Meeting documents

Apologies were received from Mr G Payne, Mr T Boyd and Mr D Johnston.

There were no announcements from the Chairman.

There were no declarations of interest.

The Minutes of the Meeting held on 30 April 2015 were agreed as a correct record.

The following points were discussed arising from the Minutes and the Action Notes:-

PSHE lessons

There would be a further update circulated in September/October 2015 once the new guidance from Ofsted had been published.

Action: Katie McDonald

Dr Gamell, Chiltern CCG would provide an update on the Natural Environment Partnership at a future meeting. This would be scheduled into the Work Programme.

Action: Katie McDonald

Bucks Physical Activity Strategy

A presentation had been given by the Director of Public Health at the last meeting on the Strategy and on Active Bucks. An update from the Active Bucks Team would be provided for information at the next meeting on 1 October 2015. The Director of Public Health would also include any examples of best practice in her Annual Report focusing on Physical Activity which would be published in the Autumn.

Action: Dr Jane O’Grady/Katie McDonald

CCG’s were already using TV screens in GP waiting rooms to put across key messages in relation to physical activity and Active Bucks.

There had been no further feedback on the Draft Safeguarding Protocol regarding relationships and therefore this action was complete.

The ADASS report had not been discussed at the last meeting due to limited time and Mr Trevor Boyd had given apologies for this meeting. It was agreed that this should be addressed at the next meeting on 1 October 2015 or picked up at the September Development Day.

Action: Katie McDonald

Members agreed that it would be helpful to include a glossary with the agenda to explain any acronyms used within reports.

Action: Katie McDonald

There were no public questions.

Richard Corbett, Healthwatch

Richard Corbett commented that Jenny Baker, Chairman was unable to attend the meeting as she was at a Healthwatch England meeting.

During his presentation the following points were outlined:-

·         Healthwatch can sometimes be viewed as a tick in the box in terms of consultation rather than contributing to good outcomes.

·         Healthwatch is involved in a large number of meetings and it is important that time is given to understanding what is happening to a broader base of the local population.

·         There are currently 4 members of staff (2 part time) with 25 volunteers.

Current work:-

·         A Transport Report has just been published to show there are issues in rural areas but also the lack of awareness of transport provision came out as a key message. For non-emergency transport for hospital services there were confusing messages about who to phone; some areas were informed to contact the GP; in other areas it was different. Parking issues at hospitals were also a problem; often people did not mind paying for parking as long as they got a space and this increased anxiety levels for patients before they entered the Hospital. It was often the practical issues that the patient remembers.

·         A video had been produced by young people so that they could give their views on health and social care. One main concern for young people was mental health issues.

·         Visits to care homes included enter and view powers. They had visited 15 care homes in Bucks as part of the Dignity Strategy to see how people are treated. These visits were not clinical in nature and also were not inspections. They would sit, watch and talk to people. Some care homes welcomed this visit and have actively asked to discuss particular projects. There were some misconceptions held by people on these visits and one visitor had been turned away at the door. It was important to see Healthwatch as a critical friend. 

Healthwatch has five aims:-

·         Influence in commissioning – seek public views, consult and influence selection process

·         Signposting – website and phone line.

·         Hold organisations to account – statutory powers to enter and view premises

·         Compliments and complaints. Dignity Awards were held earlier in the year to demonstrate good practice. Healthwatch were part of the Judging Panel.

·         Organisational Development – Healthwatch is two years old and still in its infancy with poor brand recognition. This needed to be developed with greater public contact, increased credibility with commissioners and providers.

Engagement Options

Healthwatch Torbay had a trip adviser option where people could rate individual services. Torbay Hospital had 4 stars with 108 reviews. Healthwatch Bucks wanted to see more engagement across different providers and valued having third party feedback. Sandwell and West Birmingham Hospitals have Healthwatch as a link on the front page of their website. If this approach was valued they were happy to work in partnership on this area.

During discussion the following points were made:-

·         Dr Jane O’Grady referred to the mental health issues experience by young people  ...  view the full minutes text for item 6.

Lesley Perkin – Programme Director for Integrated Care

Lesley Perkin, Programme Director Integrated Care reported that there were two key issues relating to the Better Care Fund which was the pooled budget (S75) for commissioning of services across health and social care and initiatives to be taken forward.

The Metrics Framework was attached to the agenda. There are five national indicators which are whole system indicators which include rate of emergency admission, number of permanent admissions to care homes, reablements and delayed transfer of care and patient experience.

With emergency and care homes admissions the local targets were steady against rising demand. The national target for emergency admissions was 3.5% but as Bucks County Council already benchmarks well in this area there is a target of 1.6%. With care homes, holding steady on the national indicator would be an achievement. Early indications showed that the targets with emergency admissions and care homes would not be met in April and would involve a lot of work to recover the position which was going in the wrong direction.

Improvements to reablement services were being prioritised in terms of  service change and were being aligned between adult community health care teams and Bucks Care. By the end of April both services had been brought together to create a place where staff could sit together to triage referrals and agree the best pathway for individuals including a joint response. Front line staff have started discussions on how to use the same assessment tools and paperwork.

The Metrics Framework has links to national indicators and the reablement target which the service can directly influence. It would also measure levels of independence. This will be reported on a monthly basis. In addition stories and experiences from frail older people on their user experience would be of benefit to illustrate how services were improving.

During discussion the following points were noted:-

·         Dr Annet Gamell, Chiltern CCG reported that the whole system needed to be resilient in terms of demographics.  When they went live in April it was still winter which had not happened before and this had an impact on the measures recorded for A and E. The Urgent Care Resilience Group involve all parts of the system including ambulance and mental health. It was important to develop innovative ways of delivering metrics to help provide a good measure.

