Agenda and minutes

The Chair welcomed everyone to the meeting.  Apologies for absence were received from Dr Henrietta Hughes, Andrew Fraser (Director of Schools and Children’s Services) and Ian Davis (Director of Environment). 

Andrea Clemons, Head of Community Safety, attended  to represent Ian Davis. 

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

There were no declarations of interest. 

To receive a report on the 2014 Annual Public Health Report “Mind the Gap:  Reducing the Gap in Life Expectancy”. 

The Board received a report from Dr Shahed Ahmad, the Director Public Health, on the Annual Public Health Report (APHR) 2014 – Mind the Gap: reducing the gap in life expectancy. 

1.               Presentation of the Report

Dr Tha Han presented the report to the Board highlighting the following: 

·       This year the public health focus has been on reducing the life expectancy gap in Enfield. 

·       There are two versions of the report: a full version and a much shorter summary.

·       Chapter 6 celebrates the successful joint working that has taken place between the Council, local voluntary organisations and health authorities as well as national organisations such as University College London, the British Heart Foundation and Cancer Research UK.

·       The focus for this year’s APHR was what will work in the short term.  Next year it will be on child poverty issues and thereafter other wider determinants of health. 

·       Since 2008, life expectancy at birth for males and females has improved by 1.3 and 1.1 years respectively.  This is a universal measure based on a complex mathematical formula.  Wider determinants will also have an impact. 

·       The report identifies the need to broaden the focus to Enfield Lock, Chase, Jubilee and Ponders End wards. 

2.               Questions/Comments 

2.1     Discussions about the measure of life expectancy at birth will be continued outside of the meeting.

2.2     The issues which the more deprived wards have in common are high levels of cardiovascular, cancer and lung disease. 

2.3     Wider determinants such as environment also need to be tackled but these are longer term issues. 

2.4     This year Public Health has been working closely with NHS colleagues on measures to reduce hypertension.  In over 80% of cases, blood pressure can be controlled, dramatically improving outcomes for patients. 

2.5     Work in other areas including reducing cholesterol levels is also continuing.

2.6     Good action planning will be essential to ensure improvements.  In those wards, such as Chase, it was essential that interventions were closely targeted on those with the greatest need. 

2.7     Public Health acts as an initiator and co-ordinator of other activities. 

2.8     Dr Shahed Ahmad, Director of Public Health, thanked his colleagues for their collaborative efforts. 

AGREED to note the publication and the findings of the Annual Public Health Report. 

To receive and agree a report with recommendations on the governance arrangements for the Better Care Fund.   

The Board received a joint report on the Better Care Fund Governance Arrangements from Ray James, Director of Health, Housing and Adult Social Care and Liz Wise, Enfield CCG Chief Officer. 

1.               Presentation of the Report

Bindi Nagra, Assistant Director Strategy and Resources introduced the report.  Richard Young, Interim Better Care Fund Programme Manager, presented it to the board using a powerpoint presentation.  Copies of the slides are attached to the agenda. 

The following points were highlighted: 

·       The Better Care Fund submission had been accepted with support.  One of the outstanding requirements was to agree the fund’s governance arrangements: the committee is asked to agree these tonight.   The other concerned the management of the money, which it was proposed would be handled through the section 75 agreement.  This will be looked at, at a future meeting. 

·       Two options have been put forward to replace the current arrangements.  The original structure of working group and sub board, which had been created to develop the proposals and submit the application, was no longer fit for purpose. 

·       The first option involved creating a new Integration Board which would include management of the Better Care Fund as well as wider integration matters.  It would have some measure of delegation. 

·       The second option would merge the Better Care Fund, into the existing Joint Commissioning Sub Board.  This would be purely advisory.  All decisions would be fed back to the full board. 

·       The preference of the current working group was for Option 1 focussing on integration.  Joint Commissioning was felt to be a wider issue which required its own sub board. 

·       Further details on the terms of reference would be discussed at a future meeting. 

2.               Questions/Comments

2.1     The view was expressed that the voluntary sector had better representation in Option 2.  Ray James responded that in principle there wouldn’t be any difference in voluntary sector representation between the two options.  Both were intended to be appropriately inclusive and he felt that this should not be a determinant in a choice between the options. 

2.2     It was envisaged that in Option 1 it would be possible to consider and focus on the whole shape of integration across health and social care.  Also incorporating the existing older people’s integration board.  In Option 2 the issue of integration could get lost within the whole range of commissioning activities which fall under the scope of the Joint Commissioning Board.  Whichever option was chosen there would be overlap. 

2.3     The Better Care Fund was an enabler which would help to bring about better service integration, bringing together system leaders and providers. 

2.4     The suggestion was made that someone with specialist knowledge of safeguarding issues should be included. 

2.5     Many more interested parties would be specifically represented in the sub structures of the main sub board. 

2.6     There was no political representation in either option but this was up to the board to address, if it was felt that it was needed. 

2.7     In Option 1 there was differentiation between voting  ...  view the full minutes text for item 4.

To receive an update on the development of a Pharmaceutical Needs Assessment. 

The Board received a report on the development of a Pharmaceutical Needs Assessment (PNA) from Dr Shahed Ahmad, Director of Public Health. 

1.               Dr Tha Han, Public Health Consultant, presented the report on behalf of Allison Duggal.

He highlighted the following:

·       The Health and Wellbeing Board has a statutory duty to produce a PNA by 1 April 2015. 

·       Responsibility for its production has been delegated to a steering group.

·       A consultation has begun, ending on 31 January 2015.  Responses can be completed on line.  It has been sent out to community organisations, local pharmacies and GPs. 

