Agenda and minutes

Please note this meeting may be filmed or recorded by the Council for live or subsequent broadcast via the Council’s internet site or by anyone attending the meeting using any communication method.  Although we ask members of the public recording, filming or reporting on the meeting not to include the public seating areas, members of the public attending the meeting should be aware that we cannot guarantee that they will not be filmed or recorded by others attending the meeting.  Members of the public participating in the meeting (e.g. making deputations, asking questions, making oral protests) should be aware that they are likely to be filmed, recorded or reported on.  By entering the meeting room and using the public seating area, you are consenting to being filmed and to the possible use of those images and sound recordings.

The Chair of the meeting has the discretion to terminate or suspend filming or recording, if in his or her opinion continuation of the filming, recording or reporting would disrupt or prejudice the proceedings, infringe the rights of any individual, or may lead to the breach of a legal obligation by the Council.

The Chair referred those present t agenda Item 1 as shown on the agenda in respect of filming at this meting and asked that those present reviewed and noted the information contained therein.

The Chair welcomed those present to the meeting and the Board introduced themselves.

The Chair formally thanked Cllr Moron and Cllr Waters for their contributions to the Board.

To receive any apologies for absence.

The following apologies were noted:

• Sir Paul Ennals.

·         Dr Peter Christian

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 19).

There were no items of Urgent Business.

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 Declarations of Interest.

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

No Questions, Deputations or Petitions were tabled.

To confirm the minutes of the meeting held on 23 February 2016 as a correct record.

RESOLVED:

That the minutes of the meeting held on 23^rd February 2016 be confirmed as a correct record.

A report outlining the importance of intermediate care in achieving Haringey’s vision for integrated person-centred services, as well as the findings from a local review of intermediate care provision in Haringey was included as part of the agenda pack (pages 17-21). A copy of the presentation was also included in the agenda pack (pages 23-46).  Dr Will Maimaris, Public Health Consultant introduced the report. Other contributors to the presentation were: Lynn Carrington Designated Nurse Children in Care Nurse – Whittington Health; A slightly updated version of the presentation slides was distributed as hard copies to the Board. Following the presentation the Board discussed its findings.

Dr Maimaris advised the board that an aging population, where the majority of older patients had at least one long term condition, placed huge demand on hospital services and residential care placements. Furthermore, a significant proportion of older patients were being admitted to hospital when they did not necessarily need to be admitted, intervention at an earlier stage could have prevented those admissions or services could have been provided which meant that the person was supported in their own home. Integrated or person-centred care could improve quality of care for residents and also save money. 

In the vision for the Better Care Fund (BCF) submission 2016/17, the Council set out it’s ambition to improve health and care through a reorientation of the way health and social care was provided in the borough, moving away from the model of reactive hospital-based care to a more proactive and integrated care in the community model.  The Board noted clear synergies with Priority 2 in the Haringey Health and Wellbeing Strategy (increasing healthy life expectancy) and objective 1 of Haringey Council’s Corporate Plan 2015-18; ‘enable all adults to live healthy, long and fulfilling lives’.

Dr Maimaris advised the Board that intermediate care was an extra layer of support in between low level GP-based community care services and long term care provided by hospitals. This extra support was ideally community based and was needed in response to when a patient had an escalation of need, such having had as a fall. The aim of which was to either keep that person out of hospital all together or to reduce the amount of time spent in hospital, whilst still receiving the required care. Other parts of the country had succeeded in boosting Intermediate care and had seen success in terms of reducing hospital admissions. The Board were advised that LB Waltham Forest had a very large rapid response service with over 20 nurses and it also had the lowest rate of hospital admissions across London. Evidence was starting to emerge from a number of authorities around the effectiveness and cost-effectiveness of intermediate care. 

Dr Maimaris introduced Sue Gibbs, who managed the Rapid Response and the Ambulatory Care services at Whittington Hospital. Ms Gibbs outlined a number of examples of good practice in relation to intermediate care currently being undertaken in Haringey. The Board were advised that these were two stand  ...  view the full minutes text for item 59.

