Agenda and minutes

The Vice-Chairman welcomed all to the meeting, in particular she welcomed new members Stuart Bell, Dr Bruno Holthof, Louise Patten, Yvonne Rees and Dr Ben Riley.

Apologies for absence and substitutions were as follows:

Cllr Ian Corkin for Cllr Steve Harrod

Maria Godfrey for Lucy Butler

Cllr Judith Heathcoat for Cllr Ian Hudspeth

Diane Hedges for Louise Patten

Bev Hindle for Yvonne Rees

David Radbourne sent his apologies.

Dr Ben Riley declared an interest on account of his paid employment as:

(a)  a GP partner at 19 Beaumont Street Surgery, Oxford, and, as such holds a contract to provide NHS General Medical Services; and the Surgery was a provider of some public health services commissioned by Oxfordshire County Council;

(b)  Director and Chief Clinical Officer of OxFed Health & Care Ltd which provides a range of NHS and non-NHS healthcare services in Oxford city’s population and works in partnership with other healthcare providers in the county; and

(c)  Medical Director of Curriculum and GP Education at the Royal College of GPs, London.

A request to address the Committee from Cllr Cathy Augustine, Didcot Town Council, at Agenda Item 7 had been agreed.

To approve the Notes of Decisions of the meetings held on 22 March 2018 and 10 May 2018 (HWB5) and to receive information arising from them.

The Notes of Decisions of the meetings held on 22 March 2018 and 10 May 2018 (HWB5) were approved and signed.

2:05

5 minutes

Dr Collison will report verbally on progress in relation to the development of the Health & Wellbeing Board since the changes were agreed at the special meeting on 10 May 2018.

Dr Collison reported verbally on progress in relation to the development of the Oxfordshire Health & Wellbeing Board since the changes were agreed at the special meeting of the Board on 10 May 2018. She stated that the Board comprised of a broader membership which reflected the more strategic, more visible, high-level Health & Wellbeing Board Strategy which extended across the whole system.

A member of the Board commented on the encouraging and positive progress that had been made in relation to the different bodies working together, to which Dr Collison agreed.

2:10

60 mins

(a)  The draft Joint Health & Wellbeing (HWB) Strategy will be presented by Dr McWilliam for discussion and approval prior to wider engagement (HWB7) (10 minutes).

The Board is RECOMMENDED to approve the Strategy.

(b)  Engagement Plan for the Joint HWB Strategy – This paper sets out an outline engagement plan for the updated Health & Wellbeing Strategy. (HWB7(b)) (5 minutes). Catherine Mountford (CCG) to present.

The Board is RECOMMENDED to approve the Plan.

(c)  Priorities for the Oxfordshire Health & Wellbeing Strategy

(1)  Improving the resident’s journey through the health and social care system as set out in the CQC action plan.  A presentation on the CQC Action Plan Highlight Report and Evaluation Framework will be given by the system leaders on behalf of the Integrated System Delivery Board (HWB7(c)1). The Director for Adult Social Services will also give verbal feedback from the CQC’s follow-up review which takes place on 11 November (10 minutes)

(2)  Planning for future population Health and Care needs – Proposed Framework Approach. Members of the Board are invited to consider the approach to meeting current and future population needs as set out in the report. Lou Patten, Chief Executive, OCCG, will present the report (HWB7(c)2) (15 minutes).

The Board is RECOMMENDED to approve the framework approach to meeting current and future population needs, as set out in the report.

(3)  Agreeing plans to tackle critical workforce shortages. The Director of Adult Social care will report verbally (10 minutes).

(4)  Current and Future Opportunities for Prevention. Dr Collison and Dr McWilliam will present an outline of the cross cutting theme of prevention, including population health management, healthy place-shaping and aligning prevention initiatives across the system (HWB7c(4)) (10 minutes).

The Board is asked to discuss and note these initiatives.

Prior to consideration of this item, the Board was addressed by Cllr Augustine. She expressed her concern at the perceived ‘lack of transparency’ in respect of the workshops held in private to establish the Board’s ways of working together in the future. She also pointed out her concern that the venue for this meeting was the Clinical Commissioning Group’s offices and not County Hall as was usual; which, in her view, reflected the fact that the CCG were increasingly in control. It was also Cllr Augustine’s view that the CCG’s policy of engagement with the public was unacceptable and ‘opaque’, thus making valued scrutiny impossible. 

