Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 25 August 2015.

The Minutes (copies of which had been circulated) of the meeting held on 25 August 2015 were approved as a correct record and signed by the Chair.

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

The following interests were declared:-

Personal Interests

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

The following announcements were made:-

(1)  There were currently two awareness weeks, Self-Care and Alcohol, running from 16-22 November 2015. The Council and Health partners were undertaking various activities to raise awareness amongst the public and staff.

(2)  The ‘Stockport String’ campaign had been launched at Stockport County to over 3000 fans. The campaign was being broadened to include schools.

To consider a report of the Director of Public Health

This report provides the Health and Wellbeing board with an update on progress for the Joint Strategic Needs Assessment (JSNA) for 2015/16. Planning papers have previously been considered by the board, which proposed management structures (since implemented) and set out proposals for the 2015/16 work programme. The purpose of this report is to provide the Board with an update on progress and a timeline for completion for the 2015 JSNA refresh.

The Health & Wellbeing Board is invited to:-

·         comment on and endorse the proposed plans;

·         play an active role in the forthcoming JSNA consultations and encourage response from colleagues; and

·         advise the project team on the development of the Stockport Joint Health and Wellbeing Strategy 2016-2019.

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

A report of the Director of Public Health was submitted (copies of which had been circulated) providing the Board with an update on progress with the refresh of the Joint Strategic Needs Assessment (JSNA) for 2015/16, and preparations for the revision of the Joint Health & Wellbeing Strategy (JHWBS).

The Chair emphasised the importance of wider public engagement, as had been undertaken with the development of the JHWBS.

RESOLVED – (1) That the report be noted and the proposed plans for the refresh of the Joint Strategic Needs Assessment be endorsed.

(2) That the need for wider public participation in the development of the Stockport Joint Health and Wellbeing Strategy be emphasised, recognising the challenge this presented given the complexity of the issues involved.

To consider a report of the Deputy Director of Public Health.

The purpose of this Plan is to describe how, over the next 5 years, we intend to improve the availability, access, appropriateness and effectiveness of mental health services for Children and Young People (C&YP) in Stockport. The  Plan  has been produced by the Stockport Children and Young People’s Mental Health Transformation Project Team;  a multi-agency partnership led by Stockport Clinical Commissioning Group (CCG) in collaboration with Stockport Metropolitan Borough Council (SMBC) which includes representatives from health, social care and education services, voluntary sector organisations and parents.

The Health and Well Being Board is asked to receive the documents, note the CCG allocation and support the proposed direction of the plan.

Officer contact: Alison Caven (Stockport CCG)/  Donna Sager (Stockport Council); 0161 426 5517 /0161-474-3928, alison.caven@nhs.net   donna.sager@stockport.gov.uk

The Joint Commissioning Manager, Children & Young People, Stockport Clinical Commissioning Group, submitted a report of the Deputy Director of Public Health (copies of which had been circulated) setting out the Stockport Children and Adolescent Mental Health Services (CAMHS) Local Transformation Plan that sought to describe how improvements would be made to availability, access, appropriateness and effectiveness of children 7 young people mental health services in Stockport.

Stockport had been successful at gaining £584,466 of additional funding from NHS England to support the implementation of the Transformation Plan.

The following comments were made/ issues raised:-

·         In response to a question about monitoring of outcomes it was stated that measures were being developed and new methods of data collection to reflect the changes to the service.

·         The move away from service tiers to services that were more responsive to individual need was welcomed, although it was commented that those would make monitoring more challenging.

·         It was queried whether the aspirations to attract further professionals, such as infant mental health practioners, were realistic. In response it was stated that it was hoped the additional investment, together with the proven track record of quality service in Stockport, would make recruitment attractive. The additional resources that had been provided by NHS England would allow recruitment to be undertaken soon.

·         Concerns were expressed about the additional expectations that may be placed on teachers as part of the plan. In response it was stated that the proposal was to raise awareness of mental health and the new CAMHS service amongst teachers and school staff, particularly secondary schools and colleges. It was not expected that every teacher would provide additional interventions. It was also commented that academies would be included within the offer of this new service, and they had previously been supportive and willing to engage in these kinds of services.

·         Secondary head teachers have consistently identified CAMHS capacity as a priority issue for their school. But it was important to develop services that worked alongside and within schools, as ensure children remained in school and were included was vital to the success of these intervention.

·         The ‘design-by-doing’ approach to service development set out in the plan was a positive approach.

