Agenda and minutes

There were no declarations of interest.

The minutes of the meeting held on 14^th October 2019 were agreed and signed as a true record. There were no matters arising.

The Chair, Dr Raistrick, referred to Professor Guy Daly, Coventry University, who had recently stood down as a member of the Board following his promotion to a new post at the university. She placed on record her thanks to Professor Daly for his contribution and support to the work of the Board over the past few years.

Dr Raistrick welcomed Professor Lisa Bayliss-Pratt, a new Pro-Vice Chancellor at the university who was attending her first Board meeting. 

The Chair, Councillor Caan will report at the meeting

The Chair, Dr Raistrick, reported on the positive meeting of the Place Forum held on 5^th November 2019 when colleagues shared examples of work which put the population health approach into practice. The next meeting of the Forum was scheduled for 3^rd March. She drew attention to the celebratory event for the Year of Wellbeing held on 4^th December which was well attended by colleagues across Coventry and Warwickshire. Reference was made to the first meeting of the Coventry and Warwickshire Health and Care Partnership which also took place on 5^th November.

The board were reminded that the Coventry Youth Violence Prevention Summit was taking place on 15^th January and all members were invited. It was a follow up to the Summit last year. Much work had been undertaken in the past year to move the agenda forward including a new strategy and the establishment of a new Youth Violence Prevention Board and the aim of the event was to build on this.

Dr Raistrick informed that the European City of Sport celebration was being held at the Xcel Leisure Centre on 16^th January to acknowledge the organisations and staff who had contributed and delivered programmes throughout the year, recognise achievements and detail the legacy moving forward.

The Chair also gave an update from the CCG referring to the future of a streamlined commissioning function of the CCG within Coventry and Warwickshire. A decision on the preferred option would be made in February and reported back at the next meeting of the Board. Reference was made to a positive example of joint working, a future joint appointment by UHCW and the CCG was to be advertised at the end of January for a GP director who would work across the whole Coventry place system.

Report of Gail Quinton, Deputy Chief Executive (People)

The Board considered a report of Gail Quinton, Deputy Chief Executive (People) which provided an update on progress against the Health and Wellbeing Strategy priority ‘Working Differently with our Communities’. Particular reference was made to the alignment of this activity with the work led through the Health and Care partnership.

The report indicated that work on the strategy was being led by the One Coventry Partnership. The engagement with communities and community organisations during the JSNA and Health and Wellbeing Strategy development had revealed an appetite for a change in approach to partnership working with communities. This meant working together, with communities, to improve people’s lives and the city for the better. Communities wanted to be part of the change and wanted to work with statutory partners, not to be “done to”, which meant changing traditional relationships. This was also in line with the Council’s One Coventry approach.

Reference was made to the priority objectives and the report outlined how there needed to be a shift in culture and behaviours amongst the statutory partners including:

·  Empowering and enabling community solutions by valuing the community leaders who had trust, networks, understanding and legitimacy; and getting behind existing partnerships;

·  Facilitating forums and networks to enable better collaboration and communication between public and third sector partners encouraging shared learning;

·  Taking forward work to change the way services were commissioned to better recognise social value and develop the role of anchor institutions; and

·  Providing practical support to strengthen the community sector, including by pooling resources to build capacity and connections and enable communities to maximise social action.

In order to develop the priority, engagement work had taken place with the voluntary and community sectors to understand the challenges facing the sector and to co-design an effective One Coventry engagement mechanism. The recent engagement with 70 representatives of community and voluntary sector organisations for the JSNA and 30 organisations during a visit with leaders of Arms Length Bodies has provided insights about the challenges faced which were detailed in the report and included: 

·  General support from third sector organisations to work together and with public sector organisations to make a bigger impact 

·  Achieving greater connectivity with shared aims was a big priority but was very hard to achieve as there was poor visibility of what was happening 

·  There were perceptions amongst smaller third sector organisations that the way the public sector commissions larger third sector organisations it created a two-tier system; larger organisations receive funding but expecting smaller grass roots organisations to deliver outcomes with no funding 

·  Public sector bodies were engaging in silos which caused duplication of effort and frustration

·  Resources to support effective networking were scarce 

·  Small organisations felt left out of conversations and influence and found it hard to engage through traditional mechanisms used by public sector; some probably weren’t part of any network 

·  There was wide-spread concern about how third sector organisations could achieve sustainable income streams and there was much interest in exploring more collaborative forms of commissioning.

