Agenda and minutes

The Chairman will announce details of the arrangements in case of fire or other events that might require the meeting room or building’s evacuation.

The Chairman announced details of the arrangements in the event of a fire or other event that would require evacuation of the meeting room.

(If any) – receive

Apologies were received and noted. 

Members are invited to disclose any pecuniary interest in any of the items on the agenda at this point of the meeting.  Members may still disclose any pecuniary interest in any item at any time prior to the consideration of the matter.

None disclosed.

To approve as a correct record the minutes of the Board Meeting held on 19 March 2014 and 9 April 2014 and to authorise the Chairman to sign them.

The Board considered and agreed the minutes of the meeting held on 19 March 2014 and authorised the Chairman to sign them. 

The Board considered and agreed the minutes of the meeting held on 9 April 2014 and authorised the Chairman to sign them.

The Joint Assessment Discharge project is due to go live on 1 June 2014, in the meantime, staff consultations are proceeding.

It was noted that the regulations on the Care Bill would be available at the end of the month.

A letter from NHS England providing feedback on the Better Care Fund had been received by the Health and Wellbeing Board. The Board member representing NHS England advised that there had been some national anxiety regarding the political inferences and that more work was required by NHS England, however, Havering was one of six successful boroughs in bidding for funds.

The Board were informed that Havering was the best performing borough in London and 13^th nationally in turning around “Troubled Families.”  The Chairman suggested that Havering should offer to conduct borough pilots for other schemes.

The Chairman commented that officials at NHS England appeared to be less than timely in approving GP surgery buildings and cited a practice in Rainham as an example. It was agreed that the NHS England Board member would investigate and requested that the Chairman forward all relevant data on the site.

To receive a verbal update from Conor Burke.

The Board were advised that the tri-borough bid for government funds paid from the Prime Minister’s Challenge Fund had been successful, and the Chief Officer of BHRUT CCGs thanked all those on the Health and Wellbeing Board and at NHS England for their support. The allocation of funds at £5.6m was one of the largest in the UK which would be used to improve Primary Care in the borough. A number of plans were currently being looked into jointly with NHS England colleagues and it was agreed that a report would be made available to the Board at the July meeting.

To receive a presentation from Cheryl Coppell.

The Board received a presentation from the Chief Executive Officer of Havering who also chairs the Independent Care Coalition (ICC).

The Independent Care Coalition was originally formed because of issues around the local hospitals. The ICC brought together key partners within Outer North East London to develop improvement programmes across health and social care. Since the establishment of the ICC, NHS (London) had asked that a number of partnership tasks be undertaken and these had been added to the original role of the ICC so as to prevent a range of difference partnership groups operating in a unco-ordinated manner. The Urgent Care Board (UCB) acted as a sub group of the ICC. The ICC was not a decision making body and all decisions on contracts or spending were enacted through the relevant governance structures such as Health and Wellbeing Boards, Clinical Commissioning Group (CCG) Boards and Provider Trust Boards.

The original programme, agreed by the ICC was to improve community capacity in order to prevent avoidable presentations at Accident and Emergency and hospital admissions.  Due to the high incidence of frailty, including older people presenting at A&E, the community responses were targeted at this group. In order to reduce unnecessary hospital admissions, a range of services were piloted and these have now been mainstreamed as part of the CCG contractual arrangements and the Better Care Fund. These are as follows:

a)                 Integrated Case Management (ICM)

The Havering Integrated Care (IC) Team comprise of a GP, Community Matron, District Nurse, Social Care Lead and Care Liaison Officer and deliver appropriate care to patients in the community so as to reduce avoidable hospital admissions.  In addition, they also deliver a high quality service for high risk patients. There are six clusters across Havering with a Community Matron and Integrated Care Liaison Officer allocated to each. 

Quarter 4 data identified that Havering was on target for caseloads with 2053 service users receiving support in 2013/14. Key Performance Indicators for 2014/15 would aim to facilitate improved performance in areas identified in the in-year diagnostic e.g. a greater focus on effective management of caseloads and throughput of the service.

b)                Community Treatment Teams (CTT)

The CTT consists of doctors, nurses, occupational therapists, physiotherapists, social workers, and support workers. The CTT provide the following:

·                    Short term intensive care and support to people experiencing health and/or social care crisis to help them be cared for in their own home rather than be referred to hospital.

·                    Support for people to return home as soon as possible following an acute/community inpatient stay where this is required or appropriate.

·                    A single point of access to intensive rehabilitation at home or in a bed in a community rehabilitation unit if necessary.

·                    CTT runs in all three boroughs from 8am – 10pm, seven days a week which align with peak attendances in A&E and therefore should help to relieve the pressure on A&E.

Performance data for 2013/14 indicated a good performance in the Queens hub with 1576  ...  view the full minutes text for item 40.

To receive a report and presentation from Dr M Sanomi.

The Chairman welcomed Dr M. Sanomi, Clinical Director and Chairman of the Dementia Partnership Board who gave a presentation on the Havering Dementia strategy. The Board were asked to note the accompanying report including the draft document on the Joint Dementia Strategy for Havering 2014-2017 and the Dementia Strategy Toolkit.

