Meeting documents

Introductions were made by all and Mr M Tett, the Chairman, emphasised the integrated nature and diversity of the Health and Wellbeing Board (HWB) who were working as a team to maximise the health and wellbeing of people in Buckinghamshire. 

Apologies had been received from:

• Mr W Whyte
• Mr S Bell
• Ms L Patten

There were no announcements from the Chairman.

There were no declarations of interest.  Mr N Naylor, Leader of South Bucks District Council and District Council representative was asked to complete a declaration of interest form.

Action:  Mr N Naylor

The minutes of the meeting on 7 November to be agreed as a correct record and signed by the Chairman.

The Chairman thanked everyone who participated in the last meeting which he felt was very successful.

The Chairman asked for feedback on the following actions:

Page 6 – Action for Ms J Baker to send the Healthwatch report on a joint project with Mind to Ms K McDonald was carried forward.

Action:  Ms J Baker

Page 7 – Ms McDonald confirmed that the HWB Dashboard had been corrected and that the revised version was available on the website.

Page 7 – Ms McDonald said she had looked into whether the opticians’ services came under the scope of the HWB and had found the Health Scrutiny Committee could look at all the NHS Services, including the opticians’ services and thought the HWB could probably do so as well but was awaiting a response from the Local Government Authority (LGA).  The Chairman concluded that, if needed, the HWB would look into the opticians’ services.

Page 10 – Ms McDonald advised that the domestic abuse item was still being considered for inclusion on the forward plan.

The minutes of the HWB meeting held on 7 November 2017 were agreed to be an accurate record of the meeting and were signed by the Chairman.

There were no questions.

Presenter:  Ms Katie McDonald, Health and Wellbeing Lead Officer

Ms K McDonald, Health and Wellbeing Lead Officer, ran through the paper and highlighted the reasons for the review and the proposal to set up a working group which could include colleagues from the HWB organisations. The paper asked the Board to consider the scope and timeline for the review.  Ms Darby, District Council Representative and Leader of Chiltern District Council supported the review but said she was surprised that the district councils were not recommended for membership of the working group.  Ms McDonald apologised, this was accidental and the districts were on the original list drawn up and advised she would amend the paper to make sure a district representative was included.

Action:  Ms McDonald

Members of the Board gave their support to the governance review and after discussion, the Chairman summarised that the scope of the review should also include the following:

• The Board had important information to convey to the public and the review should look at communication and engagement.
• The review should look at how the Boar should develop its relationship with the Sustainability and Transformation Partnership (STP)
• How out of county services were monitored. 

It was noted that Fiona Wise, would be joining the STP in March and that a meeting with the Chairman would be beneficial.

Action: Ms McDonald

RESOLVED:  The Board AGREED the recommendations as set out in the report and the additional recommendations listed by the Chairman.

Update on the Buckinghamshire Accountable Care System (Lou Patten)

System Leads will also be providing an update on winter planning under this agenda item.

Presenters:

Ms Lou Patten, Chief Officer, NHS Aylesbury Vale and Chiltern CCGs

Mr Neil Dardis, Chief Executive, Buckinghamshire Healthcare Trust

Ms Gladys Rhodes-White, Interim Service Director, Communities, Health and Adult Social  Care

Mr R Majilton, Deputy Chief Officer, provided an update on the paper and highlighted that there had been a number of visits by national bodies which had provided valuable feedback.   The following areas would be focussed on:

• Population health management – a steering group had been established, led by Public Health, which was very successful.
• The integrated team of Primary and Community Services had been working together to develop community hubs and integrated teams.
• Capacity to deliver; particularly looking at support to ensure the pace and ability would be provided to deliver the system wide work.
• System OD - a programme of work which would look at areas of leadership, system ways of working and culture, and the refresh of planning for 2018/19.

The following questions/comments were raised:

• Ms Baker asked if there was an ACS plan which could be shared with the Board and the public.  Mr Majilton clarified that there was not a specific ACS plan but it was built into the integration and operational plan that was signed off by the Board in March.  The public had been invited to the ACS roadshows.

• Mr G Jackson, Clinical Chair of the Clinical Commissioning Groups and Vice Chair of the Board, said that members of the public had commented that the system was disjointed.  However, as agencies delivering the services were aiming to work together, the public should see a difference in how services were delivered in the future.

The Chairman asked Mr N Dardis, Chief Executive, Buckinghamshire Healthcare Trust (BHT), to provide an update on the A&E waiting time statistics reported on the television that day.

Mr N Dardis said he had never seen such a level of scrutiny and planning for winter and that patients would get the care where and when they needed it.   Mr Dardis reassured the Board and the public that BHT was one of the better performers but they were striving to be better.  The Chairman asked how the performance was in A&E.  Mr Dardis reported that it was worse than it had been but BHT was aiming to improve waiting times.  Mr Dardis added that it was not yet known how much extra NHS funding BHT would receive for the winter preparation.

