Health & Wellbeing Board Minutes

Wednesday, 27th June, 2018
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, Cllr Sonia Bailey, Cllr Lynn Hall (SBC), Karen Grundy (Healthwatch), Sarah Bowman - Abouna, Martin Gray (SBC), Fiona Adamson (HaSH)), Dominic Gardner (TEWV), Sheila Lister (NHSE), Steve Rose (Catalyst), Ali Wilson (CCG)
Michael Henderson, Paul Walker, Mandy Mackinnon, Nick Greaves (SBC); Jo Heaney, Nichola Childs, Andy Copland (CCG)
In Attendance:
Dave Pickard (Independent Chair of Stockton Local Safeguarding Children Board).
Apologies for absence:
Cllr Kevin Faulks, Cllr Di Hewitt, Ann Workman (SBC),Barry Coppinger (PCC), Julie Gillon (NTHFT), Saleem Hassan (CCG),
Item Description Decision
RESOLVED that the update and discussion be noted.

1. the report and discussion be noted.

2. a joint communication be issued at an appropriate time, as described above.

3. an update be provided to the Board in 12 months, with any problems being reported at an early point, if necessary.

1. the information and discussion be noted.

2. the Council's Public Health Service lead on the establishment of a Group to develop an Alcohol Strategy/Strategic Action Plan.

3. periodic reports be provided to the Board .
RESOLVED that the Joint Commissioning Strategy be approved.
RESOLVED that the minutes be noted.


Cllr Ann McCoy declared a personal, non prejudicial interest in item 4 'Autism Spectrum Disorder Pathway', as she served on the Board of Governors of Tees, Esk and Wear Valleys Mental Health Foundation Trust, which was referred to in the report.

Cllr Jim Beall declared a personal, non prejudicial interest in the item entitled Autism Spectrum Disorder (ASD) Pathway', as he was the Chair of Rosebrook Primary School Governing Body, which had responsibility for an ASD Hub within the school.
The minutes of the meeting held on 30th May 2018 were confirmed as a correct record.
Members received a verbal update relating to the Stockton Local Safeguarding Children Board, from the Chair of the Safeguarding Board, Dave Pickard.

The update covered three main areas:

- The Joint Targeted Area Inspection on Adolescent Neglect.

It was explained that the inspection outcomes had been positive, though some areas for improvement had been identified and a multi agency Action Plan had been developed to deal with those areas. The Action Plan had been endorsed by Ofsted. The Health and Wellbeing Board offered assistance should there be any obstacles in terms of implementation that it could assist with. It was explained that a key learning point was to ensure that the child was kept at the centre of processes at all times.

- Safeguarding Board Sub Groups focusing on Mental Health and substance misuse.

It was noted that mental health, substance misuse and domestic abuse were the most significant causational factors for a child to come to the notice of agencies in relation to neglect. Given this, the Safeguarding Board had set up sub groups in Mental Health and substance misuse to look at issues such as pathways, service delivery options etc. Subsequently workshops had been arranged to understand the views of practioners, what blockages there were and how issues could be addressed. There would be feed back from the two sessions and this could be shared with Health and Wellbeing Board members.

- Future arrangements

Members were reminded that, from September, 2019 Safeguarding Boards would be replaced by a Partnership between three key agencies comprising the local authority, police and CCG. Local arrangements would be across the current Stockton on Tees and Hartlepool Boards' footprint. The Boards had agreed to move away from a reporting model to a predominantly active learning model, testing out what was actually happening. It was anticipated that the new arrangements would come into being well before the September 2019 deadline and potentially before the end of this year.

Arrangements that worked well across the whole of the Tees, such as Tees Procedures, would continue, under the new model.
Consideration was given to a report that provided an update on the work being undertaken:

- to address the number of children and young people waiting for a clinical assessment for Autism Spectrum Disorder (ASD).

- to progress the development of a new, needs led, ASD integrated pathway.

Members noted that additional funding had been allocated to allow the clinical assessment waiting list, as at May 2018, to be cleared within a 12 months period. The commencement of the initiative would start following recruitment of additional staff that would be required to take the work forward. It was identified that in order to improve the pathway in a sustained way, changes would be required, both in the short and longer term. An initial improvement was to change the way Children and Young People were referred onto the diagnostic pathway. This was to be developed in conjunction with the clinicians and families connected to ASD. It was explained that identified professionals would receive training in completion of a referral form, which would be introduced, to support the new referral process which, it was hoped, would commence from September 2018.

In terms of the development of a new, needs led ASD integrated pathway, it was explained that there had been work undertaken to identify best practice in other areas. In addition there was a range of positive work being progressed, including:

- developing support services for families, which would also look to work with professionals and increase the awareness around autism, across the Borough.

- identifying suitable training to upskill the workforce, to enable it to identify and meet needs, at the earliest opportunity.

- a multi-agency oversight group was going to be convened to ensure good governance.

- work with the Parent Carer forums to bring their expertise into the development of the service specification for sensory and family services.


