Agenda and minutes

The Chair welcomed everyone to the meeting.

The Democratic Services Officer drew attention to the evacuation procedure as listed on the call to the meeting.

Dr Simon Douglass, Pat Foster and Bruce Laurence sent their apologies.

Tracey Cox, Ronnie Wright and Paul Scott were their substitutes for this meeting only.

At this point in the meeting declarations of interest are received from Members in any of the agenda items under consideration at the meeting.

(a) The agenda item number in which they have an interest to declare.

(b) The nature of their interest.

(c) Whether their interest is a disclosable pecuniary interest or an other interest,  (as defined in Part 2, A and B of the Code of Conduct and Rules for Registration of Interests)

Any Member who needs to clarify any matters relating to the declaration of interests is recommended to seek advice from the Council’s Monitoring Officer or a member of his staff before the meeting to expedite dealing with the item during the meeting.

Councillor Katie Hall declared an ‘other’ interest as a Council representative on Sirona Care and Health Community Interest Company.

To confirm the minutes of the above meeting as a correct record.

The Better Care Fund (previously referred to as the “Integration Transformation Fund”) was announced in the June 2013 spending round covering 2015/16.  This national £3.8 billion fund, established by the Department of Health, is to be held by local authorities and will include funding previously transferred by local NHS commissioners to the Council under Section 256 Agreements.

This report sets out expectations about the use of the Better Care Fund (the Fund); the development of joint plans for the use of this funding; and associated sign-off and governance requirements in light of the publication of detailed guidance as an annex to the NHS England Planning Guidance on 20 December 2013 and joint statement by the Department of Health and Department for Communities and Local Government.

The Fund “…provides an opportunity to transform local services so that people are provided with better integrated care and support. It encompasses a substantial level of funding to help local areas manage pressures and improve long term sustainability. The Fund will be an important enabler to take the integration agenda forward at scale and pace, acting as a significant catalyst for change.”

The Board is asked to:

1)  Note the national planning guidance set out in this report, including the key requirement for the Board to formally sign off the local Better Care Fund plan in March 2014 for submission by 4th April 2014.

2)  Consider the requirement to select a local metric as summarised in paragraphs 5.28 to 5.30 in this report and potential use of flexibility to agree a local alternative, which could be Hospital admissions as a result of self-harm.

3)  Consider whether it is appropriate to host or undertake joint stakeholder engagement on the local Better Care Fund plan alongside the CCG’s engagement on its wider strategic and operational plans in line with the requirements of Everyone Counts: Planning for Patients 2014/15 to 2018/19.

4)  Agree to receive a further report, including the draft local Better Care Fund Plan, at its next meeting on 26th March 2014, with the aim of signing off the plan for submission by 4th April 2014.

The Chair invited Jane Shayler (Deputy Director for Adult Care, Health and Housing Strategy and Commissioning) to introduce the report.

The Chair commented that the Better Care Fund (BCF) was a great idea as it would bring all health and social care funds together, in one pot, and deliver better outcomes.  The delivery timescale were quite tight, in particular for the Clinical Commissioning Group (CCG) and the Council.

The Chair also supported local metrics as it met the Health and Wellbeing Strategy requirements.

Tracey Cox commented that some proprietary work had been done around baseline understanding against some of the outcomes and metrics.  One particular work had been undertaken around dementia diagnosis, something that the CCG was required to set in its own plan, which could be presented to the Panel in near future.

Jo Farrar acknowledged that this was a significant change and a lot of hard work had been put in this area.  The Council recognised that this would be new money, and the Council would be keen to work with health bodies on this issue, in the smoothest possible way.

John Holden expressed slight concern that the proposal of the local BCF plan would have to be submitted by 4^th April 2014, and considering that the NHS and the CCG would have to produce their two year and five year plans, there could be too much pressure put on small teams.  John Holden also said that short timescale would leave little time for innovative thinking.

Dr Ian Orpen commented that two year and five year plans were discussed with neighbouring CCGs, and one of the issues discussed at that meeting was the BCF.  From the discussion with other CCGs it was evident that B&NES CCG had had quite cohesive and collaborative partnership work with the Council when compared with other CCGs in the area.

