Agenda and minutes

Selina Rodrigues, Healthwatch Barnet, asked that the minutes of the previous meeting be changed to reflect that she was in attendance rather than Julie Pal.

RESOLVED that the minutes be amended to reflect Selina Rodrigues’ attendance.

RESOLVED that the minutes of the Health & Well-Being Board meeting held on 21 November 2013 be agreed as a correct record.

Councillor Hart, the Cabinet Member for Public Health, welcomed Andrew Travers, Chief Executive of Barnet Council, to the Meeting.

Dr Debbie Frost introduced herself as the new Chairman of Barnet CCG, having taken on the role from Dr Sue Sumners. Dr Frost thanked Dr Sumners for all that she had achieved during her time as Chairman and recognised the work she had put in to developing the shadow Health and Well-Being Board.

Apologies for absence were received from:

Dr Andrew Howe

Councillor Sachin Rajput (Councillor David Longstaff substituting)

Dr Charlotte Benjamin

Paul Bennett

There were none.

No public questions were submitted.

Councillor Hart, Chairman of the Health & Well-Being Board, welcomed the members of the Barnet, Enfield and Haringey Mental Health Trust Board and thanked them for their attendance.

Councillor Hart had brought this item to the Board due to her concerns over the quality and safety issues at Barnet, Enfield and Haringey Mental Health Trust highlighted in the Care Quality Commission report issued in November 2013.

In response to the Care Quality Commission (CQC) report, Ms Kennally advised that actions had already been taken to address the quality and safety issues faced by Barnet, Enfield and Haringey (BEH) Mental Health Trust. Members of the Health and Well-Being Board, and other senior colleagues in the Council and CCG, met with the Mental Health Trust on the 17^th January 2014 to discuss their concerns. Ms Kennally explained that the discussion had been productive, but that the group acknowledged there were a number of systemic challenges that need to be addressed. Ms Kennally emphasised the importance of Health & Well-Being Board being able to seize the opportunity to work with the Trust to improve quality issues.

Mary Sexton, Director of Nursing, Quality and Governance at BEH Mental Health Trust, advised that the Trust has taken steps to address the concerns expressed in the recent CQC report and that it is heading in a positive direction. Ms Sexton updated the Board on the changes made over the last 18 months through addressing issues with staff skills and competencies (including discussions with the local university to explore options for re-focusing training), changes to the clinical leadership in the Trust (increasing the presence of medical leaders on the wards) and actions towards raising standards (including increasing staff rotations on wards).

Ms Sexton highlighted that the changes made to the managerial leadership will take time to be fully implemented and that the level of expectation from staff has risen over the last 18 months. Ms Sexton also noted that staff have been provided with training in response to the issues raised in the Care Quality Commission.

Ms Sexton acknowledged the long-standing concerns with the quality of care provided at the Oaks Ward but expressed confidence with the extensive quality improvement work undertaken to address these issues over the last 6-9 months. She said that positive changes on the ward were evidenced in the CQC reports.

She also acknowledged that the level of learning on other wards had been lower than on the Oaks, and explained that a nurse consultant was now leading a tight implementation plan to secure improvements in the quality of care on these wards by the end of February. She explained that the Trust was working closely with the CQC on this and will be in a position to report back on progress in March. She accepted the Trust needed to ‘do better’.

Dr Jonathan Bindman, Medical Director at Barnet Enfield and Haringey Mental Health Trust informed the Board of the plans to recruit a substantive consultant in order to ensure there was the right  ...  view the full minutes text for item 5.

Vivienne Stimpson introduced this item. She noted that the Francis Report highlighted the importance of ensuring that systems work together to improve quality of care. Ms Stimpson explained that the CCG was working to improve the way it receives and analyses complaints. Ms Stimpson also updated the Board that Barnet CCG is taking a number of steps to improve its quality assurance processes with providers, such as reviewing services from different viewpoints, and adapting relevant job descriptions for new staff. Ms Stimpson also highlighted that Barnet CCG is keen to share its intelligence with the Board and key partners.

Councillor Hart noted that during the early discussions of the Francis Report, the Board had received assurances on the implementation of the main recommendations from that report. Councillor Hart expressed concerns over the feedback of poor patient experience at Royal Free Hospital. Councillor Hart  noted that Healthwatch have now initiated hospital visits and that in light of the number of Barnet residents who are treated at Royal Free Hospital,  their feedback on patient experience was critical to the Board.

Selina Rodrigues stressed that Healthwatch is planning to collect as much data as possible on patients’ experience of services. She explained that Healthwatch will begin hospital visits at Barnet and Chase Farm but is aware of the importance of working with the Royal Free Hospital too.

