Agenda and draft minutes

Cumbria Health and Wellbeing Board
Friday, 13th September, 2019 10.00 am

Venue: Council Chamber - County Offices, Kendal, LA9 4RQ. View directions

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

Items
No. Item

The Chair, on behalf of members, welcomed Nick Jarman, Interim Executive Director – People (Cumbria County Council) to his first meeting of the Board.

 

15.

Apologies for Absence

To receive any apologies for absence.

 

Minutes:

Apologies for absence were received from Mr L Conway, Mr A Cummins, Mrs M Fitzgerald, Mr A Gardner, Mr J Hawker and Mr D Rogers.

 

The Board was informed that Mr P Rooney was now working for the North Cumbria University NHS Hospitals Trust and Dr D Rogers, Accountable Officer, North Cumbria Clinical Commissioning Group would replace him as a member of the Board.

 

16.

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:

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.

 

17.

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.

 

18.

Minutes pdf icon PDF 121 KB

To confirm as a correct record the minutes of the meeting held on 5 July 2019 (copy enclosed). 

 

Minutes:

RESOLVED,     that the minutes of the meeting of the Board held on 5 July 2019 be agreed as circulated and thereupon signed by the Chair.

 

19.

Cumbria Adult Safeguarding Board - Annual Report 2018-19 pdf icon PDF 6 MB

To consider a report by the Independent Chair, Cumbria Safeguarding Adults Board (copy enclosed).

 

Additional documents:

Minutes:

The Board received the Cumbria Adult Safeguarding Board (CASB) Annual Report 2018/19. 

 

The CASB, a statutory body, had a strong focus on partnership working with organisations across Cumbria to ensure local safeguarding arrangements were effective.  It was highlighted the partners worked collaboratively to prevent abuse and neglect with safeguarding practices being continuously improved to enhance the quality of life for adults with care and support needs.

 

The Board was informed of key achievements in 2018/19, highlighting that they were committed to support the protection of and appropriate service provision for vulnerable people living in Cumbria.  It was emphasised that their vision was to put the people of Cumbria at the centre of all they did.

 

Members were informed that looking forward the CASB intended to:-

 

·                     Implement a 3 Year Strategic Plan and Annual Business Plan.

·                     Raise public awareness and improve engagement.

·                     Seek assurance from partners; changes to safeguarding arrangements.

·                     Ensure appropriate partner representation.

·                     Work in conjunction with other Strategic Boards.

 

Members discussed the financial contributions which the CASB received and drew attention to the lack of reference in the report to the significant contribution made by Cumbria County Council.  It was agreed that the information would be included in the document before the report was published. 

 

The Board drew attention to the new structures in Primary Care and asked whether CASB had connected with them.  It was confirmed that the CASB had links with a significant number of partners, encouraged multi?agency representation and regularly welcomed additional representatives to the Board.

 

During the course of discussion multi-agency training was suggested.  Members welcomed the safeguarding work undertaken by the Community Safeguarding Partnerships across the county which, it was felt, eliminated working in isolation.

 

Members raised concerns regarding the transition from childhood to adulthood and highlighted the importance of connectivity to the Board.  Officers confirmed an audit was being undertaken with the Cumbria Safeguarding Children Partnership to investigate this matter collectively.

 

The Board welcomed the positive report.

 

RESOLVED,   that the report be noted.

 

20.

New Multi-Agency Safeguarding Arrangements (MASA) for Children - Cumbria Safeguarding Children Partnership pdf icon PDF 92 KB

To consider a report by the Interim Executive Director – People (copy enclosed).

 

Additional documents:

Minutes:

The Board received a report from the Interim Executive Director – People which outlined the Cumbria response to the expectations of local areas to establish Multi-Agency Safeguarding Arrangements (MASA) which would replace the Cumbria Local Safeguarding Children Board from 29 September 2019, in line with ‘Working Together to Safeguard Children 2018.’

 

Members were informed that the partnership would be known as the ‘Cumbria Safeguarding Children Partnership’ (CSCP), and would be coterminous with the Cumbria local authority area, retaining the same footprint as the current Local Safeguarding Children Board (LSCB).  It was explained that the new arrangements placed duties on three statutory partners; the Local Authority, the area Police force, and the area Clinical Commissioning Groups (North Cumbria CCG and Morecambe Bay CCG).

