The Board RESOLVED that the minutes of the meeting of the Health & Wellbeing Board (Croydon) on 16 July 2014 be agreed as an accurate record.

Apologies were received from Stuart Routledge (Croydon Charity Services Delivery Group), Dr Jane Fryer (Medical Director for South London, NHS England), Steve Phaure (Croydon Voluntary Action) - substituted by Sarah Burns - and Adam Kerr (National Probation Service - London).

There were no disclosures of interest at this meeting.

Better Care Fund

The reason for urgency:
This report had not been published in advance and it was explained that the reason for urgency was due to the short deadlines for submission given by the Department of Health.

Following a national review of Better Care Fund Plans, ministers decided that further assurance of all plans with respect to the reducing demand on acute services was required. To this effect, new templates for the Better Care Fund were issued on 25 July 2014 with a submission date of 19 September.

Andrew Maskell (Strategic Projects Manager, Personal Support), gave a presentation on the Better Care Fund, a national initiative which aims to drive forward the integration of services, recognising the importance of social care, in order to reduce the demand for overstretched hospital services .He highlighted the very tight deadlines and the complex process involved. He added that Croydon's existing plan had not been changed, but that officers had been tasked with submitting the plan with a far more detailed template.

It was observed that challenges to be faced included the lack of information sharing and integrated IT systems and in particular the hurdles in the way of sharing information between primary and secondary care services.
 

The Board RESOLVED to:

1. To accept the report as an urgent item
2. Note the progress made in completing the revised templates for the Croydon Council and Croydon CCG Better Care Fund Plan 2014-16 (draft) in readiness for submission to NHS England by 19 September
3. Agree that for the reasons detailed in para.7, the Executive Director of Adult Services Health and Housing and the CCG Chief Operating Officer, in consultation with the Chair of the Health and Wellbeing Board, be delegated authority to approve the final Croydon Better Care Fund Plan 2014-16 for submission to NHS England by 19 September 2014.
    

There were no exempt items.

The Annual Report was introduced by Hannah Miller, Executive Director of Adult Services, Health & Housing, who conveyed the apologies of the Chair of the Adult Safeguarding Board, Jane Lawson. The Board were advised that this annual report had been signed off by the Adult Safeguarding Board, and was to be shared with Cabinet and Scrutiny.

The number of safeguarding investigations was highlighted. In total, there were 1406 safeguarding concerns raised in 2013/14, of which 882 progressed to a full safeguarding investigation (up from 858 investigations in 2012/2013).

The Board discussed the remaining inequalities in terms of reports of safeguarding concerns. It was suggested that some BME groups may still be unaware of how best to report such concerns or may be embarrassed to divulge such sensitive information to outsiders. The Board was advised that work had been conducted with the BME forum to ascertain the views of Croydon residents from ethnic minorities and use these to draw up an action plan to encourage more reporting of safeguarding risks within these communities.

The need to take the expectations, hopes and wishes of vulnerable adults was emphasised. The Board heard of the work around ‘Making Safeguarding Personal', including arranging safeguarding meetings at the adult's home when this is the preferred choice and seeking feedback at the end of the safeguarding process to check that a positive change has been brought to the circumstances of the adult at risk.

It was observed that the detailed case studies in the annual report were very useful In particular; the lessons learnt from these would be used to improve systems to protect vulnerable individuals from risk. Officers also pointed to a recent "challenge" event, from which a number of lessons had been learnt, to be published and used in future training.

The Board RESOLVED to note the report.

The Annual Report was introduced by the Executive Director for Children, Families and Learning, Paul Greenhalgh. He reported that it had been externally evaluated, with very positive feedback.

The Board noted the significant challenge presented by the growth in the numbers of children at risk and unaccompanied asylum seeking children.

The Board discussed children at risk of sexual exploitation in the borough, in the light of the recent Independent Inquiry into
Child Sexual Exploitation in Rotherham (1997 - 2013). The Executive Director for Children, Families and Learning informed the Board that a report had been commissioned for the 14 October meeting of the Children and Young People Scrutiny Sub-Committee and would also be discussed at full Council on Monday 6 October. The Board were also reminded that the Local Safeguarding Children Board had a Child sexual exploitation and missing children sub group, and that training was due to take place to equip all relevant stakeholders to tackle relevant risks and offences robustly.

Concerns were reported to the Board regarding GP access to children and the difficulties of raising concerns under the current system. Officers stated that this had been raised before and that it was important for this issue to be resolved.

