The Chair, Cllr Margaret Mead welcomed everyone to the meeting, including the guest speakers. The members of the Board introduced themselves.

The shadow board RESOLVED that the minutes of the meeting of the Health & Wellbeing Board (Croydon) on 24 April 2013 be agreed as an accurate record.

Apologies were received from John Goulston (Karen Breen deputising), Rob Atkin (Metropolitan Police), Annette Robson (Croydon College) and Aaron Watson (London Fire Brigade).

There were no disclosures of a pecuniary interest.

It was noted that not all voting Members had completed and returned their Register of Interests to the Monitoring Officer. This is a statutory requirement and failure to comply is designated as a criminal offence. Copies of the Register and the guidance for completion were made available at the meeting and had previously been sent to all voting members. The Chair urged full compliance with the legislation. Voting members are under a statutory obligation to declare any relevant interests at each meeting until they complete and return the Register. Members were also advised of the possibility of requesting a dispensation from the Ethics Committee.

There was no urgent business.

There were none.

Paula Swann gave a presentation explaining the case for change and strategy going forward.

The presentation can be viewed online: att2339.pdf

A discussion followed the presentation.

Issues and concerns raised by participants in the discussion included:

• Advice is vital but must be authoritative -requires staff training.
• 90% of contacts are with GPs: important to have a medical committee with which they can engage, to ensure good practice within GP practices.
• Need for health prevention advice, to work through existing community organisations
• Co-location of advice resources.
• Need for hospital providers all to think differently, including Council and Health & Wellbeing Board.
• Need to work together as a whole community.
• Every GP practice has a booklet but it is difficult to ensure they are kept updated.
• Most practices should a have website, which is easier to update.
• Balance in terms of focus - currently a lot of funding for early years
• Need to get the decision right, so patients are clear on on where to go
• Need to take 111 to next level - working as it should in London areas
• How will consultation on self-care reach out to the community?
• Most patients with long term conditions need support to manage their own care.
• Stop Smoking campaign - need to create more awareness

NHS England has responsibility for contracting with GPs and monitoring individual GP performance. Interesting debate going on about partnership developing - how we can work together to incentivise colleagues. The view is that promoting healthcare can be time-consuming, so it is important to introduce better practice. There is variable ability in primary care. A lot of work is going on with a focus on primary care in the future, in order to improve quality and include self-care aspects.

Stop Smoking - all GPs can provide nicotine replacement prescriptions. A range of pharmacists have the information. The Council are working to get it up on the website.

The Board, having considered opportunities for integration with other related strategies, programmes and services in Croydon, NOTED Croydon CCG's Prevention, Self Care and Shared Decision Making Strategy.

Bernadette Alves, Paul Young and Brenda Scanlan gave a brief summary of the report, which presented the revised two chapters presented in December 2012 on Schizophrenia and Depression:

• The Depression and Schizophrenia chapters are focused on adults. Because the Overview chapter also has a large adult focus, the findings and recommendations form the three chapters were considered together. There were over 90 recommendations across these chapters and many touch on similar themes and highlight common areas for development.
• Overview chapter brought together all the themes to make a more useful document - it identified 13 common issues.
• The adult mental health commissioners put together a response to the 13 themes. It identifies work already happening, some of the future plans being considered and describes some of the factors that will inform the prioritisation of the recommendations.
• The response recommends that commissioners develop a mental health strategy by January 2014, outlining actions and timescales over a three year period.
• The JSNA findings and recommendations will inform the commissioning intentions for 2014/15.
• All partners will be engaged in the process
• JSNA has provided rich intelligence on what health needs are in Croydon
• Mental health is an area of great challenge - much demand across London

The draft JSNA chapters can be viewed online (item 8): HWBPapers20130612

Issues and concerns raised by participants in the discussion included:

