Agenda and minutes

To note the attendance at this meeting of any duly appointed Reserve Members.

Reserve Members may attend meetings:-

(i)                 to take the place of an ordinary Member for whom they are a reserve;

(ii)               where the ordinary Member will be absent for the whole of the meeting; and

(iii)             the meeting notes at the start of the meeting at the item ‘Reserves’ that the Reserve Member is or will be attending as a reserve;

(iv)              if a Reserve Member whose intention to attend has been noted arrives after the commencement of the meeting, then that Reserve Member can only act as a Member from the start of the next item of business on the agenda after his/her arrival.

RESOLVED:  To note that there were no Reserve Members in attendance.

To receive declarations of disclosable pecuniary or non pecuniary interests, arising from business to be transacted at this meeting, from:

(a)               all Members of the Board;

(b)               all other Members present.

RESOLVED:  To note that there were no declarations of interests made by Members.

That the minutes of the meeting held on 1 August 2013 be taken as read and signed as a correct record.

RESOLVED:  That the minutes of the meeting held on 1 August 2013, be taken as read and signed as a correct record.

To receive questions (if any) from local residents/organisations under the provisions of Board Procedure Rule 14 (Part 4B of the Constitution).

There will be a total limit of 15 minutes for the asking and answering of public questions. A question may only be asked if notice has been given in writing, by fax or electronic mail to the Monitoring Officer at publicquestions@harrow.gov.uk no later than 3.00pm two clear days before the day of the meeting.

(1)               The following question had been submitted by a member of the public in accordance with Rule 14.3 of the Health and Wellbeing Board Procedure Rules:-

The Chairman responded as follows:  “We agree with the statistical information provided as this is taken from the 2011 Census.  However, the way national and local systems collect data on carers does not allow household composition and employment status to be measured against the level of unpaid care, which makes it impossible to respond to the assessment. 

The way families provide their care and support is very changeable and dynamic and we try and support all carers known to the Council in difficult circumstances by providing them with information and advice about what support is available to them in the community and also signposted to organisations who can support them with benefit entitlement to ensure that they are supported if they are experiencing financial hardship due to their employment status.

There is also a continuous effort made by the Council to try to identify hidden carers and carers, who may not recognise themselves as carers to ensure they can access support.  This year we have held a number of events across the borough, such as Under One Sky, to reach out to people that do not see themselves as carers to provide advice and support.

NHS Harrow CCG also acknowledges the personal challenge that Carers face, and have started a process of engagement and listening to support the development of services within the borough.  Work will take place to link this with carers initiatives already underway from the Council.

The first phase of the CCG work has resulted in the development of a General Practice Carers Awareness scheme that is currently being implemented across the borough and is supported by local carers with a view to support the standardisation of skills and support within primary care.  Work is on-going  to develop  local support for carers underpinned by acknowledgement of the diverse needs across the borough.

Carers we are in touch with are a good reflection of the diversity in our local community.  The Council’s own surveys of carers and the national census data support this equality of service provision.

As referenced  ...  view the full minutes text for item 34.

To receive petitions (if any) submitted by members of the public/Councillors under the provisions of Board Procedure Rule 13 (Part 4B of the Constitution).

RESOLVED:  To note that no petitions or deputations had been received.

To receive a reference from the Corporate Parenting Panel on 8 July 2013 regarding the Report of Mental Health Care for Children Looked After.

A verbal response will be made at the meeting.

The Board received a reference from the Corporate Parenting Panel on 8 July 2013 regarding the Report of Mental Health Care for Children Looked After.

It was reported that a joint piece of work would be undertaken by the CCG and Children’s department regarding pathways and revising strategy.  A report would be submitted to a future meeting and would include the issues raised by the Corporate Parenting Panel.

Report of the Head of Commissioning and Partnerships and the Director of Adults.

In accordance with the decision of the Board at its meeting on 1 August 2013 to authorise the officers to enter into discussions with Harrow CCG to conclude the Section 256 agreement, the Board was informed that discussions had taken place but had not been concluded.  A verbal report was received on the position to date.

An officer from Harrow Council reported that both the CCG and Harrow Council were facing financial challenges and there were immediate pressures to work out an agreement for the transfer of approximately £3,471,178 from the CCG to the Council.  The standard national criteria for the allocation of funding includes:

·                    Community equipment and adaptations;

·                    Telecare;

·                    Integrated crisis and rapid response services;

·                    Maintaining eligibility criteria;

·                    Re-enablement services;

·                    Bed-based intermediate care services;

·                    Early supported hospital discharge schemes;

·                    Mental health services;

·                    Other preventative services;

·                    Other schemes to be specified locally.