Draft Health & Wellbeing (HWB) Strategy (HWB7(a))

Dr McWilliam presented the draft Health & Wellbeing Strategy (HWB7(a)) for discussion and seeking approval for engagement with the public. He stated that this was an example of true collaboration of organisations working together for the people of Oxfordshire. He added that the Strategy covered a wide number of topics which concerned all the wider determinants of Health, that in turn influenced housing, green spaces, highways etc, thus giving a clear direction for all.

In presenting the Strategy he highlighted four priorities at Board level:

-       Prevention;

-       Emphasis on place-shaping;

-       The vital importance of the residents’ journey; and

-       The workforce.

Comments from Board members relating to the challenges and goals for the Board in the future included:

·         The Board should continue to promote DToC;

·         The Board should promote specifics in relation to its goals in order to ensure accountability, a strategic vision and measures of success. For example, engagement with staff who were as important as engagement with the public and the establishment of a five - year plan and action logs in order to enable the setting and monitoring of achievable targets and goals;

·         The emphasis on prevention was welcomed, but more work needed by the sub-groups to come up with targets on how to promote personal responsibility in people for their own health;

·         To welcome the focus in the Strategy on the workforce challenges, despite the available resources, on health inequalities and on mental health.

Diane Hedges asked to what extent should the Board set out what it wanted to do in detail, pointing out that this could be treading a difficult line. The Board was doing well in its endeavours to set the middle ground and it was already very sighted on achieving the children and adolescent targets. There was still an opportunity to shape the Strategy for further engagement.

The Board AGREED to approve the draft Health & Wellbeing Strategy for wider engagement with the public.

Engagement Plan for the Joint Health & Wellbeing Strategy (HWB7(b))

Catherine Mountford (OCCG) introduced the outline engagement plan from the updated Health & Wellbeing Board (HWB7(b)).

Cllr Stratford asked how could it be ensured that sufficient people engage with the Plan in order to be confident that the people spoken to was a fair representation. Catherine Mountford responded that all the organisations represented on the Board would utilise all the  ...  view the full minutes text for item 7.

3:10

15 minutes

Attached is a report on progress against outcomes agreed for 2017/18 (HWB8).

The Board is RECOMMENDED to hold members to account for performance against key indicators.

The report on progress against outcomes agreed for 2017-18 in the Joint Health & Wellbeing Board Strategy was before the Board at HWB8 for consideration and for the Board members to be held to account.

Board Members were reminded that this performance report represented the performance of the previous Board and would be superseded by an updated version. The appropriate framework process would be a topic for discussion at the next Board workshop, to be followed through at the next meeting.

Questions from the Board and responses received were as follows:

-       With regard to a question relating to 3.2 ‘Number of Children missing from home’, Maria Godfrey reported that officers were working with the Police to address the increase last year. However, this area was the subject of ever-growing complexity due to drug/sexual exploitation. There was a very clear policy of intervention when children go missing and a large amount of work takes place. She also pointed out that there was large amount of preventative work which was beginning to come to fruition in this area, though still much work to do;

-       In relation to 1:1 – ‘Waiting times for first appointment with the Child & Adolescent Health Services (CAMHS)’, a Board member asked how it would be possible to unblock unmet demand. Maria Godfrey responded that a significant amount of work had taken place to try to prevent escalation into the CAMHS service. Single access had been very much welcomed by services needing advice, support and referral into the service. Professor Smith added that there was a very important interface between CAMHS and young carers , and his wish to see a specific focus on supporting young carers in this respect. Dr Collison responded that there was a need for the Board to decide what approach it wished to take with regard to evaluation and what the key issues were. Maria Godfrey added that a performance dashboard would also be looked at by the Children’s Trust who could then pick out the key issues.

The Board AGREED to receive the report.

3:25

10 minutes

The draft Terms of Reference for the refreshed Oxfordshire Health & Wellbeing Board are attached for approval (HWB9). It is intended that those of the sub groups and Partnership Board will be presented to the next meeting in March 2019.

The Board is RECOMMENDED to approve the refreshed Terms of Reference.

The draft Terms of Reference for the refreshed Health & Wellbeing Board, and all of its sub-groups and Partnership Board were before the Board for approval.

Professor Smith suggested that consideration could be given, once the Board and its groups had embedded in more, a rolling 5 year Forward Plan for the Board and its sub-groups be drawn up and kept under regular review; and a more immediate action log, similar to that which is submitted to each meeting of the Oxfordshire Joint Health Overview & Scrutiny Committee, be set up to identify what actions have been taken and what is still to be done

The Board AGREED to approve the refreshed Terms of Reference for the Board and its sub-groups.

