Agenda and minutes

Apologies for absence were received from M Barkley, J Chandy, C Harries S Jacques and Dr D Smart

P Newton for M Barkley and S Perkins for S Jacques.

There were no declarations of interest.

·       Department of Health Letter - Crisis Declaration in Durham and Darlington

The Minutes of the meeting held on 5 November 2014 were confirmed by the Board as a correct record and signed by the Chairman.

Councillor M Nicholls made reference to the letter received from the Rt Hon Norman Lamb MP that thanked the Chairman for signing up to the Crisis Care Concordat (for copy see file of Minutes).   Councillor Nicholls said that a lot of good work had been carried out across the board and pointed out that one of the six priority areas in the Joint Health and Wellbeing Strategy relates to Mental Health.  He informed the Board that the Chairman was a Mental Health champion.  He advised that the Board would continue to take the work forward and that an action plan had been circulated with comments required by 6 February, following which a revised action plan would be presented in March 2015.

The Chairman said she was pleased to receive the letter and that it was recognition across the board and a testimony to the work being carried out.

The Board noted a report of the Chief Clinical Officer, Durham Dales Easington and Sedgefield Clinical Commissioning Group that provided an update on system resilience funding and winter planning following an initial report produced in 2014 (for copy see file of Minutes).

The Chief Clinical Officer, DDES CCG reported that there had been additional winter pressures throughout the whole country.  Acute hospitals were under pressure and there had been an unprecedented level of demand.  The Systems Resilience Group had allocated Resilience Funding across all major providers on a fair share split. Additional monies were also allocated to County Durham and Darlington NHS Foundation Trust and Tees, Esk and Wear Valleys NHS Foundation Trust. 

Councillor M Nicholls expressed concern that the media makes news stories worse by frightening older people into thinking they were all at risk.  The Chief Clinical Officer said that with an increasing ageing population more people will develop long term medical conditions.  He added that A&E departments had reached a tipping point and more was being done to care for the frail elderly population in the community, where it was safe to do so. 

The Corporate Director, Children and Adults Services (DCC) said that additional funding had been discussed centrally including how it would be weighted on the population size which would mean that Durham could expect £230k which would be used to alleviate hospital pressures.

The Chief Executive of North Tees and Hartlepool NHS Foundation Trust said that his trust has faced increasing pressures in A&E recently.  He said that staff were under immense pressure and demand was at an unsustainable level. 

Sarah Perkins, Associate Director of Operations and Business Development, County Durham and Darlington NHS Foundation Trust echoed those sentiments and agreed that the pressures needed to be addressed.

The Chairman asked for further information on the voluntary and community sector contribution and was informed that they were used already to help and support people in communities.

The Head of Planning and Service Strategy, Children and Adults Services (DCC) stated that it was important for the Board to have sight of any reviews carried out at local level.

The Chief Clinical Officer confirmed that there would be a winter wash-up in late spring looking at lessons learnt from the previous winter and actions agreed on how to progress for the forthcoming winter.

Resolved:

That the report be accepted for information.

The Board considered a report of the Chief Clinical Officer, Durham Dales Easington and Sedgefield Clinical Commissioning Group that invited them to contribute to the development of a Five Year Urgent Care Strategy (for copy see file of Minutes).

The Board were advised that the strategy was in draft format and feedback was invited ahead of the final strategy coming back to the Health and Wellbeing Board in July 2015.

Councillor M Nicholls commented that often older people are portrayed as the problem without highlighting the positive impacts on society older people have. The Chief Operating Officer, DDES CCG said that the health service needs to be reshaped to help people live longer, healthier lives and needed a shift to preventative care.

The Head of Planning and Service Strategy, CAS DCC welcomed the report and said that all strategies should align as part of the whole system approach and make the best use of the resources available.

Resolved:

(i)            That the report and the draft Urgent Care Strategy for information be noted.

(ii)          That initial comments from the meeting be received and any further comments be made by 13 February 2015.

(iii)         That the Urgent Care Strategy comes back to the Health and Wellbeing Board meeting in July 2015 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 completed Pharmaceutical Needs Assessment (PNA) following the statutory consultation phase, 13 October 2014 to 12 December 2014 and that sought sign off prior to the report’s wider circulation and publication in March 2015 (for copy see file of Minutes).

The Chief Clinical Officer, DDES CCG said that people were encouraged to visit their local pharmacist as the first port of call for non-emergencies.

The Director of Public Health County Durham said that NHS England use this document when they receive pharmacy applications and it helps to control the market entry.  She added that the Urgent Care Strategy looks to enhance the role of the pharmacists.

With reference to page 105 of the pack of papers, the Director of Public Health County Durham said that figures should read total number of pharmacies in 2011 as 116, and total number of pharmacies in 2014 as 125.

Resolved:

(i)            That the final PNA report be received and approved.

(ii)          That the report be signed off prior to wider circulation and publication in March 2015.

