Agenda and minutes

Cumbria Health and Wellbeing Board
Tuesday, 5th February, 2019 10.00 am

Venue: Conference Room A/B, Cumbria House, Carlisle, CA1 1RD

Contact: Lynn Harker  Email:

No. Item


Apologies for Absence

To receive any apologies for absence.



Apologies for absence were received from Mr A Cummins (Ms F Ajayi attending in his place) Mr J Hawker (substitute Mr A Gardner), Ms H Horne, Mr I Johnson and Mr J Macilwraith (substitute Ms C Whalley).



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.



Minutes pdf icon PDF 89 KB

To confirm as a correct record the minutes of the meeting held on 29 November 2018 (copy enclosed). 



RESOLVED,     that the minutes of the meeting of the Board held on 29 November 2018 be agreed as circulated and thereupon signed by the Chair.



ICS Proposals in the North Cumbria System pdf icon PDF 756 KB

To receive a presentation by North Cumbria University Hospitals NHS Trust.



The Board received a presentation from Mr S Eames regarding the Integrated Care System (ICS).


Members were informed that within the current legal framework, the NHS and their partners would be moving to create ICSs everywhere by April 2021.  It was anticipated they would bring together local organisations in a pragmatic and practical way to deliver the triple integration of primary and specialist care, physical and mental health services and health with social care.  It was emphasised that they would have a key role in working with local authorities at place level and, through ICSs, commissioners would make shared decisions with providers on population health, service redesign and long term plan implementation. 


The Board was informed that the intention was to form a North East and North Cumbria ICS which would cover over 3.3 million people.  It was anticipated this would comprise of four Integrated Care Partnerships which was a similar model to Lancashire and South Cumbria. 


It was explained that the development of the Clinical Strategy was in the early stages and would include programmes of work in key areas such as population health.  Members noted that there would be synergies where required and would include specialist support and networks and workforce modelling.


Members discussed the information received and emphasised their concerns regarding the variations in deprivation throughout communities in the county, emphasising the need to keep communities together to ensure people received the services they required.  Whilst this was acknowledged the need for the health service to be fully integrated with local government and communities was highlighted as a necessity for improvement.  During the course of discussion attention was drawn to the ongoing partnership working as ICCs developed and the question of developing links with both county and district councils was raised.  Members felt that the inclusion of district councils and third sector organisations was crucial.


The Board welcomed the partnership working and suggested that, based on the individual footprints of each local committee, which were co-terminous with district councils, engagement with local members would be welcomed. 


Members discussed the autumn timescale for a single Strategy and the need for effective public engagement was emphasised.  The Board received confirmation that it was the intention of the Trust to have an engagement plan in place.


A discussion took place regarding the advantages of the proposals.  The new cancer centre, which provided care more locally, was highlighted as a benefit explaining that this would not have been possible without partnership working with Newcastle.  It was emphasised that benefits accrued from being part of a larger organisation.



ICS Proposals in the South Cumbria and Lancashire System

To receive a verbal update from Morecambe Bay Clinical Commissioning Group.



The Board received an update from Mr A Gardner, Director of Planning and Performance - Morecambe Bay Clinical Commissioning Group on the ICS Proposals in the South Cumbria and Lancashire System.  The content of the update received from North Cumbria was echoed.


Members were informed that South Cumbria was part of the Lancashire and South Cumbria Integrated Care System which would cover approximately 1.7 million people. 


It was explained that a range of issues, including a hyper acute stroke unit and back office functions including pathology and population health, were being developed.  It was noted that consistency of framework was required but the need for localism was acknowledged.  Members were informed of the 12 months process to commission services and noted that this would be local, neighbourhood and the wider area. 


Further to the previous concerns regarding population health it was highlighted that this was an integral part of the ICS Strategy acknowledging that prevention was key.  It was explained that the provision of high quality provision as early and quickly as possible was paramount to eliminate problems in the future.  It was felt that this sat alongside the Public Health Strategy and parallel with the North Strategy. 


Concerns were raised regarding the timeframe for joining eight Clinical Commission Groups together.  It was acknowledged this would be complex and lengthy but it was stressed that behind all the challenges the changes were important.


The Board were given a positive update on the co-operative and collaborative work which was taking place in the south.  The importance of ICCs working in localities and neighbourhoods was recognised and it was felt there was a need to develop relationships with local communities.



