The Chair, Cllr Margaret Mead, welcomed two new members:
David Lindridge (the new borough commander, London Fire Brigade), replacing Aaron Watson, and Cllr Jane Avis, replacing Cllr Mark Watson.

Apologies were received from Lissa Moore (London Probation Trust), Steve Davidson (SLaM), Paul Greenhalgh and Andrew McCoig (substituted by Beran Patel, Vice-Chair of LPC).

Roger Oliver also sent apologies. He is standing down as Croydon Voluntary Sector Alliance - carer position.  The Board wished to minute their thanks for his contribution both on the Shadow and statutory Health & Wellbeing Board.

The Board RESOLVED that the REVISED minutes of the meeting of the Health & Wellbeing Board (Croydon) on 11 September 2013 be agreed as an accurate record,

There were no disclosures of a pecuniary interest at this meeting.

There was no urgent business.

There were no exempt items.

A presentation was given by Dave Morris (Housing Strategy Manager).

The following questions and issues were raised by Board members:

• There was a case of a man who died of hypothermia - very distressing - the bungalow where he was living was boarded up. Issue of hard to let properties - difficult to solving problems when we know other issues/policies are working in opposition.
• Sheltered housing block - to be turned into general housing - but older residents are distressed, anxious & worried about their future. We seem to solve one problem and create another.
• Government policy over time - not enough houses built.
• Ongoing policies - no longer any security of tenure in social housing. Impacts on vulnerable.
• Sofa surfers - young people are getting into a cycle of alcoholism and homelessness.
• Queens Gardens rebuild - important access to services provided.
• Hostels have violence and mental health issues - some people do not want to go there. People who become homeless often do not have resilience. How long are people in temporary accommodation?

Response: Will provide figures.

• Single men with problems of alcoholism and rough sleeping. What support is there likely to be? Why and how do people become homeless?

Response: Council provides housing related support for a range of people. A recent project supported rough sleepers to get off the streets. Young people - very successful STOP service. There are dedicated outreach services to rough sleepers. We capture quite a lot of reasons - young people moving out of parents' home, breakup of marriage etc.

• Boarded up properties - turnaround time for releasing properties is better for Croydon compared with other councils. Beds in sheds - we do not want people living in sub-standard accomm. Can get in and get them out but where do they go? Trafficked people - some people in beds in sheds - would be denied elsewhere. How many do we find?

Responses: We do not have these details. Partnership with UK ?? Fund recently assisting in dealing with these issues. Funding for peer mentoring project - private renting access scheme. Self referral scheme. If eligible can make referral.
We suspect we are only scratching surface on trafficking. Discover people and put through national referral system. There are facilities for dealing with children. For adults - Salvation Army has a government contract to provide housing. People with no access to public funds are dealt with through Border Agency. If vulnerable, the council must accommodate.  For those with mental health issues, we are accommodating them.

• There is an agency working with young people up to 25 - duty of care is good.  For 19-24 year olds in dispute with parents etc we do provide mediation. Do you have statistics on that age range?  They seem to be falling between the gaps.

Response: 16-17 year olds are priority but 19-24 are not. Unless vulnerable, they fall into the single homeless group. As part of the review we will try to find out more about them.

• JSNA deep dive and strategy - how do they fit? Timewise does it make sense?

Response: In terms of major services, yes. It is difficult to stop everything and have services which start and finish at the same time. Subsequent commissioning would be influenced by the JSNA and strategy.

• Do not believe figures quoted reflect what is being seen in the voluntary sector. When you do research, will you talk to voluntary sector for evidence?

Response: It is not just left up to the council. Do estimate based on information from Salvation Army, SNTs etc - a big range of groups. Figures are verified by homeless needs. We are close to doing the estimate for 2013. 2012 was 22.

• Will the report look at houses of multiple occupation?  There is a quality issue in relation to health.

Response:  Part of the proposal is to update information and we will be doing that.

• GPs echo views about underestimated data.  Part of the issue is related to people moving around - difficult to follow up, cannot monitor and provide good health.  People come out of prison with pre-existing mental conditions and have nowhere to live,. How much liaison with the prison health service do we have?

