Agenda and minutes

Dr John declared a pecuniary interest in agenda item 14, ‘Procurement Strategy and Waiver for Public Health Services Contracts in Primary Care 2015/16’ as he was a provider of General Practitioner services.

The minutes of the meeting held on 28 October 2014 were confirmed as correct.

Matthew Cole, Director of Public Health, presented the report on the Quarter 2 performance and drew the Board’s attention to a number of issues including smoking cessation, A&E treatment and ambulance wait times, the cancer pathway and emergency admissions for ambulatory care sensitive conditions. 

The Board were advised by BHRUT that the recruitment issues in A&E could take five years to improve because of the high demand across the area.

Councillor Carpenter was concerned that the conception rate per 1,000 to women aged 15 to 17 was still above the national average.  Matthew Cole responded that the rate had reduced by 19% since its highest quarter reported, which had seen 38.2 conceptions per 1,000 teenage women, and was reducing steadily, however, a study would be commissioned in the New Year to find out why the Borough was lagging behind the national average and to consider the effect of the two year programme to reduce teenage pregnancies.  Marie Kearns commented that the teenage pregnancy rate had been an issue for the Borough for years, if not decades, and we needed to find out why that was still the case as there had been a number of campaigns aimed at reducing the rate.

There was discussion about the feedback from the BAD Youth Forum / Young Inspectors in regards to the alleged refusal of pharmacies to issue condoms or emergency contraception and insisting on age identification.  Matthew Cole advised that when problems about a specific pharmacy are reported to Public Health they would make contact with the Pharmacy concerned to make sure they fully understand and were complying with their contracts, including any staff training that may be required in the Pharmacy.  Matthew Cole advised that there would be a new and different way of providing condoms as part of the new Public Health contract provision for sexual health.  The provision of a card to enable young people to ask discreetly for contraception provision was also being looked into. 

Councillor Butt asked about other contraception provision in the area.  Matthew Cole advised that the services were commissioned from GPs and other specialist centres, there were a large number of emergency contraception provider, which were widespread across the Borough.  Councillor Butt gave an example of an inaccurate website and advised that she was also aware of two month waiting lists for contraception services appointments and felt these were unacceptable.  The Chair suggested that this type of information was passed to Matthew Cole so that effort could be given to resolving such problems.

Comments were made in regard to the Health and Adult Services Select Committee looking at sexual health services as an issue for in-depth scrutiny, due to the long standing teenage pregnancy rates and problems being reported with the provision of sexual health services in the Borough, but this would be dependent on its future scrutiny programme.

The Chair said that there had been a number of occasions where initiatives that worked well in other areas, with similar communities to  ...  view the full minutes text for item 73.

Sharon Morrow, Chief Operating Officer Barking and Dagenham Clinical Commissioning Group (CCG) presented the report and explained that whilst the Barking and Dagenham CCG has a two year Operating Plan for 2014 to 2016 it is required to refresh its Operating Plans each year in order to take into account changes in local needs, central planning and financial allocations, which were expected around the 23 December for 2015/16 financial year.

Sharron Morrow drew the Boards attention to the details in the report and in particular to:

·  Mental Health – there was likely to be new access targets and a review of recent policy guidance would be undertaken to see what could be done to improve service provision.

·  Cancer Services – There would be a drive to improve early diagnosis in 2015/16 as this would have both improved patient outcomes and reduced the treatment costs overall.

·  Children’s Services – Increased effort in improving health outcomes for children with special education and disability needs, looked after children, care leavers, youth offenders and early year’s development and targeting childhood obesity.  Joint reviews were also planned for children’s therapies and CAMHs.

·  Stroke – A review of the stroke rehabilitations pathway was being undertaken to inform and develop a new model of care that meets national standards and improves patient outcomes and experience of services.

·  Primary Care Improvement – Plans to develop co-commissioning with NHS England following the release of guidance on 10 November 2014.  Away days, workshops would be held.

·  Urgent Care – Increased access to GP services in the evenings and weekends was being progressed by the GP Federations and would be part of the procurement of urgent care pathways across three CCGs.

·  Planned Care – Reviews of the pathways for diabetes and respiratory diseases would be undertaken as well as development of a community dermatology service.

