Agenda and minutes

The Chairman of the Health & Well-Being Board, Councillor Helena Hart, welcomed the members of the Board and thanked them for their attendance.

Councillor Hart also welcomed guests Katie Donlevy (Director of Integrated Care, Royal Free London NHS Foundation Trust), Dr Laura Fabumni (Consultant in Public Health Barnet and Harrow Public Health Team), James Mass (Lead Commissioner for Family and Community Well-Being), Bilal Khan (Community Barnet Children and Young People’s Service Team), Caroline Collier (Barnet Centre for Independent Living) and Kirpal Dhadda (Home-Start Barnet).

The Chairman noted that following the Annual Council meeting on 2 June 2014, the Council had moved to a new Committee system of governance and that the Health Overview and Scrutiny Committee will continue to transact business under statutory requirements.

RESOLVED that the minutes of the Health & Well-Being Board meeting held on 23 March 2014 be agreed as a correct record.

Apologies for absence were received from:

Councillor Reuben Thompstone (London Borough of Barnet)

Paul Bennett (NHS England)

There were none.

None were submitted.

Kate Kennally, the Strategic Director for Communities at LB Barnet, informed the Board that on 10 June, the Policy and Resources Committee considered the LBB Finance and Business Planning Report to 2020 and the Priorities and Spending Review report as part of its remit to set policy and financial frameworks to the end of the decade. In order to improve efficiency and forward planning, thematic committees have been allocated a savings target for the period 2016-20. Ms Kennally noted that the Health & Well-Being Board has been asked to consider a potential saving of £0.7m to improve efficiency including re-procurement of sexual health services. 

Dr Andrew Howe (Director Public Health) informed the members of the Board that in terms of sexual health services Public Health is already working together with other boroughs and NHS England to tackle the issue of HIV transmission and impact. Dr Howe stated that Public Health is taking into account the risks and options of self-service sexual health services. Furthermore, Dr Howe highlighted the benefits of working together with Barnet CCG to focus on family planning services within the Borough, and agreed to report back to the Board with further detailed proposals. (Action: Dr Andrew Howe)

The Head of Healthwatch Barnet, Selina Rodrigues, informed the Board that it has been evident from the feedback received from service users that there has been a lack of understanding about accessing health services. Ms Rodrigues highlighted that in light of the feedback, Healthwatch would welcome proposals on possibilities for accessing services.

Resolved that:

1)    Subject to the deletion of recommendation 1.3 (p10 Agenda report) the Board agrees the recommendations for item 5.

2)    Resolved that the Board notes the Finance and Business Planning Report and Priorities Spending Review.

3)    The Board agreed to receive a report from the Director of Public Health with a proposed commissioning plan and savings proposals, for agreement in advance of the Policy and Resources Committee in December 2014.

John Morton Chief Officer Barnet Clinical Commissioning Group informed the Board of the financial position and recovery plan of the Barnet CCG. The Chairman commended the work of the CCG in delivering the recovery plan in 2013/14 through reducing the deficit from £34M to £9M, and their plan to return to a breakeven position in 2017-18. Mr Morton highlighted that according to the breakdown of figures in table 7.1 (p43) the CCG will come out of a deficit position from 2016-17 onwards.

The Board noted the detailed presentation of the CCG’s Strategic and Delivery Plan 2014-2019 by the Chief Officer of Barnet CCG. Mr Morton highlighted the concerns over the delivery of health services in light of the significant growth in population in recent years. The Board noted the strategic priorities for 2014/15 and the need for wider integration of adult health and social care services.

Mr Morton stated that the next CCG Delivery Plan will be brought to the Board at the next meeting in September. It was noted that concerns over funding (to meet the demographic profile of the Borough) would need to be raised with NHS England. The Board also heard that there has been pressure on services caused by residents from neighbouring boroughs accessing services in Barnet. (Action: John Morton)

Selina Rodrigues (Healthwatch) welcomed the detailed presentation and the strategic goals identified in the report to increase engagement between GPs and patients. Ms Rodrigues highlighted the importance of identifying appropriate ways to enhance patient engagement.

Resolved that:

1)    The Board agrees the deletion of recommendation 1.1 (p.42 of the agenda report) in its entirety.

2)    The Board notes the development of the local Barnet CCG’s Strategic and Delivery Plan 2014-2019, and requests that Barnet CCG and Healthwatch co-ordinate an action plan for increasing public engagement

3)    The Board requires a further update in September on the Strategic plan following final development of Barnet CCGs Strategic and Delivery Plan

Kate Kennally, the Strategic Director for Communities LBB, reminded the Board of the reporting requirements of the Financial Planning sub-group to the Health & Well-being Board. Ms Kennally set out the proposed Terms of Reference for the sub-group, for the Board to approve. Ms Kennally also highlighted the proposed approach to allocating Section 256 money in 2014/15, for the Board’s endorsement.