• Depression chapter - no definition of depression. Important to understand it is not just being miserable but a lack of resilience and inability to cope with everyday life.
• Depression chapter - section on carers is rather scant.
• Royal College of GPs stated that a % of carers suffer mental health problems - mainly depression.
• Opportunity for GPs to have carers' registers.
• Schizophrenia section - those from a poorer background have poorer access.
• In some communities, there is avoidance of recognising mental health issues.
• Need to get out to communities and talk about mental wellbeing and signs which should drive people to ask for help.
• Important for Cognitive Behavioural Therapy (CBT) to be available - can be helpful and cost effective
• Personalisation is an important issue.
• Education, fitness - access to facilities can improve lifestyle.
• BME changes highlight the importance of taking notice about access to services as the population changes.
• The provision of mental health services is not meeting the needs of the population.
• Mental and physical health - key is not to separate them. There is a 10 year less life-expectancy for those with mental health issues.
• GP workload leads to time constraints - need longer consultations for those with mental health issues.

3% of people with depression access CBT but the government target is15%.
There is a statutory duty to involve carers. This will be developed as part of commissioning in Croydon - actions around developing needs and supporting older adults with mental health problems.
How CBT can be used to support older people in hospital with depression is also being considered.

The Board RESOLVED to:

1. Consider the full schizophrenia and depression chapters, approve the documents in principle and delegate final approval of any further amendments to the responsible directors.
2. Note the summary themes and composite recommendations arising from the overview, depression and schizophrenia chapters
3. Comment on the response of the joint adult mental health commissioners to the summary themes and composite recommendations
4. Endorse the recommendations of the mental health JSNA and the commissioner's response

Jenny Hacker highlighted significant points in the report, which outlined the topic priorities for the next year, following the best ever response with 21 topic proposals, covering 16 different areas.

Croydon's approach to the JSNA has been to combine an annual key dataset and overview of health and wellbeing in Croydon, with a smaller number of key topic areas, where a more in-depth needs analysis can be performed.

A robust and transparent prioritisation process has been developed by the JSNA steering group and was utilised once more this year. The process involves the allocation of scores to each proposal, awarded for agreed criteria.

Issues and concerns raised by participants in the discussion included:

• In terms of prevention of domestic violence and homelessness, what role do health professionals have?
• Homelessness is critical - it is becoming a moral problem.
• Domestic violence has come to the top of the council agenda. This year the number of incidents increased significantly.
• At the heart of both issues are the children - their life chances - schooling, mental health, child protection.
• Do we have data around homelessness of offenders?
• % of alcohol abuse in offenders is significantly high - important to focus on developments in prevention.
• Alcoholism covers a lot of people in homelessness groups. Is there a strategy to deal with this section of the community?
• Mental health issues often go with alcoholism - dual diagnosis needed.
• Homelessness - Young people stay with different friends - how can they be identified?
• Homelessness - For single men, being jobless is often the driver which causes the break up of relationships.
• For single people, it is a comfort to have a dog - and protection - but private landlords will not accept pets.
• Council housing allows pets but does not house single men, unless vulnerable.
• Measles issue is urgent - what has happened to regular regular reports on immunisations and infectious diseases?

There is a forum on homelessness and rough sleeping.

The Board AGREED to support the following approach to the 2013/14 JSNA:

1. Key dataset to be combined with explanatory commentary to form an overview chapter
2. At least two deep dive chapters to be completed, on homelessness and domestic violence
3. Three additional chapters to be considered on the following topics, for either needs assessment or refresh following scoping of existing work completed:
   alcohol, obesity (to include physical activity) and heart health.
4. Named commissioners allocated to each JSNA chapter

plus the extra proposal of scoping the work suggested in 1.3 in order to assess whether it should be the subject of a JSNA or another type of review. A further report will be brought to the Board in September.

(Agenda Item 10)

Dr Agnelo Fernandes and Charlotte Joll (Programme Director, BSBV) gave a presentation outlining proposed changes and what they will mean for health services in Croydon and patients and the public.

