Shadow Health and Wellbeing Board - minutes of meeting of 8

							SHADOW HEALTH AND WELLBEING BOARD: MINUTES

Date:          8th February 2012

Time:          9:35 – 11:55

Place:         Room 128, Shire Hall, Cambridge

Present:       Councillor N Clarke (Chairman), N Dawe, Councillor S Ellington,
               Dr S Hambling, M Hewins, A Loades, Councillor T Orgee, Dr D Roberts,
               Dr L Robin and M L Rowe

Apologies: S Jathanna


20.      INTRODUCTIONS AND APOLOGIES

         Introductions were made and apologies noted. The Chairman expressed concern that
         the Strategic Health Authority had scheduled a meeting at the same time as the
         Board, which had prevented the Chief Executive of NHS Cambridgeshire attending.

21.      MINUTES – 14TH DECEMBER 2011

         The minutes of the meeting held on 14th December 2011 were approved as a correct
         record and signed by the Chairman. The Board was informed that the District Council
         Health and Wellbeing Forum (the Forum) had indicated that it was not aware of the
         establishment of a working group to help develop a joint Health and Wellbeing
         Strategy, as detailed on page 5 of the minutes, second bullet. It was noted that this
         group had not yet been established but would be considered at the next Joint
         Workstreams Officer Group (JWG) in February. The Chairman asked the Cabinet
         Member for Health and Wellbeing to get involved in the work of the JWG.

22.      AREAS FOR ACTION - UPDATE

         The Board received an update on progress against the four areas for immediate
         action identified at its first Board meeting in October 2011.

         During discussion, the Board identified the need to:

         Domestic Abuse

         -     appoint a more appropriate Chairman for the Domestic Abuse Partnership to
               enable the Domestic Abuse Partnership Manager to act as a supporting officer
               rather than Chairman. The Chairman suggested the appointment of County
               Councillor Sam Hoy, the Local Member for Wisbech North. Members were
               informed that Councillor Hoy had been part of a Member Led Review on
               Domestic Abuse.

         -     take into account the views of the District Council Health and Wellbeing Forum.
               It was noted that the Forum felt that there was insufficient reference to the
               Community Safety Partnerships who carried overall responsibility for domestic
               abuse; there was concern that there might be duplication and confusion. The
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      Forum had also reported that the Domestic Abuse Partnership Manager had
      limited resources with which to manage change and to respond to increased
      pressures. The Board was advised by the Forum that the Scrutiny Committee
      Task and Finish Group was on the point of publishing a report on domestic
      abuse. It was also advised that only approximately 50 most difficult families
      had been identified.

-     have a link worker or advocate who had the authority to encourage partners
      such as GPs to work with difficult families. The Board was informed of the
      Family Intervention Project being led by Charlotte Black, Service Director:
      Children's Enhanced and Preventative Services. This project involved working
      with troubled families using time limited interventions. It was noted that GPs
      were linked in. The Board was informed of the need to provide GPs with the
      evidence base from Cochrane Reviews in support of the role of Domestic
      Violence Advocates. The Chairman queried the progress in appointing two
      Advocates from 1 April 2012 and was assured that this was being acted on.

Preventing Serious Illness and Hospital Admissions in Winter

-     use the successful Department of Health funded “Warm Homes, Health
      People” project bid of £207,000 as effectively as possible. It was noted that the
      Steering Group had been very active. Referrals had already been received by
      the Care Network. Dr Roberts had been instrumental in leading this work to
      target people vulnerable to the cold; there had been good involvement with GP
      surgeries. The Board was informed that there had been contact with
      vulnerable people regarding cheaper fuel tariffs. The Cabinet Member for
      Health and Wellbeing reminded the Board that the Council had made money
      available from its reserves before the funding was received from the
      Department of Health to help plan for cold weather.

-     target those vulnerable elderly people who were reluctant to accept help. It
      was noted that Voluntary Sector Groups were already involved, as they had
      clients which could be helped. It was acknowledged that the media had
      increased anxiety and fear about escalating fuel costs, which had resulted in
      some people reluctant to switch on heating. It was therefore important to
      provide these people with reassurance. The Chairman raised the need to
      increase communication in this area. The Cabinet Member for Health and
      Wellbeing reported that he had met with the Cabinet Member for Adult Services
      to consider forewarnings about severe weather in order to put plans into action
      to contact people before the cold weather.

