The Chair, Councillor Rachel Saunders, welcomed everyone to the meeting and then asked for introductions. 

Apologies for absence were received from Councillor Amy Whitelock Gibbs, Charlie Ladyman – Co-Chair Healthwatch Tower Hamlets, Jackie Sullivan – Managing Director of Hospitals, Barts Health Trust, Jane Ball – representative from Tower Hamlets Housing Forum, Fahimul Islam – Young Mayor and Stephen Ashley – Independent Chair of the Local Safeguarding Children’s Board.

To confirm as a correct record the minutes of the meeting of the Tower Hamlets Health and Wellbeing Board held on. Also to consider matters arising.

The minutes from the Board meeting of 18 April 2017 were agreed and approved as an accurate record of the meeting. 

Somen Banerjee, Director of Public Health, referred to the actions from the minutes of the last meeting, namely:

·         Page 4 refers to a repository where data and intelligence is collated in one place.  Mr Banerjee stated that Healthwatch had confirmed that they have a repository that can be used for this purpose.

·         Page 7 refers to Barts NHS Trust sharing findings of their research into sugar reduction and healthier foods with their new catering and facilities provider.  Mr Banerjee pointed out that there was potentially an opportunity around the catering contract.  

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

None.

Members were asked to note the forward plan for the Health and Wellbeing Board for the 2017/18 municipal year. 

Councillor Hassell referred to ‘Physical Activity and Sport Strategy’ report, stating that it was agreed at the last Board meeting that the report was brought forward from the 20 December 2017 meeting, to be considered at the 5 September 2017 meeting.  Mr Banerjee explained that the intention was to bring the report to the 7 November 2017 meeting, however, stated that the timeline had slipped.  He said that if the report came before the board in December, then it would give the Board sufficient time to comment on the consultation document.

Denise Radley, Corporate Director of Health, Adults and Community Services, stated that a report on information governance needed to be added to the agenda for 5 September 2017.

The Chair and Board Members agreed the amendment.

The Chair explained that the Council had had its AGM where she had been appointed Chair of the Health and Wellbeing Board. 

The Chair welcomed Patrick Goulbourne, Borough Commander for Tower Hamlets at the London Fire Brigade and Alison Robert – Partnership Manager, Tower Hamlets Community and Voluntary Sector as co-opted Members of the Board.  She added that Charlie Ladyman – Chair of Healthwatch was on maternity leave and confirmed that Sebastian Austin Thomas Pisano was born on 3 July at the Royal London Hospital and that both mother and baby were doing well. The Chair welcomed Karen Bollan who attended on behalf of the Health watch Chair.

The Chair pointed out that nothing significant had changed in relation to the Board’s Terms of reference, Membership and Quorum for the 2017/18 municipal year. 

RESOLVED – That:-

1.         The Terms of Reference, Quorum, Membership and dates of future meetings be noted.

2.         It be noted that Councillor Rachel Saunders was the new chair of the Health and Wellbeing Board following the announcement of the Mayor’s Executive Team at the Annual Meeting of the Council held on 17 May 2017.

3.         Patrick Goulbourne, Borough Commander at the London Fire Brigade was welcomed to the Board as a co-opted member, whilst noting that the appointment would support the Boards’ priorities around community safety and health.

Ms Radley provided a presentation on the Health and Wellbeing Board Strategy 2017-20, specifically on developing an integrated system.  In doing so, she explained the intention to deliver better health services through partnership work.  Her presentation also covered the following points:

More People Saying

·         “I have easy access to information, advice and guidance which helps me to find what I need”

·         “It’s easy to get help from my GP practices and I can contact my Care Coordinator whenever I have questions”

·         “There are different people involved in supporting me but everyone listens to what I want and helps me to achieve my goals.”

Tower Hamlets Together

·         Our integrated health and social care partnership for the borough (in NHS terms an “accountable care system”.

·         Tower Hamlets Together Health & Wellbeing Board – position as high level board overseeing the partnership and adopt branding – clear democratic accountability for the partnership.

·         Implications for the role and remit of the Board – Paper to September Board.

