Agenda and minutes

The membership of the Health and Wellbeing Board was agreed at Full Council at its meeting held on 14 May 2013.  In agreeing the membership it was resolved that the Leader of the Council be appointed as Chairman to the Board.

The Chairman, Cllr Jane Scott OBE, will welcome the newly appointed members to the Board and provide an introduction on how it is proposed the Board operate to ensure strong partnership working in the future.

The Chairman welcomed everyone to the first formal meeting of the Board, noting that the Board had been in shadow form to establish priorities prior to becoming statutory in April 2013 via the Health &Social Care Act 2012. 

Attendees were reminded that the Board had a duty to encourage integrated working between health and social care commissioners across the county and the Chairman looked forward to working with all partners of the Boards.

Before proceeding through the agenda, it was confirmed that a request had been received for the Vision Ahead item to be considered immediately following Item 5 (Joint Health & Wellbeing Strategy).  As there were no objections to the change in order this was agreed.

To confirm Steve Rowlands (Chair of Wiltshire Clinical Commissioning Group (CCG) as Vice Chairman of the Health and Wellbeing Board.

Dr Stephen Rowlands (CCG Chairman) was confirmed as Vice Chairman of the Health and Wellbeing Board.

Apologies for absence were received as follows:

Chief Executive Bath RUH (James Scott)

Patrick Geenty (Wiltshire Police Chief Constable)

Cllr Ian Thorn (Opposition Group representative)

Iain Tully (Avon & Wiltshire Mental Health Partnership)

Ken Wenman (South West Ambulance Service Trust)

Joss Foster (Bath RUH) attended on behalf of James Scott.  Dr Julie Hankin (AWP Clinical Director for Wiltshire) deputised for Iain Tully.

To declare any personal or prejudicial interests or dispensations granted by the Standards Committee.

There were no declarations of interest received.

To consider the Joint Health & Wellbeing Strategy which outlines the findings of the consultation undertaken by the Shadow Health and Wellbeing Board on Wiltshire’s draft Health and Wellbeing Strategy.

Maggie Rae, Corporate Director Wiltshire Council, introduced the Joint Health and Wellbeing Strategy which the Board had a statutory function to prepare and approve. 

In considering the strategy the Board were reminded that the Shadow Health and Wellbeing Board had been involved in the preparation of the strategy presented today which had also taken into consideration the views of the voluntary sector, area boards and the public as part of the consultation.

Deborah Fielding, Chief Officer CCG, confirmed that all parties had worked well together to produce the joint strategy which covered the mandate well and had resulted in an exciting approach.  This was fully supported by the Corporate Director with statutory responsibility for children’s services.

In opening up discussion to the floor, the NHS England representative, Debra Elliott, welcomed the document, confirming that she felt this would form a good building block for future strategies and requested that the minutes reflect her thanks to the work that had taken place in forming the strategy.

The Chairman, in drawing the Boards attention to the proposals as outlined in the report, requested an additional recommendation that an annual report highlighting progress should be brought back for consideration.  However, this should not deter update reports being presented in the interim period where significant changes were made.

It was therefore proposed that a short paper on performance monitoring of the Strategy be presented to the next meeting of the Board in November.

To communicate the content of the strategy effectively an easy read version and appropriately branded version would be requested.

In concluding discussion it was resolved as follows:

Resolved:

That the Board:

1)    Notes the findings of the consultation on the draft Joint Health and Wellbeing Strategy;

2)    Adopts the revised version of the Strategy presented to the Board as the final version;

3)    Reaffirms its commitment to reviewing the strategy again in 2014; and

4)    Receive a progress report on the Strategy at its next meeting in November 2013 with further updates provided as and when necessary thereafter.

To consider the Vision Ahead report which includes proposed improvements to services supporting the visually impaired.

Phil Matthews, Chairman of the former Wiltshire Involvement Network (WIN), was in attendance to present the Vision Ahead report which looked at the support for those with sensory impairments in the county and how this could be improved.

In presenting the report Mr Matthews confirmed the work undertaken had resulted in 24 recommendations, details of which were detailed within the report.