The Chair, on behalf of members, thanked officers for their presentations and welcomed the inclusion of the Board in the process.



Cumbria Joint Public Health Strategy pdf icon PDF 93 KB

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


Additional documents:


Members considered a report by the Director of Public Health (Cumbria County Council) regarding the Cumbria Joint Public Health Strategy which was being recommended to the Board by the Public Health Alliance.  The Strategy described wide-ranging aims to tackle the wider determinants of health and wellbeing, in line with the draft Health and Wellbeing Strategy 2019-2029.


The Board was informed that the factors which did impact on people’s health and wellbeing were many and varied, and the strategies that were used to improve health and wellbeing, therefore, also needed to be diverse and to address a number of different influences.  It was explained that recognising this, the Health and Wellbeing Strategy identified four key themes:


·                     Protecting the health of the population as a whole

·                     Improving health and wellbeing throughout the lifecourse

·                     Tackling the wider determinants of health and wellbeing

·                     Providing high quality, person-centred care.


Members noted that the Public Health Alliance recognised that it included a number of broad and ambitious goals, covering topics that were strongly influenced by national and global economic, political and social factors.  It was explained that as such it was not necessarily within the power of statutory agencies to achieve those goals.  The Strategy, therefore, represented a shared commitment to working together to make progress towards them, within the limits of the power and resources of local partners.  The Board suggested that in due course an investigation should be made as to how agencies worked with private sector organisations.


Members noted that the trusts were working closely with the County Council regarding population health and it was felt there may be an opportunity in the future for local ownership and opportunities.  It was highlighted that the Health and Wellbeing Fora did not have the same footprint as ICCs but it was felt there was a great opportunity for the Fora to have some focus on it.  


The district councils welcomed the strong Strategy which they felt had a solid foundation for the future.  A number of comments were relayed to members and it was noted that one discussion had been around under?employment and the need to maximise income for people who were not in employment for specific reasons.  The availability of good quality social housing was also highlighted.  Attention was also drawn to concerns regarding loneliness amongst young people and it was felt this needed to be addressed in future.  Members were informed that the districts had created a Cultural Panel whose key role was in social welfare and wellbeing.


The Interim Assistant Director – Integration and Partnership informed members that the Children and Young People’s Plan was currently being refreshed and the comments regarding loneliness would be included moving forward.


The Board were informed that it was intended that the Strategy would be formally adopted by, as a minimum, the County Council, the six District Councils and the Lake District National Park Authority.  It was noted that as such, the Board had a key role in recommending the Strategy for the consideration by  ...  view the full minutes text for item 44.


Cumbria County Council - Development of the Medium Term Financial Plan (MTFP) 2019 to 2022 pdf icon PDF 83 KB

To consider a report by the Director of Finance (s151 Officer) (Cumbria County Council) (copy enclosed).


Additional documents:


The Board received a report from the Director of Finance (Cumbria County Council) which provided an update on the development of the County Council’s Medium Term Financial Plan (MTFP) 2019-2022.


Members were informed that the Council was continuing to deal with significant financial challenges, by the end of 2018/19 the Council would have agreed budget savings of £249m since 2011/12.  It was explained that for the period of the next Medium Term Financial Plan (MTFP 2019/20-2021/22) the Council would need to deliver a further £49m of savings.  This meant that between 2011/12-2021/22 the Council would have made a total of £298m permanent savings from its day to day (revenue) budget.


The Board noted that Cabinet had agreed that on the basis of the balanced budget proposals, consultation with the public on the level of Council Tax for 2019/20 of 1.99% increase in general Council Tax and 2.00% increase for the Adult Social Care precept be approved.


Members were informed that without exception, all councils were facing difficult financial times, now and in the future, given reductions in funding, increasing demand and rising costs.  It was noted that as well as funding reductions from government, there was also an unprecedented level of demand on the Authority’s services, especially from those most in need.  It was explained that this included greater pressure for social care services from the growing elderly population and increased costs to look after the number of children now in the Council’s care.  It was highlighted that those ever increasing pressures meant that going forward, it was no longer just about efficiency, it was also about managing demand.


