Agenda and minutes

Apologies for absence were received from Councillor Holdich, Russell Waite, Dr Van den Bent and Dr Caskey.

There were no declarations of interest.

The minutes of the meeting held on 27 March 2014 were approved as an accurate record.

The Board is requested to consider membership of the HWBB and how new Members are agreed going forward.

The Board received a report following the Health and Wellbeing Peer Review which had been undertaken in March 2014. The Review had suggested that the membership of the Board was heavily weighted towards the local authority and that consideration should be given to a better balance, particularly in respect of Health.

Wendi Ogle-Welbourn, the Director of Communities, introduced the report and requested that Members consider the number of people they thought appropriate to sit on the Board, as well as the makeup of the Board. It was suggested that consideration be given to the following:

·         That the Board be made up of one third local authority, one third health and one third other, to be commissioners only (as the Health and Wellbeing Programme Board’s membership included providers) if they could evidence their added value to the makeup of the Board;

·         That it may be appropriate for the Vice Chairman of the Board to be someone from the Clinical Commissioning Group (CCG); and

·         A request received from the Police to have a place on the Board and for all future requests to be in writing, detailing how the agency/organisation could add value to the Board.

Members debated the report and comments and responses to questions included:

·         It was suggested that a formal written request be submitted to the CCG via the Chief Operating Officer and the Chairman, requesting a Council place on its Board. This could be undertaken jointly with Cambridge. Local authority membership would be advantageous and this process was becoming standard across the country;

·         Closer working between the Local Authority and the CCG would be beneficial in the long term;

·         Further clarification was sought as to what added value the Police would bring to the Board;

·         There was a consensus between providers that they felt ‘out of the loop’, and therefore the right balance needed to be struck with regards to their involvement;

·         It was suggested that the Chairmanship could be alternated between the local authority and Health to ensure greater health professional representation. In response to this point it was stated that it was important to have a consistent Chairman as well as a consistent Vice Chairman;

·         It was further suggested that membership could extend to a representative from the hospital;

·         A Chairman and Vice Chairman could be elected from nominations within the Board Members;

·         Providers sat on the Health and Wellbeing Programme Board (HWPB) and they could also attend any meeting of the HWB in order to make a case, as long as it was of a strategic nature;

·         The rationale behind the Police representation was due to their focus being very much around victims, including resourcing work around the drug and alcohol agenda and treatment of victims of domestic abuse. It was felt that they could bring to added value to the Board, forming part of a wider prevention and intervention strategy;

·         Parties who wished to sit on the Board should be evaluated on their own merits;

·         The focus of the Board was around Health and  ...  view the full minutes text for item 4.

The Board is requested to note the report and to discuss performance.

Tracey Cogan, Head of Public Health, NHS England, East Anglia and Dr Shylaja Thomas, Screening and Immunisation Lead, NHS England, East Anglia and Public Health England introduced a report and gave a presentation to the Board which provided an update on screening and immunisation. Key points highlighted included:

·         The presentation followed a recommendation from the Peer Review that the Board should be assured and informed of the performance around screening and immunisation in Peterborough;

·         It was agreed that exception reporting would be undertaken going forward to each meeting of the Health and Wellbeing Board;

·         The report was vital and it needed to outline the progress made in each area. Improvements needed to be made in screening rates;

·         The presentation highlighted the commissioning arrangements, the delivery arrangements and the current picture for Peterborough;

·         There were a number of programmes currently commissioned by NHS England East Anglia  for the population of Peterborough;

·         There were a number of delivery arrangements including GPs, the Cambridgeshire and Peterborough Foundation Trust and Cambridgeshire Community Services, amongst others;

·         An overview of the Abdominal Aortic Aneurysm Screening Programme was provided. This screening programme was based on lowering mortality rates in men;

·         Community Pharmacies had been commissioned for the first time in 2013 to support GPs for the delivery of flu immunisation programmes within at risk groups;

·         Performance processes were outlined, including quarterly Screening Programme Boards and the inspection of the screening service on a three yearly basis amongst others;

·         The Childhood Flu Programme had been rolled out in a pilot programme 2013, this being a nasal spray vaccine licensed for use of children between the ages of 2 and 16. The main benefit of giving the vaccine to children was to ensure the illness was not passed on to adults within the family. It was to be piloted in secondary schools in 2014;

