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Agenda and minutes

Venue: Rooms 1&2 - County Hall, New Road, Oxford OX1 1ND. View directions

Contact: Julie Dean, Tel: 07393 001089  Email: julie.dean@oxfordshire.gov.uk

Items
No. Item

1.

Welcome by Chairman, Councillor Ian Hudspeth

Minutes:

The Chairman welcomed all to the meeting. He took this opportunity to thank David Smith and Dr Joe McManners, this being their last meeting, for all their hard and very valuable work in support of the Board in their roles as Chief Executive and Chair of Oxfordshire Clinical Commissioning Group, respectively.

2.

Apologies for Absence and Temporary Appointments

Minutes:

An apology had been received from Cllr Steve Harrod, Dr Barbara Batty (OCCG) attended in place of Dr Paul Park and Dr Tony Berendt (Oxford University Hospitals NHS Foundation Trust (OUH) and Stuart Bell CBE (Oxford Health Foundation Trust and Oxfordshire Transformation Board) were in attendance.

3.

Declarations of Interest - see guidance note opposite

Minutes:

There were no declarations of interest.

4.

Petitions and Public Address

Minutes:

No requests to present a petition or address the meeting had been received.

5.

Note of Decisions of Last Meeting pdf icon PDF 274 KB

To approve the Note of Decisions of the meeting held on 13 July 2017         (HBW5) and to receive information arising from them.

Minutes:

The note of the last meeting, which took place on 13 July 2017, was approved and signed as a correct record.

 

Matters Arising

 

In relation to 6/17 – Update on Delated Transfers of Care and Better Care Fund Planning – in response to a question, Kate Terroni confirmed that, as far as possible, the rise in the hourly care worker rate had been passed on to those frontline workers where Adult Social Care had commissioned the service, given the fact that under contractual rules this could not be insisted on. However, there were a variety of means to ensure that the money had been paid to frontline workers through audit and informal channels. However it was not possible to enforce it and there was no means of control over the ‘self - funder’ market.

6.

Performance Reports pdf icon PDF 191 KB

Additional documents:

Minutes:

The Board received an update on performance against the outcomes agreed for 2017-2018, quarter 2, in the Joint Health & Wellbeing Strategy, in the following categories:

 

(a)  progress against the Outcome Measures agreed for 2017-18;

(b)  accident and Emergency Delivery Board Targets; and

(c)  Adult Social Care Outcomes Framework Published Results for 2016-17.

 

(a)  Progress against the Outcome Measures agreed for 2017 – 18

 

Target indicator 1(1:1) – Priority 1 – ‘Ensuring children have a healthy start in life and stay healthy into adulthood’ – ‘Waiting Times for first appointment with Child & Adolescent Health Services (CAMHS)’

 

In response to a challenge about  performance in this area, Stuart Bell, Oxford Health Foundation Trust (OH), reported that a new model of working with a consortium had just commenced based on work with Buckinghamshire. Barnado’s had also given significant assistance with the planning of this. He added that demand for this service had risen significantly for a variety of reasons and users should see a difference over the next few months in terms of access.

 

Target indicator 2(2:3) – Priority 2 – ‘Ensure that the attainment of pupils with SEN & Disability (SEND) but no Statement of Education Health & Care Plan is in line with the national average’

 

In relation to the challenge posed by a Board member relating to the extent that school exclusion and home school schooling could be a factor in non-attainment, Lucy Butler commented that this area was a major focus and the Children’s Services Directorate had key plans and initiatives for this area which she outlined.

 

Target indicator 3(3:5) – Priority 3: ‘Keeping children and young people safe’ – ‘Reduce the number of hospital admissions caused by unintentional and deliberate injuries in young people aged 0-14 to the national level’  -

 

In response to a challenge that the Board understand the reasons behind the sharp rise in children self-harming, non-accidental or deliberate injuries, the Board requested that a more detailed analysis be submitted to a future meeting.

 

Target indicator 3(3:6) – Priority 3: ‘Keeping children & young people safe – maintain the current number of looked after children’

 

In response to a challenge by the Board about the rise in the number of Looked After Children (LAC) which was above the national average, Lucy Butler stated that the past four years had seen a rise in child protection statistics. However this year was the first in which the trend was moving downwards. She voiced her uncertainty as to when this trend would affect the LAC statistics, but more work was taking place in this trajectory to ensure all that was possible was being carried out to keep them out of care.

