Agenda and minutes

The Chair welcomed Brendan Sarsfield as a new member of the Board.

Apologieswere received from Dr Simon Parton and Frankie Sulke.

The minutes of 19 September 2013 were agreed as an accurate record.

There were no matters arising.

Elizabeth Butler (Chair, Lewisham & Greenwich NHS Trust) explained that as her son has autism she had a non-pecuniary interest in Item 9 (“The 2010 Adult Autism Strategy Fulfilling and Rewarding Lives – Evaluating Progress”).

Carmel Langstaff (Service Manager, Policy and Strategy, Community Services, LBL) updated the Board regarding the now completed process to identify an additional voluntary and community sector representative. Peter Ramrayka of the Indo-Caribbean Organisation secured a majority of the votes at an election held at the Health and Social Care Forum in October.

The Board:

1.            Agreed to submit a recommendation to appoint Peter Ramrayka to the Health and Wellbeing Board to full Council in January; and

Agreed to change the date of the next meeting to 28 January 2014, in order to facilitate the above submission to full Council prior to the next Health and Wellbeing Board.

Katrina McCormick (Deputy Director of Public Health, LBL) presented the report, with recommendations for action for discussion and approval.

The following points were highlighted in the discussion:

·      Danny Ruta felt that successful integration would prevent needs escalating and support people to leave hospital sooner.

·      Elizabeth Butler said the focus should be on ensuring people get the right intervention at the right time.

·      Brendan Sarsfield asked Board members to consider what non-health services can do to support the identification of frail older people. Danny Ruta explained that the report recommends that further work is undertaken to develop a tool locally that could be used by a range of services. Marc Rowland suggested that existing tools could be utilised.

The Board:

·      Noted the content of the review.

·      Noted that the report will inform commissioning intentions and the development of relevant strategies, programmes and activities in relation to frail older people in Lewisham.

·      Suggested that further consideration be given to developing appropriate identification and risk stratification tools in Lewisham.

Genevieve Macklin (Head of Strategic Housing, LBL) updated the Board on the Council’s Older People’s Housing Strategy. The Board was asked to make suggestions for the further development of the strategy and consider how more integrated working between housing, health and social care might achieve better outcomes for older residents.

The following points were highlighted in the presentation and discussion:

·         The Council has a number of initiatives (for example Marine Wharf, Chiddingstone and Hazlehurst) to address the undersupply of extra care housing in the borough.

·         The “co-housing” model supports intergenerational living, facilitates entry into the property market and reintroduces the concept of the good neighbour. Community development work provides an important way of connecting communities who will support each other to stay independent.

·         The increase in life expectancy is creating a challenge to the existing model of housing provision and will require a different approach.

·         Handyman services need to be provided more quickly and be linked to the supply of specialist equipment.

·         It was suggested that the Board consider the housing stock, across all types of tenure, and examine how changing needs are identified.

The Board:

·         Noted the report; and

Agreed to further discussion at a future Board meeting on the impact of housing on health and well being.

Charles Malcolm-Smith (Head of Strategy & Organisational Development, NHS Lewisham Clinical Commissioning Group) presented Lewisham CCG’s five-year Commissioning Strategy.  The strategy sets out the vision and ambition of the CCG and includes an analysis of health needs, the financial situation and the views of the public. It identifies eight strategic priorities that are aligned with Lewisham’s Health & Wellbeing Strategy.

The strategy will inform the further development of the CCG’s commissioning intentions and QIPP implementation plans for 2014-15.  Each strategic priority area is led by a CCG clinician supported by commissioning managers from the CCG and/or the Joint Commissioning Unit.

The Board:

·          Noted the contents of the CCG’s Commissioning Strategy, its five- year vision, the case for change and the strategic priorities.

Aileen Buckton, Executive Director for Community Services, LBL, presented the Programme Initiation Document for the Integrated Adult Care Programme and sought agreement on the scope of the programme, the proposed deliverables and the arrangements to take this work forward.

Aileen Buckton updated the Board on the status of the bid submitted to the Department of Health to become a Pioneer in health and social care integration.  The National Partners informed the Council at the end of October that Lewisham’s bid was not included in the final selection but stated that they hoped that Lewisham would continue to benefit in some way from the wider programme of support planned.

