Stockton-on-Tees Borough Council

Big plans, bright future

Health & Wellbeing Board Minutes

Tuesday, 26th January, 2016
Jim Cooke Conference Suite, Stockton Central Library, Stockton on Tees, TS18 1TU
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Cllr Jim Beall(Chairman), Cllr Mrs Ann McCoy(Vice-Chairman), Cllr Sonia Bailey, Cllr Lynn Hall, Cllr David Harrington, Cllr Di Hewitt, Tony Beckwith (Healthwatch), David Brown(TEWV)(substitute Martin Barkley), Martin Gray(substitute Jane Humphreys), Karen Hawkins(CCG)(substitute Ali Wilson), Peter Kelly, Paul Williams (CCG)
Neil Schneider(Chief Executive), Emma Champley, Mark McGivern(PH), Sarah Whaley(LD)
In Attendance:
Cllr Gillian Corr (Observing), Meng Khaw (Public Health England), Adam Ogilvie (Leeds City Council, Philip Simpkins (Bradford Borough Council)
Apologies for absence:
Jane Humphreys, Martin Barkley (TEWV), Barry Coppinger (PCC), Alan Foster (NTHFT), Audrey Pickstock (NHS England), Steve Rose (Catalyst), Ali Wilson (CCG)
Item Description Decision

1. the minutes be approved and signed as a correct record by the Chair.

2. the Action Tracker be added as a standing agenda item for future Board meetings.

3. the item usually referred to as 'Chairs Update' be changed to 'Members Updates'.

RESOLVED that the report and minutes be noted.
RESOLVED that the update be noted.

1) the current progress on implementation of early help and the proposed future actions be noted.

2) the next update be scheduled into the Health and Wellbeing Board Forward Plan.
RESOLVED that the update be noted.
RESOLVED that the action plan be noted.
RESOLVED that the updates be noted.
RESOLVED that the revised Forward Plan be agreed.
2.00pm 4.05pm


The Chairman welcomed members of the Health and Wellbeing Board Peer Review Team who were present, to observe the meeting.
Paul Williams informed the Committee that he had been elected as a director of a new company the 'Hartlepool and Stockton Health', which was a Federation of all General Practices in the Hartlepool and Stockton region.

It was agreed that Dr Williams would provide the Committee with information on the purpose of the Federation at a future meeting of the Board.

Councillor David Harrington declared a non prejudicial interest in relation to the verbal update on Devolution as he was an employee of Middlesbrough Council.
Consideration was given to the minutes from the meeting which was held on the 17th December 2015 for approval and signature.

During consideration of the minutes the Chair, informed the Board that since its meeting held on the 17th December 2015, he, along with the Director of Adults and Health, Peter Kelly had visited Gateshead Health and Wellbeing Board as the first part of an agreed exchange. The visit was found to be both interesting and illuminating and had resulted in some practices which could be adopted immediately by the Stockton Health and Wellbeing Board in relation to the way it operated. The Assistant Director of Electoral, Administration and Democratic Services had been asked to produce an Action Tracker which would provide a record of decisions to enable the Board to track progress until complete. It was agreed that the Action Tracker would become an agenda item going forward. The Chair of Gateshead Health and Wellbeing board alongside their Director of Public Health would attend the next Health and Wellbeing Board Committee meeting which was scheduled for the 24th February 2016.

The Chair put forward a suggestion that the standing item 'Chairs Updates' be changed to 'Members Updates'. This would give each Member of the Board the opportunity to share information they felt would be beneficial or of interest.
The Board considered a report which highlighted the key issues contain within the minutes of the following Partnership meetings.

Adults Health and Wellbeing Partnership held on the 3rd November 2015;

- Sporting Steps Initiative which gave those with learning disabilities and mental health issues the opportunity and confidence to take part in sports activities was seeking to continue. Positive outcomes had already been seen from the initiative such as an increase in independence in those people with learning disabilities. Some participants had also seen improvements in their ability to cope better with their disabilities which impacted extremely well in their wellbeing. The initiative was also cost effective as there was less dependency on other public services.

- With regard to Stockton's bid to be part of the NHS Diabetes Prevention Programme, the Director of Adults and Health informed the Board that the bid had been unsuccessful.

Children and Young People's Partnership held on the 18 November 2015;

- The Board was informed that on-going discussions were taking place with colleagues within the Council and externally in relation to the exact shape of the health business services post April and how Family Nurse Partnership (FNP) as a model could be widened to reach more vulnerable young mums in particular. Although the work with those that had been reached so far was good, not enough were being reached.
The Chief Executive of Stockton Borough Council presented the Board with a verbal update on the progress of Devolution to date.

The key topics discussed were as follows:

- The position in the Tees Valley was that the combined authority was currently in shadow form and would come into existence officially on the 1st April 2016. There would be a directly elected Mayor as part of the conditions for the 'Devolution Deal', which would be in May 2017.

