Dorset Health and Wellbeing Board

Transcription

1 Dorset Health and Wellbeing Board Minutes of a meeting held at County Hall, Colliton Park, Dorchester on 11 November Present: HEALTH AND WELLBEING BOARD MEMBERS County/District/Borough Council Elected Members DCC Portfolio Holder, Adult Social Care DCC Portfolio Holder, Communities, Health and Wellbeing West Dorset District Council County and Council Officers DCC Director for Adult and Community Services DCC Director for Children s Services DCC/PH Director of Public Health Christchurch and East Dorset Partnership, Head of Health and Housing Health Representatives Dorset Clinical Commissioning Group, Chairman Dorset Clinical Commissioning Group, Chief Officer GP Locality Executive Team Purbeck GP Locality Executive Team Weymouth Community Representatives Bournemouth Churches Housing Association NON BOARD MEMBERS Presenting Persons/Supporting Officers PH Senior Communications Officer DCC Health Partnerships Officer DCC/PH Consultant DCC Dorset Families Matter Project Manager DCC Head of Early Help and Community Services DCC Interim Programme Director DCC/PH Assistant Director of Public Health CCG Programme Director, Transformation Healthwatch Dorset DCC Senior Democratic Services Officer Jill Haynes Rebecca Knox (Chairman) Margaret Lawrence Catherine Driscoll Sara Tough David Phillips Steve Duckett Forbes Watson (Vice-Chairman) Tim Goodson David Haines Karen Kirkham Amanda Goodenough Paul Compton Ann Harris Kate Harvey Lucy Johns Paul Leivers Miriam Maddison Rachel Partridge Phil Richardson Martyn Webster Rebecca Guest (Notes: (1) These minutes have been prepared by officers as a record of the meeting and of any decisions reached. They are to be considered and confirmed at the next meeting of the Dorset Health and Wellbeing Board, to be held on 2 March (2) Board agendas and reports are available via Apologies for Absence 80. Apologies for absence were received from Jacqueline Cotgrove, Bernie Davis, Joyce Guest, Margaret Guy, Andrew Kirby, Barbara Manuel, Patricia Miller and Ron Shields.

2 Code of Conduct 81. There were no declarations by members of any disclosable pecuniary interests under the Code of Conduct. Minutes 82. The minutes of the meeting held on 9 September 2015 were confirmed and signed. Public Participation Public Speaking 83.1 The Chairman advised members that four questions had been submitted and she highlighted the topic of each. A copy of the questions and answers were circulated to the Board and would be available on-line The questions and answers are attached to these minutes at Annexure There were no public statements received at the meeting in accordance with Standing Order 21(1). Petitions 84. There were no petitions received in accordance with the County Council s petition scheme at this meeting. Inequalities: The Picture in Dorset 85.1 The Board considered a report by the Director of Public Health, Public Health Dorset and accompanying joint presentation by the Assistant Director of Public Health, the Head of Health and Housing (Christchurch and East Dorset Partnership) and the Dorset Families Matter Project Manager which gave an overview of the key national evidence base around work on inequalities. The report was supplemented by the most up to date data on inequalities, including the Marmot Indicators Profiles for Dorset County Council and by Districts and Borough Council areas Reference was made to the Marmot Policy and National guidance that was available to aid partner organisations, and the examples of tangible activities to address some of the underlying causes of inequalities in Dorset, such as the Dorset Families Matter (DFM) project were highlighted. Members suggested that the best practices of each project be taken and shared. It was agreed that key learning themes from the DFM project should be the alternative way of working and the ability to influence culture change. This made a significant difference to the community as it gave them a greater resilience for the future The Board discussed the data supplied in appendix 4 of the report that gave comparisons between councils, but it was acknowledged that these were not direct comparisons due to authorities interpretations of the DFM s framework. In addition the Children s Services Business Support Manager advised that the criteria to put families into the programme had broadened in Phase 2. The aim was for a family focused programme with an ethos for a sustained change in the long term and therefore an overall reduction in costs Members agreed that health inequalities were related to a range of social and demographic factors, most commonly considered in terms of the socio-economic position. All parties and associated partners had to contribute to ensure its successful reduction. The Board and its partners had a range of action plans to combat inequalities, but these were not joined up and there was a possibility that due to a lack of co-ordinated effort, there may be gaps to be addressed. To ensure full coverage, officers asked whether the Board would

