Agenda and minutes

To approve the record of the meeting held on  22 October 2013.

The record of the meeting held on 22 October 2013 was agreed and signed by the Chairman. 

Apologies for absence were received from Councillor Hicks, Dr Fargher and Alison Burchell. 

A member of the Board need only disclose at any meeting the existence of a disclosable pecuniary interest (DPI) in a matter to be considered at that meeting if that DPI has not been entered on the disclosable pecuniary interests register maintained by the Monitoring Officer.

A member disclosing a DPI at a meeting must thereafter notify the Monitoring Officer in writing of that interest within 28 days from the date of disclosure at the meeting.

A member may not participate in a discussion of or vote on any matter in which he or she has a DPI (both those already registered and those disclosed at the meeting) and must withdraw from the room during such discussion/vote.

Board members may choose to voluntarily disclose a DPI at a meeting even if it is registered on the council’s register of disclosable pecuniary interests but there is no legal requirement to do so.

Members should also ensure they disclose any other interests which may give rise to a conflict under the council’s code of conduct.

In line with the training provided by the Monitoring Officer members will also need to consider bias and pre-determination in certain circumstances and whether they have a conflict of interest or should otherwise leave the room for Code reasons.

Disclosable pecuniary interests

There were none.

Other interests

There were none.

The purpose of this report is to provide information to the Board on shortlisted priority actions on the Joint Health and Wellbeing Strategy and to ask the Board to reach final agreement on key priority actions for 2014/15.

Discussion:

The Acting Consultant in Public Health Medicine gave a brief introduction to the report on the review of priority actions for the Joint Health and Wellbeing Strategy and responded to Members’ questions.

Councillor Doe queried the unemployment statistics referenced on page 35 of the agenda, which suggests that Medway’s Health Profile indicates that long term employment is significantly worse for Medway than the national average.  He felt this did not fit with information he had received about the period October to December 2013, which showed the numbers of unemployed, had reduced by 2,000 people in Medway.  The Director of Public Health agreed to check this statement to ensure that the information was still current.  Councillor Doe also expressed the view that maintaining physical health should be reflected more in the priority actions.

The Chief Clinical Officer, NHS Medway Clinical Commissioning Group, explained that while there would always be issues, which were high priority, the priority actions chosen for the Joint Health and Wellbeing Strategy were those items, which lent themselves to benefitting particularly from collaborative working.

Councillor Maple requested that the stakeholders involved in the engagement event at the St George’s Centre be kept informed of progress and sent the table attached to the report as an update.

Dr Beach welcomed being a theme lead but suggested it would be beneficial for each theme lead to be briefed on their role.

Decision: 

(a)   The Board agreed the key priority actions and theme leads for 2014/2015 with the addition of the Director, Kent and Medway Area Team, NHS England, as joint theme lead for theme 3 prevent early death and increase years of healthy life;

(b)   It was agreed that the table appended to the report would be shared with stakeholders who attended the event held at St George’s Centre;

(c)   An update was requested on unemployment figures outside of the meeting;

(d)   It was agreed that there would be a briefing provided for theme leads about their role.

This paper provides an update on the discussions that have been taking place as part of the Call to Action debate, which is being led locally by NHS England (Kent and Medway) and the NHS Medway Clinical Commissioning Group (CCG).

Discussion:

The Director, Kent and Medway Area Team, NHS England and the Chief Clinical Officer, NHS Medway CCG introduced a report setting out engagement events relating to the Call to Action debate which, it was stated, sets out the challenges facing the local NHS and calls on patients, the public, NHS staff and other key stakeholders to have an open and honest debate about the future shape of the health service.

A Pharmacy Call to Action would be held on 6 February 2014 and further events for Optometry Call to Action and Dentistry Call to Action had been planned.  The Director, Kent and Medway Area Team, NHS England undertook to advise of all Call to Action events leading up to May 2014 and responding to a request, undertook to investigate how the hard to reach groups were being reached, in particular those who were not literate or IT literate.  She explained that more detail would be available at the next meeting.

