To approve as a correct record the minutes of the Health and Wellbeing Overview and Scrutiny Committee meeting held on 17 January 2017.

The Minutes of the Health and Wellbeing Overview and Scrutiny Committee held on the 17 January 2017 were approved as a correct record.

The Chair congratulated Mandy Ansell on her new job title.

To receive additional items that the Chair is of the opinion should be considered as a matter of urgency, in accordance with Section 100B (4) (b) of the Local Government Act 1972.

There were no items of urgent business.

No interests were declared.

No items were raised by Healthwatch.

Ceri Armstrong introduced the report that informed Members that on the 9 March 2016, Cabinet approved Thurrock’s Better Care Fund Section 75 Agreement between the Council and the NHS Thurrock Clinical Commissioning Group. The Agreement allowed the creation of a pooled fund with the purpose of promoting the integration of care and support services. The pooled fund was overseen by an Integrated Commissioning Executive made up of officers from the Council and the Clinical Commissioning Group. The Report set out the arrangements for 2017/18 and 2018/19.

Councillor Collins thanked all Officers involved in the report and asked whether closer integration and improved outcomes for patients would be a more joined up service. Ceri Armstrong stated that the Better Care Fund contained a number of different schemes and these schemes identified the services to be brought together. An example given was an older people health and wellbeing service which had brought together a pharmacist, general practitioner, nurse, occupational therapist amongst other health and care professionals to work together to provide enhanced  support to care homes. Ceri Armstrong concluded that it was a broad range of services ranging from co-location and joined up working to integrated services and approaches.

RESOLVED

That the Health and Wellbeing Overview and Scrutiny Committee note the arrangements for entering into a Better Care Fund Section 75 Agreement for 2017-19.

Tania Sitch introduced the report that was aimed at the local community and described how adult social care was performing in delivering the key priorities and the progress that had been made on the actions set out in the 2015 Local Account. Members were referred to the Appendix 1 that included the review of priorities and achievements for 2016 and the 10 key priorities for 2017.

The Chair thanked Officers for the excellent report.

Councillor Collins asked how much of the report had to be written following the budget announcement on adult social care. Tania Sitch stated that this announcement had not changed the priorities too much.

Councillor Collins questioned whether an external audit would be undertaken. Tania Sitch stated that peer reviews were undertaken and that findings could be shared with Members. The use of scorecards, own carer surveys and User-Led Organisation checks were undertaken on people’s satisfaction.

Councillor Snell thanked Officers for the good news report and asked for clarification on the model of care for the new resource for falls prevention. Tania Sitch stated that additional funding via the Better Care Fund had been received to work on fall prevention. Work will be undertaken with care homes and members of the public to prevent falls, working alongside professionals including occupational health therapists. Early intervention of those at risk of falls was essential. Tania Sitch also clarified that work took place to reduce risk factors with people who had had a fall in addition to preventing falls from taking place in the first place.

Councillor Snell questioned the reason that Thurrock when compared to England statistics was worse for people using social care who received self-directed support that different local authorities had different interpretations of what should and should not be included. As part of the Care Act residents had to be made aware up front of an indicative budget. Tania Sitch stated that Thurrock had resisted doing this as it had found this had not always helped individuals to identify the best solutions for them.  Instead, Thurrock undertook assessments that were outcome-focused and worked alongside residents to ensure that they were able to find the best solutions.

Councillor Sheridan asked for clarification on the number of staff in the adult social care teams mentioned within the Better Care Fund section of the Local Account. Tania Sitch stated that the:

•           Hospital Social Care Team had 15 members of staff which included Team Manager, Deputies, Social Workers and Support Planners who dealt with the patient discharges from Basildon Hospital and also covered the three main community hospitals.

•           The Joint Enablement Team was a larger team with Physiotherapists, Occupational Therapists, Nurse, Co-ordinators and 30 Carers who deliver the joint enablement.

