Agenda and minutes

Apologies for absence were received from N Bailey, D Brown, J Gillon, B Jackson, S Jacques and S White

J Foggin for S Jacques, M Mitchell for B Jackson and K Wanley for D Brown

There were no declarations of interest.

The minutes of the meeting held on 6 March 2019 were agreed as a correct record and signed by the Chairman.

The Board received an update from the Corporate Director of Adult and Health Services, Durham County Council on the County Durham Health and Social Care Plan.  The Cabinet report had been received by CCG governing bodies and commissioners were now working on a model based on principles.  Further options would be reported back to Cabinet and CCGs in the autumn prior to implementation by April 2020.

The Chief Clinical Officer, North Durham and DDES CCG gave a presentation that provided an update on the 2019/20 GP contract which covered the following key themes:-

·         Primary Care Networks

·         Digital Improvement

·         Improving Access

·         Workforce and Indemnity Solutions

·         Changes to Quality Outcomes Framework

·         Schedule of Contract Changes 2019/20

The Chief Clinical Officer went on to explain that it was the early stages for Primary Care Networks and in future would encompass all areas of care, not just general practice. 

The Director of Public Health, Durham County Council added that link workers and social prescribing was one element of a lot of work being carried out and she highlighted that the level of funding was a risk as there were no infrastructure costs built into the model. She explained that close working was taking place within different sectors in County Durham to further develop the PCNs.

The Director of Integration commented that capacity within the sector was also a risk.

Resolved:

That the update be noted.

The Board received a report and presentation from the Chief Officer, North Durham and Durham Dales Easington & Sedgefield Clinical Commissioning Groups that presented part B (Children and Young People) of the Durham Health and Wellbeing System Plan 2019/20 (for copy see file of Minutes).

The Director of Strategy and Delivery, North Durham and DDES CCG highlighted the key areas of the plan which had been developed under the leadership of the Integrated Steering Group for Children, which included:

·         Children and Young People’s Strategy

·         The Integrated Steering Group for Children governance and work programme

·         Integrated commissioning approach for children and the priorities linked to the inspection regimes in children’s services

·         Therapy services

·         Development of place based 0-19 services

The Director of Strategy and Delivery advised of a joint development session being held on 13 June with the Adults, Wellbeing and Health Overview and Scrutiny Committee and the Health and Wellbeing Board that would discuss the development of the longerterm plan.

Councillor Gunn commented that partnership working was the key and crucial to keep improving ways of working together.  Referring to the quarter 4 presentation slide about co-production with children, young people and families, she asked how this would operate and how would engagement work.  The Director of Strategy and Delivery reported that the CCG fund an organisation to help with the co-production and that they would be going out to ask the people affected how they would like to see the services delivered.  Stakeholder groups would also be utilised to help talk to parents and carers.  Councillor Gunn added that the voice of the child ran through everything we were doing and these discussions needed to be ongoing.

The Strategic Manager, Partnerships, Durham County Council informed the board the Head of Partnerships and Community Engagement, Durham County Council was carrying out a wider piece of work in the Council and with partners to take on board the views of young people to ensure we can show what difference we are making to the lives of children and young people.

The Director of Public Health, Durham County Council added that the co-production of this area of work would also help to refresh the Joint Health and Wellbeing Strategy and the Corporate Director of Children and Young People’s Services, Durham County Council said that we needed to report more of the good things that we had done as a lot of positive work had already been undertaken with children and young people.  She added that an annual report would be developed about the ‘Voice of the Child’ and assured the board that children and families had been engaged with lots of different pieces of work.

The Chairman thanked officers for the report and was pleased that the board had some good positive actions adding that the child’s voice was fundamental in moving forward and capturing all the good things that were happening.

Resolved:

(i)            That the report and plan were noted.

(ii)          That the approach to the development of the long term Durham  ...  view the full minutes text for item 6.

The Board received a report from the Corporate Director of Children and Young Peoples Service, Durham County Council that presented a refreshed strategy for supporting work across local partners for children, young people and adults with Special Educational Needs and Disabilities (SEND) (for copy see file of Minutes).

The Head of Early Help, Inclusion and Vulnerable Children, Children and Young People’s Services, Durham County Council highlighted the key aims of the strategy and gave an update on progress made.  He went on to advise that the service continued to lobby government for extra resources as the insufficient funding was a challenge in County Durham.

