Agenda and minutes

The Chair reminded members of the Board of the need to declare any known interests in any matters to be considered at the meeting. No declarations were made.

To receive the minutes of the meeting held on 13^th December 2017.

Resolved – That the minutes of the meeting held on 13^th December 2017 be confirmed and signed as a correct record, subject to the following amendments.

Item 38. Swindon’s Transformation Plan for Children and Young People’s Mental Health and Well Being – 2017 to 2020

To note that it was the Children’s Commissioning Lead at the NHS Swindon Clinical Commissioning Groupwho had confirmed that improvement in Children’s Mental Health was a national priority and was set out in two key documents, “Future in Mind” and “The Five Year Forward view for Mental Health”.

Item 43. Swindon Substance Misuse Strategy 2017 – 2022

To note that the Strategy should be referred to as being from 2018 – 2022, with the removal of references to 2017.

Please refer to the explanatory notes below.

No public questions were received prior to or during the meeting.

The Board considered a report seeking its approval of Swindon Borough Council’s Adult Social Care Strategy 2018-2022, and asking it to recommend that both Swindon Borough Council’s Cabinet and the NHS Swindon Clinical Commissioning Group (CCG) Governing Body adopts and implements the strategy.

The report set out how the Strategy demonstrates the Council’s approach to adult social care over the next five years, and provides the context for how the Council will work with partners to provide care and support for people living in Swindon who have additional needs. The Board noted that the focus is on promoting, maintaining and enhancing people’s independence in their communities, so that they are healthier, stronger, more resilient and less reliant on formal social care services.

Ms Sue Wald, Corporate Director of Adult Social Services and Health [SJ(1] at Swindon Borough Council, introduced the report and highlighted how the Strategy provides more detail than can be found in the Health and Wellbeing Strategy and the Better Care Fund Plan, and so better informs users, partners and the public on what is being done in this service area.

Ms Wald referred to the development of the model for care and support which has been created to meet the obligations of the Care Act 2014, and to manage the key challenges in rising demand and consequent and ongoing budget pressures. The Board noted that the model has been designed to ensure that people can get the right level and type of support, at the right time, to help prevent, reduce or delay the need for ongoing support, and to maximise people’s independence. It has three levels of support, as follows:

a)    Helping you to help yourself - Accessible, friendly, quick, information, advice and advocacy, universal services for the whole community, prevention.

b)    Helping you when you need it - Immediate help, minimal delays, no presumption about long-term support, goal focussed.

c)     Helping you to live your life by providing ongoing support for those who need it - Self-directed, personal budgets, choice and control, highly personalised.

Following the presentation of the report and the Swindon Borough Council Adult Social Care Draft Strategy 2018-2022, attached at Appendix 1 to the report, Board members discussed the matters raised, including:

·       How the focus of support will shift to helping individuals to help themselves.

·       The recently awarded £10m contract for domiciliary care which contained packages of reablement to enable people to look after themselves.

·       The concerns raised by Voluntary Action Swindon over the information within the Strategy, which included: questions regarding the number of patients delayed from hospital in to social care; the lack of emphasis on the challenges of transition; recognising people’s rights; budget concerns beyond next year, and; user engagement in the design of services needing more clarity. The Board noted that these issues will be addressed in the final version of the Strategy.

·       How the Delayed Transfer of Care figures have improved in Swindon, with the figure dropping from 17 a day to under 1 per day over  ...  view the full minutes text for item 50.

The Board considered a report of the Senior Public Health Manager at Swindon Borough Council, setting out the purpose for the National Prevention Concordat, namely to provide a focus for cross-sector action to deliver a tangible increase in the adoption of public mental health approaches across local authorities, the NHS, public, private and Voluntary, Community, and Social Enterprise organisations, education settings, and employers. 

The report set out how the Prevention Concordat for Better Mental Health is underpinned by the understanding that taking a prevention-focused approach to improving the public’s mental health is shown to make a valuable contribution to achieve a fairer and more equitable society. The Board noted that the National Prevention Concordat was launched by Public Health England in September 2017, providing a focus for cross-sector action to improve people’s mental health and reduce the risk of mental illness. It was also highlighted in the report that the National Prevention Concordat states that the prevention agenda within local areas needs to be taken on at the highest level and led by this Board, and that the role of this Board is to raise the profile of this work, hold partners to account, and have annual oversight of this work. It was also noted that 2018 has been branded the Year of Mental Health for Swindon.

