Venue: Committee Room 1 - County Offices, Kendal, LA9 4RQ. View directions
Contact: Lynn Harker Email: email@example.com
Apologies for Absence
To receive any apologies for absence.
Apologies for absence were received from Mr L Conway, Mr S Eames (substitute Ms R Duguid), Ms B Reilly, Mr J Rush (substitute Dr C Patterson), Mr R Talbot and Ms G Tiller (substitute Professor J Howarth).
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 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 2 October 2018 (copy enclosed).
RESOLVED, that the minutes of the meeting of the Board held on 2 October 2018 be agreed as circulated and thereupon signed by the Chair.
To note the revised Terms of Reference of the Board (enclosed).
The Board received a report from the Executive Director – Corporate, Customer and Community Services which advised members of the revised Terms of Reference for the Board. The Chair informed members that they could be reviewed again in the future if necessary.
It was noted that under paragraph (e) – Accountability – the fourth bullet point should read ‘Clinical Commissioning Groups (CCGs)’.
RESOLVED, that the revised Terms of Reference be noted.
To consider a joint report by the Executive Director – People (Cumbria County Council) (copy enclosed).
(Anne Sheppard, Strategic Manager Emotional Wellbeing and Mental Health Cumbria County Council, Greg Everatt, Senior Commissioning Manager, North Cumbria CCG, Julia Westaway, Morecambe Bay Clinical Commissioning Group and Karen Worton, Cumbria Partnership NHS Foundation Trust).
The Board received a report from the Executive Director – People which gave an update on activity and developments since the start of 2018 under the multi-agency transformation programme led by the Children and Young Peoples Emotional Wellbeing & Mental Health Transformation Partnership Board, (CYP EWMHP Board) which was chaired by Colin Cox, Director of Public Health.
It was explained that in order to obtain assurance from NHS England who oversee the additional investment available to improve mental health support services to children, young people and their parents/carers, each area was required to annually refresh the Local Transformation Plan (LTP) setting out what had been achieved and the plan for the following 12 months period.
The Board noted that 2018-2019 was the last year for a Cumbria LTP as a review of partnership, delivery and governance arrangements had commenced so as to align this programme with the new, larger relevant Integrated Care Partnership (ICP) footprints North and South. It was explained that across Cumbria the aspirations continued to be consistent and were focused on the delivery of the National Five Year Forward View, with the outcome being improved care for Cumbria’s children and young people.
During the course of discussion the continuing challenges to improve services was emphasised to the Board. It was summarised as an increasing demand for Specialist CAMHS alongside the difficulty in recruiting and retaining staff with the appropriate clinical training and experience. Members noted that over the last year referrals to Specialist CAMHS had increased by 30%, on top of 13% increase the previous year. It was explained that a recent research report published by the Education Policy Institute reported a 39% increase in demand in the northern region over the last five years which suggested that although a national issue, Cumbria appeared to be an outlier.
Members noted that an extended crisis service had been established in North Cumbria with a crisis support model also agreed in South Cumbria which was currently being recruited to. It was explained current difficulties experienced included the necessity to improve a follow?up service following a crisis referral. The Board’s attention was also drawn to the necessity for a step down package to support young people returning home.
The Board were informed that work was being undertaken in Lancashire and South Cumbria to redesign funded services for emotional and wellbeing. It was explained that fundamentally all NHS funded services were being investigated to explore how the money could be used more effectively, highlighting that significant progress had been made this year.
Members noted that over the coming year there would be more focus on the support needs of the most vulnerable children and young people and how better support could be provided for parents, including early intervention with a view to ... view the full minutes text for item 32.
To consider a report by the Executive Director - People (copy enclosed).
The Board considered a report by the Executive Director – People which presented the Local Safeguarding Children Board (LSCB) Annual Report for 2017/18.
Members noted that the Annual Report provided a retrospective look at the work undertaken by the LSCB from 2017 to 2018. It described their work 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.
The report provided a detailed description of the significant work which had been undertaken in Cumbria during 2017?18 and provided an open and transparent assessment of the state of safeguarding for children and young people in Cumbria.
The Board noted that the LSCB had further matured and was able to evidence significant improvement across safeguarding in Cumbria highlighting key achievements.
A discussion took place regarding the LSCB performance and the demands on the system. It was explained that although demands on the child protection system continued to be a concern the service had experienced a reduction in the figures over the last few months. A number of successes were highlighted, which included no young people being admitted into police custody, 100% quality practice measures and the timescale for children looked after reviews taking place.
Members were informed that 2018?19 was a transitional year for the LSCB as it moved towards the new national safeguarding arrangements. It was explained that due to the changes in Working Together 2018 which was published alongside Transitional Guidance the LSCB had agreed to a shorter timescale for the current planning period. It was noted that the LSCB’s priorities for 2018?21 were:-
Ø Resilient Children and Young People
Ø Excellent systems of Prevention and Protection
Ø Well-devolved and Supported Workforce
The Board noted that the LSCB would undertake an LGA Peer Review in early 2019 to test the resilience and effectiveness and to inform planning for the transitional arrangements prior to a new Cumbria Safeguarding Children Plan being developed and implemented in September 2019.
