Agenda and minutes

Health and Wellbeing Board - Tuesday, 12th July, 2016 6.15 pm

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

Contact: Penelope Williams 

No. Item




The Chair welcomed everyone to the meeting and apologies for absence were received from Ian Davis (Director of Regeneration & Environment), Councillor Ayfer Orhan and Dr Henrietta Hughes (NHS England).



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 interest registered in respect of any items on the agenda.




The Chair agreed to alter the order in which items on the agenda were considered at the meeting.


Item 6.3.b (Barnet, Enfield & Haringey NHS Mental Health Trust progress update on recent CQC visit) was taken as item 3 (Sustainability and Transformation Plan (STP Submission.  The minutes reflect the order of items listed on the agenda.




To receive a submission on the Sustainability and Transformation Plan (STP) from Deborah McBeal (Deputy Chief Officer, NHS Enfield CCG).

Additional documents:


RECEIVED a submission report on the Sustainability and Transformation Plan (STP) which was submitted to NHS England on 30th June 2016, to be noted by the Health and Wellbeing Board.




Deborah McBeal, Deputy Chief Officer, NHS Enfield CCG) introduced the report to the Board, highlighting the following:


·         The STP covers the Five Year Forward View ambitions to 2020/21 specifically in three key areas:u health and wellbeingv care and quality, and w finance and efficiency in accordance with the NHS England (London) assurance process.


·         The NCL STP Submission was a “plan for a plan” and included:


-       A Case for Change – identifying care and quality gaps in health and wellbeing.

-       The financial position – identifying the finance and efficiency gap and include information about how to start to develop the contribution of the work streams to help close this gap. Currently 13 work streams have been identified within the scope of the NCL STP and they are detailed within the report.

-       The STP programme governance structure which would be reviewed as the programme moved into implementation.

-       Plans for the work that needed to be done to September 2016 to produce the full STP and implementation, with further planning to be done following that date.

-       A Stakeholder communications and engagement plan overview.


·         The NCL STP Transformation Board would provide oversight of the continued development of the NCL STP.



IN RESPONSE the following questions/comments were received:


1.    Deborah Fowler (Healthwatch) asked what the difference was between planning on a place not people basis and was concerned that the voices of the Enfield public were not being heard. She offered support to the CCG from Healthwatch Enfield in planning public engagements. This last was supported by Vivien Giladi (Voluntary Sector) who confirmed that the public were becoming increasing more anxious and sceptical as they were not clear what was happening.  Communication and engagement needed to be significantly improved so that information could be shared in a clear and concise manner, to avoid these concerns. 


2.    Sarah Thompson (CCG Chief Officer) advised that the CCG also had a contribution to this and Simon Stevens (CEO of NHS England) would be hosting a “Plan for a Plan” engagement on the 14th July. The level of further engagement required would be clearer after this event and would be implemented if required.


3.    Andrew Wright (BEH Mental Health NHS Trust) confirmed that a lot of time and energy was being focussed on governance issues initially.


4.    Ray James (Director of Health, Housing & Adult Social Care) confirmed that processes had begun and there will be the opportunity for meaningful co-production in the time ahead, where engagement will be encouraged.  The work streams were constantly developing.  The position of the Health and Wellbeing Board needed to be defined in the process; is it a commentator or a system leader


5.    Shahed Ahmad (Director of Public Health) highlighted the enormity of the plans, involving a number of Trusts, CCG’s  ...  view the full minutes text for item 4.



To receive a report on the Co-Commissioning of Primary Care Services.

Additional documents:


RECEIVED a report requesting that the Health and Wellbeing Board comment on the opportunity for the CCG, along with the other CCGs in North Central London, to apply for delegated commissioning of Primary Care Services.




Deborah McBeal, Deputy Chief Officer, NHS Enfield CCG) introduced the report to the Board, highlighting the following:


·         Co-Commissioning of Primary Care Services was an essential part of moving to place-based commissioning and a way of implementing new models of care.


