Enclosure Z

Clinical, Quality and Governance (CQG) Committee Report for the Meeting held on 28th June 2017

Achievements / Decisions Made / To Note Matters referred to lllllllllllllllll Governing Body for 1. Quality, Safety and Governance Provider reports: The Committee received the reports for Coventry and Warwickshire approval, debate or further Partnership NHS Trust (CWPT), University Hospitals Coventry and consideration: Warwickshire NHS Trust (UHCW), Care Homes and other providers. The main issues included: UHCW - the CCG to advise GP Practices about the improved performance related to urgent clinic letters; Care Homes - three care homes on escalation and enhanced monitoring and two homes had No issues referred. been removed from escalation; BMI Meriden - the action plan following the Care Quality Commission (CQC) inspection in May 2016 has been shared with the CCG; and, Virgin Healthcare, City of Coventry Walk in Centre: the walk in centre will become a Child Protection Information System pilot site. Key Issues for the Governing 2. Patient Safety Reports: Body: The Committee reviewed the reports for UHCW, CWPT and other providers, noting that both UHCW and CWPT recorded approximately 20% fewer incidents in 2016/17 compared to the previous year. The Committee also No issues highlighted. noted that BMI Meriden reported no serious incidents in 2016/17 and that South Warwickshire NHS Foundation Trust (SWFT) and George Eliot Hospital NHS Trust (GEH) each reported two incidents involving CRCCG patients. 3. Infection Prevention and Control CRCCG Performance report: The Committee reviewed the report noting that during 2016/17: the CCG achieved its target of zero MRSA bacteraemia; exceeded the locally set threshold for E-coli bacteraemia; and, remained under its locally set threshold for MSSA bacteraemia. The CCG is working with local providers and South Warwickshire and North Warwickshire CCGs to develop a collaborative approach towards the reduction of E coli bacteraemia.

4. Safeguarding Assurance Report: The Committee reviewed the report, noting the findings and supporting the actions being taken to address quality concerns. 5. Update on the Health of Looked After Children in Rugby: The Committee received the report, noting the contents and that a looked after joint commissioning sub-group involving all CCG leads had been formed to identify and oversee the next steps. 6. Transforming Care Update: The Committee noted the update, including that national team feedback was positive on all of the areas of work that we are doing. 7. Primary Care update: The Committee noted the verbal update, including that the CCG’s Primary Care Commissioning Committee had been set up and work is continuing on the reporting systems. 8. Corporate Risk Register: The Committee reviewed the register and were assured that all six risks are being actively managed. 9. Emergency Preparedness Resilience and Response (EPRR) Annual Compliance Self-Assessment: The Committee noted the EPRR activity taking place at the CCG and the progress made against the annual EPRR Core Standards assessment. The Committee approved delegation of sign off to the CCG AEO for the 2017 core standards process. 10. Other: The Committee noted: the Warwickshire Safeguarding Adults Board minutes, 2 0th October 2017; CWPT Clinical Quality Review (CQR) minutes, 15th March 2017; and, UHCW CQR minutes, 6th April 2017.

Key Information: • Committee Chair: Mr Ludlow Johnson (Lay Member, Patient and Public Involvement and Health Inequalities) • CCG Lead: Mrs Glynis Washington (Director of Nursing)/Mrs Jenny Horrabin (Deputy Director of Corporate Affairs) • Date of Next Meeting: 23rd August 2017

Clinical, Quality and Governance (CQG) Committee Report for the Meeting held on 24th May 2017

Achievements / Decisions Made / To Note Matters referred to lllllllllllllllll 1. HR Report: Governing Body for The Committee received the report, noting that at the end of June 2017 approval, debate or further CRCCG had a headcount of 200. The Committee requested further information on compliance around training and appraisal s and asked the consideration: CCG to arrange a refresher update for new staff on Electronic Staff Record (ESR) procedures. 2. Workforce Race Equality Standards (WRES) update report: No issues referred. The Committee reviewed the report, noting that the next formal WRES submission date is July 2017, and a more detailed report and action plan would be presented at the July CQG meeting. The Committee noted the following specific actions: reminder to be sent to all staff annually to highlight the importance about recording ethnic data on ESR; Key Issues for the Governing 3. NHS Staff Survey 2016 - Results and CCG Action plan: Body: The Committee reviewed the contents of the NHS Staff Survey results and endorsed the supporting CCG action plan. No issues highlighted. 4. CCG Complaints Report, 2016/17, Quarter 4 (1 Jan to 31 March 2017) : The Committee reviewed the report, noting that 24 new complaints had been received of which 19 concerned Continuing Healthcare. The Committee also noted that an equality and diversity questionnaire is sent out with all complaint response letters and any feedback received will be included in the 2016/17 Annual Complaints report. 5. Corporate Risk Register - May 2017: The Committee received the Corporate Risk Register and reviewed the six risks currently on the register and endorsed the mitigating actions in place. 6. Business Continuity Update: The Committee noted the extension to the existing Business Continuity Policy to September 2017 and the plans in place to standardise the business continuity arrangements to reflect the joint working arrangements between the CCG and Warwickshire North CCG in place from April 2017. 7. Information Governance Quarter 4 Report: The Committee noted the assurance on compliance with Information Governance requirements in Quarter 4. 8. Committee Effectiveness Tool: The Committee agreed to endorse the approach to the review of committee effectiveness, noting that the review and action plan will be presented to the July CQG meeting. 9. Clinical Governance exception report: The Committee noted the exception reports relating to Coventry and Warwickshire Partnership NHS Trust (CWPT) and University Hospitals Coventry and Warwickshire NHS Trust (UHCW); noted the CWPT National Mental Health Survey 2016 - Action Plan; endorsed the commentary for the CWPT Quality Accounts; noted the contents of the Prescribing Quality Report up to February 2017 and agreed any ongoing actions; and, noted the verbal Primary Care Update about progress to date on agreeing processes and reporting flows. 10. Other: • The Committee noted: the CWPT Clinical Quality Review (CQR) th minutes, 18 January 2017; and, South Warwickshire NHS Foundation Trust (SWFT) CQR minutes, 19th January 2017. • The Com mittee agreed that an update on Early Intervention Service (EIS) waiting times should be included in the CWPT provider report at the June CQG meeting.

Key Information: • Committee Chair: Mr Ludlow Johnson (Lay Member, Patient and Public Involvement and Health Inequalities) • CCG Lead: Mrs Glynis Washington (Director of Nursing)/Mrs Jenny Horrabin (Deputy Director of Corporate Affairs) • Date of Next Meeting: 28th June 2017

Clinical, Quality and Governance (CQG) Committee Report for the Meeting held on 26th July 2017

Achievements / Decisions Made / To Note Matters referred to lllllllllllllllll Governing Body for Governance: 1. Risk Register: approval, debate or further The Committee reviewed the risk register and endorsed the mitigating consideration: actions, noting that going forward there will be changes to the way information is presented as the risk register is being aligned with Warwickshire North CCG. No issues referred. 2. HR Report: The Committee received the report, noting that at the end of June 2017 the CCG had a headcount of 192 and compliance around mandatory training continues to be an issue. 3. Information Governance (IG) Quarter 1 (including Caldicott Log) Key Issues for the Governing report : Body: The Committee noted the compliance with IG requirements in 2016/17

Quarter 1. No issues highlighted. 4. Freedom of Information (FoI) Quarter 1 report: The Committee received the report, noting that during 2016/17 Quarter 1, 42 FoI requests had been received, with all but four responses being completed within the 20 day deadline. The Committee agreed that further details should be provided in future reports about requests where the deadline for a response had been exceeded. 5. Modern Slavery Act 2015 and statutory duties: The Committee approved the statement in relation to the modern slavery act. 6. CCG Complaints Annual Report 2016/17: The Committee approved the report for publication on the CCG website.

7. CCG Complaints Report, 2017/18, Quarter 1: The Committee reviewed the report, noting that 19 new complaints had been received of which 17 concerned Continuing Healthcare. The Committee requested that consideration is given to producing a report on how the CCG tri-angulates complaints information with other information sources, including incidents and GP Feedback, to identify themes and trends. 8. Workforce Race Equality Standards (WRES) Report (approval to publish) : The Committee reviewed the report and during the discussion identified a number of actions. Subject to resolving the actions, the Committee approved the WRES for publication on the CCG website.

9. Clinical Governance exception report: The Committee noted the exception reports relating to Coventry and Warwickshire Partnership NHS Trust (CWPT) and University Hospitals Coventry and Warwickshire NHS Trust (UHCW). Key points were: CWPT - the Care Quality Commission (CQC) draft report on Mental Health, Learning Disabilities and Dental Services expected in August 2017; UHCW - NHS England is currently in the process of reviewing the outcome of post infection reviews (PIRs) related to 4 cases of MRSA; GP Feedback - further information on the GP feedback reporting system to be presented at the

CQG October meeting. 10. Other: The Committee noted the minutes of the Coventry Safeguarding Adults Board, 23rd March 2017; CWPT Clinical Quality Review (CQR) minutes, 17th th May 2017; and, George Eliot Hospital NHS Trust (GEH) CQR minutes, 8 December 2016, 16th February 2017, 16th March 2017 and 20th April 2017.

Key Information: • Committee Chair: Mr Ludlow Johnson (Lay Member, Patient and Public Involvement and Health Inequalities) • CCG Lead: Mrs Glynis Washington (Director of Nursing)/Mrs Maria Maltby (Deputy Director of Corporate Affairs) • Date of Next Meeting: 23rd August 2017

Clinical Development Group (CDG) Report for the Meeting held on 25th July 2017

Achievements / Decisions Made / To Note Matters referred to lllllllllllllllll 1. Commissioning a Holistic ‘Risky Behaviours’ Early Intervention Governing Body for and Young People’s Substance Misuse Service: approval, debate or further Members received a briefing on the proposal by Coventry Public Health to bring the early intervention and substance mis-use services together consideration: as part of a retender process. Members discussed and noted the proposal, but requested the opportunity to comment on the draft specification, to include the promotion of GP Gateway. No issues referred. 2. Mental Health QIPP (Quality, Innovation, Productivity and Prevention) Ideas for 2018/19: Members received a briefing on the background to how outline QIPP

proposals have been generated and were invited to offer an initial clinical sense check. Members agreed that considerations should Key Issues for the Governing include how primary care and IAPT (Improving Access to Psychological Therapy) could better manage patients with i) medically unexplained Body: symptoms and ii) LTCs; ‘Crisis Houses’ and Dementia.

