available i.e. online repeat prescriptions and prescriptions that could be ordered to pick up at a local pharmacy;

·             It was suggested that GP practices could be tested on a regular basis by a scheme similar to the mystery shopper which would enable the practice to monitor the services they were delivering;

·             It was reported that the survey had highlighted the patients resistance to new ways of providing health services by GP’s and noted the challenges this presented;

·             The inconsistency of delivery in GP practices was noted in respect of customer care.  It was reported that GPs were working towards a consistent approach and a report on this would be presented to a future meeting of the Board;

·             Page 67 – Recommendation 6 – ensuring information on the new centres was made widely available across the Borough and in both local hospital A&E, Whiston and Warrington in time for their opening, it was suggested  ...  view the full minutes text for item 37.

The Board considered a report of the Strategic Director, Communities, which presented the progress of key performance indicators, milestones and targets relating to Health in Quarter 2 of 2014-15.  Appendix 1 to the report contained a progress update regarding the implementation of all Directorate high-risk mitigation measures that were relevant to the remit of the Board.

          The Lead Officer of the Board gave a verbal update on the performance monitoring targets highlighting that the majority would be achieved by the end of the year. 

The Board noted the ICT issue in respect of the Adult Social Care target regarding Safeguarding.

The following comments arose from the discussion:-

·             Information was requested on Personal Budgets and how they could be assessed and monitored.  In reply, it was reported that this task was undertaken externally, with the Council having an administration role with two reports being received to date.  It was reported that the reports had been very positive and that they could be presented to the next meeting of the Board;

·             An update was requested on the Widnes Homeless Hostel and it was reported that this would be circulated to Members of the Board;

·             PA1 – Integrated provision of frontline services – the additional resources that had been released from central government to support increased demand during the winter period was welcomed and it was commented that it would be beneficial for these resources to be available all the time.  The Board had a discussion on the provision of residential and nursing care, private vs previous Council provision;

·             PH 01 – reduce obesity rates in the local population, March 2015 – it was agreed that the review when completed would be presented to the Board for consideration; and

·             The Board noted the significant success of operation emblem and that it had reduced the number of Section 136 interventions by 90% to date and made a saving of approximately £320,000 - £360,000.  The Board also noted that the next stage would be to commission the service for a longer period and that Cheshire has also adopted the project enabling consistency across Cheshire.

RESOLVED: That the report and comments raised be noted.

The Board considered a report of the Director of Public Health which provided a summary of progress on the health and wellbeing priority for Halton’s Sustainable Community Strategy from April – September 2014.

The Board was advised that the current SCS for Halton was from 2011- 2026 and addressed five key priorities for the Council and its partners as follows:-

·       A Healthy Halton;

·       Employment, Learning and Skills in Halton;

·       A Safer Halton;

·       Children and Young People in Halton; and

·       Environment and Regeneration in Halton.

The Board was advised Appendix 1 to the report set out progress for April 2014- September 2014 for the Healthy Halton priority.

The Board welcomed the improved breastfeeding rate and the under 18 conception rates and that in Halton obesity in Year 6 children was reducing year on year, which was the opposite of the national trend.  However, the Board also noted the challenges in respect of the increase obesity in children of reception age and the number of children who were not ready for school.

RESOLVED: That the report and comments raised be noted.

(Note: Councillor Sinnott declared a Disclosable Other Interest in the following item of business as a Trustee of Halton Disability Partnership).

The Board considered a report of the Strategic Director, Communities, which informed Members on the changes involved with the new Care Act and on local progress.

The Board was advised that the changes coming into effect in April 2015 which impact directly on the Council include:

A duty to provide prevention, information and advice services;

·             A national minimum threshold for eligibility for both service users and carers;

·             The entitlement for carers to assessment, support services and review equal to that of the service user;

·             The right for people who pay for their own care to receive advice and support planning; and

·             A universal system for deferred payments for residential care.

The Board was further advised that the changes coming into effect from April 2016 which impact directly on the Council include:-

A cap on the costs that people have to pay to meet their eligible needs;-

·             A ‘care account’ giving people with eligible social care needs an annual statement of their progress towards reaching the cap, whether their care is organised by the local authority or not; and

·             Extending the financial support provided by the local authority by raising the means test threshold for people with eligible needs.