The Board considered a joint report of the Head of Planning and Service Strategy, Children and Adults Services, Durham County Council and the Director of Public Health County Durham, Children and Adults Services, Durham County Council that presented the following:-

·         An update on the development of the Joint Strategic Needs Assessment (JSNA) 2014 and Joint Health and Wellbeing Strategy 2015-18

·         A draft refresh of the JHWS 2015-18 (Appendix 2)

·         A subset of the JHWS indicators as part of the County Council’s performance arrangements for the County Durham Partnership in 2014/15 (Appendix 3)

(for copy see file of Minutes)

The Board received a joint presentation outlining the key messages from the JSNA 2014 and the new strategic actions in the JHWS 2015-2018 as a result of consultation to date.

The Head of Planning and Service Strategy informed the Board of the success of the ‘Big Tent’ event and reminded the Board that the JSNA/JHWS are available on the internet.

The Director of Public Health County Durham added that it was important to note that 10 out of the 14 AAPs have health as a priority and that the CCG and Public Health have representatives on each AAP.

Resolved:

(i)            That the draft JSNA 2014 Key Messages in the presentation be received.

(ii)          That comments on the draft Joint Health and Wellbeing Strategy 2015-18 (Appendix 2), new strategic actions and performance indicators be received by 9^th February 2015

(iii)         That the subset of JHWS indicators be reported to the CDP, be agreed.

The Board considered a report and presentation of the Director of Primary Care, Partnerships and Engagement, Durham Dales, Easington and Sedgefield Clinical Commissioning Group that gave an overview of the national five year forward view (5YFV) and that members to contribute to the discussion and inform future board strategy alignment (for copy see file of Minutes).

The Chief Clinical Officer DDES CCG gave a presentation highlighting the following aspects of the Five Year Forward View:-

·         Principles

·         Key Themes

·         New Models of Care

·         NHS as a Social Movement – Increasing Community Involvement

·         Multispeciality Community Providers (MCP)

·         Primary and Acute Care System (PACS)

·         Urgent and Emergency Care Networks

·         Other Models of Care

·         Impact

The Board were informed of the next steps, including an event being planned for 26 February 2015 that would bring providers and commissioners across the health and social care system together.

The Chair, Healthwatch County Durham asked that terminology is considered when presenting to the public using caution in the language used.  The Chief Clinical Officer said that the ultimate aim would be to simplify the messages for patients, making the services available easier to reach and understand.

The Chief Operating Officer said that it was important to make the public feel like individuals and that the engagement exercise would give a clear message about being more appropriate and effective.

The Corporate Director, CAS, DCC expressed concern in relation to the impact on the system due to local government budget reductions.

Resolved:

(i)     That the report be noted.

(ii)    That the presentation be received.

(iii)   That North Durham and DDES CCGs are working jointly in planning for the 5YFV, where indicated; an extended planning unit meeting with primary care federations and providers across County Durham is planned for 26 February 2015, be noted.

(iv)   That North Durham and DDES CCGs have submitted an expression of interest for consideration in the proposed transformation fund for small scale testing of new models of care, be noted.

(v)    That the CCGs will conduct a gap analysis to evaluate potential commissioning gaps as well as potential duplication of planning work.

The Board considered a report of the Chief Operating Officer, North Durham and Durham Dales, Easington and Sedgefield Clinical Commissioning Group that gave an update on progress of the refresh of North Durham Clinical Commissioning Group (ND CCG) and Durham Dales, Easington and Sedgefield Clinical Commissioning Group (DDES CCG) two year operational plans (for copy see file of Minutes).

Resolved:

(i)            That the Planning Progress Update and Draft Commissioning Intentions 2015-16 for comment, be received.

(ii)          That the planning timetable, be noted.

(iii)         That delegated authority to the Corporate Director of Children and Adult Services, Durham County Council, Chief Operating Officer for DDES and North Durham CCG, Chief Clinical Officer for DDES CCG in consultation with the Chair of the Health & Wellbeing Board for the agreement of the local quality premium indicators for 2015/16, be agreed.

(iv)         That the CCG commissioning plans at the Health and Wellbeing Board meeting in March 2015, be received.

The Board considered a report and presentation of the Chief Operating Officer, North Durham and Durham Dales, Easington and Sedgefield Clinical Commissioning Group that gave an update on North Durham and Durham Dales, Easington and Sedgefield and Darlington Clinical Commissioning Group’s joint application for Primary Care Co-commissioning (for copy see file of Minutes).  The Chief Operating Office advised the Board that the County Durham CCGs had bid for level 3 delegated commissioning arrangements and awaited the outcome.

Resolved:

That the report and presentation be received.

The Board considered a report of the Director of Public Health County Durham, Children and Adults Services, Durham County Council that provided a briefing on Due North: the Report of the Independent Inquiry on Health Equity for the North published on Monday 15^th September (for copy see file of Minutes).

The Director of Public Health County Durham informed the Board that the report was commissioned by the Public Health England (PHE) as part of a collaborative overarching programme called Health Equity North and focusing on three themes:-

·       a fair start for children

·       the economy and welfare

·       democratic and community empowerment

Resolved:

(i)            That the report and recommendations, specifically those that reference health and wellbeing boards and the current position in County Durham in relation to these, be noted.

