Meeting documents

Apologies were received from Mr M Tett, Mrs A Macpherson, Mr S Bell, Mrs K Wood, Mrs I Darby, Mr R Bagge, Mr N Dardis, Ms J Adey and Ms R Shimmin.

Mr H Mordue attended in place of Mrs A Macpherson and Ms S Robinson attended in place of Mr S Bell.

Dr G Jackson chaired the meeting.

The Chairman welcomed everyone to the meeting.

There were no declarations of interest.

To confirm the minutes of the meeting held on Thursday 15 December 2016 and the notes of the themed meeting on Thursday 12 January 2017.

To view the full pack of the notes from 12 January, including presentations, please click here.

The minutes of the meeting held on Thursday 15 December 2016 were confirmed as a correct record, subject to one minor amendment as follows:

Item 6, page 11, fifth bullet should read "Higher numbers of EHC (Education, Health and Care) Plans and increasing EHC assessments."

The notes of the themed meeting held on Thursday 12 January 2017 were confirmed as a correct record.

The Chairman welcomed Ms L Whitney to the meeting.  She submitted the following question in advance of the meeting which she read out.

""I wish to ask what arrangements and timetable has the Health and Wellbeing Board put in place to ensure that the Sustainability and Transformation Plan (STP) covering Buckinghamshire receive proper scrutiny from Buckinghamshire County Council.

As I am sure you are aware, STPs are the plans that every part of England has to produce to show how care will be transformed and money saved over the next five years.

As a local resident I am concerned that these plans are being attempted at a pace and with a lack of money that will render them at best unachievable, and at worst deeply damaging to local services.

There has so far been insufficient public and staff involvement in the development of the plans, and the STPs have no formal place in law, so there are further concerns about how those responsible for implementing the plans will be held to account.

At the very least, these plans should be subject to proper scrutiny by the council’s Health and Wellbeing Board.

Government minister David Mowat has stated that if STPs "are failing to address the needs of stakeholders, including councils, they won’t go ahead."

Councillors should therefore be able to play an important role in ensuring that local people and health and care staff are properly consulted on STPs, and that damaging elements of the plans are reconsidered.

And most recently STP areas have been instructed to produce "credible implementation plans" to turn proposals into action while reconciling contracts and financial targets.

I hope you will ensure that the STP covering residents in Buckinghamshire County receive the level of scrutiny and challenge that such an important plan deserves."

The Chairman explained that the STP would be discussed at this meeting and a response to the question would be provided during the item.

This item will be presented by Katie McDonald, Health and Wellbeing Lead Officer, Public Health.

Ms K McDonald, Health and Wellbeing Lead Officer, took Board Members through her presentation.  The following main points were made:-

·         Local authorities and clinical commissioning groups had equal and joint duties to prepare and publish Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies, through the Health and Wellbeing Board.

·         They were required to set out the shared vision for Health and Wellbeing across the whole county and present the high level priorities and outcomes to be used as a basis to shape commissioning and coordinate action to work towards better health and wellbeing for the whole population.

·         The strategy built on the priorities set out in the Joint Health and Wellbeing Strategy 2013-16 to ensure it would be fit for purpose for the next five years and would be aligned with future plans across health and wellbeing partnerships in the county.

·         The key priorities of the Health & Wellbeing Strategy were detailed as follows:

o   Give every child the best start in life;

o   Keep people healthier for longer and reduce the impact of long term conditions;

o   Promote good mental health and wellbeing for everyone;

o   Protect residents from harm;

o   Support communities to enable people to achieve their potential and ensure Buckinghamshire was a great place to live.

·         It was highlighted that the document is a high level strategy only and delivery of the strategy will be aligned with the wider Bucks health and social plans.  The Health and Wellbeing Board will be able to measure success of the strategy through planned themed meetings and an annual report alongside the proposed development of a dashboard, including selected health and care indicators to accompany the strategy.

RESOLVED:

The Health and Wellbeing Board confirmed the Joint Health and Wellbeing Strategy as the final version. 

Health and Wellbeing Board members agreed to submit the strategy through their own governing boards. 

Action: Board Members

The Health and Wellbeing Board held a themed meeting on mental wellbeing on 12 January as part of progressing the ‘promoting good mental health and wellbeing for everyone’ priority included in the refresh of the Joint Health and Wellbeing Strategy refresh for 2016 – 2021.

Ms K McDonald, Health & Wellbeing Lead Officer, reported on the actions coming out of the themed meeting on mental health and referred Board Members to the list of actions which had been assigned to individual organisations.

Ms McDonald to follow-up with Jenny Baker and Sian Roberts, who agreed to take forward the proposal to work with Bucks Mind in producing a county-wide mental health directory.

Action: Ms K McDonald

It was agreed to add an update the Mental Health and Wellbeing to the forward plan for the October 2017 meeting.  Ms McDonald would follow-up with organisational leads on progress before this date.

Action: Ms K McDonald

The 2015 spending review set out an ambitious plan for health and social care to be integrated across the country by 2020.  The Health & Wellbeing Board is pivotal to the development of local integration plans.

