The Board RESOLVED that the minutes of the meeting of the Health & Wellbeing Board (Croydon) on 10 December 2014 be agreed as an accurate record.

Apologies were received from Cllr Alisa Flemming, Dr Jane Fryer (NHS England), Steve Phaure (Croydon Voluntary Action) and Mark Justice (Croydon Charity Services Delivery Group). 

There were no disclosures of a pecuniary interest not already registered.

There was no urgent business.

There were no exempt items.

Stephen Warren (Director of Commissioning Designate, CCG) and Brenda Scanlan (Director of Adult Care Commissioning, Croydon Council) gave a presentation (attached):

• Improving quality of life for people with mental health needs
• Improving access to services
• Strengthening partnership working
• Integration of physical and mental health
• Shifting resources to the community to improve access
• Recognising role of the voluntary services

Issues raised:

• Frontline staff to be trained and fully aware of mental health needs
• 12 week wait to get access to service is a 'non service'.  IAP (increasing access to psychiatric services) services now 28 days for referral
• For general non-acute cases, referral takes 6-8 weeks.
• People with mental health problems have complex needs.  Need to ensure all parts of services work together - housing, finance and medical.  Caring for people as near to their needs as possible to reduce need for hospital beds.
• BME community - setting up of mental health steering groups but how large are they?  Survey of service users - does not appear to be much feedback or progress. 
• Tendency to over-medicate is a big issue, particularly amongst young black men. 
• Strategy is taking all issues into account.  How effective will steering groups be?

Responses:  Membership of Mental Health partnership includes voluntary sector, BME forum, Hear Us (consumer group) - clear overview of issues.  In the early stages, we need to look at how soon and effectively we can begin to see and get feedback of the differences. Stabilising of beds - ensuring we are not treating people outside of Croydon.  As we develop the community model, practical issues must be in forefront of our mind.

Key to invite up to 4 user groups for good engagement and feedback.

Important for CCG, Council and SLaM to be aligned.  Positioning now to begin early implementation. Need to hone action plan to ensure everything captured and to drive forward at pace we need to. 

People with mental health issues having other issues - this relates back to work being done by People department - put children's and adults' services together.  Proposal from April department will include housing need and welfare support.  Designing processes to put in place more joined up services.

• BME forum does not represent all the community.  Do you have breakdown of BME communities?  Need to know what part of BME being targeted.  How much of funding will go into stabilising services and how much into community?

Responses: BME forum covers faith groups, mainly Asian groups

We recognise BME does not cover all faiths, nor all communities.  It is important to stress why the strategy is important to all communities.  Breakdown - we do have the information and can interrogate it.  We use it as part of our planning.

Funding - £1.5m in community services.

• There are a lot of issues around dementia.

Update on Working Age Adults - about identifying and diagnosing people with dementia.  To support them, we need to move forward on dementia advisers and ensuring resources are in place.  There is an action plan and some actions are already being implemented. 

• We now have a reliance on the voluntary sector.  What is the evidence of how that is progressing?
• Every year we see strategies around mental health - this one is focusing on outcomes and trying to do something which makes a difference.  We hope to see benefits in a short space of time.  If GPs do not have access to mental health services, they end up seeing patients more often.  Involving patients with their own decisions makes access much easier.  We will see some real changes.  Firstly, we need to monitor quality.  Voluntary sector - this is a really good sector in Croydon providing psychological services.
• Appendix with actions about awareness raising - how do GPs refer and to whom?  It does not say it is available to all GPs. 
• GPs need timely up to date information.

Responses:  Under the Care Act, first class information is to be made available to all.  We need to make sure information is up to date and of value to everyone.

There is a street triage service - they telephone information quickly.  

The Board COMMENTED on the report and actions being taken to implement the strategy 2014-19.

Paula Swann gave a summary of the report with a presentation (attached).

Issues raised:

• Important document for commissioning - need to come back at a later date on commissioning for over 65s
• Concerns of locality accountability, demographic representation and speed

Responses: The strategy is about enabling services in Croydon to allow for successful implementation of the community alliance model so that GPs can support better outcomes for older people.

GPs are approaching this cautiously.  The pros and cons need to be weighed but doing nothing is noit an option.  The biggest challenge is communication with NHS England.

The Board NOTED the content of the report.

Alan Hiscutt (Head of Integrated Commissioning - Working Age Adults & Contracts Support, Croydon Council) and Paul Heynes (Head of Care Act Implementation, Croydon Council) highlighted the main points of the report with a presentation (attached):

• Care Act - 2 stages of implementation - April 2015 and April 2016
• New duties to provide information and advice
• Care Place - hosted on Council website - source of information particularly for self-funders
• Integration - Better Care Fund has opportunity to fund
• Higher threshold before people have to pay for their care

Issues raised:

• Concerned over iterative versions of report show reduced funding

The Board NOTED the content of the report.

Dr Mike Robinson explained the proposal to establish a Croydon Health Protection Forum.

