The minutes of the meeting held on 14 September were agreed as an accurate record.

There were none.

The Chair, Councillor Maggie Mansell, reported that:

The South West London Collaboration is the arrangement where commissioners, providers and Local Authorities and HWBs work together to plan and develop services across the sub-region. The Strategic Transformation plan is in draft. It consists of the direction of travel which we have discussed: self help advice, prevention, early intervention and treatment close to home, including primary care; and the development of sustainable acute care. The STP has to be delivered to NHS England this week. SWL collaboration are all supportive of the out of hospital care. The analysis of needs and resources for acute services is at an early, top level stage. There is considerable work to be done on patient pathways and service configuration. H&WB chairs felt that we were unable to endorse that part of the document because there has been no public engagement on the direction of travel for hospital services. We are discussing the issue with Council Leaders.

The following item was taken as Urgent Business, after Item 6:

Report on asylum children:

Barbara Peacock reported about children from Calais who have to be removed before the camp is closed down.  Two groups of children are coming to Lunar House, this week and next week.  The first group comes under the Dublin Treaty because they have family in the UK.  The second group of Dubs amendment children are vulnerable. The Home Office is screening and making verifications. The arrangement is to offer refuge and asylum to vulnerable children.  There is a process of assessment to verify which ones can be brought to the UK.  Once assessed, they will be distributed to other authorities.  Croydon has been accepting unaccompanied minors for a number of years and now, with government funding, NHS England is providing support.

There were none.

The Chair, Councillor Maggie Mansell, explained the CCG and Council are working together to provide an integrated plan.  Another strand, regarding in-hospital estate services, is at the early stage of development.  Public engagement will take place in November, when the plan will be agreed in principle.

Paula Swann introduced the CCG report.  NHS England has emphasised the need for tight alignment between the NHS Operational Planning process and the SWL STP and there is a target date for all 2017-19 contracts to be signed by 23 December 2016.

The Croydon CCG Commissioning Intentions cover the following broad headings:

• Planned Care and Long Term Conditions
• Urgent and Emergency Care
• Children and Young People
• Mental Health and Learning Disabilities
• Out of Hospital services
• Primary Care

The CCG has worked with colleagues across south London to set out all the changes expected and how services will be offered differently to meet local needs.  This is all within a context of special measures.

Stephen Warren elaborated on the main points:

• Financial challenge
• Asset based commissioning
• Prevention and self care - embedding into Primary Care
• Commissioning appropriate services
• Programme of work to reduce hospital admissions
• Service reviews
• Primary care is increasingly important

Issues raised included:

• How far do Croydon's plans reach into the CCGs in other boroughs?
• Croydon appears to be on its own - where does it sit?

Paula Swann: SW London has a collaboration of CCGs working together, along with providers.  There is a long history of partnership working.Originally the strategic planning authority came from the CCGs but it is now recognised that all providers should be involved. There are significant benefits in working together in order to deliver more effectively and we are looking at how to use commissioning support more effectively. Currently it is not appropriate for Croydon to look at a shared Chief Officer along with the other CCGs in South West London, as Croydon is pursuing an Accountable Care Organisation approach. There is however no suggestion that Croydon is not working with the other CCGs - the future could look very different for strategic commissioning.

Cllr Maggie Mansell: Croydon has 30 years of history with CCGs working together with the local authority.  Historically Croydon has been under-funded and it has the largest number of ethnic minorities and highest deprivation in the London area.

•  How will you ascertain what services are provided for children's mental health services (CAMHS)

Stephen Warren: We will look at what are the most important outcomes for them in terms of their care.

• The NHS in Croydon is under significant financial pressures - the ways in which solutions are transmitted to users need to be joined up.  The correct message needs to get out to the public
• Social workers are strained - more young individuals are dealing with some horrendous illnesses - how can we deal with it?

Paula Swann: 40% of placements in the mental health trust are able to be discharged.  The review illustrates that a full system response is needed - social care, commissioning, provision - in order to get them back into the community in their own homes.

Stephen Warren:  There is investment in mental health services, with liaison services in the Council.  It is important for schools to play their part.  We are developing a single point of access, working with schools and primary care.

• We need discussions about the review of mental health services with communities and parents - what is their understanding?  How can they access services? 
• Access criteria has been tightenened so there is even more pressure on parents and teachers, so we need to raise teachers' skill levels to deal with children having mental health issues

Cllr Callton Young asked if an overview could be provided as the report was 'a bit of a web of strategies, policies and plans'.

Paula Swann:  The operating plan will be more structured.  It will come out later in the year.   It will condense the information so it can be communicated better.