Responses: There is a protocol in place.  As part of the review, we need to revisit this to ensure it is working properly.
We are not complacent. Bulk of those types of household are living in council stock. We are inspecting B&B accommodation much more regularly and aiming to use temporary accommodation which is up to standard. Recently the council has purchased properties for this.

• Is there a heat map of Croydon so we can identify the concentration of homelessness?

Response: With this project, we will have time to do the JSNA and prepare a homelessness strategy based on it.

• What are the drivers of why homeless people target Croydon? Police find big issues using….service - 2/300 people Friday/Saturday???

Response: Engagement with outreach - we try to work with agencies that provide services to try to move people out of Croydon. It will be useful to find out more about single homeless people.

The Board RESOLVED to:

1. support and participate in the JSNA deep dive chapter on homeless households in TA in 2013/14 and to support the activity to implement its recommendations;
2. support the council's on-going work to increase supply of accommodation for homeless households, and provide support to these households in achieving sustainable solutions.;
3. participate in the review of homelessness and the development of a new homelessness strategy for Croydon in 2014 including priorities around early intervention/prevention, closer co-operation/joint working, and developing joint training and development for staff in health and housing services;
4. participate in (where required) and support the engagement and assertive outreach strategy for destitute Central and Eastern European squatters and local rough sleepers including sending out a clear message that a destitute lifestyle will not be supported in Croydon and enforcement activity will be taken where necessary.

Jenny Hacker (Consultant in Public Health) gave a brief summary of the report.

The following questions and issues were raised by Board members:

• Diabetes is such an important issue - there is a large cohort in Croydon.
• Dental health - do we not need to monitor the outcomes? A large number of patients are in the private sector.
• Immunisation - should we not be picking up at 11-14yrs those who missed MMR vaccination originally?

Responses: We can check and will circulate information to Board members.

Diabetes - there are 6 different indicators.
Over last year there has been a drive to offer MMR to children under 16yrs where it is known they have not been immunised.
Reminders were sent to parents.
There is a real challenge here to update the information.  There is still a large number of people who do not get the vaccination despite reminders.

• In a recent Health Scrutiny meeting there was a lot of criticism - only 47% of looked after children are up to date with immunisations.

Response:  There is more than one source of information about looked after children.  The bigger picture is that things are getting better.  Immunisations - we need to investigate why it is so difficult to get them done in Croydon.

• In detecting cancer, Croydon is slightly lower when compared to London and the UK -  but the whole of the UK is poor. What does good look like?

Responses: Director for children has an imminent top level meeting to look into the issue of immunisation of children.

This is not a new issue and it is getting worse. We need to know why - how can we tackle it differently?
There is a Health & Social Care Scrutiny meeting in November which will be focusing on the issue.
  

The Board RESOLVED to:

1. provide approval for the 2013/14 JSNA Key Dataset Appendix 2 allowing this to be disseminated to stakeholders in a timely fashion.
2. note those indicators highlighted by this report as improving and those that are deteriorating relative to the rest of England, along with others ways of utilising the breadth of information in this dataset.
3. utilise the findings from the overall dataset in their ongoing work to oversee health and well-being in Croydon.

Steve Morton (head of health & wellbeing)  explained about the Heart Town Programme.

The following  points were raised by Board members:

• Officers are keeping schools informed.
• It is important that this is partnership initiative. Paper coming to Cabinet next month. We want to reflect the totality of what different partners are doing across the borough.
• We need notices with a logo to say where the nearest resuscitation equipment is.
• The CCG welcomes this initiative. Heart disease is one of the key priorities in Croydon. We have a significant project.
• It is all about the prevention element, redesigning the system. Cardiology services - ECG in every GP practice, services in community, more holistic approach. Part of transformation already in place. Redesigning diabetes services - looking at it much more holistically.
• Other issues will be improved with the programme in place.

