The Board RESOLVED that the minutes of the meeting of the Health & Wellbeing Board (Croydon) on 10 June 2015 be agreed as an accurate record.

Apologies were received from Councillor Alisa Flemming, Kim Bennett, Dr Agnelo Fernandes, Dr Jane Fryer, Steve Phaure and Stuart Routledge.

There were no disclosures of pecuniary interest not already declared and published on the website.

The Agenda order was changed due to the Director of Public Health, Dr Mike Robinson, being at a meeting in London, so discussion items 4 and 5 were moved to the end of the meeting, before Public Questions.

Stephen Warren and Brenda Scanlan gave a presentation (attached):

• Overall aim of strategy is to improve the experience for those at the end of their life.
• Co-ordination of best quality services

This was followed by round table discussions, where the Board members split into 3 groups, each to discuss 2 different aspects of the strategy.

Table 1:

1. Make talk of death & dying normal
2. Identify all people nearing the end of life

Table 2:

1. Effective care planning
2. Care in the last days of life

Table 3:

1. Involve and support family and friends
2. Develop competencies of the workforce

The following questions were considered in relation to the specific areas discussed by each table:

Q1: Are there any gaps in the implementation plan?

• Make sure we have looked at needs of communities with different cultural and spiritual needs

• Marketing of 'Coordinating my care' eg by vox pops - dying well 
• Ensure equality impact assessment is completed

Q2: What can we do better?

• Build on the information we have around different systems that providers are using and utilise the data more effectively for families and carers
• Expand training programmes for GPs, etc so they can hold 'difficult' conversations about dying
• Are those dying in hospital within the hard to reach groups? How many hospital deaths could have occurred in another location?
• Financial sustainability - how can this be integrated?

Q3: What are the risks/issues to consider?

• Expand education and training for GPs, nurses and care home staff to ensure protection for families and carers possibly using peer support mechanism
• How can people with very complex care needs be supported at home - is this aspiration realistic/affordable?

Q4: Any other ideas for implementing the goals?

• Ensure services are comprehensive eg increase to seven days a week where appropriate across different care services

Dr Mike Robinson gave a presentation (attached):

• Independent report Director of Public Health has to produce - no set style
• Duty of Council to publish it
• This year's theme was health inequalities in Croydon

There was some discussion about which plans have short term and long term impacts. The issue of being able to interrogate individual ward statistics was also debated, to enable better targeting for interventions.

This was followed by round table discussions, where the Board members split into 3 groups.
 

Q1: Which of the future health plans should the HWB champion?

• Mental health issues -desire for the board to become more involved in championing intervention, demedicalisation and sustainability of resources to tackle the broader issue of mental health
• Walking and physical activity - lack of oversight
• Social isolation (mental health)

Q2: What is missing from the next steps?

• Picking up mental health issues earlier
• Parenting (tackled through Best Start)
• Evidence base for interventions to track cycles of deprivation

Q3: What would Board members like to see in the 2016 annual report?

• Smoking and mental health; alcohol and mental health; obesity and mental health
• Targeting of resources and outcomes to different areas/groups
• Mental health and other issues such as substance misuse
• Some exploration of the targeting of resources and improving outcomes in relation to specific groups of people. How factors such as locality and the people who live there interact

The Board NOTED the Annual Report of the Director of Public Health.

There was no urgent business.

There were no exempt items.

Cllr Yvette Hopley proposed Margaret Mead for Vice-Chair and the Board voted – all in favour.

The proposal for a 2nd Vice-Chair will be put to the next meeting, as the decision has to go to council first.

Cllr Yvette Hopley proposed the 2nd Vice-Chair to be from the CCG and this was seconded by the whole of the Board.

(This item was postponed until after item 11)

Dr Mike Robinson summarised the report which looked at recommendations from the JSNA group. Any comments should be sent to Steve Morton or Dr Mike Robinson.

Dr Mike Robinson asked that the report on selection of JSNA topics be deferred. This was agreed by the board.

Paula Swann gave a brief summary. Stephen Warren and Sam Taylor (Head of Integrated Commissioning & Partnership) clarified the main points:

• Represents opportunity for local system of emotional wellbeing for children and young people for investment into SLaM specialist service to increase access and meet demand.
• £700,000 potential additional funds
• Seeking to address range of services
• Moving to single point of access for specialist mental health support

The following issues were raised:

• Number of children with ASD looks to rise - based on what and why is it rising?

Sam Taylor: Local stats indicate referrals for diagnosis are higher than general London rates. It is a key element of the strategy. We will carry out detailed statistics to find out the underlying reasons.
John Goulston: 3 children were in Croydon University Hospital recently - the A&E department is not the right environment for children. The system needs to be transformed.

