Meeting documents

Mr G Williams, Cabinet Member for Community Engagement and Public Health welcomed everyone to the meeting and hoped that members had received the correspondence explaining that Mr M Tett had asked him to take up the chairmanship of the Health and Wellbeing Board due to his increasing workload with the preparations for the new Buckinghamshire Council.  Mr Williams stated that the terms of reference would be amended to reflect the change provided members of the Health and Wellbeing Board were in agreement. The members of the Board all agreed to Mr Williams being appointed as Chairman; Mr Williams expressed his appreciation and stated he would be honoured to take up the position of chair at a pivotal time of health and social care transformation and integration and he looked forward to working with Board members to improve the health and wellbeing of residents.

RESOLVED:  It was AGREED that Mr Williams would be Chairman of the Health and Wellbeing Board.

Apologies were received from Mr T Vouyioukas, Executive Director, Children’s Services; Mr W Whyte, Cabinet Member, Children’s Services; Dr K West, Clinical Director for Integrated Care, Buckinghamshire CCG and Vice-Chairman; Dr J Sutton, Clinical Director for Children's Services, Buckinghamshire CCG; Ms G Quinton, Executive Director, Communities, Health and Adult Social Care; Ms J Baker, OBE, Chair, Healthwatch Bucks; Ms A Macpherson, Buckinghamshire County Council, Mr S Bell, Oxford Health NHS Foundation Trust and Ms L Patten, Chief Officer Oxfordshire CCG & Buckinghamshire CCG.

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Ms J Bowie, Service Director, Integrated Commissioning, attended in place of Ms G Quinton.

Mr R Nash, Service Director, Children’s Social Care, attended in place of Mr T Vouyioukas.

Ms T Jervis, Chief Executive Healthwatch Bucks, attended in place of Ms J Baker, OBE.

Ms D Richards, Managing Director, Oxford Health NHS Foundation Trust attended in place of Mr S Bell.

Cllr P Hogan had replaced Cllr N Naylor as the South Bucks District Council representative.

There were no announcements from the Chairman.

There were no declarations of interest.

The minutes of the meeting held on 27 June 2019 were reviewed; Ms K McDonald, Health and Wellbeing Lead Officer, confirmed that the following actions had been completed:

Item 7, Health and Wellbeing Board update report on Buckinghamshire Integrated Care System (ICS):

·         Ms McDonald to circulate the presentation slides from NHS England on the changes to the ICS.

·       Ms J Hoare to provide feedback to Mr W Whyte on the 111 Direct Booking pilot at The Swan practice.

RESOLVED:  The minutes of the meeting held on 27 June 2019 were AGREED as an accurate record and were signed by the Chairman.

There were no public questions.

To be presented by Dr J O’Grady, Director of Public Health, Buckinghamshire County Council.

Dr J O’Grady, Director of Public Health, provided a presentation on the Director of Public Health Annual Report (DPHAR) 2019 entitled ‘Alcohol and Us’, appended to the minutes, and highlighted the following points:

• Two reports were available on the Public Health web page; Dr O’Grady urged the members of the board to read the full report which contained key Bucks facts along with personal stories from residents, front line staff, doctors and consultants impacted by the use of alcohol.
• One in four people drank more than the limit recommended by the Chief Medical Officer. 
• The guideline for safe drinking of alcohol was 14 units for women and 14 units for men per week.
• Most people in England were unable to correctly identify 14 units of alcohol. 
• Alcohol contributed to a wide range of long term conditions such as cancer and heart disease; it also contributed to mental health conditions such as self- harm, suicide and dementia.

·       Alcohol use affected people’s families and the wider community; it contributed to domestic violence, child abuse and neglect, violent crime and road traffic accidents, loss of employment and homelessness.

