Agenda and minutes

Councillor Perrin declared that he was a member of the Equalities, Diversity and Engagement (EDEN) Committee, Chair of the Wembley Locality Patient Participation Group and Chair of Sudbury Surgery Patient Participation Group (also known as Intergrated Health) and by consequence, the patient representative on the board of Intergrated Health.  However, he did not regard these as prejudicial interests and remained present to consider all items on the agenda.

The minutes are attached.

RESOLVED:-

that the minutes of the previous meeting held on 9 April 2014 be approved as an accurate record of the meeting, subject to the following amendment:

page 2, last paragraph, line 8 – add ‘and extended stays in hospital’ after ‘hospital admissions’.

Shaping a healthier future implementation update

Responding to a query from the Chair concerning the future of Central Middlesex Hospital (CMH), Jo Ohlson (Chief Operating Officer, Brent Clinical Commissioning Group) advised that a thorough assurance process had been undertaken by Brent Clinical Commissioning Group (CCG), the Trust Board, NHSE and Trust Development Agency who were satisfied with arrangements that would lead to the closure of the Accident and Emergency Unit (A and E) on 10 September.  She added that the Urgent Care Centre (UCC) at CMH would continue to operate on 24/7 basis and offer an enhanced specification as a standalone UCC.  A high level, detailed information campaign informing the public of the changes to services at the UCC was to be launched in the week commencing 28 July.  Members noted that the closure of the A and E at CMH was also to be discussed at the Scrutiny Committee on 6 August.  In response to a query from Councillor Perrin, Jo Ohlson advised that the information campaign contained the header ‘A and E is changing’ because although the unit was closing, it could be misleading to the public to state this as a headline as in fact the UCC would continue to operate on a  24/7 basis. 

In reply to the Chair’s query concerning what the UCC at CMH could provide, Sarah Mansuralli (Deputy Chief Operating Officer, Brent Clinical Commissioning Group) advised that it would provide primary care for minor illnesses and accidents.  There would also be signposting to relevant services for patients where treatment at the UCC was unnecessary.

Ann O’Neill (Healthwatch Brent) expressed surprise at there being no councillors present at a recent CMH consultation meeting and felt that it would be appropriate that they attend future such events.

In reply, The Chair acknowledged the importance of attending such events, explaining that some members had meetings clashing with the CMH consultation event.  The Chair requested that there be a further update about the closure of the A and E at CMH at the next meeting.

Brent Better Care Fund Plan

Phil Porter (Strategic Director, Adult Social Services) updated the Board on the Brent Better Care Fund Plan, explaining that there was now greater clarity and that the Brent Integration Board was working with the new plan and template.  He added that there would be greater focus on reducing hospital admissions whilst balancing medical and social care needs. 

This report reviews how the Health and Wellbeing Board is functioning and considers how its effectiveness can be further strengthened.

Ben Spinks (Assistant Chief Executive, Assistant Chief Executive’s Service) introduced the report that set out a starting point for discussion for future ways of working for the Health and Wellbeing Board (HWBB).  He explained that there were three types of items that the HWB to consider, these being:

·         Nationally mandated issues, including statutory responsibilities

·         System leadership

·         Leadership on key issues in Brent

Ben Spinks advised that the HWBB had been successful in meeting its statutory responsibilities, such as developing and agreeing a Joint Strategic Needs Assessment (JSNA) and health and wellbeing strategy for the borough.  The HWBB was also developing its system leadership role, an example of this was the oversight role it played for the health and wellbeing action plan that brought together all the work being undertaken by the relevant organisations in delivering the health and wellbeing strategy.  However, Ben Spinks advised that there was considerable scope for the HWBB to play a greater role in providing leadership on key issues and in view of this, the report was suggesting that the HWBB focus its development in this area over the next twelve months. 