Councillor Dine Romero expressed her concern that the BCF was aimed to adults only and not to children and young people.  Councillor Romero asked if it would be possible to be more explicit by saying that the BCF would be for adults’ health and wellbeing and specify direction where children and young people’s health might be addressed.

The Chair welcomed the comment from Councillor Romero and said that there was no explicit suggestion that the BCF was for adults only.

Jane Shayler added that there was nothing indicated that funding for children’s health and social care was precluded in use of this funding.

Councillor Katie Hall reassured John Holden that the work around the BCF was not sudden.  The Council and the CCG had known for some time about the BCF.

Douglas Blair commented that the NHS England had been encouraging people to think that this was a mechanism for support strategies. 

Paul Scott asked if there would be one metric, one indicator, or a range of metrics.  Paul Scott suggested that domestic violence could be another issue to consider, whether as new metric or to be funded directly from the  ...  view the full minutes text for item 37.

This is a briefing on Special Educational Needs & Disability (SEND) reform and its implications for Bath and North East Somerset. The report sets out the new requirements, outlines work underway and some of the issues and implications. This paper does not make firm proposals for changes to the way services are organised or funded at this stage.

The Board is invited to:

1)  Note the issues and consider the implications of SEND reform for Bath & North East Somerset.

2)  Agree to work with the SEND reform project manager to ensure B&NES Council and Clinical Commissioning Group meet their statutory duties in respect of SEND reform including the identification of  designated officers for education, health and social care and establishment of suitable strategic governance arrangements by September 2014.

3)  Agree to take a lead in ensuring all necessary consultation on the Local Offer.

The Chair invited Charlie Moat (Child and Families Group Manager) to introduce the report.

The Chair said it was important that the Health and Wellbeing Board took a role into introduction of the Special Educational Needs & Disability (SEND) reform.

Councillor Katie Hall asked about plans for School Action and School Action Plus, and where would those children go.  Councillor Hall also asked how the EBD (Emotional & Behavioural Difficulties) children would fit in the reform.

Charlie Moat replied that majority of children with Special Educational Needs (SEN) did not have, or need, a statement.  The Council had proposed an introduction of a single support plan.  The child would be covered by the plan and would receive every possible help and support along the way. Charlie Moat also said that there have been amendments in the House of Lords and the disability had been put back into the framework, so the disabled children, who were not under the SEN, would be looked after.  In case of the children with the EBD – this would be something that schools would need to manage. 

Councillor Dine Romero asked if separate piece of work on children with the EBD would happen.

Charlie Moat commented that there was a need for a piece of work on the EBD children, which could be considered separately.

Ashley Ayre said that the EBD review had been conducted around five years ago.  The Council would have another look into that review, in part driven by the SEND reform and in part driven by some other issues.  Ashley Ayre also said that there was a growing awareness around children with attachment disorder.

Dr Ian Orpen supported the reform and highlighted importance of the support for children with mental health issues.

Tracey Cox commented that there was a potential to have an innovative approach.

Charlie Moat agreed with Tracey Cox by saying that there was a radical re-think from the operational aspect.  Charlie Moat also said that he was keen to involve parents and carers of young people into this programme as trainers, and also as participants in those trainings.

The Chair welcomed the involvement of parents and carers in the programme.

It was RESOLVED to:

1)  Note the issues implications of SEND reform for Bath & North East Somerset.

2)  Agree to work with the SEND reform project manager to ensure B&NES Council and Clinical Commissioning Group meet their statutory duties in respect of SEND reform including the identification of  designated officers for education, health and social care and establishment of suitable strategic governance arrangements by September 2014.

3)  Agree to take a lead in ensuring all necessary consultation on the Local Offer.

The Health and Wellbeing Board are to consider verbal updates from the Council (Children and Adults and Public Health) and also from NHS England.  The Board are also asked to consider a verbal presentation from B&NES Clinical Commissioning Group on the five year strategic plan outlining their commissioning intentions.

The Chair informed the meeting that the Health and Wellbeing Board were asked to consider presentations (attached to these minutes) and verbal updates from the Council, Public Health, the CCG and NHS England on their commissioning intentions.

The Chair invited Jane Shayler to give presentations named ‘Integrated Commissioning Intentions – Children and Young People’ and ‘Integrated Commissioning Intentions – Adult Care & Health’.

