Agenda and minutes

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

Contact: Samantha Gorton  Tel: 01772 532471 - Email:

Note No. Item



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 2019/20 municipal year.



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 2019/2020 municipal year.



Appointment of Deputy Chair

The Board to appoint a Deputy chair for the municipal year 2019/20 as set out in the Terms of Reference.



Resolved:  That the Board agreed that Denis Gizzi, Chorley, South Ribble and Greater Preston Clinical Commissioning Groups (CCGs) be reappointed as Deputy Chair for the municipal year 2019/2020.



Membership and Terms of Reference of the Lancashire Health and Wellbeing Board pdf icon PDF 362 KB

To note the membership and terms of reference.



Resolved:  That the Board noted the current membership and Terms of Reference for the 2019/2020 municipal year, as set out in the agenda pack.


Future collaboration with Lancashire, Blackburn with Darwen and Blackpool Health and Wellbeing Boards will require Terms of Reference to be developed agreed.




Welcome, introductions and apologies

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


The Chair welcomed all to the meeting.


Apologies were noted as above.


New members of the Board were as follows:


Caroline Donovan replacing Professor Heather Tierney-Moore, Lancashire Care Foundation Trust.

County Councillor Phillippa Williamson replacing County Councillor Susie Charles.

Stephen Ashley, Lancashire Safeguarding Children's Board (Jane Booth returns to Lancashire Adult Safeguarding Board only).

Councillor Steve Hughes replacing Councillor Barbara Ashworth (East Lancashire District).


Replacements for the meeting were as follows:


Kirsty Hollis for Dr Julie Higgins, East Lancashire Clinical Commissioning Group.

Joanne Platt for Karen Partington, Lancashire Teaching Hospitals Foundation Trust.

Tim Almond for Dr Geoff Jolliffe, Morecambe Bay Clinical Commissioning Group.


Also in attendance from Blackpool Council and Blackburn with Darwen Council Health and Wellbeing Boards were:


Dominic Harrison, Director of Public Health, Blackburn with Darwen Council.

Councillor Mohammed Khan, Chair of Blackburn with Darwen Council's Health and Wellbeing Board.

Nicky Dennison, Senior Public Health Practitioner, Blackpool Council.


Apologies were received from Councillor Graham Cain, Chair of Blackpool Council's Health and Wellbeing Board.



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.


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



Minutes of the Last Meeting pdf icon PDF 321 KB

To agree the minutes of the previous meeting held on 19 March 2019.


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



Action Sheet and Forward Plan pdf icon PDF 186 KB

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

Additional documents:


There was an update on the development of the Advancing.


Following the circulation via email on 19 June 2019, of the final versions of the Joint Strategic Needs Assessment reports, the Board were asked to nominate two project sponsors for each thematic at this meeting. 


Resolved:  i)  That the Board noted the actions from the last meeting that   had been included on the forward plan, along with other   items for the Board's consideration at future meetings also   detailed on the plan.

  ii)  The Board nominated County Councillor Phillippa     Williamson for the children and young people Joint Strategic Needs Assessment project and Dr Sakthi Karunanithi for the health inequalities Joint Strategic Needs Assessment project.




Lancashire Special Educational Needs and Disabilities (SEND) Partnership- SEND Improvement Plan (updated Written Statement of Action) pdf icon PDF 127 KB

To receive a progress update on the Special Educational Needs and Disabilities Improvement Plan 2019-2020.


Additional documents:


Sian Rees, Special Educational Needs and Disabilities Consultant, Lancashire County Council, reported on the progress following the inspection by Ofsted and Care Quality Commission in November 2017 to judge how effectively the special educational needs and disability reforms had been implemented, as set out in the Children and Families Act 2014.  The inspection identified two fundamental failings and twelve areas of significant concern.


Partners in Lancashire were required to produce a Written Statement of Action, setting out the immediate priorities for action.  Progress on the implementation of these actions had been monitored by the Department for Education (DfE) and NHS England.  Formal review visits by the Department for Education and NHS England had taken place since April 2018 to consider the progress being made in line with the Written Statement of Action.  The Statement had been updated and any ongoing actions included in the Special Educational Needs and Disabilities Partnership Improvement Plan for the period April 2019 to December 2020.


