The Board RESOLVED that the minutes of the meeting of the Health & Wellbeing Board (Croydon) on 25 March 2015 be agreed as an accurate record.

Apologies were received from Councillor Alisa Flemming, Dr Mike Robinson, Dr Jane Fryer, John Goulston (Jayne Black attended as his deputy), Steve Davidson (Fran Bristow attended as his deputy), Stuart Routledge (Keith Bill attended as his deputy), Dr Agnelo Fernandes, Charlie Ladyman, Steve Phaure and Kim Bennett.

Cllr Maggie Mansell announced that, due to changes to the Constitution  being agreed , it was proposed that the AGM and election of Chair and Vice-Chair be deferred to the September meeting. This was agreed.

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

There was no urgent business.

There were no exempt items.

Jimmy Burke (Public Health Principal) summarised the report:

• 500 deaths a year from tobacco-related causes
• About reducing smoking prevalence
• Croydon is a member of Smoke-Free London
• Over 80 LAs have signed up to the Tobacco Control initiative

Issues raised:

• Concern about e-cigarettes
• Training provided has, in the past, not focused on psychology and motivation
• Importance of more advanced training
• Higher risk of glaucoma in smokers
• Need to raise awareness and encourage young people not to start smoking.

Jimmy Burke mentioned that it is hoped that young people will lead the programme.

The Board RESOLVED to agree that Croydon Council become a signatory to the Local Government Declaration on Tobacco Control.

The Leader of the Council, Councillor Tony Newman, attended the meeting to sign the declaration and Board members were photographed to commemorate the event.

Paul Greenhalgh introduced the report.  Brenda Scanlan (Director, Integrated Commissioning Unit & Adult Care Commissioning) summarised the key priority areas for the current year.

Issues raised were:

• Reference to immunisation in the report but no deadline dates or performance standards mentioned in the milestones
• Some of the milestones do not have a date

Response:  We will make sure crucial milestones are included with dates.  The appendix referred to in report is a work programme which is in development.  It is being kept under observation by the ICU executive board.

• How closely are you working with policies.....????

Response:Best Start has a strong foundation in Croydon.  From the autumn, the local authority will become responsible for commissioning ??? 5 year services.  When that happens, how services are commissioned together will be looked at in order to ensure they are all aligned.  We will ensure that Best Start is delivered well.

•  Need to indicate which working group is driving the work forward

Response:  We must make sure people know how they can contribute.  The document is to make sure that the work is on track.  For the public facing part, we will make sure that there is detail so others know which groups are involved.

• Can domestic violence be made more explicit within commissioning?

Response: It is an express commissioning responsibility.  Many of the commissioning services will have elements of domestic violence within them.

The next Croydon Conference meeting will focus on domestic violence.

The Board NOTED the contents of the report.

Paul Greenhalgh introduced the report, which was to give Board assurance of the work the Council is doing.  Amanda Tuke (Head of children's integrated commission) and Marie Hardeman (Business Support Manager) elaborated on some of the details. 

Issues raised were:

• Poverty can exacerbate ordinary everyday problems people have - affects concentration and subsequently attainment
• 20,000 children under 16 in Croydon are in poverty - 20% of all children in Croydon
• Need to encourage residents to utilise online services
• Opportunity for creating Mobile phone apps?
• Support from banks
• Can schools set up meetings with parents where someone can explain about family finance?
• Rates of child poverty are rising in Croydon
• How are services marketed?

Responses:  £200,000 pa towards maximising the customer link.  Households in debt - £24,000 collected by working with families and consolidating debts.  14% want support to get into work.

My Croydon account is a website tool which can be accessed via mobile phone.

Engagement from banks has been extremely positive.  Some people have post office accounts. 

We are supporting people to enable them to use accounts properly.  

The Pupil Premium plays an important part in enabling the redress of some inequalities. 

There will be a Cabinet report in the autumn on how to encourage other employers to use flexible working.

The services are being piloted at the moment, to learn about what level of support is needed.  This will be promoted and communication will be expanded when the services are rolled out.

The Board NOTED the report.

Paul Greenhalgh introduced the report.  David Morris (Housing Strategy Manager) and Leonard Asamoah (Director of Housing Need) gave a brief summary.

• JSNA goes into increase - types of households which are swept into homelessness
• Focuses in on households in emergency housing and how it affects their health and wellbeing
• How contact maintained with GP and other services
• Stresses on children and how they affect educational performance
• Work around increasing supply of accommodation
• How to improve engagement and improve condition
• Looking to offer more information

Issues raised were:

• How are you engaging with destitute communities?
• How many of initiatives coming on stream in future to mitigate issues of households including children?
• People need to understand that emergency treatment in A&E is available to anyone, free
• There is an expanding community of people who do not want to register through the system for various reasons
• Housing need as temporary accommodation is increasing
• More people moving out of central London, as well as asylum seekers, putting greater stress on the provision of necessary services

Responses:  We engage with over 100 destitute families and support them to access accommodation and work.

For those who fall outside the usual channels, we are commissioning other agencies to offer additional support. 

The Council is aware of the needs of people with difficult status.  We have a robust system for working closely with a range of voluntary organisations, identifying where people are and building support.  While people are in uncertain status, we have in place a system to work with them to mitigate the worst impact and to help them find support within their own community until their situation is resolved.