·  Learning Disabilities – It was intended that the commissioning functions for some learning disabilities services would b transferred to LBBD from April 2015, through a Section 75 Agreement.

·  Maternity – Would support improved public health outcomes in related to a reduction of smoking during pregnancy, late access to antenatal care and promote increased breastfeeding.

The Chair commented that the Council would fight the recreation of ‘ONEL’ (Outer North East London) and stressed that we need our own Health and Wellbeing Board to deal with the issues that affect this Borough, as they are not the same as Havering.  The Chair added that whilst it may be easier to commission for three boroughs, it may not be best for the community, especially in Barking and Dagenham. 

Councillor Carpenter commented that she was pleased to see Mental Health included. 

Councillor Carpenter raised the issue of cultural factors and if they could lead to Sudden Infant Death.  Matthew Cole responded that there were links and pointed the Board to the London Health Strategy and commented that and Simon Stevens, Chief Executive, NHS England, needed to look at the role for social prescribing rather than a purely medical role for  ...  view the full minutes text for item 74.

Anne Bristow, Corporate Director of Adult and Community Services presented the report and stressed that there was now only four months to go to stage 1 implementation.  Work plans had been put into place but there were still some inter-agency issues to be resolved, together with a lack of financial certainty as the funding would not be known until 17 December 2014. 

Anne Bristow also brought specific points to the Boards attention, including:

·  Various financial models had been undertaken to see how many people fund their own care; however, this had not resulted in any consistent answer.  Despite work to scope the impact on budgets, there was still a significant ‘unknown’ amount that might be required.

·  The Board were reminded that the law brings in a duty to cooperate on adult social care and emphasised duties around integration, and safeguarding.  The Regulations were only laid out in November 2014, as a result their implementation was causing some real logistical struggles and the issues being faced were much wider that those just affecting the Council, for example IT and housing provision.

·  Whilst there was a five year strategic plan, the Better Care Fund was the beginning of the process and there would be more demands over the coming years. 

·  Training was needed so that staff understood the implications, the processes and their roles in the new systems.  The assessments alone would require a huge cohort of people of different professional disciplines to be trained.  Anne added that LBBD had experience in joint training and could help with training for integrated teams.

·  There was also a lack of trained advocates, especially in the BME population as there were 98 languages spoken in London.

·  A report on a ‘prevention strategy’ would be brought to the Board next year.

·  There were challenges in getting partners to use existing powers and need for this cooperation would become greater.

·  The Safeguarding Adults Board becomes statutory from April 2015.

·  The effect of ‘ordinary residence’ and how councils could be responsible for the care for people that no longer have any connection with the area and the cost implications that this would have for councils.

·  That a two phase communications campaign was to be run at national level and that the Council was planning a local communications campaign using a mix of materials and methods to engage with existing and potential service users.  The local campaign would particularly target carers to increase the number of carers assessed and if necessary put support packages into place.

Anne Bristow asked that all Board partners ensure that they have read the guidance fully to see what it means for them and identify changes that they must do to comply with the Act.  If partners have an Implementation Action Plan in place they need to check on how that would be implemented and that it is fully reviewed in view of the November 2014 Regulations.  The Health and Adult Services Select Committee planned to scrutinise the implementation programme at its meeting on  ...  view the full minutes text for item 75.

Mark Tyson, Group Manager, Integration and Commissioning, presented the report and drew the Boards attention to the presentation slides produced within the report and explained how the Peer Review worked and how feedback is taken in the spirit of self improvement.  The Peer Review was undertaken through the auspices of the London Social Care Partnership, between 7 and 10 October 2014 and the emphasis was on councils working together to set standards, share and champion good practice and review each other’s performance.  This reiterated the importance of accountability to the residents for the services delivered to them at a local level.  Mark Tyson added that the Care Act had shifted the focus and created a new style of commissioning, which was the route that LBBD was already following.

Mark Tyson drew the Board’s attention to what we do well, where further work was needed and the proposed actions, the details of which were set out in the report, including the follow-up needed from the workshop held on 3 December.

Councillor Turner asked how this would link to economic regeneration as the jobs created would be largely local and low paid.  Councillor Turner asked if the employers would offer good quality training of the workforce and if there was a local worker involved in the peer review.  Mark Tyson advised that the Personal Assistants Forum and Carers networks had been involved.  Anne Bristow advised that quality standards were always at the heart of what we do and would be levered into this area of employment potential.  The Council’s Regeneration officers recognised that this was a big business opportunity and that there were real long-term jobs and the Council would be looking to see if enough support was being received from Skills for Care, the employer-led workforce development body for adult social care in England.

