Agenda and minutes

Cumbria Health and Wellbeing Board - Friday, 6th December, 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 Patricia Bell, Lawrence Conway, Aaron Cummins (Sue Smith substituting), Ramona Duguid, Stephen Eames, Jerry Hawker (Anthony Gardner substituting), John Howarth, Geoff Jolliffe and Robin Talbot.



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 113 KB

To confirm as a correct record the minutes of the meetings held on 13 September 2019 and 25 October 2019 (copies enclosed). 


Additional documents:


RESOLVED,     that the minutes of the meetings of the Board held on 13 September 2019 and 25 October 2019 be agreed as circulated and thereupon signed by the Chair.



Special Educational Needs and Disability (SEND) Improvement Update pdf icon PDF 82 KB

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


Additional documents:


The Board considered a report by the Independent Chair of the SEND Improvement Board.  It was noted following re-submission, Cumbria SEND Written Statement of Action WSOA had been approved by Ofsted. 


Members were informed the SEND Improvement Board would oversee and monitor the progress of the six working groups in delivering the commitments in the WSOA and that the DfE would undertake quarterly progress evaluation meetings.


The Board noted that the working groups were progressing the specified actions with some key achievements to note including; the development of the first Cumbria SEND Joint Strategic Needs Assessment (JSNA), the parent/carer reference group embedding as a positive and valuable forum, and the communications and engagement programme taking shape, including a second ‘SEND’ e-newsletter being published and the SEND survey being launched for parents/carers of children with an EHCP or at SEN Support level.


It was explained that a risk for the successful delivery of the WSOA remained relating to pace and capacity.  Members noted that in mitigation, funding had been secured from the partnership for a full?time project manager to co?ordinate and manage the monitoring and evidence requirements.  In addition, all agencies would need to ensure they had mechanisms and capacity in place to support the delivery of the actions committed to and continued commitment from all parties to maintain the pace of improvement activity.


The Board discussed the engagement of schools highlighting the issues which could arise due to the number of different governance models.  It was explained that due to autonomous self-managing school systems engagement could be difficult but highlighted there were committed headteacher representatives.


Members were informed a substantial amount of complaints received were about lack of confidence in schools having the ability to deliver and the lack of authority to hold them to account.  It was felt that in the short-term there was a need to retain the confidence of parents and carers through positive engagement regarding the improvements which were being achieved. 


The Chief Executive Officer from Healthwatch Cumbria informed the Board that progress had been made with regards to engagement and co?production, informing members of parent representatives on all Boards.  It was felt that engagement with parents and carers was key to ensuring there was awareness of the resources available, highlighting that expectation often outstripped resources.  Members were informed that a good response had been received to a recent survey and would provide rich data. 


The Board acknowledged that insufficient funding nationally for Education, Health and Care Plans (EHCPs) was an issue and parents and carers should be encouraged to lobby nationally about resources. 


A discussion took place regarding the establishment of an e?school nurse service as part of the new Healthy Child Programme contract that was due to start from January 2020.  It was explained that positive feedback had been received following a pilot scheme whereby trained staff carried out consultations on?line and that this would be included in the service specification.


During the course of discussion concerns were  ...  view the full minutes text for item 37.


2019-20 Better Care Fund Quarter 2 Report pdf icon PDF 545 KB

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


Additional documents:


The Board considered a report which provided an update on Cumbria’s 2019?20 Better Care Fund (BCF), including updates on the current position relating to permanent residential admissions and Delayed Transfer of Care (DToC). 


The report asked for suitable delegations to be put in place, in case either 2020?21 submission dates or initial 2020-21 BCF/iBCF financial planning requirements did not match Health and Wellbeing Board meeting dates.


Members were given an update on the 2019?20 BCF high?level performance measures: Permanent Residential Admissions, Non Elective Admissions, Delayed Transfers of Care (DToC) and Effectiveness of Reablement.  The Board was informed that all measures were improving except DToCs which had experienced considerable delays from the Spring onwards. 


It was explained that in both North Cumbria and Morecambe Bay a more proactive response was being generated to the DToC situation.  The Board was informed that in Morecambe Bay the development of the ICAT model and the Adult Social Care Reshaping work, which included the establishment of the Short?Term Intervention Service/Teams, would help to manage the medium term pressures.  Members noted that in North Cumbria, the reshaping work was expected to have similar benefits and there had also been improvements in flow as a result of ICCs.  It was explained that in addition, a Rapid Improvement Programme had been initiated which would make recommendation for immediate action to address the issue.  It was highlighted that in both systems it had been agreed to the High Impact Change Model as a framework for developing future system flow action plans.


Members were informed that in North Cumbria discussions had taken place between the local Authority and Acute Trust to look at the interface through Health and Social Care to obtain a common understanding as to the way forward and who held responsibility.  It was explained immediate interventions had been put into the Acute Trust to facilitate improvements. 


The Board noted that South Cumbria was reviewing the whole system.  It was explained the Local Government Association (LGA) and NHS Improvement would undertake work with both North and South Cumbria to understand how information was captured as there were concerns regarding accuracy of data. 


Members held a detailed discussion emphasising their concerns regarding the rise in DToC figures since the summer and highlighted the tremendous strain the whole system was under when this was combined with the recent novo virus outbreaks.


The Board drew attention to the difficulties encountered by the residential and nursing sector due to the problems recruiting staff.  Members were informed of the shortages of carers across the workforce which affected the discharge of those with learning difficulties and mental health problems as well as the elderly population.  It was highlighted this was a national problem and was linked to pay and conditions.  The Board felt there was a need to look at the workforce in different ways to reinvigorate this to maintain resources.  It was suggested that the Board receive a progress update on the  ...  view the full minutes text for item 38.


Antimicrobial Resistance and Gram Negative Blood Stream Infection Report pdf icon PDF 400 KB

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



The Board considered a report by the Director of Public Health (Cumbria County Council) which outlined the situation in Cumbria in relation to the incidence of healthcare associated gram negative blood stream infections and the issue of antimicrobial resistance.  The report also provided an overview of the work that was being undertaken in Cumbria in order to reduce the number of gram negative blood stream infections and to slow down the development of resistance to antimicrobials.


Members discussed the use of antibiotics in the farming industry and the effects this had on the human population.  It was confirmed that although the use had much improved over recent years this could lead to resistance in humans, highlighting the key challenge was about inappropriate use, particularly in cattle. 


A discussion took place regarding future engagement with farming communities and it was suggested this could be raised through the Public Health Alliance and the National Farmers’ Union.


RESOLVED,   that the report be noted.



Cumbria Public Health Alliance Update pdf icon PDF 166 KB

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



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 Arts and Culture Offer in Libraries, Local Focus Hubs and Cumbria Healthy Weight Partnership.


The Board welcomed the positive feedback regarding engagement at a local level since the re?establishment of the Barrow Health and Wellbeing Forum.  Members were encouraged to ensure all communities were engaged.


A discussion took place regarding the multiple layers in the system and it was agreed that if the architecture which was being developed was not suitable this could be reviewed and streamlined if necessary.


RESOLVED,   that the report be noted.



Future Meeting Dates pdf icon PDF 41 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 Friday 24 January at 2.00 pm in Penrith.


(2)       the next meeting of the Board would take place on Friday 7 February at 10.00 am in County Offices, Kendal.