Agenda and minutes

The Minutes of the meetings held 7 June 2011 and 28 June 2011 having been printed and circulated were signed as a correct record.

            The Board was advised that no public questions had been received.

The Board considered the Minutes of the meetings of the Executive Board Sub Committee relevant to the Health Policy and Performance Board.

            RESOLVED: That the minutes be noted.

The Board received a presentation from Mr Derek Campbell, Chief Executive, Merseyside NHS Cluster on the role and function of the cluster and how it operated within the context of the emerging NHS reforms.

The presentation, which was circulated at the meeting:-

·        Gave an overview of the proposed NHS reforms;

·        Outlined the Strategic Health Authority and Primary Care Trust roles in transition;

·        Detailed the Milestones;

·        Demonstrated the current geographic footprint;

·        Set out the clinical commissioning groups – phases of authorisation; and

·        Detailed the Merseyside cluster priorities during transition.

Mr Campbell introduced himself and Mr Steve Spoerry, Chief Executive of Halton and St Helens Primary Care Trust and reported that as he covered the four Primary Care Trusts he could not be fully involved and had therefore, appointed a managing director in each PCT.  Mr Spoerry would be based in Widnes and would help address issues in the Halton area. 

Mr Campbell reported that since being in the post he had developed a clear understanding of the relationship between Runcorn and Warrington and the boundaries.  The cluster, he added, was a temporary arrangement and would cease to exist in 18½ months.  The reasons the cluster had been established was to ensure resources and service delivery was maintained during the transition and support the development of the new system, working to a shared operating model.  He added that it was crucial that the boundaries did not have an impact on future joined up arrangements.

Mr Campbell advised the Board that the Clinical Commissioning Groups would lead commissioning and be responsible for 60% of the NHS budget.  The National Commissioning Board would allocate resources, set commissioning standards, commission specialised and primary care services and hold commissioners to account.  The local Health and Wellbeing Boards would oversee, scrutinise and co-ordinate commissioning plan.

In conclusion, Mr Campbell reported that the NHS Commissioning Board would be in shadow form as a Special Health Authority in October 2011.  Local Clinical Commissioning Groups were in the process of undertaking risk assessments and the Group’s authorisation process and ‘dry run’ would begin in October 2011.  Delegated budgets would also be in place by 2011 and it was emphasised the importance of the Local Authority establishing the Health and Wellbeing Board on the same timeline as the Clinical Commissioning Group obtaining the delegated budget i.e. October 2011.

Mr Spoerry advised the Board that it would be advantageous if the new system emerged rapidly.  Gp’s, he reported, had taken positive steps and were ahead of the timescale and would be receiving their delegated budgets and new functions in October 2011.  He emphasised the importance and benefits of the HWBB being established at the same time. 

The following comments arose from the discussion:-

·        Concern was raised that expertise would be lost during the transition period and whether there would be enough expertise remaining in the new shared system.   In response, it was reported that employees from public health would TUPE over and local expertise would remain in the new system.  ...  view the full minutes text for item 21.

Note: (Councillor M Lloyd Jones declared a Personal Interest in the following item of business due to her husband being a Non Executive Director of Halton & St Helens Primary Care Trust.)

The Board considered a report of the Strategic Director, Policy and Resources regarding the 1st Quarter Monitoring Report for:

·              Prevention and Commissioning Services; and

·              Complex Needs.

The following points arose from the discussion:-

·        Page 46 – CCC14 – Clarity was sought on the performance being slightly less in comparison to the same period last year. 

The Board was advised that the carers figure was reported in the monthly team report and exceptions were also reported to the operational teams.  The figure reported carers who had received either an assessment or a review and had received services.  A large number of carers would already be in receipt of a service (i.e. DP) and to count against the PI they had to have been reviewed in the same financial year.  This ensured that the teams conducted timely reviews / reassessments, ensured that all relevant carers could be counted against the PI and also have their care/support package reviewed in line with their needs.  A member of performance also met monthly with the operational teams, in order to monitor that regular reviews were taking place for carers and this in turn, increased the figure for CCC14.