Addressing Inequalities

-     inform the Forum of the composition of the Health Inequalities Task and Finish
      Group. It was noted that they had not been aware of the establishment of this
      group. The Chairman stressed the need for elected members to be involved.
      He asked the Cabinet Member for Health and Wellbeing to review all such
      processes to make sure elected members were engaged.

-     note that the Broad Market directive had created a change in market rents by
      including East Cambridgeshire and Fenland with Cambridge City. This would
      lead to a serious reduction in rent expectations i.e. the average rent for
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            Cambridge was higher than the maximum allowed under the local housing
            allowance. There were concerns that this would lead to tenants being forced
            out of their current accommodation into sub-standard housing or
            homelessness. There was also concern as to whether there was sufficient
            private rented capacity across Cambridgeshire to cope with this change.

      It was agreed to:

      -     appoint County Councillor Sam Hoy as the new Chairman of the Domestic
            Abuse Partnership.
      -     arrange for Dr David Roberts to be interviewed on local radio regarding action
            relating to the “Warm Homes, Healthy People” project.

23.   LOCAL HEALTHWATCH

      The Board considered how a productive way of working could be developed for
      Cambridgeshire Local HealthWatch (LHW) when it was a member of the Health and
      Wellbeing Board (HWB). It noted an overview of HealthWatch (HW) and LHW, the
      link between LHW and the Board, and the still to be determined form of the
      Cambridgeshire HW. Attention was drawn to questions and consideration of the role
      of LHW at the Board.

      During discussion, the Board identified the need to:

      -     take a completely fresh look at how LHW would work. It was suggested that
            issues of democratic accountability and challenge needed to be the key focus.
            The Leader acknowledged the importance of the role of HW but reported that
            he and his Cabinet colleagues did not want Cambridgeshire LINk activity just
            transferred to the LHW. The President of Cambridgeshire LINk reminded the
            Board that there was a requirement to carry across areas of corporate
            knowledge. He explained that the Health and Social Care Bill and "Key
            Messages" talked of the functions of LINk transferring to LHW.
            Cambridgeshire LINk activity would therefore need to be transferred to the
            LHW.

      -     ensure that LHW provided authoritative, evidence-based feedback to
            organisations responsible for commissioning or delivering local health and
            social care services.

      -     consider the functions of LHW first and then match with the skills and expertise.
            The importance of challenge was acknowledged and it was suggested that
            LHW members would require Scrutiny Committee skills. The Leader
            commented that the Chairman of the County Council’s Adults, Wellbeing and
            Health Overview and Scrutiny Committee was present at the meeting. It was
            noted that the Committee would be considering the emerging structure of HW
            and GP Commissioning. The President of Cambridgeshire LINk reported that
            there was a need to consider the overlap in complementary functions between
            scrutiny and Cambridgeshire LINk.

      -     encourage HW to involve other third sector organisations particularly those with
            a single focus in the wider agenda, which included prevention. It was
            acknowledged that there was an elaborate network of third sector

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            organisations. It was noted that the County Council would be able to map out
            the consultative arrangements in order to canvass views.

      -     encourage HW to measure outcomes. It was noted that the National Institute
            for Health and Clinical Excellence had started to produce quality outcomes for
            specific clinical areas and social care, which might assist HW. The Cabinet
            Member for Health and Wellbeing reported that he could share information
            received at a recent conference.

      It was agreed to:

      -     set up a small working party comprising the Cabinet Member for Health and
            Wellbeing, Director Public Health, Dr Caroline Lea-Cox (GP Senate), the
            President of LINks, and the Corporate Director: Customer Service and
            Transformation to consider the questions and issues raised in section 3 of the
            report, and to identify further issues and to suggest solutions.

24.   CLINICAL COMMISSIONING GROUP CONFIGURATION AND OPERATING
      MODEL

      The Board received a presentation (Appendix A) on the Clinical Commissioning
      Group configuration and Operating Model.

