Agenda and minutes

Councillor Mulherin welcomed all present to the Board’s first meeting of the 2015/16 Municipal Year.

Noting the new Council membership of the Board, the Chair led the meeting in extending thanks to former Board members Councillors Blake and Ogilvie for their contribution to the work of the Board.

The Board welcomed new members Councillors Coupar and Yeadon; and Cath Roff who had recently been appointed LCC Director of Adult Social Services.

Finally, the Chair noted that Hannah Lacey, LCC Health & Wellbeing Team Administrator, would shortly be leaving the team and expressed thanks to Hannah for her support to the Board and best wishes in her new role

To consider any appeals in accordance with Procedure Rule 15.2 of the Access to Information Rules (in the event of an Appeal the press and public will be excluded)

(*In accordance with Procedure Rule 15.2, written notice of an appeal must be received by the Head of Governance Services at least 24 hours before the meeting)

There were no appeals against the refusal of inspection of documents

1  To highlight reports or appendices which officers have identified as containing exempt information, and where officers consider that the public interest in maintaining the exemption outweighs the public interest in disclosing the information, for the reasons outlined in the report.

2   To consider whether or not to accept the officers recommendation in respect of the above information.

3   If so, to formally pass the following resolution:-

RESOLVED – That the press and public be excluded from the meeting during consideration of the following parts of the agenda designated as containing exempt information on the grounds that it is likely, in view of the nature of the business to be transacted or the nature of the proceedings, that if members of the press and public were present there would be disclosure to them of exempt information, as follows:-

The agenda contained no exempt information

To identify items which have been admitted to the agenda by the Chair for consideration

(The special circumstances shall be specified in the minutes)

No formal late items of business were added to the agenda; however the Board received the following supplementary documents prior to the meeting

Agenda Item 8 “Health and Social Care Winter Pressures in Leeds” – Revised version of Appendix 2 providing a better copy of the flow chart (minute 10 refers)

Agenda item 12 “Recommendations from the whole system review of Children and Young People Emotional and Mental Health Services in Leeds” – an additional document containing the Inquiry Report of the Scrutiny Board (Health and Wellbeing and Adult Social Care) (minute 14 refers)

Additionally, the Board were in receipt of an email from Health and Wellbeing Board member Susie Brown, Healthy Lives Leeds Representative, who had submitted comments on various items as she was unable to attend the meeting

To disclose or draw attention to any disclosable pecuniary interests for the purposes of Section 31 of the Localism Act 2011 and paragraphs 13-16 of the Members’ Code of Conduct.

No declarations of disclosable pecuniary interests were made, however the following additional declaration was made :

Linn Phipps (Healthwatch Leeds) – Agenda Item 11 Commissioning of Specialised Services in Leeds” – wished it to be recorded that she was a member of one of the national organisations involved in the consultation process, CPAG – the NHS England Clinical Priorities Advisory Group

To receive any apologies for absence

Apologies for absence were received from Councillor Coupar; Nigel Gray (Leeds North CCG); Matt Ward (Leeds South & East CCG); Phil Corrigan (Leeds West CCG); Susie Brown (Third Sector Leeds- Zest -Health for Life); Tanya Matilainen (Healthwatch Leeds) and Julian Hartley (Leeds Teaching Hospitals NHS Trust).

The Board welcomed Councillor Christine Macniven as substitute for Councillor Coupar and Simon Neville as a substitute representative for Leeds Teaching Hospitals NHS Trust

At the discretion of the Chair, a period of up to 10 minutes may be allocated at each ordinary meeting for members of the public to make representations or to ask questions on matters within the terms of reference of the Health and Wellbeing Board.  No member of the public shall speak for more than three minutes in the Open Forum, except by permission of the Chair.

No matters were raised by the public on this occasion

To agree the minutes of the previous meeting held 25^th March 2015

(Copy attached)

RESOLVED – That the minutes of the previous meeting held on 25^th March 2015 be agreed as a correct record

To note the report of the Chief Officer, LCC Health Partnerships providing a write up of the mental health workshop and official thanks to service users

The Chief Officer, Health Partnerships, submitted a report presenting key messages arising from the workshop held on 24th February 2015 on the topic of “improve people’s mental health and wellbeing’ - one of the four ‘commitments’  of the Health and Wellbeing Board. The Chair introduced the matter and expressed her thanks to all the participants who shared their lived experiences at the workshop.