3 consider co-opting members, for example from the Environment and the Economy Directorate within DCC. In addition it was commented that the emergency services and voluntary sectors should be involved to ensure a united approach The Board commented on the huge task ahead and referred to the need to concentrate its efforts to make a significant impact in key areas. The Board should have sight of activity against performance to ensure success in the key area(s) chosen and use its standing to hold partners to account. The quality of relationships within the Board would play a key part in any success Early prevention was key and a member highlighted the many roles the NHS could play from education through to maintaining a quality of life. These roles would contribute significantly to equality in Dorset Members referred to the transformations being undertaken by each partner organisation due to reducing budgets and they asked that the subject of inequalities not be forgotten during this time. Acknowledgment was given to the struggle each organisation had in balancing its priorities and that for healthcare services, this would get worse with the approach of winter. However, best use had to be made of the available resources as the Board had a real opportunity to assist all children, young people and adults to maximise their capabilities and have control over their lives A member commented that a number of families did not make use of the natural environment with some children not playing outside at all. He also referred to families that were now facing their fourth generation in unemployment and he suggested that voluntary groups may be able to help tackle these issues The Assistant Director of Public Health suggested that a stocktake of ongoing work be taken to enable identification of any gaps, thus allowing the Board to discuss and concentrate on the areas of greater need. The Chairman also asked that each organisation identify their preventative measures and detail what they considered prevention to be. The Board discussed this suggestion and agreed that they all already knew their separate areas of concern/gaps and this was the data required to steer the Board s future activity The Board recognised the political issue that surrounded health inequalities but agreed that they were in an excellent position to agree a universal approach, once this information was collated. A further report was to be presented to the Board that could also be shared with other organisations, addressing the comments by members. Resolved 86.1 That the Health and Wellbeing Board and its members cascade the messages within the report and the outcomes of discussions to as wide an audience as possible, including District and Borough Councils, schools, the Public Sector Forum and emergency services That Inequalities be a standing item on the Health and Wellbeing Board s agenda That members of the Health and Wellbeing Board learn from the Dorset Families Matter project in particular how to work differently and amend their working models accordingly That the Health and Wellbeing Board commit to working in a holistic way to achieve change That members of the Health and Wellbeing Board inform the Assistant Director of Public Health of all the gaps and challenges within their strategies and action plans.

4 86.6 That the Assistant Director of Public Health present a further report to the Health and Wellbeing Board to facilitate discussion on a universal approach towards reducing health inequalities in Dorset. Reasons for Decisions 87.1 The Board requested a thematic focus in inequalities to inform their future thinking in this area The Board was committed to reducing inequality in healthcare across Dorset County. Better Care Fund Comparative Performance Report and Update on Delayed Transfers of Care 88.1 The Board considered a report by the Director for Adult and Community Services, Dorset County Council, that provided further information to members about how progress in the main four key performance indicators had changed over time and how it compared with similar communities elsewhere in the country Members noted the action being taken to improve performance and that following the Board s comments at its meeting on 9 September 2015, the Chairman of the Joint Commissioning Board (JCB) had asked for a performance improvement plan with milestones to be prepared for the next meeting of the JCB in November Since the report was drafted it had been confirmed that the Better Care Fund (BCF) was to continue into the new financial year, and officers were considering what form this should take. However, until the results of the National Spending Review were published, the exact amount of the available funding was unknown Members reviewed the delayed transfers of care and the challenges to the service. It was acknowledged that difficult conversations with patients and families would have to take place to vacate hospital beds at the earliest opportunity. In addition long term investment was required following years of underinvestment in health services and appropriate staffing levels. A career as a carer was being promoted within schools, with partners, with the emphasis being placed on the possible progression into nursing. The Director for Adult and Community services advised that a range of options to encourage young people into the education system were available and these would be sent to members outside the meeting The Board discussed a number of other factors that influenced delayed transfers of care such as the limited number of suitable care homes in Dorset, poor discharging information and delays in the waiting time for the completion of assessments, particularly for NHS continuing care. The Cabinet Member for Adult Social Care advised that work was underway to look at the market across Dorset for care homes to consider if intervention was required Members noted that all parties had a part to play in reducing the delays transfers of care, but currently there were separate action plans to resolve this. It was suggested that one plan be developed for all parties to influence performance. Resolved 89.1 That the Interim Programme Director circulate additional information to the Health and Wellbeing Board on the range of options to encourage young people into the education system That a joint Action Plan be developed to facilitate reducing the delayed transfers of care.

