Agenda and minutes

The Chair welcomed everyone to the meeting.

Apologies for absence were received from:

Ashley Ayre – Bath and North East Somerset Council

Mark Coates – Liverty Housing

Steve Kendall – Avon and Somerset Police

Bernie Morley – University of Bath

Dr Ian Orpen – Clinical Commissioning Group

Hayley Richards – Avon and Wiltshire Partnership Trust

James Scott – Royal United Hospital Bath NHS Trust

Dr Andrew Smith – BEMS+ (Primary Care)

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 Paul May declared a non-pecuniary interest as a Non-Executive Director on the Board of Sirona.  This particularly related to item 12 on the agenda (Community Services – One Year On) and Cllr May stated that he would leave the meeting while this item was discussed if necessary.

Fred Jerrome from UNISON made a statement and asked a number of questions regarding the ongoing industrial dispute between Sirona and UNISON members working in extra and residential care.

A response to the questions was circulated at the meeting.

A copy of the statement, questions and response is attached as Appendix 1 to these minutes.

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

To receive a presentation regarding the three-conversation model.  The model draws on the individual’s own resources and encourages professionals to forge stronger links with the wider community.

10.40am – 15 minutes – Helen Wakeling/Natalie Steadman

The Board received a presentation from Helen Wakeling (Deputy Safeguarding Lead) and Natalie Steadman (Head of Transformation Programme) regarding the 3-conversations model for social care.  The model provided a graded process of conversations aimed at helping people lead independent lives with traditional (funded) support packages offered only when other options have been exhausted.

The presentation covered the following issues:

·  Overview of the 3-conversations model:

o  Conversation 1 – Listen and connect

o  Conversation 2 – Work intensively with people in crisis

o  Conversation 3 – Build a good life – for some people support in building a good life will be required

·  Progress so far:

o  Two innovation sites have been live since March 2018 – one at the RUH and one in the social care community team

o  A third team, the North East Somerset social care community team, went live with the approach in mid-May.

o  Plans are currently being developed to roll the model out to two further sites over the summer including one in a mental health team.

o  A scorecard has been developed to record the impact of the innovation sites.

·  Lessons from other areas:

o  People experience an improvement in the quality of the social care provided by getting a response in a timely way to a request for information or assistance; and by being seen as an individual with abilities, networks and resources utilising social care funding to support them in a proportionate way.

o  Other local authorities have seen a reduction of the social care purchasing spend as resources are focused on what is needed by a person rather than prescribing ‘off the shelf’ packages of care.

o  Social care staff report that, unlike some of the existing approaches, the 3 conversations approach supports their professional understanding of what a quality adult social care service should provide. 

·  Case studies from the current approach

·  The way forward:

o  The innovation sites are going to be reviewed at the end of June and a decision made about continuing the roll out across all of B&NES social care services.

o  The plan is to continuously learn, reflect and amend the approach to suit our local needs

Officers then responded to questions as follows:

·  The approach would be used for both new and experienced users of social care.

·  Staff usually communicated with people face to face and advocacy services could be provided if required.

·  A phone number access point was available.

·  The second conversation included family and friends as appropriate.

·  The approach would be evaluated and assessed and lessons would be learnt from the early pathfinder work.

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

RESOLVED:

(1)   To note the information covered in the presentation.

(2)  To request a further update on the 3-conversations model in six months’ time.

To receive a presentation regarding health inequalities.  This follows a previous report provided to the Board in July 2017.

10.55am – 20 minutes – Paul Scott

The Board received a presentation from Bruce Laurence (Director of Public Health) regarding health inequalities; this followed a previous report provided to the Board on this matter in July 2017.

The presentation covered the following issues:

·  Work themes:

o  Give every child the best start in life

o  Enable all children young people and adults to maximise their capabilities and have control over their lives

o  Create fair employment and good work for all

o  Ensure a healthy standard of living for all

o  Create and develop healthy and sustainable places and communities

o  Strengthen the role and impact of ill health prevention

o  Inequity in access to health and care services

·  The latest report on health inequalities showed that life expectancy figures linked to inequalities remained stable.

·  School readiness was a clear indicator of health inequality.

·  People suffering from mental illness often had worse physical health than those who did not.

