Venue: Conference Room A/B, Cumbria House, Carlisle, CA1 1RD
Contact: Lynn Harker Email: firstname.lastname@example.org
The Chair, on behalf of the Board, conveyed their thanks and appreciation to Colin Glover the former District Council representative for his positive contributions.
Vice-Chair of the Board
In accordance with the Board’s Terms of Reference to note that the Chair of each of the Clinical Commissioning Groups will be joint Vice?Chair of the Board.
In accordance with the Board’s Terms of Reference to note that the Chair of each of the Clinical Commissioning Groups was the joint Vice?Chair of the Board.
Apologies for Absence
To receive any apologies for absence.
Apologies for absence were received from Patricia Bell, Aaron Cummins (substitute was Sue Smith), Marion Fitzgerald, Ian Johnson and Jon Rush.
Disclosures of Interest
Members are invited to disclose any disclosable pecuniary interest they have in any item on the agenda which comprises
1 Details of any employment, office, trade, profession or vocation carried on for profit or gain.
2 Details of any payment or provision of any other financial benefit (other than from the authority) made or provided within the relevant period in respect of any expenses incurred by you in carrying out duties as a member, or towards your election expenses. (This includes any payment or financial benefit from a trade union within the meaning of the Trade Union and Labour Relations (Consolidation) Act 1992.
3 Details of any contract which is made between you (or a body in which you have a beneficial interest) and the authority
(a) Under which goods or services are to be provided or works are to be executed; and
(b) Which has not been fully discharged.
4 Details of any beneficial interest in land which is within the area of the authority.
5 Details of any licence (alone or jointly with others) to occupy land in the area of the authority for a month or longer.
6 Details of any tenancy where (to your knowledge)
(a) The landlord is the authority; and
(b) The tenant is a body in which you have a beneficial interest.
7 Details of any beneficial interest in securities of a body where
(a) that body (to your knowledge) has a place of business or land in the area of the authority; and
(b) Either –
(i) The total nominal value of the securities exceeds £25,000 or one hundredth of the total issued share capital of that body; or
(ii) If that share capital of that body is of more than one class, the total nominal value of the shares of any one class in which the relevant person has a beneficial interest exceeds one hundredth of the total issued share capital of that class.
In addition, you must also disclose other non-pecuniary interests set out in the Code of Conduct where these have not already been registered.
A “disclosable pecuniary interest” is an interest of a councillor or their partner (which means spouse or civil partner, a person with whom they are living as husband or wife, or a person with whom they are living as if they are civil partners).
There were no disclosures of interest on this occasion.
Exclusion of Press and Public
To consider whether the press and public should be excluded from the meeting during consideration of any item on the agenda.
RESOLVED, that the press and public be not excluded from the meeting for any items of business.
To confirm as a correct record the minutes of the meeting held on 18 April 2019 (copy enclosed).
With reference to minute 13 – Health and Wellbeing Board Outcome Framework members noted that following a detailed discussion at the Health and Wellbeing Board Development Day in June a further report, which would inform future work of the Board’s priorities, would be considered at their next meeting.
With reference to minute 14 – System Strategies – Update Report the Board were informed that the creation of a North East and North Cumbria ICS would not affect local development. It was explained a principle had been established which would add value to the population health programmes and digital agenda highlighting the benefits of access to patient cancer care in the North East.
RESOLVED, that the minutes of the meeting of the Board held on 18 April 2019 be agreed as circulated and thereupon signed by the Chair.
Maternity and Paediatric Services in West Cumbria
With the agreement of all members the Board received an additional positive update from Peter Rooney, Chief Operating Officer, NHS North Cumbria Clinical Commissioning Group regarding a recent decision on maternity services in West Cumbria.
Members were informed that the Independent Review Group, Chaired by Dr Bill Kirkup CBE, had made three recommendations:-
(1) The existing pattern of maternity services with consultant-led units in Whitehaven and Carlisle was operating effectively at present and was proving innovative and adaptable in overcoming challenges. A commitment should be given to sustain this service pattern.
(2) Midwifery-led services operating alongside those units were important in offering choice of birth setting in line with Better Births. A commitment should also be given to sustain this element of the service pattern.
(3) There will be challenges to sustaining this service pattern. It was important that a decision about Option 1 does not lead to any sense of complacency or ‘job done’. It was also important, however, that the stability of Option 1 was not undermined by a perception of crisis every time a challenge arises. A commitment should be given to maintaining vigilance and supporting innovative measures to counter those challenges in future, continuing the collaborative Working Together approach between the community and the NHS.
The Board were informed that the CCG Governing Body accepted all of the recommendations in full. It was explained that to achieve the third recommendation the local system would need to retain a real focus on making the service work.
