Agenda and minutes

Apologies for absence were received from Councillor Sood, Andy Keeling Chief Operating Officer, Leicester City Council, Tracie Rees, Director Care Services and Commissioning, Adult Social Care, Leicester City Council and Professor Azhar Farooqi, Co-Chair, Leicester City Clinical Commissioning Group.

Councillor Cooke, Chair of the Council’s Health and Wellbeing Scrutiny Commission was also unable to attend as an invited observer to the Board Meeting.

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

Members were asked to declare any interests they might have in the business to be discussed at the meeting.  No such declarations were made.

The Chair welcomed everyone to the meeting.

He announced that the Council had signed the NHS Statement of Support for Tobacco Control prior to the meeting.  This was a part of a national initiative to actively support work to reduce smoking prevalence and health inequalities in conjunction with local health partners.

It was also announced that the Leicester Stop Smoking Service and Wellness Service, inherited with the transfer of Public Health Services to the Council in April 2013, would be moving to be an in-house Council service from April 2015.  If was felt that the Service would be better placed to work in partnership with wider Council as well as partner services which would strengthen the public health work of the Council as a result.  

The Chair welcomed Frances Craven to her first Board meeting as the Council’s newly appointed Strategic Director of Children’s Services, Leicester City Council.   He thanked Elaine McHale, Interim Strategic Director of Children’s Services for her service and contribution to the Board whilst in her current post.

This would also be the last Board meeting for both Dr Simon Freeman, Managing Director, Leicester City Clinical Commissioning Group and Deb Watson, Strategic Director of Adult Social Care and Health, Leicester City Council.

Dr Freeman was leaving the CCG to become the Chief Operating Officer of the Greater East Midlands Commissioning Support Unit.  The Chair thanked Dr Freeman for his services to the Board and his wider contribution to health services in Leicester particularly in working to achieve the early formal recognition of the Leicester City CCG in 2013.

The Chair thanked Deb Watson for her immense contribution to health and wellbeing in the city since taking up her post.  He paid tribute to her professional expertise and integrity and her passion and enthusiasm for taking forward initiatives to improve health in the City.

Members of the Board joined the Chair in wishing both Simon Freeman and Deb Watson their very best wishes for the future.

The Minutes of the previous meeting of the Board held on 3 July 2014 are attached and the Board is asked to confirm them as a correct record.

RESOLVED:

That the Minutes of the previous meeting of the Board held on 3 July 2014 be confirmed as a correct record.

Leicester City Clinical Commissioning Group (CCG) to submit a report on the challenges in primary care in the City and what is being done to respond to these challenges.  Simon Freeman, Managing Director, Leicester City CCG and David Sharp, Director, Leicestershire and Lincolnshire Area, NHS England will present the report at the meeting.

Leicester City Clinical Commissioning Group (CCG) submitted a report on the challenges in primary care in the City and what was being done to respond to these challenges.  Dr Simon Freeman, Managing Director, Leicester City CCG and Sue Lock, Chief Operating Officer, Leicester City CCG and David Sharp, Director, Leicestershire and Lincolnshire Area, NHS England presented the report to the meeting.

It was noted that national and local policies required efficiency savings and improved quality of services to be delivered by expanding out-of-hospital services through creating sufficient capacity and capability in the primary medical care services.

The report identified the major challenges facing primary care, from both a patient and a practice perspective and gave a summary of the planned solutions to address them.

Tackling GP recruitment was the highest short-term priority as an effective and efficient GP service was vital to looking after patients and reducing the number of hospital admissions.  There was a local aging population and a backdrop of global financial pressures which required local solutions to meet the needs and deliver quality care within the resources available.