Two participant service users were in attendance at the meeting as a follow-up from the session; and the Chair thanked them and their fellow volunteers for their important contribution to the work of the Board. Discussion touched on the following matters:

·  The need to improve service delivery and address public facing issues, including inequality and stigma; and keep public focus on mental health issues

·  Support was expressed for a Leeds campaign - although the national and local success of the Mind "Time to Change" campaign was noted along with the work of the Leeds & York Partnership NHSFT with the "Change Leeds" campaign. A suggestion that the Board reflect on how best to support the existing MIND campaign was noted.

·  The potential for the positive impact of rolling out the “Time to Change” campaign across the collective Leeds NHS and LCC workforce

RESOLVED -

a)  To note the key messages, themes and priorities identified during discussions at the February mental health workshop

b)  To incorporate the outputs of the workshop in the planning for the refresh of the Joint Health and Wellbeing Strategy

c)  To thank the service user participants for their powerful contribution to this area of work.

d)  To note the intention for Leeds & York Partnership NHSFT to present a report to a future HWB on the Trusts’ work with the Change Leeds campaign.

To consider the report of the Chair of Leeds North CCG as a basis of discussion on winter pressures planning for 2015/16 across health and social care, building on lessons learnt from last winter.

The Board considered the report of the Chair of Leeds North CCG which provided an overview of health and social care winter pressures in Leeds, and the planning necessary to build a resilient health and care system. The report covered the allocation of non-recurrent funds; the evaluation of system demands and performance throughout the winter 2014/15, outlined the areas of investment in 2014/15; and presented recommendations for 2015/16.

Jason Broch (Leeds North CCG) presented the report, highlighting the following matters:

·  Recent yearly low mortality rates and their subsequent impact on the city’s demographics and service demands

·  The need to establish a resilient all-year round system and concentrate on contingency plans

·  Statistics relating to non-elective care were displayed for reference – the impact of delayed transfers and lost bed days on capacity and service provision was discussed

·  Ongoing data modelling intended to identify trends and present headline information, as well as seeking to inform decisions on how to better draw related issues together, such as discharge and urgent care services

·  Emerging issues identified included leaving hospital; creating capacity; discharge; escalation - how to integrate social care escalation systems with those of the NHS; and social care data - how to collate data on activity and capacity into NHS data systems

The HWB further highlighted :

-  the need for openness and transparent data across the city's systems and that early sight of the data by HWB was required in order to assist in the planning for the following year

-  The impact of winter pressures on community and primary care services

-  Acknowledgement that the system over-concentrated on measurable outcomes such as hospitals and beds, and not the voluntary care, social care and primary care sectors which operated within the system to support patients' very complex needs outside of hospitals

-  Noted that patients' views were reflected in the system modelling of future services

-  The impact of dealing with winter pressures on planned procedures, rehabilitation and continuing care services

-  Acknowledgement of the need to reflect on the wider Yorkshire health economy

RESOLVED –

a)  To note the contents of the discussions on the key findings of the evaluation of health and social care winter pressures in Leeds in 2014/15

b)  That the following be agreed as future actions in order to better enable the Leeds Health and Social care economy to deliver system resilience and ultimately secure good patient experience

  i.  a follow up report be presented to the September HWB on the wider West Yorkshire Health economy

  ii.  a further report be presented to the September HWB on the outcome of the ongoing data modelling, to include a focus on all year round resilience

To receive the joint report of the Leeds Teaching Hospitals Trust, Leeds Community Healthcare, Leeds and York Partnership Foundation Trust and LCC Director of Children’s Services providing a brief summary of the recent inspections of health and social care in Leeds

The Board received a joint report from Leeds Teaching Hospitals NHS Trust, Leeds Community Healthcare NHS Trust, Leeds and York Partnership NHS Foundation Trust and the Director of LCC  Children’s Services on a series of recent quality and systems inspections of partners in Leeds. The report provided a brief summary of the inspections, in order to support discussions on the implications for the Leeds Health and Social Care system.

