Agenda and minutes

Cumbria Health and Wellbeing Board
Tuesday, 20th February, 2018 10.00 am

Venue: Conference Room A, Cumbria House, Botchergate, Carlisle, CA1 1RD.

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

Items
No. Item

38.

Apologies for Absence

To receive any apologies for absence.

 

Minutes:

Apologies for absence were received from Mr A Bennett, Mr D Blacklock, Mrs A Burns, Mr S Eames, Dr J Howard, Mr J Macilwraith, Ms B Riley and Ms B Smith.

 

39.

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. 

 

40.

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.

 

41.

Minutes pdf icon PDF 91 KB

To confirm as a correct record the minutes of the meeting held on 29 November 2017 (copy enclosed). 

 

Minutes:

RESOLVED,     that the minutes of the meeting of the Board held on 29 November 2017 be confirmed as circulated and thereupon signed by the Chair.

 

42.

Childhood Obesity in Cumbria pdf icon PDF 335 KB

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

 

Minutes:

The Board received a report from the Director of Public Health on Childhood Obesity in Cumbria.

 

Members were informed that obesity was considered to be one of the most serious public health challenges of the 21st Century.  It was explained that without action, the health of children and adults would continue to suffer, health inequalities associated with obesity would remain and the economic and social costs would increase to unsustainable levels.

 

The Board noted that the World Health Organisation (WHO) regarded childhood obesity as one of the most serious global public health challenges for the 21st Century.  It was explained that being obese could increase the risk of developing a range of serious diseases, including hypertension, type 2 diabetes, cardiovascular diseases, some cancers, obstructive sleep apnoea and musculoskeletal problems.  It was noted that obese children and adolescents were also more likely to become obese adults.

 

Members were informed that Cumbria’s National Child Measurement Programme (NCMP) had been running since 2008, and was now following cohorts of children who were measured in Reception and were now in Year 6.  The data showed that there was an average 44% increase in the number of children who were overweight from Reception to Year 6.  It was explained that in addition, there had been a recent upward trend in the percentage of overweight Reception children in Cumbria, in comparison to relative stability in the England average.  It was highlighted that if those trends continued, Cumbria may be faced with an increasing proportion of children who were overweight when they started senior school.

 

The Board discussed the differences in obesity/overweight noting that at Reception Barrow-in-Furness had the greatest percentage of children (31.5%) and that the percentage of children was above the England average in Allerdale, Barrow-in-Furness, Carlisle and Copeland.  Members were informed that at Year 6 Copeland had the greatest percentage of overweight/obese children (41.4%) and the percentage of overweight/obese children was above the national England average in Barrow?in?Furness and Copeland.  During the course of discussion members discussed the effects of deprivation and obesity and it was agreed there was a correlation between the two.

 

It was highlighted that although the data showed a clear need to address issues at school age, there were challenges regarding the significant increases with Reception data which had highlighted the importance of work within the Early Years and with families to encourage healthier food choices from an early age. 

 

Members discussed the gaps in provision and it was noted that in recognition of them, and of the need for a whole systems approach, the County Council were organising a Healthy Weight Summit to be held in March 2018.  The event would enable partners from schools, catering providers, businesses, statutory, health, 3rd sector and community to come together to understand the current situation and to plan action.  It was emphasised that to tackle the identified gaps resources would be required, and following the Summit it was likely that further work would be undertaken to develop a business case  ...  view the full minutes text for item 42.

43.

CUMBRIA'S LOCAL TRANSFORMATION PLAN FOR CHILDREN AND YOUNG PEOPLE'S RESILIENCE, EMOTIONAL WELLBEING AND MENTAL HEALTH 2015-2020 pdf icon PDF 69 KB

To consider a joint report by the Corporate Director – Children and Families (Cumbria County Council), Chief Executives Clinical Commissioning Groups and Cumbria Partnership Foundation Trust (copy enclosed).

 

Additional documents:

Minutes:

The Board received a report and presentation from the Corporate Director – Children and Families Services (Cumbria County Council), Chief Executives of Cumbria Clinical Commissioning Groups and Cumbria Partnership Foundation Trust on Cumbria’s Local Transformation Plan for Children and Young People’s Resilience, Emotional Wellbeing and Mental Health 2015-2020.  Members noted that the Local Transformation Plan detailed the work programme for the next year and beyond.

 

The report updated the Board on activity and developments since July 2017, led by multi-agency partnership arrangements covering all of Cumbria.  It detailed how this priority area of work in terms of improving services and outcomes for children and young people with emotional and mental wellbeing needs was now led through the implementation of the Local Transformation Plan (referred to in appendix 1 of the report).

 

The Board noted that Cumbria had adopted a ‘whole system’ approach to this area of work since the start of 2014 and the Plan highlighted achievements since 2015 and the inception of ‘Future in Mind’.  It was explained that since the boundary changes in April 2017 the South Cumbria area continued to be part of the Cumbria LTP, however there was an intention to increasingly align LT Plans across the wider Sustainability and Transformation Partnership areas.  At present a significant piece of work was underway to redesign children and young people’s emotional wellbeing and mental health services across Lancashire and South Cumbria, which may result in changes to service delivery post April 2018.

