Room G9, Broadway House, Northbrook Street, Newbury RG14 1BA

Minutes of the Meeting of Health Watch West Berkshire Board on 15 March 2017- 10:30am Room G9, Broadway House, Northbrook Street, Newbury RG14 1BA Present Andrew Sharp Chief Officer, Healthwatch West Berkshire AS (HWWB) Alison Foster Chair, HWWB AF Dr Melanie Morgan-Jones Board Member MMJ Martha Vickers Board Member MV Ann Standen Board Member ASt Alice Kunjappy Clifton Development Officer, Healthwatch West AKC Berkshire Leia Clifton Admin & Information Officer, HWWB LC

Item Agenda Item Action No. 1. Welcome and Introductions Alison Foster started the meeting thanked everyone for coming and apologised for the time delay in getting the meeting started. Each board member introduced themselves to the meeting. 2. Apologies for Absence Mike Fereday (MF), sends his apologies to the meeting as he is out of the country. Chris Noble (CN), SEAP, sends her apologies to this meeting as she is ill. Zoe Tomes (ZT), sends her apologies to the meeting.

3. Declarations of Interest Andrew Sharp – declared that he is Chair of West Berks Rapid Response Cars. Martha Vickers – declared she is a councillor with Newbury Town Council.

4.a Minutes of the meeting held 15 March 2017 Martha Vickers stated that she was present at the last board meeting and this should be added. After this change was made the board approved and AF signed the minutes of the last meeting. 4.b Matters Arising and Actions from that meeting Action log – AS went through this and explained the actions outstanding and plans to address the outstanding items.

5. Report of the HWWB Chief Officer AS thanked the public for coming, also thanked the Board especially those who had travelled considerable distances in poor weather and staff of HWWB for ensuring all had been arranged for the meeting.

V3 HWWB Mins of Board Meeting on 15 03 2017 draft 1 Staff changes – AS thanked past staff members Leena Sakhiya, Maggie Matthews and Amelia Hamblin for their contribution to HWWB. AS stated that LC had joined HWWB as the new Admin and Digital Information Officer. AS specifically thanked AKC for her hard work, as the only member of full time staff for much of the last quarter as Development Officer. AS also thanked volunteer Nathan Pope for his contribution towards improvement of social media and the website which AS hopes will continue to see improvements.

Vulnerable People – AS stated that HWWB will continue to prioritise and look at vulnerable people as HWWB aims to reduce health inequalities locally. This has been happening through work with homeless and rough sleepers. HWWB is also involved with Brighter Berkshire and the newly formed Mental Health Action Group (MHAG- a subgroup of the West Berkshire Health and Well Being Board) to continue work on mental health in West Berkshire.

Day to Day Enquiries – AS stated that the nature of enquiries received by HWWB have become more serious. HWWB had expected to be an organisation where you’d go for GP or Dental appointment issues, but more recently HWWB have been dealing with issues to do with ‘system failures’ seriously impacting on people’s lives. Part of HWWB job therefore recently has been to remind those in charge of providing or commissioning services that real people are suffering because of problems with how services are delivered or where there are ‘gaps’.

County Border Issues – AS stated that a problem HWWB has been seeing over the past few months are issues of health or social care if someone lives on county boarders between West Berkshire, Hampshire and Wiltshire. Or if a member of the public lives in West Berkshire and attends a GP practice in Hampshire or the edge of West Berkshire and they have a complaint this raises difficulty of which Clinical Commissioning Group (CCG) HWWB should raise a complaint or concern with.

Transition in Healthcare – AS stated HWWB have also been dealing with clients who have ‘fallen through the cracks’ when transitioning in health or social care. He explained an example of this is between child and adult services. AS further explained that people who fall through the cracks in this way are in a difficult position, as they no longer have the statutory protection afforded under 18’s and struggle to be heard as adults.. They just about avoid crisis but are not are offered help they need. AS continues, ill health in this can be caused when departments/aspects of health and social care are not joined up.

Meetings with Richard Benyon – West Berkshire MP – AS explained he has had meetings with Richard Benyon on the topics of advocacy and support for military veterans. He also raised the issues of homelessness and cross county border health/social care issues with the MP.

AS praised West Berkshire Council (WBC) for their quick response, willingness to help and the difference they have made. They have particularly got involved with work done with Learning Disabilities report HWWB produced ‘The Final Transition ‘and with Mental Health events HWWB arranged called ‘Thinking Together’.