The Board NOTED the report.

Sarah Ireland introduced the Council report. 

Croydon Council’s key commissioning priorities for 2016/17 build on the previous Joint Commissioning Intentions, signed off by the Health and Wellbeing Board in December 2015. Inevitably many of the commissioning plans and objectives represent joint areas of work with Croydon CCG. The report illustrates the range of commissioning plans and priorities for 2016/17, which are either commissioned by the Council or commissioned jointly between the Council and the CCG.

Cllr Hopley asked about how commissioning takes the latest legislation into account.

Barbara Peacock: The commissioning intentions bring statutory legislation into play - the Children & Families Act.  There is an overlap, so we are trying to move together to have a more integrated focus.  From the Council perspective, a service planning process is to be launched. This will embed the operational detail into high level strategic intentions.

The Board NOTED the report.

Sarah Burns (CVA) showed a video and gave a presentation

• Croydon shortlisted by NESTA for Asset Based Community Development (ABCD) activity as a social movement for health and well being
• Working with CCG, through Together for Health, putting NHS strategies into action
• Agency project with residents in New Addington & Selsdon, Fieldway, Thornton Heath, Broad Green and Selhust
• Case studies showed how people who are often considered as 'service dependents' have been encouraged to lead on their own solutions through community led health and well being initiatives
• Focusing on assets and opportunities rather than over reliance on creating services
• 13 ABCD CVA projects so far
• Attracted funding from outside Croydon, such as: The Big Lottery, Mayor's Office- MOPAC, Sport England, ESF
• At start of 2016 CVA had nurtured 216 sustainable, community-led initiatives
• Independent cost benefit analysis gave very positive results

The following questions were raised:

• Could this process be adopted in other areas?
• What are concrete outcomes?
• What are the KPIs?  How do you judge the success of Asset Based Community Development?

Sarah Burns: Where the funding came from dictated in which areas we worked.  Community Builders need funding for the post.  Outcomes include improved mental health, reduced GP appointments and A&E admissions (film showed a young boy who states he wasn't able to speak until he took part in the project, outcome achieved friends and confidence not through a service). To judge success of preventative activity, we look at the statistics & stories - the number of people now involved in their community, Asset Maps recording the number of community led initiatives initiated, Relational/Network Maps, stories of individual & group journeys and achievements in film or tracked with Out Come Star and 'I' statements.

Zoe Reed:  It is about taking care of our own health.  It is difficult building these things.  This is a great starting point.

The link to the video is: www.cvalive.org.uk/empowering-the-community/local-strategic-partnerships/health-and-wellbeing-partnersh/prezi

Barbara Peacock and Rachel Flowers had been called away from the meeting, so this item was introduced by Paula Swann.

The report highlights the progress of the Joint Commissioning Executive in delivering its joint commissioning arrangements for the period 2016/17. It builds on the previous Joint Commissioning Intentions, signed off by the Health and Wellbeing Board in December 2015, and indicates progress made during the last 6 months, with priorities for the remainder of the year.

It is important to ensure the services work together to deliver the best possible services.

The issue of monitoring dementia was raised by the Board, in relation to the increases with earlier diagnosis.

Paula Swann and Stephen Warren elaborated:

The dementia diagnosis rates are increasing and we are currently 0.3% or 8 patients away from the national target, which we hope to pass in the near future.  In terms of earlier diagnosis, our specialist memory assessment service operates a triage system which prioritise cases based on need. As Croydon has a large number of care / nursing homes in the borough, and diagnosis rates tend to be low in these placements, the CCG have developed a project to improve dementia diagnosis rates in care homes through GPs. The outcomes of this project will be better coordinated care for people through accurate diagnosis and, subsequently, a reduction of patients in residential homes being assessed by the memory service, which will reduce waiting times and increase the capacity available for specialist assessment which supports earlier identification. In addition, the commissioned Dementia Advisors service (Oct 2015) now provides post diagnosis support in Croydon, all GPs are notified of the service and it is integrated within the memory service. Evidence suggests the availability of these services support earlier referral and identification of dementia.

Cllr Maggie Mansell mentioned she had attended a meeting where the development of a dementia action alliance was discussed, in order to achieve greater understanding within communities about the problems of managing people with dementia.

The Board NOTED the report.

The report was introduced by Lorraine Burton with Sean Olivier.  It details the activity and effectiveness of the Croydon Safeguarding Adult Board (CSAB) between April 2015 and March 2016. The Annual report is submitted by the independent chair of the Safeguarding Boards, which ensures that the Council and other agencies are given objective feedback on the effectiveness of local arrangements for safeguarding adults. The report also includes the Strategic Plan objectives for 2016/17 and sets out the key priorities for the Board for the current year.

