Draft Minutes of West Kent Health and Wellbeing Board Meeting
20 December 2016
Tonbridge & Malling Borough Council, Gibson Drive, Kings Hill,
West Malling, Kent, ME19 4LZ
Gail Arnold (GA) Chief Operating Officer, NHS West Kent Clinical Commissioning Group
Alison Broom (AB) Chief Executive, Maidstone Borough Council (MBC)
Pat Bosley (PB) Councillor, Sevenoaks District Council (SDC)
Lesley Bowles (LB) Chief Officer Communities & Business, SDC
NHS England (NHS E)
Roger Gough (Cllr RG) Councillor, Kent County Council (KCC) - Chair
Steve Humphrey (SH) Director of Planning, Housing & Environmental Health, Tonbridge & Malling Borough Council (TMBC)
Mark Lemon (ML) KCC
Gary Stevenson (GS) Head of Street Scene, Tunbridge Wells Borough Council (TWBC)
Malti Varshney (MV) Public Health Consultant, KCC, NHS WK CCG
Lynne Weatherly (Cllr LW) Councillor, TWBC
Nazima Chauhan NHS WK CCG
Kevin Driscoll (KD) Public Health England Kent, Surrey & Sussex
Tristan Godfrey (TG) STP Workforce Programme Manager , Kent and Medway Health Education England, Kent, Surrey and Sussex
Priscilla Kankam NHS WK CCG
Kas Hardy (KH) PH KCC
Jane Heeley (JH) TMBC
Matt Roberts MBC
Karen Sharp(KS) KCC
Heidi Ward TMBC
Sarah Ward (SW) MBC
Helen Wolstenholme TWBC
Yvonne Wilson (Minutes) NHS WK CCG
Welcome and Introductions
Vice Chair, Cllr Roger Gough was acting in the position of chair as Bob Bowes was unable to attend. Cllr Gough welcomed all present to the meeting.
Apologies were received from:
Dr Bob Bowes, Dr Tony Jones, Penny Graham, Cllr Maria Heslop, Dr Caroline Jessel, Reg Middleton, Dr Andrew Roxburgh, Dr Sanjay Singh, Cllr Fran Wilson, Julie Beilby had advised a Substitute – Steve Humphrey to attend.
Cllr Fran Wilson, Leader, Maidstone Borough Council will be attending the Board in the future as one of the Borough’s representatives.
Declaration of Disclosable Pecuniary Interests
There were none.
Minutes of the Previous Meeting – 18 October 2016
The minutes of the previous meeting were agreed as a true record.
Update: Implementing the Health and Wellbeing Board Annual Report Recommendations
It was reported that the date of the Board Development Event re-scheduled to the 17 January 2017 will need to re-arranged. A new date would be identified and invitations extended to Board members to participate.
Chief Executive Officer & Leader Meetings
Cllr Gough relayed feedback from Dr Bob Bowes on themes which have emerged in the course of the meetings between the CCG Accountable Officer (Ian Ayres) the Chair, Bob Bowes and the Leaders and Chief Executives of the four district and borough councils:
· Geography; the difference in size between the CCG area and the LAs’ areas make it difficult to engage and commit when the CCG has to have one policy across all. This will be simplified for the LAs by clustering of LAs but more complex for the CCG.
· Perception of the Boroughs/Districts are that although much Public Health data is received and debated by the board, the Board does not derive clear requests to commissioners from these conversations, in other words, progress seems stalled on delivery. The West Kent Health and Wellbeing Board (WK HWB) has not gained authority over commissioners, but also has not tried to do so.
· WK HWB has not moved commissioners towards budgetary unification; shared risk taking or joined-up commissioning. For example, NHS WK CCG and local authorities (LAs)have a crucial agenda in ‘one public estate’ but different stages of strategy development mean that CCG and LAs work on this has been limited so far, although good progress is being made in some areas.
