Agenda and minutes

The Chairman welcomed all to the meeting and gave the following announcements.

Next meeting of the Board

The next meeting of the Board, to be held on 22 May, would now take place at the Headquarters of Avon & Wiltshire Mental Health Partnership (AWP) noting that the meeting would be themed around mental health.

End of Life Care

The Board resolved at its meeting in November that the CCG working group, who were undertaking an exercise to help develop a strategy on end of life care, would provide a report in March 2014.

The Group were still undertaking work to develop the report and therefore this would now be brought back to the Board for consideration at a later date.

Apologies have been received from Peter Hill (Salisbury Hospital).Tracey Nutter will be in attendance.

Apologies were received from the following:

Cllr Keith Humphries (Cabinet member for Public Health, Protection, Adult Care and Housing)

Nerissa Vaughan (Great Western Hospital)

Ken Wenman (South West Ambulance Service Trust).

To approve and sign the minutes of the meeting held on 16 January and Extraordinary meeting held on 6 February 2014.

The minutes of the meeting held on 16 January and extraordinary meeting held on 6 February were signed and approved as a correct record with the following amendment:

The attendance details for the meeting held on 16 January be amended to reflect that the Chief Executive of Bath RUH (James Scott) was in attendance.

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

No declarations of interest were received.

Maggie Rae (Wiltshire Council) and Deborah Fielding (CCG) will present a report providing details on the proposed management of the Better Care Plan for the Board’s consideration.  This arises following the submission of the draft Plan to NHS England on 14 February.

Noting that feedback is still awaited from NHS England on the draft submitted and that the final Plan is required by 4 April, the Board may be asked to delegate authority to the Chair and Vice Chair to make any required changes.  These would be reported to the next meeting of the Board on 22 May 2014.

Debra Elliott, representing NHS England, will be in a position to provide verbal feedback on the Plan at the meeting.

The Chairman reminded attendees that a draft Plan had now been presented to NHS England following consideration by the Board at its extraordinary meeting held on 6 February.  Thanks were given to those who attended for their contributions. 

The Chairman and Vice Chairman were keen to highlight the importance of the document and this was captured within the introduction of the vision document accompanying the Plan. 

Although the template provided by NHS England for completion and return was strict in its requirements with a clear focus on adult social care, the vision document accompanying the Plan would continue to be expanded over time to incorporate the care of all as part of ongoing care arrangements.

The Vice Chairman confirmed that the document fitted well with the 5 year strategic and 2 year operation plans of the CCG, details of which would be discussed later in the meeting under Item 6.  In recognised the importance of integration to ensure delivery of all, clarification was given that James Roach had now been appointed as the Integration Manager for Health and Social Care and would be commencing his new role shortly.  James had hoped to attend but was unable to do so due to previous commitments.

Paul Tarplett from the Office for Public Management (OPM) was also welcomed to the meeting.  Paul had been undertaking a piece of work on the system leadership provided by the Board.  Details of his initial findings would be circulated to Board members following the meeting.  This would include that behavioural change and development of strong relationships would be required to ensure effective delivery of the Better Care Plan.

Debra Elliott, NHS England, confirmed that the Plan had been well received by NHS England who welcomed the people centred approach and recognised the desire for a joint approach between the CCG and local authority.

Health and Wellbeing Boards would be contacted the week commencing 21 April and made aware of whether further work on the Plan was required or whether the plan as submitted had been signed off by the Minister.  It was hoped that the positive response received on the draft Plan submitted by the Board would indicate that it would fall within the latter of the two options.

It was suggested that a standing item appear on future agendas to allow for a short update on measures in addition to a yearly and six monthly report on progress.  The Board were in full agreement with this suggestion and future agendas would be amended accordingly.

The report as submitted was welcomed and the proposals within accepted, noting the addition of a standing update to the Board at each meeting.

Resolved:

·         To approve the proposed governance arrangements set out in paragraphs 4 to 7 of the report and that a standing update would be provided at each future meeting;

·         To approve the proposed programme management and support arrangements set out in paragraphs 8 to 15 of the report;

·         To approve the outline scope of each work programme as  ...  view the full minutes text for item 19.

Deborah Fielding, CCG, will present the draft CCG 5 Year Strategic and 2 Year Operational Plans, noting that both are expected to be approved by the Board in draft form no later than 4 April 2014 before their submission to NHS England.

