Agenda and minutes

Health & Wellbeing Board - Wednesday, 16th January, 2019 1.00 pm

Venue: Town Hall

Contact: Victoria Freeman  Email: 01708 433862

No. Item



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 gave details of the arrangements in case of fire or other event that may require the evacuation of the meeting room or building.



(If any) – receive



Apologies were received from:


Tim Aldridge, Director of Children’s Services, London Borough of Havering

Danny Batten, NHS England

Andrew Blake-Herbert, Chief Executive, London Borough of Havering

Christopher Bown, Barking, Havering and Redbridge University Trust

Councillor Gillian Ford, London Borough of Havering

Ceri Jacob, Barking, Havering and Redbridge Clinical Commissioning Group

Steve Rubery, Barking, Havering and Redbridge Clinical Commissioning Group

Jacqui Van Rossum, North East London Foundation Trust

Councillor Damian White, London Borough of Havering



Members are invited to disclose any interest in any of the items on the agenda at this point of the meeting.


Members may still disclose any interest in any item at any time prior to the consideration of the matter.


There were no declarations of interest made in items on the agenda.



To approve as a correct record the minutes of the Committee held on 12 September 2018 and to authorise the Chairman to sign them, and to consider the Action Log and Indicator Set (attached).

Additional documents:


The minutes of the meeting held on the 12 September 2018 were agreed as a correct record and signed by the Chairman.


The following items were noted in respect of the action log:


·         17.27 – In terms of safeguarding, it was noted that information pertaining to safeguarding cases referred to courts was publicly available. 


·         18.2 - All secondary schools in Havering had confirmed that they operated a closed gate policy.


·         6 – Agenda Item. 6 refers.


·         7 – An update on the SEND Action Plan and the Therapy Review – Options Appraisal, showing a timetable to the end of October 2018, would be circulated to members.


Members received the Health and Wellbeing Board indicator set which provided an overview of the health of residents and the quality of care services available to them. 


Members received a verbal update on ‘prescribed long acting reversible contraception (LARC) excluding injections.  LARC would be a priority due to its lack of improvement and discussions would be had with the Sexual Health Service regarding the teen pregnancy plan and the indicator monitored.


Referral to treatment continued to be a concern, with performance worsening.  The improvement plan continued to be monitored through the Steering Group and an update would be presented at the next meeting of the Board.




Report attached.

Additional documents:


The Board received information which would inform future discussions about a new Joint health and wellbeing strategy.


Members received the King’s Fund paper ‘A vision for population health, towards a healthier future’ which set out the health and wellbeing challenges faced nationally and where efforts were best placed to achieve improvement. The paper provided a useful context and possible framework to help members consider how work at borough level might further the aims of the Board as expressed in any future strategy.


Although there had been great improvements in health over the past decade due to improvements in sanitation, medicines and healthcare, underpinned by economic growth, improved living standards and the establishment of the welfare state, the rate of progress had stalled in England alongside an increasing burden on health services.


Studies into determinants of our health, had identified socio-economic determinants, lifestyle and care as contributors.  The most optimistic estimate suggested that health care could contribute more than 40% of the overall health status of the population, if every effective intervention was provided at the right time to every patient who would benefit.  Other studies put the estimates at under 25%, which lead the authors of the paper to suggest that improving the health of the population and the future sustainability of high quality health and social care was dependent on decisions makers at all levels recognising the importance of other factors.


The Kings Fund report introduced the concept of four pillars of population health and explored the evidence as to how each might affect health, directly or indirectly, alone or in concert with other factors; the strength of that evidence, and the scale and speed of the impact that might be expected on health and health inequalities. 


The Kings Fund report suggested a balanced approach to four underpinning pillars, each of which were a core business of one or more statutory partners:


·         Pillar 1 – Wider determinants of health

·         Pillar 2 – Health behaviours and lifestyles

·         Pillar 3 – The places and communities we live in

·         Pillar 4 – An integrated health and care system


It was suggested that the Board adopt and champion the population health approach, which would be a significant development in the direction of the Board and frame future plans; and would encourage partners to look at the areas of overlap or joint responsibility that might otherwise be overlooked.  The Board sought clarification on the accountabilities between the Local Authority, Clinical Commissioning Groups, the Sustainability and Transformation plan and Integrated Care System.


