Agenda and minutes

Apologies for absence were received from Ann Branson, Director of Housing, Karen Chauhan, Chair of Healthwatch, Frances Craven, Strategic Director, Children’s Services,  Dr Avi Prasad, Co-Chair, Leicester City Clinical Commissioning Group, and David Sharp, Director, (Leicestershire and Lincolnshire Team), NHS England.

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.

Councillor Sood declared an Other Disclosable Interest as Chair for the Leicester Council of Faiths and as a patron of CLASP. 

In accordance with the Council’s Code of Conduct the interest was not considered so significant that it was likely to prejudice Councillor Sood’s judgement of the public interest.  Councillor Sood was not, therefore, required to withdraw from the meeting during consideration and discussion on items involving this interest.

The Chair welcomed Rod Moore, Acting Director of Public Health, Sue Lock, Managing Director, Leicester City Clinical Commissioning Group and Elaine McHale, Interim Strategic Director Adult Social Care to their first meeting in their new roles.

The Minutes of the previous meeting of the Board held on 9 October 2014 are attached and the Board is asked to confirm them as a correct record.

RESOLVED:

That the Minutes of the previous meeting held on 9 October 2014 be confirmed as a correct record.

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

The Chair announced that following the recruitment exercise in the summer and autumn, two new members had been selected to fill the existing vacancies.  The successful applicants were Richard Clark, Chief Executive of Mighty Creatives and Professor Martin Tobin who was Professor of Genetic Epidemiology and Public Health at Leicester University and an Honorary Consultant in Public Health at the University Hospitals of Leicester, NHS Trust.

The Board supported the appointments and welcomed Professor Tobin to the meeting.

The Chair also announced that the City Council had responded to NHS England’s consultation on Standards as part of the current Congenital Heart Disease Review.  A copy of the response would be circulated to all members of the Board for information.

A)        To receive verbal updates (5 minutes) on each of the five priorities:-

i)          Improve outcomes for children and young people.

ii)         Reduce premature mortality.

iii)        Support independence.

iv)        Improve mental health and resilience.

v)         Focus on the wider determinants of health through effective deployment of resources, partnership and community working. 

B)        Update on recovery plans for the four areas of concern discussed at the last Board meeting.

i)          Improve outcomes for children and young people Readiness for school age 5 – Appendix B1

ii)         Diabetes: The percentage of patients with diabetes in whom the last IFCC-HbA1c is 59 mmol/mol in the preceding 15 months – (Presentation)

iii)        Adults in contact with secondary mental health services living independently – Appendix B2

iv)        Cervical Screening Coverage – NHS England to be followed up separately - Appendix B3

C)        Presentation from the Housing Department on how they are working towards the Joint Health and Wellbeing Strategy Ann Branson, Director of Housing.

The Board received verbal updates on each of the following five priorities:-

i)       Improve outcomes for children and young people.

The priority had four elements:-

a)      Reduce infant mortality

·         The risk of mortality increased with deprivation.  Rates were reducing through a number of actions.  There was no single strategy but this element was reflected in a number of policies, plans and strategies which included:-

o   Reducing maternal obesity in pregnancy.

o   Improving rates of breast feeding and support and peer support.

o   Reduce smoking in pregnancy.

o   Achieve the UNICEF baby friendly standard in the city.

·         It was important to include infant mortality as part of an overall 0-3 year old strategy to achieve a more co-ordinated approach in larger framework.

b)                  Reduce Teenage Pregnancy

·         A number of initiatives and actions were taking place involving contraception and sexual health programmes, education programmes and raising the attainment within the city.

·      The rate of teenage pregnancies had halved since 1988 and it was important to maintain the decrease in the rates achieved.

c)      Improve readiness for school at age 5 – this was the subject of a written report later on the agenda.

d)      Promote healthy weight and lifestyles in children and young people.

·    There were a significant number of children who were overweight or obese at reception and year 6.

·    There were a number of actions ongoing to address this but it needed a continued focus to improve the situation.  There needed to be better integration in a wider 0-5 year old strategy.      

ii)      Reduce premature mortality.

