Agenda and minutes

There were no declarations of interest.

The minutes of the meeting held on 11 June were confirmed as correct.

The Board received a presentation from Sharon Morrow, B&D CCG on the East London Health and Care Partnership on the development to date of the Partnership’s response to the NHS Long-Term Plan (LTP) setting out a 5 year strategy of how partners realise the ambitions of the LTP through working together to provide high quality care and better health outcomes for patients and their families, through every stage of life.

In response to the presentation the Board whilst acknowledging the level of resident engagement to date, had concerns about how & when local residents can expect to begin to feel the benefits of the proposed integrated care & collaboration arrangements for NE London, highlighting as an example a key point made in the B&D Healthwatch findings of residents being able to get timely appointments and access to GP services. The CCG undertook to bring a report back to the Board in this respect.

Other observations included whether Barking & Dagenham’s voice would be heard under the planned Health & Care system across North East London, whether this was simply another high-level structural change unrelated to what this Board is seeking to achieve under the JNA.    

The Board noted the timelines, key dates and the next steps and that the CCG will present a further report on the detail of the final response prior to its submission on 15 November 2019. 

The Board noted and welcomed a report and presentation from the Director of Public Health on the development of the Primary Care Networks (PCN’s) in Barking and Dagenham, a key building block of the NHS Long-Term Plan which aims to bring GP’s together to work to scale covering populations of between 30 and 50,000 each, focussing on service delivery, rather than on the planning and funding of services which will remain with commissioners. The PCN’s are expected to be the building blocks around which integrated care systems will be built and represented the most significant contractual change since the NHS was created.

The presentation included details of how the PCN’s will work in a collaborative fashion and the difference they will make for patients, the proposed locality structure, the model of care, issues of accountability as well as the priorities for 2019/20 and 2020/21.

The Deputy Chair welcomed the changes which he felt would help reduce the wide variations in GP services, driving up the quality of care & allowing patients through economies of scale to benefit from a wider range of services that were currently available. The anticipated improvements will be developed using various data sets, and for the first time GP’s will be expected through the PCN’s to have an active dialogue with the voluntary sector.

The Board recognized the significance of these changes and scale of the challenges and risks they will bring, not least what it will mean for the relationship between the HWBB and proposed localities which will match the existing borough structures. It will mean a completely new role for the Board which will necessitate a detailed review by officers of the existing governance arrangements which will drive the structure forward.

Further reports will come forward to the Board in due course on the above as well as about chairing, co-ordination, leadership and the level of resources required to drive the new structures forward. Other key issues that will need addressing included managing participation effectively and raising awareness through a comprehensive comms strategy.  

Nick Swift, Chief Financial Officer presented the Board an update on progress with the BHRUT Clinical Strategy, work on which began in May this year and which details what the Trust Hospitals will look like in 2, 5 and 10 years’ time  in respect of continuing to provide high quality care for the people they serve.

The development of the strategy which is being led by clinicians and staff has involved working with partners such as GP’s and local authorities in a spirit of collaboration. Phase 1 which involved seeking views and evidence gathering has been completed, from which three key areas of work have been developed, namely

·  The principles and objectives of the strategy

·  The case for change (the opportunities to improve)

·  The 10 priority areas

The presentation concluded with information on Phase 2 of the process which will include developing a list of possible options, and using an evaluation criteria (applying a set of standards to each option to see if each would work and be of benefit to patients and the care provided), to arrive at a set of preferred options. The Trust will in the next few months be looking to engage in a dialogue with the Board on these issues.

It was reported that forming an integral part of the way forward the Trust has announced that they will be looking to appoint a Joint Chief Executive with NELFT.

A number of issues were raised by the Board including concerns over ongoing behaviours, the potential monopoly of the new structure which this Board will want to closely monitor and hold to account, the ongoing problem of the deficit, the proposed governance arrangements and finally how the Clinical Strategy will support and relate to the emerging PCN’s and Localities structures. 

The Commissioning Director, Children’s Care & Support presented a report on the outcome of the standard Inspection from OFSTED earlier in the year of Children’s Social Care Services, alongside the Council’s Improvement Plan in response to the findings which was published on 9 July 2019.

Whilst the Inspection had identified that improvement was necessary across the board, the inspectors were very positive about the impact of the new senior leadership team, the improvements that were already being made and the plans for the future.  Inspectors identified a number of areas for improvement including making six key recommendations where improvement was most strongly required. In response the Council’s Improvement Plan set out the measures that were required to address each recommendation, together with target dates and expected outcomes.

The report summarised the published arrangements alongside the plans for implementation by 30 September, together with the further development of the partnership arrangements. The independent Chair of the B&D Local safeguarding Children Board stated that the findings are a reflection on the performance of all agencies responsible for the safety of children and young persons in this borough, and that if this Board did not oversee the delivery of  the proposals set out in the Improvement Plan then collectively we would  have failed them.

