Agenda and minutes

The Chair, Councillor Caan informed the Board that David Williams, NHS England was leaving the NHS at the end of October and, consequently, would no longer be a member of the Board. He placed on record his appreciation for all his hard work, support and commitment during his time as a Board member. Councillor Caan welcomed Adrian Stokes, the new NHS England representative who was attending his first Board meeting and Sharon Goosen, West Midlands Police who was attending her first meeting.

There were no declarations of interest.

The minutes of the meeting held on 10^th July, 2017 were signed as a true record. There were no matters arising

The Chair, Councillor Caan will report at the meeting on the following:

·  West Midlands Well-being Board

·  Director of Public Sector Reform

·  Health and Wellbeing Development Days

The Chair, Councillor Caan, provided the Board with an update on the recent meeting of the West Midlands Wellbeing Board held on 6^th October; informed of the progress with providing apprenticeships; and highlighted the plans for future Health and Wellbeing development sessions.

At their last meeting the West Midlands Wellbeing Board had considered a number of issues including the West Midlands on the Move Physical Activity Strategic Framework, the aim of which was to increase the number of people who were physically active. The framework had been developed by a Working Group and work was now progressing on determining the 2017-19 priorities and gaining local authority commitment to these. Councillor Caan informed that he had been appointed as the political Physical Activity Champion for this work and that the strategy was to be launched on 16^th November in Coventry. Board Members were to be invited to this launch event.

The Wellbeing Board had agreed the following 6 priority areas for action:

Long term conditions – diabetes, cardiovascular, cancer

Prevention at a WMCA level – smoking, alcohol, physical activity

Children and young people

Transport

Housing and the build environment

Population and individual behaviour change

The Wellbeing Board were also provided with an update on the West Midlands Mental Health Commission. Thrive to work was to be launched on 20^th October and involved £8.335m being secured over a three year period to support unemployed people with a health condition to access work. The Board were informed that Henry Kippin had been appointed as Interim Director of the Public Sector Reform Programme.

Councillor Caan reported on his recent meeting with Sally Lucas, Executive Director from the Chamber of Commerce who had responsibility for Apprenticeships. The visit had been arranged as part of the Marmot work on good economic growth and opportunities for young people, to understand the work that the Chamber was doing in this area. It was the intention that the issue of Apprenticeships be discussed in detail at a future Board meeting or Development Session and that members would be asked to support apprenticeships from within their organisations.

The Board were informed of the intention to hold a Board Development Session on 27^th November and a Joint Development Session with Warwickshire on 13^th December.

RESOLVED that the arrangements for the Health and Wellbeing Developments Sessions on 27^th November and 13^th December be noted.     

Update from Brenda Howard, Programme Director who will report at the meeting on:

(a) Proactive and Preventative Care

(b) Urgent and Emergency Care

(c) Planned Care

(d) Maternity and Paediatrics

(e) Productivity and Efficiency

Further to Minute 5/17, Gail Quinton, Executive Director of People introduced the report of Brenda Howard, Programme Director, which provided an update on the Better Health, Better Care, Better Value programme. Reference was also made to the detailed report due to be considered at the cancelled meeting on 4^th September which was to inform of progress with the workstreams.

Members of Board with responsibility for the following workstreams informed of the latest position relating to:

Proactive and Preventative Care

Urgent and Emergency Care

Planned Care

Maternity and Paediatrics

Productivity and Efficiency

In relation to the Maternity and Paediatrics, a Local Transformation Plan for the local maternity system was to be submitted to NHS England by 30^th October, 2017. It was the intention that the Plan would be shared with the Board once it had been approved by the STP governance structures. The Board noted that the Council’s Health and Social Care Scrutiny Board (5) had given detailed consideration to the progress of this workstream at their meeting on 11^th October, 2017. With regard to the Urgent and Emergency Care workstream, the Board were reminded of the issue of delayed transfers of care and how all the partner organisations were working to ensure that this didn’t become problematic over the winter period. In relation to the proactive and preventive care workstream, the Board were informed of the intention to consider how to use the health economy workforce, making sure that every contact counts by discussing wider health needs at every opportunity and pushing public health offers. It was the intention to discuss this at the scheduled Development Day sessions in November and December.

The report referred to the establishment of an STP informal reference group which would provide a forum for STP Board leaders to meet with the local authority health portfolio members, Health and Wellbeing Board Chairs and representative non-executive directors. The reference group would provide an informal advisory function to the STP Board, discussing topics/issues at a preliminary stage so allowing key partner input. Initial areas for discussion were outlined.