The Board noted that despite severe cuts from Government, the Council had continued to invest in a range of major capital projects that provided real benefits to residents and service delivery.  An example of this was the provision of two new care homes in Carlisle and Whitehaven.


Looking ahead, the focus would be offering early help to those in need, promote independence and independent living, and provide a better range of preventative services by working closely with partners and communities.


A discussion took place regarding the Service Redesign - Early Help and 0?19 Healthy Child Programme integration :  Members noted that the saving would be achieved through a redesign and integration of health visiting and early help services to achieve better outcomes for families as well as improved efficiency.  During the course of discussion representatives from North Cumbria NHS Trust suggested that they would be willing to become involved in the redesign and integration.  The Board welcomed the suggestion and any further feedback from members.


During the course of discussion the importance of early help for looked after children was emphasised and acknowledged by all Board members. 


The Board’s attention was also drawn to the existing programmes ‘Promoting Independence – Children’s’ and ‘Promoting Independence – Adults’ and the impact of the process.  It was agreed this would be investigated further at a future Development Day of the Board.


The Board  ...  view the full minutes text for item 45.


Better Care Fund/Improved Better Care Fund 2019-2020 pdf icon PDF 74 KB

To consider a joint report from the Executive Director – People (Cumbria County Council) and Chief Operating Officers – North Cumbria and Morecambe Bay Clinical Commissioning Groups (copy enclosed).


Additional documents:


The Board considered a report on the Better Care Fund (BCF)/Improved Better Care Fund 2019-20.  Members were informed that the BCF assurance process required Health and Wellbeing Boards to agree the final submission.  The report sought suitable delegations to be put in place, in case the BCF submission dates did not match Health and Wellbeing Board meeting dates.


The report provided an update on the 2019-20 BCF and improved Better Care Fund (iBCF) proposals and asked the Health and Wellbeing Board to indicate their approval of the proposed allocations.


The Board noted that guidance for the 2019/20 BCF had not yet been produced but it was anticipated this would be issued in the new few weeks as the NHS Long Term Plan had now been published.  It was explained that due to the lack of guidance the figures presented to the Board were based on 2018/19 figures and did not include an inflationary uplift.  Members noted that on receipt of the guidance there would be greater clarity over mandatory minimum contributions, which would enable the usage of uplifts to be included in the final submission.


The Board’s attention was brought to a number of adjustments to the BCF presented at the meeting and members noted this had been discussed with partners through the Joint Commissioning Board.  It was explained that the changes represented adjustments to reflect the pattern of spend over the past few years, rather than material changes to the services delivered.  It was highlighted that the changes to the spend on the Integrated Community Equipment Store reflected increased usage over the past few years, which was the result of the shift towards more community based care to allow people to live independently in their own homes for longer. 


Members were informed that the approval route required for the iBCF was different to the BCF and following discussion at the Board meeting today approval was required by the County Council and the two Clinical Commissioning Groups through their own internal governance process. 


The Board noted that the development of the schemes within the iBCF had been an iterative process with learning about the impact and implementation of proposals being used to inform future proposals.  It was explained that as a result there had been some variations to the iBCF to reflect ongoing discussions between partners about the best way to meet the key intentions of the iBCF.


Members welcomed the joint working which had been undertaken to develop the proposals and reach a good consensus.  Concerns were raised regarding the risks in changes in funding with respect to the hospital home care team in the south of the County and it was felt the impact could be significant.  It was agreed that this matter would be investigated further.


During the course of discussion it was highlighted that the reference to ‘Vice-Chair’ in recommendation 3.1 should read ‘Vice-Chairs’.


RESOLVED,     that


                            (1)       if timings do not allow the Better Care Fund submission to be approved by a meeting of the  ...  view the full minutes text for item 46.


Mental Health Developments pdf icon PDF 242 KB

To receive a presentation from Northumberland, Tyne and Wear NHS Foundation Trust.



