Agenda and minutes

The Monitoring Officer to report the following change in the membership of the Board:-

Leicestershire Fire and Rescue Service have nominated Andrew Brodie, Assistant Chief Fire Officer, to be their representative on the Board.

NHS England – Midlands and East have nominated Roz Lindridge, Interim Locality Director, Central NHS England to be their representative on the Board in place of Trish Thompson.

The Board noted the following changes to the membership of the Board:-

Leicestershire Fire and Rescue Service have nominated Andrew Brodie, Assistant Chief Fire Officer, to be their representative on the Board.

NHS England – Midlands and East have nominated Roz Lindridge, Interim Locality Director, Central NHS England to be their representative on the Board in place of Trish Thompson.

The Chair welcomed the new members of the Board together with Lord Bach who was attending his first Board meeting.

Apologies for absence were received from:-

Karen Chouhan                   Healthwatch Leicester

Prof. Azhar Farooqi             Co-Chair Leicester City Clinical Commissioning Group

Roz Lindridge                       Roz Lindridge, Locality Director, Central NHS England.

Dr Avi Prasad                       Co-Chair Leicester City Clinical Commissioning Group

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 Minutes of the previous meeting of the Board held on 15 December 2016 are attached and the Board is asked to confirm them as a correct record.

RESOLVED:

The Minutes of previous meeting of the Board held on 15 December 2016 be confirmed as a correct record.

The Director of Public Health to submit a report providing an update on the progress Children’s and Young People’s Joint Strategic Needs Assessment (JSNA) for 2016.

The Director of Public Health submitted a report providing an update on the progress Children’s and Young People’s Joint Strategic Needs Assessment (JSNA) for 2016.

The Director of Public Health gave an overview presentation in which the following was noted:-

a)         The JSNA presented a series of challenges to services for children and young people in the city.  Not only were a number of key services provided by the Council and the NHS currently undergoing substantial reconfiguration and restructuring; but the data collected in the JSNA identified the key health outcomes for children.  The changing demographics of children and young people in the City also presented challenges to proving services for these emerging needs.

b)         The JSNA did not make specific recommendations for service change but provided data and evidence for key health outcomes for children.  The JSNA was used by public service, voluntary and community organisations and those bidding for funding to provide children’s services, as it provided a digest of children’s health issues in city. 

c)         In addition to the JSNA, a children and young people’s survey was currently being undertaken in the city in both primary and secondary schools and with those children who were home schooled  The survey aimed to seek young people’s views on how they viewed their own health and wellbeing and the services they would like to see provided.  The report of the findings of the survey should be available in the next few months and then discussions would be held with young people to see how the survey results could influence future service provision.

d)         The data collected in the JSNA could change quickly and it had been decided to move away from large printed documents to a web based document.  This would allow it to be updated and refreshed frequently with new information and links to nationally collected data and the data collected routinely in the council.  The web page can be found at www.leicester.gov.uk/JSNA  and the list of topics on the page are:-

•    Demographic profile of Children and Young People in Leicester

•    Pre-birth to early life

•    Early years (0-4 years)

•    School years (5-19 years)

•    Young Adulthood (20-24 years)

•    Mental Health of Children and Young People

•    Looked After Children

•    Youth Offenders

•    Other Vulnerable groups (including Female Genital Mutilation, Child Sexual Exploitation and Gypsy & Traveller Children)

For each topic there will be

•           A summary on a web-page

•           A link to a fuller briefing (printable PDF)

Both the summary and the briefing would contain links to further information

e)         The Health and Wellbeing Strategy – Closing the Gap would be updated from the JSNA and Board members were encouraged to share the JSNA within their own organisations and with partners.  There was useful data on youth offenders and on some of the big issues facing children and young people; such as female genital mutilation, child sexual exploitation and gypsy and travellers children.  Although these were small groups they had complicated health needs.  ...  view the full minutes text for item 52.

To receive a report on the review and refresh of the Transformational Plan developed in 2015 as part of the LLR Better Care Together Programme.  There was a national requirement to refresh the plan to reflect the progress that had been made in 2015.

Chris West, Director of Nursing and Quality West Leicestershire and East Leicestershire and Rutland CCGs and Tim O’Neill, Director of People, Rutland County Council will be present at the meeting to present the report.

The Board received a report on the review and a refresh of the Transformational Plan developed in 2015 as part of the LLR Better Care Together Programme.  There was a national requirement to refresh the plan to reflect the progress that had been made in 2015.

Chris West, Director of Nursing and Quality West Leicestershire and East Leicestershire and Rutland CCGs and Tim O’Neill, Director of People, Rutland County Council presented the report and answered Members questions.

The 6 core work schemes in the Plan were:-

·         Improve Resilience.

