Agenda and minutes

Councillor Hart, the Cabinet Member for Public Health, welcomed the members of the Board and thanked them for their attendance.

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

Apologies for absence were received from:

John Morton (Barnet Clinical Commissioning Group)
David Riddle (Barnet CCG)

There were none.

No public questions were submitted.

Kate Kennally, the Strategic Director for Communities at LB Barnet, informed the Board that the application of the Better Care Fund has been taken into consideration alongside the CCG’s 2 year strategic and 5 year draft plans and the Council’s Medium Term Financial Strategy. Ms Kennally noted an examination of the BCF plan would enable the Board to gain a better understanding of the financial pressures within the system and the challenges ahead. The Board noted the importance of implementing a sustainable Health and Social Care Strategy as part of the preparation for the challenges ahead and to assess the efficiency of the proposed strategies.

Resolved that the Board duly noted the minutes and discussions of the Financial Planning Group meeting on 10 February 2014

Councillor Hart commended the preparatory work for the Better Care Fund item and noted the importance of reviewing the final draft of the BCF report prior to submission to NHS England by 4 April 2014.

The Adults and Communities Director Dawn Wakeling updated the Board on the revised version of the Better Care Fund. The Board heard that the BCF is likely to be updated prior to submission to NHS England by 4 April 2014. Ms Wakeling updated the members of the Board on the feedback received from NHS England and the Local Government Association following submission of the draft BCF on 14 February. The Board heard that the feedback has been very positive and complimentary in relation to the vision and aspiration set out in the draft plan.

Ms Wakeling informed the Board of the details of the draft BCF, highlighting the affordability of the new model of care, from high-cost institutional care through to more community based approaches. A 5-tier model has been drafted (page 58: table 1) to support the submission of the revised plan, detailing the cost of the services for the BCF model. Ms Wakeling noted that the draft version of the Plan will incorporate the discussed amendments in order to strengthen the Plan and increase confidence in its deliverability.

Dawn Wakeling updated the Board on the legislation needed to ensure that the Disabled Facilities Grant can be included in the Fund. Ms Kennally informed the Board that the transfer of funding from the NHS to the Council would engage Section 256 of the NHS Act 2006 during 2014/15.

Councillor Hart noted that self-management and self-care will be key areas underpinning the success of the draft Plan in order to maximise wellbeing and independence. Ms Wakeling noted that in terms of implementing the Better Care Fund model, Public Health has agreed the lead role around tier 1: Self-Care. Dr Andrew Howe (Public Health) informed the Board that lessons from a stakeholder workshop will be taken forward by Public Health in order to develop a strategy for new self-care programmes.

Dawn Wakeling noted that Barnet Clinical Commissioning Group is working towards a shared approach around commissioning and contracting in the acute sector with other CCG’s in North and Central London.

The Head of Healthwatch Barnet, Selina Rodrigues noted the development and effective co-ordination of the Better Care Fund. Kate Kennally stated that under the Council’s new committee structure, the Adults and Safeguarding Committee will take responsibility for Adult Social Care. Further decisions about adults’ social care contributions into the Integrated Care model will be need to be taken by the new Adults and Safeguarding Committee.

Ms Kennally highlighted the importance of understanding the size of the financial challenge in order to work towards achieving a 15% activity shift over a 5-Year period. It was emphasised that this can be achieved through re-shaping parameters around the ‘core’ model and by bringing resources together. The Strategic Director for Communities noted the need to understand the risk linked to  ...  view the full minutes text for item 6.

Dr Debbie Frost, Chair of the Barnet CCG, presented the item and updated the Board on the NHS England strategic planning process and the development of Barnet CCG’s 5 year delivery plan. It was noted that the two planning documents are required to be prepared by healthcare service commissioners and that they supplement the provisions of the Better Care Fund plan.

Resolved that:

1) The Board notes the update in the report on Barnet CCG’s strategic planning.

2) In light of the planning process of NHS England, the Board signs-off the final plans in June 2014.

Councillor Hart welcomed Lee Bojtor and Mary Sexton of Barnet, Enfield and Haringey Mental Health Trust and Temmy Fasegha, Joint Commissioner for Mental Health, at Barnet CCG & LB Barnet. The Chairman referred to section 10.3 (p88) of the report and requested that the minutes be re-worded to ‘the CQC report was published on 23 November 2013 and the Trust was found to be non-compliant against 3 of the 5 domains of essential standards of quality and safety.’

Councillor Hart queried whether Barnet, Enfield and Haringey Mental Health Trust are on course to be compliant with the essential quality standards and whether learning has been applied across the Trust. Mary Sexton, the Director of Nursing, Quality and Governance at Barnet Enfield Haringey Mental Health Trust highlighted that for each area of non-compliance, an action plan has been drafted to deliver progress against all standards and that measures have been taken to address the quality concerns raised. 

Ms Kennally raised concerns over the use of seclusion rooms as bedrooms for overnight emergency admissions. Ms Sexton informed the Board that in addition to safeguarding measures, the Trust has purchased additional capacity in order to address the bed pressures which have resulted from increased acute admissions in 2013/14.

Selina Rodrigues, Head of Healthwatch Barnet, queried what assurances have been given in response to the quality concerns raised in the CQC reports. The Board heard that in the current financial year, the increased acute admissions were expected to create additional funding pressures on the availability of inpatient beds and increased use of out-of-beds from the private sector.

Ms Sexton highlighted that the Clinical Quality Review Group (CQRS) continues to monitor the situation to assure that the community pathways are working effectively and that the current reduced capacity in Tier 4 services is not affecting local residents in accessing local services.

