Meeting documents

Apologies were received from Mr M Appleyard, Mrs A Macpherson, Dr J Sutton, Dr K West, Mr S Bell and Mrs K Wood.

There were no declarations of interest.

The purpose is to provide an update on local system planning including the development of the Sustainable Transformation Plan since the last presentation at the Health and Wellbeing Board in September 2015.

Presenters:

Lou Patten, Chief Operating Officer, Aylesbury Vale CCG and Chiltern CCG

Robert Majilton, Deputy Chief Officer and Director of Sustainability & Transformation, Aylesbury Vale CCG & Chiltern CCG

Neil Dardis, Chief Executive, Buckinghamshire Healthcare Trust

Pauline Scully, Service Director, Oxford Healthcare Trust

Ms L Patten, Chief Operating Officer, Aylesbury Vale CCG and Chiltern CCG, Mr N Dardis, Chief Executive, Buckinghamshire Healthcare Trust and Dr G Jackson, Clinical Chair, took the Board Members through the presentation and the following main points were made:-

• A detailed presentation had been given to the Health & Adult Social Care Select Committee on system planning.
• Seven locality engagement events had taken place across the county during November and early December.
• Main challenges include an ageing population, a growing population, new demands which cost the NHS at least an extra £10bn a year nationally and evolving healthcare needs, such as the increase in obesity and diabetes.
• If nothing was done to meet these challenges, costs would exceed funding by about £107million over the next four years across the Buckinghamshire health system.
• The CCGs operational plan and Buckinghamshire Healthcare Trust’s plans were aligned to the overall BOBW Sustainability and Transformation Plan (Buckinghamshire, Oxfordshire and Berkshire West STP).
• The STPs would provide ‘umbrella’ plans for change and provide an opportunity to work at scale across a larger population.  The STP would also provide the mechanism for sharing innovation and collectively improving health, care and finance for the wider population.  The organisations involved would retain their own accountability whilst also working to a shared, agreed STP plan.
• The majority of the STP work would be delivered locally – 70% of the efficiencies would come from the local health and care plans and 30% from across the larger Buckinghamshire, Oxfordshire and Berkshire West footprint.
• There would be a focus on improving patient outcomes and experience and a shift in spending on bed-based care into prevention and care at home; integrating health and social care service to avoid unnecessary steps in pathways to reduce waste and duplication; deliver cost and productivity improvements; deliver urgent and emergency care services in the right place at the right time and deploy technology to enable rapid access to advice, care and support.
• Community Hubs and Locality Services were currently being developed where each locality would integrate primary care and community based services to meet the health needs of the local population – some services would be in a building whilst others may be virtual.
• The Hubs would bring together health, care and the voluntary sector, to enable more efficient access to Hospital based specialist advice.
• There were no current plans to consult in Buckinghamshire as there were no significant planned changes to services.  There would be more public engagement to provide more clarity around the workstreams outlined in the STP and how these workstreams would work locally.
• It was acknowledged that influencing behavioural change was incredibly difficult but the importance of consistent messaging across the BOBW STP footprint would be key to supporting any change.

Ms Patten took Board Members through the CCG Operational Plan, including Commissioning Intentions for 2017-2019 and made the following main points:-

·         The intention was to move towards multi-year, placed planning and delivery.  For the Buckinghamshire CCGs, it would mean moving from two x  ...  view the full minutes text for item 3.

To share the commissioning intentions and key commissioning priorities of Board member organisations for 2017-18.

For Board Members to discuss the refreshed Joint Health & Wellbeing Strategy and to discuss the next steps.

Presenters:

Trevor Boyd, Managing Director, Communities, Health and Adult Social Care

David Johnston, Managing Director for Children Social Care and Learning

Lou Patten, Chief Operating Officer, Aylesbury Vale CCG and Chiltern CCG

Robert Majilton, Deputy Chief Officer and Director of Sustainability & Transformation, Aylesbury Vale CCG & Chiltern CCG

Jane O’Grady, Director of Public Health

The Board noted that the Joint Health & Wellbeing Strategy would be discussed at the March 2017 Health & Wellbeing Board meeting.

