Agenda and minutes

The membership of the Health and Wellbeing Board was ratified at Full Council at its meeting held on 13 May 2014.  In agreeing the membership it was resolved that the Leader of the Council be re-appointed as Chairman of the Board. 

Membership of the Health and Wellbeing Board was ratified at Full Council on 13 May 2014.  In addition to the re-appointment of the Leader of the Council as Chairman to the Board, the following additional changes were made:

·         Cllr Ian Thorn (Opposition Group representative) was appointed as a full voting member.

·         Cllr Sheila Parker (Portfolio Holder Adult Care and Public Health) to be a non-voting member of the Board.

To seek the Board’s approval to re-appoint Dr Stephen Rowlands (Chairman of Wiltshire CCG) as the Vice Chairman of the Health & Wellbeing Board for the ensuing year.

Dr Stephen Rowlands (Chairman of Wiltshire Clinical Commissioning Group (CCG)) was elected as Vice Chairman of the Health and Wellbeing Board.

The Chairman will welcome attendees to the meeting and provide any announcements to include:

·         Winterbourne View Action Plan update

·         Mental Health Strategy

·         Thank you from Jane Ellison MP

The Chairman welcomed everyone to the mental health themed meeting and expressed thanks to the hosts, Avon & Wiltshire Mental Health Partnership (AWP).

Before proceeding to the next item of business, the following announcements were made:

·         Winterbourne View Action Plan update

The Board received an update on the Winterbourne View Action Plan at its meeting in November 2013 and agreed that a further update would be provided today to ensure the Board remained abreast of developments.  The Chairman drew the Boards attention to the update provided within the agenda pack at page 3 and confirmed that the Board would continue to receive regular updates hereafter.

·         Mental Health Strategy

Work was underway to develop a joint Mental Health and Wellbeing Strategy between Wiltshire Council and the Wiltshire Clinical Commissioning Group (CCG), the proposed next stages of which had been presented to the Health Select Committee on 6 May.

A brief update was provided which included that the strategy would be developed in collaboration with many stakeholders.  Once further developed the draft would be submitted to the Executive bodies of both the CCG and Wiltshire Council to seek approval for formal consultation before both the Board and Health Select Committee were presented with the draft for consideration as part of the consultation.

Dr Alex Thomson-Moore, who was leading on the strategy, would attend the next meeting and there would be an update on how the strategy was progressing.  Today’s meeting would play an important part in informing the strategy development.

·         Thank you from Jane Ellison MP

The Public Health Minister, Jane Ellison, had written to all HWB Chairs thanking them for their work in helping to improve the health of local populations.  The letter highlighted some of the national public health work underway and the important role of local partners in securing their success.

A full copy of the letter was available on-line with the agenda and could be accessed via the following link.

Apologies were received as follows:

Dr Toby Davies (CCG Chair of SARUM Group) - Dr Celia Grummitt attended on his behalf

Dr Simon Burrell (CCG Chair of NEW Group)

To approve and sign the minutes of the meeting held on 20 March 2014.

The minutes of the previous meeting held on 20 March 2014 were approved and signed as a correct record with the following amendment:

Item 20 – CCG 5 Year Strategic and 2 Year Operational Plan

The wording of the Resolution to be amended to reflect that further changes to be signed off by the Chairman of the CCG Executive Body as follows:

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 CCG Executive Body, noting that final submission of the 5 year Strategic Plan must be made by 20 June 2014.

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

No declarations of interest were received.

The Chairman of AWP, Antony Gallagher, will welcome the Board to the AWP Headquarters before introducing Dr Julia Hankin, Clinical Director AWP, who will provide an update on mental health services.

Anthony Gallagher, Chairman of AWP, was introduced to the meeting and welcomed all present to the Headquarters of AWP before handing over to Dr Julie Hankin, AWP Clinical Director, who welcomed the theme of the meeting noting the desire to provide parity of esteem between physical and mental health at a central government level and also within AWP itself.

The Department of Health (DoH) document entitled ‘Closing the Gap: Priorities for Essential Change in Mental Health Services’ which set out 25 key priorities, was highlighted.  The priorities included:

·         Mental health services

·         Children and young people

·         Crisis and diversion

·         Choice and ending discrimination

·         Improving physical health and integration

·         Support for housing and employment

·         Information and regulation

A brief film was shown highlighting the work being undertaken by AWP to meet the needs of people in Wiltshire as a provider of secondary and specialist mental health services.  A copy of this could be found via the following link:

https://www.youtube.com/watch?v=J2tJoNvlvAw&feature=youtu.be

Recognising the need for localised structures within the management of AWP, a review had been undertaken and in May 2013 a new Wiltshire Management structure had been implemented. 