 

Members were informed that specialist CAMHS and the targeted ‘My Time’ service now provided a single point of access and the ‘Kooth’ service had been jointly commissioned to enable immediate on-line support to young people aged 11 to 18.  It was felt both those services provided significant steps in the right direction.

 

The Board noted that significant challenges remained in Cumbria (as in all other areas) and the LTP detailed priorities in key work streams across six key areas:-

 

Ø   Access

Ø   Crisis

Ø   Care for the most vulnerable

Ø   Resilience

Ø   Workforce

Ø   Engagement

 

with each of the priority areas broken down into objectives and goals to be achieved with an identified framework.

 

The Board were informed that the Transformation Programme would be led by a new Children and Young People Emotional Wellbeing and Transformation and Partnership Board, who had responsibility for overseeing the overall whole system approach.  It was noted the Board would be supported by a Stakeholder Reference Group who would provide a ‘sense check’ to proposals developed by project task and finish groups.

 

The Board noted that during the last six months governance arrangements had been reviewed and revised in the light of CCG boundary changes.  It was explained that specialist and targeted services had taken action to modify delivery and improve access and services across the key priority areas highlighted by the Board at the meeting held on 3 July 2016.  Members were informed that since the boundary changes there were challenges in both areas.

 

The Board highlighted the  ...  view the full minutes text for item 43.

44.

Health and Social Care Integration Update pdf icon PDF 152 KB

To consider a report by the Corporate Director – Health, Care and Community Services (Cumbria County Council), Chief Executive, North Cumbria Clinical Commissioning Group and Chief Executive, Morecambe Bay Clinical Commissioning Group (copy enclosed).

 

Minutes:

Members received a report from the Corporate Director – Health, Care and Community Services (Cumbria County Council), Chief Executive, NHS North Cumbria Clinical Commissioning Group (CCG) and Chief Officer, NHS Morecambe Bay CCG which provided an update on progress being made to integrate health and care services in Cumbria.

 

The Board noted that the health and care system in Cumbria had faced significant recruitment and retention, financial and quality challenges; with limited market provision in some areas and mismatch of supply and demand.  It was noted that work had been undertaken with partners to investigate how those challenges could be met, including how integration of services could result in constraining costs, improving quality of care and improving patient/user experience. 

 

Members were informed that work had been ongoing for the last two years and system partners were already engaged with the integration agenda on a number of fronts.  It was explained that this included working on improvements within existing system (eg work through the Accident and Emergency Delivery Boards), the development of new systems within existing organisational forms (eg Integrated Care Communities and revised clinical/care pathways), and the exploration of potential future organisational relationships.

 

The Board noted the Health and Wellbeing Board development sessions which had taken place to explore and agree next steps, which partners were committed to making, to strengthen the emerging modes for integrated care in North and South Cumbria.  The three main priorities which partners had identified were:-

 

Ø   Articulate and communicate our vision for the health and wellbeing of the people in Cumbria.

 

Ø   Define governance arrangements that work for all partners.

 

Ø   Demonstrate the impact of more integrated ways of working by delivering agreed and specific projects.

 

Members were informed that due to the resources required for the recent Care Quality Commission Inspection work to develop actions to progress the above priorities with relevant officers from the Council and Health organisations had been delayed but would now be followed up.  It was agreed that representatives from both the University Hospital Morecambe Bay NHS Foundation Trust and the district councils would be sought to contribute to the agreed actions.

 

During the course of discussion the Chair of Healthwatch Cumbria drew the Board’s attention to a recent incident regarding poor quality of service from a Trust which had been drawn to their attention.  The representatives from both the University Hospital Morecambe Bay NHS Foundation Trust and North Cumbria University Hospitals NHS Trust emphasised the need to bring such cases to their attention and it was agreed this would be discussed further with the appropriate Trust.

 

RESOLVED,     that

 

                            (1)       the following be noted:-

 

                                        (a)       the current progress on developing more integrated services and systems between health and care partners;

 

                                        (b)       the work being undertaken to develop Integrated Care Communities;

 

                                        (c)       the work being undertaken to develop integrated information systems and an update on the Digital Roadmap be made to a future meeting of the Board;

 

                                        (d)       the current programmes of work developing models of integrated  ...  view the full minutes text for item 44.

45.

2017-19 Better Care Fund Update pdf icon PDF 673 KB

To receive a joint report from Corporate Director – Health, Care and Community Services, Chief Executive, North Cumbria Clinical Commissioning Group and Chief Executive, Morecambe Bay Clinical Commissioning Group (copy to follow).