3. Elective Care QIPP Ideas for 2018/19: No issues highlighted. Members received a briefing on proposed ideas for schemes, noting that work to look at the redesign of Dermatology had made little progress and a review of the Community MSK (Musculoskeletal) service is required. Members suggested further areas for consideration around Pre-ops; Ophthalmology; and, Community Physiotherapy.

4. Stroke Business Case: Members were advised that one of the underlying principles of the

Stroke Business Case is to screen more successfully for arterial fibrillation (AF). A national expert on stroke management had been invited to attend a meeting with local GPs. Members agreed that the Stroke Business Case should be forwarded to clinical leads for comment , and that AF should be included as a potential scheme for use of PMS monies. 5. Planned Care Programme of Work and Commissioning Policy Development: Members received updates on the: • Planned Care Programme of Work with University Hospitals Coventry and Warwickshire NHS Trust (UHCW) which is linked to the key requirements of the NHS standard contract around the link between primary and secondary care. • Policy Development Group set up to develop new commissioning policies and to ensure that existing policies, as appropriate, are up- to-date and comply with NICE guidance. Following discussion on new policy development, it was agreed that more focus is required on Equality Impact Assessments and further work is required on ways of engaging more with patients and the public and other stakeholders. Also in relation to ensuring that all policy updates are made available on GP Gateway in a timely manner.

6. Items for noting: st Arden Mental Health Commissioning Group Minutes, 1 June 2017.

7. Privacy Impact Assessment (PIA) Members were requested to advise the CCG of any comments on the PIA to allow a clinical review of patients diagnosed with Clostridium difficile or E.Coli bacteraemia.

Key Information: • Committee Chair: Mrs Clare Hollingworth (Chief Finance Officer) • CCG Lead: Mrs Clare Hollingworth • Date of Next Meeting: 22nd August 2017

Clinical Development Group (CDG) Report for the Meeting held on 27th June 2017

Achievements / Decisions Made / To Note Matters referred to lllllllllllllllll 1. Matters Arising - Appointment Slot Issues (ASI) at University Governing Body for Hospitals Coventry and Warwickshire NHS Trust (UHCW) approval, debate or further Members were advised that concerns had been raised again about ASI consideration: and the impact on the way referrals are processed and the delays for people being booked into appointment slots. The present system is a frustration for GPs who are unable to close referrals. Members agreed that the CCG should carry out a review of appointment availability and No issues referred. quality implications and then meet with appropriate stakeholders with the aim of agreeing a new process for the CDG to consider from both a commissioning and operational GP perspective.

2. Draft Coventry Young Offending Service Youth Justice Plan 2017 - 2018 Key Issues for the Governing Members received a briefing and an early opportunity to comment on Body: the draft plan before finalisation in July 2017, including information about the level of resource input from the CCG into the service. No issues highlighted. Following discussion Members endorsed the level of resource currently in the draft plan for the year ahead and agreed that the CCG’s nominated Commissioning Director would sign off the final plan on behalf of the CCG. Members wishing to comment on the draft plan were invited to do so by 11th July 2017.

3. Coventry Drug and Alcohol Strategy 2017 - 2020 and Summary: Members received a briefing on the strategy as part of the final

Consultation process. An update was also provided on progress made to address alcohol and drug mis-use against previous strategies, with reference made to the Family Drug and Alcohol service, including the Alcohol Liaison Nursing services commissioned by the CCG. Members asked for a report to be prepared and circulated to provide further details around activity for patients seen by the Alcohol Liaison Nurse. Members were also informed about a new adult service starting in Coventry in November to provide treatment and support. The contract to run the service had been awarded to Change, Grow, Live (CGL). Members noted that closer to the launch date a communication package would be prepared to involve local GPs. A similar new service is planned for Warwickshire (including Rugby) with an anticipated commencement date of summer of 2018, but the tender process had not yet started. 4. Items for noting: Arden Mental Health Commissioning Group Minutes, 2nd March 2017 th and 4 May 2017. 5. Other Members noted that the CDG Terms of Reference are being revised by the CCG’s Deputy Director of Corporate Affairs.

Key Information: • Committee Chair: Mrs Clare Hollingworth (Chief Finance Officer) • CCG Lead: Mrs Clare Hollingworth • Date of Next Meeting: 25th July 2017

Finance and Performance (F&P) Committee Report for the Meeting held on 24th July 2017

Achievements / Decisions Made / To Note Matters referred to 1. CCGlllllllllllllllll Finance Report - Month 3 (June): Governing Body for The Committee reviewed the report, noting that the financial position was in approval, debate or further line with the plan agreed with NHS England (NHSE), although based on limited data. The Committee also noted that: consideration: • The CCG is working with the Commissioning Support Unit (CSU) to Procurement update, July 2017: address data quality issues for Continuing Healthcare. The Committee recommended that the • Running cost expenditure is underspent, mainly due to slippage. Governing Body approves the extension • University Hospitals Coventry and Warwickshire NHS Trust (UHCW) of the existing Any Qualified Provider position reported as breakeven whilst activity queries relating to (AQP) contracts for the provision of Age changes in IR rules are resolved. Related Macular Degeneration (ARMD) Following discussion, the Committee requested a more in depth report services, within the clinical pathways, until covering finance, QIPP (Quality, Innovation, Productivity and Prevention) 31st March 2020. and contract performance for the next F&P meeting in August.

2. QIPP Report: Based on available information, the Committee was not assured about QIPP performance with further discussion requested at the next F&P meeting. 3. Performance Report: Key Issues for the Governing The Committee reviewed the report providing information on performance Body: against the full range of national targets and, where appropriate, the recovery actions being taken. Key areas where performance continues to Procurement Update, July 2017: be below target are Referral to Treatment (RTT); A&E 4 hour waits; and, The Committee resolved to assure the Dementia Diagnosis. The Committee noted that all nine cancer wait targets Governing Body that the Transforming were met by the CCG in May, and that six cases where patients had waited Care Partnership framework contract for more than 100 days from referral to treatment at UHCW are being reviewed learning disability services is now in place, through the Clinical Quality Review Meeting. with contracts awarded through Warwickshire County Council to four 4. Procurement Update, July 2017: st providers until 31 March 2020, with the The Committee were assured on the progress of current procurements, option to extend for up to two further including: years. • Out of Hospital: CRCCG and WNCCG Governing Bodies had approved direct awards of 3 year contracts with Coventry and

Warwickshire Partnership NHS Trust (CWPT) due to start on 1st April 2018. • Rugby Town Medical Practice: the CCG’s Primary Care Commissioning Committee to consider future APMS (Alternative Provider Medical Services) contractual arrangements at their August meeting.

(Note: also see Governing Body panels).

5. Transfer of Coventry Walk in Centre Contract Management: The Committee received the report and made the following decisions: • To approve the transfer of the Coventry walk in centre and clinical responsibility from the CCG to UHCW. • To approve the direct award of a 2 year contract to Virgin Care for continuation of delivery of the Coventry walk in centre (ahead of novation to UHCW). • To recommend that the proposed UHCW service specification is submitted to the CCG’s Clinical Development Group (CDG) for validation. 6. Action, Delivery and Recovery Plans The Committee noted the progress made to date on the UHCW A&E Action Plan; UHCW RTT Delivery Plan; and, the revised dementia diagnosis recovery plan but were not assured that these were adequate to address performance issues. Deep Dive into A&E requested for August meeting and into RTT at the September F&P meeting. A more concise Dementia Diagnosis RAP was requested for September. 7. Other Members received and noted the Clinical Operation Group Minutes, 12th June 2017, and the Financial Recovery Board Minutes of 30th June and 3rd July 2017.

Key Information: • Committee Chair: Mr Peter Maddock (Lay Member, Governance) • CCG Lead: Mrs Clare Hollingworth (Chief Finance Officer) st • Date of Next Meeting: 21 August 2017 Finance and Performance Committee Report for the Meeting held on 26th June 2017

Achievements / Decisions Made / To Note Matters referred to 1. Full Yearlllllllllllllllll Primary Care Prescribing Report 2016/17: Governing Body for The Committee received the full year prescribing report for 2016/17, noting approval, debate or further that overall the cost and quality indicators suggest strong performance The Committee received assurance that under-prescribing would be consideration: appropriately managed. The Committee thanked Medicines Management Procurement update: and GP Practices for their achievements. The Committee recommended that the 2. CCG Finance Report - Month 2 (May): Governing Body approves a 24 month The Committee reviewed the new format report, noting that the financial extension to the current direct access position was reported as on plan although based on limited data. The community based Non Obstetric Committee also noted that: Ultrasound services (NOUS) contracts • Running cost expenditure is predicted to be on plan, with a slight with UHCW and Holbrooks Health Team underspend year to date due to slippage. due to expire at the end of June 2017. • Quality, Innovation, Productivity and Prevention (QIPP) delivery is currently forecast to be in line with plan, but considerable work is required to ensure QIPP targets are met. Management of QIPP will be a key task for the CCG’s Executive Team. Key Issues for the Governing (Note: also see Governing Body panel) Body: 3. Performance Report: The Committee reviewed the report providing information on performance Finance Report Month 2: the Committee against the full range of national targets and, where appropriate, the agreed to submit the report in its current recovery actions being taken. Key areas where performance by University new format to the Governing Body. Hospitals Coventry and Warwickshire NHS Trust (UHCW) is below target are: Referral to Treatment (RTT) where a new performance notice had been Performance Report: the Committee issued and a new remedial action plan requested; A&E 4 hour waits; cancer agreed that the issues and actions raised waiting times, including where five patients breached the 31 day target, and would be included in the performance one patient the 62 day target. The Committee was assured that these report to the Governing Body. issues would be escalated with UHCW. The Committee noted that for

Dementia Diagnosis the CCG is working on the development and implementation of a remedial action plan with NHSE to improve performanc e. (Note: also see Governing Body panel)

4. Procurement Update: The Committee received the report which provided an overview of the procurement work programme and a progress update for each of the current services that are in the live procurement phase. The key points were: • The CCG’s Primary Care Commissioning Committee had extended the contracts with Virgin Healthcare for the Anchor Centre and Meridian until 30 th April 2018, whilst an option appraisal is undertaken regarding service design and procurement. • Rugby Out of Hours contract to be extended to 31st March 2018. Coventry Walk-in-Centre contract is due to end on 30th September 2017 , a recommendation on how to proceed will be brought to the July F&P Committee meeting. • Members were advised that a Procurement Group is being established to co -ordinate activities across all three Coventry and Warwickshire CCGs.