All three NHS provider trusts in Leeds had been inspected by the Care Quality Commission (CQC) on the quality of their care. Additionally, an unannounced Ofsted inspection of services for children in need of help and protection, children looked after and care leavers; and the effectiveness of partnership working, including the Leeds Safeguarding Children Board had been undertaken.

Chris Butler, Leeds and York Partnership NHS Foundation Trust, presented the CQC findings on inspection of their Trust, highlighting the key findings and differences between the two cities

Simon Neville outlined key issues in relation to Leeds Teaching Hospitals NHS Trust and reported that the matters identified for action had been addressed

Thea Stein presented highlights in relation to Leeds Community Healthcare NHS Trust and provided assurance that all issues identified during the inspections had been addressed

Nigel Richardson provided the Board with a presentation on behalf of LCC Children's Services, welcoming the rating of "good", with “outstanding” leadership and management; and highlighting that no issues had been identified as priorities for action

The HWB additionally discussed the following:

·  Staffing, the reliance on agency staff and impact on care ratings

·  In considering the workforce, nursing home staff should be referenced

·  Noted the ongoing inspection of General Practice

·  Partnership working and the instigation of an “NHS contract” allowing staff mobility and flexibility to respond, noting that skills and safety must be maintained. A suggestion that this matter be a key theme for HWB consideration for the future was noted

·  Future consideration of those issues which prevent resilience being achieved was required.

·  New services models would require different skills and roles, with an acknowledgement that investment would be required to ensure the cultural differences between service areas/providers were addressed

RESOLVED

a)  To note the summaries of the four inspections included as appendices to the submitted report

b)  That the comments made during consideration of the implications of these inspections for the Leeds Health and Social Care system, be noted

To consider the report of LCC Head of Policy and Intelligence submitted to enable discussions on the emerging messages from the Joint Strategic Needs Assessment

The Head of Policy and Intelligence, Leeds City Council submitted a report on Leeds Joint Strategic Needs Assessment (JSNA) 2015 Draft Executive Summary: Cross-Cutting Themes. The report was submitted in order to provide an opportunity for timely input by the Board into the forthcoming review of the Joint Health and Wellbeing Strategy.

Mariana Pexton, LCC and Dr Fiona Day (Leeds West CCG/LCC) presented key highlights including the cross cutting themes of the recent baby boom, the ageing population, in-work poverty and recent demographic changes to Leeds' communities

Key themes for the HWB were identified as:

·  Poor mental health and older people's mental health; reduction in the number of years of life lost and improvement in learning outcomes

·  Reflection on any links to the Lord Mayors Charity 2015/16 – supporting autism

·  Definition of assets and the request for the reference be amended and clarified during the JSNA review

The Board broadly welcomed the improvements highlighted in the report and the progress made towards narrowing the gap

RESOLVED –

a)  To note the comments made during consideration of the emerging findings of the JSNA with particular regard to how we better understand health and wellbeing needs and inequalities across and within Leeds;

b)  To note the comments made during consideration of how the JSNA can contribute to the review of the Health and Wellbeing Strategy;

c)  That the issues discussed be identified as potential priorities for the JSNA forward work programme:

To consider the report of NHS England to engage the Board on development within specialised commissioning including co-commissioning

The Board considered the report submitted by NHS England on developments within the commissioning of specialised services in Leeds this year. The report also addressed anticipated future challenges, including current national consultations and service reviews, and provided an update on co-commissioning in Leeds.

General discussion noted the following:

-  Leeds has the largest Teaching Hospital Trust in Europe

-  acknowledged that patients who lived closer to specialised service providers were most likely to receive a specialised service, the challenge being how to give access to those further away.

-  the 7% annual rise on spending for Specialised Services was not supported by a similar rise in the total NHS budget and consideration had to be given as to how best utilise that resource through partnership working, care pathways and prevention pathways

-  noted that specialised services were the most contracted services in Leeds, providing HWB with an opportunity to identify areas of expertise and investment

Moira Dumma, NHS England presented the report which contained three key questions for the Board to consider

How can we work together going forward to locally and regionally address the issues of rising demand, demographic and population factors and increased demand for specialised services?

