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Agenda and minutes

Agenda and minutes

Venue: THE COUNCIL CHAMBER - FIRST FLOOR, TOWN HALL, TOWN HALL SQUARE, LEICESTER

Contact: Graham Carey, Tel 0116 4546356 or Internal 376356 

Items
No. Item

59.

APOLOGIES FOR ABSENCE

Minutes:

Apologies for absence were received from Elaine McHale, Interim Strategic Director, Children’s Services, Leicester City Council and David Sharp, Director, Leicestershire and Lincolnshire Area, NHS England.

 

60.

WELCOME AND INTRODUCTIONS

Minutes:

Councillor Palmer welcomed everyone to the meeting.  He welcomed Karen Chouhan, Chair of Healthwatch Leicester, to her first meeting of the Board in place of Philip Parkinson following her appointment as the Chair of Healthwatch Leicester.  A welcome was also extended to Trish Thompson, Director of Operations and Delivery, Leicestershire and Lincolnshire Area, NHS England who was attending as a substitute for David Sharp.

61.

DECLARATIONS OF INTEREST

Members are asked to declare any interests they may have in the business to be discussed at the meeting.

 

Minutes:

Members were asked to declare any interests they might have in the business to be discussed at the meeting. 

 

Councillor Sood declared an Other Disclosable Interest arising from being a patron of CLASP and having family members who received social care services.

 

In accordance with the Council’s Code of Conduct, these interests were not considered so significant that they would prejudice Councillor Sood’s judgment of the public interest and she was not, therefore, required to withdraw during any discussion involving those items on the agenda.    

 

62.

MINUTES OF THE PREVIOUS MEETING pdf icon PDF 121 KB

The minutes of the previous meeting of the Board held on 30 January 2014 are attached and the Board is asked to confirm them as a correct record.

 

Minutes:

RESOLVED:

that the minutes of the previous meeting of the Board held on 30 January 2014 be confirmed as a correct record.

 

63.

BETTER CARE FUND pdf icon PDF 136 KB

The Strategic Director Adult Social Care and Health and the Managing Director, Leicester City Clinical Commissioning Group to submit a report including a draft of the Final Plan.  

Additional documents:

Minutes:

The Strategic Director Adult Social Care and Health and the Managing Director, Leicester City Clinical Commissioning Group submitted a report including a final draft of the Better Care Fund Plan.  

 

Dr Freeman stated that the previous draft plan presented to the Board on 30 January 2014 had been submitted to NHS England and the Local Government Association (LGA).   The draft plan had been refined following comments received from both NHS England and the LGA, who had no material concerns.  In addition, a number of events had been held with voluntary and community sector groups and stakeholders which had also influenced amendments and the content of the plan. 

 

Initial feedback had been received assessing the plan as having a medium risk and medium deliverability.  Specific comments had also been made on aligning the plan to the wider Leicester, Leicestershire and Rutland 5 Year Strategic Plan.

 

For ease of reference the changes to the first draft were highlighted in yellow and the final draft would be submitted to NHS England and the LGA on 4 April 2014.

 

It was noted that a number of outstanding contractual issues influencing whether the plan was affordable had been discussed the previous day between the Clinical Commissioning Group and University Hospitals of Leicester NHS Trust and a formal response to the agreements made was awaited.  It was felt that the plan would most probably be affordable subject to a contract being signed with UHL.

 

Following the Chair’s question it was reported that a Better Care Fund Implementation Group had been formed and would be led by the Lay Chair of the Leicester City Clinical Commissioning Group.  The Group, which included representatives from the CCG, the Council and providers, would oversee the delivery of the plan and develop key performance indicators to monitor the progress of the plan.  The plan represented the bulk of the Quality Innovation, Productivity and Prevention Plan (QIPP) savings plan in 2014/15 and would be reflected in the underlying contracts with the health providers.

 

It was also confirmed that the Group would report to the Joint Integrated Commissioning Board, and there was a commitment to include Healthwatch in appropriate ways in the process.  Discussions were taking place to determine the appropriate level for this representation to take place.