3:35

10 minutes

The Older People Joint Strategic Needs Assessment and draft Older People Strategy for 2019 - 24 will be presented by the Director for Adult Care and the Chief Executive and Chair of the OCCG for discussion and approval prior to wider engagement (HWB10).

The Board is RECOMMENDED to approve the new Oxfordshire Older People’s Strategy 2019 – 24 and the supporting documents.

The Older People JSNA and Older People Strategy for 2019 – 24 was presented to the Board by Kate Terroni, Director for Adult Social Services, and Dr Kiren Collison, Chair, Oxfordshire Clinical Commissioning Group for discussion prior to wider engagement.

Kate Terroni reported that conversations had taken place with older people and carers on what was required to support them in the community, prior to consultation. Dr Collison stated that this had been in a very refreshing process and that, whilst Oxfordshire was a thriving community, it also harboured issues such as loneliness, isolation, access to care and independence. She added that there were also many other pathways relevant to the Strategy and the Older People Strategy was underpinned by those. She reminded the Board that there were plans to go out to further engagement.

Professor Smith stated his view that more of a focus could be given by housing authorities to the adaptations of housing stock to aid older people. In response to this, Councillor Corkin reported that Cherwell District Council and Oxfordshire County Council had recently appointed a joint officer to work with the commissioning teams. Cllr Stratford agreed that there was insufficient longer life housing which was affordable for older people within developments, because developers deemed them as not economical. He agreed that there was a need for more shared housing, such as McCarthy Stone developments, which was both affordable and served two persons. He added that this could lead to larger family homes being freed up for larger households. Cllr Judith Heathcoat added her view that conversely, we all age differently and some older people wished to remain in their own homes, living independently where their memories were. She added that it would be interesting to see if there was a commonality with work across the piste.

The Board AGREED to:

(a)  approve the new Oxfordshire Older People’s Strategy for 2019 – 24 and its supporting documents to go forward for online consultation;

(b)  request a report for submission to the March 2019 meeting on what all the agencies were doing in respect of extra care housing, supported living, domiciliary care, to include also information on the housing agendas and efficiency;

(c)  thank all the organisations involved in preparing the Strategy.

4:00

10 minutes

Attached at HWB11 are the reports from the:

-       Children’s Trust

-       Joint Management Groups for Adults – to follow

-       Health Improvement Partnership Board

-       Integrated System Delivery Board

The Board is RECOMMENDED to receive the reports and assess progress in delivering the Joint Health & Wellbeing Strategy priorities.

The Board considered each of the reports from the Sub-Groups and Partnership Board, in order to assess progress in the delivery of the Joint Health & Wellbeing Strategy’s priorities (HWB11):

Children’s Trust Board

Tan Lea delivered the update from the Children’s Trust Board, in Cllr Steve Harrod’s absence. She highlighted the following:

-       The Children & Young People’s Plan had now been launched;

-       The multi-agency Safeguarding Hub had highlighted two strategic issues for further work. These were in relation to social media and the delivery of a Lesbian/Gay/Transgender Strategy in the future. The Programme Board would ensure that all was in place and progressing.

Joint Management Groups for Adults

Councillor Lawrie Stratford, Chairman, commended the reports to the Board.

Health Improvement Partnership Board

Councillor Andrew McHugh, Chairman, stated that this was a Board which worked together with partners to enable good health for all; for instance, to tackle smoking, encouraging people to drink less, to keep themselves healthy etc. Its principle duty was to introduce reasonable targets into the 5 - year programme to achieve improvements for the population of Oxfordshire.

Integrated Delivery Board

Dr Holthof pointed out that this Board was the driver to support the integration of Health and Social Care, focusing on tangible objectives and deliverables. To date it had achieved a significant amount, such as this year’s whole system delivery of the Winter Plan. The Board had developed a new tool which delivered all the required data on demand, together with capability around the system which included that of the Ambulance Trust, the provider Trusts (available beds), GP availability etc. He pointed out that the recent success of the DTOC statistics in relation to ‘super-stranded’ patients had all been due to the open and direct approach given from this Board. It aimed to achieve good results to show to the benefit of all patients.

Cllr Stratford concurred pointing out that the integrated team’s delivery of improved DTOC statistics was a good example of whole team working.

The Board AGREED to receive the reports.

