Agenda and draft minutes

There were no questions from the member of the public present at the meeting.

Consideration was given to the minutes of the meeting held on 12^th November, 2014.

Concern was expressed that the last sentence of the final paragraph of Minute No. S40 (Emotional Health and Wellbeing Strategy) did not accurately reflect the discussion that had taken place.  The following amendment was suggested:-

“Some partners felt it was realistic to provide outcomes as part of their strategy at this stage”.

Resolved:-  That, subject to the above amendment, the minutes of the meeting held on 12th November, 2014, be approved as a correct record.

Arising from Minute S36 (Health Action Plan), Carol Stubley, NHS England reported that the Plan being produced in relation to the CSE investigation was in draft form and had been contributed to by NHS England, Clinical Commissioning Groups and other health organisations.  There would be a meeting in the next couple of weeks to review and ascertain if there were any gaps in the provision by Health.  The Plan and Guidance were expected to be published by 23^rd December.

Arising from Minute No.S36 (Vaccinations and Immunisations), Carol Stubley, NHS England, reported that discussions had taken place with Rotherham Foundation Trust.  Unfortunately, due to the training the midwives would have to undertake, the Trust had confirmed that it was not in a position to take it forward at the current time.  All women requiring vaccinations would be signposted to Primary Care.

David Hicks, Rotherham Foundation Trust, expressed his disappointment that the Trust had not been able to facilitate this but it was due to capacity and resources.  It was hoped, and endeavours would be made, to implement it for the next financial year.  The Head of Midwifery had given a commitment to look at it for 2015/16 as it was a real opportunity missed.

The Chair asked that the Board be kept up-to-date with any developments on this issue.

·         NHS England letter on organisational alignment and capability programme (Carol Stubley)

·         Better Care Fund – verbal update (Tom/Chris Edwards)

NHS England Organisational Alignment and Capability Programme (OACP)

Carol Stubley, NHS England, presented a letter received from Eleri de Gilbert, Director NHS England (South Yorkshire and Bassetlaw) regarding the changes to the organisation’s internal structure.

The aim of the reorganisation was, across England, to reduce the number of teams from the current 27 to 12 including the London configuration and to establish 4 regional teams.  For South Yorkshire that would mean a move to 1 geographic team which would encompass Yorkshire and the Humber meaning the 3 existing teams (South Yorkshire and Bassetlaw, West Yorkshire and North Yorkshire) would disappear and form into 1.  The changes were internal to the NHS and, therefore, there had been internal consultation with staff.  The changes would be implemented as from the beginning of 2015.

Whilst moving to 1 geographic footprint, there would still be a presence in each of the localities e.g. in Oak House for South Yorkshire and Bassetlaw.

In terms of the director functions for Yorkshire and the Humber there would be a Director of Operations and Commissioning (replacing the existing area teams – an appointment made and commencing on 5^th January, 2015), a Medical Director, Finance Director and a Nursing Director.  There would be a further 3 Directors, each 1 would be locality based i.e. 1 within South Yorkshire and Bassetlaw, 1 for West Yorkshire and 1 for North Yorkshire.  The structure for this area had been developed specifically taking into account the large geographic area and the fact that each of the areas had unique issues.

There may be a change in attendance at the Health and Wellbeing Board but there would be more information once the team had been established.

The Chairman stated that he personally felt that the role of a NHS England representative on the Board was invaluable.

Better Care Fund

Chris Edwards, Rotherham Clinical Commissioning Group, reported that a meeting had been held with Nick Clarke, Better Care Adviser.  The submission was being revised and would be communicated to the next Board meeting.

Health and Wellbeing Website

Michael Holmes, Policy and Partnership officer, reported that the website was up and running but at some point the Board should consider developing a wider communication plan including the use of social media.  There had been no feedback from partners with regard to any additions required.

The website would link to the NHS Constitution.

Crisis Care Concordat

It was noted that the Council had signed up to the Concordat as had the Clinical Commissioning Group, South Yorkshire Police and RDaSH.

RDaSH

It was reported that Chris Bain was to leave her position as Chief Executive of RDaSH.

Resolved:-  That the Board’s best wishes be conveyed to Chris and appreciation for her work in supporting the Board.

Child and Adolescent Mental Health Services

Scrutiny Reviews that had implications for the Board and/or partners would be circulated at the scoping stage so there was the opportunity for the Board to discuss and possibly have an input.  ...  view the full minutes text for item 45.

