Agenda and minutes

The Chair welcomed everyone to the meeting.

Apologies for absence were received from Dr Henrietta Hughes, Councillor Doug Taylor and for lateness from Vivien Giladi and Councillor Rohini Simbodyal. 

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

There were no declarations of interests. 

Members agreed to change the order of items on the agenda so that item 7 could be bought forward to be taken at this point.  The minutes reflect the order of the agenda. 

To receive a report proposing an increase in the board membership, the appointment of a vice chair and an amendment to take account of the change in the titles of the cabinet members.

Members are asked to agree the proposals, which will then need to be formally approved by full Council as part of changes to the Board terms of reference. 

The Board received the report proposing an increase in the Board Membership, the appointment of a Vice Chair and an amendment to take account of the change cabinet member titles and remits.

NOTED

1.               The title of the Director of Public Health also needs to be changed as it is included in the Board terms of reference as the Joint Director of Public Health.  

2.               It was felt that the roles of the cabinet members that are appropriate to the board would always be those that are similar to the current members.  Therefore it was proposed that the membership should be changed to reflect the change in the cabinet member titles, which had occurred since the terms of reference were originally agreed.  These would need to be altered again if further changes occurred. 

3.               The recommendation to appoint non-voting members at a senior level from the 3 NHS providers was welcomed. 

4.               The length of the voluntary sector representatives’ term of office was thought to be three years but would be confirmed after the meeting.  This information would be included in the terms of reference.

AGREED

1.               To agree and recommend that Council approve the following changes to the board membership and terms of reference:

1.1           To authorise the creation of a vice chair to be filled by the Chair of the Enfield Clinical Commissioning Group. 

1.2           To grant board membership, without voting rights, to each of the three local NHS trusts as providers of health services in Enfield: the Royal Free London NHS Trust; North Middlesex University Hospital NHS Trust; Barnet, Enfield and Haringey Mental Health NHS Trust.

1.3           To alter the membership of the Board from the four Cabinet members listed in the terms of reference, to the following:

·       Leader of the Council

·       Cabinet Member for Health, Housing and Adult Social Care

·       Cabinet Member for Education, Children’s Services and Protection

·       Cabinet Member for Culture, Sport, Youth and Public Health

1.4           To alter the title for the Director of Public Health, as listed in the board membership, from the Joint Director of Public Health to the Director of Public Health. 

1.5           To include the length of the third sector representatives’ terms of office. 

Post Meeting Note:  The third sector representatives had been elected to serve for a three year term from April 2013. 

1.     To receive a copy of the final submission on the Better Care Fund. 

2.     To receive a report on the Better Care Fund governance arrangements. 

The Board received an update on the Better Care Fund Plan Submission and Governance Arrangements.

NOTED

1.               Ray James’s apologies for the late dispatch of the report which had been delayed as officers had hoped to be able to finalise the proposals on the governance arrangements, but this had not been possible.

2.               The suggestion that consideration of recommendation 2, 3 and 4 be postponed to give more time to enable the board to discuss at a development session.

3.               The target 3.5% yearly reduction in hospital admissions should be highlighted as a risk as part of the financial implications to the report.  This will be difficult to achieve particularly as the borough population is rising so fast. 

4.               It was felt that the aims were excellent but that they would be difficult to deliver. 

5.               It was suggested that the council and the CCG should consider integrating other health and social care budgets.  This would be subject to further discussion at a development session.  The Better Care Fund represents only 3% of the total health budget, but is part of a much greater ambition for service integration. 

AGREED

1.               To note that the Better Care Fund Plan was submitted by the 19 September 2014 as detailed in Annex 1 to the report, having been approved on behalf of the Board by the Chair under delegated authority.  The contents of the plan are included in Annex 1 of the report. 

2.               Recommendations 2, 3 and 4 of the report would be subject to further discussion at a board development session. 

3.               The board would continue to receive regular progress updates.   

To receive an update on the development of the Enfield Clinical Commissioning Group Operating Plan, Commissioning Intentions for 2015/16 and the North Central London Strategic Plan. 

The Board received a report on the CCG Commissioning Intentions, CCG Operating Plan and North Central London Strategic Plan. 