·         Progress had been made in all areas of:-

o   Reducing Smoking.

o   Increasing Physical Activity and Healthy Weight.

o   Reducing harmful alcohol consumption.

o   Improving the clinical management of cardiovascular disease, respiratory disease and cancer.

·         There was progress on smoking cessation rates but the increase of e-cigarette usage was impacting upon how smoking cessation programmes worked.

·         There were campaigns on reducing smoking in cars and homes and reducing smoking at the time of delivery for pregnant women.

·         There were a range of activities promoting exercise and healthy lifestyles and a healthy needs assessment would shape the priorities for the future.

·         There had been a substantial reduction in the number of alcohol related hospital admissions but the rate in Leicester was still above the national average.

·         The recent alcohol summit chaired by Councillor Palmer had explored a number of issues and identified that actions happened through a number of organisations and agencies and there was a need to strengthen co-ordination arrangements deliver new messages and the ways of presenting them.

·         The new diabetes pathways, the lifestyle referral hubs and the NHS health checks were also having an impact.

iii)     Support independence.

·      This covered older people, cares and people with dementia and long term conditions.

·      Much of this work was on-going through the Better Care Fund.

·      There had been 2,562 care plans prepared by 30 November 2014 for the 2% of those at high risk of admission to hospital.

·      70 people were successfully using the  ...  view the full minutes text for item 32.

The Board received a presentation from the Housing Department on how they were working towards the Joint Health and Wellbeing Strategy.  A copy of the presentation is attached to these minutes.

The Chief Operating Officer and the Head of Service (Districts), Housing gave the presentation and in addition to the points made in the attached document the following points were noted:-

·         The health of tenants was considered as being equally as important as the condition of the housing stock.

·         The role of STAR (Supporting Tenants and Residents) played a critical role in supporting tenants.

Following questions from Board members it was noted that:-

·         The original ‘decent homes standard’ was modified and adopted as higher local standard some years ago.  It was accepted that was in need of an update and it would be helpful to re-issue it to include details of what criteria were contained within it.

·         Historically the Council had been reactive when dealing with private landlords and it was accepted that this should be reviewed to see if the relationship could become more pro-active; which could include looking at the feasibility of establishing a landlords’ consultative forum.  Being proactive in this way could help to raise a number of tenants’ issues in an impersonal manner rather than creating a confrontational situation on tenants’ behalf, particularly as private tenancies were generally less secure than the Council’s own tenancies.

·         Condensation was accepted as a major problem to both tenants’ health and the condition of the housing stock when it occurred.  Members’ comments that it was always helpful to advise tenants to open windows were noted.  It was equally important for tenants to know how any window vents worked to and ensure that these were functioning correctly.

·         The £200k capital investment in carry out condensation works was insufficient and this should be reviewed to see if this could be increased within the priority of the housing budget in future years.  The causes of condensation were varied and in some instances there was a need for behavioural change and in other instances it required a technical solution.

·         Members comments that increases in mental health issue were being observed as a consequence of poor housing conditions were noted, and the importance of addressing these issues through non-medical responses was mentioned as this would help to prevent pressures building up in the primary and acute health sectors.

·         The Council’s Neighbourhood Housing Teams were well equipped to signpost tenants and help them to obtain assistance for non-housing issues.  This could involve helping tenants to access additional finances or grants to help with housing costs and heating, engaging with doctors and hospitals services.  The STAR scheme helped to maintain 80% of tenancies.

·         There was scope within the primary care strategies and health needs neighbourhood development work to develop closer working relations to address the issues discussed above.

Following questions from a member of the public it was noted that:-

·         The Council had explored the licensing registration scheme for landlords and had recently looked at the scheme  ...  view the full minutes text for item 33.

To receive an update report on the Better Care Together Joint Leicester, Leicestershire and Rutland Five Year Strategy and to agree proposals with regard to comments on the drafts and a programme of wider engagement.

Geoff Rowbotham, Interim Programme Director and Michael Cawley, Finance Director will attend the meeting to present the report.

To receive an update report on the Better Care Together Joint Leicester, Leicestershire and Rutland Five Year Strategy and to agree proposals with regard to comments on the drafts and a programme of wider engagement.

Geoff Rowbotham, Interim Programme Director and Michael Cawley, Finance Director attended the meeting to present the report.

