Agenda and minutes

The Chair welcomed everyone to the meeting and asked everyone to introduce themselves to the members of the public who were attending.

Apologies for absence were received from David Sharp, Leicestershire and Lincolnshire NHS Commissioning Board and Chief Superintendent Rob Nixon, Leicestershire Police.

Members of the Board are asked to declare any interests they may have in the business on the agenda.

Members of the Board were asked to declare any interests they might have in the business on the agenda. No such declarations were made.

The discussion session has been planned to last approximately 90 minutes and representatives of interested bodies have been invited to the meeting.  The Joint Health and Wellbeing Strategy (Closing the Gap) is attached. 

Deb Watson, Strategic Director Adult Social Care, Health and Housing and Simon Freeman, Managing Director, Leicester City Clinical Commissioning Group will also give a presentation.

Deb Watson, Strategic Director Adult Social Care and Health and Simon Freeman, Managing Director, Leicester City Clinical Commissioning Group gave a presentation on Priority 3 of the ‘Closing The Gap Strategy’ on supporting independence.  A copy of the presentation is attached.  In addition to the points shown in the presentation the following comments were made:-

·         Whilst good progress had been made there was still more to be achieved, especially around making the community aware of the issues surrounding dementia and the support that is available.

·         There had been a 30% increase in the uptake of Carers personal budgets. Out of approx. 1,800 family carers who are receiving support from adult social care, 978 are now purchasing their support through a personal budget, giving them increased choice over their support and increased control over arrangements.

·         250 carers had received training to support them in their role, including developing coping strategies, recognising the various trigger points when things can go wrong and information on where to get help.

·         Although there were 30,000 carers in the City, only a small proportion of carers made formal contacts to seek help.  More needs to be done encouraging people to identify themselves as carers and to promote the use of services available to them.

·         Significant contributors to the poorer life expectancy for people in the City were diabetes, cardio-vascular and respiratory diseases.

·         Leicester had low rates of recorded diagnosis of respiratory conditions but a high rate of hospital admissions resulting from respiratory conditions.

·         Up-skilling of GP’s, using risk stratification to focus interventions on people at high risk of deterioration and using a case management approach for people with multiple illnesses/conditions are vital to reduce/prevent people from a ‘revolving door’ syndrome of discharge and re-admissions to hospitals.

·         Half of the hospital admissions for people aged over 65 years accounted for 65% of the time and resources for emergency admissions.

·         The Integrated Commissioning Board has submitted an application to become one of 10 ‘Integration Pioneers’ pilot sites for integrated health and social care delivery.

The Healthwatch representative commented that there were a number of initiatives in primary care where people are supported to be independent with the aim of reducing the incidence of hospital admissions.  The large number of small initiatives could result in a larger cumulative impact.

The Age UK representative stated that there were a number of good ideas and pilot schemes but often it was difficult to sustain these and integrate them into strategic level and statutory service provision.  There was specific funding for ‘supporting carers for those approaching end of life’ but it was very hard to contact the right people to talk to and it often felt as though they were operating in isolation.

Professor Farooqi commented that, whilst there was widespread support for an integrated approach to service delivery, this often required reducing expenditure in the acute service sector and this presented a huge challenge.  As more systems for delivering services in the community were introduced, they usually identified and uncovered unmet  ...  view the full minutes text for item 17.

The minutes of the meeting held on 11 April 2013 have been circulated previously and the Board is asked to confirm them as a correct record.

The minutes can also been found on the Council’s Web-site at the following link:-

http://www.cabinet.leicester.gov.uk/documents/g5616/Printed%20minutes%20Thursday%2011-Apr-2013%2010.30%20Health%20and%20Wellbeing%20Board.pdf?T=1

RESOLVED:

That the minutes of the meeting held on 11 April 2013 be confirmed as a correct record.

To consider the attached report from the local Clinical Collaborative Interface Group about the recommendations in the Mid Staffordshire NHS Foundation Trust Public Inquiry Report (Francis Report).

The Board received a report on behalf of the local Clinical Collaborative The Board received a report on behalf of the local Clinical Collaborative Interface Group (CCIG) about the recommendations in the Mid Staffordshire NHS Foundation Trust Public Inquiry Report (Francis Report). At the April meeting of the Health and Wellbeing Board, it had been noted that NHS commissioners and providers in Leicester, Leicestershire and Rutland were working together on an initial response to the Francis Report. It had been agreed that this would be provided to the Health and Wellbeing Board.

The CCIG brought together the clinical leaders from the local CCGs, the NHS provider Trusts and NHS England Local Area Team.  Initial proposals for actions to be delivered in partnership included:

a)    A coherent system across Leicester, Leicestershire and Rutland (LLR) should be established to collect soft intelligence on patient care.

b)    There should be an emphasis on clinical leadership and coherent teamwork.

c)    The ‘right place, right care’ programme should be extended to primary care.

d)    An effective single front door to the Emergency Department at UHL NHS Trust be made a high priority.

Six common themes had emerged on what the priorities should be to improve services and to safeguard against the issues highlighted in the Francis Report.  These themes were transparency, listening, walking the floors, saving more lives, safe staffing levels and targeting improvement. Details of these were contained in the report.

A number of priorities for the first phase of joint work have been identified and there will be a further update in October.  These priorities were listed in the report, together with a list of each organisation’s specific area for priority.