 

The Board noted that through the new arrangements it was their intention to establish an Executive Board to replace the current LSCB, underpinned by a Business Group, a number of sub groups to support core functions and the establishment of locality based Safeguarding Groups. 

 

It was explained that the CSCP would provide strategic leadership across the County.  The arrangements would be delivered through a Lead Safeguarding Partners Group underpinned by a Board.  Members noted that a number of sub groups would continue to deliver core functions with the establishment of Locality Safeguarding Groups.

 

Members were informed the Board membership would include the chairs of the partnership sub-groups and chairs of the Locality Safeguarding Groups, the statutory partners as well as the other ‘relevant’ agencies.  It would be chaired by the existing Independent Chair for an interim period of six months, following which the chairing arrangements would be reviewed.

 

The Board noted the more streamlined approach and whilst acknowledging the new arrangements should include adults and children highlighted the role of MASA was to facilitate greater ownership and accountability of children’s safeguarding at a locality level.

 

During the course of discussion the Board welcomed the refocus of the existing Missing, Exploited and Trafficked (MET) Group as the Complex Safeguarding Group who would provide a focal point for the CSCP in ensuring oversight and consistency of responses to complex safeguarding issues. 

 

Members congratulated the work of the Cumbria Local Safeguarding Children Board and welcomed the existing Independent Chair remaining for an interim period of six months. 

 

The Chair, on behalf of the Board, thanked Gill Rigg, Independent Chair and Fiona Musgrave, Assistant Director – Integration and Partnerships for their invaluable contributions to the success of the LSCB.

 

RESOLVED,   that the new safeguarding partnership arrangements for children and young people in Cumbria be endorsed.

 

21.

Special Educational Needs and Disability (SEND) Improvement Update pdf icon PDF 76 KB

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

 

Additional documents:

Minutes:

Members considered a joint report by the Interim Director – People (Cumbria County Council), Chief Operating Officer (North Cumbria Clinical Commissioning Group (CCG)) and Chief Officer (South Cumbria CCG).

 

The Board was informed that Cumbria’s Special Educational Needs and Disability (SEND) Written Statement of Action (WSoA) had been submitted to Ofsted and the Care Quality Commission (CQC) for their approval, in line with the deadline of 21 August 2019.  Members noted that work continued to progress against the key areas for improvement outlined in the WSoA which would be monitored quarterly by Ofsted and NHS England.

 

Members were informed that the Local Area SEND Inspection had identified 9 key areas of concern which the Local Area were required to respond to in a WSoA by no later than 21 August 2019. 

 

The Board noted that improvement activity would be structured through six working groups, reporting to the SEND Improvement Board who had successfully appointed an Independent Chair.

 

Members were informed that whilst a key focus of activity over the summer had been the production of the WSoA, there had also been progression of activity against priority areas. 

 

It was explained that a risk log would be formalised with the initial assessment of risks associated with delivery of the WSoA including capacity of all agencies to deliver the actions at the pace required and the inability to fully regain the trust of parents and carers.

 

The Board noted that developing effective mechanisms for parents and carers engagement and involvement in the improvement activity had been one of the areas where improvement was required.  It was explained that a reference group would be formed which would include parents and carers who had responded to a request for volunteers to act as representatives on working groups as well as identified parents and carers sitting on the working groups.  A wide scale annual survey of parents and carers would be undertaken later in the year to support a greater understanding of the experiences and challenges which they faced.

 

The Board discussed the involvement of the Integrated Care Communities and highlighted the importance of their inclusion within communities.

 

RESOLVED,     that

 

                            (1)       the WSoA be endorsed;

 

                            (2)       the Board receive the quarterly updates of the WSoA including all information submitted for Ofsted/NHSE monitoring and programme risk log;

 

                            (3)       the response to the WSoA from Ofsted/CQC be circulated to Board members.

 

22.

Health and Wellbeing Board Prioritisation and Performance Assurance pdf icon PDF 84 KB

To consider a report by the Interim Executive Director - People (copy enclosed).