Carol Stubley, NHS England, to present

Carol Stubley, NHS England, presented the NHS 5 Year Forward View:-

The NHS have achieved a lot

-          Currently #1 healthcare system in the world

-          More than 2/3 UK public believe the NHS “works well”

-          Cancer survival is at its highest ever

-          Operation waiting lists are down – many from 18 months to 18 weeks

-          Early deaths from heart disease are down over 40%

-          160,000 more nurses, doctors and other clinicians

-          Single sex wards implemented

We are delivering more care – compared with 2009 the NHS is delivering more care

-          4,000 more people are being seen in A&E each day

-          3,000 more people are being admitted to hospital each day

-          22,000 more people have outpatient appointments each day

-          10,000 more tests are performed each day

-          17,000 more people are seeing a dentist each day

-          3,000 more people are having their eyes tested each day

Demand for care is rapidly growing

-          We are facing a rising burden of avoidable illness across England from unhealthy lifestyles:

1 in 5 adults still smoke

1/3 of people drink too much alcohol

More than 6/10 men and 5/10 women are overweight or obese

-          Furthermore:

70% of the NHS budget is now spent on long term conditions

People’s expectations are also changing

There are also new opportunities

-          New technologies and treatments

Improving our ability to predict, diagnose and treat disease

Keeping people alive longer

But resulting in more people living with long term conditions

-          New ways to deliver care

Dissolving traditional boundaries in how care is delivered

Improving the co-ordination of care around patients

Improving outcomes and quality

-          The financial challenge remains with the gap in 2020/21 previously at £30bn by NHS England, Monitor and Independent think-tanks

The future NHS – the Forward View identifies three ‘gaps’ that must be addressed:-

-          Health and Wellbeing

Radical upgrade in prevention

Back national action on major health risks

Targeted prevention initiatives e.g. diabetes

Much greater patient control

Harnessing the ‘renewable energy’ of communities

-          Care and Quality

New models of care

Neither ‘one size fits all’ nor ‘thousand flowers’

A menu of care models for local areas to consider

Investment and flexibilities to support implementation of new care models

-          Funding

Implementation of these care models and other actions could deliver significant efficiency gains

However, there remains an additional funding requirement for the next Government

Need for upfront pump-priming investment

Getting serious about Prevention

-          Focusing on Prevention

Incentivise healthier individual behaviours

Strengthen powers for local authorities

Targeted prevention programmes starting with diabetes

Additional support people to get and stay in employment

Create healthier workplaces – starting with the NHS

-          Empowering Patients

Improve information: personal access to integrated records

Investment in self-management

Support patient choice

Increase patient control including through Integrated Personal Commissioning (IPC)

-          Engaging Communities

Support England’s 5.5m carers – particularly the vulnerable

Supporting the development of new volunteering programmes

Finding new ways to engage  ...  view the full minutes text for item 46.

Presentation by Shona McFarlane, Director of Health and Wellbeing

Nigel Parr, Professional Standards and Development Service Manager, gave the following powerpoint presentation:-

Care Act 2014

-          Received Royal Assent on 14^th May, 2014

-          The Act was in 3 parts – Care and Support, Care Standards and Health

-          Part 1 of the Act consolidated and modernised the framework of care and support law with new duties for local authorities and new rights for Service users and carers

-          It replaced many previous laws e.g. Chronically Sick and Disabled Person Act 1970, Community Care (Direct Payments) Act 1996

What is the Act trying to achieve?

-          That care and support

Is clearer and fairer

Promotes people’s wellbeing

Enables people to prevent and delay the need for care and support and carers to maintain their caring role

Puts people in control of their lives so they can pursue opportunities to realise their potential

An integrated Act

-          Different sections of the Act are designed to work together

-          Local authority wide

-          Overlap with Children and Families including transitions

-          Partnerships and integration

-          Leadership

Framework of the Act and its Statutory Guidance

-          Underpinning principle

Wellbeing

-          General responsibilities and key duties

Prevention

Integration, partnerships and transitions

Information, advice and advocacy

Diversity of provision and market oversight

Safeguarding

-          Key processes

Assessment eligibility

Charging and financial assessment

Care and support planning

Personal budgets and direct payments

Review

The Wellbeing Principle

-          Wellbeing broadly defined 9 areas in particular

-          Local authorities should also have regard to other key principles when carrying out their activities such as beginning with the assumption that the individual is best-placed to judge their wellbeing

New Responsibilities of Local Authorities towards all Local People

-          Arranging services or taking other steps to prevent, reduce or delay peoples’ needs for care and support

-          Provision of information and advice including independent financial advice

-          Promoting diversity and quality in the market of care providers so that there are services/supports for people to choose from

New Duties – Integration and Market Oversight

-          A statutory requirement to collaborate and co-operate with other public authorities including duty to promote integration with NHS and other services

-          Duty for local authorities to step in to ensure that no-one is left without the care they need if their service closes because of business failure

-          Care Quality Commission oversight of financial health of providers most difficult to replace were they fo fail and to provide assistance to local authorities if providers do fail

New duties – Advocacy, Safeguarding and Transitions

-          A duty to arrange independent advocacy if a person would otherwise be unable to participate in or understand the care and support system

-          New statutory framework for protecting adults from neglect and abuse.  Duty on local authorities to investigate suspected abuse or neglect, past or present, experienced by adults still living and deceased

-          Duty to assess young people and their carers in advance of transition from Children’s to Adult Services where likely to need care and  ...  view the full minutes text for item 47.