·        Page 47 – CCC4 – Clarity was sought on performance relating to 581 clients, there being twelve less than the previous year. 

In response, it was reported that  between one year and the next, a number of clients’ packages closed and new clients came on the system to receive services.  Between Q1 2010 and Q1 2011, there were 12 less clients. There may be many reasons for this fluctuation. After checking some of the client records it was found that a client had died in one case and in another the professional support that they received in one year had been closed and therefore they did not appear in the 2011 statistics.  It was suggested that the figures were monitored closely in Q2 and if there appeared to be a decline, further investigation would be required in conjunction with the operational team.

·        Page 27 – Second Paragraph – Clarity was sought on the £256,000.  Information was also sought on the 12 monthly spend/budget profile for the community care budget and what remedial actions were being taken. 

In response, it was reported that if the spend remained static for the remainder of the year the projected overspend within community care would be £1.4m.  However, it was reported that a recovery plan was in place to dampen the increase in community care and spend in certain areas had started to decrease.

In reply, further details were requested and it was reported that additional information would be circulated to Members of the Board.

·        Page 41 – Health Watch – clarity was sought on how partnerships would be undertaken with other Councils. 

In response, it was reported that under current arrangements for the Link, the Host organisation was jointly commissioned with St Helens Borough Council. In moving forward with the development of Health watch, commissioners, along with stakeholders, would consider the  ...  view the full minutes text for item 22.

Note: (Councillor M Lloyd Jones declared a Personal Interest in the following item of business due to her husband being a Non Executive Director of Halton & St Helens Primary Care Trust.)

The Board considered a report of the Strategic Director, Communities which gave an update on the development of a Shadow Health and Wellbeing Board for Halton and presented the Draft terms of Reference for comment and discussion.

The Board was advised that the Halton Health Partnership (HHP) currently acted as the thematic partnership for the Healthy Halton priority. The Partnership reported into the Halton Strategic Partnership Board as one of the five Specialist Strategic Partnerships (SSPs).

         The Board was further advised that the HHP had a strategic responsibility for the Healthy Halton priority and for those elements of work that contributed to the objectives of the Sustainable Community Strategy (SCS) and Local Area Agreement (LAA). The Halton Health Partnership was currently chaired by the Acting Director of Public Health.

   It was reported that health priorities were also addressed by the Healthy Halton Policy and Performance Board and Children’s health issues were included in the work of the Children’s Trust and the Children and Young People’s PPB.

   It was reported that safeguarding was addressed by the Safeguarding Adults Board (SAB) which reported directly into the Safer Halton Partnership and was a non statutory board. Children’s Safeguarding issues were addressed by the Halton Safeguarding Children’s Board (HSCB) which was a statutory board that sat alongside Halton’s Children’s Trust, with each reporting into and providing challenge to the other.  The HSCB, in addition also provided an annual report to the Council’s Executive Board.

         Following an extensive consultation regarding the attached Terms of Reference set out in Appendix 1 to the report, it seemed appropriate to set up a Shadow Health and Well-being Board in Halton.

            The Shadow Health and Well-being Board would be responsible for guiding and overseeing the implementation of the ambitions outlined in the Health White Paper as well as providing the strategic direction for the Health priority in Halton.

   Formal decision- making responsibility would continue to rest with the Council’s Executive and the relevant governance bodies of the local health services until new legislation was enacted. Transitional governance arrangements were key in establishing the Shadow HWBB, given that Health and Well-being Boards would assume their statutory responsibilities from April 2013.  In addition, Overview and Scrutiny issues would remain an integral independent arrangement within the Health Policy & Performance Board.

In terms of the relationship between the HWBB and Children’s Services it would seem short sighted to disassemble existing structures when they were working well. The Children’s Trust, LSCB and SAB should therefore have representation on the Health and Well-being Board. It was proposed that the Chair of these boards would fulfil this role and the Children’s Trust continue in its current format. 

   In conclusion, it was reported that It was proposed that a Shadow Health & Wellbeing Board would be established in October 2011.  This would operate in shadow form and a review would be undertaken 12 months after its commencement and a further report to be presented to the Executive on its progress.  The current Health SSP would be  ...  view the full minutes text for item 23.