 

Additional documents:

Minutes:

Members considered a report by the Interim Executive Director – People which detailed how the Board would prioritise the various outcomes in the Health and Wellbeing Strategy and the Public Health Strategy. 

 

It was explained that at the Health and Wellbeing Board Development session on 21 June 2019, there had been consideration of what approach the Board wanted to take regarding the development of gathering assurance that the Joint Health and Wellbeing Strategy intentions were being achieved.  Members noted it also considered which of the outcomes outlined contained within the Health and Wellbeing Strategy and the Public Health Strategy would be prioritised over the coming years.  It was recommended that the Board sought assurance about the delivery of the strategies through annual reports. 

 

Members recognised that in addition to the Strategy there were key areas where system?wide collaboration was required to make the transformational change required in the health and wellbeing system to deliver improvements to the people of Cumbria.  Therefore, it was proposed to members that they prioritised future activity of the Board in the following three areas:

 

·                    Children have the best start in life (in particular goal 2.1 Improve the mental & emotional wellbeing of C&YP)

·                    People and communities in Cumbria are thriving

·                    We tackle the wider determinants of health.

 

It was explained that in order to drive improvement in those key areas it was proposed that focused actions would be undertaken in each area, whilst acknowledging the nature of those actions would vary for each priority.

 

A detailed discussion took place regarding each of the prioritised areas. 

 

Ø   First Priority - the Local Transformation Plan for Children’s Emotional and Mental Wellbeing and Resilience (LTP – CEMWR) was the main strategy through which needs were assessed, current services were evaluated and future services were developed.  Lancashire and South Cumbria LTP – CEMWR had previously been agreed by the Board and the North Cumbria Plan would be considered for final agreement by the Board at its meeting in December 2019.  It was, therefore, proposed that at that meeting a deep dive would be held to ensure that the Board could fully engage with the North Cumbria LTP - CEMWR, and at that same time review progress against the Lancashire and South Cumbria LTP - CEMWR.

 

Ø   Second Priority – recognition that this would need to link with a number of current initiatives:

 

·                    the County Council’s Thriving Communities Programme;

·                    the development of Integrated Care Communities;

·                    the County Council’s Area Planning Agenda;

·                    work being undertaken by District Councils; and

·                    work being done in the Criminal Justice System.

 

            It was therefore proposed that the Health and Wellbeing Board hosts a special development session which would afford the opportunity to address wider determinants and ensure a co-ordinated approach was taken during 2020.  It was suggested that additional agencies ie representatives from the Criminal Justice System, Cumbria Local Enterprise Partnership and Churches Together Cumbria also be invited to the development session.  Members were encouraged to make further suggestions regarding invitations.

 

            A concern was  ...  view the full minutes text for item 22.

23.

Health and Care System Wide Workforce Strategy pdf icon PDF 80 KB

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

 

Additional documents:

Minutes:

The Board received a report from the Chief Executive (Cumbria County Council) regarding the Cumbria Integrated Health and Care System Workforce Strategy which provided a vision for the health and care workforce in Cumbria.  It was explained it had been developed in response to actions identified within the Spring 2018 Care Quality Commission’s review of the Cumbria health and care system.

 

Members were informed that the system-wide Workforce Strategy did not replace the individual organisation Workforce Strategies or Workforce Plans but complemented them and provided an overarching framework bringing together the key workforce priorities for the system.

 

It was explained the introduction of a Cumbria Integrated Health and Care System Workforce Strategy recognised the need for innovative approaches to recruiting and retaining high quality staff whilst operating in an ever more challenging financial environment.

 

The Board was informed that the employers within the Health and Care sector faced the same demographic challenges and pressures and were interdependent.

 

It was explained that a number of actions were proposed that would be undertaken at individual organisation, local and system level.  It was proposed that all Health and Care organisations in Cumbria would work together on the three priorities identified at system level:

 

·                Developing cross sectoral career pathways

·                Development of cross sectoral apprenticeships

·                Establishment of traineeships to widen participation.

 

Members noted that Cumbria LEP, through their Health and Care Employer Panel, would also work collaboratively.  The actions would be overseen by a co?ordination group which would include representatives from a number of organisations and aligned to individual organisation development plans.

