Agenda and minutes

Members of the public are welcome to attend our meetings to watch them in person at any of the venues across the County. Publicly accessible meetings held in County Hall will be webcast, which means they are available to be watched live or recorded on our website. Please see our webcasting notice here. The Committee may, in certain circumstances, resolve to hold part of the meeting in private. If this is the case, you will be required to leave the meeting.

Venue: Committee Room 'C' - The Duke of Lancaster Room, County Hall, Preston. View directions

Contact: Samantha Gorton  Tel: 01772 532471, mobile 07585 983954 . Email -  sam.gorton@lancashire.gov.uk

Items
Note No. Item

10.00am

1.

Appointment of Chair

The Board is asked to note that in accordance with the Terms of Reference, County Councillor Shaun Turner, Cabinet Member for Health and Wellbeing, is appointed as the Chair for the 2018/19 municipal year.

 

Minutes:

Resolved:  That in accordance with the Terms of Reference, County Councillor Shaun Turner, as the Cabinet Member for Health and Wellbeing, was appointed as Chair for the remainder of the 2018/19 municipal year.

 

 

2.

Appointment of Deputy Chair

The Board to appoint a Deputy chair for the municipal year 2018/19 as set out in the Terms of Reference.

 

Minutes:

Resolved:  That the Clinical Commissioning Groups nominate a Deputy Chair for the municipal year 2018/19 and that the Board be updated of the appointment at the next meeting.

 

3.

Membership and Terms of Reference of the Lancashire Health and Wellbeing Board pdf icon PDF 90 KB

To note the membership and terms of reference.

Additional documents:

Minutes:

Resolved:  i)  That the Board noted the current membership and Terms of Reference for the 2018/19 municipal year, as set out in the report and at Appendix 'A'.

ii)  To appoint a Deputy Chair for the year 2018/2019 municipal year at the next meeting of the Board in September from Health as discussed at Item 2.

4.

Welcome, introductions and apologies

To welcome all to the meeting, introduction and receive apologies.

Minutes:

All were welcomed to the meeting and round table introductions took place.

 

Apologies were noted as above.

 

New members were noted as follows:

 

Stephen Young, Director of Growth, Environment, Transport and Community Services, Lancashire County Council

Tammy Bradley, Progress Housing, representing Housing Providers

Councillor Lian Pate for Councillor Tony Harrison, East Lancashire District Council

David Russel, Lancashire Fire and Rescue Service

 

Replacements were as follows:

 

Dr Tom Marland for Jennifer Aldridge, Fylde and Wyre Clinical Commissioning Group and Fylde and Wyre Health and Wellbeing Partnership

Helen Curtis for Dr Goran Bangi and Dr Sumantra Mukerji, Chorley and South Ribble Clinical Commissioning Group and Great Preston Clinical Commissioning Group

 

 

5.

Disclosure of Pecuniary and Non-Pecuniary Interests

Members of the Board are asked to consider any Pecuniary and Non-Pecuniary Interests they may have to disclose to the meeting in relation to matters under consideration on the Agenda.

Minutes:

There were no disclosures of interest in relation to items appearing on the agenda.

 

6.

Minutes of the Last Meeting held on 20 March 2018 pdf icon PDF 88 KB

To agree the minutes of the previous meeting.

Minutes:

Resolved:  That the Board agreed the minutes of the last meeting.

 

7.

Action Sheet and Forward Plan pdf icon PDF 46 KB

To note the action updates from the previous meeting and the forward plan for future meetings.

Additional documents:

Minutes:

Updates on actions from the 20 March 2018 meeting were received. 

 

New membership had already been reported to the Board at Item 4.

 

The Board were still awaiting the query on how many people the 3,479 delayed days affected.  As Paul Robinson was on leave, this information would be shared at the next Board meeting.

 

With regards the specific Better Care Fund planning session, this would be discussed further when the new guidance had been issued.

 

If there were any items for the forward plan, these should be sent to Sam Gorton, email sam.gorton@lancashire.gov.uk who would then bring them to the Chair's attention for consideration.

 

10.15am

8.

Better Care Fund and Delayed Transfers of Care Update pdf icon PDF 93 KB

To receive an update on the Better Care Fund Quarter 4 performance including the Delayed Transfers of Care Performance through Newton Europe and BCF planning.

