Agenda and minutes

There were no declarations of interest.

The minutes of the meeting held on 2^nd July, 2018 were signed as a true record. There were no matters arising.

The Chair, Councillor Caan, welcomed Richard Stanton, the new Operational Commander for Coventry and Solihull at West Midlands Fire Service, who was attending his first formal meeting on the Board.

The Chair, Councillor Caan will report at the meeting

The Chair, Councillor Caan informed the Board that work was underway to develop a new place-based Joint Strategic Needs Assessment (JSNA). Eight localities and one city wide had been approved by the Steering Group which were based on the city’s Family Hub areas. Plans were in place to deliver a data profiling tool and pilot based JSNA in two localities by March 2019. The work would inform the development of a new Health and Wellbeing Strategy for the city and a report on the Strategy was to be submitted to the January meeting of the Board.

Councillor Caan reported on his membership of the West Midlands Wellbeing Board and his speech at a network for Place-based Leadership for Health and Wellbeing in the West Midlands the previous month concerning the Board’s work through the Place Forum to upscale the prevention activity across the local health and care system. He also referred to the launch of the Refill project in partnership with Severn Trent at the end of August whereby people could fill up reusable water bottles for free at participating local businesses.

Councillor Caan reported that new cricket pitches were being created in Coventry parks and open spaces in a partnership between the City Council and the England and Wales Cricket Board. Seven non turf cricket pitches and a five lane cricket net facility were to be developed in local parks across the city in the build up to the European City of Sport. Reference was also made to the LGA Peer Review that was taking place at the Council that week. 

Report of Pete Fahy, Director of Adult Services

The Board considered a report of the Director of Adult Services which set out the progress against the Better Care Fund (BCF) Plan and informed of changes to BCF requirements.

The report indicated that the fund remained the primary tool to deliver integration of health and social care. The total value of the 2017-19 pooled budget was £179.502m, made up of £63.897m of City Council resource and £115.605m of CCG resource covering this 2 year period. The additional funding enabled investment in a number of initiatives intended to reduce system demand and improve patient flow. The governance arrangements required oversight by the Board.

The report provided detailed information on the last four quarter statistics for the planned activity against all the metrics included in Coventry’s BCF Plan. The performance reflected the national picture with improved performance in Delayed Transfer of Care (DToC) and residential admissions and the continued challenges to reduce non-elective admissions. Further information was provided on the High Impact Change Model introduced to reduce DToC, in particular, the performance of the eight system changes. The position was generally in line with other areas in that seven-day service, trusted assessors and focus on choice presented particular challenges. These areas, however, were now progressing.

The Board were informed that delivery of the BCF Plan had resulted in a number of significant and positive shifts in bringing together health and social care, including the implementation of the Red Bag Scheme.

The report referred to the Department of Health and Social Care new ‘Integration and Better Care Fund Operating Guidance 2017-2019’ published in July 2018, in particular the new challenging DToC expectations. Coventry was now expected to achieve 25.7 DToC per day. In June 2018 Coventry had an average of 31 patient delays each day, which highlighted the significant challenge the new target presented. The Coventry A and E Delivery Group had taken the approach to continue with progress against the High Impact Change Model and understanding in more detail the actual issues underpinning the delays rather than developing new plans.

The future of the Better Care Fund and the additional funding provided by the fund in the form of the iBCF grant to social services were uncertain and were linked to the spending review and the long-term funding of the NHS.

The Board discussed the potential for new money to deal with winter pressures and clarification was sought about the activity performance figures detailed in the report in relation to target variances.

RESOLVED that:

(1) The Better Care Fund performance against the national metrics be noted.

(2) The approach towards meeting the revised expectations as announced in July 2018 be supported.  

Report of Pete Fahy, Director of Adult Services

The Board considered a report of the Director of Adult Services which summarised the progress against the improvement plan arising from the Care Quality Commission (CQC) Local System Review undertaken between December 2017 and March 2018. The system wide review had looked at the health and care for people aged 65 and over in Coventry. A copy of the Improvement Plan Progress Update was set out at an appendix to the report. The progress report enabled the Board to continue to maintain oversight of the plan.

The report indicated that progress against the plan was monitored by the Department of Health and Social Care (DHSC) through monthly telephone calls with the Director of Adult Services, the Deputy Chief Executive (People) and the Accountable Officer for Coventry and Rugby CCG. The Board noted that a number of these calls had been postponed or cancelled at the request of the DHSC and no concerns had been raised to date regarding Coventry’s performance or progress.