 

Target Indicator 5(5:3) – Priority 5 – ‘Working together to improve quality and value for money in the Health and Social Care system’- ‘Reduce the average length of ‘days delay’ for people discharged from hospital to care homes’

 

A Board member challenged whether the recent reduction shown was sustainable. Kate Terroni responded that it was a challenge, but the collaborative  ...  view the full minutes text for item 6.

7.

Care Quality Commission (CQC) Inspection

2:25

20 minutes

 

Persons responsible:          Chief Executive, OCCG; Chief Executive, Oxford Health Foundation Trust (OH); Chief Executive, Oxford University Hospitals NHS Foundation Trust (OUH) Chief Executive OCC and Care Governance Lead, Strategy Team, OCC

People giving the report:    As above

 

There will be a presentation from the Chief Executives of OCCG, OH, OUH and OCC on the CQC Inspection which will take place in November 2017.   The Board is asked to critically appraise the presentation in terms of content and emphasis and to recommend changes.

Minutes:

Kate Terroni gave a presentation on the context, issues and plans for the forthcoming CQC inspection on behalf of the Chief Executives of OCCG, OH, OUH and OCC. She requested feedback from the Board on what it felt was missing, how the information given reflected Oxfordshire and the role of the Board in relation to the implementation of improved plans.

 

Feedback from Members of the Board included:

 

-        To highlight two studies to illustrate how it looked from the patients point of view. This could be used to describe innovative services but also where there was a need to do better;

-        More information could be given in relation to the workforce situation in Oxfordshire;

-        More emphasis on what was prevention-led provision;

-        Slides could be distilled taking a SWOT analysis as there was a need to unpick the gap between assessment and delivery of a service and any problems encountered;

-        The importance of ensuring that staff were told they must be frank in giving evidence;

-        The importance of showing that there was a  consistent vision and to explain that Oxfordshire had a plethora of plans; and

-        To ensure that any new technical facilities introduced were highlighted as a means of cutting down numbers going to Accident & Emergency.

8.

Early Lessons from the CQC reviews of Health and Social Care Systems pdf icon PDF 171 KB

2.45

10 minutes

 

Persons Responsible: Kate Terroni - Director of Adult Services

Jonathan McWilliam -  Director of Public Health/ Strategic Director for People

 

Persons giving the report: as above

 

The Health and Wellbeing Board are asked to consider these two completed reviews and what lessons might be learned for the Oxfordshire system in general and the review of Health Wellbeing Board Governance in particular.

(3    papers attached)

 

Additional documents:

Minutes:

The Board considered a report (HWB8) which set out the outcomes of the two completed CQC reviews of Health & Social Care systems and what lessons might be learned from the Oxfordshire system in general and the review of Health & Wellbeing Governance in particular. These were considered to be both useful and helpful. The comments on the functioning of Health and Wellbeing Boards were apposite and would help the debate on the review of Health & Wellbeing governance further down the Agenda.

 

The Board emphasised that the Health & Wellbeing Board should be seen as a composite of the main board plus its sub-groups to get the whole picture of its activities.

 

9.

Improved Better Care Fund and Delayed Transfers of Care pdf icon PDF 454 KB

2.55

10 minutes

 

Persons responsible:          Chief Executive, OCCG and Director for Adult Services, OCC

Persons giving report:         As above

 

The attached report (HWB9) aims to update the Board on developments of the improved Better Care Fund implementation and related Delayed Transfers of Care (DTOC) measurements. 

 

The Board is RECOMMENDED to review and endorse the iBCF plan.

 

The Board is RECOMMENDED to note and confirm the planned DTOC trajectory set out at paragraph 8 endorsed on behalf of the Board by the Leader of the Council with the agreement of OCCG and system partners on 26th September 2017.

 

The Board is RECOMMENDED to endorse the planned investment of the iBCF and to note  the risk to the future funding from the Government if the schemes that have been identified do not deliver a reduction in delayed discharges in line with the agreed trajectory

 

The Board is RECOMMENDED to critically appraise and endorse the performance measures that are proposed to be used to assure the delivery of the agreed trajectory

 

The Board is RECOMMENDED to agree a reporting regime to ensure effective delivery.