Ms D Richards, Director of Commissioning and Delivery for the Aylesbury Vale and Chiltern Clinical Commissioning Groups, presented "Winter Planning 2017/18"

as the Chair of the Buckinghamshire A&E Delivery Board.  Ms D Richards highlighted the following:

• It had been a long process since August and plans were being continually developed.
• There was a shared challenge due to increased demand.
• The ACS had undertaken very detailed forecasting for all the services which was updated daily.
• The ACS had mapped service availability for the winter; particularly at Christmas and the New Year period.
• The ACS was pulling together to provide more comprehensive plans and alternatives to A&E.
• Funding had been received from the Urgent and Emergency Care and Transformation Fund to roll out a project in Wycombe,  ...  view the full minutes text for item 7.

Presenter:  Ms Jane Bowie, Director of Joint Commissioning

Ms Richards presented the Better Care Fund update on behalf of Ms J Bowie, Director of Joint Commissioning and highlighted the following key points:

• The purpose of the paper was to update the Board on the progress of the Better Care Fund.
• NHS England had confirmed that the plan conformed to the guidance.
• The activities and work strands contained in the BCF plan were designed to improve performance against a set of national metrics and focussed on four key metrics.
• There were now daily processes to identify the next steps for delayed transfers of care.  It had been very well developed within Buckinghamshire and significant improvement had been noted and compared well with peers.  Self-funders were also offered help to select their care in the community.
• The Better Care Fund was also focussing on Buckinghamshire residents delayed in out of county hospitals.

The following comments were made:

The Chairman said he was concerned that the targets were not being met and the trajectory was falling.  Ms Rhodes-White, interim Executive Director, Communities, Health and Adult Social Care, agreed and said it was a national problem and the focus of attention. Ms Rhodes- White informed the Board that she had just received confirmation from the Department for Community and Local Government (DCLG) that the funding for this year and next financial year would remain in place which was important for joint initiatives. 

The Chairman recommended the Board returned to this topic at the next meeting for a significant debate in order to analyse where the problems were.  The Board agreed to the Chairman’s recommendation.

Action:  Ms McDonald      

RESOLVED:  The Board NOTED the report and AGREED that the item should be on the agenda for the next meeting.

Presenter:  Dr Jane O’Grady, Director of Public Health

Dr J O’Grady, Director of Public Health reminded the Board that there had been a successful mental health themed HWB meeting earlier in the year.  Becky Hitch, PH Principal, provided a brief overview of the report and said there had been a large amount of partnership work in the last six months in the following areas.  The overview of progress included:

• Promotion of good maternal and paternal health:  the BHT health visiting team had been working hard to increase identification and assessment of mood amongst mothers.
• Whole school approach to emotional wellbeing; the emotional wellbeing group had developed information and guidance.  An emotional wellbeing conference was held in November.  A Public Health PHSE project manager was in place to take a strategic approach in schools.
• Workplace mental wellbeing; the County Council had appointed two mental health champions and various work had taken place within the district councils.
• Improved physical health of people with mental illness; over 400 people with long term conditions in Bucks received at least 1 psychological appointment during Q1.
• Approach to dual diagnosis (people with both mental health and substance misuse problems); commissioners wereworking together to achieve the guidance. 
• Reduced risk of suicide and self-harm; a new action plan had been developed and delivered by a multi-agency group.
• A lot of training had taken place by many different organisations which was in the process of being aligned.

Ms Hitch also reported that there was some good work taking place by individual organisations on workplace mental health led by HR teams. However this currently lacked coordination. There was, at present, no forum for HR workplace health leads to link together or to link with business sector partners who were delivering mental health work within their own workplaces. A lead agency to facilitate this would need to be identified. 

Ms Hitch confirmed that the application to be an organic hub as part of the national Time to Change programme would be submitted and that a response was expected by the end of January.

The following points were raised:

• Mr Tett summarised a general agreement from the Board that coordination of workplace mental health work would be a sensible way forward.
• Ms Baker raised concern that there were a huge number of voluntary sector workers with mental health issues.  Ms Hitch recommended that a forum be established by HR leads on workplace health, and that voluntary sector partners join this.

The Chairman said it was really good to see how the strands of work had progressed and acknowledged that there was more work to be done.  The Chairman thanked Ms Hitch and all the partners involved for their work so far.

RESOLVED:  The Board NOTED the activity on the mental health actions.

Presenters:

Ms Juliet Sutton, Clinical Director, Children’s Services, Aylesbury Vale and Chilterns CCG

Ms Sian Roberts, Mental Health and Learning Disability Clinical Director, Aylesbury Vale and Chilterns CCG

Dr J Sutton, Clinical Director, Children’s Services, Aylesbury Vale and Chiltern CCG and Dr S Roberts, Mental Health and Learning Disability Clinical Director, Aylesbury Vale and Chiltern CCG presented the report.  Dr Sutton explained the role of the Children and Adolescent Mental Health Services (CAMHS) and highlighted the following points:

• The new CAMHS service in conjunction with Barnardo’s had started in October 2015.