·         The Performance and Quality Monitoring Group met monthly, with a number of Boards feeding into it. Performance could be monitored and actions identified in order to bring performance back on track if required;

·         The majority of immunisation and screening programs were doing well in Peterborough including breast screening uptake rates and diabetic eye screening uptake rates;

·         Across the programme, 25% of those booked in for abdominal aortic aneurysm screening appointments failed to attend. Further work needed to be undertaken in order to highlight the importance of this screening;

·         Improvements needed to be made in relation to uptake for some other screening programmes, such as bowel cancer and cervical screening in younger women, and improvements also needed to be made in relation to the uptake for some immunisation programmes, particularly flu immunisation programs; and

·         A number of recommendations were highlighted within the presentation in order to progress the issues forward, these being:

i.      For the Board and individual member organisations to work collaboratively with NHS England and Public Health England to promote screening and immunisation in Peterborough;

ii.    For the Board and individual member organisations to work in partnership with NHS England and Public Health England  ...  view the full minutes text for item 5a

The Board is requested to note the report and to discuss the developments in the Primary Care Strategy.

The Board received a report, and accompanying strategy document, which provided an update on the work being progressed by NHS England to provide a strategic framework for primary care development in East Anglia.

Andrew Reed introduced the report and highlighted key points including update reports being more focussed going forward and addressing the more bespoke elements of Peterborough; the work being about addressing the challenges facing primary care nationally, but with an area focus over the forthcoming five years and beyond; a lot of the work being focused on general medical services and the associated services; the strategy covering the whole of the East Anglia area, which encompassed many different areas with different needs and profiles; the drivers for change as outlined in the report which included demographic issues, patient expectations, workforce and financial issues; workforce being a major issue due to the inability to recruit GPs; more financial investment being required as the burden and expectation upon primary care was likely to increase going forward; the ambitions for the strategy including the ‘opportunities, challenges and issues specific to the Cambridgeshire and Peterborough system’ and a program of co-commissioning primary care being initiated, which was the responsibility of NHS England.

Members debated the report and comments and responses to questions included:

·         A review of Personal Medical Services (PMS) was due to be undertaken. A consequence of this would be felt across Peterborough, it being a predominantly PMS city. It was advised that any money extracted would be reinvested in primary care;

·         Peterborough was a rapidly growing authority and there had been issues faced around infrastructure etc.

·         The local issues were not reflected within the report and needed to be further explored. Bespoke plans were required for specific areas. Work would be undertaken in this regard;

·         Conversations had been held at the Joint Local Commissioning Boards in order to identify what work could be undertaken at a local level in order to address recruitment issues;

·         The CCG sought support from the Area Team for the ability for practices to begin to ‘cluster’ and to trial alternative models. This request would be taken on board and the next step would be to sit down with the CCG in order to tailor particular aspects; and

·         The amount of ‘language line’ use was not reflected within the strategy. The time spent on translation caused a number of issues.

RESOLVED

The Board noted the report.

The Board is asked to note the report and to comment on the work of PWC to date.

The Board received a report which provided an update on the Challenged Economy Programme and its planned further progress. The report was submitted to the Board following a meeting of local health and care chairs, elected members and chief officers on 30 April 2014.

Andrew Reed introduced the report and highlighted key points including the work being focussed on Cambridgeshire and Peterborough and that the report set out the work undertaken by PwC; the work being fundamentally about addressing major financial problems within the Cambridgeshire and Peterborough health economy in the context of improving services and outcomes; the CCG being the lead on the work and in the process of developing a 12 month programme; formal buy in being required from all key stakeholders within the health economy as the work progressed; work would have to be undertaken to identify exactly which providers could provide services; and that the PWC work had been at no cost to the Local CCG health economy or the Area Team;

Members debated the report and strategy and comments and responses to questions included:

·         Progress on the agreed concordat could be expected and it would be revisited regularly in order to strengthen it.

RESOLVED:

The Board noted the report.

The Board is requested to note the report and comment on the development of the programme.

The Board received a report which provided an update on the progress of the Better Care Fund since 27 March 2014.

