Agenda and minutes

Apologies for absence were received from:

Lord Willy Bach                    Leicester, Leicestershire and Rutland Police and Crime Commissioner

Andrew Brodie                     Assistant Chief Fire Officer, Leicestershire Fire and Rescue Service

Karen Chouhan                   Healthwatch Leicester

Frances Craven                   Strategic Director Children’s Services, Leicester City Council

Prof. Azah Farooqi              Co-Chair, Leicester City Clinical Commissioning Group

Andy Keeling                        Chief Operating Officer, Leicester City Council

Chief Supt Andy Lee          Head of Local Policing Directorate, Leicestershire Police

Roz Lindridge                       Locality Director Central NHS England, Midlands and East (Central England)

Dr Peter Miller                       Chief Executive, Leicestershire Partnership NHS Trust

Dr Avi Prasad                       Co-Chair, Leicester City Clinical Commissioning Group

Toby Sanders                       Senior Responsible Officer, Better Care Together Programme

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 6 February 2017 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 6 February 2017 be confirmed as a correct record.

To receive a report from the Leicester City Clinical Commission Group (CCG) on the Blueprint for General Practice – Delivering the General Practice Five Year Forward View, that was jointly published on 24 February 2017 by all 3 CCGs in Leicester, Leicestershire and Rutland.    

The Board received a report from the Leicester City Clinical Commission Group (CCG) on the Blueprint for General Practice – Delivering the General Practice Five Year Forward View; that had been jointly published on 24 February 2017 by all 3 CCGs in Leicester, Leicestershire and Rutland.

The Chief Executive, Leicester City Clinical Commissioning Group introduced the report and commented that primary medical care was the foundation of a high performing health care system and was critical to the successful implementation of the LLR Sustainability and Transformation Plan.  Ensuring the development and resilience of Primary Care would assist in bringing about the system-wide transformation required to focus on prevention and the moderation of demand growth. 

The Plan had been prepared by the three separate CCGs in LLR each had  distinct geographical, political, social and economic environments, with very differing health needs.  All three CGGS were committed to the development of our response to the GP 5 Year Forward view as a collective, and consequently there was a focus in the plan on what brought them together and how they would jointly tackle the challenge, whilst also highlighting locally sensitive solutions to their own areas of responsibility.

GPs from each CCG Board had actively engaged in the development of the plan and fully supported it.  There were many challenges facing General Practice, including workforce, funding and rising demand.   All CCGs would work together to develop and co-design a resilient and sustainable model in which general practice could thrive and meet the challenges in the future.

The CCGs had a clear direction for the future of primary care in which general practice was the foundation of a strong, vibrant, joined up health and social care system. The new system was patient centred, engaging local people who use services as equal partners in planning and commissioning which results in the provision of accessible high quality, safe, needs-based care. This would be achieved through expanded, but integrated, primary and community health care teams; offering a wider range of services in the community with increased access to rapid diagnostic assessment and, crucially, patients taking increased responsibility for their own health.

The following points were noted in response to discussion and questions from Members of the Board:-

a)            Work on the strategy had been taking place for some time in what was a complex area.  There had been a difference in approach from NHS England who had acknowledged the level of investment and resources in primary care had been inadequate.  Many GPs had complained for a number of years that the lack of investment had not enabled primary care to keep on track with the rest of the health system.

b)            The three key issues locally were:-

·         Capacity - the ability to deliver in different parts of the workforce around the LLR area. 

·         The health needs challenge presented by the city arising from deprivation.

·         The level of investment.

c)            The Primary Care strategy was seen as an enabling document for larger strategies such as the STP to  ...  view the full minutes text for item 64.

The Director of Public Health to submit a report on the Draft Health, Wellbeing and Prevention Strategy.

The Director of Public Health submitted a report on the Draft Health, Wellbeing and Prevention Strategy which would succeed the previous Joint Health and Wellbeing Strategy ‘Closing the Gap’. 

