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.

Clerks note – Dr Christian began the meeting as Chair as Cllr Kober was running late*

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.
• Dr Dina Dhorajiwala
• Sarah Price

In addition, apologies for lateness were noted from Cllr Kober and Cllr Weston

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 15).

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.

No Declarations of Interest were noted.

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 12 September 2016.

RESOLVED:

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

A report was included in the agenda pack at page 21. 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 27. The report and presentation provided an update to the Board on progress in delivering Haringey’s Health and Wellbeing Strategy 2015-18 and also set out the challenges in delivering the ambitions, as well as areas for focus for the next 18 months. Following the presentation the Board discussed the findings.

The Board was reminded that nine ambitions were identified for the Health and Wellbeing Strategy with three priority areas for sustainable improvements: Reducing obesity, increasing health life expectancy and improving mental health and wellbeing. In the first 18 months of delivering the Health and Wellbeing Strategy significant progress was reported in the following areas: Establishing strategic frameworks for delivery, establishing partnerships and governance to deliver improvements at population level and initiating key interventions. The Board noted successful improvements made through stroke prevention initiatives in Primary Care; with a 7 % increase in the number of people diagnosed with hypertension from 2014/15 – 2015/16, and a 13% increase in the number of people diagnosed with atrial fibrillation from 2014/15 – 2015/16.

The Director of Public Health updated the Board on current performance levels against the 9 nine ambitions set out in the Health & Wellbeing Strategy. The Board’s attention was drawn to significant underperformance on Ambition 4, around achieving a reduction in the rate of early death by stroke by 25%. Haringey’s stroke rate stood at 22.3 per 100k compared to 16.3 for similar boroughs and placed Haringey as the worst performing London Borough for early deaths from stroke. The Director of Public Health also drew the Board’s attention to the key areas of focus over the next 18 months. The Board previously agreed to the prevention pyramid approach which focused on getting health into all policies at a population level.  The Director of Public Health outlined examples of clear priorities that Haringey wanted to take forward at population, community and personal health levels, as well as the opportunities that existed through the Haringey and Islington Wellbeing Partnership.

The Director of Children’s Services advised that in relation to Ambition 7, he undertook a piece of work with a group of 60 young people during the summer and it was clear from the discussion that those young people had a very good awareness of mental health in and amongst each other. The Director of Children’s Services also advised that the Bridge Renewal Trust were coordinating a piece of work on young people’s mental health in Tottenham called Young Minds, and that this would provide a key opportunity for awareness raising around young people and mental health. 

The Deputy Chief Executive commented that the organisations represented at the Board, as well as the services that were commissioned through them, employed a significant number of people in the borough and advocated that if the Board was  ...  view the full minutes text for item 22.

primary care estates update

The Board received a report which was included in the agenda pack at page 21. The paper provided an update to the Board on primary care and described the progress which had been made during the year in meeting capacity demands. The report was introduced by Cassie Williams, Assistant Director of Primary Care Quality and Development – Haringey CCG. Following the introduction of the report, the Board discussed its findings.

The Board noted the opening of the new zero list practice at Hale Village in August 2016. In addition, the Board was advised that Haringey CCG had been provisionally awarded £11.6m for three estate developments in areas previously identified as having particular capacity needs; Tottenham Hale, Wood Green and Green Lanes. There was still a significant process involved in accessing these funds but the award was highlighted as being very significant, given that the total amount of funding available to London was £67m.

The Assistant Director of Primary Care Quality and Development advised the Board that 7 bids for improvement grants had been submitted to support some of the smaller scale work that was required in some of the smaller sized practices. Examples of the bids included; improved infection control, hearing loops and improved disability access. The Board was advised that notification on the outcome of the bids was expected in a month’s time. The Assistant Director of Primary Care Quality and Development also drew the Board’s attention to appendix 2 of the report which contained a draft of the guiding principles for future commissioning of premises; setting out a vision for larger premises, with a high number of clinicians and providing a high level of care. The Board’s views were sought on the governing principles and it was noted that there would also be also be a consultation process with the public.

The Leader advised that she attended a meeting the night before in Seven Sisters and that there was still significant concerns from residents around the quality of buildings and accessibility of the service, with residents still reporting difficulties in getting appointments. The Leader suggested that there was still a perception issue around primary care in the borough and that the Board needed to continue monitoring the issue.

The Chief Executive of the Bridge Renewal Trust sought clarification on how support was being offered to GP’s in commissioning excellent clinical facilities. The Assistant Director of Primary Care Quality and Development advised that following the failed Estates and Technology Transformation Fund (ETTF) bids for three premises, partners were looking at options and the financial availability to see how those schemes could be progressed without the initial capital investment from the ETTF fund. It was noted that there may be another round of bids available after 2019.

The Deputy Chief Executive commented that it was really useful having all of the information presented in the report to the Board and stated that it was important to recognise that there had been significant progress in some areas.  ...  view the full minutes text for item 23.