CCG Town Hall Event
Representatives s from the 4 local councils took up an invitation to lead an all CCG Staff event in November to start the process of strengthening joint working/collaboration and generating better awareness of the role of local councils in promoting the health and wellbeing of local residents. The Town Hall event was led by senior council officers and covered the following key issues:
· How Councils work
· Decision making
· Local authority finances
· Day in the life of a Council:
· District/borough council role in health
· Tackling the wider determinants of Health
· Health Improvement Initiatives
· Case Studies (self-neglect; weight;)
· Scenarios – ‘doing things differently – working better together’
Golden Nuggets/Future Action – Progressing Make Every Contact Count (MECC) training for a range of staff groups; use of the Primary Care information resource (DORIS) to better promote referrals into the healthy lifestyles programmes offered by local councils; Risk identification; Need to explore opportunities around the development of New Primary Care Models; Social Prescribing; Better use of Technology and others who can support/promote wellbeing e.g., Pharmacists and Care Navigators.
It was resolved: to ensure that the issues highlighted in paras 4.2 and 4.3 inform the agenda for the planned Board Development event.
Yvonne Wilson/Bob Bowes
Yvonne Wilson/Bob Bowes
Ms Varshney and Mrs Wilson gave a brief introduction to the main findings of the report, drawing the Board’s attention to the various appendices highlighting the specific outcomes and recommendations identified to address the issues in the report. The Board’s attention was drawn to the fact that there were 7 recommendations, not eight as one was duplicated.
Comments in discussion included:
· Top level analysis unhelpful as it doesn’t sufficiently express what the difference is that should be expected. Particular reference made in relation to childhood obesity – a whole family approach required and information contained in report does not help the Board to be assured.(AB)
· Is there a strategy for measuring progress on Dementia issues? KHWB had asked all local HWBs to provide assurance.
· It was acknowledged that a number of the issues highlighted will need to be addressed in the Task & Finish Groups (JH) and the specific obesity reference in the report was found to be helpful (JH).
Ms Varshney and Mrs Wilson provided some further details to Board members about the actions required to ensure delivery against the outcomes, including childhood obesity.
It was resolved that:
The recommendations presented in the report are agreed and that a report to be prepared in time for the next Board meeting that sets out the details of who will be required to take what action to ensure the recommendations can be delivered by specific agencies/groups and how progress towards delivering meaningful outcomes will be effectively monitored.
Commissioning Children’s and Maternity Services – Proposals & Prospects
Karen Sharp, the Interim lead for Children’s Commissioning shared a Powerpoint Presentation which adopted an approach that considered universal, additional, intensive and specialist support/services model. Ms Sharp outlined areas of activity within Children’s Commissioning which included:
· Health Visiting (subject to a 10% efficiency savings programme in 2016 -17 and 2017 - 2018)
· School Nursing
· Family Support (New Youth and Young Carers provision)
· Intensive Support (Troubled Families, Drugs & Alcohol and Portage)
· Commissioning against outcomes (contained in the Children & Young People Framework)
Ms Sharp outlined the review programme which was underway. Ms Sharp explained that KCC’s ambition was to re-design services (linked to the KCC Front Door Review); create a stronger focus on emotional well-being; strengthen the school nursing service offer within secondary schools settings; better align school nursing with child and adolescent mental health services and establish greater synergy between different elements of the children/family support offer.
Ms Sharp emphasised current work towards integration in partnership between KCC and North Kent CCGs. The Plan included seeking opportunities for joint procurement, re-modelling; agreement on shared local priorities and better consistency of approach.
Comments, Discussion & Questions
· What linked work was being considered with districts, borough and Local Children’s Partnership Groups(LCPGs) and between KCC Specialist Commissioning and CCGs (needs of children with disabilities)?
· Indicators within the Children and Young People Framework of interest – what endorsement had been secured from partners and had any work been carried out to assess overlaps with the Joint Health & Wellbeing Strategy and CCG Plans?
· Perceived value in assessing the progress on the integration pilot in North Kent.
