The minutes of the meeting held on 10th February 2016 were agreed as an accurate record.

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

There was no urgent business.

There were no exempt items.

Paula Swann nominated, and Councillor Mansell seconded, that Dr Agnelo Fernandes be appointed the second vice-chair of the Health and Wellbeing Board.

The Board RESOLVED to appoint Dr Agnelo Fernandes as second vice-chair.

Caroline Boardman and Ann Morling introduced this item with a presentation attached to the agenda.

Ensuring a positive user experience is a key priority for Maternity services. There are a number of key deliverables in achieving this outcome, including the numbers and quality of staff recruited as well as continuing to measure quality. The Friends and Family test provides important feedback data and comments received are captured for further action. Unique methods are being used to gather feedback such as a recent event that involved playing a board game to generate feedback which was then displayed by an artist's mural.

The profile of women in Croydon is very challenging, for example a high number of asylum seekers who may not be previously registered.  The Birth Centre had recently been refurbished and was an excellent new facility.

It is important to promote choice in relation to births, for example creating awareness that home births are a safe option. Individualised care and the increased involvement of men were both important ways of continuing to increase quality.

In response to questions from the Board the following was reported:

• CTG is a method used to measure a baby's heartbeat and VBAC is reference to Vaginal Birth After Cesarean.
• John Goulston stated that there was a national issue over still births - of which rates have not changed for 25 years. However it should be noted that the rate of still births in Croydon had gone down by 50% and were thus bucking the national trend. There is a growth assessment programme in Croydon which monitors the baby's development in the womb; this enables early intervention were complications arise.
• Maternity services booklets are only printed in English; no requests have been received for translations however there is scope for this on the website. As there are such a large number of languages spoken in the borough is not feasible to make all such literature available.
• There is social and medical complexity in Croydon, particularly with regard to safeguarding issues. There are specialist teams in place to support particularly vulnerable women and to deal with particular medical complexities such as women suffering diabetes.
• The Trust has piloted a health care assistant whose key role is to help prompt discharge after birth. The postnatal ward is very busy and the pilot has thus far been a success.
• Women have a choice as to where to give birth, including whether that be in the labour ward or at the birth centre.
• There is a challenge with regard to late registration of women and there is a high rate of missed appointments for first check-ups. This is being addressed through a poster campaign and a direct booking system on the website.
• There was close collaboration with Best Start and maternity services play an important role in this programme.
• An outreach strategy is being formulated to go out into the community to engage with different sections of the BME community
• Dr Agnelo Fernandes commented that the maternity services is an example of a success story in Croydon. Now the reputation of the service needed to be improved, particularly for residents in the south of the borough.
  
  The Board NOTED the report.

Paula Swann introduced the report with a presentation attached to the agenda.

The Operating Plans must align with the south London transformation plan and the Health and Wellbeing Board priorities. The plan must account for national and London priorities, as well as local strategy in Croydon.

There are six GP networks in place to deal with the diversity of challenges across Croydon and each of these networks has key priorities. The national priorities are mainly performance related however the local priorities include implementation of Outcomes Based Commissioning and the urgent care strategy.

The presentation slides highlight a lot of key information regarding priorities for learning disabilities, dementia care, diabetes and obesity. The targets for Improving Access to Psychological Therapies (IAPTS) have been achieved which is a significant success.

In response to questions from the Board it was stated that the transition from child mental health services to adult mental health services is being looked into as part of the strategy.

The following comments were made:

• A member of the public questioned why the issue of the north and south health divide in Croydon was not addressed in the plan.
• Councillor Mansell responded that there was not a geographical divide as such; health disparities occur on a ward by ward basis.
• Councillor Woodley stated that the most recent Annual Public Health reported touched on the north/south health disparities. There is not a clear geographical divide - New Addington is an example of a ward with high levels of deprivation but not situated in the north of the borough. Whilst an overall strategy is important, a targeted approach is needed for hard to reach areas.

The Board NOTED the report and AGREED that the Operating Plans presented were aligned with the joint health and wellbeing strategy.

Paula Swann introduced the item. It was stated that there was a requirement for the Better Care Fund (BCF) plan to be signed off by the Board. Much of the plan builds on the previous one and includes a number of services such as rapid response GP teams, personal care coordination and multidisciplinary teams.

The original purpose of the BCF was to promote better integration locally and setting a number of associated targets, for example to reduce the number of hospital admissions. Those requirements are still in place and an important aspect is to commission more services in the community. There are local plans in place to further integrate health and social care by 2020.

• Andrew McCoig raised concern about the national picture with regards to underfunding and the effect this is having on staff shortages and the current service being at full stretch.
• John Goulston responded that current staff shortages were caused by NHS workforce planning seven years ago which wrongly predicted staffing needs. The agency staff that are now being hired to cover the staffing gaps are causing considerable expense.
• Dr Agnelo Fernandes added that there is additionally a funding crisis within the NHS - most Trusts are in deficit and recruitment of GPs, doctors and nurses is very challenging. However Croydon is achieving significant outcomes despite the challenges faced.
• Councillor Woodley expressed concern that the rhetoric from central government did not reflect the true scale of recruitment needed in the service.
• Councillor Mansell acknowledged that Croydon appears to be moving in the right direction and recognised the professionalism of the staff involved.

The Board RESOLVED to:

1.1 Give delegated authority to the Health & Wellbeing Executive to approve Croydon's 2016/17 BCF plan.
1.2 Note the status of BCF delivery.
1.3 Note the progress of TACS implementations

Mark Fowler introduced the report, which was an update on the paper that had recently been submitted to Cabinet. One of the key elements of the gateway is financial inclusion and how to improve independence and wellbeing in the long term. Improving the digital programme has been a priority and went to scrutiny on 12th of this month. The Council's involvement with the Credit Union is also key for tackling poverty.

The outcomes of the gateway have included connecting with a large number of customers and providing overall financial stability. In total 347 households have been supported and this includes home visits and identifying children entitled to free school meals. Additionally a number of London Living Wage contracts are coming through and there is a significant opportunity to expand the programme with the Westfield Hammerson development.

In response to questions, the following was reported:

• The Job Centre Plus (JCP) can and does refer people to the gateway service.
• Referrals can be made by anyone and the next phase will be to promote the gateway to GPs.
• It is not yet clear what effect the introduction of universal credit will have on free school meals.
• The social care department is being worked with to see how the gateway can support their work, for example through acting on the Southwark judgement order.

The following comments were raised:

• Charlotte Ladyman stated that feedback from some children was that there was a stigma attached to free school meals.
• Councillor Woodley responded that many schools now use a contactless payment system and thus this anonymised who was in receipt of free school meals. Councillor Woodley further stated that a Parliamentary Select Committee had recently visited the gateway team and were impressed with the scheme.
• Dr Agnelo Fernandes stated that as a GP we was not aware of the gateway and that the workload GPs receive in relation to these issues has gone up. The gateway collaboration with GPs was very welcome therefore.

The Board NOTED the report.

Steve Morton introduced the report.

The Board RESOLVED to:

1.1 Note risks identified at appendix 1.
1.2 Agree the board work plan for 2016/17 at appendix 2.
1.3 Consider performance issues identified in the report at appendix 3 and summarised at paragraph 3.5.

There were no public questions.

Councillor Louisa Woodley announced that there is free online training on autism available from the Council website: https://croydon.melearning.university/course_centre

Croydon Advertiser article covering Healthwatch Child Autism event on 15 March 2016

This was noted for information only.