Chrissy Wright to present

Chrissy Wright, Strategic Commissioning Manager, submitted a Commissioning Framework for the Board’s consideration.

In order to continuously improve the quality of commissioning across the Council, the document had been developed to provide a framework for commissioning to ensure a consistent high quality commissioning activity in line with national good practice, outcome focussed and met the needs of the citizens and the Council.

The Framework set out a definition of commissioning, the commissioning principles and the legal requirements.  It was hoped that the Framework would be agreed by the appropriate bodies including the Board and the Leader of the Council as a public document.

The Framework set out the required commissioning approach particularly with respect to the Council’s Standing Orders, Financial Regulations, legislation and equality and diversity.

It was noted that the Framework corresponded with the Health and Wellbeing Strategy and Joint Strategic Needs Assessment.

The document would be refreshed to take account of the Jay report, Corporate Governance and Ofsted recommendations.

Chris Edwards, Rotherham Clinical Commissioning Group, stated that Health carried out Quality Impact Assessments of their strategies and would be willing to share their working practices.

It was noted that comments had been received from the voluntary and community sector which would be collated and forwarded to Chrissy.

 Resolved:-  (1)  That the Commissioning Framework be noted.

(2)  That the final document be submitted to future Board meetings.

Michael Holmes to present

Michael Holmes, Policy and Partnerships Officer, submitted a proposed reporting timetable that would enable the Board to review progress to date against its 6 strategic outcomes and locally determined priorities as part of the Health and Wellbeing Strategy refresh and discuss priority areas for the updated Strategy.

It was proposed that reports be submitted on 3 priority areas at the next 4 Board meetings (January to June) with members considering:-

-          What progress had been made and what factors had prevented further progress?

-          Could tangible achievements be identified?

-          Was this still a priority and why?

At the end of this process a workshop, either at the June meeting or separately arranged, could focus on the refresh considering outcomes from the Board sessions as well as other relevant issues and potential priority areas.

The Health and Wellbeing Steering Group would support priority leads helping them to prepare for the Board sessions.  From May, 2015, it was proposed that a task and finish group be established to work on the refresh.

Discussion ensued on the report with the following issues raised:-

-          Work of the workstreams had been delayed due to recent pressures on time and resources

-          The refresh would miss the current Clinical Commissioning Group round but would be considered in September/October

-          The aim would be to have 1 plan for Rotherham including all partners’ strategies but would need clarity on governance and accountability

-          Needed to take account of the Jay report, Ofsted and Corporate Governance Inspection

-          Need to ensure that the actions of the Improvement Board and Children’s Improvement Board were clear and no duplication of work

Resolved:-  That the proposed approach and timetable for the refresh of the Health and Wellbeing Strategy be noted.

A&E

There had been recent media attention surrounding the capacity of A&E.  A&E had been pressured together with staff shortages at key levels in the organisation.

The methodology used in the past had been the Intensive Support Team which had been really positive and used as a beacon at national conference.  However, that now had to become normal practice which the impending Winter Plans did state.

Rotherham’s A&E had performed at 95% in the last 2 quarters; the latest performance was just under that figure.  The next few months were very dependent upon the weather and issues that the Trust could not control.  The Resilience Board regularly discussed this issue.

The long term solution would be the proposed Emergency Care Centre.

South Yorkshire Ambulance Service

There had also been issues recently with regard to ambulance response times and instances when the Police had been called upon to transport members of the public to the hospital.

The Service was currently operating at reasonable levels.  Doncaster was operating at 93% patients seen within 4 hours, Sheffield at 94.6%, Rotherham at 94.8% and Barnsley 98%. Rotherham was only 0.2% below what was considered to be good performance nationally.  The pressure on emergency services was at a critical level.

Nevertheless, performance levels experienced currently were not acceptable and Rotherham and Barnsley particularly disadvantaged for Model A Response Target (response within 8 minutes).  Last month Rotherham had operated at 65% of patients against a target of 75%. 

There was very little scope as it was a legal requirement to contract with South Yorkshire Ambulance Service so it could not be market tested.  The Good Governance Institute had conducted a review which had only given a partial reassurance and an action plan had been drawn up. 

Walk-in Centre

Anecdotal evidence suggested that the Centre was frequently being closed on an evening to patients unless they were children or had life threatening conditions; members of the public were being sent to the A&E.

Resolved:-  That Chris Edwards submit an update on all the above issues to the next meeting.

Wednesday, 21^st January, 2015 at 11.00 a.m.

Resolved:-  That a meeting of the Health and Wellbeing Board be held on Wednesday, 21st January, 2015, commencing at 11.00 a.m. in the Rotherham Town Hall.