The Board received a report which outlined how an Accountable Care Partnership (ACP) could support delivery of the aims of the Haringey and Islington Wellbeing Partnership and to provide a vehicle for delivery of the STP. The report was introduced by Rachel Lissauer, Acting Director of Commissioning Haringey CCG and was included in the agenda pack at page 57. The Board also received a presentation to accompany the report. Following the presentation, the Board discussed its findings.

The Board considered how the Haringey and Islington Wellbeing Partnership could use its organisational structure to bring about the biggest improvements in health and social care outcomes. The Acting Director of Commissioning Haringey CCG set out what an ACP looked like in practice and examples of different models being used by other authorities. The Board noted that there was a range of terminology used around Accountable Care Organisations and that a number of models that could be adopted. The Haringey and Islington Wellbeing Partnership was currently set up as an informal collaboration but was moving to a more formal collaboration model. The Board noted that an essential feature of an Accountable Care Organisation was that it involved a population based budget for either a single or a group of providers who had responsibility for achieving health and wellbeing outcomes for that particular population.

The Board noted a number of examples of different models that were being developed in other areas:

1. Northumbria was noted as an example of how shared commissioning across the council and CCG was enabling shared provision; as both organisations had came together as joint commissioners and held the budget for population services. In this example the health foundation trust held a single contract for acute services, mental health services, community services and adult social care.

2. Stockport was in the process of establishing a care trust involving the health foundation trust, GP federation, council and another provider.

3. South Somerset had developed a much more GP led Accountable Care System, which originated from groups of practices wanting to develop ownership of community services. In practice this involved a joint venture to bring GP’s in to the community health care system, but ensuring that membership for individual practices was done on a voluntary basis.  

The Acting Director of Commissioning, Haringey CCG sought to gauge the Board’s view on the degree of ambition and the pace of change that might be required. The Board was also asked to comment on the role it would like to take in the process and how it might interact with some of the other bodies involved.

The Deputy Chief Executive commented that this discussion was partly influenced by the earlier discussions around an ACO with the Royal Free and NMUH and how to build a new partnership. The Board considered that primary care in both Haringey & Islington would play a central role along with Healthwatch, the voluntary sector, the acute trust, community health provider and adult social care services. There were a number of activities already  ...  view the full minutes text for item 24.

The Board received a report which set out progress on implementation of  a model of commissioning and pooled budgets supported by a partnership agreement under S.75 of the National Health Services

Act 2006. Lead commissioning and pooled budgets for specified care groups were due to be in place by April 2017.The report was introduced by Rachel Lissauer Director of Commissioning, Haringey CCG and was included in the agenda pack at page 69.

RESOLVED

The Health and Wellbeing Board was asked to note the work underway to ensure the following arrangements could be in place from April 2017:

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 long term conditions and older people’s services, including those services identified in the Better Care Fund 2016/17, for eligible adults resident in Haringey;

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 the commissioning of the Independent Domestic Violence Advocacy Service and the Identification and Referral to Increase Safety Service for eligible adults resident in Haringey.

A cover report was included in the agenda pack (pages 69-70), and the HSCB & HSAB annual reports were included in the agenda pack at pages 71 & 139 respectively. Patricia Durr, HSCB & HSAB Business Manager introduced the reports and the Board discussed their findings.

The Board were advised that there was a statutory requirement to produce an annual report for both bodies. The LSCB and SAB Business Manager drew the Board’s attention to the Adult’s strategic plan and the five year strategy in Children’s.

Cathy Herman, Lay Member Haringey CCG commented that there was significant work being undertaken between the HSCB and the Enfield Safeguarding Children’s Board and enquired whether there were any plans to develop similar relationships with Islington. The LSCB and SAB Business Manager advised that facilitating greater joint working across London was one of the key enabling priorities identified, particularly in dealing with major issues that existed across London such as CSE. The Board was advised Haringey was part of the wider north London cluster and that she also sat on the task and finish group for the London Safeguarding Board, both organisations also included Islington.

*Clerks Note – Cllr Kober entered the meeting*

Dr Jeanelle De Gruchy, Director of Public Health commented that the VAWG Strategy was presented at the previous meeting of the HWB and during the meeting the Board discussed the impact of VAWG on children and young people. The LSCB and SAB Business Manager reassured the Board that work was being undertaken to understand   connection between the VAWG Strategy and supporting vulnerable young people, a key element in the process was around ensuring that links were made across different services and agencies.

Sharon Grant, Chair Healthwatch Haringey commented that there was a long way to go in terms of gathering enough data to be able understand the problems that existed in adult social care. The Chair Healthwatch Haringey also commented that there were significant issues around incompatibility of systems used between the Council and other partners and questioned whether there needed to be a dedicated performance measure to track referrals into adult social services. The LSCB and SAB Business Manager agreed that there was still some way to go to fully understand where referrals came from and how to track them cross the system.

The Assistant Director of Adult Social Services acknowledged that there was a conversation to be had around ensuring the correct metrics were in place to be able to asses overall performance levels and whether improvements were being made. The Chair Healthwatch Haringey, advocated that the annual report should refer to performance around referrals to Adult Social Services and highlight where the ‘pinch points’ were in the system and how to address them. The LSCB and SAB Business Manager acknowledged these concerns and agreed to check and ascertain whether the information was contained in the accompanying performance report. The LSCB and SAB Business Manager also advised that the system around referrals changed following the implementation of the Care Act and  ...  view the full minutes text for item 26.