It was reported that to oversee the implementation of the Care Act in Halton, an overarching Care Act Strategic Group chaired by Operational Director Prevention and Assessment had been established. The strategic group in turn oversees six sub-groups each working to their own implementation plan that included working towards completion of reviewing relevant documents, policies, considering training and workforce development, charging and cost implications as well as understanding and identifying potential risks. A brief summary of each of the subgroups was included in this report.

Furthermore, it was reported that to support the implementation a grant of £125,000 had been provided and had been used in the following three ways:-

·             A full-time policy officer had been recruited;

·             A full-time post in finance to support all financial implementation of the changes in the Care Act; and

·             £25K to support joint working with Liverpool City region.

The Board were reminded of the Members seminar on the Care Act that would be taking place on Thursday 15 January 2015 at 5.30 pm.  It was reported that all Members of the Council would receive a copy of the slides.  It was also reported that a follow up event was also being considered.

It was reported that an update report would be presented to the next meeting of the Board.

The Board noted that two regional groups had been established and noted the updates from the sub-groups contained within the report.

Clarity was sought on whether additional staff had been recruited to deal with the additional workload.  In response, it was reported that a Policy Officer had been recruited and some existing Policy Officers had been allocated additional work.  The Board noted that the full time posts in finance to support all financial implementation of the changes in the Care Act were temporary secondment posts for  ...  view the full minutes text for item 40.

The Board considered a report of the Strategic Director, Communities, which provided Members with an update on mental health related activity undertaken by the Council and NHS Halton Clinical Commissioning Group (CCG).

The Board was advised of activities in the following areas:-

·             Award Winning Innovation – Haltons Wellbeing Practice approach had gained national interest winning a National Association of Primary Care (NAPC) award;

·             Mental Health in GP Practices – Training is being provided to clinicians to enable them to manage mental health within their practice;

·             Mental Health Wellbeing Nurse – Halton CCG commissioned a Mental Health Wellbeing Nurse Team to work primarily with the most vulnerable patients with complex issues;

·             Halton CCG Service Provision – Appendix 1 to the report set out a summary of some of the service provision across the age ranges;

·             New Governance Structure – A revised Governance Structure has been established to ensure robust oversight of delivery of mental health;

·             Dementia Friendly Communities – The Council and Halton and the CCG have established a Halton Dementia Action Alliance (Halton DAA) in October 2014;

·             Admiral Nurses for Dementia - The Halton Dementia Partnership Board has recently met with the Chief Admiral Nurse in England (Oct 2014) to explore the potential for investment in the Admiral Nurse service in Halton. Admiral Nurses provide families with the knowledge to understand the condition and its effects, the skills and tools to improve communication, and provide emotional and psychological support to help family carers carry on caring for their family member. A Business Case for investment is being developed;

·             In Patient Redesign Project – 5 Borough Partnership Community Foundation Trust have developed a revised improved clinical model for inpatient services;

·             Emotional Wellbeing Services for Children - NHS Halton GCCG and Public Health in the Local Authority have worked together to deliver a revised specification for  a Tier 2 level service to support young people with emerging emotional wellbeing and lower level mental health issues.  The service is currently out to tender on The Chest and interviews for bidders will be held on 6^th February 2015;

·             System Resilience Funding - NHS Halton CCG have secured £81k of additional funding from a recent bid for additional system resilience funding for mental health specifically;

·             The Mental Health Crisis Care Concordat - The Mental Health Crisis Care Concordat was published by Central Government in late 2013. Locally, Halton had been working closely with partners across the Cheshire footprint. A declaration had been developed and agreed across the partners, and an action plan was in development. Regular meetings were also taking place to monitor progress;

·             Operation Emblem/Street Triage - Operation Emblem had been piloted across Halton and Warrington for 12 months and had been commissioned by NHS Halton and Warrington CCGs.  The pilot had been very successful and reduced Section 136 by approximately 90% across the two Boroughs;

·             Liaison Psychiatry Service - The extended Liaison Psychiatry Service had been launched within Warrington and Halton Hospitals NHS Foundation Trust in August 2014;

·             IAPT – Halton Psychological  ...  view the full minutes text for item 41.