Deborah Fielding, CCG, presented the report informing the Board of the draft CCG 5 year Strategic and 2 year Operation Plan, an initial draft of which had been submitted to NHS England for consideration.

In presenting the report Deborah Fielding asked that the Board be mindful that details of the Plans had previously been presented and that the next part of the process would be further engagement with stakeholders. This was include communication through Wiltshire Council area boards on how all partners were working together to deliver both this, the Better Care Plan and their connection with the Health and Wellbeing Strategy.

The Associate Director for Communications would work with the Chairman and Vice Chairman of the Board to develop an appropriate engagement plan with the area boards, details of which would be circulated to members in due course.

Resolved:

The Board endorsed the draft 5 year Strategic/2 year Operational Plan and agreed to delegate responsibility for any further changes to be signed off by the Chairman of the Board, noting that final submission of the 5 year Strategic Plan must be made by 20 June 2014.

Debra Elliott (NHS England) will provide an update on the development of the 5 Year Strategy for Specialised Services noting that it is expected to be published in draft form in the next few months.

Debra Elliott, NHS England, presented the report on the NHS England five year commissioning plan for specialised services. 

In presenting the report confirmation was given that the strategy was being developed following a period of significant change in the structures of specialised commissioning arrangements, noting that from April 2013 NHS England became the sole direct commissioner of specialised services. 

The report highlighted that the cost of NHS specialised health services was approximately £12 billion per year which equated to approximately 10% of the total annual NHS budget and detailed where NHS England was in relation to the development of the plan and consultation undertaken.  This included a well attended event held in Chippenham on 13 February as well as engagement with Overview and Scrutiny Committees (OSCs) and Clinical Commissioning Groups (CCGs).

The development of the strategy was to be separated into two parts:

·         A mission statement (detailing the director of travel for the strategy for 2014/15-2018/19; and

·         Service level planning (detailing priorities for individual services).

The new interim Chief Executive of NHS England, Simon Stevens, was likely to have a specific view on specialised commissioning and was expected to want to review any work undertaken before release in June 2014.

Concerns were expressed over the potential evolution of specialised services away from Wiltshire, noting that many services were already outside of the county.  The Board were also mindful of some transport issues to and from some specialised centres and the potential impact this had on the health and wellbeing of patients and were of the view that the development of a hub and spoke model would be desirable.

It was understood that concerns had also been raised by the Wiltshire Overview and Scrutiny Committee (OSC) and Public Health.  Discussions had taken place with the Director of Public Health England and also with the Director of Specialised Services. The Board were informed that further local discussion (including with OSCs and CCGs) was to take place to ensure there was a clear understanding of the national programme and to allow for any concerns to be discussed.

The question of how outcomes would be monitored for the new system against those of the old was raised.  Although there was confidence that good outcomes would be delivered there was still concern relating to the services that could be catered for within the existing acute hospitals and how they would continue to serve the local population.

Noting that further discussion were to take place, commissioning plans for specialised services would remain as an item for discussion at a future meeting of the Board.

The Chairman of the Health Select Committee, in attendance, confirmed that these concerns were indeed shared by the OSC and welcomed the opportunity to work with the Board in providing a joint response to NHS England on the subject.  An important immediate priority was vascular services.

The Chairman reminded the Board that a significant number of armed forces personnel were due to rebase to the UK from Germany and there would be  ...  view the full minutes text for item 21.

A report on children’s community health services in Wiltshire was presented to the CCG Executive Body at its meeting on 28 January 2014 where it was asked to consider the re-commissioning of services. 

The Board will receive:

·         An update report from Julia Cramp, Joint Associate Director Commissioning, Performance and School, on the outcome of the meeting held on 28 January 2014.

·         An update from Amy Bird, Consultant in Public Health, on the transition of 0-5 year children’s public health commissioning to Wiltshire Council.

Carolyn Godfrey, Corporate Director Wiltshire Council, provided an update in relation to children’s community health services in Wiltshire.

Children’s Community Health Services in Wiltshire

In presenting the first of two reports clarification was made that services were currently delivered by five separate organisations.  The CCG and Wiltshire Council had agreed at a recent Governing Body meeting of the CCG that a joint project would be undertaken to re-commission services in an attempt to bring all under a single contract/provider. 