Ms Stimpson informed the Board that the Commissioning Support Unit has been developing a patient feedback dashboard for the CCG, which is looking good. It will be populated from Clinical Quality Review Group meetings and individual Trusts. Ms Stimpson also talked about the increase in “walk through” exercises taking place, and explained that where possible patient information is made available to staff prior to the exercise. Ms Stimpson said the CCG was working with the CSU to explore the collection of ‘real time’ data. Ms Stimpson welcomed this as a great opportunity to engage with patients and to work with providers in a co-ordinated way.

Kate Kennally thanked Ms Stimpson for her report and stressed the importance of moving forward with positive leadership in order to deliver assurances on quality and safety issues. Ms Kennally questioned how the 2014 quality accounts that will be going to the Health Overview & Scrutiny Committee will be informed by these plans. Ms Stimpson explained that the CCG are trying to prevent quality accounts from being a provider led process, by asking the accounts to be presented at the Clinical Quality Review Group on a quarterly basis. This will ensure that when the CCG Board assures the Quality Accounts, they have a closer understanding of the issues. Ms Kennally suggested it would be helpful for the CCG to give advice to the Health Overview & Scrutiny Committee so as to stitch together discussions by local Councillors and local clinical professionals about health care quality in the Borough.

Councillor Reuben Thompstone, Cabinet Member for Education, Children and Families, emphasised the importance of the new duty of candour in improving service quality. Ms Stimpson  ...  view the full minutes text for item 6.

Councillor Hart welcomed the report and congratulated Healthwatch Barnet on their achievements in ensuring that the experiences of vulnerable communities are heard and represented.

Selina Rodrigues presented the report and explained that Healthwatch Barnet is meeting all of its contractual targets. Ms Rodrigues outlined plans to continue to support the Council’s Care Quality Team with Enter and View visits, to ensure as many care homes as possible are reviewed. Ms Rodrigues explained that the Enter and View visits will be extended to hospitals from February, starting at Barnet and Chase Farm Trust. Ms Rodrigues also explained that Healthwatch would be referring their Enter and Visits to the Mental Health Trust to the Health Overview and Scrutiny Committee. She said that Healthwatch would be happy to take forward further Enter and View visits in mental health services, to support the Board assess the quality of these services in Barnet.

Ms Rodrigues highlighted the work Healthwatch is doing to support improvement of patient feedback services at GP surgeries. Selina Rodrigues welcomed the opportunity to consult with CCG Barnet on effective engagement plans, to avoid duplication of work and concentrate on outcomes and monitoring of feedback from patients. Ms Rodrigues explained that Healthwatch Barnet is working with partners to understand any redesign of services and how to involve patients in the redesign of services.

Ray Booth, CEO at Barnet Mencap, noted the charity’s current plans to enable a better understanding of the issues affecting the care of people with learning disabilities. Mr Booth expressed concerns over the relatively high percentage of patients reporting poor experience. Patient feedback showcased frustration experienced by patients in understanding results and decisions of consultation visits, prompting the introduction of user friendly feedback forums and summary of decisions notices. Mr Booth explained that he would be bringing a full report on this issue to the Health and Well-Being Board meeting in March.

Councillor Hart asked whether there is a strategy in place for improving meaningful communication with ethnic minority communities. Councillor Hart requested that Healthwatch fully engage with organisations such as Sangam and work with them to access hard to reach groups. Selina Rodrigues informed the Board that Healthwatch Barnet continues to work on improving engagement with members of ethnic minority communities within the planning for Year 2.

Ms Rodrigues highlighted that health and social care providers needed clearer forward plans for working together with Healthwatch and for Chase Farm to actively promote usage of complaints and feedback process.

Dr Frost noted the success achieved by Healthwatch Barnet for its consultation and engagement with service users, and noted that it is essential that all care providers work together more closely and to share intelligence and feedback. Dr Frost asked Healthwatch to share its complaints information with the CCG so that they could include it in their GP bulletin. (Action: Ms Rodrigues)

Councillor Longstaff queried whether additional factors will be taken into account in gathering feedback from respondents. Ms Rodrigues informed the Board that factors such as age and disability  ...  view the full minutes text for item 7.

Mathew Kendall updated the Board on the contract management of Healthwatch Barnet by the Adults and Communities Department at Barnet Council. He explained that Healthwatch and the contract managers had been focusing on getting structures and activities in place to support delivery of the contract. Mr Kendall explained that he would ensure Councillor Hart’s comments were taken on Board.