The draft strategy had been developed through informal engagement within the city council and local NHS. The strategy set out a framework for prevention in the city across 5 key themes and provisionally identified bodies to take responsibility for moving forward particular elements of the strategy, led by the Health and Wellbeing Board.  The key themes, responsible bodies and their responsibilities would need to be confirmed.  Implementation of the strategy would be supported through an annual action plan

Public engagement on the Strategy was provisionally planned for May.  A one-page public facing version of the Strategy would also be prepared for the final version.  The strategy had 5 key themes:-

• Healthy Start – covering maternity, ante-natal and childhood services.

• Healthy Lives – covering lifestyle factors and helping people to live healthier lives

• Healthy Minds – mental health and wellbeing and good services and community provision for people with low level mental health concerns to prevent them becoming more acute

• Healthy Ageing – reducing isolation and helping people live longer and healthier for longer.

• Healthy Places – how to make better use of, and recognise the importance of,  ‘place’ which was around making the best use of resources , assets, facilities and social capital in communities to help make communities healthier.  It was about linking in with opportunities that were provided by consultations and engagement on other plans such as the local plan policy framework which also shape and affect communities.

Each of the themes had key outcomes and specific indicators to measure performance. 

The Chair asked for views on whether the specific indicators and the structure of the strategy were appropriate and whether the outcomes addressed the challenges being faced in communities, and by the Council and the NHS.

The Director of Public Health commented that the draft strategy had been built upon the previous work undertaken in ‘Closing the Gap’ and developing existing work.  It was important to outline what ‘prevention’ would look like in a local strategy designed to bring about long term changes and differences in health needs identified in Joint Strategic Needs Assessment beyond the nominal lifetime of these 5 year strategies.   There would be more engagement and consultation as the strategy developed.

The Assistant City Mayor, Children, Young People and School stressed the importance of linking the strategy with work in other strategies and with the work of other Boards.  She felt that draft strategy should include an outcome around ‘attachment’ which could fit into any of the first three themes.  Getting the outcomes right for young people was an important part of long term prevention measures.

The Chair commented that the series of public engagements and development of the prevention strategy would take place in May and encouraged partners to take an active part in those events.

AGREED:

1)    That the draft strategy be received  ...  view the full minutes text for item 65.

The Director of Public Health submits an update on the Sport England’s new strategy ‘Towards and Active Nation’.  A presentation will be made to the Board on local proposals being developed by the Council and its partners.    

The Director of Public Health submitted an update on Sport England’s new strategy ‘Towards and Active Nation’.  The Director also made a presentation on the local proposals that were being developed by the Council and its partners.

The following was noted during the presentation:-

a)            Sport England introduced a new strategy on 1 April 2017.  One of the funding streams was called ‘Local Delivery’ which was a placed based fund.  10 local areas would be funded to implement local strategies for physical activities and sport.  There was £130m available for this funding stream and there was a particular focus on addressing physical inactivity and working with under-represented groups.   Sport England were not being prescriptive and were seeking genuine innovation and wanted to see a whole system approach in proposals put forward.

b)            The Council had formed a coalition with 4 professional sports clubs that had existing public community projects and engagement in community.  The coalition would provide leadership and oversight of project management as well as identify target communities and provide ‘needs’ information.

c)            Both local universities were engaged to provide support to the Expression of Interest and the bid preparation and would undertake research regarding interventions.

d)            A stakeholder workshop included membership from NHS, the 2 local universities, staff from the Council’s parks, active transport, leisure and public health services, community groups and Voluntary Action Leicester.  Other sports clubs and community groups would provide support and enable access and potential delivery of some initiatives.

e)            Sports England did not require well defined plans at his stage but wanted details of the prospective proposals to address the locally identified needs through engagement with community groups.

f)             The short term outcomes of after the first 2 years (2107-19) were expected to be:-

·         Development of evidence based plans.

·         Identification of priority audience groups and local challenges/goals.

·         Building deeper understanding of audience and needs.

·         Genuine engagement and consultation.