The Chairman welcomed Ms S Norris, Managing Director of Communities, Health and Adult Social Care (CHASC).  Ms Norris took Board Members through the report and made the following main points:-

·         As a system-wide forum, the Health & Wellbeing Board was pivotal to the development of local integration plans.

·         The Sustainability and Transformation Plan guidance stipulates that STPs should be aligned with local integration.

·         The Health & Wellbeing Board had a key role to play in oversight of progress to drive forward transformation of services in Bucks.

·         Given the rising demand on services and financial pressures all agencies were facing, there was a growing need to work together to improve performance and transform care.

·         The Buckinghamshire system was developing, taking a strategic view with a set of agreed and shared outcomes and clear action plans to drive forward to reach a fully integrated health and care system by 2020/21.

·         To support the next phase of development, four closely interlinked areas of work had been identified – each underpinned by an action plan which was currently being reviewed by the Transformation Delivery Group:-

o   Joint Commissioning

o   Integrated Provision

o   Back office (One Public Estate, Communications and Business Intelligence)

o   Governance.

RESOLVED:

Board Members noted the report and agreed the approach for the Health & Wellbeing Board’s role in the on-going oversight of achieving integration by 2020.

Presenters for this item:

Neil Dardis, Chief Executive, Buckinghamshire Healthcare Trust

Dr Graham Jackson, Clinical Chair, NHS Aylesbury Vale CCG

Lou Patten, Chief Officer, Aylesbury Vale & Chiltern CCGs

Graeme Betts, Interim Managing Director, Adult Social Care

Ms L Patten, Chief Officer for Aylesbury Vale and Chiltern Clinical Commissioning Groups, and Mr D Williams, Director of Strategy at Buckinghamshire Healthcare NHS Trust took Board Members through the presentation.  The following main points were made:-

·         44 STP footprints across England of a scale which should enable transformative change and the implementation of the Five Year Forward View vision of:

o   Better health and wellbeing;

o   Improved quality of care; and

o   Stronger NHS finance and efficiency.

·         Buckinghamshire, Oxfordshire, Berkshire West (BOB) ‘footprint’ 1.8m population, £2.5bn place based allocation, 7 Clinical Commissioning Groups, 6 Foundation Trust & NHS Trust providers, 14 local authorities.

·         Resources allocated to BOB CCG commissioners for purchasing health services total £2.55bn in 2016/17 and will increase to £2.87bn by 2020/21, an increase of 12%.

·         Programme management structure and process were reviewed in January 2017 and continues to be refined.

·         The Sustainability and Transformation Plan (STP) Executive Board continues to drive this work.

·         STP Operational Group oversees and aligns delivery of the three health and care system plans and BOB wide programmes.

·         About 30% of efficiencies would come from working at scale at STP level and about 70% would come from local health and care plans.

RESOLVED:

Board Members discussed the presentation on Buckinghamshire Health and Care System Plans.

The Better Care Fund is a local single pooled budget, to incentivise the NHS and local government to work in partnership to integrate health and social care services.

Presenter for this item:

Jane Bowie, Director of Joint Commissioning

The Chairman welcomed Jane Bowie, Director of Joint Commissioning (BCC) and Debbie Richards, Director of Commissioning and Delivery (CCGs).  The following main points were made during the discussion:-

·         The Better Care Fund (BCF) was a local single pooled budget to incentivise the NHS and local government to work in partnership to integrate health and social care services.

·         The BCF was governed through a S75 agreement.

·         The BCF in Buckinghamshire had followed the nationally-set financial contributions, made up of:

o   CCG minimum contributions;

o   Disabled Facilities Grant;

o   Care Act 2014 monies;

o   Former Carers’ Breaks funding.

·         There was a joint recognition that more could be done with the BCF to further the system integration.

·         NHS England (NHSE) was due to issue a planning template and guidance at the end of 2016 but this had not yet happened.  The latest timings for the guidance were mid-March.

·         Once the guidance had been published, Buckinghamshire would submit a BCF Plan to NHSE which would consolidate many of the initiatives that were in the 2016/17 BCF.

·         The final plan would go to the Council’s Cabinet, the Integrated Commissioning Executive Team (ICET) and the CCG Executives for sign-off before being submitted to NHSE by mid-May (date to be confirmed).

·         There would be a BCF workshop in June to consider the BCF Plan involving a wider range of stakeholders, including Health and Wellbeing Board Members.

·         Members discussed how they could improve reporting of data to the Health and Wellbeing Board, including more detail on the exact numbers involved within the reported indicators.

RESOLVED:

Board Members agreed the approach outlined in the report and noted that the final submission would not be taken to the Health & Wellbeing Board (no planned meeting prior to the national submission deadline). 

Board Members agreed that the Integrated Commissioning Executive Team would secure approval of the submission through its governance channels and would keep the Chairman and Vice-Chairman of the Health & Wellbeing Board informed throughout the process.