 

A discussion took place regarding inclusion of the independent sector.  The Board was informed that a number of representatives from the independent sector had attended the multi?agency workforce summit but engagement was proving difficult.  A suggestion was made to link with the GP Federation and it was confirmed this had been undertaken. 

 

The Board discussed apprenticeship opportunities which would enable a flexible and adaptable workforce through investment in educating and training new and current staff.  Members were informed that apprenticeships could provide career pathways to support recruitment and retention strategies and that they had a successful history within the health and care system.  It was explained they would continue to support social mobility, widen participation and provide an important route into the modern health and care system.  Whilst the success of apprenticeships was welcomed there was also a suggestion that engagement take place with the global and European workforce.

 

The Board discussed how education providers could be influenced.  It was explained that, although in the early stages, a network of enterprise advisors was being developed to support schools and colleges in understanding the sector.

 

Members noted that from a County Council point of view the Authority was looking to reduce demand for services through the Promoting Independence programme, highlighting one of the biggest challenges was also to maintain acute services.

 

The Board welcomed the report and highlighted the importance of the Strategy whilst acknowledging a whole system approach was required  ...  view the full minutes text for item 23.

24.

2019-20 Better Care Fund Quarter 1 Report pdf icon PDF 832 KB

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

 

Minutes:

The Board considered a report by the Interim Director – People (Cumbria County Council), Chief Operating Officer (North Cumbria Clinical Commissioning Group (CCG)) and Chief Officer (South Cumbria CCG) which provided an update on the Cumbria Better Care Fund with financial and activity reporting.

 

Members noted the four high level performance measures which were required to be reported on a quarterly basis to NHS England:

 

·                     Permanent Residential Admissions

·                     Non Elective Admissions

·                     Delay Transfer of Care (DTOCs)

·                     Effectiveness of Reablement

 

The Board was informed that the DToC figures for July had shown an improvement and were now below the BCF target.  It was explained that a number of workstreams had been put in place to deal with DToCs; South Cumbria would oversee them through the Intermediate Care Group and North Cumbria now had a rapid improvement process in place.

 

Members welcomed the workstreams and improvements which had been made.  Officers emphasised there was no complacency and highlighted the potential winter challenges.

 

A discussion took place regarding nursing home providers, particularly in the Barrow area where there was only one.  It was explained that the geography of the county was problematic when encouraging providers to Cumbria and also the County Council’s resources were fully committed, therefore, they could not guarantee business to the providers.

 

The Board noted the slight deterioration in the Effectiveness of Reablement and was informed this was still in line with comparative family authorities.

 

RESOLVED,   that the report be noted.

 

25.

Better Care Fund 2019-20 Submission/Planning Requirements pdf icon PDF 84 KB

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

 

Minutes:

Members received a report from the Interim Director – People (Cumbria County Council), Chief Operating Officer (North Cumbria Clinical Commissioning Group (CCG)) and Chief Officer (South Cumbria CCG) which set out the submission and planning requirements for the Better Care Fund 2019/20 and the process in making the submission.

 

RESOLVED,   that the report be noted.

 

26.

Cumbria Public Health Alliance Update pdf icon PDF 98 KB

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

 

Minutes:

Members considered a report from the Director of Public Health (Cumbria County Council) which provided 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 the Board on the recent meeting of the Public Health Alliance, held on 4 September which comprised of a pre-meeting on the Solway View project; Winter Campaigns; NHS 5-Year Plan consultation outcomes and the Joint Public Health Strategy Implementation Plan.

 

Members noted that future meetings would focus on topics that related directly to the Joint Public Health Strategy, to support the delivery of the actions and priorities therein.

 

RESOLVED,     that the report be noted.

 

27.

Future Meeting Dates pdf icon PDF 42 KB

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

 

Minutes:

The Board noted that:-

 

(1)       the next Cumbria Health and Wellbeing Board Development day would take place on Friday 4 October 2019 at 10.00 am in Penrith.

 

(2)       the next meeting of the Board would take place on Friday 25 October 2019 at 10.00 am at Cumbria House, Carlisle.