Agenda and minutes

The Chairman, Councillor Helena Hart welcomed all attendees to the March meeting of the Health and Wellbeing Board. Speaking on behalf of the Board, the Chairman placed on record the gratitude and appreciation to Dr Andrew Howe for all his sterling work as Director of Public Health for the Council and the CCG and wished him every happiness and success in the future.

The Board was informed by the Chairman that all the actions from the previous minutes were taken including the requested amendments to the Smoking Cessation Strategy and to the Update on the Delivery of the Prevent Agenda in Barnet.

Ms Kay Matthews Chief Operating Officer for Barnet CCG, noted a correction on page 7 of the minutes to read: Ms Matthews spoke about the work delivered and noted that the CCG as a statutory body will review the proposal at its Governing Body meeting and take the decision on next steps.

It was RESOLVED that subject to the correction referred to above, the previous minutes of the Health and Wellbeing Board be approved as a correct record.

Apologies for absence were received from:

·         Councillor Sachin Rajput

·         Ms Ceri Jacob

Dr Debbie Frost made a joint non-pecuniary declaration on behalf of Barnet CCG Board members; Dr Clare Stephens, Dr Charlotte Benjamin and herself, in relation to Agenda Item 11, by virtue of being impacted through their respective GP practices.

Councillor Helena Hart declared a non-pecuniary interest in relation to Care Closer to Home - which is referred to under Item 11 and includes reforms to Secondary Care, by virtue of her son being a Consultant at the Royal Free Hospital which could be affected in the future by any such reforms.

None.

None were received.

The Chairman introduced the item which had previously been requested by the Board. She emphasised the importance the Board places on screening and the vital role it plays in early detection and prevention of disease.

The Board noted the importance of this message being disseminated to all sections of the Barnet community and the necessity to try and ensure far greater take up. To this end, the Chairman welcomed the work currently being done with the Communities Together Network to address take up – particularly in the diverse communities in Barnet.

The Chairman referred to her previously expressed concerns regarding the range, availability, accessibility and take up of cancer screening.

Bearing in mind the pivotal role that cancer screening plays in identifying the early signs of this devastating disease in otherwise healthy people and the opportunities thereby presented for suitably effective treatment, the Chairman expressed her concerns that approximately one third of eligible patients for breast and cervical screening and over a half of patients eligible for bowel screening are not being screened. The Chairman also noted that the true figures are not known as there is a real lack of clear reporting arrangements.

The Board welcomed Dr Jeff Lake, Public Health, Dr Shona Ash, Commissioning Manager Antenatal & New born Screening, NHSE.

The Chairman asked Ms Shona Ash, NHSE to outline the actions they are taking to improve take up and the dates those actions will be completed. She also asked Dr Jeff Lake to comment on the actions and set out when the reporting problems will be resolved.

The Chairman also asked Dr Lake to comment on childhood and new born screening and whether there were any recommendations as to how these might be taken further.  

Ms Shona Ash delivered a presentation to the Board and spoke about the Antenatal & New born (ANNB) KPIs. Ms Ash referred to the processes put into place and noted that there are some challenges within certain groups in Barnet with regards to uptake. She spoke about the work being done to work with various groups in Barnet to improve uptake in screening.

The Strategic Director for Children and Young People, Mr Chris Munday referred to the information in the appendix to the report and noted that data refers to the NCL area.

It was requested that in the future where possible, data be included for Barnet specifically across all indicators so that comparisons can be made in relation to any improvements and changes in uptake figures. (Action)

Dr Lake referred to the previous discussions held by the Board which have emphasised the need for consistent reporting and addressing of low take up figures.

The Chairman invited Dr Catherine Heffernan, Principal Advisor for Commissioning Immunisations and Vaccination Services to the table. She noted that data tends to be very high at programme level rather than at borough level.

She emphasised that in comparison to other areas, London is good in terms of uptake and coverage but that performance at national level has  ...  view the full minutes text for item 6.

The Chairman welcomed the update report on the progress of the Barnet Children’s Services Improvement Action Plan. Referring to the second monitoring letter, she noted that it stated that “the Local Authority is continuing to progress and consolidate recent improvements to services for children and young people seen during the first monitoring visit. Senior leaders and managers are appropriately focused to improve and embed good quality social work practice”. 

Whilst this was a positive message in the right direction, the Chairman noted that there still remains a lot of work to do and she was concerned that while OFSTED found that “Strategy discussions are timely – although the quality of these remains variable. While inspectors note improvements in police attendance at strategy meetings, the attendance of health professionals is still inconsistent”.

She invited Mr Munday to comment on this and highlight some of the discussion points held at the previous Children, Education, Libraries and Safeguarding Committee meeting on 7^th March.