5 89.3 That the Cabinet Member for Adult Social Care support investigations by the Authority to determine the number of beds available across Dorset. Reason for Decisions 90. The Better Care Fund plan and schemes captured part of the activity that aimed to secure improved health and social care outcomes for local residents; and an improved and more integrated approach for the delivery of adult health and social care locally. Better Together Programme Progress Update 91.1 The Board considered a report by the Director for Adult and Community Services, Dorset County Council, that updated members of the progress made against individual project milestones and the Dorset Care Record s Working Group recommendation for a firm time-line for the procurement up until 24 March The suggested time-line from 25 March to 22 July 2016 needed further work to understand the various partner governance dates for April, May and June The time-line had been accepted by the Project Board and progress was now back on track Members noted that work had started with the Sponsor Board to plan for the new financial year. This would be brought to the two Health and Wellbeing Boards for initial consideration at workshops in January and February 2016, prior to formal consideration in March Noted Clinical Services Review - update 92.1 The Board received a presentation by the NHS Dorset Clinical Commissioning Group (CCG) that updated members on the Clinical Services Review development in view of the new timings for formal public consultation, including plans and assumptions when planning, and a summary of the Dorset Vanguard and the Acute Care Collaboration Vanguard Members noted a number of forthcoming key milestones including the ongoing development of the acute models of care, implementation of the Acute Vanguard awarded to three acute trusts from July 2016 and of the Dorset Vanguard early adopters in March A holistic approach was being taken, with investigations into an integrated view and the appropriate support mechanisms, such as ICT. The CCG was intent to showcase how care could be delivered at scale and were looking at a pragmatic approach across services The exact start date of the anticipated public consultation was yet to be determined, however assurances were given that it would commence in Prior to this, numerous engagement exercises were taking place with a number of stakeholders, patients and the public. The Board offered their help with the CCG s communications and feedback was given to the Transformation Programme Director following a recent community engagement event. The Board s suggestions were welcomed The Board supported the development of the models of care but commented on the need to have appropriate support at ground level to enable people to receive personalised care in their own homes. The Transformation Programme Director advised that the Senate s report was advising the CCG though the NHS assurance process, after which it would be published The Chairman of the CCG confirmed the review was a joint vision that needed all partner involvement to achieve its goals. Noted