Members indicated their commitment to achieving a set of explicit time limited goals relevant to the four pillars and the development of a programme of work that was actively managed.   Furthermore, members felt that there should be a more balanced approach and for an increased focus on individuals placing more onus on their own health.


During discussion, concern was raised regarding the number of children in families classified as homeless.  There were issues locally regarding accountability and the importance of engagement Health and  ...  view the full minutes text for item 5.



Report attached.

Additional documents:



Members received the Health Improvement Report which illustrated how the Council had broadened its preventative approach to tackle the wider determinants of health, and health behaviours and lifestyles.


Living and working conditions, including access to education, employment, decent housing, access to high quality built and natural environment, were major determinants of health and wellbeing. 


The eighteen separate programmes of work summarise in the report, when taken together, responded to the greatest health challenges of today, those of non-communicable diseases such as diabetes, health inequality and increasing health and social care costs.


Public Health and Planning had worked together on a health impact assessment of the Local Plan, and this showed that it is possible to take a very practical approach to health in all policies, and this led to further interest in assessing other strategies and policies for their impact on health


During discussion, members noted that the inclusion of Health and Wellbeing impact statements in key decisions was to be piloted; that the Equality and Health Impact Assessment was being evaluated; and that further training needs in understanding health and wellbeing impacts would be considered. 


The health and wellbeing in schools service had supported schools to achieve Healthy Schools London awards, and had delivered training to school staff on a range of health and wellbeing topics. The service was supporting schools to prepare for new curriculum content on Sex and Relationship education.  Havering was one of six London boroughs to participate in Healthy Early Years London pilot, with eight awards achieved during the pilot phase. A Healthier Catering Committee was planned to be introduced in 2019, focusing on supporting restaurants and cafes to take action to prompt customers to opt for healthier choices.


Air quality was the largest environmental risk to the public’s health and contributed to cardiovascular disease, lung cancer, and respiratory diseases, and increased the chances of hospital admissions and visits to emergency departments.  Although poor air quality affected everyone, it had a disproportionate impact on the young, old, sick and the poor.  The Public Protection service was leading a piece of work on an agreed air quality action plan.


Local authorities were mandated to provide NHS health checks free of charge to local residents aged 40 to 74 who have not already been diagnosed with a Cardio Vascular Condition (CVD).  The check identified those who have CVD, as well as those who were at high risk of CVD, and these residents are given lifestyle advice.  The General Data Protection Regulations had impacted negatively on the flow of information between the CCG and other agencies, and this was a concern as joint working was dependent on information sharing.   


The Health Improvement Plan contained some top line information on sexual health, including strengthened commissioning arrangements; drug and alcohol harm reduction and health visiting and school nursing.  Health visiting and school nursing services, provided by the North East London NHS Foundation Trust (NELFT), had improved and would be re-procured in 2020. 


Since the cessation of the smoking service, which  ...  view the full minutes text for item 6.



Report attached.

Additional documents:


The Board received an update on how the focus on developing ‘Localities’ collectively contributed to the aspirations set out in the Kings Fund report, in respect of pillar 3: The places and communities we live in.


The wider transformation programme of the Council, together with Localities development would contribute to the role that places and communities play in health (including mental health) including the impact of social relationships and community.  The programme would produce a new locality model which would focus on prevention; build social capital; provide holistic wrap around care and support for individuals and create a broader coherent range of services, networks and pathways in defined areas of the borough. 


The Local Authority were looking at community hubs in town centres, following the benefits experienced in Thurrock; closer working with Housing to create opportunities for vulnerable people to remain in Havering; to follow the Better Living model which had been piloted since February 2018; to have a joined up approached to early help in order to create a cohesive service for families and integrating its commissioning to focus.