1.               Presentation of the Report

Graham MacDougal (Director of Strategy and Performance) presented the report to the Board highlighting the following: 

·       He apologised for the late paper.  There would be two versions a full version and an abridged version for key stakeholders. 

·       The CCG is also developing an Enfield specific public facing prospectus including the themes from the 5 year North Central London (NCL) Strategic Plan and the CCG Commissioning Intentions.

·       Patient scenarios and patient stories will be included in the prospectus.  

·       The commissioning relationship with the local authority will be open to wider development in the future. 

·       It was the aim of the CCG to engage with all local GP practices when commissioning to reflect the different needs and populations in the different areas. 

·       Following the initial submission, the 5 NCL CCGs had been asked to strengthen the 5 year financial plan and the plans for the delivery of a range of initiatives.

·       Governance arrangements across the five CCGs are still subject to discussion.  Consideration is being given towards the creation of joint boards.

2.               Questions/Comments on the report

2.1     The new contract starts in October 2015.  There will be challenges with the delivery and discussions have already begun with the local authorities involved.  If the mental health trust is not part of the new provision there will be a 90 day consultation period with the staff.

2.2           It was felt that the patient experience was key to driving change.  Each programme and initiative should include patient engagement.  All engagement was being bought together to ensure that there is focus on the patient experience in improving the quality of services. 

2.3           Outcomes based quality was a fundamental part of the improvement programme. 

2.4           There will be a focus on improving the mental health and wellbeing of the patients in Enfield.  Recovery enablement was being considered.  It was felt that an extra bullet point should be added to the report to specify improving the mental health of young people.

2.5           Outcomes will need to be defined, measured and agreed.

2.6           How to work with mental health issues was being considered. 

2.7           It was also suggested that the need for ensuring resilience in service quality during times of major change should be included. 

AGREED

1.               To note the progress to date on the development of the North Central London Strategic Planning Group five year plan.

2.               To note the update on the NHS Enfield CCG Operating Plan.

3.               To note the revisions to the NHS Enfield commissioning intentions for 15/16.

To receive for information the Adult and Child Annual Safeguarding reports. 

The Board received the annual reports of Children’s and Adults Safeguarding Boards. 

1.               Presentation of the Safeguarding Reports

1.1     Marian Harrington (Independent Chair of the Adult Safeguarding Board) and Geraldine Gavin (Independent Chair of the Children’s Safeguarding Board) attended the meeting to present the reports to the Board. 

Marian Harrington presented the Adult Safeguarding Annual Report and highlighted the following: 

·       There had been an increase in the number of abuses reported to the board: last year nearly 1000 alerts were received.  These are increasing year by year. 

·       New statutory guidance is about to be released, coming out of the Care Act 2014, which will make the Adult Safeguarding Board statutory.  Changes will be made, but the details would not be clear until the guidance was received.

·       The Board works closely with the police and other agencies. 

·       Enfield has a significant number of nursing homes, more than any other London borough, apart from Croydon, which means we have larger numbers of vulnerable people.

·       Early warning indicators are being developed, specifically for Enfield, in conjunction with the Care Quality Commission (CQC) and Enfield Clinical Commissioning Group (CCG).

·       The Board has been talking to victims and alleged victims to get some feedback on what can be done to improve services, making sure people are at the centre of what is being done.

·       The number of requests for Deprivation of Liberty Safeguards for people lacking mental capacity is much greater than was previously understood. 

·       Workloads are increasing in all areas and it is more and more important to ensure that people are seen appropriately. 

1.2     Geraldine Gavin presented the Children’s Safeguarding Report highlighting the following: 

·       Children’s safeguarding issues are receiving lots of attention, subject to daily comment in the national press. 

·       This has been a tricky year trying to balance the effect of the national headlines as well as the reputational risk of safeguarding issues.

·       Female Genital Mutilation has received a great deal of publicity thanks partly to the campaign in the London Evening Standard which has bought the issue to the fore. 

·       The major child sexual exploitation case in Rotherham had also raised many concerns and the lessons and outcomes are being considered. 

·       In Enfield we have 30-35 young people who have been identified as potentially at risk.  They were being monitored.

·       Multi-disciplinary work was taking place and work to improve communications across the partnership.

·       Communication, learning from serious case reviews and from other health colleagues was key.

·       A major concern was the lack of access to counselling for young people with mental health issues.

