Agenda and minutes

Apologies for absence were received from J Chandy, M Barkley, C Harries and A Lynch.

M Lavender for A Lynch and P Newton for M Barkley.

There were no declarations of interest.

The Minutes of the meeting held on 3 July 2014 were confirmed by the Board as a correct record and signed by the Chairman.

The Board received a presentation from the Public Health Portfolio Lead, Public Health County Durham, Children and Adults Services, Durham County Council that supported a bolder vision of Making Smoking History (for copy of presentation see file of Minutes).

Dianne Woodall, Public Health Portfolio Lead highlighted the following:-

• County Durham Vision
• Cost of Smoking in County Durham
• How Durham compares to the region and England averages
• Local Action Planning
• Highlighted that children not adults start smoking
• Outlined Health inequalities
• Funding

She concluded her presentation by informing the Board about the NHS Statement of Support for Tobacco Control that acknowledged the impact of tobacco and welcomed the commitment, opportunity and endorsement.  The Statement of Support commits NHS organisations to:

• Actively support local work to reduce smoking prevalence and health inequalities;
• Develop plans with partners and local communities;
• Play a role in tackling smoking through appropriate interventions such as ‘Make Every Contact Count’;
• Support Government action at national level;
• Participate in local and regional networks for support;
• Join the Smokefree Action Coalition (SFAC).

The Chairman thanked the Public Health Portfolio Lead for her presentation.

Dr Stewart Findley, Chief Clinical Officer, Durham Dales Easington and Sedgefield Clinical Commissioning Group was informed that e-cigarettes were not included in this work, but it was recognised that there needs to be local and national debates about the issue.  The Public Health Portfolio Lead added that regulation for e-cigarettes is expected and that the percentage of young people using them was low.

Alan Foster, Chief Executive of North Tees and Hartlepool NHS Foundation Trust asked for an update on the Smoke Free Play Areas consultation in relation to the policing of the code and was informed that this would be voluntary and would rely on people speaking up.  The Chairman added that the consultation had been well received by the public with a high percentage agreeing with the proposals to ban smoking from play areas and asked that regular updates are provided to the Board on progress.

Resolved:

That local NHS Providers and the County Durham Health and Wellbeing Board sign up to the NHS Statement of Support for Tobacco Control.

The Board considered a report of the Chief Operating Officer of North Durham and Durham Dales, Easington and Sedgefield Clinical Commissioning Group, which presented the County Durham Implementation Plan of the “No Health without Mental Health” National Strategy (for copy see file of Minutes).

Rachael Shimmin, Corporate Director, Children and Adults Services, Durham County Council said that this was an important document with a focus on mental health.  Judith Mashiter, Joint Chair of Healthwatch County Durham, commented that the statistics for those predicted to have mental health needs were very high .

Ron Hogg, Durham Police and Crime Commissioner welcomed the report and fully supported the document.  The Durham PCC stated that Social Media was a factor in relation to young people and self-harming which was captured within the document. 

Peter Appleton, Head of Planning and Service Strategy, Children and Adults Services, Durham County Council said that it would be appropriate for the Health and Wellbeing Board to obtain a review position in six months.  The Chief Operating Officer, Durham Dales, Easington and Sedgefield and North Durham CCGs agreed to take this back to the Chair of the Mental Health Partnership Board to agree this as an appropriate time.

Resolved:

(i)            That the report be received;

(ii)          That the contents of the report and the Implementation Plan be noted; and

(iii)         That the priorities set out in the plan and the approach for implementation be agreed.

The Board considered a report of the Chief Operating Officer of North Durham and Durham Dales, Easington and Sedgefield Clinical Commissioning Group, that gave an update on the local response to the mental health crisis care concordat and presented the local declaration for sign up and support (for copy see file of Minutes).

The Chief Operating Officer, North Durham and DDES CCG informed the Board that a further report would be presented in March 2015 which will include the local action plan.  She added that the key priority for the Board would be to focus on people in crisis and outlined the mental health services to support those in crisis. Members were advised that a Task & Finish group had been set up and once sign up and support from key organisations had been confirmed the declaration would be uploaded onto the national website by the deadline of December 2014. 

