northlincs.gov.uk

PRESENT:  Councillor Waltham in the chair.
Statutory Members

Allison Cooke, Frances Cunning, Simon Driver, Denise Hyde and Julia Pollock

Non-Statutory Members

Tracey Clarke, Ewart Gibbs, Sam Proctor and Alan Usher.

Councillors Mrs Bromby, Collinson, Robinson, Whiteley and Wilson attended the meeting in accordance with Procedure Rule 1.36(b).

Dean Gillon, Farzana Khanum, Julie Poole, Susan Twemlow and Mel Holmes also attended the meeting.

The meeting was held at the Civic Centre, Scunthorpe.

13.  WELCOME AND INTRODUCTIONS – The chairman welcomed all those present to the second meeting of the board, and invited all members and officers to introduce themselves.

14.  DECLARATIONS OF DISCLOSABLE PECUNIARY INTERESTS AND PERSONAL OR PERSONAL AND PREJUDICIAL INTERESTS – There were no declarations of interests.

15.  MINUTES – Resolved – That the minutes of the meeting of the board held on 14 June 2013 be approved as a correct record.

16.  (9)  JOINT HEALTH AND WELLBEING STRATEGY DELIVERY PLAN 2013/2014 – With reference to minute 6, the Director of Public Health submitted a report seeking approval of the Joint Health and Wellbeing Strategy (JHWS) draft Delivery Plan for 2013/2014.

Following the board’s approval of the Joint Health and Wellbeing Strategy at its first meeting on 14 June 2013 board members and identified council officers were tasked with the development of a delivery plan.  Previously, via a process of using the growing evidence base contained within the Joint Strategic Needs Assessment (JSNA), the outcomes of Health and Wellbeing Board Partnership and Consultation events and ongoing consultation six key strategic priority outcomes had been identified as detailed in paragraph 2.2 of the report.  The JSNA had identified multiple needs and challenges but it was not appropriate for all of these to be treated as a priority action within the Joint Health and Wellbeing Strategy.  These would continue to be worked on in individual organisations or in partnership with the Joint Health and Wellbeing Strategy providing the framework for them to continue to be prioritised where evidence supported the need to do so.

By means of a clear consultation process to determine which of the many demands should be prioritised for partnership action under the auspices of the Joint Health and Wellbeing Strategy, a number of priority actions had been identified as detailed in paragraph 2.3 of the report.

The focus of these five priority actions was on “adding value” and all had been agreed in partnership via the appropriate consultation processes with the exception of priority action 1, which was a late edition and was based on feedback from members of the Health and Wellbeing Board during the draft document consultation period.  All five priority actions were identified as having clear links to at least one of the strategic priority outcomes.

Priority action officer leads and champions had been identified in order to develop a series of Joint Health and Wellbeing Strategy delivery actions and, following the establishment of a small working group, identification of draft actions, a period of discussion and another Health and Wellbeing Board/Priority Action Lead Development Session in early September, it had been agreed that the original proposed format for the delivery plans was not fit for purpose.  This was because the delivery plans were becoming increasingly operational and posed problems for outcome measurement.

The most recent development session determined that the delivery plan needed to be established within a framework of themes relating to –

• Employability (Apprenticeships, Internships of Volunteering).
• Organisational change.
• The wider environment (place shaping).

The rationale for the three themes was based on what could be done organisationally and partnership wide –

• Add value.
• Create high level response.
• Meet more than one of the priority actions and strategic outcomes.

The discussions had also agreed that all delivery plan themes and priority actions would be delivered within an infrastructure of organisational commitment, the same as that contained within the Joint Health and Wellbeing Strategy, which focused on –

• Integrated working.
• Commissioning and investment (Value for Money).
• Monitoring and reviews.
• Organisation and information sharing (intelligent hubs) and signposting.
• Agreement and co-ordination of language and messages (i.e. simplification of messages for staff to understand and deal with debt and financial advice).

Details of these themes were set out in Appendix A of the report.

Following identification of the actions, the working group had agreed that the actions detailed within Appendix A should then be set within a series of Health and Wellbeing Board pledges which were detailed in Appendix B to the report.  These pledges identified areas of partnership action for the Health and Wellbeing Board to focus on, demonstrating its commitment to work together to achieve the best possible outcomes in relation to employability, organisational change and place shaping in order to reduce the equalities and improve health and wellbeing for people in North Lincolnshire.  Following agreement by the board to these pledges, lead officers, with support from the working group would contribute to developing measures and reporting mechanisms on presentation to the board in the future.

