The minutes of the meeting held on 21st October 2015 were agreed as an accurate record, after the following additions and corrections were made:

• As it was his last meeting before leaving South London & Maudsley NHS Foundation Trust, the Board thanked Steve Davidson for his contribution.
• It was noted that Marie Brown, who represented Croydon College, has left.
• Stephen Warren represented the CCG at the meeting
• Ashtaq Arain sent apologies which had been omitted

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

There was no urgent business.

There were no exempt items.

The CCG's commissioning intentions set out in the main the continuation of current plans, which deliver local priorities such as those set out in the Health and Well Being Strategy as wells as South West London, London and national priorities.

The Strategic Commissioning report focused on the high level commissioning intentions of the Local Authority for 2016/17. Aligned with the CCG's commissioning intentions these translate into the work programme of the (Local Authority and CCG) Integrated Commissioning Unit (ICU), which has the aim securing health, social care and well-being for Croydon people. The purpose of the report was to enable the Health and Wellbeing Board to comment on the alignment of these intentions with the priorities identified in the joint health and wellbeing strategy 2013-18 as informed by the joint strategic needs assessment (JSNA).
 

Paul Greenhalgh introduced the Strategic Commissioning Intentions report with an overview of the wider concerns, particularly a massive increase in demand for services.  There needs to be a significant mind shift to encourage people to look after their own lives.

Paula Swann gave an overview of the CCG Commissioning Intentions report and Stephen Warren summarised the report:

• Context - taking into account various national and local policies
• Move towards outcomes based commissioning
• Focus on over 65s services 

Brenda Scanlan gave a summary of the Strategic Commissioning Intentions report:

• Embedded around prevention
• Enabling people to take more responsibility for their own health, care and wellbeing
• Sets out high level priorities for the coming year
• Work designed to identify the synergies between the services of the NHS and the Council to enable the best offer for local residents

A number of issues were raised following the presentations including

1. the number of families in B&B placements over 6 weeks which were reported to have reduced by 30%
2. the CCG 10 year contract with Age UK
3. whether integration will really be achieved as it has been spoken about over the last 20 years 
4. the redesign of sexual health services I and the role of pharmacies in the providing these services and why there was no pharmacy representative on the Transformation Board. It was reported that the Pharmaceutical Committee would be included when the formal consultations began.

The Board then broke up into groups to consider the extent to which CCG's and the Council's commissioning intentions for 2016-17 reflect the following priorities in the joint health and wellbeing strategy:
 

Table 1

Giving our children a good start

The 3 main points identified from these discussions were:

1. Focus on children's mental health welcomed, with a single point of referral, although there is still an issue around self-referral
2. Getting transition for 19-25 year old services right is critical - needs further consideration
3. Rethinking children's public health services is currently missing

Table 2

Preventing illness and injury and helping people recover

Preventing premature death and long term health conditions

Supporting people to be resilient and independent

The 3 main points identified from these discussions were:

1. Prevention of falls will be increased by support from pharmacies referring people to the falls prevention service
2. Better communication is needed to increase expectations about the public's role in taking responsibility for their own health
3. There is a role for local communities taking responsibility for assisting the elderly.  A number of community groups, such as Neighbourhood Care, raise money for this already and more awareness of this activity needs to be promoted

Table 3

Providing integrated, safe, high quality services

Improving people's experience of care

The 3 main points identified from these discussions were:

1. The report did not show success indicators of integration
2. Issue of whether integration should be borough-wide or locally - how services are developed, taking into account different needs
3. Inequalities of care - good example in Tower Hamlets where housing helped to improve this.  Closer neighbourhood integration needed and giving early support to parents to prevent children's problems later

(N.B. Councillor Louisa Woodley entered the meeting at 3pm.)

The Board was asked to:

• NOTE the CCG commissioning intentions for 2016/17
• NOTE that comment on the CCGs draft Operating Plan will be sought in February
• COMMENT on the alignment of strategic 2016/17 commissioning intentions to the joint health and wellbeing strategy 2013-18.

In September 2015 the CCG Governing Body discussed the Croydon Urgent Care Re-procurement strategy. The strategy proposed 8 scenarios that could make up the reconfiguration of Urgent care services in Croydon.  Following the detailing modelling work, two key documents for the public have been produced. The link to these documents is outlined in the presentation which will take the reader to all the main engagement documents on the CCG website.

Paula Swan gave the presentation (see attached).

• Current contracts expire in March 2017
• Need to align services with SW London strategy
• Urgent care services very confusing
• Strategy to ensure safe service providing high quality care in future
• Opportunity to provide much more flexible services across the borough

Following the presentation a number of issues were raised including, the length of time needed to award the contract, different options being considered and the extent and quality of the consultation exercise. On consultation the following points were made:

• Disappointingly poor response to various events held around the borough. The options were advertised in local newspapers and tweeted. The Croydon Advertiser wrote an article and it was put on the website. GP services around the borough were notified. Maximum turnout only around 10 but CCG thinking of doing another event in early January.
  • Forms on back page of brochure but not clear on website
  • Why not spread awareness through faith organisations? Mosque in Purley - Friday night have captive audience of over 1000.

There was also some discussion about the role of pharmacies given that Croydon had the highest number of pharmacies. Late night pharmacies (3 contracted to open until 10pm-12am) and 2 offer 24/7 services (walk-in centre and near Croydon University Hospital). Ad hoc arrangements need to be formalised and included in the urgent care review.

There was discussion about the hub structure. Hopefully hubs will be in current locations or in the vicinity but cannot be guaranteed. It will depend on the commissioning and which service providers are contracted. There was a discussion about a fourth hub in Purley?
CVA is running an engagement exercise in collaboration with CCG, schools and GP surgeries - collecting information and putting it out in newsletter and on website.