The Chairman welcomed Ms R Carley (interim Head of Strategic Commissioning, Adults), Ms S Butt (Head of Strategic Commissioning, Children’s) and Ms K Taylor (Lead Commissioner) who took Board Members through the commissioning intentions for both Adult Social Care and Children’s Social Care and Learning.  Dr J O’Grady took Members through the Public Health priorities.

During the presentation, the following main points were made:-

• Key themes across all services were around early help, prevention and intervention and supporting families and communities to be more resilient to avoid additional pressures on the system.
• Health and Social Care Integration – both to meet the formal requirement for integrating services by 2020 but also holistically to provide a better service for our residents.
• Improving the patient experience and services received at the key transition points.
• The Service areas continue to work very closely with health partners.
• Children’s commissioning already spanned social care, education and health and the integration with colleagues in adult social care provided more opportunity to take a stronger life-course approach to commissioning.
• In response to a question around mental health services, Ms Butt explained that CAMHS (Children and Adults Mental Health Services)  was jointly commissioned in 2015.  NHS England had invested significantly into CAMHS for expanding services and had targeted people with eating disorders so that a quicker pathway could be devised.  It was acknowledged that more work needed to be done around children’s mental health.  There was a link CAMHS worker to each school so that issues could be highlighted at an early stage.  Parity of esteem was recognised as a huge agenda for CAMHS.
• In Adults, a new operating framework with a focus on prevention and self-care had been developed.
• The investment in prevention was significantly less than in treatment.  The challenge was around getting people and communities to take on more responsibility and to do more for themselves.
• Public Health priorities were reflected in the HWB Strategy.  A number of  services had been recommissioned in 2015, including sexual health services and the healthy living centre.  In the next 18 months, the drug and alcohol services for adults, and smoking cessation would be recommissioned.  There was a move towards more integrated services and providing services digitally.

RESOLVED:

Board Members noted the commissioning intentions for Adult Social Care and Children’s Social Care and Learning and noted the Public Health priorities for 2016-21.

The presentation provides the Health and Wellbeing Board with an update on the focus and scope for the progression of the Buckinghamshire Better Care Fund for 2017-19.

It also includes the Dashboard for the Quarter 2 data published in November 2016 which demonstrates the progress against targets and integration milestones for delivering better integrated care.

Presenter:

Rajni Cairns, Programme Manager for Integrated Care, Joint Commissioning

The Chairman welcomed Ms R Cairns, Programme Manager for Integrated Care (Joint Commissioning).  During the presentation, the following main points were made:-

• NHS England was due to release shortly the funding allocations, planning guidance and template.
• The Better Care Fund (BCF) created a local, single pooled budget via a S75 agreement to ensure a transformation in integrated health and social care.
• A first draft plan needed to be submitted to NHS England in mid-January and the final plan in March.  The plan needed to align with the STP and would form an essential part of the integration agenda.
• The focus and scope of the plan for 2017-19 would include progress towards full integration of health and social care by 2020, a move towards a pooled budget and to continue to strengthen relationships and partnership working.
• The BCF was aligned to BOBW STP and Buckinghamshire’s Health & Wellbeing Strategy.
• The performance dashboard had been updated for Quarter 2 and showed that Buckinghamshire was performing well in terms of non-elective admissions and permanent admissions to care homes.  Performance in relation to delayed transfers of care was still over target but was improving.  This activity was being overseen by the A&E Delivery Board and delays managed through daily updates.

RESOLVED:

Board Members noted the content of the presentation, timings for the 2017-19 BCF plan and the performance against the metrics.

David Johnston, Managing Director for Children’s Social Care and Learning will provide the Health and Wellbeing Board with an update on the Children and Young People improvement plan:

To include:

·         An update on the Ofsted and Department for Education Visits

·         Transforming services

·         An opportunity to comment on the Annual Buckinghamshire Safeguarding Children Annual Report 2015-16 (report attached)

·         SEND Review and Strategy – presented by Gillian Shurrock, Head of SEN

The Chairman welcomed Mr D Johnston, Managing Director for Children’s Social Care and Learning and Ms G Shurrock, Head of SEN. 