The Durham Police and Crime Commissioner said he was very supportive of the concordat. He added that Section 135 & 136 arrests currently mean that people with mental health needs are held in a police cell and national targets were to reduce this.  The PCC also touched on the victims of crime and how they needed protecting as they can often be vulnerable if suffering with mental health issues.  Michael Banks, Deputy Chief Constable, had also attended the meeting in support of the work relating to the concordat.

The Board agreed following a proposal from the Corporate Director, Children and Adults Services that this would be placed on the Safe Durham Partnership agenda.

Resolved:

(i)         That the local mental health crisis care declaration be signed up to and supported: and

(ii)        That the approach to developing the local response to the crisis care concordat be noted.

The Board considered a Joint Report of Chief Officer, Darlington Clinical Commissioning Group and Clinical Chair, Hartlepool and Stockton on Tees Clinical Commissioning Group, that gave an update on the Securing Quality in Health Services Project (for copy see file of Minutes).

Dr Boleslaw Posmyk, Clinical Chair, Hartlepool and Stockton on Tees CCG gave background to the project and explained that the project is being delivered in three Phases:

·         Phase one aimed to establish a consensus in relation to the key clinical quality standards that should be commissioned in acute hospitals. 

·         Phase two worked with individual organisations to update the assessment in terms of meeting the clinical quality standards now and by April 2015. It also included an assessment of the implications of meeting the standards and where there are challenges to this across the system.

·         Phase three will focus on how organisations and services might work together in the future to deliver the standards and identify a model of care across the Durham, Darlington and Tees area that will maximise the ability to meet the standards within the resources available.

Martin Phillips, Chief Officer, Darlington CCG added that this was about ensuring people had the best access to the best possible care in hospital.  Phase 3 was about balancing investment of planning for the future whilst maintaining delivery.

The Chairman thanked the Chief Officer, Darlington CCG and the Clinical Chair, Hartlepool and Stockton on Tees CCG for a very detailed report and recognised that there would be work to bring back to the Board in due course.

Sue Jacques, County Durham and Darlington NHS Foundation Trust said that the NHS had produced a 5 year Forward View that set out the case for change nationally.  It was agreed that the national and local response would come back to the Health and Wellbeing Board in due course.

The Chief Executive of North Tees and Hartlepool NHS Foundation Trust supported the ongoing work and said that further discussions would be taking place regarding the areas requiring quality improvements.  He added that diagnostic services were under immense pressure and the number of standards were increasing.  He said it was about all three Trusts working together to ensure the best possible care in hospitals and in the community.

Resolved:

(i)            That the contents of this report be noted; and

(ii)          That a further update from the project team in due course be received.

The Board considered a Joint Report of the Corporate Director, Children and Adults Services, Durham County Council, Chief Clinical Officer, Durham Dales Easington and Sedgefield Clinical Commissioning Group and Chief Operating Officer, North Durham and Durham Dales Easington and Sedgefield Clinical Commissioning Group, that sought to ratify the Better Care Fund Plan (for copy see file of Minutes).

Paul Darby, Head Of Finance - Financial Services, Resources, Durham County Council informed the Board that the plan had been formally submitted on 19 September following further refinement.  Notification had been received that the plan has been approved with support and the Task & Finish Group would now be working on the practicalities and governance arrangements.

The Head of Planning and Service Strategy said that this had been a challenging process and thanked those involved in developing the BCF.

Resolved:

(i)            That the content of the report be noted; and

(ii)          That the BCF Plan be ratified.

The Board received a Joint Report of Strategic Manager, Policy, Planning & Partnerships, Children and Adults Services, Durham County Council, Safeguarding and Practice Development Manager, Children and Adults Services, Durham County Council and Local Safeguarding Children Board Business Manager, Children and Adults Services, Durham County Council that sought formal agreement and ratification on the Safeguarding Framework (for copy see file of Minutes).

Resolved:

That the Safeguarding Framework be formally agreed and ratified; and that the partnership arrangements in place to protect vulnerable children and adults from harm be noted.

The Board considered a report of the Director of Public Health County Durham Children and Adults Services, Durham County Council which presented the first County Durham Drug Strategy 2014-2017 (for copy see file of Minutes).

Resolved:

(i)             That the Drugs Strategy (2014-2017) for agreement be received ; and

(ii)            That the Drug Strategy has been subject to consultation and discussed widely and comments incorporated accordingly be noted.