Meetings with Royal Berkshire Hospital Chief Executive – AS stated that Steve McManus is the new Chief Executive of RBHFT. As states that he has met him twice and that AS believes McManus is already doing a good job of changing the ethos of the Trust and HWWB has had much more contact with those working in Healthcare at Royal Berkshire Hospital . He further stated Steve McManus is coming to West Berkshire later in the year and is trying to work on moving more appointments/services to West Berkshire for those who live here.

CCG Merger – AS explained that unlike WBC the local NHS have been ‘hearing’ but not really ‘listening’ and general not willing to take things on that have been brought to them by HWWB. AS also mentioned the forthcoming proposed merger of the four CCG’s in Berkshire West into one CCG . He hopes the new merger of the four local CCG’s will help this improve and react more effectively to issues raised by HWWB.

Annual report – AS stated that the only organisations who haven’t responded to their mention of failing to respond to a HWWB request and hence highlighted in the annual report were South Central Ambulance AS and Service(SCAS) and Reading North CCG regarding LD services and that HWWB Team will chase that up.

Annual Conference – AS stated recently MF and AKC attended the Healthwatch England’s Annual conference in Nottingham and it was very helpful in terms of learning from other Healthwatch’s. HWWB was singled out for praise within the conference opening address by its Chair, Jane Mordue, for its Thinking Together project. HWWB also has a meeting with Imelda Redmond, the National Director of Healthwatch England in October.

MV asked whether the Board was aware of progress being made with health and social care as there was criticism between CCG and local authority about what progress will be made. AS responded by saying that there is an integration agenda between health and social care and how they are trying to work together seamlessly. AS then explained how a challenge facing integration is information governance and not breaching data protection. AS further explained that key areas seen have been impressive performance with connected care programmes and initiatives like social workers being placed in Royal Berkshire Hospital(RBH) to try and get people out of hospital quicker. Focussed integration is working well however the places where there is not specifically focussed integration between health and social care was not so good.

AF stated that there is lots of change happening locally with health and social care including integration and this may be confusing for the public as it is

V3 HWWB Mins of Board Meeting on 15 03 2017 draft 3 difficult to navigate.

AS stated that the language used by the NHS healthcare system NHS is often confusing. Such as the use of terms such as ‘urgent care centres which are different from A&E, Minor Injury Units, or Walk in Centres. More care needs to be taken to avoid confusion for the public.

MV stated that there is a money saving suspicion by the public concerning the NHS. With the focus on that drawing away from the person. AS responded saying that it is not a suspicion but a fact, demand year on year is rising and someone needs to alter services to fill the gap left by austerity. AF concurred that the local council has had to save millions the role of HWWB is making sure that the person remains at the centre. AS continues that if the system isn’t working for one person then it isn’t working for anyone.

An Audience Member thanked HWWB for the Thinking Together report as it has had a big impact on the WB Health and Wellbeing Board. Thanks HWWB on behalf of service users.

6. Appointing a Vice Chair – AF suggested opening up for a Vice Chair role because staff at HWWB is very busy and cannot attend every meeting that they wish to MMJ recommended ZF (who was not present) as she has knowledge of this area. The board suggested talking about this point externally.

ACTION – Board to discuss appointing a Vice Chair externally via email as AS many of the board members are not present.

7. Annual Report Update -

AS first told the public in attendance at the board meeting that the Annual Report is available on the HWWB website. AS stated that he was pleased that HWWB are now dealing with more cases and now have a bigger footprint to help make change. He stated one of the concerns raised by the annual report is the homeless population locally and how they are receiving care. AS said that the system wasn’t working for a group of people despite saying it was.

Whistle blowers – Since the annual report HWWB has been listening to whistle blowers. Despite it not being HWWB’s area they did what little they could as whistle blowers came to them after they have exhausted every other option. AS explained that a whistle-blower becomes unemployed or unemployable, this should not happen as services should encourage whistle blowers and they should be encouraged and not picked on.

8. Roles and Responsibilities – Healthwatch Board

AS stated that a Vice Chair is needed as HWWB require this level of support. He continued to say more people need to be recruited for the board that are willing to be very involved in the complex world of Health and Social Care – it cannot be a passive role.

MMJ stated that she would like to be more involved as a board member she asked whether it would be possible for her to experience every different thing in Health and Social Care. She suggested a day in a different part of the work HWWB undertakes in H&S care every 3 weeks in order to be able to experience everything.

ACTION – Look into how MMJ can experience different aspects of H&S care every 3 weeks in order to increase her experience in order to become more involved as a Healthwatch board member.

ASt suggested that the advert to recruit a new board member should be clear and should fully explain what is required of a new board member including what skills are required and what people will be required to get involved with and how they are willing to be engaged.

