Apologies for absence were received from Mr R Bekeen, Mr S Clee, Mr P Deneen and Mrs S Doheny.

Mr A Dawson for Mr R Bekeen, Mr C Merker for Mr S Clee, Mr K Andrews for Mr P Deneen and Mr B Hanford for Mrs S Doheny.

None.

To approve and sign the Minutes of the meeting held on 15 July 2014.

The Minutes of the meeting held on the 15 July 2014 were signed and approved as a correct record.

To receive questions from Members of the Public relating to matters within the Board’s Terms of Reference.

(Questions must be submitted by midday eight clear working days before the day of the meeting (ie on the Wednesday 13 calendar days before a meeting to be held on a Tuesday.))

None.

To receive a report on System Wide Transformation – The Case for Change.

The Board received a report on the System Wide Transformation Board from the Chief Executive, Herefordshire Council. During his presentation he highlighted the following areas:

·         That the Transformation Board would cover the whole Health and Social Care System in the County, and not a single part of it as the quality of services needed to be improved in order to deliver better long term outcomes for patients.

·         The transformation programme that would be drawn up would concentrate on three main areas:  improved outcomes for residents, greater efficiencies for providers and commissioners and projects and schemes that would deliver cash savings. The intention would be to drive improvements in order to release unnecessary costs in the system.  The West Midlands Ambulance Service and the Powys Teaching Health Board would also be included in order to ensure cross border engagement.

·         Progress would be reported to the Health and Wellbeing Board on a regular basis.

Councillor Millar said that he was Interim Chairman of the Transformation Board, and he felt the key was to focus on the case for change and the outcomes that were produced by the changes that were made. He concurred with comments that a multi-layered approach was needed, and said that there was a need to redesign the whole system delivery.

The Chairman said that the work of the Board should be driven by the results, and that radical change of the system was necessary.  The Chief Executive, Herefordshire Council concurred, and said that the work of the Board would be incremental, and undertaken in manageable steps that would reshape the way work was undertaken in the Health and Social Care landscape. It was noted that West Mercia Police were also undertaking a transformational programme, which would deliver initial outcomes in February 2015.

Resolved: that the development of a Health and Wellbeing system wide transformation programme be noted

To receive a report on the Better Care Fund Plan.

A report on the Better Care Fund (BCF) was noted.  The Director of Adults Wellbeing highlighted the following areas:

That in order to secure the necessary transformational change, agreed areas between the Herefordshire CCG (HCCG) and the Council would be focused upon.   These were outlined in Appendix One of the report.

The BCF had been submitted in line with national guidance and timescales but some key areas still required agreement. The minimum fund had been agreed, as had the target percentage for reduction in hospital admissions. Outstanding areas that required agreement were the Protection of Adult Social Care, Risk Sharing, Section 75 monies and the detailed implementation plan

A Ten Week Implementation Plan was in place to ensure that the areas not yet agreed were progressed. 

The outcome of the national assurance process was due to be announced by the end of October 2014, with four possible outcomes.  These were No Assurance, Assurance with Conditions, Assurance with Support or Assured

It is likely that Herefordshire would either be in the Assurance with conditions or Assurance with Support categories.

In the ensuing discussion, the following points were raised:

·         That the Health and Wellbeing Board might be expected to assume responsibility for the BCF monies, but it was not yet clear where the responsibility for performance management would lie.  It was possible that the Board could also be in charge of this.

·         That change to the guidance included a new assurance process and target reduction of 3.5% in emergency admissions.  Latitude had been included in this, as it had been felt that such changes would place undue pressures on the health system nationally.

·         That there was a specific function for the Health and Wellbeing Board to oversee the implementation of the BCF, and that this would give the Board a strong role in moving toward a prevention agenda.

·         There was a move to empower service users and the importance of personal budgets would increase not only in social care, but also in the NHS as people with complex health needs would be offered them. 

·         That whilst the BCF work predated the Transformational Board, it was one of the agents of change that the Board would be using. The BCF was changing what was happening in health and social care, and was allowing partner agencies to engage with finding alternative ways forward. 

