Agenda and draft minutes

There were no members of the press and public present at the meeting.

Resolved:-  That the minutes of the meeting held on 3^rd December, 2014, be approved as a correct record.

Arising from Minute No. S48 (Commissioning Framework) it was noted that consultation feedback was still awaited.  Chrissy Wright was to meet with the Leader later that day to progress it.

The Authority was going to hold a training session on the Act.  Details would be circulated to anyone interested.

Jason Page reported that the initiative was about working together with local pharmacists and them providing certain medications to the general public without having to see their GP.

If someone did not normally pay the NHS prescription charge then any medicine supplied under the Pharmacy First scheme would also be free.

All pharmacists were signed up and there would be 1 participating in each area.

A publicity campaign was always run at this time of the year to publicise the service.

Agencies could assist with publicising the service on their respective websites and communication channels.

Chris Edwards, Rotherham Clinical Commissioning Group, to report

Chris Edwards, Rotherham Clinical Commissioning Group, reported that informal communication had been received regarding Rotherham’s submission but official written confirmation was awaited.

Shona McFarlane, Director of Adult Social Services, to report

Shona McFarlane, Director of Adult Social Services, referred to the programme submitted for the ADASS integration event to be held on 6^th March, 2015.

If any Board member wished to attend they should contact Shona before the end of January.

The above funding application had been submitted through Public Health for research into the benefits of an active lifestyle particularly for people with long term conditions.

It was noted that a significant bid had been submitted by Age UK in reaching communities so the 2 needed to be joined up as well as linking up with the Police.

Resolved:-  That the Board support the submitted funding bid as well as the project governance scheme associated with the application.

Chairman/Michael Holmes to report

The Chairman referred to the original intention of holding a ½ day development session on 13^th February, 2015, for the Health and Wellbeing Strategy refresh.  However, an offer had been received for external facilitation by the Local Government Association of a more indepth look at the Strategy.

It was suggested that the ½ day session could bring all the workstreams together and review them in anticipation of the new Strategy.

Discussion ensued with the following issues raised:-

-          An opportunity to revisit the objectives and strengthen the support for children

-          The original intention had been for the 13^th February session to discuss a 1 vision for Rotherham and how to maximise the Strategy

-          The ½ day session could be used to look back on the success/challenges faced by the Board during its first couple of years of operation as well as identifying what future challenges it faced

-          The proposed facilitator had worked with many authorities across the country

-          The 4 days facilitation would involve meeting with some Board members to get a feeling of where things had been, how the Board had been operating, clarity about the process and return at a later date to help to flesh out the Strategy and how the Board wanted to operate in the future.

-          The Peer Review was suspended in September for 6 months due to the publication of the Alex Jay report.  It had been the intention to use that resource to review the Strategy and there was a danger of duplication.  Some of the preliminary work on the Review had already taken place

-          A view was expressed that the Peer Review was about the system and not just the Board.  The Board should use the Local Government Association (LGA) support to refresh the Strategy and the Peer Review used to look at how the system would operate to make the Strategy happen – the Peer Review should not take place until the Board understood where its business was going in the future

-          The Rotherham Clinical Commissioning Group was of the view that the current delivery mechanisms were not fit for purpose and there was some urgency to the issue

-          Both the LGA offer of facilitation and the Peer Review were real opportunities to be taken advantage of but they needed to be integrated

-          National guidance that Health and Wellbeing Boards now had to operate to had been released but that could be subject to change dependent upon the outcome of the General Election

-          Any refresh also had to take account of the forthcoming Corporate Governance Inspection report

Resolved:-  (1)  That, given the concerns raised, discussion take place with the Local Government Association regarding the Peer Review to clarify when this could be rescheduled for.

(2)  That a separate meeting be held to agree how the peer review and separate Local Government Association facilitated support sessions could best be utilised to support Board and strategy development and strengthen governance.

(3)  ...  view the full minutes text for item 59.

Tony Baxter/Jo Abbott, Public Health, to report

Tony Baxter, Interim Director of Public Health, presented an update on the performance of the Health and Wellbeing Strategy with attention drawn to the following red rate Indicators:-

Priority 1 Smoking

-          Smoking at delivery rates rose slightly during 2013/14 – anticipated continued fall.  A number of factors could have influenced this including transition of Service from the Stop Smoking Service to Midwifery, specialist midwife sickness during Q4 affecting capacity, inaccurate recording of smoking at delivery status and uncertainty of Midwifery staff about how to record smoking status of women who switch to electronic cigarettes during pregnancy

-          New systems put into place since the team moved to Midwifery including electronic booking of stop smoking appointments by Community Midwives, clinic lists and test appointment reminders.