Facilitated workshops  ...  view the full minutes text for item 28.

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 of the Marmot Steering Group which provided an update on progress against one of the  priorities of the Coventry Health and Wellbeing Strategy 2016-2019 ‘Working together as a Marmot City to reduce health and wellbeing inequalities’ and set out how the Marmot Steering Group would lead and co-ordinate work to deliver the ‘Wider Determinants’ element of the population health model contained within the new Health and Wellbeing Strategy 2019-23. Ryan Forrester, West Midlands Fire Service presented the report in the absence of Richard Stanton.

The report referred to the Poverty Summit held in November 2018 which looked at how Coventry could tackle the impact of poverty and the Marmot Steering Group committed to taking forward the priorities from the Summit. In October 2019 a broad range of partners attended a ‘Now What’ workshop with Professor Sir Michael Marmot to review future priorities. The new priorities had now been themed and further prioritised by the Steering Group. In addition to the new priorities the workshop agreed to continue to focus on the existing two key priorities:

i) Tackling inequalities disproportionately affecting young people

ii) Ensuring that all Coventry people, including vulnerable residents, could benefit from ‘good growth’ which would bring jobs, housing and other benefits to the city.

Examples of new and existing work under these priorities included:

·  Business Rate Reduction Scheme which aimed to give 20 small businesses access to a grant of £2,500 each if they took on a long-term unemployed person

·  Family Health and Lifestyles’ service development plans to drive the provision of increasing support to families across the social gradient (proportionate universalism).

·  The Raising Aspirations Programme (Positive Youth Foundation) providing support for young people either excluded or on the verge of exclusion from education settings

·  Partnership work was on-going with the Chamber of Commerce to support employers to provide and promote good quality jobs in Coventry.

·  The Poverty Summit held in November 2018 which led to the development of new sub groups.

Further information was provided on the outcomes relating to the monitoring of the two priorities.

The report referred to the refresh of the Marmot Action Plan which would take place to reflect the revised Health and Wellbeing Strategy, the findings of the Marmot Evaluation, the new priorities identified in the ‘Now What?’ workshop and the recommendations of the Director of Public Health’s Annual Public Health Report on Health Inequalities, Bridging the Health Gap. This revised Strategy took a population health approach which allowed for a holistic view of everything that impacted on people’s health and wellbeing across the whole population, with an emphasis on reducing inequalities in health as well as improving health overall.

A key element of the population health model was ‘Wider Determinants’, and a key role for the Marmot Steering Group was to embed the Marmot City approach through working in partnership, with the aim of reducing health inequalities by addressing the social determinants of health.  ...  view the full minutes text for item 29.

Report of Liz Gaulton, Director of Public Health and Wellbeing

The Board considered a report of Liz Gaulton, Director of Public Health and Wellbeing, which provided an update on the outcomes of the Place Forum meeting held on 5^th November at University Hospital Coventry and informed of the Year of Wellbeing activities.

The report indicated that the meeting the Forum:

·  Received a presentation from Nigel Minns and Gail Quinton outlining how the population health approach was being embedded in both Coventry and Warwickshire’s  Health and Wellbeing Strategies and the Five-Year Strategic Health and Care Plan.

·  Received an update on the positive progress of the Year of Wellbeing, with a focus on the physical activity theme. The End of Year event on 4th December would offer an important opportunity to shape the legacy and build on the momentum around prevention and population health that had been generated.

·  Heard from Dave Moorcroft on the role of physical activity in wellbeing and links to Coventry European City of Sport and UK City of Culture. Vicky Joel of Think Active also highlighted their valuable work with schools to promote and embed physical activity for children and young people.

·  Professor Don Berwick shared his reflections on the work of the Forum, reinforcing that health was not achievable through medical care alone, referring to the work of Sir Michael Marmot.

The following actions were agreed as part of the Place Plan, a copy of which was set out at an appendix to the report:

·  Share feedback on the Five Year Strategic Health and Care Plan by 8^th November, ahead of final submission

·  Promote physical activity within the Forum’s organisations

·  Continue to lead and support the Year of Wellbeing and plan for its legacy, including consideration of the role of Anchor Institutions

·  Attend the celebration of Year of Wellbeing event on 4 December

·  Progress work on a Strategic Framework for Coventry and Warwickshire

·  Seek opportunities to embed a population health approach across the organisations

·  Develop the role of the Place Forum alongside the Coventry and Warwickshire Health and Care Partnership Board.