Aileen Buckton explained that £4.9m is available from the Integration Transformation Fund to support Lewisham’s integration programme in 2013-14.  In 2014-15, additional monies are proposed and Lewisham’s total allocation is expected to be in the region of £5.9m. The specific amount to be transferred to Lewisham for 2015-16 has not yet been announced. The Board was asked to approve the budget for 2013-14. Detailed discussions are currently taking place between the CCG and the Council, and a proposal regarding the 2014-15 budget will be presented to the Health and Wellbeing Board for approval in January.

Next steps include:

·         Leads and project groups for each of the proposed workstreams to be established.

·         Each workstream to develop a project plan, ensuring that existing projects are aligned under the appropriate workstream.

·         The Adult Integration Programme Board (AIPB) to identify critical dependencies to ensure that projects are prioritised appropriately.

·         The AIPB to ensure that a robust evaluation framework is in place for the programme.

·         A communications plan to be developed.

·         Each project group to provide regular progress reports to the AIPB, the Health and Wellbeing Board and other key stakeholder boards.

·         Detailed financial modelling will be undertaken as part of the programme.

The following points were highlighted in the discussion:

·         The majority of resources from the Integration Transformation Fund (ITF) do not represent new money. ITF funding will be performance-related.

·         The approach to integration needs to be understood and reiterated by partners including GPs in order to achieve culture change among professionals and residents. 

·         The programme needs to establish a whole system approach to achieve sustainable and cost effective change.

·         The Government has identified a set of indicators to measure performance. Local measures will be developed to capture benefits of the preventative programmes.

·         The benefits of healthy living should be publicised for Lewisham’s residents through agreed common messages.

·         Integration will remain on the Board’s agenda for the next 2-3 years.

The Board:

·         Agreed the Programme Initiation Document and noted the proposed next steps to take this work forward.

·         Secured commitment from member organisations to engage with each workstream as and when necessary.

·         Agreed the expenditure schedule to be submitted to NHS England regarding the spend in 2013/14.

·         Noted the unsuccessful outcome of the Pioneer bid.

Agreed that the Adult Integration Programme Boardwould map the structures and strategies in place at the  ...  view the full minutes text for item 7.

Jane Miller (Deputy Director of Public Health, LBL) presented the report which outlined the contribution that the participatory budgeting schemes have made to improving health outcomes of the overall North Lewisham Health Improvement programme. 

NICE guidance states that community engagement can improve health outcomes. Evidence from the five local schemes developed within the North Lewisham Health Improvement Programme demonstrates that allocating funding to community organisations is an effective way of engaging local communities and responding to their different needs. Improved health outcomes included: increased consumption of fruit and vegetables, increased levels of physical activity and improved mental wellbeing. The schemes also raised awareness of alcohol consumption and sign-posted users to the Stop Smoking Service.

As a result of the programme, a rich knowledge base about how to reach communities, raise awareness, change behaviour and improve health outcomes had been developed. In the discussion, members commented that it was important to utilise the knowledge and expertise on participatory budgeting that now exists in Lewisham.

The Board:

·         Noted the effectiveness of participatory budgeting in reaching communities, encouraging behaviour change and improving health outcomes.

·         Agreed that the use of participatory budgeting schemes will be considered in the delivery of the Health and Wellbeing Strategy objectives and as part of the delivery of the Integrated Adult Care Programme.

Agreed to ensure that the learning about how to run participatory budgeting schemes effectively will be applied to new schemes.

Corinne Moocarme (Associate Director, Physical Disability, NHS Lewisham Clinical Commissioning Group, Joint Commissioning Unit) presented the report and explained that Directors of Adult Social Services had been requested by the Department of Health to take forward the second self-assessment exercise for the implementation of the Adult Autism Strategy. It is a requirement of this process that submissions are discussed by the local Health and Wellbeing Board by the end of January 2014. The returns will be analysed by the Public Health England learning disabilities observatory. All local responses will be published in full online.

The self-assessment highlights that Lewisham is looking to establish a community that accepts and understands autism and provide an infrastructure that supports adults with Autism/Asperger’s syndrome to live fulfilling and rewarding lives. Corinne reported that there had already been several promising and innovative developments in response to the National Strategy. The Joint Commissioning Plan for Adults with Autism may need to be reviewed in light of the self-assessment.

Rita Craft (CLASH) made a brief presentation that outlined the need for specialist housing support for adults with Asperger’s Syndrome and autism. CLASH felt that the work of the housing support group had stalled and explained that they had been informed that specialist housing is not available for high-functioning (autistic) adults. Rita argued that housing for autistic people, who are often economically very active, should be part of the Lewisham Housing Strategy.

