Agenda and minutes

The Chairman of the Health and Wellbeing Board, Councillor Helena Hart welcomed all attendees to the meeting. She particularly welcomed Ms Kay Matthews, the recently appointed Chief Operating Officer at Barnet CCG and said how much the whole Board looked forward to working with her in the future. Councillor Hart also welcomed Ms Selina Rodrigues back to the Board as Head of Healthwatch Barnet.

The Board noted that Ms Helen Pettersen, Accountable Officer at Barnet CCG and the Leader, Councillor Richard Cornelius have now joined the Board as substitute Members replacing Ms Cathy Gritzner and Councillor Wendy Prentice respectively.

The Chairman recorded the HWB Board’s heartfelt thanks to Ms Cathy Gritzner for all the progress that they had made together and looked forward to building on these achievements in the future together with colleagues across the partnership.

RESOLVED that the minutes of the previous meeting held on 9^th March 2017 be agreed as a correct record with all necessary actions having been taken forward.

Apologies for absence were received from:

·         Mr Chris Miller (Independent Chairman, Adults and Children’s Safeguarding Boards)

·         Ms Ceri Jacob (NHS England)

Councillor Helena Hart declared a personal non-pecuniary interest in relation to agenda item 7 by virtue of her son being a Consultant at the Royal Free Hospital.

Dr Debbie Frost made a joint declaration on behalf of Barnet CCG Board members, Dr Clare Stephens, Dr Charlotte Benjamin and herself, in relation to agenda items 7 and 8 by virtue of being impacted by STP proposals through their respective GP practices. 

None.

None received.

The Chairman introduced the report and noted that early intervention and prevention is a key priority of the Children and Young People’s Plan and the Joint Health and Wellbeing Strategy. She stressed its importance in pregnancy and in the early years for young families, especially vulnerable teenage mothers and their children and leaving care clients up to the age of 24.The Board was asked to note that the Family Nurse Partnership (FNP) is one of the evidenced based programmes that is commissioned by the London Borough Barnet and provided by Central London Community HealthCare Trust and is provided on a home visiting basis.

Angela Cody, Supervisor FNP at CLCH and Tunde Adewopo Senior Joint Children’s Commissioner, LBB/Barnet CCG joined the table and presented the FNP report. The Chairman also welcomed parents who addressed the Board from the residents’ perspective of the Service and spoke most movingly about their positive experiences with the Family Nurse services. The Board was told how the programme had helped the entire family, both mother and father and that as a result they had improved both their mental and physical health, progressed on smoking cessation and employment opportunities.

The Board heard about the many benefits of the programme and the Chairman highlighted the work to address the six early years high impact areas of transition to parenthood, maternal mental health, breastfeeding, healthy birth weight and nutrition, managing minor illness and reducing accidents, and supporting child development.

Dr Clare Stephens welcomed the report and queried whether the service users could be supported through a formal support group. Ms Cody informed the Board about the informal support groups in place and that the process could be overseen by a formalised support network.

The Board thanked all the residents for attending and sharing their experiences with the HWB Board and particularly commended their achievements – including the very fine behaviour of their very young sons who attended with them.

It was RESOLVED:

That the Health and Wellbeing Board noted the ongoing work of the FNP Programme Board and the long term benefits to young people and their babies across Barnet, recognising the benefits and long term cost avoidance when considering future commissioning plans.

The Chairman introduced the report and reminded the Board that the Sustainability and Transformation Plan is not a London Borough of Barnet Plan nor that of any of the other 4 Local Authorities affected by it. STPs across the Country are an NHS England requirement and have been put together by the NHS with some limited input from LA officers.

The Chairman reiterated the concerns expressed previously about the lack of public and democratic engagement and input into the development of the Plan. She also drew particular attention to - and voiced her concern over - the statements in the Forward to the Plan which drew attention to the lack of financial balance and the necessity for the Plan to redress this and the warning that difficult choices would have to be made.

She again expressed her very grave reservations as to any possible changes in services which could adversely impact on their safety and accessibility for Barnet patients.

The Strategic Director for Adults, Communities and Health, Ms Dawn Wakeling noted the challenges in relation to achieving a financial balance which will require partnership working as part of the Capped Expenditure Process. 

Dr Charlotte Benjamin highlighted the practical concerns facing health partners in terms of delivery of services with a small budget and small team.

Dr Debbie Frost, Chair of Barnet CCG noted the importance of partnership working and bringing health services commissioners together. She reiterated the benefits around CC2H plans and expressed concerns over the lack of engagement.

The Strategic Director for Children and Young People, Mr Chris Munday noted the need to reiterate the message around partnership working of different service areas. He also noted the need for a multi-disciplinary approach to jointly tackle issues early on.