The Board noted that the quarterly review with the NHS regulators had taken place on 13^th September. The focus of the meeting had been the performance of the system against core health performance targets and preparedness for winter pressures. The formal feedback would be reported to the Board in due course.

The update report concluded with information about the STP joint working with Voluntary Action Coventry which included details on recently established initiatives.

Members of the Board expressed support for the establishment of the STP informal reference group.

RESOLVED that the content of the report be noted.    

Report of Andrea Green, Coventry and Rugby Clinical Commissioning Group

The Board considered a report of Andrea Green, Coventry and Warwickshire CCG which provided an update on the Out of Hospital (OoH) Transformation Programme which aimed to achieve truly integrated services based on the changing population needs by using an outcome based commissioning approach. A detailed overview of the programme and process was set out at an appendix to the report. The work programme was underpinned by extensive public, patient and stakeholder engagement and sought to address the structure, cultural and professional barriers to delivering person centred care.

The report indicated that the three Coventry and Warwickshire CCGs commenced the OoH programme of work in 2015 with the aim of improving the integration of community services to deliver a more personal-centred offer. The programme represented a significant component of the CCG strategy and had been bought into the Proactive and Preventative Care workstream of the Better Care, Better Health, Better Value programme. Initial work involved commissioners working with patients, the public, clinicians and key stakeholders including Local Authority representatives to shape and define a set of outcomes and objectives for a future clinical model of care.

The Board noted that the commissioners had agreed the following objectives for the programme:

·  To reduce the health and wellbeing inequalities

·  To address the care and quality gap by ensuring more services use evidence based best practices

·  Identifying those most in need and co-ordinating their care more effectively by commissioning and ensuring interdisciplinary working

·  To work within tight financial parameters by developing and delivering services around the needs of patients and carers and reduce duplication and waste of resources.

Attention was drawn to the six domains, developed to ensure the providers deliver agreed outcomes.   

In April 2017 the CCG Governing Bodies formally adopted the Clinical Model. The Programme Board then undertook a process to determine the necessary contracts. The Board were informed that delivering the transformation required to make the system truly integrated would require sustained effort over a number of years by the commissioners and providers. The model and outcomes commissioned would be consistent across Coventry and Warwickshire but the underpinning contracts would be based on geographical areas. This way resources could be targeted to reflect the different health needs of each population, different service provision and different historical levels of resourcing.  

In July, 2017 the Governing Body of Coventry and Rugby CCG considered a range of commissioning and contract options and decided to make a direct award to Coventry and Warwickshire Partnership Trust for Coventry residents and South Warwickshire Foundation Trust for Warwickshire residents. It was anticipated that the new type of contract would come into operation from April 2018. The Collaborative Commissioning Board was to be responsible for the future governance of the programme.

 Members asked for examples of how patients would see a difference between the existing service and that provided by the new commissioning approach. An assurance was sought that the sharing of data between the health partners would not become an issue and information was requested  ...  view the full minutes text for item 18.

Report from Chief Superintendent Sharon Goosen, West Midlands Police and Interim Chair of the Multiple Complex Needs Board

The Board considered a report of Chief Superintendent Sharon Goosen, West Midland Police and interim Chair of the Multiple Complex Needs (MCN) Board which informed of the decisions taken by the MCN Board at their meeting on 4^th August, 2017 and sought approval for the ‘next steps’ to be taken.

The report indicated that there had been 7 key members of the MCN Board who had transitioned roles and responsibilities between January and July which had implications for progress with the project. As a consequence, prior to the MCN Board meeting on 4^th August, Chief Superintendent Goosen, had reviewed the strategic focus, activity and outcomes of the Board to date. The Terms of Reference were discussed at the Board meeting and amendments were to be made to reflect the membership and commitment required to deliver the strategic objectives of the Board. In addition, the PID document was to be reworked into a clear strategy document that set out the Board’s ambition, strategic intent, delivery mechanism and measures of success.

The MCN Operational Delivery Group met for the first time on 20^th July, 2017. An Operational Group was established to support the Board. The Group were to identify a cohort of individuals with multiple complex needs to inform pathways and transformation of services. The Health and Wellbeing Board were informed that data collection presented challenges and the cohort had yet to be defined and agreed by the Board.

