Venue: Conference Room A/B, Cumbria House, Carlisle, CA1 1RD
Contact: Lynn Harker Email: firstname.lastname@example.org
The Chair welcomed Ian Johnson, Chair of University Hospital Morecambe Bay NHS Foundation Trust and Aaron Cummins, Chief Executive of University Hospital Morecambe Bay NHS Foundation Trust to their first meeting of the Board.
Apologies for Absence
To receive any apologies for absence.
Apologies for absence were received from Mr A Bennett, Mr C Cox, Ms E Dixon, Mr S Eames, Ms B Reilly, Mr P Rooney and Ms B Smith.
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).
Ms H Horne declared a pecuniary interest in agenda item 10 – Care Quality Commission System Review (minute 60 refers) as she was a member of Healthwatch England Committee which was a Sub?Committee of the Care Quality Commission.
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 20 February 2018 (copy enclosed).
RESOLVED, that the minutes of the meeting of the Board held on 20 February 2018 be agreed as circulated and thereupon signed by the Chair.
To consider a report by the Independent Chair, Cumbria Local Safeguarding Children Board (copy enclosed).
Members received a report from the Ms G Rigg, Independent Chair, Cumbria Local Safeguarding Children Board (LSCB) which presented their Annual Report for 2016/17.
The report provided a retrospective look at the work undertaken by the LSCB from 2016 to 2017. It described the work of the Board over the past year, the structure and work of the sub?groups and identified the local context for children and young people growing up in Cumbria, outlining the state of safeguarding in Cumbria.
Members discussed the next steps and noted that following the successful delivery of the LSCB 2016-19 Business Plan it had been agreed it now needed to show a more aspirational set of priorities and must be more “fleet of foot” going forward to ensure it was well-placed for the changes set out in the Children & Social Work Act.
The Board noted that the Children and Social Work Act 2017 (the Act) replaced Local Safeguarding Children Boards (LSCBs) with new local safeguarding arrangements, led by three safeguarding partners (local authorities, chief officers of police, and clinical commissioning groups). It was explained that LSCBs must continue to carry out all of their statutory functions until the point at which safeguarding partner arrangements began to operate in a local area.
Members welcomed the report highlighting the success of the Board and raised their concerns regarding the new arrangements with regards to the new Children and Social Work Act 2017.
A discussion took place regarding the agreed priorities for 2017-20:-
Ø Resilient Children and Young People
Ø Excellent Systems of Prevention and Protection
Ø Well-devolved and Supported Workforce.
Members felt that the priorities were broad but were assured that the three cross?cutting themes would encapsulate all areas, explaining that sub?groups would still exist within each priority to look at specific issues.
A discussion took place regarding domestic abuse and members were informed that Safer Cumbria would be responsible for this element and adults and children would be combined.
The Chair, on behalf of the Board, asked that their thanks and appreciation be conveyed to the LSCB members and officers for the significant amount of work which had been undertaken.
RESOLVED, that the report be noted.
To receive a presentation from the Corporate Director – Children and Families Services.
The Board received a presentation from the Assistant Director – Learning and Inclusion on the Special Educational Needs and Disabilities (SEND) Review.
Members were given an update on the local area SEND inspection preparation update which included the partnership, journey and self?evaluation headlines.
It was noted that inspections of local area SEND partnerships had begun in Autumn 2016 and looked at three broad areas:-
Ø Identification of SEND
Ø Assessment and meeting need
Ø Outcomes for children
The Board were informed that as the result of a Peer Review of the local area SEND in March 2017 an action plan had been overseen by the Children with Disabilities Sub?Group of the Children’s Trust Board. It was explained that concurrently a local authority SEND preparation group was created with the purpose of establishing an accurate self-view and developing an ongoing action plan.
Members noted that work was being undertaken on self evaluation with a refresh of the Self Evaluation Form (SEF), with a view to establishing a balanced and accurate self-view, drawing from the partnership. The wide?ranging self-evaluation from the process had been synthesized into broad headlines:
Ø Assess and Meet Need
Ø Improve Outcomes
In conclusion it was explained that the next steps included an action plan, implementation and continuous review.
The Board welcomed the presentation highlighting how this involved the most vulnerable children in the community and it was suggested that this be brought to the attention of all colleagues and partners.
A discussion took place regarding the impact of changes in funding and it was explained that funding had not been reduced but demand for the service was increasing. It was noted there had been a re?design of services in order to meet the increased demand within the resources available.
The Board discussed the possibility of an inspection and it was noted that an inspection of local area and not local authority arrangements was possible at one week’s notice.
Members discussed the transition from children to adult services and were informed there was now a multi-agency Transition Steering Group involved in this process. It was highlighted that protocol issues regarding sharing information was challenging and it was felt this whole issue needed to be investigated in the future.
RESOLVED, that the update be noted.
To consider a report by the Director of Public Health (copy enclosed).