The Board noted that Cllr Brian Ford had been appointed as the Mental Health Champion for Swindon, and that partner organisations will be asked to champion activities to raise awareness of mental health issues.

Resolved – (1) That the adoption of the Prevention Concordat for Better Mental Health in Swindon be supported, and the priority areas set out in paragraph 1.8 of the report be endorsed.

          (2) That Swindon Borough Council’s Cabinet and the NHS Swindon Clinical Commissioning Group’s Governing Body be recommended to adopt the Prevention Concordat for Better Mental Health in Swindon.

The Board considered a report presenting the first Swindon Air Quality Joint Strategic Needs Assessment (JSNA), developed following recent national guidance on improving air quality from the Government and the National Institute for Health and Care Excellence.

Ms Cherry Jones, Director of Public Health at Swindon Borough Council, introduced the report and referred to how air pollution is a serious public health challenge, with the Department of Health estimating in 2010 that the burden of particulate air pollution in the UK to be equivalent to nearly 29,000 deathsand an associated loss of population life of 340,000 life years lost. The Board noted that the key concern in Swindon is the levels of Nitrogen Dioxide, which is monitored and measured using diffusion tubes across the town, with particulate matter being less of a concern across the Borough.

The Board noted that Cabinet, at its meeting on 7^th February 2018, had approved the declaration of an Air Quality Management Area on Kingshill Road based on recorded annual average of Nitrogen Dioxide exceeding the thresholds advised by the Department for Environment, Food and Rural Affairs (Defra). The report set out how a management steering group, chaired by the Director of Public Health at Swindon Borough Council, has been established and is in the process of producing an Air Quality Action Plan for this area. The Board also noted that the Cabinet Member for Housing and Public Safety will be setting up a Cabinet Member Advisory Group to consider Air Quality Issues across the borough.

Ms Jones referred to the recommendations that had arisen from the JSNA, set out in paragraph 3.12 of the report and in the Bulletin attached at Appendix 1, and highlighted key actions which the steering group will be considering, including:

a)    The prioritisation of active and sustainable methods of transport to reduce air pollution from a variety of pollutants. This will lead to improvements in health and wellbeing through increased physical activity and improved air quality.

b)    Ensuring that the vehicles that are travelling through and around Swindon are as clean as possible. To do this there needs to be a move towards zero- and low-emission vehicles. One way to assist with this transition is through applying for available funding and grants to ensure the development of an electric vehicle infrastructure.

c)     Ensuring that any specific local solutions in areas of higher nitrogen dioxide, as identified within the Borough Council’s Air Quality Annual Statement Report to Defra, take place.

Following the presentation of the report and the Swindon Air Quality Joint Strategic Needs Assessment Bulletin 2017, attached at Appendix 1 to the report, Board members discussed the matters raised, including:

·       The proposed timeline for the Air Quality Action Plan, and how it will be monitored by the steering group which is expected to report to both Cabinet and this Board in around twelve months’ time, following consultation with residents.

·       How the Board can champion activities amongst partner organisations to help improve air quality.

·       Plans by  ...  view the full minutes text for item 52.

The Board considered a report setting out its statutory responsibility to prepare a JSNA for Swindon. The Board noted that the JSNA must describe the current and future health and wellbeing needs of the people of Swindon, and is the principal work stream to inform the Joint Health and Wellbeing Strategy.

Mr Tom Frost, Senior Public Health Intelligence Analyst at Swindon Borough Council, introduced the report and referred to how the Swindon JSNA is an on-going iterative process, led by Swindon Borough Council’s Public Health Team, and involves a wide range of stakeholders. Mr Frost confirmed that it also informs decisions about how services are commissioned, designed and developed.

Mr Frost highlighted that the JSNA Summary for 2017/18, attached at Appendix 1 to the report, provided an overview of the current and future health and wellbeing needs of people in Swindon as well as signposting to other useful resources, and is an update to the previous three annual versions of this document.

Mr Frost advised that key issues within the JSNA have been reviewed and revised by subject matter experts, and highlighted the new key facts, indicators and information within it. The Board noted that the production of this document is a lengthy process, requiring an early deadline for the submission of information. This, however, has led to some data within the JSNA being out of date, with more up to date information available if required. Once approved, the document will be published to the JSNA website.