 

(2 papers attached)

Additional documents:

Minutes:

Dr Barbara Batty, OCCG and Benedict Leigh, OCC gave an update (HWB9) on the development of the improved Better Care Fund (BCF) implementation and delayed Delayed Transfers of Care (DTOC) measurements. The Board was asked to review and endorse the Improved Better Care Fund Plan.

Dr Batty reported that all agencies had worked together and plans had now been finalised for delivery.

Professor Smith challenged that, in HWO’s view, the best conceivable value for money was to provide more help and support for carers in a climate where the availability of respite had declined, together with interaction with carers.

Dr McManners gave the view that, in his view, the HART service was too focused on hospital discharge, in a situation where a patient required a high level of hospital intervention. Dr Batty agreed adding that GPs spent a lot of time trying to avoid patient admission to hospital and therefore failing to access the HART service for them. However it was understood that people could self – refer. In reality, GPs would refer if there was no support at home.

In response to a query about how the HART service will work with the rising complexity of cases to deal with, given that patients would be sicker and suffering from more complicated illnesses. Kate Terroni responded that it was about ensuring that there was sufficient scrutiny in place in this area to ensure people have the correct level of care. Dr Batty added that one of the risks will be that people will be receiving earlier and bigger care packages and more care at home.

In response to a challenge that there should be more notional savings given that an expensive acute bed would be freed up and that money should be identified for staffing and retained within the system, David Smith responded that this would be part of the work around the workforce strategy within the acute Trust. The Trust Board would be re-gearing the system to look at where the best value was and the best benefit for patients.

The Board AGREED to:

(a)  endorse the Improved Better Care Fund Plan;

(b)  note and confirm the planned DTOC trajectory as set out in paragraph 8 , endorsed by the Leader of the Council with the agreement of OCCG and system partners on 26 September 2017;

(c)  endorse the planned investment of the iBCF and to note the risk to the future funding from the Government if the schemes that have been identified do not deliver a reduction in delayed discharges in line with the agreed trajectory;

(d)  critically appraise and endorse the performance measures that are proposed to be used to assure the delivery of the agreed trajectory;

(e)  to request that this item be brought to each future meeting, together with information on the situation with regard to the questions posed regarding the HART service, as set out above; and the trajectory numbers; and

(f)    request the Director of Adult Social Care to ensure where possible that  ...  view the full minutes text for item 9.

10.

The Oxfordshire Transformation Board

3.05

10 minutes

 

Person Responsible:  Chief Executive, Oxford Health NHS Foundation Trust

Person giving report:  as above

 

Stuart Bell, the Chief Executive of Oxford Health NHS Foundation Trust, will give a progress report from Oxfordshire’s Transformation Board.

 

Minutes:

Stuart Bell, Chief Executive, Oxford Health NHS Foundation Trust, gave an update on the work of Oxfordshire’s Transformation Board (TB). The Board had been in existence for 3 years. It has no statutory responsibility. To date it has looked at changes in demography and the effect on Health and Social Care services across Oxfordshire, and what changes are necessary to address the sets of demands, resource availability and the shape of future services. Numbers had increased on the Board over time from organisations such as the South Central Ambulance Trust and it had grown in its range and depth of coverage. There had been very good representation from OCC at member/officer level, the Local Medical Council, and clinical and GP representatives.

 

For the last 18 months there had been a focus on the following areas of work:

 

-        Work on the case for change and the message for change for services such as Mental Health services;

-        The need to manage better care out of hospitals. This was all aligned with work with Older People’s services;

-        More recently there had been much focus on the first phase of the Oxfordshire Transformation Plan in areas such as workforce pressures etc. This has not yet been resolved due to referral to the Secretary of State by HOSC;

-        Use of the TB to bring together all organisations regarding the CQC inspection;

-        The TB was looking at updates from ambulatory services;

-        The TB was currently doing a stock-take on how it was working and there would be discussions taking place with others with regard to this;

-        The Board was looking at STP issues in the Oxfordshire context and is a sub-group of the BOB STP was serving as a forum for this. Stuart Bell was also a member of the STP Executive Group. It was envisaged that the role of the TB may become more important in light of David Smith’s imminent retirement as leader of the STP Executive Group;

-        An important task for the TB would be to contribute to the development of an ACS within the County.