The Board received a report from the Director of Public Health which outlined the process of the Joint Strategic Needs Assessment (JSNA).
Members were informed that the purpose of the JSNA and the Joint Health and Wellbeing Strategy (JHWS) was to improve the health and wellbeing outcomes of the local community and reduce inequalities for all ages.
It was noted that following a three year programme the process had been reconsidered to support the development of the JSNA to ensure it was fit for purpose.
The Board were informed that a workshop had been held to establish with JSNA users its current use and what was required in the future. It was explained that the development of a proposal for the JSNA contained three elements:-
Ø The first element of the proposed process would be to expand the range of data that was currently available via the Intelligence Observatory website, utilising nationally published datasets. This element would be supplemented with local datasets, generally in a tabular form, for extraction within each theme area. The intention would be that relevant data relating to the needs around particular issues or groups in Cumbria was available in an accessible format wherever possible.
Ø The second element would be to provide links to all data already aggregated and available for consideration with benchmarking in national or local tools, including links to briefings/summaries produced for other arenas. It was explained this would ensure the JSNA was not encouraging duplication and was utilising the wealth of tools readily available, particularly from Public Health England. Those two elements would provide a comprehensive range of information for self-serve usage.
Ø The final proposed component was for the Board to be able to commission additional deep dive needs analyses to meet their requirements. This would provide flexibility and allow the analysis to be appropriate to the Board’s requirements on a particular issue or need, therefore, enabling the development of information into intelligence, building on the data and tools readily available. It would also provide an opportunity for relevant stakeholders to be involved in developing an appropriate deep dive analysis within a defined scope. It was expected that no more than two deep dive analyses would be completed in any 12 month period.
It was explained to members that it was felt the proposal maintained a continuous process approach to the JSNA whilst ensuring the process was sustainable and efficient across partners.
The Board acknowledged that the JSNA would inform the Joint Health and Wellbeing Strategy whilst highlighting that in terms of reports to the Board they should be more robust than at present and link in more closely with Integrated Care Partnerships.
A concern was raised regarding the sole use of technology for the JSNA and the effects this could have on individuals with no access to such systems. Whilst the concerns were acknowledged it was explained that a common set of data was required which was accessible to everyone concerned as it was anticipated the information would ... view the full minutes text for item 57.
To consider a report by the Director of Public Health (copy enclosed).
The Board received a report from the Director of Public Health which outlined a proposed approach for the refresh of the Joint Health and Wellbeing Strategy 2019?22.
Members noted that local authorities and clinical commissioning groups (CCGs) had equal and joint duties to prepare the Joint Health and Wellbeing Strategy (JHWS) through the Health and Wellbeing Board and the current Strategy expired at the end of March 2019.
The Board were informed that the scope of the Joint Health and Wellbeing Strategy should build on and not duplicate existing programmes, recognising each body’s contribution and identifying good practice. It was explained that it should address the wider determinants of health, how individuals and communities could be mobilised to change behaviours; how individuals and communities could co-produce the design and operationalisation of new models of care; and how the health and care system, by being better integrated, could shift resources to tackle the necessary upstream activity.
The Board discussed the reference to ‘population as a whole’ stakeholder and the mechanisms of engagement. It was explained that a 12 weeks consultation would be undertaken and engagement would be sought with a number of organisations including Healthwatch, service providers and 3rd sector organisations.
During the course of discussion members emphasised the need to include children and young people, highlighting a number of avenues such as the Youth Parliament which could be pursued.
Members drew attention to the split of the Cumbria Clinical Commissioning Groups in Cumbria and the potential challenges.
The Board highlighted the lack of reference to population place based care and it was agreed to investigate this further.
The Board acknowledged that due to the tight timescales it was important to begin the process. Members agreed that all organisations had a role to play and it was incumbent to ensure everyone was aware of their role and responsibility.
RESOLVED, that the process for producing the Joint Health and Wellbeing Strategy continue to be co-ordinated by the County Council’s Director of Public Health and the Chief Operating Officers’ of the North Cumbria and Morecambe Bay Clinical Commissioning Groups.
To consider a report by the Director of Public Health (copy to follow).
Members received a positive report by the Director of Public Health which gave an update from the Cumbria Healthy Weight Summit which was held on 23 March 2018 together with a summary of the pledges from the day which would form the action plan going forwards.
The Board welcomed the Local Government Healthy Weight Declaration which had been signed up to by Cumbria County Council and the six district councils with the anticipation of imminent signing by Cumbria Association of Local Councils. Members noted the focus would include:-
Ø Children [0-5]
Ø Children and Families [0-19]
Ø Health Inequalities
Ø Creating Healthier Environments
Ø Adult Healthy Weight
Ø Workplace and Better Health at Work
Members were informed that the next steps would be to formulate and agree an action plan around a Whole Systems Obesity/Six Phased Continuous Journey:-
Phase 1 - Set up
Phase 2 - Building the Local Picture
Phase 3 - Mapping the Local Reality
Phase 4 - Action
Phase 5 - Creating a Local Dynamic System
Phase 6 - Reflection
It was noted that the governance and structures for the above would be developed and agreed by a countywide Steering Group and delivered in localities. It was agreed that feedback would be made to the Board via the regular Cumbria Public Health Alliance updates.