·         The Chairman commented that it was important to clarify the Board’s role in terms of taking action when targets were not met or whether this was for another Board to monitor. Dr Annet Gamell reported that the resilience urgent care group and the Adult Joint Executive Team look at metrics on the frail elderly pathway but it was important for the Health and Wellbeing Board to have oversight of these figures. Representatives from those Groups did attend this meeting and could report any concerns.

·         Lesley Perkin reported that it was a complex system and it was important for a number of bodies to monitor the BCF. The Adult JET monitor metrics line by line and  ...  view the full minutes text for item 7.

Susie Yapp, Service Director for Commissioning and Service Improvement provided an update to the Board. Attendees also included Kurt Moxley, Senior Joint Commissioner, Alan Baldwin Assistant Chief Constable Neighbourhood Policing and Will Hancock Chief Executive South Central Ambulance NHS Foundation Trust and Eddie McLaughlin, Service Director for Adult Mental Health Services on behalf of Yvonne Taylor.

Kurt Moxley reported that the Mental Health Crisis Care Concordat brought together a number of organisations that were involved in providing care to a person in a crisis with mental health issues. This was a Government initiative which was implemented at the end of the last financial year. An Action Plan was tabled and would be circulated via email.

Action: Kurt Moxley

During discussion the following points were made:-

·         Dr Graham Jackson asked whether the support service included 30 people in total not just those in crisis. This was confirmed.

·         Dr Karen West referred to the increase in ambulance use and whether this put any pressure around response times. In response it was noted that there was a much greater awareness by officers and that the front line ambulance was better than a police car for people with mental health problems. Further down the line this would move to more appropriate vehicles such as ambulance cars.

·         Dr Stephen Murphy referred to the street triage. Alan Baldwin mentioned the Oxford pilot which had reduced the number of people in custody and this was being implemented in Aylesbury; the feedback was already good. This was also being introduced in the South of the County, in Berkshire and Milton Keynes. This was a health issue not enforcement.

·         The Chairman asked a question on behalf of the public in terms of safety and protecting residents. The individual needs to be taken to a place of safety where their mental health issues can be dealt with properly. The responsibility for the police comes where there is a serious and imminent risk to the public. Health care professionals can access records on individuals which is of benefit in terms of assessment and knowing how to respond whereas the police are often unaware of how the individual will respond. The Chairman referred to a small number of high profile cases where individuals had been injured and killed and the public needed reassurance that the police would still provide assistance. Alan Baldwin reassured Members that the police were still investing time, vehicles and training but wanted to make sure that people with mental health issues were looked after in the most appropriate setting.

·         Dr Juliet Sutton commented that primary care representatives had very limited training in restraint and dealing with violent patients. If they were concerned at any point they could phone the police who would response in a timely manner - 15/20 mins for situations that were serious or imminent.

·         Lou Patten complimented the work at Whiteleaf Centre in Aylesbury which was considered the best response having dealt with up to 300 cases as a place of safety. Police custody was  ...  view the full minutes text for item 8.

David Johnston, Strategic Director CYP

Hannah Dell, Programme Manager reported that the Improvement Board had met that morning which was good timing for providing an update to this Board Meeting. There were green shoots of progress. Critical measures were starting to change from red to amber. They were pleased with key measures and putting resources into early help such as the Multi Agency Safeguarding Hub and early triage and referral. Lou Patten reported that the health strands of the work had been well received but there was further work to be undertaken.

The Cabinet Member for Children’s Services, Lin Hazell reported that for any weaknesses identified, staff were undertaking ‘deep dives’ to identify action that needed to be taken forward. 16 full time staff had now joined the service with positive external interest.

Ms Isobel Darby commented on the need for less reporting and undertaking action. The Improvement Board had an independent chairman which met monthly. Reports were also submitted to key partners through the Health and Wellbeing Board and senior officers through the One Council Board. There was also monitoring by the Select Committee which was looking at workstreams. A quarterly report was submitted to Cabinet and a report had been submitted to full Council twice.

Dr Graham Jackson commented that if any Boards met in public the information submitted was difficult to read with many acronyms and emphasised the importance of plain English. He commented that a glossary would be very helpful. He also expressed concern that there was a lot of scrutiny but not enough clarity. An Executive Summary would help with an overview and high level summary to assure Members that improvement was being taken forward. Lou Patten reported that the main aim was improved outcomes for children and this Board should be focusing on health and wellbeing outcomes.

Dr Jane O’Grady referred to the Bucks Safeguarding Board and the importance of not duplicating reports. Nicola Lester reported that a simple balanced scorecard would provide key information. At the next meeting there should be a report outlining the key performance indicators.

Action: Hannah Dell/Katie McDonald

To agree the Work Programme

The following areas would be included in the Work Programme:-

October meeting

ADASS report (the planning group would clarify whether this would be an update for information)

December

Six month update on the Mental Health Concordat

A detailed look at the implementation of the Better Care Fund (risks and performance)

Natural Environment Partnership – October/December.

Regular Update

Ofsted Improvement Plan balanced score card specific for the HWB.

Areas to consider

Suicide Prevention Plan – this would be submitted first to the Adult JET for consideration.  This included adults and children.

JNSA progress – round table event in July and the Development Day in September. A short update early October with an update on the planned refresh for December.

The planning group would look at the Work Programme at their July meeting to confirm items.

Information for Board Members only

The report was noted.

01 October 2015, 14.00pm, Mezzanine Room 2, County Hall, Aylesbury (will be webcast)

To agree dates for future meetings

1 October 2015 – 2pm. Future dates for next year would be circulated by email.

Action: Clare Gray