The CCG had undertaken an analysis of the local health economy and of the 62 GP practices in the City, 13% were single GP practices compared to a national average of 9%.  In addition, approximately 50% of the principal GPs were aged over 50 years old.  There was a changing GP workforce profile in Leicester from one which was predominately comprised of principal GPs to one that was now approximately a third principal GPs, a third salaried GPs and a third locum GPs.  Given the changing emphasis of health care to focus on prevention and reducing hospital admissions, it was considered essential to address the GP recruitment issue, particularly in view the large proportion of the population living in deprivation, which was a key driver of health needs.  The diversity of the population, particularly where English was not spoken as a first language presented further challenges to conducting effective consultation on services.  A number of engagement activities had been undertaken with the public, patient groups, member practices and wider stakeholders since November 2013 to understand the perceived issues and challenges.  The results demonstrated that the challenges facing practices were causing the issues and concerns raised by patients.  This supported the view that addressing the GP issues was a key factor in delivering the Better Care Together programme.

NHS England were proposing a pilot project to address GP recruitment and retention issues in order to underpin the overall strategy for developing a growing range of primary care services and to develop the 7 day per week market for providing services.  Attracting GPs to enter and stay in the local workforce required incentives in order to compete with the competitive market for GP services.

Following the outline of the pilot proposals and questions from Members, it was noted that:-

a)         The pilot scheme would involve a fund of £250k to recruit and retain GPs in the City by providing an incentive  ...  view the full minutes text for item 17.

Geoff Rowbotham, Interim Programme Director Better Care Together, to submit a report providing an update on the progress of the Better Care Together Strategy.

Geoff Rowbotham, Interim Programme Director Better Care Together, submitted a report providing an update on the progress of the Better Care Together Strategy.

The report noted that the Better Care Together (BCT) Programme Board was responsible for the production of the 5 year strategic plan for the Leicester, Leicestershire and Rutland (LLR) health and social care system. The Programme Board included local social care, health commissioners and providers, public and patient representatives. It was supported by a structure of clinical, patient, public, and political reference groups, and by enabling groups e.g. Estates, Workforce, Information Technology.

The BCT Programme Board had taken a phased approach to the production of the 5 year strategic plan: development (to June 2014); discussion and review (June to Sept 2014) and, implementation and formal consultation where required (Oct onwards).  A draft plan had been made available to the public as part of the ‘discussion and review stage’.  It had also been received by Health and Wellbeing Boards and Healthwatch groups across Leicester, Leicestershire and Rutland. Comments received were being incorporated within the draft plan through a ‘You said, we did’ section prior to it being proposed for formal approval alongside the supporting Programme Initiation Document (PID) and Strategic Outline Case (SOC)

During July –August 2014 the BCT programme has been focused on:-

i.     LLR draft 5 year plan- ‘discussion and review’ phase.

ii.    Leadership and governance of the BCT programme.

iii.   Developing, resourcing and commencing service reconfiguration.

Considerable progress had been made during the past 8 weeks resulting in the programme being on schedule; despite the challenging timescales it had set itself. The report intended to provide a high level update on progress during this time and highlighted the key programme priorities for the next 3 months.

The Interim Programme Director made the following observations and comments on the progress that had been made:-

·         There had been extensive consultation in the discussion and review phase with public and patient groups, voluntary and community sectors groups and Healthwatch which had produced a number of comments around the plan.

·         The responses to the ‘You said – we did’ section of the plan would be taken back to the public and patient groups etc for comment and approval before being formally being submitted to the Board in November.

·         There were now Public and Patient Involvement representatives on all programme streams.

·         Kaye Burnett had now been recruited as a permanent Chair of the BCT Partnership Board and would take up the duties later in October.  Thanks were extended to Philip Parkinson for his work as Interim Chair of the Board.

·         The BCT Board had agreed that it would meet in public from the New Year and this would strengthen the engagement and transparency aspects within the governance arrangements.

·         All of the 8 work streams were due to be completed by the end of October.

·         The Plan had been extensively reviewed by all key stakeholders in the local health economy.

·         Two key supporting documents to  ...  view the full minutes text for item 18.

a)         Dr Simon Freeman, Managing Director, Leicester City Clinical Commissioning Group, to submit the six monthly update report on the progress of the Joint Health and Wellbeing Strategy.

b)         Andrew L Smith, Director Planning, Transportation & Economic Development, Leicester City Council, to report on how the Directorate are working to support the Joint Health and Wellbeing Strategy. 

