Agenda and draft minutes

Cumbria Health and Wellbeing Board
Monday, 2nd July, 2018 10.00 am

Venue: Committee Room 1 - County Offices, Kendal, LA9 4RQ. View directions

Contact: Lynn Harker  Email: lynn.harker@cumbria.gov.uk

Items
No. Item

1.

Election of Vice-Chair

In accordance with the Board’s Terms of Reference to appoint a Vice?Chair who shall be a Clinical Commissioning Group Chair for the ensuing year.

 

Minutes:

It was noted that in accordance with the Board’s Terms of Reference a Vice?Chair would be appointed for the ensuing year who would be a Clinical Commissioning Group Chair.

 

RESOLVED,     that Mr J Rush, Chair of North Cumbria Clinical Commissioning Group, be elected Vice-Chair of the Board for the ensuing year.

 

2.

Apologies for Absence

To receive any apologies for absence.

 

Minutes:

Apologies for absence were received from Mr A Bennett (Anthony Gardner attended in his place), Mrs A Burns, Mr L Conway, Mr S Eames, Ms D Earl, Miss K Fairclough (Dr D Roberts attended in her place), Dr A Gaw, Mr J Macilwraith, Dr D Rogers, Mr P Thornton and Ms G Tiller.

 

3.

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.

 

Note

 

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).  

 

Minutes:

There were no disclosures of interest on this occasion.

 

4.

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.

 

Minutes:

RESOLVED,     that the press and public be not excluded from the meeting for any items of business.

 

5.

Minutes pdf icon PDF 114 KB

To confirm as a correct record the minutes of the meeting held on 10 April 2018 (copy enclosed). 

 

Minutes:

RESOLVED,     that the minutes of the meeting of the Board held on 10 April 2018 be agreed as circulated and thereupon signed by the Chair.

 

6.

Cumbria Local System Review pdf icon PDF 89 KB

To consider a report by the Chief Executive (Cumbria County Council) (copy enclosed (Appendix 2 to follow)).

 

Additional documents:

Minutes:

The Board received 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 the action plan that addressed the issues raised in the report.

 

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.  It was explained that 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.

 

The Board noted that following the site visit in Cumbria a report was published which highlighted areas of good practice, in particular:

 

·               a clear shared and agreed purpose, vision and strategy for health and social care as a result of having a single Health and Wellbeing Strategy;

 

·               a clear and robust local place based approach of Integrated Care Communities, (ICCs) and this was a key element in delivering the Health and Wellbeing Board’s vision;

 

·               Cumbria’s plans were in their early stages, but this was consistent with the national picture;

 

·               Delayed Transfers of Care (DTOC) remained a priority area for improvement.  Despite the fact that there had been a 22% reduction of DTOCs by January 2018 it was recognised that more work was needed to drive out further improvements in this area;

 

·               acknowledgement that in many other areas Cumbria’s Performance was actually above the national average.

 

The Committee noted that as well as recognising areas of good practice the report suggested the following ten areas of focus for the system to secure improvement:

 

·               system leaders within Cumbria must work together to develop implementation plans for delivery of their countywide strategy.  The implementation plans should include agreed joint outcomes and financial protocols, relevant ICT support, a communications strategy and a co-production approach to ensure that feedback from local people results in changes to delivery intentions.

 

·               system leaders should develop a coherent health and social care workforce strategy for Cumbria to work in synergy with financial, housing and transport strategies.

 

·               System partners should develop risk sharing and governance mechanisms to measure whether they are using resources in the best way possible to achieve intended outcomes for people in Cumbria.

 

·               System leaders within Cumbria should develop robust governance arrangements for implementation within the ICCs, which include a monitoring and review structure, defined roles, responsibilities and accountabilities.

 

·               System leaders should develop system-wide commissioning arrangements, including market shaping.

 

·               System leaders should work with people who use services, carers, VCSE organisations and independent care providers to co-design services.

 

·               System partners should extend GP hours so GPs are more accessible for local people.

 

·               The system should review reablement provision and services across Cumbria.

 

·               The system should review continuing healthcare assessment processes to ensure assessments are timely and there is equality across Cumbria.