The following points were highlighted in those presentations:

‘Integrated Commissioning Intentions – Children and Young People’

·  Needs Assessment informing the integrated commissioning intentions

·  Emerging Priorities for the CYPP 2014/7 to influence commissioning intentions

·  Specialist commissioning Intentions (Health) 2014/5

·  Specialist commissioning Intentions 2012/3 : recommissioning in process, contracts to be awarded in 2014

·  Preventative Commissioning Intentions 2012/3 : recommissioning in process, contracts to be awarded in 2014

·  Opportunities for integrated commissioning in 2015/6

‘Integrated Commissioning Intentions – Adult Care & Health’

·  Needs Assessment informing commissioning intentions:

·  Emerging priorities influencing current and future commissioning intentions (in addition to those set out in current strategies including the Health & Wellbeing Strategy)

·  Re-commissioning in process, contract award (if relevant) and/or service in place in 2014/15

·  Re-commissioning in 2014/15, contract award (if relevant) and/or service in place in 2015/16- 2016/17

Councillor Dine Romero asked if children from Gypsy and travellers group, and also from armed service, were considered under emerging priorities.

Ashley Ayre responded that the Council, together with the CCG and Public Health, has been commissioning special services for children with Gypsy and travellers background, as well as for people who live on river and canals.  Also, the Council had been working with education personnel for armed forces, in order to track any children from that group.

The Chair invited Paul Scott to give a presentation named ‘Integrated Commissioning Intentions – Public Health’.

The following points were highlighted in the presentation:

·  Needs assessment and issues informing commissioning intentions

·  Emerging priorities for commissioning and strategy in 2014/15

·  New strategy, pathways, services or programmes expected to be in place in 2014/15

The Chair commented that there was a real shift to prevention, which was helpful.  Public Health was having an impact in the Council, such as their role in the development of the Economic Strategy, Placemaking Plan and similar.

The Board welcomed the Director of Public Health (DPH) awards scheme.

Paul Scott said that the DPH awards scheme was on-going scheme.  The scheme had been working with schools and early years services, in order to promote the health and wellbeing of children.

The Chair requested a report on the Director of Public Health award for one of the future meetings of the Board.

The Chair invited Dr Ian Orpen and Tracey Cox to give a presentation named 'The Road ahead - Plan for 2014-15 & 5 year plan development'.

The following points were highlighted in the presentation:

·  CCG's refreshed strategic objectives

·  Commissioning intentions for 2014/15 (available on the CCG's website)

·  New Urgent Care Service Arrangements

·  New Maternity Service Arrangements

·  Embed Community Cluster Model

·  Future of the Royal National Hospital for Rheumatic Diseases

·  New and continuing service arrangements  ...  view the full minutes text for item 39.

This report provides an update on the work of IVASP (the Interpersonal Violence and Abuse Strategic Partnership) to improve services for victims and to reduce domestic violence and abuse in the context of our membership of the national Public Service Transformation Network. It is designed, alongside the feedback from Health and Wellbeing Network, to act as a starting point for a multi-agency conversation to draw on local strengths and transform partnership working on this issue.

The Board is asked to:

1)  Reaffirm the cross-partner importance of addressing domestic violence and abuse as priorities of the Health and Wellbeing Board and the Community Safety Partnership

2)  Consider its response to the key issues and questions set out in Paragraph 5.10 of the report, particularly the need to focus on early intervention

3)  Consider how to further strengthen the referral mechanisms relating to domestic violence and health services, in particular the IRIS scheme

4)  Discuss the potential to transform services for service users by linking with emerging thinking relating to Multi-Agency Safeguarding Hub, data-sharing and Integrated Victims Strategy.

The Chairman invited Andy Thomas to give a presentation to the Board.

The following points were highlighted in the presentation:

·  Definition of domestic abuse

·  Graph showing types of alleged abuse experienced by domestic abuse related referrals to Adult Safeguarding in B&NES (March 2011-2013)

·  Health and vulnerability issues of the domestic abuse referrals to Adult Safeguarding in B&NES (March 2011-2013)#

·  Domestic abuse and health

·  Focus groups findings 2013-14

·  An Opportunity - Public Service transformation

·  Links with other projects and initiatives

·  IRIS - Identification & Referral to Improve Safety

·  IRIS - Bristol

·  IRIS GP surgeries and the number of referrals received by different GPs in each practice (Jan-Jun 2013)

A full copy of the presentation is attached to these minutes.