The following issues were raised:

• What is being done to reach hard-to-reach communities?

Sean Olivier: We have a very successful relationship with the BME Forum.  We will ensure that the momentum lost in the last few months will be regained to plug any gaps.

• Can the details of those aged over 75 in their own homes or care homes be broken down?

Sean Olivier:  A quarter of safeguarding issues come from the care home market.  The cases are higher for females than males, particularly relating to domestic violence.  We are looking at what work we can do around prevention of sexual exploitation.  For the over 75s, we rely on intelligence sharing, bringing together communities, health workers, CQC and other relevant teams, to formulate the concerns and what to do. We are providing a co-ordinated approach to the managed market.

Paula Swann: Some referrals relate to pressure ulcers and are not safeguarding issues.

Sean Olivier:  Under Section 42 there are a lot of neglect cases in the care home setting.   There is also financial abuse.  We are working on a protocol between Board partners.

• To what number do the percentages relate?

Sean Oliver:  Approximately 2,500 referrals a year.

The Board NOTED the report.

Maureen Floyd and Gavin Swann summarised the report.  It details the activity and effectiveness of the Croydon Safeguarding Children Board (CSCB) between April 2015 and March 2016. The report is submitted by the independent chair of the Safeguarding Board, which ensures that the Council and other agencies are given objective feedback on the effectiveness of local arrangements for safeguarding children. The report includes the Strategic Plan objectives for 2016/17 and sets out the key priorities for the Board over the current year.

Some specific points were highlighted and were further discussed by the Board:

The report gives an understanding of what the Board covers:

• Missing children
• Child Sexual Exploitation (CSE)
  • Bringing information to the community - 100 taxi drivers logged onto the CSCB website for safeguarding training on Child Sexual Exploitation
• Trafficking
• Gangs

The following issues were raised:

• What percentage of young people are sexually exploited?

Gavin Swann: Since covering radicalisation, it is apparent that CSE is often linked - victims are diverted from CSE.  But the numbers are quite low. (See p38 of the Annual Report)

• FGM - families find it difficult to talk about and children don't want to take their parents through the prosecution system.  We are working with communities to dissuade people from continuing this cultural tradition.

Sarah Burns:  One of the project groups in ABCD worked with FGM.

Maureen Floyd: Community work is most important.  Most of referrals come from maternity units.

• How well do we think we are doing - what is the evidence?
• Is it only secondary schools which raise the issue?

Gavin Swann:  We can always do better.  There is quite a sophisticated array of evidence.

Maureen Floyd: All schools are involved.

The Board NOTED the report.

Stephen Warren presented the report.

The Better Care Fund (BCF) is a national initiative which aims to promote better integration between health and social care to provide a whole system approach to improving patient outcomes through investing in community based services and by doing so reduce demand on acute services.

The following points were made:

• We are under-resourced for reablement. If we have the right service outside hospital, the incidence of re-admission is reduced.
• If patients are ready to go home, they need to be discharged quickly or they end up staying in a lot longer.

The Board NOTED the report and the status of the BCF delivery.

Charlie Ladyman summarised the report.  Healthwatch spoke to 1,800 residents on their views about GPs.  The research has found that patients are broadly satisfied with the quality of treatment received, with many accounts of ‘professional and knowledgeable' doctors and nurses. Patients are also positive about receptionists and practice management, on the whole.  However, there are some noticeable negative trends.

The following comments were made:

• The electronic prescription service (EPS) is slow and has some distance to travel.  NHS spine goes down quite frequently. It brings pharmacies' EPS system to a complete halt. It was down for 3 days recently.
• "EPS just let me down. I went to the doctor 4 wks ago and the pills he prescribed worked. The receptionist asked for the next prescription to be sent to the pharmacy but it did not arrive."
• The results of the national GP review were published July.  Results for Croydon are in line with national results, within 1%.
• Surprised at how much receptionistsmake clinical decisions and decide whether a patient should see the doctor.
• "Receptionists in some areas of the borough are appalling - they need training."
• Asking for emotional responses works better than tick box responses.

The Board NOTED the report.

Cllr Maggie Mansell offered best wishes to Charlie Ladyman in her career, as this was her last meeting before moving on from Healthwatch Croydon.

There were no questions.

The Board RESOLVED to:

• Note the planned review of the local strategic partnership including the health and wellbeing board.
• Note risks identified at appendix 1.
• Agree revisions to the board work plan for 2016/17 in section 3.4.1.

There were no public questions.