The report referred to the Making Every Adult Matter (MEAM) bid which had been submitted and subsequently shortlisted to become an official MEAM area. This would result in national co-ordinator support, peer networking and access to national research and strategy, all funded through Big Lottery initiative. The MEAM coalition currently worked with 27 service areas across England that were designing and delivering better co-ordinated services for people with multiple needs. Coventry’s cohort needed to be clearly defined and agreed to underpin this programme of work. The Coventry MCN team were interviewed by MEAM on 28^th September and the outcome of the application was due the following day. Chief Superintendent Goosen placed on record her thanks to all involved in this submission.

At 4^th August meeting, Mitchell Lee (WMFS) had provided an update on the MCN work being undertaken by the West Midlands Combined Authority. This focused on preventative work/early intervention within ‘adverse child experiences (ACE s)’ with work to date being centred on pupil referral units and a pathfinder programme, supported by a multiagency team, to reduce demand on services.

The Board noted the decision, previously taken by the MCN Board, not to pursue ACEs as this was covered through the work of Ignite and Troubled Families.

The Board noted that Chief Superintendent Goosen had commissioned work to clearly define the area of focus and cohort. A paper had been presented to the MCN Board at the recent meeting on 12^th October. The Board were informed that the next  ...  view the full minutes text for item 19.

Report of Pete Fahy, Director of Adult Services

The Board considered a briefing note of Pete Fahy, Director of Adult Services, which provided an update on the Better Care Fund (BCF) Plan for 2017-19, a copy of the plan was attached as an appendix to the note. The briefing note was also to be considered by the Health and Social Care Scrutiny Board (5) meeting on 18^th October, 2017.

The briefing note indicated that the integration of health and care had been a long standing national policy ambition based on the premise that more joined up services would help improve the health and care of local populations and make more efficient use of available resources. Prior to, and subsequently alongside the Better Health, Better Care, Better Value programme, the BCF was implemented in 2015 as part of the government drive to integrate health and care. In response a BCF Plan was developed locally. A new plan was now required to cover the period 1^st April, 2017 to 31^st March, 2019 including how the Coventry element of additional funding in the spring budget for Adult Social Care was to be used.

The Board noted that the planning schedule meant that the planning tools were available in July, 2017 with the plan being submitted by 11^th September, 2017, with the support of the Chair, Councillor Caan. Meeting timescales meant the plan now required retrospective approval by the Board.

The total value of the 2017-19 pooled budget from ring-fenced City Council and Coventry and Rugby CCG funds was £179.5m (£63.897m of local authority resources and £115.605m of CCG resources).

The Board were informed that a detailed policy framework for the implementation of the BCF was published in April, with further detailed guidance on delayed transfers of care being issued to local areas in July. There was an expectation that delayed transfers of care should equate to no more than 3.5% of all hospital beds by November, 2017. It was emphasised that this was extremely challenging to Coventry and a trajectory had been included within the BCF Plan to meet this expectation.

Detailed financial and operational plans had been developed to reflect the current CCG and social care priorities within the city. The following three purposes had been assigned to the additional BCF grant announced in the spring budget and set out in the plan: to meet Adult Social Care; to provide support to the NHS (especially through the application of 8 high impact changes) and to sustain the social care provider market.

The plan recognised that as well as achieving effective discharge, preventing admission to hospital was just as crucial to the effectiveness of the health and care system. Consequently activity under the BCF would also focus on a range of projects that sought to improve support to people away from the hospital setting.

The briefing note highlighted the mandatory content and the national conditions contained in the plan and provided an update on governance. Following the submission of the plan by the NHS deadline  ...  view the full minutes text for item 20.

David Peplow, Chair of the Coventry Safeguarding Children’s Board has been invited to the meeting for the consideration of the Annual Report

The Board considered a report of the Executive Director of People which presented the Coventry Safeguarding Children Board (CSCB) Annual Report for September 2016 to March 2017, a copy of which was set out at an appendix to the report. The report had previously been submitted to the Children’s Services Scrutiny Board (2) at their meeting on 14^th September, 2017. David Peplow, Independent Chair of the Safeguarding Board, attended the meeting for the consideration of this item. 

The production of the annual report was a statutory requirement under the Children Act. The report summarised the progress over the last six months and set out a new direction for the Board for 2017/18. The report outlined the achievements and challenges of the Board and assessed progress on outcomes for children and young people in respect of safeguarding. It evaluated the impact of Coventry’s Safeguarding Services on outcomes for children and showed how the work of the Board had contributed to improving outcomes.

