Agenda and minutes

The Chair welcomed everyone to the meeting. Apologies for absence were received from Councillor Alev Cazimoglu and from Andrew Wright (Barnet, Enfield and Haringey Mental Health NHS Trust).

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 registered in respect of any items on the agenda.

To receive a report from Sam Morris (Strategic Partnerships Manager) containing recommendations relating to the Health and Wellbeing Board sub boards.

RECEIVED a report from Sam Morris (Strategic Partnerships Manager) in respect of the review of the current Health and Wellbeing Board Sub-Boards structure.

NOTED

Sam Morris introduced the report, highlighting the following:

?  There was ongoing review and development of the Enfield Health and Wellbeing Board (EH&WB), and recommendations were now put forward regarding the Sub Boards.

?  The proposals had been discussed with the Chair of EH&WB and Sub Board leads.

IN RESPONSE the following comments were received:

1.    Ray James (Director of Health, Housing & Adult Social Care) advised that as the Sustainability and Transformation Plan went forward, some of the joint work may have other structures it should connect with. This should be kept under review, while making sure links were maintained.

2.    Deborah Fowler (Healthwatch) welcomed the report recommendations and the comments of Ray James, and supported the greater focus, but with some concern if there would be only a single specific priority for each year. Deborah also felt that Sub Board work plans should be signed off by the EH&WB.

3.    Action plans from the Sub Boards should be expected and could be reviewed by EH&WB.

AGREED

a)    Revision of the EH&WB Sub Board Terms of Reference so members of both the EH&WB and Sub Boards are clear about the remit and role of each, as well as clarity on reporting lines and expectation of deliverables.

b)    Presentation of proposed Sub Boards’ work programmes to the EH&WB at the beginning of calendar year 2017.

c)    A twice yearly Sub Boards progress report to be presented and fully discussed at each EH&WB, instead of reports going as items for information to every EH&WB.

d)    Agree Health and Wellbeing priority to be the focus of the EH&WB and its Sub Boards for calendar year 2017.

e)    A section of each EH&WB agenda to be dedicated to exploring a specific challenge or issue which is directly related to a Sub Board area.

To receive reports from the Clinical Commissioning Group (attached) and the London Borough of Enfield (to follow) on their financial and commissioning intentions. 

To receive a progress update from Enfield CCG: on the Financial Recovery Plan 2016/17 and beyond. 

RECEIVED the report of Graham MacDougall (Director of Commissioning, NHS Enfield CCG) presenting the Enfield CCG commissioning intentions for 2017-19.

NOTED

Graham MacDougall and Rob Whiteford (Chief Finance Officer Enfield CCG) introduced the report, highlighting the following:

?  Savings targets were clarified, and the deficit situation was improving.

?  There would need to be efficiencies in the way services were delivered and where money was invested.

?  The strategic context was set out.

?  The Sustainability and Transformation Plan (STP) over the next five years would have a significant effect on commissioning intentions.

?  Funding was coming through to support substantial transformation.

?  There were national efficiency programmes to reduce variation across CCGs.

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

1.    Councillor Orhan drew attention to the lack of reference to children and young people in the four domains relating to the CCG Improvement and Assessment Framework, and in the commissioning objectives. It was advised that adults and children were included in the sections, but this could be better articulated and made clearer. Graham MacDougall agreed to draw out the areas specific to children.

2.    In response to Tony Theodoulou’s query regarding Enfield CCG as an outlier in high levels of musculoskeletal surgical intervention, Graham MacDougall confirmed that bench-marking had shown higher surgery rates relative to Enfield’s peers, and a programme had been set with a new provider to reduce surgical intervention and ensure there was a consistent offer to all patients, and that thresholds for treatment were adhered to.

3.    Dr Mo Abedi noted that for each workstream in Right Care, the national transformation programme, had involved GPs in looking at pathways and audits.

4.    Deborah Fowler (Healthwatch) stressed the need for as much transparency as possible to provide reassurance to people about what they could reasonably expect, and questioned whether there was definitive guidance publicly available. She also asked where the biggest changes could be expected to be seen. Graham MacDougall highlighted the tie-in with the Sustainability and Transformation Plan (STP) and that providers would be working in different ways. In the second and third year of the STP – 2017/18 and 2018/19 – new contracts with providers would see significant changes.

5.    Vivien Giladi (Voluntary Sector) re-iterated the need for the CCG to provide reassurance to the public about changes and thresholds.

6.    Ray James commented that while the aims of the changes were recognised, the Enfield Health and Wellbeing Board would be exercised about decisions in respect of Enfield being taken ahead of North Central London and there should not be earlier rationing for the people of Enfield than for people of other boroughs.