- Members noted the complexities associated with this matter and the significant progress that had been made.

- It was envisaged that the additional resources would clear the waiting list, as at May 2018, and other work around the pathway would prevent significant waiting lists occurring in the future.

- It was noted that much of the additional funding, identified for clearing the waiting list and training, would be non- recurrent. However, there may be some recurrent costs, associated with the new pathway, that may need to be built into financial plans going forward.

- TEWV indicated that, in terms of recruiting additional staff to deal with the waiting list, it was likely that it would recruit on a permanent basis, recognising that this would be more appealing to potential candidates. In addition, those staff could also be used to fill gaps in other parts of the service.

- The multi-agency approach had allowed resources to be applied in a better, more effective, way than would have been the case on an individual agency basis.

- It was confirmed that Daisy Chain was involved and was leading on a number of pieces of work, such as training and supporting families

- A joint communication was being prepared and it was suggested that it be highlighted that the Board had recognized that there had been an issue and it had come together and identified a potential solution, including significant additional resources. It was agreed that the Council's Communications Team could put out a statement to this effect. However, it would be important that contact was made with individual families first. Further consideration would be given to an appropriate time to release a statement and the CCG would advise the Council's Director of Children's Services in this regard.

It was agreed that an update be provided, to the Board, in 12 months' time. However, should any issues occur in the intervening period reports could be submitted as necessary.
Members received a presentation on the impact of alcohol misuse on residents and services within the Borough.

Members noted that a previous attempt to develop a multi-agency strategic plan, around alcohol, had stalled and the Board was asked to provide the leadership to kick start and encourage a process that would see a strategic plan put in place.


- Members noted that there could be a little tension between the benefits of building a vibrant night time economy, in the Borough, and encouraging positive healthy behaviours. This, together with regular changes in Chairmanship had been factors in why a previous attempt to develop a multi-agency action plan had not progressed.

- It was noted that health was not a key objective, within the licensing framework, and therefore it could not, generally, be used as a reason to manage the number, concentration and types of licensed premises in the Borough. That said, some Councils were looking at what might be applied, and Stockton was monitoring this.

- Members were provided with data that highlighted the considerable health risks associated with certain drinking behaviors and the impact those behaviours had on a range of services.

- The Board felt alcohol was a significant issue and a broad section of partners, beyond the membership of the Board, had to be involved to address it.

- The Board recognized the negative impact alcohol consumption could have on children and families and It was suggested that a similar approach to the one taken to address Domestic Abuse may be of benefit.

- It was suggested that some actions identified may be appropriate to implement across a wider footprint than the Borough, but local actions were the priority.

Members agreed that a Group be established, comprising appropriate agencies, to consider the evidence and look at the work already going on in order to develop a strategy/strategic action plan. The Group could take a Task and Finish approach to each key issue, to really focus partners' energy and help maintain momentum. Periodic reports should be provided to the Board, including highlighting issues that it could potentially help resolve. The Council's Public Health Service agreed to lead on the establishment and to support/facilitation of the Group. Requests for representatives should go to Board Members who would ensure appropriate representation.

It was suggested that a GP representative be invited to serve on the Group given the impact alcohol had on primary care. The Police and Crime Commissioner's Office also needed to be involved.
The Board was provided with a SEND Joint Commissioning Strategy.

The purpose of the strategy was to:

- Identify a set of key commitments and priorities that would underpin all joint planning and commissioning decisions around SEND.

- Form the basis for a review of SEND service provisions (including Emotional Health and Wellbeing Services, Speech and Language Therapy, physiotherapy and equipment provision) to be taken forward by the SEND Development Joint Commissioning subgroup, which would develop an action plan. It also provided a framework for effective joint planning, understanding and review of SEND services in the Borough.
Members considered the following minutes;

- Children and Young People's Health and Wellbeing Commissioning Group - 5 March 2018.

- Adults' Health and Wellbeing Joint Commissioning Group - 29 March 2018.

- Adults' Health and Wellbeing Partnership - 6 March 2018.
Members provided the following updates:

- It was noted that the local urgent care service had been nominated for an award within the NHS Parliamentary Awards and the results would be known soon.

- TEWV was being inspected by the Care Quality Commission and early feedback had been positive.

- It was noted that the Tees Valley Joint Scrutiny Committee would be undertaking a Task and Finish review into the impact of building defects, at Roseberry Park, had had on patients and carers. It was agreed that a report on Roseberry Park be provided to a future meeting of the Board.

- The Chair explained that he had been copied into a letter from NHS's National Director of Urgent and Emergency Care relating to reducing long stays in hospital and an aspiration to reduce long stay patients in hospitals by 25%. It was noted that long stays in hospital had long terms negative effects on patients' recovery. This issue was picked up locally by the A and E Delivery Board and through the Better Care Fund.
Members noted the Forward Plan.

It was agreed that Members be contacted to establish their availability for a Development Day on 25th July 2018 or 29th August 2018, 1pm to 4 pm.

It was agreed that the Healthwatch Annual Report come to the Board in September, for information.

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