      During discussion, the Board identified the need to:

      -     adopt a simple structure. The Board welcomed the fact that Cambridgeshire
            had one Clinical Commissioning Group (CCG) covering two upper tier
            authorities. The Chairman reported that Peterborough City Council was keen
            to share experiences. It was therefore proposed that the Cabinet Member for
            Health and Wellbeing should sit on the Peterborough HWB as a non voting
            member and the Peterborough equivalent should sit on Cambridgeshire’s
            HWB.

      -     note that there were eight Local Commissioning Groups covering four former
            Trust areas. The aim of the two Huntingdonshire groups was to co-operate in
            order to avoid duplication. The Chairman was concerned that the public were
            unaware of the CCG configuration and operating model. He welcomed the
            very helpful presentation and suggested that it should be publicised.

      -     define the meaning of health, which was being used a synonym for illness.
            There needed to be greater focus on wellbeing particularly prevention.

      -     consider the focus of the proposed model, which was in this case still a medical
            one. The Chairman highlighted the need for the presentation to be expanded
            to focus on people rather than organisations. Dr Hambling reported that he had
            met twice with the CCG Leadership Group where he had reminded them of the
            need to refer to population and not patients. The focus should be on keeping
            people healthy to avoid the cost of hospital provision.

      -     stop keeping people in hospital who did not want to be there. It was
            acknowledged that there was a failure in the explanation if people with a real
            medical need wanted to discharge themselves from hospital. However, there
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            was an issue in relation to delayed discharges where some people were being
            kept in hospital when they did not wish to be there.

      -     consider what partners were doing collectively to change thinking in relation to
            focusing on people and not organisations. It was suggested that there was a
            requirement on partner organisations i.e. social care to produce slides detailing
            how the arrangements would impact on them.

      -     consider the impact of changes to the Health and Social Care Bill on CCG
            configuration and the operating model. It was noted that the presentation set
            out how the new commissioning model would work within the existing
            framework. Dr Hambling explained that the Bill would not make a difference to
            these arrangements except to the terminology. He added that it was important
            to maintain the change in culture of the PCT to one which was more responsive
            to people’s needs. He informed the Board that there were elements missing
            from the Bill even though it was the longest one in history. There was therefore
            an opportunity to write rules relevant for Cambridgeshire.

      -     consider how LCGs would manage referrals. The Executive Director: Children
            and Young People’s Services highlighted the experience of devolved funding to
            schools for alternative provision. Peer pressure had helped four out of five
            partnerships work well but the high level of referrals from one school had
            almost broken one of the partnerships. It was noted that there needed to be
            greater self discipline regarding the way LCGs worked to avoid reverting to
            command and control. It was therefore acknowledged that significant peer
            pressure would be helpful.

      It was agreed to:

      -     ask the Director of Public Health and the Cabinet Member for Health and
            Wellbeing to consider the language around the operation of the CCG
            particularly in relation to prevention.

      -     ask the County Council/PCT communication teams to put together quickly a
            package detailing in simple terms the operation of the CCG in relation to
            people, providers and organisations.

25.   DEVELOPING A JOINT HEALTH AND WELLBEING STRATEGY

      The Board received a report proposing how the development of a Joint Health and
      Wellbeing Strategy for Cambridgeshire could be achieved. Attention was drawn to the
      proposed timeline and process. It was proposed to hold a special meeting of the
      shadow Board in early June to approve the draft Strategy for consultation.

      During discussion, the Board identified the need to:

      -     start the 90 day public consultation in June in order to avoid the start of the
            school holidays.

      -     hold the special meeting at the Oasis Centre in Wisbech, if possible, which was
            one of the County’s high need areas. The official launch should take place
            after the meeting to enable the Board to meet with local institutions.
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      -     note that an iterative five year strategy would impact on commissioning plans.

      It was agreed to:

      i)    approve the development of a Joint Health and Wellbeing Strategy for
            Cambridgeshire to the timetable outlined in the report.

      ii)   approve a special meeting of the shadow Health and Wellbeing Board in early
            June in Wisbech, to launch the draft Strategy for consultation.

26.   CAMBRIDGESHIRE CHILDREN’S TRUST ARRANGEMENTS

      The Board received a report detailing proposals to reshape Cambridgeshire Children’s
      Trust arrangements. Attention was drawn to the relationship between the HWB and
      the Trust. There was a need for the HWB and the Trust to be aware of each other’s
      work in order to be able to influence appropriately.