A report was included in the agenda pack at page 47. Zina Etheridge introduced the report to the Board which provided information about a partnership that was being formed between NHS organisations and local authorities in Haringey and Islington. Ms Etheridge introduced Anni Hartley-Walder, Programme Director for the Wellbeing Partnership to the Board. Following the presentation the Board discussed the findings.

The Board were advised that the partnership was made up of representatives of Haringey & Islington Councils, Haringey & Islington CCGs, Whittington Hospital and Camden and Islington Mental Health Trust and built upon some work that had been undertaken around bidding for NHS innovation funding. The Wellbeing Partnership looked at whether there were ways for the organisations to work together more effectively; to make sure that they were reshaping the health and social care economy across Haringey and Islington to support better quality outcomes for service users and to do so in a more financially stable way. 

The Deputy Chief Executive advised that the report was brought to the Board to outline the proposed governance arrangements, reflect on next steps and to highlight that there were significant benefits for residents in both boroughs to continue to work in a more joined up way. It was proposed that the Haringey & Islington Health and Wellbeing Boards would provide the overall governance for the programme and that on occasion the two Health and Wellbeing Boards would come together and meet as a joint body to provide high level governance. The Board noted that the constitutional arrangements for any joint meetings would need to be determined.

The Deputy Chief Executive advised that the Wellbeing Partnership was a really important part of the overall NCL Sustainability & Transformation Plan and formed a key platform for governing and taking forward the reshaping of the health and social care economy locally. The Chief Officer Haringey CCG suggested that the Wellbeing Partnership would be an obvious home for some of the work being undertaken around outcomes based commissioning. The Board were advised that the themes of frailty in older people and diabetes care would benefit from being aligned together and then pulling them in to the value based commissioning work to ensure an alignment of incentives for all the organisations involved, to provide the desired outcomes such as keeping patients at home.

The Chair advised the Board that she had met with Richard Watts, the Chair of the Islington Health and Wellbeing Board along with the Wellbeing Partnership Sponsor Board on two occasions recently. The Chair fed back that the progress made in those two meetings was fairly heartening and that there was a significant improvement in coherence from the first meeting to the second. The Chair advised that at the last meeting it was agreed that the next step was to arrange a joint meeting of the two Health and Wellbeing Boards, ideally before the summer holidays to give the impetus and oversight that the project required. Clerk to look into holding a joint Health and Wellbeing Boards and  ...  view the full minutes text for item 60.

The Board received a report which provided an update on a new strategic planning approach being taken by NHS England and partners to ensure a whole system focus across health and social care. The new STPs will be produced in partnership with providers of health and care services, Councils and CCGs. The report was introduced by the Chief Officer CCG and was included in the agenda pack at pages 57-59. A presentation on the North central London STP was also included in the agenda pack at pages 61-70. 

Along with Barnet, Camden, Enfield and Islington, Haringey was working as part of the North Central London (NCL) STP footprint area. NCL has established a Transformational Board and Programme Management Office to oversee the production of the NCL STP, which was scheduled to be submitted at the end of June. The Board noted that the plan would look at how NCL could be financially sustainable over a five year period, how they could improve the health and wellbeing of residents and how they could improve the quality of services delivered over that five year period.

The Board was advised that the Chief Executive of Camden was pulling together the views of Councils across the five boroughs, whilst the Chief Officer of Camden CCG was the CCGs representative and the David Sloman who was the Chief Executive of the Royal Free Hospital was leading on the provider side. Meetings were taking place on a monthly basis with all representatives of health and social care from the five boroughs, with smaller groups meeting more frequently including the Director of Children’s Services who was LBH’s representative. The Chief Officer advised that current estimates suggested that a do nothing option would result in a funding shortfall of around £600m by 2020. The Chief Officer further advised that prior to submission of the STP the next steps were, an engagement exercise and the development of a communications plan. The Chief Officer commented that she would be speaking to individuals outside of the meeting for their inputs. (Action: Sarah Price).

