Apologies were received from: Cllr Sirajul Islam, Denise Radley, Dr Navina Evans – Edwin Ndlovu attended as a substitute, Marcus Barnett – Dan Rutland attended as a substitute, Selina Douglas – Steve Collins attended as a substitute, Jackie Fearon.

To note any declarations of interest made by members of the Board. (See attached note of Monitoring Officer).

There were no declarations of pecuniary interests.

To confirm as a correct record the minutes of the meeting of the Tower Hamlets Health and Wellbeing Board held on 16 July 2019 and to note the Forward Plan.

RESOLVED:

1.    The minutes of the meeting held on 16 July 2019 were approved as an accurate record and signed by the Chair.

Simon Hall (Director of TransformationEast London Health & Care Partnership) briefed the Board on his work on developing a long term plan for north east London.

Summary of key points:

·         NHS England had instructed the north east London Health and Care Partnership to draw up a Long Term Plan which required the inclusion of three key elements. These were:

o   To develop a strategy delivery plan or ‘the narrative plan’.

o    To submit a planning tool – this would be a spreadsheet containing activities, financial resource and workforce requirement.

o   To submit a Long Term Plan Collection Tool – this was essentially a performance tool with 50 key metrics to monitor. 

·         Engagement exercises included running workshops on mental health, bringing systems together and there was a showcase event in June.  A first draft had been prepared but a firmer second version would be available to executive Board members in the next few days, including the Chair and Director of Public Health.

·         The Board were asked to comment on whether the document looked accurate and whether it was suited to the north east London and local level.

·         Maternity and mental health plans were on the east london health and care partner website. It was noted the work on metrics and workforce would not be completed until the 27 September 2019. These aspects would be completed on the day the first draft is submitted to NHS England. So far out of 50 performance indicators, guidance had been submitted for around 30 of them.

·         The final draft would be submitted to NHS England on 15 November 2019.

·         Local challenges were highlighted. These included: 

o   Significant population growth 2.02 million to 2.28millon by 2028. 13% rise so the new system would need to ensure resources could meet needs. 

o   2. Variation in clinical quality and outcomes across the north east London patch and the need to tackle health inequalities as a system.

o   3. Workforce was identified as a big challenge, difficulty in recruiting staff in all disciples was a concern. It was noted that technology would be required to be used more efficiently and local workforce would need to be grown. 

o   4. It was noted the current health and care system did not have the financial resource to continue with the existing financial model and this would need to be addressed in the plan.

·         In order to mitigate challenges the following solutions were identified:

o   Greater emphasis in preventing ill health and empowering people to take control of their own health.  And putting resources behind prevention.

o   Ensuring the services provided were integrated and joined up.

o   The need to rapidly modernise the approach to service provision including utilising the NHS academic and research base.

·         Emerging vision - the intention behind the plan was for it to be realistic for the north east London area and for it to link with other clinical strategies and the London Mayor’s vision.

·         Transparency and openness was a principle behind the plan. It was important  ...  view the full minutes text for item 4.

The Board received the report of Phil Carr (strategy & policy manager HAC) and Carrie Kilpatrick (Commissioning Manager) on the Mental Health Strategy Refresh.

In response to the report the following comments were made by the Board:

Benchmarking:

A member asked for a benchmarking exercise to take place on the level of mental health need in the borough compared with neighbouring boroughs.

Impact of adverse childhood experiences:

There was a question on to what extent the strategy considered parenting and adverse childhood experiences. It was noted this was mentioned in the third priority in reference to perinatal care but not throughout the life course.

Strategy alignment:

The Board noted it was important for the mental health strategy to align with the Health and Wellbeing Strategy and Long Term Plan to ensure consistency especially around the ‘I’ statements.  In addition to this the Substance Misuse Strategy was identified as another key strategy to align with due to the interconnection with duel diagnosis. Officers said it was an opportunity to strengthen engagement between the two strategies.

The Chair suggested it would be useful to appoint a substance misuse representative to join the Health and Wellbeing Board.

Governance of the Strategy

Members asked who was responsible for the overall governance of the strategy. It was noted that there was a mental health strategy working group but the Health and Wellbeing Board was ultimately responsible for the strategy’s sign off.  It was decided that a Health and Wellbeing Board member should participate in the mental health strategy working group to oversee the work.

Alternative solutions

There was a comment that the pressure on the Adult Improving Access to Psychological Therapies programme (IAPT) to address need and the inevitability of having to look at broader ways of accessing care, such as self-care or digital support, was not mentioned in the strategy document.