· Broad endorsement of the ‘direction of travel’ outlined and keenness expressed in reviewing progress and prospects for adopting/embedding good practice elsewhere.
· Note cross-Kent work to strengthen Children’s Centre, Early Help and Health Visiting collaboration.
· Interest in exploring the approach to risk assessment and early preventative support e.g., reviewing needs of families at risk of homelessness; vulnerable young people; young care leavers so as to anticipate needs and assemble early support/intervention.
It was resolved that:
The agencies represented on the WK HWB seek to formally endorse the Children & Young People Framework
Officers requested to prepare a report that provides a detailed update on the progress made towards embedding the new operational arrangements for integrated/ joint working currently being piloted by North Kent CCGs and KCC be submitted to the Board in 6-9 months’ time. The purpose will be to consider lessons learnt and to assess the prospects for implementing an integrated children’s service model across health and KCC in the West Kent area.
Relevant WK HWB Member organisations
Addressing Health Inequalities in West Kent
Ms Varshney and Ms Hardy introduced this item by presenting an overview of the key Public Health issues in relation to understanding relative deprivation across West Kent. Ms Hardy explained that mapping across Kent was evaluated at a West Kent level and paints the picture of little deprivation compared to Kent, with only 5 Lower Super Output Areas (LSOAs) being identified in the West Kent CCG area of having deprivation scores of 37.9 or above. However, this did not mean that West Kent does not have deprivation relative to its more affluent areas. Examples of the types of deprivation found in West Kent were shared.
Maidstone Borough Council
Sarah Ward, Maidstone’s Health & Housing Manager reported on how the Borough council had addressed the inequalities agenda. Ms Ward explained that the Maidstone Health and Wellbeing Board is the key mechanism for driving forward priorities identified for the area and owns the Inequalities Action Plan. Internal departments also held responsibility for contributing to delivery. A review of progress highlights that the following areas are significantly worse than the national average:
· Statutory Homelessness Acceptances (per 1000 households)
· Admission episodes for alcohol-related conditions (ASR per 100,000)
· Excess winter deaths (single year, all ages/person)
Four sub groups are established to lead delivery and in addition, a range of other stakeholders will contribute, such as KCC, CCGs and voluntary and community sector partners.
Sevenoaks District Council
Lesley Bowles, Chief Officer, Communities and Business updated the Board on the objectives, actions and priorities set out in the council’s Inequalities Plan. Ms Bowles explained the arrangements for reviewing progress, identifying achievements and areas of challenge. Five main areas of concern have been highlighted:
· An increase in numbers killed or seriously injured on our roads (45.1 to 51.8 per 100,000 population)
· Increases in smoking related deaths (164 to 236.1 per 100,00 population), excess winter deaths (17.6 to 19.6 ratio) and hip fractures in 65s and over (451 to 616 per 100,000 population)
· Increases in recorded diabetes (5.0% to 5.4%) and malignant melanoma (13.7 to 18.0 per 100,000 population)
· An increase in drug use (2.0 to 2.2 per 1,000 population)
· An increase in alcohol specific hospital stays for the under 18s (35.0 to 28.9 per 100,00 population)
Ms Bowles reported that a new three year plan which includes six priorities for action had been approved for the period 2015 – 2018 and at the half year stage, just over 89% of actions were ‘on target’.
Tonbridge & Malling Borough Council
Jane Heeley, the Chief Environmental Health Officer presented the update on work carried out at TMBC. Ms Heeley explained that a partnership body and a group representing key frontline services held responsibility for delivering a range of activities intended to address health inequalities. Ms Heeley explained how the Council’s Inequalities Plan reflected the six Life-course objectives as categorised in the Marmot Review (2010).
Ms Heeley reported on the plans for developing a new Health Inequalities Action Plan in 2017 to run until 2020 and made reference to the current work on ‘devolution’ in partnership with Sevenoaks District Council and Tunbridge Wells Borough Council. Ms Heeley explained that the new devolution proposals were likely to positively impact on delivering health improvement across the three council areas. A detailed progress update schedule was attached to the report allowing closer examination of the objectives agreed and outcomes.
