Agenda and minutes

Health and Wellbeing Board
Thursday, 8th February, 2018 6.15 pm

Venue: Room 1, Civic Centre, Silver Street, Enfield, EN1 3XA. View directions

Contact: Jane Creer 

Items
No. Item

1.

Welcome and Apologies

Minutes:

NOTED

 

1.    Councillor Doug Taylor (Chair) welcomed everyone to the meeting, including the two new Youth Parliament representatives.

2.    Apologies for absence were received from John Wardell, Dr Helene Brown, Andrew Wright, Natalie Forrest and Ian Davis.

3.    This would be the last Board meeting attended by Tessa Lindfield. Health and Wellbeing Board recorded thanks to Tessa for her work during her time at Enfield and her contributions to the Board.

2.

Declaration of Interests

Members are asked to declare any pecuniary, other pecuniary or non-pecuniary interests relating to items on the agenda. 

Minutes:

NOTED the declaration of Vivien Giladi that she was a member of the co-op and the Co-operative Party.

3.

WHOLE SYSTEM APPROACH TO URGENT CARE RESILIENCE pdf icon PDF 75 KB

To receive a report and presentation from John Wardell, Chief Operating Officer, Enfield Clinical Commissioning Group (CCG).

Additional documents:

Minutes:

RECEIVED the report of John Wardell, Chief Operating Officer, Enfield Clinical Commissioning Group (CCG).

 

NOTED

 

As John Wardell was unwell and unable to attend the meeting, Vince McCabe (Director of Commissioning, Enfield CCG) introduced the report, highlighting the following:

?  Boxing Day onwards saw a huge surge in demand across North Central London and this was sustained in both patient numbers and acuity, leading to extreme pressure at local A&Es. There was also an increase in emergency admissions in December and January.

?  The North Middlesex Hospital University Trust (NMUH) recovery trajectory was set to reach 90% in December 2017 and 95% in March 2018.

?  Enfield was consistently overachieving against the National Delayed Transfer of Care target. He thanked the social care locally.

?  There had been an increase in the number of out-of-hours GP appointments available, and continuous communication kept up.

?  Work with care homes had increased the confidence of providers to seek advice, and to minimise A&E attendance.

?  Streaming through the Urgent Care Centre and NMUH was higher than many peers. At the peak it had been necessary to open over 60 escalation beds. A new way of managing clinical flow was being implemented to make it sustainable.

?  There had been reductions in delayed discharges, and more people were assessed at home in a safer environment. Partnership working was key.

?  Planning had already started for winter 2018/19.

?  Healthwatch Enfield had been commissioned to help understand why people went to A&E, particularly walk-in patients.

?  He would like to hear how elected members wished to continue to be involved.

 

IN RESPONSE comments and questions were received, including:

1.    The Chair thanked Vince McCabe for the helpful presentation, and asked about the percentage of discharges which resulted in re-admission within two weeks. In response it was advised that re-admission was monitored and taken seriously, and that NMUH was not an outlier on this.

2.    In response to Councillor Cazimoglu’s queries about cancelled operations, it was advised that planning began early on not scheduling elective surgery during December/January. These were not last minute cancellations. Elective surgery was now being phased back in. Cancer and emergency surgery continued. The hospital was now able to close escalation beds to increase the capacity available for elective surgery.

3.    In response to Councillor Cazimoglu’s question about discharge to assess, it was confirmed that assessment at home was done only if it was safe to happen, and had been very successful to date with good feedback.

4.    Maria Kane was asked for more details about the work carried out by Enfield Healthwatch. It had been noted that there was very high A&E attendance in December, but the admission rate was half the national average, which indicated a lot of people were coming to A&E who did not need to be there. Surveys were carried out by Healthwatch, using community languages, and a narrow set of questions, and 37,000 pieces of data were collected. This confirmed that many of the attendees did not  ...  view the full minutes text for item 3.

4.

HEALTHY HOSPITALS - THE EXPERIENCE OF THE ROYAL FREE HOSPITAL AND CHASE FARM HOSPITAL pdf icon PDF 1 MB

To receive a presentation from Angela Bartley, Consultant in Public Health at the Royal Free on the work she is doing across Royal Free and Chase Farm Hospitals.