In response to a question from Dr John, Mark Tyson advised that there had not been a particular session for partners and personal assistants.  The Chair added that she was aware that the review team had certainly met with the stakeholders at Marks Gate.

The Board:

(i)  Received the presentation and report, which provided an outline of the findings of the Peer Review team, and the response developed in partnership through the workshop on 3 December 2014;

(ii)  Discussed the Market Management Peer Review and supported the proposed direction of travel in managing the adult social care market in Barking and Dagenham, as set out in the report.

Anne Bristow, Corporate Director of Adult and Community Services, presented the report and advised that over the last six months the Council had been working with partners to refresh its Adult Autism Strategy and to reflect the new ‘Think Autism’ national update, the Winterbourne View Concordat, the Care Act and Children and Families Act.  The Council had commissioned the Sycamore Trust to consult and engage with local individuals, carers and professionals on the Strategy.  The consultation period had ended in December.

Anne Bristow drew the Board’s attention to the aims of the three year plan and the nine priorities, set out in section 2.7 of the report, and advised that the Strategy could be refreshed if there were any significant changes to national guidance. 

The proposal was for the Learning Disability Partnership Board (LDPB) to monitor the progress of the Strategy, with them reporting to the Health and Wellbeing Board on its implementation after one year. 

An £18,000 innovation grant had been offered by the Department of Health to assist the Council and its partners to implement ‘Think Autism’, this was a one off grant and could be used for capital works, including electrical equipment and IT developments or for making public areas more autism friendly.  The plans for the use of the innovation grant were being worked up and would be submitted to the Department of Health by the 12 December.

Whilst the Adult Autism Strategy and the Children’s Autism Strategy were separate documents an integrated approach would underpin both.

Councillor Carpenter said it was a shame that the Adult and Children’s Autism Strategies could not have been issued together.  The Chair and Anne Bristow confirmed that there were areas of overlap within the strategies and that the Adult Autism Strategy had been produced in discussion with Children’s Services.  The Children’s Strategy was still in development so it was not possible to finalise them at the same time, nor was it appropriate to delay the Adult Strategy and the work that would follow on from it. 

Ann Graham, Divisional Director of Complex Needs and Social Care, advised that there would be issues of expectation to manage at the point of transition.  Anne Bristow added that the resources and legislative requirements were different for children and adults and accordingly financial resources for adults were less as well.  Anne Bristow commended the Adult Autism Strategy to the Board and advised that should there be a need for a refresh of either strategy that could be done in due course.

The Board:

(i)  Noted the explanation from the Corporate Director of Adult and Community Services on the reasons why the Adult Autism Strategy needed to be put into place at this time and that work would be undertaken with Children’s Service to ensure synergy with the Children’s Autism Strategy where possible, and should any major changes or refresh be necessary these would be brought back to the Board in due course.

(ii)  Agreed the Adult Autism Strategy 2015 to 2017,  ...  view the full minutes text for item 77.

Gill Mills, Integrated Care Director, NELFT, gave a presentation, which outlined the local position in regards to ‘Tier 4’ provision for Child and Adolescent Mental Health Services and availability of acute and crises inpatient services for young people with mental health problems.  This was particularly in the public eye following press reports concerning a 16 year old girl who having been sectioned had to be held in custody by Police in Devon over a weekend due to a national lack of beds for adolescent mental health crisis.

Since April 2013, CAMHS Tier 4 inpatient beds have moved from being locally commissioned to being nationally commissioned by NHS England (NHSE).  Gill Mills drew the Board’s attention to the map showing provision across the country, from which it could be seen that beds centred around London and the South East and also showed there was demand on local beds from across the country.  A review had been undertaken and as a result NHSE would be tending in the new financial year to increase the number of CAMHS specialist beds by 50.  There would also be three new case managers for the London area.  Overall it would improve the way young people move in and out of specialised care and provide consistent criteria for admission and discharges based on best practice. 

A longer-term strategic review of CAMHS would be undertaken as part of a wider review of specialist services. 