 

RESOLVED:

 

1)    that Better Care Plan be approved for submission to NHS England and the Local Government Association on 4 April;

 

2)    that the Chair of the Board (Deputy City Mayor), Dr Simon Freeman (Managing Director, Leicester City Clinical Commissioning Group) and Andy Keeling (Chief Operating Officer, Leicester City Council) be given delegated authority to make any necessary subsequent amendments and approve the plan for final submission.

 

3)    that the Joint Integrated Commissioning Board submit progress reports on the implementation of the Better Care Fund Plan to the Health and Wellbeing Board at regular intervals.                  

 

64.

JOINT HEALTH AND WELLBEING STRATEGY pdf icon PDF 343 KB

The Chair of the Integrated Commissioning Board to submit a report providing an update on the implementation of the Joint Health and Wellbeing Strategy.

Minutes:

The Chair of the Integrated Commissioning Board submitted a report providing an update on the implementation of the Joint Health and Wellbeing Strategy.  This was the second bi-annual progress report to the Board and it aimed to provide an assurance that actions identified in the strategy were either being delivered and/or were flagged up as potential risks to delivery.  In addition the report also aimed to report on the performance indicators used to monitor the progress of the strategy.  The report monitored the strategy at a high level and was underpinned by separate monitoring and reporting through governance arrangements of partner organisations.

 

It was noted that there were no areas of the strategy where serious concerns were expressed or where action had not taken place.  There were 6 areas where progress was slower than expected but it was considered that progress could be recovered.  There were 10 areas where good progress was being made, particularly in relation to the initiatives relating to teenage pregnancy, alcohol, NHS checks, dementia, carers and mental health.  Substantial improvements had been made in relation to initiatives for sustaining breastfeeding, bowel cancer screening uptake, reducing the number of persons aged 65+ years being admitted permanently to residential or nursing care and the success of reablement (older people supported to live at home following discharged from hospital). 

 

Three indicators had worsened either since the strategy was published or since the last report.  These were smoking cessation which was showing lower achievements of people quitting than in previous years, which was thought to be largely attributable to people using e-cigarettes and reflected a nationwide trend.  There was also a slight deterioration in the number of women smoking in pregnancy, but there were relatively small numbers involved which exaggerated the fluctuations in percentage changes in this indicator.  This was not felt to be a specific cause of concern or trend but there were actions being taken to strengthen performance.  The third area related to indicators in relation to carers number of actions had been taken to improve the experience of carers and how they felt they were supported. 

 

In response to a question about outcomes, it was noted that the agreed indicators contained in Appendix 2 of the report were broadly used as a monitoring process to indicate whether the contents of the strategy were delivering the changes that were being sought. Specific outcomes beneath these indicators would be monitored by the various stakeholders involved in implementing the various actions.  In addition, the CCG Operational Plan had a range of outcomes, including one relating to potential years of life lost to healthcare amenable conditions, and as part of this the CGG had to commit to series of reduction trajectories relating to these areas.

 

It was also noted that in relation to young carers, work was in progress to enhance the current joint carer strategies between Adult Social Care, Children’s Services and the CCG.

 

Following questions about whether there was a further breakdown of figures for ethnicity etc in relation  ...  view the full minutes text for item 64.

65.

LEICESTER CITY CLINICAL COMMISSIONING GROUP - 2 YEAR PLAN

The Managing Director, Leicester City Clinical Commissioning Group (CCG) to give a presentation providing an overview of Leicester City Clinical Commissioning Group’s 2 Year Operational Plan which has to be submitted to NHS England on 4 April 2014.    

Minutes:

The Managing Director, Leicester City Clinical Commissioning Group (CCG) gave an introduction to the presentation providing an overview of Leicester City Clinical Commissioning Group’s 2 Year Operational Plan which had to be submitted to NHS England on 4 April 2014.  The whole of the health economy in Leicester and the County were required to submit a 5 Year Strategic Plan setting out the medium term direction of travel for health care and support provided across Leicester, Leicestershire and Rutland by the three CCGs, the three local authorities with responsibility for health and the two main health NHS Trust providers.

