Westminster Health & Wellbeing Board

WESTMINSTER HEALTH & WELLBEING BOARD

27 FEBRUARY 2014

MINUTES OF PROCEEDINGS

Minutes of a meeting of the Westminster Health & Wellbeing Board held on

Thursday 27 February 2014 at 4.00pm at Westminster City Hall, 64 Victoria Street, London SW1E 6QP.

Members Present:

Chairman: Councillor Rachael Robathan, Cabinet Member for Adult Services & Health

Cabinet Member for Children & Young People: Councillor Danny Chalkley

Interim Director of Public Health: Sue Atkinson

Tri-Borough Executive Director of Children’s Services: Steve Bywater (acting as Deputy)

Tri-Borough Executive Director of Adult Social Care: Cath Attlee (acting as Deputy)

Clinical Representative from the Central London Clinical Commissioning Group:

Matthew Bazeley (acting as Deputy)

Clinical Representative from the West London Clinical Commissioning Group:

Dr Naomi Katz

Representative of Healthwatch Westminster: Janice Horsman

Chair of the Westminster Community Network: Jackie Rosenberg

Representative for NHS England: David Finch

1. MEMBERSHIP

1.1  Apologies for absence were received from Dr Ruth O’Hare (Chair of Central London Clinical Commissioning Group). Matthew Bazeley and Dr Jonathon Munday attended as her Deputies. Apologies for absence were also received from Andrew Christie (Tri-borough Director of Children’s Services). Steve Bywater attended as his Deputy.

1.2 The Chairman reported that Meradin Peachey would become the new Tri-borough Director of Public Health on 10 March; and that Stuart Lines had been appointed as a Tri-borough Public Health Consultant and Deputy Director of Public Health in the London Borough of Hammersmith and Fulham. The Chairman also welcomed Simone Ranson (Tri-Borough Health & Wellbeing Programme Manager) to the meeting.

2. DECLARATIONS OF INTEREST

2.1 Dr David Finch declared a personal non-prejudicial interest as a partner of a GP Practice. Dr Jonathan Munday also declared an interest as Chairman of the Westminster WSIC bid for the Central London Clinical Commissioning Group.

3. MINUTES AND ACTION TRACKER

3.1 Resolved:

3.1.1 That the minutes of the meeting held on 12 December 2013 were approved for signature by the Chairman.

3.1.2 That progress in implementing actions and recommendations agreed by the Board be noted.

3.2  Actions Arising:

3.2.1  The Chairman reported that the Task and Finish Group that was being established to look in more detail at the mental health and emotional needs of children and young people and parental health, on a Tri-borough basis, would be launched on 4 March 2014.

4. CENTRAL AND WEST LONDON CLINICAL COMMISSIONING GROUPS: STRATEGIC AND OPERATIONAL PLANNING 2014/15 – 2018/19

4.1 Matthew Bazeley and Dr Jonathan Munday (Central London CCG), and Dr. Naomi Katz (West London CCG) outlined the proposed trajectories for a range of nationally specified and locally chosen indicators and local priorities for the Central London and West London Clinical Commissioning Groups.

4.2 As part of the NHS England planning cycle, Clinical Commissioning Groups (CCGS) were required to submit improvement trajectories for a range of indicators, some of which included improvements over 2 and 5 year periods. Achievement in some of the trajectories was linked to financial incentives as part of the CCG Quality Premium. Funds awarded under the Quality Premium could be invested in improving the quality of local health services for the CCGs’ populations.

4.3 The Central London and West London CCGs had sought advice from Public Health in order to ensure the proposals were of an appropriate level of ambition and were supported by Public Health commissioning priorities. The Westminster Health & Wellbeing Board was now asked to formally endorse the commissioning intentions, which had been considered at its two previous meetings. The CCGs needed to make a final submission to NHS England by 4 April 2014.

4.4 Clinical Commissioning Groups had also been asked to identify one local priority for improvement in 2014/15, and the Board noted that the two CCGs had selected Care Planning for this indicator.