Further points raised included:

• Best outcomes will be in the right place for the person not in the traditional emergency model. 
• More people are being dealt with within 2 hours in different location.  More people being seen quicker and being discharged.  Fewer people are needing to be seen by specialists.  Relieving pressure on A&E. 
• Rapid access medical assessment unit - more people can be seen by right person more quickly.  Model we have has been a successful one.

The Board NOTED the approved modelling documents for the public engagement which commenced on Friday 27th November.

Following a previous update by the Director of the SW London Health Protection Unit, the Board requested annual updates on local health protection issues.  In March 2015, the Health and Wellbeing Board endorsed the establishment of a Health Protection Forum for Croydon to advise the director of public health and to facilitate the regular review of health protection priorities, appropriateness of local plans and horizon scanning of potential risks to the local population.
 

Dr Ellen Schwartz gave a brief summary of the report:

• Forum met twice this year
• Ensured right people involved
• Established annual work plan
• Identified priorities for Croydon
  • Childhood infections
  • Sexually transmitted diseases
  • Tuberculosis
• Will work through areas in coming months

Cllr Yvette Hopley asked about are the numbers of people with tubercolosis who are exhibiting resistance to treatments.

Dr Ellen Schwartz:  There is a small number of people but we are dealing with complex cases.  There needs to be some consultation on who is responsible for this treatment.  It involves long treatment over many months and it is important that they complete the treatment.

The Board NOTED the health protection priorities identified by the Health Protection Forum.

The Maternal Health JSNA chapter forms part of Croydon's 2014/2015.  Gaps in the ability to achieve healthy relationships within current service provision have been identified, and recommendations have been formulated after reviewing the data and audit, for future developments.

Dr Sarah Nicholls summarised the report:

• Significant challenges in Croydon
• 2014 just over 5,500 babies born - 2/3rds within Croydon
• Quarter of mothers book relatively late after first 12 weeks of pregnancy
• Mothers smoking and new born babies born below average birth weight has risen
• 13% of women attending first ante-natal class have little or no English
• Half of mothers were overweight when booked in
• 5% of pregnant women have diabetes

The following issues were raised and discussed:

• The rise in numbers mothers with pre-existing conditions
• The role of schools in maintaining good healthy bodyweight before getting pregnant and early access to ante-natal clinic and also advice on contraceptive services
• Sexual health education - need for good relationship education.

Following discussion, the Board:

• APPROVED the document in principle and
• AGREED that delegated authority be granted to the Acting Director of Public Health, Executive Director of People.

A recent survey/analysis of the service user experience of patient transport reported an 80% negative sentiment with regards to the NEPT service.

In consequence, the management of the NEPT service has recently been restructured and is now within the Estates & Facilities department. These domains have been the focus of the new monthly performance/contract meetings, whereby both the Trust and ERS Medical (the NEPT external contractor awarded to deliver the service) have signed up to improve the service delivery.

Charlie Ladyman explained every Friday Healthwatch volunteers go over the data in a Patient Experience Panel (PEP). The PEP scrutinises issues, applies clinical coding, identifies serious concerns, monitors equality and diversity, and discovers leading health and social care related trends. 

Cllr Maggie Mansell expressed concern that 80% gave negative comments.

John Goulston explained that part of the unhappiness is the way the service is batched.  It is not seamless - patients are picked up and have a long wait until taken home again.  It is not on an individual basis.  There is some confusion about escorts - decision made by clinical teams.

Cllr Margaret Mead mentioned that patients are confused about the contact number and location of the discharge lounge.

John Goulston agreed to do something about making the contact number clearer.  Patient transport is moving and will have a nice home when finalised.  The discharge lounge is not in the most convenient place. The signposting needs to be improved.

Cllr Yvette Hopley asked about the contract and whether specialist transport is used.

John Goulston explained that transport is provided through the London Procurement Partnership, run by department of health criteria.  Most people are picked up in ambulance type vehicles.  Out of hours, if someone misses the run, then they may sub contract to a taxi service.  It is a fairly standard specification across hospital and community settings.

Dr Agnelo Fernandes mentioned that a lot of people who need some form of transport do not need that type of vehicle.  Patient experience of using taxis has been positive.  The main criticism is being told to be ready very early but not being picked up for 3 hours.

The report was for information only.

Paul Greenhalgh gave a short presentation.

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. A summary of risks is at appendix 1.

The health and wellbeing board agreed its work plan for 2015/16 at its meeting on 25 March 2015. The work plan is regularly reviewed by the executive group and the chair. This paper includes the most recent update of the board work plan at appendix 2.

There were no questions on the report.

Steve Morton advised the Board that, if anyone has questions about the Performance Report, the Executive Group will take them on board at the next meeting.

Cllr Yvette Hopley asked if it would be possible to have the numbers as well as the % rates.

The Board:

• NOTED the risks identified at appendix 1
• AGREED changes to the board work plan set out in paragraph 3.4
• CONSIDERED the report at appendix 3, identifying performance against key indicators for board priorities set out in the joint health and wellbeing strategy.
• NOTED the two areas identified for further consideration at a joint workshop between the board and the Opportunity and Fairness commission on 21 October 2015: social isolation and early years.

Item 6 - CCG Commissioning intentions - Peter Doye asked why paragraphs regarding Finance, Legal and Equalities issues were all 'non-applicable'.

It was explained that, as the report was only for information, not for decision, those sections are not required.

The CCG plans will be taken forward into the operating plan.  Before the governing body is presented with a decision, there will be a full report in February.  It will include extremely detailed information on finances.  A very high level impact assessment has been carried out and is on the website.  Recommendation of Option 1 is the best in terms of the equalities impact. 

The CCG has met with representatives of residents and agreed to meet again in the next week to discuss modelling.