Agenda and minutes

The Chairman welcomed all to the meeting.

Apologies were received from Dr Andrew Girdher, Cara Charles-Barks (represented at the meeting by Andy Hyett), Tracey Dasziewicz, Nerissa Vaughan, Dr Bill Bruce-Jones and Chris Graves.

The Chairman noted that the Health Select Committee Chairman Councillor Christine Crisp was not able to attend but that the Committee’s Vice-Chair Councillor Gordon King was in attendance.

To confirm the minutes of the meeting held on 25 January 2018.

The minutes of the previous meeting were considered.

Resolved

That the minutes of the meeting held on the 25 January 2018 be confirmed as a correct record.

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

There were no declarations of interest.

·       Salisbury

·       CQC review in March

·       Local Area SEND Inspection Outcome

The following announcements were made:

·         CQC review in March

It was noted that there had been a recent CQC inspection that would be the subject of a report to the Health & Wellbeing Board at a later date once the full report had been released.

The Leader also took the opportunity to thank Graham Wilkin for his work at the authority as this would be his last day with the council.

·         Local Area SEND Inspection Outcome

It was noted that Ofsted and Care Quality Commission had undertaken an inspection to assess Wiltshire’s effectiveness in identifying and meeting the needs of children and young people who have special educational needs and/or disabilities (SEND). It was noted that the inspection letter had only been published recently, and that the authority was pleased overall with commendation for the  ambitious outcomes and good partnership working, but there remained areas for further focus including improving outcomes at KS4 and reducing exclusions.

·         Salisbury

The Chairman gave an update on the situation on Salisbury and recorded the thanks of the Board for the good partnership working evident in the aftermath.

The Council welcomes contributions from members of the public.

Statements

If you would like to make a statement at this meeting on any item on this agenda, please register to do so at least 10 minutes prior to the meeting. Up to 3 speakers are permitted to speak for up to 3 minutes each on any agenda item. Please contact the officer named on the front of the agenda for any further clarification.

Questions

To receive any questions from members of the public or members of the Council received in accordance with the constitution.

Those wishing to ask questions are required to give notice of any such questions in writing to the officer named on the front of this agenda no later than 5pm on Thursday 22 March 2018 in order to be guaranteed of a written response. In order to receive a verbal response questions must be submitted no later than 5pm on Monday 26 March 2018. Please contact the officer named on the front of this agenda for further advice. Questions may be asked without notice if the Chairman decides that the matter is urgent.

Details of any questions received will be circulated to Committee members prior to the meeting and made available at the meeting and on the Council’s website.

There were no public questions or statements received.

To update the Board on the implications of these reviews

Responsible Officers: Richard Crompton

Report author: Emily Kavanagh

Richard Compton, Chairman of the Wiltshire Safeguarding Adults Board presented the item to report to the Health and Wellbeing Board the outcome of two Safeguarding Adults Review (SAR) completed by the Wiltshire Safeguarding Adults Board (WSAB) in March 2018 and which are due to be published by the Board in April 2018. It was noted that the Safeguarding Adults Board must arrange a Safeguarding Adults Review (SAR) when an adult in its area dies as a result of abuse or neglect, whether known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult.

Matters highlighted in the course of the presentation and discussion included: the plans for next year, and how it will reflect any lessons learned from the reviews; how national changes and challenges are reflected in the incidents under review; the impact of financial and demographic pressures; the implications of legislative changes; that the last time there was a SAR/Serious Case Review in 2014; the processes for strengthening learning and partnership approaches to address the issues highlighted in the review; the learning from areas such as discharge and the opportunities that were not taken that could have improved the outcome; the concerns over self-neglect; that understanding in professionals about capacity and understanding was not deep-enough; issues in relation to self-funding and their impact; the adequacy of discharge planning;  that there had been some failures in communication and coordination; the continued focus on supporting training in particular; the impact of the reviews on the business and strategic plans; desire to continue to build capacity of board and agencies; the focus on preventative work; the opportunities to work with partners; that both reviews would be on the website in April, and that work had begun to develop plans in response to key recommendations and those needed for different individual agencies.

It was discussed that further information on the plans could be shared as soon as possible, and that the Board would want to see progress by summer and have review to the Health & Wellbeing Board at an appropriate date.

