Agenda and minutes

The Chair stated that as this was the last meeting of the Board in the current municipal cycle before the elections in May. He wished to thank everyone for their participation in the Board’s work over the last four years.  During this period the Board had existed in Shadow form for the two years prior to it formally coming into being on 1 April 2013.   He also thanked the support officers who had worked with the Board during the last four years.

Apologies for absence were received from Sir Peter Soulsby, City Mayor, Councillor Manjula Sood, Assistant City Mayor, Frances Craven, Strategic Director Children’s Services, Dr Avi Prasad, Co-Chair Leicester City Clinical Commissioning Group, David Sharp, Director (Leicestershire and Lincolnshire Area) NHS England and Trish Thompson, Director of Operations and Delivery, NHS England Local. 

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 to invite questions from members of the public.

The Chair invited questions from members of the public.  No questions were received.

The Minutes of the previous meeting of the Board held on 5 February 2015 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 5 February 2015 be confirmed as a correct record.

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

The Chair welcomed Karen Chouhan back to the Board, following the recent difficulties with VAL in relation to them novating the Healthwatch Leicester contract.  He was pleased that Healthwatch was now on a more positive footing and was moving forward to be completely independent.

Karen Chouhan, thanked the Chair and the Council for its involvement in helping to resolving the issue.  She also requested a copy of the report on the outcomes of the workshop held on 3 February 2105 which had discussed issues in service gaps for adults and children in crisis.  The Chair confirmed that this would be forwarded in due course.  `  

The Chair also referred to the publication of the recent OFSTED Inspection report.  He did not intend to discuss the issue or repeat discussions that had already happened elsewhere but wished to give assurances that there was active and intense scrutiny taking place as a result.  He wished to acknowledge the references in the report to the Board and to the wider health community.  The issues in the report were of utmost concern to all partners involved with the Board.  The report cited the Health and Wellbeing Board and commented that the Safeguarding of Children was not explicitly mentioned in the Board’s strategy.  Whilst that was an important observation, he wished to affirm that this did not mean that the issues were not of importance or significance in the day to day management of all the organisations involved with the Board.  Each of the organisations had statutory responsibilities and undertook vigorous and robust work around a number of themes and issues and these were acknowledged in the report.

Following the publication of the report the Chair had written to NHS England and the Clinical Commissioning Group to seek assurances about their approach to these issues and the training given to front line health professionals around safeguarding of children.  The responses received provided those reassurances.  There was no place for complacency and the Board would continue to take a keen interest in these issues across all the Board’s work areas.  The Board had already demonstrated this by signing the protocols with the Children’s Trust and the Children Safeguarding Board and had strengthened the membership of the Board by the addition of the Lead Executive Member for children’s and young services.

The Board would be holding development sessions to address the issues raised by the report and to consider the Board’s response to them.  Other partners mentioned in the report would also be preparing their own responses.  The Chair intended to bring a report to a future Board meeting on the Board’s response to the OFSTED report to be considered in public.

Sue Lock, Managing Director, Leicester City Clinical Commissioning Group, supported the Chair’s comments and felt it was important to recognise the high priority that is given to safeguarding. She welcomed the proposed development sessions which would help to strengthen an area that was already a firm focus within the CCG.

Andy Keeling, Chief Operating  ...  view the full minutes text for item 65.

The Acting Director of Public Health to submit a report seeking approval of the Pharmaceutical Needs Assessment (PNA).

The Board is asked to:-

1)   Approve the final PNA report for publication;

2)   Note the need to update the PNA by  March 2018, as set out in the Pharmaceutical Regulations;

3)   Note and approve the ongoing responsibilities with respect to the publication of an up-to-date map of all pharmacy provision and the arrangements that have been proposed to ensure that this takes place.

The Acting Director of Public Health submitted a report seeking approval of the Pharmaceutical Needs Assessment (PNA).

The Acting Director commented that it is a statutory responsibility of the Board, to produce the PNA.  The responsibility had transferred from the Primary Care Trust to the Health and Wellbeing Board in April 2013.  One of the key functions of the PNA is to provide a basis upon which NHS England can responds to applications for new pharmacies in the area.

It was noted that there are three main components in the national contractual framework.  These are Essential Services, which must be provided by all contractors, Advance Services, which community pharmacies can choose to provide following appropriate training or accreditation by NHS England, and Community Based Services, which pharmacies can offer to provide if commissioned by local health commissioners, the CCG and local authorities, to meet local health needs.

The PNA also provides information on how services in the national framework are delivered locally and on the wider voluntary role of pharmacies.  It also considers the future projected needs and predicted population growths.  The list of statutory consultees is outlined in section 7 of the assessment and, whilst there was no obligation to consult with the public, the public were consulted and made responses either through paper questionnaires or on-line through the website.  A summary of responses from both the statutory consultees and the public were listed in the PNA.  The PNA presented a number of conclusions and recommendations for commissioners to consider. 