Mr Frost drew attention to the following facts stated within the JSNA:

a)    How life expectancy levels have risen in Swindon.

b)    How smoking prevalence has reduced to 14.9% of adults in Swindon.

c)     The importance of placing mental health on a par with physical health due to the estimated 17,000 females and 11,000 males in Swindon with common mental health problems.

d)    The health inequality in Swindon, with males residing in the most deprived areas of Swindon living 8 years less than those in the least deprived areas, with the equivalent figure for females being 4 years.

Following the presentation of the report and the draft Joint Strategic Needs Assessment Summary 2017/18: An Overview of Health and Wellbeing in Swindon, attached at Appendix 1 to the report, Board members discussed the matters raised, including:

·       Concern over the increase in the numbers of residents aged over 65 in Swindon, which has been going up by around 2,000 each year.

·       Targeting prevention activities to those in the most deprived areas in Swindon to help reduce the difference in life expectancy levels, and looking at links between deprivation and long term conditions to help target work to achieve the most benefits. 

Resolved – (1) That the draft Joint Strategic Needs Assessment: An Overview of Health and Wellbeing in Swindon JSNA Summary 2017/18 be noted, and that its use in commissioning and strategy preparation, including the Joint Health and Wellbeing Strategy, be endorsed.

          (2) That the finalised document be shared with the NHS Swindon Clinical Commissioning  ...  view the full minutes text for item 53.

The Board considered a report setting out how the Health and Social Care Act 2012 transferred the statutory responsibility for the developing and updating of Pharmaceutical Needs Assessments (PNA) to this Board, and how the PNA is required to be published by 1^st April 2018.

Ms Cherry Jones, Director of Public Health at Swindon Borough Council, introduced the report and advised that the PNA will ultimately form the basis of commissioning plans of NHS England for services within community pharmacies, and will be used for several key purposes, including:

a)    To record the local health needs and identify how these health needs could be met by the provision of pharmaceutical services.

b)    To inform commissioning of local services by the CCG and Swindon Borough Council.

c)     To enable external stakeholders to understand the needs of the local population and the requirements for pharmaceutical services to meet those needs. Providers will be able to use the PNA to inform applications to provide pharmaceutical and other relevant services.

d)    To be referred to by NHS England when it has to make decisions on whether or not to approve applications to open new pharmaceutical services and dispensing doctors. It will also use this PNA when existing providers of NHS pharmaceutical services apply to make changes to their terms of service.

e)    To help this Board to work with providers to ensure that services are targeted to the areas where they are needed to avoid duplication of services in areas where there is adequate provision.

Ms Jones highlighted how the PNA will be updated as and when housing developments are built to help inform commissioners of changes to local need. The Board noted that the 60 day statutory consultation period has closed, with the local population, local pharmacies and neighbouring authorities having been consulted. The overall conclusion is that the pharmacy provision in Swindon is satisfactory.

Following the presentation of the report and the draft Swindon Pharmaceutical Needs Assessment 2018-2021, attached at Appendix 1 to the report, Board members discussed the matters raised, including:

·       The out-of-hours GP service provided on the Great Western Hospital site having been transferred to the Moredon Medical Centre, which will be reflected in the final version of the PNA.

·       How the PNA can be publicised more widely without hard copies being printed to reduce costs. 

Resolved – (1) That the conclusions from the Swindon Pharmaceutical Needs Assessment, as set out in pages 36 – 37 in Appendix 1 to the report, be noted, and the recommendations accepted.   

          (2) That the intention to issue additional statements to support the Pharmaceutical Needs Assessment, if and when housing development and occupation suggests the current pharmaceutical need has changed, be noted.

          (3) That the final version of the Swindon Pharmaceutical Needs Assessment 2018-2021 be approved for publication by 1^st April 2018.

The Board considered a report which provided an overview of both the national and local context of urgent and emergency care.

Ms Nicki Millin, Accountable Officer at the CCG, introduced the report and referred to the national direction of travel set by the NHS, which has provided the context within which the strategy for Swindon has been set. Ms Millin highlighted a number of expected changes going forward, which included:

a)    The out-of-hours service transferring to Moredon Medical Centre, with the contract for service provision having been awarded to Medvivo on a fixed term basis. The Board noted that the contract will be procured on a long term basis within the next year, and that the specifications will link in with other urgent care proposals.

b)    That the Urgent Care Centre on the Great Western Hospital site will be changed to an Urgent Treatment Centre to meet national standards, and will have more emphasis on diagnostics.

c)     Re-ablement models are being tested with the aim of reducing the length of time people stay in hospital. The Board noted how a number of schemes were commissioned using winter funding whereby temporary beds were procured in care homes on a step down basis to allow for rehabilitation. 

d)    The work being done to monitor patient safety and experience at the Great Western Hospital. The Board noted that the hospital is not meeting national standards, but that this does not seem to have had a negative impact on people in terms of their clinical experience.