The report contained further information in relation to the proposed delivery plan and members of the board discussed the contents of the report. In particular, discussions centred around the draft pledges with a view that these were on the right lines and should be accepted as drafts but that further work would be required at the next development session in relation to the detail of the pledges.  It was also considered that they would potentially require some external validation.

Resolved – (a)That the board acknowledges the process and rationale for arriving at the themes and priorities framework for the delivery actions as detailed in Appendix A to the report; (b) that the board agrees the draft pledges of partnership action and that a further report be submitted to the next meeting of the board with further details of the pledges and proposals for specific, measurable, achievable, realistic and timely (SMART) actions together with detailed timescales for implementation of the pledges, and (c) that the board agrees that progress against the delivery pledges will ultimately be monitored by lead officers with support from the working group and with reports being submitted to each meeting of the Health and Wellbeing Board.

17.  (10)  HEALTHY LIVES HEALTHY FUTURES AND INTEGRATION TRANSFORMATION FUND – The Chief Officer, Clinical Commissioning Group gave a detailed presentation to the board.  The first part of the presentation related to healthy lives, healthy futures and the second part which was presented jointly with the Chief Executive of North Lincolnshire Council was in relation to the Integration Transformation Fund.

The first part of the detailed presentation was in relation to healthy lives, healthy futures and referred to the work being carried out in relation to this matter which would eventually culminate in the production of a strategic plan in January 2014.

The second part of the presentation was in relation to the Integration Transformation Fund which would eventually require approval by the board.

Members commented on the details of the presentations which were very informative.

Resolved – (a) That Allison Cooke and Simon Driver be thanked for their presentations.

18.  (11)  KEEPING WELL AND MAINTAINING INDEPENDENCE – The Chief Officer, Clinical Commissioning Group presented a report which shared with the board a report commissioned by the CCG in relation to what people need to maintain their independence and keep well, to identify the key findings in the report and how they could be implemented in North Lincolnshire and identify actions for the Health and Wellbeing Board.

In March 2013, the North Lincolnshire CCG had commissioned a programme of engagement which answered the question “what needs to happen in your community so that you and yours feel confident about keeping well and living an independent life to the full”.

The aim of this work was to co-design a strategy with a wide range of North Lincolnshire residents and produce a report that made recommendations to the CCG about what needs to happen, including investment priorities, to help people keep well and live an independent life to the full. This work would also inform the healthy lives, healthy futures work stream by supporting people to remain healthy, therefore drawing less on health and care support in the future.  The expected outcome of the work was that the CCG would understand what matters to people about their health services, commissioners would also have a much more clearly defined set of outcomes and critical success factors that describe “success” in terms of sustainable services and the outcomes that matter to local people.

The CCG recognised that to secure the required transformational change to deliver  sustainable health services in the future, the public needed to feel that they had sufficient support to keep themselves healthy and to live independently.  The CCG had received the full report at its meeting on 8 August 2013 which provided the findings of the keeping well and living an independent life project.  The project engaged over 200 people at 14 different events and these were set out in detail in paragraph 2.4 of the report.  The report was structured to provide a full report supported by 12 appendices which contained the report relevant to particular groups. In considering the report the CCG had identified proposed priorities for taking forward during 2013/2014 some of which were for the CCG to action and some would require wider partnerships through this board.

It was suggested that future commissioning intentions across the North Lincolnshire CCG and North Lincolnshire Council should reflect the findings of the report.  These also needed to be considered alongside healthy lives, healthy futures and influence commissioning or support to keep people well and independent to reduce utilisation of health and care services.

The actions required in response to the report were much broader than Health and Social Care Commissioning and demonstrated the wider impacts on health and independence e.g. highways, planning, voluntary sector peer support etc.  The report suggested a wide range of potential actions and the CCG proposed that through the Health and Wellbeing Board the focus should initially be on a small number of the recommendations for initial action.  These were detailed within paragraph 3.2 of the report including details of how they might be taken forward.

Board members commented on the contents of the report and the need to endorse the key actions.