The Board considered a report of Halton’s CCG which informed Members that on 23 October 2014 NHS England, in partnership with five other national organisations involved in setting the strategic direction and regulatory framework for the NHS, had published Five Year Forward View. 

The Board was advised that on 4 December 2014 NHS Halton Clinical Commissioning Group (CCG) had commenced a two month dialogue with local people and partners in regard to a Halton response to Five Year Forward View. Strategic decisions would need to be made by NHS Halton CCG Governing Body following Five Year Forward View, particularly in regard to new models of care.

The Board was further advised that the purpose of the Five Year Forward View was to articulate why change was required, what that change might look like and how it could be achieved. It described various models of care which could be provided in the future, defining the actions required at local and national level to support delivery. Everyone would need to play their part – system leaders, NHS staff, patients and the public – to realise the potential benefits to all. It covered areas such as disease prevention; new, flexible models of service delivery tailored to local populations and needs; integration between services; and consistent leadership across the health and care system.

The Board noted the importance of integration between services provided by the Council, the NHS, GPs and CCG’s etc.  The Board also noted that there was a need for politicians to engage with the public to raise awareness of their responsibilities in taking care of their health rather than relying on the NHS i.e obesity.

RESOLVED: That the report and comments raised be noted.

The Board considered a report of Halton’s CCG which aimed to provide clarity and transparency around co-commissioning options, providing CCGs and area teams with information and tools they need to choose and implement the right form of co-commissioning for their local health economy.  NHS Halton CCG was required to decide by 9 January 2015, the level of primary care co-commissioning the organisation wished to undertake with NHS England.

The Board noted the Joint Commissioning model and the details set out in paragraphs 4.2 of the report.  It was highlighted that the area teams and the CCGs would agree the full membership of their joint committees and that a local HealthWatch representative and a Local Authority representative would have the right to join the joint committee.  The Board discussed the Membership of the Committee and Sub-Committee and it was noted that Councillors who were not a member of the Health PPB could be a member of the sub Committee.

The Board was advised that the document had been submitted on 9 January 2015 and the Strategy would be presented to the Board in March 2015.

RESOLVED: That the report and comments raised be noted.

The Board was reminded that Standing Order 51 of the Council’s constitution stated that meetings should not continue beyond 9 pm

RESOLVED: That Standing Order 51 be waived to allow the meeting to continue beyond 9 pm.

The Board considered a report of the Halton’s CCG which informed Members of work that was progressing across Cheshire and Merseyside to sustain and develop maternity services.

The Board was advised that Cheshire and Merseyside Clinical Commissioning Groups (CCGs) had agreed to undertake a review of maternity services across the sub-region.  This review was being undertaken with the support of provider organisations and the Cheshire and Merseyside Strategic Clinical Network (SCN).  It was reported that the involvement of the SCN was crucial as it ensured that clinicians were engaged in and leading this work. 

It was reported that work was currently underway to develop a baseline understanding of the nature and shape of maternity services in Cheshire and Merseyside.  Using all available data this was specifically looking at:

·             clinical outcomes;

·             patient experience and choice;

·             education and training of the current and future workforce;

·             co-dependencies with other services including neonatal intensive care, co-surgical support, critical care, A&E and other specialist services

·             safeguarding;

·             capacity and size of current provision;

·             current and future demographics and geographical access;

·             epidemiology of the population; and

·             current commissioning and financial arrangements.

The Board was further advised that the next phase of the work would involve developing options for improvement, using evidence of national and international best practice.  Any options for change would be subject to engagement and consultation with patients and the public in Cheshire and Merseyside.

The importance of getting the pathway correct for the child and mother was noted.    It was also noted that there was a lot of public health messages regarding anti-natal but more was required post natal to identify post natal depression and support young single women with their new born child. 

The Board raised concern that historically after giving birth the mother would stay in the hospital for a week and receive support from health visitors when they returned home, whereas now they are discharged after four hours with no aftercare.  In reply, it was reported that standards of care across pathways would be considered and creative ways to address issues would be identified.

The Board welcomed the report and that it would enable children to be born in the Borough.

After discussion, it was agreed that an update report be presented to a future meeting of the Board.

RESOLVED: That the report and comments raised be noted.