·       It had been a very busy year and would continue to be so next year with the issues being so much in the political arena. 

2.               Questions/comments arising from the presentation and the reports

2.1     The point at which the increase in the number of cases becomes more than reassuring, as an indicator that that more people are alert to the risks, is difficult to ascertain but can be judged based on existing  ...  view the full minutes text for item 7.

To receive the following updates from the Board’s Sub Boards:

a.     Health Improvement Partnership Board

b.     Joint Commissioning Board

c.     Improving Primary Care Board

1.               Health Improvement Partnership Board

The Board received a report updating them on the work of the Health Improvement Partnership Board:

1.1     Presentation of the Report

Allison Duggal, Consultant in Public Health, presented the report to the Board, highlighting the following: 

·       Two versions of the Annual Public Health Report had just been published: an abridged summary as well as a more detailed report.  The reports detail the work being carried out to tackle health inequalities across the borough.

·       Enfield’s report has synergies with the Better Health for London Report.

·       Public Health has recently produced some GP and locality based profiles to help inform commissioning decisions.  Ward profiles are also being put together.

·       On the 17 November 2014 a Child Poverty Conference will be held, showcasing the work being done to tackle child poverty.  From this an action plan will be put together to mitigate the effects of poverty as well as to minimise the intergenerational effects.

·       A poster campaign is being run to raise awareness of the need for adults to cut down on salt intake to reduce hypertension and heart disease.  

·       Public Health have had a successful engagement with four local mosques to raise awareness of health issues such as diabetes. 

·       They have worked closely with CCG colleagues providing advice and intelligence to feed into health care strategies.  

·       Pathway redesign has been prioritised for long term conditions including musculoskeletal, diabetes, cardiology and respiratory. 

·       12 independent funding requests had been received since April 2014.

·       The Pharmaceutical Needs Assessment Steering Group is making process on producing the pharmaceutical needs assessment.  A report will be bought to the Board later in the year.

·       A report on tobacco use in the Turkish Community has highlighted the fact that 50% of 11-25 year olds use tobacco and 37% of respondents use shisha.  Many are unaware of the risks.  Public Health will be running focus groups to enable targeted interventions. 

·       Quarter 1 figures for health checks will be available at the end of the month and will be included in the next report.

·       A universal BCG vaccination programme is being introduced across London.  Flu planning and immunisations are in place and the Ebola outbreak is being kept under review.

1.2           Questions/Comments

1.2.1         Members praised the quality and user friendliness of the Annual Public Health Report. 

1.2.2         The GP profiles were welcomed and it was hoped that they would provide a qualitative step forward in planning for the future needs. 

1.2.3         Concern was expressed about the situation where NHS England has the control over GP budgets.  It was felt that it would be more appropriate for the local CCG to control this area. 

1.2.4         The CCG was pleased to work in partnership with public health.  At one time a Turkish speaking officer had been employed to work with the Turkish community to help people give up smoking.  This has had excellent results.

1.2.5         It was suggested that it would be helpful to have the papers in advance for the Child Poverty Conference.

1.2.6         The suggestion was  ...  view the full minutes text for item 8.

To receive and agree the minutes of the meeting held on 17 July 2014. 

The minutes of the meeting held on 17 July 2014 were received and agreed as a correct record.

To note the dates agreed for future meetings of the board:

·       Thursday 11 December 2014

·       Thursday 12 February 2015

·       Tuesday 14 April 2015

To note the dates agreed for future board development sessions:

·       Thursday 13 November 2014

·       Thursday 22 January 2015

·       Thursday 12 March 2015

The Board noted the dates agreed for future meetings: 

·       Thursday 11 December 2014

·       Thursday 12 February 2015

·       Tuesday 14 April 2015

The Board noted the dates agreed for development sessions:

·       Thursday 13 November 2014

·       Thursday 22 January 2015

·       Thursday 12 March 2015

If necessary, to consider passing a resolution under Section 100A(4) of the Local Government Act 1972 excluding the press and public from the meeting for any items of business moved to part 2 of the agenda on the grounds that they involve the likely disclosure of exempt information as defined in those paragraphs of Part 1 of Schedule 12A to the Act (as amended by the Local Government (Access to Information) (Variation) Order 2006).

(There is no part 2 agenda)