Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 11 September 2013.

The Minutes (copies of which had been circulated) of the meeting held on 11 September 2013 were approved as a correct record and signed by the Chair.

Members and officers were invited to declare any interests they had in any of the items on the agenda for the meeting.

No declarations of interest were made.

To achieve any announcements from the Chair on matters related to the activity of the Board.

The Chair reported on the following issues:-

(i)            Recent announcements had been made by the Department of Health and Local Government Association in relation to the Integration Transformation Fund and details were included elsewhere on the agenda.

(ii)          A recent letter from the Secretary of State for Health, Jeremy Hunt MP, in relation to end of life care had been circulated to Board Members.

(iii)         Greater Manchester’s bid to be a Pioneer Area for health and social care integration had been unsuccessful, despite being a strong and innovative bid.

To consider any update on health and social care integration work.

The Chief Operating Officer (Stockport Clinical Commissioning Group) and the Service Director (Adult Care Services) (Stockport Council) provided a verbal report to the Board updating them on developments since the report considered at the last meeting on the integration of health and social care services in Stockport.

The update included the following key points:-

·         The Locality Hub model had been refined and it was planned to roll-out the Marple & Werneth Hub by the end of January 2014. This would include the co-location of partners.

·         Work was ongoing on the economic analysis of the model with a draft Strategic Business Case due to be completed by December 2013.

·         An interim ICT solution was now in place which would allow data sharing and viewing between organisations while retaining each organisation’s control over its own systems and data.

Members discussed the advantages and disadvantages of fully integrated ICT systems to underpin integrated working and service provision. It was stated that a fully integrated solution would take considerable time to implement, at significant cost, and would not be able to provide the level of functionality needed by each partner organisation for their own needs.

Members further discussed the financial arrangements supporting integration and the complexity of the financial modelling.

RESOLVED – (1) That the report be noted.

(2) That the proposals and approach to the integration of adult social care and health services in Stockport, as detailed in the report considered at the meeting on 11 September 2013 and as described in the update at this meeting be endorsed.

Enclosed is a letter from Lord Smith, Chair of AGMA, and Dr Hamish Stedman, Chair of the Association of GM CCGs, setting out the next steps for Health and Social Care Reform in Greater Manchester.

A copy of a letter from the Chair of the Association of Greater Manchester Authorities (AGMA) and the Association of Greater Manchester CCGs (AGMCCG) was submitted (copies of which had been circulated) summarising the outcome of informal meetings of AGMA Leaders and of AGMCCGs at which the approach to the development of out of hospital care across Greater Manchester was endorsed.

RESOLVED – That the letter be noted.

Enclosed are three documents recently published relating to the Integration Transformation Fund.

The first is a letter from Carolyn Downs, Chief Executive of the Local Government Association and Bill McCarthy, National Director of Policy at NHS England outlining the next steps in the roll-out of the integration transformation fund.

The second is a letter from Sir David Nicholson, Chief Executive of NHS England, setting out key strategic guidance to commissioners in advance of further planning guidance arising from the paper ‘The NHS belongs to the people – a call to action’.

The third document is a copy of the draft submission template for bids to the transformation fund.

(a)          2013/14 NHS Transfer Funding to Social Care

A report of the Service Director (Adult Social Care) (Stockport Council) and the Chief Operating Officer (Stockport Clinical Commissioning Group) was submitted (copies of which had been circulated) detailing the amount of resource to be transferred from the NHS to Stockport Council under Section 256 of the NHS Act 2006 to support adult social care services. The report set out the arrangements underpinning the transfer and the range of services the transferred resource would support during 2013/14.

RESOLVED – That the report be noted and approval be given to the transfer of funding from the NHS to Stockport Council’s Adult Social Care Service for the purposes identified in the report and confirmed within the authorised Section 256 (NHS Act 2006) Memorandum of Agreement.

(b)          Integrated Transformation Fund

Copies of various documents relating to the Integrated Transformation Fund (ITF) circulated to Health & Wellbeing Board Chairs, local authorities and CCGs by the LGA and NHS England were submitted (copies of which had been circulated) that sought to provide additional information on the key elements of the Fund for 2014/15 and beyond.