Details of the variety of services provided by AWP were highlighted which included primary care, acute hospital liaison, crisis and home treatment teams and adult inpatient care.

A Primary Care Liaison Service (PCLS) and Memory Clinics had been established to allow dementia specialists, primary care and clinicians to provide the most appropriate support.

In line with ongoing improvements for 2014/15 was the reprofiling of community teams to align them with community transformation structures and the CCG 5 year strategy. 

The restructure arising from the reprofiling would result in 4 community mental health teams functioning as 8 workgroups alongside smaller community teams and GP practices.

As part of the wider review to ensure appropriate service delivery, AWP had sought the assistance of Wiltshire Council’s Transformation Team to help establish cultural change within the Trust, including discussion on how campus’ could be utilised to provide services. 

Premature mortality and serious mental illness (SMI) was also highlighted with figures showing that people with SMI had an average of 3.6% higher change of premature mortality than the general population.  Wiltshire was slightly above the average.

The Board welcomed AWPs ambition of better parity between mental and physical health and acknowledged the drive to deliver dual diagnosis in the future, noting the benefits this would bring, for example, on drug and alcohol services.

Upon further discussion in relation to the higher than average mortality figures for Wiltshire, the Board requested that any investigative work should take into account the military and that a target for improvement should be set.

Acknowledgment was made to the excellent work undertaken around S136 which had resulted in a significant reduction in the numbers taken into custody. As a result Wiltshire was placed within the top 6 areas of the country identified as minimising custody placements.

Noting that the police were often a first point of call for mental health related calls  ...  view the full minutes text for item 33.

Debra Elliott, on behalf of NHS England, will provide an update on work undertaken to deliver ‘parity of esteem’ between mental and physical health and on specialist commissioning for mental health.

Colonel Smith will also be in attendance and will provide an update on mental health and the impact of the army rebasing programme following discussions at the Military Civilian Integration Partnership.

Debra Elliott, NHS England, presented a report on the work undertaken to deliver parity of esteem between mental and physical health as well as an update on specialist commissioning of mental health. 

Parity of Esteem

The report highlighted that parity between mental and physical health was expected to result in significant improvements to the health and wellbeing of the population and would reduce the financial pressures both in the short and long term.

Although a parity of esteem programme was being developed, 3 key areas, as detailed below, had already been identified for initial focus and improvement:

·         Access to psychological therapies (IAPT) by March 2015

·         Diagnosis and support for people with Dementia by March 2015

·         Awareness and focus on the duties within the Mental Capacity Act

An evidence gathering exercise had been undertaken and presented to the House of Lords in March 2014, resulting in the latter priority following concerns raised over the duties and expectations of CCGs in relation to the Mental Capacity Act. 

Within the Bath and North East Somerset, Gloucestershire, Swindon and Wiltshire (BGSW) area an organisation had been commissioned to work alongside NHS England to address the above themes with an interim report expected in July and final report in September 2014.

A number of websites provided information on good practice, tools and guidance which was recognised to be important for commissioners to enable them to deliver the national requirements.  Intensive support was also being developed to support CCGs in delivering the national ambitions, further details of which were available on the IAPT website.

Specialised commissioning

143 specialised services were commissioned by NHS England, 11 of which related closely to mental health.  It was understood that a programme of work was being developed and was likely to be completed by the end of July when a further update report would be provided to the Board.

Patient Right to Choose

After presenting the report, Debra Elliott confirmed that NHS England had now published interim guidance on Patient Right to Choose.  A link to the website could be found below:

http://www.england.nhs.uk/2014/05/21/guide-published/

Commissioners, GPs and Providers were asked to give consideration to the interim guidance and provide any comments to NHS England no later than 5pm on Friday 15 August.

Major Dickie Gittins and Tony Jackson were welcomed to the meeting to provide an update on mental health services for army personnel which included recognition of the importance of mental health services required by army personnel including veterans, many of which had a desire to remain in the county.

Monthly case conference meetings included attendance by AWP representatives and helped with the transition into civilian life.  There was awareness that the numbers were likely to increase in the future.

Tony Jackson confirmed that although the welfare service was outside the chain of command of the army, it worked alongside the army to provide support to army personnel and their families within the area.  The service was currently undergoing a review in consultation with senior management. 

The Board noted that  ...  view the full minutes text for item 34.

James Cawley, Associate Director Wiltshire Council, and Dr Ted Wilson, Manager CCG NEW, will present a report on the draft Wiltshire Dementia Strategy 2014-2021 consultation (which ends on 19 May) and provide further details of the dementia friendly communities campaign ‘Before I Forget’.

