Agenda and minutes

To report any changes to the Membership of the meeting.

1.1       An apology for absence was received from David Finch (NHS England).

1.2       Apologies for absence were also received from Councillor Danny Chalkley (Cabinet Member for Children and Young People), Councillor Barrie Taylor (Minority Group Representative), Liz Bruce (Tri-borough Director of Adult Social Care), Melissa Caslake (Tri-borough Children’s Services) and Janice Horsman (Healthwatch Westminster). Councillor Karen Scarborough (Deputy Cabinet Member for Children and Young People), Councillor Barbara Grahame (Minority Group Representative), Sarah McBride (Tri-Borough Director for Whole Systems Integration Health and Care), Jayne Vertkin (Head of Early Years Help) and Carena Rogers (Healthwatch Westminster) attended as their respective Deputies.

1.3       Apologies for absence were also received from Jules Martin (Managing Director, NHS Central London Clinical Commissioning Group) and Louise Proctor (Managing Director, NHS West London Clinical Commissioning Group). Chris Neill (Interim Deputy Managing Director, NHS Central London Clinical Commissioning Group) and Kerry Doyle (Head of Corporate Services, NHS West London Clinical Commissioning Group) attended on their behalf.

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

2.1       There were no declarations of interest.

I)             To agree the Minutes of the meeting held on 15 September 2016.

II)            To note progress in actions arising.

3.1       RESOLVED:

1.    That the minutes of the meeting held on 15^th September 2016 be signed by the Chairman as a correct record of proceedings, subject to the following sentence to be added to the end of paragraph 5.3, page 5:

Councillor Karen Scarborough (Deputy Cabinet Member for Children and Young People) requested whether a GP could be based at Family Hubs. Dr Neville Purssell (NHS Central London Clinical Commissioning Group) indicated that this may be feasible.

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 Westminster’s Joint Health and Wellbeing Strategy.

4.1       The Chairman introduced the item and advised that sign-off of the North West London Sustainability Transformation Plan (STP) had been put back until the end of December. There was still considerable work to be undertaken until this point and the Council was taking leadership of the finance and property workstreams.

4.2       Chris Neill (Interim Deputy Managing Director, NHS Central London Clinical Commissioning Group) then provided an update on progress with the STP and advised that the draft STP had been published online on 21^st October. He advised that the areas of work the STP was focusing on included governance, resources and reporting, finance, contracting processes and system leadership, with a whole systems approach being taken. The operational plan was due to be completed by 23^rd November and contract processes by 23rd December.

4.3       Meenara Islam (Principal Policy Officer) introduced the update on the Joint Health and Wellbeing Strategy and handed over to Emma Playford (Engagement and Corporate Affairs Lead, NHS Central London Clinical Commissioning Group) who gave a presentation on progress on the strategy. Emma Playford informed Members that there had been 76 responses to the online consultation on the strategy, with around 83% from individuals and 17% from organisations. There had also been five formal submissions to the joint health and wellbeing strategy dedicated email address, 23 written submissions to the Open Forum event and feedback received from the three events organised with stakeholders. Meenara Islam advised that the four headline priorities of the strategy were supported by most of the respondents. Respondents wished to see partners promote existing services already available to improve health and the majority were supportive of partnership working across housing, leisure and wellbeing, transport and planning and public health to realise further health benefits. Respondents also welcomed and supported a focus on ensuring people have regular opportunities to be active and on person-centred care. Emma Playford then referred to the changes to the strategy since taking on board feedback from the consultation as set out in the Appendix 1 of the report.

4.4       Phoebe Morris-Jones (Policy Officer) then advised Members that the next steps included any further amendments in response to the Board’s and the NHS Central London and NHS West London Clinical Commissioning Groups’ (CCG) respective Governing Bodies. The strategy would then be put before the Council’s Cabinet and the NHS Central London and NHS West London CCGs’ Leadership Executive Committee and Operations Group respectively, with a view to launching the strategy on 19^th December. From January 2017, an implementation plan and performance monitoring mechanism would be developed by the Council, NHS Central London and NHS West London CCGs, the voluntary and community sector and Healthwatch to align with the STP’s implementation plan and would be brought to the Board at the 2^nd February 2017 meeting.

4.5       The Chairman added that there was also a strong desire to report back to communities on how the strategy was progressing in meeting its’ objectives and this would be undertaken  ...  view the full minutes text for item 4.

To consider the Local Safeguarding Children Board annual report for 2015-16.

5.1       Jean Daintith (Independent Chair of the Local Safeguarding Children Board) presented the report and stated that this was the fifth annual report that the Local Safeguarding Children Board (LSBC) had produced. An Ofsted inspection of all three of the tri-boroughs had taken place during 2015-16 and there had also been five serious case reviews over the same period. Jean Daintith advised that the Government was consulting on changes to LSBCs that were due to take place. This included Children’s Services taking an enhanced role in safeguarding children. The draft annual report was due to go to the Children, Sports and Leisure Policy and Scrutiny Committee and there were still some changes to be made to it. Each member of LSBC had the opportunity to contribute to the report and to provide updates in key areas and it was noted that there was a health representative on the LSBC.