·         Change in ways of working to increase collaboration.

g)            It was already known that a third of the local population exercised for less than 30 minutes a week and Leicester’s performance was worse than many other places with similar characteristics.  The trend had changed little since 2012.  Surveys had shown that many were motivated to change their lifestyle and exercise regimes but felt there were numerous barriers preventing them from doing so.  If the right solutions could be found, there was a existing cohort of people who were willing to make a change.  There was good information on what people had identified as the barriers stopping them from changing their routines. These included:-

·         Too busy/no time – 42%

·         Ill-health – 17%

·         Work commitments – 17%

·         Laziness – 16%

·         Weather – 8%

·         Tiredness – 7%

·         Affordability – 5%

·         Disability – 4%

·         Nearness to facilities – 2%

·         Afraid of injuries – 2%

h)           The challenge was to normalise exercise and build it into people’s lives.  There were specific challenges around older people but lots could be done to achieve light exercise through swimming and GPs would  ...  view the full minutes text for item 66.

To discuss the possible impact of Brexit on the LLR NHS and Care workforce.

The Board discussed the possible impact of Brexit on the LLR NHS and Care workforce.  The Deputy City Mayor and the Chief Executive of University Hospitals Leicester NHS Trust (UHL) made a joint presentation to the Board on the issues involved. 

The Chair had asked for this to be discussed by the Board following the formal triggering Article of 50.  This was now a very big, worrying and strategic work force challenge for health and social care system.  The NHS had included a useful statement in their Next Steps for the Five Year Forward View, indicating that they would work actively with the government to safeguard and secure the contribution made by international doctors and nurses and other staff as the Brexit negotiations proceeded.

The Chair felt that it was of concern that no government statement had been made to provide clarity or certainty for other nationals of EU member states working in the health and social care sector or in the private sector.  The Chair had met trades union representatives earlier to explore ways of reaching out and supporting the Council’s staff and was interested in hearing others views as to what they were doing in this area.

It was noted that nationally there were 10,150 doctors and 21,032 nurses & health visitors who worked in parts of NHS originally from EU countries.  This represented 9.7% of doctors and 7.1% of nursed and health care workers.  There had also been no statement to clarify whether the NHS would receive the £350m per week that had been inferred during the campaigning for the referendum as part of the Article 50 announcement.

The Chief Executive of University Hospitals Leicester NHS Trust (UHL) stated that:-

a)         UHL’s employment of staff with EU nationalities was slightly            higher than that of LPT as the Trust had previously had a recruitment campaign to attract nurses from EU countries.

b)         Overall 6.4% of UHL’s full time equivalent staff were EU nationals which was slightly higher than the national average of 5%.  There were, however variances within specific service areas. For example 11% of nursing and midwifery staff were EU citizens; which was higher than the national average, whilst the 8.8% of medical and dental staff was lower than the national average.

c)         There were approximately as many EU citizens as there were non-EU citizens working for UHL.

d)         The turn-over rate for staff had now stabilised and was flattening out after the rise in EU staff turnover immediately prior to the referendum.  The Trust had made concerted efforts to reassure EU staff that the Trust valued them and did not wish them to leave.  Since the Brexit vote there were now less EU citizens coming forward for employment. Many other hospitals were focusing on recruiting in other Non-EU countries.  UHL were switching their focus to recruiting staff from the Philippines.  Historically staff from the Philippines tended to stay locally longer than compared to EU staff, who tended to stay for shorter periods before moving to other areas  ...  view the full minutes text for item 67.

The Chair to invite questions from members of the public.

There were no questions form members of the public.

To note that future meetings of the Board will be published after the Annual Meeting of the Council on 11 May 2017.

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. 

It was noted that future meetings of the Board would be published after the Annual Meeting of the Council on 11 May 2017.  Meetings of the Board were usually held in Meeting Room G01 at City Hall. 

There were no items of Any Other Urgent Business.

The Chair declared the meeting closed at 3.30pm.