• People who abused alcohol died much younger; the average age was 54.
• 1 in 4 people in receipt of treatment were living in a house with a child and the report contained a section on how alcohol impacted on children's wellbeing.
• Approximately 118,000 people in Buckinghamshire were drinking more than the safe limit which was significantly higher than the national average.
• 24% of people attending NHS health checks were identified as drinking too much and did not realise they were harming their health or recognised that they had a problem with alcohol.
• There were 9,000 alcohol related hospital admissions in Buckinghamshire last year.
• Dr O’Grady listed what was known to work at a national and local level and the benefits of alcohol treatment.
• It was known that identifying people early who were drinking too much and giving them brief advice on how to reduce their drinking was effective and could reduce the amount people drank by 12%.
• It was estimated that for every £1.00 spent treating alcohol users, £2.80 of benefits was realised across crime, the NHS, local authorities and to the individual.  For users with more complex needs the return was £3.40 for every pound invested in the treatment.
• 85% of dependent drinkers were not in a structured treatment programme.
• There had been 399 new referrals to specialist services in 2018/19; 77% of the referrals were self-referrals or from family and friends.  It was not known how many of those had had discussions with health or social care staff but the number of direct referrals from other partners was low.
• The Oxford Health NHS Foundation Trust and Buckinghamshire Healthcare NHS Trust had signed up to the NHS CQUIN which was a quality improvement initiative to screen those admitted to an inpatient ward for at least one night for alcohol use, given brief advice or offered specialist referral.
• Dr O’Grady read out the recommendations contained  ...  view the full minutes text for item 7.

NHS Long Term Plan Update

Mr R Majilton, Deputy Chief Officer, Buckinghamshire Clinical Commissioning Group, provided a presentation on the NHS Long Term Plan Update and highlighted the following points:  

• The slides replicated what was in the long term plan produced by NHS England during the planning process at the beginning of the year. 
• There were a number of work streams across the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS) e.g. maternity, prevention. 
• The BOB Strategy summary was now due on 9 September 2019, not 2 September 2019 as stated in the pack.
• The acronym ‘DOG’ stood for ‘Delivery Oversight Group’.
• The final draft would be circulated to the Health and Wellbeing Board for comment before submission to NHSE/I on 1 November 2019.
• A Briefing session would be set up for HWB members before submission

ACTION: Ms McDonald

RESOLVED:  The Health and Wellbeing Board NOTED the ICS Long Term Plan Timeline.

Summary of Multi-Morbidity Analyses

Dr J O’Grady, Director of Public Health, provided a presentation on the Summary of Multi-Morbidity Analyses for Buckinghamshire and highlighted the following:

• Work had been undertaken between Public Health and the NHS to help identify the most important areas to focus on to improve people's health and wellbeing.  The aim was to produce bespoke profiles for the primary care networks to inform them about the needs of their population; the levels of deprivation and where emergency admissions were happening.
• The meaning of multi-morbidity was that a person had more than one long term condition (LTC). 
• Half of patients in Buckinghamshire had a LTC, and 30% had two or more LTCs.
• 62.6% of non-GP costs were for multi-morbid patients but they only made up 29.2% of all patients.
• Many LTCs were caused by lifestyle factors and were preventable. 
• An ageing population increased the chance of developing a LTC; a healthy lifestyle helped delay LTCs. 
• Multi-morbidity was very common and occurred in predictable patterns in the population i.e. in more deprived areas.
• A significant proportion of the patients also had a mental health diagnosis.
• Prevention and holistic support was needed to support these patients to manage their varying conditions as GPs had identified that if LTCs were seen as a whole, care and wellbeing improved along with a reduction in GP time.

The following points were noted in discussion and in answer to members’ questions:

• Dr O’Grady confirmed that the statistics for Buckinghamshire were consistent with the national picture. 
• The Chairman commented that it would mean a major change in the way patients were treated and asked how it would work in practice and how the outcomes would be followed up.  Dr O’Grady explained that Public Health had diagnosed the problem and work would be carried out with the primary care networks and clinical leads as well as the hospitals, Adult Social Care and the voluntary sector.  No specific model would be proposed; it would be co-designed with the Integrated Care Partnership. 
• A member of the board added that the vast majority of LTCs  ...  view the full minutes text for item 8.

To be presented by Dr S Roberts, Clinical Director for Mental Health, Buckinghamshire CCG.