(ii)          That where the Due North recommendations provide a good fit with the HWB priorities these will be included in the Joint Health and Wellbeing Strategy, be agreed.

(iii)         That the next steps detailed in paragraph 14 and suggested action to map against relevant County Durham strategies, be noted.

(iv)         That the report will be widely discussed at a number of Forums / Networks, be noted.

The Board considered a report of the Strategic Manager, Policy, Planning & Partnerships, Children and Adults Services, Durham County Council  that informed of the duties and responsibilities in the Care Act 2014 and outlined how the adult social care reforms will be implemented in Durham (for copy see file of Minutes).

The Strategic Manager, Policy, Planning & Partnerships advised that the cap on care costs would be set at £72k. She also advised that as Durham had a number of prisons there was focused work taking place on this part of the Act. .  She advised that there would be an increase in demand and responsibility for the local authority and that a lot of work would be ongoing until implementation in April 2015 for the first phase of the reforms.

Resolved:

(i)            That the content of this report and the timetable of key national milestones in Appendix 2, be noted.

(ii)          That to receive a further update in relation to the implementation of the Care Act, be agreed.

The Board considered a report of the Chair, Healthwatch County Durham that gave an update on the strategic direction, structural changes, activities and outcomes of Healthwatch County Durham during the period April to September 2014 (for copy see file of Minutes).

The Chair, Healthwatch County Durham advised that their focus of work had been on listening, advising and speaking up.  The Board were advised that people had raised concerns over a number of issues that Healthwatch followed up and spoke up about, including:-

·         10 people raised issue with access to GP appointments

·         30 people raised issue with the physical environment and waiting times at Bishop Auckland Eye Clinic

·         9 people raised dissatisfaction with various aspects of the service at University of Durham A&E

·         14 positive comments were raised about an individual staff member at Bishop Auckland Hospital

·         6 people with Blue Badges raised issue with the inadequate signing and arrangements for reclaiming parking fees at University of Durham Hospital

Resolved:

(i)            That the activities and outcomes of Healthwatch County Durham’s work in gathering views, advising people and speaking up for health and social care service users, be noted.

(ii)          That the preparations being made for Healthwatch County Durham becoming an independent social enterprise, be noted.

The Board received a report that gave an update on the Better Care Fund (BCF) (for copy see file of Minutes).

The Head Of Finance - Financial Services, Resources, Durham County Council informed the Board that the Task & Finish Group were meeting around the governance arrangements and advised that a risk-sharing agreement has been agreed in principle by the three partner organisations.  The Board were informed that the Better Care Fund will be monitored on a regular basis as part of the Chief Officers meeting to ensure that the plan was being delivered.

Resolved:-

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

(ii)          That the Risk Sharing Agreement attached at Appendix 2, with further update reports on delivery of the Better Care Fund Plans being brought to the Board in 2015/16, be approved.

The Board considered a report of the Director of Public Health County Durham, Children and Adults Services, Durham County Council which presented the 2013/14 annual report (for copy of report and slides see file of Minutes).

The Director of Public Health advised that the report focused on social isolation and how this impacts on the community as a whole.  She said that this was not an issue that could be tackled by one organisation and would need a partnership approach.  Key messages in the report were highlighted.

The Chairman said that the report delivered a powerful message and highlighted hidden problems within the community.  Councillor Nicholls suggested that the report be circulated to all councillors for them to share in their own communities.

Resolved:

(i)            That the 2014 Annual Report of the Director of Public Health, County Durham and note the key messages and recommendations, be received.

(ii)          That the report is used to inform commissioning plans, service developments and assessment of need to support a range of funding bids, particularly by third sector organisations be noted.

The Board considered a report of the Strategic Manager, Policy, Planning & Partnerships, Children and Adults Services, Durham County Council that gave an update on preparations for the Local Government Association (LGA) supported Health and Wellbeing Peer Challenge (for copy see file of Minutes).

The Strategic Manager, Policy, Planning & Partnerships advised that the Peer Review would be taking place from 24 – 27 February 2015 with a feedback session taking place on the last day.

Resolved:

That the progress and next steps outlined in the report be noted.

The Chairman considered that this item was of sufficient urgency to warrant consideration.

Health Premium Incentive Scheme Update

The Director of Public Health, County Durham, Children and Adults Services, Durham County Council informed the Board that further to the introduction of the Health Premium Incentive Scheme, £5m has been allocated for the first year of the incentive.  Each authority’s share of the £5m will be proportional to its 2014-15 target allocation, and also dependent on the authority passing their threshold for payment.  Targets would be set against two indicators:-

i. National indicator - ‘Successful completion of drugs treatment’ with combined PHOF data for opiate and non-opiate users; and

ii. A local indicator - Selected by Local authorities from the list approved indicators

The Board were informed that the local authority must demonstrate an improvement from the baseline figure to receive any funding.  Transparency around the funding was difficult as worked around a points system.  A paper would come to the Board at a future meeting.

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, Children and Adults Services, Durham County Council 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 November 2014 (for copy see file of Minutes).

Resolved:

That the Board note the Pharmacy Relocation Applications received.