It was reported that uncertainty about the detail of the ITF remained and would not be released until the 5 December Autumn Budget Statement at which time the local government and CCG financial settlements would also be known. Access to the fund was conditional on a number of criteria being met, including the agreement of a plan for the use of the resource that had the endorsement of the Health & Wellbeing Board, and progress in a number of key areas. It was stated that Stockport was well-placed to deliver against the measures required through the current work on integration.

It was stated that prior to being signed-off by the Chair of the Board the proposed submission would need to be considered by the Council’s Executive on 11 February and the CCG Board on 14 February 2014.

RESOLVED – (1) That the documents from the LGA and NHS England be noted.

(2) That the Service Director (Adult Social Care), Stockport Council and the Chief Operating Officer (Stockport CCG) be requested to submit details of the proposed Integrated Transformation Fund Plan and submission to the Department of Health to the 15 January 2013 meeting of the Board for endorsement.

To consider a report of the Director of Public Health.

The Health and Social Care Act 2012 has given local authorities and clinical commissioning groups equal and joint duties to prepare a Joint Strategic Needs Assessment (JSNA) and Pharmaceutical Needs Assessment (PNA) through the health and wellbeing board.

This report sets out proposals for how this duty cold be discharged in 2014/15, including recommendations for the governance, management and process of delivering both the JSNA and PNA.

The Board is invited to:-

·         comment and, if accepted, approve the model for JSNA project governance set out in section 3.1 of the report;

·         identify any further areas that the JSNA should address which have not been detailed in the report, especially within section 3.2;

·         approve or provide alternative comments on the proposal that the PNA is published by March 2015.

Officer contact: Eleanor Banister,  0161 474 2447, eleanor.banister@stockport.gov.uk

The Director of Public Health submitted a report (copies of which had been circulated) detailing a proposal for the process for refreshing the Joint Strategic Needs Assessment (JSNA) in 2014/15, including a Pharmaceutical Needs Assessment (PNA), and inviting the Board to make suggestions for areas of further work or analysis.

The following comments were made/ issues raised:-

·         The previous iteration of the JSNA involved a significant element of public engagement which was a strength of the document and should be continued.

·         The current JSNA would be used to inform decisions and thinking on the integration work as it was very much a ‘live’ document.

·         With Public Health now being based within the Council there was now additional capacity and expertise to help deliver the refreshed JSNA.

·         The JSNA, along with a suite of other documents such as the Annual Public Health Report and the Health & Wellbeing Strategy, provided ample analysis of inequalities and would informed proposals and policy development.

·         Safeguarding, the needs of vulnerable groups and healthy life expectancy should be considered for inclusion in the refresh in addition to issues that emerge from the process.

RESOLVED – (1) That

·         the model for the JSNA refresh project governance as set out in section 3.1 of the report be approved;

·         that consideration be given to the inclusion of the areas identified in the comments above, and

·         the proposals for the PNA be approved for publication by March 2015.

(2) That partners be requested to provide nominations for project leads form their organisations as soon as possible.

To consider a report of the Director of Public Health.

The report presents the health and wellbeing performance indicators previously agreed by the Health and Wellbeing Board. Data is taken from the quarterly PPRRs (Portfolio Performance Resource Reports) for the Health and Wellbeing, Adult Social Care and Children and Young People portfolios wherever possible, so that these processes are aligned.

The intention is to give the Health and Wellbeing Board an overview of current performance, and the progress of measures supporting the Health and Wellbeing Strategy. Indicators have been chosen in balanced way, so as to give a snapshot of both health and social care, and wherever possible, focus on the links between the services.

The Board is invited to:-

·         receive and note this report and the key indicators summarised within it;

·         comment on whether the snapshot data presented in the tables give the Board the level of detail they regularly require for assurance and advising on health improvement;

·         identify whether future outcome reports should include commentary on the data or key work programmes.

Officer contact: Eleanor Bannister, 0161 474 2447, eleanor.banister@stockport.gov.uk

The Director of Public Health submitted a report (copies of which had been circulated) detailing performance against a range of relevant performance indicators in the second quarter of 2013/14, aligned to the Health & Wellbeing Strategy, and seeking the Board’s view on the format and style of future reporting.