6 Health and Wellbeing Commissioning Intelligence Group (CIG) and Joint Strategic Needs Assessment (JSNA) update 93. The Board considered a report by the Director of Public Health, Public Health Dorset, that provided members with an overview of progress against the Joint Strategic Needs Assessment (JSNA) work plan and gave a high level overview of health indicators for Dorset discussion on approaches to priority setting. Noted Update from the Communications and Engagement Group 94.1 The Board considered a joint report by Healthwatch Dorset and Public Health Dorset that provided an update on the work of the pan-dorset Health and Wellbeing Boards Communications and Engagement Group (CEG), and summarised progress made since the adoption of a Communications and Engagement Strategy by both the Dorset Health and Wellbeing Board (HWB) and the Bournemouth and Poole HWB in The Board discussed the CEG and the role it could play in supporting them. Members were asked to consider who their audience was and the story that it wanted to express. The use of the appropriate media for the intended audience was also considered and how the Board could increase public engagement, including meeting at various locations within Dorset Members agreed to use their own contacts and individual organisations communication departments to disseminate information on the HWB and its activities. The Senior Communications Officer advised that the CEG would be meeting again next month and he would present the Board s request for support. Resolved 95.1 That the Dorset Health and Wellbeing Board s request for support be discussed at the next meeting of the Communications and Engagement Group That the Dorset Health and Wellbeing Board contact their own communications team to discuss how they could support and cascade the outcomes of discussions, to as wide an audience as possible. Physical Activity Strategy 96.1 The Board considered a report by the Director for Adult and Community Services, Dorset County Council, that updated members on the development of the Dorset Cultural Strategy which aimed to increase rates of physical activity in Dorset in line with national recommendations to improve health and wellbeing outcomes. The Strategy would adopt a life-course approach with a particular emphasis on those who were currently inactive, and was endorsed by DCC s Cabinet in April The DCC Head of Early Help and Community Services advised the Board that more work was required to further develop the Strategy and communications, whilst recognising the decreasing budgets of each service and organisation. He was confident however, that the aims of the Strategy could be achieved by all parties working together in partnership. Some members of the Board advised that they would have preferred early consultation on the Strategy, enabling them to act as champions. The DCC Cabinet Members for Communities, Health & Wellbeing and Adult Social Care advised that whilst the Strategy had been initiated within the county council, it was a living document and could be refreshed. However another member commented that due to social movements, strategies of this nature quickly became out of date The Board highlighted the importance of early intervention to achieve a long term generational culture change and stated that all partners around the table had channels

7 of communication that could be used to promote a healthy environment. Novice events should also be promoted to encourage those not yet motivated and currently inactive The Chairman advised that in addition to the Dorset County Council, each District and Borough Council had also endorsed the Strategy, however concerns were raised that this had not been widely circulated. This would be taken forward as an action Members commented on how they would promote the Strategy in their own areas such as Purbeck HWB s proposal to take exercise as their next Pledge and the Strategy being presented to the Schools Forum at their next meeting. Resolved 97.1 That the Dorset Health and Wellbeing Board commit to support the Dorset Cultural Strategy for their organisations where there is benefit and it fits with their organisational aims That DCC Cabinet Members hold discussions with district and borough councils to assist them to identify priority outcomes and partnership contributions That the Purbeck HWB consider taking exercise as their next Pledge That members of the Dorset Health and Wellbeing Board become Champions for the Strategy within their own organisations That the Physical Activity Strategy be presented to the next Schools Forum meeting to consider how best to support and contribute towards the work set out in the Council s Strategy. Reason for Decisions 98. The strategy contributes to the Health and Wellbeing Board s aim to reduce health inequalities and to promote integrated working. Forward Work Plan 99.1 The Board considered a report by the Director for Adult and Community Services, Dorset County Council, that updated members on the current Forward Plan for Board meetings and events Additional items to be added to the work programme were set out in minutes 86.2 and Noted Meeting Duration: 2.00 p.m. to 5.05 p.m.

8 ANNEXURE 1 Questions Under Standing Order 21(1) Question 1 Young people s access to Mental Health services in Dorset is extremely limited and last year 5 areas were in the worst 1% in the country for access to services. The provision of CAMHS is under review and DCC Youth Services funding will be cut by 1m in the very near future followed by further significant cuts. What plans are there to mitigate the impact of these cuts, reduce health inequalities and provide improved access to services for children & young people in Dorset? Answer provided by Dorset County Council, Children s Services We recognise the need to improve access to CAMHS and have been actively working towards this. The Clinical Commissioning Group has placed an additional 250,000 investment in CAMHS this year, and we are developing a new joint strategy currently. A bid has also been made for further additional funding for CAMHS and we are awaiting the outcome. A public consultation on the future of Youth Services in Dorset opens on 17 November and this will set out our plans to mitigate the impact of cuts. This is a difficult time for the children and young people who use the services and for the staff who support them, but we hope to secure a sustainable service for the coming years which will promote a preventative approach to wellbeing. For further information please contact Claire Shiels, Commissioning and Procurement Manager: c.shiels@dorsetcc.gcsx.gov.uk Question 2 What provision is being made to meet the health and care needs of BME communities, including Gypsy, Romani and Traveller Communities and communities from Eastern Europe? Answer provided by NHS Dorset Clinical Commissioning Group The Clinical Commissioning Group actively engages with local BME communities to make sure their needs are incorporated into our service planning. We have also established a BME health engagement panel which helps us to understand needs and who we provide information to. Important health information including, how to access health services and choosing well is available in the 12 languages, including Polish. We are currently working with the Dorset Race Equality Council to look how we can develop community health ambassadors in specific areas including: diabetes, mental health and carers. Important information is sent out to different groups including gypsy, travellers and communities from eastern Europe through DREC and Healthwatch and is available in a variety of formats on request. We also provide funding to Dorset Healthcare for community development workers to work specifically with BME communities around mental health issues. For more information please contact our Engagement and Diversity Officer: ebi.sosseh@dorsetccg.nhs.uk