Additional documents:

Minutes:

The year 2017/18 saw considerable activity and change across the Lancashire Better Care Fund (BCF).  The performance against metrics was good for both reablement and reducing the numbers of permanent admissions to residential and nursing homes.  It was also so for the number of non-elective admissions that were slightly below the target.

 

The main area of focus for the year was the level of Delayed Transfers of Care (DToC) across hospitals in Lancashire and the split of responsibility for these across health and social care.  There was an overall reduction during the year that saw a convergence towards the revised and highly challenging targets.  The greater reduction was seen in social care attributable delays. 

 

There was a high level of cooperation and challenge across the whole health and social care system that has resulted in improved Delayed Transfers of Care performance and a continuing improvement in collaborative working that includes the voluntary sector and district councils.

 

The level of funding via the Better Care Fund increased overall and was then supplemented by the Improved Better Care Fund (iBCF).  This required and ultimately enabled better joint working and decision making across health and social care and targeting of new and enhanced services at shared priorities.

 

Such was the challenge around Delayed Transfers of Care that national resources were allocated to provide currently ongoing Delayed Transfers of Care diagnostic work that has presented its findings and is now shaping up how the improvement themes will be applied. 

 

As there is a two year Better Care Fund and an Improved Better Fund plan in place there is no need for further detailed planning at present.  The NHS plan and social care green paper due in Autumn will provide detail of the nature and purpose of the Better Care Fund beyond 2019/20 although it has been indicated that there will be an increased emphasis on integration and the Better Care Fund will be at the centre of this.  A report will be provided to the board when the information becomes available.

 

The Disabled Facilities Grant funding at Wyre District Council had been used in innovative ways and this had been shared with other Districts.

 

It was reported that, notwithstanding progress made, parts of the Better Care Fund resources are non-recurrent and ending in two years' time.  It was noted that there were schemes funded by the local authority and the NHS that were not included in the Better Care Fund but were intended to achieve same outcomes as the Better Care Fund.  The Board agreed to scope and review the overall health and care budget that fund these schemes to inform planning beyond the Better Care Fund period. 

 

Resolved:  That the Health and Wellbeing Board:

 

i)  Noted the Better Care Fund annual summary provided at Appendix 'A'.

ii)  Requested a further report on the outcomes of the Delayed Transfers of Care diagnostic work once this is completed.

iii)  Requested a report on future planning requirements for the Better Care Fund  ...  view the full minutes text for item 8.

10.45am

9.

Fylde and Wyre Local Delivery Plan pdf icon PDF 2 MB

To receive an update report from Fylde and Wyre on the Local Delivery Plan.

 

Minutes:

The Board received an update on the Fylde Coast Local Delivery plan and not the Wyre Local Delivery Plan.  Peter Tinson, NHS Fylde and Wyre Clinical Commissioning Group presented the attached PowerPoint presentation to the Board.

 

Within the Fylde Coast, 11 neighbourhoods had been in operation for over four years.   The Clinical Commissioning Group was working closely with Lancashire County Council and Dr Sakthi Karunanithi in planning for neighbourhood level integration.

 

Links were being made with Lancashire County Council's proposed priorities on neighbourhood level integrated care systems, improving delayed transfers of care, improving stroke outcomes, addressing variation in diabetes care and reducing suicides.

 

Excellent progress was being made already within the Integrated Care Plan system across clinical and non-clinical areas.

 

Clinical Senate had been established to drive vision forward and brings together a range of professionals to share best practice including GPs, Consultants, Nurses, Therapists and Public Health practitioners which would provide leadership, guidance and input.

 

Delayed Transfers of Care have significantly reduced since last year and were beneath the 3.5% target.

 

Peter Tinson was thanked for his presentation.

 

11.05am

10.

Prevention and Population Health Plan and Neighbourhood Working pdf icon PDF 98 KB

To receive an update on prevention in the context of the Integrated Care System and receive an update on neighbourhood working following the Health and Wellbeing workshop.

Additional documents:

Minutes:

Dr Sakthi Karunanithi, Director of Public Health, Lancashire County Council presented the report and PowerPoint to the Board that were attached to the agenda.