There was a duty to keep the PNA up to date and for it to be reviewed in 3 years’ time.  There was a requirement to publish a map of the pharmaceutical services in the City on the Council’s website and it was proposed that this would become part of the Joint Integrated Commissioning Board’s responsibilities to facilitate the plan being kept up to date.  This would also be dependent upon NHS England to provide the information required, which was an implicit requirement within the PNA process.

Professor Farooqi referred to recent media reports which described how pharmacists were being used by some GP practices elsewhere in the country to treat patients for minor ailments as part of the process to address the shortage of GPs.  He asked if there was any evidence that pharmacies were being underutilised and, if so, what plans were there to utilise these services.

In response, the Acting Director of Public Health stated that this responsibility lay with the commissioners in the first instance.  There were only 3 pharmacies undertaking the maximum of 400 Medicines Use Reviews (MURs) per year in the City. This was a free NHS service offered by pharmacies to have a private consultation with a patient to discuss their knowledge and use of the medicines.   Professor Farooqi felt that this was an under-utilised resource because if people used their medications properly it did have an impact upon future health care and pressures on GP services.  He  ...  view the full minutes text for item 66.

To receive reports on the Joint Health and Social Care Learning Disability Self-Assessment – Evaluating Progress in Local Authority Partnership Board Areas (Appendix C) and for the 2014/15 Adult Autism Strategy: Autism Self-Assessment – Evaluating Progress in Local Authorities along with Partner Agencies. (Appendix C1)

A copy of a presentation on the reports is also attached. (Appendix C2)

The Board is requested to:-

1)         Accept and Validate the Learning Disability Self-Assessment and the Autism Self-Assessment submissions; and

2)         Support the recommendations in both submissions for future work to ensure the Council along with partner agencies are able to meet their legal responsibilities and raise standards

The Board received reports on the Joint Health and Social Care Learning Disability Self-Assessment – Evaluating Progress in Local Authority Partnership Board Areas  and for the 2014/15 Adult Autism Strategy: Autism Self-Assessment – Evaluating Progress in Local Authorities along with Partner Agencies.  A copy of a presentation on the reports had also been previously circulated to members with the agenda.

Yasmin Surti, Lead Commissioner for Learning Disabilities and Mental Health presented the reports to the Board.  This was the second year that these annual assessments had been submitted. There were three main areas for the self-assessments around, keeping people healthy, keeping people safe and ensuring people are living well.

In relation to Learning Disability, there had been an improvement in 5 areas, 16 areas had stayed the same and the area relating to annual reviews was flagged as ‘Red’.  This area of work had now been prioritised for both health and social care staff.   An action plan was being developed with the Learning Disability Partnership Board and quarterly reports would be submitted to them on progress.  Progress would also be reported to the Joint Integrated Commissioning Board (JICB).

Care managers, heads of service and senior directors had been asked how these assessments can be prioritised and those involved had been requested to report back on a monthly basis to monitor progress through the Joint Integrated Commissioning Board.  The Council had been assured that health workers’ priorities had been changed and by the end of the year 100% of annual reviews would be completed for those individuals whose care was fully funded by health.  This would be monitored through contractual arrangements.  In relation to the future, funds were being sought to establish a Community Interest Group comprising individual service users and carers, to provide an independent viewpoint for the self-assessments in relation to the checks made upon services where a contract was in place to provide support people with learning disabilities.

In relation to the Autism Self-Assessment, 7 areas were considered to be good, 10 areas were considered ‘OK’ but could improve and three areas were considered poor.  The proposed actions to address these issues were shown in the presentation.  Work had progressed to work with Police and the Disability Strategy Group to improve raising awareness throughout the courts, prison and probation services.

Karen Chouhan, Chair of Healthwatch Leicester, offered the involvement of Healthwatch services to support the areas for improvement. 

RESOLVED:

1)         That the Learning Disability Self-Assessment and the Autism Self-Assessment submissions be accepted and validated.

2)         That the recommendations in both submissions for future work to ensure the Council along with partner agencies are able to meet their legal responsibilities and raise standards be supported.

3)         That when the Action Plans are developed these be circulated to the Board members so that they can comment upon and support the work that is being done.

Councillor Cooke, Chair of the Leicester City Health and Wellbeing Scrutiny Commission to present a report on the outcomes of a ‘Fit for Purpose Review’ carried out on the Commission’s behalf by the Centre for Public Scrutiny with a view to improving health scrutiny.

The Board is requested to:

1.    Endorse the “Improving Health Scrutiny Arrangements following the ‘Fit for Purpose’ Review Report”.

2.    Endorse the “Implementation Plan’ of actions and the prescribed way forward as a means to drive and co-ordinate improvement to future health scrutiny arrangements.

3.    Support the need for mandatory training for all members of the Health & Wellbeing Scrutiny Commission.

Councillor Cooke, Chair of the Leicester City Health and Wellbeing Scrutiny Commission, presented a progress report on the outcomes of a ‘Fit for Purpose Review’ carried out on the Commission’s behalf by the Centre for Public Scrutiny (CfPS) with a view to improving health scrutiny.  Following the publication of the CfPS Review Report, the Scrutiny Commission had developed an Implementation Plan to address the recommendations that had been made. 