Housing:

A Member raised a point about training housing officers to recognise mental health and the implications of poor housing on mental health. Officers explained that the strategy was committed to providing mental health first aid training which would include to housing officers and mental health would be considered in the Place strategy. The Chair asked if there was any way of monitoring the commitments made by other strategies. Officers explained that the delivery plan would link to commitments made and monitor progress.

Engagement

The Board expressed concern that the strategy had not sufficiently conducted outreach and engagement work, particularly with the BME and other risk groups identified in the report. The Chair said that given high levels of mental health amongst the BME community in the borough, it was imperative greater outreach work was conducted and that a one size fits all strategy would not serve the needs of borough.

The Chair used the example of the reclassification of Khat to a class A drug and its effects on the Somali community, as an example of the depth of engagement she would have like the strategy to present in relation to BME mental  ...  view the full minutes text for item 5.

The Board received an update on the Health and Wellbeing Strategy consultation 2020-2025 from Dr Somen Banerjee, Director of Public Health.

Approach to the strategy consultation and sought the members views on the approach.

The Board were asked to consider the following:

·         The strategic leadership of the Board and how to work together in the new health and social care system.

·         How to co-produce priorities of the strategy.

·         There was a subsequent piece of work on how to measure the ‘I’ statements clustered around the themes of wider determinants of health, healthy lives, quality of care and support, integration and quality of life. These formed the framework for engagement.

·         There was a summary of questions that would be posed to the public at upcoming engagement events.

·         Plan to engage health and wellbeing locality networks. It was noted that it was important to be inclusive and identify potential gaps in perspectives.

·         It was noted the strategy would be discussed at the December 2019 Health Summit.

·         It was noted that there was a Health and Wellbeing Board workshop scheduled for February 2020 to discuss Board priorities and alignment with other work streams on key issues.

Member comments:

·         With regard to questions to pose at consultation events, it was suggested that providers should also be asked ‘what is the reality of your staff?’  It was noted staff health and wellbeing should also be considered.

·         There was a suggestion to include in the document a section on ‘what people wanted us to do’ and ‘what we did.’ Members said people tended to want to engage when they could see they had made a difference.

·         To cross fertilise the Health and Wellbeing Strategy with the Long Term Plan.

·         Overall Members were in agreement with the development and direction of the Health and Wellbeing Strategy draft.

RESOLVED:

1.    To note the update on the development of the Health and Wellbeing Strategy 2020.

The Board received an update on the SEND improvement plan from Christine McGinnes (Service Head Education & Partnership).

In response to the briefing the following discussions took place:

JSNA

Simon Twite (Public Health Programme - Lead Early Years) was thanked for his work on integrating the SEND plan into the JSNA refresh.

Risks

A poor track record of sharing data and professionals speaking as one voice on an agreed narrative, were identified as potential risks during the inspection.

Given the high needs funding block, it was noted there was a growing demand for support shown by a higher uptake of education health and care plans (EHCPs) and an increase in SEND Transport need.  Officers said the council had excellent provision for SEND was committed to providing a range of support including continued provision in mainstream schools and special schools.

Rationing

A Member asked whether the action plans and recovery plans were working or if rationing was required. Officers explained that the recovery plan for the Dedicated School Grand had been submitted to the Department for Education and the council was awaiting a response from the government regarding additional grant funding.

Officers said they were reviewing the EHCP process to ensure it was rigorous enough and EHCPs were suited to the people receiving them. There were no plans to ration EHCPs but it was likely some flexibility would be required to ensure the system was working properly, such as providing earlier intervention for speech and language issues. Officers informed the Board that a consultation was also underway to review a reduction of top up funding and gather views on the level of funding for the different bands of EHCP. They also said council was also looking to improve transport and support more people to travel independently.

Members were encouraged to attend the SEND event roadshows and get in touch with Christine for details.

ACTION: For Christine to circulate the SEND Code of Practice and the SEND Self-Assessment document to the Board.

RESOLVED:

1.    To note the update.

Members were invited to the Barts Health AGM on 18 September 2019 at the Royal London 11am-3pm and Mile End Hospital at 3-6pm.

There was a request to reduce the number of pages in the agenda pack. The Chair sought ideas from the Board to change the format of the meeting to make it more interactive rather than reports based. Members were advised to contact the Chair for if they had any thoughts on the matter.

The vice chair suggested verbal updates from Board Members would be useful as well as shorter reports to tease out and discuss key issues.

Dr Somen Banerjee informed the Board he was working with the communications team to develop a Health and Wellbeing Board web page.

The Chair noted that the timing of the meeting was difficult for some Members. It was agreed the next meeting would start at 6pm on a trial basis to monitor attendance.

There was a discussion on changing the location of the meeting but members advised against the idea saying that it had been tried in the past and did not result in more engagement with the public. It was also difficult to find suitable venues.