Agenda and minutes

All Members who believe they have a Disclosable Pecuniary or other Pecuniary or non pecuniary Interest in any matter to be considered at the meeting must declare that interest and, having regard to the circumstances described in Section 3 paragraphs 3.25 – 3.27 of the Councillors’ Code of Conduct, leave the meeting while the matter is discussed, save for exercising any right to speak in accordance with Paragraph 3.28 of the Code.

The Chair will ask Members to confirm that they do not have a declarable interest.

All Members making a declaration will be required to complete a Declaration of Interests at Meetings form detailing the nature of their interest.

Agenda Item 11(a): Pharmaceutical Needs Assessment - Dr O’Donnell declared that the GP Practice he worked at had a pharmacy on site. Dr O’Donnell remained in the meeting and took part in the discussion regarding this agenda item.

Resolved –  That the minutes of the meeting held on 16^th July 2014 be approved as a correct record.

NB – update on Better Care Fund to follow.

The Board were presented with an updated Better Care Fund (BCF) Plan and reminded that the purpose of the BCF was to create a health and social care  pooled budget, which brought together services for adults in order to improve integrated and holistic working with the aim of improving outcomes for service users. Board Members were provided with an update on the implications, benefits and risks associated with the updated BCF.

The Assistant Director, Adult Social Care, reminded Members that NHS England would transfer £1,100m to local authorities during 2014/15 to fund adult social care services, £200m of which was intended to assist local authorities and clinical commissioning groups prepare for the implementation of the BCF pooled budget in 2015/16. There were a number of conditions associated with the funding:

• That each Health and Wellbeing Board must have agreed its Better Care Fund Plan in order to have access to its share of the £200m Better Care Fund allocated in 2014/15.
• That the remaining £900m must be used to support adult social care services which have a health benefit; local authorities must demonstrate how the funding transfer will make a positive difference to social care services.
• That there was joint leadership of the CCG and the Council through the Health and Wellbeing Board and that there is agreement on how funding is best used.
• That there is regard to the local Joint Strategic Needs Assessment and existing partnership commissioning plans in how the funding is used. 

It was explained that funding in Slough would be used on a range of existing preventative and core services that would support the wellbeing of residents, deliver integrated care and allow service users to be supported at home. It was anticipated that these schemes would make a significant contribution to admission avoidance, promoting earlier discharge from hospitals and increased capacity in the local health and social care economy.

Board Members were advised that due to legislative and policy changes, the BCF Plan had been updated and a revised version had been submitted to NHS England on 19^th September 2014. Four priority areas identified for Slough’s BCF delivery were detailed as:

• Proactive Care: identifying those people in the community who were most vulnerable and supporting them through care planning and providing access to an accountable professional. 
• A single point of access: establishing and running a single contact point (with a single telephone number) for accessing a range of short term health and social care services; supporting those in crisis and directing them into the right services in a co-ordinated and timely manner.
• Integrated Care Services: Greater co-ordination of the range of services locally that supported people in crisis or short term need.
• Strengthening Community Capacity: Greater utilisation and development of the voluntary and community sector through a more co-ordinated and integrated commissioning approach.

A query was raised relating to how vulnerable individuals were identified. The Board were informed that all partner agencies had a responsibility to identify vulnerable individuals and for this information to be shared with all agencies. In addition, a pro-active approach would be implemented with GP surgeries, each of whom had a 2% risk list of vulnerable patients. The importance of data sharing and a joint approach by all partners was emphasized.

Concern relating to performance related funding was raised. The Assistant Director explained that funding corresponding to any reductions, formed one element of the pay for performance fund. It was brought to Members attention that a 3.5% minimum target level reduction in total emergency admissions was set for Slough. If the locally set target was achieved then all of the funding linked to performance would be released to spend on agreed BCF activities. However, if the target was not achieved, the Clinical Commissioning Group (CCG) would retain the money proportional to performance, to be spent by the CCG in consultation with the Wellbeing Board.

Board Members welcomed the updated BCF Plan, noting that it provided a strengthened opportunity for improved partnership working and enabling the health and social care needs of residents and patients of Slough to be met in a more integrated and cost effective manner.

Resolved –  a) That the Board note that the Council will enter into a Section 256 Agreement to receive £2.362m for the purpose of providing health and social care services and that this funding forms part of the Slough Better Care Fund from 2104/15.

  b) That the proposed use of funding to maintain existing services, protect preventative services and to invest in new services to meet increased demand arising from population growth and ill health be approved.

c)  That the proposed targets and governance arrangements for the spending of the funds be approved. 

d)  That the updated Slough Better Care Fund Plan 2015/16, as submitted to NHS England on 19^th September, be endorsed.

e)  That a further report on the Better Care Fund performance, funding and delivery to be presented to the Board in February 2015.  