The Chief Clinical Officer, NHS Medway CCG referred to a local event which had taken place in July and measures which had been taken to communicate with the public, patients and stakeholders which included an advertisement in Medway Matters and Mosaic profiling to ensure that the views were representative of the whole population.  He anticipated there being a strategy document by late March to encapsulate a lot of the information gleaned from the Call to Action event.

Responding to a question about difficulties accessing nurses, continuity of GPs and the use of new technology between clinical professionals, he stated:

• Plans are progressing to allow nurses in training to have placements in primary care within Medway. The hope is that they will both be able to provide some additional service provision whilst training but also be more likely to consider working in primary care in Medway in the future.

• 10 practices in Medway are involved in training doctors. As well as doctors training to be GPs there are an increasing number of doctors who as part of their general foundation training are spending time in general practice to gain experience. This can have the effect of lessening the continuity of care patients receive but should improve the quality of care that's provided in the future by having better trained doctors. Where patients particularly want to see a particular doctor most practices try to accommodate this but it may mean a slightly longer wait.

• Technology is already being used to improve the availability of patient information and therefore patient care. Medway has both a high rate of uploading of a patients summary care record from their GP notes and a high usage of that information in out of hour care. Use of patient identifiable information can only be done with the consent of the patient and access is audited and monitored.  Consideration was being given as to how this could be enhanced in the future.

Referring to page 65 of the agenda Dr Beach requested that Healthwatch Medway be involved in  ...  view the full minutes text for item 693.

This paper provides an update on the development of the CCG plan with a focus on the alignment to the proposed priorities in the Joint Health and Wellbeing Strategy.

The detailed CCG plan (draft) will be presented to the February Health and Wellbeing Board meeting; this will include more detail on the vision and transformational priorities and 2 year operational plans.

Discussion:

The Chief Clinical Officer, NHS Medway CCG explained that the report contained a high level summary of the NHS Medway CCG Commissioning plan and stated that the plan would be required to be submitted to NHS England by mid February.  

He stated that the intention was to work smarter, engaging with partners and service users with the aim of encouraging people to take more responsibility for their health needs in order to prevent ill-health.

The view was expressed that education around preventing ill-health was important and needed to be embedded in the system.  Responding to a question, the Director of Children and Adults referred to ongoing work in secondary schools but also set out the high demands on schools in what could and could not be covered as part of the curriculum.

Dr Beach referred to the document `Transforming participation in Health and Care “The NHS belongs to us all” set out in the following link:

http://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf

He commended the engagement cycle set out in the document.  The Director of Public Health then referred to the fact the communications and engagement paper would be considered at the next meeting of the Board and it was agreed that consideration could be given to the engagement cycle then.

The Chief Clinical Officer, NHS Medway CCG responding to a question agreed to make sure that the mapping exercise referenced on page 76 of the agenda did not duplicate any of the work of the mapping exercise being undertaken by Public Health.

Decision: 

The report was noted and it was acknowledged that the full commissioning plans would be considered at the next meeting of the Board.

This report provides the Health and Wellbeing Board with background information in relation to the Better Care Fund Plan and its implications for Medway.

The Board is requested to note the progress made to date in relation to developing the Better Care Fund Plan for submission to the Local Government Association (LGA)/NHS England by 14 February 2014, given the externally imposed deadlines currently being worked towards.

Discussion:

The Deputy Director, Children and Adults gave a powerpoint presentation setting out the basic principles of the Better Care Fund Plan and the potential schemes which could be developed as a result of it.  Emphasis was, however, placed on the fact that this was not new money and was set in a backdrop of pressures in the system where savings had to be made.  The money would be subject to payment by results and nationally agreed performance indicators would be set with a minimal space for local indicators.

The local vision, aims and objectives were set out and the success of the prevention agenda would be crucial in reducing unnecessary hospital admissions or lengths of stay.  The Chief Clinical Officer of NHS Medway CCG pointed out that having invested commissioning resources in the Better Care Fund the CCG would still be responsible for commissioning in the acute sector if the preventions did not work.

