Agenda and minutes

Apologies were received from Councillor Joy Bratherton, Jerry Hawker, Kath O’Dwyer, and Tom Knight.

To provide an opportunity for Members and Officers to declare any disclosable pecuniary and non-pecuniary interests in any item on the agenda.

Councillor S Corcoran declared a non-pecuniary interest by virtue of his wife being a GP and a Director of South Cheshire and Vale Royal GP Alliance Ltd.

To approve the minutes of the meeting held on 26 September 2017

RESOLVED:

That the minutes of the meeting held on 26 September 2017 be approved as a correct record, subject to the deletion of minute 27 as the wording was a duplicate of minute 26 and renumbering of subsequent minutes.

In accordance with Procedure Rules Nos.11 and 35 a period of 10 minutes is allocated for members of the public to address the meeting on any matter relevant to the work of the body in question.  Individual members of the public may speak for up to 5 minutes but the Chairman or person presiding will decide how the period of time allocated for public speaking will be apportioned where there are a number of speakers. Members of the public are not required to give notice to use this facility. However, as a matter of courtesy, a period of 24 hours’ notice is encouraged.

Members of the public wishing to ask a question at the meeting should provide at least three clear working days’ notice in writing and should include the question with that notice. This will enable an informed answer to be given.

No members of the public present wished to speak.

To consider a report on the progress made since publication of the NHS South and Eastern Cheshire Clinical Commissioning Groups Safeguarding Annual reports July 16 - 17

The Board considered a report which provided an update on the health of Cared for Children and Young People.

Sally Rogers, Quality and Safeguarding Director Eastern Cheshire CCG and Shan McParland, Designated Nurse Looked After Children, were in attendance for this item.

The CCG had reviewed its commissioning arrangements and the Looked after Children (LAC) team was now employed by Wirral Community Partnership Trust, which had improved alignment and communication with community services across Cheshire East.  In parallel an opportunity had arisen to review of the role of the Designated Nurse for Cared for Children in order to maximise the available clinical time. 

The Designated Nurses and Doctors across the four Cheshire CCG areas had undertaken a root cause analysis on the Initial Health Assessments and as a result had implemented a number of recommendations to improve performance, as detailed in Appendix D to the Report.

Shan McParland gave a short presentation on the case of a young person and how the work of the service had helped them. 

RESOLVED:

That the update report be received.

To consider a report on the self-assessment of progress to date against the recommendations from the Ofsted inspection

The Board considered a report on the self-assessment of progress to date against the recommendations from the Ofsted inspection in July 2015 .

The Health and Wellbeing Board was the accountable body for the Children’s Improvement Plan for the recommendations from the Ofsted inspection.

The Appendix to the report provided details of the annual review of progress against the recommendations. 

Nigel Moorhouse, Director of Children Social Care, was in attendance for this item.

Concerns were raised that it may still be too soon to replace dedicated improvement monitoring with business as usual activities. Assurances were given that there were checks and balances in place, which included monitoring by the Overview and Scrutiny Committees and the Corporate Parenting Committee.

RESOLVED: 

That the Health and Wellbeing Board

1        note the progress against the Ofsted recommendations;

2        endorse the recommendation that dedicated improvement monitoring activity is replaced by business as usual activities to reduce duplication; and

3        endorse the recommendation that the Health and Wellbeing Board continue to monitor progress through six monthly progress reports on the recommendations that are not yet being met.

To consider a report on the current Delayed Transfers of Care performance and the implications of this for the health and social care system

The Board considered a report on the Delayed Transfer of Care (DTOC) performance and the implications of this for the health and social care system.

The reporting requirements for the DTOC had been placed under increased scrutiny by both the Local Government Association and NHS England, with greater emphasis on seeking an equitable split between delays due to health and social care. 

Activity across East and South Cheshire had seen the introduction and extension of a number of additional schemes which are starting to have an impact on the ability to deliver extremely challenging targets.

The Department of Health had been closely reviewing DTOC performance nationally, in order to benchmark those areas that were not making sufficient progress against agreed trajectories.

In October 2017 Cheshire East Council had received correspondence from Sajid David and Jeremey Hunt confirming that the Cheshire East DTOC performance was not within the 32 poorest performers nationally.  The data took into account performance up to and including August 2017, where Cheshire East had performed well against the trajectory. This would continue to be closely monitored so it was important that the local system maintained a focus on DTOC to ensure the best outcomes for patients and most effective use of resources.

RESOLVED:

That the Health and Wellbeing Board acknowledge:

1        the significant efforts made by those working in the health and social care system to achieve the current targets set within the challenging trajectory set by NHS England;

2        the work being undertaken as part of the ‘Delivering the Better Fund Plan in Cheshire East 2017-19’ Better Care Fund plan, which provides the overarching strategy for health and social care transformation, of which DTOC is one of the four nationally mandated metrics;

3        how the new approach to data management adopted by Cheshire East Council, NHS Eastern Cheshire and NHS South Cheshire CCGs has provided the pivotal shift in the interpretation and use of information to create accurate trajectories; and

4        the correspondence from Sajid David and Jeremy Hunt that Cheshire East is not within the group whose DTOC performance identifies them as the poorest performers nationally.

To consider a report on the direction of travel for the Health and Wellbeing Board, following discussion held at the informal meeting of the Board on the 27 June 2017

The Board considered a report on the direction of travel for the Health and Wellbeing Board.

The key finding from the 2017 Local Government Association report “The Power of Place” was that Health and Wellbeing Boards should undertake an annual self-assessment review to examine the progress that they had made and that this should focus on: place (i.e. linking wider determinants and health improvement); leadership; collaborative working and making the geography work. 

A workshop had been held at the June informal meeting of the Board and the report detailed the results of the discussions.

It was confirmed that the Executive Director of Place membership of the Board would be as a non-voting associate member.

RESOLVED:  That

1        the number of priorities be reduced in the refreshed Health and Wellbeing Strategy, identified by the Joint Strategic Needs Assessment;

2        Partners ensure that actions discussed at the Health and Wellbeing Board are followed up in each organisation – acknowledging that the Board has a strategic role and implementation occurs outside the Board;

3        links be strengthened with sub regional working via expanded membership to include the Cheshire East Executive Director of Place;

4        Stakeholder mapping be revisited to identify actions taking place across the Borough; and

5        the agenda of the Health and Wellbeing Board be expanded to include Place issues (e.g. Crewe Masterplan).

To consider a report on the newly introduced CQC Local System Reviews

The Board considered a report on the newly introduced Care Quality Commission (CQC) Local System Reviews.

The CQC was reviewing health and social care systems in 20 local areas to find out how services were working together to care for people aged 65 and older.  The reviews would include a review of commissioning across the interface of health and social care and an assessment of the governance in place for the management of resources and would focus on how services meet people’s needs and how care providers work together.

An example of the pre-Review questionnaire was attached to the Report.

The first twelve reviews were underway and would be completed by early 2018.  Eight more reviews would be conducted but the areas had not yet been identified.

Cheshire East Council and health partners had started to prepare plans in case a review into the Cheshire East Health and Care system was announced.

RESOLVED:

That the Board support the plans being developed to prepare for a Review.