Minutes:

The Board received a slide presentation from Angela Bartley, Deputy Director of Public Health, The Royal Free London NHS Foundation Trust.

 

The following points were highlighted:

?  There was potential in an acute trust in improving the health of the populations they work with. The Royal Free was one of the first to have public health based in an acute trust.

?  There was currently focus on three areas: obesogenic environment; domestic abuse; and making every contact count.

?  Providing healthier food offered in retailers within the hospital and in the restaurant led to increased sales. Posters by lifts encouraged a choice to be physically active.

?  Initiatives around domestic abuse included screening for domestic abuse in clinics, and advisers within the hospital.

?  Work on staff health and wellbeing at the Royal Free was being evaluated, and targeted work was being done with the facilities team.

 

IN RESPONSE comments and questions were received, including:

1.    Angela Bartley was thanked for the presentation, and the slides would be shared with the Board members and attached to the minutes.

2.    Councillor Fonyonga was encouraged by the differences which had been made. The strategic approaches should be considered elsewhere, including at LB Enfield.

5.

VIOLENCE AGAINST WOMEN AND GIRLS STRATEGY pdf icon PDF 104 KB

To receive the report of Shan Kilby, Domestic Violence Coordinator, LBE Community Safety Unit.

Minutes:

RECEIVED the report of Shan Kilby, Domestic Violence Coordinator, LB Enfield Community Safety Unit.

 

NOTED

 

Andrea Clemons (Head of Community Safety, LB Enfield) introduced the report, highlighting the following:

?  Discussions had taken place at the Board development session, and Board members were thanked for their support and agreement to assist in developing the plan and reflecting what they were doing already into the action plan.

?  There had been commitment to audit how far Enfield met the guidelines, and commitment to roll out routine enquiry.

?  A champion would be identified from this group to work towards being a white ribbon borough.

?  She hoped to come back to the Board for further discussions and to report on progress.

?  Board members were encouraged to look at the strategy online and particularly in respect of contributing to the action plan:

https://new.enfield.gov.uk/enfieldlscb/wp-content/uploads/2017/10/VAWG-Strategy-July-2017.pdf

 

IN RESPONSE comments and questions were received, including:

1.    It was confirmed that Mo Abedi had volunteered as champion from the Board, and he was happy to support increased uptake amongst GP practices.

2.    Councillor Orhan praised the work being done, and the knock on effect on families.

3.    Councillor Cazimoglu wished to record congratulations on the strategy and the work of Shan Kilby.

4.    Tessa Lindfield noted the synergies with the Healthy Hospitals presentation, and that routine enquiry should be included in performance monitoring of more contracts.

5.    Information updates would be provided in performance reports to Health and Wellbeing Board.

6.    Councillor Fonyonga suggested a development session in respect of serious youth violence.

 

AGREED

(1)  The contributions from partners to the Violence Against Women and Girls (VAWG) Action Plan.

(2)  Progression of the agreed recommendations detailed from the recent Health and Wellbeing Board development session.

6.

CARE CLOSER TO HOME INTEGRATED NETWORKS pdf icon PDF 293 KB

To receive the report of John Wardell, Chief Operating Officer, Enfield CCG and Jon Newton, Head of Older People & Physical Disabilities, LB Enfield.

Additional documents:

Minutes:

RECEIVED the report of John Wardell, Chief Operating Officer, Enfield CCG and Jon Newton, Head of Older People and Physical Disabilities, LB Enfield.

 

NOTED

 

Dr Mo Abedi and Jon Newton (Head of Older People & Physical Disabilities, LB Enfield) introduced the report, highlighting the following:

?  The ambition for the Sustainability and Transformation Plan (STP) included equity across North Central London so there was a reduction in variation across Barnet, Enfield, Haringey, Camden and Islington.

?  There were 12 work streams within the STP including a Health and Care Closer to Home work stream charged with delivering Care Closer to Home Integrated Networks (CHINs). This was being progressed collaboratively and the progress to date was set out in the report.

?  There were four locality teams in Enfield to locate services together and work to deliver health and social care and to understand the local area and its needs, as different parts of the borough had different needs.

?  A number of outcomes had already been achieved in 2017.