 

At the Lancashire Health and Wellbeing Board (HWBB) workshop held on the 15 May 2018, it was agreed that the single next focus for integration (alongside the existing activity on hospital flow and Delayed Transfers of Care (DTOC) was the whole system approach to health and care at neighbourhood level.

 

A task and finish group comprising of the Cabinet Member for Health and Wellbeing and officers from the NHS and local government met on the 29 June 20218.  The working title for this programme of work was 'Total Neighbourhoods'.  The task and finish group discussed the offer and ask from the County Council to progress this work and agreed two key activities.

 

They included:

 

1.  ‘Operational alignment’ of NHS, district council and Voluntary, Community and Faith Sector services at neighbourhood level, starting with public health and preventative services and then to consider adult social care and other relevant services of the County Council as as the programme develops.

 

2.  'Strategic design' work to further develop integrated care including pooled budgets, joint commissioning, risk and gain share agreements and regulation.

 

Discussion ensued around the Neighbourhood Operating model and looking at this on an integrated care system level which was aligned to the Council's footprint.  Each neighbourhood could be unique and it includes services for all ages and not just physical health. 

 

The Board agreed that they would stand to make some huge gains with neighbourhood working and that this had to be a whole system approach to keep people safe and well in their own homes and communities.  The Board needed to align itself operationally and be innovative.

 

Lancashire Adult Learning could offer support with this, and the Board were informed that they had been invited to present at the next meeting in September 2018.

 

The active ageing proposal being developed by the Voluntary, Community and Faith sector will also support this.

 

Some work was already being done in certain neighbourhoods so would look to them to design and lead as first wave of neighbourhoods starting in Autumn 2018 with a view to scale up and spread the neighbourhood level integration of services during 2019/20 and the year after.

 

It was requested that Lancashire's Health and Wellbeing Board asks the five Health and Wellbeing Partnerships to develop plans to support the neighbourhood level working in their respective areas.  It was noted that this will also support the priorities of Lancashire and South Cumbria Integrated Care System.

 

Resolved:  That the Health and Wellbeing Board agreed to:

 

i)  Support the 'offer' and 'ask' from the County Council to integrate services at the neighbourhood level.

ii)  Support a detailed design of this programme with NHS, districts and partner organisations to invite first wave of neighbourhoods, starting in Autumn 2018.

iii)  Endorse the implementation of this programme via Lancashire and South Cumbria Integrated System and its associated Integrated Care Partnerships

iv)  ...  view the full minutes text for item 10.

11.45am

11.

Special Educational Needs and Disabilities Improvement Plan pdf icon PDF 110 KB

To receive an update on the Improvement Plan and the updated Written Statement of Action.

Additional documents:

Minutes:

Lancashire local area Special Educational Needs and Disabilities services were inspected by Ofsted and the Care Quality Commission (CQC) in November 2017 to judge how effective the special educational needs and disability (SEND) reforms had been implemented, as set out in the Children and Families Act 2014.  The inspection identified areas of significant concern and required a written statement of action to be developed to address these.

 

The Lancashire SEND Partnership had produced a written statement of action and this had been accepted and signed off by Ofsted and CQC.  Actions had been organised into working groups and delivery had commenced.  Activity on these actions was monitored by the Department for Education (DfE) and NHS England.  An initial monitoring visit had been held and feedback received had been positive.  The next monitoring visit is on 25 July 2018.

 

Key achievements of the working groups to date were listed in the report.

 

As part of this work a series of parent/carer engagement events were taking place across the county. 

 

It is hugely important that partners and commissioners were involved with SEND Services, so that the required outcomes were achieved.

 

Resolved:  That the Health and Wellbeing Board:

 

(i)  Noted the detail of the written statement of action.

(ii)  Noted the progress of delivery on the written statement of action.

(iii)  Will receive an update to the next Board meeting.

 

12.00 noon

12.

Transforming Care - In Patient Provision pdf icon PDF 112 KB

To receive an update of the current status, progress and upcoming plans for specialist Learning Disability and Autism inpatient provision within the Lancashire and South Cumbria Transforming Care Programme.