Dr Simon Freeman, Managing Director, Leicester City Clinical Commissioning Group submitted the six monthly update report on the progress of the Joint Health and Wellbeing Strategy on behalf of the Joint Integrated Commissioning Board (JICB).

It was noted that:-

·         No areas of activity had been ‘red flagged’, but there were fewer areas rated ‘green’ and more ‘amber’ than in the previous report; indicating a modest increase in risk to delivery.

·         In relation to the Key Performance Indicators where data was available, 45% showed improvement from the baseline, 32% showed no significant change and 23% showed a worsening of the position.

·         There were four areas of concern:-

o   Readiness for school at age 5 years old.

o   The coverage for cervical screening in women.

o   Diabetes – the management of blood sugar levels.

o   Proportion of adults in contact with secondary mental health services living independently with or without support.

·      Measures showing particular improvement to the baseline were:-

o  The number of NHS Health Checks carried out was amongst the best outputs in the country.  25,886 health checks had been carried out and 3,535 patients were subsequently having a health management plan put in place.

o  The trend for carers receiving needs assessments was continuing to improve and they were currently at 28.4%.

o  Reablement continued to be a great success with 91.2% of older people, who had received support to live at home following discharge from hospital, still living at home 91 days after their discharge.

Following Members’ questions on the four areas of concern, the following responses were noted:-

·         Readiness for school at age 5 years old.

o   The assessment for this indicator was a complex assessment and to achieve a good level of development it expected 12 of the 17 early learning goals to be achieved.  These goals involved personal development, independence, ability to communicate, language and physical activity etc.

o    The indicator was useful to see how a young child was developing and to benchmark against other areas. 

o    The indicator changed in 2013 so comparisons cannot be made directly with 2012.  However, although there has been some improvement this year the performance in Leicester still lags behind the national levels and more work needs to be done to improve this as it translates into outcomes for youngsters achievement at Key Stages 1 and 2 and GCSE.  There was evidence to suggest that children who do not do well in early years do not do well later on in school.

o    Steps were being taken to improve data systems and collection to improve the early identification of vulnerable children.  Appropriate information was being shared with staff in health services, children centres and those in early years’ settings to identify where resources need to be placed.  

o    There was good partnership working so that vulnerable children and families take up the services that were n offer to them.

o    Increasing the participation of 3 and 4 year olds in education and ensuring that all the available  ...  view the full minutes text for item 19.

Andrew L Smith, Director Planning, Transportation & Economic Development, Leicester City Council gave a presentation on how the Directorate were working to support the Joint Health and Wellbeing Strategy.  A copy of the presentation is attached to these minutes.

The Director commented that the department was working closely together as a set of disciplines and professions in delivering programme and projects which contributed to the holistic approach towards improving health and wellbeing through addressing the wider determinants of the physical, mental and social wellbeing of people and communities.   There were linkages to the Closing The Gap Strategy in numerous plans and strategies such as the Local Plan, Local Transport Plan, Economic Action Plan and Cycle City etc.

The preparation of the new local plan for the City was an opportunity to embed health and wellbeing issues within the document that will shape the built and green environment in the future.  It was also an opportunity to link in a health impact assessment with the sustainability appraisal which was required to be carried out and this was possibly the first time it had been done in the country.  The Issues and Options document (the first stage of the local plan process) would be issued shortly and had a chapter on health. It was proposed to establish a themed workshop to focus on health and wellbeing issues and Members of the Board were invited to take part and help develop and improve the plan and the put forward the key issues that need to be included in the new plan document.

The new 10 year cycling strategy aims to substantially increase the number of people cycling in the City.  There were currently approximately 13,000 cyclists a day across the City and there was an ambitious target to double these numbers by 2018.  There were proposals to improve the infrastructure, training, promotion of cycling as an alternative mode of transport and work with a number of cycling bodies to help to achieve the targets. The Action Plan was likely to be launched in November.