 

IN RESPONSE comments and questions were received, including:

1.    Parin Bahl welcomed much of the progress and ideas, but there should be emphasis on keeping people well, and making systems easier for patients to understand. Healthwatch were happy to help with the design process.

2.    Vivien Giladi expressed reservations about the STP and cost-cutting, and asked for reassurance that the north-east of the borough would not be failed. She was in favour of a united GP network but questioned the name Enfield Healthcare Co-operative Limited and in particular the use of the word Co-operative.

3.    Councillor Orhan supported previous comments and had concerns for several reasons, including the seemingly top down approach and exclusion of the public. She would also like to see cost factors in documentation. There should also be more details on what the public were not going to receive in future.

4.    Councillor Cazimoglu acknowledged the progress and hard work, but also expressed concerns about viability.

5.    Councillor Fonyonga echoed colleagues’ comments, and noted the benefits to Enfield of the GP Federation but there must also be a way to capture feedback and the reality of how systems were working.

6.    Tessa Lindfield considered that the CHINs model would happen in any case, and recommended that the Board focus on the QIST in the light of variation in approach to different communities.

7.    In response to comments received, Mo Abedi advised that use of Co-operative referred to mutual collaboration rather than being a legal term. He also confirmed that primary care single offer, atrial fibrillation, and pre-diabetes were additional services after the core contract, and nothing would be lost as a result of providing those services. The walk in centres were currently under utilised, and there was data available in respect of the hubs which he would bring back to the Board. He would suggest a development session should be held around patient experience on that pathway, and this was supported by the Board.

 

AGREED

(1)  That the Health and Wellbeing Board  ...  view the full minutes text for item 6.

7.

THE INTEGRATION AND BETTER CARE FUND - QUARTER 3 2017/2018 BCF UPDATE pdf icon PDF 487 KB

To receive the report of Bindi Nagra, Director of Adult Social Care, LB Enfield and Vince McCabe, Director of Strategy & Partnerships, Enfield CCG.

Minutes:

RECEIVED the report of Bindi Nagra, Director of Adult Social Care, LB Enfield, and Vince McCabe, Director of Strategy and Partnerships, Enfield CCG.

 

AGREED that Health and Wellbeing Board noted

(1)  The Enfield Integration and Better Care Fund (BCF) 2017-2019 Plan has been approved.

(2)  The current BCF performance against metrics and scheme outcomes.

(3)  The Quarter 3 financial position, which is projecting a balanced position.

8.

PROGRESS UPDATE ON JOINT HEALTH AND WELLBEING STRATEGY (JHWS) pdf icon PDF 428 KB

To receive the report of Tessa Lindfield, Director of Public Health.

Minutes:

RECEIVED the report of Tessa Lindfield (Director of Public Health).

 

AGREED that Health and Wellbeing Board:

(1)  Noted the progress on HWB monitoring areas.

(2)  Noted the recommendations in respect of support of the HWB priority areas.

9.

MINUTES OF THE MEETING HELD ON 5 DECEMBER 2017 pdf icon PDF 101 KB

To receive and agree the minutes of the meeting held on 5 December 2017.

Minutes:

AGREED the minutes of the meeting held on 5 December 2017.

10.

INFORMATION BULLETIN pdf icon PDF 248 KB

Minutes:

NOTED the Information Bulletin items.

11.

HEALTH AND WELLBEING BOARD FORWARD PLAN pdf icon PDF 178 KB

The current version of the Forward Plan is attached.

Minutes:

NOTED the proposed forward plan and the additions to be made further to this meeting to schedule development sessions to consider (1) CHINs and accountable care organisations, (2) whole system approach to urgent care resilience; and (3) serious youth violence (this session could be held at 4:00pm rather than 2:00pm to fit in with Youth Parliament members’ availability). An amended forward plan should be circulated to the Board.

12.

Dates of Future Meetings

Members are asked to note the dates of meetings of the Health and Wellbeing Board:

 

?          Tuesday 17 April 2018

 

All meetings take place at 6:15pm unless otherwise indicated.

 

Members are asked to note the dates of meetings of the Health and Wellbeing Board Development Sessions:

 

?          Tuesday 20 March 2018

 

The development sessions take place at 2:00pm unless otherwise indicated.

Minutes:

NOTED the dates of future meetings of the Health and Wellbeing Board and dates of future development sessions.