 

Additional documents:

Minutes:

The Board received a report from the Corporate Director – Health, Care and Community Services (Cumbria County Council), Chief Executive, NHS North Cumbria CCG and Chief Officer, NHS Morecambe Bay CCG which provided an update on Cumbria’s 2017-19 Better Care Fund (BCF).

 

A discussion took place regarding Delayed Transfers of Care (DTOC) and members welcomed the substantial reduction to the end of December 2017.

 

The Board received additional information at the meeting regarding the iBCF return, therefore, it was agreed that members be afforded the opportunity to read the document outside the meeting and comment separately if necessary.  Members were informed that a decision on the use of underspends in the BCF/iBCF was required before the next scheduled meeting of the Panel in April, therefore, it was suggested that County Council officers meet with representatives from the North Cumbria and Morecambe Bay Cumbria Clinical Commissioning Groups and provide feedback to the Chair and Vice?Chair of the Board.

 

RESOLVED,     that

 

                            (1)       the report be noted;

 

                            (2)       members be afforded the opportunity to read the tabled document outside the meeting and comment separately if necessary.  County Council officers will meet with representatives from the North Cumbria and Morecambe Bay Cumbria Clinical Commissioning Groups and provide feedback to the Chair and Vice?Chair of the Board.

 

46.

Pharmaceutical Needs Assessment pdf icon PDF 81 KB

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

 

Additional documents:

Minutes:

The Board received a report from the Director of Public Health regarding the Pharmaceutical Needs Assessment. 

 

Members were informed that the NHS (Pharmaceutical Services and Local Pharmaceutical Services) Regulations 2013 that came into force on 1 April 2013 meant that each Health and Wellbeing Board had to publish a copy of its approved Pharmaceutical Needs Assessment (PNA) on or before 1 April 2015

 

The Board noted that the last PNA agreed by the Board was published in March 2015 and there was a requirement to publish a revised assessment within three years of publication of the first assessment.

 

It was explained to members that the revised draft PNA was agreed by the Board in November 2017 which then went out for public consultation during the period 24 November 2017 to 23 January 2018 (an analysis of responses to the consultation can be found in Appendix 1 to the report).

 

Members highlighted the importance of being aware of the impact of any closures on communities if supporting local based services.

 

RESOLVED,     that the PNA accurately reflects current pharmaceutical provision, and the overall provision of pharmaceutical services is considered to be adequate as confirmed by NHS England – Cumbria and the North East.

 

47.

Cumbria Health and Wellbeing Strategy 2016-19 - Delivery Plan Performance pdf icon PDF 74 KB

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

 

Additional documents:

Minutes:

A report was presented to the Board by the Director of Public Health regarding the Cumbria Health and Wellbeing Strategy 2016?19 – Delivery Plan Performance.  The report 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 3 2017/18 (detailed in Appendix 1 to the report).

 

Members welcomed the report and discussed in detail the recorded breastfeeding status.  The significant variation across the districts from 57.0% in Barrow?in?Furness to 87.9% in Copeland was highlighted and concerns were raised regarding issues in Barrow?in?Furness.  The Trusts recognised their support in the recording of information and agreed to investigate this matter.

 

The Board agreed that in future it was necessary to analyse the data captured and actions taken to enable challenges to be made.  It was agreed that future information should be more cross?cutting on overall direction of travel.

 

RESOLVED,     that the report be noted.

 

48.

Joint Strategic Needs Assessment - Military Veterans pdf icon PDF 75 KB

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

 

Additional documents:

Minutes:

The Board considered a report by the Director of Public Health regarding the Joint Strategy Needs Assessment – Military Veterans.

 

Members noted that the Military Veterans chapter was currently being consulted on by the Health and Wellbeing Locality Forums and the Public Health Alliance members.  It was also agreed that the Veterans’ Association should have sight of the document.  The deadline for responses was 28 February 2018 and any updates would be considered along with comments from the Board.

 

RESOLVED,     that

 

                            (1)       the Chapter be considered by the Public Health Alliance and the Director of Public Health be provided with any comments made;

 

                            (2)       the Director of Public Health reviews any incorporated comments before publication of the Military Veterans JSNA chapter.

 

49.

Cumbria Public Health Alliance Update pdf icon PDF 65 KB

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

 

Additional documents:

Minutes:

Members received a report from the Director of Public Health which provided an update on the development of the Public Health Alliance (PHA).

 

The report gave an update on FareShare – Ending Food Waste, Healthy Weight Declaration and the Cumbria Joint Public Health Strategy. 

 

RESOLVED,     that the report be noted.

 

50.

Future Meeting Dates pdf icon PDF 35 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 Wednesday 21 March 2018 at 2.00 pm in Cumbria House, Carlisle.

 

(2)       the next meeting of the Board would take place on Tuesday 10 April 2018 at 10.00 am in Cumbria House, Carlisle.

 

Members noted that this would be the last Board meeting which Mr P Butler and Mr S Childs would attend in their respective roles.  The Chair, on behalf of the Board, expressed their thanks and appreciation for their support to the Board and wished them both well for the future.