-  The 10 West Yorkshire CCGs and local Health Scrutiny Boards were working collaboratively on specialised services

-  the issue of how providers were collaborating was raised.

-  HWB consideration of collaborative working would need to look wider than Leeds and also have regard to fact that health providers were set up to compete against each other for award of contracts

What opportunities exist for collaboration to address key risk factors already in HWBB plan, eg smoking, obesity, alcohol, which impact on demand for specialised services?

-  Noted that LTHT had an established Prevention Policy place and the intention for LTHT to liaise with the CCGs

-  Considered that often same response is made annually to the same issue, which can result in a plateau of improvement. Increased support and/or innovation from NHS E would be welcomed

-  Prevention remained a key issue, however it was acknowledged that successful prevention equated to longer life and subsequently a greater call on specialised services later in life. At some point, an ethical discussion would be required on treatment in later life/end of life care

How can NHS England engender an approach of the culture of trust and transparency in decision making (in relation to new models of care for the delivery of specialised services)

-  Recognition that reconfiguration of services raised concerns amongst service users over how that change was communicated to them. Key issues being how families remained in communication with a family member receiving treatment at a distance and the stress and strain this added to families in what were already difficult circumstances; and how service providers provide support in those instances

-  Recognised the need to work with providers and to network services to minimise the number of visits required to the central point of service provision

-  The role  ...  view the full minutes text for item 13.

To consider the joint report of Leeds South and East CCG and LCC Director of Children’s Services on the recommendations of the review of Children’s and Young People’s emotional and mental health and CAMHS/TAMHS services and potential service changes as a result of the findings

Leeds South and East CCG and LCC Childrens Services submitted a joint report on the work undertaken and the recommendations made within the recent whole system review of Children and Young People’s emotional and mental health services in Leeds. The review had been sponsored by the Integrated Commissioning Executive (ICE) in response to concerns shared about the unclear and fragmented local service offer; and the complexity of commissioning arrangements. It was noted that the review team had reported the findings and 11 recommendations to ICE on 17th March 2015.  All the recommendations were agreed at ICE for recommendation to the Health and Wellbeing Board.

The Board received assurance that work was underway to develop a programme plan to deliver the system changes required and it was  anticipated that this would become the local transformation plan, a requirement set out in the Future in Mind, (DH, 2015) document.

Dr Jane Mischenko, Ruth Gordon and Elaine McShane presented the report to the Board highlighting the priorities identified as being a single access point; working with Clusters; and early prevention. It was noted that the revised CYPP would include a new priority of social and emotional mental health. During discussion, the Board:

-  Noted that school head teachers stated children's mental health and wellbeing as one of their biggest concerns. Work with Clusters and schools and providers would bring a positive response

-  Recognised that investment was required across the services to meet demand and provide holistic support

-  Recognised multi-generational implications of providing the services and the impact on family and later adult life for the individual

-  Noted the request for Targeted Mental Health in Schools (TaMHS) mapping as a useful tool for the HWB

-  Referenced the tabled Scrutiny Board report, noting the gaps in service identified and highlighting the need to keep Scrutiny involved when reviewing / reconfiguring the service

In conclusion, the Chair extended thanks to officers for their work on the EMH and welcomed the involvement of Youthwatch.

RESOLVED

a)  To note the recognition of the critical role of the Board in ‘Future in Mind’ (DH, 2015), which advises that the HWBB strategy should place an onus on HWBBs to demonstrate the highest level of local senior level commitment to child mental health (p58)

b)  To support the recommendations of the review

c)  To task Integrated Commissioning Executive to ensure effective delivery

d)  To recognise that prioritising children and young people’s emotional and mental health is critical in the delivery of HWBB strategy priority 7 ‘Improve people’s mental health and wellbeing’ and to note that this report would help to shape and inform discussions at the forthcoming JHWS workshop

e)  To request a TaMHS mapping exercise be undertaken to assist the HWB

An update on the work undertaken in the city to deliver outcome 4 of the Joint Health and Wellbeing Strategy

The Board considered the report of Healthwatch Leeds on the progress of the work undertaken in support of Outcome 4: “People are involved in decisions made about them” of the Joint Health and Wellbeing Strategy. The report provided a brief update on the progress of work in the city to make local people’s voices stronger in health and social care and including information on the People’s Voices Group and examples of specific areas where progress had been made towards identifying key issues for local people and reducing duplication.