The progress report for July will have details of review dates where timescales have been missed.  The report will be presented to the Special Educational Needs Partnership Board and will then come to the next meeting of the Health and Wellbeing Board.


Resolved:  That the Health and Wellbeing Board:


i)  Received and considered the Special Educational Needs Improvement Plan, noting that this would continue to drive forward improvement over the next two years.

ii)  Considered the first assessment of progress on the newly implemented plan and would expect to receive regular updates at future meetings.




Integrated Care System pdf icon PDF 119 KB

To note the integrated care system strategic narrative.


Additional documents:


Gary Raphael, Executive Director of Finance and Investment, Lancashire & South Cumbria Integrated Care System, informed the Board of a proposed that regular updates on both the development of the plans (operational and strategic) during the year be provided.


The paper was intended to support the development of a strategic narrative for the Lancashire and South Cumbria Integrated Care System by Clinical Commissioning Group Governing Bodies, Provider Trust Board and Local Authority leadership teams.  The paper also outlined the process of engagement on that narrative that is being undertaken.


The presentation in the agenda pack proposed that the Lancashire and South Cumbria Integrated Care System endorses eight partnership priorities for changing the way we work as a system – priorities which enable explanation of our vision for future system working to our staff, patients, citizens and stakeholders and to set out how working in partnership will enable our most significant challenges to be tackled.


The plans were not only for the NHS to lead on however, they were to ensure a partnership approach when formulating and delivering them.  During the engagement process, comments, advice and recommendations were being sought from Councils and the public.


The Board welcomed the document and felt that this identified a role for the Local Authority as well as committing joint working teams across the Integrated Care System, Integrated Care Partnerships and at neighbourhood levels and going forward they would monitor the plan collectively.  The plan also needed to be aligned with the six principles that the Local Government Association, Directors of Adult Social Services, NHS Clinical Commissioners, NHS Providers, NHS Confederation and the Association of Directors of Public Health had recently signed up to.  The six principles were:


·  Collaborative leadership

·  Subsidiarity – decision-making as close to communities as possible

·  Building on existing, successful local arrangements

·  A person-centred and co-productive approach

·  A preventative, assets-based and population-health management approach

·  Achieving best value


Deadlines for the plan was for completion by the end of September with the Board signing it off following that.


With a deficit of £112 million, £20.5 billion had been put aside for the NHS over the next five years with £4.5 billion set aside for improving Primary and Community Care Services which was a big financial challenge for acute trusts.  Significant change will be required and Trusts have been looking to improve joint working and also take the same approach when working in specialisms.  There was still a significant amount of work to do.


It was anticipated that the Health and Wellbeing Board would come together as a system to challenge and form a high level of scrutiny of the proposals going forward.


Resolved:  That the Health and Wellbeing Board:


i)  Commented on the strategic narrative which had been developed by the Lancashire and South Cumbria Integrated Care System.

ii)  Endorsed the strategic narrative document as the basis for the development of the Lancashire and South Cumbria Integrated Care System five year plan.

iii)  Endorsed in principle the eight priorities within the document, subject to  ...  view the full minutes text for item 9.



Review of Intermediate Care in Lancashire pdf icon PDF 288 KB

To receive a report on the propositions from the Intermediate Care Review.



Tony Pounder, Director of Adult Services, Lancashire County Council provided an update on the review intermediate care in Lancashire.


Work started towards the end of 2019 and was now drawing to a conclusion with an expected end date in July 2019. A presentation drew out the main findings from the final report, its key recommendations and the implications for the Health and Social Care system across Lancashire and South Cumbria.


It was recognised that serious effort would be needed to deliver the changes outlined and this could take 3-4 years.  The Advancing Integration Board would take ownership as it requires delivery by the whole health and social care system.


Resolved:  That the Health and Wellbeing Board:


i)  Noted the key findings of the report.

ii)  Approved the next steps for implementation.

iii)  Agreed that the Advancing Integration Board (formerly Better Care Fund Steering Group) to hold the accountability for driving implementation reporting at regular intervals to be determined to the Health and Wellbeing Board.