Verbal update from David Johnston, Managing Director of Children’s Social Care and Learning

Mr D Johnston, Managing Director for Children’s Social Care and Learning provided Board Members with a verbal update on the CYP Improvement Plan.  The following main points were made:-

·         Following an Inspection in 2014, Buckinghamshire County Council’s Children and Young People Services had been subject to an improvement notice, resulting in an Improvement Board and Improvement Plan being put in place.

·         Ofsted letters were published on Ofsted’s website.  Ofsted visits had taken place every three months.

·         The Council was due a follow-up visit at the end of Feb but had been delayed until 11^th and 12th April.  The resulting letter would be published on Ofsted’s website within approximately 3 weeks.

·         Ofsted had not confirmed the date of their next full inspection.

·         There had been an improvement in the recruitment and retention of social worker staff and the Council’s agency staff level was around 20% which reflected favourably with the Council’s peers.

·         The Children in Need service had been restructured and there were now dedicated specialist teams in place.

·         A transformation plan was being developed which focussed on children and families most in need and sought to support families and children at an earlier stage.

The Chairman thanked Mr Johnston for his update.

In the refresh of the Joint Health and Wellbeing Strategy 2016-2021, the Health and Wellbeing Board has committed to promote the Active Bucks programme and support the update and implementation of the Buckinghamshire Physical Activity Strategy and action plan.

Presenters for this item:

Dr Jane O’Grady, Director of Public Health

Tom Burton, Public Health Practitioner

The Chairman welcomed Mr T Burton, Public Health Practitioner.  The following main points were made during the presentation:-

·         The Active Bucks programme had been designed to provide Bucks residents with the opportunity to increase their levels of regular physical activity, with a focus on engaging residents that do not achieve recommended activity guidelines.

·         Between May 2016-September 2017, a minimum 142 activity programmes would be commissioned.

·         3,500 residents had provided feedback to help shape activities.

·         2,202 unique participants had taken part so far – 74.9% of these participants did not meet the activity guidelines at the point they registered with 35% classifying themselves as inactive.

·         There had been over 10,300 attendances.

·         26 active Community Champions had been recruited to promote and support activity.

·         There had been over 29,000 visits to the website with over 1,850 ‘first session free’ activity vouchers downloaded.

·         The current Buckinghamshire Physical Activity Strategy was developed in 2013/14 to last until March 2017.  A multi-agency group agreed that the Strategy should be extended for an additional year to March 2018 to ensure the new Strategy incorporated the implications of the new national Sport England Strategy. 

·         Buckinghamshire County Council had been shortlilsted for an LGC award (Public Health category) for its whole system approach to physical activity.

·         The Public Health team was currently working with 20 Bucks primary schools to introduce the Daily Mile initiative.  Active travel was also being encouraged in schools by encouraging them to adopt School Travel Plans and improve cycling skills through the Bikeability programme.

·         Adolescent girls remained more inactive than their male counterparts.  A ‘Girls Active’ project was working with 11 Bucks secondary schools.

·         Physical activity had been embedded into the Live Well, Stay Well single point of access for lifestyles and long term conditions.  Physical activity was also highlighted in the Sustainability and Transformation Plan (STP) as a key means to prevent and treat various long-term conditions.

·         Health walks through Simply Walks continued to expand with 80 individual weekly walks taking place across Bucks.

·         An Expression of Interest had been submitted to Sports England as part of their Active Ageing Fund.

RESOLVED:

Board Members agreed to continue to support promotion of the Active Bucks website using all available communication channels to staff and residents.  Members also agreed to continue to share any physical activity good practice, or project ideas, with Mr T Burton to ensure sharing across wider networks.

Action: Board Members

Board Members agreed to support and approve the development of the new Physical Activity Strategy to be ready by 2018.

This report presents the proposal for refreshing the 2018 Pharmaceutical Needs Assessment for approval by the Health & Wellbeing Board.

Presenter for this item:

Dr Emily Youngman, Consultant, Public Health Medicine

The Chairman welcomed Dr E Youngman, Consultant in Public Health Medicine.  The following main points were made during the presentation:-

·         The Health and Social Care Act 2012 gave Health and Wellbeing Boards the statutory duty to develop and publish Pharmaceutical Needs Assessments (PNAs) for their areas by 1 April 2015.

·         The Buckinghamshire Health & Wellbeing Board published their PNA in March 2015.  Health & Wellbeing Boards were required to publish a revised assessment within three years of publication of their first assessment – by the end of March 2018.

·         It was proposed that a steering group be established to complete the 2018 PNA.

·         Ms L Patten, Chief Officer for Aylesbury Vale and Chiltern CCGs, offered her professional support and advice to the steering group.

RESOLVED:

Board Members noted and approved the process for carrying out a fit for purpose pharmaceutical needs assessment for Buckinghamshire as set out in the paper.

The PNA Steering Group to summit a progress report in September 2017.

Action: Dr Youngman on behalf of the PNA Steering Group

The next meeting is due to take place on Thursday 15 June 2017 at 10.30am.

The next meeting is due to take place on Thursday 15 June 2017 at 10.30am.