The Board requested that Exhibit 2 on page 38 of the agenda be amended to highlight the partnership approach between the Local Authority and the CCG. In addition, the Board requested a change in the wording from ‘Local Authority Cabinets’ with ‘Local Authority Executives’. (Action)

Following discussion, it was agreed that a joint letter be sent from the Chairman and Vice-Chairman setting out the feedback from the Board about the challenges for service users and providers, lack of democratic engagement and capacity issues around the STP. (Action)

RESOLVED:

That the Health and Wellbeing Board noted and commented as above on the North Central London Sustainability and Transformation Plan.  

The item was introduced by the Chairman who noted that the BCF plan has been a key mechanism for delivering our vision for an integrated health and social care system for Barnet’s frail and older population since its inception in 2013.

She reiterated the overarching aim of the Plan to jointly provide integrated care and support which intervenes early, prevents crises, responds quickly and helps people stay independent for longer.

The Board noted that HWBBs this year are required to submit 2-year BCF plans. The Chairman invited Ms Wakeling and Ms Matthews to jointly present the report.

In relation to national conditions, Ms Wakeling noted that for the period 2017-19 there has been a reduction in comparison with previous years with an updated and new condition. She noted that the number of key BCF performance metrics have also been reduced.

It was noted that local areas are asked to set out in their BCF plan how they will achieve further integration by 2020 and to set out the local vision for integrated care. It was noted that this will enable each HWBB to determine the best approach to integration for their residents and patients.

The Board also noted the increased emphasis on reducing delayed transfers of care and the submission of the plan to address this.

Ms Wakeling noted that an updated draft plan will be circulated to Board members prior to submission.

Following endorsement, it was RESOLVED that the Health and Wellbeing Board:

1.    Noted the BCF requirements 2017-19; including amended national conditions and financial requirements. 

2.    Noted the progress made on implementing the integrated approach to BCF and Care closer to home.

3.    Endorsed the Barnet Council and Barnet Clinical Commissioning Group summary shared position on integrated care.

4.    Considered and supported the scope of the BCF plan (care strategy).

5.    As the submission date for the BCF plan is before the next Health and Wellbeing Board meeting on 14th September, the HWB delegated its agreement to the BCF plan being approved for submission to NHSE by the Chairman and Vice-Chairman on behalf of the full Board.

The Chairman welcomed the report which the Board had previously requested from Public Health for a detailed analysis following an item which had seemed to suggest that life expectancy gaps were increasing.

Having noted the improvement in the employment profile for young people, the Chairman commended the work of all agencies involved in supporting residents into work, particularly the BOOST teams in Burnt Oak and Childs Hill.

Dr Jeff Lake, Consultant in Public Health joined the table and presented the report. Dr Lake briefed the Board about the issues set out in the report and noted that there has been a steady improvement in life expectancy. The Board noted the drivers for health inequality which includes circulatory diseases and cancer.

Following a query from the Board about screening uptake, Dr Lake noted that the broader agenda needs to be considered which includes early screening uptake.

Dr Frost emphasised the need for a partnership approach to disseminate information about cancer screening and to improve uptake using technology and sources.

Ms Wakeling noted that Communities Together Network are in the process of launching communication to raise awareness of cancer screening.

The Head of Barnet Healthwatch, Ms Selina Rodrigues welcomed the comments and noted that information could be disseminated through Healthwatch networks. Dr Benjamin also noted that health champions within communities can be used to disseminate information. 

Dr Jeff Lake briefed the Board about the work undertaken in relation to suicide prevention including the Thrive LDN Programme. He noted that work has commenced to review the pathways that respond to suicide and the follow up on that with health partners.

Councillor Sachin Rajput welcomed the comments and also suggested making use of social and digital communication channels. He also raised awareness of the issues around different forms of cyber bullying and online harassment and intimidation which also need to be taken into account.

The Chairman thanked Members of the Board for their comments. It was RESOLVED

1.    That the Health and Wellbeing Board noted the analysis of life expectancy inequality (at Appendix 1).

2.    That the Board approved the 2017 suicide prevention report and action plan (at Appendix 2).

3.    That the Board noted the launch of the Thrive London mental health programme.

The Chairman welcomed the update report and noted that in November 2016 the Board had received its first Annual Report on the updated Strategy and had agreed a list of nine priority areas, as set out on p.191 of the agenda.

Throughout this year colleagues across the partnership have been working to deliver the actions set out in the Strategy’s implementation plan.  She noted the good progress made in most areas but  expressed her continuing concerns around screening and immunisation.