• Important that all schools doing best to address emotional issues. Training of staff vital. The pinchpoint is assessment. The waiting time for assessment is too long.
• Hard to tackle range of problems. Report welcomed. Children are waiting for beds not available. It is a serious London and national issue.

Sam Taylor: Content of report is at a deliberately high level. One of the recommendations is to enable local areas to sign up to tight timescales. There will be a further opportunity for members of the Board to consider the detail. Arrangements in Croydon are different to those in other SLaM boroughs. Can we in Croydon adopt a more on-site liaison in-house team? There will be a cost for the service to extend hours to 9 or 10pm but we need stronger out of hours response. National pathways have been developed for this type of referral.
Pinchpoint around assessments - we do not have clear pathways into the tier 3 system. Key priority is to identify what is that pathway. We are piloting the development of a schools offer - combination of whole school approach - training offer for workforce development. There is a need to clarify counselling of individuals.

• Analysis of ethnicity in terms of the breakdown?
• Diversity of population in Croydon increasing - approach cannot be ‘one size fits all'. Of interest to broader voluntary sector.
• Breakdown of diversity - disappointed not there already. Important - historically there has been a lack of concern over mental health service provision particularly to the BME community

Sam Taylor: Tier 4 beds and A&E breaches are due to unavailability of beds. Working towards improving the situation but it still remains an intrinsic issue. 2013-14 - there was a detailed piece of work in terms of deep dive, in relation to demography of local need. (Get link from Sam - should be on previous meeting)
Best Start is looking at the 0-5years population. Recruiting voluntary sector support. A broader piece of work is going through the Council corporately. Information, advice and guidance are important.
Paula Swann: Funding is only available for 3 years.

• If transformation plan yet to be prepared - will it be circulated to Board members first?

The Board agreed the recommendations and commitment to Board members that the plan will be emailed when prepared in October.

The Health and Wellbeing Board RESOLVED to:

1. Note the national process for the development of Local Transformation Plans and the short timescales for their agreement and submission.
2. In line with the national guidance, to delegate the Health and Wellbeing Board's sign off of the Local Transformation Plan to the Lead Member for children and young people, Chair of the Board, the statutory Director of Children's Services and the Director of Public Health.
3. Note that any proposed pathway changes will be discussed and considered with the CCG's Clinical Leadership Group on the 4th September 2015.
4. Note the high-level timetable for the development of the Plan.

The Board noted the Risk Summary and thanked Paul Greenhalgh for the report.

The Board RESOLVED to agree changes to the board work plan set out in paragraph 3.8.

The following question had been received from at the previous meeting and the following response was prepared and read out:

Question:
We have been considering the impact of the Care Act 2014 for the customers we serve who are homeless and have complex and multiple needs. They were previously dismissed (by and large) as FACS ineligible under the old system. The average life expectancy for someone sleeping rough is 40.5 years - therefore under the new regulations, their complex needs (physical health, mental health) have a significant impact on their wellbeing. Please can you tell us how social services is changing to move away from the FACS system and eligible/ineligible groups and how we can now refer rough sleepers with complex and multiple needs forward for a full assessment?'

Debra Ives
Head of Central and Community Services
South London YMCA

Response:
If someone presents to the council and is vulnerable and has housing needs, the first priority is to help them to access suitable accommodation, whether that be a hostel, B&B or another type of accommodation. We would also expect the vulnerable person to be referred to the Adult Social Care Duty Team. We would carry out an assessment of anyone who appears to require care and support, regardless of their likely eligibility for state-funded care and use the new national minimum threshold to judge eligibility for publicly funded care and support. We would also consider other things besides care services that can contribute to the desired outcomes (e.g. preventive services, community support). The person would have a right to be given the appropriate advice and information and signposting to relevant agencies - for example MIND; substance misuse providers, the IAPTS service - according to their needs. We would also help them register with a GP or make a referral to our gateway services for access to welfare benefits, employment advice etc. We also fund a homeless outreach worker who is based with our A&E liaison social work team at Croydon University Hospital. This post picks up cases in A&E or on the wards of homeless people who are living in temporary accommodation or who are rough sleepers.

N.B.  Referral of rough sleepers for social care assessment can be made through the intake team referral.team2@croydon.gov.uk. YMCA colleagues have access to this referral route, as do Croydon Reach, our commissioned service for outreach and the resettlement of rough sleepers.

Pratima Solanki
Director of adult care services
Croydon Council

The response to another question from Peter Doye, which was submitted at the 25 March meeting, was omitted from the minutes for the 9 June meeting:

The Question and Response will be read out at the next meeting on 21 October 2015.