To approve as a correct record the minutes of the Health and Wellbeing Board meeting held on 16 March 2018

Apologies were noted. The Chair welcomed Cllr Fish and Cllr Rice as Health and Wellbeing Board members.

To receive additional items that the Chair is of the opinion should be considered as a matter of urgency, in accordance with Section 100B (4) (b) of the Local Government Act 1972.

There were no urgent items raised in advance of the meeting.  However, the Chair wished to raise and welcome Cllr Little’s work with partners to provide support for looked after children.  Cllr Little showed members the new personal health passport that provides advice and guidance on various matters including information about local services and advice on areas such as contraception and support services. 

There were no declarations of interest.

A verbal update will be presented by Mandy Ansell, Accountable Officer Thurrock CCG

Mandy Ansell provided members with a verbal update.  The following points were made:

·         The STP is currently in a decision making phase following public consultation which closed on 23 March.  As part of the consultation exercise a range of materials and suite of documents were made available that included supplementary documentation specifically focussed on proposals for Orsett hospital and an easy read STP consultation document.  

·         A recent review of the STP undertaken and led by Paul Watson, NHS England, received positive feedback

·         The CCG Joint Committee will take decisions in July 2018 taking into consideration consultation responses received.

·         Members were reminded that the STP continues to engage strategic partners across the STP footprint and a joint HOSC will meet on a monthly basis.

Item will be presented by Clare Culpin, Managing Director BTUH.  A copy of the Powerpoint presentation is provided in members’ papers

Clare Culpin presented the item to members.  Key points included:

·         A reduction in severe injurious falls has been delivered (15 compared to 21 in 16/17). The Trust remains just below the national average

·         A&E has experienced a challenging year seeing approximately 35,000 patients per quarter.  To address the increase the following measures have been introduced:

o   New frailty & AEC units introduced

o   AEC hours extended over winter 17/18

o   Established Urgent & Emergency Care village in purpose built areas

·         Overall all ED Performance for 17/18 is 87.72% (6th out of 13 hospitals across the East of England.  The East of England ED performance is 87.00%

·         The KPI for cancer around the 2 week wait national standard is 93% and is now being achieved. 

During discussions the following points were made:

·         Reassurance was provided to members that BTUH endeavours to address understaffing.  Actions include:

o   Encouraging and supporting staff to work flexibly

o   Given the increase in people attending A&E members supported the new approach adopted whereby patients are streamed to the appropriate service, ensuring they follow an appropriate care pathway.

·         Action is being taken to reduce delay discharges of care, which is monitored effectively and robustly.  Members acknowledged that DTOC is a shared social care and health responsibility and partners are working closely together. 

·         Consideration was provided as to whether Sepsis is increasing and the positive impact of awareness raising campaigns by BTUH and NELFT on site and on patient care pathways.

·         A GP has been employed at BTUH since October 2017 to ensure patients requiring the local GP service can be seen immediately or be advised to see their own GP.

·         It was acknowledged that the 62 day cancer standard was not being achieved and members were reassured that the cancer lists is considered daily and proactive action is being taken to improve performance.

·         Concerns were raised about some of the experiences of patients in A&E, particularly during busy periods.  Some Board members set out concerns about their personal experiences.  Members learned that additional action has now been taken to create additional capacity in A&E including changing the patterns of ambulance arrival at the site.

·         Members were reassured that the retention of Executive Management team and changes in leadership and/or roles has not adversely impacted upon performance. 

RESOLVED: Health and Wellbeing Board members:

·         Noted the contents of the update.

Item to be presented by Maria Payne, Senior Public Health Programme Manager – Health Intelligence public Health.

Members’ papers include a cover report, Executive Summary which will also be used to present the JSNA and a full version of the JSNA

Maria Payne, Senior Public Health Programme Manager, Health Intelligence public Health presented the item to members.  Key points included:

·         We know that the mental health of our children and young people is a major concern for young people, parents, teachers and other professionals. One in ten young people has some form of diagnosable mental health condition (DoH & DfE, 2017). Between a quarter and half of all adult mental health disorders could be averted with effective childhood interventions (COI, 2011).

·         The Joint Strategic Needs Assessment (JSNA) process involves an assessment of the current and future health and social care needs of the local community – these are needs that could be met by the local authority, Clinical Commissioning Groups (CCGs), or NHS England. It is intended to provide a shared, evidence-based consensus about key local priorities and support commissioning to improve health and wellbeing outcomes and reduce inequalities.