Tunbridge Wells Borough Council
Gary Stevenson, the Head of Environment & Street Scene outlined the local activity relating to health inequalities and updated the Health & Wellbeing Board on progress against the Tunbridge Wells Health Inequalities Action Plan.
Mr Stevenson reported on the aims of the group which oversees the health inequalities agenda in Tunbridge Wells which includes supporting the wider workforce to understand the causes of Health Inequalities and how the work that is undertaken and decisions made have a positive or negative influence on Health Inequalities. Mr Stevenson highlighted the importance placed on joint work with partners to facilitate a reduction in Health Inequalities and shared information on the new model for consolidating the resources of the three councils participating in the ‘West Kent Deal’(TWBC, SDC and TMBC). Mr Stevenson explained that the West Kent Deal aimed to offer a single referral point for the three Districts that feeds into a local arrangement for each district or borough that enables a holistic assessment of individual needs and considers the wider determinants of health such as debt, employment and housing conditions.
NHS West Kent CCG
Gail Arnold, Chief Operating Officer gave a detailed slide presentation to Board members which set out the CCG vision for primary care built on a strong bedrock of General Practice with the following characteristics:
ü In A Suitable Estate
ü Supported By Technology
ü Skilled Workforce
ü High Performing
ü Patient Centred
ü Population Based Healthcare
Ms Arnold explained that the new primary care model is based on a ‘hub and cluster’ model, but working with the other local care providers to fully align and further develop to full ‘Multi-specialty Community Provider’ (MCP) status. Ms Arnold outlined the workstreams (and enablers) being developed to help transform care for patients moving towards a model which prevents ill health, intervenes earlier and delivers excellent, integrated care closer to home.
Ms Arnold explained how in line with the model outlined in the “The Five Year Forward View”, practices are getting together in clusters or network of practices to share knowledge, resources and teams. Ms Arnold reported on the ways in which inequalities would be addressed by intervening earlier; (more and timely preventative measures) and reducing the gap in health and wellbeing outcomes.
The Chair Cllr Gough thanked all the officers who had presented the work being led by the six agencies across West Kent.
Questions, Comments and Discussion:
· That there were examples of shared approaches to addressing inequalities in local communities. (Cllr RG)
· The majority of the most deprived LSOAs are in Maidstone and two are in Sevenoaks District. (AB, MV)
· The Public Health presentation provides a useful starting point for considering the content, variation and outcomes of NHS Health Checks (GS, GA)
· That the Asset Mapping approach adopted by KCC PH potentially offers a useful approach to targeted work in areas showing features of deprivation (GS, MV, AB)
· Interest was expressed in the targeted approach to intervention undertaken by the KCC Children’s Services Commissioning Unit (GA)
It was resolved:
To receive a report at the next meeting which identifies common areas of interest where partners can learn lessons that help provide assurance in relation to addressing inequalities. This would explicitly explore the correlation between delivery outcomes of NHS Health Checks and areas of Deprivation and assess the potential for creating bespoke elements to be added to the Health Check – to influence improved outcomes and greater confidence in the value of the programme.
A report to be presented to a future Board meeting on the outcomes identified in the Asset Mapping work completed in TWBC area with a view to exploring the potential for a ‘consistency of approaches’ towards asset mapping (to also relate to the Devolution Deal; focus on the formation of Local Care facilities and ‘spatial patterns’ within the context of the development of New Models of Primary Care).