(Note: also see Governing Body panel) 5. Other • Members noted the Clinical Operation Group minutes, 8th May 2017 and the Financial Recovery Board minutes, 30th May 2017. • This was Mrs Sampson’s last meeting and Members thanked her for her hard work and contribution over the years in her role as Lay Member (Public and Patient Involvement).

Key Information: • Committee Chair: Mr Peter Maddock (Lay Member, Governance) • CCG Lead: Mrs Clare Hollingworth (Chief Finance Officer) th • Date of Next Meeting: 24 July 2017

Coventry City Council Minutes of the Meeting of Coventry Health and Well-being Board held at 2.00 pm on Monday, 10 April 2017

Present:

Board Members: Councillor Abbott Councillor Caan (Chair) Councillor Ruane Councillor Taylor Stephen Banbury, Voluntary Action Coventry Dr Adrian Canale-Parola, Coventry and Rugby CCG (Deputy Chair) Professor Guy Daly, Coventry University Ben Diamond, West Midlands Fire Service Liz Gaulton, Acting Director of Public Health Simon Gilby, Coventry and Warwickshire Partnership Trust Andrea Green, Coventry and Rugby CCG Andy Hardy, University Hospitals Coventry and Warwickshire Ruth Light, Coventry Healthwatch Danny Long, West Midlands Police Gail Quinton, Deputy Chief Executive (People)

Other Representatives: Councillor Ali Paula Deas, Coventry and Warwickshire Local Enterprise Partnership

Employees (by Directorate):

Place: L Knight People: R Nawaz

Apologies: Councillor Duggins John Mason, Coventry Healthwatch Martin Reeves, Coventry City Council Professor Caroline Meyer, Warwick University

Public Business

108. Declarations of Interest

There were no declarations of interest.

109. Minutes of Previous Meeting

The minutes of the meeting held on 6th February, 2017 were signed as a true record. There were no matters arising.

110. Employment , Economic Growth and Health - working with Coventry and Warwickshire Chamber of Commerce and Coventry and Warwickshire Local Enterprise Partnership

– 1 – The Board considered a joint report and received a presentation from Paula Deas, Coventry and Warwickshire Local Enterprise Partnership (LEP) which informed how partners were working together with Coventry and Warwickshire Chamber of Commerce and the LEP to create good growth and reduce health inequalities in Coventry.

The report highlighted that ensuring that people were able to get into work would reduce health inequalities, but they must be good quality sustainable jobs which provided a reasonable wage, opportunities for development and safe working conditions. The unemployment rate in the city was currently 6% compared to the national rate of 5.1%.

The Marmot Steering Group provided an effective mechanism for the LEP and Chamber of Commerce to work with other key statutory and voluntary organisations to address health inequality issues linked with growing economic prosperity in the city and to recognise and build upon the links between a healthy population, good work and economic growth. The vital role of employers was emphasised. Reference was made to the Strategic Economic Plan produced by the LEP and the Marmot Strategy which were aligned in some of their overall goals. The LEP worked across Coventry and Warwickshire in alignment with the Health and Wellbeing concordat. The report indicated that the focus of the LEP upon economic growth and development, if successful, would result in an increase of over 50,000 new jobs by 2031, improving the skills of the workforce and increasing the productivity of the area, so reducing health inequalities.

The report provided an update on Marmot to date. Since Coventry became a Marmot City in 2013 there had been progress in outcomes across health and across society including improvements in school readiness at 5, health outcomes, life satisfaction, employment and reductions in crime in priority locations. Key areas of focus for the next three years were detailed. Reference was made to the effective partnership working between members of the Marmot Steering Committee. All partners had signed up to the three year Marmot Action Plan and the priorities were outlined.

The Chamber of Commerce was a committed member of the Marmot Steering Group who worked with employers to educate them about the benefits of recruiting locally and also increase the number of apprenticeships. The Chamber was also keen to explore ways to encourage employees to maximise their use of funds to support the employment of people with physical disabilities and mental health issues. The Board were informed that the LEP was not a member of the Marmot Steering Group. Inclusion of a representative from the LEP would be beneficial to all Marmot partners and would enable practical discussions around ways of working that would bring together the aims and objectives of the Strategic Economic Plan with those of Marmot and other statutory and voluntary organisations.

The presentation set out the background to the development of the LEP; provided information on its governance arrangements; informed of the LEP’s achievements to date which included over £300m of government investment in local priorities and 2,928 jobs created; and drew attention to the assets of the area. Further information was provided on the benefits to the Coventry and Warwickshire area. The presentation concluded with the issues for the next five years including the

– 2 – Local Growth Fund; more devolution of powers and finance; the mayoral influence; and the changing political landscape.

Members expressed support for the work of the LEP and the opportunities for partnership working. Further information was requested about the funding opportunities available for local businesses and whether funding had been made available to support the health economy. A request was made for assistance for an individual company and the officer undertook to investigate.

RESOLVED that:

(1) Approval be given for the LEP to become a member of the Marmot Steering Group and contribute to the Marmot Action Plan.

(2) Approval be given that the Chamber of Commerce continue to attend the Marmot Steering Group and contribute to the Marmot Action Plan.

(3) The Health and Wellbeing Board contribute to the LEP’s Strategic Economic Plan.

111. Coventry & Warwickshire Sustainability and Transformation Plan Update

The Board considered a progress report from Andy Hardy, University Hospitals Coventry and Warwickshire (UHCW) which provided an update on progress with the Sustainability and Transformation Plan (STP), with particular reference to the content and progress with the individual work streams.

Urgent and Emergency Care

The current work stream priority was right sizing hospital urgent and emergency care systems in the context of changes driven through other work streams and the national Urgent and Emergency Care Plan. It was anticipated that the proposed model of Urgent and Emergency Care would be presented to the STP Design Authority for internal clinical agreement in the autumn of 2017.

The Board were informed that the Coventry and Warwickshire Stroke Programme was at the pre-consultation stage, with the pre-consultation Business Case within the NHS England assurance process. It was anticipated that this would go to an Assurance Panel in the early summer.

Planned Care

The report informed that the current work stream focus was on the first elective pathway review, muscular-skeletal, with emphasis being on hip and knee replacements with a view to start to change in practice during 2017. A Clinical Reference Group had been established and had met several times and a clinical workshop was planned for April/May. A revised MSK pathway was now in place in North Warwickshire and, subject to approval, was due to start in Coventry at the end of quarter 1 2017. The review/ revision of other elective pathways would follow in quarterly waves including General Surgery, ENT, Ophthalmology, Specialist Surgery and other smaller specialities. Following pathway redesign, policies would be revisited.

– 3 – In relation to cancer care, work was underway to achieve the cancer 38 day target.

Maternity and Paediatrics

Work was underway to refocus the work stream’s programme in line with the national ‘Better Births’ strategy. A work stream ‘away day’ had been arranged for April.

Proactive and Preventative Care

The Out of Hospital Programme was progressing to plan with proposals developed by providers currently undergoing commissioner moderation, prior to a decision on procurement. The scope of the programme beyond the Out of Hospital was much broader and was currently being developed. The Board noted that this offered the major interface with Health and Wellbeing Boards and Local Authority led services relating to the promotion of healthy lifestyles and the building of community capacity. These were also key features of Health and Wellbeing Strategies and emerging transformational plans for local authorities. Reference was made to the three steps to be undertaken to support prevention. To date efforts had focused on the first phase in terms of developing an understanding of the level and nature of work in the system. To succeed prevention needed to feature in every element of work and become ‘everybody’s business’.

Productivity and Efficiency

Progress in this area had been slow. Individual organisations had just received feedback from the National Benchmarking and this was currently being collated to give an STP wide picture, so organisational differences could be examined.

Andy Hardy informed the Board of the recent appointment of Brenda Howard as the Programme Director. She would be establishing a Programme Management Team and would establish systems and processes to oversee progress and delivery of the STP. The programme team would be supporting the work streams to deliver their priorities. The Board were also informed about the new guidance from NHS England concerning next steps on the Five Year Forward View and STPs.

Members of the Board raised a number of issues in response to the report including:  How the Programme Director post was funded and the actual costs involved  Clarification about the ‘Big Conversation’ phase on pre-consultation relating to maternity care that had been due to commence at the end of November (Minute 112 below refers)  Further information about the latest position relating to the proposals for stroke services which was with NHS England for assurance  Clarification about the timings and schedules of the individual work streams and whether there had been delays  Whether the STP would work in isolation or whether there would be implications for the STP if other STPs from the surrounding areas had failings

– 4 –  The links between the individual work streams  Further information about the thresholds and proposals for hip and knee replacements  Support for all the hard work involved with progressing the STP work streams  The importance of ensuring successful communication with the public when progressing the work streams including consideration of the terminology to be used.

Professor Guy Daly informed the Board about the work of the STP Design Authority and suggested that a report including the terms of reference and membership be submitted to a future meeting. He recommended that members be provided with a copy of the update on the Five Year Forward View.

RESOLVED that:

(1) The report be noted and the direction of travel for the STP be supported.

(2) A report on the STP Design Authority be submitted to a future meeting.

(3) The update on the Five Year Forward View be circulated to Members.