The Board were reminded that the Self Care, Personal Responsibility and Engagement Task and Finish Group was established by the Board in March 2013. The remit of the Group was to establish a programme of activities that supported the Slough Wellbeing Board in its ambition to encourage residents to take a more active role in their own wellbeing and that of their wider communities and manage their health more successfully. 

Members were informed that the Group developed five themes to focus on in further detail  - access to primary care, young carers, health checks, domestic abuse and civic responsibility/volunteering. A summary of activities undertaken under each work stream and outcomes achieved were highlighted.

It was brought to Members attention that in response to reducing the number of visits made to secondary care providers for issues that could be effectively resolved by primary care providers; 147,000 patients were now able to book appointments into the early evening Monday to Friday and at weekends. Patients were also being offered more flexible appointments by telephone and email. It was agreed that further work was required to examine the reasons relating to those GP appointments that were not attended by individuals and whether techniques could be developed to emphasise the impact of not attending an appointment.

It was explained that using a range of behavioural techniques had not only assisted officers in developing a range of more innovative interventions that were more effective and possibly cheaper to deliver; but had also ensured that residents received a more pleasant experience. Such an approach had led to partners collaborating on the delivery of a range of joint wellbeing priorities. 

Board Members welcomed the experience led commissioning approach and emphasized the importance of maximising the ‘Self Care, Personal Responsibility’ elements within the Better Care Fund Plan.

It was agreed that due to the outcomes for a number of work streams not yet finalised, a further report would be brought to the Board once these had been completed. 

Resolved – a) That details of the report be noted and a further report be considered by the Board in six months time.

b) Conclusions formulated regarding the findings of the Group be circulated to all partner agencies.

c) Further work to be carried out by the Group examining GP appointments not attended by individuals.

Colin Pill, Chair of Healthwatch, Slough, presented details of the Annual Report 2013/14. The legislative context within which Healthwatch was established was outlined and the Board reminded that Healthwatch was the independent consumer champion for health and social care for children, young people and adults living, working and using services in Slough.

Board Members were informed that there were six priority themes which would inform the work plan for Healthwatch in 2014/15. The themes were noted as:

• Access to Services including timeliness
• Information about service provision and treatment
• Quality (including process and outcomes)
• Integration of Health and Social Care
• Grievance and redress i.e. complaints process and outcomes 
• Dignity/Respect

Progress on the work plan was outlined and projects for 2014/15 highlighted. Current projects included Wexham Park Hospital Discharge Project and GP appointments.

Mr Pill raised concerns in relation to funding of and resources available to Healthwatch. A number of suggestions were made to increase the profile of Healthwatch which included an article in the Council’s online newspaper, The Citizen, leaflets in GP surgeries and information on the Streetlife website – a local information sharing network.  It was agreed that contact details of the Streetlife website would be forwarded to Mr Pill. 

Resolved – That the Healthwatch Annual Report 2013/14 and Work Plan 2014/15 be endorsed.

The Board considered a draft report of the Slough Safeguarding Adults Board for the period April 2013 to March 2014. Members were informed that there had been significant personnel and organisational changes over the past twelve months. Members were reminded of the strategic objectives, as set out in the Board’ three year Strategic Business Plan. Key developments were brought to Members attention including:

·  In ensuring all agencies had a clear process for managing safeguarding cases, a training session – focusing on the emergency services – was held in March 2014. South Central Ambulance Service were moving towards electronic record keeping which would assist in the quality and speed of safeguarding referrals.

·  Heatherwood and Wexham Park Hospitals NHS Foundation Trust had reviewed their discharge policy and set up a new discharge group to focus on safe discharges.

·  Over the past twelve months the Board had reviewed and developed its Sub-Groups.

Plans for each of the partner agencies for the forthcoming year were outlined. A Multi-Agency Safeguarding Hub (MASH) had been created with a view to identify how to implement MASH facilities across Berkshire. The aim was to increase multi-agency decision making within the safeguarding arena for children and adults, thus improving the quality of information sharing between agencies in order that decision making can be both quicker and better. 

A Member asked whether the appropriate mechanisms were in place to deal with the wide ranging issues that may arise in relation to adult safeguarding. The Assistant Director, Adult Social Care informed the Board that a Safeguarding Review Panel had been established that monitored safeguarding issues that arose across the country and any relevant information was reported to the Safeguarding Adults Board. Although there had been an increase in the number of service users of Adult Social Care during 2013/14, it was explained that in 2012/13 the figure had been significantly lower than the England average.

Following a general discussion regarding safeguarding alerts and referrals, the issue of individuals from abroad marrying vulnerable adults was raised. The Assistant Director confirmed that no such referrals had been made and that the Adult Safeguarding Board had carried out work in relation to this specific issue a number of years ago.

Resolved – That the Slough Safeguarding Adults Board Report April 2013 to March 2014 be noted.

The Assistant Director, Children, Young People and Families presented the Annual Report of the Local Safeguarding Children Board (LSCB) 2013/14. It was brought to Members attention that since the publication of the LSCB annual report the Independent Chair had left and procedures were in place to replace the vacancy as soon as possible.

