Agenda and minutes

The Chair welcome those present to the meetings and introductions will then be made.

In the absence of the Chair the Vice–Chair (Dr Sherry Tang) took the Chair.

The Chair welcomed those present to the meeting.  

To receive any apologies for absence.

The following apologies were noted:

• Gill Hawken (HAVCO)
• Councillor Peter Morton (Cabinet Member for Health and Wellbeing)

In addition, Cllr Kober sent apologies for late arrival.

The Chair will consider the admission of any late items of urgent business. (Late items will be considered under the agenda item where they appear. New items will be dealt with at agenda item 14).

None.

A member with a disclosable pecuniary interest or a prejudicial interest in a matter who attends a meeting of the authority at which the matter is considered:

(i) must disclose the interest at the start of the meeting or when the interest becomes apparent, and

(ii) may not participate in any discussion or vote on the matter and must withdraw from the meeting room.

A member who discloses at a meeting a disclosable pecuniary interest which is not registered in the Register of Members’ Interests or the subject of a pending notification must notify the Monitoring Officer of the interest within 28 days of the disclosure.

Disclosable pecuniary interests, personal interests and prejudicial interests are defined at Paragraphs 5-7 and Appendix A of the Members’ Code of Conduct.

Sharon Grant noted the following two amendments to the register of interests:

• Was recently confirmed as Chair of Healthwatch Haringey, as opposed to Interim Chair.
• Confirmed as Director of Public Voice CIC, and that it was envisaged that this community interest company would manage Healthwatch Haringey from April 2015.

To consider any requests received in accordance with Part 4, Section B, Paragraph 29 of the Council’s Constitution.

There were no declarations of interest made.

To consider and agree the minutes of the meeting of the Board held on 30 September 2014.

It was noted that there were two main actions contained in the previous minutes:

• Set up a Task and Finish Group around Primary Care. This will be discussed later as part of item 8.
• Report back to the Health and Wellbeing Board on how the Board will be included in the Health and Care Integration Programme. This will be discussed later as part of Item 10.

RESOLVED:

That the minutes of the meeting held on 30 September 2014 be confirmed as a correct record.

Cllr Kober arrived at the meeting and assumed the role of Chair.

The Board received a presentation, from Ms Cassie Williams, Assistant Director of Primary Care Quality and Development for Haringey CCG giving an overview of primary care. Following the presentation the Board discussed the findings.

It was noted that NHS England had put out an offer for Co-Commissioning of Primary Care with local Clinical Commissioning Groups (CCG’s). The aim of which was to create a joined-up clinically led commissioning system delivering integrated routine and unplanned primary care services based on the needs of local people. There were three types of co-commissioning offered: Greater involvement; joint commissioning or delegated responsibility. North Central London opted for a joint commissioning approach. Ms Williams noted that this process was still ongoing and that Haringey CCG was submitting a further bid to provide joint commissioning at the end of January.

The three main elements of the strategic  commissioning framework were:

• Proactive Care: Promoting self-care, health literacy and helping people to stay healthy.
• Accessible Care: Providing a personalised, responsive, timely and accessible service.
• Co-ordinated Care: Patient centred, co-ordinated care with GP-patient continuity.

Ms Williams outlined NHS England’s 5 year forward view. The three main areas were noted as:

• Prevention
• Restructure how care is provided
• Invest into Primary Care

In response to this the Government had agreed to give an additional £1.95 billion to the NHS for 2015/16.

Haringey CCG’s Primary Care Strategy was currently being redrafted. The key objectives of which were noted as:

• Make primary care more accessible
• Coordinate care around the needs of our patients
• Make care more proactive
• Support practices to work at scale 
• Develop our workforce, recruit & retain the best staff
• Ensure our premises are of the highest possible quality
• Improve our technology and information systems

Ms Williams advised that one of the most significant technological improvements was the development of interoperable IT databases so that GP’s etc would be able to see each other’s records. The acute care and community providers would shortly have the capacity to do this as well.

Dr Helen Pelendrides commented that as a GP, the ability to access a patient’s records across different surgeries and IT systems was “revolutionary”. Every GP in Haringey had agreed to the data sharing protocols, not just among themselves but with other partners externally. This would have a significant impact on health and care integration. The next stage was to complete the join up with synthesis in A&E and Out of Hours services.

The Chair asked Dr Pelendrides what the impact of this change would be on her as a GP in 5 years time. Dr Pelendrides responded that this would positively impact on both the quality of patient care as well as deliver financial savings as the number of duplicate referrals and wasted appointments should dramatically decrease, with patients being able to access services with fewer delays. It was noted that, by way of an information safeguard, patient consent to share these records was required every time a  ...  view the full minutes text for item 121.