Gail Arnold and Karen Sharp
Delivering the Five Year Forward View
Workforce Development & Role of Make Every Contact Count (MECC)
Tristan Godfrey, STP Workforce Programme Manager for Kent & Medway, (Health Education England, Kent, Surrey & Sussex, Policy Adviser for STP Workforce workstream) and Kevin Driscoll, Public Health England, Kent, Surrey & Sussex MECC Lead, gave a joint presentation to the Board. Mr Godfrey and Mr Driscoll highlighted that Workforce is a key enabler for the Kent and Medway STP and reported that £480k funding had been allocated through Medway Council, to deliver Making Every Contact Count (MECC) as an integral aspect of workforce development and the prevention agenda which is at the heart of the STP. It was explained that a portion of this funding was to be made available specifically for the benefit of the primary care workforce
Mr Driscoll reported that six MECC Spearheads have been established across Kent, Surrey and Sussex. The current position was that longer term planning was required to ensure that MECC is aligned with local STP aims and objectives and to tackle three key issues which have emerged in delivering MECC across Kent and Medway:
i. Harnessing targeted workforces e.g. ‘housing sector’;
ii. Industrializing preventative working across all sectors and scoping the training needed for this approach;
iii. Working with new ICO/MCPs in embedding a new culture of pro-active health and social care.
It was resolved:
To note the report.
To ask officers to continue local efforts to develop arrangements for delivering MECC training to key occupational groups across West Kent.
Agencies represented on WK HWB
Kent Health and Wellbeing Board
Cllr Roger Gough provided feedback from the Kent Health and Wellbeing Board on issues of joint concern for the West Kent Board.
It was resolved:
That the West Kent HWB contribute to work around ‘One Public Estate’ initiative.
That the WK HWB ensures that there is an integrated system for assurance in relation to Dementia (including work with care homes; and arrangements for ‘end of life care)
That once the H&WB Strategy Review is completed later in 2017 – WK HWB to ensure that it takes full account of it to ensure it establishes a plan of action that adds value to the STP ambitions
Dave Holman/Yvonne Wilson
Update: Obesity Task & Finish Group
Jane Heeley reported progress of the Obesity Task & Finish Group including:
· Chair and Member Champion attendance at the recent National Conference which focussed on national guidance and monitoring, through contributions from the authors of the Childhood Obesity Action Plan and NICE, as well as highlighting a number of interventions that have achieved some strong outcomes.
· Engagement with KCC PH Campaigns officers who reported on the outcomes of the local booster campaign to support national Change4Life Sugar Smart initiative and shared options for continuing to strengthen the proposed follow up national campaign. In addition, members explored the issue of value for money of interventions in relation to outcomes – issues linked to the findings in relation to National Child Measurement Programme.
· Discussions regarding the National Diabetes Screening Programme and links with Healthy Lifestyles Programmes; Audit of ‘commissioned arrangements for Tier 2 services (to help avoid duplication and effective use of local resources)
· Acknowledgement of the need for effective engagement with other agencies and partnerships around the Obesity agenda.
It was resolved:
That the Task & Finish Group Chair provide a report to the next Board meeting on its intentions for extending its influence to strengthen the delivery actions of a range of agencies across the system could be encouraged to undertake – given the issues highlighted under the Health Inequalities agenda item – where progress remains poor in addressing obesity.
Cllr Lynne Weatherly/Jane Heeley
Any Other Business – Future Agenda Items
It was resolved that:
The items suggested on the meeting agenda were agreed to be brought forward onto the Work Programme for the Health and Wellbeing Board.
Date of Next Meeting
21 February 2017 Cancelled
Next Meeting - 18 April 2017 – Sevenoaks District Council
Board Development Event :
21 February 2017,
13.30 – 17.00,
Mercure Hotel, 8 Tonbridge Road, Pembury, Tunbridge Wells, TN2 4QL
West Kent Health & Wellbeing Board Meetings:
Proposed Future Meeting Dates 2017 -2018
· 20 June 2017
· 15 August 2017
· 17 October 2017
· 19 December 2017 TBC
· 20 February 2018
· 17 April 2018
For any matters relating to the West Kent Health & Wellbeing Board, please contact:
Yvonne Wilson, Health & Wellbeing Partnerships Officer
NHS West Kent CCG
Tel: 01732 375251
Quorum 7: To be made up of at least one representative from each of the main partners (Kent County Council, District/Borough Councils and West Kent CCG)