The new Chair of the Board, Catherine Doran, highlighted the considerable challenge presented by the rising number of children at risk, compounded by staff retention issues in the borough. She added that a review of the MASH was about to be commissioned to examine its effectiveness.

The Board discussed training needs to ensure effective safeguarding in the borough. It was advised that 1000 staff had recently received training through workshops, and that a learning and development trainer had been appointed to meet training needs in children's services. Members enquired whether they could also receive training on the safeguarding of children and young people, which was warmly welcomed by officers. The Board were advised that council members' training on safeguarding issues was under discussion with Democratic Services officers with a view to arranging appropriate learning and development events.

The Board discussed unaccompanied asylum seeking children and young people. They were advised that there were approximately 450 children under the care of Croydon and that this was a growing trend.

Officers explained that the Safeguarding Board was working hard with the Home Office on suspected and confirmed cases of missing children, accurate age assessments being a particular issue. It was noted that the Home Office had good links with their counterparts in Albania, where many of Croydon's unaccompanied minors come from.

Members of the Board complained that people were not fully briefed on how to report an illegal asylum seeker, one problem being confusion over whether to contact adult or children's services. This comment was welcomed and the Board was advised that efforts were being made to ensure that the Adult and Children's Safeguarding Boards worked together to iron out any unnecessary overlaps and duplication of services, and that efforts were being made to work with families rather than individuals to provide more holistic solutions. Executive Directors undertook to provide relevant contact details and advice on how to make such reports.

The Board RESOLVED to note the report.

There were no public questions.

Steve Morton, Head of Health and Wellbeing, highlighted changes to the Board work plan. In addition, he reported that risk ref. LSPHC0008 had been downgraded after a number of controls had been put into place, and drew attention to the fact that 61% of control measures had been implemented, not 1% as shown on page 32 of the agenda.

The Board heard that the Executive Group had met on 10 September and put forward the recommendation that its membership should include the Chair and Vice-Chair of the Health and Wellbeing Board, and that these arrangements should be reviewed after 6 months.

The Board RESOLVED to:
- agree the above recommendation.
- note risks identified at appendix 2
- note changes to the board work plan set out in paragraphs 3.7 and 3.8

Richard Pacitti (MIND in Croydon) introduced the findings of a survey of the views of 118 people who had been using mental health day services in Croydon since 2009. He drew the Board's attention to the following key findings:
- A third of people said that their mental health and quality of life had got worse since 2009
- Nearly 40% said their physical health and quality of life were worse
- Nearly 60% of respondents said that they had been admitted to hospital (both physical and psychiatric) more frequently.

It was noted that in some cases, a mental health service user would visit their GP as a result of the stress brought on by financial worries, and then be referred to the South London and Maudsley NHS Foundation Trust to address the stress, rather than to an agency which could provide advice on money matters and resolve the causes of their stress.

The Board heard that the findings of the survey had been shared with the CCG, with whom variations to service contracts were negotiated in an 18 month pilot scheme, including the following:
- weekend opening
- a simplified referral process for services

Baseline data for service users was kept and progress was measured during the 18 month pilot. At the end of it, only one person had had a brief hospital admission.

The findings of the survey and 18 month pilot lead to the production of 4 recommendations to commissioners, focusing on good partnership work to ascertain service users' needs and using them to fine-tune services. It was highlighted that the type of service sought by mental health service users was not of an acute nature, but rather, support with run-of -the-mill aspects of life, such as advice on money matters and welfare benefit applications, which were common causes of stress, and providing opportunities for social contacts, as social isolation was known to be a major cause of poor physical and mental health.

It was suggested that the findings of the survey and pilot could be gathered into an action plan to provide support to mental health service users, and that they could be drawn on by many of the members of the board when agreeing their commissioning intentions. It was also felt that the erstwhile benefits forum should be restarted and that specialist mental health training should be provided to advisers as it was known that about 65% of people using mental health services did not get the welfare benefits they were entitled to, in some cases because they were unable to initiate or manage their welfare benefit applications.

The Board RESOLVED to note the report.

The Board noted with regret that three agenda items earmarked for the 11 September Board meeting had not been ready in time for the meeting. They looked forward to seeing these items on a forthcoming agenda.

The next meeting of the Health and Wellbeing Board will be on Wednesday 22 October at 2pm in the Council Chamber, Croydon Town Hall.