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.

Apologies for absence were received from:

Morgan Daly - Healthwatch

Councillor Vic Pritchard – B&NES Council

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 no declarations of interest.

The Chair informed the Board that this would be the last meeting under the current format.  The strategic direction of the Board was being refreshed recognising the opportunities for further growth and to include wider representation.  There would be a development session in February with the next formal meeting taking place in March.

There were no public questions or statements.

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

To receive a presentation giving an update on Your Care Your Way.

The Board received a presentation from Sue Blackman, Project Lead at B&NES Council and Jayne Carroll, Regional Director of Operations at Virgin Care.  A copy of the presentation is attached as Appendix 1 of these minutes.

In November the intention to award the contract for community health and social care services in B&NES to Virgin Care was announced.  The presentation covered the following issues:

·  Details of the Virgin Care Executive Team

·  Local Virgin Care delivery team structure

·  Virgin Care values and vision – Strive for better, Heartfelt service,  Team spirit

·  Over the forthcoming year the project would move into the transition stage.  It was important to effectively join up health and social care.  The focus would be on the individual and their needs to enable people to remain as independent as they can for as long as possible.  Information flows were very important.

·  Mobilisation would take place on 1 April 2017.  It was very important to ensure a safe transfer to Virgin Care.  Strong governance programmes were in place, a steering group had been set up and representatives from Virgin Care would join the group in December.

·  Managing the transfer of staff was also very important.  Safe and robust plans would be in place for Day 1 of the transfer.

·  There would be opportunities for both members and officers to scrutinise the contract.

·  Commissioning outcomes would be measured rather than purely input and output.

Questions

There was then an opportunity to ask questions regarding the your care your way project.  It was confirmed that the video regarding Virgin Care was available on the Virgin website. 

There would be opportunities for staff training and development and work was being carried out in conjunction with universities to provide this.  When populating the posts to be filled it was important to protect the rights of staff and to follow the TUPE process.  It was acknowledge that posts needed to be filled as soon as possible and Virgin Care would be working with Sirona to ensure that this happens.

Councillor Tim Warren thanked the B&NES staff for all the work they had undertaken on the your care your way project and for the open and transparent way this had been carried out.

Councillor Michael Evans welcomed the joining up of health and social care services but expressed disappointment that bed blocking was still taking place.  Officers stressed how important it was to work with GPs and acute providers to prevent any avoidable hospital admissions.  Benchmarking was regularly carried out with the aim of continually improving services and Virgin Care will become part of this process.

The Health and Wellbeing Board NOTED the update.

To receive a presentation about the key messages regarding annual commissioning intentions.

The Board received a presentation from Jane Shayler, Deputy Director Adult Care, Health and Housing Strategy, B&NES Council and Tracey Cox, Chief Officer, CCG, regarding commissioning intentions.  A copy of the presentation is attached as Appendix 2 to these minutes.

The following issues were outlined in the presentation:

·  How best to translate national priorities to local priorities

·  It was important to consider how to use the resources available to best provide positive outcomes for the B&NES population.  The financial context was very challenging.  The Council had an estimated budget gap of £37m for the next 3 years covering 2017/18 to 2019/20.  Of this £37m, the Strategic Review reported last year found £14m, leaving a further £23m to identify.  The CCG had savings plan requirements of £7.8m (3-4% in 2017/18 and £4.3m in 2018/19 (1.8%).  There were also a greater number of people living with complex needs.

·  The your care your way project aimed to provide a sustainable, preventative, integrated health and care system in the local community with services co-ordinated around locality hubs aligned with groups of GP practices.

·  The Primary Care – Statement of Intent aimed to address concerns regarding the sustainability of the primary care service.  Future plans including the estates and technology fund were outlined.  A bid for 2 years funding for all 26 practices for a new practice website, online consultation software and extension to patient partner funding had been successful.

·  Plans for the mental health service were also outlined and it was noted that access to psychological therapies in B&NES was the highest in the country.

·  Urgent Care procurements included a GP out of hours service, NHS 111, Clinical Hub, Urgent Care Centre and Homeless Health Service.

John Holden stated that the saving targets outlined could not simply be achieved by efficiencies within the service.  He queried whether thought had been given to stopping the provision of some services.  Tracey Cox confirmed that these issues had been considered at Board level and it was hoped that shared arrangements such as co-working with the Wiltshire area would be beneficial.  The need to find budget savings was a challenge and it would be important to find ways to provide services differently.  Consideration was being given to whether to continue to provide certain services such as gluten free products on the NHS and discussions were ongoing.

Ashley Ayre explained that the budget plan for the next three years would be published on 3 January 2017.  He acknowledged that there were currently huge financial pressures on health and social care.

The Health and Wellbeing Board NOTED the presentation.

To receive a presentation regarding the Sustainability and Transformation Plan.

The Board received a presentation from Tracey Cox, Chief Officer, B&NES CCG, on behalf of James Scott, Senior Responsible Officer and Chief Executive of the Royal United Hospitals, Bath regarding the Sustainability and Transformation Plan for B&NES, Swindon and Wiltshire.  A copy of the presentation is attached as Appendix 3 to these minutes. 