Representatives from the Trust highlighted the change in direction in recognition of rural hospitals, highlighting their significance for the area and community as a whole. They emphasised their support of the outcome of the review.
The Chair, on behalf of the Board, welcomed the decision and welcomed this approach for any future arrangements; offering support to Trust colleagues as necessary.
To consider a report by the Chief Operating Officer, Healthwatch Cumbria (copy enclosed).
The Board received a report from Healthwatch Cumbria regarding the project ‘Everyone has a Voice – What does a good life look like?’. It was explained this had been developed by Healthwatch Cumbria and explored the experiences of people with learning difficulties in Cumbria from a variety of perspectives to provide feedback on what was working well and what could be working better.
Members were informed that the work was also in line with the ‘Transforming Care’ agenda which was focused on improving the lives of people with learning difficulties. It was explained the aim was to reduce reliance on out of county and/or hospital based care and also enable people to live longer with more enriched lives in their own communities.
The Board noted that engagement had taken place with over 540 people, including people with learning difficulties, parent/carers, social workers, commissioners and service providers. It was explained that over 120 people were spoken to directly as well as109 responses to the online survey.
The Board was informed that work was now progressing through the Cumbria Learning Difficulties and Autism Partnership Board to ensure that its agenda addressed highlighted issues. It was explained that to date work had taken place to explore relationships, hate and mate crime and transport challenges, with future themes such as education, training and employment, accommodation and staff and carer support.
Members then received a presentation and update from Sue Stevenson, Chief Operating Officer, Healthwatch Cumbria and Lou Townsend, People First Trustee.
The Trustee highlighted to the Board the day service hours available to clients and how the reduction in those were impacting negatively upon the quality of life of individuals and families. It was explained that the system meant service users were forced to bank up hours by foregoing support sessions in order to accumulate hours for leisure activities.
Members raised their concerns regarding the banking of day service hours and it was felt there was a need to look more innovatively at this to ensure there was a robust Volunteer Workforce Strategy.
The Board were given examples of difficulties experienced by people with learning difficulties during daily events and social activities. It was felt that consideration as to the provision of support and resource for people with learning difficulties, or any member of the public collaborating to support service design and development was required.
Members welcomed the update and suggested this should also be considered by the Cumbria Local Enterprise Partnership to encourage a better understanding of the opportunities for the employment of people with learning difficulties.
The Board acknowledged the difficulties encountered for people with learning difficulties and invitations were extended to Sue Stevenson and Lou Townsend to meet representatives of North Cumbria Health and Care System to discuss the issues further. It was also suggested that the LEP may be interested in receiving a similar presentation to explore issues around employment and skills. The invitations were welcomed but concerns were raised regarding the need for the service user to bank day ... view the full minutes text for item 7.
To consider a report by the Executive Director – People (copy enclosed).
The Board considered a report and presentation by the Executive Director – People regarding the Authority’s SEND Inspection.
Members were informed that in March 2019 Ofsted and the Care Quality Commission (CQC) had carried out a joint inspection of Cumbria’s local area. It was explained the Inspection Team had assessed how well the system identified, assessed and met needs together with the delivery of outcomes for children and young people with Special Educational Needs and Disabilities (SEND).
The Board’s attention was drawn to the headline findings:-
Ø the impact of the SEND reforms on children, young people and families in Cumbria as variable with not enough pace in implementing the reforms;
Ø a lack of joint working between health, care and education and inequitable access to services;
Ø a number of parents and carers had lost faith and trust in the local area and felt co?production was weak, however, leaders were beginning to develop a clearer understanding of the main strengths and weaknesses and there was glowing praise about individual staff members.
The outcomes of the inspection included the local area being issued with a Written Statement of Action which the Authority and Clinical Commissioning Groups were jointly responsible for and contained nine key areas (outlined in the presentation) which were highlighted for improvement. Members were informed there would be quarterly monitoring visits with a further inspection in approximately 18?24 months.
The Board noted it had been proposed that Cumbria’s Health and Wellbeing Board would hear regular updates from the Chair and relevant officers from the Improvement Board. It was explained that functioning was the highest tier of governance, and was anticipated the Health and Wellbeing Board would provide the accountability, support and challenge necessary to ensure the successful delivery of the Improvement Board’s priorities.
A detailed discussion took place regarding the Inspection and Board members felt the SEND improvements were a whole system responsibility. It was suggested that service users, carers and parents should also be engaged. Members agreed with formally reporting to the Board to ensure progress was being achieved.
The Board raised its concerns regarding the loss of trust by parents and carers and felt that the inclusion strategy should ensure that children and young people and both parents and carers had a choice. Members recognised that moving forward would be difficult if there was no feeling of support for children and young people and welcomed the recent inclusion of parents and carers more routinely in the re?design of services; highlighting the Parent Advisory Groups as a good example. It was felt that where opportunities for co-production were embraced, services typically met the needs of families and lead to positive outcomes. The Board felt that co?production groups should be encouraged to ensure a carer or parent was included in their membership and that the appropriate training was put in place.