The Board received a presentation from Mr S Eames on Mental Health Developments which informed members of the commissioning intentions in 2017:-


Ø   integration as a core part of the Integrated Health and Care System (IHCS) arrangements, facilitating integration physical and mental health services at neighbourhood Integrated Care Communities (ICC) and IHCS level, and promoting parity of esteem;


Ø   delivery by the same organisation providing Children and Adolescent Mental Health Services (CAMHS) and Learning Disabilities services due to the clinical interdependence;


Ø   delivery by a trust with sufficient clinical capacity, leadership and clinical governance to ensure a robust and sustainable service for the medium term.  The initial consideration is that this could not be delivered exclusively on a North Cumbria or Morecambe Bay basis; the service would need to be delivered by a Trust which could provide sufficient resilience across a wider footprint than the two local HCS systems (ie for small, specialist services; or to manage inpatient bed flows over a wider network) and could operate within a common care model in the wider STP footprints;


Ø   in south Cumbria there were obvious advantages to the service being provided by an existing partner in the Bay Health and Care Partnership, meaning Lancashire Care NHS Foundation Trust, given the need to work to a common care model across the STP footprint;


Ø   in north Cumbria the commissioning intention was for services to be delivered by a Trust with sufficient clinical, managerial and leadership capacity to provide a resilient service over the medium term, meaning services would need to be delivered by, or in a robust partnership with, a Trust serving a broader area.


Ø   The advantages to this approach included the delivery of specialist patient flows into Lancashire and the North East respectively, for example, including the developing arrangements for perinatal inpatient mental health and community outreach.


The Board noted the current position:-


Ø   Service model - ICC/specialist services;


Ø   Agreement to transfer North Cumbria Mental Health and Learning Disabilities services to Northumberland Tyne and Wear NHS Foundation Trust with effect from October 2019;


Ø   North Tyne and Wear were running an improvement programme for CAMHS Cumbria?wide to reduce waiting lists and improve recruitment;


Ø   the transfer of services to Lancashire Care Foundation Trust was still being investigated.


During the course of discussion concerns were raised regarding the lack of engagement with service users emphasising the need for better engagement with the community. 


The Board then raised their concerns regarding the lack of resources within CAMHS in the south of the county emphasising the number of young people who required the service.  Members were informed that this had been highlighted as an issue by the appropriate Governing Body and the need to ensure there were improvements in the service had been identified.  The Board emphasised that although the county fell within two systems the service delivered should be consistent.


The requirement for improvement in the service was acknowledged and it was explained that additional resources, such as nurses, had  ...  view the full minutes text for item 47.


Cumbria Local System Review pdf icon PDF 99 KB

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


Additional documents:


The Board considered a report by 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 the progress against the action plan that addressed the issues raised in the report (referred to in Appendix 1 of the report) be noted.


The report showed that 90% of the actions were on track or completed and, following agreement at an earlier meeting of the Board, the CQC Action Plan would be closed down at the next meeting in April ensuring that actions had either been completed or were being incorporated into mainstream activity.


RESOLVED,     that the report be noted.



Cumbria Public Health Alliance Update pdf icon PDF 91 KB

To receive a report from the Director of Public Health (Cumbria County Council) (copy to follow).



The Board received a report from the Director of Public Health (Cumbria County Council) which gave an update on the development of the Cumbria 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.


Members received an update on Social Prescribing, Cumbria Joint Public Health Strategy and Healthy Weight in Cumbria.


The Board were informed that Social Prescribing was a relatively new concept which involved GPs developing the expertise in the area in which they worked to enable them to provide advice and suggested activities for patients as an alternative to prescribing medication. 


Members were informed that concerns had been expressed that social prescribing could mean that patients were referred to third sector organisations for support in the community, without a specified resource being attached to what could be a greater demand on their services.  Officers confirmed that collaborative work was being undertaken with the third sector to investigate further investment to support additional resources which may be required.


Members noted that following the Healthy Weight Conference in 2018 it was felt a more concrete approach to measuring activities against priorities was required to demonstrate that activities across the county were having an impact on the health outcomes for communities in Cumbria.


RESOLVED,     that the report be noted.



Future Meeting Dates pdf icon PDF 36 KB

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 Tuesday 19 March 2019 at 2.00 pm at Cumbria House, Carlisle.


(2)       the next meeting of the Board would take place on Thursday 18 April 2019 at 10.00 am at County Offices, Kendal.


Members were informed that this would be the last meeting of the Board that Gina Tiller would attend in her capacity as Chair of the North Cumbria University Hospitals NHS Trust.  


The Chair, on behalf of the Board, thanked her for her contributions highlighting the improvements in partnership working and wished her well for the future.