It was noted that discussions had started at the Joint Commissioning Board.

Recommendation

1. To note the outcome of the 2018 Safeguarding Adults Reviews relating to Adult A and to Adult B

2. To ensure that this learning has an impact on the work of its member agencies

3. To ask the WSAB to share the finalised action plan with HWB to ensure that the recommendations of the two SARs and the learning from these reviews are shared and effect change.

4. To support the necessary partnership resources to ensure that action plan can be delivered effectively.

5. To acknowledge the aims of the WSAB’s business plan for 2018-2019 and continues to support the work of the Board to safeguard vulnerable adults in Wiltshire

To review the implementation plan for end of life care for children, following input from local hospices.

Responsible Officer: Susan Tanner/ Ted Wilson

Report author: Myfi Champness

Ted Wilson and Myfi Champness presented the item which outlined the plan which had been developed following a multi-agency review of End of Life care for Wiltshire children against NICE guidelines. Chris Roys (Chief Executive of Jessie May) and Heather Philpotts (lead nurse for Julia’s House) were also be in attendance.

Matters highlighted in the course of the presentation and discussion included: that the development of the plan had been requested following the presentation of the plan in relation adults; the differences in the relation to services for children’s palliative care e.g that it is a smaller cohort and that there were different physical and psychological needs; that life-limiting conditions for children and young-people are often rarer conditions; the impact on the mental health of patients and families and the support to families; how the review has developed a better understanding and developed approaches to meet gaps in the care; that this was the start of an ongoing process; the importance of access to 24/7 medical cover and advice from paediatrics, and the options for providing this; that engagement with GPs is inconsistent, and the role for training and support; the support for other staff to develop specialisms in palliative care; how best to utilised data to help prevent deaths; that the steering group would meet quarterly; the desire to support people to die in the place of their choice.

In answer to a question from the Chairman, it was acknowledged that there could be greater provision for family support is before and after death and that could be considered in the plan.

Recommendation:

1. To note the findings of the review and associated resulting actions; and
2. That officers be asked to report progress to the Board at a later date.

To consider the transformation plan for maternity ahead of consultation.

Responsible Officer: Linda Prosser

Report author: Lucy Baker

Lucy Baker and colleagues presented the item which outlined the transformation plan for maternity ahead of consultation.

Matters highlighted in the course of the presentation and discussion included: that a Local Maternity System (LMS) had been created across our STP footprint to help the system respond to the nationally mandated Better Birth recommendations and further improve the experience for our local women and families; that the LMS was co-created, with service users and partner stakeholders, a Maternity Transformation Plan (MTP) to create a strategic vision for the future; the governance links to local, regional and national structures; the trend in births and the projections in different areas of the STP; the changes in demographics and challenges that this presents including obesity and breast-feeding initiation; the plans to reduce smoking; how best to incorporate other partners to progress the plan; the main aims driving the desire to change the service including a focus on safe outcomes, and parity of access; the financial and resource constraints; the timeline for the development of the project; how stakeholders are involved in the plan including those in hard-to-reach groups; the aim to make any changes cost-neutral; the increase in the take-up in flu vaccinations; the successes in reducing the risk of still-birth; the review of work-force numbers to meet demand across the area; the identified risk including understanding demand, and training and recruiting staff; the impact of digilisation and personalisation.

The Chairman requested that officers consider that officers consider undertaking a briefing for local councillors so they can understand it better.

Resolved

1.     To note the Maternity Transformation Plan; and

2.     To note the development of options for anticipated formal consultation from September 2018.

To receive an update on the delivery of the Better Care Plan for Wiltshire and emerging plans for 2018/19.

Responsible Officers: Linda Prosser, Graham Wilkin

Report author: Tony Marvell

Jeremy Hooper presented the item which gave an update on the latest figures for delayed discharges

Matters highlighted in the course of the presentation and discussion included: the January data and the trends; the different performances at different locations; the reasons for the delays; that the seasonal weather and flu were no the only reasons; that the JCB had considered the issues recently and discussed how family choice which impacts on these figures; the work to address domiciliary care issues; how to encourage smaller care providers in areas that larger organisation struggle to recruit.