The Local Sustainable Transport Fund worked closely with health partners to achieve health and wellbeing outcomes.  Details of these initiatives were shown on the presentation.  Many of these initiatives were targeted at areas of high unemployment and deprivation, targeting those likely to have health issues.  There were schemes to promote walking and to develop personalised travel planning encouraging people to change their travel behaviour.  The Sky Bike Ride was one of the most successful in the country and this year it included the news areas of access in the city.  There was also an additional Special Needs Ride around a shorter route involving specially adapted cycles and wheelchairs which was extremely well used. 

There were a number of schemes improving the infrastructure for cycling and walking around the city and approximately 11km of pedestrian routes had been completed.  Major transport infrastructure improvement schemes were included and detailed walking and cycling audits were undertaken so the opportunity for people to travel  ...  view the full minutes text for item 20.

West Leicestershire Clinical Commissioning Group to submit a report providing an update on the Children and Adolescent Mental Health Service Review (CAMHS).  Leon Charikar CAMHS Commissioning Manager Leicester, Leicestershire and Rutland will attend the meeting to present the report.

Leon Charikar, CAMHS Commissioning Manager, Leicester, Leicestershire and Rutland attended the meeting to present the report providing an update on the Children and Adolescent Mental Health Service Review (CAMHS).  It was noted that the Commissioning Manager worked as part of the team that was funded by all three CCGs operating in Leicester, Leicestershire and Rutland.

This report addressed the work that had been taken across Leicester City, Leicestershire County and Rutland County to produce a joint multi-agency strategic approach to improving the emotional and mental health of children and young people. This strategy was based on four strands:

·         Promotion of good emotional health through universal services

·         Co-ordinated and integrated early and targeted support services

·         Clear care pathways to and from specialist clinical services for children with mental health or developmental disorders

·         Joint strategic direction and leadership to ensure strong co-ordination and joint working across organisations

The report also provided an update on the review of the Child and Adolescent Outpatient Mental Health Services provided by Leicestershire Partnership Trust.

It was noted that:-

·         theCAMHS service saw 1,800 children per year which was a small proportion of the children across Leicester, Leicestershire and Rutland.

·         The review had been instigated by health commissioners following concerns raised by referring agencies, families and partner agencies that there were difficulties in accessing the service and it was not communicating very well with referrers or families.

·         The initial findings of the independent review were referred back initially to the CAMHS service on 22 September and then to a wider group of stakeholders.

·         Some of the key issues were around waiting times for routine referrals for which the target of 13 weeks from being referred to assessment was regularly being breeched, and there were concerns that the target itself was not appropriate.  An urgent referral was seen within 4 weeks and work was needed to review that process. 

·         The assessment was carried out with a multi-disciplinary team with the families and the review was looking to streamline the process so that a single practitioner undertook the assessment.

·         Referral rates were different for different GPS practices and referral rates are lower in the City than in the County area.  This was being investigated to see if there were other services available in the City, young people do not know about CAMHS,  whether local services do not understand how to access CAMHS, or whether there were cultural difference in the prevalence rates of identification of mental health conditions.

·         The CAMHS service was also an outlier service as it appeared to hold onto to cases longer than the national average, and this also impacts upon waiting times. 

·         Improvements were also needed for family engagement and support arrangements and outcome measures needed to be used systematically across the service.

·         It was recognised that CAMHS services were underfunded nationally and this had been raised both by the Department of Health and a Government Inquiry looking at a lack of beds in the in-patient provision.

·         Approximately 6% of  ...  view the full minutes text for item 21.

Rod Moore, Divisional Director Public Health, Leicester City Council to provide a verbal update on the progress of the development of Leicester’s Pharmaceutical Needs Assessment (PNA).  A copy of the consultation document on the Draft PNA which runs from 29 September 2014 to 28 November 2014 is attached for information.

Rod Moore, Divisional Director Public Health, Leicester City Council provided a verbal update on the progress of the development of Leicester’s Pharmaceutical Needs Assessment (PNA).  A copy of the consultation document on the Draft PNA which started on 29 September 2014 and ended on 28 November 2014 had previously been circulated to Members.

