Agenda and minutes

To include the following:

Chairman’s Announcement – RNIB Eye Pod at County Hall

The Chairman welcomed all to the meeting and provided the following announcements:

·         The RNIB Eye Pod Simulator was outside County Hall.  All were encouraged to attend where possible as the Pod provided a good insight into the various eye conditions and what services were available.  The Pod was on site until 6pm.

·         Christine Graves, Healthwatch Wiltshire representative on the Board, had been taken into hospital and was unable to attend the meeting.  The Chairman extended the best wishes of the Board for a speedy recovery.

·         The CQC would be re-inspecting Bath RUH in December and would also be undertaking public meetings on Thursday 5 December at the following two locations:

Bath Racecourse – 6:30pm

County Hall, Trowbridge – 6:30pm

·         The agenda had been republished to incorporate the following amendments:

Item 10 – Safeguarding Boards Annual Report – a revised report in relation to the Wiltshire Safeguarding Children Board Annual Report was provided.

Item 14 – Adult Autism Self Assessment – this had been moved to the end of the agenda.

Apologies for absence were received from:

Christine Graves (Healthwatch Wiltshire)

Dr Toby Davies (CCG Chair of SARUM Group)

Iain Tully (Avon and Wiltshire Mental Health Partnership)

Cllr Ian Thorn (Opposition Group)

To approve and sign the minutes of the meeting held on Thursday 12 September 2013.

The minutes of the previous meeting held on 12 September 2013 were signed and approved as a correct record.

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

There were no declarations of interest received.

The Board adopted a revised version of the Joint Health and Wellbeing Strategy at its meeting held in September 2013 and resolved to receive a further progress report at its next meeting.

A report is now attached outlining recent activity and progress made against the priorities of the strategy for the Boards consideration and comment.

This item was moved forward on the agenda whilst the Board awaited the arrival of Ian Biggs (Area Director, NHS England) for the ‘Call to Action’ item 5.

The Board at its previous meeting held in September 2013 formally agreed the Joint Health and Wellbeing Strategy and requested a progress report on the work currently underway in relation to its delivery. 

In addition the Board had also requested that an easy read version of the document be prepared to ensure the content of the Strategy was communicated effectively.  Thanks were given to the Associate Director for Communications and Communities for the preparation of the branded document in conjunction with colleagues within the authority and CCG.

The Associate Director provided hard copies for consideration by Board members and confirmed that it captured the essence of the strategy and its main priorities in a plain English format.

Deborah Fielding, CCG, confirmed that the item linked well with the presentation that would follow on ‘A Call to Action’ and congratulated the Communications team at Wiltshire Council for its preparation, noting the easy to read format.

The Chairman confirmed the importance of releasing the document at the earliest opportunity to highlight the work being undertaken and the priorities identified.  With this in mind all were requested to provide any feedback to the Wiltshire Council Communications team within the next 7 days. 

The Associate Director for Communications and Communities was working with the CCG to develop a communications plan.  This would include the circulation of the Strategy which would be disseminated within the county to public locations, such as libraries, GP surgeries, leisure centres, etc.

The Chairman thanked the Associate Director again for the preparation of the document and looked forward to seeing the finalised version shortly.

Resolved:

That the Board:

1)    Note the progress made on joint activity to deliver Wiltshire’s Joint Health and Wellbeing Strategy;

2)    Agrees to a full annual report by the end of 2014 to inform any update of Wiltshire’s Joint Health and Wellbeing Strategy; and

3)    Requests that any comments in relation to the plain English version of the document be provided to the Associate Director, Communications and Communities within the next 7 days from this meeting.

In June 2013, NHS England announced the start of a strategic process led by NHS England in partnership with Clinical Commissioning Groups (CCGs), Health and Wellbeing Boards and national partners.

The process is intended to promote a new style and method of working focused on how best to shape care around the interests of patients now and for future generations.

A presentation providing further information will be given by Deborah Fielding (CCG), Debra Elliott (NHS England) and Maggie Rae (Wiltshire Council).

