Agenda and minutes

Apologies were received from Dr Jagan John (Deputy Chair); Elaine Allegretti, Bob Champion, Fiona Peskett and Cllr Lynda Rice. 

The minutes of the meeting held on 13 November 2019 were confirmed as correct subject to the inclusion of Melody Williams, NELFT in the list of those present.

Following concerns raised by the LSCB and Ofsted around the outcomes for vulnerable children in Barking and Dagenham across the health and care system, the Board noted the key findings of a review conducted by the Director of Public Health (DPH) to understand the key challenges facing vulnerable children and young people and their access to services. The full report was presented to the LSCB in November 2019, and which was appended under agenda item 16 following the passing of a resolution to exclude the public and press from the meeting.

The DPH stressed to the Board the need to take collective responsibility to address the issues highlighted in the review, the findings from which highlighted in many ways what was already known and which illustrated that in the case of vulnerable children and young people there are gaps in dealing with such high demand which is posing considerable challenges in workforce recruitment in the context of a highly competitive market, when compared to neighbouring boroughs with less challenging environs.

It was noted that a joint meeting was held earlier today between the CCG and the Council to look at the process of achieving more joined up working through commissioning. This should include looking at ways to encourage the Schools Improvement Partnership to take an active part. 

By way of example the Chair commented that themes emerging out of the pilot Thames Locality Board shows that the growth in the local population means more vulnerable families require support, and demonstrates why as a Board it cannot ignore the challenge of dealing with the unprecedented demand in this area whilst at the same time making the ‘space’ to look at new ways of delivering services. In this respect transformation monies could be made available through the CCG to create the capacity to allow this strategic thinking to take place. 

This will inevitably include improving data sharing between partners, notwithstanding the implications of GDPR, although as the Chair pointed out this should not be seen as a barrier as in most instances the issues of GDPR can be got around. 

In the light of the presentation and following the detailed discussion the Board agreed to: 

(i)  Consider reviewing current data sharing agreements between the partners to provide relevant individual level data for Child & Adolescent Mental Health Service (CAMHs) and Speech & Language Therapy (SALT). This will improve data-driven planning and delivery of care to achieve maximum impact. By facilitating segmentation, stratification and impact modelling to identify local ‘at-risk’ cohorts and, in turn, the designing of more cost-effective integrated arrangements for targeting interventions to improve care and reducing unwarranted variations in outcomes, and

(ii)   Consider the need for an agreed whole system strategic commissioning plan that sets out a clear integrated universal and targeted pathway from Tier 1 to Tier 4 setting out clear thresholds for access. Key considerations include:

·  working towards a multi-agency autism service/pathway across early help, education, health and social care;

·  putting in place an effective behavioural pathway; and

·  better use  ...  view the full minutes text for item 41.

Further to Minute 16/9/19 the Board received an update from the East London Health Care Partnership (ELHCP) on its response to the NHS England Long Term Plan setting out a 5 year strategic delivery plan known as the System Operating Plan (SOP) showing how the Partnership will work with partners to known challenges and deliver improvements to health and care services that was published in January 2019.

Given the theme of the meeting the presentation focused on those aspects of the SOP addressing the health needs of children. A report on the aspects of the Plan addressing the specific needs of adults will be presented to the Board in March 2020, albeit there is some crossover between both. 

Whilst welcoming the objectives the Board asked what if any monies were behind the Plan to improve the outcomes for children? The ELHCP responded that there were elements of funding associated with mental health and end of life work programmes.  Likewise, CCG transformation monies will come on-line to help deliver outcomes.

At the request of the Board more information about the details of funding for end of life care will be provided.

The Chair referenced the recent meeting of the Integrated Care Partnership Board (ICPB) where with providers and health partners the challenge of joint commissioning was discussed. Similar discussions also took place at the joint meeting earlier today between the CCG and the Council arranged to discuss integrated commission for children, looking at what outcomes all would wish to see and at which a good level of progress was made.

It was not obvious from the NE London Plan where the responsibility of the seven London Boroughs that make up the Region compared to the three local Boroughs including LBBD lies. Consequently, with the needs of each Borough being so different joint commissioning becomes very challenging. That said it was confirmed by NELFT that under their transformation work streams they are looking at commissioning models across the Boroughs, the challenge to which is how to achieve coordination at Borough, BHRUT and NE London region levels. 