Resolved – (a) That the board accepts and endorses the detailed contents of the report; (b) that the board notes that the report and the individual summary reports had been shared with the groups who had participated in the consultation and that the reports were published on the CCG’s website; (c) that the insights contained in the report be utilised as part of the North Lincolnshire Joint Strategic Needs Assessment and be made available through the data observatory; (d) that the board and its working groups consider the findings of the report in the future commissioning of services to ensure commissioned services were person to person centred and reflected the needs identified within the report, and (e) that the board support the proposed priority actions.

19.  (12)  FEEDBACK ON THE EXPRESSION OF INTEREST BID TO BE A PIONEER FOR HEALTH AND SOCIAL CARE INTEGRATION AND NEXT STEPS – A joint report was submitted  by the Director of People and the Chief Officer, Clinical Commissioning Group informing the board of the outcomes of the expression of interest to become a pioneer for Health and Social Care integration and asking the board to acknowledge the feedback from the national panel.  The report also requested that it supports local action to include primary care in its future working and requested that it continues to prioritise local work towards whole system integration to ensure the board fulfils its statutory function and ensures it is best placed to maximise the opportunities of the Integration Transformation Fund and in particular the Payment by Results.

The report indicated that partners across North Lincolnshire had developed an expression of interest to become a pioneer for Health and Social Care integration.  The expression was predicated on –

• A whole system approach that would see integration at every level of service i.e. universal, targeted and specialist services.
• Integration to be a feature of provision across all life stages from eternity to end of life.
• Transformation of services to result in improved outcomes for all service users.

The expectations of the impact on the Health and Wellbeing outcomes for the people of North Lincolnshire of a very successful pioneer initiative were identified as –

• More people would remain in their local communities.
• Fewer people would need to use specialist services in other areas.
• Service users would experience high quality provision.
• Service users would be directly involved in their assessment and planned interventions.
• Service users would be actively involved in setting outcomes for their needs to be met.
• Commissioners would maximise the resources available for the commissioning of services.

The board had endorsed the expression of interest at its meeting held on 14 June 2013 (minute 11 refers) and the application had been submitted to the Department of Health for consideration.

Recently the government had published a statement on the Health and Social Care Integration Transformation Fund (ITF).  Whilst primarily being concerned about funding arrangements between local health and social care commissioners, the guidance was explicit that the funding was to be used to secure the provision of the right care, in the right place at the right time and would build on the work that clinical commissioning groups and local authorities were doing together including the Integrated Care Pioneers Initiative.  The ITF included a substantial transfer of funding which was linked to payment by results.  Although the criteria had not yet been published it was likely that the impacts identified above would be key to delivering the required elements for the payment by results.

The Department of Health had also announced the shortlist of pioneers and North Lincolnshire had not been included on the list.  However, the report contained detailed information about the feedback from the Department of Health which was very positive.  In particular, this indicated that there was strength in the expressions of interest submitted within North Lincolnshire and indicated a need to build on this commitment and sustain the momentum, taking time to consider how to more effectively engage with primary care so that a whole system approach could be fostered locally with ambitions for transformation to be achieved.  The board discussed the contents of the report and again reference was made to the need to map resources and to be SMART (Specific, Measurable, Achievable, Realistic and Timely) in everything that was done in relation to health and wellbeing.

Resolved – (a) That the board acknowledges the outcome of the expression of interest and the positive feedback from the national panel; (b) that the board supports local action to include primary care in future working, and (c) that the board continues to prioritise local work towards whole system integration to ensure that they fulfil their statutory function and to ensure they are best placed to maximise the opportunities of the Integration Transformation Fund and Payment by Results.

20.  (13)  INTEGRATED WORKING PARTNERSHIP – The Director of People submitted a report updating the board on the work of the Integrated Working Partnership.

The partnership continued to meet on a monthly basis chaired by the Director of People from North Lincolnshire Council.  At the June meeting the partnership focussed on the development of the expression of interest for integration pioneer status agreed to be developed at the last meeting of the board.  Subsequent meetings had focussed on the development of action plans to put in place the arrangements to deliver –

• A whole system approach that would see integration at every level of service i.e. universal, targeted and specialist services.
• Integration to be a feature of provision across all life stages from eternity to end of life.
• Transformation of services to result in improved outcomes for all service users.

The initial work had focussed on three distinct life stages as described in the expression of interest –

• Conception to two years.
• Young people who are vulnerable to risk taking behaviours aged 13 plus.
• Frail Adults including those who are older.