In order to strengthen its leadership on key issues in the borough, Ben Spinks suggested some ways in which this could be done, including:

·         Facilitation of workshops by the council and through other organisations in Brent as appropriate

·         External facilitation of workshops by a relevant expert

·         Appoint a partner to lead the facilitation across all topics

Ben Spinks then referred members to the recommendations in the report.

Phil Porter added that the HWBB could look at issues across a number of  areas and its work programme would be flexible to reflect any changes either at local or national level.  He suggested that a more workshop like approach could be taken at meetings, with greater participation from a wider audience and providing a clear focus in achieving practical outcomes.

During discussion by Board members, Councillor Moher stated that it had been agreed by the Board last year that there would be a distinction between business meetings and other meetings and she sought clarification that both such types of items would be covered during meetings and whether there would be sufficient time to consider both.  Councillor Hirani indicated his support for the proposals and members agreed to his suggestion that Board’s work programme should be guided by the Joint Strategic Needs Assessment (JSNA) and the HWBB strategy.  Councillor Hirani felt that a discussion about dementia would be a useful topic of discussion at a future meeting and the Board agreed that this be part of its future work programme.  Ann O’Neill (Brent Health Watch) emphasised the need for the HWBB’s work to relate to the public and for them to have faith in its effectiveness.  She felt that there was a need for more community engagement and use of feedback from Brent Connect Forums and other local evidence should be used.  Ann O’Neill felt that external facilitation of workshops was a good idea and it would  ...  view the full minutes text for item 4.

The covering report and Brent alcohol reduction strategy 2014 – 2017 is attached.

Melanie Smith introduced the report and advised that there had been wide input into producing the alcohol harm reduction strategy.  The strategy aimed to reduce alcohol related harm through three desired outcomes, these being:

·         A healthier community

·         A safer community

·         A more responsible community

Melanie Smith then drew the Board’s attention to the recommendations as set out in the report.  She added that work was already underway in developing the strategy’s action plan.

During discussion, Councillor Moher noted the role the police had in respect of making representations for licensing applications and she queried whether higher fees could be set for certain kinds of licences.  Councillor Perrin stated that there was a worrying increase in the number of counterfeit spirits and concerted efforts were being made in prosecuting retailers who sold alcohol to those who were under the legal age.  Councillor Hirani felt there was a need for stronger licensing enforcement and consideration should be given to not approving licences in areas of the borough where alcohol misuse and its associated problems were at their highest. 

Dr Sarah Basham emphasised the importance of outreach work and appropriate signposting for those affected by alcohol misuse.  Sarah Mansuralli advised that there had been an increase in alcohol related admissions to hospitals and a number of such patients were frequent visitors which underlined the need to support intervention services.  Jo Ohlson stated that there was a need for a broader risk assessment of those who may be at risk from alcohol misuse.  Ann O’ Neill felt that there was also a need to provide the relevant contacts for the public for those affected by others’ drinking, such as street drinkers.   Gail Tolley (Strategic Director, Children and Young People) enquired whether there were any current figures in respect of the desired outcomes.

The Chair noted and expressed concern about the increase in alcohol related crime and alcohol violent crime estimates in Brent compared to the London average which was decreasing, as set out in charts six and seven in the report.  He enquired whether the HWBB would receive regular updates on the performance on achieving the strategy’s outcomes.

In reply to the issues raised, Melanie Smith advised that the council had information for example on some of the businesses selling alcohol early in the morning.  The licensing team were planning to review the council’s Statement of Licensing Policy and there would be a focus on health.  She felt that although the services provided to address alcohol misuse were good, they were not being used as much as they should and there needed to be better working between the relevant services and agencies to help reduce the number of hospital referrals.  An early intervention alcohol service had been trialled without much success and so the service was currently being redesigned.  Members noted that figures for the action plan were currently being populated and that there would be regular performance updates as part of the strategy.

RESOLVED:

(i)         that the Brent alcohol harm reduction  ...  view the full minutes text for item 5.

