Apologies were received from Jo Davidson, Simon Hairsnape, Diane Jones, and Cllr JG Lester.

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

Chris Baird substituted for Jo Davidson, Hazel Braund for Simon Hairsnape and Councillor JA Hyde for Councillor JG Lester.

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 19 October 2016.

RESOLVED

That the minutes of the meeting held on 19 October 2016 be agreed as a correct record of the meeting and signed by the chairman.

It was noted that following the previous meeting, communications and engagement activity had been taking place on the sustainability and transformation plan (STP), and clarification was being sought from health leadership on the extent to which this involved wider staff groups within health. A report was expected on STP the communications and engagement processes for the health and social care overview and scrutiny committee on 27 February. 

There had been a proposal for a joint Herefordshire and Worcestershire health and wellbeing board on the outcomes from the engagement exercise for the STP. A date for the meeting was under negotiation and board members were asked to prioritise this 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 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.))

There were no questions received.

Herefordshire Safeguarding Children Board (HSCB)

The independent chair, HSCB, presented the annual report for 2015/16, setting out progress on the board’s priorities. 

The priorities of the safeguarding board and the health and wellbeing strategy were aligned, so it was important for both to have critical oversight of each other to make a difference to safety of children.  The following key points were highlighted:

·         The number of child protection plans in the county were found to be higher than expected and this had been addressed by supporting professionals to manage risk and access higher thresholds of need only when in the best interest of the child, by focusing on early help and ensuring early indicators of harm were spotted

·         A new priority to focus on neglect was identified as this was an emerging concern and this was an area that the health and wellbeing board could support

·         there were other areas that the health and wellbeing board could consider that would improve health outcomes for children to give them the best start. Examples included    fluoridation of the water supply to improve dental health, and further co-ordinated early intervention and commissioning to address the ‘toxic trio’ of domestic abuse, mental health and substance misuse

·         that there was a significantly higher rate of sexual offences against children in Herefordshire compared with national figures, which needed to be better understood   

In the discussion that followed, these key points were noted:

·         water fluoridation had been considered in the past and although it was generally an obvious solution it was not the whole solution. The nature of the county also meant that there was no single water supply to households, and it would be a significant cost that would not benefit the whole population

·         there was an awareness of dental health amongst children that had been assessed through work on dental care by Healthwatch and Crucial Crew  

·         domestic abuse was a priority for the community safety partnership board

·         it was important to ensure that all partners were supported to attend MARAC (multi-agency risk assessment conference) meetings so that all were connected and sharing information

·         sexual abuse of children could coincide with domestic abuse and as rates were high in the county, a multi-agency approach was needed to understand this issue better in terms of patterns of incidence. This was something the community safety partnership could look at.

·         the refreshed joint strategic needs assessment could provide a focus on sexual abuse of children and coincidence with domestic abuse, linking to mental health and adult safeguarding 

·         a further dimension was that these issues featured as having an impact on children coming into care

Herefordshire Safeguarding Adults Board (HSAB)

The independent chair, HSAB, presented the annual report, highlighting the following:

·         both safeguarding boards and the community safety partnership were supported by a joint business unit and this facilitated the sharing of cross-cutting themes

·         the focus of adult safeguarding was different from that of children as it worked within the personalisation agenda and within the context of people making choices  ...  view the full minutes text for item 99.

The deputy director of operations (NHS Herefordshire Clinical Commissioning Group) presented an update on the mental health priority contained within the health and wellbeing strategy. It was noted that this was a positive report as developments in mental health care provision had started to take effect. The update noted the following points:

·         a feature of the strategy was to reduce the stigma associated with mental health, and there had been a groundswell of talking within communities, and this could be developed through the strong young minds project.