The Board considered a report of the Strategic Director, Communities which gave Members an update on the key issues and progression of the agenda for Safeguarding Vulnerable Adults.

The Board was advised that Halton’s Learning Disabilities Partnership Board had held a Business Planning Event where ‘Keeping Safe’ had been a key theme.  The resulting Business Plan included priorities and actions drawn up during the event around safeguarding vulnerable adults and hate crime/hate incidents, including the following, some of which were already being progressed:

·        Help people to understand the danger signs;

·        Support for people and staff to understand how to keep safe; and

·        Talk to more people who may have been a victim of abuse or hate crime.

The Board was further advised that the following priorities had been drawn up during the event around personalisation and which also had the potential to impact on the way in which we support people to stay safe from abuse and exploitation:-

·        Train personal assistants;

·        Check that support plans are making a difference to people’s lives;

·        Look at how we can check how good support plans are; and

·        Check that people are being supported to become more independent.

It was reported that the Safeguarding Adults and Safeguarding Children brief presentations had been incorporated into Halton Borough Council’s Corporate Induction Programme from September 2011.

The Board noted the key issues and progressions of the safeguarding agenda set out in paragraphs 3.2 – 3.14 of the report.

The following points arose from the discussion:-

·        Concern was raised regarding short term agency staff not having a current CRB.  In response, it was reported that this would be raised at the Task Group Meeting;

·        The mechanisms in place to ensure the safety of individuals who were living independently but were deemed to be vulnerable but did not consider themselves to be so was noted; and

·        It was noted that the CRB checks were not being abandoned, but would merge with the vetting and barring system.

RESOLVED: That the report and comments raised be noted.

The Board considered a report of the Strategic Director, Communities which informed Members of the proposal to make public play areas in Halton Smoke Free and provide Members with an opportunity to comment on the proposal.

The Board was advised that the report set out a proposal to implement a voluntary code to make children’s play areas smoke free.  The initiative aimed to de-normalise smoking amongst young children and reduce the likelihood of them becoming smokers in the future.

The Board was further advised that 26% of adults in the Borough smoked. Whilst this level had decreased over recent years the level was still above the national average. Halton’s rate of early deaths caused by smoking remained significantly higher then the national average. Reducing the rates of illness and death caused by smoking was one of Halton’s key public health priorities. To achieve this objective there was a need to reduce the number of people who smoked. This includeed initiatives that helped prevent Halton’s children from becoming the next generation of smokers.

It was reported that internationally, smoking in public play areas and parks was already prohibited in Spain, Hong Kong, Latvia, Singapore and in cities in Australia, New Zealand, Canada and the USA, including New York and San Francisco.

In the UK Inverclyde council in Scotland had made all of their play areas smoke free with 90% of residents supporting the initiative. Pendle council in Lancashire had prohibited smoking in their 57 outdoor play areas and skate parks in 2010.

Furthermore, the Halton Smoke Free Play areas initiative was being undertaken as a partnership between Halton BC, Halton and St Helens PCT.  The Heart of Cheshire and the Cheshire & Merseyside Tobacco Alliance (CMTA).  Liverpool, Sefton and Knowsley Council’s werecurrently consulting their residents with a view to implementing a similar voluntary scheme in their area. 

In conclusion, it was reported that children from Oakfield primary school in Widnes had designed signs and slogans that would be used for the smoke free play areas in Halton. It was intended that the design for these signs would eventually be used across Merseyside by authorities who adopt the scheme.

The following points arose from the discussion:-

·        Concern was raised that employees could be at risk when giving advice and guidance to people smoking in play areas as it could create a confrontational situation.  In response, it was reported that the survey had shown that there was a lot of public support for the proposal and the signs would be erected in play areas where children and young people congregated. It was also reported that it would not create conflict as the Wardens would only be highlighting the signs and passing on child friendly literature.  In addition, the Wardens had been issuing Fixed Penalty Notices for a considerable time and were trained with the necessary skills to give advice and deal with aggressive people.   It was also reported that Senior Managers had indicated  ...  view the full minutes text for item 25.