 

Stuart Bell was thanked for his update and for the useful information it gave the Health & Wellbeing Board in considering the next agenda items on accountable care systems and its own governance review.

 

 

11.

Accountable Care Systems - Update pdf icon PDF 192 KB

3.15

5 minutes

 

Persons responsible:          Chief Executive and Chair, OCCG

Persons giving report:         As above

 

The paper (HW11) sets out the current situation in respect of Accountable Care Systems.

 

The Board is recommended to consider the development of Accountable Care Systems and how the Oxfordshire Health and Wellbeing Board wishes to be involved in their development.

Minutes:

The Board considered an update report on the development of Accountable Care Systems (ACS) including how this Board should be involved in its development.

 

David Smith and Dr Joe McManners, who were leading on this issue, presented the report. They raised the following points:

·       At present there was no agreed line signed off from all organisations involved;

·       The work was about getting organisations properly aligned and working together as an organisation. It was important to be very focused on the purposes of each particular system before taking the system as a whole, and then for this Board to make the final decisions on systems to be included;

·       Key pieces of work would be required, for example, to ensure Health Inequalities work was aligned and all systems were pushing in a particular way;

·       In relation to the endeavour to work out what was best for Oxfordshire, the following questions were put to aid discussion;

 

-        What are the best outcomes for the residents of Oxfordshire?

-        What is the pool of money available?

-        What are the risks for each organisation?

 

Suggestions, views and comments during the discussion included the following:

 

·       To take a number of patient studies to discuss the patient flow and to look at the strengths/weaknesses of the flow and if it could improve;

·       There was a need to have one accountable body;

·       Experience from Buckinghamshire was that there was a need to test the values of an ACS via individual care histories. However, this was not sufficient in itself and much could be built upon what had already taken place. Factors that Buckinghamshire found that made a difference was:

-        Proper co-ordination of primary care and community services helped to progress the ACS;

-        Integration with Social Care was also required not necessarily organisationally, but via the effective co-ordination of patient resources;

-        Thought would be required on how resources were used via a shared control function and a move away from contractual resources – development of a means of allocation to elected, urgent, mental health care etc; and

-        Preparedness for the alignment of Local Government and Health and to see through the change.

 

The Board AGREED that it was willing, in principle, to move in the direction of an accountable care system as described, pending a future report.

 

 

12.

Health & Wellbeing Governance Review Proposal pdf icon PDF 147 KB

3.20

10 minutes

 

Person responsible:                        Dr Jonathan McWilliam, Strategic Director for People, OCC

 

Person giving report:                       As above

 

A report is attached at HWB12.

 

The Board is RECOMMENDED to discuss and agree to review the governance of the Health and Wellbeing Board taking into account the emerging findings of CQC reviews, current performance and outcome measures, the report on the Better Care Fund, the work of the Transformation Board and the emergence of Accountable Care Systems as set out in the preceding papers. 

Minutes:

The Board was asked to discuss and agree to review the governance of this Board, taking into account the emerging findings of the CQC reviews, current measures, the report on the Better Care Fund, the work of the Transformation Board and the emergence of Accountable Care Systems, as set out in the preceding papers.

 

Dr McWilliam suggested that it was timely for a review of governance to be done by March 2018, and that travel towards Accountable Care Systems should be an explicit part of that process.

 

Views expressed by the Board members included:

 

·       The future report should be informed by the Health Inequalities work, including more reflection on inequalities and the raising of standards;

·       Representation should be from the following groups: the older people’s population, the voluntary sector, care groups, the older age and the working age social care user groups, plus some of the key service users that are monitored via this Board;

·       Some Board members felt that a discussion needed to take place about representation on the Board. It was feared that the Board would become too unwieldy if there was a significant rise in membership. They were assured that this was the point of the governance review.

 

Peter Clark, OCC, stated that if the Board agreed that it was timely to conduct a review on governance, then some proposed terms of reference could be considered at the next meeting. If agreement was reached, than some fully formed proposals could then be brought back to the following meeting. This would also allow time for discussion of the proposals with the Chairman and Vice Chairman of the Board.