112. Engagement Strategy Update

Further to Minute 89/16, the Board considered a report of Andrea Green, Coventry and Rugby Clinical Commissioning Group (CCG) which detailed progress on the Sustainability and Transformation Plan (STP) Engagement Strategy.

The report indicated that the three local Clinical Commissioning Groups, the City Council and Warwickshire County Council had formed a collaborative Engagement Team who developed the Engagement Strategy.

The initial activity was to start to hold some “Big Conversations” with local Mothers and Carers, to find out what was important to them in respect of Maternity services, as a new national strategy on Better Births had been released by NHS England, and local leaders were considering the sustainability and transformation of the service, as part of the local long term direction of travel for healthcare, the STP. Conversations were held with Mothers and their Carers at the venues they were attending to receive their antenatal and postnatal care. This first phase of engagement included completing 57 conversations, at venues, mainly Children’s Centres across Coventry and Warwickshire. The participants included people who already had children, those who had past miscarriages and/or, traumatic births as well as those who were first time Mothers.

The Board were informed that the outcome of this phase of discussions found that all those asked had very similar expectations of maternity services, but these were not always met. The key themes in the discussions were around consistency of care; being listened to; personalised care; family friendly care; professional attitude of staff; feeling reassured; support with aspects of caring for a new baby; access to information, antenatal and postnatal support.

– 5 – The engagement identified some inequalities in the services available in antenatal and postnatal groups; breastfeeding support and continuity of care.

Andrea Green emphasised that this was the start of the process. The Board noted that the views and themes would be bought together with information from the 0 to 5s work undertaken by Coventry and Warwickshire Councils; data on local inequalities and access; and the national engagement work on maternity care currently underway, to inform the next stages of co-design which would produce a set of local views of critical success factors that the future services would need to address.

Members raised a number of questions about the work to date including:

 Did the 57 contacts reflect the diverse population of Coventry  Whether 57 conversations was a sufficient number considering the size of the locality and the potential for significant service change  A concern about the implications of Strep B infections in babies and if this was an issue for the city.

RESOLVED that:

(1) The progress to date on the Engagement Strategy be noted.

(2) Details about the arrangements for screening for Strep B be circulated.

113. Coventry and Warwickshire System Wide Care and Health Peer Challenge Feedback

Further to Minute 104, Liz Gaulton, Acting Director of Public Health introduced the Coventry and Warwickshire System Wide Care and Health Peer Challenge feedback presentation following on from the review which took place between 14th to 16th March, 2017. The focus of the review had been: ‘To provide a constructive assessment of the current and potential value to the HWB system of the HWBBs of Coventry and Warwickshire, independently and together. To consider how the Boards can bring the spirit and commitment of the Coventry and Warwickshire Alliance Concordat to life’.

The presentation set out the brief and the products of the challenge. Membership of the Peer Challenge Team was detailed along with the process that was followed. The key messages for Coventry were highlighted which including the positive strengths of the Board; ‘Marmot City’ being a good brand with further potential; the development for joint working between the Boards without Coventry losing its identity; and the importance of working beyond different boundaries including the West Midlands Combined Authority. There was an acknowledgement that the STP had not ‘landed well’ but a line needed to be drawn under it and a coherent health and social care plan for Coventry and Warwickshire needed to be developed. The suggested next steps for Coventry were set out.

The presentation also referred to the key messages for both Coventry and Warwickshire with the Concordat being viewed as a huge asset. Members noted

– 6 – both the barriers and enablers for implementing the next steps in Coventry and Warwickshire.

It was clarified that, from the feedback provided, the Board was operating well and areas for development were clear. The Board acknowledged the success of their joint working with Warwickshire.

RESOLVED that:

(1) The feedback from the Peer Challenge be noted.

(2) Approval be given to progress the proposed next steps, continuing the joint working with Warwickshire.

114. Health and Wellbeing Strategy Update - Improving the Health and Wellbeing of People with Multiple Complex Needs

The Board received a presentation from Chief Inspector Danny Long, West Midlands Police which provided an update on the Health and Wellbeing strategy priority ‘Improving the Health and Wellbeing of People with Multiple Complex Needs’. A copy of the Project Initiation Document had been circulated as background information.

The Board were reminded of the purpose of the project, to improve the health and wellbeing of people facing Multiple Complex Needs (MCN), to make it as easy as possible so that they:  Feel more resilient and connected  Are empowered to lead productive lives, free from harm  Reduce their dependency on intensive public services. It aimed to enable people with MCN to manage their lives better through access to more person centred and co-ordinated services.

The project involved a five stage plan as follows: i) Baseline data – characteristics of people facing MCN and service provision ii) Future mode – identifying options for improving services iii) Define changes needed – detailed definition of what changes were needed iv) Plan and organise – implementation plan v) Evaluation framework – understand the impact of proposed interventions.

Detailed information was provided on the research programme which had been split into two phases: Phase I – to identify the extent and nature of MCN within the city Phase II – to demonstrate how transforming the experience of people facing MCN could improve outcomes and reduce costs to the system.

The Board were informed of the various partner organisations used to gather baseline data and the key factors obtained. Findings taken from the baseline data, lived experiences and frontline professionals were outlined with detailed statistics from the Probation Service, Staffordshire and West Midlands Community Rehabilitation Company and West Midlands Police. In addition, individual case studies had been provided by West Midlands Fire Service, Aquarius, Citizens Advice Bureau, Ignite, Troubled Families, Swanswell and Whitefriars Housing.

– 7 – The Board’s attention was drawn to the combination maps which allowed comparing and contrasting different data sets. As expected most deprived areas saw more problems.

The Board were informed that there was now lots of data including evidence of local services and contract spend and much detailed local intelligence providing a comprehensive understanding of what it meant to experience MCN in Coventry and how factors related to one another. Examples of service scoping were also highlighted.

The presentation concluded with the next stage in the process, stage 3, and to become involved with:  The opportunity to work with West Midlands Mental Health Commission and develop nationally funded pilots in Coventry  Trial the MEAM approach by identifying a cohort of users who could be supported using a whole system  An Operational Group being set up to develop these opportunities and implement.

The Board asked about ‘wet’ houses in the city and where people could access support to help them ‘dry out’. It was determined that further work was required in this area.

RESOLVED that:

(1) The work to date on the strategy to improve the health and wellbeing of people with multiple complex needs be noted.

(2) The Multiple Complex Needs Board, as part of their existing work, to look at those affected by alcohol misuses and to make suggestions as to how they can be supported.

115. Coventry Female Genital Mutilation (FGM) Programme

The Board considered a report of Liz Gaulton, Acting Director of Public Health which provided an update on the progress made to tackle Female Genital Mutilation (FGM) in Coventry. The report also provided an update on the prevalence of FGM in the city and detailed progress against the recommendations endorsed by the City Council’s Scrutiny Co-ordination Committee at their meeting on 9th September, 2015.

The report provided an explanation of FGM, detailed the reasons given for practising FGM and set out the background to the work being undertaken in Coventry to eradicate the practice.

Information was provided on the current position. The Board noted that data for FGM was limited both locally and nationally but the issue was being tackled nationally with the introduction of mandatory requirements for Healthcare Professionals to record FGM. It was estimated that 137,000 women and girls were living with FGM in the UK and that 60,000 girls aged 13 and under were at risk of FGM. A recent report by City University London and Equity now concerning FGM

– 8 – in England and Wales estimated Coventry had a rate of more than seven per 1,000. Between April 2015 and March 2016 there had been 65 women accessing UHCW midwifery services who had been affected by FGM.

The report provided police data showing FGM referrals for West Midlands which showed a high percentage of referrals for Coventry during 2014-16 which was probably due to the well-established referral processes and reporting procedures in the city.

The Board noted that in June 2015 the City Council’s Public Health team commissioned Coventry Haven (in partnership with CRASAC and Birmingham and Solihull Women’s Aid (BSWA)) to provide a specialist FGM service to tackle FGM in Coventry. This service was the main vehicle through which the Scrutiny Co- ordination Committee’s recommendations were being delivered. The report provided a progress report on the actions undertaken in respect of these recommendations:  Preventing FGM from taking place by raising awareness and engaging with communities  Supporting professionals to identify and support girls and women at risk of or affected by FGM  Supporting victims of FGM throughout their lives  Building knowledge and intelligence.

The report indicated that a significant amount of the work to tackle FGM had been provided by Coventry Haven in partnership. The contract for this work was due to end on 31st May, 2017 and there was no resource available to extend the contract beyond this date. However the service was designed to be self-sustaining through the recruitment of community champions.

Coventry’s work to tackle FGM had been highlighted regionally and nationally as an example of good practice and the evidence from the work was being incorporated into national policy.

The report detailed the measures to be implemented over the coming months to ensure the service’s work to engage with communities, train professionals and support women who have undergone FGM could be sustained beyond May 2017.

Members asked if there had been any convictions for FGM and expressed support for the new webapp ‘Petals’ developed by researchers at Coventry University to help protect young girls and women from FGM and their subsequent webapp ‘Petals for Professionals’.

RESOLVED that the progress update set out in section 5 of the report be noted.

116. Joint Pharmaceutical Needs Assessment (PNA) and Applications for Pharmacies Update

The Board considered a report of Liz Gaulton, Acting Director of Public Health which sought approval for the plans to produce a revised Pharmaceutical Needs Assessment (PNA) for 2018.

– 9 – The report indicated that as a result of the Health and Social Care Act 2012 the responsibility to develop and update PNAs passed to local Health and Wellbeing Boards. The PNA would be used to inform NHS England in its determination as to whether to approve applications to join the pharmaceutical list. It also considers whether the number of pharmacies would still be adequate in the next four years.

Coventry’s first assessment was published in 2015. It was produced by evaluating the health needs of the local population with consideration of the existing services provided by pharmacies. It was a statutory requirement that the PNA be updated every 3 years.

The report provided detailed information on the purpose of the PNA along with information about what NHS Pharmaceutical services include.