Whilst there are sufficient beds in the London area, for London Children, there was pressure on these beds caused by shortages elsewhere.  This had resulted in children being moved across the country, sometimes over some distance, into those beds.

Brookside, which was one of 10 facilities in London, had 14 beds acute beds and 4 high dependency beds for 12 to 18 year olds who had severe psychological, behavioural or emotional difficulties and also provided a day service.  NELFT also provided the ‘Interact service’ which enables care to be provided in the community and minimised the need for admission.  There had been over 130 admissions to Brookside in the past year and 60% of young people admitted had a personality disorder and work was being undertaken to reduce the need for admission.  The presentation provided details of the admissions from various authorities to Brookside during the twelve month period August 2013 to August 2014 and also the out of area CAHMS beds. 

Gill Mills advised the Board of a pilot scheme which was being run to extend access to services until 9.00 p.m., the results of which would be fed into future commissioning. 

In response to a question Gill advised that wherever possible a local bed was provided for local young people and also that early intervention and support reduced the need for bed admissions.

The Chair commented that she was concerned that because of the national pressure on local beds there was still potential for a 12 to 18 year old being in a cell rather than a hospital bed.  In response  ...  view the full minutes text for item 78.

Ann Graham, Divisional Director, Complex Needs and Social Care, presented the report which provided a review of operational service developments and inspections over the 2013/14 financial year, an overview of local demand pressures and outcomes of the Ofsted Inspection in May 2014 of services for children in need of help and protection, children looked after and care leavers.  Overall performance was going well and there had been a period of increased stability, the full details of which were contained within the report.

Ann Graham drew particular attention to both the Adoption Service and the successful launch on 1 April 2014 of the Multi Agency Safeguarding Hub (MASH), which was based in Barking, and the partners involved with it. 

The Chair commended the report as providing a comprehensive overview, which was particularly usable for non-child care specialists.

The Board:

(i)  Noted the work undertaken over the year:

(ii)  Noted the service improvements contained within the review report and action taken in response to local demand pressures; and

(iii)  Noted the content and outcomes of the Ofsted inspection of services for children in need, looked after children, care leavers and the Local Authority Children’s Services' Improvement Plan, as set out in the report.

Ann Graham, Divisional Director, Complex Needs and Social Care, presented the Barking and Dagenham Safeguarding Children Board (BDSCB) Annual Report 2013/14, attached as Appendix 1 to the report, which demonstrated the impact of the work of the BDSCB partners in safeguarding children and young people within the Borough.  In line with statutory guidance the Annual report has been shared with the Chair of the Health and Wellbeing Board and the wider partnership and would also be shared with the Children’sTrust.

The Boards attention was drawn to five priorities identified by the BDSCB for 2014/15, the details of which were set out in the report.  The evaluation of priorities would be provided in the next BDSCB Annual Report.

The Chair commented that she would wish to see more information on child exploitation and what we were doing to identify potential victims or vulnerable children.  Councillor Turner informed the Board that a brief had been sent to all Councillors, a specialist from the Home Office would be visiting the Borough and Ofsted had also undertaken some work.  Councillor Turner said it was important not to switch resources to the trends of the day but to identify local needs and concentrate on those. Councillor Turner also raised the issues of witch craft and spirit exorcism, female genital mutilation and missing children.  Councillor Turner added that child exploitation and trafficking was a national problem that crossed different local authority and police force boundaries.  Sean Wilson commented that the issues were very complex with those trafficked being too scared of reprisals on families back home or of being deported to come forward and there was often denial by the individual that they were victims.

Ann Graham advised that LBBD had been selected as an area of interest and support due to indicators such as deprivation and teenage pregnancy rates.

The Board:

(i)  Noted the Barking and Dagenham Safeguarding Children Board (BDSCB) Annual Report 2013-14

(ii)  Noted that a report on child exploitation would be provided to the Health and Wellbeing Board in due course.

Ann Graham, Divisional Director, Complex Needs and Social Care, presented the report, which showed improved performance over the last three years, and provided information on the Adoption Diagnostic, the details of which were set out in the report.

Marie Kearns asked if potential adopters were mostly from the Borough.  In response Anne Graham advised that they were from a mixed area but were predominantly white, but the service was part of a consortium which tried to fit children where the best match is for each child, regardless of geographical location.