 

Sara Prema, Chief Strategy and Planning Officer, Leicester City CCG, gave the presentation, a copy of which is attached as an appendix to these minutes.  In addition to the points illustrated in the presentation, the following comments were made:-

 

a)    Whilst everyone over 75 years old would have an accountable GP and a care plan, not everyone would need a detailed care plan, as this would be dependent upon their health condition.

 

b)    The Urgent Care Working Group were taking action to deliver improvements in urgent care and to deliver the NHS responsibility to provide access to A&E and this would be discussed further at the later meeting of the Board.

 

 

Following questions on the presentation it was noted that:-

 

a)    Transforming primary care services would require a new model of GP service delivery.  The old model for basic patient care had worked well but there would not be any improvements in service delivery without a new service model.  Discussions on a new model were at an early stage and other models that had worked well elsewhere in the country were being appraised.  The new models would need to provide for more team working and integrated coverage based upon federation or locality working, particularly in view of the large number of single doctor practices in the City.

 

b)    GPs recognised that the existing model was not sufficiently robust to meet the challenges on meeting the transformation of primary care services, through the Better Care Fund, and a major challenge was getting sufficient resources in the community to ensure that it was possible to move from one model to another.  There were challenges to recruit more GPs to work in City practices, develop a trained workforce that was fit for purpose, develop effective team working and ensure there was good communication with all sectors of the heath economy and social care, if the desire to keep people out of hospitals was to be delivered.

 

c)    There was more to be done on ‘patient education’ within the context of communications as part of the strategic objectives to make patient aware of different referral pathways.  Specific work was taking place with local authorities around the lifestyle hub as part of this.  More communications work was needed reducing the need for hospital care and retaining patients within the primary care and community care sector for longer to reduce hospital admissions.  A strong communications  ...  view the full minutes text for item 65.

66.

LEICESTER, LEICESTERSHIRE AND RUTLAND 5 YEAR STRATEGY (BETTER CARE TOGETHER) pdf icon PDF 113 KB

The Programme Director Leicester, Leicestershire and Rutland Five Year Strategy to submit a report on the 5 Year Strategic Plan required to be submitted to NHS England.

Minutes:

The recently appointed Programme Director for Leicester, Leicestershire and Rutland Five Year Strategy submitted a report on the 5 Year Strategic Plan required to be submitted to NHS England.

 

The Leicester, Leicestershire and Rutland (LLR) Better Care Together Board held a Health and Social Care partner summit in January 2014 at which a shared vision for all partners was agreed together with the key actions required to support its successful delivery.

 

Five priority clinical work streams based on local needs assessments had been agreed for immediate review.  These were cancer, cardiovascular disease, respiratory disease, dementia and mental health and substance abuse.

 

The Leicester, Leicestershire and Rutland health economy had been identified as one of the 11 distressed health economies that would be offered support from April 2104 by NHS England, the Trust Development Authority and Monitor to develop the 5 Year Strategic Plan.  Ernst and Young had been commissioned nationally to help with producing the 5 Year Plan in the 11 distressed health economies by the end of June.  The framework document for the 5 Year Plan would be submitted on the following day and would form the basis for developing the details of the 5 Year Plan with Ernst and Young.

 

The Programme Director had met approximately 60 partners in health and social care including Healthwatch and the voluntary sector to review the current position in relation the governance of the programme.  It is being proposed that the programme will be streamlined to become more effective and focused. The Programme Board would also be extended to include the 3 Chairs of the LLR Health and Wellbeing Boards and the 3 Chairs of the LLR Healthwatches to make the Board more balanced.  Reference groups have also been introduced to provide a reference point for the Board as the strategy develops and is implemented.  The Public and Patient reference group would be co-ordinated by the 3 Healthwatch Chairs.  The other two reference groups would be drawn from clinical and political representatives.  The Political Group would help the Board to understand how to take the recommendations forward through the various political structures within Leicester, Leicestershire and Rutland.

