Agenda and minutes

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

Members were welcomed to the meeting and introductions made.

The Board was informed that since the last meeting, and because there had not been a Full Council prior to this meeting, the revised terms of reference and changes to membership had been approved at the Urgency Committee held on 7 July 2015. It was therefore noted that CC Jennifer Mein, Leader of the County Council would be the new Chair of the Health & Wellbeing Board.

Apologies were received from:

·  Tony Pounder, Director of Adult Services

·  Dr Simon Frampton, West Lancashire CCG

·  Dr Gora Bangi, Chorley South Ribble CCG

·  Dr Tony Naughton, Fylde & Wyre CCG

·  Dr Dinesh Patel, Greater Preston CCG

Mr Ishwer Tailor replaced Gail Stanley for Healthwatch

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.

None noted

To agree the minutes of the previous meeting.

The minutes of the Board meeting held on 5 June were agreed as a correct record

The Board receive an update on actions agreed at the last meeting.

Chris Calvert, Partnership Officer introduced this item.

The Action Sheet provided the Board with progress against previous recommendations and decisions of the Board

Whilst no significant comments were made by members Bob Stott, Director of Children's Services suggested that Board consider how to engage with PULSE

It was resolved that the Action Sheet be noted

The Board understand and engage in the Your Hospitals, Your Health consultation.

The Board consider the outcome of the Monitor investigation and any response or action from the HWBB or individual partners.

Dr Mark Pugh, Consultant Anaesthetist Medical Director provided the Board with a review of their clinical services and hospital estate, to make sure they can respond to the challenges they are facing and continue to provide the highest standards of care, and effective services whilst ensuring they are viable for the future.

The purpose of the presentation was to provide the Board with:-

•  An overview of the case for change in their clinical services

•  What will affect the new models of care that they are developing

•  What they are proposing to do to meet these challenges – the process moving forward

Dr Pugh highlighted a number of key points:

•  The NHS is facing the biggest challenge in its history.

•  The population is ageing - The number of over 85 year olds will increase by 106% by 2032.

•  This has significant implications for the NHS because older people use health services more than other age groups.

•  Nearly two thirds of people admitted to hospital are aged over 65.

•  Since 2006 the number of people aged 85 years and older admitted to hospital, as an emergency, has increased by 48%.

•  On average, at Royal Preston Hospital 24% of patients are now over the age of 80, and 43% of medical patients are elderly. 

•  At Chorley and South Ribble Hospital 46% of patients are now over the age of 80, and 55.5% of medical patients are elderly.

•  Elderly medical patients tend to stay in hospital for longer than young people, in fact three times longer. 

•  Because the elderly population is projected to increase, hospitals will get busier and busier if we don’t do something differently. 

•  People are now living for longer with chronic conditions such as diabetes, heart disease and respiratory illness - which is great news and shows how much treatment and care has improved in the past decade or so.

•  Whilst the total number of people with one long term condition is not expected to change very much, the number of people with three or more chronic illness is predicted to rise by 1m by 2018. 

•  People with several chronic conditions generally need a lot of health and social care support, visit hospital regularly, and often stay in hospital for a long period, so with the predicted rise in people with one or more chronic illness we can expect hospitals to get busier.

•  Our lifestyles are becoming less healthy. 

•  One in five of us smoke.

•  One in three drink too much alcohol.

•  And two in three are overweight.

•  Unhealthy lifestyle choices are causing an increase in largely preventable conditions such as type 2 diabetes, heart and liver disease, and certain cancers, all of which means more people need more care.

•  Together these factors – an ageing population, people living for longer with chronic conditions, and our increasingly unhealthy lifestyles – has created a significant increase in demand for healthcare,  ...  view the full minutes text for item 5.

The Board is updated on progress in Lancashire since 2013 / Winterbourne and receives information on the Fast Track programme that Lancashire is now part of and the next steps to develop this.

Ian Crabtree and Sharon Martin presented the Board with a summary of issues associated with the Transforming Care agenda which included:-

·  An update on progress pan Lancashire.

·  Information on Lancashire's inclusion in a National "Fast Track" programme, which is a strategically led collaboration of CCGs, local authorities and NHS England specialised commissioners, where the transformation needed can be planned and implemented at a greater speed.

Ian reported that it is was approximately 2 years since the Board had last received an update and drew members attention to the current situation in Lancashire and the recent inclusion in the Fast Track programme. A shared action plan and vision was to be developed by early September and the Transforming Care Board had been established with its first meeting to be held on 17 July. The action plan developed by the Transforming Care Board would be reported back to the Collaborative Commissioning Board for agreement and sign-off after which the Health & Wellbeing Board would be asked to sign off the action plan. Ian suggested that if the Board does not meet again prior to the requirement for sign-off the Chair be asked to agree the action plan on behalf of the Board.

A brief discussion took place and the main points were:

·  In response to a concern regarding nurses in special schools it was clarified that this area was not included within the Fast Track programme, however officers assured the Board that a separate piece of work is being undertaken to look at staffing as part of a whole workforce review

·  One member asked if Lancashire has community placements. Ian stated that the Fast Track programme comes with some funding (approximately £1m) and it is the intention to develop community resources as they are quite patchy across the county.

·  The Board were informed that Jan Ledward had been identified as the senior responsible officer to lead the Fast Track process and had already written to NHS England setting out Lancashire's requirements for a bespoke package of support. It was suggested that the Board support this approach.