The Board were informed that the next meeting of the Place Forum was scheduled to take place in Coventry on 3 March 2020, with the focus being population health management.

RESOLVED that:

(1) The outcomes of the Place Forum meeting held on 5^th November 2019 be noted.

(2) The ongoing activity as part of the Coventry and Warwickshire Year of Wellbeing 2019 be noted.   

Report of Rachael Danter, Coventry and Warwickshire Health and Care Partnership

Professor Sir Chris Ham, Coventry and Warwickshire Health and Care Partnership, presented the report which provided an update on progress on the work of the Coventry and Warwickshire Health and Care Partnership.

The report indicated that the Partnership’s Strategic Five Year Plan remained a work in progress and the latest draft was to be submitted to NHSE/I for final sign-off in January. A detailed narrative was preceded by a public-facing, plain English ‘easy read’ preface, plus an introductory foreword by Chairman Professor Sir Chris Ham. A tentative date had been set for the launch to internal stakeholders and the workforce as 10 February, followed by a full public launch a week later. The Board noted that these dates were subject to change. The launch of the Plan would coincide with a major refresh of the Partnership’s website and social media profiles designed to effectively amplify the Plan’s contents and aspirations.

The report provided updates on the following areas of work:

·  Cancer

·  Digital

·  Medicine Optimisation

·  Operating Plans

·  Urgent and Emergency Care

·  Frailty

·  Planned Care

·  Service Improvement Schemes

·  Population Health

·  Voluntary Sector Engagement

·  Primary Care Networks

In relation to cancer, digital and medicine optimisation, reference was made to three successful events held during November 2019. Under operation plans, the Board were informed that the Partnership was in the process of producing its 2020/21 annual Operating Plan which aligned to the 2019-24 Five Year Plan. The report detailed the likely contents of this plan.

Regarding Urgent and Emergency Care, the report informed of the winter funding secured to support two schemes at UHCW and a scheme at George Eliot hospital. Additional information was provided on the continuation of pilot schemes concerning frailty.

The Board noted that the Partnership was to establish a dedicated Clinical Diagnostic workstream early in 2020 with the aim of quickening diagnostic services for patients making them more efficient wherever possible. They had also secured a dedicated resource to support the Partnership’s work in engaging and mobilising the voluntary and community sector.

The report indicated that the Partnership’s primary care strategy had recently been approved by all CCGs following an extensive engagement process. The strategy was due to be published on CCG websites.

Members discussed the current financial position associated with the Plan and the implications of the Plan for local residents. A concern was raised that by avoiding duplication of service provision, this would mean patients having to travel further distances. Members referred to the benefits to be provided by the digital agenda and discussed the opportunities for the voluntary sector.

RESOLVED that the contents of the report be noted.    

Report of Matt Gilks, Coventry and Rugby Clinical Commissioning Group (CCG)

The Board considered a report of Matt Gilks, Director of Commissioning and Chair of the Children and Young People Mental Health and Wellbeing Board, Coventry and Rugby CCG, on the Child and Adolescent Mental Health Services (CAMHS) Local Transformation Plan: Year 4 Refresh. A copy of the refreshed plan was set out at an appendix to the report. The report sought feedback on the plan which was to be submitted to the next Board meeting in March 2020 for final sign off. Particular reference was made to the revised priorities from 1 November 2019 to 31 October 2020. Chris Evans, Coventry and Warwickshire Partnership Trust, attended the meeting for the consideration of this item.

The report indicated that this is the fourth year of the CAMHS Transformation Plan refresh which highlighted progress against the priorities for 2018/19 and further progress planned for 2019/20. The refresh process was led by Coventry and Rugby CCG with the refreshed plan being signed off by NHS England. There was a requirement for the plans to be developed collaboratively with key partners. Consequently, the refresh process was managed through the multi-agency Coventry and Warwickshire CYP Mental Health and Wellbeing Partnership Board.