James Cawley, Associate Director Wiltshire Council, and Dr Ted Wilson, Group Director CCG, presented the draft Wiltshire Dementia Strategy report which included details of the strategy consultation which ended on 19 May.

The Board were made aware that by 2020 there was expected to be a 30% increase in the number of dementia sufferers in the UK and that the draft strategy had been developed as a result of listening to those with dementia as well as those who provided support.

The consultation identified memory service and telecare as areas that were doing well but care in hospital and support for carers as areas that could be improved.

The key message arising from initial findings was that dementia was the responsibility of everyone and that dementia friendly communities were important to ensure sufferers were able to live at home and within the community, a requirement identified by dementia sufferers.

In response the ‘Before I Forget’ campaign to make communities dementia friendly, had been launched in the Royal Wootton Bassett and Cricklade area and was being rolled out across the whole of the County. 

Consultation responses indicated that people were in general positive and supportive of the direction and commissioning intentions of the strategy but that rural communities, where isolation often occurred, should be a focus for further work.  Listening to and involving carers and families and reducing the stigma associated with dementia were also identified as areas for focus.

The redraft of the Strategy would be submitted to the CCG and WC governing bodies once the full findings of the consultation had been considered.  Once approved, implementation of the final strategy would be overseen by the Dementia Delivery Board.

Ongoing engagement and consultation facilitated by Healthwatch Wiltshire was being planned and packs for dementia friendly communities were made available for attendees to take away with them.

Reference was made to the ‘safe places’ scheme which was being rolled out across the county following initial pilots in Salisbury, Devizes and Swindon and required businesses to sign up to provide a safe place for vulnerable people.   

Details of the ‘missing people’ programme was also mentioned noting that a significant proportion of those reported as missing were dementia sufferers.

The Board recognised the need for a joined up approach to the support services in place and requested that further details on the differing programmes taking place (including ‘Safe Places’ and ‘Missing Persons Programme’) should be presented at the next meeting.  Noting that a monthly newsletter had been launched by Wiltshire Council on dementia it was suggested that further details on the varying programmes could also be highlighted within this.

The attending Vice Chairman of the Health Select Committee was supportive of a one point of contact approach and indicated the importance of ensuring the right funding stream was in place to meet the increasing demands on the service.

The Select Committee response on the strategy had included a requirement to strengthen some areas and the Committee awaited further details for review in due  ...  view the full minutes text for item 35.

Julia Cramp, Associate Director Wiltshire Council/CCG, will present an update on the development of the Children’s Emotional Health and Wellbeing Strategy and the Child and Adolescent Mental Health Service in Wiltshire.

Julia Cramp, Associate Director Wiltshire Council/CCG presented the Children’s Mental health report which included details on the Children’s Emotional Health and Wellbeing Strategy 2014-17 and Child and Adolescent Mental Health Service in Wiltshire.

The strategy had been produced by the Children’s Trust Commissioning Executive in line with the Children’s Trust’s Commissioning Framework and extensive consultation had been undertaken to seek the views of children and young people on key issues.  Feedback had included:

·         Better mental health education in schools for both children and adults help recognise the signs as early as possible;

·         Better e-safety education to address cyber bullying; and

·         Helping to build young people’s self esteem and confidence

The consultation had sought the views of staff working with young people and priorities for action had been proposed which included promoting Youth Mental Health First Aid Training for adults and youth.  Four sessions a year currently took place and were run by education psychologists to help participants recognise the signs of mental health illness in young people.

Other priorities identified following initial discussions were:

·         Promote positive mental health and build resilience in children and young people;

·         Build capacity and knowledge of mental health issues in the children’s workforce;

·         Improve access to primary and specialist child and adolescent mental health services (CAMHS); and

·         Ensure effective access, referral routes and pathways to services (including to adult services).

The draft strategy was currently out for consultation.  Further details could be found via the ‘Pathways’ website:

http://www.wiltshirepathways.org/GenPage.asp?ID=55

Following completion of the consultation an action plan would be developed and, once approved, would be overseen by the multi-agency Emotional Wellbeing and Mental health Group, a sub-group of the Children’s Trust.

The Voice and Influence team based within the Council would be looking into the safeguarding of young people in relation to social media, noting the concerns raised by young people in relation cyber bullying.

