Agenda and minutes

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

In the absence of Cllr Kober, Cllr Morton took the Chair.

The Chair welcomed those present to the meeting. 

To receive any apologies for absence.

The following apologies were noted:

• Dr Jeanelle de Gruchy (Director of Public Health, LBOH)
• Cathy Herman (Lay Member, Haringey CCG)
• Dr Sherry Tang (Chair, Haringey CCG)

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 13 ).

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.

There were no questions, deputations or petitions tabled.

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

There were no questions, deputations or petitions tabled.

To consider and agree the minutes of the meeting of the Board held on 13^th January 2015.

Sir Paul Ennals, the Chair of Haringey LSCB, queried that one of the actions contained in the previous minutes was to bring the Health and Wellbeing Strategy back to the March meeting of the Board.

Zina Etheridge, the Deputy Chief Executive responded that the matter would be briefly covered at the meeting but, as the item was out to public consultation, legal advice was that the Board should not formally consider the Item until the following meeting in June.

Sharon Grant, Chair of Healthwatch Haringey, noted that the Board agreed to keep the future makeup of the Board under review, particularly in terms of the patient/user representation. Ms Grant requested clarification on how the makeup would be kept under review. The Chair agreed to address the issue outside of the meeting and come back via correspondence; If necessary the item would be brought back to the following meeting. 

RESOLVED:

That the minutes of the meeting held on 13th January 2015 be confirmed as a correct record.

The Board received a presentation, from Ms. Zina Etheridge and Ms. Sarah Price, the Chief Operating Officer of Haringey Clinical Commissioning Group, giving an overview of key developments related to Health & Wellbeing in Haringey. Ms. Etheridge noted that the Mental Health and Wellbeing Framework was tabled as an appendix to the report in the agenda pack. Following the presentation the Board discussed the findings.

The Board noted that the Care Act 2014 involved the biggest change to adult social care since the foundation of the Welfare State in 1948.  Included in the Act was a provision that the Council had a duty to promote an individual’s wellbeing. It was noted that the Care Act 2014 made the principle of wellbeing a cross-Council, cross-partner and cross-third sector concern; which created a community based definition of wellbeing.

Ms. Etheridge outlined the key elements of the Children and Families Act 2014. The Board noted that the Act involved changes to adoption and reforms to the way Looked after Children were cared for. It was also noted that the act integrated educational training provision with health care and social care provision in the context of promoting wellbeing. This duty provided a much greater emphasis of health care and social care providers to work in a more joined-up fashion and, as a result, engendered joint commissioning arrangements between the Council and the CCG in relation to children and young people with those needs.

Ms. Price noted that the Five Year Forward View for the NHS was set out in October last year and this document brought together all of the health care organisations such as NHS England, Public Health England and the Trust Development Agency to jointly set out what those organisations wanted to achieve over the next five years. The document showed how the transformation of services was to be delivered, in order to make it both affordable and also improve the quality and ensure sustainability going forward.  The key consideration was noted of changing health demographics, with a rise in long term conditions and associated costs involved. The Board noted that Haringey CCG was awarded an additional £5m (including £1.7m to assist with additional demand pressures during winter) from the £1.95B announced in the Autumn Statement to support the changes set out in the Five Year Forward View. Additionally, £200m was allocated for pump priming the new models of care set out in the report and £250m a year, for a four year period, was set aside to improve primary care. Ms Price advised that the local outcome of those two bids would be known around Easter time.

Ms. Price outlined the main elements of the Haringey CCG Five Year Plan, which was coming to the end of the first year of its planning cycle. The plan had been developed locally and discussions had also been undertaken with Camden, Islington, Barnet and Enfield to ascertain what their plans were and what could be achieved through a collaborative plan. The CCG was looking to  ...  view the full minutes text for item 136.

Sarah Barron, Interim Manager, Primary Care at NHS England & Cassie Williams, Assistant Director of Primary Care Quality and Development, gave a presentation to the Board on the interim findings from the Strategic Plan for Primary Care. Ms Barron emphasised that the findings were interim as the Strategic Plan was due for completion in April.