·         The JSNA focuses on the mental health of Thurrock’s children and young people in a broad sense – addressing the protective factors for positive mental health and risk factors for poor mental health, rather than focusing solely on diagnosed mental health conditions. This JSNA aims to:

o   Understand the main protective factors and risk factors for mental health and wellbeing in children

o   Provide analyses from the Brighter Futures Survey conducted in a number of Thurrock schools last year to demonstrate young people’s needs

o   Provide an overview of what is currently being done in Thurrock in relation to these broader factors

o   Provide an overview of the evidence on what works to improve children and young people’s mental health including key case studies

o   Identify priority areas for action to improve children and young people’s mental health in Thurrock

o   mental ill health which is being addressed through the Long Term Condition profile card.

During discussions the following points were made:

·         The JSNA included limited references to looked after children. Reassurances were provided to members that a JSNA which focusses on looked after children is currently being considered by Public Health which will include mental health. 

·         Members were advised about action being taken that recognises and supports positive parenting and positive role models

·         Members welcomed the involvement of schools in the Brighter Futures Survey which helped to inform the JSNA by asking children about their emotional health and wellbeing.

RESOLVED: 

·         The contents of the JSNA document be approved by the Health and Wellbeing Board including the recommendations found in the report and that Board members use the contents and recommendations of this JSNA product to drive local commissioning decisions around children and young people’s mental health.

·         The Health and Wellbeing Board agreed the work on this JSNA is pivotal to a wider programme of partnership working around this topic

Feedback will be presented by Malcolm Taylor, Strategic Lead Inclusion, Thurrock Council

Due to the due items 8 and 9 being interlinked and discussions on the Mental Health Summit being intertwined with the discussion on the Information Portal and Self Harm Management Toolkit Suicide Prevention both items are reported together.

The Chair introduced the item advising members that the Summit had taken place on 18 May and had been very positively received.  The Summit was jointly chaired by Cllr Halden and the Chair of the Schools Forum.

Malcolm Taylor, strategic lead, inclusion, provided members with a presentation.  Key points included:

·         Feedback from Summit workshops suggested

o   That there is a demand for treatment, as highlighted in JSNA,

o   Capacity of agencies to support complex needs must be suitable,

o   Waiting times should be as short as possible

o   There should be a flexibility of treatment approaches

·         Positive feedback was provided about individual programmes and there was strong support for collaborative working arrangements and some focus being provided to approaches based on prevention.

·         An outcome of the Summit was agreement to establish a New Partnership School- Based Model for Thurrock that:

o   Supports schools in coping with children and young people with signs of poor mental health.

o   Builds capacity within existing services through ongoing support and training

o   Provides a strong focus on the preventative factors and universal approaches to emotional wellbeing

·         An online portal has also been launched that supports schools with effectively supporting children with emotional wellbeing and mental health in young people.  The portal includes advice and guidance on self-harm and suicide prevention

During discussions the following points were made:

·         Members welcomed the work undertaken on mental health by all partners.

·         It was agreed that schools and youth services should be supported to identify and manage mental ill health and have the confidence to do so.

·         Support for staff health and wellbeing within the online portal was strongly welcomed by members.

Item to be presented by Malcolm Taylor, Strategic Lead Inclusion

Key discussion points are set out under previous agenda item

Item to be presented by Mandy Ansell, Accountable Officer Thurrock CCG. 

Members have been provided with a short update report within their meeting papers

Mandy Ansell provided members with an update:

·         NHS England and NHS Improvement have set a target for GPs and Clinical Commissioning Groups (CCGs) to improve access to healthcare for people with a learning disability so that by 2020, 75% of people on a GP Learning Disability register in England will be receiving an annual health check. In 2017/18, 77.4% of people registered with a Learning Disability in Thurrock received a health check.

Board members acknowledged the increase in LD Health checks and congratulated the CCG and partners on performance

To note and be provided with an opportunity to comment on the minutes of ICE meetings of Feb, March and April 2018

RESOLVED:   Members noted the Integrated Commissioning Executive (ICE) minutes for meetings that took place in February, March and April 2018. 

RESOLVED: The Board noted the future work programme.  Cllr Halden requested the future planner includes items on:

·         Cancer care

·         Air Quality and

·         The East of England Ambulance Service