·         Work was progressing with increasing access to psychological therapies, supported by the crisis care concordat, the children and young people’s plan and these were extending to enhance adult services.  A number of agencies contributed to these and a multi-disciplinary and co-ordinated approach to early intervention was progressing

·         referrals into services were being seen within 4 weeks for adults and 2 weeks for children and dementia services and the child and adolescent mental health services were regarded highly within the West Midlands

·         The focus was now on promoting early intervention and prevention. Communities had contributed to development of this and the message could be reinforced through organisations such as Carers’ Support, Healthwatch and the Ross project, a community-led focus on mental health support 

·         with regard to provision of a formal place of safety, a capital build was to commence in March 2017 at the Stonebow Unit. This would support crisis care management and Mental Health Act section 136 assessments. This was a positive step as it meant that people were no longer being taken to a police cell

·         multi-agency training on mental health awareness was ongoing

·         a mental health toolkit was developed and there was awareness raising through young peoples’ ambassadors. The board was reminded this it was children’s mental health week and the young peoples’ ambassadors were working on a blog and using the online community to promote mental health awareness

·         with regard to improving access to psychological therapies (IAPT), there was under-representation for mild and moderate depression and a workplace project was to commence in 2018

·         a joint pathway was being developed for working with emotional and behavioural development issues around attachment and bonding and there would be further work to inform this

·         there were to be further developments on mental health partnerships, workforce development and awareness raising.  It was noted that suicide prevention work would commence this spring and also a care pathway for physical and mental health care.

·         prevention and mental health promotion remained a cornerstone

In response to the update, the following points were noted:

·         It would be beneficial to produce a briefing note to provide reassurance on positive developments in mental health work. There was a press campaign for young peoples’ mental health week, and it was noted that a range of media was required to help to promote mental health work.  The briefing note would be a useful medium in which to define the common mental health issues that affected the 1 in 4 people statistically

·         It  ...  view the full minutes text for item 100.

To note the better care fund 2016/17 quarter two national performance report as per the requirements of the programme.

The director for adults and wellbeing outlined that this report set out the quarter 2 return that had already been submitted to NHS England as it had not been possible to align the national deadline for submissions with board meetings.   The headlines of the report were that:

·         with regard to residential care, there was more detailed analysis on the rate of admissions for the over 65 age group, showing that admissions were broadly in line with demographics

·         demand for residential care was being overtaken by transfers directly into nursing care, with dementia care needs becoming more prevalent

·         new guidance on the better care fund was awaited and so some informed projections were necessary with regard to funding

·         It was hoped that the guidance would take a lighter touch approach and it was anticipated that under new guidance, with regard to full health and social care integration by 2020, this would be outlined in the BCF plan, with local interpretation

Discussion took place regarding delayed transfers of care, noting a shift from health related transfers, towards delays relating to social care support, particularly for transfers to out of county services. There was better understanding of the delays and identifying opportunities to support discharge planning, working together across the system, and addressing delays earlier.  The patient’s perspective was noted as it was important for people to be fully aware of care needs in time to be able to plan.

The following additional points were noted:

·         the BCF would reflect limited changes in the overall budget as it was a small element and the majority of budget commitment sat outside the BCF and it was expected that the planned 2 per cent increase in the social care precept would be more than absorbed by cost increases

·         the overall budget for adults and wellbeing was £85k less in cash terms in 2017/18 than it had been in 2016/17 and without the council tax increase there would have been a shortfall of around £2million. The budget for social care therefore needed to be reviewed to ensure it was sustainable once central government grant ceased and the council became fully reliant on locally-raised taxation from 2020

·          there was regular dialogue with MPs about the budgetary pressures and ability to meet demand. However there were national pressures and changes to peoples’ care provision, with all services facing significant reductions which put pressure on healthcare

·         delayed transfers of care was a whole system issue and about working together to keep people safe

·         there was value in the board looking at aspects of joint commissioning work as the BCF represented just 5 per cent of the budget  

RESOLVED

That:

(a)  the quarter 2 BCF return, as submitted, be noted; and

(b)  a report on joint working across the Herefordshire health and wellbeing system be presented to the next meeting