The Board considered a report of the Director of Public Health County Durham, Children and Adults Services, Durham County Council that presented the Strategy for Prevention of Unintentional Injuries in Children and Young People (0-19 years).

The Head of Planning and Service Strategy said that this was an important document and suggested that the group working on the Strategy report back to Health and Wellbeing Board in due course.

The prevention of Unintentional Injuries in Children and Young People Strategy will be presented to the Children and Families Partnership.

Resolved:

That the Strategy for the Prevention of Unintentional Injuries in Children and Young People (0-19 years) in County Durham be agreed.

The Board considered a report of the Director of Public Health County Durham, Children and Adults Services, Durham County Council that presented the Healthy Weight Strategic Framework for agreement (for copy see file of Minutes).

Dr Mike Lavender, Public Health Consultant informed the Board about the aims and objectives of the framework, the scope, challenge and what we will do through strategic actions and multi-agency sub-groups.

The Board agreed that obesity in children was a serious issue that needed a wider spread of ownership and more effective communication.  The Head of Planning and Service Strategy added that the Children and Families Partnership would need to consider this issue.  The Public Health Consultant agreed that a stronger case for obesity would be made with projections and predictions showing the effect on teenagers in 10-15 years’ time.

The Corporate Director, Children and Adults Services suggested that this issue should be discussed at the Chairs of Health and Wellbeing Board meetings.  Paul Newton, the Director of Operations, TEWV NHS Foundation Trust said that the CAMHS strategy would pick up the points relating to children’s mental health that are interlinked with this Strategy.

Resolved:

(i)            That the Healthy Weight Strategic Framework for County Durham be agreed;

(ii)          That the alignment of the Healthy Weight Strategic Framework to a range of existing strategies between Durham County Council and partner organisations be noted;

(iii)         That the need for collaborative working with all relevant partners required for implementation of the strategic framework be noted;

(iv)         That the tiered approach to delivery required across the life course be noted;

(v)          That the scale of the challenge and potential impact if action to tackle obesity is not progressed be noted; and

(vi)         That this is a long-term approach and actions are programmes over the six year time frame be noted

The Board considered a report of the Chief Operating Officer, North Durham and Durham Dales, Easington and Sedgefield Clinical Commissioning Group that presented the County Durham Interim Child and Adolescent Mental Health Services (CAMHS) Joint Strategy for 2014/16 (for copy see file of Minutes).

The Chief Operating Officer informed the Board that this supercedes the previous Strategy of 2007/10.  A key priority in the interim Strategy focuses on reducing self-harm.

Councillor Nicholls asked if there was any evidence to show that mental health issues could be passed on through family members in the same household, just as evidence shows that an adult smoker in a household can lead to a child or young adult starting to smoke.  The Chief Operating Officer explained that this could happen and is evidenced in terms of stressors but is not in the same way as smoking habits.

The Corporate Director, Children and Adult Services welcomed the strategy as an area of focus.  The Chief Clinical Officer, DDES CCG recognised the variations for localities and commented that the figures for Durham Dales were high. 

The Director of Operations, TEWV NHS Foundation Trust welcomed the report and advised the Board that there had been a significant increase in demand and therefore placed a lot of pressure on the CAMHS service.

The Chairman agreed that this was a very important strategy with many issues to address.  She referred to the waiting time for referrals and pointed out that a month was a long period of time for a young person to wait for a mental health service.

The Chief Operating Officer ND and DDES CCG stated that an update will be provided to the Health and Wellbeing Board in due course.

Resolved:

(i)            That the content of this report be noted; and

(ii)          That the County Durham Child and Adolescent Interim Joint Strategy 2014-16 be ratified.

The Board received a report of the Head of Children's Services, Children and Adults Services, Durham County Council that introduced the final copy of the Early Help Strategy (for copy see file of Minutes).

The Head of Planning and Service Strategy highlighted the three ways that children could be helped – Prevention, Early Intervention and Protection and the three ambitions of the vision – Work collaboratively; right help at the right time; and help that works.  He said that there was a clear message in the strategy that we could “not do nothing”.  Referring to the staircase of continuum he advised that each step should be exhausted before moving on to the next.

Resolved:

That regular updates on the Early Help Strategy’s implementation and success be received.

The Board considered a report of the Head of Planning and Service Strategy, Children and Adults Services that described the progress being made against the priorities and outcomes set within the County Durham Joint Health & Wellbeing Strategy (JHWS) 2014-17 (for copy see file of Minutes).

