Agenda and minutes

1.            Minutes of the last meeting and matters arising

1.1       The minutes of the last meeting were agreed as an accurate record, with no matters arising.

2.         Declarations of Interest

2.1       Items 4 and 6 for Charles Gostling (Clinical Director, Lewisham CCG) and Charles Malcolm-Smith (Deputy Director, Strategy & Organisational Development, Lewisham CCG).

3.         Healthier Communities Select Committee Referral on Lewisham Pensioner’s Forum Report (12/01/17)

3.1       The Chair introduced a referral report from the Healthier Communities Select Committee. This report informed the Health and Wellbeing Board of the views of the Healthier Communities Select Committee following evidence received from the Lewisham Pensioner’s Forum during the third evidence session of the committee’s review of health and adult social care integration on 12 January 2017.

3.2       Cathy Ashley and Judy Harrington of the Lewisham Pensioners’ Forum were invited, by the Chair, to address the Board. During their address, the representatives of the Lewisham Pensioners’ Forum:

·         raised concerns about the cost of implementation of adult social care and health integration;

·         noted that 'better care when you need it' is not a reality on the ground;

·         raised concerns about the resilience of the social care market;

·         noted that there is a need for resilient communities to absorb the gap in funding;

·         noted that it is only when services are needed that people are able to appreciate the impact of lost funding; and

·         asked that the Health & Wellbeing Board use its executive powers to consider the impact of spending cuts, on services, upon those who need them most.

3.3       Responding, Cllr Chris Best noted that although the Council had been under pressure, it had taken active steps to make the best use of funding available to it. Cllr Best also gave example of services that had been safeguarded such as swimming.

3.4       Responding, the Chair Sir Steve Bullock also stressed that the Council is taking steps to mitigate the impact of spending cuts on older people.

3.5       Action: The Board agreed the referral recommendations and for the response to go back to the Healthier Communities Select Committee. 

4.         South East London Sustainability and Transformation Plan: Update

4.1       Charles Malcolm-Smith (Deputy Director, Strategy & Organisational Development, Lewisham CCG) provided the Board with an update on the NHS South East London Sustainability and Transformation Plan, including the proposals for elective orthopaedic service.

4.2       A summary of key points from the briefing are as follows:

·         A leadership team of four individuals has been established to oversee the STP. In addition, governance arrangements have been revised through the development of a Strategic Planning Group involving all local NHS organisations, local government and patient representatives.

·         Public consultation into proposals to develop elective orthopaedic centres has been postponed until spring 2017.

·         The intention is to further develop proposals that would enable the public to consider the pros and cons of a two site as well as three site consolidation options.

·         Further engagement  will be undertaken during 2017, with local people and interest groups, to enable them to find out more about ‘Our Healthier South East London’s’ plans.

4.3       Responding to briefing, the Board noted that:

·         The governance arrangements for the South East London partnership need to be worked on.

·         Council leaders are committed to making the partnership work, however partners are not yet convinced that the finance for the strategic plan have been satisfactorily addressed.

·         There is still some confusion about the role and purpose of STPs, given that they are non-statutory entities.

4.4       Action: The Board noted the contents of the report.

5.         Better Care Fund Planning 2017-19

5.1       Bobbie Scott (Programme Support Officer, Lewisham CCG) provided members of the Board with an update on Better Care Fund (BCF) planning for 2017-18 and 2018-19.

5.2       The Policy Framework for the implementation of the BCF in 2017-18 and 2018-19 was published on 31 March 2017. The main change to the Framework from last year is the inclusion of a new grant for adult social care announced in the 2015 Spending Review and 2017 Spring Budget as the ‘Improved Better Care Fund (iBCF)’.

5.3       The iBCF will be paid directly to local authorities and must be used to meet adult social care needs, reduce NHS pressures and to stimulate the local social care provider market.

5.4       The number of national conditions in the framework has been reduced from eight in 2016-17 to four in 2017-19.

5.5       The detailed planning requirements and allocations that underpin the framework are still in the process of being finalised. As in 2016/17 the BCF Plan will be developed by Lewisham Council and Lewisham CCG.

5.6       The timetable for assurance and approval of BCF plans will be published in the Planning Guidance. The delay in publication is likely to result in a tight timetable for submission of our local BCF Plan. It is possible that approval and sign-off of the Plan will fall before the next meeting of the Health and Wellbeing Board in July.