Members recognised that this should be looked at as a framework to improve emphasising that Cumbria had a commitment to their children.
RESOLVED ... view the full minutes text for item 8.
To consider a report by the Director of Public Health (copy enclosed).
The Board considered a report on the Multi-Agency Suicide Prevention Strategy for Cumbria 2019-2022.
Members were informed that overall national suicide rates were reducing slowly, however, remained too high with the highest being in the north of England. It was explained that suicide was the leading cause of death in men aged 20?49 and self?harm was a known risk factor which was particularly high in younger age groups and women.
The update of the Multi Agency Suicide Prevention Strategy for Cumbria reflected on more recent guidance; this included a greater emphasis on self-harm and its prevention; and announcement of additional resource for suicide prevention: £25M over the 3 year period 2018-21, to Integrated Care Systems (ICSs). It was highlighted that national policy and guidance continued to emphasise the role of local authorities in leading, developing, and overseeing delivery of local suicide prevention by multiagency partnerships.
The Board was informed that both the North and South ICSs would receive Wave 2 transformation funding in 2019/20 (with the South ICS also having received Wave 1 funding in 2018/19) to support the developing suicide prevention work. It was explained that both of the ICSs covering Cumbria had aligned plans following the agreed aims and objectives set out in the Strategy.
Members welcomed the report and attention was drawn to the number of suicides due to personal financial issues and a concern was raised regarding the lack of reference to this. The Board were informed that debt was aligned with the ICS strategies highlighting that Lancashire were more advanced due to their first wave of funding but assured members that this matter was being addressed.
The Board raised its concerns regarding the high number of male suicides in the county. During the course of discussion reference was made to a group who had previously produced a number of different forms of communication such as beer mats and posters to raise awareness of the help which was available and it was agreed this would be investigated further.
A concern was raised regarding the high levels of self?harm, particularly in younger people, and a request was made for this to be considered further in the future. It was acknowledged this was a significant issue which had to be addressed.
The Board discussed the number of suicides in children and young people highlighting the multi-agency work which quickly took place to support this and drew attention to the lack of reference to this in the action plan.
The suicide prevention awareness and training of over 6,000 people was welcomed and the Board encouraged more of this. Members were informed that awareness training continued and it was anticipated this would also include private employers in the future.
The Board thanked officers for the update.
RESOLVED, that the Strategy is ratified.
To consider a report by the Director of Public Health (Cumbria County Council) (copy enclosed).
The Board considered a report from the Director of Public Health which set out the impact of Adverse Childhood Experiences (ACEs) and described a range of appropriate interventions using the “pentagon” framework of Prevent, Detect, Protect, Manage, and Recover, before making a series of recommendations for action.
The Board was informed that the term ACEs could be used to describe a wide range of stressful or traumatic events that happened during childhood which could be single events or repeated experiences. Members noted that the three main groups included neglect, abuse and household challenges. It was explained that ACEs in the first two of those groups could cause direct emotional or physical harm to children, while those in the third group could cause indirect harm through their effect on the home environment.
Members were informed that ACEs could have a significant and long term effect on health and wellbeing and, in recognising this, the 2018 Public Health Annual Report had taken ACEs as its key focus. It was highlighted that ACEs affected a large number of children; explaining this could have both a physical and psychological impact on individual lives. It was felt that this was transgenerational and the importance of long-term intervention and support was needed for future generations.
The Board noted that the issue of ACEs had also been receiving wider attention within Cumbria. It was explained that a major local conference on the subject had been held in March 2019, generating an outline joint action plan. Members noted that had subsequently been written up by an informal ACEs Steering Group which was now chaired by the Director of Public Health. The Steering Group was now seeking the endorsement of the Board for this work to ensure that it had sufficient strategic support to ensure success.
The Board drew attention to the impacts of access to housing, poverty and resilience and access to green spaces and clean air. The district councils felt they could make positive contributions to help with those issues. The Board was informed that although there was no evidence that housing and poverty were a contributory factor it was felt that there should be more collaborative working to try to mitigate issues.
The Board felt this was a collective responsibility and noted the Cumbria Local Safeguarding Children Board and the Children Trust Board also had a leadership role.
Members suggested that the information should be shared with the Chief Executives’ Group and Cumbria Leaders’ Board.
The Board welcomed the report and felt it was incumbent for everyone to discuss this further with their respective organisations and any insight into improvements would be welcomed.
