Agenda and minutes

Dr Ian Orpen informed the meeting that he would Chair this meeting of the Board according to co-Charing agreement approved at the last Board meeting.

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.

Pat Foster had sent her apologies for this meeting.  Ronnie Wright (Healthwatch) was her substitute for this meeting.

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.

There were none.

The Chair informed the meeting that he had agreed to include a briefing (attached to these minutes) from Council officers regarding a response to the recent pressures at the RUH and the fact that £325,000 had been awarded in extra money to support social care.

The Chair suggested that the Board should consider this document under ‘Commissioning Intentions’ agenda item rather than at this point of the meeting.

The Board agreed to consider this document as part of the ‘Commissioning Intentions’ item.

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

B&NES Council have commissioned Your Say Advocacy since 2006 to support and facilitate the ‘Networks’ for People with Learning Disabilities across the B&NES area.

Historically this has meant 3 different ‘Network’ groups meeting in the 3 main geographical areas of B&NES: - Bath, Keynsham and Norton Radstock.

The Network have worked on local and B&NES wide issues affecting the lives of people with learning disabilities and worked to make change happen to improve people’s lives.

The Board are asked to consider a presentation from Your Say Advocacy representatives.

The Chair invited Kirsty Mann and Kate Hurden from ‘Your Say Advocacy’ and Mike McCallum to give the presentation to the Board.

The Board welcomed the presentation.  Members of the Board had felt that work of the Your Say Advocacy Network with people who had learning disabilities had been quite inspirational. 

Bruce Laurence asked what would be key messages from the Your Say Advocacy to the Board.

Kirsty Mann replied that people with learning difficulties had experienced everything that any other vulnerable group had been experiencing but they do have different needs.  For instance they would need more time at the GP to fully understand what they were told.

Dr Orpen commented that an issue of GP appointments for people with learning difficulties was a valid point.

Councillor Crossley commented that the new library in Keynsham had had positive feedback from the Network and asked if there had been any other development work across the area where the Network could be involved.

Kirsty Mann replied that there were other developments across the area in which the Network could have an input.

Councillor Allen commented that the Board should receive regular updates from the Network on their partnership conversations.

Jo Farrar commented that she was pleased that the Network had been involved in the new development in Keynsham and, as a result of that, they were invited to become Partners in the One Stop Shop.

Councillor Romero asked if the Network had been involved in consultation run by the Council.

Kirsty Mann responded that the Network would want to be involved in consultations run by the Council.  Kirsty Mann added that the One Stop Shop in Keynsham was a good example how the Network were involved from the beginning of development.

Ashley Ayre asked if the Network had had any links with the special schools and colleges.

Kirsty Mann responded that the Network had had link with the main learning disability special needs school though not with mainstream schools.  Kirsty Mann added that there have been some links with colleges but not as strong as the Network would want to have.

Ronnie Wright suggested that the Network should get in touch with the Healthwatch who could amplify their messages on their website and also on their networking events.

Dr Orpen invited the Network to give a presentation to the CCG Board.  Kirsty Mann took that offer on board.

It was RESOLVED to note the report.

Bath & North East Somerset Council (B&NES) and BaNES CCG intends to work towards developing, publishing and implementing a ‘Making it Real’ action plan, with a view to embedding the principles of personalisation, co-production and integration within the decision making processes of adult health and social care commissioning. The embedding of a truly personalised approach is key to the successful implementation of the Care Act.

The Board is asked to endorse:

•  The commitment to Making it Real

•  The proposal to develop a ‘Making it Real’ action plan

•  The principles of co-production which this will entail

•  The draft programme structure and draft action plan as attached at Appendix 5.

The Board is also requested to receive six monthly progress reports.

The Chair invited Wendy Sharman (Transformation & Strategic Planning Manager) to give the presentation to the Board.

Wendy Sharman highlighted the following points in her presentation:

·  What is Personalisation?

·  What does Personalisation mean to us?

·  Making it Real

·  Markers for Change

·  Risk enablement – feeling in control and safe

·  Making it Real in Bath and North East Somerset

·  Our proposal

A full copy of the presentation is available on the Minute Book in Democratic Services.

Tracey Cox commented that ‘Making it Real’ action plan appears to have massive agenda and asked if conversation with commissioners and large providers took place.

Wendy Sharman responded that the CCG B&NES, together with the Council, had supported the application.  Wendy Sharman also said that draft programme structure and action plan for ‘Making it Real’ would be communicated with large area providers, like Sirona and the RUH Bath.

Councillor Allen supported ‘Making it Real’ action plan.  He added that the proposed structure for B&NES would result in fully embedding co-production and the principles of ‘Making it Real’ throughout the decision making processes of Bath & North East Somerset Council Adult Social Services.  It would do this by eventually establishing a ‘Making it Real Implementation Group’ supported by working groups. The Implementation Group would sit alongside the Care Act Implementation Board and would share a number of work streams with that Board.

Bruce Laurence and Tracey Cox commented that there should be caution on the aspiration of the ‘Making it Real’ action plan.  Wendy Sharman replied that it was good to set high goals in order to motivate ourselves and others.

Ronnie Wright commented that the Healthwatch, together with Wendy Sharman and her team would talk more about the Personalisation and ‘Making it Real’ plan.

It was RESOLVED to endorse:

·  The commitment to Making it Real

·  The proposal to develop a ‘Making it Real’ action plan

·  The principles of co-production which this will entail

·  The draft programme structure and draft action plan

The Board RESOLVED to receive six monthly progress reports.