5.7       In the meantime, a review of the 2016/17 BCF plan is taking place and a first draft of the 2017-18 and 2018-19 plan is being prepared addressing the key areas as set out in the Policy Framework.

5.8       In response the Board noted the following:

·         The Board should receive assurances that initiatives are working and that updates to this effect should be provided.

·         That an additional meeting of the Health and Wellbeing Board (before July) be scheduled to sign off the Better Care Fund Plan, if this cannot be done at the July meeting.

5.9       Action: The Board noted the contents of the report. An additional meeting of the Board was agreed if required.

6.         Whole System Model of Care – Neighbourhood Care Networks

6.1       Carmel Langstaff (Portfolio Manager, Whole System Model of Care) provided the Board with an update on the development of Neighbourhood Care Networks (NCN) in Lewisham.

6.2       Lewisham’s Neighbourhood Care Networks bring together local care networks, delivered by Lewisham’s Health and Care Partners (LHCP) and the networks of voluntary and community sector organisations within the same model.

6.3       LHCP are developing a local care network in each neighbourhood to transform the way in which community based care is delivered. By operating at this smaller scale, local care networks can more easily develop local connections between services, co-ordinate care and strengthen relationships between professionals.

6.4       The neighbourhood care network model is also being applied to existing services that work with children and young people and being further developed through the re-commissioning and re-design of children’s centres and health visitor services.

6.5       The following were highlighted as next steps for the whole system model of care approach:

·         strengthening the network of professionals delivering care and support;

·         strengthening the network of voluntary and community sectors organisations; and

·         strengthening the relationships between the statutory and voluntary sectors.

6.6       The LHCP Executive Board is supported by a number of steering groups, including a Communications and Engagement Steering Group. This group is accountable for developing and undertaking effective system wide communication and engagement activity.

6.7       Responding, the Board asked to know more about how the Hubs will be tweaked to reflect the needs of each area.  Carmel noted that the Hubs will be more than a ‘physical space’ and will instead be geared towards promoting community resilience. Carmel added that the use of digital technologies will be an important part of this.

6.8       Action: The recommendations of the report were agreed.

7.         Performance Dashboard Update – Exceptions Reporting

7.1       Dr Danny Ruta (Director of Public Health, LBL) provided members of the Board with an update on performance against its agreed priorities within the Health and Wellbeing Strategy and the performance indicators for the Better Care Fund.

7.2       A summary of key points from the briefing are as follows:

·         Premature deaths from cardio vascular disease has dropped (although not able to explain why) this could be part of a national trend.

·         Childhood obesity rates have come down; noted that a lot of work has gone into tackling obesity.

·         Breast feeding and MMR rates have increased; noted that a lot of work has gone into improve performance across both of these measures.

·         Premature deaths from cancer have increased. Noted that rising rates of adult obesity could be a factor in this, as this contributes to cancer.

·         Flu vaccinations have dropped.

·         Cervical screening rates have dropped.

7.3       Following the presentation a wider discussion ensued about funding for transformation in order to deliver improved health and well-being. The Board also discussed how systems can be used more effectively to manage the population’s health and identify those who might be vulnerable.

7.4       Action: The Board noted the contents of the report.

8.         Lewisham CCG Annual Report 2016-17 Update

8.1       Charles Malcolm-Smith (Deputy Director, Strategy & Organisational Development, Lewisham CCG) provided members of the Board with an update on the CCG’s annual report and accounts for 2016/17.

8.2       A requirement of the Health and Social Care Act 2012 is that the report includes the CCG’s contribution to local plans and strategies and that the Board is consulted in this regard in the preparation of the annual report.

8.3       The Board was invited to note the timescales that the CCG is working to.

8.4       Action: The Board noted the contents of the report.

9.         Health and Wellbeing Board Work Programme

9.1       Paul Aladenika (Clerk to the Board) presented the Board with a draft work programme for discussion and approval.

9.2       In response to a question raised by the Chair about the rationale for the Joint Strategic Needs Assessment Update, planned for July, Danny Ruta stated that he was looking to facilitate intelligent debate, at the Board, on the way forward.

9.3       Liz Butler asked for an item on One Public Estates to be included on the agenda for the July 2017 meeting.

9.4       Action: The Board noted the contents of the report.

A – Lewisham Safeguarding Children’s Board Annual Report 2015-16

B – Adult Social Care Local Account 2016-17