RESOLVED that the minutes of the meeting held on 8 February were agreed as an accurate record.

The Chair mentioned Detoc - delayed transfer of care - and suggested it for the next meeting.

There were no disclosures at this meeting.

There was none.

There were none.

The report encompassed issues raised in the Household income and child poverty paper update agreed at cabinet on 13th April 2016.  It provided the background behind the work the council has undertaken, clearly defining our rationale and how these issues have been linked to wider pieces of work such as the approach to financial inclusion, considering whole family solutions through gateway and outcomes from the Opportunity and Fairness Commission (OFC).  The report shows the work completed to date, the number of customers that have been assisted and the Council's plans, and next steps for the future.
 

Barbara Peacock introduced the report, stressing the importance of the paper - one of the key indicators around health inequalities being the impact of poverty on both child and adult health. It is vital to maximise the assets people have and to get them into employment.

Mark Fowler (Director of Gateway Services) summarised the main points:

• Some issues have got worse
• Challenges remain the same
• 3.17 - table showing particular issues being addressed to ensure families living in poverty benefit from the plan
• 4.1 - staff training to enable staff to engage better with customers
• Work around the website and internet tools
• 25% increase in use of online tools
• Ensuring financial banking services are available to all vulnerable people
• London living wage - encouraging local businesses is working well
• Universal credit - ensuring easy access
• £9m in additional benefits
• Over 1800 residents have accessed work opportunities
• 200 new families are claiming benefits
• Work to ensure people can access free services (childcare etc)
• Gateway supported over 1700 residents to maximise their income
• Over 5000 children identified and supplied with free school meals
• Fuel poverty - Croydon Healthy Homes helping to provide energy efficiency
• Focus is to develop single view of the household

The following issues were raised:

• Important work recognised by the National committee
• Croydon is leading the way on this work
• One of series identifying the determinants of health
• Can the reduction being achieved be monitored?

Mark Fowler: Cannot monitor specifically within children in poverty - nationally covered. Benefit cap lowered - 650 households in Croydon affected. We have found solutions for over half. We are confident we have solutions in Croydon.

• In Newham, for debt crisis management, they have arranged legal pro bono work through a London firm.  Has Croydon got links to do the same?

Mark Fowler: We have good relationships with the South London Law Society. We work with Credit Union - hoping to address issues regarding pay-day lenders. Currently we have no links with London law firms.
Barbara Peacock:  We have a very clear and strategic approach. People are trained to do this work. We are looking at people in a rounded way - difficult to do this through volunteers.

• People often get into debt through poor budgeting and financial management. Are there provisions for more education in schools?
• It is positive to get half an hour of free legal advice but often it is a shock to find out the ongoing costs. Pro bono is only short term.
• We want to resolve issues before advice is needed.
• Do we have an evaluation of the impact?
• There are a lot of children in poverty whose parents are in work. How do you support those families - how do you identify them?

Rachel Flowers: There is an issue of schools - Public Health is working to identify these children. It is about embedding commitment, to reduce inequalities.

• What are we doing to target unmet needs? What about the involvement of faith groups? Changes in child benefits - how will they impact?
• People can access the service through Access Croydon and other centres. Are there plans to take the service to surgeries and to build awareness of services?

Mark Fowler: Poor budgeting is a key element team looks at - look at work, budgeting, the overall situation. Links to schools are important - what is the best approach? Work is planned. We have engaged with some of the head teachers. Evaluation is difficult. There is a national data set but it runs slowly and it is difficult to get at local information. We are trying to aggregate information across the council. Requirement is increasing but resources are staying the same. There is in work poverty - some shocking statistics show 65% are living in poverty. People are working but are still in debt - trying to resolve problems before people are losing their homes etc. Targeting is important - welfare reform - restrictions - good resource of information across the council. We can engage with people directly through applications. Over 8500 households are registered with the Council so we can record and monitor. Welcome feedback from GP surgeries to follow up on previous work.

• There is also the Croydon Caribbean Credit Union - what do we do to promote other options available?

Mark Fowler: We have a list of partners which is available.
Cllr Maggie Mansell: We are using faith groups, GPs etc. to refer.
 

The Board NOTED the contents of the report.

The report was an update on the progress of the development of Croydon's social isolation action plan 2017/19.  The public health team is liaising with a broad number of organisations and stakeholders and each of the theme partnership boards within the Local Strategic Partnership (LSP) to align agendas and join up efforts to reduce social isolation.  A set of high level priorities for reducing social isolation, following a lifecourse approach is proposed.  The action plan is expected to be completed in summer 2017.

Rachel Flowers introduced the report. Work started in December. Jack Bedeman (Public Health Registrar) gave an update, mentioning the 13 potential priority groups which were for discussion.
 

