Kingston Clinical Commissioning Group Report Summary Meeting Title Governing Body in public Date 7 th November 2017 Report Title Health & Well Being Board Minutes 14 th September 2017 Agenda Item 15 Attachment Q Purpose (please indicate with X) Approval/ Ratification Discussion / Comment Information x Report Author: (name & job title) Presented by: (name & job title) HEALTH AND WELLBEING BOARD 14 SEPTEMBER 2017 6:30 pm 8:17 pm Members of the Board Councillors: Councillors Kevin Davis (Co-Chair), Linsey Cottington, Tom Davies, Chris Hayes, Cathy Roberts, Hugh Scantlebury and Margaret Thompson* Representatives from Kingston CCG, Healthwatch and the Voluntary Sector: Dr Naz Jivani (Co- Chair), Dr Phil Moore, Dr Peter Smith*, Grahame Snelling* and Patricia Turner Council Officers (non voting): Rob Henderson*, Iona Lidington and Stephen Taylor* Advisory Members (non voting): Siobhan Clarke Your Healthcare, Tonia Michaelides Kingston CCG, Dr Mark Potter* South West London and St George s Mental Health Trust, Jane Wilson* Kingston Hospital NHS Trust, Gwen Kennedy* NHS England and Dr Anthony Hughes Kingston GP Chambers * Absent 12. QUESTIONS AND PUBLIC PARTICPATION There were no questions from the public. 13. DECLARATIONS OF INTEREST There were no declarations of interest. Version: Final Q - 1
14. APOLOGIES FOR ABSENCE AND ATTENDANCE OF SUBSTITUTE MEMBERS Apologies were received from Councillor Margaret Thompson, Dr Pete Smith, Dr Mark Potter, Rob Henderson, Stephen Taylor and Jane Wilson. Stephen Bitti attended the meeting in an informal capacity on behalf of Grahame Snelling of Healthwatch. 15. MINUTES The minutes of the meeting of the Board held on 15th June 2017 were approved and signed as a correct record. 16. DIRECTORS UPDATE Appendix A The Board received updates from the Directors of Adult Social Care and Children s Services, the Interim Director of Public Health and the Chief Officer of Kingston Clinical Commissioning Group, on a variety of issues. These included; The successful launch of the Thrive Kingston Mental Health Strategy The commencement of work to update the Pharmaceutical Needs Assessment Discussions with the Joint Strategic Needs Assessment Working Group s members on a review of the processes and content of the Assessment The latest position in respect of the Kingston Coordinated Care programme including Home Care Transformation, the New Model of Care, the Council and CCG s joint commissioning arrangements, the Active and Supportive Communities project and the Kingston Care Record The Community Sponsorship event hosted by the Council in July for people who may be interested in sponsoring refugees relocated to the Borough A forthcoming table top exercise to test responses to a flu pandemic A two year pilot to improve cancer screening uptake in marginalised groups The roll out of Mental Health first aid train the trainer courses for staff working with both adults and young people The progression of the new Self Care Kingston programme designed to reduce pressure on services, including proposals for an event during national Self Care Week in November at which the Cancer Strategy for Kingston would be launched. Members endorsed details of the emerging Connect Well Kingston proposal, which formed part of the Self Care programme. The intention was to co-design and implement new ways of working for frontline workers across the borough in order to provide a consistent training offer, improved community networks and champions providing early support and signposting. Service providers on the Board were asked to engage in the co-production of the model and nominate a lead for their respective organisations. The Board also noted guidance from the Department for Education (DfE) which recommended that schools should consider the installation of automated external defibrillators (AEDs) on their premises. These were already widely available in Kingston in areas where a high footfall was expected and where higher risk physical activities were undertaken. It was emphasised, however, that the risk of out of hospital cardiac arrests in children and adolescents was very low and only a small proportion of these would take place on school grounds. AEDs could not be Version: Final Q - 2
considered a Public Access Defibrilator (PAD) because they would be unlikely to be available for use outside school hours and off the premises. Training for PAD use and CPR was of value both in the secondary school setting and the wider context and schools would be encouraged to take part in the British Heart Foundation s Restart a Heart campaign. RESOLVED that 1) The collective working approach in respect of the Connect Well Kingston proposals set out in paragraphs 32-36 of the agenda report be endorsed and service providers on the Board be asked to engage in the co-production of the model for Kingston and nominate a lead for their organisation; and 2) Schools be encouraged to participate in the British Heart Foundation s Restart a Heart campaign. Voting Unanimous 17. VERBAL UPDATES FROM KINGSTON VOLUNTARY ACTION AND HEALTHWATCH KINGSTON The Board received updates on the latest activity of Kingston Voluntary Action (KVA) and Healthwatch Kingston. Patricia Turner reported that KVA was participating in the Macmillan social prescribing project steering group and had welcomed the new Social Prescribing worker as part of her induction. A new Active and Supportive Communities network had been established for voluntary organisations commissioned to deliver the outcomes of the Strategy as part of the Kingston Coordinated Care programme. The network, which had met for the first time in June, had developed a tool to assist pharmacists refer people directly to voluntary groups in order to reduce pressure on GPs and A&E. A number of voluntary organisations had attended the initial multidisciplinary team meetings in New Malden and Patricia Turner was herself now attending the Kingston and Richmond Local Transformation Board. The Health and Wellbeing network meeting the following week was due to look at means of supporting the CCG s work on primary care. Stephen Bitti, the new manager of Healthwatch attending on behalf of Grahame Snelling, advised that the full complement of three members of staff were now in place and dealing with the logistics of establishing a new office. He was presently also engaged in meeting key stakeholders. In addition four new Trustees had been recruited. 