 

The five clinical work streams were being developed and work was being prioritised along 3 key criteria areas of quality (improve outcomes and patient experience), scaleability (opportunity to scale up to have the maximum impact in the quickest time) and achievability.

 

The four key next steps were:-

 

a)    A LLR Health and Social Care Partnership Group had been established to develop the 5 Year Strategy with the external consultants.

 

b)    A cross partnership programme governance structure was being put in place to ensure an effective and timely approval and implementation of the Plan and to demonstrate that there is a clear governance structure.

 

c)    Developing an Integrated Health and Social Care Communication & Engagement Programme. A further summit was planned for the 6 May 2014.

 

d)    Philip Parkinson had agreed to be the Interim Chair of LLR Board over the next few months and to lead  ...  view the full minutes text for item 66.

67.

NHS ENGLAND DRAFT OPERATIONAL PLAN 2014/15 AND EMERGING STRATEGY UPDATE pdf icon PDF 143 KB

David Sharp, Director, Leicestershire and Lincolnshire Area Team, NHS England, to submit a report on the Draft Operational Plan 2014/15 and Emerging Strategy update.

Additional documents:

Minutes:

Trish Thompson, Director of Operations and Delivery, Leicestershire and Lincolnshire Area Team, NHS England, presented a report on the Draft Operational Plan 2014/15 and Emerging Strategy update.

 

The draft plan had been prepared by taking account of the health needs of the population from resources made available and by canvassing Directors of Public Health to identify key strategic issues.  The draft plan was being shared with all Health and Wellbeing Boards and public health colleagues with a view to receiving comments during April so that the final plans would take account of commissioning appropriate services to meet the needs of the population.

 

The Strategic Director for Adult Social Care and Health referred to the floor targets in the Commissioning Intentions for NHS England nationally and to the undertaking made by the Area Director at the last meeting that where the targets in Leicester were higher than the floor targets, there would be no reduction in these targets as Leicester wished to see a process of continual improvement particularly in relation to immunisation and cancer screening.  The Strategic Director also made the following comments:-

 

a)    The performance data in the plans related to Leicester, Leicestershire, Rutland and Lincolnshire and these average figures did not present a true picture for Leicester as it tended to perform less well than Leicestershire, Rutland and Lincolnshire.  Specific performance data for Leicester would be preferable.

 

b)    Equally, the overall targets for Leicestershire, Rutland and Lincolnshire could also be made specific to Leicester.

 

c)    It was unlikely that the 75% target for seasonal flu immunisations for the over 65 year olds would be achieved in 2014/15, and it was suggested that, as public health and social care staff with voluntary sector partners had already taken part in work relating to this, they could work with NHS England to strengthen the outputs required.

 

d)    The 5 year strategic and 2 year operational plans currently being prepared relied heavily on a robust primary care sector and it was difficult to see what means of funding for primary care was in these draft plans.

 

e)    It was welcomed that the importance of oral health in the City was recognised given the last dental survey which had led to the City putting in place a local strategy to improve the situation. The support from NHS England in this strategy was also welcomed.  Increasing the overall provision of dental services would also be welcomed to improve dental care in the City.

 

In response, the Director of Operations and Delivery stated that:-

 

a)    The comments relating to providing more focused performance data and overall target aims were noted and it should be possible to provide more Leicester focused information and targets.

 

b)    In relation to the funding issues it would be possible to provide a further briefing specifically relating to Leicester.

 

 

Members of the Board referred to recent communications and a meeting the previous day relating to the loss of practice differential rates for GPs funding.  A number of points raised included:-

 

a)  ...  view the full minutes text for item 67.

68.

QUALITY PREMIUM REQUIREMENT - INCREASED REPORTING OF MEDICATION INCIDENTS pdf icon PDF 166 KB

Dawn Leese, Director of Nursing and Quality, Leicester City CCG to submit a report on the Quality Premium Requirement – Increased Reporting of Medication Incidents.