The following issues were raised:

• There is a waiting list for young people with mental health issues - what other issues are there? How did you get to the 13 priorities?
• There are a lot of elderly people - we need to ensure they are included.

Cllr Maggie Mansell: At the Croydon Congress meeting there was a lot more on elderly people.

• There is a sub group of elderly - 1st generation immigrants - where their children have moved away.
• A lot of groups go across all age groups.

Jack Bedeman: The discussion looked at strategies each of the boards have around social isolation. We looked at opportunity areas where something is already happening.

• Paragraph 3.10 acknowledges that for older people social isolation is a social determinant. There is an enormous budget attached to outcome based commissioning which is not yet all allocated.

Steve Morton: The Board had a discussion session at a previous meeting and the feedback was taken back to agree the priorities.
Rachel Flowers: Work in progress. More informal opportunity to discuss further? Suggest Board members give feedback. Have a workshop to link back into the work.

Rachel Flowers asked Board members to email feedback and comments to Jack.Bedeman@croydon.gov.uk
 

The Board:

• Noted the progress in developing the plan and next steps
• Commented on the high level priorities in 3.18 

Dr Agnelo Fernandes introduced Dr Emily Symington (GP and CCG Governing Board member) who gave a presentation (attached):

• 4 key aspects - prevention, self-care, self-management and share decision making
• Concern about people worrying about health when there are no problems
• Raft of different approaches
• App to help patients navigate the system - Health Help Now

The following issues were raised:

• How do we take this forward and roll it out?

Rachel Flowers:  Encouraging results - they link into the isolation issue.  It is not just about behaviour change of the people living with diabetes but who we are impacting most

• A lot of CVA work is about social isolation. Lot of wellbeing projects ar being developed in those communities.
• There is a solid foundation but it is only covering one GP network - what about the other 5?
• There is European social funding. The CVA has been invited by Big Lottery Fund to go to stage 2 of the bid. We are most interested in qualitative research telling personal stories about their journeys.
• When will we have this operating borough-wide?
• COPD patients are isolated.

Dr Emily Symington: We are working hard to promote the programme to practices. It helps GPs to learn a different approach to consulting. We are in contact with other GPs nationwide across a wide range of issues.

• Slight concern - what will it replace in terms of people's health?
• Will this process cost money - without funding what will it replace?
• The most difficult patients have not really engaged - how do you reach them?
• Croydon University Hospital does a lot of group sessions covering different issues (e.g. back pain) - how do we link all this together?

Dr Emily Symington: We are not suggesting everyone has to have group consultation. It is not advanced enough yet to work out where the balance is between group and one-to-one sessions. Croydon is the biggest pilot nationally.

• Why not scale up the programme to work across a number of practices?

Dr Emily Symington: There are issues around management - patients' notes are with their own GP.
 

The Board NOTED the contents of the presentation.

The report focuses on Croydon's Clinical Commissioning Group's (CCG's) two-year operating plan for 2017/18 and 2018/19.  As a statutory organisation, the CCG is required to submit its commissioning and operating plans and associated financial assumptions for the financial years 2017/18 and 2018/19. The commissioning cycle is set out by NHS England.

CCGs are required to develop and publish an operating plan which balance local determination of priorities in a sustainable financial and service framework in order to continue to improvement of NHS performance for existing mandated priorities.

Croydon CCG's Operating Plan sets out our plans to deliver our strategic direction and ambition for 2017/18 and 2018/19 within the context of the local priorities and emerging national, London and South West London priorities.

Paula Swann introduced the report. Stephen Warren (Director of Commissioning, CCG) gave a presentation (attached).

• Key highlights:
  • Primary Care
  • Mental Health
  • Urgent Care
  • Transformation of Out of Hospital and Planned Care
  • STP
• QIPP (Quality, Innovation, Productivity and Prevention plans)
• Significant transformational change is needed - shifting from acute to a primary care and community setting

The following issues were raised:

• P12 refers to NEFA - leaving people until they are ill, before receiving treatment - what if the targets are not met within 2 years?
• Mental health - on 17 May there is an open meeting to consider the Woodley report

Paula Swann: We are reviewing AYA (Cancer in Adolescents and Young Adults).  The target keeps increasing - was 15%, but going up. Planning how best to achieve compliance - believe we should be able to improve. We do not have a waiting list.

• Woodley review - voluntary sector raised issues over concerns with GP mental health services review. Voluntary organisations are delivering preventative services.  There is a 6 month review. 5 year strategy will underpin whether voluntary organisations will be able to continue services.
• What are other major risks?
• Patients can decide which hospital/healthcare centre they are using - how is that being addressed?

Paula Swann: There are huge risks - much is dependent on transformation. Patient choice is a fundamental patient right.
Stephen Warren: We are working with GPs, CHS and the Council to achieve integrated pathways.

