Agenda and minutes

To report any changes to the Membership of the meeting.

1.1       Apologies for absence were received from Councillor Danny Chalkley (Cabinet Member for Children and Young People) and Sarah Mitchell (Westminster Community Network). Councillor Karen Scarborough (Deputy Cabinet Member for Children and Young People) and Lainya Offside-Keivani (Westminster Community Network) attended as their respective Deputies.

To receive declarations of interest by Board Members and Officers of any personal or prejudicial interests.

2.1       Janice Horsman (Healthwatch Westminster Representative) declared that in respect of item 10 on the agenda, Housing Support and Care Joint Strategic Needs Assessment, she is the Chief Executive of Wandsworth and Westminster Mind, who provide counselling services. However, she did not regard this as a prejudicial interest and remained present to consider this item.

I)             To agree the Minutes of the meeting held on 14^th July 2016.

II)            To note progress in actions arising.

3.1       RESOLVED:

1.    That the Minutes of the meeting held on 14^th July 2016 be signed by the Chairman as a correct record of proceedings; and

2.    That progress in implementing actions and recommendations agreed by the Westminster Health and Wellbeing Board be noted.

To consider updates on the North West London Sustainability Transformation Plan and the Westminster Joint Health and Wellbeing and Strategy.

4.1       The Chairman introduced the item and stated that although the North West London Sustainability Transformation Plan (STP) and the Westminster Joint Health and Wellbeing Strategy were separate pieces of work, they were strongly interlinked with each other. She advised Members that the STP paper was at its first stage and a more detailed submission would be available in October.

4.2       Meenara Islam (Principal Policy Officer) then updated the Board on the draft Westminster Joint Health and Wellbeing Strategy. She advised that there had been 44 consultation responses to date and two consultation events had taken place. The first event, a Health and Care Providers Roundtable held on 8^th September, and the second, ‘Everyone’s Business’ on 14^th September, an event for businesses to discuss improving health and wellbeing, had both provided fruitful discussions and the importance of preventative work and early intervention had been emphasised.  Meenara Islam advised that the next consultation event was a Public Drop-In Health Fair on 5 October where local health and wellbeing organisations and voluntary and community sector organisations would be invited to participate and Board Members were also welcome to attend. Meenara Islam advised that the consultation would end on 16 October and following this, a redrafted strategy would be presented to the Board on 17 November and would also be considered by both the NHS Central London Clinical Commissioning Group (CCG) and the NHS West London CCG. The strategy would then be put to Cabinet for formal approval, prior to its publication by 23 December, with a view to implementing the strategy in January 2017.

4.3       During Members’ discussions, it was suggested that Queens Park Community Council be engaged in the strategy consultation, whilst the views of the Neighbourhood Forums should also be sought. It was asked whether the Cabinet had been briefed about the strategy consultation and had the Westminster Parents Participation Group been consulted. Lainya Offside-Keivani advised that a South Westminster resilient families meeting targeting the needs of vulnerable children was taking place on 22 September at the Abbey Community Centre and she suggested that the strategy be made available for consultation at this meeting.

4.4       In reply to the issues raised, Meenara Islam advised that Queens Park Community Council and the Neighbourhood Forums had been written to at the beginning of the consultation, however she would remind these organisations about the consultation and the events taking place. She confirmed that Cabinet had been briefed about the strategy consultation and would consider arrangements for the strategy to be available for consultation at the South Westminster resilient families meeting.

4.5       The Chairman drew the Board’s attention to the timetable of consultation events and welcomed Members’ attendance of these and any further suggestions on other organisations that could be approached and other meetings that could be arranged. She thanked those who had been involved in organising the events and confirmed that the final detailed strategy would be presented to the Board at its next meeting on 17^th November.

4.6       Louise  ...  view the full minutes text for item 4.

To consider a report on developing Family Hubs.

5.1       Melissa Caslake (Tri-Borough Children’s Services) presented the report and advised that the proposed Family Hubs would provide a virtual network of providers working with children 0 – 19 years with the aim to provide a more streamlined and effective service. The proposed key outcomes included reducing referrals to higher level interventions, preventing family breakdowns that result in children and young people being received into care or entering the criminal justice system, promoting strong and resilient parents and improving outcomes for children and young people across health and wellbeing indicators. Training would be offered to frontline staff to facilitate this. Melissa Caslake then referred to the core offer to achieve these outcomes in the report through integrating Children’s Services, Public Health and CCG activity. This included a one-stop access for universal services, such as birth registrations, to reinforce the hub as the place to go, and providing housing advice to tackle this issue early.

