Agenda and minutes

The Board is asked to note the following change to the Board’s Membership.

Healthwatch

Frances Carroll has now been replaced by Nathan Singelton, Director of Families and Young People, Lifeline.

Noted the appointment of Nathan Singleton as the Healthwatch representative.

There were no declarations of interest.

The minutes of the meeting held on 6 September 2017 were confirmed as correct.

Councillors Bright and Butt arrived during this item.

Fiona Wright, Consultant in Public Health Medicine, LBBD, presented the report, which also acted as an introduction to the interactive workshop session that was undertaken during the Board meeting. 

Fiona explained that the Mayor of London’s aim was to reduce unfair health equalities across London and the consultation period was underway on his draft strategy, which sets out five key aims for reducing health inequalities in London by 2027, namely Healthy Children, Healthy Minds, Healthy Places, Healthy Communities and Healthy Habits.  The deadline for responses to the Mayor was 30 November 2017. 

The Board was reminded of the recently published Borough Manifesto, the statutory background, other local plans including, the key ambitions of the Joint Health and Wellbeing Strategy and Joint Strategic Needs Assessment (JSNA), which were due to be refreshed, and sub-regional and demographic changes that were occurring.  There was now an opportunity to look afresh at what could be achieved across London and in the Borough with the help of the Mayor.  Fiona drew specific attention to the areas where the Borough was rating poorly including, child obesity, the proportion of people with mental illness in settled accommodation, deprivation and employment levels, more than 50% of households in 4 out of 17 wards have deficient access to nature, high levels of criminal notifiable offences and their impact on health and wellbeing, and high smoking rates particularly in pregnant women.  However, there would also be an opportunity to promote areas of good practice within the Borough in the response to the Mayor.

In response to a question from Cllr Carpenter, LBBD Cabinet Member for Educational Attainment and School Improvement, regarding early years actions, Anne Bristow, LBBD Deputy Chief Executive & Strategic Director for Service Development and Integration, said that she felt that we needed to look at more than just physical health and should investigate putting actions and interventions in place before birth.  For example, we need to look at using antenatal classes for more than physical care skills, such as how to bath a baby, and also use them to teach parents about emotional needs such as how to talk to their baby.  Ian Tompkins, Director of Communications & Engagement, East London Health & Care Partnership, commented that education on good health choices and health risks is important, however, we need to look at why people continue their bad practices when they know the consequences.  Cllr Turner LBBD Cabinet Member for Corporate Performance and Delivery, commented on the lack of reference to what is in the Mayor’s powers, where he could specifically make changes, for example there was no mention of public transport.  Cllr Turner drew the Board’s attention to the aims set out on pages 23 and 24 and also questioned why some diseases were targeted but not others.  The Chair raised several issues including, the potential to use Town Planning as a tool for change, funding and parity of provision. 

The Board:

(i)  Having considered the draft Mayor of London’s  ...  view the full minutes text for item 35.

Susan Lloyd, LBBD Consultant in Public Health, presented the report and explained the difference between the different types of diabetes and the actions needed to identify and treat diabetes and to reduce the secondary complications and issues which it causes. 

There had been significant improvements in diabetes care in the community over the past year and the report provided details of the progress to-date and the future partnership working that would be needed to achieve the desired continued improvements.  The prevention of diabetes was becoming a significant driver to reduce pressures on care and health services and the community and to improve the wellbeing of those that are, or could become affected by the condition.  Next year a preventative programme would be started to identify and check individuals that had the risk factors for developing the disease and to encourage lifestyle changes that can reduce or remove their risk.  A mixed commissioning approach would also encourage closer working between primary and secondary health care.  The Board was advised that the levels of type 1 were quite low compared to the national average, however, type 2 had a higher than national incidence rate with around 13,300 individuals currently being treated.  In addition, there was an estimated 10,000 residents at pre-condition stage and potentially at risk of going on to develop diabetes type 2.  The Borough also had significantly higher ethnic / demographic risks than the national average.  Sue explained that £4.3m is spent on diabetes medication alone, which is 15% of the total prescription medication costs for the Borough, and there are also significant and indirect costs, e.g. social care and lost work attendance.  Susan also clarified that an average of 10% was used as it was not possible to attribute costs because many individuals had multiple conditions.  However, what was clear was that the prevention of developing diabetes and reduction of complications, such as foot amputations, would produce significant financial savings: but more importantly the life style and of individuals would be positively enhanced.

The Board noted that 27 GP Practices had been approached but so far only two had responded to the on-line services trial.  Dr Waseem Mohi, Barking and Dagenham Clinical Commissioning Group (CG) stressed that the changes undertaken in one year were considerable, and were more than had been achieved in 10 years or more in other boroughs.  A cohort of some 20,000 individuals with potentially controllable and pre-diabetes were being targeted.