The resulting contract/provider would need to ensure support across the whole county was provided, was easily accessible and provided a clear pathway designed for the user noting that currently there was a wide spectrum of services within a wide structure.

A project steering group had been established to oversee the re-commissioning exercise chaired by the Director of Children’s Services and with senior representation from CCG and NHS England.  A Project Manager would also be brought in to work 3 days per week on the project.

Discussions were already underway with providers and neighbouring commissioners to ensure that the resulting service model worked in harmony with the county’s neighbours, noting that the resulting provider was likely to provide services to neighbouring authorities.

Transfer of Commissioning Responsibilities for Public Health for 0-5 year olds (Health Visiting)

Amy Bird, Consultant in Public Health, presented a report on the transfer of Health Visiting from NHS England to Wiltshire Council.  This included that following the demise of the PCT commissioning arrangements had passed to NHS England noting that these, together with school nursing, were to transfer to the local authority at a later date.  This would take effect from 1 October 2015.

Thanks were provided to Debra Elliott and her team at NHS England for their work and support during this period, noting that there had been a positive increase in the number of Health Visitors under its leadership.  The work undertaken by the team was recognised by the Board who acknowledged that early intervention resulted in reduced problems later in life.

The Chairman thanked the presenters for the information provided.

Resolved:

The Board noted the updates provided.

Cliff Turner, Independent Chair of the Childrens’ Safeguarding Board, will present the 2012/13 Annual Report and provide the current Business Plan together with a verbal update on plans for updating this for 2014/15.

Cliff Turner, Independent Chairman of the Childrens’ Safeguarding Board, presented the Safeguarding Board’s annual report for 2012/13. 

In presenting the report, which included details on the background of the Board, clarification was given that Cliff Turner had been appointed to his role, following an OfSTED inspector in the summer of 2012 which had found that the Board had failed in its primary objective.

In the winter of 2012/13 a review of the Board was undertaken, including with its membership and the number of sub groups operating within it.

A wider peer review of childrens services was undertaken in January 2013 where positive comments had been received on the work undertaken by the Board.  OFSTED returned in July 2013, questioned the changes brought about since the peer review and were satisfied that governance arrangements were now appropriate.

A further review was undertaken in December 2013 to look specifically at the work of the Board itself.  The outcome of the review resulted in a number of action points to be taken forward but the work of the Board was complimented.  Further details could be found within the annual report provided, together with the accompanying Business Plan which outlined work undertaken since.

The Cabinet member for Childrens Services was pleased to confirm that the improvement notice given following the OFSTED inspection had been lifted in early March.  However, the authority would always look to improvement on the service it provided.

The Chairman thanked Cliff Turner for the update.

Resolved:

The Board noted the report and ongoing work of the Safeguarding Board.

Angus Macpherson, Police and Crime Commissioner, will present a report on the transfer of health commissioning responsibilities to NHS England.  The Board will be asked to provide comment as appropriate.

Angus Macpherson, Police and Crime Commissioner, presented a report on the transfer of some health commissioning responsibilities to NHS England from April 2015. 

In noting that there were often links between mental health and those in police custody discussion took place relating to Section 136 of the Mental Health Act specifically relating to young people.  Work was underway with the Avon and Wiltshire Mental Health Partnership (AWP) and the way in which young people are now dealt with has shown improvement.

Noting that the next meeting of the HWB was to be focused primarily on mental health, the Commissioner welcomed the opportunity to present further papers at that meeting which were likely to include details on mental health issues relating to domestic abuse and violence.

The Chief Constable reiterated his concern over the proportion of offenders with mental health problems, of all ages, and would welcome the opportunity to explore this further with the Board.  A report on the subject would be submitted to the next meeting of the Board in May.

The Chairman thanked the Commissioner and Chief Constable for the information provided and confirmed that a report on S136 would be added to the next agenda.

Resolved:

The Board would receive a report from Wiltshire Police on S136 at the next meeting in May 2014.

To consider any urgent items that the Chairman feels appropriate.

There were no urgent items considered.

The next meeting of the Board will take place at 3pm on Thursday 22 May 2014 at AWP, Jenner House, Langley Park, Chippenham, Wiltshire.

The next meeting of the Board would take place at 3pm on Thursday 22 May at Jenner House, AWP Headquarters, Langley Park, Chippenham, Wiltshire.