The key finding was identified as reinforcement of the shortfall in primary care capacity issue which had been previously identified by the Board in the area around Tottenham Hale, Tottenham Green and Bruce Grove. Ms Barron argued that although the issue had been raised previously, there was a lack of evidence of strategic need to take to the NHS Finance Committee. The findings of the report and the capacity analysis would be used to develop that strategic need. Ms Barron commented that the minutes of the Board in September, along with the Healthwatch report that was tabled was to be used as evidence to support an application for additional primary care capacity. The Board were invited to put forward any other items that may help evidence the strategic need.

Ms Barron advised that the data was complex and that a significant gap existed between the GP registered population in that area and the resident population. As a result, the Board was advised that it was difficult to make a commitment on exactly how much additional capacity was to be commissioned. However, Ms Barron estimated that, based on the figures in the Healthwatch report,  there was a shortfall of around 4500 patients which equated to roughly 3 GP’s. The capacity analysis would be taken to the Primary Care Decision Making group next which would recommend a commissioning option; either an additional primary care practice procured, or a new premises would be commissioned and an existing practice moved in to that premises. After having been through the primary care decision making group, the decision would then be taken forward to the NHS finance committee for approval. The Board noted that the process was likely to take 2-3 months. The second option to commission a new premises and then move a new existing practice into that site was identified as problematic due to the deficit in primary care capacity identified in the area.

Ms Barron noted that details of the Primary Care Infrastructure fund of around £1B over four years had been released since the last meeting. Bids from across London had been assessed under the scheme, however it was noted that the results were not available until 27^th March. The Board noted that seven bids in Haringey had been approved subject to significant clarification, 5 of which were in east Haringey. It was noted that some of these bids might be in a position to support capacity in the area. These bids would be developed further in April in conjunction with the commissioning plans described earlier to ensure that a solution was found in the next three months.

Ms Barron stated that a piece of work  ...  view the full minutes text for item 137.

The Board received a presentation, from Dr. Djuretic, on the Pharmaceutical needs Assessment. Following the presentation the Board discussed the group’s findings.

Dr. Djuretic noted that production of a Pharmaceutical Needs Assessment (PNA) was a statutory duty of the Health and Wellbeing Board. The PNA was the document that NHS England requested when it decided if new pharmacies were needed and to make decisions on which NHS funded services need to be provided by local community pharmacies.  The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 require every Health & Wellbeing Board to publish its first PNA by 1^st April 2015.

The Board noted that there were 59 pharmacies in Haringey and the PNA report concluded that Haringey was well resourced in terms of pharmaceutical services and that there were no current needs for either extension, enhanced or advanced services identified. The PNA also highlighted that there was good alignment with GP surgeries in areas of population and there was a reasonable correlation between population and number of pharmacies. The area of north east Tottenham does have a below average number of pharmacies available. In addition, given the expected population growth in Tottenham over the next ten years, there will be need for additional pharmacies going forward. It was proposed that Public Health would maintain the PNA and review the needs going forward as the Tottenham regeneration programme progressed.  The Board noted that the average number of prescriptions dispensed in each pharmacy was lower than both the London and England average.

Ms. Grant noted that the report was particularly relevant given the increasing role that pharmacies play in health care. The fact that there was additional capacity within Haringey was welcomed. Cllr Waters, Cabinet Member for Children & Families, welcomed the report and thanked the report author for their work.

RESOLVED:

1. That Haringey’s Pharmaceutical Needs Assessment 2015 be approved.

The Board received a report from Sarah Hart, Senior Commissioning Manager Haringey CCG, which updated the Board on the work undertaken around health and homelessness. The task and finish group that was set up to look into this issue had previous identified three key issues in terms of health barriers facing homeless people in Haringey:

• The process of GP registration was not transparent which allowed some practices to ask for photo ID as part of the registration process.
• It was not clear what type of primary care model should be adopted for homeless people in Haringey.
• There was a homeless discharge pilot at the North Middlesex Hospital which had no links into Council or primary care services.

The Board noted that the following  progress had been achieved:

• Guidelines had been published on registering with a GP which were homeless friendly including some discretion that GP’s could use in terms of establishing place of residence.
• The Homeless Health Charter was signed by Cllr Morton on behalf of the Board.
• A multi-agency workshop including partners from across the spectrum was established.

The Board noted that in terms of the actions that are still unresolved, a key consideration was which model the Board wanted to adopt for primary care for homeless people. Ms. Hart noted that the workshop agreed that some form specialist primary care provision would be required and so a full JSNA would need to be undertaken. In addition, surveys would be undertaken amongst Haringey’s homeless population to ascertain need.

