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 to agenda Item 1 as shown on the agenda in respect of filming at this meeting and asked that those present reviewed and noted the information contained therein.

The Chair will welcome those present to the meeting and introductions will be given.

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

To receive any apologies for absence.

The following apologies were noted:

• Sir Paul Ennals.

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 ).

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.

Dr Christian informed the Board that, in respect of commissioning primary care, one of the applications for central funding for new premises involved the Muswell Hill practice where he worked.

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 consider and agree the minutes of the meeting of the Board held on 19^th May.

The Board commented that there was a typographical error on page 2 of the minutes; the heading should read ‘Intermediate Care and Integration.’

The Board also noted that, on page 17 of the pack, the 4^th paragraph should refer to the Chair of Healthwatch, not the Director.

RESOLVED:

That the minutes of the meeting held on 19^th May 2016 be confirmed as a correct record.

A cover report was included in the agenda pack (pages 21-22), which  updated the board on the work being undertaken at a local level around health and social care within Haringey; jointly between Haringey and Islington through the Wellbeing Partnership and, across North Central London through the Sustainable Transformation Plan.  Zina Etheridge, Deputy Chief Executive introduced the report. A presentation was also given jointly to the Board by the Deputy Chief Executive and Sarah Price, Chair Haringey CCG. Hard copies of the presentation were tabled at the meeting.

The Board were advised that together, Haringey & Islington were best placed to tackle local issues and lead transformational change at pace. However, the Board needed to start considering next steps to ensure the right structures were in place to work with communities to deliver better health and care over the long term. Some of the key considerations outlined in the presentation included: Whether there was a need for a more formal, shared governance structure with shared accountabilities, risks and incentives; should there be a more radical approach to pooling financial resources; how to improve the commissioner/provider relationships; and how to embed incentive structures aligned to outcomes rather than processes.

The Board considered that any new approach would need to enable the Wellbeing Partnership to deliver improvements for residents, front-line change and financial efficiencies faster and more effectively. In summary, the Deputy Chief Executive advised that development of the STP for North Central London led to a series of questions about how best to deliver ongoing improvements to health and care in Haringey. The Board was informed that the next step was to start exploring whether a more formal arrangement for the Wellbeing Partnership could help achieve these improvements. The Deputy Chief Executive acknowledged that there was a significant amount of information to consider and suggested that the Board might want to consider and discuss its initial findings, and that subsequent conversations could be held either on a one-to-one basis or potentially at the next Joint Health and Wellbeing Board with Islington.

Cllr Weston, Cabinet Member for Children and Families commented that the increasingly formalised nature of joint working with both Islington and across NCL created the need for an overarching structure in place in order to ensure successful delivery. This was especially apparent given the resources already invested and the risks involved. The Chief Officer, Haringey CCG agreed that the process needed to be embedded and become more formalised, and advised that the focus was very much on the population as opposed to the organisations that sat within them. It was advocated that that this was crucial in making sure the services delivered met local needs.

The Deputy Chief Executive outlined that the initial emphasis for forming the Wellbeing Partnership was the application to become a vanguard organisation for the NHS’s New Models of Care programme which, whilst unsuccessful, elicited further discussions around developing a new model of care that brought in Islington and a host of new providers and led  ...  view the full minutes text for item 77.

A report was included in the agenda pack at page 25. Jeanelle de Gruchy, the Director of Public Health introduced the report to the Board. There was also a presentation which was included in the agenda pack at page 33. The report and presentation provided an update to the Board on progress of the Healthy Environment Strand of the Haringey Prevention Pilot. Following the presentation the Board discussed the findings.

The Board was advised that a business case outlining the proposals for the devolution pilot was presented to the London Health and Care Devolution Programme Board at the end of July. Haringey would continue to work with London partners and national government over the coming months to refine those proposals. A final business case was due to be submitted to the London Prevention Board by December 2016.

The Director of Public Health circulated three handouts which provided a conceptual approach to prevention, using a pyramid diagram to outline the primary, secondary and tertiary prevention approaches. The approaches to prevention were broken down into three types of intervention; population level, community development and personal services. The three diagrams represented the separate approaches for children and young people and for adults, as well as a version with ‘I’ statements i.e. how residents would experience the outcome of interventions.

The Chair enquired whether the empty boxes represented the absence of population level interventions at the secondary prevention stage or whether it suggested that there was an intervention that did not currently take place, but which might be developed in the future. The Director of Public Health advised that population level interventions also impacted as secondary and tertiary interventions. The Director of Public Health advised that this would be better illustrated in future versions of the diagram. The Board was given an example of someone recovering from a heart attack that utilised parks or council leisure services which were available to the whole population. 

The Chair of Healthwatch Haringey suggested that one possibility in this area would be measures that were aimed at the whole population which increased understanding of certain conditions particularly within certain groups of the population. The Director of Public Health acknowledged that there was a cross cutting aspect of prevention around information advice and guidance and also stated that this was where the ‘I’ statements contained in the overview diagram were relevant.