 

·               Cumberland Infirmary should ensure that staff communicate relevant and reliable  ...  view the full minutes text for item 6.

7.

North Cumbria Health and Care System Update pdf icon PDF 103 KB

To consider a report by the Chief Operating Officer, North Cumbria Clinical Commissioning Group (copy enclosed).

 

Minutes:

Members received a report from the Chief Operating Officer, North Cumbria Clinical Commissioning Group which provided a brief overview of recent developments across North Cumbria.

 

The Board noted that North Cumbria had been confirmed by NHS England and NHS Improvement as part of the next wave of Integrated Care Systems (ICS) which put the area at the forefront of national policy.  It was explained that as part of the development of the ICS a new system leadership process was being established to make shared decisions across the system with the establishment of a collective System Leadership Board.

 

It was explained that officers from Cumbria County Council also attended the Board with the ambition to hold this meeting in public from the Autumn as new processes became established.  Members welcomed the establishment of a Stakeholder Forum to ensure the view of the community and third sector groups could be heard and influence decisions as part of continued commitment to co-production.  Concerns were raised by Healthwatch Cumbria regarding the lack of acknowledgement of communications sent regarding the System Leadership Board and it was agreed that representatives from NCUHT would investigate this matter and report back direct.

 

Members were updated on the progress on healthcare for the future highlighting the significant increase in the range of clinical services currently available at West Cumberland Hospital.  The Board agreed that continued positive communication with the public regarding the assets at West Cumberland Hospital was essential.

 

The Board noted that work continued with community alliances with regards to the transition to community-based services at Alston, Maryport and Wigton including robust staff consultation processes.  It was anticipated that by 1 October 2018 beds in the community hospitals would be closed.

 

Members discussed mental health commissioning and noted that commissioners of those services (including child and adolescent mental health and learning disability services across Cumbria) had confirmed that services needed to be delivered into the integrated health and care systems covering north and south Cumbria from April 2019.

 

A discussion took place regarding the recent national consultation regarding the availability of gluten-free foods on NHS and to limit the range of products available on prescription.  Members were informed that broadly this had received support, partly due to the significant change in availability of gluten?free products in supermarkets.  It was explained that NHS North Cumbria CCG would change its arrangements for the supply of products with effect from 1 July 2018.

 

A discussion took place regarding the continuation of major challenges in delivering the elective referral to treatment 18 week standard and some of the cancer waiting times standards.  Members were informed there were a range of standards regarding cancer waiting times but acknowledged that a closer relationship was needed with out-of-county tertiary centres with a view to improving timescales. 

 

RESOLVED,     that the report be noted.

 

8.

Bay Health and Care Partners Integrated Care Partnership - Progress Update pdf icon PDF 233 KB

To consider a report by the Chief Officer, Morecambe Bay Clinical Commissioning Group (copy enclosed).

Minutes:

Members received a report from the Chief Officer, Morecambe Bay Clinical Commissioning Group which outlined some of the key areas of progress associated with Bay Health & Care Partners (BH&CPs) joint working over the last year, highlighting:

 

·               Summary of the key outcomes and achievements at the end of the national Vanguard new care models investment programme, which was being carried forward into the “business as usual” system change work.

 

·               Early work which had been undertaken as a care partnership in developing a population health management approach targeted at impacting on the population health and wellbeing status.

 

·               Development of the ICP leadership team and supporting governance arrangements to support the shared decision making.

 

·               Development of the five year system BH&CP Delivery Plan to ensure there was collective clarity on what all system partners would be seeking to achieve in 2018/19 and beyond and this would be undertaken.

 

Members drew attention to the proposed five year plan and suggested that, in view of the proposed national ten year plan, a local plan for ten years should be considered.

 

RESOLVED,     that the report be noted.

 

9.

Public Health Annual Report 2017 pdf icon PDF 5 MB

To consider a report by the Director of Public Health (copy enclosed).

 

Minutes:

The Board welcomed the Public Health Annual Report 2017.

 

Members noted that Public Health could be seen as having three main strands: health improvement, health protection, and healthcare public health and the focus for the plan was on how public health related to healthcare.