Resolved: 

That;

a)      The summary of the revised guidance be noted;

b)     The elements of the plan agreed using the delegated powers agreed by the Health and Wellbeing Board subject to the completion of the ongoing work as required in the guidance and submission be approved;

c)      the task and finish approach for completion of further requirements and agreements be approved;

d)     the national assurance process and feedback to date was noted;

e)      authority be delegated to the Chair of the Health and Wellbeing Board, the Chief Accountable Officer of the CCG and the Director of Adults and Wellbeing as appropriate to agree further BCF plan submissions if required in November  ...  view the full minutes text for item 63.

To receive the Herefordshire Safeguarding Children Board (HSCB) Annual Report and Business Plan.

The Board noted the Herefordshire Safeguarding Children’s Board (HSCB) Annual Report and Business Plan.  The Director of Children’s Wellbeing reported that the intention was to ensure the Board was paying due regard to Children’s Safeguarding and to express views on the content and priorities of the Business Plan.  In the ensuing discussion, the following points were raised:

·         That in order to see an improvement within safeguarding, the HSCB would need to be more proactive.

·         The HSCB had ensured  the programme, had an ongoing focus on safeguarding in agency work within the County and ensured that the culture of sharing information between partners and the quality of that information was honest and open to challenge

·         Priorities within the Business Plan related to issues around safeguarding as a whole and specific areas such as the identification and response to children at high risk of experiencing sexual exploitation.

·         The HSCB had recently introduced a  new level of need guidance for the Council and all agencies to follow to ensure children were receiving support at the right time and in the right place in the  child protection system.

·         That there continued to be a need to strengthen and ensure an effective and accurate audit system in the Council and partner agencies.

·         That the HSCB provided oversight of safeguarding across all agencies and it was important that the strategic governance of the Board continues to be improved.

·         That there was active engagement of partners with the work of the Board, but some were finding it harder to maintain this as a result of  changes within their organisations – as organisations went through national change, such as the Probation Service and Community Rehabilitation Company, or local change, such as the policing changes.  However, new and active members were bringing a different dynamic to the Board, particularly the lay members.  It was noted that a national pilot peer diagnostic, led by the Local Government Association, had been commissioned into the work of the Board which would take place in November and help inform the Board’s development.

Resolved:

That;

(a)  the effectiveness of safeguarding arrangements in Herefordshire as assessed by the Safeguarding Board be noted; and;

(b)  the priorities of the Board in relation to specific safeguarding issues in Herefordshire be acknowledged;

To note the outcome of the Ofsted inspection of services for children in need of help and protection, children looked after and care leavers, which was conducted between 29 April and 21 May 2014 and to comment on the council’s response to the areas for improvement identified.

The Board noted the Ofsted Action Plan. The following matters were raised during the debate:

That the rating of good for the adoption performance related not only to the work of the Council, but to partner agencies throughout the County.

·         That the fact that no children were found to have been left at risk of harm during the inspection was fundamental to the success of the service.

·         There were 28 specific areas for improvement that were detailed in Appendix one of the report.  Whilst many were operational, there were a number of strategic recommendations that included the need to ensure that elected members understood and effectively undertook their corporate parent role.  The Action Plan related to the role of Councillors, but Board Members of all partner organisations needed to be both aware of and strengthen the way they met their corporate parenting responsibilities. A training and development plan for Councillors had been developed and was under consideration.

·         That the management of resources and caseloads for not only social workers but also other front line services was an issue of importance  for all in social care in the County.

·         That the Action Plan had now been sent to Ofsted, and the Council was awaiting the outcome from their deliberations.

It was suggested that the Health and Wellbeing Board should ensure that positive stories appeared in the media concerning the improvements in social care in the County as this would help to attract talented staff to the area.

Resolved:

That:

a)         the outcome of the inspection attached at Appendix 1 and the relevant issues for the Health and Wellbeing Board be noted; 

b)        The Chairman considers any recommendations for any further actions to be added to the action plan and/or the Committee’s work.

To receive an update on the council’s response to the government consultation on the Care Act regulations and guidance and update the Board on the projected impact of the Care Act on Herefordshire Council.

The Board received a report on the Council’s response to the government consultation on the Care Act regulations and guidance.

Resolved:

That:

(a)       The Council’s response to the Government consultation on the Care Act regulations and guidance, included at Appendix A, be noted; and

 (b)      The infographic, included at Appendix B, outlining the financial impact

of the Care Act on Herefordshire Council be noted

To receive the Board’s Work Programme.

The Board noted its work programme.

Resolved: that the report be noted.