The Chair commented on the work of the Adoption Team and the efforts made to move the service forward and increase the level of children being placed.

The Board:

(i)  Noted the work and performance of the Adoption Service during 2013-14, as set out in the report and its appendix.

(ii)  The Board also wished to commend the Adoption Team for their efforts in improving the service and the number of children placed for adoption.

Matthew Cole, Director of Public Health presented the report which informed the Board it had a statutory duty to publish a Pharmaceutical Needs Assessment (PNA) at least every three years and that the PNA was in preparation with a view to it being published by the statutory deadline of 1 April 2015.  The PNA would provide an assessment of the local need for pharmaceutical services and NHS England would rely on the PNA when making decision on application to open new pharmacy and dispensing appliance contractor premises.

The Board:

(i)  Noted that the draft Pharmaceutical Needs Assessment (PNA) would be issued on 19 December 2014 for the statutory 60 day public consultation, which would close on 16 February 2015.

(ii)  Noted the draft PNA would be shared with interested members of the Health and Wellbeing Board and we also have a statutory duty to share the draft PNA with neighbouring boroughs’ Health and Wellbeing Boards.

(iii)  Noted the final draft PNA will be presented to the Health and Wellbeing Board at its March 2015 meeting in preparation for publication to meet the statutory deadline of 1 April 2015.

Matthew Cole, Director of Public Health, presented the report and explained that a number of contracts would expire on 31 March 2015 and under the Council’s Constitution, Contract Rules, a waiver of tendering requirements was needed as there were exceptional circumstance as to why a procurement exercise could not be undertaken at the current time, the details of which were set out in the report.

The Board:

(i)  Approved the strategy, for the procurement of the Public Health Programmes contracts within the primary care setting from the 1 April 2015, for a period of one year for:

(a)  NHS Health Check Programme (mandated Council Public Health function)

(b)  Chlamydia Screening

(c)  Smoking Cessation Level 2 Service

(d)  Contraceptive Intrauterine Devices (IUDs) and Contraceptive Implants

(e)  Pharmacy sexual health Service

(f)  Shared Care in GP Practices (Drug Treatment Service)

(g)  Supervised Consumption in Pharmacies (Drug Treatment Service)

the details of which were set out in sections 2.1 to 2.6 of the report;

(ii)  In accordance with Contract Rule 6.6.8, waived the requirement to conduct a competitive procurement exercise for the contracts above; and,

(iii)  Delegated Authority to the Corporate Director of Adult and Community Services, in consultation with the Director of Public Health, Head of Legal Services and the Chief Finance Officer to award the Public Health service contracts, as set out above, to the nominated General Practice and Pharmacy providers.

The Board:

(i)  Received the update from the Systems Resilience Group, including the briefings attached to the report of the Group’s meetings held on the 30 September 2014 and 31 October and the verbal update following the meeting held on 24 November 2014.

(ii)  Noted that efforts were clearly continuing to improve performance and patient experience but the Board was still concerned that Accident and Emergency targets were still not being met.

The Board noted update reports from the following:

(i)  Integrated Care Sub-Group

(ii)  Mental Health Sub-Group

(iii)  Learning Disability Partnership Board

(iv)  Children and Maternity Sub-Group

(v)  Public Health Programme Board

The Board noted the Chair’s report, which provided information on a number of events / issues:

(i)  Lets make 2015 the year we start to turn the tide on obesity – Health will be one of the areas of focus for the 50th Anniversary of the Borough, and offer the opportunity for individuals to pledge to increase activity levels and undertake more healthy lifestyles.  Other activities will highlight heritage, success and future plans.

(ii)  Complex Primary Care Practice Project – Health 1000

(iii)  Health and Wellbeing Board Development Day – 16 April 2015

(iv)  Health and Wellbeing Strategy – consultation during January 2015

(v)  Publication on 15 October 2014 of the London Health Commission’s Better Health for London report.

(vi)  News from NHS England in regards to 21st Century IT system and patients digital access to their records.

The Board:

(i)  Noted the draft Forward Plan for the Health and Wellbeing Board and there had been some changes and items added since the publication of the agenda; and,

(ii)  Noted any new items / changes must be provided to Democratic Services by no later than noon 12 January 2015 for them to be considered at the 10 February 2015 meeting or later.