The Board noted the letter relating to the allocations transferred to Barnet to deliver both the main social care services and to prepare for the Better Care Fund.

Resolved that the Board:

1)    Notes the minutes of the Financial Panning Sub-Group of 19^th May 2014

2)    Approves the proposed approach to allocating Section 256 money in 2014/15

3)    Approves the terms of reference for the Financial Planning Sub-Group

4)    Notes the local plans to review the future of mental health services in Barnet and approves the suggestion that a position paper on  mental health services is presented to the Board in September 2014 to help inform future options.

The Board noted the detailed presentation by Katie Donlevy Director of Integrated Care, Royal Free London NHS Foundation Trust and the timeline of progress towards approval of the acquisition of Barnet and Chase Farm hospital.

Kate Kennally highlighted the importance of working in partnership to ensure the delivery of best possible outcomes, and of implementation of improved training for staff members.

Ms Rodrigues (Healthwatch) welcomed the presentation and the way the restructure would enable improved quality of services to be delivered. Ms Rodrigues further noted that Healthwatch would be keen to see positive patient engagement, particularly through formal and informal community engagement and by developing closer partnership with the Trust.

The Family and Community Well-Being Lead Commissioner James Mass presented the Early Years Review item.

Mr Mass stressed the importance of ensuring that children in need are supported in their early years, as identified in the Children and Young People’s Plan 2013-2016 by the Children’s Trust Board. The members of the Board noted the need to integrate health visiting into the new early years commission to make better use of the service’s universal reach and to identify the most vulnerable families.

Dr Debbie Frost requested a further breakdown of the figures in relation to the savings projected in the Family Services Budget as a result of these proposals. James Mass informed the Board that the Full Business Case will identify further details of how the Medium Term Financial Strategy will be achieved. 

The Strategic Director for Communities expressed the importance of continued partnership working to improve outcomes for local residents. The Chairman thanked James Mass for the detailed presentation and commended the discussion and approach for improved integration.   

Resolved that:

1)    The Health & Well-Being Board endorses the recommendations made as part of the Early Years Review Outline Business Case.

2)    The Board supports the work being developed as part of the early years health and well-being working group.

3)    The Board supports the business case being made to NHS England that Barnet needs sufficient health visitors to deliver the Healthy Child Programme.

The Board noted the aims of the Charter to support vulnerable children and young people and the steps being taken to ensure that their needs are understood by local partners.  The Chairman noted that Barnet is one of only 6 London Boroughs to have signed up to The Charter so far.

The Strategic Director for Communities, Kate Kennally, noted the commitment in the Charter for early intervention and the need for joint working amongst relevant public bodies. Ms Kennally also highlighted the importance of data collection and analysis for effective local service planning on behalf of disabled children and their families. The Charter requires that the Board has detailed and accurate information to identify the needs of disabled children and their partners.

The Chairman of the Board noted the importance of engagement with young people in light of the commitment under the Charter to embed the participation of disabled children and young people in the work of the Board.

The Head of Healthwatch Barnet, Selina Rodrigues informed the Board that Healthwatch would welcome any representation from community organisations and further engagement with organisations and partners to help take this work forward. Ms Kennally highlighted the importance of incorporating the feedback from the wider set of organisations into the work of the Board, and to ensure the Board makes use of the opportunities, advised by Healthwatch, to engage with parents and children.

Resolved that:

1)         The Health & Well-Being Board reviews the recommendations in the report and agrees the priorities to ensure the commitments of the Disabled Children’s Charter are met.

2)         The Board recommends additional evidence to support compilation of a final set of evidence by November 2014.

3)         The Board identifies leads from each partner organisation to ensure robust oversight of the delivery of the Charter’s commitments.

Dr Laura Fabunmi (Public Health) introduced the item and informed the Board of the tuberculosis (TB) rates in Barnet. It was noted that TB rates in London have stabilised since 2005 but remain considerably higher compared to other parts of the UK. Dr Fabunmi informed that although the rates for Barnet are twice the England average, they are still lower than the London average. Furthermore it was noted that the TB rates vary across the Borough with smaller areas of high incidence.

Dr Fabunmi noted that the key to TB control is prompt identification of active and latent cases of the disease. Effective management and appropriate patient support were identified as critical components to reducing TB rates. Kate Kennally noted that a London TB Control Board has been established to provide strategic oversight with the objective to reduce tuberculosis across London by 50% by 2018.

Dr Fabunmi stated that the recommendation in section 10.5 (p180) of the report was based on findings from the situational report, NICE guidance, stakeholders views and other national policy.