9 Answer provided by Dorset HealthCare University NHS Foundation Trust The Trust has an overarching strategy and dedicated team working to reduce inequalities, promote diversity and ensure everyone has access to our services and information. National and local studies on health inequalities are used to identify specific health and care needs for communities in Dorset alongside a programme of community engagement and links to community-led groups so we may listen to communities needs and address their concerns. An integral part of this work is staff training and awareness of specific BME community needs. The Trust appointed an additional Community Development Worker five weeks ago who is working specifically with Gypsy, Romani and Traveller communities. Dave Corbin, Equality and Diversity advisor at Dorset HealthCare will be happy to answer any further queries and can be contacted on david.corbin@dhuft.nhs.uk Answer provided by Dorset County Hospital NHS Foundation Trust We do not dedicate health care resources to specific minority groups. The NHS constitution describes the approach to access and fair treatment, and as a Trust we follow this guidance. For further information, please see the Equality and Diversity section of the Trust s web site. Answer provided by Dorset County Council (DCC) Dorset County Council has committed to a Joint Equality Scheme, with an action plan for the period 2013 to The Scheme sets out how we will meet our legal duties under the Equality Act 2010 and how we will promote equality and diversity as community leaders, service providers and employers. Key objectives include: ensuring that we identify areas of potential discrimination, ensuring that nobody in Dorset is disadvantaged in getting access to public services and ensuring that staff and members have access to training and support to enable them to fulfil their duties in this respect. For further details, please contact: Kelly Haggett k.haggett@dorsetcc.gov.uk Corporate Policy and Performance Officer (Equalities), Chief Executives Office, Dorset County Council. Joint Equality Scheme: In addition, DCC coordinates the Dorset Forum for Equality and Diversity a community group that has been set up to enable individuals and groups to advise public services on how best to involve and consult with the wider community, identify problems that affect people's quality of life and work together to find solutions. People can get involved in a number of ways: by attending meetings, or contacting the Forum by phone, letter, text or (via Kelly Haggett). Answer provided by DCC Environment and Economy From the point of view of the Gypsy and Traveller Liaison Service, Paula Clover acts as a first point of contact for Gypsy, Roma and Traveller communities for health, welfare, housing and education issues. Whenever an unauthorised encampment occurs, the Gypsy & Traveller Liaison Officer visits and makes an assessment of the situation. If it is in a quiet location and causing little nuisance a decision may be made to leave the travellers in place for an agreed period, as there is no point in evicting from one site to a worse one. It is in everyone's interest to agree