The presentation covered the following issues:

·  Policy Context within Healthcare.

·  There was a £300m funding deficit for the NHS across the footprint and an equally challenging saving target for the relevant Local Authorities.  It was, therefore, very important to focus on collaboration at this time.

·  Putting the person at the centre of service planning was key.

·  The case for change – population and demographic pressures.

·  Performance and financial pressures.

·  Update on progress made.

·  Details of over 40 projects across 7 workstreams.

·  Future focus “Transformation” – opportunities in the next phase.  10 opportunities to strengthen services were identified including improved communication through on-line presence and growing the working relationship across organisations.

·  Challenges.

·  Key dates over the next 6 months:

o  14 December 2016 – publication of the full emerging plan

o  2 January 2017 – development of the plan through workforce and public engagement

o  10 February 2017 – 30 day checkpoint

o  24 March 2017 – 60 day checkpoint workshop

o  April 2017 – update plan – approval process

o  May 2017 – publish updated plan

The Health and Wellbeing Board NOTED the update.

To consider a report and recommendations from the Children and Young People Sub-Group of the Health and Wellbeing Board.

The Board considered a report and recommendations from the Children and Young People Sub-Group.  The Group takes the strategic lead in ensuring that the priorities identified in the Children and Young People’s Plan 2014-17 are met.  The Group is chaired by a member of the Health and Wellbeing Board and includes representatives from other groups.

It was noted that all priorities were currently either amber or green using the traffic light system.  The current transformation plan was available on-line and on the Council website.  The effective delivery of the CAMHS Transformation Plan 2016/17 would be monitored through the group and any comments should be fed through to Mary Kearney Knowles, Senior Commissioning Manager.

Members of the Health and Wellbeing Board felt that it would be helpful for the Group to focus on some key priority areas and evidence based outcomes.  They welcomed the opportunity for reciprocal challenge.

RESOLVED:

(1)  To note the Year 2 review of the Children and Young People’s Plan 2014-17.

(2)  To note the plan to complete the Year 3 review of the Children and Young People’s Plan 2014-17 and the proposal that the completed Year 3 review is presented to the Health and Wellbeing Board in September 2017.

(3)  To note the details of the CAMHS Transformation Plan 2016/17.

(4)  To retain the existing priorities of the current CYPP and develop an outcomes framework as follows:

·  Children and Young People are healthy

·  Children and Young People are safe

·  Children and Young People have equal life chances

(5)  To receive 6 monthly reports in June and December on the work undertaken by the CYP Sub Group and its delivery groups.

(6)  To note that the B&NES LSCB issue challenges each year to the CYP Sub Group from the work of the LSCB and its Annual Report 2015-16 and Business Plan 2015-18.  To agree that these will provide the reciprocal challenge to the Health and Wellbeing Board on its delivery to children and young people as outlined in the Terms of Reference 3.2 and that these challenges will be reported on every 6 months within the LSCB Business Plan and annually to the Health and Wellbeing Board.

To consider the Annual Report and Business Plan of the Local Safeguarding Adults Board.

The Board considered the Annual Report and Business Plan of the Local Safeguarding Adults Board (LSAB).  The report outlined the work of the Board during 2015-16 and analysed safeguarding case activity.

It was noted that there was now a joint training and development group and that a good deal of collaborative work was being undertaken between the adult and children safeguarding groups.

Self-neglect was now included within the safeguarding arena as a new category of abuse type.

This year there had been the highest ever number of safeguarding concerns received.  The 1,137 concerns represented an increase of 53% when compared with 2014/15.  A total of 422 concerns had moved into a Safeguarding Enquiry during 2015/16, this represented 37% of the concerns raised.  It was noted that service users could choose not to go through safeguarding procedures and 4% of referrals ceased investigation at the person’s request.  In 7% of cases no action was taken.

Bruce Laurence queried whether there should be disaggregation to identify service users over the age of 85 rather than simply over 65s.  Officers confirmed that the categories used were national reporting figures but agreed to consider this suggestion.

The numbers of safeguarding referrals had increased between 2005 and 2014 and it was noted that this impact on service delivery was likely to be linked to work carried out to raise awareness of safeguarding issues and reporting methods.  Ashley Ayre pointed out that adult social care has been an emerging area of work and that improved awareness and an increase in the number of people being categorised as vulnerable were factors.

The Health and Wellbeing Board thanked the team for all the work they had carried out on adult safeguarding.

RESOLVED:  To note the Local Safeguarding Adults Board Annual Report, Executive Summary and Business Plan.

To note that future meetings of the Health and Wellbeing Board will take place on the following dates:

15 February 2017

29 March 2017 – Development Session

17 May 2017

12 July 2017

6 September 2017

25 October 2017

6 December 2017

All meetings will be held at The Guildhall, Bath and will commence at 10.30am.

It was noted that future meetings would take place on the following dates in 2017:

15 February – development session – invitees only

29 March

17 May

12 July

6 September

25 October

6 December

All meetings will take place in the Guildhall, Bath commencing at 10.30am.