·         Enhance Early Help.

·         Improve access to specialist Children and Adolescent Mental Health Services (CAMHS).

·         Enhance the Community Eating Disorder Service.

·         Develop a Children’s Crisis and Home Treatment Service.

·         Workforce development.

In presenting the report it was noted that:-

a)         Phase 1 of improving resilience was underway and 11 out of 24 schools in city were currently involved in the work stream.  The procurement process was underway and it was envisaged that the 3 year contract would be up and running in July 2017.

b)         CAMHS access had improved and the service was now meeting the 13 weeks’ target for assessments to be carried out.

c)         The service for eating disorders was now available 24 hours and 7 days a week and was running fully.

d)         The crisis and home treatment service had started but was as yet not fully operational.  Staff had been recruited and the service was moving into new premises with an on line direct phone line service at the end of February 2017.

e)         The workforce development work-stream had concentrated on identifying the training needs of the staff that were already in place and the development of staff moving forward.  This was currently at the assessment stage and some non-recurrent funds were being used to fund training resources packages for staff.

f)          The steering group overseeing the process had encouraged members to see that the 6 work-streams were connected to each other and good progress had been made.  Parts of the procurement process had been both complex and challenging but there had been good engagement and support across the partnership in the city.  The challenge moving into next financial year would be to gather the data to assess the impact of the work that had been put in place.

g)         The procurement for early health had gone ahead as planned but it had not been possible to secure a provider that met the required needs across the LLR.  It was accepted that the plan did not fully reflect the work that had already been done in the city around early health.

h)        The next refresh to the Plan would be a more comprehensive explanation of all of the work under each of the work-streams and an assessment of how it was making a difference for children. 

Members of the Board commented that:-

a)         Prior to the publication of the refresh, it should reflect the terminology used in the city so that all agencies understood that there was a local  ...  view the full minutes text for item 53.

To receive a verbal update on STP Primary Care proposals from Professor Azhar Farooqi, Co-Chair Leicester City Clinical Commissioning Group and Time Sacks, Chief Operating Officer, East Leicestershire and Rutland Clinical Commissioning Group.

The Chief Executive Leicester City CCG reported that:-

a)         The primary care developments within the STP were guided primarily from NHS England’s GP Forward View.  More details on the GP Forward View had recently been issued and CCGs were required to submit an improvement plan in response to them by 24 February 2017. The improvement plan was at an STP level of plan but with CCG specific sections added to it.

b)         The first STP engagement event in the City was being held at the Peepul Centre, Orchardson Avenue, Leicester on 23rd February 2017 and the primary care work within the STP will be important part of that.

c)         The Primary Care Commissioning draft strategy was to be considered at the CCG Board the following day and would be submitted to the Health and Wellbeing Board as part of the engagement process for the strategy.

AGREED:

            That the update be noted and that the Primary Care Commissioning draft strategy be submitted to a future Board meeting.

To receive a report from Maria Smith, Strategic Lead for Personal Health Budgets for Leicester City, West Leicestershire and East Leicestershire and Rutland Clinical Commissioning Groups.  The report sets out the CCG’s Local Offer and the plans currently in development to expand the offer in line with national guidance.

The Board received a report from Maria Smith, Strategic Lead for Personal Health Budgets for Leicester City, West Leicestershire and East Leicestershire and Rutland Clinical Commissioning Groups.  The report set out the CCG’s Local Offer and the plans currently in development to expand the offer in line with national guidance.

It was noted that:-

a)         There was requirement for Health and Wellbeing Board to be informed of the local personal health budget (PHB) offer.  

b)         Individuals eligible for continued health care (CHC) had been given the right to have a personal health budget since 2014. 

c)         The Integrated Implementation Group comprised representatives of all three local authority‘s children’s, adult social care and education services, LPT, the 3 Healthwatch groups in the LLR and procurement, finance and communications representatives.  The group were building the integrated personal budget process and the broad pathway for the future.

d)         Services for individuals requiring a mental health package would be the main focus for 2017/18 and the focus in 2018/19 would be those with long term health conditions.

e)         One challenge of offering personal budgets was that existing funds were predominately contained within large block contracts and disaggregating these elements to release the resources to offer services in a different way was a complex process.  Work was progressing with LPT and contracting and commissioning colleagues to resolve these issues. 

f)          The proposals for the PHBs Local Offer linked well with the work already being undertaken on the STP.  There were close links with the STP’s Integrated Locality Teams Programme Board to ensure the models they were creating also had an integrated personal budget offer as part of their delivery offer.