Three working groups had been identified to take, develop and implement the action plans.  The core elements of the three action plans were detailed in paragraph 3.5 of the report and the board was clear that these groups should be seen as “getting on with it groups.”

The board discussed the contents of the report.

Resolved – (a) That the board note the activity undertaken through the Integrated Working Partnership since the last meeting of the board in June, and (b) that the three action plans based on the SMART principles, be submitted to the next meeting of the board taking into account the resources required and information and data sharing based on national principles.

21.  (14)  INTEGRATED COMMISSIONING PARTNERSHIP – A report was submitted by the Chief Officer, Clinical Commissioning Group, updating the board on the work of the Integrated Commissioning Partnership.  This partnership continued to meet on a monthly basis chaired by the Chief Officer, Clinical Commissioning Group and the report provided a summary of the key communication messages from meetings held in June, July and August.

The June meeting was used to focus on the development of the expression of interest for integration pioneer service agreed at the last meeting of this board whilst the July meeting considered and supported a number of messages including –

• The creation of a transforming complex care task and finish group to ensure we continue to meet the requirements of the Winterbourne view concordat requirements.
• Progress in agreeing partnership agreements to support integrated provision and improved outcomes for local people.
• The announcement of the Integration Transformation Fund as part of the comprehensive spending review of the North Lincolnshire expression of interest to be a health and social care integration pioneer.

The meeting in August considered and supported the following messages for communication –

• The “keeping well” experience led commissioning engagement feedback to be available to be used by partners to influence plans.
• Positive message regarding the pioneer result shared with integrated working partnership.

Resolved – That the board notes the activity undertaken through the Integrated Commissioning Partnership.

22.  (15)  TRANSFORMING COMPLEX CARE IN NORTH LINCOLNSHIRE – UPDATE – The Chief Officer, Clinical Commissioning Group and the Director of People submitted a joint report updating the board on progress made on the implementation of the Winterbourne concordat with reference to a proposed delivery vehicle and draft terms of reference.

In May 2011, a BBC Panorama Programme showed unmanaged Winterbourne View Hospital Staff mistreating and assaulting adults with learning disabilities and autism.  Following the programme South Gloucestershire’s Adult Safeguarding Board had commissioned a serious case review.

Transforming care was the Department of Health’s response to criminal abuse at Winterbourne View Hospital which had been revealed in the BBC Panorama programme.  It built on the evidence and issues set out in the Department of Health interim report which had been published in June 2012.  The government’s mandate to the NHS Commissioning Board says –

“The NHS Commissioning Board’s objective is to ensure that Clinical Commissioning Groups work with local authorities to ensure that vulnerable people, particularly those with learning disabilities and autism, receive safe, appropriate, high quality care.  The presumption should always be that services are local and that people remain in their communities; we expect to see a substantial reduction in reliance on inpatient care for these groups of people.”

The final report sets out 63 actions, both local and national, with a firm timetable for delivery.

The Winterbourne View concordat is a programme of action issued by the Department of Health with the support of 50 different organisations.  The programme of action is based on three phases, details of which were contained in paragraph 2.3 of the report.

The North Lincolnshire Complex Care Review provided evidence to support the development of local services.  It formed the basis for effective commissioning providing a pathway for those based out of area whilst ensuring the delivery of quality, cost effective services for those individuals in area, their families and carers.  The review sits within the QIPP agenda.

A project group had now been formed to take forward the Complex Care Review in light of the Winterbourne View concordat.  The role of the group would be to take forward the recommendations of both Winterbourne and the Complex Care Review.  The group would re-visit the Complex Care Action Plan and the established responsibilities for governance and reporting arrangements.  The definition of Complex Care as defined under the North Lincolnshire Complex Care Project Outcome Report, September 2012 was detailed in paragraph 2.5 of the report.  The report was seeking the support of the board in relation to the revised proposals to transform the complex care and delivery architecture and in relation to the delivery actions required in the agreed timescale.

The board discussed the contents of the report and the Chairman indicated that there was an essential need for the board to be assured that another Winterbourne View could not happen in North Lincolnshire.  To that end the board would need to support the work identified within the report.