The process of producing a PNA took around 12 months and involved a period of consultation concluding with the Board sign off. The Board were informed that to maximise the resources available and align with local planning footprints, officers were exploring a Coventry and Warwickshire PNA for 2018. This would also align with the Coventry and Warwickshire Alliance Concordat. The work was to be led by the Directors of Public Health and their teams from Coventry and Warwickshire. A small Steering Group was to be established. It was the intention to submit an update report to a future Board meeting with final approval being sought by February 2018.

Ruth Light informed of the recent work undertaken by Coventry Healthwatch about the public’s use of pharmacies. Healthwatch has produced 9 recommendations arising from discussions with residents. The importance of publicising pharmacies to the Coventry public was emphasised.

RESOLVED that:

(1) The update and progress on the Pharmaceutical Needs Assessment be noted.

(2) Approval be given for Coventry to conduct its revised PNA in partnership with Warwickshire County Council.

117. Coventry, Warwickshire and Solihull's Transforming Care Partnership

Further to Minute 56/16, the Board noted a joint report, submitted to Members for information, which provided an update on Coventry, Warwickshire and Solihull’s Transforming Care Programme. Details of progress made was set out in an appendix to the report.

The report indicated that partners had worked collaboratively to develop and implement a new model of care for adults to support the delivery of the Transforming Care programme locally. Work was currently taking place to ensure this effectively met the needs of adults with autistic spectrum disorders. Work was also taking place with stakeholders to develop a new model of care to support children and young people in the community preventing admissions to hospital and residential settings where appropriate.

– 10 – Progress had been made regarding the financial arrangements to deliver the programme and work was ongoing to clarify the amount and mechanism for funds to be distributed to local areas from NHS England.

During 2016/17 the Transforming Care Programme had not met planned trajectories. It was anticipated that the programme would be back on track with trajectories in quarter two of 2017/18.

RESOLVED that the content of the update report set out at the appendix and the key points relating to progress and local issues be noted and the Board continue to receive periodic briefings on progress relating to the delivery of the Transforming Care programme.

118. Any other items of public business - Social Care Summit

Professor Guy Daly, Coventry University informed of the intention to hold a Social Care Summit, organised by Coventry and Warwick Universities. A provision date of 26th June had been agreed and a number of early invitations had been circulated. It was the intention to invite members of the Health and Wellbeing Board once more details had been finalised.

(Meeting closed at 3.55 pm)

– 11 – Coventry City Council Minutes of the Meeting of Coventry Health and Well-being Board held at 2.00 pm on Monday, 10 July 2017

Present:

Board Members: Councillor Abbott Councillor Caan (Chair) Councillor Taylor Rob Allison, Voluntary Action Coventry Sarah Baxter, Coventry University Dr Adrian Canale-Parola, Coventry and Rugby CCG (Deputy Chair) Ben Diamond, West Midlands Fire Service Andrea Green, Coventry and Rugby CCG Ruth Light, Coventry Healthwatch John Mason, Coventry Healthwatch Gail Quinton, Deputy Chief Executive (People) Justine Richards, Coventry and Warwickshire Partnership Trust Rebecca Southall, University Hospitals Coventry and Warwickshire

Other Representatives: Councillor Gannon Brenda Howard, University Hospitals Coventry and Warwickshire

Employees (by Directorate):

Place: L Knight People: P Fahy J Fowles R Nawaz

Apologies: Councillor Duggins Guy Daly, Coventry University Liz Gaulton, Acting Director of Public Health Simon Gilby, Coventry and Warwickshire Partnership Trust Sharon Goosen, West Midlands Police Andy Hardy, University Hospitals Coventry and Warwickshire Danny Long, West Midlands Police David Williams, NHS Area Team

Public Business

1. Declarations of Interest

There were no declarations of interest.

2. Minutes of Previous Meeting

The minutes of the meeting held on 10th April, 2017 were signed as a true record. Further to Minute 118 headed ‘Any other items of public business – Social Care

– 1 – Summit’ it was reported that the Social Care Summit organised by Coventry and Warwick Universities had taken place on 26th June.

There were no other matters arising.

3. Appointment of Deputy Chair of the Health and Wellbeing Board

RESOLVED that Dr Adrian Canale-Parola be appointed as Deputy Chair of the Health and Wellbeing Board for 2017/18.

4. Progress Update on Coventry's Marmot City Strategy 2016-2019

The Board considered a report and received a presentation by Ben Diamond, West Midlands Fire Service and Co-Chair of the Marmot Steering Group which provided a progress update on the Coventry Health and Wellbeing Strategy priority ‘Working together as a Marmot City to reduce health and wellbeing inequalities’.

The report set out the background to Coventry’s position as a Marmot City from 2013 to 2015 and the involvement in the initial Marmot Programme to reduce health inequalities. In 2016 Sir Michael Marmot and his team committed to working with Coventry for a further three years to progress the health inequalities work. Partners were continuing to work together on a number of projects initiated in the first two years. In addition the Marmot City priorities now were to tackle inequalities disproportionately affecting young people and ensuring all Coventry people, including vulnerable residents, could benefit from good growth which would bring jobs, housing and other benefits to the city.

The Board were informed that there remained a strong commitment to the Marmot programme from all the partners on the Steering Group. The Marmot Action Plan set out ways in which partners and stakeholders would work to achieve the key priorities. Progress against the programme indicators included:

 92% of children and young people reporting an increased awareness of the risks of sexual violence and support services available following the delivery of the sexual violence prevention programme.  Employment and training support to over 500 young people not in education, training and employment as part of the Ambition Coventry programme.  All key policy decisions taken by the City Council now consider the potential implications on inequalities across the city  Voluntary Action Coventry and the West Midlands Fire Service had both signed up to the Workplace Wellbeing Charter.

Progress against the Action Plan and indicators was set out in an appendix attached to the report under the following two headings: young people and good growth. Indicators were split into programme indicators (output focused) and overarching indicators (outcome focused). The Marmot Steering Group met on a quarterly basis to receive updates from partners, discuss progress and identify areas for development and partnership working.

The presentation informed of the continuing national recognition of the work in Coventry and gave detailed information on the supporting young people and good

– 2 – growth priorities highlighting achievements to date against targets. Comparisons of outcomes from 2015/16 to 2016/17 for both priorities clearly demonstrated positive progress. The presentation concluded with a summary of the next steps for the current year.

Members raised a number of issues arising from the presentation including:

 Clarification regarding some of the indicator statistics in the report  Further information about the reasons for the positive increase in the number of new young clients accessing the CRASAC Counselling Service  A request for further updates on progress with the indicators in due course  What Members could do to support organisations to sign up to the Workplace Wellbeing Charter and the need to market the Charter to employers  The suggestion that contact be made with the Welfare Reform Group and the Group supporting the Feeding Coventry Initiative to provide access for good guidance concerning health inequalities  An acknowledgement of the links to the Better Health, Better Care, Better Value programme  The role of the Voluntary Sector in supporting young people into work  A suggestion that contact be made with individual trade unions to gain their support for the Workplace Wellbeing Charter

Ben Diamond indicated that he would make contact with the links suggested by Members.

RESOLVED that:

(1) The progress made to date against the Marmot Action Plan be endorsed.

(2) Further progress updates from the Marmot Steering Group be submitted to future meetings of the Board every six months.

5. Coventry and Warwickshire Sustainability and Transformation Plan Update

The Board considered a report of Professor Andy Hardy, University Hospitals Coventry and Warwickshire (UHCW) and received a presentation from Brenda Howard, UHCW which provided an update on the Better Health, Better Care, Better Value programme and work streams.

The report highlighted that the Sustainability and Transformation Plan had recently been renamed ‘Better Health, Better Care, Better Value’ reflecting the triple challenges facing health and social care as set out in the ‘Five Year Forward View’ report.

On 25th May, 2017 Board Members met NHS England and NHS Improvement for a quarter one review of progress. The meeting was positive with the strength of the collaboration being commended. The well-defined governance and executive leadership structures were acknowledged. A copy of the formal response received was set out at an appendix to the report.

– 3 – The Board had agreed its support structure to enable the transformational and enabling work streams to deliver their priorities and objectives. Recruitment was underway and the aim was, as far as possible, to attract internal partner organisation applicants as secondments. It was intended to establish a ‘System Leadership Academy’ enabling participants to experience working in the different organisations within the system.

A second appendix set out the reinforced governance arrangements for the programme. The Design Authority had been reframed with greater representation from local clinical leaders and a Programme Delivery Group had been established. The Board were informed that it had recently been decided that mental health services should be designated as a transformational work stream and arrangements were now progressing to establish this. In addition it had also been decided to establish a cancer work stream as part of the approach to planned care.

The report provided detailed information on progress, including individual priorities, with the following transformation work streams: maternity and paediatrics; urgent and emergency care; mental health; proactive and preventative; productivity and efficiency; planned care and cancer.

The report also referred to the enabling work streams. Work force challenges would be an issue for all work streams and the workforce group had established three key areas of focus: career pathways, leadership, and new roles and new ways of working.

In relation to Estates, the Estates Group provided a report to the Board outlining its key priorities relating to a premises stocktake, resources required to deliver the future model and the efficiency delivery of infrastructure functions. The group was progressing discussions on a Health and Wellbeing Campus model for George Elliot Hospital and a workshop for partners across the system was planned for 11th July. An updated briefing on the Estates Strategy was tabled at the meeting which included background information on the Naylor Report and referred to local plans and key priorities The report also highlighted the communication and engagement sessions which had taken place since the last report to the Health and Wellbeing Board.

The presentation highlighted the programme governance, structure and work streams; reviewed progress with the regulators; referred to the estates strategy; and concluded with the next steps.

Members raised a number of issues in response to the presentation including:  Clarification about the estate premises under consideration and whether it included buildings owned by other organisations  The complexities associated with the mental health work stream community capacity and resilience  Examples of how voluntary organisations can support and help people suffering from mental health issues and the importance of using these community assets  The importance of including patients and the public in the structures and ensuring their views are taken into account as work progresses on the work streams

– 4 –  The importance of using Elected Members who can engage with local residents helping to get the right messages out  An acknowledgement of the need for organisations to continue to work together putting patients at heart of any new system.

RESOLVED that the contents of the report and presentation be noted. .