The Health and Wellbeing Board are to receive a presentation from commissioners across the Council (Adults, Children’s and Public Health), the Clinical Commissioning Group and NHS England with an overview of their annual commissioning intentions.  This will include consideration of our shared local priorities and our plans for integrated working to deliver on them.

The Chair invited the following officers to give their presentations (as per attached report):

·  NHS England – Julia Davison

·  B&NES Council – Jane Shayler

·  B&NES CCG – Tracey Cox

·  Public Health – Bruce Laurence

John Holden commented that he was very encouraged with presentations.  John Holden noted that Tracey Cox had said that commissioning intentions had gone to providers by end of November 2014, which seemed to be consistent with ordinary process to get things in place by April 2015, though he wasn’t quite sure when the material from the NHS England had been received.  If material was received in December 2014, how could the CCG encompass items from the NHS England presentation?

Tracey Cox replied that the guidance did not come out until 23^rd December.  However, the CCG always caveat commissioning intentions for that subsequent guidance that was likely to be issued.  The good thing was that there were only few surprises with new guidance, and everything else has been pretty much expected.

Councillor Allen welcomed increased focus on mental health and also that care and quality within the urgent care system had been maintained.  Councillor Allen added that the most positive thing was joint commissioning of primary care between the Council and CCG.

Jo Farrar said that she was pleased with comments from Julia Davison that B&NES had been setting directions for other places in the UK.  Jo Farrar said that the Board should receive a report in near future on why we do work well and how we would take that to the next level, from strategic point of view.

The Chair agreed with the comment from Jo Farrar and supported her suggestion for a report on why do we work well in comparison to others. 

It was RESOLVED to note the presentation and to receive a report on why we work well in comparison to other authorities.

This paper will update the Board on what can be learnt from the ideas within the national Making Every Contact Count initiative, as discussed through the Network, and how might we take these ideas forward at a local level.

The Board is asked to:

•  Note the outcomes of the meeting

•  Consider possible next steps in relation to Making Every Contact Count

The Chair invited Ronnie Wright to introduce the report.

It was RESOLVED to note the outcomes of the meeting.

It is a statutory responsibility of the DPH (to write) and the Council (to publish) an annual report on the public health. This is to present the latest report to the HWB in its capacity as the body overseeing the population’s health and wellbeing.

The Board is asked to note the publication of this report and comment on its contents and format.

The Chair invited Bruce Laurence to introduce the report.

It was RESOLVED to note the report.

This is a briefing on the work and future scrutiny of the LSCB.

The Board is asked to note this report and make any recommendations for additional scrutiny.

The Chair invited Reg Pengelly (Independent Chair of the Local Safeguarding Children’s Board - LSCB) to introduce the report).

Ashley Ayre complemented Reg Pengelly as the Chair of the LSCB.  Ashley Ayre also said that there had been an ongoing work on recruiting lay members of the LSCB.  The LSCB had worked very hard on ensuring clear accountability.

Ashley Ayre also informed the Board that Reg Pengelly had been appointed as the Chair of the Local Safeguarding Adult Board.

Councillor Allen commented that independence of the LSCB was important and that it should stay as independent body.

Councillor Romero suggested that Reg Pengelly should provide further update to the Health and Wellbeing Board at one of the future meetings.

It was RESOLVED to note the report and to receive further update regarding the work of the B&NES Local Safeguarding Children Board (LSCB).

The Chair informed the meeting that there had been three questions from Twitter.

NOTE: Questions from Twitter had been asked without prior notice so responses from the Board were provided at the meeting.

1.  @AnalogueAndy asked ‘#ZeroSuicide in the news. More than 4,700 deaths in 2013. What does the Board think it needs to do?

Bruce Laurence, Director of Public Health, said:

‘The work done in Detroit was very strong and I have read about it in some detail, but there is a significant difference in that the target was reached there not in the whole population of the city but in a section of the population enrolled in a particular health insurance scheme which will therefore exclude some of the most needy and vulnerable who aren't covered and that will also ensure that everyone is known to services. The NHS has responsibility for the whole population including the most vulnerable and needy and some who will not be known to any services. But the work done there is impressive and we can try to learn from it.

Suicide is a major problem and there is some evidence that it increases in times of economic stress. To a large extent suicide is an indication of long term and exceptional stress, but sometimes it can be more impulsive with much less reason to suspect that there might be a danger.

Suicides are tragic to the families affected and we treat every suicide seriously and audit to see if each suicide could have been avoided.

Sometimes people are in contact with services but often, in maybe around half of cases,  they are not so to manage suicide is not just about picking up and managing risks among those who come to the attention of services, but also about looking at the health and wellbeing and particularly mental health of all residents.

This then brings in contributions of many, starts with good early years development and support to young families, education and training, jobs and benefits, housing  and therefore this involves all of our services state, voluntary and indeed society as a whole.

We know that loneliness and social isolation are important and paradoxically the connectivity of the internet has negative as well as positive influence. It can create strong supportive relations and networks that protect people from stress and isolation but can also allow bullying and there are websites that actively encourage dangerous behaviour.

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It involves some of what we have heard this morning about personalised care and the idea that people need control of the support that they get to best meet their needs. Perhaps one of the most important things that the Detroit experience has shown is the power of coordinating different services around individuals thought to be at high risk.

Some of the more specific areas where we are strengthening services that impact on mental health are the increased access to talking services for people who have anxiety and depression, drug and alcohol treatment services and  ...  view the full minutes text for item 74.