Agenda and minutes

The Chairman welcomed everyone to the meeting.

Apologies were received from Cllr Sheila Parker and Debra Elliot.

To confirm the minutes of the meeting held on 25 September 2014 (copy attached).

The minutes of the previous meeting held on 25 September 2014 were 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.

a)    Peer Challenge

b)    Health & Wellbeing Awards

c)    Mental Health Strategy

Peer Challenge

The Chair gave a short update on the recent Peer Challenge ahead of a written report to the next Board meeting. She thanked all those staff and partners who had taken time to meet the peer team.

Public Health Awards

The Chair announced that nominations were now open, and encouraged people to visit the website to make nominations.

Mental Health Strategy

The draft Mental Health Strategy isnow out to consultation. A proposed action plan will come before the Board in March.

RUH’s Trust Status

The Chair offered her congratulations to RUH on achieving Foundation Trust Status. She expressed her hope that they go from strength to strength.

Following the announcement of foundation trust status, there will be a joint presentation regarding the work of the Royal United Hospitals Bath NHS Foundation Trust with the Royal National Hospital for Rheumatic Diseases

Presenters: James Scott (Chief Executive of Royal United Hospitals Bath NHS Foundation Trust)  and Kirsty Matthews (CEO of The Royal National Hospital for Rheumatic Diseases)

James Scott (Chief Executive of Royal United Hospitals Bath NHS Foundation Trust) and Kirsty Matthews (CEO of The Royal National Hospital for Rheumatic Diseases) gave a joint presentation, published as a supplement to the agenda papers, regarding the work of the Royal United Hospitals Bath NHS Foundation Trust and their intention to acquire the Royal National Hospital for Rheumatic Diseases.

Issues highlighted included that:

• It had been a long standing aspiration to combine the work of the two hospitals, with conversations starting in 2008.

• Some of the key principals that guide the merger are continuation of services and impact on the brand/reputation of the two hospitals.

• As part of the consultation, information was shared with the public as to how the NHS works to the public e.g. the provider/commissioner split.

• The Royal National Hospital for Rheumatic Diseases is one of 19 specialist hospitals in England and the only Rheumatic Specialist. Naturally it wants to protect its brand and reputation.

• Some of the benefits, to both sets of patients and both hospitals, include: sharing best practice e.g. learning from non-medical/psychological approaches to pain management; sharing of facilities and resources, better ensuring financial stability; exploring opportunities to maintain and promote services nationally and internationally; and the promotion of research and development.

• With regard to environmental issues include: there were no plans in place to change buildings, but co-locational options would be explored. Whilst the existing Royal National Hospital for Rheumatic Diseases building would be used for the next 3 years, it may not be considered sustainable in the long-term.

• The impact of the changes on the Endoscopy service was discussed including: The support of the clinical staff, that the small number of patients affected would be contracted personally to assure them that the continuity of their care would be protected.

• The process for the decision making process was outlined, including the approval of the regulators, and the final decision should come into force on the 1^st February.

The Chair thanked them for the presentation and wished them well for the future.

The purpose of the item is to consider the analysis of declined referrals and the initial proposed actions to ensure that children and young people get the right support where there are concerns about their emotional wellbeing.

Presenters: Carolyn Godfrey (Corporate Director, Wiltshire Council) and Deborah Fielding (Chief Officer, NHS Wiltshire CCG)

Report author: Julia Cramp (Associate Director, Wiltshire Council)

Carolyn Godfrey (Corporate Director, Wiltshire Council), Deborah Fielding (Chief Officer, NHS Wiltshire CCG) and Julia Cramp (Associate Director, Wiltshire Council) presented the item which asked the Board to consider the analysis of declined referrals and the initial proposed actions to ensure that children and young people get the right support where there are concerns about their emotional wellbeing.

Issues discussed included:

·       That recent analysis had shown that there were 347 referrals through the single point of access to CAMHS in April and May 2014, of which 73 were declined.

·       There had been an increase in referrals, as there had been nationally, with the most common reason for refusing a referral being that there isn’t evidence of mental health problems.

·       Officers were looking at what work can be done to train frontline workers to help them focus on Young People’s mental health issues and recognising the symptoms.

·       There was a need to set out a clear pathway, signposting alternative help if referral is refused.

