Agenda item

a)         Dr Simon Freeman, Managing Director, Leicester City Clinical Commissioning Group, to submit the six monthly update report on the progress of the Joint Health and Wellbeing Strategy.

 

b)         Andrew L Smith, Director Planning, Transportation & Economic Development, Leicester City Council, to report on how the Directorate are working to support the Joint Health and Wellbeing Strategy. 

Dr Simon Freeman, Managing Director, Leicester City Clinical Commissioning Group submitted the six monthly update report on the progress of the Joint Health and Wellbeing Strategy on behalf of the Joint Integrated Commissioning Board (JICB).

 

It was noted that:-

 

·         No areas of activity had been ‘red flagged’, but there were fewer areas rated ‘green’ and more ‘amber’ than in the previous report; indicating a modest increase in risk to delivery.

 

·         In relation to the Key Performance Indicators where data was available, 45% showed improvement from the baseline, 32% showed no significant change and 23% showed a worsening of the position.

 

·         There were four areas of concern:-

 

o   Readiness for school at age 5 years old.

o   The coverage for cervical screening in women.

o   Diabetes – the management of blood sugar levels.

o   Proportion of adults in contact with secondary mental health services living independently with or without support.

 

·      Measures showing particular improvement to the baseline were:-

 

o  The number of NHS Health Checks carried out was amongst the best outputs in the country.  25,886 health checks had been carried out and 3,535 patients were subsequently having a health management plan put in place.

 

o  The trend for carers receiving needs assessments was continuing to improve and they were currently at 28.4%.

 

o  Reablement continued to be a great success with 91.2% of older people, who had received support to live at home following discharge from hospital, still living at home 91 days after their discharge.

 

 

Following Members’ questions on the four areas of concern, the following responses were noted:-

 

·         Readiness for school at age 5 years old.

 

o   The assessment for this indicator was a complex assessment and to achieve a good level of development it expected 12 of the 17 early learning goals to be achieved.  These goals involved personal development, independence, ability to communicate, language and physical activity etc.

 

o    The indicator was useful to see how a young child was developing and to benchmark against other areas. 

 

o    The indicator changed in 2013 so comparisons cannot be made directly with 2012.  However, although there has been some improvement this year the performance in Leicester still lags behind the national levels and more work needs to be done to improve this as it translates into outcomes for youngsters achievement at Key Stages 1 and 2 and GCSE.  There was evidence to suggest that children who do not do well in early years do not do well later on in school.

 

o    Steps were being taken to improve data systems and collection to improve the early identification of vulnerable children.  Appropriate information was being shared with staff in health services, children centres and those in early years’ settings to identify where resources need to be placed.  

 

o    There was good partnership working so that vulnerable children and families take up the services that were n offer to them.

 

o    Increasing the participation of 3 and 4 year olds in education and ensuring that all the available free education place were taken up was a priority, as this contributes to children being ready for school.

 

o    More work was needed to communicate the expectations to staff to improve the current rate of 41%.

 

o    Measures were in place for the early identification of children who were vulnerable with additional needs (such as a disability) so that arrangements could be put in place to support the child in school.

 

o    Good attendance at school was encouraged and maintained.  The Council was working with the Leicester Education Strategic Partnership around reading literacy and numeracy to ensure there was a link between school and home settings to ensure that youngsters were ready for school. Parents were also supported in helping children to have the numeracy and literacy skills through early leaning activity in children centres and other partnership working.  

 

o    The Early Years Pupil premium was coming on stream in April 2015 and this was being targeted to gain maximum impact from it.

 

·         Cervical Screening in Women

 

o    There was a small fall in the national and a similar fall in local levels of screening.

 

o    NHS England proposed to look at the individual primary care provision to find out the uptake rate, work on a higher quality set of materials, more engagement and development programmes with primary care and patient reference groups to highlight this as being an important part of the primary care offer.  This also fitted in with the Early Diagnosis and Intervention Programme which is aimed at improving outcomes by improving early diagnosis and treatment.

 

o    The take up rate had declined faster in Leicester than nationally and an assessment had been carried to looking at attitudinal and cultural aspects of the take up and there was no obvious explanation for the decline in the local take up rate.

 

o    There was a successful model in Lincolnshire that had seen a significant uptake in rates and NHS England were intending to role this model out in Leicester as the practical response to the concern.  

 

·         Management of Blood Sugar Levels

 

o   This was a key measure of the effective management of diabetes.

 

o   There was a small fall in national levels, mirrored by a small fall in Leicester levels, but the Leicester position does need to be viewed against the significant increase in detection and prevalence within the City.

 

o   The 1% decrease in the indicator should be seen against the 10% increase in prevalence over the last two years.  There had been an increase in diagnosis of 3% in the last year so there were far more people who were in the early stages of being controlled.  Improvements would require the support of patients and public engagement in the process.

 

o   The CCG had also invested in upskilling diabetic education amongst GPs through the Eden Model to allow GPs to deliver more complex diabetes care to patients in the community and this will also have a beneficial impact in the future.

 

·         Proportion of adults in contact with secondary mental health services living independently with or without support.

 

o   The position showed a fall in relation England.

 

o   There were some local issues in changes of data which may not necessarily accurately reflect the actual current position.

 

o   The data and the performance measures were collected by Leicestershire Partnership Trust (LPT) and there were changes in both the ways that the data was recorded and reported at the end of 2011/12 which is when the dip in the performance measure was observed.

 

o   LPT were in discussion with Adult Social Care to improve the working of this measure.  LPT would know who was being seen in secondary care but not all these would be eligible for statutory adult social care services and, therefore, the join up of these two issues in data terms was complicated.

 

o   The practical difficulties of this mis-match in comparing the local data to national data were recognised.  Locally a task and finish group had been established to actively explore and understand the reason for the apparent halving of the performance on the indicator, whilst there had not been any diminishing of the services and arrangements in place to support and help people to live independently.  There had been additional services such as an adult care worker on the Bradgate Unit supporting patients with their exit planning for discharge from hospital including their accommodation needs.  Extra care streams had also been introduced which would have been expected to improve the performance measure rather than seeing a decline in the measure.

 

The next steps to be taken were that the agencies concerned would be asked to report back to the JICB with an assessment and understanding of the recovery plans for these areas on concern and these would subsequently be brought back to the Board.

Councillor Dempster referred to the critical need for the co-ordination of effort between the work of schools, school nurses, children centre’s staff and health visitors to avoid duplication of effort and to ensure that everyone was working at the right level at the appropriate time to maximise the support to children.  She suggested that a further report on this work be submitted to a future meeting of the Board as early years was critical to the long term welfare of children and families.  It was noted that Leicester had made a submission to the Big Lottery Scheme for ‘Fulfilling Lives –  A Better Start’ and, as part of the bid preparation process, there was a great deal of work done on differentiating the data on early years for social and emotional development and language and communication skills.  Teasing out the aspects of early years and readiness for school that Leicester was particularly challenged about and also looking at the spread of those issues across the City by wards, would provide a good platform for the report. 

 

RESOLVED:

 

1)         That the progress on the delivery on the Joint Health and Wellbeing Strategy be noted.

 

 

2)         That a further report on the recovery plans for the areas of the Strategy that were causing concern be submitted to a future meeting.

 

3)         That a report be submitted to the Board early in 2015 on the progress made with improving the readiness of children for school at age 5 years old.