Agenda and minutes

Consideration was given to the appointment of a Chairman to the Board.

RESOLVED

That Cllr Michael Jones be appointed as Chairman.

Consideration was given to the appointment of a Vice-chairman to the Board.

RESOLVED

That Dr Andrew Wilson be appointed as Vice-chairman.

(Dr Wilson took the chair).

Apologies for absence were received from Cllr Michael Jones, Dr Paul Bowen and Tracy Bullock.

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 GPs Alliance Ltd.

To approve the minutes as a correct record.

RESOLVED

That the minute be approved as a correct record

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.

There were no members of the public present wishing to use public speaking time.

To receive a presentation relating to the Complex Dependency Programme.

Ali Stathers Tracey, Programme Director, attended the meeting and gave a presentation in respect of the Complex Dependency Programme.

£5m had been awarded, in December 2014, from the Department of Communities and Local Government (DCLG) for the programme. The vision was to establish a ground-breaking multi-agency approach to tackling issues of complex dependency for children, families and vulnerable adults across Warrington, Cheshire West and Chester, Halton and Cheshire East. The cohort would be drawn from, adults and children involved in crime or anti-social behaviour, children who had problems at school, children who needed help, adults out of work or at risk of financial exclusion, individuals and families affected by domestic violence and abuse, individuals with a range of (non-age related) health problems and young people affected by homelessness/rough sleeping.

It was felt that the system, as a whole, was not working and was characterised by multiple assessments, with many key workers and multiple data systems, fragmented accountability and ownership of the problem, a gap in the space between service users and crisis services, leading to a lack of suitable provision to meet complex needs, with a focus on individuals, without considering their social/family context and a lack of capacity to redesign the system, due to day-to-day pressures.

There had been two sub-regional partnership workshops and a single vision had been agreed, together with governance arrangements,  performance outcomes, links between the sub Programme Board, Programme Team and localities, a detailed delivery plan and commissioned programme coordination arrangements with each Local Authority.

The vision was for a better customer experience, with a single point of contact, a single plan, a single lead worker and system, with a more empowering approach that would enable agencies to tackle the root causes involved in complex needs. The Model was for an “Integrated Front Door”, with a defined route into services, with a single point of access and triage. It was proposed to have a dedicated multi-agency team, co-located and coordinated by single line management, with agreed protocols and pathways and links with a wide range of partner agencies. It was proposed to invest in interventions with a proven track record of reducing demand on crisis services and that there be a local directory of services and support that could be accessed by case work staff. Commissioners would co-produce and design new service specifications with health, education and social care providers to align support against the likely demand

Following the presentation, members of the Board raised a number of questions and comments. It was considered that it would be important to be clear on the scope of the programme and who it would support and that it was important that it did not repeat the work undertaken through the Children and Young People and Caring Together and Connecting Care programmes.  Further discussions should take place to ensure appropriate alignment and connectivity.

To consider the recommendations in respect of the Children and Young People’s Improvement Plan (to meet the OFSTED recommendations).

Consideration was given to a report updating the Board on the proposed action plan to address the recommendations and areas for improvement identified by Ofsted in its inspection report of Children’s Services, published in September 2015.

The Health and Wellbeing Board had a statutory responsibility to improve the health and wellbeing of the children, young people and their families in Cheshire East, reduce health inequalities and promote the integration of services. It was important that the Board was appraised of the strengths and areas for improvement within Children’s Services and was assured that arrangements were in place to develop, implement and scrutinise plans that met the areas for improvement, as described in the improvement plan, set out at appendix 1 of the report. An action plan was also set out at appendix 2 of the report.

Members of the Board raised a number of comments and questions and it was requested that the Improvement Plan and Improvement Action Plan be linked together, to enable monitoring. It was noted that this would be picked up as part of the governance consideration. It was also felt that there needed to be clarity around the governance arrangements, particularly below the Health and Wellbeing Board, as to accountability and who the various bodies were accountable to. It was noted that there needed to be a development plan for the HWBB, to enable it to take on the new role. The Health and Adult Social Care and Children and Families Overview and Scrutiny Committees would have a joint role in scrutinising the improvement plan and it was suggested that both bodies may wish to come together to do this.

It was agreed that the governance arrangements should be discussed at a future informal meeting of the Board and considered at a future public meeting of the Board.

RESOLVED

1.    That the contents of the report, the draft improvement plan at Appendix 1 and the Action Plan at Appendix 2 of the report be noted.

2.      That, subject to the above comments, the arrangements for submitting the plan to the Department for Education and Ofsted in December 2015 be endorsed.