6. Proactive and Preventative Work Stream - Public Health Preventative Framework

The Board received a presentation from Gail Quinton, Deputy Chief Executive (People) on the Proactive and Preventative work stream of the Better Health, Better Care, Better Value programme. Jane Fowles, Public Health Consultant, also attended for the consideration of this item.

The presentation set out the benefits of a targeted proactive and preventative approach. It was important for this to be undertaken at the current time as there was a greater level of need, conditions for success were stronger and the work stream enabled partners to build on the work already underway. The presentation set out the foundation already in place and highlighted the partnership principles to drive change.

Prevention was to be being integrated into all aspects of the health and care model with agreed prevention priorities being smoking prevention; obesity; falls prevention; and the Thrive Mental Health Commission report. Reference was made to the work programme in a three stage model:  80% - community based self-help for the general population  10% - at risk or early intervention  10% - specialist care Additional information including the links to the partner organisations and the features for each of these stages were provided.

The presentation concluded with attention being drawn to the need for partner organisations to adopt the model and partnership principles and to provide a clear statement of commitment to be a public organisation which prioritises prevention and supports people to help themselves.

Jane Fowles detailed the support to be provided by Public Health to the Proactive and Preventative programme and the Chair, Councillor Caan expressed support for the Public Health initiatives including fitness in the parks and the recent event in Broadgate. Dr Canale–Parola, Deputy Chair highlighted the importance of the role of the community.

RESOLVED that the progress with the Proactive and Preventative work stream be noted.

7. Redesign and Improvement of Stroke Services

The Board received a report from Andrea Green, Coventry and Rugby Clinical Commissioning Group (CCG) on the proposals for the redesign and improvement of stroke services.

– 5 – The report referred to the establishment of a project in April, 2014 by Coventry and Warwickshire CCGs to improve local stroke services for those who have had a stroke or a transient ischemic attack (mini stroke). In due course the proposals were expanded to include improvements to acute services, specialist rehabilitation and primary prevention of strokes. Reference was made to the project governance structure including the Project Stakeholder Board and an expert Patient and Public Advisory Group.

The report set out the case for change as follows: Access to Service is time critical both to saving lives and reducing disability Local gaps in timelines for people who stroke Local TIA (mini stroke) service variation Workforce gaps – Stroke Specialist Consultants Unwarranted variation and inequality in stroke specialist rehabilitation services.

The Board were informed of the engagement with patients, carers and key stakeholders. A pre-consultation engagement programme was undertaken in the initial stage of the project to understand the views of key stakeholders and local people about the potential scenarios for a new stroke pathway in order to shape the future of stroke services in Coventry and Warwickshire. The aims of the discussions were to ensure everyone had a clear understanding of the services delivered currently, the evidence base and rationale for change and what scenarios were being discussed. Four possible scenarios for the future of acute stroke care were put forward. Key themes received from the early engagement with stroke survivors, carers and the public were related to transport issues, communication difficulties, compassion and dignity, staffing and discharge support. Following engagement, the following proposals were developed:  Having one specialist stroke team based at UHCW, made up of experts in stroke services. They will treat people in the important first few days after a stroke  A community support service for people who are recovering at home  Closure of the specialist stroke services at Warwick Hospital and George Eliot Hospital  The provision of hospital beds for people who need to be in hospital while they recover at Leamington Hospital and George Eliot Hospital.

Following treatment at Hyper Acute and the Acute Stroke Unit on the UHCW site, patients would be referred to one of five settings to meet their rehabilitation or ongoing needs:

 Home with Early Supported Discharge Service  Cared for in a nurse led stroke ‘bedded’ rehabilitation service at a local hospital  Home with the Stroke Community Rehabilitation Service  Home with a package of care  Nursing or residential care for those with more complex needs.

Attention was drawn to the support from the West Midlands Clinical Senate of national experts on Stroke Care for the model.

– 6 – It was anticipated that improvements would be a reduced number of people who stroke; a reduction in deaths from stroke; a reduced disability from those who suffer a stroke; and improved cognitive function for people after a stroke.

Further information was provided on the four week public and patient engagement on the proposals. Appendices to the report detailed the consultation questionnaire and the four engagement events to be held during July. NHS England would then need to complete their assurance process before any consultation commenced.

Members raised a number of questions in response to the report, matters raised included:

 The anticipated average length of stay at Leamington or George Eliot hospitals  The importance of providing the public with a consistent message being clear on the benefits of the proposals during the engagement and consultation stages  The requirement to tighten up on communications ensuring the message was all about better patient outcomes as oppose to saving money  The importance of all the partners supporting the redesigned and improved stroke services.

RESOLVED that, having reviewed the proposals to improve stroke services, it be noted that the CCGs are: a) Completing a further phase of engagement as the scenarios for improvement have now been translated from the feedback from patients, the public and clinicians into proposals attached at Appendix A b) Have commissioned another integrated impact assessment of the proposals c) About to enter the final stage of assurance with NHS England.

8. Improved Better Care Fund

The Board considered a report of the Deputy Chief Executive (People) which sought approval for the use of additional Better Care Fund resource to support three intended purposes. The report was also to be considered by Cabinet on 1st August and Council at their meeting on 5th September.

The report indicated that whilst the Sustainability and Transformation Programme (STP) was the primary planning tool for health and care, the Better Care Fund was the only mandatory policy to facilitate integration of health and care. The programme spanned both the NHS and local government and sought to join up health and care services so that people could manage their own health and wellbeing, and live independently in their communities for as long as possible.

In March 2017 a new policy framework for the Better Care Fund covering the period 2017 to 2019 was issued at the same time as significant additional funding being made available to Councils in order to protect adult social care. These sums came from the 2015 spending review and the 2017 spring budget and taken together comprised the Improved Better Care Fund. The additional funding element over and above the budget for Coventry was £18.6m as follows: 2017/18 - £7.1m, 2018/19 - £4.4m and 2019/10 - £7.1m (although the 2019/20 figure was

– 7 – outside the scope of the current planning). This additional funding was provided direct to Councils for the following three purposes:  To meet adult social care need  To provide support to the NHS – especially through the application of 8 high impact changes  To sustain the social care provider market

The Board were informed that plans for the use of the grant needed to be approved by the City Council, Coventry and Rugby CCG and the Health and Wellbeing Board. Resources could then start to be spent through a pooled budget arrangement.

The Board noted that a new Better Care Plan was being developed for the period up to 31st March, 2019 with a supporting section 75 partnership agreement identifying how the additional resources were to be used.

An appendix to the report set out the programme plan which contained a series of project areas which would deliver against the three purposes of the funding.

Members raised a number of issues including transparency of the funding and proposals; the positive aspects of receiving additional resource; and clarification about the current reasons for delayed discharges from hospital.

RESOLVED that:

(1) The programme plan for the resources made available through the improved Better Care Fund against the areas identified be supported.

(2) A further report on the Better Care Fund plan be submitted to a future meeting once the planning tools have been provided and completed.

9. Coventry Drug and Alcohol Strategy 2017 - 2020

The Board considered a report of Liz Gaulton, Acting Director of Public Health on the Coventry Drug and Alcohol Strategy 2017-2020, a copy of which was set out at an appendix to the report. An update was provided on the progress to address alcohol and drug misuse against the previous strategies was detailed in a further appendix.

The report indicated that Coventry’s vision was to reduce the harms caused by alcohol and drug misuse making Coventry a healthier, wealthier and happier place to live, where less alcohol and fewer drugs were consumed and where professionals were confident and well-equipped to challenge behaviour and support change. This linked to all three of the priorities in the 2016-2019 Health and Wellbeing Strategy. Reference was made to the finding in the 2016 Coventry Drug and Alcohol Needs Assessment which indicated that drug use was falling and that Coventry had a considerably larger alcohol abstinent population than many other areas although there were still sections of the population drinking at harmful levels with approximately 14,000 people in the city being high risk drinkers.

– 8 – The development of the new Drug and Alcohol Strategy coincided with the re- commissioning of drug and alcohol recovery services in the city. As drug and alcohol misuse was a cross-cutting issue, it required a multi-agency response. The strategy involved partners and covered a wide range of issues such as multiple complex needs, prevention, early intervention, education, training, employment, housing, finance, crime, recovery and support.

The strategy had been developed by, and was being implemented by, a wide range of partners including the City Council, Coventry and Rugby CCG, West Midlands Police, Probation, Youth Offending Service, drug and alcohol treatment providers and the Coventry Recovery Community. It was a three year citywide strategy for both drug and alcohol use covering both young people and adults.

The three strategic priorities were to: (i) Prevent people from taking drugs or drinking harmful levels of alcohol and intervene early to minimise harm (ii) Support those with drug and/or alcohol problems and those with multiple complex needs (iii) Promote sustainable recovery and enable people to live healthy, safe and meaningful lives. The report highlighted the main actions to be undertaken in the first twelve months.

The strategy was to be reviewed on a quarterly basis by the Drug and Alcohol Strategy Steering Group and would have an action plan detailing the specific actions. The Steering Group reported to this Board and to the Police and Crime Board.

RESOLVED that:

(1) The report summarising actions to date on the current Coventry Drug Strategy and Coventry Alcohol Strategy be noted.

(2) The Coventry Drug and Alcohol Strategy 2017-2020 be endorsed.

10. Forward Plan Agenda Items and Health and Wellbeing Board Development Day

The Chair, Councillor Caan informed the Board that arrangements were being put in place for a half day development session prior to the Board’s next formal meeting on 4th September, 2017.

11. Re-inspection of Services for Children in Need of Help and Protection, Children Looked After and Care Leavers

The Board considered a report of John Gregg, Director of Children’s Services which informed of the re-inspection of services for children in need of help and protection, children looked after and care leavers specifically in relation to partners by Ofsted between 6th and 30th March, 2017. A copy of the Inspection Report was set out at an appendix to the report.

– 9 – The report indicated that the Ofsted re-inspection of services report published on 13th June, 2017 judged overall Children’s Services in Coventry ‘requires improvement to be good’. Services were no longer inadequate which marked a key point in the improvement journey and demonstrated the improvements made. The Ofsted judgements were: Children who need help and protection – requires improvement Children looked after and achieving permanence – requires improvement - Adoption performance – requires improvement - Experience and progress of care leavers – good Leadership, management and governance – requires improvement.