The following comments were made/ issues raised:-

·         The current performance data was broadly in line with expectations.

·         Although inequalities underpinned the whole Strategy, it may be useful to have specific performance data for this issue.

·         The factors underlying the increase in cancer deaths was complex – it may not be that there were more deaths but success in reducing death from other causes had resulted in a greater proportion of deaths being attributable to cancer. Similarly with rates of malignant melanoma, although there was higher incidence for which Stockport was an outlier, this was not the case for deaths.

·         Including information on healthy life expectancy would be useful. There was a concern that the Office of National Statistic would soon cease to collect data on healthy life expectancy as well as range of other areas such as cot death.

RESOLVED – (1) That the report be noted.

(2) That the Director of Public Health be requested to include performance data on inequalities and health life expectancy in future reports.

(3) The Chair be recommended to write to the Office of National Statistics to inform them of the Board’s concerns about potential changes to the collection and publication of data relevant to the work of the health and social care partners, particularly in relation to healthy life expectancy, and rates of sudden infant death syndrome.

To consider the Forward Plan of agenda items for future meetings of the Health & Wellbeing Board.

Officer contact: Jonathan Vali/ Gill Walters, 0161 474 3201 / 07800 618299, jonathan.vali@stockport.gov.uk / gill.walters@stockport.gov.uk 

The Chair submitted a report (copies of which had been circulated) setting out a forward plan of agenda items for future meetings of the Board.

RESOLVED – That the report be noted.

To consider a joint report of the Chief Operating Officer, Stockport CCG and the Service Director (Adult Social Care), Stockport Council.

The report sets out the process and results for the Stockport locality in undertaking the Joint Health and Social Care Self-assessment exercise. The report also sets out the actions needed that will help address inequalities in health and improve the lives of people with learning disabilities in Stockport. The Board considered an interim report at its meeting in June 2013.

The Health and Well-being Board is invited to: -

·         note and comment on the report

·         Support the ratings for final submission.

Officer contact: Gina Evans/ Mark Warren / Barbara Mitchell, 0161 426 5516/ 0161 474 5364/ 0161 218 1273

A report of the Chief Operating Officer (Stockport CCG) and the Service Director (Adult Social Care) (Stockport Council) was submitted (copies of which had been circulated) detailing the process and results for the Joint Health and Social Care Self-Assessment exercise that had taken place in Stockport, identifying where further action was needed to address inequalities in health and quality of life for people with learning disabilities in Stockport.

Since publication of the report, further data had been analysed and there was sufficient evidence to recommend that performance against two of the indicators marked as ‘red’ should now be considered ‘amber, namely ‘Assurance of Monitor Compliance for Foundation Trust’ and ‘Assurance of safeguarding for people with learning disability in all provided services and support’.

Members commented that the report highlighted inadequate data handling and sharing arrangements in the NHS which was hampering efforts to improve outcomes.

Members also commended the work done to complete the self-assessment and to improve services and outcomes as a result.

RESOLVED – (1) That the report be noted.

(2) That the ratings contained in Joint Health and Social Care Self-Assessment be accepted for submission to NHS England, Department of Health and the Association of Directors of Social Services, subject to the re-rating to ‘amber’ of the following measures:-

·         Assurance of Monitor Compliance for Foundation Trust

·         Assurance of safeguarding for people with learning disability in all provided services and support

(3) That the thanks of the Board be recorded for the hard work of those involved in completing the Self-Assessment.

To consider a report of the Director of Public Health.

The report provides an update on activity taking place in Stockport in support of  the Stoptober smoking cessation campaign, is the national 28 day Stop smoking campaign delivered by Public Health England (PHE).  The campaign is running for the 2nd year. 

The Board is invited to note the report.

Officer contact: Sarah Clarke, 0161 474 2456, sarah.clarke@stockport.gov.uk

The Director of Public Health submitted a report (copies of which had been circulated) providing the Board with an interim update on activity that had taken place in Stockport as part of the national ‘Stoptober’ smoking cessation campaign as well as an assessment of the potential impact. Coverage of the campaign in Stockport had been good and participation levels high.