The transfer would require sign-off by CCG.  The discussions were relatively close to reaching a position that was acceptable to all and which included a request for Council support of the STARRS services.

An officer of the CCG reported that subsequent to the discussions at the Joint Executive meeting on 25 September, an internal discussion had been held with the Harrow CCG Quality, Innovation, Productivity and Prevention Committee (QIPP) Committee.  Whilst there had been earlier discussions between Council and CCG about the allocation for the 2013/14 S256 funding, the Committee felt that it was not able to support the discussion which took place at the Joint Executive.  The Committee wanted the Council to give consideration to funding the STARRS stretch element before it could sign off any proposals.  The QUIPP Committee also requested that clear principles of working are agreed across both organisations with respect to this and any other future allocations.

As a result officers from the CCG were seeking to find a mutually agreeable position as a way forward as a ‘half way house’ between what had been agreed with Harrow officers and the requirements of the QIPP.  The areas to be considered in finding a way forward are:

·                    the need to expand the existing STARRS service, which would be of benefit to both the CCG and Harrow Council;

·                    clarity on how any outstanding legacy public health invoices will be settled;

·                    the Council’s allocation of £3.5 million as it currently stood was a valid allocation, however the CCG would appreciate it if pressures on both sides could be examined and incorporated into the allocation.  Winter social care monies was part of the allocation and Harrow Council would receive a share should any underspends be identified.

A Board clinical lead representative of the CCG stated that there was the opportunity to work together to ensure the best use of funding, and to appreciate each others pressures.  The future value of the Health and Wellbeing Board was in jointly formulating plans and ensuring that discussions took place early in the financial year and not mid year.

The Chairman expressed concern that the £3.471 million was outstanding as she  ...  view the full minutes text for item 37.

Report of the Corporate Director, Children and Families, Harrow Council and Chief Operating Officer, Harrow Clinical Commissioning Group

The Board received a report which introduced the new joint plan for children and family services.

An officer informed the Board that the Plan, which had been launched that day, replaced the 2011/14 Children and Young People Commissioning Plan.  He made the following points:

·                     it was more accessible being an A5 sized booklet;

·                     it was based on the previous Joint Strategic Needs Assessment (JSNA) and the commissioning intentions outlined by the Health and Wellbeing Board;

·                     the Plan would be refreshed in six months following wide consultation which would include parents, front line staff, young people, partner and provider organisations;

·                     the Plan detailed the co-produced outcomes expected at key stages in the child’s development;

·                     transparency would be achieved by simplifying governance and decision-making and making improvements to the way the system was designed;

·                     the Plan covered the period 2013 to 2018 which aligned with the Council’s transformation programme.

The Board welcomed the report as a demonstration of the integrated work being undertaken by the Local Authority and CCG.  It was partly health led and partly LA led and addressed common needs.  The format enabled the Plan to be refreshed as needs and plans became more definite.

In response to a question as to how outcomes were monitored it was noted that:

·                     the Performance Board would bring together the health projects;

·                     Health Visiting and School Nursing papers would provide targets and look at added value.

A representative of the Board stated that there was a need to relate back to the overriding plan to ensure inclusion of all needs such as autism.

RESOLVED:  That the new joint plan entitled Our Plan: Children and Families be noted.

Joint Verbal Report from the Chair of Harrow Clinical Commissioning Group and Corporate Director, Community Health and Wellbeing.

The Board received a joint verbal report from Harrow Council and the CCG on integration work and the Pioneer Bid.

Board Members were aware that the emphasis was on support for people at home wherever possible and to this end:

·                     5711 people now had shared care plans;

·                     five new projects had been implemented – including the formation of a team supporting care homes, work with Age UK regarding the home/hospital service and the launch of a blue book where all client information was shared;

·                     work was now being undertaken to the next level and this would continue whether or not the Pioneer Bid was approved.

The achievements of the Director of Adult Services, the Chairman of the CCG and the CCG were recognised.

It would be known in October whether the Pioneer Bid had been successful.  The next six months would be crucial with the need to understand how the eight boroughs involved in the programme would work together and how to ensure that the outcomes met the needs of Harrow residents.