The report is attached.  Sarah Mansuralli (Deputy Chief Operating Officer, Brent Clinical Commissioning Group) and Phil Porter (Strategic Director Adults, Brent Council) will present the report.

Phil Porter presented the item and stated that Whole Systems Integrated Care (WSIC) Brent Early Adopter project was an ambitious programme that was a key part of the North West London Pioneer Project.  He stated that the WSIC vision contained four main objectives, these being:

·         Ensuring funding flows to where it is needed

·         Patients and communities are recognised as assets

·         Care is provided in the most appropriate setting

·         Care is coordinated around the individual

Phil Porter then referred members to the WSIC approach to population grouping as set out in the report.  Members heard that each GP locality had been given the opportunity to take part in the Early Adopter project, however it was the Harness and Kilburn GP networks that had volunteered to participate.  The WSIC also sought to develop the model of care and this would include four evidence based principles, these being:

·         A collaborative multi-disciplinary team structure

·         Care coordination

·         Self-management by the patient

·         A single shared care plan

Phil Porter advised that there were also significant barriers to overcome as outlined in the report.  In terms of measuring success and the impact on service users and providers, this would not just be measured in terms of reducing admissions and residential care, but also in improving quality and outcomes.  Phil Porter confirmed that the deadline to finalise the business case for the programme was 31 October and the timetable of activities was also a challenging one.

Sarah Mansuralli added that a more collaborative approach with acute providers was being taken across the whole of North West London.

During members’ discussion, Councillor Perrin enquired how patients would be supported to self-manage their health and wellbeing as mentioned in the report and he sought further comments in respect of one of the desired outcomes of over 75s patients to remain at home.  Councillor Hirani enquired whether the programme would cover patients who received services from specialised commissioning.  Ann O’Neill enquired what steps would be taken to inform the public about the programme and the reasons why it was being undertaken. 

At the invitation of the Chair, Elcena Jeffers addressed the Board.  Elcena Jeffers stressed that it was important for all stakeholders to work together to provide more effective care and she felt that another meeting should take place between them before the next HWBB meeting in October. 

The Chair welcomed the report, however he enquired why it lacked any figures and asked how many patients would be affected by the programme and who would it impact upon most, whilst information on the budget was also sought.  He suggested that by offering a simpler and more streamlined service, this was representing a positive message and he enquired whether anyone would be adversely affected by the proposals. 

In reply to members’ queries, Phil Porter advised that patients would self-manage to the extent that was practically possible and the proposals would be an improvement from the current system where decisions by different agencies were not necessarily joined up.  With regard to the desired  ...  view the full minutes text for item 6.

The Health and Social Care Act 2012 conferred the duty for publishing and keeping up to date a statement of the population needs for pharmaceutical services in their area, referred to as a pharmaceutical needs assessment (PNA) onto Health and WellBeing Boards.

This paper proposes how this responsibility should be discharged.

Melanie Smith presented the report that detailed the requirement for a Pharmaceutical Needs Assessment (PNA) and how this would be carried out.  She thanked Brent Clinical Commissioning Group and the Local Pharmacy Committee for their input into the work.

RESOLVED:

(i)           that the establishment of a task and finish PNA Steering Group be agreed;

(ii)          that the terms of reference for the PNA Steering Group which form appendix 1 to this report be agreed; and

(iii)         that the PNA Steering Group be delegated the task of overseeing the conduct, consultation and publication of the revised Brent PNA.

The report and presentation are attached.  Mark Eaton (Head of Delivery and Performance for Brent, Harrow and Hillingdon Clinical Commissioning Groups) will present the report.