Councillor Collins stated that good service improvements had been made.

Councillor Collins made reference to those National Key Performance Indicators that had gone down in the direction of travel and to ensure that the same services were being incorporated in each assessment. Tania Sitch that regular performance meetings  ...  view the full minutes text for item 48.

Tania Sitch passionately introduced the report that described the creation of the “Thurrock First” single point of access for adult residents in Thurrock. Thurrock First was part of the Health and Adult Social Care Transformation Programme “For Thurrock in Thurrock”.

Thurrock First will be an integrated community physical and mental health and adult social care information, advice and assessment service which would be jointly delivered and funded by North East London Foundation Trust (NELFT), South Essex Partnership Trust (SEPT) and Thurrock Council. The service will be operationally co-ordinated by a manager who would be recruited by all three participating organisations.

The report described the Options considered and the steps being taken to develop the service and the service model with the proposed launch date of 1 June 2017.

The direct contact telephone number advertised will be for Thurrock residents only and be manned by team members from Thurrock who would be knowledgeable of the local area and be able to assist first hand.

Councillor Snell congratulated Officers on the fantastic news and how this service would make a difference to Thurrock.

Councillor Watkins asked how this service would be communicated to all residents. Tania Sitch stated that a lot of work had already been undertaken with HealthWatch and that local social media, posters and hearsay would be used to promote this service.

Councillor Watkins asked how internal targets would be monitored. Tania Sitch stated the key performance indicators would be set amongst the three executives which would then be agreed with the commissioner and published. It was important that these targets captured the outcomes.

The Chair thanked all for their commitment to “Thurrock First” and requested that the item be added to the work programme for 2017/18.

Councillor Collins thanked Officers for their hard work and commitment.

Councillor Sheridan questioned the costs for the pilot and could there be potential cuts in the future. Tania Sitch stated that it was first time that three executives (NELFT, SEPT and Thurrock Council) had shared set up costs. This was a one-off cost within the organisations of £200,000 and no targets had been set on savings.  Tania Sitch stated that efficiencies were likely but that this would mean that more people could access the service. The service would be evaluated after a year.

RESOLVED

That the Health and Wellbeing Overview and Scrutiny Committee endorse proposals to establish a new single point of access service called “Thurrock First”.

Ian Wake introduced the Accountable Care Organisation report that detailed the two initiatives that had been designed to address current issues in the local Health and Social Care system. The Development of an Accountable Care Organisation for the Tilbury Locality and development of four Integrated Healthy Living Centres across Thurrock.

Thurrock remained one of the most “under doctored” areas in England in terms of the ratio between general practitioners and patients and there was an unacceptable level of variation in the clinical care of patients with long term conditions between different general practitioner practice populations.

The Annual Report of The Director of Public Health in 2016 considered the health and social care system sustainability in Thurrock and concluded that fragmentation within constituent parts of the system and inadequate capacity and quality of Primary Care was leading to preventable serious health events within our population and was a key underlying driver of system unsustainability.

Ian Wake updated Members on the development of Thurrock Integrated Healthy Living Centres. Due to the complexity of current National Health Service commissioning arrangements the implementation of the project had been slower than expected.  A team of consultants from Currie and Brown have been appointed to move the project forward so that a business case could be presented to Cabinet to seek approval to borrow the required capital for construction to start and setting out how revenue would be recouped from the National Health Service. It was expected that the business case would be ready in late 2017.

Mandy Ansell expanded on the concept that was being piloted in Tilbury. Jeannette Hucey had been working on the concept of a new Lead Partner Model for 18 months built on learning from the Vanguard sites that had been given specific funding to develop new models of care. Jeanette Hucey had formed a “buddy” arrangement with Dudley in the West Midlands who are a Vanguard site and have been leading on new model development. The challenge in many cases has been getting the providers to work together and full credit should be given to local providers North East London Foundation Trust (NELFT), South Essex Partnership Trust (SEPT), and Basildon and Thurrock University Hospital Trust  (BTUH), where there was now greater trust allowing for conversations around risk and gain share to emerge.  Work continues on the Legal contract, which was incredibly complex and advice being sought from Hempsons in support.