The Board were informed that a representative from the DHSC would be attending their next Place Forum on 7^th November with a view to observing, in action, how the Board were progressing health and care in the region. They would also provide a short session on the CQC review and a national perspective on key findings from other local system reviews.

Work on the improvement plan was due to be completed by March 2019 and system improvements would be embedded in programmes and activities thereafter. Good progress was being made on many of the actions, however some actions had slipped due to resourcing factors and capacity.

The report provided a brief summary of progress against the following themes:

Vision and strategy

Engagement and involvement

Performance, pace and drive

Flow and use of capacity

Market development

Workforce

Information sharing and system navigation.

Although good progress had been made, it was important that the completion of the improvement plan continued to enable the Board to sign off the plan in March 2019.

A request was made for a dash-board of data to provide the Board and members of the public with an understanding of how the system was working including dealing with winter pressures.

RESOLVED that:

(1) The progress made and the areas still to be addressed against the actions in the improvement plan arising from the CQC local system review be noted.

(2) The Board continue to maintain oversight of progress against the improvement plan at future meetings.

Report of Gail Quinton, Deputy Chief Executive (People)

The Board considered a report of the Deputy Chief Executive (People) on the Adult Social Care Annual Report 2017/18 (Local Account) which detailed the performance of Adult Social Care and the progress made against the priorities for the year. It also provided specific examples of the operational activities to support service users and carers. The report was aligned around the Adult Social Care values and principles. A copy of the report was attached at an appendix to the report. The report had already been considered by the Health and Social Care Scrutiny Board (5) at their meeting on 19^th September and by Cabinet at their meeting on 2^nd October.

The report indicated that it was considered good practice to produce an annual report as it provided the opportunity to be open and transparent about the success and challenges facing Adult Social Care and to highlight what was being done to improve outcomes for those who came into contact with Adult Social Care. The Annual Report had been structured around the ten themes that contributed to the Adult Social Care vision and provided a commentary on what had been done to make progress against each of the themes.

The production of the report had drawn on feedback and information gathered over the year from a range of sources including social care staff, Partnership Boards, Adult Social Care Stakeholder Reference Group, providers and people that had been in contact with Adult Social Care.

Some of the key improvements delivered in 2017/18 included:

i) A new facility offering a purpose built specialist Housing with Care Scheme for people either living with dementia or with a cognitive impairment – a new approach enabling people to live independently in a safe environment.

ii) The introduction of a new home support framework from June 2017 which aimed to improve quality and performance and has led to a reduction in waiting times for services.

Some of the key challenges being addressed included:

i) Increasing demand for services resulting from an aging population with the number of over 85s being expected to grow by 22% in the next ten years.

ii) The increasing costs of care as a result of external factors including the National Living Wage and the complexity of the care needs that people are experiencing.

To address these challenges, improvements were being made to the approach to promoting independence and to the experience at initial contact.

Councillor Abbott, Cabinet Member for Adult Services outlined her support for the report which highlighted good examples of partnership work.

RESOLVED that the Adult Social Care Annual Report 2017/18 be noted.

Report and presentation of Liz Gaulton, Director of Public Health and Wellbeing

The Board considered a report and presentation of the Director of Public Health and Wellbeing concerning her Annual Report for 2017/8 ‘Healthier for Longer, Securing Healthy Futures for our Communities’, a copy of which was set out at an appendix to the report. The report included recommendations for health and wellbeing partners across Coventry. The report was a statutory report produced each year. This year the report focused on healthy aging and the health of older people. It had been produced in partnership with Adult Social Care.

Information was provided on the health of Coventry’s older population, with the city having an estimated 50,400 residents aged 65 and over. The population of those over the age of 75 was projected to increase by nearly 50% over the next 20 years. Reference was made to the gap between healthy life expectancy and life expectancy. In Coventry men could expect to live just over a fifth of their lives in poor health whilst women could expect to live almost a quarter of their lives in poor health.

The annual report took the opportunity to highlight the importance of prevention and early intervention in promoting good health in later years, and managing the demand for health and social care services. The Board noted that Coventry was still behind the England average on many healthy behaviours and risk factors.

