Agenda and minutes

The Chair welcomed everyone to the meeting.

Apologies for absence were received from:

Ashley Ayre – B&NES Council – substitute David Trethewey

Mark Coates – Liverty

Alex Francis - Healthwatch

Stuart Matthews – Avon Fire and Rescue Service

Hayley Richards – Avon and Wiltshire Partnership

Sarah Shatwell – Developing Health and Independence

Elaine Wainwright – Bath Spa University

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.

Cllr Lin Patterson addressed the Board regarding the environment and the positive effects that nature can have upon health.  She referred to Local Plans and the importance of “building with nature” to include green spaces in developments.  Cllr Patterson supported the charter put forward by the West of England Nature Partnership and hoped that the Health and Wellbeing Board would sign up to this.

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

The minutes of the meeting held on 30 January 2018 were approved as a correct record and signed by the Chair.

To receive an overview of dementia services and support in B&NES including information on the Alzheimer’s Social Care campaign.

10.40am – 15 mins – Chris Atkinson and Ben Stevens (Alzheimer’s Society)

The Board received a presentation from representatives of the Alzheimer’s Society which provided an overview of dementia services and support available in the B&NES area.  The presentation covered the following matters:

·  Information regarding the Alzheimer’s Society

·  Dementia statistics in Bath and North East Somerset – the diagnosis rate in the area is 61.9% which is well below the target set by NHS England (66.7%) and below the West of England average (67.3% and the South West average (62.2%)

·  The percentage of residential care and nursing home beds rating as good or outstanding is only just over half as compared with 62.4% across the South West region.

·  The Alzheimer’s Society delivers many services and projects to help people with dementia in the B&NES area.  There are a number of support workers who aim to eradicate the social isolation for those people with dementia.

·  Local Authorities have a great impact on the experience of residents with dementia and it was noted that B&NES Council has made a commitment to becoming more dementia friendly.

·  There are 850,000 people living with dementia in the UK and this number is set to rise to 1 million by 2021.

·  The Government is due to release a Green Paper over the summer and this provides an opportunity to affect the future of social care in the UK.  The Alzheimer’s Society will be campaigning to ensure it reflects the needs of people with dementia.

The following issues were then discussed:

·  Tracey Cox stated that the CCG is working to improve diagnosis figures in line with NHS targets.

·  James Scott pointed out that the RUH undertakes a lot of work with the Alzheimer’s Society and the Research Institute for the Care of Older People (RICE) including research regarding dementia.  This is an important issue for the RUH which is aiming to become the most dementia friendly hospital in the country.  With the increasing age expectancy this will become more and more important.

·  Steve Kendall reported that the police service has contact with a growing number of people suffering from dementia.  More training in this area would be welcomed by the Police Service.

·  It was noted that “dementia friends” can help to give confidence when interacting with people with dementia.

·  Jane Shayler stated that the Council is aware of the below average number of care home beds which were rated as good or outstanding and informed the Board that action is being taken to improve this.  This statistic could be linked to the high cost of living in the B&NES area which in turn leads to rising staffing costs and recruitment difficulties.  The Council is working closely with the Care Quality Commission on this issue.

·  It was noted that the Alzheimer’s Society can provide courses for staff working in care homes.

RESOLVED: To note the information provided in the report and presentation.

To receive an update on plans between the Clinical Commissioning Group (CCG) and Council to move to a single commissioning structure.

10:55am – 20 mins – Tracey Cox and Jane Shayler

Tracey Cox, Chief Officer of B&NES CCG, gave an update regarding the Integrated Care Partnership.  The following matters were covered in the presentation:

·  Sustainability and Transformation Partnerships, Integrated Care Systems (ICSs) and Integrated Care Organisations are different ways of delivering integration.

·  ICSs are key to sustainable improvement in health care by creating more robust cross-organisational arrangements to tackle the systemic challenges facing the NHS.

·  The role and membership of the ICS Partnership Board (which is a sub-group of the Health and Wellbeing Board).

·  Progress so far – there is no shared consensus on a “vision”.  However a key theme of a recent event was “we want to get on with it” with a strong desire to generate a plan for action.  There was also agreement that B&NES is a workable footprint in terms of size and geography.

·  An initial set of draft principles that the Leadership Team may wish to adopt in order to guide their actions and behaviours.

·  Actions identified at the Leadership Event e.g. .targeting specific areas such as “stranded and super stranded patients”, resource sharing and having honest conversations where needed to facilitate collaborative working.

·  The vision set out in the Health and Wellbeing Board draft statement of intent is “One Health and Wellbeing system that enables people to live happier, healthier lives.”

·  The Draft Statement of Intent sets out three clear aims:

o  Shared leadership of a sustainable health and wellbeing system which is innovative and affordable.

o  Ill health is prevented.

o  Putting people at the heart of reform.

·  Next Steps:

o  The CCG to identify some dedicated transformation capacity to support the development of ICS arrangements.

o  A further meeting of the ICS Board to progress actions and confirm the vision.

o  Priority actions – development of a Memorandum of Understanding and mapping of organisational activities in priority areas of Frailty, MDT working and stranded patients.

James Scott stressed the importance of getting on with this, in particular the actions relating to stranded patients which was a major issue for the RUH.

Andrew Smith stated that the work appeared to be quite reactive, needs a more integrated approach and noted that it would be helpful to link in with existing projects.

Tracey Cox confirmed that a gap analysis was taking place to address these concerns.

A copy of the presentation slides is attached as Appendix 1 to these minutes.

RESOLVED: To note the update regarding the Integrated Care Partnership Board.