5.2       Jean Dainitith advised that the tri-boroughs were considering alternative arrangements for Children’s Services which were going through a transitional phase and it may be 18 months before everything was finalised. The LSBC had a number of sub-groups which aimed to help frontline staff and the Health and Wellbeing Board could also play a role in measuring impact on frontline services.

5.3       During Members’ discussions, the Chairman emphasised the importance of ensuring that the Board did not repeat the discussions to be heard at the Children, Sports and Leisure Policy and Scrutiny Committee and she sought views as to what the Board should focus on. Another Member stressed the importance of data sharing and asked what steps were being taken to promote this. Barbara Brownlee (Director of Housing and Regeneration) advised that Housing were working ever closer with Children’s Services, with some Housing staff based at Children’s Hubs and she added that having a GP located at these hubs would also be beneficial. Housing was also working closely with health services and affordable housing providers who housed a significant proportion of vulnerable people. A Member asked why there had been a reduction in the number of children in care. In respect of young carers, it was commented that there had been recent changes to the way they were supported and concerns had been expressed about how this area would be monitored and the number it may impact upon.

5.4       In reply to the issues raised, Jean Daintith emphasised the role of the STP in ensuring there was appropriate safeguarding of children and remarked that for instance, there were very few children who transferred from Child and Adolescent Mental Health Services (CAMHS) to adult mental health services and this was an area the Board could focus on. Other areas including the mental wellbeing of children and their relationships with their parents and the impact of events such as moving home and Children’s Services were working closely with Housing on such matters. The overall health of children could also be looked at and the effectiveness of services such as the school nurse service,  ...  view the full minutes text for item 5.

To consider the Safeguarding Adults Executive Board annual report for 2015-16.

6.1       Helen Banham (Strategic Lead in Professional Standards and Safeguarding) presented the report and gave an apology for absence on behalf of Mike Howard (Independent Chair of the Safeguarding Adults Executive Board). Helen Banham advised that this was the third annual report that the Safeguarding Adults Executive Board (SAEB) had produced, and the first since Schedule 2 of the Care Act 2014 had been introduced and the report sought to focus what needed to be in place under Schedule 2. Members heard that the Chairman of SAEB welcomed a broad approach in involving a number of organisations and the safeguarding of adults was the responsibility of a wide range of partner organisations. The sub groups of SAEB were all chaired by people outside of Adult Social Care and this helped to engage a wider audience. The SAEB had identified a number of issues to be addressed and consulted with the public on what safeguarding is. There were a number of issues identified that had led to abuse and this helped inform the creation of preventative measures.

6.2       Helen Banham referred to a serious case review highlighted in the report concerning the death of a person living in a residential care home that involved another resident who had severe dementia. A number of lessons had been learnt from this incident and there had been good engagement and joined up working with Housing, the CCGs, the Police, the Coroner and Adult Social Care and a number of changes had since been made as a result of this incident. Helen Banham added that the voluntary sector had made a valuable contribution to safeguarding adults.

6.3       During Members’ discussion, Barbara Brownlee emphasised the strong link between Housing and Adult Social Care in respect of adults safeguarding, including provision of new housing and refurbishing existing housing appropriately as a preventative measure. A Member sought further information on work being undertaken in respect of Deprivation of Liberty Safeguard (DoLS) assessments. Sarah McBride (Tri-borough Adult Social Care) stated that new models of care were being developed and would be influenced by changes to primary care and GPs were also involved in serious case reviews. She asked how information learned from the serious case reviews was fed back to the SAEB. Sarah McBride noted that 60% of incidents of abuse reported to have occurred in victim’s homes was comparatively high, with a lower number in care homes, whilst financial abuse was also comparatively high and she sought a further explanation of this.

6.4       The Chairman advised that she had met with the Chief Executive of CityWest Homes and it had been agreed that focus be given to providing housing that was more appropriate for those that were vulnerable. She also informed the Board that a workshop was also to take place involving housing and health colleagues and Members were invited to attend to provide their feedback and to discuss the kind of accommodation specification that could make a difference.

6.5       Chris Neill asked if there were  ...  view the full minutes text for item 6.

To consider a report on the Older People hubs.

7.1       The Chairman introduced the item and advised that the Health and Wellbeing Hubs Programme sought to re-design services to support the preventative agenda. The programme included three workstreams, one of which was the Older People Hubs programme.

7.2       Sarah McBride (Tri-Borough Director for Whole Systems Integration Health and Care) presented the report to update Members on the Older People Hubs programme in light of changes taking place as a result of the North West London STP and increased partnership working. She advised that a joint strategic review of health and adult social care preventative services for older people was nearing completion which would inform the approach for new contracts being in place from 1 August 2017. Members then received a presentation on the Older People Hubs programme and Sarah McBride advised that the objectives of this work stream included identifying opportunities to reduce duplication of services, increasing integration with partners and making best use of health and wellbeing hubs for older people. A multi-agency project team was also to be established to shape and agree the future service model for the Older People’s preventative programme.

