Agenda and minutes

To receive any apologies for absence received.

Apologies were noted from the following:

·         Steve Crocker, Director of Children's Services. His substitute Stuart Ashley, Deputy Director for Children and Families also gave apologies.

·         Dr Barbara Rushton, Chairman South East Hampshire Clinical Commissioning Group (Vice Chairman of the Board). Her substitute Susanne Hasselmann attended in her place.

·         Dr Sarah Schofield, Chairman West Hampshire Clinical Commissioning Group. Her substitute Dr Rory Honney also gave apologies.

·         Michael Lane Police and Crime Commissioner for Hampshire. His substitute Anja Kimberley, Head of Performance and Information attended in his place.

·         Dr Sallie Bacon, Director of Public Health. Her substitute Simon Bryant attended in her place.

·         Nick Broughton, Southern Health. His substitute Sue Harriman from Solent also gave apologies.

·         Dr Peter Bibawy, North East Hampshire and Farnham Clinical Commissioning Group. His substitute Dr Andrew Whitfield also gave apologies.

All Members who believe they have a Disclosable Pecuniary Interest in any matter to be considered at the meeting must declare that interest and, having regard to the circumstances described in Part 3 Paragraph 1.5 of the County Council's Members' Code of Conduct, leave the meeting while the matter is discussed, save for exercising any right to speak in accordance with Paragraph 1.6 of the Code. Furthermore all Members with a Non-Pecuniary interest in a matter being considered at the meeting should consider whether such interest should be declared, and having regard to Part 5, Paragraph 2 of the Code, consider whether it is appropriate to leave the meeting while the matter is discussed, save for exercising any right to speak in accordance with the Code.

Members were mindful that where they believed they had a Disclosable Pecuniary Interest in any matter considered at the meeting they must declare that interest at the time of the relevant debate and, having regard to the circumstances described in Part 3, Paragraph 1.5 of the County Council's Members' Code of Conduct, leave the meeting while the matter was discussed, save for exercising any right to speak in accordance with Paragraph 1.6 of the Code. Furthermore Members were mindful that where they believed they had a Non-Pecuniary interest in a matter being considered at the meeting they considered whether such interest should be declared, and having regard to Part 5, Paragraph 2 of the Code, considered whether it was appropriate to leave the meeting whilst the matter was discussed, save for exercising any right to speak in accordance with the Code.

To confirm the minutes of the previous meeting

The minutes of the last meeting were reviewed and agreed.

To receive any deputations notified under Standing Order 12.

No deputations were received at this meeting.

To receive any announcements the Chairman may wish to make.

Co-production workshop

The Chairman reported that at the last meeting she had announced that it was planned to hold a coproduction workshop following this meeting. It had since been decided that as this was an important area of work for the Board and linked into an action in the CQC action plan, that the Board should plan a standalone workshop event on this topic. It was hoped to hold this early in 2019, involving experts by experience in planning and participating in the workshop.

Care and Health Information Exchange (CHIE)

The Chairman sought to raise Board Members awareness of the Care and Health Information Exchange – previously known as the Hampshire Health Record. This provided a way of sharing information better, reducing delays to care and treatment and helping reduce the need for patients/service users to keep telling their story to different professionals. A briefing on it had been produced that would be circulated to Board Members after the meeting.

The Board is required to appoint the Vice Chairman for the Board each year.

It was noted that the Board is required to appoint the Vice Chairman each year. It was proposed that Dr Barbara Rushton continue as Vice Chairman, which received unanimous agreement. Susanne Hasselmann gave thanks on her behalf and highlighted that Dr Rushton had recently been appointed as co-chair of a national body of clinical commissioners. The Chairman congratulated her on this appointment on behalf of the Board, and it was agreed to send her a letter of congratulation from the Board.

RESOLVED:

Dr Barbara Rushton be appointed as Vice Chairman of the Health and Wellbeing Board for 2018/19.

To consider the outcomes of the local system review undertaken by CQC of the Hampshire Health and Care System, and the plan to respond to the recommendations.

The Board received a report and supporting presentation from the Director of Adults’ Health and Care at Hampshire County Council, regarding the Action Plan developed in response to the Care Quality Commission (CQC) local system review of the Hampshire health and care system. 

It was noted that the CQC had made eleven recommendations for improvement in their report. System partners had already been aware that delayed transfers of care were an issue in Hampshire, and had commissioned an external party, Newton Europe, to do some detailed analysis of the issues. Their findings had informed the response proposed in the Action Plan. The system was starting to see improvements in this area, however the pressure would build going in to winter. The actions in the Action Plan had completion timescales of three, six and twelve months, across five themes. It was planned to present performance after the three month milestone to the Board at the December meeting. 