The report highlighted activities across the city to promote good health and prevent ill-health across all age groups to support increases in healthy life expectancy which included:

a) Tackling loneliness and social isolation

b) The new Healthy Lifestyles Coventry services commissioned by the Public Health team

c) Supporting those at risk of fuel poverty

d) Interventions from the Adult Social Care team to promote early help and maintain independence

e) Reducing delayed transfers from hospital

The report also highlighted the progress and commitment across health and wellbeing providers to make sure that residents received the right care when they needed it and in a way that met their needs and achieved their outcomes. Throughout the report there was a focus on an individual family and other members of the community to provide examples at living longer in good health.

The presentation provided information on aging in good health; what influenced healthy life expectancy; taking care of your body and mind; and the health and care services for the older population of Coventry. Attention was drawn to the recommendations of the Annual Report which were as follows:

Identify older people community assets

Promote community-based groups to combat social isolation

Encourage the further reduction of health inequalities including Marmot City

Increase the profile of ill health prevention

Improve immunisation rates through partnership working

Encourage co-design of services with older people

Design health and care pathways to deliver high quality care for older people.

The presentation concluded with an update on the recommendations from the 2016/17 Annual Report ‘Shape Up Coventry, The Urgency of Promoting Healthy Weight Among Children and Young People’.

The Board discussed the implications of  ...  view the full minutes text for item 19.

Report and presentation of Andrea Green, Accountable Officer, Coventry and Rugby CCG and Matt Gilks, Director of Commissioning

(Please see the following link for additional information https://www.coventryrugbyccg.nhs.uk/ )

The Board considered a joint report of Andrea Green and Matt Gilks, Coventry and Rugby CCG which provided an update on the 2018 Annual Report and the process to develop the 2019/20 Commissioning Intentions. Particular reference was made to performance against the NHS constitutional standards; updates to work programmes to enhance health and wellbeing and improve outcomes; and the process to developing a refreshed set of commissioning intentions following extensive engagement and feedback. A copy of the Annual Report Summary 2017/18 was tabled at the meeting.

The report indicated that the CCG’s plans to improve the health and wellbeing of their local population for 2019/20 were set out in the context of ongoing and significant financial and clinical workforce challenges. These commissioning intentions had been developed in line with extensive engagement with clinicians, stakeholders and the public; the health needs of the local population as defined in the local Joint Strategic Needs Assessment; and national health deliverables for 2019/20.

The commissioning intentions would also set out the strategic direction for the CCG within the context of the local system, looking at ways for all health and care providers to work more closely together. To reflect the more collaborative approach, the CCG were working closely with Warwickshire North CCG and South Warwickshire CCG to develop commissioning intentions to benefit everyone across Coventry and Warwickshire.

The resulting refreshed commissioning intentions were published in September 2018 and had been divided into groupings based on the Better Health Better Care Better Value work streams as follows: primary care, out of hospital, maternity and paediatrics, urgent care, planned care, mental health and self-care. As part of the process, a full stocktake of progress against these priority work stream areas had been undertaken. The Board were informed that a summary of progress and key achievements to date were included in the commissioning intention documents.

Andrea Green provided an update on the CCG performance against NHS constitutional standards, which saw the CCG performing well on cancer waits for diagnosis and treatments. Two waiting time standards were not achieved – referral for treatment waiting times for non-urgent and A and E waiting times. She also provided the Board with an update on some of the achievements for the year which included improving the link between mental and physical health; a new scheme to help improve the detection and diagnosis of asthma; dementia pop up clinics to improve support for dementia sufferers and carers; the implementation of prescription ordering direct; educating parents on the importance of safe sleeping for babies; a second round of engagement for the redesign of stroke services; and new services for CAMHS.

Further information was provided on the commissioning intentions and key priorities. Joint working was now at the forefront, with the Health and Wellbeing Concordat and the Better Health Better Care Better Value programme providing building blocks for future system strategy. Services would be delivered locally, managed locally and planned locally through partnerships.

Members discussed the ability to deliver and meet future demand  ...  view the full minutes text for item 20.

Report of Richard Stanton, West Midlands Fire Service and Co-Chair of the Marmot Steering Group

The Board considered a report of Richard Stanton, West Midlands Fire Service and Co-Chair of the Marmot Steering Group, which provided an update on the progress made against the first priority of the Health and Wellbeing Strategy – working together as a Marmot City to reduce health and wellbeing inequalities.

A copy of the Action Plan detailing the progress and barriers to the individual actions was attached as an appendix to the report.