·         The five CCGs in North Central London (namely Barnet, Camden, Enfield, Haringey and Islington) had submitted an application to undertaken joint co-commissioning of primary care services with NHS England and have since operated as joint commissioners of Primary Care Services, having made the governance changes required to do so.


·         The benefits for NCL of becoming delegated commissioners of Primary Care were perceived as follows:


-       Collaborative primary care commissioning;

-       Ability to influence local primary care transformation;

-       Local input in decision making;

-       Ability to redesign local incentive schemes;

-       Clinical leadership and decision making;

-       CCG insight into practices and ability to harness CCG expertise to drive up quality;

-       Control of primary care medical budgets

-       Greater control of the workforce and processes supporting co-commissioning.

-       Expectation nationally that CCGs take on level 3 delegated commissioning at some point in the future.


·         The CCGs in NCL needed to determine whether to move to delegated commissioning, with an application due in October 2016 for interested CCGs.


IN RESPONSE the following comments were received:


·         Enfield have sought and been granted permission to proceed with the work.

·         NHS England had struggled to commission Primary Care in Enfield and there was a need to mitigate risk as the CCG was still under directions.


AGREED that Enfield recommend the active commissioning of the development of Primary Care Services.


CHILD HEALTH pdf icon PDF 917 KB

To receive a briefing on Child Health by Allison Duggal (Consultant in Public Health).


RECEIVED a briefing on the local child health profiles and health behaviours of young people for Enfield.  The profile allows comparison with national and regional data on child health and allows the targeting of areas for local improvement.


IN RESPONSE to the report, the following comments were received:


·         Looking at the context of the data, child obesity rates in Enfield were of concern. Sam Morris (Strategic Partnerships Manager) had recently attended the “Great Weight Debate” meeting at London Councils. He reported back that feedback received on child obesity rates was also of concern across all Boroughs.  The Obesity Strategy was due to be released soon. In order to deal with the issue, engagement is needed and the Health & Wellbeing Board could play an active role in this.

·         Immunisation rates had increased. An action plan from NHS and Public Health England was being implemented. The issue of recording immunisation rates in the past were being looked at and data was being collated. An Assurance Board was to be set up on immunisation rates.

·         Hospital Admissions needed to be looked at as there were high numbers of children attending A&E departments with ear, nose and throat (ENT) issues.

·         A separate paediatric urgent care pathway was to be piloted so that children were seen by GP’s instead of Paediatricians.

·         With regard to Female Genital Mutilation (FGM) – there was national work in progress and a campaign on African TV which has also been shown on some channels in the UK. FGM was also on the agenda for the next Overview & Scrutiny Committee and a FGM steering group also exists.

·         Allison Duggal was thanked for her excellent briefing which was a useful basis of reference, especially in respect of FGM.  It was noted that Allison will be leaving Enfield and taking on a new position at another local authority and the Board unanimously sent their best wishes to her.


AGREED to note the briefing.







To receive an update on the following:


1.    Health & Wellbeing Board Sub Boards, namely Joint Commissioning Board (Pages 49 – 78) and Health Improvement Partnership Board (Pages 79 – 84).


2.    Better Care Fund 2016/17 Plan (Pages 85 – 158).


3.    Specific local service developments by providers:


a)    Richard Gourlay, Director of Strategic Development to provide an update on North Middlesex Hospital service developments.

b)    Barnet, Enfield & Haringey NHS Mental Health Trust to provide an update on progress following a recent CQC visit.



Additional documents:



7.1       Updates from Sub-Boards:


RECEIVED updates from the following Health & Wellbeing Board Sub Boards:


7.1.1   Joint Commissioning Board Sub Board:


NOTED that the Board received an update from the Joint Commissioning Sub Board. 12.3.3 of report refers to a Local Authority Trading Company, which will be operating in October and will manage Adult Social Care provider services. 



7.1.2   Health Improvement Partnership Board:


NOTED that the Board received an update from the Health Improvement Partnership Sub Board.