Mr Munday presented the fourth Update report on the progress of Barnet Children’s Services Improvement Action Plan. He noted the significant improvements made in various areas. The update on progress is divided into the seven improvement themes in the action plan.

He informed the Board about the monitoring visit which focussed on the ‘front door’ arrangements in the Multi-Agency Safeguarding Hub (MASH), the Duty & Assessment Teams and Intervention and Planning Teams.

In response to the query raised by the Chairman, Mr Munday noted that further work is needed to improve the quality of strategy discussions which remains variable as social workers are not consistently inviting health professionals to participate.

He updated the Board about the health discussions held in January which involved health and noted the importance of ensuring that staff realise the need to involve health in strategy discussions. He emphasised the need to reinforce with social workers the regulatory requirement that health workers are involved.

In addition, he noted the importance of participation by health workers and making use of technology solutions to enable debates to happen, such as Skype for Business. He noted the improvements made and noted that further improvement is needed.

It was RESOLVED that:

1.    That the Board noted the progress of the Barnet Children's Services Improvement Action Plan as set out in paragraphs 1.4 to 1.50.

2.    That the Board noted details of Ofsted’s monitoring visit set out in paragraphs 1.11 to 1.19 and the monitoring visit feedback letter received from Ofsted attached in Appendix 1.

3.    That the Board noted the performance information provided in paragraphs 1.51 to 1.61 and Barnet Children’s Services Improvement Plan Data Dashboard attached in Appendix 2.

The Chairman introduced the report and noted that the Board is being asked to endorse this important Strategy, which aims to help children and young people with special educational needs – and disabilities achieve their full potential.

The Strategy sets clear goals for supporting children and families through integrated working, with health, education and the local authority working together. She very much welcomed the focus on integrated commissioning, inclusive education and the ambition for the best outcomes possible for children and young people with special needs.

The Chairman invited Mr Simon James, Assistant Director, SEND & Inclusion to join the meeting. She asked Mr James to comment on the lessons learnt from SEND inspection by the CQC and Ofsted that need local attention to improve outcomes for this particular group of children.

Mr James noted spoke about the preparation for the inspection and the importance of ensuring that robust governance and leadership is in place. He spoke about work done in other critical areas such as working with families and to ensure that a child’s and their family’s voice is at the centre of decision making.

Following a query from Mr Munday about the quality of the plans in place for improvement – Mr James spoke about the steps needed to improve participation and co-production with key partners, parents, families, children and young people in decision making. In relation to SEND reforms, Mr James noted that the statutory assessment system is now replaced by a 0-25 education, health and care plan. In relation to waiting times, it was noted that an update will be brought to the Board on whether waiting times have come down. (Action)

Following a query from the Board, Mr James noted that Educational Psychology provision are also deployed through schools noting the importance of the role that school plays. 

Mr Munday thanked Mr James for his efforts and engagement with partners in this area of work.

Dr Debbie Frost emphasised the need to reduce waiting times and to explore a partnership approach to work closely together. Mr James informed the Board about the monthly partnership board meetings as the relevant forum for the discussions and to consider the systematic issues.

It was RESOLVED that:

1.    That the Health and Wellbeing Board endorsed the priorities outlined in the Special Educational Needs and Disabilities (SEND) Strategy 2017-2020 for Barnet.

2.    That the Board endorsed the next steps outlined in the Special Educational Needs and Disabilities (SEND) Strategy 2017-2020 for Barnet.

3.    That the Board endorsed the recommendations of the SEND JSNA and notes that the findings feed into the SEND Strategy.

The Chairman introduced the Fit and Active Barnet Programme. She stated that due to the crucial part it plays in good physical and mental health and wellbeing, her view was that the programme should be called Fit, Active and Healthy Barnet. Levels of physical activity in the Borough have been worryingly low for many years now and so helping people to be more physically active has been a core priority both for the Joint Health and Wellbeing Strategy and across the whole Council.

This Report also sets out the good progress made to expand the opportunities available to residents. The Board at its previous meeting heard about some of the results of this with levels of physical activity improving and some 77% of over 16s now taking part in sport and physical activity.

She also stated that this report highlights that Barnet is the first Council in England to make public health outcomes key performance requirements of the leisure contract, an achievement of which, as the Chairman of the Health and Wellbeing Board and Lead Member for Public Health, she is extremely proud.  She drew particular attention to the truly excellent new range of services from the leisure centres for residents detailed in section 2.2 – particularly

·         the generous discounts and concessions for residents,

·         free swimming for under 8s,

·         the weight management schemes,

·         the Cancer rehabilitation scheme,

·         the Carers’ Pass,

·         the Community programme and

·         the Activate Healthy Lifestyle Schools programme to name a few.

The Chairman invited Ms Cassie Bridger, Strategic Lead, Sport and Physical Activity to deliver the presentation and expand on the points raised about and the significant capital investment.