During Mr Johnston’s verbal update, the following main points were made:-

• Within Children’s Social Care, the Service had received a number of monitoring visits by Ofsted who looked at the Council’s services to children needing help and protection.  Positive feedback was received.  The letter was posted on Ofsted’s website
• There was a further visit by Ofsted to review the Council’s looked after children and children who had recently come into care – the feedback included comment that children were well known by their social worker and well monitored.  The Council is awaiting the final letter which would be published on Ofsted’s website on 10^th January 2017.
• There were still pressures on the system but the Service was reported to be moving in the right direction.
• In response to a question about whether the Service was where it wanted to be, Mr Johnston explained that a lot of work had been undertaken to integrate services and increase partnership working and there had been a concerted effort to convert some agency staff to Bucks County Council staff.  There was more work to be done in terms of recruiting more foster carers.

Buckinghamshire Safeguarding Children Board Annual Report

Mr Johnston referred Members to the Annual report.  The Safeguarding Board was reported as being in a strong position and had been reinstated with a refreshed membership following the Ofsted inspection.

RESOLVED:

Board Members noted the content of the Buckinghamshire Safeguarding Children Board Annual Report 2015-16 and accepted the priorities for 2016-17.

Update on Children with Special Educational Needs and Disabilities Review and SEND Strategy for 2017-2020

The Chairman welcomed Ms G Shurrock, Head of SEN to the meeting.  The following main points were made during the presentation:-

• The Dedicated Schools Grant Schools Block had successively overspent on Higher Needs budget.
• SEN specialist fieldwork staff were prevented from working with schools at an early stage due to formal assessment pressures or conflicting priorities.
• The SEN administration was "at capacity" and, at times, "over capacity".
• Parents and carers were losing confidence in mainstream education and pressing for special school places.  Exclusions and transfers to special school were increasing.
• Higher numbers of EHC (Educational Healthcare) Plans and increasing EHC assessments.
• Ongoing and increasing spend – over budget.
• A number of issues had been identified which need resolving including threshold management, placement trends, operational integration of specialist SEND services and teams, confidence, competence and capacity within mainstream schools and long standing cultures and beliefs in schools and professional staff, parents and carers.
• Seven strategic priorities had been identified to help resolve the issues.
• The SEND Strategy was due to be finalised and published by January 2017.
• A programme manager/co-ordinator had been recruited to start in March 2017.

RESOLVED:

Board Members noted the priorities arising from the SEND review and, in particular, the need to strengthen leadership, reduce dependencies on special school provision and build increased capacity  ...  view the full minutes text for item 6.

To confirm the minutes of the meeting held on Thursday 15 September 2016 as a correct record.

The minutes of the meeting held on Thursday 15 September 2016 were agreed as a correct record.

The Chairman referred Members to the list of actions included in the agenda pack.  He expressed his disappointment at not having received a response from David Smith, the local Senior Responsible Officer for the Sustainability and Transformation Plan, to an invitation to attend a Health & Wellbeing meeting.

The Chairman reminded Members that there was still time to submit their comments on the refreshed Joint Health and Wellbeing Strategy (JHWBS).

ACTION:

·         Ms K Mcdonald to add the Healthwatch Bucks Annual report to the Forward Plan.

·         Board Members to submit comments on the refreshed JHWBS.

There were no public questions received within the timeframe.

The work programme for the Health & Wellbeing Board is attached.

Board Members were asked to note the Forward Plan.

The Chairman reiterated the importance of receiving regular updates on the progress of the STP, particularly in relation to how care pathways might change and therefore any impact this could have on patient outcomes.

The next meeting is due to take place on Thursday 12 January at 10.30am (pre-meeting for Board Members at 9.30am) in the Exhibition Suite, Old County Hall, Aylesbury.

The next meeting is due to take place on Thursday 12 January at from 10-12.30 (pre-meet at 9.30am).  The meeting will take place in Room1, Exhibition Suite, Old County Hall, Aylesbury.