 

The Board noted that for all practical purposes Cumbria was separating into two systems, with services in the north of the county looking towards the North East for their networks of specialist provision, whilst services in the south were aligning much more closely to Lancashire.  It was explained, however, that both were working towards ever greater integration with social care, a greater focus on community based services, and an emphasis on improving the health of their populations as a whole, not just on providing treatment services.

 

The report, therefore, aimed to highlight both the public health role in supporting the health and social care system, and the role that system could play in promoting wider public health.  The first part of the report described the emerging Integrated Care Partnerships covering Morecambe Bay and north Cumbria, and highlighted some of the work they had undertaken to promote public health.  The second part focussed on the public health role of health services across the life-course.  It was highlighted that the life-course was an important framework through which to design and deliver health and care services, enabling targeted work that could promote wellbeing and also support the most vulnerable, across each of four life-course stages: starting well, living well, ageing well and dying well.

 

The Board noted that the health care services had a critical part to play in public health.  In Cumbria, health services had taken that on board and were working positively towards a new population health approach.

 

During the course of discussion a query was raised regarding the lack of a specific recommendation with regards to Child and Adolescent Mental Health.  It was explained that this formed part of the Child and Adolescent Mental Health Partnership.

 

RESOLVED,     that the report be noted.

 

10.

2017-18 Better Care Fund Year End pdf icon PDF 777 KB

To consider a report by the Executive Director – People (Deputy Chief Executive) (Cumbria County Council), Chief Operating Officer, North Cumbria Clinical Commissioning Group and Chief Officer, Morecambe Bay Clinical Commissioning Group (copy enclosed).

 

Additional documents:

Minutes:

The Board considered a report from the Executive Director – People (Cumbria County Council), Chief Executive, NHS North Cumbria Clinical Commissioning Group and Chief Officer, NHS Morecambe Bay Clinical Commissioning Group which provided an update on Cumbria’s 2017-19 Better Care Fund (BCF) and asked the Board to note the submission of the 2017/18 Quarter 4 (Q4) performance return (referred to at Appendix 1 of the report); and also financial and activity reporting.

 

In addition, members were also asked to note the iBCF Q4 return (referred to at Appendix 2 of the report) that was submitted at the same time as the BCF return and note the latest financial position.

 

Members were informed the rate of permanent admissions of older people to residential and nursing care homes had decreased from 172.3 per 100,000 to 129.7 in quarter 3 during 2017/18.  It was noted that the actual number of admissions in quarter 4 was 152 (78 in north Cumbria, 67 in south Cumbria and seven out of county).  It was highlighted that scrutiny on long-term residential requests continued to be a high priority and there was continued care and support to enable people to live independently in their own homes. 

 

The Board’s attention was drawn to the Delayed Transfers of Care (DTOC) and whilst there had been an increase during January-March it was explained that the latest information showed a substantial reduction overall with the latest data being maintained. 

 

RESOLVED,     that the contents of the report and, in particular, the BCF Q4 Return (referred to at Appendix 1 of the report) the iBCF Q4 Return (referred to at Appendix 2 of the report) and the iBCF financial outturn report (referred to at Appendix 3 of the report) be noted.

 

11.

2018-19 Better Care Fund/iBCF pdf icon PDF 287 KB

To consider a report by the Executive Director – People (Deputy Chief Executive) (Cumbria County Council), Chief Operating Officer, North Cumbria Clinical Commissioning Group and Chief Officer, Morecambe Bay Clinical Commissioning Group (copy enclosed).

 

Additional documents:

Minutes:

The Board received a report from the Executive Director – People (Cumbria County Council), Chief Executive, NHS North Cumbria Clinical Commissioning Group and Chief Officer, NHS Morecambe Bay Clinical Commissioning Group which provided an update on Cumbria’s 2018-19 Better Care Fund (BCF) and improved Better Care Fund (iBCF).  Members were asked to note issues arising and, in particular, the allocation of the 2017/18 iBCF underspends (referred to at Appendix 1 of the report).