During the course of discussion it was highlighted that a system change was required to strengthen families, emphasising that the LSCB and partners were committed to carry out this role to keep children safe within their own families.
The role of the corporate parent was highlighted, together with the necessity to promote the services which were available to families, to help them keep their children within the family unit wherever possible.
In conclusion the need for a shift from reactive care to preventative care was highlighted and the Board welcomed the partnership working which was being undertaken to assist with this.
RESOLVED, the progress of the LSCB over the past 12 months and the current priorities are noted.
To consider a report by the Chief Executive (Cumbria County Council (copy enclosed).
The Board received a report from the Chief Executive, Cumbria County Council which updated members on the delivery of the Action Plan that arose out of the Care Quality Commission (CQC) system review process and asked that progress against the action plan that addresses the issues raised in the report (referred to in Appendix 1 of the report) be noted.
Members were informed that the majority of actions were on track or completed, however, there were a number of actions which were now red. It was noted that this was, in part, due to a more strict moderation process to ensure a consistent approach to reporting across the different workstreams. It was explained that where a deadline for an action had passed it had been decided that there were only three possible ways of this being recorded – blue (action complete), red (the action had not been completed to timescale) and a request to change the timescale.
The Board discussed the various workstreams and it was agreed that a deep dive take place at the next Cumbria Health and Wellbeing Development session with regards to Workstream 1 – ICT.
The Board noted that where an action was red the narrative should include any action that was being taken in mitigation and an estimate of when the action was due to be complete. It was explained that as a result of this a number of changes were being requested to timescale as detailed below.
A discussion took place on how to take forward the CQC action plan in the future and it was suggested that this be closed down with a final report. This suggestion was met with a positive response from the Board.
(1) Workstream 2 - Workforce (Action B12) – the timescale be changed to 2019 to reflect commissioning timetable;
(2) Workstream 4 – Commissioning (Action C2) – the timescale be changed to 2019 to reflect commissioning timetable;
(3) Workstream 5 – System Development (Action D1) – this be removed from the action plan as it is no longer an agreed activity;
(4) a deep dive on Workstream 1 - ICT take place at the next Cumbria Health and Wellbeing Development session;
(5) the CQC Action Plan be closed with a final report to the Board;
(6) the performance report on the CQC Local System Review Action Plan be noted.
To receive a joint report from Executive Director – People (Cumbria County Council) and Chief Operating Officers - North Cumbria and Morecambe Bay Clinical Commissioning Groups (copy enclosed).
Members considered a report by the Executive Director – People, Cumbria County Council, Chief Operating Officer, NHS North Cumbria CCG and Chief Officer, NHS Morecambe Bay CCG 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 2 (Q2) return and financial and activity reporting.
The Board were informed that although Delayed Transfer of Care (DToC) figures had previously made significant improvements there had, however, been a deterioration during September. It was explained that more recently figures had improved and were closer target due to the reactive work which had been undertaken, but the fragility of the service was highlighted. Members welcomed the implementation of shift based commissioning teams and the improvements they were making to the DToC figures.
Members discussed the £5.824m Disabled Facilities Grant (DFG) funding which had been passported to the six district councils. It was explained that local authorities were able to spend this on wider social care capital projects and local areas would be encouraged to use the funding innovatively by working with others across health and social care. It was noted that work was currently underway with district councils on how to utilise this more effectively on non?mandatory DFG schemes. The representative of the six District Councils asked that any issues being experienced in the areas be brought to his attention.
The Board drew attention to the funding available to the County Council under the Chronically Sick and Disabled Act and asked whether there was any co?ordination with the district councils as to how that funding was allocated. It was explained that the funding available through the Chronically Sick and Disabled Act was for minor adaptations to be carried out in a short space of time to avoid admissions.
A discussion took place regarding the pooling of both grants and it was agreed that this matter be discussed further at a future meeting of the Cumbria Leadership Board.
RESOLVED, the Board note the contents of the report.
To consider a report by the Chair – NHS North Cumbria Clinical Commissioning Group (copy enclosed).
The Board received a report from the Chair of NHS North Cumbria Clinical Commissioning Group which asked the Board to nominate a representative to the NHS North Cumbria Clinical Commissioning Group Primary Care Commissioning Committee.
Members noted that previously Councillor P Thornton had been nominated but following a recent change in the membership of the County Council’s Cabinet he was no longer a member of the Board and had been replaced by Councillor Patricia Bell.
RESOLVED, that Councillor Patricia Bell be nominated as the Board’s representative to the NHS North Cumbria Clinical Commissioning Group Primary Care Commissioning Committee.
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 11 January 2019 at 2.00 pm at Cumbria House, Carlisle.
(2) the next meeting of the Board would take place on Tuesday 5 February 2019 at 10.00 am at Cumbria House, Carlisle.