RESOLVED -

a)  To  continue to promote the involvement and engagement of the local people in Leeds in all stages of service planning and delivery, and take a view on progress since the start of the Joint Health and Wellbeing Strategy in involving people in their care.

b)  To continue to support work to share and improve local voices through shared approach and recruitment of patient and lay representatives across the city

c)  To note the request to identify any further gaps in engagement and involvement around health and social care that the People’s Voices Group could lead on addressing

d)  To note the all-age character of this outcome, including recent work to map engagement with Children and Young People through Leeds Beckett University

To note the report of the Director of LCC Adult Social Care providing an update on learning disability work and challenges in Leeds

The Board considered the report of the Director of Adult Social Care providing an update on learning disability work and challenges in Leeds. The report detailed key issues, including:

-  Key areas from the Leeds learning disability self-assessment

-  Leeds’ response to the Transforming Care Programme following the Winterbourne View Concordat

-  The launch of the Leeds Learning Disability Partnership Board (LDPB) Strategy ‘Being Me’ in June 2015.

RESOLVED -

a)  To note the partnership work which is already happening to meet the requirements of the self-assessment and the transforming care programme.

b)  To support the Partnership Board in the implementation of the Leeds Learning Disability Partnership Board Strategy ‘Being Me’.

c)  To receive further reports on progress against the Transforming Care programme, the Self-Assessment and the delivery of the objectives within the Leeds Learning Disability Partnership Board Strategy ‘Being Me’.

To note receipt of the June 2015 “Delivering the Strategy Document”, a bi-monthly report which enables the Board to monitor progress on the Joint Health and Wellbeing Strategy 2013-15

The Board receive d a copy of the June 2015 “Delivering the Strategy” document; a bi-monthly report which gives the Board the opportunity to monitor the progress of the Joint Health and Wellbeing Strategy 2013-15

RESOLVED – To note receipt of the June 2015 “Delivering the Strategy” Joint Health and Wellbeing Strategy monitoring report

To receive an update from the Director of LCC Adult Social Care on the Every Disabled Child Matters charter audit. The report also seeks the Boards’ approval of the audit findings and Leeds’ responses to the Charter, as well as consideration of the establishment of a mechanism to monitor outcomes

The Director of LCC Children’s Services submitted a report for information on the findings of the audit undertaken to determine how the Health & Wellbeing Board and its’ partners measure against the 7 commitments made against the Every Disabled Child Matters (EDCM) Charter.

Louise Snowden, LCC Children’s Services, attended the meeting, emphasising that the audit showed the Boards’ strong commitment to the Charter and seeking support to encourage swift responses from all partner organisations to requests for information required for monitoring purposes

RESOLVED

a)  That the audit findings provided in the submitted report be approved

b)  That the Leeds baseline responses to the commitments of the H&WB EDCM Charter be approved and signed off

c)  That approval be given for the establishment of a resource to regularly monitor the areas for development related to the commitments as discussed in the report and to update the charter commitments with an annual report to the Health and Wellbeing Board. This resource should also provide a mechanism for providing an up to date and accurate response to any enquiries in respect of the EDCM charter.

d)  That LCC Children’s Services, on behalf of the Children’s Trust Board would offer this resource on behalf of the HWB.

St Mungo’s Broadway Charter – It was noted that Councillor Mulherin was scheduled to sign the St Mungo’s Broadway Homeless Health Charter after this meeting

Public Health Grant – The Board noted brief discussions on the implications for Public Health in Leeds following the Budget announcement to remove £200m from the national Public Health grant

To note the date and time of the next meeting as Wednesday 30^th September 2015 at 1.30 pm

RESOLVED - To note the date and time of the next formal meeting as Wednesday 30^th September 2015 at 1.30 pm