·  It was acknowledged that even though the Board were talking about relatively small numbers of people their outcomes were very poor in terms of life expectancy, employment and receipt of health checks. In addition tremendous pressure was being placed on providers such as Calderstones to make changes happen quickly but caution needs to be taken to ensure that service users are managed safely.

It was resolved that:

  i.  The Health and Wellbeing Board note the progress made in developing the Transforming Care agenda in Lancashire and agree to provide future support and challenge that will enable effective engagement in the fast track programme

  ii.  The Chair be asked on behalf of the Board to sign-off the action plan

The Board agree a response to mitigate the impact of in year reductions to the public health budget.

Sakthi Karunanithi presented the Board with a report that identified how the in-year reductions of Lancashire County Council's public health budget will have implications for services across the health system. There is a need to ensure that the impact of these cuts is minimised and the development of a place based public health system across Lancashire is a priority.

At the meeting of the Health and Wellbeing Board on the 5 June 2015 an item was raised under urgent business that alerted the Board to a government announcement of in year cuts to the public health budget. The Department of Health had announced an overall reduction of £200 million to this budget which it is estimated will equate to £4 million for Lancashire County Council.

He updated members on further information that had been made available since the last meeting. He explained that the current fragmented systems need to be unified and as commissioning responsibilities lie with both NHS England and CCGs there is a need for discussions to take place about how to re-unify the Public Health system within those commissioning responsibilities and that as this is a pan Lancashire issue Blackpool and Blackburn with Darwen should also be included.

He stated that reductions in funding had not been confirmed but once known work can be undertaken to look at the impact.

It was resolved that the Health & Wellbeing Board:

  i.  agree to the development of discussion and activity between Lancashire County Council, NHS England and Public Health England to enable a more joined up public health system.

  ii.  invite Blackburn with Darwen and Blackpool to engage in this work

The Board understands the challenges, opportunities and developments in North Lancashire and considers how the Board can support these.

Andrew Bennett and Hilary Fordham from Lancashire North CCG provided the Board with a presentation on the local health and care strategy, Better Care Together (BCT)

A copy of the presentation is appended to the minutes

Following the presentation a discussion took place and the main points were:

·  In response to the question of who were the North Lancashire Medical Services it was explained that it was a federation of all of the 12 GP practices in the Lancashire North CCG area who came together as a network to represent GPs at scale.

·  The Board were assured that integration referred to with the presentation also included social care

·  It was clarified that any references to workforce reduction related to hospital based workforce and not the total workforce

·  It was explained that the Vanguard status achieved would enable Better Care Together to progress more quickly

·  It was acknowledged that within the BCT area there were 3 distinct and very different communities (Lancashire North, South Lakes and Barrow) and the work undertaken with Millom had sparked the conversation about how we work with very localised communities, in terms of how we utilise the assets of a community to improve the health of the population.

·  It was agreed that better engagement would be required regarding how the public would be informed and consulted on alternatives uses for hospital sites.

·  It response to the request for a nominated County Councillor to sit on the local Health & Wellbeing Partnership the Chair indicated that she would ensure that Partnership be provided with a representative as soon as possible.

·  It was suggested that each local Health & Wellbeing Partnership should include a County Councillor in its membership.

·  Members felt it would be useful for the Board to receive a further update on the progress of Better Care Together in due course. Sakthi suggested that he liaise with officers from Lancashire North CCG to agree what further information should be presented to the Board and that they report back in approximately 12 months time.

It was resolved that:

  i.  The presentation and comments be noted

  ii.  A further update on Better Care Together be presented to the Board in 12 months.

  iii.  The Chair of the Board progress the nomination of a County Councillor for the North Lancashire Health & Wellbeing Partnership

The Board endorses the #hello, my name is... campaign and agrees to promote this across Lancashire through their organisations.

Louise Taylor introduced the report and provided the Board with background on the campaign and asked the Board members to support it within their own organisations. A link to the website can be found at Hello My Name Is...

Many members endorsed the campaign and stated how their organisations had already signed up to it and that it was being embraced by all staff.

It was resolved that:

  i.  The Health & Wellbeing Board endorse the campaign #hello my name is

  ii.  Individual organisations consider how they will promote the campaign internally

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.

Two items of urgent business was brought to the attention of the Board, they were:

§  CC Ali raised the issue of Child and Adolescent Mental Health (CAMHs) – The Future in Mind report which recommends that the HWBB oversees and signs off the development of CCG transformation plans for CAMHs. Louise Taylor responded that the findings and recommendations of the above report would be factored into a model which would be presented to the October Board meeting.

·  Young Carers – Cllr Hennessey flagged an issue in a West Lancashire school where the attendance and behaviour of a pupil had dipped significantly. It was established that he had been caring for his mum, for some time, who had been unwell. The issue for the HWBB is how, when GPs become aware of a long term illness for parents, they are able to ascertain how care will be provided and that it is not through children.

It was resolved that:

  i.  In relation to CAMHS, a transformation plan would be presented to the Board in October

  ii.  In relation to young carers, Sakthi will take the issue to the West Lancashire HWB Partnership for further discussion and report back the learning to a future Health & Wellbeing Board meeting

The next scheduled meeting of the Board will be held at 2.00pm on Thursday, 29 October 2015 in The Duke of Lancaster Room, (formerly Cabinet Room C) at County Hall, Preston.

The date of the next meeting was agreed as Thursday 29 October, 2.00pm in Cabinet Room C, County Hall, Preston

The Board were informed that as per their revised terms of reference the Board would aim to meet every 2 months therefore officers would be contacting them to arrange the additional meetings.