Key highlights of the achievements in the past year included:

·  Population Health Management Group – this was a NHSE pilot project involving a system wide approach around data collection and analysis to help understand growing trends of population health and wellbeing needs

·  Trailblazer Funding – in July 2019 additional funding was secured from NHSE to implement Mental Health Support Teams within schools. The project was in its early stages with teams being implemented within 8 schools from January. The project was aimed to be fully operational by December 2020 reaching out to around 40 schools in the city

·  Tier 2 Recommissioning – a commissioning review had commenced to understand what services were required moving forward

·  Crisis Support – significant work had been undertaken to expand mental health crises care for children and young people with the Acute Liaison Team expanding from 5 days to 7 days  a week and the implementation of a new 7 day service which incorporated crisis response and home treatment.

The Board were informed that the Transformation Operational Group (TOG) had been refreshed to strengthen multi-agency operational involvement and oversight of the CAMHS system. TOG and the Partnership Board had developed the following priority areas for 2019/20:

a) Strengthen approaches to resilience, early help and prevention through work both with schools and family hubs and community partnerships

b) Improve the breadth of access, timeliness and effectiveness of emotional well-being and mental health support available to children and young people aged 0 - 25

c) Continue to develop the eating disorder pathway and service

d) Continue to strengthen the multi-agency approach to children and young people experiencing mental health crisis

e) Further develop the digital offer to increase access to services and support for children and young people

f) Strengthen support for vulnerable children and young people, particularly Looked After Children  ...  view the full minutes text for item 32.

Report of Jane Fowles, Consultant Public Health and Steven Hill, Chair of Coventry Suicide Prevention Steering Group

The Board considered a joint report of Jane Fowles, Public Health Consultant and Steve Hill, Chair of the Coventry Prevention Steering Group, which provided an update on the delivery of the Coventry Suicide Prevention Plan 2016-19 (Not one more/ one is enough) and sought approval of the forward plan for 2020-21. Steve Hill attended the meeting for the consideration of this item. A copy of the 2016-19 Plan was set out at an appendix to the report along with the strategic statement and legacy for 2020-21.

The report indicated that whilst the strategy, vision and strategic priorities for the prevention plan remained current, the original action plan to November 2019 had been refreshed by the steering group and developed into a forward plan for 2020-21. Given the national and local Coventry and Warwickshire Health and Care Partnership focus on this agenda it was recommended that the planning process remained live and that national and regional policy development was incorporated as appropriate throughout 2020. Key activity would include:

·  LGA regional (and local) sector led improvement programmes

·  NHSE evaluation of wave one funded sites and HCP programme review

·  NHSE funding roll out for postvention support

·  Delivery and funding of the Long-Term Plan; primary care, acute and crisis transformation, underpinned by the clinical strategy for Mental Health and Emotional Wellbeing.

The report provided data information on the numbers of suicides across Coventry and Warwickshire between 2006 and 2016 with reference to patients with mental health issues. 

The Board were informed that in July 2018, the standard of proof used by coroners to determine whether a death was caused by suicide was lowered to the “civil standard” – balance of probabilities – where previously a “criminal standard” was applied – beyond all reasonable doubt. It was likely that lowering the standard of proof would also result in an increased number of deaths recorded as suicide and a potential discontinuity in the national data series.

The report referred to the Health and Care Partnership (HCP) NHSE funded suicide prevention programme. In 2018 the partnership received NHSE funding of £352,000 per year for two years as one of 8 wave one sites identified due to prevalence rates (Warwickshire’s rates have been consistently above the national average). The programme had included several proof of concepts projects and programmes, these had been incorporated into the delivery plan this year and covered:

·  Multi-Agency Training

·  It Takes Balls To Talk and Public Campaigns (Year of Wellbeing)

·  Support for individuals with concurrent mental health and substance misuse issues

·  Secondary and Primary Care pathways and training; risk management and safety planning

·  Digital developments – public facing apps, stakeholder and staff resources

·  Bereavement support research

·  Real Time Data & monitoring; multi-agency surveillance

·  Safe Havens (crisis support)

The HCP were part of a nationally commissioned evaluation of the NHSE funding which was in the early stages of reporting. The report detailed the interim findings.

The report detailed the key highlights from the year two strategic priorities which included:

·  Action plan refresh and alignment with Warwickshire  ...  view the full minutes text for item 33.

Report of Rebekah Eaves, Safeguarding Partnership and Board Business Manager

The Board considered a report of Rebekah Eaves, Safeguarding Partnership and Board Business Manager, on the Local Safeguarding Children’s Board Annual Report 2018-19. A copy of the report was attached as an appendix to the report. A copy of the Board’s Business Plan on a page was set out at a second appendix. The report was submitted to the Board in accordance with the statutory duty under Working Together 2015. 