It was noted that:

·         The 5 year plan was reviewed in June and incorporated comments previously made by the Board.  This document was now publically available on the website.

·         Both the Strategic Outline Case (SOC), essentially the investment proposal to support the plan; and the Program Initiation Document (PID) setting out the governance arrangements for the programme, had been developed.  These documents had been submitted to the various partnership boards for development and approval.   It was intended to put these documents in the public arena during February and March 2015.  There would be a series of engagement events with the staff and the public to receive comments and feedback on the documents.

·         It was proposed to hold a voluntary sector summit in February to identify how and where the sector could support and interface with the programme.

·         Once all the documents were in a final form there would be a further opportunity for stakeholders to comment on the proposals. 

·         The programme contained a number of proposals that would require formal statutory and work was underway to identify to identify these and develop proposals for the consultation process.   When this was completed this would be presented to the Council’s Health and Wellbeing Scrutiny Commission for comment.

·         Work was progressing on developing the work that had previously been carried out under the Better Care Fund between health and social care partners to incorporate this into the Better Care Together Programme proposals.  It was recognised that there were challenges facing local authority partners in social care in relation to future budgets and to integrating the work of both health and social care workforces into the required outcomes for the programme.  Work was on-going through the Partnership Board to achieve this and to develop detailed implementation plans.

Following questions from members of the Board it was noted that:-

·         The concerns expressed about the ability of the local arrangements to have the capacity to change to meet the proposals within the suggested timescales for the proposals for the ‘beds programme and left shift’ in the report were noted.  However, one of the guiding principles in the programme was that there would be no intention to move capacity out of acute sector until the provision had been established in the community and this should not, therefore, put patient care a risk.  This principle had financial implications and this had been taken into account within the proposals.  Assurances were also being sought from the Adult Safeguarding Boards requesting them to examine the proposals and to confirm that individuals were not being put at risk.

·         The proposed reduction in children’s beds was based on a clinical view that if high quality  ...  view the full minutes text for item 34.

To receive a report from the Interim Director for Adult Social Care and the Managing Director, Leicester City Clinical Commissioning Group on the funding transfer from NHS England to Social Care 2014/15 and to approve the plan.

The Interim Director for Adult Social Care and the Managing Director, Leicester City Clinical Commissioning Group submitted a report on the funding transfer from NHS England to Social Care for 2014/15 and requested approval of the plan.

Since the abolition of the Primary Care Trusts in April 2013, the funds for joint working between the NHS and social care have been made to the Council directly by NHS England.  The use of the funding, was, however, subject to a local agreement between the Council and the Leicester City CCG.  A joint plan, agreed by both bodies was submitted with the report.

RESOLVED:

That the Joint NHS Leicester City Clinical Commissioning Group and Leicester City Council Plan to support the Funding Transfer from NHS England to Social Care for 20154/15 be approved.   

To receive a report from the Acting Director of Public Health on the Joint Specific Needs Assessment for Mental Health.

The Acting Director of Public Health submitted a report on the Joint Specific Needs Assessment for Mental Health (JSNA).

It was noted that the JSNA had already been used to inform the Better Care Together Mental Health workstream and was currently being used as the basis fo r the development of the Joint Health and Social Care Commissioning Strategy for Mental Health.

The Chair commented that it was an informative and useful document and felt there should be references to it in policies and decisions which were drawn for a JSNA.

RESOLVED:

That the Joint Specific Needs Assessment on Mental Health in Leicester be received, and that its use be promoted in shaping strategic intentions and defining specific commissioning activities to improve mental health in the city.       

To receive an update on the progress of the Better Care Fund from the Interim Director for Adult Social Care and the Managing Director, Leicester City Clinical Commissioning Group.

The Interim Director for Adult Social Care and the Managing Director, Leicester City Clinical Commissioning Group submitted a report providing an update on the Better Care Fund.

The Chair commented that the Better Care Fund had achieved a rating of ‘Approved with support’ from the National Consistent Assurance Review process, which was the highest rating available to the city as a challenged health economy.  The Chair thanked everyone involved in developing the programme for this achievement.