• Better Services, Better Value (BSBV) is the project to reform hospital and out of hospital services provided in South West London and Epsom.
• Local doctors and nurses support the need for change and recommend that services should be configures and, in some cases, centralised. The recommendations seek to provide better outcomes for the population, whilst ensuring that services are clinically safe, sustainable and affordable.
• There are 3 options - (1) preferred, (2) alternative option and (3) least preferred option.
• One of the options, (3), will impact significantly on services delivered at Croydon Hospital services.
• Consultation for 14 weeks from July to September 2013

The presentation can be viewed online: att2348.pdf

Issues and concerns raised by participants in the discussion included:

• If elective surgery goes to Epsom, will Croydon still have A&E and maternity?
• Children's services - wherever treated, should be to highest standards as previously.
• Croydon under-funded for decades.
• Difference between A&E and urgent?

The third major acute hospital is Croydon, or the lesser preferred option is St Helier.
Urgent care is a range of non life-threatening conditions which can be managed by other professionals. A&E is for emergencies.

The Board NOTED the contents of the report.

(Agenda Item 11)

Dr Mike Robinson summarised the salient points of the report, which aims to draw attention to how local residents can take more responsibility for their health. It is one of a number of documents, including the Joint Strategic Needs Assessment (JSNA), which informs Croydon's joint health and well-being strategy for 2012-15.

• Independent report on health in Croydon
• Purpose to demonstrate how people in Croydon can take responsibility for their own health and how council services can help to support this
• Designed for a wide readership
• Ideas requested for disseminating the report

Issues and concerns raised by participants in the discussion included:

• Regret what is missing. We rely on data historically contained in the report and Croydon Observatory does not handle it in the same way.
• This is a really accessible document for ordinary people to understand.

The Board NOTED the contents of the report.

(Agenda Item 12 taken earlier)

Paul Young gave a presentation, illuminating the report about the delivery plan and its complexities:

• Hospital at home services and children's services are included in home support
• Looking at co-ordinating with care in the community.
• Fewer personnel but productivity levels are higher.
• Information governance - data sharing - may involve amending legislation and this is a big impediment to integration.
• Need to consider non-clinical side of community care. Case studies talk about self-advocacy - clinical side is only a part of the whole picture. Impact on health & wellbeing of good quality non-clinical support is so important.
• With multi-disciplinary teams it is necessary to see the whole person.

The presentation can be viewed online: att2351.pdf

The Board NOTED the contents of the report and presentation.

Steve Morton (Head of Health & Wellbeing) gave a brief summary of the report which set out proposals for the standing partnership groups which in future will either be accountable, or report, to the health and wellbeing board, following a review of partnership groups by the executive group and consultation with those groups affected by the proposals.

Issues and concerns raised by participants in the discussion included:

• Regular feedback needs to be expanded more - HWB should have a way of shaping their agenda.
• Groups want their comments to be taken on board by HWB
• Need to bring back some of the focus of the old Healthy Croydon partnership

The Board AGREED the configuration of standing partnership groups reporting to the health and wellbeing board as set out in paragraphs 3.14 to 3.22 in the report.

The following questions were raised by members of the public:

Q: Request to see greater inclusion of other groups on HWB. Croydon residents - north & east - will rely on Kings College and other major hospitals in central London; south - other hospitals. BSBV report - will HWB also insist on consultation with neighbouring CCGs?
R: SW London and Surrey CCG group will automatically include views of all surrounding areas. CCG consultation process. The feedback will be presented to the HWB.

Q: When will you get your websites up to date. Took 18 minutes to find calendar for this meeting. Website is shop window. NHS England just as bad. Cannot find out information easily. CCG has wrong link to HWB Croydon.
R: Useful feedback. Will take suggestion on board. We need to be better at communication.

Q: 1 in 3 women experience violence in their life, including in childhood. This has an impact on their mental health. What is HWB's strategy for supporting Rape Crisis in Croydon.
R: Some of the issues will be looked at in the new JSNA on Domestic Violence. Sexual violence is part of domestic violence.

Q: Sexual violence is much wider than just in the home.
R: We will make sure one of the public health consultants gets in touch.

Steve Morton gave an overview of the work plan for 2013-14.

• Received large number of suggestions from members of the Board
• These will be considered by the Executive Group

The Board AGREED the Work Plan.

All future meetings will be held in public, at 2pm in the council chamber, on Wednesdays:
11 September 2013
23 October 2013
4 December 2013