·         Tower Hamlets Together governance structure under this – borough focus on integrated health and social care – streamline.

·         HWB development session – shared vision and governance (to be re-arranged).

·         Development of joint commissioning within this framework – Director of Integrated Commissioning.

·         East London Health & Care Partnership, Transforming Services Together (subsidiarity).

·         Locality focused health and social care delivery model.

Shared Vision

Key elements are:

·         Arranging care around the person

·         Tackling poverty /deprivation

·         Care closer to home

·         Task – to restate the vision in simple terms

Community Engagement

·         Tower Hamlets Together engagement activity to date

·         THT Engagement Forum

·         Community commissioning work on community contract in CCG

·         Co-produced local strategies e.g. carers, older people

·         Developing the measures around the effectiveness of co-ordination

·         Needs to be clear how this happens at all parts of THT – public engagement and co-production

·         Providers – we need to get the networks right

·         Locality Integrated Care Boards – review of role

Fully integrated health and care system

·         New Joint Role – Director of Integrated Commissioning

·         Joint Commissioning – the culture changes needed to achieve this

·         Transparency around total spend and contractual arrangements

·         Define what “accountable care” means to us in TH – accepting it is NHS language and has no single definition – focus on a collaboration which aims to address our local issues within a clear financial envelope

·         Future of the alliance contract model within the CCG

·         Consolidation/alliance versus provider plurality and diversity

Culture Change

·         Focus on individuals and outcomes

·         Tiered model – what are we doing to support different parts of the population

·         OD programme – how do we get the right measures

·         Trust and confidence in staff taking the right decisions close to the front line – support when people make a mistake

·         Getting the measures – bringing together how each organisation tracks

·         Overall measure of satisfaction?

·         Feedback to services – how do we make this a system wide approach?

·         What is key to delivering culture change?  Single point of access?

·         Sufficient focus on adult social care

Further Reflections

·         Single registration?  A  ...  view the full minutes text for item 5.1

Somen Banerjee, Director of Public Health introduced the report which provided an action plan that set out what will have been achieved by March 2018, the overall plan for the year, what will be done in the next three months and how success would be measured for each of the actions within the ‘healthier place’ priority. 

Mr Banerjee referred to page 32 of the report and explained that previously the Board had agreed on areas that would need improvement. 

Councillor Edgar referred to Action 2.1 and asked how money was being spent to try and shape the process.  It was also pointed out that prioritising was important in this instance as every application submitted could not be assessed.  Councillor Hassell impressed the importance of selecting the right applications. 

Dr Everington referred to Action 2.1 and stated that 50% of children were vitamin D deficient and said this was a measure of them not spending much time outside. 

Councillor Edgar stated that it was important to change people’s views with regard to children playing outside.  He referred to certain signs (for example – no ball games allowed) that restricted children playing and said that people needed to become more tolerant.  He pointed out that many people considered children playing in green spaces to be anti-social behaviour.  Ms Radley explained that the Council had been specific in saying that they did not consider such activity to be anti-social behaviour.

Dr Ian Basnett, Public Health Director of Barts Health NHS Trust, stated that it was important to consider what could be done collectively.  He suggested that initiatives such as supporting cycle to work schemes and bans on idling vehicles would be advantageous and said that it would be beneficial to ask membership organisations to sign up to the initiatives.  Mr Banerjee agreed that there were many existing frameworks which could be turned into local pledges. 

Patrick Goulbourne, Borough Commander for London Fire Brigade (LFB), explained that the LFB had committed to change their fleet to electric vehicles.  He made the point that it would be beneficial if other organisations made a similar commitment.

Mr Banerjee introduced the report and explained that the foundation of the Health and Wellbeing Strategy was a shared outcomes framework that articulated the partnership aspiration for improvement of health and wellbeing in the borough. 

Mr Banerjee stated that the work commissioned by Tower Hamlets Together in 2016/17 involved working with partners and the public to identify a set of primary outcomes and primary and secondary indicators to track progress against primary outcomes.  He then explained that the report outlined the plans for 2017/18 to establish the Outcomes Framework as a foundation and central point of reference and logic modelling for driving improvement in health outcomes.