Dr Debbie Frost welcomed the recommendations and requested an Action Plan for partners to take an approach to TB control within the Borough. Dr Andrew Howe also welcomed the recommendations and requested the Board to identify leads to move forward with an Action and Communications Plan for the prevention and treatment of tuberculosis in Barnet.

Resolved that:

1)    The Health & Well-Being Board considers the recommendations for effective prevention and treatment of TB and agrees for key partners to take them forward.

2)    Members of the Health and Well-Being Board report back on progress with implementing the recommendations of the TB control work programme in 6 months’ time.

The Head of Healthwatch Barnet, Selina Rodrigues introduced the Healthwatch annual report for Year 1. Ms Rodrigues raised on-going concern over lack of understanding and awareness of access to local services by service users. The Board also noted concerns over lack of understanding of accessing dental services, dental costs and responses from GP referrals.

The Chairman stated that the concerns over access to NHS England dentistry services could be addressed within the Year 2 work plan for Healthwatch.

The Chairman noted the recommendations made in the report to raise awareness with residents about the health and social care services available locally. Dr Clare Stephens highlighted that local schools may be involved in providing information to parents about accessing health and social care services.

The Chairman commended the discussions and noted the opportunity for partners to work closer together with other local service providers to improve effective communication and feedback.

The Board received the presentation from Kirpal Dhadda on the Home-Start Barnet Engagement with Families and Young Parents Report. It was noted that 22 families took part in the consultation. The Board were informed that over 60% of the families considered the healthcare facilities to be of good standard but that there remain issues with accessibility of services - almost 10% respondents had not accessed a dentist in the past year. Kirpal Dhadda noted that in light of the findings, there is a need for additional work to improve accessibility of healthcare services. Ms Rodrigues highlighted that the views of the service users provide vital information about the way services are delivered and their accessibility.

The Board noted the presentation of Caroline Collier on Barnet Centre for Independent Living. Ms Collier informed the Board of the themes emerging from the online survey which received 29 responses. Ms Collier further noted that acknowledgement of concerns can play a major part towards resolving complaints. The Board noted the recommendations of the BCIL report (p271 agenda report) that will be taken forward with mental health service providers to improve the complaints and feedback services.

Bilal Khan Youth Engagement Officer, Community Barnet Children and Young People’s Service Team informed the Board that an online survey had been developed and that focus groups have been established to gain a wider understanding of the experiences of young people using health and social care services. Mr Khan noted that one of the concerns raised in the focus groups was a lack of understanding about confidentiality, particularly in relation to mental health services.  The Board heard the possibilities of electronic and anonymous consultation with young people and the need to explore further options to tackle confidentiality issues. 

Resolved that

1)    The Health & Well-Being Board notes the update report and the consultation reports.

2)    The Board requests the Health Overview and Scrutiny Committee to consider the recommendations from these reports when the relevant Quality Accounts are reviewed at Committee, in order to ensure that recommendations are enacted on.

The Chairman commended the achievements of Healthwatch over Year 1 and requested that the Board supports the aims of Healthwatch to continue to provide constructive feedback and criticism to help improve services for Year 2, whilst always ensuring that compliments as well as complaints are noted.

Resolved that:

1)    The Board notes the progress of Healthwatch Barnet in relation to its statutory functions.

2)    The Board reviews the progress made by Barnet Council to manage the contract with CommUNITY Barnet for the delivery of Healthwatch Barnet and receives further comments as appropriate.

The Director of Public Health Dr Andrew Howe informed the Board of the Strategy and Delivery Plan being implemented thorough the Fit and Active Barnet Partnership Board.

Dr Howe noted that part of the Fit and Active Barnet Delivery Plan will be to provide updates to the Board on the effective use of parks and green spaces. The Chairman highlighted the importance of encouraging residents of all age groups and abilities to be physically active and to undertake more physical activity

Dr Debbie Frost (Barnet CCG) queried the steps taken to promote sports programmes for older people as an under-represented group.  Dawn Wakeling informed the Board of the actions being taken to promote seniors club rooms as a social opportunity for the elderly to engage in exercise activities. 

Kate Kennally requested that the Sports and Physical Activity (SPA) Delivery Plan be updated with the actions for exercise programmes for older people. (Action: Public Health)

Resolved that the Board agrees the establishment of the Fit and Active Barnet (FAB) Partnership Board and notes the Sport and Physical Activity (SPA) Strategy delivery plan

The Strategic Director for Communities Kate Kennally presented the 12 month Forward Work Programme which will be published and updated on a regular basis. It was noted that a new reports template has been designed to align to the template used for the new Council Committees.

The Chairman requested that the Board continues to review the Forward Work Programme regularly in light of the Board’s new responsibilities as the Commissioning Committee for Public Health.

Resolved that the Health & Well-being Board agrees the recommendations for the 12 month Forward Work Programme (p308 of Agenda report).

There were none.