The Lay Member Haringey CCG commented that the fuel poverty and work intervention captured on the adults diagram appeared to be marooned between secondary and tertiary areas of prevention but could be considered to be more of a counterbalance to the whole of the population level activities. The Director of Public Health responded that the fuel poverty work tended to be targeted more toward older people. The Lay Member Haringey CCG elaborated that her concern was that by looking at specific interventions at the secondary and tertiary levels there was a risk of missing some of the wider determinants at a primary prevention level. The Lay Member Haringey  ...  view the full minutes text for item 78.

The Board received a report and the Violence Against Women and Girls (VAWG) draft strategy as part of the agenda pack at pages 45 and 51 respectively. The strategy was out for public consultation and the Board were asked to give its views with a particular focus on the impact of VAWG on children and young people.

The report was introduced by Fiona Dwyer, the Strategic Lead for Violence Against Women and Girls. The Board also received a presentation from the Strategic Lead for Violence Against Women and Girls with additional input received from Emily Sayer from the Highgate Woods Young Feminist Group. Ms Sayer outlined the role of the organisation and their experience of engaging schools around VAWG. Sean Thrasher and Celina Guler, two young people who had undergone training through the council-funded VAWG prevention project called Protect Our Women, also spoke to the Board as part of the presentation.

Ms Sayer advised the Board that she had recently taken over responsibility for the Highgate Woods Young Feminist Group and that the group was established to provide a space for the girls at the school to discuss issues that were affecting them and to also make them aware that the issues involved affected society as a whole. Ms Sayer commented that discussions during meetings were often quite advanced and that examples of topics ranged from the school’s uniform policy to casual sexism and cat-calling in the street. The students who attended the meetings ranged from years 7-13 and Ms Sayer considered that the students’ awareness of, and ability to engage around, those issues was clearly beneficial. However, it was also worrying that students at such a young age were so affected by these issues and this demonstrated the need for a group of this type.  The group was in the process of arranging for a workshop session with the Strategic Lead for Violence Against Women to come to the school and speak to pupils.

The Deputy Chief Executive asked what the impact was on the children of being able to have these discussions. Ms Sayer responded that the Head Teacher had spoken to staff on the first day of term around the way in which the uniform policy was enforced and that this was a tangible demonstration that the discussions had had an effect. Less tangible impacts were around offering them advice on how to deal with particular situations and creating a sense of community; reassuring them that other people were feeling the same way as them.

The Cabinet Member for Children and Families asked whether boys were able to and encouraged to join the group. Cllr Weston elaborated that part of the proposed strategy around VAWG was to focus on perpetrators and that in the instance of cat-calling most perpetrators would be boys and young men. Ms Sayer responded that some of their sessions were targeted at particular groups and that some of these sessions were open to both boys and girls but that it was a  ...  view the full minutes text for item 79.

The Board received a report which outlined proposed changes to the Board’s membership and terms of reference following a review undertaken, as agreed at the Board meeting of 26^th February 2016. The report was introduced by Stephen Lawrence-Orumwense, Assistant Head of Legal and was included in the agenda pack at page 77. The aim of the review was to ensure the right level of representation to provide system leadership for Haringey and its residents, and to take account of wider developments across the local health and care system. The developments mentioned in the review included the introduction of five year Sustainability and Transformation Plans, the increasing collaboration between Haringey and Islington health and care economies, and the statutory footing of the Safeguarding Adults Board under the Care Act 2014. The review also considered the Board’s terms of reference to ensure that they reflected current operations and supported its future ambitions. The Board was advised that following consideration of the paper, any revisions to membership would go forward to Full Council for approval.

The Board was advised that one of the key findings of the review was that the Board should consider maintaining its existing terms of reference as they provided clear mechanisms for engagement, but that the board should seek to utilise these frameworks in order to engage with other stakeholders. Furthermore, the review also identified some minor changes in order to better reflect its current way of working; including formalising the inclusion of the Deputy Chief Executive to the Board and the inclusion of the Independent Chair of the SAB. The review further proposed that the terms of reference should be amended to reflect the Board’s ambition to collaborate across borough boundaries and to enter into joint working arrangements with other HWB’s.

The Chair of Healthwatch Haringey suggested that the review raised questions about the role of the Health and Wellbeing Board and advocated that there was a serious problem of local accountability in terms of Health and Social Care. The Chair of Healthwatch Haringey commented that the recent review of the workings of the partnership boards was fairly critical of the way those boards represented the users of health and social care services and suggested that the Health and Wellbeing Board had minimal representation of patients and service users in its current format.

The Chair of Healthwatch Haringey suggested that one solution might be to undertake supplementary activities under the auspices of the Health and Wellbeing Board to enable further patient and user engagement. The Board was advised that there had been significant changes to health and social care in the last year, particularly around the closure of residential homes and services for people suffering from conditions such as autism and dementia. The Board considered that the relatives and families of those affected had to go through a very stressful process, addressing a number of different forums to voice their disapproval.