To receive an update on the Sustainability and Transformation Partnership (STP).

11:15am – 20 mins – Chris Brown and Tracey Cox

Tracey Cox gave an update regarding the Sustainability and Transformation Partnership (STP).  The presentation covered the following matters:

·  National Context

·  STP priorities for 2018/19

·  Delivery channels

·  Ways of working

·  STP Financial Recovery Plan

It was noted that there is a need to strengthen community care.  This sector faced challenges as a result of demographic change leading to an aging population.  There were also recruitment and retention challenges in the care professions.

Cllr Pritchard stressed the importance of social care and the role of the Council in the health and wellbeing of its population.  It was important to align the agendas of health and social care.

The financial context showed that the STP is currently a facing a shortfall of £30m.  A financial recovery plan has been put in place to address the deficit and to identify ways to close the gap.

Cllr Pritchard queried whether the financial position put the whole STP at risk as three different local authorities are involved.  Tracey Cox confirmed that the position across the three authorities was variable but there was a shared consensus and the authorities could take action together.

James Scott explained that the fundamental issue for the STP is to add value.  Most work would be place based and the majority of work will take place in the B&NES area.

A copy of the presentation slides is attached as Appendix 2 to these minutes.

RESOLVED: To note the update on the Sustainability and Transformation Partnership.

To receive a presentation regarding the Safe and Well Initiative to provide an understanding of the initiative which is a collaboration of opportunities between the Avon Fire and Rescue Service and health and social care.

11.35am – 15 mins – Neil Liddington

Neil Liddington, from the Avon and Fire Rescue Service, gave a presentation regarding the “Safe and Well” initiative.  The presentation covered the following matters:

·  Historical context

·  Relevant literature

·  Current national situation

·  Current situation at Avon Fire and Rescue Service

·  What can be done working together

·  Projects currently underway (such as slips, trips and falls hazard assessment, dementia checks/mental health, social isolation/loneliness)

·  Potential issues

·  Requirements

·  Next steps

It was noted that the Fire and Rescue Service can add value to health and wellbeing services.  Funding is available to develop four packages working alongside an app developer.  The Fire and Rescue Service was keen to identify which of the 4 unitary areas in the Avon locality wished to work on which project and also a named contact for each authority.

It would also be important to evaluate this initiative to identify what success should look like.  Discussions could also take place on future collaborative working on issues such as healthy lifestyles.

Board members acknowledged that there was a good deal of commonality between the different services.  This is an excellent offer from the Fire and Rescue Service and further discussions will now take place to clarify how this can be taken forward.

Bruce Laurence stated that this is a generous offer and noted that a great deal of planning will be required.  It is important to choose a theme that will add value and will provide positive outcomes against existing priorities.

The presentation slides are attached as Appendix 3 to these minutes.

RESOLVED:

(1)  To note the information provided regarding the Safe and Well initiative.

(2)  To agree that Tracey Cox, Bruce Laurence and Kirsty Matthews discuss the best way to progress this matter. 

The Board is asked to consider the attached Charter which commits to joint action on improving health and wellbeing through nature between the B&NES Health and Wellbeing Board and the West of England Nature Partnership.

11:50am – 15 mins – Selena Gray

This item was withdrawn from the agenda and will be considered at a future meeting.

To consider and endorse the annual report of the Director of Public Health 2017.

This year’s theme is “What is Health?”  The introduction discusses how health, for good or ill, develops through life, shaped by the interaction of many individual and social factors.

The main chapters consist of a small number of topics, carefully chosen to demonstrate the great diversity of influences that affect mental health and physical wellbeing.  These include: air quality, children’s mental health, domestic abuse, working towards a more physically active culture and the crucial and intricate inter-relationship between health and work.  Some of these topics were selected in response to public feedback on last year’s report.

12:05pm – 15 mins – Bruce Laurence

Bruce Laurence, Director of Public Health, presented his 2017 report.  The report included the following areas:

·  Active living – including active lifestyles, active travel, active design and active environments

·  Children’s mental health – the importance of getting the best start in life

·  Air quality – what is being done locally and what individuals can do

·  Domestic abuse – community prevention, early disclosure and help, support for victims, working with perpetrators and developing the workforce

·  Health and work – including in-work poverty and getting back to work

·  A day in the life – details of a day in the life of a school nurse

·  Public health outcomes framework and other key indicators – top ten public health problems:

o  Environmental damage

o  Poverty, inequality and lack of opportunity

o  Poor diet

o  Inactivity

o  An ageing population with unmet needs

o  Shortage of affordable housing

o  Children’s mental health and adverse childhood experiences

o  Tobacco, alcohol and other drugs

o  Reduced social cohesion, mutual intolerance and hardening politics

o  Deteriorating public services

The Board thanked the Director of Public Health for his excellent report.  Cllr Paul May welcomed the specific chapter on children and young people.  He highlighted the need to focus more on the large number of university and college students living in the community.  Bernie Morley from Bath University explained that the Student and Community Partnership provide a useful link regarding community and social issues relating to students.

A copy of the presentation slides is attached as Appendix 4 to these minutes.

RESOLVED:

(1)  To note and endorse the annual report of the Director of Public Health 2017.

(2)  To invite representatives from the Student and Community Partnership to attend a future meeting of the Board.

To receive closing remarks from the Chair.

12.20pm – 5 mins – Dr Ian Orpen

The Chair thanked everyone for attending the meeting.  Members were also asked to view and score the posters submitted by school pupils as part of the Clean Air Project being run by the Public Health Team.

It was noted that the next meeting will take place on Tuesday 26 June 2018.