 

Additional documents:

Minutes:

Rachel Snow Miller and Sharon Walkden, Midlands and Lancashire Commissioning Support Unit, Andrew Simpson, NHS England and Ian Crabtree, Lancashire County Council gave an update of the current status, progress and upcoming plans for specialist Learning Disability and Autism inpatient provision within the Lancashire and South Cumbria Transforming Care Programme.

 

Updates were provided on Medium Secure Units (MSU) and Low Secure Units (LSU) provision including the determined location of the MSU and the options for future provision of the LSU.

 

The paper also outlined plans for the future model of care for non-secure, Clinical Commissioning Group commissioned beds and the upcoming consultation process.

 

The current provision of CCG commissioned beds was through the Enhanced Support Service (ESS) based on the Mersey Care Foundation Trust (MCFT) Whalley site (Calderstones).  This was supplemented by a number of spot-purchased, out of area beds from independent providers.  At the start of the Transforming Care Partnership programme in 2016/17 Lancashire and South Cumbria were required to discharge 61 patients from Specialised Commissioning (SC) Beds and 46 patients from CCG commissioned beds.  Any patients who were admitted to ESS/out of area beds in the meantime were also added to the numbers counted.

 

Papers detailing transformational proposals and project timelines, in line with national requirements were presented and approved at the Collaborative Commissioning Board (CCB) and the Joint Committee of Clinical Commissioning Groups (JCCCG) in November 2017. The initial plan approved a two staged approach that incorporated an interim solution and the development of a long-term, permanent model.

 

Interim Solution - It was proposed that during 2018-19, care would be delivered through the optimisation of the existing ESS service on the MCFT Whalley Site.  This would enable patients from out of area placements to return to Lancashire and South Cumbria and help retain a highly skilled learning disability workforce.

 

Permanent Model – was developed by clinical experts within the North West Learning Disability and Autism Operational Delivery Network (ODN). Their proposed model satisfies the Building the Right Support (BRS) target for the Lancashire and South Cumbria footprint. The model incorporates:

 

·  Provision of 14-16 beds in a specialist in patient unit (a mix of rehabilitation and Assessment and Treatment beds) co-located / in close proximity to a hospital site and on a bus route and close to amenities/community. 

 

·  10 step-up / step-down placements (homes not beds).  It was proposed that these placements were Care Quality Commission registered as Domiciliary Care and not as hospital beds.  These placements would offer short term placements with a clear pathway into supported living once appropriate. 

 

In addition there would be a need for a number of individual tenancies for service users who would be provided with the necessary packages of support in their own homes.  Initially it was suggested that 10 such tenancies would be required.

 

Based on this approach the total model would take up to 2021 to deliver. It was now clear that this time line would not be acceptable to NHS England and that all learning  ...  view the full minutes text for item 12.

12.20pm

13.

Clinical Commissioning Groups (CCGs) Annual Report 2017/18 pdf icon PDF 115 KB

To receive the positions statement from all Clinical Commissioning Groups (CCGs).

Minutes:

Consultation had taken place on the Clinical Commissioning Group (CCG) Annual Reports 2017/18, as part of the statutory requirement outlined in guidance.  Reports from four CCGs had been received.

 

Resolved:  That the Health and Wellbeing Board:

 

i)  Acknowledged the receipt of CCG Annual Reports, as per the Boards request.

 

ii)  Noted the contribution and continued delivery of the joint Lancashire Health and Wellbeing strategy priorities.

 

12.25pm

14.

Urgent Business

An item of Urgent Business may only be considered under this heading, where, by reason of special circumstances to be recorded in the minutes, the Chair of the meeting is of the opinion that the item should be considered at the meeting as a matter of urgency.  Wherever possible, the Chief Executive should be given advance warning of any Members' intention to raise a matter under this heading.

Minutes:

There were no matters of urgent business received.

 

12.30pm

15.

Date of Next Meeting

The next scheduled meeting of the Board will be held at 10.00 on Tuesday, 18 September 2018 in Committee Room 'C' – Duke of Lancaster Room at County Hall, Preston.

Minutes:

The next scheduled meeting of the Board will be held at 10am on Tuesday, 18 September 2018 in Committee Room 'C' – Duke of Lancaster Room at County Hall, Preston.