10 a leaving date with the travellers, as they get a period of stability and the County Council saves the not inconsiderable costs of eviction. If and when a decision is made to take legal action there are procedures to be followed. The Courts require public bodies like local authorities to take account of considerations of common humanity, so we must carry out needs and welfare audits to discover if any allowances should be made before we proceed. More information can be found at: Traveller-Liaison-Service, including Paula's contact details. The link also contains a link to Dorset County Council s current Gypsy and Traveller policy. Answer provided by DCC Adult and Community Services and Children s Services The provision of services to individuals living in Dorset is based on eligibility criteria and assessments which follow the County Council s principles of equality and recognise the diversity of people and their communities. Efforts are made to ensure that information and advice is accessible to all and all our hard copy information such as factsheets /leaflets are available in other formats which includes large print, Braille, audio, easy read and other languages (please telephone: ). For adults, the My life my care website (our main information and advice source for the public) includes Google translate as well as Readspeaker which makes the content available by audio. With regard to children, we work with all our schools to ensure that all pupils make good progress. Schools look in detail at the progress of different groups of children, including those from Gypsy, Romani and Traveller communities and communities from Eastern Europe. It is important to note that DCC also have a translation service which provides support for anyone who contacts us and may encounter communication barriers. This service is coordinated through our Dorset Direct contact team and provides both interpretation and translation services, whether this is required in person or via other methods of communication, including text talk for the hearing impaired. The provision of this service has recently been redesigned to encourage a greater take up of translation and interpreting services for our citizens and visitors, which will enable us to better tailor and develop services. Question 3 How does the NHS deal with cultural and faith issues of Asian women? Answer provided by NHS Dorset Clinical Commissioning Group We have delivered a number of health awareness sessions around diabetes and carers issues to the Dorset s Bangladeshi Women s Group, and we provide information about heart disease, diabetes and other conditions (which are more prevalent within the south Asian community) in a number of languages. This information has been distributed to various communities within Dorset through Dorset Race Equality Council (DREC). For more information please contact our Engagement and Diversity Officer: ebi.sosseh@dorsetccg.nhs.uk

11 Answer provided by Dorset HealthCare University NHS Foundation Trust Recognising cultural and faith issues is a part of the inpatient admissions process and we also monitor activity and collect data to assess the extent that care plans are individual and account for the person s wellbeing and spiritual needs. Access to supporting materials and quiet areas for prayer are provided as part of everyday practice. Particular issues have been raised when because of cultural or faith issues women have requested treatment only by other women or males have requested to be present during examinations. While these wishes are understood and taken into consideration it cannot be guaranteed in every situation. Depending on the setting, each case has to be looked at individually and we will always do our very best to meet any request made or to provide an alternative solution. Dave Corbin, Equality and Diversity advisor at Dorset HealthCare will be happy to answer any further queries and can be contacted on david.corbin@dhuft.nhs.uk Answer provided by Dorset County Hospital NHS Foundation Trust The Trust aims to treat all patients and service users equally and with respect. Training is provided around Equality and Diversity, and translation service is made available to our patients and service users if required. For further information, please see the Equality and Diversity section of the Trust s web site. Question 4 Do you offer training for staff on eligibility of migrants? Are you sure you are not turning away people unfairly? Answer provided by NHS Dorset Clinical Commissioning Group The NHS is free at the point of need and any patients presenting at providers requiring urgent or emergency treatment would receive it. Providers train their staff to capture the information required to re-charge the cost of treatment as appropriate. Our own Engagement and Diversity Officer also provides customer service and Equality and Diversity training to GP practice staff on request. Eligibility, which covers migrants, is included in this training. For more information please contact our Engagement and Diversity Officer: ebi.sosseh@dorsetccg.nhs.uk Answer provided by Dorset HealthCare University NHS Foundation Trust The Trust works with and supports many vulnerable or small communities, such as the homeless and working women, and migrant communities are entitled to and receive the same healthcare services as any other person living in Dorset, where they meet the clinical access criteria. We constantly look to identify changes in our communities or new communities arriving, so that we can make any necessary changes to make sure we meet everyone s needs. Dave Corbin, Equality and Diversity advisor at Dorset HealthCare will be happy to answer any further queries and can be contacted on david.corbin@dhuft.nhs.uk

12 Answer provided by Dorset County Hospital NHS Foundation Trust The Trust complies with national guidance and regulations in respect to access of services, and our employees are made aware of changes in relation to funding for foreign nationals as necessary. This would not result in the delay of any emergency care. For further information, please see the Equality and Diversity section of the Trust s web site. Answer provided by Dorset County Council (DCC) All Dorset County Council staff and members have access to equality and diversity training and those taking part in management training participate in a more specialist session as part of a wider course. New laws have given public services specific duties to promote equality and diversity in their workforces and in their local communities. We aim to do this by seeking to promote an environment that accepts and actively supports diversity in the broadest sense; we will achieve this in the way we deliver our services, employ people and in our role as community leaders. For further details, please contact: Kelly Haggett k.haggett@dorsetcc.gov.uk