Agenda item

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 the wellbeing college which has been mentioned already and that is designed to be a strong entry point through which people can be engaged in a discussion and pointed to all the already existing services.

One final point is that it isn't always clear that people, and especially young people, always understand how dangerous some activities are and we need to find ways to have a better dialogue with young people around this to make them aware of danger without doing anything to promote what we are seeking to avoid, which is quite a challenge to us.

We have a suicide strategy that tries to pull these diverse threads together.

Meanwhile we will continue to look at each suicide and learn lessons that might help for the future. 

I am not sure that we can really achieve zero suicides and we have had targets over the years to concentrate minds and efforts, but it is a noble aspiration and we must always be aiming to reduce rates to the minimum.

2.  @AnalogueAndy asked ‘Active travel, walking and cycling have key role to play in prevention. What is the Board doing to support it?’

Jo Farrar, B&NES Council Chief Executive said:

‘The Board is very aware and encourages active lifestyles, as you can see from the Health and Wellbeing Strategy and, as a Council who works with partners around this table, we use that Strategy to develop important provision for the local area.  To give two examples – one is our Fit for Life Strategy, which is our leisure strategy. We are soon to re-commission our Leisure Services which promotes walking and cycling as a way to keep fit and remain healthy; another strategy is the Transport Strategy for Bath, which we just consulted on and where we have put on big emphasis on walking and cycling and recognising Bath as a city known to be good to walk around.  We will soon be expanding the Transport Strategy and we will be looking at the Keynsham area and then the wider North East Somerset area.’

Dr Orpen added ‘Study showed that 20 minutes of walking each day could have a significant impact on your health and wellbeing’.

3.  @AnalogueAndy commented ‘Market testing sounds like euphemism for privatisation. Board must ensure pounds are spent as intended – not to boost companies’ profits.’

Tracey Cox (B&NES CCG Chief Operating Officer) said:

‘The CCG and Local Authority are embarking on engagement process at the moment with our stakeholders about future of community services and we are looking at the latest what data tells us about the needs of our local people.  We don’t know yet what the outcome of that process will be and it is likely that it will be potentially a range of options so once we are at the end of that process we may decide that some bits of our services do need to be put out to the market for re-procurement, but we may decide that others don’t.  So, there is a range of potential options and outcomes and obviously, due course, we will keep the HWB informed on progress.  If you think about national direction of travel, and what we want – we want capable providers that are able to integrate services, and able to provide really good quality outcomes for our patients.  When we go to the market, and we test our providers, the price element is often not one of the major factors.  At the CCG Board we do some preliminary work to think about relative weight and balance of all of the criteria that we will use to evaluate providers against.  The money, perhaps, takes lower priority than people might anticipate. 

It isn’t about the lowest cost service – it is about the right service.’

Dr Orpen added ‘To endorse that the money is not the driver; it is the quality of the service.  If you have a quality service then you will get the best outcomes.’