There were no apologies received.

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

There were no substitutes.

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

There were no declarations of interest.

To approve and sign the minutes of the meeting held on 7 September 2017.

RESOLVED

That the minutes of the meeting held on 7 September 2017 be agreed as a correct record and signed by the chairman.

To receive questions from members of the public.

Questions must be submitted by 5pm two clear working days before the day of the meeting, in this case by 5pm on Thursday 8 February 2018.

Please submit questions to: councillorservices@herefordshire.gov.uk

Accepted questions will be published as a supplement prior to the meeting.

There were no questions from members of the public.

To receive questions from councillors.

Questions must be submitted by 5pm two clear working days before the day of the meeting, in this case by 5pm on Thursday 8 February 2018.

Please submit questions to: councillorservices@herefordshire.gov.uk

Accepted questions will be published as a supplement prior to the meeting.

There were no questions from councillors.

To review the better care fund 2017/18 quarter two and quarter three national performance reports, as per the requirements of the programme.

The director for adults and wellbeing presented the report. He explained that the council and the clinical commissioning group (CCG) received funding through the Better Care Fund (BCF) via NHS England, and that further funding was channelled through the improved Better Care Fund (iBCF) to the council from the Ministry of Housing Communities and Local Government. Together, both allocations were intended to support integration of health and social care provision.

There was a requirement to provide quarterly update reports to NHS England. These were expected to be signed off by the health and wellbeing board before submission. However, the submission dates tended to be released at short notice which meant they were not aligned to health and wellbeing board meetings. The update reports for quarters 2 and 3 had therefore already been submitted to NHS England through an agreement for delegated approval from the board to the director for adults and wellbeing and the CCG accountable officer. 

In presenting the headlines of the submissions for quarters 2 and 3, the following points were highlighted:

·         There were significant achievements in reducing the number of people going into residential care either by avoiding or postponing need

·         Targets for reducing non-elective admissions and delayed transfers of care (DToC) had been largely achieved, noting that Herefordshire had been given the largest percentage reduction target for any county in the country, being expected to reduce DToC attributable to adult social care by 69% from February 2017.

·         This had been achieved although it had been a challenge and presented pressures across the system, but meant that an expanded range of care and service developments were implemented based on clinical evidence that people did better at home.

·         Members were reminded of recent debate around the future of the facilities provided at the Hillside Centre, and that service developments were connected to investment in community services to enable people to benefit from being at home sooner, and which was reflected in the reduction of DToC.

·         There was good performance across the system and the submissions were commended to the board.

The CCG accountable officer reinforced that this performance was positive and reflected the open relationship between the CCG and partners with meaningful outcomes for people in Herefordshire.

A board member noted that there were people included in the figures who were not Herefordshire residents, and asked what progress was being made in managing discharges across borders for those people.

The CCG accountable officer explained that there had been some difficulties for Powys residents which had been escalated to regional level to address. The Welsh Assembly Government had been involved and there was now a range of measures to get people home more quickly, and some progress had been made between English and Welsh services to support this. 

The chairman asked, in view of the report’s recommendations, what the board sought from this update. A member suggested that it was important to ensure that work was in progress and that the overall plan remained on target.

RESOLVED

That

a)  ...  view the full minutes text for item 149.

To update the Health and Wellbeing Board on the work to improve health and wellbeing through the Herefordshire and Worcestershire Sustainability and Transformation Partnership (STP), and its local delivery mechanism the ‘One Herefordshire’ transformation programme.

To confirm the strategic priorities for the board's focus as an output of a workshop held in November 2017 identifying priority health and care themes.

The One Herefordshire director of transformation presented the paper, making the following key points:

·         The Herefordshire and Worcestershire sustainability and transformation partnership (STP) was part of the national NHS programme, and Herefordshire was represented on the regional board by the director for adults and wellbeing.

·         The purpose was to deliver the ‘triple aim’ of improved population health and wellbeing, high quality services, and financial sustainability and efficiency.  

·         STPs were being encouraged to progress towards becoming integrated care systems. These were intended to be place based and to focus on providing a wellbeing service to keep people well but being available to support when unwell.

·         The developments presented significant cultural changes with closer working with partners.

·         One Herefordshire was the delivery mechanism for Herefordshire, and started with the health and social care elements and working closely across the public sector, initially focused on adults and looking holistically at the individual in their own surroundings.

Responding to a question from the vice-chair about the functioning of the system in the context of reductions to the public health budget, it was explained that this was about the wider approach across the system where wellbeing was everyone’s business. The principle of ‘making every contact count’ was essential to the prevention agenda and to prioritising resources. An example to illustrate the approach was around smoking cessation, which should be picked up by any professional in contact with an individual, captured in public messages and extended to employers in promoting healthy workplaces. These were the areas to establish the best approach to target in a co-ordinated way.

The director for adults and wellbeing pointed out that public health grant was set to reduce to £8million over the next few years and would eventually be phased out completely, as it would be subsumed into the council’s wider revenue. It was therefore less helpful for it to be a ring fenced grant because it did not represent the reality of what was spent by the overall system on public health, so it was imperative that all expenditure made by the council, and indeed wider partners, had positive impact.

The incoming director of public health added that the public health grant was a small concern and the key message was about the whole picture and where influence was needed.

The CCG accountable officer commented that gradual reorganisation within the system was an opportunity to reconsider the relationship with neighbours, especially with Worcestershire, moving from a transactional relationship to a consensus. It was hoped that a new culture would help to bring about the changes. There were risks but also some opportunities so it was important to take the opportunity to deliver the changes that were needed. Although it was not an easy concept to explain, the key was to bring providers into the way of working to move to a partnership based approach, where all took responsibility for the system as a whole achieving the triple aim, rather than one of commissioner and provider. 

The chairman noted that the  ...  view the full minutes text for item 150.