The Board RESOLVED that the minutes of the meeting of the Health & Wellbeing Board (Croydon) on 9 September 2015 be agreed as an accurate record.

The outstanding response to Peter Doye's question from March was read out at the meeting (see Public Questions at A65/15).

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

BETTER CARE FUND UPDATE

This report had not been circulated in time and the Chair proposed it be taken as an urgent item. The reason for urgency is that The Health and Wellbeing Board agreed the Better Care Fund plan on 11 September 2014. Good governance requires annual reporting of progress against the Better Care Fund plan to the board.

The Board agreed to accept it as an urgent item.

Stephen Warren gave a summary of the report and the mitigations put in place for transforming the adult care service.

The Better Care Fund (BCF) is a national initiative which introduced the potential for a shared budget between Clinical Commissioning Groups (CCG) and Local Authorities, providing an opportunity to transform local services. People will be provided care and support. through better integration between health and social care. It will provide a whole system approach, improving patient outcomes through investing in community based services, reducing demand on acute services. The BCF enables local authorities and CCGs to focus on both physical and mental health needs in their BCF plans.

In 2014/15, the programme contributed savings of £2.2m towards the £11.0m Quality, Innovation, Productivity and Prevention (QIPP) efficiency savings achieved by Croydon CCG.

The following issues were raised by the Board:

• Request for an indication of timescale for schemes to be in place
• Need to ensure information is available for nursing and care homes through the Care Homes Forum meetings
• Young people with mental health issues: Some are ending up in A&E. A robust package is needed to get them referred to CAMHS services
• CAMHS: need for referral waiting times to be reduced and noted that this is being addressed in the CAMHS Transformation Plan

The Board NOTED progress in implementing the Better Care Plan and mitigations on performance identified in Section 6.1 of the report

There were no exempt items.

JSNA KEY DATASET 2015/16

(This item was taken at the end of the meeting.)

Lisa Colledge (Public Health Intelligence Analyst) gave a presentation (see attached).

The summary of the JSNA Key Dataset highlights areas where Croydon's performance relative to the rest of England is better/improving over time or worse/deteriorating over time.

The areas where Croydon is described as performing well include: breastfeeding, smoking during pregnancy, road casualties, chlamydia screening coverage, hip fracture care and smoking quitters, liver disease, life expectancy, households on local authority housing waiting lists, avoidable hospital admissions, healthcare associated infection.

Where performance is described as a challenge include: childhood immunisations, school attainment at age 11, youth offending, use of tobacco products other than cigarettes and e-cigarettes at age 15, mental health admissions for children, sexual and reproductive health, pneumococcal vaccination coverage for older people, injuries due to falls in older people, cycling, breast screening, people who have received an NHS health check, homelessness, diagnosis rate for dementia, patient reported outcomes for hip replacement and knee replacement, proportion of people dying at home, violence.

Croydon's population also has high or increasing need relative to other areas in the following: child poverty, looked after children, children with autism, population growth and turnover.

Round table discussions followed the presentation. The issues considered were:

• Are there needs or issues identified in this year's key dataset to which the Board should give greater attention over the coming year?
• Are there issues or needs that you believe are important but which are not highlighted in the report?

Issues raised:

• Shisha bars - potential harm for young people
• Teenage pregnancy
• Croydon has higher prevalence of people with HIV due to demographics in the borough
• Challenges around vaccination data
• Children and young people - autism, rise in domestic & sexual violence, outcome based commissioning up to 19 years
• Youth Hub - to deal with all issues eg so that GUM Clinic is not so visible or Broad Hub - comprising primary care, community services, voluntary sector or use of different access points for sexual health services
• Health Checks - issue of GP data not being available to public health a big issue. Targeting the younger age range is a priority (ie 40+)
• Mental health - pattern of some people being detained on a regular basis
  
   

Main points fed back from each table regarding issues needing greater attention:

• Wellbeing of children - focus on immunisation and sexual health
• Difference of Croydon from other boroughs with more violence and youth re-offending
• Mental health - more data required around how many people are detained under the Mental Health Act and how many times these people have not been secured appropriately
• Emotional wellbeing (domestic/sexual violence) - accessing/signposting children and victims earlier
• Location of sexual health clinics - further discussion required

Issues not addressed in the report:

• Drop in Key stage 2 attainment
• Validation of data, particularly for adverse indicators
• More up to date population turnover data
• *Shisha awareness - more communication required on potential harm and if possible, more stringent planning/licensing policies

(*Shisha smoking - also called hookah, narghile, waterpipe, or hubble bubble smoking - is a way of smoking tobacco, sometimes mixed with fruit or molasses sugar, through a bowl and hose or tube.)