 

The Board AGREED to conduct a governance review and would consider terms of reference at its next meeting.

13.

Development of a new Older People's Strategy pdf icon PDF 162 KB

3.30

10 minutes

 

Person responsible:                        Director for Adult Services, OCC

Person giving report:           Director for Adult Services, OCC

 

To seek agreement to a proposed approach to developing a new Older People’s Strategy (HWB11).

 

The Board is RECOMMENDED to agree the proposed approach to developing the Older People’s Strategy, including the broader focus and engagement of wider range of people and partner organisations.

 

Minutes:

The Board considered a proposed approach to developing an Older People’s Strategy (HWB13) as a refreshed version of the existing strategy. This is timely in light of the focus on older people’s issues arising in the rest of the agenda.

 

The Board AGREED to  the proposed approach to developing the Older People’s Strategy, including the boarder focus as set out in the report.

14.

Healthwatch Oxfordshire (HWO) - Update pdf icon PDF 232 KB

3.40

10 minutes

 

Persons responsible:          Chief Executive Officer and Chairman of Healthwatch Oxfordshire (HWO)

Persons giving report:         Chairman of HWO

 

 

There will be an update on HWO activities given by the Chairman of HWO Professor George Smith (HWB14).

 

The Board is RECOMMENDED to note the report.

 

Minutes:

Professor Smith, Chairman of Healthwatch Oxfordshire (HWO) presented the regular update report on activities (HWB14).

 

In relation to paragraph 6.2 of the report - Schools – Drug and alcohol sessions, Professor Smith undertook to follow up whether the school health nurses could have a useful role in delivering drug and alcohol sessions in schools, with an emphasis on harm reduction, as preferred by HWO.

 

Professor Smith was thanked for his report.

 

The Board AGREED to receive the report.

15.

Annual Reports from Adult and Children Safeguarding Boards pdf icon PDF 446 KB

3.50

30 minutes

 

Persons responsible:          Independent Chairs of OSCB and OSAB

Persons giving reports:       Independent Chairs of OSCB and OSAB

 

The Oxfordshire Safeguarding Children’s Board (OSCB) and the Oxfordshire Safeguarding Adults Board (OSAB) are required to report annually on the work of the Boards and of its partners, assessing the position of the partnerships in relation to the safeguarding of children and adults at risk within Oxfordshire. Paul Burnett, Chairman of OSCB and Pamela Marsden, Chair of OSAB will present the reports (HWB15).

 

The Board is RECOMMENDED to receive the reports.

 

 

Additional documents:

Minutes:

Pamela Marsden and Paul Burnett, Chairs of the Adult Safeguarding Board the Children Safeguarding Board attended the meeting to present a synopsis of their reports and the main issues arising from them.

 

Pamela Marsden, who was accompanied by Karen Fuller, Deputy Director, Adult Social Care, was asked whether the Team anticipated a rise in vulnerable adult referrals as a result of the rise in the numbers of people suffering from dementia. She responded that Oxfordshire had not seen much if a rise to date. Karen Fuller added that 2 or 3 people had come to the Team’s attention but these were already known to the Children’s Safeguarding Team and had received the right support.

 

Paul Burnett, when presenting the synopsis, paid tribute to the partner agencies in Oxfordshire for their good support and input, which had made for the best decisions which could then be disseminated into agencies in a better way.. He pointed out that the recent Section 11 Audit had found that all organisations were fully compliant, or close to compliance (via a peer challenge). He believed that this was a robust compliment for the organisation. He also paid tribute to the training pool which had been short-listed for a training award.

 

When asked about which age ranges gave the highest levels of safeguarding cases, Paul Burnett stated that the first was babies/infants in respect of physical abuse and neglect, and the other was teenagers. This latter age range was more complex and it was particularly important to focus on neglect in the early years as it had a profound effect later in the teenage years. Paul Burnett was also asked if there was any one factor, or factors affecting teenagers in the safeguarding arena. He responded that there were links to parenting skills and economic well-being, but neglect in early years was the most important element in the story.

 

Pamela Marsden and Paul Burnett were thanked for their attendance.

 

The Board AGREED to receive the reports.

16.