The Department for Education removed Children’s Services from intervention on 13th June, 2017 and the service was no longer subject to an improvement notice.

The inspection report identified nine recommendations, two of which specifically related two partners: Recommendation 2 – Ensure that the Local Safeguarding Children Board supports partners to understand and consistently apply appropriate thresholds to levels of need at every stage of the child’s journey, including the early help pathway. Recommendation 3 – Ensure that the introduction of risk management methodology across the authority includes partners and the authority at all stages.

The report highlighted the areas of partnership strength detailed in the Ofsted report.

A Children’s Services Improvement Plan had been developed in response to the Ofsted recommendations and areas for development. Information was provided on the areas for partners which included a risk averse approach across partners.

RESOLVED that, having considered the recommendations highlighted in the inspection report, the agreed approach of multi-agency engagement and support to improve outcomes for children be endorsed.

12. Any other items of public business

There were no additional items of public business.

(Meeting closed at 3.55 pm)

– 10 –

Minutes of the Meeting of the Warwickshire Health and Wellbeing Board held on 26 July 2017

Present :-

Warwickshire County Councillors Councillor Izzi Seccombe (Chair) Councillor Les Caborn Councillor John Holland Councillor Jeff Morgan

Warwickshire County Council (WCC) Officers John Dixon (Interim Strategic Director for People Group) Helen King (Deputy Director of Public Health)

Clinical Commissioning Groups (CCG) Dr Adrian Canale-Parola (Coventry and Rugby CCG) Dr Deryth Stevens (Warwickshire North CCG) Dr David Spraggett (Vice Chair, South Warwickshire CCG)

Provider Representatives Mike Williams (Coventry & Warwickshire Partnership Trust)

Healthwatch Warwickshire Robin Wensley

Borough/District Councillors Councillor Margaret Bell (North Warwickshire Borough Council) Councillor Tony Jefferson (Stratford District Council) Councillor Andrew Thompson (Warwick District Council) Councillor Barry Longden (Nuneaton and Bedworth Borough Council)

1. General

(1) Apologies for Absence

Dr John Linnane (Director of Public Health), Stuart Annan (George Eliot Hospital), Andy Meehan (University Hospitals Coventry & Warwickshire), Jagtar Singh (Coventry & Warwickshire Partnership Trust), David Williams (NHS England), Philip Seccombe (Police and Crime Commissioner), Helen Earp (Office of the Police and Crime Commissioner) and Councillor Emma Crane (Rugby Borough Council).

(2) Members’ Declarations of Pecuniary and Non-Pecuniary Interests

Councillor Margaret Bell declared a non-pecuniary interest, as a member of the County Council’s Adult Social Care and Health Overview and Scrutiny Committee.

(3) Chair’s Announcements

The Chair welcomed new Board members, Councillors Jeff Morgan, John Holland and Andrew Thompson. She introduced Brenda Howard, the STP programme director and other attendees, who would be presenting to the meeting. The Chair also spoke of her

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attendance at the recent launch of Creative Health: the arts for health and wellbeing and circulated a pack of information to the Board.

(4) Minutes of the meeting held on 22 March 2017 and matters arising.

The Minutes were agreed as a true record.

2. Draft Health and Wellbeing Board Annual Review 2016/17 and Delivery Plan 2017/18

John Dixon, Interim Strategic Director for People Group at WCC presented a report which set out the achievements made by the Health and Wellbeing Board’s (HWBB) partners over the past year, together with the activity programme for 2017/18. This demonstrated the breadth of achievements made to date, also looking to the next phase of activity. The document was the product of three workshops where progress against the current strategy had been reviewed and priorities for future work identified. This working document would focus the Board’s activity in 2017/18. Sections of the report focussed on:

• Examples of success • Roles and remit of the Board • Partnership principles • A common model of working • Delivery programme for 2017/18 • Development programme

Feedback on the draft document was invited in time for the final version to be considered at the September Board meeting, alongside the Director of Public Health’s Annual report. John Dixon took the Board through the document, highlighting the key additions to work streams including children’s services, housing and the focus on the proactive and preventative work stream.

Several Board members complimented the easy read format of the document. It was suggested that the document was too inwardly focussed and that links to Coventry should be emphasised, including the Concordat. A number of sections of the document were suggested where reference could be made to the close working with Coventry. Similarly, there should be recognition that residents close to the county boundaries looked to health services in neighbouring areas.

Comments were made about the ‘Hub’ approach to providing health services and the need to ensure that local communities were able to access those services. Andrea Green, Chief Officer of Warwickshire North and Coventry and Rugby CCGs explained how the Hub model would work, connecting to other local services. There was a need to make the arrangements for service provision more visible to communities. Further information was sought about the Planned and Preventative (P&P) work stream, which was seen as key to reducing pressures on acute services. It was suggested that targets were needed for the P&P work stream to show a reducing demand for hospital interventions. Andrea Green suggested these areas could be discussed further through the health partnership for the north of the county. For out of hospital services, clarification was provided on how these would be delivered in each area of the county.

There was discussion about life expectancy, closing the gap in life expectancy between men and women, and between those in the north and south of the county. A related

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aspect was about healthy life expectancy, as people were living longer, but with significant illnesses.

The section of the report on the Board’s role and remit was discussed, with reference made to the Board’s structure. A proposal was to increase the HWBB membership to include the chief executives health organisations as board members, in addition to their Trust Chairs. Furthermore reciprocal arrangements could be sought to involve a representative of the Coventry HWBB. Following discussion, it was agreed that a report be submitted to the September Board meeting to provide a light touch review of governance.

Resolved

That the Health and Wellbeing Board:

1. Notes the achievements made to date as set out in the Annual Review.

2. Approves the proposed role of the Board, its partnership principles and common model of working.

3. Endorses the Delivery and Development Plan for 2017/18.

4. Receives a report at its September meeting to provide a light touch review of governance.

3. Place-based Joint Strategic Needs Assessment

In March 2017, the Board received a report on the Joint Strategic Needs Assessment (JSNA). An update was provided by Spencer Payne, WCC’s Business and Commissioning Intelligence Service Manager. This explained the progress made to date and particularly the development of 22 geographical boundaries that would be used to profile Warwickshire communities and create a common evidence base.

The WCC Insight Service had led a programme of work to define these boundaries for use across all partner organisations, to understand and respond to the health and wellbeing needs of communities. The task was to create a set of areas that met the following criteria:

• Approximately 30,000 to 50,000 each in terms of population • Aligned to district/borough and CCG boundaries • Aligned to super output areas (the small geographical units used when official statistics were published)

The geographies had been developed in consultation with a wide range of partners and approved by the JSNA Strategic Group. The next stage was production of a profiling tool. This would enable partners to view statistical profiles and a common set of localities and data, to inform strategic planning. The Board was asked to reaffirm its commitment to these areas being applied to strategic planning activity. The report updated on other key JSNA activity, with appendices providing further information on the JSNA Annual Review document and the results of the Living in Warwickshire Survey.

On the Living in Warwickshire Survey, the Chair felt more detail should be provided about children’s services and mental health. Comments were made on the proposed

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geographies. For area four, Councillor Bell asked officers to review the decision to include Mancetter in this area with Hartshill and Atherstone as it had not been part of the pilot area. The renaming of area five, ‘Nuneaton Common’ was suggested, as this was not recognised by the residents of that area.

Resolved

That the Health and Wellbeing Board:

1. Thanks officers for the recent activity completed, including the development of a new set of geographical areas to be used for understanding the health and wellbeing needs of our communities.

2. Reaffirms the Board’s commitment to using a common evidence base across all partners to inform strategic planning and commissioning activity. The provision of a community profiling tool will enable partners to use consistent data for commissioning plans in 2018.

4. Warwickshire Better Together Programme and HEART project

The Health and Wellbeing Board (HWBB) received an update from Chris Lewington, Head of Strategic Commissioning at WCC and Paul Coopey of Nuneaton and Bedworth Borough Council. A summary of the position of the Warwickshire Better Together programme was provided, together with a focused presentation on the Home Environment Assessment Response Team (HEART) project.

At a recent HWBB workshop it was agreed that Housing would be one of the Board’s four priorities. This aligned to the ‘Warwickshire Cares Better Together Programme’ (WCBT), emergent housing issues impacting on the health and care system and the need for greater synergies to be forged with district and borough colleagues. A Housing Partnership was formed, which met the requirements of the Better Care Fund (BCF) guidance and in particular those relating to Disabled Facilities Grants. The new HEART service was funded via the Disabled Facilities Grant and reported into the WCBT Housing Board. The achievements of the HEART project were the main focus of this report and an accompanying presentation. A launch of the project would take place on 18 August 2017.

Areas discussed included the ability of the project to meet demand within the funding available, which was confirmed, how the project worked with housing associations and linking into the work of the Warwickshire Fire and Rescue Service. There were requirements attached to the additional funding from the BCF, so robust targets and performance measures would be put in place to evidence how this additional funding was making a difference.

Resolved

That the Health and Wellbeing Board:

1. Notes that Housing is a work stream of the Warwickshire Cares Better Together Programme, given the changes to the funding allocation of the Disabled Facilities Grant, now through top tier authorities and its importance to the health and care system and;

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2. Acknowledges the achievements of the Home Environment Assessment Response Team project, as part of the wider work of the Warwickshire Cares Better Together programme.

5. Improving Stroke Services in Coventry and Warwickshire

Andrea Green and the clinical commissioning group (CCG) Board members introduced this report. In April 2014, Warwickshire and Coventry CCGs initiated a project to improve local services for those who had suffered a Stroke, or a Transient Ischemic Attack (TIA – known as a mini stroke). The report gave an overview of the project, the wide engagement of stakeholders, use of an expert Patient and Public Advisory Group and an Expert Clinical Advisory Panel. Based on earlier feedback received from the public and patients, the CCGs had expanded the scope of the project from hospital service improvements, to include improvements to acute services, specialist rehabilitation and primary prevention of strokes. Further detail was provided on:

• The background to the review • Key facts about stroke • The prevalence of stroke and the configuration of local services • The case for change – key issues for service delivery and current gaps • Engagement with patients, carers and key stakeholders • Options for service configuration/ redesign, for improvement in stroke outcomes • The next phase of testing the proposals - public and patient engagement.