Resolved – (a) That the revised proposed delivery architecture and draft terms of reference for the project group referred to in paragraph 2.4 of the report be approved and adopted, and (b) that this board receive update reports in line with the proposed reporting arrangements of the group as detailed in the report and its appendices.

23.  (16)  SECTION 75 PARTNERSHIP AGREEMENTS TO UNDERPIN MORE INTEGRATED COMMISSIONING BETWEEN THE CLININCAL COMMISSIONING GROUP (CCG) AND NORTH LINCOLNSHIRE COUNCIL – The Chief Officer, Clinical Commissioning Group and the Director of People submitted a report updating the board on the progress in developing the Section 75 Partnership Agreements that would underpin integrated commissioning between the Clinical Commissioning Group and North Lincolnshire Council and also sought agreement to the finalised agreements being presented to the board at its next meeting on 10 December 2013.

The Health and Social Care Act 2012 required each local authority area to establish a Health and Wellbeing Board.  That board would have four core functions.  One of these functions was to encourage closer integration between the Commissioners of Health and Social Care.

Section 195 of the Act specifically identified the role of this board to support the use of Section 75 Partnership Agreements to equally support effective integration.

At its first meeting in June 2013 the board approved a Statement of Intent that confirmed the continued commitment to working in partnership between Health and the Local Authority whilst the Section 75 Partnership Agreements were being finalised.  It was also agreed that the Section 75 Partnership Agreements would be underpinned by a set of agreed principles (minute 8 refers) as follows –

• Services to be person centred.
• Services to promote self care and independent living where possible.
• Services to be outward focused.
• Service users to receive services in the community.

The transforming Complex Care stock take and action plan in response to the National Transforming Care (Winterbourne) recommendations included the requirement to have in place a pooled budget.  The current pooled budget did not includes these areas.  Consideration needed to be given therefore as to whether this was covered by the development of an additional Section 75 agreement or incorporated into one of the others.

The report contained further detailed information about the ongoing work in relation to the Section 75 Partnership Agreements which were being developed in North Lincolnshire, one in respect of services to adults with learning disabilities, one in respect of services to adults with mental health needs and one for services to children.  Work was also underway to scope the complex care requirements to determine if that should be incorporated into one of these or be covered by a separate agreement.  The development of separate agreements reflected best practice.

Resolved – (a) That the progress in the development of the Section 75 Partnership Agreements be noted, (b) that the finalised Partnership Agreements be submitted to the next meeting of the board in December 2013.

24.  (17)  HEALTHWATCH NORTH LINCOLNSHIRE – UPDATE – The Chair of the Healthwatch Board submitted a report which updated the board on progress on the implementation of Healthwatch, North Lincolnshire.

An initial report in relation to Healthwatch had been submitted to the first meeting of this board on 14 June 2013, (minute 10 refers) detailing progress to date in the establishment of Healthwatch, North Lincolnshire. Following consideration of that support the board had agreed to involve Healthwatch as a partner and confirm that Healthwatch would –

• Support the board to meet his priorities outlined in the Health and Wellbeing Strategy.
• Fulfil its strategy duty to involve local people and be accountable to the community.

It had been further agreed that the functions of Healthwatch North Lincolnshire would be promoted to staff within the council and its partners in order to raise awareness, and encourage individuals to volunteer with Healthwatch North Lincolnshire.

A further Healthwatch North Lincolnshire Status Report for September 2013 had been produced and was attached as an appendix to the report.

The board considered the update report from Healthwatch and the new chair of Healthwatch, Julia Pollock updated the report.  Reference was made to the need to encourage volunteers including younger volunteers through the schools and colleges and the youth council.

Resolved – That the progress of Healthwatch North Lincolnshire be noted and that organisation continued to fulfil its role on the Health and Wellbeing Board.

25.  DATE AND TIME OF NEXT MEETING –  It was reported that the next meeting of the board will be held at 10.00 am on 10 December 2013.

In relation to that meeting the chairman referred to the need to consider not only issues relating to health but also wellbeing for the citizens of North Lincolnshire.  Some of the focus of the meeting in December should therefore be on issues such as planning and transport, employment and careers, the needs of local communities, housing and infrastructure and how these can be designed to improve both health and wellbeing for the citizens of north Lincolnshire.  He asked therefore that some consideration be given to an initial plan about how these things could be incorporated into the work of the board.

The chairman also asked that consideration be given to developing a process for public engagement at meetings of the board in the future.