Dementia remains a high national and local priority. Since the launch of the Government’s National Dementia Strategy in 2009 (Living Well with Dementia: a National Dementia Strategy), numerous additional national policy guidelines and initiatives have followed, which included:

·      Prime Minister’s Challenge on Dementia

·      The Mandate

·      Joint Commissioning Framework: National Dementia Strategy

·      Outcomes Frameworks for Public Health, Adult Social Care, and Health, all with specific reference to dementia

·      Establishment of National Dementia Action Alliance

·      The Care Bill

·      Dementia: A state of the nation report on dementia care and support in England

Dementia and dementia care, therefore, is a key issue at a national level and would remain so, given the overall changing and ageing population.  Within the National Dementia Strategy (DH, 2009), there is a requirement for all local areas to have a joint commissioning strategy for dementia. Despite the fact that the National Strategy ends in 2014, it is felt both important and timely to produce a joint strategy for Havering.  It is vital that the public, stakeholders, commissioners and providers develop a shared vision of aspirations for the future with regard to dementia care and services.

Havering has one of the highest proportions of older people in London and it is estimated that 3,275 people aged over 65 years have dementia.  This figure is predicted to rise to 3,794 by 2020.  Further work is required to fully understand the local level of need for people with early onset dementia (before the age of 65).  Dementia in Primary Care aims to identify specific groups of people at higher risk of developing dementia including those with a learning disability, at an early stage.

Both key commissioning organisations, that is, Havering CCG and LBH, are committed to working together, with dementia identified as a key shared priority area by the Health and Wellbeing Board. New and emerging structures within both organisations will provide an added impetus and focus for co-ordinated commissioning in the future.

The local Dementia Partnership Board meets on a bi-monthly basis and is accountable to Havering’s Health and Wellbeing Board. The Dementia Partnership Board brings together key commissioners across the health and social care economy. The Board will oversee and monitor the delivery of this strategy and implementation plan.  The key highlights being:

·                Setting out the vision and principles of dementia care

·                Describing the current position, mapped against the locally agreed pathway

·                Developing an integrated community based service model for Memory Services

·                Work being undertaken with BHRUT to improve services within the hospital for people with dementia

·                Mapping of total resource for dementia across the system, amounting to £14,673,914

·                Supporting the Implementation Plan to be overseen and monitored by Dementia Partnership Board

·                Prototype of Dementia Dashboard in development  ...  view the full minutes text for item 41.

To receive a presentation from Phillipa Brent-Isherwood.

The Board received a presentation from the Head of Business and Performance on the integrated Multi Agency Safeguarding Hub (MASH) pilot and development of the Community Multi-Agency Risk Assessment Conferences for adults.

Following the development of the MASH scheme for children and young people in Havering, a pilot scheme to include the safeguarding of adults would be commencing on June 9 2014.  Officers advised there were many  benefits in utilising the MASH hub for adult safeguarding. The unit was secure, had strong protocols and there was the opportunity to share vital information with partners so as to make informed decisions.

The Children’s and Young People MASH had been operating since 2012 which had resulted in fewer contacts actually becoming referrals to Children’s Services. In addition, more referrals were becoming assessments and there had been a reduction in the duplication of reports to Children’s Services.  In addition, cases were also being referred to other services.  The Police were currently receiving 20 alerts a week through the MASH hub.

In integrating children’s and adults, there would be the benefit of managing demand and again the opportunity to share information. This would also prompt change in police alert (MERLIN) analysis as currently a third of the number of MERLIN alerts received weekly received no services. It was also important to note that many adult issues affected children such as domestic violence, parental substance misuse and adult mental health.  A number of children’s MERLINS had led to raised concerns about the adults within the same household. 

The Board were advised that upon receipt of a referral, this would be triaged and rag rated on a risk basis. Red equated to immediate serious harm and action would be taken within four hours. Amber was not considered as immediate and action would be taken within one working day. Green stipulated that there were concerns about an individual but these were not critical.

Officers advised that the scope of the pilot was somewhat limited to acting on Adult Merlins and Safeguarding Alerts. The co-location of the Child Abuse and Investigation Team (CAIT) desk and the development of community MARACs – Multi-Agency Risk Assessment Conferences Panel would lead to a more efficient use of resources.

Partners in the scheme were London Borough of Havering, Metropolitan Police, NELFT, Clinical Commissioning Group, Probation Service and London Councils.

In setting up the scheme, the following had been arranged:

·                Staffing structure agreed and new jobs being advertised

·                Referral process and pathways for adults agreed

·                Terms of Reference, Risk Assessment,  referral form and chairing arrangements for Community MARAC agreed

·                Accommodation and IT

·                Governance arrangements and Steering Group

·                Performance Management Framework

·                Communications Plan

It was planned to enter into an Information Sharing Agreement and Table top exercise. In addition, there were plans to hold a “Dry run” of a Community MARAC meeting. 

The next steps would be to:

·                Deliver Communications Plan

·                Go live 9 June

·                Sources of contacts

·                Reasons for contacts

·                Turnaround times

·                Agency participation in information sharing

·                Changes in RAG ratings

·                Outcomes of  ...  view the full minutes text for item 42.

None raised.