Key messages in the report included that the Board had grown in the way agencies were able to challenge each other and hold others to account and that the multi-agency response to child exploitation was a real strength. The previous progress in the way the voice of children was listened to and responded to had continued, with individual organisations improving their focus on children. The Board were informed that the work to protect children and young people from the effects of domestic abuse had made less progress and more needed to be done to ensure the effectiveness of the city-wide early help offer. The Independent Chair, had continued to work closely with the Chairs of the Local Safeguarding Adult’s Board, the Police and Crime Board and the Health and Wellbeing Board, through the Strategic Boards Group. This ensured where Boards had a shared interest in a subject area there was clear ownership and a forum for discussing the appropriate way forward.

The Board raised a number of issue including the priority now given to sexual exploitation matters; whether there were any problems of data sharing between the partner organisations including GPs; an acknowledgment of the success of partnership work/ sharing information arising from the Multi-Agency Safeguarding Hub (MASH); and the need to improve preventative education. Members expressed support for the Annual Report.

RESOLVED that, having considered the content of the Coventry Safeguarding Children’s Board Annual Report, the progress made and the areas for future development be noted.

Joan Beck, Chair of the Coventry Safeguarding Adults Board has been invited to the meeting for the consideration of the Annual Report

The Board considered a report of the Executive Director of People concerning the Coventry Safeguarding Adults Board Annual Report for 2016/17, a copy of which was set out at an appendix to the report. The Annual Report had also been submitted to the meeting of the Health and Social Care Board (5) pn 13^th September, 2017.

The Coventry Safeguarding Adults Board was a multi-agency partnership made up of a range of organisations that contributing towards safeguarding in Coventry. The Board was required to publish an annual report and business plan. The report summarised the key messages for the year and included the business plan which enabled the Board to plan upcoming work. The annual report also included performance data for the year which was monitored on a quarterly basis by the Board. The annual report was a key way of raising awareness of the issue of safeguarding adults.

The key messages in the report were highlighted which including the Board making good progress in ensuring that learning from Safeguarding Adult Reviews was embedded into training and practice and good progress in the way in which agencies were able to make safeguarding personal. The Board were informed that Joan Beck, Independent Chair, continued to work closely with the Chairs of the Local Safeguarding Children’s Board, the Police and Crime Board and the Health and Wellbeing Board, through the Strategic Boards Group. This ensured where Boards had a shared interest in a subject area there was clear ownership and a forum for discussing the appropriate way forward.   

Members expressed support for the Annual Report.

RESOLVED that, having considered the content of the Coventry Safeguarding Adults Board Annual Report, the report be noted.

Report of Pete Fahy, Director of Adult Services

The Board considered a report of Pete Fahy, Director of Adult Services which provided information on the forthcoming Care Quality Commission (CQC) review of the Health and Social Care System in Coventry.

Following the spring budget announcement of additional funding for adult social care, the Department of Health asked the CQC to undertake a programme of targeted reviews in Local authority areas. It was then announced that there would be 20 reviews where there were challenges particularly in relation to delayed transfers of care. Coventry had been selected as one of the first 12 areas to be reviewed.

The report indicated that the review would be wide ranging and would take a ‘whole system approach’, focusing on how people moved between health and social care, including delayed transfers, with a particular focus on people over 65. The review would seek to answer the following question:

‘How well do people move through the health and social care system, with a particular focus on the interface between the two, and what improvements could be made?’

A number of pressure points had been identified by the CQC as significant in the interface between health and social care and these were set out at an appendix to the report. The report highlighted the key lines of enquiry to be explored.

On completion of the review, the findings would be reported to the Health and Well-being Board with the expectation that a joint action plan would be agreed to progress any recommendations. The Board were informed that the CQC had asked the local authority to co-ordinate the review, ensuring the input of partners, with the Board taking ownership of the review, its outcomes and resulting action plan.

The Board noted that the likely timescale for the review was 12-14 weeks including an on-site week. The timescale was detailed in a second appendix to the report. The Coventry on-site week was scheduled for the week commencing 22nd January, 2018. The report provided further information about the requirements in the lead in to the review and the preparation works already underway.

RESOLVED that:

(1) Full support and ownership of the review process be provided through members participating in the review as required, supporting the review within their organisations and advocating for this review as being an opportunity for system improvement.

(2) The preparation underway be supported and the Coventry Accident and Emergency Delivery Board be endorsed as being the body for the co-ordination and preparation for the review. 

The Chair, Councillor Caan reminded Members that invitations would be circulated for the launch of WM on the Move in Coventry on 16^th November. He referred to the two Development Sessions on 27^th November and 13^th December and asked for suggestions for discussion to be sent to Robina Nawaz.