No firm proposals had been agreed for the future stop smoking model. Any plans would need to be discussed with the CCG and agreed by council’s CMB.



7.1.3   Better Care Fund 2016/17 Plan:


It was noted that further to the HWB meeting held on 21st April, the 2016-17 plan was agreed and submitted to NHS England. Full approval was expected. The Board received and noted the contents of the plan.


Keezia Obi was thanked for her valued work on the Better Care Fund Plan to date.


7.2       Updates from Partners:


RECEIVED updates on specific local service developments by providers, as follows:


7.2.1   Future Organisational Models at North Middlesex University Hospital (NMUH) NHS Trust


The Board received a presentation from Richard Gourlay (Director of Strategic Development at NMUH NHS Trust).




·         NMUH was to be involved in the Acute Care Vanguard which was to be developed as part of the NHS five year forward view.  The aim of the vanguard was to enhance viability of local hospitals, to share formal working relationships and improve efficiency of back office administrative functions.

·         There are currently 13 successful acute care vanguards across the country.

·         The chain concept had been developed in Salford & Wigan, and Northumbria Foundation Group.  The Royal Free London could work with these foundation trusts in developing plans for their own group and the creation of a multi-provider hospital.

·         Under the models of established hospital groups, there were a range of membership scenarios. u Buddying v Shared Services and Back Office w Shared clinical support x Full membership.  The latter being the preferred choice for the Royal Free London Board who would assume full responsibility for the other hospitals.

·         The group model preferred by Royal Free would involve individual hospitals joining a group as operational units, with the group executive overseeing all units and each operational unit would be accountable to a group management structure.

·         This would provide scope to increase the resilience and efficiency of non-clinical services by increasing the pool of clinical resources available including executive leadership, finance and commercial expertise, human resources, information management and technology, procurement, communications, teaching, education and research.

·         Discussions with the Trust Board were held in March 2016 which led to an agreement to a “memorandum of understanding” to enable them to proceed to explore membership as part of RFL vanguard, envisaged from April 2017. This would also help maintain existing clinical pathways with other organisations.


IN RESPONSE the following questions/comments were received:


1.         The NMUH were clinical specialists on their own, through shared services with other  ...  view the full minutes text for item 7.



To receive the following items for information:


1.    Annual Public Health report (attached for information and can also be viewed on the following link):-



8.1       Annual Public Health Report 2015/16



The Board received and noted the Annual Public Health report for information including key public health indicators at Enfield including the Life Expectancy Gap and Infant Mortality which had significantly improved since 2010.


The Board thanked Allison Duggal for the update.


8.2       Thanks to Dr Shahed Ahmad & Allison Duggal


The Board thanked Dr Shahed Ahmad for his contributions over the last 7 years and wished him luck in his new role at NHS England and also wished Allison Duggal well in her new role at another authority.



To receive and agree the minutes of the meeting held on 24th April 2016.


The minutes of the meeting held on the 21st April 2016 were agreed subject to an amendment to Item 3, CCG Operating Plan 2016/17, no 7: A Healthwatch representative attended the Transformation Board as an observer only, not a full member.



Dates for future Health & Wellbeing Board meetings are as follows:


Wednesday 5th October 2016 – Room 1 – 6:15pm

Thursday 8th December 2016 – Conference Room – 6:15pm

Thursday 9th February 2017 – Conference Room – 6:15pm

Wednesday 19th April 2017 – Conference Room – 6:15pm


For information the future Health & Wellbeing Board Development Sessions are as follows:


Tuesday 6th September 2016 – Room 1 – 2-5pm

Thursday 24th November 2016 – Conference Room – 2-5pm

Wednesday 11th January 2017 – Conference Room – 2-5pm

Tuesday 21st March 2017 – Room 1 – 2-5pm



The date of the next meeting was confirmed as Wednesday 5th October 2016 at 6:15pm in Room 1.