We ensure households including children are looked after and they are referred to the proper support agencies.  We are building improved accommodation for families including children and improvements in their environment.

The Board NOTED and ENDORSED the recommendations set out in the needs assessment.

Paul Greenhalgh introduced the report.  Sarah Nicholls (Public Health Consultant) gave an overview.

Issues raised were:

• Weightwatchers were commissioned to provide a weight loss service to adults but the service needs to be more joined up
• Missed opportunity of being able to refer overweight people via pharmacies
• Lack of a peer pathway into pharmaceutical services
• Need to increase take up of health checks
• Obese children are a concern, with a high % in Year 6
• People do not realise the thin line between obesity and normal weight
• Young carers are a concern - need to form a direct link

Responses: Referrals can be made by GPs and other health professionals.  We want to get pharmacies to provide another referral route.  

The Board ENDORSED the Healthy Weight action plan (2015 - 2017).

Paul Greenhalgh introduced the report.

• To give Board assurance that work being done.
• Ensure agencies aware of their responsibilities in regard to people who may be deprived of their liberty

Kay Murray briefly summarised:

• Sourced additional doctors to undertake assessments - Section 12 doctors
• Developed lists of doctors who can carry out this work
• Started training programme for social workers in-house
• Delivered training to managing authorities

Issues raised were:

• Croydon has large number of residential and nursing homes - have they all been contacted?
• Contact with people outside of care homes

Responses: Written information has been sent to all.  A number of care forums have been well attended - 85 homes represented at each forum. Where managing authorities are unsure, a lot of individual work is done with care homes.

We work in hospitals to build awareness with clinical and medical staff.  We need to produce more leaflets to distribute.  The debate is for all to raise awareness.

We have additional safeguarding in the CCG.

The Board NOTED the content of the report and AGREED to take steps to ensure that all health and social care agencies affected by this ruling are aware of their responsibilities to people who lack capacity and who may be deprived of their liberty.

Dr Ellen Schwartz (Consultant in Public Health) introduced the report.

• Key priorities around sexual health in Croydon

Issues raised were:

• For some people it is inappropriate to contact through some services
• HIV - higher rates in Croydon due to its demography - need for a target to improve awareness - it is treatable, manageable and it is best to be checked

Responses: We are aware of the need to redesign health engagement; putting targeted services in the community, starting with young people and then more vulnerable ones.

There is a mixed variety of providers.  Pharmacies in the borough provide more sexual health services in only 10 units than the whole of the rest of the borough.

The Board RESOLVED to:

1. Endorse the local priorities identified for sexual health in Croydon set out at para.3.4.1 and 3.4.2;
2. Note the principles for the re-design of sexual health services commissioned by Croydon Council set out at para.3.4.3;
3. Discuss opportunities for collaborative working between health and wellbeing board member organisations to improve sexual and reproductive health outcomes in Croydon.

Paula Swann introduced the report.  Sean Morgan gave a brief update on the actions taking place.

• Aim to change the culture
• Ensure staff aware they need to consider patients' needs
• Staff performance reviewed regularly

Issues raised were:

• Difficulty of recruitment - Standards of staff ratios and qualifications increased, leading to a reduction in availability of nursing staff
• Workforce planning currently done on a regional basis - need for 'growing our own' rather than 'robbing' staff from elsewhere
• Black staff are under-represented in recruitment and promotion, so there is less opportunity for them to receive higher level training.

Responses:  There is a bigger focus on recruitment retention and the right standard of staff.  It is a key issue which is on the risk register.

We will take this concern back.  There is a high number of BME people using services.  There is a particular problem of staffing in Croydon because it does not attract inner London weighting.  There are more posts to fill but we have additional funding.

We have changed the stance on recruitment.  We are making Croydon a place where staff want to come and train and stay.  For medical staff there are a number of issues, particularly around the middle grade - but this is a national problem. 

The Board NOTED the update on the Francis report and the local work being carried forward.

Bernadette Alves (Consultant in Public Health) highlighted the main issues in the report.

Issues raised were:

• It is an ongoing social concern - alcoholism is a disease but people have to accept they have a problem
• About education and information. 
• Opportunity to use people who have overcome their problem to give support to other sufferers.
• Physical change in body and also psychological but cannot deal with the latter until drinking issues are overcome.

The Board NOTED and ENDORSED the recommendations set out in the needs assessment.

Peter Doye asked about the zero tolerance policy towards bullying within NHS staff.

Croydon Health Services:  It is about people understanding.   If the issue comes to a staff survey, it is taken forward and there is a whistle-blowing procedure.  There are small numbers of cases but they are taken seriously.  There is an annual survey and we do cross checks on a quarterly basis.

South London and Maudsley:  We have similar procedure.  There is staff counselling.

Cllr Maggie Mansell:  The best prevention is a supportive culture, which comes from the top.

(See Appendix for responses to questions from 25 March meeting.)

Paul Greenhalgh summarised the report.

The Board RESOLVED to:

• Note risks identified at appendix 1
• Agree changes to the board work plan set out in paragraph 3.4
• Consider the report at appendix 3 identifying performance against key indicators for board priorities set out in the joint health and wellbeing strategy

The Carers Report and Heart Town Annual Report were attached to the agenda for information. 

The next meeting will be on Wednesday 9 September at 2pm.  (NOTE VENUE CHANGE: Croydon Conference Centre, Surrey Street, Croydon)