Better Care Fund Progress pdf icon PDF 250 KB

To receive an update on:


·  The Better Care Fund and Better Care Fund finances for 2018/2019 and 2019/2020 and also on the outcomes and next steps from the local workshop and a session that followed the finance meeting.

·  The Better Care Fund Quarter 4 progress, including clarification of Fylde and Wyre data.

·  The Better Care Fund and integration reviews, full planning frameworks and guidance.

·  The progress in respect of having health expenditure 'in view' to support alignment/pooling of public health funds with Integrated Care Partnership neighbourhoods.



Additional documents:


Louise Taylor, Executive Director for Adult Services and Health and Wellbeing, Lancashire County Council gave an update to the Board on:


Better Care Fund Metrics


·  Residential and nursing home admissions continued to fall but at a much lower rate than previously. They remained much higher than the national average.

·  Reablement continued to be successful with increasing take up and consistently high success.

·  Non elective admissions continued to exceed target and have seen a year on year increase for the last three years.

·  Delayed Transfers of Care were considerably lower for 2018/19 than 2017/18 but performance had deteriorated over recent quarters.


BCF planning and Finances


Despite the delay in publication of Better Care Fund planning guidance partners were making progress in confirming local plans across health and social care.


Confirmation of the level of contributions to the fund was also delayed. An additional element of the Better Care Fund for 2019/20 would be the Winter Pressures Grant of £5.5m for Lancashire. Partners had discussed and agreed the spending plan for this.


Advancing Integration


A high level of joint working had resulted in significant progress in designing a model for making integration across health and social care happen. The model provides the structure to manage the Better Care Fund, the Intermediate Care Review and integration as a whole. It was proposed that the Better Care Fund steering group was replaced by the Advancing Integration Board, to take on this wider responsibility while remaining accountable to the Health and Wellbeing Board.


Resolved:  That the Health and Wellbeing Board:


(i)  Noted the Better Care Fund performance against the required metrics.

(ii)  Noted the planning and financial arrangements for the Better Care fund in 2019/2020.

(iii)  Noted the work to date on Advancing Integration across health and social care using the Better Care Fund as an enabler.

(iv)  Approved the development of the Advancing Integration Board.

(v)  Approved the creation of the Advancing Integration transformation team.

(vi)  Approved the approach to Advancing Integration based around levels of neighbourhoods, districts, Integrated Care Partnerships and the Integrated Care System.




Collaboration - Health and Wellbeing Boards pdf icon PDF 229 KB

To note the commitment to and progress on governance through Health and Wellbeing Board alignment/amalgamation; health expenditure 'in view' to support alignment/pooling of public health and associated Clinical Commissioning Groups budgets at Integrated Care System/Integrated Care Partnership/neighbourhood levels.


Clare Platt, Head of Service Health, Equity, Welfare and Partnerships, Lancashire County Council presented the report where over recent months there had been a number of discussions highlighting the opportunity for the Health and Wellbeing Boards to work with, and influence, the Lancashire and South Cumbria Integrated Care System to promote integration and improve population health outcomes. Recently the Integrated Care System had been reviewing its governance arrangements, and so it was timely to consider the opportunities for a system-wide approach to integrated health and social care, prevention, and tackling health inequalities.


There were a number of examples of such arrangements across the Country, with the Local Government Association (LGA) supporting Health and Wellbeing Boards in developing this approach, and publishing associated case studies. The Local Government Association had offered support in delivering joint arrangements for Lancashire and South Cumbria.


The report identified learning and best practice in relation to joint working, progress and the governance options available for consideration.


The Board agreed that there was a need for collaboration to deliver one strategy and ensure more health and social integration and that there should be one collaborative arrangement under the Integrated Care System, with five Integrated Care Partnerships. 


Following this meeting there would need to be discussions between the three chairs of the Health and Wellbeing Boards in Lancashire, Blackburn with Darwen and Blackpool so that each understood what each Board could bring to the collaboration and how to ensure it worked including holding the Integrated Care System to account.  This was a real opportunity to look at a broader agenda.