Director of Public Health Annual Report 2016-2017 pdf icon PDF 3 MB

4.20

15 minutes

 

Person Responsible:                      Director of Public Health

Person giving report:                       Director of Public Health

 

The Director of Public Health will present his Annual Report for 2016/17 (HWB16). It is an independent report with robust recommendations for all organisations and individuals.

 

The annual report summarises key issues associated with the Public Health of the County. It included details of progress over the past year as well as specific and robust recommendations for future work.

 

The Oxfordshire Joint Health Overview & Scrutiny Committee and Cabinet at their meetings on 14 September 2017 and 17 October 2017 discussed the report.  The comments of the Oxfordshire Joint Health Overview & Scrutiny Committee are included and comments from Cabinet will be circulated separately.

 

The Board is RECOMMENDED to consider the report and to advise the appropriate bodies of their responsibilities in implementing the recommendations.

Additional documents:

Minutes:

The Director of Public Health’s annual independent report for 2016/17 was before the Board (HWB16).

 

The comments of the Oxfordshire Joint Health Overview & Scrutiny Committee on 14 September 2017 and Oxfordshire County Council’s Cabinet were also before the Board.

 

The Board AGREED to receive the report and to advise the appropriate bodies of their responsibilities in considering its recommendations.

17.

Development of the Joint Strategic Needs Assessment (JSNA) for 2018-19 pdf icon PDF 68 KB

4.35

15 mins

 

Person Responsible:  Director of Public Health

Person Giving Report: Director of Public Health

 

The Board is asked to discuss proposals for further development of the Joint Strategic Needs Assessment (JSNA) and to decide direction for 2018-19

 

Minutes:

Dr McWilliam (OCC) gave a presentation on the proposals for the further development of the JSNA and its direction for 2018-19.

 

David Smith (OCCG) spoke of the importance of the OCCG Locality Plans in its development given the good work that had been done throughout the year using the JSNA to inform these plans and asked that this information be included in further iterations of the JSNA.

 

Members of the Board congratulated the officers on the JSNA and its use by the system and on a very good report.

 

The Board appreciated the fact that, although it was an aspiration, in reality it would prove too expensive to give wholly accurate locality – based predictions on housing growth area by area collecting real-time data. However, current projections and housing growth statistics would continue to be used to give the best summary data for planning purposes.

 

The Board AGREED to accept the proposals for further development of the JSNA and its direction for 2018-19.

18.

Health Inequalities Commission - Implementation Plan pdf icon PDF 370 KB

4.50

15 minutes

 

Person responsible:            Dr Jonathan McWilliam, Strategic Director for People & Director of Public Health

 

Persons giving report:         Chair of OCCG, Dr Joe McManners and Dr. Jonathan McWilliam, Strategic Director for People & Director of Public Health

 

 

The report HWB18 sets out updated action to implement the recommendations for the Commission.

 

An annex is available on the web site on health inequalities indicators.

 

The Board is asked to ensure timely implementation of this work by all partners.

Additional documents:

Minutes:

The Board had before them a report (HWB18) which set out updated action to implement the recommendations from the Commission.

 

An Annex setting out the Health Inequalities indicators was also available on the County Council website.

 

Dr McWilliam reported that a further report would be brought back to the Board on further developments. He added that the Board’s sub-groups were keeping abreast of ongoing work in relation to the implementation of the Commission’s report on a regular basis.

 

The Board noted the report HWB18.

19.

Reports from Children's Trust, Joint Management Group for Adults and Health Improvement Partnership Board pdf icon PDF 200 KB

5:05

10 minutes

 

Attached are the written reports on activities to deliver the priorities set out in the Joint Health & Wellbeing Strategy since the last Health & Wellbeing Board in July (HWB19) from:

 

·         Children’s Trust Board

·         Health Improvement Partnership Board

·         Joint Management Group for Adults (to be circulated separately)

 

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

 

Additional documents:

Minutes:

The Board received the reports.

20.

PAPERS FOR INFORMATION ONLY pdf icon PDF 155 KB

The following paper is attached for the information of Board members at HWB20:

 

·         Milestone report on the statutory duty to revise the Oxfordshire Pharmaceutical Needs Assessment

 

Minutes:

Noted.