Members discussed e-cigarettes and the need for further work on their impact and the implications for public health and other policies.

RESOLVED – That the report be noted and the thanks of the Board be extended to all those involved in the ‘Stoptober’ campaign in Stockport.

To consider a report of the Director of Public Health.

The report and presentation will cover developments in national policy and updates on progress towards achieving the ‘we wills’ for children and young people contained in the Joint Health & Wellbeing Strategy. The report contains statistical analysis of key performance data.

The Board is invited to comment of the report and the issues raised in the presentation.

Officer contact: Duncan Weldrake, 0161 474 2443, Duncan.weldrake@stockport.gov.uk

Duncan Weldrake (Public Health Specialist) (Stockport Council) made a presentation and submitted a report (copies of which had been circulated) on progress with delivering the ‘We Wills’ contained in Chapter 1 of the Health & Wellbeing Strategy entitled ‘Early Intervention with Children and Families’.

The following comments were made/ issues raised:-

·         School nursing had a key public health role and work was planned to pilot an enhanced role for school nurses following an analysis of the gaps in current provision. There was a danger that too great a demand was being placed on school nurses to support safeguarding activity so focus was being lost on the promotion of good health.

·         Members expressed disappointment that transition/ 16-19 services had been identified as a weakness as this was a longstanding area of concern.

·         Addressing the high rates of admissions to hospital for children and young people was a priority for the CCG and work had been done to improve pathways, although these either had not yet been implemented or had insufficient time to lead to improvements.

·         There was further work needed to enhance preventative work around lifestyles in pregnancy and early motherhood as part of the re-specification of services. The Council had recently commissioned specialist community-based breastfeeding support. The reintroduction of the Nursing Partnership next year would also provide significant support although because it was focused intervention it was unlikely to have a significant impact of the statistics.

·         Members queried the seeming contradiction between generally high levels of oral hygiene and high rates of cavity disease requiring admission. In response it was stated that caution was needed with the data as the sampling may have created a distorted view. It was also suggested that compared to Stockport other areas of the region had more community dental facilities that would deal with cavity disease so rates of admission would be lower, although incidence may be higher. Collaborative and partnership working around dental health had been identified as an area of weakness in Stockport.

RESOLVED – (1) That the report be noted and Duncan Weldrake be thanked for his attendance and presentation.

(2) That the Democratic Services Manager be requested to circulate the report and presentation to all councillors for their information.

(3) That the Director of Public Health be recommended to investigate the joint-working between Bolton and Wigan Councils in relation to early intervention and prevention for children and families.

To consider a report of the Director of Public Health

The report provides a brief update to the board on progress against the ‘We Wills’ within Chapter 2 Physical Activity and Healthy Weight, with a particular focus on children and young people.

The Board is invited to note the report and highlight further areas where their organisations can make an active contribution to this priority

Officer contact: Russ Boaler, 0161 474 3941, russ.boaler@stockport.gov.uk

Russ Boaler (Consultant for PE, Sport & Physical Activity)(Stockport Council) attended the meeting to present a report (copies of which had been circulated) on progress with delivering the ‘We Wills’ contained in Chapter 2 of the Health & Wellbeing Strategy entitled ‘Physical Activity and Healthy Weight’.

The following comments were made/ issues raised:-

·         The Council had made significant strides through the planning process to curb fast food outlets near schools but there appeared to be an increasing trend of mobile food outlets operating instead. Changes to school meal provision and the increasing number of providers operating in schools may hamper efforts to promote healthy menus and diets. While it was acknowledged that academies and free schools were not bound by regulations on school meals, it was acknowledged that governors of these establishments were not unconcerned by the issue.

·         Schools were working hard to support the physical activity agenda, and the Council had been more successful than some local authorities in maintaining levels of support, but there was increasing pressure on resources and time.

·         There remained concern about whether there were sufficient opportunities and support for young people to take part in physical activity outside of school.  While the Olympics had led to an increase in interest in sport, there was a persistent 20-15% of young people who were not interested so opportunities for them to be physically active were needed. This could include encouraging walking or cycling to school.

RESOLVED – That the report be noted and Russ Boaler be thanked for his attendance and presentation.