Resolved:  That the Health and Wellbeing Board:


i)  Noted the report and agreed to progress joint arrangements.

ii)  Agreed that the offer of support from the Local Government Association be accepted.

iii)  Required an update on progress to the next meeting of the Board.


Prevention and Population Health Services


Clare Platt also gave an update on discussions that had taken place with East Lancashire, Fylde and Wyre, Greater Preston, Chorley and South Ribble and Morecambe Bay Clinical Commissioning Groups about alignment of public health services.  A further conversation with West Lancashire was to be held shortly.  Discussions revealed that there were different interpretations of the Lancashire County Council offer across each Clinical Commissioning Group footprint. This posed a significant challenge for Lancashire County Council in terms of planning, consistency and risk management.


Clinical Commissioning Groups are keen to understand the degree of devolution whether it was involvement in decision making or devolution of public health grant monies with an associated performance framework or something between the two.


There needed to be more clarity re development of a Memorandum of Understanding, governance and the opportunity for oversight by the Health and Wellbeing Board.


A paper had also been requested that could be shared with all Clinical Commissioning Group Boards outlining the proposal, followed up by more detail on governance at a later state.


Resolved:  That the Health and Wellbeing Board welcomed the update.




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.


Motor Neurone Disease Association


The Chair reminded the Board of the Motor Neurone Disease event taking place on 31 July 2019 and to confirm attendance.




Date of Next Meeting

The next scheduled meeting of the Board will be held at 2pm on 10 September 2019 in the Duke of Lancaster Room – Committee Room 'C' at County Hall, Preston.


The next scheduled meeting will be held at 2pm on 10 September 2019 in the Duke of Lancaster Room – Committee Room 'C' at County Hall, Preston.



Exclusion of Press and Public

The Health and Wellbeing Board is asked to consider whether, under Section 100A(4) of the Local Government Act 1972, it considers that the public should be excluded from the meeting during consideration of the following items of business on grounds that there would be likely disclosure of exempt information as defined in the appropriate paragraph of Part 1 of Schedule 12A to the Local Government Act 1972 as indicated against the heading to the item.


This item was not required as the Part II report at agenda item 13 was discussed under Part I.




Health and Social Care Integration - Advancing Information Systems Interoperability pdf icon PDF 30 KB

Reason for inclusion in Part II, if appropriate


Exempt information as defined in Paragraph 3 of Part 1 of Schedule 12A to the Local Government Act 1972. The report contains information relating to the financial or business affairs of any particular person (including the authority holding that information). It is considered that in all the circumstances of the case the public interest in maintaining the exemption outweighs the public interest in disclosing the information.



Tony Pounder, Director Adult Services, Lancashire County Council and Declan Hadley, Digital Lead, Healthier Lancashire and South Cumbria informed the Board about the progress on the Advancing Information Systems Interoperability.


NHS organisations and local authority social care organisations within the Lancashire and South Cumbria Integrated Care System need to share information with one another about individuals they treat or support so they can be effective and efficient in delivering joined up care and ensuring timely transfer of responsibilities between agencies.  Given the number of different information systems in operation across these organisations the Integrated Care System had been committed through its Digital Strategy to ensuring these systems could talk to one another by devising solutions that advance interoperability. 


The report and presentation to the Board sets out the recent success Lancashire County Council and Lancashire Teaching Hospitals have had in establishing the information governance, technical and operational arrangements to allow for the smooth and timely flow of information about those people waiting for discharge from hospital.  It will further outline the provisional Grant Award recently communicated by NHS England to Lancashire County Council as part of the Social Care Digital Pathfinders programme to plan for these arrangements to be widened out to all hospitals and local authorities within the Integrated Care System.


Resolved:  That the Health and Wellbeing Board:


i)  Noted and commended the progress on advancing information systems interoperability between Lancashire County Council and Lancashire Teaching Hospitals in relation to hospital discharge


ii)  Noted and welcomed the provisional award of a Grant from NHS England from its Social Care Digital Pathfinder fund to enable planning for advancing system interoperability between all councils and NHS hospital trusts within the Integrated   Care System in relation to hospital discharge.