7.3       During the Board’s discussions, the Chairman stressed the importance of this piece of work and taking a joined-up approach with other services and organisations and of the need to manage the estates more effectively and she welcomed any further feedback. The desirability of having GPs present at the Older People Hubs and involving the voluntary sector more was also raised by Members.

7.4       Chris Neill stated that there was a need to make local links with models of service and commissioning pathways. Some work could be focused on local pressures, such as homelessness, rough sleeping and drug taking.

7.5       Barbara Brownlee advised that a new pathway was being developed in respect of housing and rough sleepers and this was a big area of work. However, helping those who were not Westminster residents was difficult and usually the only services available to such category of rough sleepers were the Accident and Emergency units in hospitals.

7.6       The Chairman stated that the Newman Street Pilot had achieved early successes in helping young people by providing accommodation and helping their health needs, with 100% of these residents now registered with GPs. She concurred on the need for joint pathways working with partner organisations. The Chairman added that the purpose of the hubs was not necessarily to have all services based in one building, but to ensure that services were linked up more effectively and that the estates were used more effectively. She suggested that birth registrations could also be undertaken at Children and Family Hubs.

To consider a report on progress on the Dementia Joint Strategic Needs Assessment.

8.1       Ben Gladstone (Head of Complex Needs Older People) presented the report and stated that a Joint Health and Social Care Dementia Programme Board (JHSCDPB) had been created to implement the recommendations of the dementia joint strategic needs assessment. He drew Members’ attention to the five priorities identified and the progress made against these to date as set out in the report. In respect of the second priority concerning coordinated training and support for people across the dementia pathway, the first wave of internet training was due to be completed by February 2017. In respect of establishing a Joint Dementia Programme Board, Ben Gladstone advised that this would be linked to the work of the Safeguarding Adults Executive Board. The JHSCDPB, which met four times a year, would also continue to work closely with the Safeguarding Adults Executive Board.

8.2       Sarah McBride welcomed the priorities set out in the report and stated that there needed to be a performance management tool in place to monitor progress. She also emphasised the need for the JHSCDPB to align its work with that of the Health and Wellbeing Board’s strategy and its delivery plan for dementia, which would include a set of actions to measure. The Board indicated its support for the work of the JHSCDPB.

To consider an update on the Children and Young People’s Mental Health Transformation Plan.

9.1       At this point, Councillor Rachael Robathan (Chairman and Cabinet Member for Adults and Public Health) left the meeting and Dr Neville Purssell assumed the role of Chairman.

9.2       Angela Caulder (CAMHS Commissioner) introduced the report and advised that the Transformation Plan had been submitted to NHS England. Achievements to date included the introduction of new services, including co-production work with young people and a Young People’s Mental Health Conference had been held on 29^th October. She advised that the next steps involved a re-design of the CAMHS service, increasing work in schools and mapping delivery services across the tri-boroughs for those with learning disabilities, including autism. A Partnership Alliance was also due to be launched on 17^th January 2017.

9.3       Jackie Shaw (Central and North West London Service Director of Westminster CAMHS) then provided details on the new community eating and disorder service for young people, advising that it already supported 25 young people and had received positive feedback from both young people and parents.

9.4      A Member commented on the lack of uptake in transition of services from CAMHS to adult mental health services and asked what steps were being taken to address this. Another Member enquired why the number of school aged pupils with Special Educational Needs (SEN) in Westminster was the highest amongst North West London boroughs. Members also noted that the Council was considering withdrawing or re-directing funding in respect of young people’s mental health services and further comments were sought on this matter.

9.5      In reply, Angela Caulder advised that there were difficulties in transition of services from CAMHS to adult mental health services nationally, with the issue complicated by the fact that local authorities arrangements varied. In particular, there was a gap in services for young people between 16 to 25 years old with less serious mental health conditions. Angela Caulder stated that this was one of the reasons for running a pilot scheme for high functioning young people with autism in which it was hoped enough evidence could be compiled to re-design services. She acknowledged that the possibility of the Council withdrawing or re-directing funding for young people’s mental health services was a concern and alternatives would need to be identified if this happened. Eva Hrobonova (Tri-borough Public Health) added that the Council’s financial capacity overall needed to be considered in the context of this issue.

9.6      In noting the financial situation, the Board indicated its support for the work undertaken in transforming mental health services for young people whilst it currently received some funding from the Council.

To consider the Work Programme for 2016/17.

10.1    Meenara Islam advised that the next Pharmaceutical Needs Assessment was due to commence shortly and the first report would be presented to the Board at the next meeting on 2 February 2017.

10.2    Chris Neill suggested that an item on regeneration schemes and their impact on adult social care be added to the work programme.

11.1    There was no other business.