- Due to the fact that there was already a long standing historical and tradition of really good collaborative working across the five Councils within the Tees Valley on Economic Development and Growth, there was a confidence to enable the sub region to seize the opportunity presented by Government to take greater responsibility and control of affairs locally.

- It was made clear that the work to date of the Combined Authority was focussed wholly on Economic Growth and Development, Strategic Transport, inward investment, business support and skills. The Leaders collectively had been deliberate and clear that those were the problem priorities that needed tackling in the Tees Valley.

- Other areas such as Manchester and others had been at a more advanced stage in the devolution deal compared to the Tees Valley. However there was a danger for the Tees Valley that including a broader agenda which could have included services such as Police, Fire, Health and Social Care may impact negatively in an already capacity strained devolution deal which had been negotiated with government.

- The five Tees Valley authorities would receive an additional £15 million per year for the next 30 years. Formation of the single capital pot giving local discretion and decision making on certain strategic priorities.

- The Board was aware that there had been a number of proposed devolution deals in other areas of the country which had been secured by combined authorities and a number which had been tagged around Health and Social Care and potentially NHS budgets and it would be interesting to see how things developed in these areas.

The Chair informed the Board that the Association of North East Councils (ANEC) was now coming to an end in its current form, partly due to the new Combined Authority arrangements and partly due to the need to reduce local authority budgets. ANEC supported the Health and Wellbeing Board Chairs’ Network which was attended and chaired by Councillor Jim Beall. There was one more meeting scheduled for March 2016 where future options would be considered, one such option was to consider opportunities based on the footprint of the combined authorities. It was the Chairs intention to invite the Chairs from the other Health and Wellbeing Boards in the Tees Valley to explore how they might be able to work across that footprint going forward.

It was explained that NHS planning guidance was encouraging the NHS to work across a wider footprint, although also encouraging maintaining a local focus. Reference was made to the 'Better Health Programme' which was looking at some of the wider health issues, particularly in relation to acute care across areas including Darlington, Teesside, parts of County Durham and as far down as Northallerton. The NHS was being encouraged to work on a wider footprint; however, it was in the early stages of defining what the footprint may look like.
The Board considered a report which provided an update on the implementation of Early Help, including an initial analysis of impact, and outlined a series of actions to strengthen the approach, which provide the basis of an action plan for 2016/17.

The Early Help Peer Review had also been circulated to the Board which had been extremely helpful in benchmarking where Stockton was, and looking at what opportunities there might be for shared and collaborative work across Teesside. Also, included was a report detailing the uptake of the Common Assessment Framework which was now referred to as the Early Help Assessment.

The key messages of the report and the main issues discussed were as follows:

- Early Help would have cost saving benefits from the early intervention of working with young people and families experiencing difficulties. Cost savings were not only saved at local authority level but were also seen nationally across a whole range of services.

- It was reported that there was some very good activity, engagement and innovation with many different groups working together around the Early Help Agenda. An example of this was the secondments from TEWV into the Early Help Team which focussed on early identification of mental health and behaviour issues with similar input from CAB and Harbour.

- It was very early to see evidence of progress, however, it was anticipated that the overall approach would result in reduced pressure on social care services. It was too early to categorise and quantify that impact, however, what was being seen was the increased use of Early Help Assessment across a range of services which was starting to pick up those issues much earlier with Early Help Assessments doubling in the last 12 months. This was enabling cases to be allocated for individuals working with those families in an intensive way. There was a steady increase of cases coming through Social Care which had been worked with through Early Help where appropriate referrals had been made.

- In relation to Future Priorities, approaches to targeting was to be redefined, using data and also working in a much more coherent and consistent way with those young people and families who were possibly considered high impact. This would enable them to be seen by different agencies across the system. A more intelligent approach would be used to target families until they were in receipt of services.

- There was lots of activity around commissioning 0-5's where there was interesting work on-going relating to redesigning of CAMHS services which was more focused on early help and intervention.

- It was agreed that when MACH started it would be important to gather evidence to try and understand what services each child had received after signposting, and why referrals were required. It was also important that children were not lost in the system after referral.

- Members discussed the possibilities of utilising local authority libraries for partner agencies to work together and reach some of the harder to reach groups. Libraries were seen to be one of the most neutral government services available to the general public, it was noted that there was to be a focus on venues, libraries would be one of those that would be explored going forward.

- It was noted that the Fairer Start Programme, in terms of the basic principles about engagement and working differently and flexibly, responding to need could be rolled out to other parts of the Borough.

- Members noted that real opportunities to develop the role of the voluntary sector in children's services, going forward, with the availability of better intelligence and through commissioning, via the Early Help Strategy and a Fairer Start.

Members commended Officers for a well put together and detailed report on such complex issues.
The Board considered a report which provided an update on NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group (CCG) development of an Integrated Urgent Care Service (IUCS) and an outline of next steps.

