Apologies were received from Simon Hairsnape (NHS Herefordshire CCG), Dr Andy Watts (NHS Herefordshire CCG), Jo-Anne Alner (NHS England) and Councillor JG Lester.

To receive any details of members nominated to attend the meeting in place of a member of the committee.

Hazel Braund attended on behalf of Simon Hairsnape (NHS Herefordshire CCG) and Jo Melling attended on behalf of Jo-Anne Alner (NHS England).

To receive any declarations of interest by members in respect of items on the agenda.

None.

To approve and sign the minutes of the meeting held on 23 February 2016.

RESOLVED

That the minutes of the meeting held on 23 February 2016 be approved as a correct record of the meeting.

To receive questions from members of the public relating to matters within the board’s terms of reference.

(Questions must be submitted by midday three clear working days before the day of the meeting)

None received.

To review whether the commissioning plans and arrangements for the NHS, public health and social care (including Better Care Fund submissions) are in line with and have given due regard to the health and wellbeing strategy.

The corporate delivery plan was presented by the directorate services team leader, economy, communities and corporate (ECC).

The health and wellbeing strategy priorities aligned broadly with the priorities and objectives set out in the corporate plan. Whilst the plan was not laid out by directorate, the main linkages lay within the vulnerable adults, children and young people and some of the economic objectives.   Underlying data allowed for performance to be measured and comparisons to be made with other authorities. The expectation was that there would be clear change in relation to the national outcomes frameworks.

With reference to children and young people, it was confirmed that plans were in line with the health and wellbeing strategy and the expectation was that health and education outcomes in Herefordshire would aim be in the top quartile nationally. 

The following comments were made in response to the content of the plan:

·         In terms of showing achievements, it was important to include reference to overall expectations and aspiration, for example, to achieve increases to low wage levels.

·         The plan was cross-cutting, with areas such as the prevention agenda being covered in a number of objectives and a key point would be to identify how other organisations were turning the health and wellbeing strategy into reality.

·         Making the link to NHS planning, whilst a lot of detail supported the planning, it was important to retain simplicity in the plan to ensure it was accessible, and show links to key performance indicators.

·         It was important to ensure that joint responsibility for strategies was maintained in order for services to work together and to gain the benefits.

·         The health and wellbeing strategy was strong on integration and resilient communities, for example, in the attainment gap for young carers.

·         The key objective of achieving value for money was acknowledged.

·         It was felt that outcome-based commissioning needed to be referenced.

·         It was important to highlight integration as a key factor in the success of the plan but there were no key performance indicators to show success or otherwise in this area.

It was clarified that this initial draft plan would be presented to Cabinet and that the end of year performance report would become available during May. Links to the finalised delivery plan and performance reports would be shared with the board.

RESOLVED

That it be confirmed to cabinet that the corporate delivery plan is broadly aligned with the health and wellbeing strategy. 

To update the health and wellbeing board, and seek its views on the following:

·         Current status and developments connected to the five year sustainability and transformation plan (STP) for health and care systems across England

·         The timelines, governance framework and processes intended to support the development of the plan

·         The 2016/17 priorities and work programme of NHS Herefordshire clinical commissioning group (CCG)

An update was presented by the director of operations, NHS Herefordshire CCG. This was developed jointly with the director for adults and wellbeing and included information on the sustainability and transformation plan (STP) and the CCG operational plan with links to drivers such as the Better Care Fund (BCF).  The CCG was required to submit a revised operational plan each year, to which the STP requirements were added in December 2015.

Appendix 1 showed the current position on governance arrangements moving forward to the STP.  The next stage was to make a formal submission by Easter on priorities for closing the triple aim gaps, although it was not expected that a detailed picture would be available at that stage. Work on progressing One Herefordshire had been shared with Worcestershire who were replicating many aspects of the methodology.

A strategic lead for this work had been agreed as Sarah Dugan (chief executive, Worcestershire Health and Care NHS Trust).  It was intended to appoint an independent chair, noting that this needed to have a clear role and a transparent appointment process in the longer term.  There would also need to be a process to appoint a programme director to oversee the implementation programme as a priority.

The plan needed the collective support of all partners and was to be submitted by the end of June 2016, identifying the opportunities for the triple aims. It was noted that there were opportunities for partners to engage; there was already input from adult social care, and recognition and encouragement for young people and children’s wellbeing to be involved.

It was acknowledged that it would be a challenge to make the savings required, although it was noted that there was no expectation that there would be resolution in the next year as this would not be realistic or safe.  However, there was a need to consider realistic and sustainable ways of providing services within available resources, including consideration of regionalised services for specialist care. The local context also needed to be considered in terms of population distribution and transportation, workforce distribution and recognition of cross-border access to services.

Discussion took place around comparisons with devolution and the benefits and drawbacks of different models for grouping geographical areas. It was recognised that the STP determined the core planning structure and would continue to work with other counties and also with Welsh health boards due to the numbers of patients using services in Herefordshire, and this was important for leadership to recognise.

Whilst it was a requirement to submit the STP in June, it could be flexible and used as an opportunity to formalise and improve upon service provision, some of which was already in practice.  It would move services away from a simple market contract model to one of organisations working together to provide services in a more sustainable and collective way, and recognising the remit of local government to promote the health and wellbeing of the population. 

It was important for the public to understand the  ...  view the full minutes text for item 64.