Following questions, the Board heard:

·         The findings of the Newton Europe work on delayed transfers of care could be circulated to Board Members

·         The CQC had since published a report called ‘beyond barriers’ regarding the overall findings from the twenty system reviews they had undertaken to date. This could be circulated to Board Members for information 

·         The Governance remit for the local system review sits with the Board. The Board could hold the system to account for the actions taken as a result of the review, based on performance information that would be provided at future meetings. The review of the Joint Health and Wellbeing Strategy would also seek to clarify the role of the Board. 

·         An Improvement and Transformation Board had recently been established, and as it found it’s feet, there would be opportunity for this to report up to the Board

RESOLVED:

That the Health and Wellbeing Board:

a) notes the overview of the Care Quality Commission’s Local System Review of Hampshire and the Action Plan that had been jointly developed by Hampshire’s health and care system leaders to respond to the Review’s findings.

 b) agrees to oversee the delivery of the Action Plan, initially via an update at the next meeting in December including performance data.

To receive an update on governance relevant to the Board including the recent establishment of an Improvement and Transformation Board, for which the terms of reference are attached.

The Board received an update from the Director of Adults’ Health and Care at Hampshire County Council regarding governance developments relevant to the Board. It was noted that an Improvement and Transformation Board (ITB) had been established, which included senior officer representation from providers and commissioners of health and care services in Hampshire, with a remit to focus on six areas of work. (the terms of reference had been included in the agenda pack)

The Healthwatch representative requested that co-production of solutions be explicitly recognised within the terms of reference of this group. The Director of Adults’ Health and Care indicated that this was an enabling thread that runs through all of the programmes this group was considering. 

The South East Hampshire CCG representative queried how the Integrated Care Partnership Board linked in to this governance structure. It was acknowledged the governance architecture was complex, and the ITB was one part of a wider system. 

RESOLVED:

The Health and Wellbeing Board note the Governance update.

To receive an update on the refresh of the Joint Health and Wellbeing Strategy.

The Board received a presentation from the Board Manager regarding the refresh of the Joint Health and Wellbeing Strategy. It was requested that the Board support the extension of the current Strategy up to March 2019, so that the new Strategy could be prepared to start from April 2019 and follow the financial year. It was noted that it was planned to bring the draft Strategy to the December meeting of the Board, to then undertake engagement on the Strategy in early 2019 and then the Board to agree the final version at the March 2019 meeting.

It was proposed that the Strategy outline high level aims for a five year period, and then each year a programme of work in support of the Strategy could be undertaken. The Strategy would be focused on the remit of the Board and grounded in the findings of the Joint Strategic Needs Assessment. It was proposed to continue the themes in the current Joint Health and Wellbeing Strategy, with the addition of a ‘Strategic Leadership’ cross cutting theme, and a ‘dying well’ theme to cover end of life care. It was planned to provide a dashboard accompanying the Strategy to enable the Board to measure performance over time.

Board Members were supportive of the direction of travel outlined for the planned Strategy, including the proposed addition of an ‘end of life’ theme. The NHS England representative highlighted that a long term plan for the health service nationally was due to be published in November, which could help inform the Strategy. The Director of Adults’ Health and Care welcomed feedback on the opportunity for the Board to have a small budget to enable it to undertake activity in support of the Strategy.

RESOLVED:

a)    To extend the current Joint Health and Wellbeing Strategy to cover up to March 2019.

b)    The Board note the progress with refreshing the Joint Health and Wellbeing Strategy. 

To consider the system reform proposals from the Hampshire and Isle of Wight Sustainability & Transformation Partnership, see attached cover letter and pack.

The Board received a presentation regarding the System Reform Proposals by the Hampshire and Isle of Wight Sustainability and Transformation Partnership (STP) from the Director of Adults’ Health and Care and the Senior Responsible Officer for the STP. This was in support of the Statutory Body Pack about the proposals included in the agenda pack. It was noted that the Frimley Hospital came under a different Integrated Care System and a different STP.

The Board heard that the cornerstone of the proposed delivery model was to provide primary and community care based on clusters, of which there would be 23 across Hampshire. Clusters would include groups of GP practices, based around natural communities, and include provision of other health services to those communities through multi agency teams. It was discussed that the Clinical Commissioning Groups were providing transformation funding to support the establishment of clusters. The model was in development, and governance structures to support this way of working would be established in due course.

One of the District Council representatives expressed concern that the Board was being asked to support a model that was still in development. It was acknowledged support was sought for the direction of travel. It was discussed that there was increasing evidence that Integrated Care Systems delivered better outcomes, and the regulatory system was increasingly looking at systems rather than individual organisations. Board Members commented that supporting governance structures were needed to clarify responsibility and decision making under this model. It was noted that legislative change would help to support this new way of working in the NHS.

RESOLVED:

The Health and Wellbeing Board support the direction of travel of the Hampshire and Isle of Wight Sustainability and Transformation Partnership System Reform Proposals.

The Chairman reminded Board Members that the next meeting of the Committee was due to take place on 13 December 2018. The South East Hampshire CCG representative requested an update on progress with joint commissioning of children’s health services be provided for the next meeting.