Dr S Roberts, Clinical Director for Mental Health, Buckinghamshire Clinical Commissioning Groups (CCG) reminded the board that mental health had been a key priority for the board since the refresh of the Joint Health and Wellbeing Strategy in 2016.  Whilst Buckinghamshire benchmarked very well nationally, those living with serious mental illness (SMI) were dying unnecessarily.  Dr Roberts provided a presentation and highlighted the following points:

·      For people to live well they must have both good physical and mental health. 

·      SMI e.g. schizophrenia, bi-polar disorder and psychotic illness were a long term condition. 

·      Life expectancy for people with a SMI was reduced by approximately 15-20 years due to mainly preventable physical illness.

·      The goals of the Mental Health Five Year Forward View was to improve access to physical health checks and follow up interventions for people with SMI and to improve the quality of physical health checks and follow up interventions for people with SMI.

·      Buckinghamshire CCG commissioned a primary care enhanced service in July 2018; at least 50% of adults on the SMI register should receive six key physical health assessments as part of their routine mental health review and provide the appropriate interventions.

·      Secondary care should provide similar physical health assessments to approximately 10% of those on the GP SMI registers.

·      The Live Well Stay Well service prioritised additional support for those with a SMI; it was a unique model. 

·      The presentation included a list of future ideas and Dr Roberts asked the members of the board to help by raising awareness on how important it was to look after physical health as well as mental health.

The following points were noted in discussion and in answer to members’ questions:

• In response to a question on whether an assessment was carried out to consider if the combination of drugs that a patient with a SMI was prescribed could affect their mood; Dr Roberts stated that medical reviews were important and were undertaken but the focus on physical health was often missing.
• Dr Roberts confirmed that there was no data on whether SMI patients were engaging in national screening programmes.  However, the PCNs were aware and work was being undertaken at practice level to increase uptake.
• The point was raised as to whether the prevention services would have the capacity if volumes increased due to the new initiatives. Dr O’Grady confirmed that the services would cope, particularly the smoking cessation service and the alcohol treatment service.
• Dr Roberts confirmed that the mental Health Partnership Group had looked into the barriers people with SMI faced and had fed into the information provided to the practices to support people.

RESOLVED:  The Health and Wellbeing Board NOTED the presentation and the update.

RESOLVED:  The Health and Wellbeing Board NOTED the request to identify how their organisations could contribute to and support improving the physical health outcomes for patients with serious mental health illness and raise awareness in Buckinghamshire. 

To be presented by Dr S Roberts, Clinical Director for Mental Health, Buckinghamshire CCG.

Dr S Roberts, Clinical Director for Mental Health, Buckinghamshire Clinical Commissioning Groups (CCG) reminded the members of the board that ‘Futures in Mind’ was published by the government in 2015.  The Transformation Plan for Children and Young People’s Mental Health and Wellbeing was published in 2015 and was refreshed annually and presented to the Health and Wellbeing Board. This year it would also be shared with the Children’s Partnership Board and the Safeguarding Children Board before being submitted to NHSE by the end of October 2019.

The following points were noted in discussion and in answer to members’ questions:

• In response to a question on whether the access to children’s services had improved; Dr Roberts confirmed that there had been a lot of progress since 2015.
• Mr R Nash, Service Director, Children’s Social Care, advised that work was being undertaken to align resources in the best way.  A review of what had been achieved was also being carried out.  Mr Nash stated the service had strengthened through working together but there was always more work that could be done.
• Ms D Richards, Managing Director, Oxford Health NHS Foundation Trust, emphasised that a lot of work had been carried out and provided assurance that in terms of CAMHS access, there were three standards that were monitored: emergency referrals within 24 hours, and urgent referrals to be seen within 7 days routinely achieved 100%, however, under pressure with routine access (to be seen in four weeks) was underperforming due to a significant increase in demand of 70%.  This increase demonstrated a good point of access and greater awareness. 

RESOLVED:  The Health and Wellbeing Board NOTED the annual refresh and commented on the draft priorities and NOTED the plans for sign off and publication.

To be presented by Ms K McDonald, Health and Wellbeing Lead Officer, Buckinghamshire County Council.

Ms K McDonald, Health and Wellbeing Lead, mentioned the items on the forward plan for the meeting on 5 December 2019 and asked the members of the Board to email her with any additional items for future meetings.

Thursday 5 December 2019.

Thursday 5 December 2019.