The Chair invited Ronnie Wright to update the Board on the Health and Wellbeing Network meeting held earlier in the day.

Ronnie Wright said that discussions held earlier in the day were quite productive and involved representatives from over 30 organisations.

Ronnie Wright commented that three key areas had been highlighted at the meeting:

·  Raising Awareness

o  Best Practice

o  Training

o  Domestic Abuse Champions

o  Co-ordination

o  Information

o  Networking

·  Knowledge and understanding

o  Research

o  Vulnerability to abuse

§  Mental Health

§  Disability and Learning Difficulties

§  Child victims of sexual abuse

o  Building a profile of potential victims

·  Isolation

o  Geographical

o  Culture

§  Communities

§  BME

§  Armed Forces

The Chair thanked Andy Thomas for the presentation and Ronnie Wright for a feedback from the session held this morning.  The Chair highlighted a need for collaboration between organisations in order to prevent people fall through the gap.

The Chair invited Sue Mountstevens (Police and Crime Commissioner) to comment on the subject of domestic abuse.

Sue Mountstevens said that Domestic Abuse was one of the priorities for the Police and Crime Plan.  Sue Mountstevens valued what had been discussed today but one of the key points was to prevent people fall through the gap, and that there was far too much work in silos.  Sue Mountstevens felt that all partners and organisations would need to work together and share their findings.

Sue Mountstevens was slightly concerned that victims of domestic abuse were not coming forward in expected numbers.  Health and wellbeing had been a key player on this matter considering that victims were far more confident talking to their GPs. 

Sue Mountstevens was also supportive of IDVAs (Independent Domestic Violence Advisors) in A&E, who were, in particularly, helping young people which were victims of domestic abuse.  Early intervention was a key in preventing people being abused and re-victimised.

Robin Cowen (Local Safeguarding Adults Board) said that there was a slight overlap between the agendas in Adult Safeguarding and what had been discussed at networking meeting today about Domestic Abuse.  Robin Cowen welcomed that this subject had been on more than one agenda though the language and culture were different and people had not been looking into this matter enough and in a right way.  The level of  ...  view the full minutes text for item 40.

This paper provides an update on the Bath and North East Somerset Autism Strategy and the findings of the Autism Self Evaluation, completed in September 2013 and submitted to Public Health England as part of a National return.

A ministerial letter dated 2nd August 2013 confirmed that the purpose of the self-evaluation was to:

•  assist Local Authorities and their partners in assessing progress in implementing the 2010 Adult Autism Strategy;

•  see how much progress has been made since the baseline survey, as at February 2012;

•  provide evidence of examples of good progress made that can be shared and of remaining challenges.

And that the content of the return should be discussed by the Health and Wellbeing Board before the end of January 2014.

The Board is asked to note the content of this paper and the self-evaluation and make any recommendations for further development of the local autism strategy and its implementation.

The Chair invited Jane Shayler to introduce the report.

The Chair thanked Andrea Morland and Mike MacCallam for leading on this work and to all who contributed to this work.  The Chair said that the work on autism had involved people with autism, carers and social workers and that he was really pleased with the outcome.

Ashley Ayre said that the training had been marked as red, although there were two special schools with beacons for autistic spectrum disorder (Fosseway School and Three Ways School) which could be involved in future provision of training.

Paul Scott asked about the waiting period following the completion of the self-evaluation assessment.

Andrea Morland (Commissioning Manager for Mental Health) responded that waiting period would be up to 18 weeks from completion of the self-evaluation assessment.

It was RESOLVED to note the report.

The Children Trust Board and Bath and North East Somerset Local Authority have jointly agreed to the development of a new Children and Young People's Plan (CYPP) 2014-2017. This plan will be a non-statutory plan document building on previous plans. It will clearly define the priorities which will directly influence the future commissioning intentions for the delivery of services. The new plan is aligned to the Joint Health and Well Being Strategy 2013.

The Board is asked to;-

1)  Receive and note the draft CYPP

2)  Discuss and comment, either collectively or individually on the draft plan

The Chair invited Ashley Ayre to introduce the report.

It was RESOLVED to note the draft Children and Young People's Plan (CYPP) 2014-2017.