The Chair advised that Sir Paul Ennals had to leave the meeting at around 14:50 and so proposed that Item 11 was brought forward, after which the Board would return to the agenda. The Board agreed to the variation.

The Board received a copy of the annual report, previously circulated within the agenda pack, from Sir Paul Ennals, Chair of Haringey’s LSCB.

Sir Paul Ennals summarised some of the key aspects of the report. It was commented that the LSCB had two roles; one to promote partnership and the other was to bring together all of the relevant agencies within Haringey, in order to facilitate each agency being able to hold one another to account. There was a legal requirement that an annual report was published. It was noted that in summary, for last year, there were no serious concerns highlighted in the report. Sir Paul Ennals commented that hopefully this year’s report would show an improvement.

Cathy Herman from the Haringey Clinical Commissioning Group commented that when the board last looked at attendance there were a couple of organisations that stood out as having low attendance. Ms Herman asked what happened when organisations do not attend these meetings regularly. Sir Paul Ennals responded that if this became a serious issue then contact would be made with the head of the relevant agency and regular attendance would be requested. Sir Paul Ennals advised that attendance at the meeting was not the most accurate way of measuring engagement with the LCSB process.  It was also commented that one of the issues raised by Ofsted and referred to in the tabled report was difficulties with getting schools engaged in this process (now that schools are fully independent). Significant progress had been made in the last period and engagement was much improved.

Ms Herman asked Sir Paul Ennals what happened if, despite contacting the head of the partner agency and reiterating expectations around levels of engagement, this did not improve. In response, Sir Paul highlighted that there was a process of biennial formal reviews of safeguarding practices in all partner agencies which every LSCB undertakes. This involved each agency doing a self evaluation of safeguarding practice and then this would be challenged and scrutinised by each of the constituent agencies.

Ms Herman further commented that a key challenge going forward for the Board was how to make consultations more joined up with partners, particularly around young people. Sir Paul Ennals responded that this was indeed one of the priorities identified in the report.  

The Chair commented that she was pleased to see the link between gangs and Child Sexual Exploitation highlighted as a priority for this year in the annual report and asked Sir Paul to comment on how he thought this work was progressing. In response, he commented that one of the actions arising from previous LSCB discussion was the need to update and expand our CSE strategy. Ms Etheridge was leading a task and finish group bringing together all of the  ...  view the full minutes text for item 122.

The Board received a presentation, previously circulated within the agenda pack, from Sarah Barron, Interim Manager, Primary Care at NHS England on behalf of the Task & Finish Group Following the presentation the Board discussed the group’s findings.

Ms Barron noted that she had asked Ms Williams to help present this item in order to show that NHS England and the CCGs had been working closely on this to allay the perception that the two organisations tend to work in isolation. It was also noted that Nicky Hopkins of North London Estate Partnerships had also been asked to help present part of this item. Ms Hopkins would be presenting what North London Estate Partnerships would be doing as part of the strategic plan that was being developed.

Ms Barron commented that although she was on a short term interim posting, she was fully aware of the level of concern around primary care access around east Haringey and Tottenham Hale in particularly. At the last meeting in September 2014 a mapping of need was called for and proposals were requested from NHS England on how that need for primary care would be met. As part of this process a Task and Finish group was established and it was noted that it had now had three meetings. In addition an officer sub-group and an access taskforce was also set up as a sub group to look at the immediate issues that were arising. The idea was that the Task &Finish group would look at the strategic concerns that have been raised.

Ms Barron noted that since that last meeting of the HWB a PID document was submitted to the NHS Finance Investment Committee to get funding to undertake a full strategic plan. This included what needs to happen around primary care as part of the regeneration of east Haringey, but also what quick wins could be achieved to tackle immediate concerns around primary care. It was commented that the process of commissioning primary care was a statutory process and that it required clear evidence of strategic need; this was what the strategic plan was intended to give. Ms Barron noted that the plan would hopefully provide evidence of the strategic case for investment. The plan was envisaged to be completed by April but a draft would be brought to the next meeting of this Board.

Ms Barron advised there seemed to be some disconnection between known capacity and what patients were experiencing. The presentation tabled in the agenda pack contained a graph showing the GP Full Time Equivalent rate (FTE) across London of which Haringey sat in the middle. When the figures were broken down to show individual practices that were experiencing problems with access, these practices did not necessarily have the fewest doctors.  In addition, it was noted that one particular practice that concerns were raised with in the past regarding access was actually towards the upper end of GP FTE rate scores.MS Barron commented that this showed that GP access was  ...  view the full minutes text for item 123.

The Board received a report, previously circulated within the agenda pack, from Dr de Gruchy. A draft copy of the Health and Wellbeing strategy and an accompanying presentation was also tabled. Ms De Gruchy talked through the presentation and both reports and then summarised the key points.