The ‘Little Book’ providing emotional wellbeing and mental health support for young people was highlighted as a useful tool to help support young people.  This was available via GP practises but could also be found on-line via the following link:

http://www.wiltshirepathways.org/UploadedFiles/Wiltshire_Little_Book_Jan13.pdf

Laura Mayes, the Cabinet member for Children’s Services, highlighted the importance of providing appropriate out of hours support for young people, noting the increase in suicide and self harm figures over the weekend period.  YoungMinds was referenced as the UK’s leading charity committed to improving the emotional wellbeing and mental health of young people and should be signposted as a source of support.

The benefits of early intervention were highlighted and the Board welcomed the recognition of this within the draft strategy.

A mental health charter had also been produced which it was hoped all schools within Wiltshire would sign up to by the end of the year to help provide greater support to young people.

Child and Adolescent Mental Health Service

In April 2010 a new contract had been approved for child and mental health services resulting in significant changes to the service such as:

·         24 hour access

·         Outreach  ...  view the full minutes text for item 36.

Angus Macpherson, Police and Crime Commissioner for Wiltshire, will provide an update on the development of a mental health crisis care concordat, the pilot of psychiatric nurses in custody suites and the detention of people with mental health needs under s136 of the Mental Health Act.

Angus Macpherson, Police and Crime Commissioner, presented a report on the Crisis Care Concordat, which was the agreement signed by more than 20 national organisations to work together to achieve continued improvements to crisis care for people with mental health issues.

The agreement included 18 pages of actions to be embedded at a local level and the PCC was keen to secure the buy in of every organisation within the county to ensure this took place.

The PCC also drew attention to the joint Department of Health and Home Office review to examine the operation of Section 135 and 136.  Wiltshire Police would be responding to the consultation which ended on 1 June. 

The Commissioner stated that confusion often arose in relation to responses to patients in crisis with the police often responding instead of the ambulance service. Contact would be made with South West Ambulance Service Trust to seek clarity on their understanding and highlight available guidance.

A future objective of Wiltshire Police was to work with health partners to improve training for officers and the strategies that could be deployed to calm often difficult situations.  The Positive and Safe Programme was highlighted as an example that could be included.

The Mental Health First Aid Training programme was also referenced.  Further details of the programme would be made available to the Board members following the meeting.

Emma Cooper, Chief Executive Healthwatch Wiltshire, will present the draft Healthwatch Wiltshire annual report for the Board’s consideration.

Christine Graves, Healthwatch Wiltshire, presented enterprises first draft annual report and introduced Emma Cooper, Chief Executive of Healthwatch Wiltshire, who would provide further details.

Details of the opportunities and challenges faced by Healthwatch Wiltshire in its first year were highlighted which included the high level of expectation placed on them following their creation as a social enterprise, in contrast to many other local authorities.

The annual report set out all the activities of the enterprise and demonstrated the significant achievements made within the first year, in contract to many other local healthwatch organisations.

An ambitious but deliverable work programme for the ensuing year had been developed and worked in harmony with existing services to offer support and advice where required.

The Chairman and Vice Chairman of the Board congratulated Healthwatch Wiltshire and recognised the positive role model that other local healthwatch organisations might aspire towards.

James Roach, Integration Director Wiltshire Council/CCG, will provide an update on the implementation of the Better Care Plan.

James Roach, Integration Director, provided a brief presentation on the implementation of the Better Care Plan.

The concerns raised in the national press were highlighted regarding the expectations of the integration model.  However Wiltshire was confident that our Plan submitted was fit for purpose, acknowledging the positive integration work already taking place.

The key priorities of the Plan and progress made to date against them were provided.  This included improved steps to provide care as close to home as possible such as an integrated hospital to home pathway and as reviews of pathways to provide integration in other areas.

The Chief Executive of Swindon Hospital Trust told of the reduction in patient numbers admitted from the Wiltshire area and increased numbers from the Berkshire and Gloucestershire areas which seemed to indicate that the model of integration within Wiltshire was beginning to demonstrate positive results. 

RUH Bath was also seeing fewer numbers from the Wiltshire area but increased numbers from Somerset which it felt could in part be as a result of the closure of Frenchay Hospital.  The improvements as a result of integration could also be seen within the older people’s unit of the hospital.

A recent Foundation Trust Network meeting had highlighted the positive work of Wiltshire which was seen to be significantly advanced in comparison to other areas.

Healthwatch Wiltshire complimented the positive work taking place in delivering the new service model but reiterated the need to ensure the public were fully informed of the changes to ensure confidence in the new model.

A Chairs of Area Boards meeting was taking place shortly where changes taking place in healthcare services would be provided to review how the boards could be used to communicate the message.

There were no urgent items discussed.

The next meeting of the Board will take place at 3pm on Thursday 31 July 2014 at County Hall, Trowbridge.

The next meeting is scheduled for 3pm on Thursday 31 July 2014.