In response to Members’ questions the following responses were received:-

a)         At present there were 105 PHBs in place within LLR and the early evidence suggested that individuals had yet not chosen to have radically different health care support than they had received in previous packages.  Initial feedback from patients, their representative and carers on the group generally indicated that, whilst they were some frustrations with the process as it was being developed, there was, nonetheless, indications that recipients of PHBs were happier with their care compared to their previous continued health care packages.  A cultural change was needed within the NHS to move away from a service led approach, which may not always provide services to meet individual needs.  Equally, a corresponding cultural change was also required from individuals who were still generally asking for a specified number of hours for their care rather than opting for other forms of care.

b)         There was no evidence to suggest that PHBs for people with physical and mental health issues had been subjected to financial abuse.  Those administering the PHBs also had some experience of monitoring budgets for those who couldn’t look after themselves within the current CHC packages.   Whilst financial abuse could never be guaranteed, there were safeguards and guidelines in place intended to prevent this.  Third party organisations were also  ...  view the full minutes text for item 55.

To receive the Leicester City Safeguarding Adults Board Annual Report Executive Summary for 2016.

Jane Geraghty – Chair of Leicester Safeguarding Adults Board will be present at the meeting to present the report.

The Board received the Leicester City Safeguarding Adults Board Annual Report and Executive Summary for 2016.  Jane Geraghty, Chair of Leicester Safeguarding Adults Board presented the report and answered Members’ questions.

In presenting the report, the following comments were noted:-

a)         The was the first report since the Adult Leicester Safeguarding Board became a statutory body following the implementation of the Care Act and the Board was compliant with the statutory requirements Care Act requirements.

b)         The Safeguarding Board was responsible for holding all partners to account for their responsibilities and to ensure that each worked with all partners in order that vulnerable adults were safeguarded.  Over 350 cases had been considered as part of the Board’s work.

c)         The Safeguarding Board was working well having committed partners and clear priorities and partners were now engaging in the Board’s work and leading sub-groups.  This was considered as a sign that significant progress had be made in partnership working.

d)         It was of concern that cases coming into the system didn’t reflect the ethnic population of the city and the Safeguarding Board had asked the Stakeholder Engagement Forum (Chaired by Healthwatch) to lead the work on this in order to understand the underlying reasons.  Initial thoughts considered it might be that the people were not aware of the processes in place to protect vulnerable people or know how to access them.  It could also be that people were being kept safe within their own homes.

e)         86 individuals had come back into the system on more than one occasion and there was currently an audit underway to investigate the reasons for this. It was important to know if this was the result of an inappropriate response being given the first time or whether there were other reasons. 

f)          The Safeguarding Board had asked to be part of a pilot for a peer review in May 2017 to assess whether the Board was providing good governance and to assess the impact of work being undertaken and whether the Board was able to demonstrate that its work was improving the safety of people within the system.

The Strategic Director of Adult Social Services commented that the service was not achieving its obligations on safeguarding as there were currently 548 people who were waiting to be screened or assessed and that this level of outstanding screening and assessments had been experienced for some time.   The Cheshire West judgement had confirmed that this was not a new burden for adult social care services and that there were no extra resources to meet the increased demand.   The service had changed the risk assessment process behind DoLS (Deprivation of Liberty Safeguards) and the biggest group affected by the changes were those coming forward from acute and hostels settings.  Currently they were the least likely to be assessed at the present time.   A government review was underway and some provisional arrangements and suggestions for a new approach to DoLS had emerged, but these would not have addressed  ...  view the full minutes text for item 56.

The Chair to invite questions from members of the public.

In response to a question from a member of the public relating to the scrutiny function of the STP and being made aware of the outcomes so the public can be made aware of what is good or what is a concern, the Chair stated that :-

•           The Health and Wellbeing Scrutiny Commission had the responsibility to scrutinise the STP.  The Commission met in public and members of the public could make their views known to the Chair through statements of case, representations or questions etc.

•           It had originally been intended to have a debate at Council in February, as stated in the minutes of the last meeting, but this may not now be until the March Council meeting, when the STP proposals announced in the engagement process would be debated and the Council would come to a view.  This did not mean that the Council would not consider the issue again after the formal consultation process had started on the STP.

•           It was not appropriate not for him to comment upon the scrutiny role, as comments and views on this should be discussed with the Chair of the Scrutiny Commission.

•           He hoped that when the proposals were fully known and the public saw the future affects upon of specific services, then they would also make their views known and that members would also be engaged in that process.

To note that the next meeting of the Board will be held on Monday 3rd April 2017 at 2.00pm

Meetings of the Board are scheduled to be held in Meeting Room G01 at City Hall unless stated otherwise on the agenda for the meeting. 

The Board noted that the next meeting would be held on Monday 3rd April 2017 at 2.00pm

Note: Meetings of the Board are scheduled to be held in Meeting Room G01 at City Hall 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 4.48 pm