Mark Eaton (Head of Delivery and Performance, Brent Clinical Commissioning Group) presented the report that set out Brent CCG’s proposals to address Domain 5 of the CCG’s 2014/15 Quality Premium.  The main aim of Domain 5 was for CCGs to work more closely with key providers to increase the number of medically related incidents reported in order to capture the estimated 80% of medication incidents that go unreported.  Mark Eaton confirmed that NHS England had accepted proposals for Brent CCG to work with Harrow CCG and Hillingdon CCG in delivering Domain 5.  Agreement on the targets and the approach for Domain 5 had been agreed between NHS England and Brent, Harrow and Hillingdon CCGs and the providers.  However, Mark Eaton advised that even if only one CCG failed to deliver its targets, then none of the three CCGs will be accredited with achieving Domain 5.  The Board noted that three of the four providers were being asked to increase the rate of reported medication related incidents, whilst the other, Imperial Hospital, was being asked to maintain its figures. 

During members’ discussion, Ann O’Neill enquired why this item needed to be reported to the HWBB and how much the Domain 5 was worth to the CCGs.  The Chair noted that the targets were set for December 2014, and in view that this was only a short while away, he sought further comments about the likelihood of these being delivered.

In reply, Mark Eaton advised that achieving Domain 5 was worth around £700,000 across all three CCGs and he felt that the targets were achievable by December.  Jo Ohlson confirmed that Brent CCG’s 2014/15 Quality Premium was statutorily required to be reported to the HWBB.

There is a requirement to have clarity about the roles and responsibilities of the strategic boards in Brent. Brent Local Safeguarding Children Board has drafted a range of protocols to address these requirements which are being presented to the respective Boards.

Gail Tolley presented the report which sought members’ approval for the protocol agreement between the Brent Local Safeguarding Children Board and the HWBB.  She advised that Local Safeguarding Children’s Boards were now to be reviewed, conducted under 15 (A) of the Children Act and there was an expectation clear governance protocols were in place.

In reply to a query from Jo Ohlson, Phil Porter confirmed that similar arrangements were being made with regard to the Brent Safeguarding Adults Board.

RESOLVED:

that the protocol agreement between the Brent Local Safeguarding Children Board and the Health and Wellbeing Board be agreed.

The report is attached.  Kate Lawrence (Strategy and Transformation, NHS North West London Collaboration of Clinical Commissioning Groups) will present the report.

Kate Lawrence (North West London Strategy and Transformation Team, NHS) presented the report and advised that the eight CCGs participating in the North West London Five Year Strategic plan were Brent, Central London, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow and West London CCGs.  The eight CCGs had combined to produce a joint strategic plan as it was consistent with other strategic planning that they had been involved in, such as the Shaping a Healthier Future programme.  Kate Lawrence drew members’ attention to the process for developing the plan and what the plan meant to Brent as set out in the report.  She explained that the strategy was outcomes focused and referred to the desired outcomes listed in the report and the ways in the HWBB would be involved. 

During members’ discussion, Gail Tolley enquired if there was any children and young people representation on the North West London Strategic Planning Group.  The Chair added that the proposals seemed quite adults focused and in noting the reference to giving every child the best start in life in the report, he felt there should also be more priorities involving children and young people. 

With the invitation of the Chair, Elcena Jeffers addressed the Board and she requested that there be a sign in sheet at future HWBB meetings so there was a record of all who had attended, which the Chair agreed to.

In reply to the issues raised, Sarah Mansuralli acknowledged that there was a need to focus more on children and young people and efforts would be made to undertake this.

The next meeting of the Health and Wellbeing Board is scheduled to take place on Thursday, 30 October at 7.00 pm.

It was noted that the next meeting of the HWBB was scheduled to take place on Thursday, 30 October 2014 at 7.00 pm.  Phil Porter advised that the next meeting would consider issues relating to dementia in Brent.

Jo Ohlson confirmed that she would be leaving Brent CCG to take up a position at NHS England.  Sarah Mansuralli would take over her role as Chief Operating Officer of Brent CCG.

Phil Porter advised that a bid had been made with the endorsement of the HWBB to receive funds from the Integrated Technology Fund.  If the bid was successful, Phil Porter stated that the funding would be of particular use in saving on unnecessary bureaucratic processes and he would inform members of the outcome of the bid.