18. SOUTH WEST LONDON SUSTAINABILITY AND Appendix B TRANSFORMATION PARTNERSHIP UPDATE Tonia Michaelides, Managing Director of Kingston and Richmond Clinical Commissioning Groups, provided the Board with an update on the major work programmes of the South West London Sustainability and Transformation Partnership (previously the Sustainability and Transformation Plan). Members noted that a refresh of the STP strategy was being undertaken in order to move towards local planning and delivery to keep people healthy and out of hospital. Local Transformation Boards (LTBs) had been established for each Local Delivery Unit, the new structures continued to be embedded to lead the development and delivery of the new local health and care models and new leadership appointments and structures had been approved. Version: Final Q - 3
The Kingston and Richmond LTB, which brought together senior leaders from across the health and care system in both boroughs, had been meeting since January 2017 and its focus to date had been on reviewing progress of the development of the health and care model, its own workplan and initiation of work on how to develop an accountable care system. The Board was also informed that detailed implementation planning was underway in respect of 5 year Forward View programmes across South West London in urgent and emergency care, cancer, primary care and mental health. Further work continued in delivering common approaches to musculo-skeletal services and effective commissioning as well as agreement of a delivery plan for maternity services to meet the Better Births recommendations. Enabling digital, workforce and estates programmes were in place to support the transformation and the focus of communications and engagement was to be shifted into the individual LTB areas. It was anticipated that by the end of November 2017, when a refreshed strategy document was due to be published, local health and care systems would have reviewed feedback from engagement with residents, analysed local data and identified their main challenges. They would then be in a position to set out how they planned to work together to improve services and be clinically and financially sustainable going forward. Existing engagement activity would be further developed to ensure that local people were involved in the planning of services and there would be consultation on proposals for significant change. It was agreed that future updates to the Board would contain more information on Kingston specific activities and the implications for the local population. 19. CHILD DEATH OVERVIEW PANEL ANNUAL REPORT 2016-17 Appendix C Amanda Boodhoo and Sarah Bennet of the Local Safeguarding Childrens Board presented the 2016/17 annual report of the Child Death Overview Panel, a sub group of the Board which examined deaths in Kingston and Richmond with a view to understanding how and why children died and to develop interventions to prevent future deaths. Members noted that there had been a total of 16 child deaths in Kingston and 12 in Richmond during the course of the year. Some 62% of the Kingston children were from a White British ethnic background against a borough demographic of 67%. Eight of the deaths investigated were thought to have had modifiable factors. The main causes or categories of death overall were perinatal/neonatal events (11) and chromosomal, genetic and congenital anomalies (5). Most of the deaths had occurred in infants under 12 months of age. The Panel s promotion of the availability of Government funding for defibrillators in schools was noted but it was recognised that the primary need was to reinforce messages of basic life support. Public access to defibrillators was now reasonably good but the training of young people in CPR techniques was likely to be of greater benefit. To this end the Council was promoting the British Heart Foundation s Restart a Heart campaign. Members of the Board requested that the Child Death Overview Panel s updates be circulated directly to individual GPs rather than via Practices and also provided to Councillors. Version: Final Q - 4
20. LONDON MAYOR S HEALTH INEQUALITIES STRATEGY - Appendix D CONSULTATION The Board received a presentation on the Mayor of London s proposed new London Health Inequalities Strategy and gave consideration to its implications for Kingston. Members noted that the Mayor was seeking to develop and implement a new strategy to reduce health inequalities in London between 2017 and 2027 in partnership with local authorities and the NHS. The draft document currently out for consultation contained five strategic priorities, namely; healthy children, healthy minds, healthy places, healthy communities and healthy habits. This aligned well with the actions contained in Kingston s existing Joint Health and Wellbeing Strategy. Both the London wide and the local documents shared aims to support children and improve mental health and emphasised the importance of ill-health, community empowerment and reducing disadvantage. It was acknowledged that although Kingston was one of the least deprived unitary authorities in England with higher life expectancies for both men and women than the national and London norms, there remained substantial inequalities within the borough. Women living in the most deprived area of the borough were expected to live for 4.8 years less than those in the least deprived while for men the gap was 5.1 years. The significant cost of health inequalities to public services and the wider economy was also recognised. Members therefore gave consideration in brief break-out discussion