To consider the Caring Together/Connecting Care Transformation Programmes progress updates and future timelines.

Consideration was given to two reports providing an update in respect of the Caring Together and Connecting Care Transformation Programmes, including future timelines.

With regard to the Caring Together report, it was reported that Eastern Cheshire was taking a system wide approach to address the challenges of caring for the fastest ageing population in the North West of England, within the available resources. The Caring Together vision of “joining up local care for all our wellbeing” was the first step of bringing together local people and professionals to co-design a new approach to care which had empowering people at its heart. At the centre of the programme was the co-development of eight ambitions, supported by a Caring Together Outcomes Framework, uniquely focussed on a new type of integrated care model. The development of the framework was the first step on the journey towards commissioning for outcomes. Core to the Caring Together Programme was the introduction of an integrated care system, which was depicted in Diagram 1 of the Caring Together report.

The report provided an update on recent progress within the programme, focussing specifically on two workstreams: Community Based Co-ordinated Care and Primary Care. It also provided an update on the recent changes to the governance structure for the programme.

With regard to the Connecting Care report, it was reported that the Connecting Care Programme existed to realise a different future for public and staff delivering health and social care. That future was one in which people were supported to maintain and improve their health and well being and one where services were integrated and seamlessly designed around people. The Connecting Care Board (CCB) had responsibility for the Connecting Care Strategy and it was the responsibility of the Senior Responsible Officer (SRO) group to implement this and report progress to the CCB. This report served to update on progress since March 2015 and focused on six main developments: Connecting care ‘reason for being’, Transformation delivery, Connecting Care programme workstreams, Connecting Care configuration and other update issues.

RESOLVED

That an update report be submitted to a future meeting of the Board, when the Implementation Plan was available and that consideration be given to which plans needed to be revisited at a future informal meeting of the Board.

To consider a report requesting the Board to sign-off the JSNA policies for testing.

Consideration was given to a report, requesting the Board sign off the Joint Strategic Needs Assessment (JSNA) Policies. It was reported that the JSNA informed the identification of Health and Wellbeing Strategy priorities. The proposed approach for creating and updating the JSNA would support the development of associated plans and their monitoring and evaluation.

           At the Health and Wellbeing Board meeting on 28^th April 2015, it had been agreed that, as part of the JSNA presentation, three JSNA policies would be brought back to the Board. The Board was now asked to endorse testing the implementation of these policies, namely :-

·         JSNA work programme development

·         JSNA content production -partnership working and community involvement

·         JSNA governance

RESOLVED

That the testing of the above policies be endorsed.

Verbal Update.

Dr Andrew Wilson provided an update in respect of the Health and Wellbeing Strategy. The Health and Wellbeing Strategy Steering Group  had been asked to refresh the current Strategy, which would come to an end in March 2016.

The Steering Group had discussed the geographical footprint that the Strategy should cover and whilst it was clear that this  was a strategy for the Health and Wellbeing Board footprint, the group had asked whether this would always be the case, in a changing world. There were considered to be two major areas which needed to be addressed: what was the health and wellbeing need for the system in terms of resilience and flexibility and, taking a place based approach, what could not be done and where more needed to be done, in terms of need. The group had set 10-15 key indicators and the agenda had been driven by the strategy.

The next meeting of the Steering Group was due to take place on 10 December and it was proposed to consider what the public, staff and leaders considered needed to be in the strategy. It had not been felt necessary to speak to the staff and public again, but to collate the information that had already been taken.

There was to be a separate workstream for the leadership consultation and the evidence of need in this area and it was agreed that that this issue should be included on the agenda for a future informal meeting of the Board. It was also suggested that consideration be given as to whether the horizon scanning work should be done at the next informal meeting.

Following the update, members of the Board raised a number of questions and commented that, as the strategy was updated, the work done on the Peer Review and workshop needed to be borne in mind and that 10-15 key indicators seemed rather a lot and that 2-4 might be more appropriate.

RESOLVED

That the update be noted.

   To consider the recommendations in respect of the Joint Commissioning Leadership Team Review.

Consideration was given to a report concerning the recommendations from the Joint Commissioning Leadership Team (JCLT), which had been formally created in April 2013, with a shared purpose of collaboratively commissioning and reviewing services across Cheshire East.

A number of drivers had led to the need to review the form and function of JCLT, both as a joint commissioning group and in relation to overseeing the progress of the  Better Care Fund (BCF). . The review had involved a series of small groups or individual conversations with strategic partners, to gather the views and experiences and, most importantly, to identify what collective commissioners believed needed to be in place to support integrated service delivery and commissioning for the future.