There was no discussion on this item due to time constraints.

RESOLVED

The Board noted the report.

The Board is requested to note and comment on the report.

The Board received a report which informed of the arrangements that ensured the responsibilities of Peterborough City Council regarding Health Protection were discharged and reported, and that there was an appropriate process to address any incidents or concerns relating to health protection.

The Interim Director of Public Health introduced the report and provided a summary overview of the structures and governance arrangements in place for managing the entirety of the Health Protection, Emergency Planning and Emergency Response agenda. It was advised that it was a complicated scenario which was split in terms of commissioning, delivery and scrutiny across multiple partners. An overview of structures was provided and it was advised that it was a work in progress, however the Board was to be assured that the basic structures and governance arrangements were in place. 

RESOLVED

The Board noted and agreed the proposed arrangements

The Board is requested to note the report.

The Board received a report which informed of the arrangements under which the healthcare public health advice service would be supplied to the LCGs/CCG, as per the Memorandum of Understanding (MoU), which had been signed off by Peterborough City Council and the LCGs/CCG, and to inform and invite comment on the draft work plan, particularly with respect to the extent to which it reflected the agreed priorities of the Board.

The Interim Director of Public Health introduced the report and advised that the Peterborough Public Health team had a statutory responsibility to provide the healthcare public health advice service to the CCG. The original arrangement had commenced in April 2013 however it was subsequently identified that this arrangement was not adequate as it did not pick up the particular needs of Peterborough, as the focus of the work was CCG centric. Therefore the MoU had been terminated and a new one had been drafted and was attached to the covering report submitted to the Board. It was further advised that further work was underway to create the first annual work plan which reflected the priorities of the HWB.

RESOLVED

The Board noted the Memorandum of Understanding (MoU) and the draft work plan.

For the Board to note and comment on the proposals for progressing cardiovascular disease (CVD) as the Board’s top priority.

(a)    Update on Cardiovascular Disease Priority Work Programme

The Board received a report which followed the decision taken by the Health and Wellbeing Programme Board (HWPB) at its May meeting that Cardiovascular Disease (CVD) should be at the top priority focus area. The HWPB had tasked the Public Health Team with leading an exercise to scope CVD and to propose a work plan with key performance indicators and outcomes, to be considered and signed off by the HWPB and the HWB.

The Interim Director for Public Health introduced the report and advised that at its June meeting, the HWPB agreed that it would act as the steering group/programme board for CVD, given its priority on the health and wellbeing agenda.  It would be important to identify work streams already established for CVD to ensure that these were included in the governance arrangements and to avoid duplication.

It was further advised that the best approach to embedding the CVD priority was to pull together all work currently taking place within the city across organisations which related to CVD and its treatment or causes, to ensure that CVD was given a higher profile in these work streams and that there were reporting streams with metrics and data collection aligned.

The HWPB had agreed that the CVD Programme should be split into three thematic work streams, these being:

·           Prevention and Early Intervention;

·           Healthcare and Rehabilitation/Reablement; and

·           Continuing Support

The arrangements for progression of work were outlined, as proposed by the HWPB which included a half day stakeholder and work stream mapping event being led by the Public Health Team, to build upon the proposed work streams.

Members debated the report and comments and responses to questions included:

·         The CCG had CVD as a priority and the work should remain connected with the new duties and responsibilities arising from the Care Act;

·         The Area Team hosted a strategic clinical network for Cardio Vascular services and support would be readily available from them; and

·         This was an extremely important issue for the city, and the way the situation was approached needed to be clarified going forward.

RESOLVED

The Board noted the proposals for progressing Cardiovascular Disease (CVD) as the Board’s top priority.

For the Board to receive a verbal update.

This was to be a verbal update to the Board and due to time constraints, the Board agreed to receive further an update in writing.

The Board is requested to comment on the letter and draft action plan.

The Board received a report which followed the feedback letter being received from the Peer Review and development of a draft action plan.

RESOLVED

The Board noted the report.

The Board to receive and note the Cabinet report of the 30 June 2014.

The Board received the noted the report as presented to Cabinet on 30 June 2014.

The Board noted the dates and agreed future agenda items for the Board.