Councillor Gunn expressed concerns about the SEND funding, which was a national problem.  She was pleased that Durham County Council had committed £5.6m from reserves as a one-off contribution and that the service were looking at ways that spending could be reduced in the longer term.  She applauded the staff who worked extremely hard in the schools and Council and confirmed that she was involved in lobbying the Secretary of State and Minister for Schools and Education on these concerns around funding.  Councillor Gunn also chairs Regional Lead Member meetings that had committed to making this a priority across the region.

Resolved:

(i)            That the refreshed strategy be approved.

(ii)          That the strategy be updated in 2019/20 following completion of an in depth health needs analysis.

The Board received a report from the Chief Officer North Durham and Durham Dales, Easington and Sedgefield Clinical Commissioning Groups that provided an update on work being undertaken by the CCGs to reduce paediatric admissions to hospital (for copy see file of Minutes).  The report had previously been requested from the Board due to the number of non-elective admissions of young people into hospital that had impacted upon performance through Better Care Fund monitoring. In addition the aim was to improve outcomes for children and young people who were not best placed to be admitted to hospital.

The Director of Strategy and Delivery, North Durham and DDES CCG explained about the number partnership projects underway to help reduce paediatric admissions and how to improve pathways by looking at training needs.  She highlighted a concern about bed wetting and constipation and a pilot in Newton Aycliffe with community nurses aimed at reducing admissions to hospital and building confidence for parents.  She went on to inform the board that a lot of work was required in order to change perceptions, cultures and behaviours.

Councillor Allen asked how we would ensure that parents were given the confidence that they needed, and was advised that this would be done with better communication.  The Director of Strategy and Delivery explained that engagement with people so that they better understood the 111 service would be taking place, as a number of expert clinicians were available for people to speak to.  The Deputy Director of Public Health added that this would encompass a wider systems approach, including housing strategies for public, private landlords and for personally owned homes, as most injuries occurred in the home.  A further issue was around smoking and advice and guidance was given around second hand smoke and how to communicate with families and the wider community around this.

Resolved:

That the report be accepted and progress to date be noted.

The Board considered a report of the Independent Chair of Durham Safeguarding Children Partnership that provided an update on the transition from the Local Safeguarding Children Board (LSCB) to the new statutory partnership arrangement known as the Durham Safeguarding Children Partnership (DSCP).

The Independent Chair referred the board to a copy of the plan that outlined the new safeguarding arrangements and he highlighted the vision of what the partnership were trying to achieve.  He advised of the structure including the day to day functioning and the independent scrutiny arrangements.

He went on to explain the DSCP would engage with the Criminal Justice Service, Education Sector, Health Service and the Voluntary and Community Sector who would help to shape the agenda for the Executive.

Councillor Allen asked what key differences these changes would make to children and young people in County Durham.  The Independent Chair explained that there would be better engagement with partners and the voice of the child.  He added that a survey had been carried out with young people which would help shape better outcomes.

Councillor Gunn commented that safeguarding children was hugely important and this new structure had the potential to improve the ways things were done, such as sharing information.

The Corporate Director of Children and Young People’s Services highlighted the importance of the benefits of having equal partners who were equally accountable for safeguarding children and young people.  She praised the independent chair for being very robust throughout the transition period and for introducing a fundamental shift in the way partners would work together.

The Chairman thanked the Independent Chair for his report and said that safeguarding was everyone’s business so was pleased to see these new ways of working being introduced.

Resolved:

(i)            That the content of the report be noted.

(ii)          That the update of the transition arrangements was received.

(iii)         That an annual update from the DSCP to ensure links were made between local child death issues and learning from regional reviews be agreed.

The Board received a report of the Director of Public Health, Durham County Council that presented the first annual update of the Pharmaceutical Needs Assessment (PNA) 2018-21 action plan (for copy see file of Minutes).

The Public Health Pharmacy Advisor, Durham County Council highlighted the progress made against the actions of the PNA with joint partnership working and one of the key statements was to promote the role of the pharmacy.  She thanked the support and help from the Local Pharmaceutical Committee and Healthwatch.

The Chairman was pleased to see good practice being shared and everyone playing their part.

Resolved:

That the first annual update, progress to date and ongoing and future workstreams be noted.