The following issues were discussed:

·  It was felt that the key focus area to reduce inequalities was maximising early years’ investment.

·  Sarah Shatwell highlighted the need to make the best use of the voluntary sector to help reduce inequalities as the community sector was very diverse.

·  Elaine Wainwright stated that there were links between employment and mental health.  It was noted that there was a project in B&NES to promote healthy workplaces and that it would be helpful to see more emphasis on this.

·  Jane Shaylor informed the Board that under the mental health pathway review occupation is a key workstream.  Some work may be sponsored with smaller employers on how best to support employees and this will involve testing what works well in this area.

·  Cllr Paul May noted the importance of school readiness and support for communities.  As Cabinet member for Children and Young People he would follow this up with the West of England Combined Authority (WECA) who had responsibility for learning and skills.

·  Bruce Laurence stressed the importance of communication between organisations to take this issue forward.  A government green paper regarding child mental health was in the process of being produced and this could link into reducing inequalities.

·  The Board noted the problems that some parents had in obtaining support for children who required assistance due to conditions such as autism.  Cllr Ball pointed out that sometimes without a diagnosis no help or support was available.  Cllr Jackson stated that the prescription of drugs such as Ritalin to children had doubled in the last 5 years.  Members felt that it would be useful to discuss children’s mental health at the next meeting.

A copy of the presentation slides is attached as Appendix 3 to these minutes.

RESOLVED:

(1)  To note the information provided in the presentation.

(2)  To request a report regarding children’s mental health services at the next meeting.

(3)  To request a further update on health inequalities in one year’s time.

To consider a report concerning the recommissioning of homecare and reablement services in Bath & North East Somerset. It focusses on creating services to deliver outcomes which make a tangible difference to people’s lives and promote care market sustainability.

11.15am – 20 minutes – Vince Edwards

The Board considered a report regarding the recommissioning of homecare and reablement services in Bath and North East Somerset.  The report focussed on creating services to deliver outcomes which make a tangible difference to peoples’ lives and to promote care market sustainability.

The Board also received a presentation from Vince Edwards (Commissioning Manager, Adult Social Care) and Alison Enever (Commissioning Project Manager) regarding this matter covering the following issues:

·  Overview – the recommissioning aimed to maximise independence and ethical good quality care and to deliver outcomes that make a tangible difference to people’s lives by:

o  Innovation co-operation and emerging good practice

o  Review and remodel existing services

o  Designing new pathways

o  Re-framing the role of formal care in a modern care and health landscape

·  Details and timeline of the transformation programme

·  Challenges in the care sector:

o  Urgent care

o  Social care

o  Motivation

o  New methods

·  Workshops and consultation

·  Ethical care standards temperature check

·  What we are trying to achieve:

o  A reabling focus to care – people at the heart of services

o  A range of options – right support at the right time

o  Support for rural communities – making best use of capacity

o  Learning from best practice

o  Developing relationships between providers – joined up services

o  Empowering people to live happier, healthier lives

It was noted that homecare was mainly provided for older residents.  Currently there was a good mixed model provided primarily through Virgin Care.  About 70% of care in B&NES was provided by 4 organisations.

It was difficult to recruit and retain staff in the care sector and a number of initiatives were being considered to address this challenge.

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

RESOLVED: To note the report.

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.

11.35am – 20 minutes – Professor Selena Gray

The Board considered a report which proposed closer partnership working between the B&NES Health and Wellbeing Board and the West of England Nature Partnership to support the shared aims of a healthy society.  A Charter was circulated which provided an overview of the value of natural assets and their importance for health and wellbeing and suggested guiding principles for partnership working.

Prefessor Selena Gray, Chair, West of England Nature Partnership gave a presentation regarding the charter.  The following issues were covered in the presentation:

·  Information regarding the West of England Nature Partnership, its aims and mission statement.

·  Information regarding the work of the West of England Nature Partnership.

·  The purpose of the charter for joint action was to achieve a high-level commitment to work together to achieve the shared vision of a healthy society.

·  The spectrum of green care and the importance of experiencing and interacting with nature.

·  Links to sustainable development goals.