Following receipt of the standards and upon identification of the number of developments outlined in section 3 the CCG Governing Body determined a required extension of timescales for procurement. The impact of this decision being that the IUCS would now commence in April 2017, six months later than originally intended.

The Commissioning Standards had not affeced the services in the main that the CCG was looking to bring under the umbrella of the IUCS with the exception of the out of hours service. The Commissioning Standards set out the requirement to look at integration between the 111 service and the calls handling element of the definitive clinical assessment element of an out of hours service which was intended to be procured under the CCG's own IUCS. This however had been changed as it would now be considered regionally in terms of how the 111 service would work with a clinical hub. Patients would contact the clinical hub and have a clinical assessment undertaken immediately.

In relation to Vanguard the CCG's across the North East had been awarded accelerator site status. The submission of the value proposition bid for 16/17 would be completed on the 8th February 2016.

The CCG was expected to collaborate on a wider footprint and therefore required to work collaboratively with other commissioners.

The Board heard that dental patients also used out of hours services when in dental pain. NHS England were currently undertaking a review of urgent dental provision and this would need to be incorporated into the pathway designed by the CCG for IUCS.

In relation to NHS Planning Guidance the CCG was required to review and impact and assess the guidance to determine any changes that may be required to the current IUCS specification/model of care.

Board Members queried the future of walk-in provision. It was explained that there was an intention to combine the walk in centre with the GP out of hours and the minor injuries unit. Provision would be made by a single provider in a single location, therefore, from April 2017 there would not be a separate stand-alone walk in.

Member asked if the number of GP surgeries operating extended hours was known. It was explained that the number would be dependent on what was negotiated nationally and whether mandated or not through the contract. It was noted that if GP surgeries were to operate extended hours then it was expected that a reduction in demand would be seen in other areas.

The Board agreed that accessibility was a key factor to consider when determining the location of out of hours services. Assurances were given by the CCG that where providers were determining where services would be placed they would have to be accessible and providers would be expected to demonstrate that through the procurement process.
The Board considered a report which provided it with a proposed action plan, coming from its self-assessment event, held on 4th November 2015.

The action plan detailed a number of actions designed to increase the effectiveness of the Board.

Members of the Board were invited to share any information they felt would be of interest to one another. The main topics raised were as follows:

- The 'Better Health Programme', Communication, Consultation and Engagement process was currently underway with an event being held at Sedgefield Racecourse on Wednesday the 27th January 2016 which was to be attended by the Chair and the Director of Adults and Health. An update report would be presented to the Board at a future meeting outlining the whole programme. It was important that Health and Wellbeing Boards were built into the programme of engagement and for it to be included in the Forward Plan for an early update in that field.

- The Chair was to meet with the Chairs of Stockton's Local Children's Safeguarding Board and the Tees Wide Adults Safeguarding Board and the Safer Stockton Partnership in February 2016. The purpose was to revisit previous work about how each Board communicated and related to each other as Bodies, sharing information, avoiding duplication and keeping the communication channels open. The Board would be provided with an outcome report.

- The Board was informed that the Wolfson Annual Lecture was to be held on the 4th May 2016 at the Durham University Queens Campus in Stockton and Sir Michael Marmot was to give the lecture this year.

- An update was given to the Board in relation to the new initiative 'Encompass'. The initiative allowed Police officers, attending a home where an incident of domestic violence had been reported and children were present, to report the incident to the child's school, the next morning.

- National work was being undertaken to determine if it would be beneficial for schools to have a dedicated Health and Wellbeing person. There were resource implications attached to this however the work would determine if the benefits would justify those.

- A paper would be presented to the Board at the next Health and Wellbeing meeting by the CCG in relation to the Planning Guidance that had been published in December 2015 and what impact that would have going forward.

- An update in relation to the delegated commissioning arrangements for Primary Care would be brought to the Board in either March or April 2016. The CCG were to assume responsibility for delegated commissioning for Primary Care from the 1st April 2016.

- The Chair gave a brief update in relation to the Neonatal Unit and informed Members that the work was now being subsumed into the Better Health Programme as the Board had advocated.

- Giving Children the Best Start in Life had secured some none recurrent money that would extend the children's crisis and home treatment service to cover 24 hours.

- An update was given in relation to the warmer homes initiative. 3000 homes in the borough had now received external cladding in a bid to make them warmer through work with Eon. There was to be a piece of work to be carried out detailing the impact of warmer homes on wellbeing.
The Chair informed the Board that an update would be asked for at the next meeting on the North Tees and Hartlepool Foundation Trust CQC Inspection Outcome.

A verbal update in relation to the GP federation would be presented at the next meeting of the Board.

The item to be scheduled entitled Sexual Health was to come off the Forward Plan.

The Board considered the Forward Plan.

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