5.2       Melissa Caslake advised that a considerable amount of hard work lay ahead in delivering the family hubs, however a shared vision and shared values, and working more collaboratively and effectively together, would help achieve the desired outcomes. She then requested the Board’s support and endorsement of the Family Hubs Programme.

5.3       Members came forward in welcoming the report and made a number of further comments. It was asked whether the programme would involve developing peer pathway support. Members welcomed the programme’s focus on prevention, however lessons needed to be learnt from Sure Start and there were also issues about how to get GPs more involved. It was commented that Community Care for Children Programme had not been mentioned in the report and it was suggested that the Family Hubs Programme should join up its work with this programme. A Member welcomed the housing advice initiative in the programme and stated that around 30% of homeless had separated from their families. She asked whether it was possible to place workers within GP practices to help patients access the Family Hubs Programme and emphasised the importance of organisations and departments in sharing information and taking a joined-up approach. Another Member suggested that GP registrars could also be involved to help improve sign posting to the Family Hubs Programme.

5.4       A Member suggested that the programme offered the opportunity to consider issues such as vulnerable families. She stated that a recent survey of 100 families undertaken by her organisation had identified that their key concerns were welfare dependency, fear of moving and wishing to receive financial advice. Another Member felt that consideration should be given as to what the public perception would be of describing the programme as a virtual network of providers and he suggested that an alternative way of describing the programme be considered. He added that registered social landlords and housing associations would be keen to be engaged with the programme as they encountered such issues the programme sought to address on a daily basis.

5.5       The Chairman expressed her support for the programme and  ...  view the full minutes text for item 5.

To consider a report on progress on the Children and Families Act Implementation and Preparation for Local Area Inspection.

6.1       Ian Heggs (Tri-Borough Director of Schools Commissioning) presented

            the report and advised that the Children and Families Act was now in its third year of implementation. He advised that the Act had replaced Special Educational Statements (SEN) with Education, Health and Care (EHC) plans, meaning local authorities needed to undertake transfer reviews of all SEN statement children and young people to EHC plans. Although Westminster had only completed 1.1% of the transfer reviews as of December 2015, good feedback had been received on the EHC plans completed to date, and additional resources were being put in place to ensure all transfer reviews were completed by the April 2018 deadline. Ian Heggs advised that a key issue to be addressed jointly by the Council and its health partners was in reducing the time taken by paediatricians to provide health advice for the 20 week EHC assessment process, however he was hopeful that this could be achieved.

6.2       Ian Heggs advised that a Commissioning Strategy was being developed to include plans for areas such as speech and language therapy and occupational therapy where demand had risen, although there were no additional resources for this. He added that autism was a key area of demand. Members noted that a narrative judgement would be given in respect of preparation for the Local Area Inspection. Ian Heggs informed Members that there had been a positive discussion with Ofsted on 15^th September about the inspection.

6.3       During discussions, a Member commented on the reduction of services in diagnosing autism and asked whether this would make completing EHC plans more difficult. Another Member stated that personality disorder was a big issue and no statutory laws were in place to enable intervention and support and he suggested that this matter be raised.

6.4       In reply to the issues raised, Mandy Lawson (Tri-Borough Assistant Director, Special Educational Needs and Vulnerable Children’s Services) advised that there was national guidance in respect of diagnosing autism and that there needed to be further consideration of the impact of autism on a person’s daily life. Ian Heggs advised that under the local offer, the issue of personality disorder could be looked at in the context of mental health.

The Board to receive a verbal update on the Primary Care Modelling project.

7.1       The Board received a verbal update on the Primary Care Modelling project. Damien Highwood (Evaluation and Performance Manager) began by advising that there had been considerable progress in respect of comparing projected model demand against registered population with NHS Central London CCG. In respect of the supply aspect and estates, this had been discussed at a meeting on 9^th August, although no further update on this matter was available at this stage.

7.2       Rufus Fearnley (NHS North West London Collaboration of Clinical Commisioning Groups) advised that there was considerable variation between the sets of data in some areas, with the figures for cancer and dementia for the registered NHS Central London CCGs population being considerably higher than the modelled data. The registered data also suggested that the Westminster population was not as healthy as the modelled data had assumed, with GPs suggesting that around 70% of the population was healthy, compared to the modelled assumption of around 80%. Louise Proctor added the West London CCG was in the process of obtaining data from its West London GPs, which may further impact upon the results.

7.3       The Chairman stated that a clearer picture would emerge about the current supply and demand balance once more data was available.

To consider a report on the Public Health Vision Statement.

8.1       Ann Ramage (Bi-Borough Head of Environmental Health – Commercial) presented the report and advised that the Public Health Vision Statement aimed to pull together all the main public health focuses. Work was being undertaken to explain to the public what these focuses are and what the intended outcomes would be. The Chairman added that the Vision Statement was Westminster specific. The Board noted the report.