Considerable interest was shown about the monitoring of outcomes for the public and progress against indicators and the Deputy Director, Children and Adults was requested to consider how best to report this information to the board in the future.

In view of the short timescales involved in submitting a draft plan by 14 February and then the final plan by 4 April 2014 it was agreed that the first submission would be sent round electronically to all Board members allowing them 48 hours to comment.  A special meeting of the Board would be held in late March to enable them to endorse the plan before final submission.

Decision: 

(a)   The Board noted and supported the proposed governance journey for the delivery of the Better Care Fund Plan, with the addition of the following wording (shown in bold below) to the recommendation set out in the Cabinet papers for 14 January 2014 meeting as follows:

8.3.           That Cabinet agree to delegate authority for the final sign off of the plan to the Director of Children and Adults Services, in consultation with the Portfolio Holder for Adults Services following endorsement of the plan by the Health and Wellbeing Board.

(b)   It was agreed that a special meeting of the Health and Wellbeing Board should be arranged for late March to enable the Board to endorse the plans before final submission;

(c)   It was agreed that the Deputy Director, Children and Adults would advise the Board how they will be kept informed of progress against performance following that submission.

At the Board meeting on 22 October the Head of Communications and Marketing explained the concept of having the three key messages for the Board flowing from each Board meeting and the responsibility of Board Members to feedback on the outcome at the next meeting.  The three key messages from the last meeting related to:

1. Bringing together the organisations working in Medway to pave the way for improving the health and wellbeing of people in the area
2. Backing Medway’s Lottery bid
3. Delivering work to map people, places and organisations involved in healthy eating and physical activity in Medway

It is suggested that a number of Board Members will be invited to contribute as appropriate at the meeting.

Discussion:

The Director of Public Health explained the concept of three key messages, which it was stated, would be agreed at each meeting and taken forward to the next.  The intention being that each Board member would incorporate those key messages in their work between meetings and report back any issues to the next meeting.

It was also stated that the Big Lottery Bid had involved engagement in a large scale and there had also been engagement in relation to the mapping exercise, which would be considered later in the meeting.

The three key messages to be taken forward were handed out at the meeting and can be accessed on the following link:

http://democracy.medway.gov.uk/mgConvert2Pdf.aspx?ID=7532&T=9

Decision:

The three key messages handed out at the meeting were noted.

This report is for information but seeks comments on the proposal to undertake consultation on a draft planning guidance note to tackle the issue of obesity through the built environment. The guidance will encourage the restriction of hot food takeaways in sensitive areas where children are likely to gather, such as schools and play areas. Following consultation, the intention is to implement a final guidance note that can form a material consideration in the determination of planning applications for hot food takeaways.

Discussion:

The Development Policy and Engagement Manager, assisted by the Planner (Policy) introduced the guidance note that had been devised to form a material consideration in the determination of planning applications for hot food takeaways and responded to Board Members’ questions.

Board Members welcomed the guidance and the point was made that now Public Health were embedded into the local authority more guidance should follow to create an environment which supports people to make healthy lifestyle choices.

Responding to a question, the Development Policy and Engagement Manager undertook to share with the Board the key timetable around the consultation on this guidance.

Following further questions it was agreed that consultation should be undertaken with schools and faith communities and that the research, which supports the view that preventing such outlets close to schools actually improves healthy eating, should be shared with the Board.

Board Members felt that the co-operation of schools would be important in getting the messages about healthy eating across.  Reference was made to the Member Task Group on Healthy Eating and its impact.

Councillor Carr expressed caution at the guidance on the basis that the Planning Inspectorate may not be supportive of it and would be likely to overturn any decision made by the local authority following any appeal.

Decision: 

Officers were thanked for their report and the Board gave support to the consultation process and suggested that schools are invited to be involved in the application of the guidance.