·  Principles of the charter for joint action:

o  Place based approach

o  Leadership

o  Investment and support

·  Outcomes for the charter for joint action:

o  Reciprocal representation between the Health and Wellbeing Board and the West of England Nature Partnership

o  Collaborate at South West level (SW LNPs) where possible

o  Identify and actively promote commissioning of nature-based solutions (green care)

o  Collaboration on natural assets and healthcare outcomes embedded in local policies and strategies

o  Community Connectors trained in nature-based solutions and opportunities (green care)

Cllr Pritchard stated that he saw this proposal as a component to preserve both physical and mental health.

Bruce Laurence noted that it was important to promote local opportunities and supported the adoption of the charter.  There was evidence to support the positive effect of nature on health and wellbeing.

Cllr Paul May was also supportive of this work and felt that it was an important area to protect and develop.

A copy of the presentation slides are attached as Appendix 5 to these minutes.

RESOLVED: To agree to the principle of the Charter attached as Appendix 1 to the report 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 Partnership.

To consider the attached report which provides an overview of the first year (2017/18) of the Virgin Care Services Ltd (VCSL) community services contract, including delivery of transformation priorities and quality and performance of service delivery.

11.55am – 20 minutes – Kirsty Matthews/Jane Shayler

The Board considered a report which provided an overview of the first year (2017/18) of the Virgin Care Services community services contract including:

·  Delivery of transformation priorities; and

·  Quality and performance of service delivery

The Board also received a presentation from Kirsty Matthews (Managing Director, Virgin Care) which covered the following matters:

·  Key achievements

·  Progress on transformation

·  2018/19 transformation focus

·  Service quality report

·  Friends and family test feedback

·  B&NES priorities

o  Workforce plan to strengthen recruitment, decrease agency spend and develop workforce

o  Service quality, safety and enhancing user experience

o  Estates and Hotel Facilities Strategic Plan

o  Delivering Year 2 Transformation Plan

o  Meeting the B&NES System Needs, including expanding the Home First service and Reablement review

o  Review and make changes to commissioning

Sarah Shatwell asked about the current mental health review and queried whether this would be delayed until December.  Jane Shayler stated that the initial round of consultation and engagement had resulted in some initial messages which needed to be considered.  It was important to obtain a strong voice from the “seldom heard” groups and it was hoped that adjustments could be made as necessary.  She explained that the timetable for the review was being looked at in the light of any further engagement that needed to take place.  She confirmed that B&NES was not anticipating decommissioning or changing the overall spend on these services.  She acknowledged the concerns of the providers regarding any potential delay and wanted to support partner collaboration and make necessary adjustments.  She also confirmed that the contracts had to be in place by April 2019.

Cllr Pritchard proposed that a report on the mental health review be considered at a future meeting of the Board.

Alex Francis from Healthwatch asked whether the breadth and pace of the transformation had affected the capacity of Virgin Care to meaningfully engage with patients, families and staff.  Kirsty Matthews responded stating that the number of consultees on the Citizens’ Panel was lower than hoped.  With each of the services provided there was an opportunity for service users to engage.  She confirmed that Virgin Care were working with colleagues to ensure that engagement was meaningful.

Alex Francis then asked whether there would be an opportunity to reflect on the changes given the large scale transformation.  Kirsty Matthews stated that there was a dedicated transformation team working on this which provided scope for challenge.

Mike Bowden stated that this had been a very large undertaking and that further updates could be brought to the Board in due course.

Cllr Pritchard noted that the first 100 days had passed without incident, although there had been a somewhat difficult start.  He noted that the real transformation was now beginning.  He confirmed that there would be further updates regarding the transformation of community services which would be brought to future meetings of the Board.

A copy of the presentation slides is attached as Appendix 6 to these minutes.

RESOLVED:

(1)  To note the contents of the report  ...  view the full minutes text for item 12.

To note that the next meeting will take place on Tuesday 25 September 2018 at 10.30am in the Brunswick Room, Guildhall.

It was noted that the next meeting will take place on Tuesday 25 September 2018 at 10.30am in the Brunswick Room, Guildhall.

Closing remarks from the Chair.

12.15pm – 5 minutes – Cllr Vic Pritchard

The Chair thanked everyone for attending the meeting.