Noting that in June 2013 NHS England had announced the start of a strategic process led by NHS England in partnership with Clinical Commissioning Group (CCGs), Health and Wellbeing Boards (HBSs) and national partners, a request was made at the last meeting of the Board for a presentation to be made providing further details on the NHS ‘Call to Action’.

Ian Biggs (Area Director, NHS England) was in attendance to provide a presentation on ‘Call to Action’ in conjunction with Deborah Fielding (Chief Officer Wiltshire CCG) and Maggie Rae (Corporate Director, Wiltshire Council).

In making the presentation, Ian Biggs confirmed that ‘Call to Action’ was a sustained programme of engagement to seek the views of patients, the public, staff and stakeholders to assist with future planning of services to reflect the needs of the population, within the funding available.

In drawing the Board’s attention to the projected resources available up to 2020/21 it was noted that a financial gap of approximately £30bn would exist in order to meet the population needs.  An ageing society, an increase in long-term conditions and lifestyle risk factors would all provide further financial pressures on the system.

Recommendations for improvement already existed with the release of key documents (such as the Bruce Keogh report and Berwick review); it was acknowledged that further changes would be required.

The way in which healthcare was delivered would need to be organised in such a way that services supported primary care and met the needs of the patient within the community itself.  A significant shift in future resource was likely to provide services that allowed patients to remain at home where possible.  This would meet the needs of the patient, reduce financial pressures and the associated pressures on hospitals.

Promoting healthier life paths and driving a preventative rather than reactive approach to healthcare would be required.  This would be achieved by giving service users a greater control over their health and moving away from a one size fits all model of care.

Deborah Fielding confirmed that Wiltshire was in a strong position in comparison with many other areas, noting the preventative measures already in place.  This would be emphasised further with the support of the clinical executive who would continue to focus on local services, policy development and planning.

Noting the financial implications a severe winter could have on resources, information on the preparations of all three hospital trusts in the area, Primary Care, Wiltshire Council the Community and Medvivo WMS was highlighted.

As part of ongoing consultation, NHS England has requested CCGs to lead on the development of a local 5 year plan, noting that financial planning in the past has been arranged in one or two year blocks.  Wiltshire CCG were currently in the second year of their ‘Clear and Credible’ Plan and were currently working up commissioning intentions for 2014/15 which would be announced shortly.  The 5 year plan would run from 2014/15 to ensure an overlap with the 2014/15 Delivery Plan.

Key assumptions had been  ...  view the full minutes text for item 23.

The Board resolved at its previous meeting to receive an update report on the work being undertaken for future integration of commissioning and service delivery.

A joint report from Wiltshire CCG and Wiltshire Council is now provided with details of the work taking place.

The Board is asked to endorse the next steps proposed within the report.

At its previous meeting the Board requested to receive an update on work being undertaken for future integration of commissioning and services delivery between Wiltshire Council Adult Social Care services and Wiltshire CCG.

Deborah Fielding presented the report which included a proposed approach to commissioning and set out key governance steps to ensure effectiveness was enhanced.

A working group has been established reporting initially to the Joint Commissioning Board for Adults’ Services, to help develop future integration plans, including to outline plans for the Integration Transformation Fund (ITF).  Although this would not come into full effect until 2015/16 there was a clear expectation from central government that CCGs and local authorities should have a two-year plan in place from March 2014.

The report proposed that a report on the two-year integration plans be presented to the Board in March 2014.  However it was noted that these were to be submitted to NHS England at that time and therefore the report should be brought back for the Board’s consideration in January 2014 to ensure any comments received could be incorporated.

During discussion clarification was also sought on the outcome of conversations taking place between CCG and NHS England with regards to Community Services Transformation, as highlighted at the previous meeting of the Board.  It was noted that a paper was to be presented to the CCG on Tuesday the following week.  The Board would be provided with details on the outcome of this meeting in due course.