-          An audit of smoking at booking and smoking at delivery recording was planned as this had been shown to be inaccurate in other areas in Yorkshire and Humber with appropriate follow-up dependent upon results

Priority 2 Alcohol

-          The Team to deliver this piece of work had now been selected with work scheduled to begin in October/November 2013 but this was delayed until Q4.  Due to the late start the 2013/14 target was adjusted to maintain 2012/13 level with the 20% reduction set as the 2014/15 target

-          Although not demonstrating reductions in admissions overall, reductions for the cohort of 3+ admitters were now in evidence and the length of stay significantly reduced

-          Programme was making good progress to reduce the length of stay but as overall admissions had increased the figure had also increased

-          There was evidence that the programme was reducing admissions for the specified cohort

Priority 3 Obesity

-          2012/13 and 2013/14 data for overweight and obese children in Reception/Y6 data was higher than for 2011/12 especially for Reception.  Once detailed data was available for 2012/13 it would be analysed to highlight the reasons behind the increased

-          No further Healthy Eating Prevalence data after the 2011/12 baseline.  Indicator replaced by Excess Weight in Adults in Local Authority health profiles

-          Indicator was to be included in the Public Health Outcomes Framework similar to ‘healthy eating prevalence’, data to be collected via the Active People Survey from late 2014 and hoped to be published in February or May, 2015

Priority 4 NEET

-          Of the cohort of 28:-

14 (50%) were aged 18 and 19 – they were able to claim benefit in their own right and live independently – an extremely hard group to engage in any form of learning

9 (33%) were Y13 - 6 resident outside of Rotherham

5 (17%) had all recently left compulsory education and had a range of complex needs.  2 were resident outside of Rotherham but still supported by the Service, 1 in temporary accommodation at Rush House with intensive support from the Service, 1 had health issues which prevented engagement in Learning, 1 had never engaged despite persistent attempts whilst the remaining 1 was current engaging with the Service and moving  ...  view the full minutes text for item 60.

Alison Iliff/Joanna Saunders, Public Health, to report

Joanna Saunders, Head of Health Improvement, and Alison Illiff, Public Health Principal (Health Improvement), gave the following powerpoint presentation:-

Overarching Outcome in Healthy Lifestyles Theme

-          People in Rotherham will be aware of health risks and be able to take up opportunities to adopt healthy lifestyles

Priorities in Healthy Lifestyles Theme

-          We will work together to understand our community assets; identifying what and where they are across the borough and how we use them effectively

-          We will use the Health and Wellbeing Strategy to influence local planning and transport services to help us promote healthy lifestyles

-          We will promote active leisure and ensure those who wish to are able to access affordable, accessible leisure centres and activities

The Determinants of Health (1992)

-          General socioeconomic, Cultural and Environmental Conditions

-          Agriculture and food production

-          Education

-          Work environment

-          Living and working conditions

-          Unemployment

-          Water and sanitation

-          Health care services

-          Housing

-          Social and Community networks

-          Individual lifestyle factors

-          Age, sex and hereditary factors

Healthy Lifestyles Work Plan

-          Specific actions for overarching outcome and priorities – most not target driven

-          Headline achievements

-          Challenges

-          What do we need to do next?

Achievements – Overarching Outcome

-          Tobacco Control and Weight Management Services recommissioned in 2014/15

-          Strengthening performance management through data management systems and reporting/review

-          Promotion of social norms and social marketing – linking with national programmes and local ones

-          Higher profile for public Mental health linked to Welfare Reform Programme and self-harm

Achievements – Priorities

-          Increased awareness of behaviour change services in communities – networks, marketing and social media) links with EI&P theme)

-          Service review following feedback (links with Expectations and Aspirations theme)

-          Building community capacity to support behaviour change (links with Dependence-Independence theme)

-          Stronger links with Planning Department and health proofing of local plan

-          National recognition (academic and policy publications) of Affordable Warmth Programme including social marketing tools (links with Poverty theme)

-          Successful Safer Roads Partnership and Casualty Reduction Programme

-          Increased opportunities for accessible and affordable physical activity

-          Physical activity rehabilitation programmes (links with Long Term Conditions theme)

-          Successful bids for external funding to support physical activity programmes

Challenges

-          Premature mortality and years of life lost

-          Challenges of measuring improvements

-          Progressing Making Every Contact Count

-          Sustaining investment in health improvement/prevention programmes

What could we do in a refreshed strategy?

-          Review priorities (within this theme/strategy priorities)

-          Still about investment in prevention and early intervention

-          Mandated Public Health priorities

-          Local priorities

-          Early diagnosis and referral to treatment

-          Continued role for partners

Tobacco Control Priority

A smokefree town

-          Goal 1: Preventing the initiation of tobacco use among children and young people

-          Goal 2: Reducing harm to adults from tobacco consumption

-          Specific actions and targets for each goal

-          Headline achievements

-          Challenges

-          What do we need to do next

Achievements

-          New  ...  view the full minutes text for item 61.