The results of the changes would be seen in five to ten years, when amputations, blindness and hospital admissions and care costs were reduced. 

In response to a question from Anne Bristow as to why we were only getting half of the eight processes and what the barriers were, Dr Mohi explained that we needed incentives to push change and that was now starting to have an impact, however, it needed to be noted that GPs in the Borough have on average 1,000 more patients that national average.  There was clearly a spend to save  ...  view the full minutes text for item 36.

The appendix to this item is included in the ‘Supporting Documents’ pack.

Matthew Cole, LBBD Director of Public Health introduced his 17th Annual Report and advised that the revised summary in the covering report would be provided on the web site.  Matthew then advised that during the preparation of his Annual Report he had looked back to see what impact or positive change had been achieved and had noted that for all but four reports the focus had been on health care public health with a focus on variations in care and outcomes.  However, in the last four years Public Health had been a function of the Council and the focus has increasingly been on what causes people to be ill in the first place.  Matthew drew the Board’s attention to several issues:

Chapter 1. The growing youth violence was a serious concern.

Chapter 2. This dealt with the growing concerns of mental health and the growing perception of year 10 children that their mental health is not good.  This then raised the question of provision and the services by CAMHS and if we need to challenge what we do, how we do it, have we got the provision right or do we need to invest more at Tiers 1, 2 and 3.

Chapter 3. This was championing prevention, looking at social determinants, the drivers for change and the potential for Community Solutions to add value and opportunity to delivering health outcomes and ELHCP / STP and other organisations to provide seamless wrap around services.  Recent innovation included the support to keep people in their tenancies and help individuals, particularly children, escape the cycle and effects of domestic violence.  The use of devolved powers was also a driver for change.

Chapter 4. Reviewed the evidence and analysed how the Grant had been used to contain or reduce the costs of health and social care, without negative effects on health outcomes and also the returns against expenditure.  However, while data is often used to support insight and decision making, it should only be part of our tool kit: listening and talking to the population, not just patients, was equally important.

Chapter 5. This included the model for health town at Riverside and why this and learning from it could be expanded to all developments.

Mathew said that he hoped that he had had an impact on people’s view of how we look at serious violent youth crime, what is driving that.  This in turn lead on to learning about youth culture and causes of violence.  Matthew stressed that this is a very real problem and arresting children who may be experiencing trauma associated with violence in their past and who may have progressed from victim to perpetrator, was not the answer

The Chair moved that the meeting be extended to 8.30 p.m.  This was agreed by the Board.

The Chair thanked Matthew for his frank and thought-provoking report.  The Chair and Cllr Butt, LBBD Cabinet Member for Enforcement and Community Safety, explained that they were now working with young people, which had  ...  view the full minutes text for item 37.

The appendices to this item are included in the ‘Supporting Documents’ pack.

Mathew Cole, LBBD, Director of Public Health, presented the report, and advised that the Board had previously agreed an outcomes framework which prioritised key issues for the improvement of the public’s health and their health and social care services.  The Board also monitored this high-level dashboard on a quarterly basis.  The report set out the performance for Quarter 2, which ended September 2017, or the latest data available.  The report also highlighted the changes that had been made to the indicators that are included in the dashboard.  Having received the overarching view of performance, including areas of concern and improvement, the Board:

(i)   Noted the performance and the areas where there were still challenges and the inclusion of two new indicators for:

·  The number of children who turn 15 months old in the reporting quarter who received a 12-month check.

·  Bowel screening – coverage of people aged 60–74 years;

(ii)  Noted the achievement of the Health Visitor Service in achieving green level indicators for all their services for two months running and commended the significant effort of the staff in achieving this; and

(iii)  Noted that the challenges of winter pressures would soon start to impact on services.

The appendices to this item are included in the ‘Supporting Documents’ pack.

By Minute 23, 6 September 2017, the Board had supported the case for a target for social care related discharge delays in the order of 44 to 45 days total per month.  Mark Tyson, LBBD, Commissioning Director, Adults’ Care and Support, reminded the Board that this was not in line with NHS England’s expectations at that time of ‘maintenance’ from the previous year, because of their selection of a restricted three-month baseline window.  NHS England’s had threatened to rate the Plan as non-compliant, which would potentially have impacted on the funding available to social care through the Improved Better Care Fund.  This was despite the case that had been made that a more stringent target risked unsafe discharges.  In response to the NHS England view point the Council and CCG had proposed a compromise in which the difference between the current social care performance and the NHS England target would be shared between the two organisations, the details of which were set out in the report.  The Plan had subsequently been accepted by NHS England.