Resolved:

That the Health and Wellbeing Board:

1)    Note the developments in respect of integration of health and social care services; including:

·         The ongoing development of a shared vision

·         The establishment of an officer working group reporting to the Joint Commissioning Board (JCB) and shared principles for joint commissioning

·         The drafting of a Joint Business Agreement (JBA) to provide a framework for all existing and new joint arrangements

·         The ongoing development of proposals for joint commissioning of learning disabilities services and mental health services, which will be reported back to the Board for decisions in early 2014

·         Community transformation development

·         The work towards planning for the Integration Transformation Fund (ITF)

2)    Receive a report at its meeting in January 2014 on the plans for use of the Integration Transformation Fund (ITF) ahead of its submission to NHS England in March 2014.

3)    Endorse the commitment to a shared intent to move towards the further joint commissioning of community services and authorise the Joint Commissioning Board (JCB) to develop next steps in terms of:

·         The scope of services to be jointly commissioning or aligned

·         Recommending any organisational/structural changes required to support joint commissioning

·         Setting out performance monitoring and review frameworks

4)    Note the pending decision of the CCG Governing Body on 26 November 2013 regarding tendering options for community health services and that the Board is updated on the outcome of this meeting in due course.

The Board at its previous meeting in September resolved to receive a further update report on progress made in relation to the DoH report ‘Transforming Care: a National Response to Winterbourne View Hospital’. 

A joint report from Wiltshire CCG and Wiltshire Council is now provided for the Boards consideration and comment.

The Board at its previous meeting in September considered a joint update from Wiltshire Council and Wiltshire CCG on progress made in relation to the Department of Health (DoH) report ‘Transforming Care: a National Response to Winterbourne View Hospital’ and resolved to receive a further update at its next meeting.

An update report was duly presented by James Cawley, Associate Director Wiltshire Council who highlighted that the report was as a result of the CQC visit which had asked all involved to respond accordingly on how they were to progress joint commissioning issues in addition to the outcome of individual cases.

The Board noted the report which included a stock take on progress made as well as work still to be undertaken in relation to future integration of service.  Reassurance was also given that the care needs of former residents were being met in the most appropriate way.

The Chairman thanked the officer for the report and requested that the Board receive future regular updates.

Resolved:

That the Board would receive a further update report in May 2014.

The Public Health Annual report, highlighting public health activity for 2012/13, was noted by Wiltshire Council Cabinet at its meeting held in September 2013.

A link to the report is provided with this agenda and hard copies will be made available at the meeting for noting.

The Public Health Annual report, which highlighted public health activity for 2012/13, was presented by Maggie Rae, Corporate Director Wiltshire Council.

Confirmation was given that the integration of public health was at the heart of all public services and was one of the 12 objectives identified within the Wiltshire Council Business Plan to help deliver the 3 priorities of the authority.

The report had been presented to the Wiltshire Council Cabinet in September and would be presented to the CCG Board at its next meeting in November.

It was hoped that the document would be distributed widely.  With this in mind it was proposed that distribution should take place alongside that of the easy read version of the Joint Health and Wellbeing Strategy.

A report from the Wiltshire Safeguarding Adults Board (WSAB) is attached for the Board’s consideration.

A further report from the Wiltshire Safeguarding Children Board (WSCB) is also attached requesting that the Board invite the Independent Chairman to attend its next meeting in January where the WSCB Annual Report will be considered.

Attendees were reminded that the agenda had been republished to incorporate a revised report in relation to the Wiltshire Safeguarding Children’s Board Annual Report which would now be brought to the Board for consideration in January 2014.

James Cawley, Associate Director Wiltshire Council, and Margaret Sheather, Independent Chair of the Wiltshire Safeguarding Adults Board, were welcomed to the meeting to present the WSAB Annual Report, copies of which were available at the meeting and electronically.

The Independent WSAB Chairman was pleased to be able to present the 2012/13 report to the Board noting that the previous year’s annual report had been considered by the Board in its shadow form.  With this in mind it was acknowledged that the HWB was the natural partner to which the Safeguarding Adults Board reports.

The Board were asked to note the progress made in terms of the WSAB’s responsibilities which had continued even with the continued change and financial pressures faced by public services.

The WSAB would also soon be on the same statutory footing as the WSCB following changes made in the Care Bill.  Further details in relation to the outcome of regulations and resulting guidance were awaited whilst the Bill moved through parliament.