James Cawley, Service Director Wiltshire Council, emphasised the positive work undertaken to produce the report, the good partnership working and agreed that individual organisations should be encouraged to consider the recommendations provided and find ways to implement where possible. 

The Board welcomed the report and proposed that the Adults Joint Commissioning Board take forward the recommendations made.

Resolved:

That the recommendations contained within the Vision report be passed to the Joint Commissioning Board to progress.

Cllr Laura Mayes, Cabinet member for Children’s Services, to provide an update on the findings of the recent unannounced OFSTED inspection.

Cllr Laura Mayes, Cabinet member for Childrens Services, gave a verbal update following the recent unannounced Ofsted Inspection in July.

Cllr Mayes was pleased to confirm that a judgement had been made in August that the classification of the services for the protection of children and young people had now moved from inadequate to adequate.  Thanks were given to Carolyn Godfrey, Corporate Director with statutory responsibility for children’s services, and her team acknowledging the significant changes that were brought about in order to achieve the change in status.

Cllr Mayes commented that she was now much more confident in the quality of services, however, there was still more to do and the Council was not complacent. The aspiration was to provide an outstanding service for children and young people.

For those wishing to view the Ofsted report this could be found via the following link:

www.ofsted.gov.uk

Resolved:

To note the update provided.

To consider the attached joint report between Wiltshire Council and CCG which provides an update on the actions being undertaken to ensure safeguarding.

James Cawley, Service Director Wiltshire Council, presented the joint report from Wiltshire Council and Wiltshire CCG which provided details on progress made in relation to the Department of Health’s (DoH) recommendations.

In presenting the report attention was drawn to areas requiring further work as outlined which included governance arrangements and the roles and responsibilities within the team which was progressing well with regular discussions on progress taking place.

Joint Commissioning was also identified as an area requiring further work with confirmation that the Joint Commissioning Board was to consider a report at its October meeting which would include an update on the expected standards identified by the DoH.

Attention was drawn to Appendix 2 of the report (Action Plan) which having been in place for a significant period of time had resulted in most of the actions now being completed.

Confirmation was given that the Wiltshire residents who had been placed at Winterbourne View were now safe and comfortable and being looked after well.

To ensure the Board remained fully updated on progress made, it was proposed that a report from the Joint Commissioning Board would be presented to the Board at its next meeting in November.

Resolved:

1)    That the Board note the report and progress made in relation to the Department of Health report ‘Transforming Care: a National Response to Winterbourne View Hospital’; and

2)    That an update report be presented to the Board at its next meeting in November 2013.

To consider the attached report on the temporary transfer of maternity services from Trowbridge Birthing Centre.

Nerissa Vaughan, Chief Executive Great Western Hospital (GWH), presented the report provided on the temporary transfer of maternity services from Trowbridge Birthing Centre.

In presenting the report clarification was made that a visit by the Care Quality Commission (CQC) in December had resulted in concerns over midwifery staffing levels which had not met national guidelines.  Although it was understood that in part this was caused by natural reductions such as holidays and sickness levels, the Trust had invested a further £250k towards staffing and the Centre was now in a position to reopen on 30 September 2013.

The Chairman proposed that a joint press release from the Board and GWH be released providing clarification of the Centre opening date and that a briefing note should also be provided to Wiltshire Councillors at the same time.

In discussing lessons learnt, the Chief Executive apologised for the way the information had been made public.

The Chairman thanked Nerissa Vaughan for the update and it was resolved as follows:

Resolved:

1)    To note the update provided; and

2)    That a joint press release from the Health and Wellbeing Board and Great Western Hospital and a Councillor briefing note would be provided to include details of the reopening dates of the Birthing Centre.

To consider the report on community services provision, inclusive of tendering and integration of service plans.

The Chairman clarified that there were several service transformation projects underway at present but that the report presented today related to adult community services.  Children’s services commissioning was being reviewed and would be on a future agenda for the Board’s consideration.

The Chairman introduced Debbie Fielding, Chief Officer Wiltshire CCG, who was asked to present the report on adult Community Services Transformation.