Philip Parkinson commented that it was encouraging that the responses were positive and the commitment to listening to patients, staff and stakeholders views was welcomed.  He asked if there were log of reported incidents which could be placed in the public domain.  Simon Freemen confirmed that this could be done and that a list of engagements could also be shared.  

Professor Farooqi commented that the joint response was ‘work in progress’ and any feedback on the responses to the individual organisations would be helpful.  

RESOLVED:

1)    that the assurances on the work underway to progress the recommendation of the Francis Report be received;

2)    that the priorities of work identified in the report be supported; and

3)    that a further update on the progress achieved be submitted to a future meeting of the Board.

To note a report on the Health Protection Board and to note that it has met for the first time.

The Strategic Director for Adult Social Care and Health presented a report on the first meeting of the Health Protection Board (HPB) which had taken place on 5 June 2013.  The Board had made a number of minor changes to its Terms of Reference which were listed in full in the report.  The HPB will meet quarterly and further report will be brought to the health and Wellbeing Board in due course.

RESOLVED:

that the report and the changes to the Terms of Reference be noted.

To note a letter from Norman Lamb MP (Minister of State for Care and Support) about the Winterbourne View Concordat and a report summarising progress.  The letter and report are attached.

The Board received a letter from Norman Lamb MP (Minister of State for Care and Support) about the Winterbourne View Concordat together with a report summarising progress. 

The Strategic Director for Adult Social Care, Health and Housing explained the background to the concordat which had arisen following the ‘Panorama’ exposé of the treatment of people at the Winterbourne View hospital who had learning difficulties/autism and displayed challenging behaviour or serious mental health issues. 

The Minister had asked partners on Health and Wellbeing Boards to provide a stocktake of the local progress following the Winterbourne View Concordat.  The stocktake for Leicester had been completed and a timeline had been identified for moving on/discharge for each person.  There was shared understanding of the current care arrangements for the 17 adults and 2 children affected and the register was being updated to ensure the dataset reflected the requirements of the Winterbourne Joint Improvement Programme.  The reports also contained other actions that had been carried out in response to the concordat.

RESOLVED:

that letter from the Minister be noted together with the stocktake report that was submitted to the Winterbourne View Joint Improvement Board on 5 July 2013.     

.     

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

The Chair made the following announcements:-

LGA Peer Challenge

The Chair had accepted an invitation from the Local Government Association to take part in a Peer Challenge Review for Health and Wellbeing Boards next February.  He would circulate the details to Board Members.

Integration Pioneer Initiative

The CCG had made an application to become a health and social care integration pioneer.  The City Council supported the bid and if it was successful it could result in national and international support to ‘pioneers’ for 5 years which would help to achieve innovative changes.

Joint Integrated Commissioning Board

The Chair had agreed to the Joint Integrated Commissioning Board having responsibility for taking the Closing The Gap Joint Health and Wellbeing Strategy forward, as it was more appropriate to use an existing organisational structure than create a new one for this purpose.

City of Culture 2017

The City had been successful in becoming one of four Cities on the final shortlist for the City of Culture 2017 together with Dundee, Hull and Swansea Bay.  The health community could make a considerable contribution to the bid if it was successful as it could underline and contribute to cultural activities.    

The Chair to invite questions from members of the public.

The Chair invited questions from members of the public and the following questions were received and answered:-

Question - Number of residents not registered with a GP

The number of residents not registered with a GP practice was raised at the last meeting of the Board and what steps had been taken since then to reduce the numbers and how many were still not registered?

Response

The on-going campaign included arrangements for people who attended emergency centres at UHL for treatment to register at the centre if they were not already registered.  A campaign would continue to run in part of the City where lower than expected levels of registration were observed.  Publicity was undertaken in shopping precincts etc to encourage people to register.  The Square Mile Project around the University survey responses suggested that nearly all residents were registered with a GP.  The focus of this campaign would now centre on when people last saw their GP and would follow up on those not registered.  

It was stated that non- registration had been a longstanding issue but there was no overwhelming evidence to suggest that the level of non-registration was a significant problem or a barrier to the provision of healthcare when it was needed.  Registration was important for immunisation and core screening programmes.

NHS England were also known to be undertaking a national clearing exercise of GP lists as the number of people registered with GP’s was greater than the total population.  It was estimated that this could result in a 2-3% reduction in the number of people registered.  The main reason for the discrepancy in numbers appeared to be people who had moved away from an area but were still registered with the GP in that area.

It was also noted that the Secretary of State for Health was considering charging patients from overseas for GP services and if this was introduced it could discourage people from registering.

The Chair stated that he would consider a methodology for asking questions in advance of the meeting so that a detailed written response could be prepared and the questioner may have the opportunity to then ask a supplementary question.

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

Tuesday 8 October 2013

Thursday 30 January 2014

Thursday 3 April 2013

Thursday 3 July 2014

Thursday 9 October 2014

Meetings of the Board will be held in the Tea Room, 1^st Floor Town Hall at 10.00am unless stated otherwise on the agenda for the meetings.

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

Tuesday 8 October 2013

Thursday 30 January 2014

Thursday 3 April 2013

Thursday 3 July 2014

Thursday 9 October 2014

Meetings would take place in the Tea Room, 1^st Floor Town Hall at 10.00am unless stated otherwise on the agenda for the meetings.

The Chair also invited Board members to submit views and observations on how the Board could conduct its meetings.  A number of different approaches had already been tied and feedback would be welcomed.  

The Chair declared the meeting closed at 11.45am.