• Health Protection is not an issue which is the responsibility of one agency

The Board RESOLVED to:

1. Agree to the development of a Health Protection Forum for Croydon, by the Director of Public Health
2. Establish a standing item for the Director of Public Health at  HWB meetings, on a quarterly basis, to facilitate regular update on health protection issues

(This item was taken before Croydon Health Protection Forum)

Jimmy Burke (Public Health Principal) highlighted the main points in the report:

• Reducing smoking prevalence will make significant impact on goals of health & wellbeing strategy
• Illicit tobacco - particular issue with young smokers

Issues raised:

• Shisha bar in Norbury - this issue has grown alarmingly.
• Shisha is becoming a real problem within the Asian community. There are 4 or 5 shops within the Norbury area. It affects mostly young people and is an expensive habit. We need an aggressive policy to inform in primary schools.
• Young people encouraged to get together in sheds - social aspect worrying.
• Some pharmacists 'peddle' e-cigarettes. There is concern about them. There has been a noticeable drop in people ceasing to smoke. We should not be condoning their use.

Responses:

Lambeth and Southwark taking up some ideas to counter the issue

Shisha contains more tar and more carbon monoxide, adulterants and contaminants than normal cigarettes.

At present there is no evidence that young people are taking up e-cigarettes wholesale but teachers are confiscating them and shisha pens regularly. It will become illegal to sell e-cigarettes to under-18s. We are working with schools to make sure the messages get out.

Licensing and Public Health are leading on the issue.

We are looking at possible initiatives to be taken in hospitals to help stop smoking.

We need to be more informed before we put too much out but we have spoken to local press about the paper so there will be some coverage.

We need to say there is no such thing as a safe drug addiction.

The Board RESOLVED to:

1. Agree to supporting and overseeing the continued development of a broad tobacco control approach and to see an action report at the next meeting (or, if not at the June meeting)
2. Agree that the Council should follow the lead of other councils and sign up to the Local Government Declaration on Tobacco Control as a demonstration of commitment to promoting the health, wellbeing and health equality of the local population

Ann Creighton: Written responses will be provided to 2 written questions received at the next meeting on 25 March. 

Anne Milstead:  Firstly, may put on public record, and thank Dr Mike Robinson for having the courage to admit that he did not engage with people in New Addington about the removal of contraceptive services. And I do not wish that to be seen as rubbing it in at all by making this comment.

Would that that honesty were more prevalent.

Paula Swann and the CCG have given a presentation today about commissioning and co-commissioning with South West London CCGs and NHS England.

The 2012 Health and Social Care Act says:

"the second duty places a requirement on CCGs and NHS England to ensure public involvement and consultation in commissioning processes and decisions i.e. planning of commissioning arrangements, which might include consideration of alteration of services, and needs assessments and and service specification".

And "CCGs must make arrangements to secure that individuals to whom the services are being or may be provided are involved:
one) in the planning of the commissioning arrangements
two) in the development and consideration by the group for changes in the commissioning arrangements".

My question therefore is in three parts:

1. the CCG has mentioned HealthWatch and Health and Well-being Board but where is the public involvement in the commissioning model?
2. Mr Ashtaq Arain has already this afternoon mentioned a lack of consultation with faith groups.
3. I have mentioned lack of engagement with public on numerous occasions but the answer I get is that rthe CCG is a "new organisation" but you have been operating for two years now, in shadow form before that and in the PCT before that, so that's no excuse, especially when this duty was also in the 2009 Legislation.

So when are commissioners in CCG and Local Authroity going to get the message and do public involvement properly?
 

Maggie Mansell:  Hope PPGs involved with GP practices.  All commissioners try to target specific user groups.  Healthwatch and PPGs should be involved in commissioning.

Agnelo Fernandes:  Made some start - not easy to engage everyone.  Started developing dialogue with GPs.  Whole host of other people.  Healthwatch invited to GP forums.  Always can be more engagement.  Either referendum on everything or else try to engage as many groups as possible.  Engagement about how to do it effectively.

Paula Swann:  Room for improvement.  Next governing body - have section on agenda about engagement.  Share much more widely.

Vanessa Hosford: Engagement - with whom and what about?  Healthwatch trying to get broader cross-section.

Peter Howard: Staffing at CUH - Do staff get protection if they put in a grievance against the management of the hospital?

John Goulston:  HR procedures enable any member of staff who has a grievance to raise it.  Standard procedure used by all NHS organisations.

Recruitment - vacancy rates were higher - all in public domain on website.  General rate is around 13% - average for NHS hospital or community trust in London.  Some departments have higher rate e.g. A&E around 20% vacancy rate. 

Maggie Mansell: Barrier to recruitment because Croydon is just outside barrier for London weighting.  Failure of workforce planning organisation of NHS to plan for needs.

Steve Morton summarised the report.

Mike Robinson explained that the Executive have reviewed membership.  It was proposed asking Dr Jane Fryer to join the group, because NHS England is a very important commissioner of services.

Councillor Maggie Mansell seconded the proposal and the Board agreed.

The Board RESOLVED to:

• Note risks identified at appendix 1
• Agree proposed changes to the board work plan set out at paragraph 3.4
   

Approval of Better Care Fund submission - a letter from NHS England and explanation of how the plans have met the conditions were distributed with the agenda and are attached.

The date of the next meeting is Wednesday 25 March at 2pm in the Council Chamber, Croydon Town Hall.