4:10

20 minutes

The Chairs of the Oxfordshire Children Safeguarding Board and the Oxfordshire Adult Safeguarding Board will attend to present a synopsis of the work undertaken by the Boards and their members to improve safeguarding in Oxfordshire during 2017-18, as well as outlining their priorities for 2018-19 (HWB12).

The Board is RECOMMENDED to receive the reports and provide any comment.

Pam Marsden, Chair, Adult Safeguarding Board and Melanie Pearce (Service Manager, Safeguarding) and Superintendent Joe Kidman (Deputy Chair, Children Safeguarding Board) and Tan Lea (Strategic Safeguarding Partnerships Manager) attended to present the above annual reports for 2017/18.

Pam Marsden highlighted the following:

-       The report itself had been re-designed with the aim of increasing the engagement from the public. Much of the information contained within it had been written by partner agencies and utilised to explain the Board’s activities;

-       Service users had been asked what they had needed and what they had received, thus personalising the detail of the work undertaken;

-       Joint priorities had been worked through with the Children’s Safeguarding Board and training given, with, for example, Housing providers. This had led to safeguarding leads being identified amongst each of the housing providers;

-       A challenge for the Board, which was also welcomed, was the increased demand made on Health and Social Care as a result of the Mental Capacity Act.

The Board thanked Pam Marsden for her excellent report and particularly for the move towards further accessibility to the public.

Joe Kidman, presented the report of the Children’s Safeguarding Board on behalf of its Chair, Richard Simpson. He gave credit to Tan Lea and the Business Unit for a very good piece of work which had also delivered a sense of challenge. Some of the challenges highlighted were as follows:

-       The Board had sought to partner with Barnados for the purposes of independent scrutiny, which had proved both innovative and testing as a result;

-       The increase of home education for children and the lack of legislative structure which accompanied it. A Team on learner engagement had been established for children not in education;

-       There had been an increasing demand on the statutory system with more focus on the Child Protection Plans and on neglect. The heavy demand on CAMHS was a matter for concern;

-       More work was required to respond to domestic abuse, to ensure a more joined up and child focused response.

He informed the Board that there had been a move into a new statutory structure to include the local authority, Health and Police partners, where a Board would not be necessary. However, there had been a wish amongst partners to retain the Board structure, with the community structure sitting above it.

In response to a question asking how effective male role models were in the children in care system, Tan Lea responded that there was a significant

amount of attention paid to achieving a good balance of role models. Training was also delivered on this subject.

The Board AGREED to receive the reports and to thank Pam Marsden and Superintendent Joe Kidman for their presentations.

4:30

10 minutes

The Board will receive an update on activities given by the Chairman and Chief Executive Officer of Healthwatch Oxfordshire (HWB13).

The Board is RECOMMENDED to note the report.

Professor Smith gave an update (HWB13) on the activities of Healthwatch Oxfordshire highlighting its interventions which contributed to the commissioning by NHS England of a further dental practice in Bicester and improvements to the MSK Physiotherapy Service. He also directed the Board’s attention to HWO’S aspirations to establish a ‘Young Healthwatchers’ service in a similar vein to that of Buckinghamshire’s.

The Board AGREED to note the report.

4:40

5 minutes

The Director for Adult Social Services and the Chief Executive of Oxfordshire Clinical Commissioning Group will present the report (HWB14).

The Board is RECOMMENDED to:

(a)   review and endorse the Improved Better Care Fund plan; and

(b)   critically appraise and endorse the performance measures that are proposed to be used to ensure confidence in the effectiveness of the spend.

The Director for Adult Social Care presented the Improved Better Care Fund Allocation Plan which also included the performance measures that were proposed to be used to ensure confidence in the effectiveness of the spend(HWB14).

The Board AGREED to:

(a)  endorse the Improved Better Care Allocation Plan; and

(b)  endorse the performance measures to be used, as contained in the report.

4:45

10 minutes

The Director of Public Health’s annual independent report for 2017-18 is before the Board for discussion and agreement (HWB15).

The comments of the Oxfordshire Joint Health Overview & Scrutiny Committee (HOSC), Cabinet at its meeting on 16 October and Council on 6 November is attached at HWB15.

The Board is RECOMMENDED to receive the report, note the recommendations of HOSC, Cabinet and Council and to advise the appropriate bodies of their responsibilities in considering its recommendations.

The Board had before them the Director of Public Health’s Annual Report for 2017-18, for consideration (HWB15).