In presenting the report note was made that the Board, in its shadow form, had also considered several update on the review of adult community service provision.  It was also noted that an important part of the proposed service provision would be the clustering of GP hubs and the CCG were working closely with GP colleagues to develop services around GP practices.  With this in mind, it was proposed that primary care services would be based around 23 clusters, each with a population of around 20,000.  A Care Coordinator would be assigned to each cluster and it was understood that there was almost a full complement now appointed.

The above model of care would be aligned to meet the needs of the population throughout their lives, striving to ensure people were able to live independently at home for as long as possible.

The priorities for joint health and social care development were also highlighted.  These included the STARR scheme (for supporting those coming both in and out of hospital), multi-disciplinary working and work around Transfer of Care.  Noting the latter it was confirmed that a pilot project had been running at the Bath RUH to identify patients who, with the right packages of care, should be better placed to leave hospital at an earlier opportunity.  

It had been noted that a rapid response within one hour of crisis contributed to reducing unnecessary admissions.  The Care Coordinators would take on the responsibility of working within this timeframe and were expected to work in conjunction with a simple point of access for healthcare professionals.

In noting the positive joint commissioning of voluntary and community sector services already in existence, the Community Transformation Programme would also be exploring other opportunities in this area.

Maggie Rae, Corporate Director Wiltshire Council, thanked all involved in the current delivery of community services and was pleased to see the proposed local service model presented, noting the national mandate issued by central government for integration of health and social care services by 2018.

The Board recognised the need for cultural change and for the public to be kept abreast of services changes in the future, noting that as the integration of service developed there would be a natural change in culture and expectations.  Strong, clear and consistent communication of this message would also be required.

All were in agreement with the content of the report and its aims but recognised that the timeframes around the retendering of contracts could be problematic.

The Chairman, in expressing concern over the timeframe, noted that it could impact on integrated services with uncertainty on how partnership working could be developed  ...  view the full minutes text for item 10.

To consider the attached PNA report, noting that the Board has a statutory function to publish its first PNA no later than 1 April 2015.

Maggie Rae, Corporate Director Wiltshire Council, presented the report on Pharmaceutical Needs Assessment (PNA), noting that the Board was required by statute to develop and publish the PNA by 1 April 2015.

The Board were asked to note that a small working group had met to discuss the requirements, the membership of which were outlined within the report.  The working group having considered the requirements placed upon the Board felt that the inherited PNA was fit for purpose and made proposals for the future development of the PNA.  This included proposals for consultation and sign off on a new PNA ahead of April 2015.

The Chairman thanked the Corporate Director for the report and the Board resolved as follows:

Resolved:

That the Board:

1)    Accept the recommendations from the PNA group that the inherited PNA is fit for purpose;

2)    Agree the proposed timeline for publishing the first HWB PNA and inclusion of the PNA on the forward plan for July 2014 and February/March 2015;

3)    Delegate the PNA process and decisions to the PNA working group which includes two Health and Wellbeing Board members (Cllr Keith Humphries and Steve Rowlands); and

4)    Delegate the updating of the PNA to the Director of Public Health and the Public Health lead.

To consider the attached report on future funding of serious case reviews.

James Cawley, Service Director Wiltshire Council, presented the report on funding for serious care reviews which requested that a full partnership approach to adult case reviews should be undertaken, including equal financial contributions from each of the commissioning bodies.

Ensuing discussion included the difference in funding arrangements between Children’s and adults safeguarding noting the statutory functions placed on the LSCB.

In noting the differences in approach to the children and adult boards and that the adult board was to become affected by statute in the future it was proposed that a report on the funding approach of both Boards (not just for serious case reviews) be considered by the Board in due course.

The Service Director clarified that the proposal for funding applied to commissioning partners only and as such requested that the Police and Crime Commissioner (PCC), CCG and Wiltshire Council representatives consider whether equal contributions of around £15k each would be acceptable.

All were in favour of the proposal and each would ensure that written confirmation of this would be provided.

Resolved:

That the involved partners (namely Wiltshire Council, CCG and PCC) contribute on an equal basis towards the cost of serious case reviews (envisaged to be approximately £15k).

To note the attached update report on the Disabled Children and Adults Pathfinder project and ongoing consultation.

