Apologies were received from Jo-Anne Alner (NHS England), Cllr JG Lester and Prof Rod Thomson.

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

Cllr JA Hyde attended as a substitute for Cllr JG Lester, Alan Exell attended for Jo-Anne Alner (NHS England) and Andrea Westlake for Prof Rod Thomson.

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

None.

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

RESOLVED

That the minutes of the meeting held on 23 March 2016 be approved as a correct record and signed by the chairman.

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.

To appoint a chair of the health and wellbeing board.

Councillor PM Morgan was thanked for her work over the past year.

The board noted the reappointment of Councillor PM Morgan as the chair of the health and wellbeing board.

RESOLVED

That Councillor PM Morgan be appointed as the chairman of the board. 

To appoint a vice-chair of the health and wellbeing board.

The chair thanked Mrs Diane Jones MBE for her hard work over the past year.

She nominated Dr Dominic Horne as new vice-chairman of the health and wellbeing board. Simon Hairsnape seconded the nomination and Dr Horne was elected unanimously as the vice-chairman.

RESOLVED

That Dr Dominic Horne be appointed as vice-chairman of the health and wellbeing board.  

The director for adults and wellbeing introduced these reports under a new standing agenda item to consider integration. The reports presented today were prepared jointly by the council and the clinical commissioning group.

Better Care Fund

It was a requirement to report to NHS England on the performance of the better care fund at required intervals. Board meetings had been aligned to the submission dates given by NHS England but changes to data templates had not made it possible to seek formal board approval of submissions and meet the timescale for submission. It was recognised that this was not ideal and retrospective approval was sought.

A key issue identified as regards financial implications was that of agreed risk sharing.  The total spending pool on residential, nursing and health care was in the region of £20m and had overspent by £1.3m which meant that the risk share was bulk-funded by the council. There would be considerable input to the new better care fund to address this issue.    

Board members confirmed that in terms of performance of the fund, they would be guided on significant issues and support would be given to officers in decision-making. 

In terms of quality of care, the quality monitoring team was working with contracted services, although board members were reminded that 70% of care was self-funded.  A new quality framework was in process of implementation with a balanced score-card approach for each home to use. This would enable closer involvement to maintain quality.

It was noted that care was provided for the most vulnerable people who were not always able to speak up about the quality of their care and the intention was to work across adults’ and children’s care to see the whole picture. 

In answer to a question regarding a new integrated framework regarding contracts, the director for adults and wellbeing reported that  the focus was on working towards a single contract with all residential and nursing homes.  There was close working with the CCG which allowed for streamlining of systems and better engagement with the market. For individuals placed or reviewed since April 2015, there was confidence that they were in right place with the right care package at the right price. The focus was on individuals who had not had a review and were not already on standard rates, to ensure proper and full review and risk sharing. 

It was noted that although it was possible to place people at standard rates, sometimes placement was not as close to home as wished. Whilst there was some pressure, this was not due to capacity, although it was noted that domiciliary care was more difficult, particularly for people with complex needs in more rural areas where it was less easy to establish cost effective visiting routes. To address this, reprocurement was intended, with active public consultation. 

The director of children’s wellbeing explained that there were also children and young people with complex needs and although numbers were small, a new approach was introduced to support  ...  view the full minutes text for item 78.

To provide assurance that the early help strategy (attached at appendix 1) is aligned and fulfils the aims and priorities of the health and wellbeing board strategy.

The director of children’s wellbeing introduced the report.  Board members were reminded that the children and young people’s plan included a refreshed approach to early help and there was a lot of evidence that it was not intervening at an early enough point to reduce the number of children reaching the higher tiers of service provision to get help.  The children and young people’s partnership recommended the refreshed strategy.  

The head of children’s commissioning summarised the key features of the strategy, which were:

·         family focused, addressing the issues of the whole family

·         community focused – drawing on strengths and services in each locality  and working with families to build resilience

·         targeted – ensuring the right level of support and the right time and integrating with the families first programme

·         multi-agency – to reflect the complex issues faced by families

·         aimed at building resilience in families – equipping families with skills to self-support in the future and looking at alternative ways to support families.