An asset-based approach to improving physical and mental health and wellbeing is being taken in Medway. This approach is intended to complement Medway’s Joint Strategic Needs Assessment and significantly enhance understanding of the strengths and assets, as well as the deficits, which exist within Medway’s communities.

The initial phase of this approach involves the mapping of Medway-wide assets relating to physical activity and healthy eating. The purpose of this paper is to update the Board on progress on this asset mapping project.

Discussion:

The Acting Consultant in Public Health Medicine gave a short introduction to a report updating the Board on progress with mapping local assets.  She referred to the work of the Steering Group and stated that there was a robust quality assurance process in place and further assets would be identified by late March.  Phase 1 was on target for completion at the end of May 2014, following which Phase 2 would be planned.

Decision: 

The update was noted.

There will be a verbal update on progress at Medway Maritime Hospital as a consequence of the Keogh review. 

Discussion:

The Director, Kent and Medway Area Team, NHS England gave a verbal update on the Keogh review at Medway Maritime Hospital and stated that Medway NHS Foundation Trust were making a strenuous effort to implement the action plan but some of these efforts had been hampered by the recent floods and evacuation of vulnerable people and the unannounced inspection of the Accident and Emergency department on 31 December 2013.  A report on that inspection should be received within a few days.

The Chairman referred to the Member briefing conducted by the Chief Executive of Medway NHS Foundation Trust and referred to a second briefing, which had yet to be scheduled.  He agreed to forward details from the earlier briefing to all Members of the Board.

In response to a question the Director, Kent and Medway Area Team, NHS England confirmed that a Healthwatch Medway representative had been present at the review meetings at the hospital.

Decision: 

The verbal report was noted and it was agreed that there would be a more detailed update to the next meeting from Kent and Medway Area Team, NHS England and NHS Medway CCG.

This report presents the Annual Public Health Report of the Director of Public Health for 2012/13.  The report focuses on the health of school-aged children and makes recommendations for Medway Council and partners. 

Discussion:

The Director of Public Health gave a brief introduction to her report, which focussed on the health of school-aged children.  Board members commended the Director of Public Health and her staff on the usefulness of the report and expressed the view that it contained a wealth of information. 

Decision:

The Board noted the report.

This report advises the Board of the forward work programme for discussion in the light of latest priorities, issues and circumstances.  It gives the Board an opportunity to shape and direct the Board’s activities.  The Board is asked to note that the Health and Adult Social Care Overview and Scrutiny Committee has invited representatives from this Committee to attend its meeting on 18 April 2014 in order to scrutinise the work of the Health and Wellbeing Board.

Discussion:

The Democratic Services Officer referred to a supplementary paper circulated at the meeting, shown on the following link:

http://democracy.medway.gov.uk/mgConvert2Pdf.aspx?ID=7525&T=9

This set out a request from Health and Adult Social Care Overview and Scrutiny Committee for the Board to ask NHS England to write to the General Medical Council to conclude their hearing for Dr Oshinusi before the Care Quality Commission conduct their appeal into the practice registration in March 2014.

She also pointed out a request made at the pre-planning meeting for the Board for a presentation on pharmaceutical contracting at a future meeting.

The Chairman requested that the 25 February meeting be moved to 4pm.  As this presented a problem for some Board Members the Democratic Services Officer was requested to look at options outside of the meeting.

In relation to the appearance of the Board at Health and Adult Social Care Overview and Scrutiny Committee in April 2014, it was stated that this would be dealt with in a similar way to scrutiny of the Community Safety Partnership and it was suggested that each group represented on the Board could attend. In advance of the meeting a written update from the Director of Public Health would be submitted updating on progress so far with a forward look also included.

Decision:

(a)   It was agreed that Kent and Medway, NHS England be asked to write to the General Medical Council as set out above;

(b)   The Board agreed to have a presentation on pharmaceutical contracting at a future meeting, with a date to be agreed;

(c)   It was noted that an invitation to the Board to attend Health and Adult Social Care Overview and Scrutiny Committee on 18 April 2014 had been received.  Nominations would be put forward closer to the time of the meeting;