• The CVA has resuscitation equipment in every location. We support the report and plans to extend the initiative. The Board and its partners need to consider how to embed more voluntary action. People are more likely to take up good practice if they are surrounded by others who do it already.  There is a lot of grass roots level activity which we should stimulate more.
• The voluntary sector can help with promoting information about food in schools.

Response: There is a programme of events and we can incorporate this.  We are planning events and seeking organisations and individuals to register - go through networks to encourage more volunteering.

• What can we do to start the ball rolling in supporting people in self-care?
• there was a ‘Team Life Check' programme, where young people took part in schools. It was an outstanding success but disappeared overnight. Is there are replacement or could it be reactivated?

Responses:  There is short term funding for pilots. We will refer it to consultants in Public Health.  There are a number of applications about health which can be downloaded onto smart phones. 

• Croydon University Hospital heart failure team is concerned about fast food outlets in Croydon.
• One of biggest concerns is about the number of fast food outlets. Can HWB talk to Planning?
• There is concern about the fat used in fast food outlets being toxic. Government needs to legislate.

Response: There is an initiative to get outlets to offer healthy options.  Some fats are good - we need to assess.
 

• The council invests in tobacco and smoking impacts on cardiovascular disease.

Response: The Pension Fund managers have been asked to find alternatives but they must produce the same revenue. It will take time.
 

The Board RESOLVED to:

1.  Endorse the strategic partnership approach to improving heart health in the borough;
2. Support the use of the Heart Town brand to connect a range of existing and new initiatives, encompassing the promotion of healthy eating, sport and physical activity, stop smoking and tobacco control;
3. Support the extension of Croydon's Heart Town programme from two to five years to enable the programme to demonstrate measurable improvements in health and wellbeing.

Martin Ellender (Head of Strategy & Performance, SCPP)  summarised and explained the report.

The issues raised by Board members included:

•  Why were there no reminders sent out about the 'flu jan?  People are having to wait 6 wks to get to their surgery.

Dr Fryer: This is down to local GPs.
 

• There has been confusion about whether the 'flu jab is acceptable for muslims.

Dr Fryer: This has been raised nationally. Information is being circulated that it is acceptable for muslims.
 

• How can we claim achievements of the Board?   We need to communicate them to others.

Response:  The Board will take every opportunity to promote its work through local media - performance of the Health & Wellbeing Board is mentioned in the annual report of the Director of Public Health.

The Board RESOLVED to note the performance trends highlighted within this report and agree further action as appropriate.

3 written questions were submitted by members of the public in advance and were read out. A fourth question was handed in at the meeting.

The questions are attached with the responses.

Two further questions were put at the meeting:
Anne Milstead: Regarding exercise, I congratulate Croydon for its efforts but more work could be done on using the exercise referral scheme. People are not being referred. There needs to be more joining up with people who run the scheme and GPs. People get referred and go for 12 wks but there is no follow up. It needs more monitoring. Some people do not realise how their size has expanded. We need more information about healthy eating. Is there some way it can be joined up with the exercise scheme, using patient participation groups?

Dr Mike Robinson: The exercise referral scheme allows participants to have 12 weeks of subsidised use of a gym. Research indicates that once people have been going for 12 weeks, the habit is established and most people will continue. It is not a medical matter. Everyone should take responsibility for themselves. Walking is a most excellent form of healthy exercise.
Cllr Mead: There are a number of open air gyms, which are free.

Peter Doye: Regarding mental health and homelessness, please can you give some clarification about the 98% of homeless households which have somewhere to live: Is there any gender breakdown and what number of people are involved in homeless households?

Hannah Miller: We can provide that information. Many homeless households are single mothers with one or two children. (See attached appendix)

Dr Mike Robinson highlighted that once a year there is an opportunity for any voluntary sector organisations or members of the public to make a case for a given topic to be prioritised for a deep dive.

Steve Morton (Head of Health & Wellbeing)  gave an update on the Work Plan.

The Board RESOLVED to agree the changes to the Work Plan, as set out in paragraph 3.2 of the report.

This was an extra 'for information' report.

The following links and reports were provided for information:

4 December 2013
12 February 2014
26 March 2014