·       Police and Partners had worked hard to develop a protocol to reduce s136 referrals.

·       That there are a range of providers of mental health services, including private, third sector and educational psychologist.

·       Improvements to the process were more important in addressing this issue than changes to providers.

·       At the moment too many referrals were being made to specialist services when there should be more early intervention services.

·       There is a need to improve how people access preventative services early enough and quickly enough.

·       Mental health first aid training could be rolled out for school children to improve their emotional resilience.

·       GPs may not have had much training in CAMHS issues, and can be faced with a bewildering choice of services, using forms that can be complex and difficult to fill in, and may not have all the information to hand.

·       Further analysis on all young people using the service could be used to aid discussion between commissioners and allow the case for additional investment in Primary CAMHS to be considered.

·       In the meantime, having a single point of access and clear pathway is key to successfully accessing the right services at the right time. The issue of consent to refer the case on (from young people and their parents) can be key.

The Chair thanked officers for the report, and implored them to take expeditious action to address this pressing issue.

Resolved

1.     To note the content of the report;

2.     To ask to ask officer to give further update on what changes and improvements have been made in 6 months.

To outline AWP’s action plan in response to the latest CQC inspection.

Presenter: Dr Elizabeth Hardwick (Interim Clinical Director for Wiltshire, AWP) and Iain Tulley (Chief Executive, AWP).

Report author: Julie Hankin (Clinical Director Wiltshire, AWP)

Dr Elizabeth Hardwick (Interim Clinical Director) and Iain Tulley (Chief Executive) outlined AWP’s action plan in response to the latest CQC inspection.

It was noted that Julie Hankin has been promoted to Nottingham Healthcare, and that she had conveyed her thanks to the Board for including providers and for consideration of mental health issues. The Chair asked for the thanks of the Board to be passed on to Julie for her input.

Issues discussed include that:

·       AWP is going through a transitional period of improvement, focusing on quality, clinician led care and developing relationships with local partners.

·       AWP had invited CQC to perform a pilot inspection, as AWP wished to be open and candid about their services.

·       The inspection had noted the good quality leadership, responsive services and compassionate staff.

·       Whilst Wiltshire had issues recruiting and retaining staff, particularly in the south of the county, there was also a national shortage of mental health staff.

·       Action was being taken to address some warning notices given as part of the inspections, and officer hopped that the notices would be rescinded following a follow-up visit before Christmas.

·       Partners recognised that there had been improvements, driven by more engaged management and a dedicated local lead for Wiltshire.

·       Partners also offered to look at how they could help AWP address their challenges, for instance possibly offering accommodation for staff.

The Chair thanked the officers for the update.

A report in response to a request for an update from Healthwatch Wiltshire, on plans to respond to a recent judgement by the Supreme Court that has clarified Deprivation of Liberty Safeguards.

Presenter: James Cawley (Associate Director, Wiltshire Council) and Jacqui Chidgey-Clark (Director of Quality and Safety, Wiltshire CCG)

Report author: Heather Alleyne (Interim Head Safeguarding, Wiltshire Council)

Maggie Rae (Corporate Director, Wiltshire Council) and Jacqui Chidgey-Clark (Director of Quality and Safety, Wiltshire CCG) presented plans to respond to a recent judgement by the Supreme Court that has clarified Deprivation of Liberty Safeguards (in response to request from Healthwatch Wiltshire).

Issues discussed that:

·       The Council and Partners had to decide how best to implement new procedures in response to the judgement.

·       There was a determination to act with sensitivity and common sense, but the comprehensive nature of the judgement meant to staff would have to err on the side of caution.

·       Steve Wheeler, Healthwatch Wiltshire, offered to lobby Healthwatch England regarding the concern that the implementation of the judgement could be bureaucratic or have negative impacts – for example, on families with members who had dementia or were in comas.

The Chair thanked the officers for their update.

To present details of the Board’s annual report, noting in particular the implications for commissioners and providers.

Presenter: Margaret Sheather (Independent Chair, Wiltshire Safeguarding Adults Board)

Report author: Heather Alleyne (Interim Head Safeguarding, Wiltshire Council)

Margaret Sheather (Independent Chair of the Wiltshire Safeguarding Adults Board) presented details of the Board’s annual report.