The review work had commenced in July and concluded in mid August. The report had been shared with the JCLT / BCF group, at its September 2015 meeting and this has informed the final report of the group to the Health and Wellbeing Board. There had been a number of key areas of agreement and one lack of agreement had been identified with regard to the challenge around the geography and what footprint should be operated to. It had been agreed that a number of recommendations should be made to the Board. Details of these are set out below:-

i)       Acknowledge the findings of the review as highlighted above.

ii)     Advise on the future expectations of JCLT.

iii)    In the interim, consider delegating authority for developing joint commissioning governance to key members of HWB (namely CCG Chief Executives, Directors of Adults’ and Children’s Social Services and the Director of Public Health).

iv)    Approve BCF governance being withdrawn from JCLT and managed via a discrete sub-group comprising finance and commissioning leads from the CCGs and CEC. This group will provide assurance and monitoring prior to formal reports going to HWB for approval. Reports to JCLT will be by exception.

v)     Approve the draft Terms of Reference for both JCLT and BCF Governance Group (see Appendices 1 and 2 respectively).

           In considering the recommendations, the Board agreed that it would be better to withdraw the BCF governance from the JCLT. However, it was not felt that the Terms of Reference should be approved at this stage and that work should continue under the existing arrangements and that the Terms of Reference be considered at a future meeting, early in the new year, if required.  It would be necessary to discuss the governance arrangements, including collaborative governance and to consider at what point there needed to be a report back to Cabinet.

           It was suggested that it may be appropriate to look at geographical/footprint issues in the commissioning approach and to link this to the horizon scanning work, in order to address this.

          RESOLVED

1.    That the findings of the review as highlighted in the report be acknowledged.

2.    That, in the interim, authority for developing joint commissioning governance be delegated to key members of HWB (namely CCG Chief Executives, Directors of Adults’ and  ...  view the full minutes text for item 40.

To consider the recommendations in respect of the Local Transformation

 Plans for Children and Young People’s Mental Health and Wellbeing.

                           (Copies of the documents embedded in the Plans are available on request, by contacting the officer listed on the front of the agenda).

  Consideration was given to a report regarding the requirement to develop a Local Transformation Plan for Children and Young People’s Mental Health and Wellbeing, in order to access additional funding that was available to the Clinical Commissioning Groups (CCGs) to support the delivery of this plan.

The report presented the plans, proposed ongoing development and raised issues about the implementation of these plans. They are intentionally very similar.

The plans required sign-off by a representative of the Health and Wellbeing Board and, as agreed, at the September meeting of the Board, Cllr Janet Clowes, as Chairman, had provided the sign-off and the Plans had been submitted.

South Cheshire CCG and Eastern Cheshire CCG had both received letters from NHS England on 9^th November, asking them to review two specific elements around eating disorder services and engagement and partnership. However, these elements were considered easy to adjust and therefore, the CCG would receive their allocated transformation funding in the November allocation.

It was recommended that the Health and Wellbeing Board note the two plans that have been successfully assured.

RESOLVED

1.    That it be noted that the two plans that have been submitted.

2.    That the ambition and future development of the plans be considered at a future meeting of the Board, and that the further development and implementation of the plans be delegated to the Children and Young People’s Joint Commissioning Group.

          To consider and sign off the NHS England 2015/16 BCF Quarter 2 performance report, so that the NHS England reporting deadline of midday on 27^th November 2015 can be met.

                Consideration was given to a report providing an overview of 2015/16 Better Care Fund(BCF) Quarter 2 performance.

               The Health and Wellbeing Board was responsible for the strategic oversight of the Better Care Fund plan and had significant influence in supporting partnership working across health and social care. The report provided the Board with an update on the progress and implementation of schemes and the expected outcomes and provided assurance to the Board on the delivery of the Cheshire East BCF plan and the BCF national conditions

                NHS England would issue standard reports that would fulfil both local and national reporting obligations against the key requirements and conditions of the BCF Fund. The standard reports aimed to fulfil both the quarterly reporting and annual reporting requirements, to monitor the totality of the BCF at Health and Wellbeing Board level.

                NHS England would be expecting quarterly updates on the progress of the                BCF and the Board was required to review and sign off of these quarterly returns in line with the published timescales.

               RESOLVED

               That the NHS England 2015/16 Quarter 2 performance report be signed off, so that the NHS England reporting deadline of midday on 27^th November 2015 can be met.

Thanks were expressed by the Board Members to Cllr Janet Clowes for her chairmanship and contribution to the work of the Board over the past years.