The Board again emphasised the importance of the proposed PCN Locality structures in supporting the delivery of the changes required in response to the OFSTED findings. Given the challenges set out in the Improvement Plan it was felt that the Board should initially focus on one recommended action and to that end it was suggested and agreed that a report would be brought to the Board on progress with addressing recommendation 5- The strategic relationship with health services, and operational delivery across a range of health functions.

The Chair mentioned that given its relevance to children safeguarding the Domestic Violence Commission (a joint venture between the Council and the Refuge Charity) is formally being launched on 25 September. One of the aspects of the Commission will be to focus on why DV is so normalised in the local community.  Dr John proposed, and the Board agreed that given the importance of this issue a standing item should be included on each of the Locality Collaboratives on what is being done to address these issues.  

The Children and Social Work Act 2017, the Child Safeguarding Practice Review and Relevant Agency (England) Regulations and Working Together to Safeguard Children 2018 Guidance legislated for the formal ending of Local Safeguarding Children’s Boards. This also included a series of expectations which included all local areas publishing new multi-agency safeguarding children arrangements led by local authorities, CCG’s and the Police. These arrangements were required to be shared with the Department for Education and published by 30 June, and formally in place by 30 September 2019.

Accordingly, the Board were presented with a report summarising the details of the published arrangements together with the partners plans for implementing the arrangements by the due date, as well as outlining the intentions to ensure the key elements of the new partnership arrangements are in place by October 2019 and fully embedded with supporting structures by April 2020.

The Board in noting the current position added that it was very important that the new safeguarding arrangements should link to the wider localities network referred to in the earlier report and not be seen as an add-on.

The current Independent Chair of the Local Safeguarding Children Board stated that whilst he supported the proposed arrangements, similar to his remarks in response to the previous report on the feedback from the OFSTED Inspection of Children Service, he emphasised to the Board that they should not lose sight of what really matters, namely the protection and well-being of our children and young people and that the Board should grasp this opportunity to change for the better. 

The Board noted the Safeguarding Adults Board (SAB) Annual Report 2018/19 presented by Brian Parrott, Independent Chair. This included an outline of the purpose and function of the Board, key achievements over the past year, work of the partners, as well as the key challenges and priorities for the coming year. He concluded that the SAB had a robust assurance process in place which challenged the partners at the Board.  

Following an overview of the final report of the Childhood Obesity Scrutiny Review from the Chair of the Health Scrutiny Committee,

The Board agreed to:

(i)  Note the Review findings set out in the report;  

(ii)  Approve the action plan as set out at Appendix 2 to the report; and

(iii)  Receive six-monthly progress reports on the delivery of the action plan

The Board noted the progress to date on the implementation of the eleven recommendations making up the action plan for the Cancer Prevention, Awareness and Early Detection Scrutiny Review.  

The Board noted the progress to date on the implementation of the eight recommendations making up the action plan for the Oral Health in Early Years Scrutiny Review. 

The Board received the high-level dashboard performance report for the first quarter of 2019/20 financial year. The Chair asked Board Members to come back to her with any comments.

Verbal update from the Chair ICPB

The Chair reported that the Partnership were embarking on a further Governance Review.

The Board noted the Forward Plan for the remainder of the 2019/20 municipal year.

Given that today is World Suicide Day the Director of People & Resilience was planning to present a report on mental health issues which will now come forward to the next meeting in November.

Sharon Morrow delivered a presentation on BHR CCG consultation on their proposed policy around decisions for Continuing Healthcare Placement’s (CHP) which related to the package of ongoing care, arranged and funded solely by the NHS, for adults assessed as having a ‘primary health need’, as set out in the Department of Health and Social Care’s national framework for CHC. This could be provided in different settings, including an individual’s own home or in a care or nursing home. The proposed Policy did not concern the eligibility criteria for CHC, rather it related to decisions by the BHR CCG as to where the care would be provided.

The Policy included:

o  The considerations that would be taken into account when deciding the most appropriate location for a CHC package including exceptional circumstances;

o  The review process for CHC packages; and

o  The appeals process for when patients and/or their families/carers disagreed with a decision on placement.

A similar presentation had been given to the Health Scrutiny Committee (HSC) on 3 September 2019. Councillor Keller as Chair summarised the concerns expressed by the Committee which have been communicated in writing to the BHR CCG.

Dr John as Chair of the CCG made the point that only a small number of Borough residents would be affected by the changes, decisions on which would be made for clinical and not monetary reasons.

Notwithstanding those comments the Board expressed concerns with the Policy in as much that it appeared to contradict the NHS Long-Term Plan. Furthermore, given the relatively low number of care homes in the Borough compared to neighbouring boroughs, they were not comfortable that local residents would potentially be forced against their or their family’s wishes to go into a care home not of their choice.

The Chair intended to submit a robust response to the BHR CCG on behalf of the Board.

The Board noted that the Cabinet member for equalities would be running a stall with the support of a Women’s Group to raise awareness of World Menopause Day on 18 October 2019