Issues discussed included that:

·       A shorter, summary of the Annual report would soon be available on the website and be made available to Board members.

·       Changes in membership and workloads of constituent organisations had impacted on the work capacity of members of the board, which meant that the Board had to mindful of this when setting its work plans.

·       It was noted that Healthwatch Wiltshire and the probation service are attending Board meetings now.

·       A Service User Reference Group meets quarterly, between the Board meetings, and provides regular feed back to the main Board.

·       A Serious Case Review had been undertaken, summarised in section 4 of Annual Report, and action will be incorporated into the plan.

The Chair thanked Margaret Sheather for the update and for her hard work during the year.

To provide a summary and give an opportunity to discuss the implications of the Five Year Forward View, for Wiltshire.

Presenter and report author:       Debra Elliot (Director of Commissioning, NHS England)

In the officer’s absence, the item was deferred to the next meeting.

To update the Board on arrangements to ensure system resilience and immediate plans for winter.

Presenter: Jo Cullen (Group Director, West Wiltshire, Yatton Keynell and Devizes NHS Wiltshire CCG) and James Cawley (Associate Director, Wiltshire Council)                                                                                        

Report Author:       Jo Cullen

Deborah Fielding (Chief Officer CCG) provided an update to the Board on arrangements to ensure system resilience and immediate plans for winter.

Issues discussed included that:

·       Additional services were developed for peak demand times, not just in Winter.

·       Some £8.5m had been invested in Wiltshire, across 30 projects as part of the programme.

·       NHS England monitor issues through a Wiltshire System Resilience Group but there were also dedicated groups for each of the three Acute trusts.

·       All the relevant organisations were represented by appropriately senior people.

·       The NHS and partners have completed a range of actions to prepare the environment to deal with possible pressures.

The Chair asked that the meeting note the reports, and asked officers to inform the Parliamentary Under Secretary of State for Public Health of the plans.

To receive a verbal update on the results of the 100 Day Challenge, so far, and the implications for the delivery of the Better Care Plan.

Presenter: James Roach (Integration Direction, Wiltshire Council)

James Roach (Integration Director, Wiltshire Council) presented a verbal update, slides published as a supplement with the agenda papers, on the results of the 100 Day Challenge, so far, and the implications for the delivery of the Better Care Plan.

Issues discussed included:

·       That there were some challenges in the south of the county that were linked with capacity.

·       That work with AWP and Ambulance Service continued, to improve pathways.

·       That a daily operational dashboard was giving good information to target action.

·       That the project was looking at how community beds can be managed more effectively.

·       That data showed that hospitals were not discharging people as much on the weekend.

·       The 100 days challenge ends 9^th December, and the focus would be on how the identified barriers would be dealt with.

The Chair thanked the officer for the update and asked for the full report on the outcomes of the 100 day challenge to come to the next meeting.

To consider an update of the Joint Strategic Assessment on End of Life Care and receive a draft Implementation Plan for the End of Life Care Strategy.

Presenter and Report Author: Jacqui Chidgey-Clark (Director of Quality and Patient Safety, Wiltshire Clinical Commissioning Group).

Jacqui Chidgey-Clark (Director of Quality and Patient Safety, Wiltshire Clinical Commissioning Group) presented an update of the Joint Strategic Assessment on End of Life Care and the latest on delivery of the End of Life Care Strategy.

Issues discussed included:

·       That patient’s electronic records were migrating to a system that was compatible with that used by GPs, Community Services and Out of Hours Services: This would help with the Single View of the Customer aspirations.

·       Some processes had been streamlined to improve links to the Better Care Plan.

·       That further training of staff, it was hoped, would give staff increased confidence to get the right support in quickly for patients at home, including accessing the right pain relief at the end of life.

·       Action could be taken to ensure timely access to pain relief.

The Chair thanked the officer for the report.

There were no urgent items.

Thursday, 15 January at 3:00 pm, in the Salisbury Room, County Hall, Trowbridge.

The Chair drew the meeting’s attention to the date of next meeting, Thursday, 15 January at 3:00 pm, in County Hall, Trowbridge, to be proceeded by an update on the Peer Review at 2pm.

Partners were reminded to contact David Bowater, if they wanted to suggest items for the agenda.