4.5 The Board noted that proposals to improve Dementia Diagnosis rates and access to Psychological Therapies were targets that were on the Risk Register, and which could be achieved if supported by investment. The Board highlighted the importance of encouraging GPs to make early referrals to the dementia service at 42 Westbourne Park Road, and expressed concern that there were reports about a waiting list for this service. It was acknowledged that that investment was needed to increase capacity, and that the numbers of people diagnosed with dementia would increase temporarily in line with the rise in the number of GP referrals. Matthew Bazeley agreed to provide the Board with updates on dementia figures over the course of the forthcoming year.

4.6 Board members discussed accessibility to GP services, and noted that open access medical centres were not distributed evenly across Westminster. The CCG’s acknowledged the need for better communication of where the open access centres were located.

4.7 The Board considered how the improvement to Care Plans could improve services for patients, and Matthew Bazeley commented that Plans should be devised with the patient and their carers and be owned by them; and seek to enable patients to be treated closer to home rather than going into hospital. All of the CCG’s sought to provide one joined-up co-ordinated Care Plan covering health and social care. Dr Jonathan Munday (Central London CCG) suggested that a more holistic approach to Care Plans was needed for people with multiple needs

4.8 Jackie Rosenberg (Westminster Community Network) highlighted the value of the social and community offer which was available from the voluntary sector and community organisations, and which could support health and social care.

4.9 Board members highlighted the importance of clear lead roles and accountability and the need for patients to be offered a choice; and commented on the availability of the joint-funded Open Age service for older people’s activities across Westminster.

4.10 The Board endorsed the trajectories and local priorities that had been set out in the paper, and formally endorsed the 2014/15 commissioning intentions of both Clinical Commissioning Groups, which had been considered in detail by the Board at previous meetings. The Board agreed that the issues of Dementia and Care Planning should be discussed in more detail at the next meeting on 24 April.

5. BETTER CARE FUND PLAN

5.1 The Board received a further draft of the Better Care Fund Plan from Cath Attlee (Tri-borough Adult Social Care). The Plan ( previously titled the Integration Transformation Fund), had been considered at previous meetings, and had been developed by the Tri-borough local authorities, NHS partners and Commissioners in response to a Government request, setting out how health and social care could be integrated and transformed across the Tri-borough area for the period 2014-2016. The Plan needed to reflect the priorities drawn from the Joint Strategic Needs Assessment and needed to be signed off by all three Health & Wellbeing Boards. If targets were fully met, it was estimated that the programme would contribute to the delivery of approximately £21m in savings across Tri-borough in 2015/16.

5.2 A copy of the Plan was attached to the report, and the Board was invited to provide comments for inclusion in the final version which would be considered by the Clinical Commissioning Groups (CCGs) and the Cabinet Member during March 2014.

5.3 The Board noted that the delivery of better outcomes would be measured by national metrics from NHS England which related to hospital admissions, transfers and discharges; and by metrics for patient experience of health and social care. Schemes to be taken forward included the development of seven day services and Community Independence Services; with consideration being given to including integrated contracting and commissioning, and programme delivery.

5.4 Board Members commented upon the demographics of patient and CCG boundaries, which did not always match, and which led to areas receiving social services from other boroughs which operated different systems. The Board noted that this had led to issues of compatibility, and acknowledged that agencies within different boundaries could work together more effectively.

5.5 Members also commented on the provision of support for young people who were transitioning into adults, and suggested that patients’ experience of health services could be monitored by Healthwatch.

5.6 The Board requested that more structured detail be provided on the process for the governance of the Plan, and on how decisions would be referred to the Health & Wellbeing Board. The Board noted that in view of the timing of the next meeting, a copy of the final Plan would be circulated to members in March so that any further comments could be incorporated into the final version, and approval be given prior to submission by the due date of 4 April 2014.

6. JOINT STRATEGIC NEEDS ASSESSMENT AND PHARMACEUTICAL NEEDS ASSESSMENT

6.1 The Board received an update from Colin Brodie (Public Health Services) on the JSNA Programme; and on the key points and recommendations rising from the “deep dive” JSNA reports on Tuberculosis and Physical Activity, which had been completed since the last meeting. Tuberculosis (TB) was still an issue among the homeless and high density populations, and the TB health needs assessment had supported the development of a Tri-borough strategy and CCG commissioning intentions.