To consider a report on the Draft Rough Sleeping Strategy 2017-20.

9.1       Members received a presentation on the Draft Rough Sleeping Strategy 2017-20. Richard Cressey (Principal Policy Officer) began by advising that the strategy was about to go to consultation and he then highlighted the strategy’s three priorities, these being:

·                     Preventing rough sleeping and providing a rapid response

·                     Supporting people to rebuild their lives

·                     Tackling anti-social behaviour and keeping the city safe.

9.2       Focusing on supporting people to rebuild their lives, Richard Cressey advised that a key objective of this priority was improving rough sleepers’ health and wellbeing, with a particular focus on addressing mental health and substance misuse issues. He advised that the Rough Sleepers Joint Strategic Needs Assessment in 2013 had identified that rough sleepers have more health needs and suffered from greater health inequalities than the general population, with their life expectancy around 30 years shorter than the average population. Rough sleeping was also associated with ‘tri-morbidity’, involving physical and mental health issues and substance misuse, as well as complex health needs and premature death. Members heard that rough sleepers were more than four times more likely to use Accident and Emergency Services and their secondary healthcare costs were at least five times more expensive than the general population. In addition, there were specific barriers in accessing services for rough sleepers and hospital discharge was not always managed well.

9.3       Jennifer Travassos (Senior Manager of Rough Sleeping) then informed Members of the initiatives taken to take to tackle rough sleeping to date. This included an Integrated Care Network to provide physical and mental health bed spaces in hostels for those rough sleepers needing extra support, such as those patients discharged from hospital, and this also helped reduce hospital admissions. Homeless health peer advocates were also being used to help break down barriers and navigate rough sleepers through the health system. A new Common Health Assessment Tool had been introduced to the rough sleeping pathway and there had been 100% completion of this for all residents in 2015/16. Jennifer Travassos added that 99% of people in the rough sleeping pathway and over 90% of core rough sleepers were now registered with a GP. A Homeless Coordination Project in partnership with Public Health had also been commissioned.

9.4       Jennifer Travassos then informed Members about the proposed actions for the new strategy. As well as building on the achievements of the last strategy, the new strategy sought to increase the percentage of people in the Council’s accommodation services with mental health needs who are engaging with mental health services from 64% to 80%. In respect of substance misuse, dual diagnosis was proposed to explore new routes into treatment services for rough sleepers in accommodation services, focusing on areas such as users of novel psychoactive substances, including ‘Spice’. Initiatives would also be undertaken in addressing patients discharged from hospital in becoming homeless. Jennifer Travassos advised that the strategy would also seek to join up with Joint Health and Wellbeing Strategy and to work closely with the Board to ensure effective strategic oversight  ...  view the full minutes text for item 9.

To consider a report on the Housing Support and Care Joint Strategic Needs Assessment.

10.1    Anna Waterman (Strategic Public Health Adviser) presented the report and stated that it was recognised that better quality housing could help improve health outcomes, whilst poor quality housing could exacerbate existing health problems. The Housing Support and Care Joint Strategic Needs Assessment (JSNA) was a deep dive JSNA that sought to provide integrated solutions to integrated problems and to explore ways in which collaboration can improve customer journeys and value for money. It also sought to complement and support the draft Joint Westminster Health and Wellbeing Strategy, the North West London STP, the Whole Systems Integrated Care and the Like Minded CCG programmes. Anna Waterman then referred to the seven themes underpinning the JSNA:

·                     Joint commissioning and pooled budgets

·                     IT data sharing protocols and information governance

·                     Smooth customer journeys supported by referral rights and   referral pathways

·                     Quality services and facilities, appropriately tailored and targeted

·                     Asset based approaches (for individuals and for communities)

·                     Workforce development

·                     Local intelligence

10.2    Anna Waterman referred to the 12 recommendations in the JSNA, many of which included a range of opportunities for consideration by partners for local implementation. She asked the Board to agree the recommendations in the report.

10.3    During Members’ discussions, Louise Proctor commented that commissioning needed to be looked at in practical terms and informed choices need to be made taking into account budget limitations.  The Board agreed to the Chairman’s suggestion that JSNA be looked at in more detail by Members and that the recommendations in the report be supported, subject to any concerns raised by Members in the next two weeks.

To consider the Work Programme for 2016/17.

11.1    Meenara Islam advised that the Westminster Health and Wellbeing Strategy would be presented to the Board at the next meeting for approval, prior to its submission to Cabinet on 12^th December 2016 for final approval. She added that there would also be an update on the implementing the recommendations of the JSNA on dementia at the next meeting.

12.1    There was no other business.