The Board:

(i)  Noted that submission of the Better Car Fund (BCF) Plan and that the approval from NHS England had now been received;

(ii)  Noted the steps taken to ensure the Plan’s compliance with NHS England requirements, particularly the redistribution of the delayed transfers of care days target between social care and health  However, the Board still had concerns about the focus on hospital discharge targets and noted that lobbying of the government would continue; and

(iii)  Noted the data on performance was expected to be published by the government on 9 November and the continuing uncertainty in the scope and criteria of the November ‘review’ by NHS England, the need for a sustained focus on performance, and the potential for inclusion in the national review programme should performance drop.

The appendices to this item are included in the ‘Supporting Documents’ pack.

Ian Tompkins, Director of Communications and Engagement, East London Health and Care Partnership (ELHCP), presented the report which provided an update on the development of the ELHCP and the Sustainability and Transformation Plan (STP). 

Ian advised that as a Partnership, the ELHCP would be responding to the Mayor of London’s Health Inequalities Strategy and he would take some of the comments made at the Board tonight back for consideration and inclusion in their response to the Mayor of London. 

The Board’s attention was drawn to page 55 of the agenda and the implications and current position for local devolution, transformation and integration and how the 2017-19 Integration and Better Care Fund would have a staged approach over the next two years to ensure that strong and established governance arrangements support meaningful integration and innovation.  A Partnership Agreement had now been developed for the ELHCP, which it was intended would develop and implement the NEL STP.  It was hoped that this Agreement will provided common understanding and commitment between the partner organisations on the range, principles and processes and objectives of the governance arrangements, which will support the development and implementation of the STP. 

Ian drew the Board’s attention to page 79 of the support papers pack and advised that meetings had now been set up with Healthwatch.  Workshops would also be held with the voluntary and charity section to see how that important network can be strengthened and feedback from this and the housing conference in Dagenham, would be shared with the Board in due course.  Other concerns such as maternity provision, emergency care and attracting and training of the workforce, and the sharing of ideas were noted.

In response to a question from Cllr Carpenter about the role of the Health and Wellbeing Boards in the structure, the Chair advised that the boards are a statutory requirement and the ELHCP has to work with the seven separate Boards. The Chair reminded the Board that the wish to have elected representative(s) involved in the ELHCP structure had already been raised on numerous occasions.  Ian explained that Appendix 3, in the support papers pack, showed the current structure and gave an assurance that the Health and Wellbeing Boards will be part of the new structure as they have both a statutory role and important local knowledge. 

The Board noted the update and that a further report would be provided in due course. 

The appendix to this item is included in the ‘Supporting Documents’ pack.

The Board noted the work of the Barking and Dagenham, Havering and Redbridge (BHR) Integrated Care Partnership Board (ICPB) as set out in Appendix A, in the support papers pack.  The Board also noted that joint commissioning and working that was now being undertaken.

The appendices to this item are included in the ‘Supporting Documents’ pack.

Mark Tyson, Commissioning Director Adults’ Care and Support, presented the report on the developments of the Board’s Sub-Group structure, the details of which were set out in the report and its appendices.

The Board:

(i)  Children’s Partnership

Agreed to the Children’s Partnership being a Sub-Group of the Health and Wellbeing Board, and to the Vision and Terms of Reference for the Children’s Partnership;

(ii)  Mental Health Sub-Group

Noted the revised membership;

(iii)  Integrated Care Steering Group

Noted the review of this Group; and,

(iv)  Health and Wellbeing Board (H&WB) Substructure

Noted that the substructure of the H&WB will be addressed in line with the new Health and Wellbeing Strategy 2018.

The appendix to this item is included in the ‘Supporting Documents’ pack.

The Board noted the reports / notes of meetings of the:

·  Mental Health Sub-Group, 16 October 2017.

·  Learning Disability Partnership Board, 4 October 2017.

·  Children’s Partnership Board, 20 September 2017. 

The appendix to this item is included in the ‘Supporting Documents’ pack.

The Board noted the Chair’s report, which included information on:

·  Older People’s Week, 1 to 7 October 2017.

·  End of Life Conference, September 2017.

·  Community Solutions

A new key service within the Council, which had commenced full operations on 2 October 2017, which will include the following services:

-  Housing

-  Housing advice

-  Information and advice on adult social care

-  Integrated youth services

-  Children’s early intervention

-  Employment and skills

-  Financial support

-  Parts of community safety dealing with anti-social behaviour

-  Libraries

• Flu Vaccination Programme.

The appendix to this item is included in the ‘Supporting Documents’ pack.

The Board noted the draft January 2017 edition of the Forward Plan and the 13 December deadline for changes.