The Board also noted that feedback from the pilot at North Middlesex Hospital suggested that Haringey didn’t have a particular problem with homeless people without GP access. Ms. Hart advised that the workshop found this very hard to believe. The consensus from the workshop was that that the pilot was aimed towards indentifying a traditional Westminster rough sleeper; however this wasn’t reflective of Haringey. Haringey’s homeless population was characterised by a number of people who were vulnerably housed, including those either sofa surfing or who were housed in hostels. Hostels had fed back that a key issue was inappropriate discharge of patents from hospitals. It was recommended that the Board set up a small working group to look at what the local hospital discharge strategies were for the homeless population.

The Chair commented that he recently visited a St Mungo’s Broadway premises and emphasised the quality of care offered and the work that was done to put people back on their feet.  Ms Etheridge commended the report and noted that it was a very thorough comprehensive piece of work. Dr. Helen Pelendrides, Vice-Chair Haringey CCG, commented that there was a model adopted in Barnet that did not use a specialist service but had developed a GP who had become very interested in homeless service and had set up a separate service for homeless patients. Officers agreed to liaise with Barnet around this service, it was agreed that a key consideration was around capacity and the number of primary care practitioners required.  ...  view the full minutes text for item 139.

Ms. Etheridge tabled a report updating the Board on the progress of the Health and Care integration Programme. It was noted that monthly programme board meetings were underway.  The Board noted that the programme had agreed three key themes, integrated care for adults, children, and mental health and wellbeing.  These themes aligned with the outcomes set out in Haringey’s Health and Wellbeing Strategy, the Council’s Corporate Plan and the 5 year strategy for CCGs in North Central London

It was recommended that a more comprehensive update was brought back to the Health and Wellbeing Board for discussion in the Summer.

Ms Grant commented that Healthwatch would like to be involved a number of the projects undertaken in relation to this item. Officers responded that there were a number of projects underway at a variety of different stages. Officers would take this request away and give consideration as to which projects might be suitable and when they were evaluated.

RESOLVED:

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

That a further update around Health and Care integration be brought back to a future meeting of the Health and Wellbeing Board.

Ms. Grant presented a report to the Board that outlined the CQC’s new approach to raising concerns and complaints, following the Francis Inquiry Report. The Board noted that the CQC had adopted a new key line of enquiry towards complaints which was in the process of being implemented across the board from April 2015. The Parliamentary & Health Service Ombudsman, the Local Government Ombudsman and Healthwatch England had set out universal expectations of good complaints handling and developed a user-led vision for raising concerns and complaints which the CQC adopted.

Dr. Pelendrides fed back that discussions had been undertaken with Healthwatch, as a GP provider, on what an adequate display of a complaints procedure was and how to make the complaints process more patient friendly. Dr. Pelendrides welcomed the opportunity to input into this process. Stephen Lawrence-Orumwense, Assistant Head of Legal Services, suggested a minor change to the report so that recommendation 2.2 asked commissioners to ‘note’ the new complaints framework, as appose to ‘adopt it’, as recommending an external body adopt the recommendation was outside the terms of reference of the Board.

Ms. Price commented that the NHS contract stipulated that providers took on board and reported on serious complaints. This would form part of the performance management framework for health care providers and the CGG would liaise with practices about the new complaint standards. 

It was:

RESOLVED:

1. That the new CQC key line of enquiry relating to complaints be noted; and

2. That commissioners from the CCG and local authority be asked to note the new complaints framework as appropriate in their provider contract specifications, to achieve a consistent approach in Haringey.

3. That agreement for the CQC complaints framework to inform CCG and local authority commissioners in monitoring existing contracts be given; and providers be encouraged to improve their existing complaints system.

4. That NHS England’s use of the new user led complaints framework as a performance management tool, to be built into the NHS Outcomes Framework be noted; and

That Healthwatch Haringey’s adoption of the new CQC user led framework when reviewing complaints processes in provider organisations be noted.

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 dates of future meetings will be advised at the meeting on 24 March 2015.

It was noted that the date of the next meeting was 9^th June at 13:30.

The following agenda items were agreed for the next meeting:

• Health and Care Integration update
• Health & Wellbeing Strategy

The Chair noted that this was the last Health and Wellbeing Board that Dr Pelendrides would attend and thanked Dr Pelendrides for her contribution to the Board.