The Board considered a report of the Strategic Programme Manager Integration, Adult and Health Services, Durham County Council that provided an update on the Better Care Fund (BCF) Quarter 3 2018/19 performance metrics (for copy see file of Minutes).

The Corporate Director of Adult and Health Services highlighted the improvements and challenges for quarter three data, including non-elective admissions.

Further to a query from Councillor Gunn about how long the work taking place on non-elective admissions would be to impact positively on performance, the Corporate Director of Adult and Health Services explained that there would be a 12-24 month timescale as it was not something that happened overnight.

The Director of Integration assured the board that there was a focus on non-elective admissions with two threads – one to avoid admissions and two, to reduce the length of stay and encourage discharge as soon as practically possible.

Resolved:

(i)            That the contents of this report be noted.

(ii)          That to receive further updates in relation to BCF quarterly performance be agreed.

The Board considered a report and presentation from the Corporate Director Adult and Health Services, Durham County Council that provided an update on initiatives linked to the Adult Care Transformation and Innovation Fund (for copy see of Minutes).

The Corporate Director of Adult and Health Services gave a presentation that highlighted:-

·         Main areas of supporting the provider market

·         Winter pressures

·         Alleviating NHS pressure

·         List of agreed schemes

Referring to winter pressures, Mrs Mitchell, Healthwatch asked what would happen to those people who did not have care connect.  She was assured by the Director of Integration that not everyone takes that up as an option however, assessments would be carried out and people could receive a service regardless of funding capacity.  It may not be care connect but a service based on need.

Resolved:

(i)            That the report be updated.

(ii)          That the continued use of ACTIF funding to alleviate system pressures and support the local health and social care system, including providers, be endorsed.

(iii)         That further updates on the use of funding be received.

The Board received a report from the Interim Head of Commissioning, Durham County Council and Associate Director of Nursing, Patient Safety and Governance, County Durham and Darlington NHS Foundation Trust that gave an update of the work undertaken as set out in the Community Action Plan element of the Falls Prevention Strategy 2018-21 (for copy see file of Minutes).

The Strategic Commissioning Manager OP/PDSI, Adult and Health Services, Durham County Council gave an update on the performance and progress.  He informed the board that additional funding had been received from the Adult Care Transformation and Innovation Fund and Care Connect for the purchase of two raizers, a system used to lift someone when they had fallen. 

Mrs Mitchell, Healthwatch thanked the service for operating the raizers as she had witnessed first hand how they were operated and said that this was very positive step forward.  The Strategic Manager offered to share a clip of how the system worked.

Resolved:

(i)            That the report be noted.

(ii)          That updates on the strategy be received.

The Board noted a presentation from the Director of Public Health, on the following public health campaigns (for copy of presentation see file of minutes):

• Alcohol
• Tobacco
• Stay Well This Winter
• Mental Health
• Breastfeeding

Referring to breastfeeding the Operational Director, Harrogate and District NHSFT said that they had received some positive feedback after speaking to mothers, especially young and first-time mothers.

Councillor Allen suggested that we should be asking what people needed at a local level and develop those ideas as we had for dementia and autism friendly services such as ‘friendly town’ statuses.

The Deputy Director of Public Health said that it was important to change the cultures around breastfeeding and to ‘normalise’ it.  Public Health were encouraging places to display a sticker to promote that they were breastfeeding friendly.

Councillor Gunn said that community centres and local communities should try to provide a place where mothers felt welcome.  She encouraged all partners to promote this.

The Chairman commented that it was important to lead by example as a Health and Wellbeing Board.  All members of the Board agreed to undertake an audit of their premises with the intention of as many as possible being breastfeeding friendly and advertised as this.  This would show the Board’s commitment to improving breastfeeding rates across the county.  It was agreed that a report would be provided back in six months’ time following the audit and to outline next steps for all organisations who form the Board.  This was felt to be a positive step by the Board, especially as we were encouraging other organisations to be breastfeeding friendly.

The Chairman informed the board that the Quality Accounts had been received from the three trusts in the region and a draft response had been circulated.  Any comments on the accounts should be fed back to the Strategic Manager, Partnerships, Durham County Council by the end of 8 May 2019.

The Strategic Manager, Partnerships advised that the Local Government Association had asked the board to contribute to one of their publications.  Work had therefore been carried out with the Director of Public Health on the Voice of the Child, Integration and the work on Tobacco.  The publication would be launched at the LGA’s annual conference in July.