·         The disparity between the expected number of referrals into CAMHS and the actual number, which was less, was striking. It was likely that as the transformation plan was implemented this may lead to an increase and so the Plan needed to take account of this probable growth.

·         Concerns were expressed that the non-recurrent funding being targeted on waiting list reduction for CAMHS referrals was insufficient given the likely increase in demand. It was also commented that reducing waiting times from 20 to 18 weeks still meant that young people were waiting a very long time for an appointment. In response it was stated that other measures in the Plan were intended to provide other opportunities to receive support earlier and perhaps more effectively. It was emphasised that a key element of the process of implementing the Plan, work was being undertaken to align a range of other services that could bridge the gap between referral and appointment. It was also commented that new NHS guidelines were likely that would see waiting time targets reduce from 18 weeks.

RESOLVED – (1) That the ‘Improving Children & Young People’s Mental Health in Stockport’ Local Transformation Plan 2015-2020 be received and the proposed direction of the Plan be endorsed.

(2) That the allocation of additional resources by the Stockport Clinical Commissioning Group, as set out in the report, be noted.

(3) That the Board recognise the importance of improving outcomes for children and young people’s mental health, noting the importance of work with schools.

To consider a joint report of the Corporate Director for Corporate and Support Services (Stockport Council) and the Chief Finance Officer (Stockport Clinical Commissioning Group).

The report sets our data relating to performance of the Better Care Fund for the second quarter of 2015/16. The report also includes completed template returns required by NHS England.

Officer contact: Michael Cullen (Council) / Marc Brady (CCG), 0161 474 4631, 0161 426 5589

A joint report of the Chief Finance Officer (Stockport Clinical Commissioning Group) and the Corporate Director for Corporate and Support Services (Stockport Council) was submitted (copies of which had been circulated) providing the Quarter 2 Data Collection Return for the Better Care Fund that was required for submission to NHS England.

It was reported that because the number of Non-Elective Admissions was 9,837 which was in excess of the planned figure no performance funding would be released by NHS England.

The Board were invited to consider the proposal of reviewing and revising the planned activity figure for Quarter 4 that would impact on the 2016/17 Better Care Fund. It was proposed to revise the figure to 9,303 non-elective admissions, as set out in paragraph 3.3 of the report.

RESOLVED – (1) That in relation to the Better Care Fund Quarter 2 Data Collection Return:-

·         the continuation of growth of Non-Elective admissions at a rate greater than plan and therefore no element of the performance fund being released be noted;

·         approval be given to the submission of the Q2 BCF monitoring tool to NHS England on or before 27 November 2015;

·         the financial performance of the BCF as at Q2 be noted; and

·         approval be given to revising the Q4 2015-16 plan to reflect a decrease of 3.5% on Q4 14/15 actual admissions on a planning basis, subject to ongoing review.

To consider a verbal update from the Corporate Director for People and Senior Responsible Owner for Stockport Together.

The Board will be provided with an update on progress with the Stockport Together project.

At the request of the Chair a copy of Stockport Together’s leaflet on information sharing and the Care Record has also been circulated.

Officer contact: Andrew Webb, 0161 474 3808, andrew.webb@stockport.gov.uk

Andrew Webb, Corporate Director for People and Senior Responsible Owner for Stockport Together, provided the Board with an update on the Stockport Together Programme and the work with the NHS England Vanguard team.

The update included:-

·         By the third week of December it was anticipated that a clear plan for the Health & Social Care Economy would have been developed for consideration through each partner’s governance arrangements and to inform budget and spending plans, subject to the announcements as part of the Comprehensive Spending Review and other funding settlement announcements.

·         There had been a decision in principal to pool Adult Social Care and Public Health budgets by the Council with corresponding CCG budgets as part of the programme to develop an integrated service for the over 65 cohort.

·         Work continued with Vanguard, although the Stockport Together programme, including the development of a multi-agency provider, was wider than the remit of the original Vanguard bid.

·         The Leaders Group (comprising senior representatives from each of the partners) had agreed to accelerate work to prepare for a further decision on pooling, for the creation of a Single Commissioning Function by April 2016.

·         The development of the single provider service was more challenging. It was hoped to create a structure or arrangements that would allow professionals working together at a locality basis.

·         A multi-disciplinary team had been established and was operating in the Cheadle & Bramhall locality since October. It was hoped to replication this to the remaining two localities by February 2016.

·         Work was underway to develop a suitable governance structure to support the future arrangements.