A discussion took place regarding reception years and the aspirational targets to reduce prevalence of overweight and obesity in reception years from 28.2% (2016/17) to 23% (current national average) by 2020/21. Members acknowledged this was challenging and were informed that collaborative work was being undertaken with the Health and Wellbeing Forums and ICC reference groups to achieve the targets.
RESOLVED, that the report and suggested key themes identified for future locality activity be noted.
To consider a report by the Chief Executive, Cumbria County Council (copy enclosed).
The Board considered a report from the Chief Executive, Cumbria County Council which gave an update on the Care Quality Commission (CQC) system review process and asked members to agree delegations to the Chief Executive to enable the action plan to be submitted within CQC timescales.
Members were informed that the CQC had carried out a review of the Cumbria Health and Care System following a request from the Secretaries of State for Health and Communities and Local Government to undertake a programme of 20 targeted reviews of local authority areas. The purpose of the review was to understand how people moved through the health and social care system with a focus on the interfaces between services.
Members noted that following a site visit in February it was expected that the CQC would publish a report setting out the findings of their review including recommendations the week beginning 21 May. It was explained the Board would have 20 working days to submit an action plan for approval to the Department of Health and Social Care.
(1) the report be noted;
(2) submission of the Health and Wellbeing Board Action Plan on the outcomes of the system review be delegated to the Chief Executive of the County Council in consultation with the Chair and Vice?Chair of the Health and Wellbeing Board.
To consider a report by the Monitoring Officer, Cumbria County Council (copy to follow).
The Board considered a report from the Monitoring Officer (Cumbria County Council) regarding a proposal to make provision for named substitutes for members of the Health and Wellbeing Board.
Members noted that the Monitoring Officer was asked in 2017 by the Constitution Review Group (Chaired by the Leader of the Council) to look at whether the Terms of Reference of the Health and Wellbeing Board could permit members of the Board to appoint a named substitute.
It was noted that it was proposed to include the following in the Terms of Reference of the Health and Wellbeing Board in the Council’s Constitution as follows:-
5.1 Except as provided in 5.2, 5.3 and 5.4 each member of the Health and Wellbeing Board may appoint one named substitute and must notify the County Council of the appointment.
5.2 The Leader of the Council may nominate named elected member substitutes equal in number to the number of County Council members appointed to the Board. County Council members are nominated by the Leader of the Council and appointed by the County Council.
5.3 The District Councils may between them appoint one named substitute.
5.4 Where members of the Board are officers of an organisation rather than elected members, they are permitted to nominate up to two named substitutes but only one can attend at any time.
5.5 Substitute members must comply with all the requirements of the Council’s Code of Conduct, including the registration of personal interests.
5.6 A member of the Health and Wellbeing Board who is unable to attend a meeting of the Board (or one of its committees) must notify the Council in writing (which includes by email) before the start of the meeting, giving the name of the substitute member who will attend in his/her place.
5.7 A substitute member has the same voting rights and responsibilities at meetings of the Board as the member they are substituting for, provided the Board Member is not in attendance.
5.8 A substitute member will be counted for the purpose of deciding whether a quorum is present unless he/she is also attending the meeting as a Board member.”
Members welcomed the proposal for a full review of the Terms of Reference of the Board to take place during 2018/19. The district councils’ representative suggested that representation from two district councils on the Board be considered as part of the review.
(1) it be RECOMMENDED to Council on 19 April 2018 that the Terms of Reference of the Health and Wellbeing Board (detailed above) include provision for named substitute members and amendments to the list of members;
(2) the proposal for a full review of the Terms of Reference of the Health and Wellbeing Board in 2018/19 be noted and agreed.
To receive a report from the Director of Public Health (copy enclosed).
Members received a report from the Director of Public Health which provided an update on the development of the Public Health Alliance.
The Senior Manager – Public Health and Communities gave an explanation to the Board with regards to the ‘obesity’ and ‘overweight’ figures which had been discussed at minute 59 – Cumbria Healthy Weight Summit Update. It was agreed that members would be provided with separate figures to give them a better understanding of the separate elements of the statistic.
The representative of the six District Councils drew the Board’s attention to the Smoking Cessation Contract which was due to expire in September 2018 and it was agreed that an update would be provided direct.
RESOLVED, that the report be noted.
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 Monday 4 June 2018 at 2.00 pm at Cumbria House, Carlisle.
(2) the next meeting of the Board would take place on Monday 2 July 2018 at 10.00 am at County Offices, Kendal.