Following the presentation of the report and the Urgent and Emergency Care document, attached at Appendix 1 to the report, Board members discussed the matters raised, including:

·       The challenge of ensuring that any communications to patients are plain and simple to enable them to make the right choices.

·       How messages about the changes set out above will be communicated to residents, using social media, letters, posters and websites.

·       That, from May 2018, the 111 number will have more clinical people answering the calls, and how it will be an integrated, locally focussed service able to signpost people accordingly the first time. The national message is to simplify access by using this single number, and this will be replicated locally under the ‘Talk Before You Walk’ strategy.

·       The proposed timeline for introducing these changes, and how communication will be managed so as not to cause confusion amongst patients.

·       The link in communications amongst partner organisations, and how messages are ‘retweeted’.

Resolved – That the report be noted.

The Board considered a report providing an update on Swindon’s Better Care Fund Plan (BCF) 2017/19 which sets out how partners will work together to improve the delivery of integrated community and acute pathways across Swindon’s health and social care system.

The report set out how one of the key outcomes for the Plan is to enable more patients to leave hospital without delay. The Board noted that the Government requires that performance against the BCF Plan 2017/19 is considered by this Board, and that this report focused on Swindon’s Delayed Transfers of Care (DToC) performance.

Ms Sue Wald, Corporate Director of Adult Social Services and Health at Swindon Borough Council, introduced the report and highlighted the work done on addressing the delays for patients across health and social care, especially at the Great Western Hospital, as it is acknowledged that patients are likely to get better more quickly at home, with support in a familiar environment.

Ms Wald referred to how delays are calculated over a month across health and social care, and then broken down to a number of beds per day. The Board noted that the target for March is 13, and that the actual figure for February (which has not yet been validated) is expected to be lower than this. Ms Wald referred to the contributing factors which have lowered the DToC figures, including:

a)    That discussions are now being held three times a week, chaired by the CCG, looking at patients ready to leave the hospital and the plans that need to be in place to discharge them.

b)    That internal daily telephone calls are now taking place to discuss social care patients and ensuring that plans are in place for them.

c)     That the CCG had commissioned extra beds which had allowed for additional reablement domiciliary care over the winter period.

d)    That the period of pressure during the recent winter period had been shorter than in previous years.

e)    That the CCG has appointed a Trusted Assessor to liaise between the hospital and care homes, as older people falling are the biggest number of people being admitted to hospital.

f)      The funding provided by NHS England for the additional winter provision.

Ms Wald advised that the Care Quality Commission (CQC) is currently undertaking a review of Wiltshire Council due to its high number of delays. The Board noted that the CQC has indicated that it may extend the review to look at how all partners across the system, including those in Swindon, are working to secure the best outcomes for patients.

Ms Wald referred to the plans in place for the forthcoming Easter break, which will include seven days a week working to ensure discharges take place every day.

Following the presentation of the report, Board members discussed the matters raised, including:

·       How the reduction of the DToC figures have been achieved within existing budgets.

·       The need to put wider community systems in place to help support this improved discharge  ...  view the full minutes text for item 56.

The Board considered a report providing an update on the activities of Healthwatch Swindon during the period October to December 2017.

Ms Tori Jones, Healthwatch Manager, introduced the report and highlighted key points contained within the update, which included:

a)    The development work being undertaken with the Healthwatch Advisory Group, a steering group empowered to advise Healthwatch on its work plan, looking at retention on the group, building skills as volunteers on the group, and how its agenda is set. The Board noted that there are now fifteen people in the group, and its agenda has been tied in to the Health and Wellbeing Strategy.

b)    The new client record management system being adopted in April 2018, which will enable Healthwatch to assess the journey of its clients through its processes.

c)     The success of the Patient Participation Groups, which have been doing work with the CCG on how integrated services could function going forward.

d)    The project taking place in conjunction with Swindon Advocacy Movement in relation to transforming the care partnership plan. The Board noted that the project has involved Healthwatch in Swindon, BANES and Wiltshire, which have been recruiting volunteers who will use their experience of learning disabilities and autism to visit and review local health and social care services, from June 2018 until March 2019.

e)    The increased number of referrals to the Healthwatch Swindon Advocacy Service due to the improved marketing communications.