The Lay Member CCG commented that there was a limit to the amount of  consultation that can be undertaken on this project due to need to access transformation funding given the budgetary pressures involved and suggested that the only way to achieve the savings required was to work together collectively. The Lay Member CCG also drew the Board’s attention to the Health Service Journal which contained Simon Stevens categorically backing David Sloman and highlighting that individual organisations would not be allowed to veto the STP. The article also stated that some form of consolidation across CCGs would be required. The Leader agreed with the points raised and commented that the Haringey and Islington Wellbeing Partnership was a very useful exercise in terms of laying the ground work for the STP and provided a base from which projects could be scaled up.

The Chair Healthwatch Haringey advocated that a broad consultation should be undertaken with the public around what  ...  view the full minutes text for item 61.

The Board received a report which outlined the proposed Memorandum of Understanding that had been put in place for North Middlesex University Trust (NMUH) with the Royal Free NHS Foundation Trust to explore becoming a founding member of the Royal Free London Group. This was part of a wider stream of vanguard development work happening nationally to look at hospitals working together to develop more sustainable models of care delivery. The report was introduced by Richard Gourlay, Director of Strategic Development NMUH and was included in the agenda pack at page 71. The Director of Strategic Development also gave a presentation to the Board. The Clerk agreed to circulate the presentation slides to the Board after the meeting. (Action: Clerk).

Mr Gourlay advised that the work around the drafting of the Memorandum of Understanding took place in April and the next steps would involve developing more detailed project plans and the establishment of a Partnership Board from early June. The Partnership Board would have a number of work streams sitting underneath it which would start to develop and design the model for the Royal Free London Group.

The Chief Executive BRT asked for clarification on what benefits could be expected from this arrangement. Mr Gourlay advised that there were a number of benefits from the care provider’s perspective, particularly around resilience such as staffing and capacity in specialist areas such as A&E.  Mr Gourlay also advised that this would assist in the development of additional clinical pathways that would improve the quality of care across a range of services.

The Deputy Chief Executive welcomed the proposals, advocating that any steps taken to improve resilience and patient care were clear benefits. The Deputy Chief Executive cautioned that the Board continued to monitor what the implications of that change model were going forward suggesting that for instance, it was important that the hospital did not become more divorced from the wider population based measures that were being proposed.

 RESOLVED:

I). That the Health and Wellbeing Board note the work that is underway between NMUH and RFL.

The Board received a report which outlined the main findings of the Mental Health and Wellbeing Survey undertaken in Haringey. A copy of the findings from the survey were attached as an appendix to the report. The report was introduced by Tamara Djuretic, AD Public Health and was included in the agenda pack at page 73 and the survey results were included at pages 77-155.

The AD Public Health outlined some of the key headlines from the findings:

• The survey was conducted in July last year and encompassed 1000 people being canvassed, 500 from across the borough and an additional 500 responses sought from the most deprived areas.
• The Haringey Mental Wellbeing Survey 2015 results would provide the baseline, with the specific aim of increasing the average short Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) score by 2018.
• Average WEMWBS score for adults in Haringey measured by a survey across the borough was 26.10 and in the most deprived areas was 26.21. Any score of 21 or less was regarded as low in Haringey, scores between 22 and 29, or 30 for most deprived was a moderate score and anything over 30 was regarded as a high score.
• Respondents between 16 and 24 years old were most likely to have low mental wellbeing in the “across area” sample, whilst those aged 65 years and over were most likely to have low mental wellbeing in the most deprived sample. More men than women were categorised as having high mental wellbeing across both samples.
• Good health and fewer medical conditions were associated with better mental wellbeing
• Employment was associated with better mental wellbeing, whilst those unable to work due to sickness or disability were most likely to report low mental wellbeing.  Poor educational attainment was associated with worse mental wellbeing, as were financial difficulties.

The survey also explored the overall health of the residents in

relation to mental health and wellbeing. Some of the key

findings identified were:

·         The prevalence of smoking was 20% across the borough and increased to 24.2% in the most deprived sample. Smoking was strongly associated with lower mental health and wellbeing scores.

·         The prevalence of cannabis use was approximately 6% across the borough and a further 16% of residents were ex-users.