The Board was fully supportive of the work undertaken by the WSAB and thanks were given to the Independent Chairman in attendance for the report.

Resolved:

1)    That the Board note the report provided; and

2)    That the Wiltshire Safeguarding Adults Board (WSAB) accepts the Health and Wellbeing Board (HWB) as the partnership to which it reports.

A review of the End of Life Care Strategy is currently being undertaken by Government and is due to be reported in January 2014.  The Secretary of State for Health has written to Health and Wellbeing Boards to alert them to the work being undertaken and inviting them to consider it within their own JSNA and JHWS. 

Wiltshire’s Joint Health and Wellbeing Strategy already includes a range of activity in Wiltshire to improve end of life planning and coordination and an End of Life Strategy Group is currently drafting a revised strategy for Wiltshire which should also be available for discussion in January.

A report for the Board’s consideration is provided.

The Secretary of State for Health had written to Health and Wellbeing Boards alerting them to a review of the End of Life Care Strategy and requesting that each consider the Strategy within their own Joint Strategic Assessment (JSA) and Joint Health and Wellbeing Strategy (JHWS).

Wiltshire’s JHWS already includes a range of activity on end of life planning and coordination.  In addition a strategy group was drafting a revised Strategy for Wiltshire which was expected to be available for discussion in January 2014.

The Chairman, in noting the positive work being undertaken to ensure an effective Strategy, stressed the importance of also ensuring delivery of the service and the aspirations for Wiltshire to be the best provider of that service.

In considering care provided, the Board expressed concern with the number of people that were still admitted to hospital at the end of life and were supportive of a system that with the right support would allow patients to be at home, noting that patient choice remained at the heart of care provided.

Deborah Fielding confirmed that a CCG working group of experienced individuals had already been established to consider end of life care provided.  It was therefore proposed noting that Deborah Fielding was a lead on this group that it should be asked to consider the current approach to end of life care in Wiltshire and report back to the Board by March 2014.  All were in favour of this request.

Resolved:

That the CCG working group would review the approach to end of life care in Wiltshire and report its findings to the Board at its meeting in March 2014.

From April 2013 NHS England took up its duties to deliver better outcomes for patients within its available resources.  One of the responsibilities will be to directly commission health services for those members of the Armed Forces and their families registered with Defence Medical Services Medical Centres.

The attached report sets out where NHS commissioning responsibility lies for all members of the Armed Forces Community.

The Board is asked to note the report and NHS England’s desire for the commissioning of health care services to be discussed at the Military Civilian Integration Partnership with the objective of developing and agreeing a co-commissioning approach to armed forces personnel and their families.

From April 2013 NHS England was tasked with ensuring the delivery of better outcomes for patients within its available resources, including the commissioning of health services for armed forces members and their families registered with Defence Medical Services Medical Centres.

Debra Elliott, NHS England, had requested that the Board consider a report outlining where joint commissioning responsibility lies and requesting that the Board approve the proposed plans within.

The Chairman, before handing over to Debra Elliott, confirmed the pertinence of the report, noting the rebasing of approximately 4,000 armed forces personnel in Wiltshire by 2020.

Debra Elliott confirmed that NHS England would be responsible for the commissioning of services for armed forces members and their families, with the CCG taking responsibility for non registered and veteran personnel.

Noting the plans for army rebasing in Wiltshire and the services that would be needed, discussions had already commenced between NHS England, Wiltshire Council and the CCG on how these would be delivered.

To ensure adequate consideration of the health and wellbeing services that would be required it was proposed that joint commissioning be discussed at the Military Civilian Integration Partnership (MCIP) hosted by Wiltshire Council, to agree a joint commissioning plan.

During discussion the important work of the Armed Forces Network was raised and it was agreed that this should have been identified within the report.

In order to identify at as early a stage as possible the requirements of personnel moving back to the UK, officers had been in discussion with families based in Germany with further contact planned.

Deborah Fielding, CCG, confirmed that a similar venture had been undertaken with Gloucester Council the previous year and was therefore fully supportive of this approach.

Discussions were also taking place with all 3 acute hospitals and these would be taken into consideration as part of the joint commissioning plans.