Following the presentation of the report and the Q3 Feedback Feed Forward report, attached at Appendix 1 to the report, Board members discussed the matters raised, including:

·       How officers at the Borough Council could provide links to young people who may like to join the Healthwatch Advisory Group, or become young inspectors.

·       The possibility of joint working amongst partners on improving the mental health and wellbeing of young people in Swindon, involving the Youth MPs.

·       The ongoing audit of the number of meetings attended by representatives from Healthwatch Swindon.

The Chair referred to a letter sent to all local government Leaders and Chief Executives on 22 March 2018 from Imelda Redmond CBE, National Director of Healthwatch England, which had been circulated to Board members prior to the meeting, and hard copies provided at the meeting. The Board noted the letter contained an offer of support to help with commissioning and contract management.

Resolved – (1) That the report and the work completed by Healthwatch Swindon during October to December 2017 be noted.

(2) That receipt of the letter from the National Director of Healthwatch England be logged, and the contents noted.

The Board considered a report providing an update on the development of the Accountable Care system in Swindon.

Nicki Millin, Accountable Officer at the CCG, introduced the report and highlighted that this will be known as ‘Integrated Care’ going forward. Ms Millin referred to the key pieces of work that had been taking place over the winter period, which had included:

a)    Developing a main point of contact for residents to access health services, and looking at virtual access, mobile phone apps and phone access.

b)    With support from Prospect Hospice, testing the operating model for those who are in their end of life period, with the final model going live in June 2018.

c)     Supporting people to more effectively manage one or more chronic diseases with the aim of reducing the number of hospital admissions.

Resolved – That the content of the report be noted.

The Board considered a report which provided an opportunity for members to consider the merging of the One Swindon Leadership Board (OSLB) with this Board.

The report set out how the OSLB had been created before the Health and Social Care Act 2012, which had established Health and Wellbeing Boards as a forum where key leaders from the health and care system work together to improve the health and wellbeing of the local population and reduce health inequalities. The Board noted the duplication of membership and agendas across these two Boards.

Ms Cherry Jones, Director of Public Health at Swindon Borough Council, introduced the report and confirmed that the OSLB had agreed to the merge at its meeting on 23^rd January 2018, due to the duplication in focus and priorities between the two Boards. Ms Jones referred to the three priorities of the OSLB, namely homelessness, domestic abuse and education, and explained how this Board and other forums address these issues.

Ms Jones went through the proposed timeline for the merge, beginning with the proposed Terms of Reference being considered by this Board at its meeting on 23^rd May 2018, followed by full Council adopting it in July 2018. The new One Swindon Health and Wellbeing Board (OSHWB) will then convene in October 2018.

Following the presentation of the report, Board members discussed the proposal and raised the following issues and concerns:

·       How the Swindon Challenge Board is not multi-agency as stated within the report.

·       That a large increase in the size of the membership may lead to the meeting being unmanageable.

·       How discussion may have to remain high level due to time constraints, leading to lost opportunities for discussion of topics in detail.

·       Whether additional Cabinet Members should be invited to join the membership of the OSHWB given their democratically elected responsibility for their respective budgets.

·       How the OSHWB could have a two-tier membership of voting and non-voting members.

·       The need for further consultation with partners on the proposals prior to the Board’s meeting in May 2018.

·       How some of the OSLB work will not map to the new OSHWB, and so those members relating to this area of work will not require representation going forward.

·       How provider representatives should not be able to vote on commissioning decisions due to their conflict of interest, and how the current Providers Forum could be retained to capture their input which would further reduce the membership of the OSHWB.

·       How the new OSHWB will concentrate on strategic level decisions, with the essential role of scrutiny being provided by the scrutiny function at the Borough Council.

·       How the merge of the two Boards will strengthen decision-making, and how the amended Terms of Reference will ensure that any statutory obligations and functions are fulfilled.

·       That the recommendations should be amended to reflect that the Director of Public Health be requested to draft the revised Terms of Reference in conjunction with the Monitoring Officer and colleagues from the CCG.

·       How minutes from other  ...  view the full minutes text for item 59.

Resolved – That the minutes of the Joint Commissioning Group meetings held on 22^nd November 2017 and 9^th January 2018 be noted.