The report indicated that partners were continuing to work together on a number of project initiatives as part of the first two years of Coventry’s Marmot City programme. In addition, for the following three years, the Marmot City priorities were tackling inequalities disproportionally affecting young people and ensuring that all Coventry people, including vulnerable residents, could benefit from ‘good growth’ which would bring jobs, housing and other benefits to the city.

An additional priority had recently been added to the Marmot City programme – the mitigation and prevention of poverty across the city. A working group had recently been set up to explore the issues and opportunities related to in-work poverty and worklessness.

The Board was informed that a Poverty Summit was currently being planned for 12^th November, 2018 with Sir Michael Marmot attending as the key-note speaker. The intention was to provide an opportunity to bring together a range of stakeholders to discuss the key issues and identify new ways of working. A wide ranging and robust evaluation of the Marmot Programme in the city was also due to start in November and was expected to take 6-9 months to complete.

The Board noted that there remained strong commitment to the Marmot programme from the City Council and its partners on the Steering Group. The action plan was currently being revised to reflect new projects and the new theme of poverty in the city. The plan showed delivery up to the end of quarter four for 2017/18 demonstrating progress against the programme indicators through a range of projects including:

·  187 young people with disabilities or health problems accessing Ambition Coventry work coaches (against a target of 170)

·  254 young people supported by Ambition Coventry into employment, education or training (against a target of 214)

·  392 new clients accessing CRASAC’s counselling service and helpline, aged 25 and under (against a target of 183)

·  982 people supported into employment by the Coventry Job Shop (against a target of 1200)

·  Coventry and Warwickshire Chamber of Commerce working with local businesses to address issues around domestic violence and its impact on the workplace

The report also highlighted the next steps for the Marmot Group.

The Chair, Councillor Caan, encouraged members to attend the Poverty Summit. Reference was made to the opportunity for partners to work together avoiding duplication of work. 

RESOLVED that:

(1) The progress to date against the Marmot Action Plan be endorsed.

(2) Further progress updates from the Marmot Steering Group be submitted to future Board meetings every six months.

Report and presentation of Liz Gaulton, Director of Public Health and Wellbeing

The Board considered a report and presentation of Liz Gaulton, Director of Public Health and Wellbeing which provided an update on the outcomes of the last Place Forum meeting held on 16^th July and informed of the plans for the next Forum meeting on 7th November. It also outlined the delivery profile for the Year of Wellbeing 2019 which was to be signed off and launched at the next Place Forum meeting.

The report indicated that at the July meeting the Forum had endorsed the refreshed Concordat and system design; agreed a high level plan for the Year of Wellbeing; and noted updates on Integrated Care Systems and the Better Health, Better Care, Better Value programme. The Forum agreed a series of actions as part of the Place Plan, further details of which were set out in an appendix to the report. Significant progress had been made and the Place Plan would be continually reviewed and updated as the work of the Forum developed.

The focus for the November Forum meeting was preparations for the Year of Wellbeing; progressing the place-based JSNA rollout; embedding prevention and early intervention in other areas; and developing an outcome framework and performance dashboard. Proposed agenda items were set out. The meeting was to be facilitated by John Bewick from the Local Government Association who was supporting work on the Upscaling Prevention pilot programme.

The report highlighted that the Year of Wellbeing 2019 was a key deliverable for the Place Forum and the current focus of the proactive and preventative work. Significant progress had been made since the last Place Forum including the development of a logo and branding; a communications strategy had been drafted; and training has been delivered to a cohort of wellbeing champions with further training planned. ‘Prevention Matters’ training was also being arranged for elected members from Coventry and Warwickshire. A delivery profile for the Year of Wellbeing had also been developed and this was set out at a second appendix to the report. This would evolve as further pledges of support were received.

The presentation focused on the outcomes of the July Place Forum including the agreed actions and included a progress and timeline for the Year of Wellbeing.

The Chair, Councillor Caan referred to the significant opportunities presented by the Year of Wellbeing.

RESOLVED that:

(1) The outcomes of the Place Forum meeting held on 16^th July, 2018 be noted.

(2) The proposed agenda items for the Place Forum on 7^th November, 2018 be noted.

(3) The delivery profile for the Year of Wellbeing be submitted to the Place Forum meeting on 7^th November for sign off and launch.

Report of Rachael Danter, Programme Director, Better Health, Better Care, Better Value

The Board considered a report of Rachael Danter, Programme Director Better Health, Better Care, Better Value which provided an update on the Better Health, Better Care, Better Value programme and workstreams.