The following points were highlighted in the discussion:

·          The needs of people with autism are very varied and further work is needed to identify a range of appropriate housing options.

·          Elizabeth Butler queried the range of opportunities and support available in the Borough to support employment of adults with autism.  She felt it could not be a “one size fits all” approach as adults with autism had a wide range of different skills and abilities.  Corinne referenced an autism-specific apprenticeship scheme at St Thomas’s Hospital, and said that as large employers (health and social care) we should all consider our duties towards inclusivity (especially with regard to apprenticeship schemes).  Burgess Autistic Trust is actively working with potential employees to widen the range of job opportunities locally for adults with autism.

·          In response to a query from Marc Rowland regarding the role of Primary Care in supporting the implementation of the Autism Strategy, Corinne referred to the recommendations contained in Dr Ratna Ganguly’s report Autism in Lewisham, (June 2013). This recommended a review of the needs of children and young people with autism spectrum disorder in transition and a regular audit of the number of people diagnosed with Autism.  Corinne said that more work needed to be done to identify what sort of training primary care staff required and how best this could be provided.

The Board:

·          Noted the content of the Lewisham Autism Self Assessment Framework and declared its support for local implementation work.

·          Agreed that further work should be undertaken to identify a range of specialist housing options and  ...  view the full minutes text for item 9.

Jane Miller (Deputy Director of Public Health, LBL) presented the report. She explained the background to the Local Government Declaration on Tobacco Control and sought support for the London Borough of Lewisham to sign the declaration.

The Declaration commits the Council to:

•                    Reducing smoking prevalence and health inequalities

•                    Developing plans with partners and local communities

•                    Participating in local and regional networks

•                    Supporting Government action at national level

•                   Protecting tobacco control work from the commercial and vested interests   of the tobacco industry

•                    Monitoring the progress of plans

•                    Joining the Smokefree Action Coalition.           

Lewisham had been invited to attend the Parliamentary launch of the Local Government Declaration on Tobacco Control on 11 December.

The Board:

Agreed that it would be beneficial for the London Borough of Lewisham tosign the Local Government Declaration on Tobacco Control.

Ed Knowles (Service Manager - Commissioning and Strategy, Children and Young People) presented the proposal on the bid. He explained that the Fulfilling Lives – A Better Start is a Big Lottery Fund bid for between £30 - £50million over 10 years, to achieve:

•         A step change in outcomes for 0-3 year olds and their families, specifically in the areas of:

-          Diet and nutrition

-          Speech and communication

-          Social and emotional wellbeing.

•         A system change that provides the evidence for early intervention and preventative activity and results in communities empowered to support parents-to-be, parents, young families and their children.

•         A commensurate reduction in the need for reactive or remedial interventions from statutory organisations.

Lewisham’s proposal has been shortlisted and work is now underway to develop the final bid.  It proposes intensive activity in four wards: Bellingham, Downham, Evelyn and New Cross.  The deadline for applications is 28 February 2014.

Investment will:

•        Provide support and skills to parents-to-be

•        Develop community resources and expertise

•        Encourage healthy, safe and supporting environments 

•        Tailor healthcare and other local services, including early years providers, so that they respond early and in a way that best meets the needs of the child and the carers.

The Board was invited to:

•         Ensure that its understanding of local needs draws upon the expertise and working practice of partner organizations.

•         Consider whether there are innovative, evidence-based interventions that could be expanded in these four wards.

•         Participate in the resource-mapping exercise so that we have a clear understanding of the existing level of investment.

•         Attend ‘A Better Start’, the conference planned for February 2014.

•         Provide support around the forthcoming strategy day.

The following points were highlighted in the discussion:

•         The bid was welcomed as a positive development and should highlight Lewisham’s track record of delivery.

•         4-year-olds are coming into schools with complex needs and evidence of this should be gathered from schools to support the bid.

The Board:

·          Agreed to support the bid.

Carmel Langstaff highlighted key reports from the upcoming programme for 2014, noting that the entries for May and July would be completed as items were proposed.

The Chair requested that Integration should always appear on the Board’s agenda, and even if that is the only item, the meeting should be scheduled around it.

The Board:

·          Requested that the work programme be amended to:

-          Ensure that integration is considered at every Health and Wellbeing Board meeting

-          Include an update on housing

-          Include 6-monthly updates on the Adult Autism Strategy.

The meeting ended at 15:10 hrs.