The Board received a report which provided an updated version of the CAMHS plan, taking into account the work that had been completed in the last year and to also set out further details on what implementation would look like over the next four year period. The report was introduced by Catherine Swaile, Vulnerable Children’s Joint Commissioning Manager and was included in the agenda pack at page 217. The updated CAMHS Transformation Plan was also included in the agenda pack at page 221, as an appendix to the report.

The Lay Member, Haringey CCG commended the report and commented that it was a really helpful piece of work that clearly set out what the issues were and what was being done to tackle them.

The Director of Children’s Services raised concerns about the transition of young people into adult mental health services and commented that although the report set out that this shouldn’t be arbitrarily based on age, there was a concern that this was still the case and that there were significant issues involved. The Director of Children’s Services queried how that transition could be improved.

In response the Vulnerable Children’s Joint Commissioning Manager advised that a number of pieces of work had been undertaken following an Overview and Scrutiny Committee report on CAMHS transition in 2014. A three year action plan around transition had been developed with the aim of understanding the current cohort, who was making the transition and how many wanted additional support but were ineligible. In addition, there was a pilot scheme being introduced involving BEH Mental Health Services, the voluntary sector and a group of young people at transition age. The pilot scheme involved the co-production of a manualised training package for young people about life skills and the development of peer support arrangements. The Vulnerable Children’s Joint Commissioning Manager advised that this would hopefully be successful in helping those young people between tier 2 and tier 3 who would not be eligible for additional support at transition.

The Board were also advised that work was being undertaken to look at how to relax the boundary between CAMHS and adult mental health services to ensure that the young person was referred to the most appropriate treatment. There would be a joint panel with adult mental health services and CAMHS to decide the best referral pathway. In response the Director of Children’s Services urged that the transitional approach should involve a wider array of partners including Children’s services and Adult Social Services.

RESOLVED:

To note the contents of the CAMHS Transformation Plan Refresh and formally sign-off the plan for publication

*Clerks Note – Cllr Kober took over as Chair for the remainder of the meeting*

A cover report was included in the agenda pack (pages 317-318), which  updated the board on proposals being developed around the NMUH joining the Royal free London NHS Foundation Trust “Group”.  A presentation was also given jointly to the Board by the Richard Gourlay, Director of Strategic Development, North Middlesex University Hospital and Ron Agble, Director of Partnership & Transactions, Royal Free London Hospital.

The Board were advised that Royal Free London proposed developing as a Group in order to develop the capability and infrastructure to reduce unwarranted variation – which was intended to result in improved clinical outcomes, patient safety and patient satisfaction. The Group intended to consolidate a range of clinical support services and non-clinical activity, which should also deliver financial benefits. NMUH had experienced significant operational challenges, in terms of both quality and delivery of access standards that may have been mitigated with access to a wider workforce resource.

North Middlesex University Hospital took a decision in March 2016 to explore how joining the group would help secure the future sustainability of services – both financially and clinically.  A Partnership Board was established in June 2016 to maintain an overview of the progress towards the decision and the integration of NMUH into the new group structure.  This Partnership Board incorporated senior leaders from the Trusts as well as representatives from Haringey CCG, Enfield CCG, NHS England and NHS Improvement. Both trusts boards would make ultimate decisions regarding progress of the Partnership Programme, with the Partnership Board acting as the collective forum to oversee the work on behalf of both organisations. The Director of Partnership & Transactions, Royal Free London Hospital assured the Board that any decision to join the Royal Free London Group would not result in NMUH being centrally managed from RFL and that local management arrangements would be maintained.

In response to a request for clarification on the risks involved in the proposal, the Board was advised that during a leadership away day for senior managers at NMUH’ one of the key areas of concern was around the need to protect the identity of NMUH. The Director of Partnership & Transactions, Royal Free London Hospital advised that the biggest risk in his opinion was around staff retention and staff recruitment.

The Director of Strategic Development, NMUH emphasised the need for any investment to deliver a return given the financial pressures facing the NHS and that getting this wrong would carry significant risks around public perception and wasting public money. The Board were also advised that there were risks to wasting the time and commitment of clinical staff and the wider impact this could have on staff morale. The Director of Strategic Development advised that whilst the group was aware of the risks involved, there was a much greater risk around not doing anything at all.

In reference to a possible Accountable Care Organisation model, the Deputy Chief Executive stressed the need  ...  view the full minutes text for item 28.

To consider any new items of urgent business admitted at Item 4 above.

None

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

The next meeting of the Board is 2^nd March 2017 18:00-20:00.

The Board agreed in principle to holding a joint meeting of the HWB and Community Safety Partnership at the next Board meeting in March.

It was agreed that there would be short Board meeting for business items and that the main strategic item would be a joint discussion of both Boards focusing on one of the key areas of overlap such as VAWG, alcohol or mental health.

It was noted that the future meeting dates were:

• 2^nd March 2017 at 18:00