The report referred to the Integrated Care System highlighting that the twelve week development programme offered to all localities across the West Midlands providing support for senior leaders and their teams had now concluded. The draft plan which started to identify what actions would be required to allow Coventry and Warwickshire STP to reach Shadow Integrated Care System status was presented to NHS England on 24^th August and formal status was awaited. The plan would continue to be developed and would be circulated in due course.

The report set out progress with the following transformational and enabling programmes of work:

Transformational

Proactive and Preventative

Maternity and Paediatrics

Mental Health and Emotional Wellbeing

Planned Care

Productivity and Efficiency

Urgent and Emergency Care

Enabling

Estates

Digital Transformation

Workforce

The report indicated that a separate work programme had been set up for cancer which included primary care and prevention; rapid access/ diagnostic pathways; living with and beyond cancer; waiting time standards; and radiotherapy.

Reference was made to the review of Stroke Services in Coventry and Warwickshire. Programme leads participated in next stage NHS England Assurance Panel on 25^th May. They assessed that the programme had partially met the requirements but further work and evidence was required prior to being ready for consultation. Additional evidence was needed for workforce planning, ‘stress testing’ the proposals for times of peak demand on hospitals and confirmation from the West Midlands Clinical Senate that their recommendations from their comprehensive review in 2016 had been met. A meeting was held with the Clinical Senate in July and the Senate were assured that the recommendations had been actioned. The next NHSE Assurance Panel was expected to take place in November.

The preferred option was for a centralised centre of excellence at UHCW for the immediate stages after having a stroke, the hyper cute and acute stages. The three CCGs held four public engagement events during September to gather views on the stroke rehabilitation services. They were now bringing together a group of experts and interested individuals/ organisations, including patients, carers, Councillors, Healthwatch and the Stroke Association, to listen to feedback and help to assess the proposals for stroke rehabilitation services.   

The Board discussed the promotion of Suicide Prevention Day in September and the plans for an engagement event to be held at Coventry Rugby Club on World Mental Health Day on 10^th October. This would update on the programme plans and progress and was aimed at service users, partners and other stakeholders. Further discussion centred on the role of the Board to provide democratic accountability for the work for the different strategies.

RESOLVED that the content of the report be noted. 

Report of Gail Quinton, Deputy Chief Executive (People)

The Board considered a report of Pete Fahy, Director of Adult Services and Councillor Faye Abbott, Cabinet Member for Adult Services concerning the Local Government Association (LGA) Green Paper for Adult Social Care and Wellbeing ‘The Lives We Want to Lead’ setting out the Council’s response to the paper, a copy of which was set out at an appendix to the report. The report had been considered by Cabinet at their meeting on 2^nd October, 2018.

On 31 July 2018 the Local Government Association (LGA) launched its own green paper for adult social care and well-being for consultation. The publication of this paper was as a result of the Government’s recent decision to delay its long-awaited green paper on Adult Social Care until the autumn. 

Important issues were raised in the consultation in terms of the role of Adult Social Care in helping people live the life they want to lead and how this was funded. These issues affected all stakeholders in Adult Social Care and it was important that the City Council contributed to the national debate on these issues. It was particularly important in the context of resourcing challenges facing Adult Social Care. The short term funding arrangements from central government currently in place through the Better Care Fund and improved Better Care Fund would come to an end in 2020/21. 

As well as the issue of achieving sustainability in Adult Social Care much of the consultation sought views on the role of local government in improving the well-being of its population. The responses given emphasised that local government was fundamental to achieving this goal. This needed to be considered in the wider role of local government by including public health, housing and leisure. 

Throughout the consultation response, and to demonstrate the points made, examples had been provided of work underway in Coventry that demonstrated the progress being made to improve well-being. These examples included the Health and Wellbeing Concordat, Year of Wellbeing, the work on improving Delayed Transfers of Care and the Community Promoting Independence programmes.

Councillor Abbott, Cabinet Member for Adult Services, highlighted the problems associated with the funding of Adult Social Care and the need for a long term funding solution. The Board discussed the importance of the work of the voluntary organisations, the churches, the community groups and all the carers in the city who all supported Adult Social Care in the city.

RESOLVED that the Council’s response to the Local Government Association Green Paper ‘The Lives We Want to Lead’ be noted.

Any other items of public business which the Chair decides to take as matters of urgency because of the special circumstances involved

There were no additional items of public business.