RESOLVED that the minutes of the meeting held on 19 October were agreed as an accurate record.

Cllr Maggie Mansell mentioned that a number of ideas were put forward at the Seminar on 25 January.  There will be a report at the next Board meeting.

There were no disclosures at this meeting.

There was none.

There were none.

Stephen Warren gave a presentation (attached) and summarised the report.  Since April 2015, Croydon CCG, alongside the 5 other CCGs in South West London, have been moving towards increasing their ability to have greater influence over the commissioning of primary care services, to support the implementation of local out of hospital strategies.  Croydon CCG has submitted an application to NHS England for delegated commissioning, to be effective from the 1st April 2017, to increase its ability to influence primary care commissioning and outcomes.  Stephen Warren outlined the significant opportunities this would provide to ensure primary care is a key part of developing the Out of Hospital Transformation and the ability to shape local primary care services in response to local need.

Issues raised included:

• Pharmacies want to be more involved but they do not have access to patient notes
• Feedback on BAME issues from relevant sources

The Board NOTED the contents of 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.

Stephen Warren and Guy Van Dichele presented the report and answered questions raised.

The following issues were raised:

• Recent publicity indicates it is not working elsewhere. It is an opportunity to fund transaction costs of changing services, bringing health and social services closer together.
• Financial savings have not been made but the work has not happened yet. It might alleviate problems we have now, by keeping work strains moving and embedded. There are issues about not having care packages and other issues.
• There are quite a large number of people in Croydon in a lot of care homes.  A lot of these people are funded from other boroughs. It creates difficulties if they need care beyond what care the home is providing. Dementia is more complex, with mental and physical needs.
• We must learn from other areas and improve. It is not only about social care but also about hospitals - the way the system is organised. More support is needed in the community.  We need to look at how it links into primary care. Prevention is important - evidence shows developing systems with continuity is critical.
• Effective management of A&E is also important.

Guy Van Dichele: It is not about one issue. It is more complex. We need to ensure support when patients come out of hospital.

The Board NOTED the report.
 

Rachel Flowers introduced the report.  The paper sets out recommendations for a change to the process of producing Croydon JSNA.  Previously an annual key dataset was produced with a small number of chapters on key topic areas, with the latter guided by an agreed prioritisation process to rank proposals received from stakeholders each year.  Rachel Flowers explained that this is only the beginning of the process.  The JSNA is not just about commissioning. We need to be more agile. Most JSNA programmes previously had a big document but something more useful - bite sized - would be preferable. It is a work in progress, more data-based. It will be on the website.  There are lots of examples of good practice. Practice in one borough does not necessarily work elsewhere but can be shared with colleagues. Data is available for all statutory agencies.

The following issues were raised:

• Croydon has wide ranging levels of deprivation

Rachel Flowers: Evidence shows the gap is closing. We need to drill down into the data to find out what it means; look for patterns. We can triangulate hard data with what we pick up from observation.

• Decisions need to be taken more rapidly. There is a lack of commissioner 'buy in'.  Commissioners should identify the problems. How do you link in with other stakeholders - Healthwatch, CVA etc.?

Rachel Flowers: The commissioning cycle is quite rigid. Some of the data arrived after the cycle finished. Often people pick up issues before it appears in hard data. We need to make sure other relevant people are in the room - has to be evidence based. It is an important part of 'what's out there' in terms of anecdotes, to ensure we don't miss anything.

• Troubled by it being 'commissioner led'. Involvement of the community is significant. We may hear things that come up before they show in the data. If communities go through the process of responding we may then triangulate their information with data. We must look at ways of strong engagement with voluntary sector and other stakeholders. The greatest challenge is the implementation of recommendations and governance arrangements.

Rachel Flowers: Why would we not involve the community? It is a different kind of health literacy - people need to understand why decisions are made. Too often the commissioning process is done and is very well intentioned but communities do not feel part of the process. The JSNA is available to everyone.

The Board ENDORSED the following recommendations:

1. Retention of a key dataset to enable the health and wellbeing board and stakeholder organisations to have an overview of health and wellbeing needs in the borough
2. A commissioner led process for identifying and conducting topic based needs assessment
3. A more rapid turnaround of needs assessments and a wider range of JSNA 'briefings' rather than a small number of detailed needs assessment
    

Jai Jayaraman gave a verbal report. A report on the experiences of teenagers in using sexual health services - age range 16-19 years, based on speaking to users of the facilities at The CASH Edridge Road, The Turnaround Centre and The Point, Croydon University Hospital, will be brought to the next Board.
 

Steve Morton explained about the Workshop on 25 January, from which a social isolation action plan, including dementia friendly communities, will be forthcoming.   It requires significant work across the borough over several years. The first action will be to set up a Dementia Action Alliance. This will launch in May and member organisations will be asked to sign up.

The Board RESOLVED to:

• Note work undertaken by the executive group since the last board meeting on 14 December 2016
• Support a proposal from the board workshop held on 25 January 2017 that Croydon works to achieve dementia friendly community status and that this is included in the social isolation action plan for Croydon
• Note risks identified at appendix 1
• Agree revisions to the health and wellbeing board work plan in section 3.4

There were no public questions.

Some points about health meetings in public were discussed:
Peter Howard: Primary Care co-commissioning - when involving the public, nobody quantifies who is invited and when the meetings happen.

Cllr Mansell: There are networks. CVA have an enormous network. Those who are interested can join these networks.
Nero Ughwujabo: There is a reducing number of members of public attending public meetings.
Sara Milocco: We summarise minutes of meetings and they are sent out and put on the CVA website. We need to make topics understandable.
Rachel Flowers: Meetings should go to the public and be relevant. HWBs are strategic but there may be value in thinking about going out to different carer groups etc. How do we make sure that we don't just get the 'usual suspects'? There are topic based conversations to be had with communities.
Stephen Warren: There are different areas of strategy. Other meetings go on that feed into the Board.
 

Reports attached.

Health App Now can be downloaded here: http://croydonandsutton.healthhelpnow.nhs.uk/

The next meeting is Wednesday 5 April at 2pm in the Council Chamber.