7.    Ray James apologised to members expecting an update from the Council under this agenda item, as its budget planning would fall naturally in December, and more detail would be provided for the next meeting.

8.    Sarah Thompson (CCG) advised that this piece of work was initiated by Enfield, but it actively sought to engage with the four other CCGs across North Central  ...  view the full minutes text for item 4.

NOTED that the order of the agenda was varied and that a number of attendees had to go on to Health Scrutiny Standing Workstream at 7:30pm. The minutes follow the order of the meeting.

To discuss the impact of potential changes to the NHS Bursary system.

RECEIVED a letter from UNISON to Ray James (Director of Health, Housing & Adult Social Care) in respect of the proposed NHS bursary removal.

NOTED

1.    Ray James confirmed that a copy of the letter had been sent to him and others and inviting consideration by local health and wellbeing boards.

2.    An emailed response from Andrew Wright (Barnet, Enfield and Haringey Mental Health NHS Trust) was tabled in his absence. BEH-MHT was clear that this proposal, if implemented, would add to their current difficulties in recruiting nurses.

3.    Vivien Giladi (Voluntary Sector) wished the Board to support the UNISON letter, noting that trainee nurses did a lot of unpaid work, which was also physically and emotionally draining, and under the proposals would face debt and paying to work for nothing. When there was a need for increased numbers of nurses, this plan seemed counter-productive.

4.    Libby McManus (North Middlesex Hospital NHS Trust) reported a recent debate at Kings College London which heard views from both sides, and noted that those applying for undergraduate nurse training places were often surprised that there were still bursaries. She was therefore unsure what impact there may be.

5.    Councillor Orhan expressed support for the template letter of response, and considered that this proposal would be a naïve and false saving which would have a huge impact on nurses coming through the system. She also suggested that UNISON be invited to send a representative to the next meeting.

6.    Deborah Fowler (Healthwatch) agreed that the risks and lack of research should be highlighted, but accusatory points be avoided.

7.    The Chair recommended an evidence based approach in a response from the Board, and that the proposal should not proceed at this time.

8.    Ray James would wish to refine the template letter to also encourage further strategic planning for health and social care nursing workforce, and agreed to circulate a draft letter to Board members for comment.

AGREED that a letter be prepared on behalf of Enfield Health and Wellbeing Board to send to the Government in response to the proposed changes in healthcare education funding.

To receive a report on the North Central London Sustainability and Transformation Plan draft.

RECEIVED the North Central London Sustainability and Transformation Plan (STP) draft document.

NOTED

1.    Relevant issues had also been discussed at the Health and Wellbeing Board Development Session on 4 October.

2.    Deborah Fowler (Healthwatch) wished to emphasize the importance of fulsome public involvement and engagement.

3.    Vivien Giladi (Voluntary Sector) re-iterated Deborah Fowler’s point and also that it would be important to have accountable local politicians, and for there to be lay people on the Transformation Board.

4.    Councillor Orhan welcomed the report, which highlighted some of the fundamental issues facing people in Enfield and across North London. She was pleased there was recognition of the requirement of improving children’s and young people’s health mentioned throughout. She questioned historical understanding shown and knowledge of the area, and alignment with current local arrangements in place.

5.    The Chair expressed that Barnet and Enfield seemed to be downplayed compared with other boroughs. Also, some of the base information was given in percentages and some in numbers; which was important given the different sizes of the boroughs. He hoped that when resources were considered going forward, Barnet and Enfield’s positions of need and demand were borne in mind.

6.    Vivien Giladi considered that the need for accountable politicians had been demonstrated by the above point, and while she agreed this was a useful document, it hid the ideological and financial drivers behind the transformation plans.

7.    The more detailed paper would be published on 21 October, when it would be submitted to NHS England.

8.    Ray James gave assurance that there was awareness regarding the concerns raised, and that partners were committed to delivering the STP.

AGREED to note the North Central London Sustainability and Transformation Plan (STP) draft document.

7.1       New Models of Care

7.2       Hospital Chains

7.3       Additional Development Session (04/10/16)

RECEIVED the report of Sam Morris (Strategic Partnerships Manager) summarising the topics presented at the recent Health and Wellbeing Board development session on 6 September 2016.

NOTED that an additional development session was held on 4 October which had been a helpful preparation for this Board meeting.

AGREED to note the report.

To receive for information the Safeguarding Adults Board Annual Report 2015-16 from Marian Harrington (Independent Chair of Enfield Safeguarding Adults Board).

To receive for information the Safeguarding Children’s Board Annual Report 2015-16 from Geraldine Gavin (Independent Chair of Enfield Safeguarding Children’s Board).

RECEIVED

(a)  The Safeguarding Adults Board Annual Report 2015-16; and

(b)  The Safeguarding Children’s Board Annual Report 2015-16.