ANNUAL REPORTS OF THE SAFEGUARDING ADULTS AND SAFEGUARDING CHILDREN'S BOARDS

The safeguarding annual reports are submitted by the respective independent chairs of the Safeguarding Boards, to ensure that the Council and other agencies are given objective feedback on the effectiveness of local arrangements for safeguarding children and adults. The annual reports also include the Business Plans for 2015/16. The key priorities for the Boards for the current year were summarised by Paul Greenhalgh (Executive Director of People):

Children's Report:

• Improved data and reporting
• Child Sexual Exploitation - improved working
• Improved joint working with police
• Development of strand on FGM (female genital mutilation) - particularly on awareness
• Next steps:
  • Continuing to work with departments towards contribution partners make
  • Strengthening links across partnerships

Adults Report:

• Implementation of Care Act requirements
  • Making care personal
  • Reducing fire risk in homes
  • Improved quality assurance

The following comments were made:

• Increase in Safeguarding reporting from BME communities
• The new independent chair - Catherine Doran - has done a huge amount of work around child sexual exploitation
• Important to have these reports to ensure communication between HWB and the safeguarding boards 

The Board NOTED the effectiveness of the Boards in ensuring the safeguarding of children, young people and adults in Croydon.

(This item was taken before the Safeguarding item.)

Autism is a "catch all" term and has a wide spectrum on which a person can be diagnosed. Ranging from classic autism at one end to Asperger's syndrome at the other the needs and abilities vary on an individual, case by case basis. 

The report set out Croydon's strategy for meeting the needs of adults in with autistic spectrum conditions, by improving the provision for such adults by Croydon Council and local health services.

Simon Wadsworth, Strategic Projects Manager, summarised the report.

It was noted that Cllr Andrew Rendle has brought a tremendous amount of passion as Autism Champion. He was unable to attend due to illness.
 

The following issues were raised:

• Diagnosis seems quite low.

In response, it was stated that, according to the NAS (National Autistic Society), the prevalence is about 1 in 100. Recent work indicates 1 in 50. Now there is better diagnosis and greater awareness. Short and long term service - local authorities are now required to collect data regarding diagnosis - not able to accept self diagnosis. Some people engage with the service but have not been formally diagnosed. About 30% of adults with learning disability have an autism diagnosis.

• Many adults with communication difficulties get agitated in social situations. It is important to have frontline service where staff aware of issues so they can manage accordingly.   

In response, it was stated that there are capital funds from the Department of Health, to develop an e-learning platform. It will be available to anyone living in the borough and should be up and running by April 2016.

The Board NOTED the report.

1. The financial context in which the Act and national autism strategy is set;
2. The commissioning approach to local implementation of the national autism strategy;
3. The partnership approach to the local implementation of the national autism strategy.

A number of strategic risks were identified by the board at a seminar on 1 August 2013. The board agreed that the executive group would keep these risks under review on its behalf. A summary of risks is in Appendix 1. 

The Board agreed a work plan for 2015/16 at its meeting on 10 June 2015. The board work plan is regularly reviewed and updated by the executive group and the chair. The most recent version of the board work plan is in Appendix 2.

There were no questions raised on this report.
 

The Board:

• NOTED the risks identified in Appendix 1
• AGREED the proposed changes to the Board Work Plan set out at paragraph 3.6

Mrs Maureen Levy raised the following question:

• Is Urgent Care Reprocurement being part of consultations on CCG proposals? Also, is the Board aware of the 8 Purley RAs' 6A scenario proposals in addition to the 8 put forward by the CCG, who seem to be pushing for 4 or 6? 6A proposal is supported by Chris Philp MP, Steve O'Connell, GLA Member, and Councillors.

RESPONSE

The CCG is about to undertake a reprocurement of urgent care services.. Further engagement will be undertaken over December – and January, with a final decision being made at the February CCG GB. Option 6A put forward by the resident’s associations had been included in the scenarios and will be modelled along with the existing scenarios reflected in the Reprocurement Strategy. 

Below is a question from Peter Doye, which was submitted at the March meeting:

QUESTION
The HSJ on 24 March 2015 referred to funds handed to local authorities for NHS complaints advocacy services not necessarily being used for this purpose. What is the Croydon situation in relation to this issue?

RESPONSE
A consortium of local authorities of which Croydon is a member have a contract for the provision of NHS advocacy services which is provided by Voiceability. The contract is monitored monthly through provision of reports from the provider as well as monthly meetings with the provider.

The contract value reflects the funds received by the local authority when responsibility transferred to councils from the NHS.

Details of the funding received and allocated by Croydon Council were provided to Healthwatch England in a response to a Freedom of Information Request and can be found in their report which prompted the article in the Health Service Journal.

The full report is at www.healthwatch.co.uk/news/patchy-complaints-support-putting-vulnerable-people-risk
 

As it was his last meeting before leaving South London & Maudsley NHS Foundation Trust, the Board thanked Steve Davidson for his contribution over the years since the Shadow Health & Wellbeing Board was set up in December 2011.

It was also noted that Marie Brown, who represented Croydon College, has left.