The Board considered a report of the Strategic Director, Communities which sought support to carry out a scrutiny review of Homelessness Services as outlined in Appendix 1 to the report.

The Board was advised that Councils had a range of duties to those who were homeless or threatened with homelessness in 28 days and at the very least they were obliged to provide advice and assistance on housing options. In addition, it was reported that some households were owed the main homelessness duty, which was the provision of settled accommodation. Local authorities were also expected to implement services to prevent homelessness.

The Board was further advised that to respond to the housing needs of those who were homeless, it was necessary to provide a range of preventative support services; and  in addition to provide temporary accommodation that could be accessed in emergencies until settled accommodation could be found.

It was reported that it was good practice to periodically assess the effectiveness of the services provided and the report sought approval to carry out a scrutiny review of the Councils duty in respect to homelessness and the services we provided in response to that duty.

The Chairman sought nominations from Members of the Board to form a Member led scrutiny working group. 

RESOLVED: That

(1)                     a working group be established to review the Homelessness Service; and

(2)                     the following Members be nominated onto the Working Group:-

·        Councillor E Cargill;

·        Councillor Baker

·        Councillor C Loftus;

·        Councillor M Lloyd-Jones;

·        Councillor J Lowe; and

·        Councillor Wright

Note: (Councillor M Lloyd Jones declared a Personal Interest in the following item of business due to her husband being a Non Executive Director of Halton & St Helens Primary Care Trust.)

The Board was reminded that Standing Order 51 of the Council’s constitution stated that meetings should not continue beyond 9 pm

RESOLVED: That Standing Order 51 be waived to allow the meeting continue beyond 9 pm.

The Board considered a report of the Strategic Director, Communities and the Primary Care Trust which advised Members of the progress of the implementation of the Model of Care and outlined the next steps. 

The Board was advised that in 2008 a review in-patient and community based learning disability services in the boroughs of Halton, Knowsley, St Helens and Warrington had been undertaken.

It was reported that the review had recommended the following:-

·         That the four boroughs and the PCTs agree to adopt a joint strategy of phased change to locally determine models of service that further enhanced community focused support and reduced reliance on specialist learning disability in-patient services and out of area placements;

·        That Commissioners ensured that admissions to in-patients units conformed to the admission process set out in Section 14 of the recently agreed service specification;

·        That the four boroughs and the PCT agree to a reduction in the number of commissioned in-patient beds, and that these should be placed together for reasons of efficiency, effectiveness and economy, with consideration for the most appropriate location to be subject of further discussion at the Alliance Board;

·        That, subject to local resource availability, and based on joint work between the PCT’s and the boroughs, early progress be made on the expansion of community services through pump-priming investment; 

·        That, a project was commissioned to review best practice, and provide detailed recommendations, by Autumn 2009 for the further development of community focused services, in relation to the anticipated release of £2m from current in-patient investment; and

·        That, Commissioners gave consideration to the in-patient bed requirement beyond 2010, in light of the planned expansion of community services, and secure appropriate approvals for decisions in relation to the renewal of the current contract.

Members noted the progress in Appendix 1 and the following recommendations set out in the report:-

·        1 – develop ‘model of care’;

·        2 – in-patient admissions;

·        3 – reduction of in-patient beds;

·        4 – community services (pump priming);

·        5 – best practice/pathway; and

·        6 – in-patient contractual requirements.

Mr C Bean, Primary Care Trust circulated a copy of the Stakeholder Engagement on the redesign of inpatient and community helath services for adults with learning disabilities at the meeting.

The following comments arose from the discussion:-

·        It was noted that in the economic climate and the changes in the NHS Reforms that services would need to be shared.  However, the importance of ensuring there was adequate services for the people of Halton was also noted;

·        Clarity was sought on the reduction of beds and the impact it would have on the people in the Borough.  In response, it was reported that beds were being reduced as they were not being utilised.  In addition,  people were being supported in the community and there was a commitment to ensure that what was commissioned for Halton would meet the needs of the community.  It was also reported that the monitoring framework would be more robust;

·        The reasons for some young people  ...  view the full minutes text for item 28.