Julia Cramp, Service Director Wiltshire Council, was in attendance to present a report which outlined the requirements of the Children and Families Bill, provided a brief update on progress in relation to the Pathfinder project and consultation to create a fully integrated 0-25 Special Educational Needs and Disability (SEND) Service.

In presenting the report clarification was made that the Bill required organisations to work together to jointly commission services across education and care and to ensure clear guidance existed on those services.

The Service Director confirmed that the authority was in a good position to meet the requirements which included streamlining arrangements and creating an Education, Health and Care Plan for each young person by September 2014.

It was noted that the vision of the Bill for an integrated service focusing on the needs of children, young people and their families, was in line with the work already undertaken by the Pathfinder project and that the decision to re-align service structures for the creation of the SEND service had been fully supported by Cabinet.  Formal consultation with effected staff on the proposed structure was underway.

The Board noted the importance of ensuring that guidance on the service was available in an easy to read format for those using the service itself.  Specific reference was made to a recent easy read report presented to Swindon Borough Council as an indication of what might be required.  The JSNA report referred to was produced by the Swindon Advocacy Movement (SAM) and could be found via the following link:

http://ww5.swindon.gov.uk/moderngov/documents/s61668/LD%20-%20Appendix%202.pdf

The Chairman thanked the officer for the report.

Resolved:

To note the update provided.

To consider the attached report which outlines the Charter and the commitments placed on the Health & Wellbeing Board should it be adopted.

Julia Cramp, Service Director Wiltshire Council, introduced a report on the Disabled Children Charter which requested that the Boards consider signing up to the Charter, noting the commitment this would place upon it in doing so.

The Charter had been created to support HWBs in meeting their responsibilities towards children and young people with disabilities and SEN and was aligned with current SEND legislation changes as referred to within the previous item.

The Board were supportive of signing up to the Charter noting the commitments as outlined within the report.

Resolved:

1)    That the Board agree to sign up to the Disabled Children’s Charter; and

2)    That an update report would be brought back to the Board in 12 months on progress.

To consider the attached Health Prospectus which is intended to provide an introductory document to the CCG, its functions and purpose.

Debbie Fielding, Chief Officer CCG, presented the draft Prospectus for the Board’s consideration and comment.

In presenting the prospectus it was confirmed that at the formation of the CCG there had been a requirement to produce a 2 year plan (Clear and Credible Plan), detailed strategy and commissioning plans.  Details of this plan were considered by the Shadow Board and were available on the following website:

http://www.wiltshireccg.nhs.uk/publications/reports-and-strategies

NHS England had now requested that CCGs produce a prospectus based on the 2 year plan that was easily understood by the public.  The version provided for discussion was at a very early draft stage whilst the communications team developed a more user friendly version.

Clarification was provided that the 2 year plan referred to above applied to 2013/14 and the CCG would be issuing details of its commissioning intentions for the following 3 to 5 years thereafter.  

In seeking the views of the Board, confirmation was provided that the document would include further information on partnership working.  The Wiltshire Council and CCG communications teams would assist further in this area.

Resolved:

1)    The CCG is asked to note the comments of the Board; and

2)    That Wiltshire Council and CCG Communication teams liaise to progress references to partnership working within the Prospectus.

21 November 2013.

The next meeting of the Wiltshire Health and Wellbeing Board would take place at 3pm on Thursday 21 November 2013. 

To consider any other items of business that the Chairman agrees to consider as a matter of urgency.

The Chairman asked that thanks be given to the Chief Executive of Salisbury Hospital for allowing the first formal meeting of the Board to be held at the venue.

All Board members were reminded that all partners were encouraged to request any relevant items for inclusion on future agendas.

With this noted, the CCG requested that the NHS England 10 year strategy (A Call to Action) be included as an agenda item at the next meeting to be held in November as it was felt that the consultation around the strategy should be led by the Board.  The consultation would be an opportunity to ask the community of Wiltshire to identify the health priorities within the resources available.

Resolved:

That the NHS England 10 year strategy (A Call to Action) would be considered as the first item at the next meeting of the Board in November.