The changes meant that families would be empowered and equipped to identify their own needs and solutions using local resources in their community. Based on a ‘team around the family’ approach, this would enable support to be accessed at lower levels of need, and avoid the most intensive intervention as far as possible. Any interventions would be based on appropriate assessments and review.

The refreshed strategy presented challenges around changing cultures and strategic developments in the context of One Herefordshire and the STP, and there would need to be co-ordination with care pathways.  Effectiveness would be evidenced by an outcomes scorecard which would be reported to the CYPP.

A pilot had commenced in Leominster in order to test the model, extending to Bromyard, and, by the end of the year, would be county-wide.

Support and commitment was sought from the board for the early help strategy and for board members to provide the leadership to ensure that care pathways between partners were joined up.

It was acknowledged that a commitment to the strategy was required from all partners and a rebalancing of resources would be required in order for there to be a beneficial and sustainable service.  The need to for earlier contact with families was noted, and in such a way that was supportive and empowering.

The Leominster pilot used community connections and was an opportunity to test those connections, working with a number of families.  

The director of children’s wellbeing explained that in some cases the biggest issue for families was around the neglect of children but for whom major intervention would not be necessary if they received the right early help provision.  The safeguarding board set out the levels of need to show the appropriate level of intervention for children at significant risk of significant harm.  However it was evident that the higher level of intervention at level 4 was sometimes applied in escalation to ensure that a child accessed the provision that was needed.  Support for professionals was needed in order to reduce  ...  view the full minutes text for item 79.

To approve Understanding Herefordshire 2016 including the joint strategic needs assessment, and to agree arrangements for its future review and development.

The director for adults and wellbeing introduced the report and explained that it was a statutory requirement for a joint strategic needs assessment and locally, this was branded as Understanding Herefordshire as a comprehensive online resource.  

The key points were that:

·         Herefordshire had a population of 187,000 people which was not ethnically diverse

·         the county had an older population compared with the national average although people were living longer in poor health, which had implications for the wellbeing of the population

·         the county contained 12 lower super output areas (geographic areas for the purpose of gathering population data) which were in the top 25% nationally of most deprived areas. This had increased by four, to include Bromyard, since 2010.

·         4500 children lived in deprived households although the level of deprivation was hidden in the  county

·         mortality was linked to deprivation and there were many examples of the wider determinants of health impacting on life chances. The JSNA looked at wellbeing more broadly so, for example, child sexual exploitation and neglect were considered as being consequential to behaviours.

There was a busy and active public health team and the board was asked to consider how to use the resource to best effect in order to ensure that policies and commissioning were evidence based.   Although the JSNA informed planning and commissioning, and the focus on the social and economic aspects of the county was welcomed, it was noted that it could be used more to map services and identify gaps in provision.  For example, a specific issue was the poor state of dental health and the need to address this, noting the policy to not provide fluoride in the county’s water supply.  

On the matter of dental health, steps were being taken with Public Health England to address funding streams supported by additional data and to encourage schools to engage with dentists.  It was noted that Herefordshire was not allocated funding for dental health and a solution was sought with NHS England and PH England.  

The JSNA would support a refreshed health and wellbeing strategy and inform the annual report of the director of public health.   Whilst is was noted that the data was essential, the themes should be prioritised for focused reporting rather than reporting on every aspect each year.

Assurance was given that NHS England was engaged with the process and that involvement would be reviewed to enable better outcomes. 

It was noted that there was a wealth of data within Understanding Herefordshire which highlighted issues that needed attention.  One Herefordshire would support planning cycles and commissioning to be more cohesive.  

Understanding Herefordshire was to be presented to Cabinet next week.

Board members were advised that the annual report of the director of public health would give more information on public health’s work around inequalities and outcomes. The report would be presented to the health and wellbeing board in September.

RESOLVED

That Understanding Herefordshire: JSNA 2016 be approved for publication.