The CfPS concluded that there were four areas of work that needed to be improved.  These were:-

            Improved public and community involvement

Clarification of relationships

Effective prioritisation of issues to scrutinise

Member skills development

The Commission’s responses to each of the 20 recommendations in the CfPS Review Report and the progress made on them to date were detailed in the Improvement Plan.  Some improvements had been achieved by simply rearranging the seating layout for the meeting, which had made a big impact in changing the dynamics of the meeting and establishing a more forensic approach to scrutiny.   Others were more complex such as the protocols on joint working arrangements, which would have benefits in the long term.  The first protocol was signed in June 2014 with Healthwatch and two other protocols had been developed with NHS England and the Care Quality Commission. It was intended to sign these during April.  These protocols would help to maximise mutual knowledge and help each organisation to learn from each other.

Councillor Cooke hoped that his successor would be able to bring a further report back in 6-12 months to demonstrate that further progress had be made on the Implementation Plan.  He also felt that there had always been an issue of the competence of the Commission to carry out its functions and this had been reinforced recently by the publication of guidance on the function of health scrutiny.  Health scrutiny was a statutory responsibility of the Council and it was important that the Commission members understood the legal framework in which they were required to operate. It was therefore essential that there should be mandatory training for health scrutiny members similar to that already for provided for members of the Planning Committee and the Licensing and Public Safety Committee.  Both these had statutory regulatory responsibilities.  He felt that there was capacity to provide this training in-house and there was a real need to understand how the complex NHS system worked and how the Council’s scrutiny process fitted in with both the NHS  structure and, equally importantly, the relationship between the Scrutiny Commission and the Board.

The Commission had undertaken some joint working which had proved both interesting and challenging.  Joint scrutiny had taken place with the Adult Social Care Scrutiny Commission on topics of common interest; but it had not been possible to persuade the County Council to pursue joint scrutiny, as had happened in 2012/13, when the joint working secured a review of the Safe and Sustainable outcomes by the Minister of State in relation to the Congenital Heart Unit at  ...  view the full minutes text for item 68.

To note reports on the following items for information:-

a)         Joint Health and Wellbeing Strategy – 6 Monthly Update

(Appendix E1 – Page )

b)         Better Care Together – Update (Appendix E2 – Page )

c)         Leicester City Council Adult Social Care Commissioning Intentions (Appendix E3 – Page )

d)         Air Quality Action Pan – consultation (Appendix E4 - Page)

The Board noted the reports on the following items for information:-

a)         Joint Health and Wellbeing Strategy – 6 Monthly Update

            This was the fourth bi-annual update report and more data was now available to show the progress with the direction of travel for 23 of the 25 measures now available. The Joint Integrated Commissioning Board (JICB) had been requested to provide summary action plans on all the measures that were showing deterioration in performance.   The summary action plans for NHS Health Checks, Self-Reported wellbeing – people with a high anxiety score and smoking cessation were at Appendix 3 of the report.  Summary action plans were still awaited from NHS England on the uptake of bowel cancer screening in men and women and the coverage of cervical screening in women. Both the CCG and Public Health were also pursuing these independently with NHS England to better understand the reasons for this deterioration.  The CCG were also using data from GPs as part of this process to see if there was a correlation with particular geographical areas or particular sections of the population or whether there was just a general reduction in uptake of screening for no apparent reason.

The Chair commented that the Board had previously discussed the idea of having a Board Member to champion specific themes in the strategy but this had not materialised.  He felt that this should be re-visited in the near future as there was now a larger membership of the Board. 

b)         Better Care Together – Update

            The Chair commented that the engagement process needed to be effective and well communicated to the public.  The scrutiny of the Programme was still best placed with the Health and Wellbeing Scrutiny Commission in view of the Board members’ active involvement with initiatives with the programme.  Healthwatch also had an important role in the public and patient engagement aspects of the scrutiny process.

            In response to questions from members of the public, Mary Barber, Programme Director, Better Care Together, stated that:-

i)          945 questionnaires had been completed to date.  This was higher than in previous baseline responses.

ii)         The emerging themes of concerns expressed by the public were:-

·         What were the proposals for the General Hospital?

·         Will the primary care sector be able to cope with the additional services they would be expected to provide?

·         What will be the impacts upon social care provision?

iii)        Detailed plans were currently being developed for 2015/16 and 2016/17.  Any changes to services in the 2015/16 plan would only be implemented if they did not require formal public consultation. These changes to be implemented could involve improvements in performance and increases in service provision.  Services that required public consultation were currently being identified and it was intended to submit a list of these to the meeting of the Partnership Board in May.

iv)        The number of beds provided within the NHS constantly changed from week to week and month to month.  The primary issue was not necessarily the  ...  view the full minutes text for item 69.

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

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 otherwise on the agenda for the meeting.

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

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 otherwise on the agenda for the meeting.

There were no items of Any Other Urgent Business.

The Chair declared the meeting closed at 10.20 am.