Resolved:

That the Board acknowledge that joint commissioning of services will be discussed at the Military Civilian Integration Partnership (MCIP) hosted by Wiltshire Council with the objective of developing and agreeing a joint commissioning plan for armed forces personnel and their families who are currently or will be residing in Wiltshire.

The Board holds an important relationship with other governance structures, including that with Council, Safeguarding and joint commissioning boards for adults and children’s services. 

To assist partners with their role on the Board and as a reminder of current arrangements governing health and wellbeing in Wiltshire a report is attached which sets out the relationship of the Board with the other governance structures.

The Health and Wellbeing Board has a number of important relationships with other governance structures, including the Council, safeguarding boards and joint commissioning boards for adult and children services.

To allow the Board to undertake its work effectively, it is important that all partners have a shared understanding of its role and that of the differing boards responsible for varying aspects of health and wellbeing in Wiltshire.

Noting the significant changes in governance arrangements as a result of the Health and Social Care Act 2012 of which were outlined and endorsed within a report to Full Council in May 2013, a report to the Board outlining the current governing arrangements was presented by Robin Townsend, Interim Associate Director Wiltshire Council.

Upon consideration of the report, it was noted that the Terms of Reference for the Joint Commissioning Board required updating in light of the report to full council which outlined the relationship between the Commissioning Board and Health and Wellbeing Board.  Further clarity was also sought on how the Board undertook future work planning. 

Resolved:

1)    That details of the work identified by the Health and Wellbeing Board for future consideration would be shared with members of the Board and Health Select Committee for comment; and

2)      That a revised report on governance arrangements would be presented to the Board at a later date to reflect any developments since consideration of the report to Full Council in May 2013.

The Department of Health (DoH) is currently leading a formal review of progress against the Adult Autism Strategy including seeking assurances from local authorities and the NHS on progress made and that the Strategy objectives remain fit for purpose.  Local authorities were contacted to provide assistance in taking forward a second self assessment exercise. 

As part of the process, Health and Wellbeing Boards are expected to discuss the assessments by the end of January 2014 to provide evidence for local planning and health needs assessment strategy development and to support local implementation work.

In line with this request a report is attached for consideration and comment.

The Department of Health (DoH) was leading a formal review of progress against the Adult Autism Strategy.  As part of this process local authorities had been contacted and asked to take forward a second self assessment exercise to be submitted to the DoH as part of the review.

The findings of the assessment, undertaken by the Wiltshire Autism Partnership, were presented in the report which the Board was asked to support.

Patti Harrison, Wiltshire Parent Carer Council (PPCC) representative on the Wiltshire Autism Partnership, was welcomed to the meeting to present the report.  In doing so, Patti confirmed her support for the multi-agency approach to developing the Wiltshire Strategy and the work being undertaken by the authority to spread awareness. 

Emphasis was put on the funding and support available, noting that ongoing support for those leaving education was required to ensure next steps toward independence could be achieved. 

Adults of all ages were now able to access a diagnostic service.  Although this was a positive step forward, the next stages post diagnosis were equally important with suggestions discussed on how this could be improved which included:

·         The publication of material providing frequently asked questions and details of available support services;

·         Follow up appointments to allow for the digestion of information by those diagnosed, noting that there were likely to be many questions once diagnosis was made.

Noting that within the children’s services department a post diagnostic pack was being developed, it was proposed that this could perhaps also be adapted for use by adults.

An attending Avon and Wiltshire Mental Health Partnership (AWP) representative (commissioned by the CCG to provide diagnostic services within Wiltshire) would feed back the comments of the meeting to the respective officers for due consideration.

Resolved:

That the Health and Wellbeing Board was fully supportive of the direction that the Wiltshire Autism Partnership was taking.

There were no urgent items considered.

The next meeting of the Health and Wellbeing Board will take place on 16 January 2014.

The meeting will take place at 3pm at Great Western Hospitals Lecture Hall, Swindon.

The next meeting of the Board would take place at 3pm on Thursday 16 January 2014 and would be held at Great Western Hospital Lecture Hall, Swindon.