·         The most common medical conditions reported by residents were high blood pressure (12-15%), anxiety, depression and stress (9-10%) and diabetes (5.3 – 6.5%).

·         Those with three or more conditions had significantly lower mental wellbeing scores.

It was proposed that the survey was repeated on annual basis.

In terms of the next steps, the AD Public Health advised that as well as taking the Mental Health Survey to the Priority 3 Board, it would also be taken to the Priority 1 and Priority 2 Boards.

The Chair, Healthwatch Haringey commented that there seemed to be a lack of data broken down by ethnicity, advising that this seemed to be an important dimension of the mental health picture in Haringey. The AD Public Health advised that around 200-300 of  ...  view the full minutes text for item 64.

The Board received a report which gave an update to the Board on the Sustainable Employment strand of the Devolution Prevention Pilot. The report was introduced by Tamara Djuretic, AD Public Health and was included in the agenda pack at page 155-161 and a copy of the presentation slides were attached to the report, at pages 163-167 of the agenda pack. The AD Public Health introduced Vicky Clark, Head of Economic Growth and Development to the Board, who assisted in presenting this item to the Board.

The Board were advised that the pilot scheme would focus

on the cohort of people with mental ill health as there was a clear need

and a good evidence base that their health and employment outcomes

could be improved. The main objective of the pilot was to support

people who were living with/recovering from a mental health problem

to have sustainable employment – an outcome evidenced by reduced

numbers of people with a mental health condition claiming

Employment Support Allowance (ESA) and reduced demand for health

services, specifically primary care. Early intervention was at the heart

of the proposed model - preventing people from becoming

unemployed in the first place.

The following comments were noted in relation to piloting the

proposed early intervention model:

·         Evidence suggested that length of absence from work, and employer status (Public/Private sector, large company vs. small and medium businesses) were the way to segment the cohort and this was reflected in our proposed model.

·         The current intention was to conduct a small pilot of this model to test whether this is the best way to segment the cohort, and whether we can identify any additional criteria that may be more relevant (e.g. factors based on social functioning, behaviour and attitudes).

·         Initial conversations with Maximus – the provider of the national Fit for Work service (remote occupational health advice) – suggest that they may be interested in working with Haringey to test the impact of a more locally tailored service, which introduced face-to-face support. Maximus would potentially be the source of the additional capacity required to run a small pilot.

·         It was anticipated that the evidence gathered through a small pilot would enable the development of a business case for a scaled-up invest-to-save model that we would put forward to the Government as devolution ‘ask’. The Sustainability and Transformation Plan (STP) process or the Innovation Fund of the (joint DWP/DH) Work and Health Unit, were two possible vehicles for the business case.

·         This would be a large ‘at scale’ transformation, starting with the introduction of genuinely new ways of working on the ground through a pilot.

The Chair Healthwatch Haringey commented that she had concerns about the application of the Fit for Work programme and particularly in light of some of the mistakes made by ASOS. The Chair Healthwatch Haringey requested that the Board be kept up to date with the progress of this work and an evaluation of its implementation. The AD Public Health commented that there would be  ...  view the full minutes text for item 65.

A report was included in the agenda pack at pages 169-183, which provided an update on the joint response of the Haringey CCG and Haringey Council to the three-year Transforming Care expectations, developed by NHS England, the LGA and ADASS and publicised in October 2015. 

RESOLVED:

1. To note report and the joint work to develop a three year plan for the delivery of the transforming Care programme.

Urgent action taken by the Chair of the Health and Wellbeing Board for noting.

·         Better Care Fund

The Board noted the record of Urgent Action taken following the previous meeting regarding the Better Care Fund submission 2016/17. 

To consider any new items of urgent business admitted at Item 4 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 are as follows:

·         12^th  September 2016 - 18:00-20:00

·         8^th December  2016- 18:00-20:00

·         2^nd March 2017 -18:00-20:00

It was noted that the future meeting dates were provisional:

• 12^th  September 2016 at 18:00
• 8^th December 2016 at 18:00
• 2^nd March 2017 at 18:00