The consultation document was available on the Council website and had been circulated to a number of interested parties, as well as the statutory consultees, and was also available upon on request.  Comments in response to the consultation could be submitted in writing or orally at public meetings that had been publicised. 

In response to questions from Board Members it was noted that:-

·         The pharmacies in Leicester were not evenly distributed throughout the City as many had been established before the current regulations had come into force. 

·         There were sufficient pharmacies in relation to the population within the City, even though they were not evenly distributed.

·         The pharmacies open for 100 hours or more were situated in Westcotes, Eyres Monsell, Spinney Hills, Stoneygate and Latimer wards resulting in the west of the City being poorly served.

RESOLVED:

1)         That the consultation document and the update on the consultation process be noted.

2)         That a further report on the responses to the consultation be submitted to a future meeting of the Board.

To receive and note the Better Care Fund submission.

The Board at its meeting on 3 April 2014 considered the draft submission and gave delegated authority to Councillor Palmer, Chair of the Board, Dr Simon Freeman, Managing Director Leicester City Clinical Commissioning Group, and Andy Keeling, Chief Operating Officer, Leicester City Council to approve the final submission.  (Minute 63 refers)

An update report was received which outlined the process that had been followed to achieve the national deadline for the resubmission of the Better Care Fund Plan to NHS England and the Local Government Association by the deadline on September 19^th 2014.  The paper outlined the key sections of guidance which had impacted upon the resubmission and the actions taken locally to address these.  The paper also outlined the assurance process which was currently being undertaken.

The Strategic Director of Adult Social Care and Health stated that the plan had been based upon the previous draft that had been considered by the Board.  The initial feedback required more work to be undertaken around the assurance process, and the considerable work undertaken by the CCG and the Council on this was acknowledged.  Since the final Plan was submitted it was currently going through the assurance process, details for which were contained in the report.  KPMG were undertaking an external assurance assessment and the initial feedback had been positive, and few changes had been requested.  The changes made were mainly of additional narrative.

It was noted that the Plan was likely to be rated as ‘Assured with Support’ which would be the highest rating that it could be given because of the current classification of the CCG as a ‘distressed health economy’.  

If was further noted that:-

·         Schemes already implemented under the Plan were generally working well, although the number of people going through these schemes would need to continue to rise. 

·         It was encouraging that a member of the Social Care Intervention Crisis Response Team had worked with the emergency department on the previous Sunday and had prevented 5 people from being admitted to hospital and enabled them to stay at home.  It was hoped to eventually roll this provision out as a mainstream service.

·         There was clear evidence of increased social care services bringing benefit to the health service and to people that were using the services.

·         The fund was a powerful example of the strength of joint working between the Council and CCG which will develop into bringing considerable benefits to the City.

RESOLVED:

That the Better Care Fund Plan submitted to NHS England and the Local Government Association by the deadline on September 19^th 2014 be received and noted and that everyone contributing to its production be thanked.

The Chair to invite questions from members of the public.

A member of the public commented that he was surprised that arts had not been mentioned in the presentation given earlier in the meeting.

The Chair stated that the arts were recognised as having a positive influence on people’s health and wellbeing.  These services were not provided by the Directorate that gave the presentation but would be covered in the appropriate Directorate’s presentation to a future Board meeting.

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

Thursday 11 December 2014

Thursday 5 February 2015

Thursday 26 March 2015

Thursday 25 June 2015

Thursday 3 September 2015

Thursday 29 October 2015

Thursday 10 December 2015

Thursday 4 February 2015

Thursday 7 April 2016

( Note: - Meetings of the Board are likely to be held in City Hall from December onwards.)

It was noted that future meetings of the Board would be held on the following dates:-

Thursday 11 December 2014

Thursday 5 February 2015

Thursday 26 March 2015

Thursday 25 June 2015

Thursday 3 September 2015

Thursday 29 October 2015

Thursday 10 December 2015

Thursday 4 February 2015

Thursday 7 April 2016

(Note: - Meetings of the Board are likely to be held in City Hall from January onwards.)

The Chair declared the meeting closed at 12.05 pm.