The Managing Director, Leicester City CCG stated that it had now been agreed with the Relationship Manager that any outstanding evidence and information had been submitted. Full approval was now awaited together with confirmation that this level of support had been removed.  It was also pleased that when guidance and information was sent out to all CCGs, the City Better Care Fund was the only one cited as being of high quality.

RESOLVED:

That the timetable and expectations of the final submission of the Leicester City Better Care Fund be noted.

To receive a report from the Acting Director of Public Health on the outcome of the Leicester Health and Wellbeing Scrutiny Commission consideration of a report from NHS England on childhood immunisations in 2013/14 and Q1 2014/15.

The Acting Director of Public Health submitted a report on the outcome of the Leicester Health and Wellbeing Scrutiny Commission’s consideration of a report from NHS England on childhood immunisations in 2013/14 and Q1 2014/15.

The Board had previously requested the Commission to receive quarterly progress reports to ensure that the level of performance in previous years was being maintained.  The Commission found that despite a slight reduction in the boosters in 5 years olds in 2013/14 progress was satisfactory.  The Commission also made a number of comments regarding improving the performance for the age 5 boosters, the poor experience of the administration of the Fluenz in schools, the challenge of getting teenagers to attend appointments and the problems they and their parents had in keeping track of the immunisations they have had. 

These comments had been passed onto NHS England and these had been taken into consideration for the future.

RESOLVED:

That the report be noted and further reports be received on a quarterly basis.

The Chair to invite questions from members of the public.

There were no questions from the members of the public present at the meeting.

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

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 2016

Thursday 7 April 2016

Meetings of the Board are scheduled to be held in City Hall, at 10.00am unless stated that otherwise on the agenda for the meeting.

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

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 2016

Thursday 7 April 2016

Meetings of the Board were scheduled to be held in City Hall, at 10.00am.

The Chair stated that he had agreed to take an item of any other urgent business on the Urgent Care System.

Urgent Care System

The Chair invited the Managing Director of Leicester City Clinical Commissioning Group to comment upon the recent publication of the report by Dr Ian Sturgess following his six month review of the Urgent Care System within Leicester, Leicestershire and Rutland.

It was noted that:-

·         Dr Sturgess had been commissioned by the CCG to undertake the review and had spent nearly four months in a hospital setting and the remaining time looking at primary and community care elements.

·         The report contained over 180 recommendations.

·         An initial report was submitted to the Wider Urgent Care Board after his work in the hospital setting and a number of the recommendations have already been considered and work was progressing on them.

·         Following the publication of the full integrated report on both the in and out of hospital services, the Local Urgent Care Plan has already been updated to accommodate the highest priority level of his recommendations.

·         The remaining recommendations will be considered in the near future.  The more strategic recommendations will be fed into the Better Care Together Programme, particularly around those involving the change of culture. Those more immediate operational actions would be brought into the Urgent Care Plan.

·         The recommendations focussed on issues relating to the following main themes:-

o   Admission avoidance – ensuring that people receive care in the setting best suited to their needs rather than the Emergency Department.

o   Preventative care – putting more emphasis on helping people to stay well with particular support to those with known long term conditions or complex needs.

o   Improving processes within Leicester’s Hospitals – improving the Emergency Department and patient flow within the hospitals to improve patient experience and ensure there is capacity in all areas.

o   Discharge processes across the whole system – ensuring there are simple discharge pathways with swift and efficient transfers of care.

·         The report stressed that the 4 hour target for a patient to be seen in the emergency department was not an indicator of how the emergency department was working but was essentially a measure of the effectiveness of the whole system’s management of the urgent and emergency care pathway.

·         A further key message was that the system should focus on getting people home rather than finding them a bed in hospital as an interim measure, as there was a tendency for people to decondition and become less able to look after themselves once they had been admitted into hospital.  The key was getting a good rapid assessment and accessing good community services to help the person to remain at home.

The Interim Director of Adult Social Care stated that social care performed well in the City and the requirement to for patients to be discharged from hospitals as soon as possible was understood.  More work was needed to prevent admissions to hospitals but this required an infrastructure with more support from  ...  view the full minutes text for item 41.

The Chair declared the meeting closed at 12.02 pm.