The Board received and noted a report and presentation from the Group Manager, School Investment, Organisation and Admissions outlining the increasing demand for primary and secondary school places for pupils with Special Educational Needs and disabilities (SEND), with indications of the anticipated level of demand over the next four-year period based on a new SEND forecasting model.

The presentation outlined the four areas which are generally acknowledged to have contributed to the significant rise in local children with a statement of SEND or an Education, Health and Care Plan (EHCP) and the number of children who have been permanently excluded and or who require alternative provision. These were seen as legislation, underlying demographic factors, policy decisions impacting on inclusion and funding pressures.

A common strand of tonight’s discussions at the Board had centred on commissioning, and how in this instance it can come together around the significant challenges highlighted in the report and presentation such as poor Ofsted reports and children with complex needs being repatriated in the Borough. Barking & Dagenham has seen a significant rise in the number of children with complex health and/or education needs, and therefore what is urgently required is a new model of health commissioning established within an education setting.  

Given the lack of available funding and recognising other practicalities such as the struggle to recruit health specialists such as speech & language therapists, the Chair commented that there needs to be a broad discussion about models of support that can be offered to parents/carers, which given the increasingly level of demand needs to build in flexibility, something recognised by both the CCG and NELFT.

From the Council’s perspective under the new operating model they are looking at Community Solutions to provide a gateway for early interventions such as rapid diagnosis of children so that plans can be put in place to accommodate their specialist needs for their continued education.                  

The Board received presentations from the Head of Maternity Programme, ELHCP providing an overview of the current position of maternity services and future planning across NE London Maternity Providers, and the Director of Midwifery, BHRUT outlining the context and position at Queen’s Hospital including birthing trends, numbers of women accessing the hospital maternity services who live outside the catchment boundaries, and how this is being addressed as a system.

The Board noted that the East London Local Maternity System (ELLMS) made up of NHS providers and commissioners of maternity services across NE London are undertaking a 4-month review until March 2020 looking at current and anticipated future demand and capacity across maternity and neonatal services in the region. This review will include engaging with local women to find out where and why they chose to give birth to give a greater understanding to the issues and so as to ensure that local women and babies have safe and high quality care, and that the local maternity and neonatal services workforce are supported to make this happen.

ELLMS undertook to brief the Board about the findings from the review at a future meeting. 

The Board received a report and presentation updating on progress with the Early Years Transformation Academy 2019/20, an Applied Learning programme for staff working across maternity and early years. The vision for the Academy was set out as an appendix to the report.

The programme is being delivered in partnership with the Early Intervention Foundation (EIF), a Government supported charity established to champion and support the use of effective early intervention to improve the lives of children and young people at risk of experiencing poor outcomes. 

In the light of the presentation the Board agreed to:

·  Continue to support staff capacity to make the most of this opportunity that has been secured for Barking and Dagenham;

·  Support the mobilisation and delivery of the transformation plan developed during the process of the Academy;

·  Encourage partner organisations to make the most of this opportunity and to support mobilisation of the transformation plan following completion of the Academy, and

·  Discuss and explore the applicability of the Academy learning model to other health and wellbeing transformation initiatives.

The Board received a presentation from the Out of Schools Setting (OOSS) Project Officer on:

(i) the considerable progress to date with the first phase of a DfE funded pilot project designed to improve the oversight of, and safeguarding in OOSS by:

·  Strengthening the understanding of these settings and the associated risks

·  Identifying and sharing best practice on identification and intervention, and

·  Further developing the evidence base to inform a national approach, including the case for potential future action.

(ii) That a formal partnership strategy will be developed which sets out a clear, comprehensive, and transparent approach to dealing with unregistered educational settings in the Borough.

In response to an observation from the Chair the Project Officer informed the Board that guidance was being worked on for parents and carers to make them aware of things to look out for in OOSS. 

The Project Officer undertook to update the Board as the project develops. 

The Board received and noted the Safeguarding Children Board Child Death Overview Panel (CDOP) Annual Report 2018-19, the final one prior to combining the three Borough (Barking & Dagenham, Havering and Redbridge) CDOP’s and child death review process in line with the requirements from ‘Working Together to Safeguard Children Government guidance issued in 2018.

The Board agreed to defer this item until the next meeting in March 2020.

The Chair updated the Board during the meeting with developments at the Integrated Care Partnership including details of a meeting held with health providers looking at the challenges of joint commissioning.

The Boardnoted the current draft edition of the Forward Plan.