Ms Wakeling briefed the Board about the work streams being delivered and the progress made. The Board noted the actions being taken around improving employment opportunities for disabled people. She recognised that there are still some challenges around the area of screening.

Mr Munday informed the Board about the initial health assessment conducted for children and noted that 100% of the assessments have been completed in time. He noted the progress made in relation to the CAMHS programme and that a report will be coming to the Board about immunisation.

It was RESOLVED:

That the Health and Wellbeing Board noted and commented as above on the progress to deliver the Joint Health and Wellbeing Strategy (2015-2020) including Care Closer to Home.

The Chairman introduced the Report and commended the actions that have been taken to ensure that services are both responsive and accessible for all residents. She also welcomed the Guide to Good Engagement, appended to the Report, which she found to be clear, informative and extremely readable and invited all partners to support its use. The Chairman also thanked everyone involved in organising the Annual Engagement Summit on 6^th July which she had attended together with Cllr. Alison Cornelius and Cllr Graham Old, Chairman and Vice Chairman of the HOSC.

The Chairman welcomed the Assistant Director for Community Wellbeing, Mr James Mass and Ms Ella Goschalk, Engagement Lead Community Wellbeing, to present the Report. Mr Mass noted the transfer to the new structure and the positive reception of the engagement events both by service users and their carers. Ms Wakeling also noted the work streams which serve residents across the system and encouraged participation from all interested colleagues

RESOLVED:

1.    That the Health and Wellbeing Board noted the progress made to date as part of the Adults and Communities Engagement Strategy.

2.    That the Health and Wellbeing Board continues to support and champion engagement activity in social care and health.

3.    That the Health and Wellbeing Board noted and commented as above on the completed Guide to Good Engagement and support with its dissemination and use.

The Chairman introduced the item and noted the extremely positive reception given to the HWB’s public awareness campaign to reduce the prevalence of Shisha smoking in the Borough.

She congratulated the Public Health and Communications teams on the success of this programme - which included 35% of respondents reporting that they had stopped smoking Shisha as a result of seeing the campaign.

It was noted that over 4000 students had engaged in this Campaign and that over 80% felt more aware of the risks, with just under 80% saying they would consider not smoking Shisha in the future.

The Board noted that the Shisha Awareness Campaign ‘The Truth Behind the Smoke’ has been shortlisted for a Public Sector Communications Award.

The Chairman welcomed Ms Natalia Clifford, Consultant in Public Health to join the table. Ms Clifford presented the report and spoke about the extensive coverage of the campaign and the substantial level of engagement.

Following a query from the Board about visits to Shisha premises, Ms Clifford also noted that repeat visits to premises will continue and that all available tools will be utilised to ensure that legislation and licensing objectives are complied with.

The Chairman commended the report. It was RESOLVED:

1.    The Health and Wellbeing Board noted the successes of joined up activities to highlight the health risks associated with smoking shisha to the target audience.

2.    The Health and Wellbeing Board acknowledged the findings of the shisha evaluation report and supports the implementation of key recommendations.

3.    The Health and Wellbeing Board noted that further work on shisha will be taken forward by Smoking Prevention Working group for Barnet.

The Chairman noted the standing item on the agenda and the minutes from the meetings of JCEG in February and April as well as the updated Terms of Reference for the JCE CC2H Programme Board and minutes from its meeting in April and May.  

The Board agreed and approved an amendment to recommendation 1 to read:

That the Health and Wellbeing Board, subject to the agreed amendments to procedure and CCG personnel updates, to be inserted by the Strategic Director for Adults, Communities and Health and Barnet CCG COO,  approve the Joint Commissioning Executive Care Closer to Home Programme Board Terms of Reference (appendix 1).

RESOLVED:

1.    That the Health and Wellbeing Board, subject to the agreed amendments to procedure and CCG personnel updates, to be inserted by the Strategic Director for Adults, Communities and Health and Barnet CCG COO,  approved the Joint Commissioning Executive Care Closer to Home Programme Board Terms of Reference (appendix 1).

2.    That the Health and Wellbeing Board approved the minutes of the Joint Commissioning Executive Group meetings of 20 February 2017 (appendix 2) and 25 April 2017 (appendix 3).

3.    That the Health and Wellbeing Board approved the minutes of the Joint Commissioning Executive Care Closer to Home Programme Board of 27 April 2017 (appendix 4) and 18 May 2017 (appendix 5).

The Board noted the items on the Forward Work Programme for 2017-18. The Board agreed to include an item for the November meeting on:

·         The Development of Care Closer to Home Integrated Networks (CHINs) in Barnet

RESOLVED:

That the Health and Wellbeing Board considered and commented on the items included in the Forward Work Programme (see Appendix 1).

None.