In essence, the review sought to deliver a better service and better patient outcomes. The proposal was for a specialist centre at University Hospitals Coventry and Warwickshire (UHCW), with intensive support for rehabilitation at home rather than in hospital for the majority. It was recognised that some patients might require rehabilitation in hospital. The revised service would cost more, as there would be increased rehabilitation costs and primary care costs. It was important that the public did not view this as a service cut, or as a result of Sustainability and Transformation Plan (STP), as the review was already planned ahead of the STP. Its aims were to reduce mortality and levels of disability following a stroke. The approach was similar to that successfully introduced in London.

The Board was supportive of the proposals, with a number of comments and questions being submitted. In particular, it was questioned whether there were enough specialist staff at UHCW and concerns about travel times to UHCW from some parts of the county, given the target for treatment within 30 minutes of the stroke occurring. Getting a referral for preventative treatment due to GP waiting times was raised. It was suggested that the new measures be implemented and evidence of reductions in demand provided, before withdrawing the existing services at other Warwickshire hospitals. Lifestyle choices and identifying those most at risk of a stroke were further aspects discussed.

Andrea Green gave an update on feedback to the engagement, with 300 comments being received to date. It was requested that the feedback be provided to the Board and this was agreed. In terms of staffing, she acknowledged there was a shortage of specialist consultants, nurses and therapists. The proposals sought to make best use of existing staff, but some additional recruitment would be required. The delivery and implementation plan would be formulated once the engagement had concluded and the way forward had been agreed. The points on travel to treatment time were also acknowledged. This aspect of the proposals had been scrutinised closely by the clinical senate. A few Warwickshire residents might need to travel to specialist centres in

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neighbouring areas, but the majority could reach UHCW within 30 minutes. Use of a ‘pull through’ system meant staff were notified and assembled in readiness for the patient’s arrival at hospital. Rehabilitation at home was a key element of the proposals.

A councillor drew comparison to the previous review of maternity services and retention of the existing service following significant public opposition to proposals. Encouraging people to visit their GP surgery for an assessment of risk of a stroke and preventative treatment were also discussed.

Resolved

That the Health and Wellbeing Board notes the proposals to improve stroke services from NHS Coventry and Rugby, NHS Warwickshire North, and NHS South Warwickshire CCGs, noting that the CCGs are:

• Completing a further phase of engagement as the scenarios for improvement have now been translated from the feedback from patients, the public and clinicians into the proposals submitted • Commissioning another integrated impact assessment of the proposals • About to enter the final stage of assurance with NHS England.

6. 0-5 Redesign and Consultation

Beate Wagner, WCC Head of Children and Families introduced this item. On 2nd February 2017, the County Council approved its One Organisational Plan, which set out the corporate direction over the next 3 years. At the same time WCC’s budget was agreed which required a saving of £1,120,000 to be made to the Children’s Centres budget from 1st April 2018. A proposal was being consulted upon, to address this challenge within the context of wider transformation activity by WCC and which also had regard to the national context in relation to Children Centres.

Beate Wagner reminded of the focus on services for 0-5 year olds as part of the Children’s Transformation Plan. The Chair confirmed that WCC was seeking the Board’s input as part of the current consultation.

There were 5 key areas proposed in relation to the 39 children centres:

• Conversion of 12 Centres into Family Hubs that would extend the range of multi- agency services from the current 0-5 to 0-19 (or 25 in the case of disabilities) • Reassessing the use of the remaining 27 Centres with a view to the building being maintained by the community, partners or providers from where services coould be delivered or where this was not feasible to consider potential closure • A universal provision delivered in hubs, libraries, community centres that facilitated access, signposting and self-help and promoted school readiness • An Integrated Family Support Worker Service • Developing community capacity through building resilience in parents, carers and children.

The report confirmed the priority areas identified at the workshop in relation children and families:

• Improved commitment, visibility and engagement in Children and Families within the HWBB

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• Secured assurance of alignment with development of a hub model and 0-5 redesign • Progression of the Multi Agency Children and Families Champions to engage, influence and ensure a partnership approach to safeguarding and services to children and families • Progress of integration, commissioning, delivery and outcome models for children and families

Adrian Canale-Parola noted that one of the centres in Hilmorton, to the east of Rugby could be closed under the proposals. With the anticipated population growth for this area, due to significant housing development, the strategic reasoning for this was questioned. The point was noted and would be included in the consultation feedback. Councillor Barry Longden raised concerns that the revised services would cover the 0- 19 year age range and there was a potential for conflict if antisocial behaviour occurred when very young children were present at the same venue. He added that the benefits of children’s centres had been evidenced and he was also concerned about the way the consultation document was structured. Beate Wagner acknowledged the points raised, explaining the rationale for the review and the aim to provide an equitable service. Some centres were only open for a few hours each week, so the buildings were under-utilised. Councillor Morgan as the Cabinet member for Children assured that safeguarding was of prime importance. John Dixon added that this was a thorough consultation process seeking feedback through public meetings and drop in sessions, meetings at children’s centres and through on line responses.

The consultation period closed on 11 September 2017. Thereafter the results would be analysed with a view to final recommendations being submitted to the WCC Cabinet in the autumn and then implementation of the new arrangements from April 2018.

Resolved

1. That the comments made by the Board be included in the consultation responses.

2. That Board Members disseminate the consultation document within their own organisations, with a view to encouraging individual and collective responses.

3. That the priority areas identified above be used as the basis for developing actions during 2017/18.

7. Report from District and Borough Council Portfolio Group

Councillor Les Caborn gave a verbal update on the areas discussed at the June meeting with the portfolio holders of each district and borough council. It had been agreed to provide an activity update to the Board twice each year and to extend this to be a place-based update that included partner updates as well.

Resolved

That the Health and Wellbeing Board notes the update.

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8. Health and Wellbeing Executive Team Report

John Dixon provided a verbal update. As shown in the earlier agenda item, the main focus of the Executive Group’s recent activity had been the Annual Review and Delivery Plan.

Resolved

That the Board notes the update.

9. Coventry and Warwickshire Better Health, Better Care, Better Value (formerly STP) Programme

The Board received an update from Andy Hardy and Brenda Howard. Mr Hardy confirmed that the Sustainability and Transformation Plan (STP) was recently renamed “Better Health, Better Care, Better Value”. He reported the joint vision: “To work together to deliver high quality care which supports our communities to live well, stay independent and enjoy life”.

The report set out the progress since the last update to the HWBB, which comprised:

• A positive meeting between Board members, NHS England and NHS Improvement to provide a stocktake on progress. • The Board had agreed its support structure and recruitment was underway. The ambition was to attract applicants internal to partner organisations as secondments, with external applications also being invited. A “System Leadership Academy” was proposed, enabling participants to experience working in different organisations within the system. • The governance arrangements for the programme had been reinforced and the design authority reframed, with greater representation from local clinical leaders. Also, a Programme Delivery Group supporting the Board had been established with all work streams having executive leads. • It had been concluded that mental health services should be designated as a transformational work stream and arrangements were progressing to establish this. Also agreed to establish a cancer work stream, as part of the approach to planned care. Progress in this area would be overseen by the regional Cancer Alliance. • Participation in a developmental process led by Health Education England and to work with well-respected facilitator John Berwick.

Transformation and Enabling work stream updates were provided in relation to: • Maternity and Paediatrics • Urgent and Emergency Care • Mental Health • Proactive and Preventative • Productivity and Efficiency • Planned Care • Cancer • Workforce • Estates • Information management and technology • Communications and engagement • Primary care development

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A number of questions were submitted on the work streams. On the proactive and preventative work stream, Andy Hardy acknowledged that more funding should be spent on prevention, an example being a focus on reducing the risk of strokes. The impact of additional development and associated population increases for primary care services was raised. Population growth was modelled and funding sought for additional surgeries through Section 106 (planning) agreements. A move to primary care hubs, also involving social care was seen as the way forward. The removal of, or a reduction in funding for low priority procedures would attract public concern, when the detail became known. On maternity services, reference was made to the Better Births Strategy, the aims of that strategy, assessing the gap between its vision and current provision and the options for achievement of the strategy.

Councillor Longden felt that local councillors and the public were not informed on this process and found out about decisions after they had been taken. Andy Hardy responded that no decisions had been taken on service reconfigurations as shown by the report on stroke services, earlier on this agenda.

The Chair commented that the former STP process had been very health centric, with numerous restrictions placed on those involved. However, good progress was now being made and WCC was significantly involved in the proactive and preventative work stream. She also spoke about the joint work with Coventry’s HWBB, the unity and strength this brought and there was a need for an equal value to health in working together.

Public engagement was discussed. This work stream was led by Andrea Green, who explained the difficulties in engaging the public in the high level plans, as evidenced by the reaction to the STP process. Many of the detailed plans were not yet sufficiently formulated to enable public consultation. Robyn Wensley of Healthwatch added that learning could come from each consultation process to improve subsequent ones.

There was a public perception that changes reduced services or made them less easy to access. The Chair responded that there could also be opportunities from change and a role of the Board was to shape such changes, within the finances available. Mr Hardy added that unlike some public sectors, health spending was still increasing. He also referred to the recent worldwide assessment of health services, ranking the NHS highest in several categories. It was requested that a briefing be provided for the Board, following the next quarterly stocktake meeting with NHS England and NHS Improvement on progress.

Resolved

That the Health and Wellbeing Board notes the report.

10. Forward Plan

The Chair referred to the circulated report, which detailed the agenda items for formal meetings and the focus of the agreed workshop sessions. Board member input was sought to the future programme.

Resolved

That the Board members note the Forward Plan.

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11. Any Other Business

It was noted that immediately following the Board there would be an interactive session on Communication Strategy Development.

The meeting rose at 12.55pm

.... Chair

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