• The CCGs then received additional funding (transformation money) to transform services.
• The Plan had been developed with the engagement of the Children and Young People Service, parents and carers and the Children and Young People Wellbeing Group. 
• The investment in year one had resulted in a specialised eating disorder service which provided timely access to evidence based treatment.  There had been some indication it had reduced the length of stay and number of mental health hospital admissions.
• There had been a big drive to improve integrated neuro developmental pathways.
• The CAMHS had seen an 18% increase in referrals over the last year (an increase of 15% in the number of referrals accepted). 
• There was a slight increase in the number of referrals not accepted which was partly due to the ease of getting advice from a single point of access.  
• There had been an expansion of the emergency referral and the crisis team (OSCAR) which had resulted in 100% of referrals being seen within 24 hours. 

Dr Roberts recognised the need to look at transition ages and provide an all-inclusive service which met the needs of all the children in Buckinghamshire.  Working as an ACS would enable work to take place with services in the third sector.  Ms Roberts highlighted the new priorities:

• To align with the five year forward view for mental health. 
• Increased access for all children in a timely way.
• To provide support to families and carers of children.
• To develop technology; social media and websites. 
• To develop a "Little blue book of sunshine" listing all available services.

The Chairman thanked Dr Roberts and Dr Sutton for their report.

RESOLVED:  The Board NOTED the report.

Presenter:  Mr Tolis Vouyioukas, Executive Director, Children’s Services

Mr T Vouyioukas, Executive Director, Children’s Services provided a brief update on three priorities in Children’s Services:

• Health assessments for looked after children
• Health passports for care leavers
• The role of the Designated Clinical Officer for the Special Educational Needs and Disability (SEND) service

The following points were raised:

• A member of the Board agreed that the Designated Clinical Officer (DCO) had made a huge difference and the achievements had been monumental and had shown the benefits of integrated working.
• Concern was expressed over the children who were on a 20 week wait for their Educational Health Care Plans (EHCP); Mr Vouyioukas said he was confident that the right system was in place to ensure children received the right support. Mr Vouyioukas acknowledged that there had been an issue with capacity for those children on incoming plans but this had been dealt with and he was confident that performance would improve.

• The Chairman emphasised that the issues were a national problem and that the conversion from statement to an ECHP provided the opportunity for reassessment of the children’s needs.
• The CAMHS were working on more preventative work to stop the increase in the amount of children needing the EHC plans. 

RESOLVED:  The Board NOTED the report.

Presenter:  Ms Frances Gosling-Thomas, Independent Chair

Ms F Gosling-Thomas, Independent Chair, ran through the presentation and highlighted the following points:

• The roles and responsibilities of the Local Safeguarding Children’s Board (LSCB).
• The Health and Social Care Act (HCSA)
• Top Priorities for 2017/18
• Achievements
• The Childs Voice and Journey
• Child Exploitation
• What is working well
• Areas for improvement
• Next steps

Ms Gosling-Thomas thanked all the partners who have worked with the LSCB.

The following question/comments were raised:

The Chairman asked Ms Gosling-Thomas to summarise the participation from colleagues and changes in the integrated working areas.  Ms Gosling-Thomas reported that it had been recognised it was important to achieve good attendance at the child protection conferences and that there was now improved integrated paperwork.  The use of schools, GP surgeries and other locations to aid participation had also made a difference to the success of the conferences.  Ms Gosling-Thomas emphasised that the challenge was to maintain the work and stressed the need for further work.

The Chairman thanked Ms Gosling-Thomas for transforming the LSCB over the last three years and for her comprehensive presentation.

RESOLVED:  The Board NOTED the report.

Verbal update by Ms Katie McDonald, Health and Wellbeing Lead Officer

Ms McDonald reported that there had been a meeting on Female Genital Mutilation (FGM) on 23 November which was attended by various agencies and followed on from the Challenge session held two years ago.  The meeting looked at the strategy and the action plan and discussed what changes were needed.  It was recognised that the national data did not tell us about the situation in Buckinghamshire and it was an opportunity to hear about referrals which had taken place in Buckinghamshire.  Ms McDonald said she would provide a full report to the Board at a future meeting.  The FGM statistics could be found in the Health and Wellbeing Board Dashboard.

The Chairman acknowledged that it was hard to understand the size of the issue of FGM and was pleased that this area was being looked at in more detail.

RESOLVED:  The Board NOTED the verbal report.

Presenter:  Ms Katie McDonald, Health and Wellbeing Lead Officer

The Chairman advised there would be an increased focus on the Better Care Fund, Delayed Transfers of Care (DToC) issue.  Ms McDonald advised that the report deadline for the next meeting was 8January 2018 and that the Better Care Fund would be included on the agenda.

The Chairman thanked the Board for their contributions to the HWB.

18 January 2018

Thursday 18 January 2018.