sessions to the respective roles of individual members of the Board in reducing local health inequalities, how to align existing joint strategic plans in Kingston with the London wide priorities contained in the draft strategy and what needed to be in place across London to better enable local action in Kingston. Issues raised in the discussions included the opportunities for mental health created by the Prevention Concordat, the need for a national framework to reduce inequalities and for national, pan-london and local programmes to align and create synergy. It was recognised that the Mayor could only deliver through London boroughs local was better in many respects though his influence through the exercise of other functions was considerable. To this end the principles of the Strategy would need to be embedded in The London Plan, the spatial planning document due to be published in draft later in the year. Members also commented that it was important to focus on the wider determinants of health, which was where the most difference could be made. The detailed feedback from the break-out sessions would help shape both the response to the consultation and the development of local implementation plans. It was noted that partners would be able to draw on the Council s consultation response in preparing their own submissions. RESOLVED that 1) the five aims of the draft strategy, as described below and in paragraph 6 of the agenda report be endorsed; 2) the Director of Public Health be authorised to prepare a detailed consultation response in consultation with the Co-Chairs of the Board; and 3) local implementation plans be developed and submitted to the Board as appropriate after publication of the final London strategy. Voting Unanimous Version: Final Q - 5
21. LONDON CRISIS PROGRAMME UPDATE - HEALTH BASED Appendix E PLACE OF SAFETY The Board received details of pan London proposals to improve access to services for patients detained under Section 136 of the Mental Health Act. Members noted that there continued to be a disparity between care provision for people with mental health issues and those with physical problems. Service users were often denied access to Health based Places of Safety (for example hospitals), left in the back of Police cars and ambulances or transferred unnecessarily between A&E Departments and Mental Health Trusts due to a lack of integrated, holistic, care. Existing difficulties were likely to be compounded by forthcoming legislative changes which would reduce detention time from 72 to 24 hours and increase the scope of S136 which was likely to mean an increase in the number of people being detained. In order to mitigate these problems, and help ensure the crisis care system had sufficient capacity and processes in place to respond to the changes, the Healthy London Partnership had developed a new model of care which included: a pan-london approach to care with individuals taken to the nearest place of safety and, if necessary following assessment, being transferred to their local mental health trust; transparency around capacity at Place of Safety sites and robust escalation processes when capacity was full; a dedicated 24/7 staffed service at Place of Safety sites; increased physical health competencies at Place of Safety sites to ensure unnecessary referrals to A&E departments and more timely, integrated care; and streamlined pathways between A&E Departments and Place of Safety sites for when individuals required more intensive physical health treatment The existing local Health Based Place of Safety, at South West London and St George s Hospital Mental Health Trust s Springfield site was to be retained, thereby ensuring that the key components of the new arrangements would be met. Potential issues with travel times to the site from outer reaches of its catchment areas were acknowledged but it was emphasised that the site would not necessarily need to cater for all of South West London. Much of the population in Croydon, for example, tended to look to South East London provision. Mental Health STP programmes would lead on further engagement in their respective areas over the next six months to definitively establish the preferred options. The outcome of this consultation would be reported to the Board. 22. BETTER CARE FUND PLAN 2017-18 Appendix F The Board retrospectively endorsed the Better Care Fund Plan for 2017/18 which had been submitted to NHS England just prior to the meeting. Members noted that the local vision for health and social care integration, which strongly aligned with the STP and sought to embed the principles of the Kingston Coordinated Care programme, was unchanged. There remained a commitment to the aims set out in the 2016/17 Plan, namely; to support the development of active and supportive communities in which people were enabled to live healthy and well, independently within a thriving and resilient community, and Version: Final Q - 6
to develop customer centred care that supported people with complex needs to achieve the best possible quality of life and the goals that mattered to them with an increased focus on prevention, proactive care and self-reliance Once again it was intended that these aims would be achieved by putting in place a customer centred approach, building resilience within communities with access to a variety of community support options and the design and implementation of a new model of simpler, streamlined, cost effective and integrated services. It was agreed that although the Plan was intended as a commissioning document there would be value in sharing its contents with providers, including Kingston hospital. RESOLVED that the Better Care Fund Plan for 2017/18 attached at Annex 1 to the agenda be endorsed. Voting Unanimous 23. HEALTH OVERVIEW PANEL - MINUTES Appendix G The minutes of the meeting of the Health Overview Panel held on 13th July 2017 were noted. 24. URGENT ITEMS AUTHORISED BY THE CHAIR There were no urgent items. Signed.Date Co- Chair Version: Final Q - 7