 

Members noted that unlike previous years the BCF plan lasted for two years, and unless the Board chose otherwise then the budgets agreed would be used for 2018/19 year.

 

The Board discussed the proposed changes to DTOC targets noting that NHS England had recently consulted on a proposed change to the methodology that was used to calculate targets for delayed transfers of care.  The national preferred option was to refresh ambitions using a single national methodology.  It was explained that the preferred option brought a more consistent approach to setting the ambitions by using the same approach for both NHS and Adult Social Care (ASC) rather than using two separate processes.

 

Members noted it was felt adopting this approach would see a significant number of ambitions change.  However, it was envisaged that proportionally more areas would see their ambitions become easier or remain the same using the methodology, as opposed to becoming more difficult.  It was highlighted that 26 areas that could see their expectation becoming harder had already met this expectation based on current performance. 

 

The Board discussed the 2019/20 BCF/iBCF and members highlighted the importance of early discussions regarding agreement of this.  It was agreed that this would be discussed at the meeting of the Board in October.

 

RESOLVED,     that

 

                            (1)       the contents of the report and, in particular, the allocation of the 2017/18 iBCF underspends and the revised 2018/19 spending (referred to in Appendix 1 of the report) be noted;

 

                            (2)       if timings do not allow the Better Care Fund quarterly report to be approved by a Health and Wellbeing Board meeting, then the Chief Executive can approve it in consultation with the Chair and Vice?Chair of the Board under her delegated powers (detailed in paragraphs 8.4 to 8.6 of the report) be agreed.

 

12.

Cumbria Health and Wellbeing Strategy 2016-19, Delivery Plan Performance pdf icon PDF 85 KB

To consider a report by the Director of Public Health, Cumbria County Council (copy enclosed).

 

Additional documents:

Minutes:

The Board considered a report from the Director of Public Health (Cumbria County Council) which provided a progress update on the performance measures of the 2016-2019 Joint Health & Wellbeing Strategy Annual Delivery Plan using the latest and relevant available performance information for Quarter 4 2017/18 (referred to at Appendix 1 of the report).

 

Members were informed of breastfeeding initiation statistics highlighting that through relationships with colleagues in the CPFT the data was improving.

 

The Board’s attention was drawn to ongoing work being undertaken relating to concerns regarding alcohol misuse, highlighting the anti-social behaviour and related crimes associated with this. 

 

Members discussed the increase in hospital admissions relating to self?harm in young people and the challenges this brought to the Children and Adolescent Mental Health service.

 

The Board discussed the emergency hospital admissions for injuries due to falls in older people.  Members noted that the chiropody and podiatry were a crucial service to help prevent falls.  It was agreed that further information on those services would be made at a future meeting of the Board.

 

Members discussed the performance scorecard and, taking into account how public health had been challenged over the last few years queried the lack of green RAG ratings.  It was explained that the ability to invest had been more challenging highlighting that Public Health could not be a lone system to deal efficiently and effectively with all the issues.  It was explained that the Authority continued to make representations regarding with low base level for Public Health.

 

RESOLVED,     that the report be noted.

 

13.

Cumbria Public Health Alliance Update pdf icon PDF 76 KB

To receive a report from the Director of Public Health (copy enclosed).

 

Minutes:

Members received a report from the Director of Public Health (Cumbria County Council) which provided an update on the development of the Public Health Alliance, 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 Board drew attention to the concerns of Alliance members regarding the lack of clear coverage for the south of the county and that consultation with district councils appeared lacking.  The Director of Public Health agreed to investigate this matter and report back to representatives of the Morecambe Bay Clinical Commissioning Group direct.

 

RESOLVED,     that the report be noted.

 

14.

Future Meeting Dates pdf icon PDF 34 KB

To note the list of future meeting and development dates (copy enclosed).

 

Minutes:

The Board noted that:-

 

(1)       the next meeting of the Board would take place on Tuesday 2 October 2018 at 10.00 am at Cumbria House, Carlisle.

 

(2)       the next Cumbria Health and Wellbeing Board Development day would take place on Thursday 25 October 2018 at 2.00 pm at Cumbria House, Carlisle.