      During discussion, the Board identified the need to:

      -     include two District representatives (one Councillor and one officer) in the
            proposed membership of the Trust. Whilst the Board welcomed the need to
            reduce the membership to eight statutory members and eleven relevant
            partners, it was important that the District Councils were properly represented.

      -     note that the (GPs) CCG would in time replace the Primary Care Trusts. It was
            suggested that the CCG representative could currently fulfil both roles.

      -     rationalise the number of Boards in existence. It was then important that the
            remaining Boards were linked in order to provide some joined up thinking.
            Members were informed that there would be informal reporting arrangements to
            deal with information reports.

      -     consider how a suitable representative for the Voluntary Sector would be
            identified. The Board was informed that the Trust would continue to approach
            Young Lives for a representative.

      It was agreed to:

      -     ask the Children’s Trust to include two District representatives (one Councillor
            and one officer) in its proposed membership.

27.   SECOND STAGE SERVICE FINANCIAL OVERVIEW

      The Board received a presentation (Appendix B) on the Joint Strategic Needs
      Assessment in relation to how best to use resources to the meet the needs of older
      people. The LGSS: Director Finance asked the Board where it would like to focus
      effort and to assist discussion he highlighted a number of options.

      During discussion, the Board identified the need to:



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      -     prepare a map containing arrows detailing the decision making points for the
            HWB.

      -     bear in mind that prevention meant different things to different age groups. For
            example, people going into residential care were generally over 85, which was
            above average life expectancy. It was therefore important to understand the
            bigger picture.

      -     work on the basis that prevention was a relative concept. It was therefore
            important to collect all existing data to identify any gaps. It was also important
            to translate some overarching figures into real life experiences by preparing
            individual case studies, as this would provide an opportunity to see pathways
            through services. It was acknowledged that picking stories would enable
            services to spot need.

      -     prevent emergency admissions. There was a need to provide training for
            residential home staff as part of the licensing arrangements. One Member
            highlighted the need to consider the side effects of medications for those aged
            85+.

      -     include in the care plan provision for when a carer was ill.

      -     use the data available to keep people out of services. It was important to
            identify what people actually wanted as part of the process.

      -     make contact with older people who did not make contact with services.

      -     work with District Councils to provide older people with more appropriate
            accommodation for their age.

      -     add the impact of mental health to the list.

      -     take a risk and be more innovative.

28.   HEALTH AND WELLBEING: THE OVERVIEW AND SCRUTINY ROLE

      The Chairman of the Adults, Wellbeing and Health Overview and Scrutiny Committee
      and the Scrutiny and Improvement Officer introduced a report on the role that
      overview and scrutiny could plan in relation to the emerging HWB and the contribution
      that it could make to developing effective relationships between local government, the
      NHS, HW and other stakeholders to improve health and wellbeing outcomes. The
      Overview and Scrutiny Chairman offered to give a presentation to the CCG.

29.   ANNUAL WORK PROGRAMME AND FORWARD AGENDA PLAN

      (a)   Annual Work Programme

      The Board considered a proposed work plan and queried how it could get involved in
      issues. It was noted that District Councils were happy to be involved further. The
      Chairman asked for a timeline of key decision points and actions before that. He
      suggested that the Board might need to form sub groups to meet objectives.


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      It was agreed to:

      i)     approve the proposed workplan for the shadow Health and Wellbeing Board
             attached at Annex A to the report.
      ii)    assume governance oversight of the work of the Joint Workstreams Officer
             Group, following disbanding of the Community Wellbeing Partnership.

      iii)   agree the formation of an officer group to support the shadow Board, which
             included officer representation from all five District/City Councils.

      iv)    agree to take forward a review of potential links with the wider Health and
             Wellbeing Network, for which Cambridgeshire had been offered funded
             consultancy time by the Local Government Association.

      (b)    Forward Agenda Plan

      The Board considered its current forward agenda plan. It was informed that the Local
      Health Partnerships would be unable to present their priorities until June.

30.   DATE OF NEXT MEETING

      The Board noted that the next meeting would take place on 11th April 2012, 15.00 -
      17.00.




                                                                                    Chairman




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