NOTED

(a)  The Safeguarding Adults Board Annual Report 2015-16

The report was introduced by Marian Harrington (Independent Chair of Enfield Safeguarding Adults Board).

?  This year there had been two Safeguarding Adult Reviews into incidents of poor care, and subsequent actions had been embedded by partner agencies. Two more of these reviews were in progress.

?  Key areas of improvement were noted in quality of care locally.

?  A link with Healthwatch would enable access to NHS premises too.

?  There had been awareness-raising regarding hate crime and domestic violence.

?  A thematic safeguarding adults review would be reported next year.

?  Multi-agency working would help in the collection of evidence at an early stage to enable successful prosecution.

The following questions were received:

1.    In response to Councillor Fonyonga’s queries in relation to domestic violence and vulnerable adults, it was confirmed there still sometimes seemed to be a feeling that vulnerable people would not make credible witnesses and that they would have difficulty giving evidence in court. There were ways people could be supported, but better evidence gathering at the beginning would strengthen our case. Raising the awareness of the Crown Prosecution Service was also important.

2.    In response to Councillor Orhan’s queries regarding neglect, it was advised that work had taken place to help people who did not think of themselves in that way to identify themselves as carers, as there was help and support available and they could be put in touch with the local carers association. Often neglect was not deliberate, but was due to people not realising what they should be doing.

3.    In response to Vivian Giladi’s queries in relation to ethnicity statistics in the report, it was confirmed that awareness raising had targeted under-represented groups and work would continue with voluntary sector organisations.

4.    Ray James highlighted the pleasing performance in achieving outcomes from safeguarding adult inquiry investigations, and that there was better understanding and reporting. He also wished to give credit to Georgina Diba (Safeguarding Adults Service) for the quality of the report. Confirming that Marian Harrington was stepping down from her role, he wished his thanks to be recorded for her skilled stewardship.

5.    The Chair requested that the minutes reflected the thanks of Enfield Health and Wellbeing Board to Marian Harrington, and to everyone who contributed to the success of the Safeguarding Adults Board, and noting the challenges going forward.

(b)  The Safeguarding Children’s Board Annual Report 2015-16

The report was introduced by Geraldine Gavin (Independent Chair of Enfield Safeguarding Children’s Board).

?  The main focuses of the year had been child sexual exploitation, female genital mutilation, and tackling concerns of increased radicalisation.

?  Two excellent lay members of the Board had brought in views from the community.

?  Two serious case reviews had been published in the last year.

?  Successful training and awareness events had been held.

?  Information exchange was improving, and was critical. The new Borough Commander was  ...  view the full minutes text for item 9.

To receive for information a report from Gosaye Fida (Senior Public Health Strategist) published in August 2016.

RECEIVED the Diabetes in Enfield Annual Public Health Report.

NOTED

1.    Dr Tha Han (Public Health Consultant) introduced the report and thanked all those involved for their contributions.

2.    The report summarised every aspect of diabetes, and highlighted that much diabetes could be preventable, and that there was a very clear relationship between the incidence of diabetes and obesity.

3.    Dr Tha Han invited any questions to be emailed to him at Tha.Han@enfield.gov.uk.

4.    Councillor Fonyonga also recorded thanks to Miho Yoshizaki (Health Intelligence Manager, Public Health) for this high quality report.

To receive for information a report on the Overview and Scrutiny Committee work plan for 2016/17, approved by full Council. 

NOTED the Overview and Scrutiny Committee work plan for 2016/17.

To receive updates from the following sub boards:

·         Health Improvement Partnership Board – Please note that the September meeting of the HIP Board was cancelled and that the HIP Board meetings will resume with the new Director of Public Health

·         Joint Commissioning Board

·         Primary Care Sub Board

NOTED

1.    Updates from sub boards.

2.    An interim appointment had been made for Director of Public Health to Tessa Lindfield, but she was unfortunately unable to attend this meeting. The importance of resumption of Health Improvement Partnership Board meetings was noted.

To receive and agree the minutes of the meeting held on 12 July 2016. 

AGREED the minutes of the meeting held on 12 July 2016.

To consider the work programme for 2016/17 and to agree any changes. 

NOTED the work programme for 2016/17.

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

·       Thursday 8 December 2016

·       Thursday 9 February 2017

·       Wednesday 19 April 2017

All meetings take place at 6.15pm unless otherwise indicated. 

Members are asked to note the dates for future Health and Wellbeing Board Development Sessions: 

·       Thursday 24 November 2016

·       Wednesday 11 January 2016

·       Tuesday 21 March 2016

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

NOTED the dates of future meetings of the Health and Wellbeing Board and dates of future Development Sessions.