·         The further Stockport Together Plan would be submitted to this Board in due course.

A copy of a recently published leaflet on Information Sharing that had been developed by the Stockport Together was also submitted for the Boards information (copies of which had been circulated).

The following comments were made/ issues raised:-

·         There had been concerns expressed about the governance arrangements underpinning the Section 75 Agreement and the increase in the pooled budget. Increasing awareness amongst councillors and the public of developments around the integrated locality hubs, such as through area committees, would go some way to addressing accountability concerns.

·         Partners had developed an information sharing agreement that was currently subject to final legal opinion prior to sharing.

·         Challenges remained in relation to the accountancy and business rules that different partners operated.

·         The aspiration of partners was to move beyond the Stockport Health Record to develop a single record that would allow professionals to access information about patients and service users in real time.

RESOLVED – (1) That the update on Stockport Together and ‘Vanguard be noted.

(2) That progress with developing information sharing arrangements be noted and the Board welcome the efforts to sign a final agreement.

(3) That the concerns of the Board in relation to the governance arrangements and accountability concerns be recorded.

To consider a report of the Corporate Director for People/ Senior Responsible Owner for Stockport Together.

To inform the Health and Wellbeing Board of the most recent locality plan, submitted on behalf of the Stockport Health and Care economy, to the Greater Manchester devolution programme.

The Board is asked to:

•      receive the latest version of the Locality Plan;

•      note the scale of the financial challenge;

•      comment on the strategy and detailed approaches to re-shaping the local heath and care economy;

•      contribute to the debate about the interaction of the Locality Plan and Greater Manchester aspirations for an integrated approach to Health and Social Care.

Officer contact: Andrew Webb, 0161 474 3808, andrew.webb@stockport.gov.uk

The Corporate Director for People and Senior Responsible Owner submitted a report (copies of which had been circulated) to inform the Board of the development of the Locality Plan, submitted on behalf of the Stockport Health and Care economy, to the Greater Manchester devolution programme. The Plan was used as the basis for the projections that formed part of the submission relating to the Comprehensive Spending Review (CSR) and the Devolution negotiation.

The Plan was a snapshot of the economy in September. A further was being developed that would include the outcome of the CSR and would therefore have fewer assumptions within it.

The following comments were made/ issues raised:-

·         Work was underway within Greater Manchester to develop targets and measures for the next five years.

·         Concerns were expressed about how out-of-hours care fit within the locality model, in particular the access to district nursing and the NHS 111 Service. In response it was stated that since the document had been developed, further work had been undertaken to explore how emergency care could be integrated with the work of the localities.

·         There had been positive engagement with clinicians in the Stockport Together work generally, particularly with GPs in neighbourhoods and at a strategic level. It wasn’t clear how well ‘operational’ hospital clinicians were engaged.

·         The development of a multi-agency provider could help to resolve concerns about clinical accountability that had been raised in respect of integration more generally.

RESOLVED – That the latest version of the Health and Social Care Locality Plan, and the scale of the financial challenge facing the economy be noted.

To consider a report of the Corporate Director for People / Senior Responsible Owner for Stockport Together

The report highlights the contents of the Greater Manchester devolution team’s progress report towards developing an integrated approach to the local Health and Care economy; and to inform the Board of the contents of the Greater Manchester submission to HM Treasury’s Comprehensive Spending Review.

The Board is asked to consider the implications of the devolution plans for the Stockport economy; and to steer the work of local stakeholders in aligning local ambitions with those of the conurbation.

Officer contact: Andrew Webb, 0161 474 3808, andrew.webb@stockport.gov.uk

The Corporate Director for People and Senior Responsible Owner submitted a range of documents (copies of which had been circulated) to provide the Board with an update on developments at a Greater Manchester level, including the development of a Health & Social Care Strategy.

The aims of this work, including Healthier Together, were to exploit the opportunities for conurbation-wide economies of scale; the minimisation of variation in service standards and outcomes; to address the gap between projected spend on health and social care as against the likely resources available.

It was anticipated that a draft Strategy would be developed by December that would then provide greater detail and clarity to inform local planning.

RESOLVED – That the reports be noted.

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

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

A representative of the Democratic Services Manager submitted a report (copies of which had been circulated) setting out a forward plan of agenda items for future meetings of the Board.

RESOLVED – (1) That the report be noted.

(2) That the Corporate Director for People be requested to submit a revised Stockport Locality Plan to the January 2016 meeting.