Following an Ofsted inspection in November 2013, Slough’s children services were judged as inadequate. Whilst the inspectors recognised that improvements had been secured since the previous inspection in 2011, these were not deemed sufficient to secure an improved grade judgement. It was noted that failure to recruit permanent social workers had had a significant impact on delivery of services. Furthermore, the inability to evidence clear and positive impact on the delivery or early help and child protection services in terms of the quality of these services and their impact on safeguarding outcomes for children and young people had contributed to the overall inadequate judgement. The areas identified for immediate action and development in the Ofsted review for the LSCB were incorporated into the Business Plan for 2013/14 with immediate effect and also featured prominently in the Business Plan for 2014/15. 

The Board were reminded that Ofsted had recognised that the LSCB key priorities were appropriate and clearly identified and therefore the priorities for 2014-17 remained unchanged from the previous year. The priorities were outlined as:

i)  To be assured of the effectiveness and co-ordination of safeguarding practice in Slough.

ii)  To target areas that had been identified of particular safeguarding risk in Slough.

iii)  To improve the effectiveness of the Slough LSCB.

iv)  To improve communication and engagement between the Slough LSCB and children and young people, wider communities, front line practitioners and partner agencies.

v)  To develop the workforce to enable it to deliver the improvements and outcomes sought. 

Details of the work carried out by the LSCB were highlighted. In 2013 the Early Help Strategy and supporting Early Help Action Plan were reviewed and revised accordingly, to secure greater effectiveness in early intervention work and to secure greater synergy between early help and children’s social care interventions. A key part of this new strategy was the introduction of a single ‘front door’ for access to services.

The Board were informed that the Local Authority had a statutory obligation to  employ a Designated Officer, that was the point of contact should any partner agency have concerns relating to a social worker. Since the individual had been in post there had been an increase in the number of referrals made to the Designated Officer when compared to previous years. This meant that the most appropriate response was targeted to any given situation.

Work of the various sub-groups was outlined and specifically that of the Child Sexual Exploitation (CSE) and Trafficking Sub-Group. Key pieces of work were implemented following securing of the CSE Coordinator Post, including developing a CSE indicator tool. The indicator tool was used to aid referrals and information sharing in relation to young people who were at risk of CSE or exploitation. Training to increase awareness of CSE had been carried out with partner agencies, schools and various sections of the community.

A number of points were raised in the ensuing discussion, which included:

·  Low attendance figures from a number of organisations was noted.  Members were informed that a number of measures had been implemented to ensure an improvement in attendance at future meetings.

·  A Member asked what measures had been taken to increase awareness of CSE, both within the communities of Slough and education settings. The Assistant Director informed the Board that all schools in Slough had appointed a senior teacher from within their school as a designated Child Protection lead in relation to CSE. A publicity campaign had been carried out raising awareness amongst licensed premises trade, licensed drivers and voluntary sector partners. In addition, CSE continued to be raised amongst local businesses and communities via the Neighbourhood Watch Officers. The Director, Strategic Health and Wellbeing informed Board Members that a CSE Task Group, to include elected members and representatives from Thames valley Police, was in the process of being established.

·  Arrangements were in place to recruit to the vacant LSCB Independent Chair position and the Board would be informed of the appointment in due course.

Resolved –  That the Local Safeguarding Children Board Annual Report 2013/14 be noted. 

Members were informed that the Children and Young People’s Partnership Board had agreed to revise its terms of reference in order to strengthen the accountability of Members and the effectiveness of the Board to implement the children and young people’s agenda.

Resolved – That the amendments to the terms of reference for the Children and Young People’s Partnership Board, as set out in the report, be endorsed.

Board Members were provided with an update on current Climate Change and Carbon Management projects and achievements.

Resolved – That the report be noted.

Details of Slough’s Joint Autism Strategy 2014-17 were noted.

Resolved – That the Joint Autism Strategy 2014-17 be noted.

Board Members noted the results of the Sexual Health Service Review and the procurement options appraisal exercise.

Resolved –  That the update on Sexual Health Services procurement be noted. 

Board Members were reminded that from April 2013 Health and Wellbeing Boards had a statutory responsibility to keep an up to date statement of the Pharmaceutical Needs Assessment (PNA). It was noted that a PNA was a statement of the pharmaceutical services which were currently provided, together with when and where these are available to a given population.

The draft PNA was considered by the Board and it was agreed that subject to agreement of the document by key stakeholders, a consultation would be carried out over the autumn. The PNA would be presented to the Board in February 2015, prior to a final document being agreed in April 2015.

Resolved – That the draft PNA be circulated for consultation.

To note.

Details of the work programme for the year ahead were noted.

Resolved – That the Future Work Programme be noted.

Resolved – That the record of Members Attendance be noted.

12^th November 2014

The date of the next meeting was confirmed as 12^th November 2014.