• Is there anything the Council can do to support this?

Paula Swann: We have worked with providers, urgent care and other stakeholders. It is about working together to deliver for Croydon.
Dr Agnelo Fernandes: It is also about giving the right information so patients can choose. People have historical views about their local hospitals. Quality of care in Croydon is a lot better than elsewhere. Waiting time much lower than elsewhere but people do not know this.

• We need to advertise this more.
• What is the process for linking QIPP programme with consultation engagement?
   

Stephen Warren: The operating plan as a whole - where we are making significant changes, we are engaging with partners.

• Have you validated there are no waiting lists?

Stephen Warren: Currently patients wait about a week for an appointment and another couple of weeks for treatment. It was an issue 3-4 years ago.
 

The Board:

• Noted the operating plan
• Commented on the alignment with the Joint Health & Wellbeing Strategy 2013-18

The report provides an update on Health Protection Forum work since the last report to the board, including progress against action plans around immunisations, tuberculosis and screening.

One of the four domains of public health practice is health protection, which includes infectious diseases, chemicals and poisons, radiation, emergency response and environmental health hazards.
 

The Croydon Health Protection Forum (HPF) was established in July 2015 with the purpose to have a strategic overview of health protection matters and with the aim to provide assurance to the Director of Public Health that arrangements in place to protect the health of residents are robust and implemented appropriately to local health needs. The health protection issues discussed at the Forum include adult and child immunisation programmes, national screening programmes.

Rachel Flowers summarised the report.

The following issues were raised:

• Accommodation in Croydon for homeless people, particularly those with mental health issues - this is a pan-London issue
• TB is an increasing issue - which part of our population is presenting with TB?

Rachel Flowers: There is an increased number of people living in poverty and this relates to the incidence of TB.  A report about TB incidence will be presented to the Health & Wellbeing Board.

• 3.3.2 - Air pollution - I thought there was more south of the borough?

Rachel Flowers: There is a lot of work around this - I will check. Air quality across Croydon should be better.
 

The Board NOTED the report.

Healthwatch Croydon carried out a survey on Sexual Health Services - Experiences of Young People. Jai Jayaraman introduced Gordon Kay (Marketing Officer, Healthwatch Croydon) who summarised the findings:

• 65 face-to-face interviews for details to a number of questions
• Identified significant sexual health issues for young people
• Sample size reflected difficulties in accessing these particular service users
• Quality of data of a high standard as face-to-face
• Survey was carried out August-October 2016
• 4 areas for consideration:
  • Accessibility - evenings and weekends preferred and walk-in appointments
  • Marketing - needs to be more focused
  • Help and support - big barrier around embarrassment, teenagers being particularly vulnerable; health setting preferred for advice
  • Delivery - Needs to be more welcoming environment - involve teenagers in service design?

Paula Swann: The survey is very helpful in signposting.
Barbara Peacock: We need to involve young people in designing services. Confidentiality is tricky, as there is a challenging set of issues. There is a caveat around safeguarding and issues around sexual exploitation and abuse.

Rachel Flowers: Across London we are seeing a high level of Hepatitus A. There is a range of sexualities to be considered.
Cllr Mansell: We should include gay websites in advertising.
 

The Board:

• Noted the report
• Endorsed the recommendation and workshop

This is a standard item presented at all Board meetings.  The report summarises work undertaken by the Health and Wellbeing Board executive group since the last meeting of the Board on 8 February 2017.

The Health and Wellbeing Board work plan is regularly reviewed by the executive group and the chair and includes an outline plan for 2017/18.

Barbara Peacock highlighted the key points.

• One red risk - concern about financial implications around social care.
• Number of ambers but most are being mitigated.

There were no questions on this item.

The Board:

• Noted work undertaken by the Executive Group since 8 February
• Noted risks identified in appendix 1
• Agreed the 2017/18 Work Plan at appendix 2
   

The following comment and question were received from Michael Hembest:

COMMENT

Part of the CCGs (Clinical Commissioning Group) presentation (pages 9 & 10) is littered with unexplained acronyms which makes it impossible to understand.

QUESTION
This is the 5th day of the new GP Hubs. Has the CCG had any feedback from the public on the quality of the new pathway?
 

Paula Swann: There was feedback from residents' associations around signage and communications - not right yet.
John Goulston: Publicity is important. 106 on first day - not a lot for a Saturday. Tuesday 56 people across all three.

Question: Is adult access to mental health services covered?

Stephen Warren: Adult Services is going through significant transformation
Cllr Maggie Mansell: Access is improved - including training for SENCOs and head teachers.
Stephen Warren: Closely involved with the schools, so children can access the services more easily.
Karen Stott: Croydon now has single points of access.

Dates of future meetings:

• 7 June 2017
• 13 September
• 18 October