Dr de Gruchy outlined the wider context of the strategy and the HWB Strategy refresh programme. It was noted that the refresh programme was agreed by the HWB in May 2014 and included reviewing the Joint Strategic Needs assessment (JSNA). The program also included setting up a range of key stakeholder group meetings and setting up workshop survey focus groups of voluntary sector stakeholders set up by HAVCO and Healthwatch and some of this work was included in the wider Council budget consultation for the Council’s Corporate Plan. These measures were then integrated to facilitate an understanding of areas where we need to take a strong strategic lead.

Dr de Gruchy then gave a brief overview of the outcomes identified in the strategy and a summary of the highs and lows. It was noted that:

·         Outcome 1 was to give every child the best start in life and that the key points were: A reduction in teenage pregnancy (but was still high compared to London and nationally); a reduction in infant mortality (but was still high compared to London and nationally); one in three children lived in poverty; childhood obesity was high and tooth decay in children has worsened.

·         Outcome 2 was to increase healthy life expectancy. The key points were: Life expectancy was improving generally, especially for men. But men died younger than women primarily due to early death from heart disease and stroke); the inequality gap for men (8 years) and women (about three years) has remained constant over the last 10 years; on average, women lived the last 20 years of their lives in poor health which was worse than London and national average and the number of people with dementia and long term conditions was increasing.

Dr de Gruchy outlined that analysis of demographics around life expectancy was increasingly focused on ‘healthy life expectancy’. A graph included in the presentation slides showed the average life expectancy and average healthy life expectancy against an index of deprivation levels. It was commented that in the most deprived areas long term poor health started to develop around age 53 and this was increased to around age 70 for the most affluent areas. 

·         Outcome 3 was improving mental health and emotional wellbeing and the key points were: Recorded crime was down 40%, partially due to a downward trend in drug use; there was an increased national focus on mental health; there were high numbers of children with behavioural problems; a high level of people suffering from anxiety and depression who were not receiving help and a high level of people with severe mental illness across the borough.

Dr de Gruchy commented that this showed that there are still a number of ongoing challenges  ...  view the full minutes text for item 124.

Ms Etheridge asked the Board to note that progress was being made with Health and Care integration. It was commented that there was a renewed strategic governance structure in Appendix A, on page 35 of the agenda pack, and Ms Etheridge asked the Board to note and approve the revised governance structure.

It was:

RESOLVED:

1. That the progress made to date around Health and Care integration be noted; and

2. That the proposed governance structure in Appendix A of the report be noted and approved.

Ms Price, from the Haringey CCG, outlined that the Mental Health Crisis Concordat is something that ties-in very closely with the work of the Board. The Mental Health Crisis Concordat was published in February 2014 by the Department of Health and the Home Office and it set out how organisations would work together to ensure that people receive the required help when suffering mental health crisis. As part of the concordat, there was a requirement to achieve local sign-up and to develop an action plan to deliver the aims of the concordat. Following a London workshop in October local organisations signed the concordat before the 31^st December deadline. The task was now to develop a multi-agency action plan by March 2015; some resources had been secured to assist with the development of the action plan.

It was:

RESOLVED:

1. that the Mental Health Crisis Concordat be noted and endorsed; and

2. That an action plan be brought for consideration and approval to the Health and Wellbeing Board on 24 March 2015.

The Board considered a report, previously circulated, which recommended a change to the HWB membership to change the Lay Member to a full voting member and also confirmed the appointment of the Chair of the LSCB as a non-voting member of the Board. It was suggested that the reason for this change was that that following the appointment of an additional elected member to the Board, there had been an imbalance in the voting rights between Council and non-Council members of the Board. 

Ms Grant noted that she had no objection to the proposal but asked whether the composition of the Board could be altered further to strengthen patient/user representation levels. 

It was:

RESOLVED:

1. That the Chair of the Haringey LSCB be appointed to the Health and Wellbeing Board as a non-voting member of the Board.

2. That it be recommended to Full Council that voting composition on the Health and Well Being Board be amended to allow  voting rights to  the Lay Board Member of the Clinical Commissioning Group; and

3. That the detail of the  report be accepted and agreed as a consultation by Full Council, for  the purpose of altering the voting rights of the Board member.

4. That the voting rights issue be progressed without further delay due to the immediate need to resolve the imbalance in voting rights.

5. That the makeup of the Board be kept under review

That future business be brought back for consideration at the Health and Wellbeing Board on the 24^th March.

To consider any new items of urgent business admitted at item 3 above.

No new items of urgent business were tabled.

Members of the Board are invited to suggest future agenda items.

The next meeting is scheduled for 19 March 2015 but is subject to confirmation and possible rescheduling.

It was noted that the date of the next meeting was 24^th March at 18:30.