Chris Edwards, Rotherham Clinical Commissioning Group, to report

Chris Edwards, Rotherham Clinical Commissioning Group, presented a summary of performance across Urgent Health Care Services in Rotherham identifying poor performance and setting out remedial actions as follows:-

Accident and Emergency

-          There had been a consistent increase in attendances each month in 2014/15 compared to 2012/13 and 2013/14 – 5.2% increase

-          From August to November, 2014, A&E had failed to achieve the 95% target for patients who had been waiting for treatment

-          It was clear that a contributing factor was the increase in demand at A&E as well as increased acuity of patients and difficulties in the recruiting of doctors

-          Performance was currently around 94%

-          Second best performing Trust out of the 4 in South Yorkshire

-          National pressure on A&E

Walk-In Centre

-          The maximum activity target for the Service was 1,000 per week – attendances had fallen just below this form July, 2014

-          The fall in referrals was the result of a range of demand management initiatives that had been introduced by Care UK with the support of Rotherham Clinical Commissioning Group

-          Rotherham Clinical Commissioning group had also recently realigned the contract removing incentives for Care UK to generate additional activity

NHS111

-          The number of calls had increased by 37% probably due to the transfer of GP Out-of-Hours calls to NHS 11 that took place in 2014

-          The proportion of calls transferred to a clinical adviser dropped by 1.7%

-          Proportion of call backs within 10 minutes had reduced by 7.6%

-          Proportion of calls being diverted to A&E or 999 had reduced by 1.4% compared to 2013/14

-          A larger proportion of calls were being diverted to the GP Out-of-Hours Service

Yorkshire Ambulance Service

-          Continued struggle with performance on Red call-outs

-          Good Governance Institute recently conducted a review of performance detailing a number of recommendations for both Commissioners and the Service:-

·           Commissioners should design a 3 year service model for urgent and emergency care

·           Commissioners needed to clarify the lines of accountability for the Service and indicate whether and in what circumstances a locality approach should be taken outside of the overall Yorkshire and Humber approach

·           The Service needed to consolidate senior leadership team and appoint a Director of Operations to strengthen leadership

·           The Service was to understand a thorough review of middle management arrangements

·           A large scale cost and efficiency approach should be considered to support future service models

·           Develop a sustainable workforce strategy that addressed the sickness rate and overtime costs

-          A Recovery Plan recently implemented aimed at reversing the trajectory on Red calls

-          Despite this the Ambulance Service unlikely to achieve the 75% required performance for 2014/15

-          Compares relatively favourably with other ambulance services

-          Nation-wide issue

-          Rotherham Clinical Commissioning Group had requested assistance from NHS England

Care Co-ordination Centre

-          The number of patients managed by the Service continues to rise

Summary of Remedial Actions agreed by the System Resilience Group to improve performance  ...  view the full minutes text for item 62.

Tony Baxter/Sally Jenks, Public Health, to report

Dr. Tony Baxter, Interim Director of Public Health, presented the Pharmaceutical Needs Assessment (PNA) which had been subject to a 60 days public consultation and was submitted for ratification by the Board.

The Board was legally bound to publish its PNA BY 1^st April, 2015.

Rotherham was a relatively deprived population which was well provided with community pharmacies.  The overall coverage for access to medicines in and out of hours had increased since 2010 with the number of pharmacies per 100,000 population greater than the national average.  Access to community pharmacies across Rotherham was well provided for during core and supplementary opening hours with access to 8 100 hour pharmacies 1 of which was open 365 days a year.

The document would be reviewed in a year or sooner if necessary to ensure progress was being taken or should there be any significant changes in Legislation or commissioning intentions.

Resolved:-  (1)  That the Pharmaceutical needs Assessment be approved.

(2)  That an annual review of pharmaceutical developments against the current Pharmaceutical Needs Assessment recommendations be undertaken and where there were any changes to current Services, notifications (supplementary statements) should be made available on the Council’s Pharmaceutical Needs Assessment website page.

(3)  That where any changes were considered significant, a full review and rewrite of the Pharmaceutical Needs Assessment would be required following the Regulatory Framework.

(4)  That the Director of Public Health be delegated the responsibility for the ongoing management of the document who would submit the necessary updates to the Board.

Wednesday, 18^th February, 2015 at 11.00 a.m.

Resolved:-  That a meeting of the Health and Wellbeing Board be held on Wednesday, 18th February, 2015, commencing at 11.00 a.m. in the Rotherham Town Hall.