It was noted that a three year integration plan would be set up, to be concluded in March 2014. £3.8 billion Integration Transformation Fund (ITF) had been allocated nationally for this work, with Harrow’s share being £14-15 million which would need to be accounted for.  The majority of this was not ‘new money’ and the CCG was requested to consider making an allocation for this.

By 15 February 2014 there was the need to submit a return in outline on the purposes of the plan and how it would meet the key outcomes.

The Board welcomed the verbal report and reconfirmed the principles, which were agreed by the HWB at the June meeting.  A discussion ensued on the importance of engagement and partnership, to also deal with the rise in expectations and to seek to imbed self care with integrated care planning.  The Board considered that this could be furthered by the role of the neighbourhood champion, the recognition of peer support groups such as for mental health and diabetes, a long term strategy for engagement, and activities at Healthwatch Harrow supported by a matrix of priority.

RESOLVED:  That

(1)               the six principles underpinning the Pioneer Bid be confirmed in relation to the ITF;

(2)               the CCG and Council be authorised to make submissions to the Board in January prior to submission on 14 February 2014;

(3)               a report on a final three year plan be submitted to a meeting of the Board in March/April 2014;

(4)               a report on engagement on the plan and a broader piece of work on engagement be submitted to a future meeting of the Board.

Report of the Consultant, Public Health.

The Board received a report reviewing School Nursing and Health Visiting in Harrow and Barnet, together with an update on Call to Action; National Plan to Recruit Additional Health Visitors.  There was a joint discussion on the items due to the common themes.

It was noted that the representative of NHS England (NHSE) had submitted apologies for absence from the meeting.

A CCG representative welcomed the review and stressed the importance of CCG being part of the process due to its historic knowledge and experience of working closely with primary care.  It was noted that the Health Visitor contract was held by NHSE with the monitoring delegated to Harrow CCG.  The resources available for the service were limited and priority was given to items such as birth visits, safeguarding, and safety work.

An officer reported that a joint review was being undertaken with Barnet to ensure a model for the future.  The issues for the two services were generally the same but there were separate providers with school nursing being a LA function and it was anticipated that Health Visiting would be commissioned by the LA from 1 April 2015. 

The Board was advised that:

·                     due to procurement problems the selection of an alternative provider was under consideration. In order to increase the recruitment of health visitors, the specification was being revised in consultation with health visitors;

·                     a review was being undertaken by a steering group to create a best model of service which would deliver the best outcomes for  children and young people.  Current provision was being mapped, linked to health needs, with input from a wide range of stakeholders, and workforce gaps identified.  The Early Year Reviews had fed into the review and some pan London work had taken place;

·                     school nursing numbers in Harrow were the lowest in west London.  The Consultant, Public Health, had met with headteachers to see how recruitment could be improved in order to increase the number of staff available to undertake health checks in schools;

·                     as it was recognised that reviews could result in staff anxieties, service managers were included in the process to counter concerns during the transition.

The Board members expressed concern at the shortfall in Health Visitor numbers and discussion ensued on the need to advertise Harrow as an attractive employer for Health Visitors.  It was noted that it was a national problem and that various models would be examined to ascertain best practice.  Suggestions raised by Board Members and officers included emphasising: clinical leadership opportunities, the mixed caseload including generic public health work and the elderly, local support,  building teams around GPs to ensure it is seen as an attractive profession, and mapping out some examples of complementary opportunities.  It was noted that a London wide group chaired by the Chief Executive of Richmond Council was considering strategies to enhance recruitment.

An officer undertook to seek an assurance from NHS England that despite the lack of numbers, the school nursing service in Harrow was a safe environment.  ...  view the full minutes text for item 40.

Report of the Director of Quality and Safety –BEHH.

The Board received a report which advised on the action planning in relation to taking forward the key concerns raised by the Francis Inquiry together with the Keogh review into quality and treatment provided by 14 hospital trusts in England and the Berwick review of patient safety and safety within the NHS.

An officer from the CCG introduced the report and advised that there had been 220 recommendations from the Francis inquiry report of which 20 had been specifically targeted by the commission.  In June working groups of managers and clinicians across the four BEHH CCGs with input from Harrow Members had undertaken work on the four key themes from the report:

·                     Accountability – who is accountable where there are lots of different organisations and to ensure that providers recognise their own accountability;

·                     Culture and leadership - to explain the role of commissioners regarding their provider organisations, for example specifications;

·                     listening and ensuring that hear what is being said with a greater imperative to respond. How to capture information from both individual consultations and more strategic consultations;

·                     information and transparency – to include further conversations with the Council regarding Information Technology.