Mandy Ansell stated that this was an incredible exciting project and those involved deserved a “big pat on the back”.

Ian Wake stated that this was one of the most exciting project he had worked on in his 22 year career.

The Chair thanked Officers for the continuing good news on the agenda.

Councillor Collins questioned whether the “double running” would result in the budget doubling over the period of time and for how long was this period of time. Ian Wake stated that it was likely that funding would be placed within the Better Care Fund. Additional government money  ...  view the full minutes text for item 50.

Jane Itangata, Senior Commissioning Officer, Clinical Commissioning Group, introduced the report that as of 1 April 2017, the Clinical Commissioning Group would enter into co-commissioning arrangements with the National Health Service Public Health England to deliver the Learning Disability Health Checks. This had facilitated the opportunity for an alternative service to undertake health checks for people who cannot access these from their general practitioner surgeries.

This co-commissioning between National Health Service England and Thurrock Clinical Commissioning Group had provided the opportunity to use evidence and co-production techniques to design the approaches that would enhance activities to support the health check delivery and create sustainable arrangements that would be maintained to ensure adequate coverage for delivery of quality health checks and implementation of subsequent plans.

Annual Learning Disability Health Checks are available for anyone with a learning disability who was aged 14 years of age or over. Under the Directed Enhanced Service all general practitioners contract holders across Midlands and East (East) would be given the opportunity to provide Learning Disability Health Checks.

Jane Itangata reported that as of 15 March 2017 the coverage of health checks was 63 per cent of eligible people having had their health checks completed with a target of 70 per cent by the end of the year.

The Chair thanked Officers for the clear improvement and the considerable work that had been undertaken.

Councillor Watkins questioned what work was being undertaken with Thurrock residents in schools outside the borough and how would work be carried out with those schools. Jane Itangata stated that this was work in progress work alongside HealthWatch and would start with the schools more aware of and then move out to outer borough schools. Jane Itangata explained to Members that data was manually collated as data supplied by National Health England was not always up to date and a proper picture would not be formed. Manual collated included ringing surgeries to encourage general practitioners to update their records.

Councillor Snell commented that the report demonstrated another Thurrock success and a good news update.

Councillor Collins asked Officers to explain a Health Action Plan. Jane Itangata stated that any young person or adult with learning disabilities should have a Health Action Plan. These are prepared by a doctor, nurse or health worker or supported who help at home.

Neil Woodbridge stated that Essex Police as part of the Advisory Panel were offering “Ride Along Scheme” to improve public trust and confidence in Essex Police by ensuring the processes and procedures are transparent were allowing members of the public the opportunity to observe everyday policing activities. Members can contact Neil Woodbridge directly if interested.

Mandy Ansell updated Members on the work undertaken by Jane Itangata and Mark Tebbs with Essex Police on the procedure that from the 1 April 2017 anyone picked up with mental health issues or challenging behaviour would not be placed in police cells and that designated nurses would accompany Essex Police on these call outs. It was also noted  ...  view the full minutes text for item 51.

The Chair stated that this was the last Health and Wellbeing Overview and Scrutiny Committee for this municipal year and that the work programme was now complete.

The Chair thanked Members and Officers for their contribution and their continued support to the Health and Wellbeing Overview and Scrutiny Committees.

The Chair asked Members if there were any items to be added or discussed for the work programme for the next municipal year.

RESOLVED

1.         That the item Thurrock First will be added to the work programme for 2017/18.

2.         That the item Learning Disability Health Checks will be added to the work programme for 2017/18.

3.         That the item Review of Careline will be added to the work programme for 2017/18.

4.         That the item General Practitioner Five Year Forward Review will be added to the work programme for 2017/18.