Resolved

To note the update

To receive an update on the delivery of the Better Care Plan for Wiltshire and emerging plans for 2018/19.

Responsible Officers: Linda Prosser, Graham Wilkin

Report author: Tony Marvell

Tony Marvell  presented the item which gave an update on the delivery of the Better Care Plan for Wiltshire and emerging plans for 2018/19.

Matters highlighted in the course of the presentation and discussion included: the information in the dashboard, and the work to take stock of the Better Care Fund and whether the right schemes are in place to impact positively on the system; the changes to the governance of the BCF sitting alongside the JCB; the impact of the CQC review.

Resolved

To note the Performance levels contained in the Integration and Better Care Fund Dashboard and the completion of the Section 75 agreement.

An update on the rollout of Single View and the requirement for additional information sharing protocols

Responsible Officers: Carlton Brand, Linda Prosser

Report author: Ian Baker, Liz Creedy

Ian Baker and Liz Creedy presented the item which provided an update on the rollout of Single View and the requirement for additional information sharing protocols. The paper seeks approval to implement a single over-arching data sharing charter that will replace a number of existing agreements where partner organisations have a common obligation or desire to provide services within Wiltshire.

Matters highlighted in the course of the presentation and discussion included: the plans to revise existing data sharing agreements to have one data sharing agreement; the document was based on a Dorset charter already in use with over a 100 organisations; that proposals were fully compliant with new legislative requirements; that some organisations are already supportive; that there was some requirement for 2nd tier more detailed agreements; that police were very supportive; the wider role for the STP and that further information could be shared with them.

Resolved

That the Board recommend to constituent Board Members to:

1. Agree to progress the implementation of and sign up to the Wiltshire Information Sharing Charter (WiSC)
2. Agree to circulate draft to all constituent organisations
3. Bring back a later date to finalise signing.
4. Agree to nominate an information governance lead from their organisation who can assist in establishing a single Information Governance (IG) Board to sit across the whole of Wiltshire, so progressing the implementation and continuation of the Wiltshire Information Sharing Charter.
5. Encourage all partners to nominate IG contact.

A presentation seeking agreement for Wiltshire’s participation in the PHE Mental Health Concordat.

Responsible Officer: Tracy Daszkiewicz

Report author: Karen Spence

Kate Blackburn presented the item which sought agreement for Wiltshire’s participation in the PHE Mental Health Concordat.

Matters highlighted in the course of the presentation and discussion included: that the concordat had been launched by Public Health England; that the concordat was looking at the wider determinents; the steps towards developing a plan, and what work was already in place including understading needs and the resources available; that officers intended to come back with a local Wiltshire concordat to circulate  to all organisations before adoption by the Board.

Recommendation:

That the Health and Wellbeing Board take a lead role by:

·        Signing up to an agreed concordat, and to recommend that constituent partners and wider stakeholders sign up too;

·        agreeing to raise the profile of this work

·        inviting partners and other groups to account for progress

·        supporting coordination across the system

To ask officers to bring back a paper to:

• address how the Health and Wellbeing Board might identify, in its priorities, one or two additional specific preventative activities
• invite partners and other groups to account for progress
• support coordination across the system initiatives to promote good mental health and wellbeing in Wiltshire.

A presentation on progress with the action plan, places of safety and the pathways review.

Responsible Officers: Ted Wilson

Report author: Georgina Ruddle

Ted Wilson gave the presentation updating the meeting on the mental health crisis care concordat.

Matters highlighted in the course of the presentation and discussion included: that the places of safety had now been centralised in Devizes; the instances of delays in assessment; the additional investment in medical resources needed to undertake assessments; that officers had led the project across the STP to develop a place of calm café with the voluntary sector but that officers were awaiting the outcome of the bid for funding for the project; the continuing challenges that need to be addressed with the wider-sector; that there are still a lot of police time taken up with dealing with issues.

The Chairman noted that she was pleased to see that an agreement with Swindon had been reached.

Cllr Jerry Wickham stated that information in further updates regarding occupancy rates and where people had been referred from.

Resolved

To note the update.

The next meeting will be on 17 May 2018

It was noted that the next meeting would be on 17 May 2018

There were no urgent items.