Julie Pal requested that papers from the contract managers should in future ensure that the reference in paragraph 4.1 to the status of Community Barnet is accurate.

RESOLVED that the progress of Healthwatch Barnet be noted.

The minutes were noted by the Board.

RESOLVED that the Board duly noted and approved the Minutes of the Financial Planning Sub-Group of 13 December 2013.

Dawn Wakeling presented the working draft of the Better Care Fund plan. The name of the fund has been changed to Better Care Fund from the Integration Transformation Fund. For 2014/2015 the core fund of £6.6m has been allocated for Barnet for funding schemes including: Prevention, Older People’s Integrated Care, Ageing Well and Campus re-provision. Ms Wakeling updated the Board that the BCF fund for 2015-2016 amounts to £23,412M which includes additional funding from the NHS.

Ms Wakeling invited the Board to provide comments and feedback prior to submission of the draft BCF Plan to NHS England by 14 February 2014.

In terms of the submission of the final plan, Ms Wakeling agreed to submit the final draft BCF Plan to the Health and Well-Being Board meeting on 20 March 2014 and for any amendments to be signed off by the Chairman.  (Action: Dawn Wakeling)

Ms Wakeling invited the Board to note the investments that will feed into tier (ii) of the integration model between Barnet Council and CCG for delivering integrated care across Barnet. Ms Wakeling asked public health to confirm their investment figures for 2014/15 that would support delivery of the model. (Action: Jeff Lake)

Ms Wakeling emphasised that most of the BCF is not new or additional resources, but the reallocation of existing service provision budgets to a new pooled budget format.

For 2014/15, Ms Wakeling noted that budget monitoring of Council and CCG spend will include reviewing the entire system of total spend for Older People, Prevention, Carers, Learning Disabilities and Continuing Health Care. For 2015/16, Ms Wakeling indicated that the aim is to have a fully integrated/ aligned fund for the model.

Ms Wakeling also indicated that in additional to the five nationally proposed performance indicators for spend of this money- around permanent admissions, discharge proportion of older people and delayed transfers of care from hospital- a local measure will need to be chosen as metric from the relevant Outcomes Framework.

John Morton invited the Board to provide feedback on the Metrics and Performance Indicators. Mr Morton suggested that ideally the metric should be a social care metric, or a measure which reflects the social care level in the community. Mr Morton highlighted the need to cover children’s services in the metrics where appropriate.

Councillor Hart asked for guidance on choosing the most appropriate and useful metric for Barnet residents.

Ms Wakeling noted the need to review any additional metrics for the final report. (Action: Dawn Wakeling)

Kate Kennally emphasised the importance of considering whether children services commissioning should be included in the final draft prior to submission of the final plan to NHS England by 4 April.

Dr Debbie Frost concurred with the views expressed over the importance of having patients involved.

Andrew Travers welcomed the plan and encouraged the positive nature of discussions on co-operation between the Council and CCG on wider issues around health and adult social care. Mr Travers highlighted that as a partnership, the challenge is to focus on the  ...  view the full minutes text for item 10.

Dr Jeff Lake (Public Health, substituting for Dr Andrew Howe) noted the Public Health principles outlined in the Commissioning Intentions Report such as primary prevention, intervention in early years and supporting elderly people as the basis for a highly effective strategy for helping people live healthier lives and reduce their need for care. 

Dr Lake outlined the new areas for investment for 2014-15. Dr Lake emphasised the broader programme of supporting individuals affected by welfare reforms into work in conjunction with other Council initiatives (at page 105). Dr Lake noted that further broader strategies are needed for effective alcohol intervention and alcohol treatment services. Dr Lake finally noted the particular focus in 2014-15 on physical activity promotion through the Fit and Active Barnet campaign.

The Chairman noted that alarming reports had been received focusing on the increasing use of Shisha (water pipes) and its effects on health, particularly pertaining to the risks of spreading tuberculosis. The Chairman noted the need for a comprehensive Health Campaign informing of the health risks of smoking Shisha, involving promotional materials and effective tobacco information campaigns.

Councillor Hart noted the plans for further investment in Outdoor Gyms in 2014-15 and highlighted that more work is needed to promote physical activity in order to combat health risks associated with obesity.

David Riddle queried whether the figures in the budget plan (at page 106) represent any changes in comparison to the previous year, based on current trends in performance. Mr Riddle noted the importance of transparency in relation to the published figures for 2014-15 budget. Dr Jeffrey Lake advised that the aim is to achieve better outcomes through increased provision in area of Health Checks, continued provision in the area of tobacco control, and new investment to provider universal activities to tackle obesity. Dr Lake also explained that the public health team and CCG were working together to design a targeted obesity offer.