6.2. The ‘deep dive’ report on TB had made a number of recommendations:

1: Pooling staff, clinics and resources where appropriate – with the better use of resources

2: To consider how hospital and community services could be provided more effectively and efficiently

3: To review current commissioning arrangements and establish specific service specification and Service Level Agreements for TB

4: To establish a local pathway for the management of TB

6.2.1 Colin Brodie reported that the NHS had created a TB Control Board with largely similar aims and objectives, and that the author of the ‘deep dive’ report would be speaking to Public Health England and NHS England to discuss the work that had been done.

6.3 The Board noted that the Physical Activity ‘deep dive’ assessment had sought to inform local strategies and promote physical activity across the Tri-borough area. The report had made a number of recommendations:

1: An asset mapping exercise should be undertaken in each of the boroughs to address specific or targeted needs

2: Consistent messaging was needed to promote physical activity promotion

3: Local authorities, the NHS, and the third sector should take a lead in promoting participation in physical activity across the tri-borough

4: All Health and Social Care workers should be offered training on giving advice on physical activity

5: A process should be established to capture data on levels of physical activity and physical education in schools

6: Specific groups should be targeted around the promotion of physical activity, and access to opportunities for physical activity.

7: The implementation of the Lets Get Moving Physical Activity Care Pathway should be facilitated across the Tri-borough.

6.3.1 A Tri-borough Physical Activity Steering Group had been established, which would draw up an action plan to take the recommendations forward.

6.3.2 Councillor Danny Chalkley (Cabinet Member for Children & Young People) highlighted the potential difficulties of engaging with schools to capture levels of physical activity. Colin Brodie acknowledged that the available data was historical, and of limited use in indicating trends or the need for interventions, and the Board supported the recommendation that the process be reinstated.

6.4 Colin Brodie also provided an update on the progress of other deep-dive JSNA’s in the 2013/14 programme. The Learning Disabilities JSNA had now been completed, and would be presented to the Westminster Health Wellbeing Board at its meeting in April 2014. An appointment had also now been made for a JSNA Programme Manager, who would take up post on 7 April.

6.5 The Board discussed the JSNA process, and suggested that the Public Health team took a more pro-active role in considering the commissioning intentions of Health & Wellbeing Board partners, and where there were issues that could benefit from JSNA support. Board members also discussed the implementation of the recommendations in ‘deep dive’ reports, and highlighted the importance of the timing of assessments to enable recommendations to be taken into account when contracts were renewed.

6.6 Holly Manktelow (Senior Policy Officer) provided the Board with an update on the development of the Pharmaceutical Needs Assessment (PNA) for Westminster, which was to be incorporated into the JSNA work programme.

6.6.1 The PNA was being carried out on a Tri-borough basis, with overall responsibility and accountability resting with individual Health Wellbeing Boards, and it was suggested that the three Boards produce their individual PNAs through a jointly-agreed and combined approach.

6.6.2 The data required to produce the assessments was held by a number of organisations, which included Local Authorities, the Commissioning Support Unit and the Clinical Commissioning Groups. NHS England had also provided each Health Wellbeing Board with a “heat map” which provided an analysis of the current PNA held by the Board. The combined heat map for Westminster, Hammersmith Fulham and Kensington Chelsea was attached to the report. The Board noted that a consultation draft PNA would be submitted to the Westminster Health & Wellbeing Board in September.

6.6.3 Board members suggested that consideration be given to pharmacies having a wider role in the community, by offering advice on interventions, and by signposting other wider services.

6.7 Resolved: That

(i) The arrangements and timescales for the development of the Pharmaceutical Needs Assessment for Westminster by April 2015 be agreed;

(ii) The provision of information required to support the development of the Pharmaceutical Needs Assessment be noted and agreed where necessary;

(iii) The report from the second meeting of the Tri-borough JSNA Steering Group held on 21 January 2014 be noted;

(iv) Progress made against the 2013/14 JSNA Programme be noted;

(v) The Physical Activity ‘deep dive’ JSNA report previously circulated to the Board as an information item be published; and

(vi) The Tuberculosis ‘deep dive’ JSNA report previously circulated to the Board as an information item be published.

7. CHELSEA AND WESTMINSTER NHS TRUST: HEALTH & WELLBEING STRATEGY

7.1 The Board received a presentation from Abigail Knight (Public Health Speciality Registrar), on the Chelsea & Westminster (ChelWest) Hospital NHS Foundation Trust’s draft Health & Wellbeing Strategy for 2014 to 2017.