·       When complete, the PNA will be used by NHS England, to determine applications from providers to provide pharmaceutical services.  The CCG and the local authority will also be able to use it to consider what services are needed, from pharmaceutical providers, to improve the health and wellbeing of the community. 

·       Enfield has a lower than average number of pharmacies at 18.9 per 100,000 of the population, although these pharmacies do issue more prescriptions per pharmacy than average.  The majority of pharmacies open during the evenings and on Saturdays, with 20% opening on Sunday, mainly in shopping areas. 

·       A survey of pharmacy users was carried out.  It was found that 96% of respondents rated pharmacies as excellent or good; 95% rated confidence in the pharmacists’ knowledge and advice as excellent or good, 71% rated it as important that the pharmacy was close to their home and 45% that it was close to their doctor’s surgery.  55% walk to their community surgery, 22% go by car and 79% had no trouble travelling to their pharmacy. 

·       The greatest number of correspondents had no most convenient day or time for visiting their pharmacy.  65% of correspondents have a journey time of no more than 10 minutes and 91% no more than 20 minutes.  96% indicated that the ease of obtaining prescription medication from their pharmacy was very easy or fairly easy. 

·       The survey had not identified any gaps in provision. 

·       The Health and Wellbeing Board will be asked to approve the final version of the PNA in Spring 2015. 

2.       Questions/Comments

2.1     A firm based in Leeds, Pharmacy Direct, had been targeting older Enfield residents, using information about patients including their doctor’s surgery, offering to organise the dispatch of prescriptions by post.  The information must have been provided by the NHS.  The firm could provide a threat to the existence of the smaller independent chemist in Enfield who depended on NHS prescriptions for 75% of their business.  Andrea Clemons agreed to look into whether the practice was acceptable in trading standards terms. 

2.2     The list of data collected for this survey seemed very wide.  The suggestion was made that it would be more helpful to have had a shorter list of more relevant data, as well as a glossary. 

2.3     The scope of the report was limited and was not designed to include future forecasts, or take account of any predicted changes to the population.  It  ...  view the full minutes text for item 5.

To receive the following updates from the sub boards:

a.     Health Improvement Partnership Board

b.     Joint Commissioning Board

c.     Improving Primary Care Board

1.               Health Improvement Partnership Update

The Board received a report from Dr Shahed Ahmad, Director of Public Health, updating them on the work of the Health Improvement Partnership Board. 

1.1     Dr Tha Han introduced the report and invited questions. 

1.2     Questions/Comments

1.2.1     Work supporting other boroughs is carried out as part of a group of health sub groups looking at various issues across London. 

1.2.2     A DVD had been developed as part of a joint venture with Haringey about early access to maternity, talking to communities, that book in late, about their fears and what would change as a result of earlier booking. 

1.2.3     A scheme to work on extending the benefits of the HiLo project is being considered by the CCG. 

1.2.4     Recently there had been a successful conference on Female Genital Mutilation (FGM) with a good turnout of over 100 men and women.  An imam from a local mosque had attended and given a clear message that the practice was not a religious requirement. 

1.2.5     A report about the adequacy and quality of FGM services should be ready in February 2015. 

1.2.6     Individual Funding Requests involve very rare conditions that fall outside provider contracts. There is no policy or guidance governing them and they can be hard to justify. 

1.2.7     A fuller report on the initiatives coming out of the Child Death Overview Panel will be provided for the next meeting. 

1.2.8     Further information on the effectiveness of the media campaigns would be helpful, including how long the campaigns were running for, how many people have come forward and other outcomes. 

1.2.9     The smoking cessation targets were being met.

1.2.10  Enfield is currently working at just above the targets for carrying out health checks.

1.2.11  Everyone involved, including local GPs, were thanked for their work with the partnership. 

AGREED to note the report. 

2.               Joint Commissioning Sub Board Update Report

The Board received a report from Bindi Nagra, Assistant Director Strategy and Resources, Health, Housing and Adult Social Care, updating them on the work of the Joint Commissioning Sub Board.

2.1     Presentation of Report

Bindi Nagra presented the report to the Board highlighting the following: 

·       The Better Care Fund had been approved with support, which was a good outcome considering the challenging health and social care financial situation.  Thirty amendments were required, including the approval of the governance arrangements and issues around consultation responses.  This would not affect the programme or the finances. 

·       Once the changes had been agreed, the plan will need to re-signed by the Chair of the Health and Wellbeing Board, Chair of the Enfield CCG and the Leader of the Council before being sent back to NHS England. 

·       The procurement for the Sexual Health and School Nursing Services has currently been postponed, but it may be necessary to go out to tender early next year. 

·       Clinical Commissioning Groups are being given the option to choose a different co-commissioning model.  There are three possible models: greater involvement in commissioning decisions, joint commissioning  ...  view the full minutes text for item 6.

To receive and agree the minutes of the meeting held on Thursday 16 October 2014. 

The minutes of the meeting held on 16 October 2014 were agreed as a correct record. 

Noted that Andrew Wright and Kim Fleming had attended the meeting and should have been included in the minutes. 

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

·       Thursday 12 February 2015

·       Tuesday 14 April 2015

To note the dates agreed for Board development sessions:

·       Friday 16 January 2015

·       Thursday 22 January 2015

·       Thursday 12 March 2015

Noted the dates agreed for future meetings of the board: 

·       Thursday 12 February 2015

·       Tuesday 14 April 2015

Noted the dates agreed for future board development sessions:

·       Friday 16 January 2015

·       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)