Resolved:

(i)            That the performance highlights and areas for improvements identified throughout this report, be noted.

(ii)          That the actions taking place to improve performance and agree any additional actions where relevant, be noted.

The Board received a report of the Head of Commissioning, Children and Adults Services, Durham County Council that gave an update on progress in response to the statutory guidance Implementing “Fulfilling and Rewarding Lives” (for copy see file of Minutes).

The Head of Commissioning referred to the new service provided for 30 people with autism.  The Head of Commissioning stated that she would provide information relating to throughput which is outlined in the Contract to Dr Mike Lavendar.  The Joint Chair of Healthwatch County Durham welcomed the report and would take the opportunity to follow up with the Head of Commissioning in relation to further service user and carer engagement.

Diagnostics and accommodation issues were sighted as requiring further work by the Director of Operations, Tees, Esk and Wear Valley NHS Foundation Trust.

Resolved:

That the report be received.

The Board considered a report of the Corporate Director, Children and Adults Services, Durham County Council and Chief Operating Officer, North Durham and Durham Dales, Easington and Sedgefield Clinical Commissioning Group that informed of the intention to submit a bid on behalf of Durham County Council and North Durham and Durham Dales, Easington and Sedgefield Clinical Commissioning Groups, to be part of the national Integrated Personal Commissioning pilot (for copy see file of Minutes).

Resolved:

(i)            That the submission of a bid be supported;

(ii)          That authority to Cllr Lucy Hovvels as Chair of the Board to formally sign off the submission be delegated; and

(iii)         That updates on the outcome of the submission be received.

The Board considered a report of the Head of Commissioning, Children and Adults Services, Durham County Council that gave an update on progress in relation to the Winterbourne View Concordat and Action Plan implementation in County Durham (for copy see file of Minutes).

The Head of Commissioning highlighted the key actions and advised about the 10 individuals on the County Durham register.  The plan would be reported back to the Department of Health and at the Health and Wellbeing Board.  The Board were advised that Councillor Nicholls had been identified as the Learning Disability Champion.

The Corporate Director, Children and Adults Services said that the Board needed greater sight of the totality of people with learning disabilities as outlined in the Winterbourne View concordat.  She referred to the key questions in the Health and Wellbeing Board practice guide and stated that we need to answer these questions and come back to the Board. She advised the Board that the Chairs of the Health & Wellbeing Boards wrote to the Department of Health on behalf of Directors of Adult Social Services to start thinking about the issue regionally.

The Director of Operations, TEWV NHS Foundation Trust stated that this was a complex issue and advised that there were a number of people whose services are commissioned through the Area Team.  Individual packages for all could end up costing a lot of money and detailed planning was required for all service users who are impacted.

The Corporate Director, Children and Adults Services added that the next update to the Board should also include those people who receive specialist commissioning services.  It was agreed that this issue was unresolved at a national level and that this would be raised further by the Chair at the next Regional Health and Wellbeing Board Chairs meeting.

Resolved:-

(i)            That the update and assurance that plans are in place to work collaboratively between DCC and Clinical Commissioning Groups to develop long-term solutions for the identified individuals be received;

(ii)          That further progress updates, including a detailed action plan in relation to any significant ‘resource shifts’ from hospital to community-based services be received; and

(iii)         That Councillor Morris Nicholls be endorsed as the champion responsible for Learning Disabilities.

The Board received a report of the Director of Public Health County Durham, Children and Adults Services, Durham County Council that gave an update on the progress regarding the transfer of 0-5 commissioning responsibilities (health visitors and family nurse partnership) to local government (for copy see file of Minutes).

Resolved:

That the updated position in relation to the transfer of 0-5 commissioning responsibilities be noted.

Resolved:

That under Section 100 A (4) of the Local Government Act 1972, the public be excluded from the meeting for the following item of business on the grounds that it involves the likely disclosure of exempt information as defined in paragraph 3 of Schedule 12A to the said Act.

The Board considered a report of the Director of Public Health County Durham which provided a summary of Pharmacy Relocation Applications received from NHS England in accordance with the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 since the last formal meeting of the Board in July 2014 (for copy see file of Minutes).

Resolved:

That the Board note the Pharmacy Relocation Applications received.