Dr McWilliam directed the Board’s attention to the comments of the Oxfordshire Joint Health & Overview Committee (HOSC) at its meeting on 20 September 2018, Cabinet on 16 October 2018 and County Council on 6 November 2018, in particular to that of HOSC’s recommendations in relation to alcohol pricing and fast food advertising. In this regard, a draft letter from the Secretary of State for Health from the Chairmen of HOSC and this Board was before the Board for approval. which were attached also at HWB15.

At this point Cllr Andrew McHugh declared a personal interest on account of his membership of the South - East Combat Stress: Mental Health Support for Veterans and as a trustee of Help the Heroes Campaign.

The Board AGREED to:

(a)  receive the Director of Public Health’s report; and

(b)  approve the above-mentioned letter to the Secretary of State for Health for despatch.

4:55

5 minutes

The attached report outlines progress and future plans for the work of the Health Inequalities Commission (HWB16). Dr Collison and Jackie Wilderspin (Public Health Consultant) will address the report.

The Board is RECOMMENDED to:

(a)  endorse the decisions of the Implementation Group to work in a more strategic way to make further progress with this work;

(b)  agree that sharing of good practice on addressing health inequalities should be facilitated across the system; and

(c)  ensure that the 5 principles for addressing health inequalities set out by the Health Inequalities Commission are embedded in the Joint Health & Wellbeing Board Strategy and all other associated strategies and plans.

Two years on since the Commission first initiated the report, Dr Collison (CCG) and Jackie Wilderspin (Public Health Consultant) presented an update report on how each area highlighted had progressed and also outlined future plans for the work of the Commission.

Dr McWilliam stated his view, to which Dr Collison agreed, that now was the appropriate time to take a look at where the health inequalities work had manifested itself, and then to formulate some decisions as to whether the health inequality principles had ‘baked in’ sufficiently or whether more work was required. In essence, there was a need for a more searching and strategic look at the way this work had progressed, and then to take it forward for use within the new Board’s inter-generational approach to its Strategy.

Professor Smith added his full support, stating his view that a more structured plan was required, perhaps over 5 years, in order to achieve a clearer long-term vision for the Board to drive forward.

The Board AGREED:

(a)  to endorse the decisions of the Implementation Group to work in a more strategic way to make further progress with this work;

(b)  that the sharing of good practice on addressing health inequalities should be facilitated across the system;

(c)  to ensure that the 5 principles for addressing health inequalities as set out by the Health Inequalities Commission were embedded in the Joint Health & Wellbeing Board Strategy and all other associated strategies and plans; and

(d)  (unanimously) convene a workshop for the Board to engage in a more in-depth discussion of where this could be taken.

5:00

10 minutes

The Prevention Concordat for Better Mental Health and the associated guidance was published by Public Health England in 2017. The concordat aims to galvanise local cross-sector action to support the prevention of mental health problems and the promotion of good mental healthacross the whole system. It will guide effective prevention and planning arrangements which could be achieved locally through the development of an Oxfordshire Mental Wellbeing Framework.

The consensus statements of the Prevention Concordat for Better Mental Healthdescribe the shared commitment of partner organisations to work together via the concordat to prevent mental health problems and promote good mental health.

The Mental Wellbeing Prevention Concordat is before the Board to discuss and agree to endorse the statements set (HWB17).

Cllr Lawrie Stratford will present the report.

The Board is RECOMMENDED to:

(a)   endorse the consensus statements of the Prevention Concordat for Better Mental Health; and

(b)  support a call for action to all partners to develop an Oxfordshire Mental Wellbeing Framework for local cross-sector action

The Prevention Concordat for Better Mental Health and the associated guidance was published by Public Health England in 2017. The Concordat aimed to galvanise local cross-sector action to support the prevention of mental health problems and the promotion of good mental health across the whole system. It will guide effective prevention and planning arrangements which could be achieved locally through the development of an Oxfordshire Mental Wellbeing Framework.

The consensus statements of the Prevention Concordat for Better Mental Health describe the shared commitment of partner organisations to work together via the concordat to prevent mental health problems and promote good mental health.

The Mental Wellbeing Prevention Concordat was before the Board for discussion and approval (HWB17).

Cllr Lawrie Stratford presented the report. He expressed his hope that each organisation would sign up to the Concordat and each would then focus their attention to what could be achieved in their local environment.

The Board AGREED to:

(a)  endorse the consensus statements of the Prevention Concordat for Better Mental Health; and

(b)  support a call for action to all partners to develop an Oxfordshire Mental Wellbeing Framework for local cross-sector action.