Ms Bridger delivered a presentation on the Fit and Active Barnet Programme and the new leisure service contract to promote health and wellbeing. She emphasised that the leisure service contract will achieve £1.5million of average annual payment to the council and includes innovations and operator investment. The income achieved will enable the construction of the two new leisure centres.

Following a comment from the Board, Ms Bridger noted that discussions will be held to consider roll out of the Golden Kilometre initiative for adults as well as children and young people.

Ms Bridger informed the Board that the collaboration with Middlesex University will include a cross-departmental team who will evaluate the effectiveness of GLL’s programmes in supporting Barnet residents to get fitter and healthier.

The Chairman of the CELS Committee, Councillor Reuben Thompstone welcomed the report and queried when residents can apply for the 30% or 50% discounts. The Board noted that this is likely to become available from May this year.

The Board welcomed the report and requested to receive an update in 6 months and/ or 12 months depending on the availability of data. (Action: Forward Work Programme)

It was RESOLVED that the Health and Wellbeing Board considered and discussed the progress made to encourage healthier lifestyles.

The Chairman welcomed this report which is being reported to the Board at her request, following the decision of the Adults and Safeguarding Committee to progress the establishment of an Adults MASH in Barnet. This MASH is a key priority for the Barnet Safeguarding Adults Board and should be a priority for the Health and Wellbeing Board.

The Chairman invited the Board to discuss how to ensure that the health and care system in Barnet will work with the MASH and how the Board as a partnership can help the MASH be a success.

Ms Dawn Wakeling, Strategic Director for Adults, Health and Communities presented the report and noted that the MASH will go live as the Council moves its offices to Colindale. She noted that this will help the Council provide much better safeguarding services working with partners to tackle abuse and neglect.

In terms of different ways of providing services, the Board welcomed the report and expressed interest in the option to work as a virtual and a co-located team with a central coordinator linked to contacts in each organisation, facilitating the sharing of information.

It was RESOLVED that:

That the Health and Wellbeing Board commented on and endorsed the approach to developing the Adults MASH as set out within the report.

Ms Wakeling introduced the standing item on the agenda. The Board noted the details of the discussions and actions covered in the minutes of the Care Closer to Home Programme Board meetings as well as the Joint Commissioning Executive Group meeting.

It was RESOLVED that:

That the Health and Wellbeing Board approved the minutes of the Care Closer to Home Programme Board meetings of 16 November 2017 and 18 January 2018; and the Joint Commissioning Executive Group meeting of 5 December 2017.

It was RESOLVED that the Board noted the items of business on the Forward Work Programme for 2018.

Councillor Helena Hart, Chairman of the Health and Wellbeing Board made the following closing statement:

As this is not only the last HWBB Meeting of the municipal year but also of this current Council with a new HWBB to be approved at the Annual Meeting of the Council perhaps I could be permitted to make a few closing personal remarks. 

As most of you already know after a total of some 20 years on the Council and a great deal of heart searching I have finally decided to stand down – and in this case, it really is a question of spending more time with my family. There are many things I will miss but most of all the work we have managed to do together to improve the real quality of life in Barnet.

Virgil said that the greatest wealth is health but improving that health does take money and commitment and dedication. I think the work we have done as a Council, as a CCG, as Healthwatch and as individual members of this HWBB from its very inception bears testament to what can really be achieved if we all work as one. Thinking back over the last 16 years in , I remember as a newly re-elected Councillor in 2002 I had a Members Policy item to Council asking for us to institute a Healthy Catering and Eating Certification Scheme across the Borough.  Well it only took about 10 years to institute our Healthy Catering Commitment Awards but we got there in the end and it has given me the very greatest pleasure to be able to present certificates to so many different establishments over the last 5 years. 

16 years ago, our only real focus on children’s health was based on how many children were registered with an NHS dentist and how many decayed or missing or filled teeth they had – today our concentration on all aspects of Children’s Mental and Physical Health and Wellbeing is embedded across the Council. 16 ears ago we seemed to deal solely with the effects of poor mental and physical health – and all too often just recording them.  Today it is universally accepted that it is the role of every one of us to do everything in our power to educate and empower residents to avoid ill health. 

When the then Leader of the Council Mike Freer appointed me as Barnet’s very first Cabinet Member for Public Health in 2006, I had no Budget whatsoever and only goodwill for backup – hence my alternative title as Cabinet Member for nagging and spending other people’s money.  Nagging I have to say which came in very useful when negotiating for our nigh on £3 million uplift in our transferred Public Health budget. 

In closing, may I thank each and every one of you for all your patience, help, support and sheer goodwill towards me both as Chairman of the Health & Wellbeing Board and in my previous role as Cabinet Member for  ...  view the full minutes text for item 13.