Dr Lake informed the Board that media attention and concerns regarding increased use of tobacco products will be followed up in the meeting with Tobacco Alliance. The lessons and action plans from the meeting will be shared with Board.

Dr Debbie Frost informed the Board that providers are currently trying to establish the extent of alcohol problems, with particular focus on excess alcohol consumption and misuse of alcohol. Dr Lake noted the need to work with Barnet CCG in order to generate solutions to tackle alcohol misuse.

Dr Clare Stephens, Barnet CCG Board Member, noted the high proportion of cancer diagnosis figures attributable to smoking. Highlighting the health risks related to smoking, Dr Stephens noted the need for an action plan to control the number of venues that are providing shisha.

Kate Kennally concurred and outlined the need for dialogue around shisha usage and information campaigns in schools and colleges. Dr Stephens queried whether public health funds could also be used to increase participation in cancer screening, in particular screening for breast cancer.  

Kate Kennally highlighted the challenges around increasing physical activity rates  ...  view the full minutes text for item 11.

Dr Jeffrey Lake introduced the JSNA item asking the Board to accept the amended JSNA reports. He explained that these had been revised following discussions with CCG clinical leads. He also explained that the Public Health team will be establishing a JSNA Programme Board to continue working in partnership to develop Needs Assessments in future. Dr Frost noted the quality of the reports and thanked the Public Health team for their co-operation with the CCG to provide analysis of local issues.

Dr Lake explained that the value of having a Programme Board across the Boroughs of Barnet and Harrow is critical for ensuring efficiencies are made by the team and that intelligence relevant to both Boroughs is shared effectively. He reassured the Board that the JSNAs would continue to be Borough specific despite the establishment of a shared Programme Board.

Dr Lake noted the need to review the way in which the JSNA supports the working of the Health & Well-being Board and to identify areas for further assessment and scrutiny.

RESOLVED that the Board accepts the recommendations and final reports, and notes the actions to further refresh the JSNA.

John Morton introduced the item and noted that commissioners are required to prepare a two-year operational plan, commencing in 2014/15. Mr Morton advised that the two-year operational plan for Barnet will follow. Mr Morton also explained that CCGs are required to work on a longer footprint too, and will be asked to produce 5 year Strategic plans this year. Mr Morton emphasised the importance of working together on strategic issues for best value and to incorporate previous discussions on the Better Care Fund in the CCGs longer-term plans. The Chairman concurred with the points expressed.

RESOLVED that the Board notes the requirements on Barnet CCG for the development of the operational and strategic plans.

Dr Debbie Frost introduced the CCG’s Primary Care Strategy, noting the importance of good partnerships. Dr Frost emphasised the benefits for GP surgeries to work together and extend learning through peer review. Dr Frost also noted that electronic systems could be used to enable options such as safer and easier electronic prescriptions and utilising text messaging services as appointment reminders.

The Chairman concurred with the views expressed and noted that text messaging services could ideally be used in saving resources and time.

Selina Rodrigues welcomed the development of the GP networks and requested that the CCG forward on further details about these to Healthwatch so they can promote the primary care services available (Action: Debbie Frost)

John Morton advised the Board that Barnet CCG is implementing plans to support GPs in lower level administrative tasks in order to allow practitioners to focus on complex patient responsibilities.

John Morton also advised that the CCG and Public Health team would be submitting a response to the NHS England Call to Action consultation. Selina Rodrigues informed the Board that Healthwatch would also be submitting a response to this Consultation.

RESOLVED that the recommendations of the report are agreed by the Board.

The Chairman noted that following the Local Elections in May 2014, the move to a new committee system of governance will be implemented. A new Calendar of meetings is being drafted and there will no meetings planned in May- it is therefore important to capture all items for discussion in the next meeting of the Health & Well-Being Board on 20 March 2014.

RESOLVED that the Board reviews the scheduling of agenda items for the next Health & Well-being Board meeting on 20 March 2014, in light of local elections taking place in May 2014.

Mr Morton provided an update on the acquisition of Barnet & Chase Farm NHS Hospitals Trust by the Royal Free Hospital London NHS Foundation Trust. He explained that the Royal Free Trust Board had decided to proceed with the acquisition and would be submitting a full Business Case to Monitor. Mr Morton explained that each CCG involved in the acquisition would need to decide individually whether they are supportive of this acquisition or not.