That the Board considered the Localities Update and sought clarification on the localities/transformation programme.




Report attached.

Additional documents:


The Board received a presentation which summarised how health and social care partners across BHR plan to accelerate improved health and wellbeing outcomes of the people of Barking and Dagenham, Havering and Redbridge and deliver sustainable provision of high quality health and wellbeing services. The presentation covered the BHR Integrated Care Partnership and its vision, the local system recovery plan, key service transformation areas and the new, clinically led, transformation boards.


The key issues faced were:


·      BHR: system deficit of £25m in 2014/15 growing to £75m by the end of 2017/18 alongside the need to improve outcomes for local people and address local workforce gaps, placing strain on the ability of the system to deliver its constitutional standards and has driven an insufficient focus on transformational change, meaning that the improvement in overall patient outcomes had not been achieved.


·      BHR CCGs and BHRUT are required to deliver joint financial recovery but it was recognised that this could not be achieved without partnership work with NELFT and the BHR GP Federations.


Going forward it was proposed to address the following issues:


·      The overall efficiency of the system to eliminate historic and in-year deficits.

·      To move activity out of hospital and closer to home by 2020/21, to crease a sustainable financial model going forward.

·      The overall director of travel for the health and care system in BHR to take into account the Integrated Care System.

·      Establish an NHS Recovery Board to ensure a co-ordinated approach and to provide a forum for senior leaders; and the establishment of a number of clinically led Transformation Boards to target the key population and coordinate transformational change across the system.


The Board would receive an in depth update on the transformation of services and the progress of individual programmes at a future meeting.




That the Board noted the presentation.



Report attached.

Additional documents:


The Board received a report that detailed the work of the Integrated Care Partnership. 


During discussion, clarification was sought on the relationship between the Integrated Care Partnership Board and the Health and Wellbeing Board.  It was highlighted that the Health and Wellbeing Board was not included in the governance arrangements for the Integrated Care Partnership Board and that similar approaches were unlikely to be adopted across each of the boroughs.  The Integrated Care Partnership Board recognised the need to understand the issues that each borough was experiencing and welcomed opportunities through joint commissioning.


Consideration would be given to a proposal of incorporating the Health and Wellbeing Board in the governance arrangements of the Integrated Care Partnership Board, with particular oversight on Havering Localities and that recommendations would be presented to members at the next development session.




That the Board:


      I.        Noted the contents of the report, where it detailed the governance and current direction of travel of the Integrated Care Partnership, including the issues that arose from its recent consideration of the programme so far.

    II.        Noted the proposals around locality boards and any considerations around how this might be established.

   III.        Provide any comment back to the Integrated Care Partnership Board on the work that it is undertaking, and how the Health and Wellbeing Board can be more meaningfully involved in the future.

  IV.        Agreed the proposal that a further report comes back which outlines the ways in which the ICPB work programmes will support delivery of the new Health and Wellbeing Strategy for Havering.

   V.        Noted the presentation on the NHS Financial Recovery Programme and discuss the key areas of focus and any areas of concern raised by the proposed approach; and

  VI.        Agree how the HWBB would like to receive the final version of the Recovery Plan when it has been updated following Regulator feedback.





BETTER CARE FUND 2017-19 pdf icon PDF 252 KB

Report attached.

Additional documents:


The Board received a report which provided an update on the way in which the Better Care Fund (BCF) was being utilised during 2018/19 and how it was delivering against plan.  The report also sought to set out further details about the proposed plans for the next year.




That the report, be noted.


FORWARD PLAN pdf icon PDF 262 KB

Plan attached.


The Board agreed the forward plan as circulated in the agenda, subject to progress on the development sessions.



The next meeting is scheduled to be held on 13 March 2019, commencing at 1.00pm, at Havering Town Hall.


Members noted that the next meeting was scheduled to be held on the 13 March 2019, commencing at 1.00pm, at Havering Town Hall.