Dr Navina Evans, Director of Operations and Deputy Chief Executive of East London NHS and the Foundation, stated that she was interested in patient reported outcome measures.  She explained that if they worked well, what was discovered could be a reflection on the whole system. 

Dr Basnett described the content of the report as being excellent.  He asked that, in setting the system up, could a capability be created to analyse the information from an equality perspective.  

Lonica Vanclay, Interim Project Manager, Joint Commissioning, Clinical Commissioning Group, introduced the report and explained that the report presented a near final draft of the annual learning disability Strategy with information about the process and timescales for completion.  She stated that the aim was to provide the Board with an opportunity to input to and guide the Strategy.

Ms Vanclay explained that in drafting the Strategy, they had sought views from those with learning disabilities, partners and carers.  She stated that those with learning difficulties had lower life expectancies and lower employment levels that the rest of the population. 

Ms Vanclay said that the Strategy set out key actions for the next few years and confirmed that it would be brought back to the Board for final sign off. 

The Chair asked that it was made clear in the Strategy how people with learning difficulties have gained employment and that case studies were used to highlight the point. 

Ms Radley said that this was a big issue and asked if there was more that could be done in this Council to improve the number of people employed with learning difficulties. 

Mr Banerjee asked where the drive would come from in Primary Care for this to happen and whether GPs were being championed. 

RESOLVED – That the Health and Wellbeing Board:

1.    Agrees that the Strategy does use Health and Wellbeing branding

2.    Agrees that the joint Chairs of the Board do wish to have a foreword under their signature in the Strategy.

3.     Notes that the final designed version will come to the Board for approval on 5 September 2017 (then to CCG Governing Body on 6 September and Cabinet on 19 September).

4.    Agrees that the Learning Disability Partnership Board report to the Board through the Joint Commissioning Executive.

Dr Hannah Emmett, Speciality Registrar in Public Health, gave a short introduction on the report and provided a presentation on creating a Suicide Prevention Plan for Tower Hamlets and, in doing so, focussed on the following points:

Context

·         5 year forward view for mental health: requirement for all local authorities to have a suicide prevention plan in place by 2017.

·         National target – 10% reduction 2016-21

·         Public Health England guidance: risk factors and possible areas for action

Risk Factors – children and young people

·         Mental ill health and domestic violence in the family

·         Academic and exam pressures

·         Physical, emotional or sexual abuse or neglect

·         Social isolation or withdrawal

·         Bereavement of a family member of friend

·         Physical health conditions that have a special impact

·         Bullying either in person or online impact

·         Excessive alcohol use or illicit drug use

·         Suicide-related internet use

·         Mental ill health, suicidal ideation, self-harm

Focus for consultation

·         Are these the right priorities?

·         Are the monitoring arrangements sufficient?

·         Should the zero suicide option be adopted?

Risk Factors

·         Long-term circumstances e.g. history of drug or alcohol abuse

·         Acute life events e.g. loss of employment or debt

Key Issues

·         Numbers relatively small

·         Far-reaching impact

·         Specific local concerns

Local data

·         Men outnumber women 4 to 1

·         Over half suicides are aged 20-39

·         Most common methods are injury and hanging

Improving help for those in crisis – long term aims

More people will:

·         Feel in control of their mental health

·         Know how to access help when they need it

·         Access mental health services in an appropriate setting

Improving help for those in crisis – in the next 12 months

We will:

·         Examine the needs of people attending A&E in crisis

·         Map the current crisis referral pathway and address any gaps

Shaping the Strategy

·         LBTH Council departments

·         NHS

·         Emergency services

·         Universities and schools

·         Voluntary sector

·         Transport services

·         Directorate Leadership Team (DLT) and Corporate Leadership Team (CLT)

·         Mental Health Partnership Board

·         Drug and Alcohol Action Team

·         Educational psychology

·         TH Inter Faith Forum

Early intervention and prevention – long term aims

More people will:

·         Access services in the early stages of mental illness

·         Be assessed for mental illness when they are most at risk

·         Have the personal tools to help them cope with stressors

Early intervention and prevention – in the next 12 months

We will:

·         Work with specialist mental health services for targeted groups

·         Improve signposting of our existing preventative work

Identifying the needs of vulnerable people – long term aims

·         Frontline staff will recognise signs of mental illness and have a range of referral options

·         Service users in temporary accommodation will be followed up appropriately

·         Responsibility for service users housed outside the borough will be clear

Identifying the needs of vulnerable people – in the next 12 months

We will:

·         Share safeguarding lessons learnt

·         Improve practice in  non-clinical statutory services

·         Improve support for specific vulnerable groups

Addressing training needs – long term aims

We will:

·         Ensure that suicide prevention is embedded in the wider community

·         Meet the training needs of clinical and non-clinical  ...  view the full minutes text for item 7.

Karen Sugars, Interim Service Head of Commissioning and Health, introduced the report and in doing so, explained that in June 2013, the Government Spending Round set out plans for new funding arrangements, now referred to as the Better Care Fund (BCF).  She confirmed that the aim of the BCF was to deliver better outcomes and secure greater efficiency in health and social care services through better integration of provision and to accelerate health and social care integration across the country. 

Councillor Hassell stated that he was pleased to see planned work around anti-social behaviour and mental health. The Chair asked for a note setting out the work being done in those areas.

The Health and Wellbeing Board were recommended to:

1.1         note the current position concerning the development of the Improved Better Care Fund programme for 2017-19.

1.2         approve the approach being followed and the proposed programme summarised in Appendix 2.

1.3         agree that oversight of the final programme should be delegated to the Joint Commissioning Executive.

1.4         agree that, subject to agreement by the Joint Commissioning Executive, the proposed contingency provision should be allocated to further initiatives.

1.5         agree that, subject to the finalisation of the proposals, schemes should be initiated with immediate effect.

The remaining Members of the Board agreed that the above recommendations were put to the Health and Wellbeing Board on 5 September 2017, for formal adoption. 

Abigail Knight, Associate Director of Public Health for Children and Families, introduced the report.  She explained that the School Health service and the Children and Family Weight Management service were funded from the local authority public health grant and were moving into the final year of three year contracts and, as a result, would need to be re-commissioned. 

The Chair stated that child obesity was a priority for the Board and explained that there was a sub-group charged with reviewing the issue.  She stated that the subject needed a more detailed conversation and Councillor Hassell requested an update on what pressures there were. 

The Health and Wellbeing Board was recommended to review the briefing and comment on the proposed new model. 

The remaining Members of the Board agreed that the briefing was reviewed and that the proposed new model was further commented on at the next Health and Wellbeing Board on 5 September 2017.

Health and Wellbeing Development Session

The Chair explained that the Board was trying to schedule a Health and Wellbeing development session to focus on shared vision and governance.  The Chair proposed setting a date in September to continue discussions.  She asked that colleagues provide details of their availability to Jamal Uddin – Strategy, Policy and Performance Officer. 

The Chair also suggested the Board consider extending the start of the next Board meeting by an hour to facilitate the development session (i.e. 5^th September at 4.30pm).

Physical Activity and Sport Strategy

The Chair explained that a previous meeting of the Health and Wellbeing Board, Members had shown interest in engaging with the Physical Activity and Sport Strategy.  She stated that it would not be possible to bring an update to the Board at the September 2017 meeting but confirmed that she would like to hold a consultation session with Board members only, in order to encourage Board participation.

Healthwatch Community Event

The Chair confirmed that Healthwatch was holding a community event with Health and Wellbeing Board partners on Wednesday 9 August at 11.30am – 3.30pm.  She stated that the event would take place in Victoria Park next to the large children’s playground.  She confirmed that:

·         Board Members were encouraged to attend and spread the word; and

·         An e-flier would be circulated to Board Members for information.

Tuesday, 5 September 2017 at 5.30 p.m. in MP702, 7th Floor, Mulberry Place, 5 Clove Crescent, London, E14 2BG.