Ms Kennally emphasised the importance of reviewing the findings and lessons learnt from the CQC inspections to ensure that there is clarity of expectations across the Trust as to the actions being undertaken and to monitor the progress going forward.

Lee Bojtor, Chief Operating Officer at Barnet, Enfield and Haringey Mental Health Trust informed the Board of the discussions with the CCGs care provision and the development of the mental health strategy in order to improve service quality.

The Joint Commissioner for Mental Health at Barnet CCG & LB Barnet, Temmy Fasegha noted the need to consult with the wider community in terms of the implementation of the CQC action plan. The Board noted the importance of focusing efforts to improve the quality of care for patients.

Dawn Wakeling highlighted the development of the plans to pilot an Integrated Primary Care Mental Health model, which aims to increase the capacity and capability of primary care to manage mental health care and treatment in order to drive improvements through the system. Dr Benjamin informed the Board that a formal evaluation of the pilot will be undertaken in order to inform future commissioning arrangements  ...  view the full minutes text for item 8.

Dawn Wakeling, Adults and Communities Director at LBB introduced the item and updated the Board on local progress made towards achieving the priorities set out in the Concordat since the previous report in September 2013. It was noted that the Concordat requires local health and care commissioners to have reviewed hospital placements for people with learning difficulties and to support anyone inappropriately placed in hospital to move to community-based support by beginning of June 2014.

Ms Wakeling informed the Board that the number of Barnet patients with learning disabilities within the scope of the Concordat has been reduced from 17 to 12 since the last report was made to the Board. Councillor Hart highlighted that this number should be viewed comparatively to other London Boroughs.

The Board heard that despite significant progress, challenges remain in achieving the objectives of the Concordat to reach a state of full compliance by 1 June 2014. A number of patients are mandated to undergo treatment which may only be provided in a hospital setting, under the Mental Health Act. It was noted that some patients are subject to Court of Protection proceedings which have resulted in delays in the progress of these cases.

Councillor Sachin Rajput noted the need to scrutinise and review of community-based services. Councillor Hart emphasised the importance of regular reviews to ensure that moves from hospital settings take place safely and as quickly as possible.

Action: Ms Wakeling to review the implementation of the principles and objectives set out in the Concordat

Resolved that the Board notes the progress made towards achieving the Concordat objectives since the 2013 Report to the Board and to ensure the implementation of the principles set out in the Concordat

Ray Booth, the Chief Executive of Barnet Mencap introduced the report and highlighted the recommendations from the research in to the needs of people with learning disabilities using health services. The Board noted that all participants in the focus group indicated that health care professionals are not meeting the communication needs of individuals. Following the key findings from the research, Mr Booth stated the need for health care professionals to create an easy to read summary of the appointment and to provide people with a feedback form after every appointment for monitoring purposes.

Councillor Hart noted that in consultation with Dr Benjamin a written request will be sent regarding the appointment of the Acute Liaison Nurse, addressed to the Chief Executives at Finchley Memorial Hospital and Royal Free Hospital in order to bridge the gaps in the breakdown of communication between health professional and people with learning difficulties. (Action: Claire Mundle, Dr Charlotte Benjamin)

Ms Kennally noted that the Board welcomed the recommendations in the report and requested that the Board considers next steps to ensure that lessons are taken forward to help deliver quality and efficient service for people.

Resolved that the Health & Well-being Board notes the key findings and recommendations set out in the update report.

Resolved that with the addition of a final recommendation for a letter with regard to the Acute Liaison Nurse, the Board notes the recommendations for the posts of Acute Liaison Nurse and Health Facilitator for Learning Disabilities.

Dr Andrew Howe presented the Sport and Physical Activity Strategy and Opinion Research Services (ORS) Consultation Report. Dr Howe highlighted that the aim of the Strategy is for the Barnet population to be more physically active and that the Borough provides excellent opportunities for sports development and physical activity.

Action: for Dr Andrew Howe to update the Board on the effective use of parks and green spaces for physical activity and exercise

Dr Clare Stephens, Barnet CCG Board Member, noted the importance of promoting outdoor activities and the effective use of parks and green spaces for exercise. Dr Stephens requested that the Board considers consulting with management of parks to encourage options for use of tarmacked paths and earlier opening times as an incentive to promote physical activity throughout the year.

Action: for Dr Clare Stephens to receive a full report pack of the Barnet SPA Strategy.

Councillor Hart noted the plans to increase the number of volunteers, coaches and clubs participating in the various schemes and to develop the Fit and Active Barnet (FAB) as an umbrella brand to support the implementation of the sport and physical activity strategy.

Councillor Reuben Thompstone welcomed the report and highlighted the need to work together with schools across the Borough to raise the profile of the range of outdoor activities and to inform young people about nutrition. Kate Kennally noted that the Board will receive the final Strategy statement and delivery plans at the meeting in June 2014.

Resolved that the Board considers the comments on the SPA Strategy statement in light of the Consultation on Leisure Services Summary.

Councillor Hart informed the Board that following the Local Elections, the Council will move to a Committee system of governance, which is due to come into place from Annual Council on 2 June 2014.

Ms Kennally suggested to the Board that a special away day may be planned between June and July 2014 to allow for discussion in relation to the change in the Council’s governance structure. This will be an opportunity to inform the Board members of the implementation of the new arrangements. The Forward Work Programme will include a key item on the CCG Strategic Plan.

There were none.