The report indicated that the Local Safeguarding Children’s Board had five priorities for 2018-19 as follows:

·  Children and young people who are looked after have equal opportunities to other children and young people.

·  Early help services, including mental health support, are available to children and young people and are resulting in positive outcomes.

·  Missing children and young people, and those at risk of child exploitation, are protected by effective multi agency arrangements.

·  The profile of understanding of emotional abuse and neglect, including domestic abuse, is raised, that abuse is identified as early as possible, and that appropriate interventions are provided to prevent further abuse and harm.

·  To work towards developing the partnership and continue to look forward and improve in light of the Wood Report and Children and Social Work Act 2017.

Highlights relating to the activity between April 2018 to March 2019 included:

·  The Board had now transitioned to Coventry Safeguarding Children’s Partnership and had made the decision to recruit a Joint Chair to oversee the work of both the Coventry Safeguarding Children’s Partnership and Coventry Safeguarding Adults Board to improve joint working and to look at improving the transition between Children’s and Adult’s services.

·  Coventry had moved to an early help model and eight family hubs had opened which were leading to positive results for children and families.

·  Signs of Safety training had been rolled out across the Partnership.

·  In 2018 the response to missing children in Coventry was improved by the launch of the Vulnerable and Missing Persons Operational Group, which was a multi-agency group that led, reviewed and recommended actions in relation to children that were missing and at risk of exploitation.

·  Partners had demonstrated that they were delivering improvements in relation to looked after children and in some areas, such as school attendance, looked after children were achieving better outcomes than their non looked after peers.

·  A strong partnership commitment to protecting children and young people from exploitation

·  The Board had developed low risk CSE guidance which was a significant step in responding to the fact that children and young people could move very quickly between the levels of risk.

·  The Board was assured that across the City there were good policies, procedures and training in place to ensure that Domestic Abuse was identified at the earliest opportunity across agencies. There was also a clear recognition that tackling domestic abuse required a focus on the behaviour of the perpetrator and there were some examples of agencies working together to respond to this need.

The Board were informed that three priorities had been agreed for 2019-2021:  ...  view the full minutes text for item 34.

Report of Pete Fahy, Director of Adult Services

The Board considered a report of Pete Fahy, Director of Adult Services, which informed of the forthcoming Adult Social Care peer challenge which was due to take place from 3 to 5 March 2020. Peer challenges were a key part of how social care continued to improve within the city.

The report indicated that the case file audit took place in October 2018.  The timescale between the case file audit and the peer challenge was longer than usual as Coventry had offered to be first to trial a new methodology for the case file audit that took a more rounded view of social work practice than could be gathered from an isolated review of 20 cases. 

In respect of establishing the Key Lines of Enquiry reference was made to the core Adult Social Care objective of supporting people to be as independent as possible within their own homes and communities.  This objective aligns with the system vision of: ‘We will do everything in our power to enable people across Coventry and Warwickshire to pursue happy, healthy lives and put people at the heart of everything we do’. Based on Adult Social Care performance data two areas where there could be potential to improve in order to further support the delivery of this core objective were identified from which the following two Key Lines of Enquiry were established:

(i) Admissions to residential care

A number of changes had been made to how people are supported at home in recent years. It is appropriate that the peer challenge team consider what else could be done in order to reduce levels of residential admissions and support people in their own communities.

(ii) Effectiveness of promoting independence.

The work to develop the promoting independence approach was ongoing and this would always be the case. Could the peer challenge team advise on further improvements in this area and what opportunities for improvement existed through working closer with internal and external stakeholders. 

Data to support these two Key Lines of Enquiry was set out at an appendix to the report.

The report also detailed recent and proposed improvements being introduced by Adult Social Care as the Department worked to improve the services for Coventry residents.

The Board noted that there was no absolute requirement to participate in a peer challenge for Adult Social Care as the challenge team were essentially ‘invited’ to undertake the challenge. These processes did however provide valuable learning opportunities for Adult Social Care and often the wider system.

RESOLVED that:

(1) The content of the report be noted and the Key Lines of Enquiry for the peer challenge be supported.

(2) Organisational support to engage in the peer challenge be provided so that opportunities for system learning can be taken.  

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.