The Cabinet Member for Health and Finance commented that in relation to the recommendations contained in  ...  view the full minutes text for item 80.

The Board received a report which set out the ongoing work in Haringey in relation to Primary Care, specifically around General Practice. The report was introduced by Cassie Williams AD Primary Care Quality and Development, Haringey CCG and was included in the agenda pack at page 91 and the Haringey General Practice Development Programme 2016-17 was also included in the agenda pack as an appendix to the report at page 97.

The report included an update on Primary Care premises development, particularly in relation to the new zero list practice in Tottenham Hale, which opened on 31^st August, and additional work being progressed to secure adequate and appropriate premises for general practice in Haringey.This work was developed out of the Haringey Strategic Premises Development Plan which was presented to the Health and Wellbeing Board on 23^rd June 2015.  The report further detailed the current and future options for Haringey in relation to primary care commissioning.  Haringey CCG, in collaboration with the other 4 CCGs of North Central London, currently jointly commissioned General Practice together with NHS England but was being invited to consider whether to submit an expression of interest to take on Level 3, delegated commissioning from April 2017. 

The Chair of Healthwatch Haringey raised concerns about maintaining adequate levels of accountability in General Practice going forwards and enquired what mechanisms were in place to ensure that any future gaps in primary care capacity would be addressed. The AD Primary Care Quality and Development responded that there was significant work underway in the development and use of dashboards to produce high-level data and to flag up any quality concerns in relation to practices. The CCG and partners were increasingly developing their evidence base to ensure that they had a firm understanding of the health care situation in Haringey.  The Deputy Chief Executive advised that the Board had previously agreed that an assessment of primary care in the borough would come back to the Board at an appropriate point in the cycle, to ensure strategic oversight was maintained. In response to a question, the AD Primary Care Quality and Development responded that the dashboard data was reviewed through internal governance routes, such as the primary care transformation boards and was also disseminated to GP practices, and was part of the peer review process.

The Board considered the report and noted its contents.

The Board received a report which set out the Haringey CCG and local authority draft commissioning intentions for 2017/18. The report was introduced by Sarah Price, Chief Officer Haringey CCG and was included in the agenda pack at page 103.  The Health and Wellbeing Board were advised that organisations’ Commissioning Intentions were developed each year in order to signal changes to contractual process, any services to undergo procurement or any changes to strategy. For the purposes of NHS organisations formal notice of contractual changes needed to be issued to providers by 30 September. The Board considered that Haringey (LBH and CCG) had been developing joint CommissioningIntentions for 2017-2020. The Board was advised that the Commissioning Intentions would fall under the STP going forwards and that broader intentions would be developed across the five boroughs.

RESOLVED:

I). To note the progress on the Commissioning Intentions.

A report was included in the agenda pack at pages 109-220, which proposed the implementation of a model of commissioning and pooled budgets supported by a partnership agreement under S.75 of the National Health Services Act 2006. The partnership agreement set out the shared outcomes and objectives sought, and contained detailed schedules which enabled; lead commissioning and pooled budgets for specified care groups.

Whilst the initial focus was on adult services, the partnership agreement would act as a framework and was designed to enable schedules to be added for other care groups, including Children’s Services, as required. The partnership agreement was due to be presented to Cabinet for approval on 13^th September 2016 and to the CCG’s Governing Body for approval on 23^rd September 2016. The implementation of pooled budgets was due to be in place by April 2016.

In response to a request from the Cabinet Member for Children and Families, the Board agreed that the Cabinet Member and Director of Children’s Services would be added to the oversight body at the point in which any pooling of budgets was undertaken for Children’s Services; in order to ensure the requisite oversight mechanisms were in place. The Chair of Haringey CCG agreed to feed back this request.

RESOLVED:

The Health and Wellbeing Board was asked to consider and endorse

the proposed S.75 Partnership Agreement between the Council and

the CCG which provides for:

1. Lead commissioning and the establishment and maintenance of pooled fund for the commissioning of learning disability services for eligible adults resident in Haringey;
2. Lead commissioning and the establishment and maintenance of a pooled fund for the commissioning of mental health services for eligible adults resident in Haringey;
3. Lead commissioning and the establishment and maintenance of a pooled fund for the commissioning of older people’s services, including those services identified in the Better Care Fund 2016/17, for eligible adults resident;
4. Joint commissioning and the establishment and maintenance of a pooled fund for the commissioning of children and adolescent mental health services for the residents of the London Borough of Haringey;
5. Lead commissioning and the establishment and maintenance of a pooled fund for thecommissioning of the Independent Domestic Violence Advocacy Service and the Identification and Referral to Increase Safety Service for eligible adults resident in Haringey: and
6. which is attached as Appendix 1 of the report and is due to be considered by the Cabinet and the CCG’s Governing Body in September. 

The Board noted the action log. 

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:

It was noted that the future meeting dates were:

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