Minutes:

Dawn Leese, Director of Nursing and Quality, Leicester City CCG submitted a report on the Quality Premium Requirement – Increased Reporting of Medication Incidents.  Sarah Prema, Chief Strategy and Planning Officer, gave a short presentation on the report These premiums were being paid to CCGs as an incentive to increase outputs and reduce inequalities.  The payments were £5 per head and payments earned in 2014/15 could be spent on healthcare in 2015/16 if targets and conditions were met.  Equally the payments could be reduced if conditions were not met.

 

There were 6 measures, 5 of which were prescribed and one chosen locally.  These were:-

 

-       Reducing potential years of life lost from causes considered amenable to healthcare and addressing locally agreed priorities for reducing premature mortality (seasonal flu, falls and pneumonia etc).  The target was a 3.2% reduction in the first year increasing to 7.4% in 2018/19.  It was not considered that 3.2% would be achieved in the first year so a target of a 1.5% reduction per year had been agreed.

 

-       Improving Access to Psychological Therapies – 17% of the population to enter treatment by the end of 2014/15 and 20% by the end of 2015/16.

 

-       Reducing avoidable emergency admissions – either a reduction of the 2013/14 outturn or less than 1,000 admissions per 100,000 population. 

 

-       Addressing issues identified in the 2013/14 Friends and Family Test (FFT) supporting the roll out of the FFT in 2014/15 and showing improvement in locally selected measures.  (Move from 162.6 to 159.4 in 2014/15 of proportion of people reporting poor patient experience of inpatient care).

 

-       Improving the reporting of medication related safety incidents based on a locally selected measure.  Increase reporting incidents by 15%.

 

-       Increase referral to weight management services following a NHS Health Check (Local Measure). Increase referrals to 619 in 2014/15 (5% increase) 

 

Each of the six targets accounted for 15% of the total payment, except the target to reduce emergency admissions which accounted for 25% of the total payment.

 

Details for the local indicator were set out in full in the report.

 

RESOLVED:

 

1)    That the quality improvement requirement for the CCG in 2014/15 be noted.

 

2)    That the target increases and approach be approved.   

69.

PEER CHALLENGE REVIEW FEEDBACK

The Chair to provide a verbal update on the feedback received on the Peer Challenge Review.

Minutes:

The Chair provided an update on the initial feedback received on the Peer Challenge Review.  The Chair thanked everyone for their participation in the review and stated that the initial feedback had been positive, indicating the Board had a clear sense of direction and good levels of understanding of the issues before it.  The Chair was having a discussion by phone with the review lead the following day and would circulate the formal letter/report of the review. A Board development day focusing on the report would be held later in the month.    

70.

ANNOUNCEMENTS

Members of the Board to make announcements, if appropriate, on topics of current interest.

Minutes:

There were no announcements from Members of the Board.  

71.

QUESTIONS FROM MEMBERS OF THE PUBLIC

The Chair to invite questions from members of the public.

Minutes:

No further questions were received from members of the public attending the meeting.

72.

DATES OF FUTURE MEETINGS

To note that future meetings of the Board will be held on the following dates:-

 

Thursday 3 July 2014

Thursday 9 October 2014

 

Meetings of the Board will be held in the Council Chamber, 1st Floor Town Hall, at 10.00am unless stated otherwise on the agenda for the meeting.

 

Minutes:

The Board noted that future meeting would be held on the following dates:-

 

Thursday 3 July 2014

Thursday 9 October 2014

 

Meetings of the Board would be held in the Council Chamber, 1st Floor Town Hall, at 10.00am unless stated otherwise on the agenda for the meeting.

 

The Chair stated that meetings of the Board may become more frequent as a result of the LGA Peer Challenge Review.  Details of any additional meetings would be notified in due course.

 

 

73.

CLOSE OF MEETING

Minutes:

The Chair declared the meeting closed at 11.25 am.