An officer reported that the urgency of the work required was recognised by the executive groups across the Council and CCG.  The attention of Scrutiny officers and members would be drawn to the recommendation with respect to Overview and Scrutiny as the Committee in the area of the review had not identified a problem.

The Board welcomed the dialogue and the engagement in the review of the current contracts.  It was considered that transparency was vital whether or not it was good news.

RESOLVED:  That

(1)               the report be noted;

(2)               a final action plan report be submitted to the January meeting.

Report of the Director of Adult Social Services.

Further to a discussion at the Board meeting in June 2013 about the future of Partnership Boards in Harrow, a report was received that outlined the subsequent actions taken and conclusions in relation to ending Partnership Boards and details of their replacements.

It was noted that an initial report would be presented to the Health and Wellbeing Board on the progress and plans by each group.  Each Strategic Group would then submit updates to the Board at agreed intervals of three to six months.

A Member of the Board representing the community stated that he had raised a number of issues regarding the EQIAs and in particular the need for underpinning with a communication strategy.  In response, an officer stated that the risks were clear and well articulated.  Reports would be submitted to future meetings on the work of the groups.

RESOLVED:  To note that

(1)               the conclusions of Equality Impact Assessment (EQIAs) and discussion with Partnership Board members to bring the Boards to an end;

(2)               the alternative groups that will be focused on meeting HWB objectives and progress with implementing these;

(3)               Partnership Boards are not stipulated by statute and are at the discretion of local areas;

(4)               the CCG would nominate leads for Dementia and Carers’ Groups.

(5)               reports from strategic groups would be submitted to the Board from January with a review in six months.

Report of the Chief Operating Officer, Harrow Clinical Commissioning Group

As requested at its last meeting, the Board received a report on the current performance of unscheduled care pressures, the additional Accident and Emergency funding bids for winter 2013/14, publicising the Accident and Emergency recovery plan and the NHS England assurance process. Harrow Council’s performance in supporting discharge was highlighted as rated 7^th best in London.

A CCG representative introduced the report and referred to the 95% target for patients attending A&E to be seen within four hours and the effect of timely discharges, an admission avoidance scheme and the 9% increase in the number of patients sent by GPs.

It was noted that the key focus was on the North West London Hospital Trust (NWLHT).  An officer described the data which provided a snapshot of NWLHT’s performance in unscheduled care activity.  The current A&E performance indicated that NWLHT was improving and was now in line with the national 4 hour standard.  Northwick Park Hospital performance had seen an improvement from 78% to 95%.

Attention was drawn to the fact that the key provider relied heavily on observation beds where diagnosis and treatment were not confirmed after four hours and of which the majority of cases were discharged.  The principle cause of breaches in Northwick Park Hospital had been a large number of patients waiting for a bed.  The A&E recovery plan and separate winter plan aimed to resolve pathway issues and to realign resources across the patient pathway.  Compared to last years, A&E attendances had decreased in line with the expansion of the Urgent Care Centre, however less complex cases were reducing.  There were schemes to treat simpler cases in the community with provision of additional re-enablement beds. 

Extra support had been made available to support quarters 3 and 4 2013/14 to support winter pressures.  This support included:

·                     additional Brent and Harrow community rehabilitation beds

·                     additional Brent and Harrow reablement beds

·                     increased resources to support acute capacity and flow at NWLHT

·                     London Ambulance intelligent conveyancing scheme

·                     acute psychiatric unit to support A & E

·                     increased capacity for Harrow existing community rehabilitation bed.

Sometimes key clinical resources were diverted further into the hospital in order that observation beds were available for a specialist to treat acute admissions.  By the consultants working in A&E the bed was released if the patient could be discharged home with specialist care.  NWLHT is entering a staff consultation to move to a seven day therapies model to support greater continuity of care and patient experience, which aligns to the whole systems integrated care model.

The Board thanked the officer for the explanation of the graphic information.  It was considered that an officer/councillor group including the Head of Communications should take responsibility for identifying the action to be taken on communication.  This would include use of Harrow People, review of appropriate discharges and identification of regular users of A&E.

RESOLVED:  That

(1)               the report be noted;

(2)               Councillor Williams, together with the Director of Healthwatch, Head of Unscheduled  ...  view the full minutes text for item 43.