(1) the 2018 Public Health Annual report be noted;
(2) the Board act as the senior governance route for reporting by the ACEs Steering Group;
(3) an action plan, developed by the Cumbria ACEs Steering Group, to address the recommendations contained in the 2018 Public Health Annual report be made available to the Cumbria Health and Wellbeing Board.
To consider a joint report by the Executive Director – People (Cumbria County Council), Chief Operating Officer - North Cumbria Clinical Commissioning Group and Chief Officer - Morecambe Bay Clinical Commissioning Group (copy enclosed).
Members considered a report which provided an update on Cumbria’s 2017?19 Better Care Fund (BCF) and asked the Board to note the submission of the joint BCF/iBCF 2018/19 Quarter 4 (Q4) performance return (referred to in Appendix 1 of the report); and also financial and activity reporting.
The Board’s attention was drawn to the unpublished planning requirements for the BCF 2019/20 explaining it was anticipated their publication was imminent. Members were assured that the agreed outturn for BCF spending activity was taking place.
RESOLVED, that the report be noted.
To consider a report by the Director of Public Health (Cumbria County Council) (copy enclosed).
Members considered a report from the Health Protection Oversight Group (HPOG) which had been established by the Cumbria Health and Wellbeing Board and provided a framework for health protection across Cumbria and governance and assurance for local health protection arrangements. It was noted this was the first agreed formal report to Board and provided an overview of screening and immunisation programmes in Cumbria.
Members were informed that the health protection agenda covered the following themes:-
• National screening programmes
• Adult and childhood immunisation against infectious diseases
• Healthcare Associated Infections
• Communicable Disease Control
• Antimicrobial Resistance
• Infection Prevention and Control
• Emergency Planning for Health.
and that further reports would be made to future Board meetings detailing information on those themes.
A discussion took place regarding the Screening Programme. Members asked whether it was felt an increase in the number of people being screened in certain areas would have an impact on identifying healthy people who may have an increased risk of a particular condition. The Director of Public Health agreed to investigate screening programme data and provide further information on this.
A concern was raised regarding variations in the uptake of screening and further information was requested on longitudinal trends and variations.
Members discussed the update of screening for people with learning difficulties. It was explained that Healthwatch Cumbria and Lancashire had improved information to help people with learning difficulties understand the importance. It was agreed this would be circulated to the Board.
A discussion took place regarding immunisations and it was felt critical that to be effective a designated person in each doctors practice should take ownership of the agenda and monitor the data.
The Board welcomed the report and highlighted the importance of screening and immunisation to enhance the lives of people.
RESOLVED, that the report be noted.
To receive a report from the Director of Public Health (Cumbria County Council) (copy enclosed).
The Board received a report from the Director of Public Health which gave an update on the development of the Cumbria Public Health Alliance (PHA), its links to the Locality Forums and the mechanisms for ensuring two way influence and dialogue between the Board and each locality through agreed strategic aims and locally identified priorities.
The report updated members on the recent meeting of the Public Health Alliance held on 5 June 2019 which comprised Suicide Prevention Strategy, Joint Public Health Strategy, Learning Disability and Autism Partnership Board and Drugs Deaths in Cumbria.
The Board discussed the increase in the number of drugs deaths in Cumbria over time noting that Barrow had the highest rates in the county, and over twice the average for England. Members were informed that whilst this was challenging a full study into the deaths had been undertaken and a response had been identified to tackle the issues underlying the deaths to help prevent future deaths.
The Board’s attention was brought to the successful Egerton Court Project in Barrow; a flat which provided support to vulnerable adults with drug or alcohol addiction and aimed to address additional mental health or social issues. It was highlighted as a fantastic approach to multi agency working and a great example of population health approach.
A discussion took place regarding The Well Project in Barrow which provided support to people recovering from drug and alcohol addiction through therapy, counselling, peer mentoring, employment training and social activities. The challenges regarding funding for the Project through the Public Health Alliance was highlighted, noting that the reduction in their budget was realising service efficiencies. Members raised their concerns regarding the risks to the Service due to the budget reductions. It was agreed that further information would be sought and, as a system, future funding would be investigated.
(1) the report be noted;
(2) further information on The Well Project be sought and future funding be investigated.
To note the list of future meeting and development dates (copy enclosed).
The Board noted that:-
(1) the next Cumbria Health and Wellbeing Board Development day would take place on Friday 6 September 2019 at 10.00 am in Cumbria House, Carlisle.
(2) the next meeting of the Board would take place on Friday 13 September 2019 at 10.00 am in County Offices, Kendal.
The Board were informed that this was the last meeting the Executive Director – People would attend as he was leaving the Authority. The Chair, on behalf of the Board, wished him well for the future and expressed his thanks and appreciation for the work which he had undertaken during his time with the County Council, highlighting the successful relationships which John had formed with partners.
The Cabinet Member for Children’s Services reiterated the comments of the Chair.