ACTION – Begin recruitment process to find a board member who is willing to be as committed as required by HWWB. MV asked how HWWB would go about adverts

AS replied saying this would happen through press releases, social media and through the press. 9. Ratification of ‘New’ Work Plan

The Board read through the new workplan. AS stated that the Work Plan has been changed to become a clearer log of what HWWB are doing. AS further suggested that the Work Plan has started being realistic with what HWWB can and cannot do work and resource wise. The champions group are a big help to organise the workplan as they come to HWWB and show where the big challenges are in Health and Social care. AS said for example GP enquiries and access issues remain of concern locally, there aren’t a huge amount of other GP issues but the frequency seemed to be rising therefore it stays high priority concerning the Work Plan.

AS stated that department of health stated GP needs to open 7 days. ASt added the UK hasn’t improved in health terms and it has rather stalled, the Care Act (2014) was supposed to fix this but local authorities sometimes ignore it as it is costing them too much.

MV stated that perhaps the Health and Wellbeing Board should cover ‘Living Healthily’ in terms of using resources to make Newbury/West Berkshire a ‘Marmot’ town. MV then asked what it would take for Newbury/West Berkshire to become a Marmot Town. AS replied it would be a matter of procedure linking all services Health and Social care and beyond. Services should become a ‘one stop shop’ where everyone takes responsibility rather then deciding there is nothing that particular service can do for someone in need. An Audience Member then commented that the board had touched on

V3 HWWB Mins of Board Meeting on 15 03 2017 draft 5 how people become disillusioned with health and social care as it feels like some professionals have a lack of empathy and professionals at times discard cases instead of passing it on to someone who could help.

AS stated ‘Eligibility Criteria’ and ‘Living Healthily’ to be taken off the Work Plan in order to focus on ‘key’ issues or what HWWB have feedback on. If HWWB receives feedback on either of those issues then it can be reconsidered in terms of returning to the work plan, it doesn’t have to be many people who come forward for this to take place.

ACTION: ‘Eligibility Criteria’ and ‘Living Healthily’ to be taken off the Work Plan in order to focus on local issues or what HWWB have feedback on due to limitations of resource.

10. Contact & Issues Report – AS/Team - Thinking Together Report AS stated the last Thinking Together event was a success, the chair of HW England even came and stayed the whole day as well as many senior officers. The Thinking Together report was put in front of the Health and Wellbeing board continues to make a difference. The Mental Health Action Group (MHAG) has been formed and comes up with local strategies that can help the people of West Berkshire whilst fitting into wider regional/nationwide strategies. AS explained that Richard Benyon (MP) is set to attend the Health and Well Being Board meeting in November at which the MHAG would present its initial plans. AS said another Thinking Together event is set to be held in order to ask the service users what they think in general and about changes the MHAG is proposing since the last Thinking Together event ASt said that the point of an event such as Thinking Together is that people take ownership of what needs to happen. MV then stated that West Berkshire has one of the lowest suicide rates in the country and many of those with mental health issues prematurely dying therefore, are dying of physical health reasons AF then stated that this is a public health issue, local services treating someone with mental health problem the same as if they didn’t, professional stigma is allowing this to happen. AF also explained that West Berkshire now has a mental health Champion in the Council.

An audience member who works for Newbury Survivors of Bereavement stated that the numbers of suicide rates are low because Coroners in certain examples have put a suicide down as a misadventure rather than a suicide so the real numbers of suicide don’t match the statistics. Another Audience Member stated that GP’s often give those with mental health problems and in danger of suicide anti-depressants, they did not feel GP’s were sensitive to this issue. Another Audience member explained they felt exasperated as a parent of someone with a mental health issue. They wished that patients at a GP surgery were seen holistically and that mental health and LD were better integrated into education. AF explained that the community needs to value mental health and in order to achieve this there needs to be a loud voice around mental health. An Audience Member stated they have been a mental health sufferer for a few years yet has just had their ESA stopped. Another Audience Member stated they want to be normal and do well despite his learning difficulties but felt he had been treated as though he was incapable and it left him feeling hopeless. AF and ASt agreed the personal experiences shared by the audience members are valuable in making real change concerning mental health. An Audience Member explained that improvements to self-care have a big impact in mental health. MV stated that mental health first aid is being rolled out as an optional course. AS states that is should be mandatory as training like HSE is in the workplace. Action: Should try to capture the personal experiences from the Audience Members from the Board Meeting if they give consent to and collected, in order to be put in front of those who can make real change in mental health. - The Final Transition When carers can no longer care AS stated that this LD focused report should go from highlighting the issue to getting something done, hoping the report will make things better than it was. AS said the WBC l acknowledged that something needed to be done and had followed the recommendations of the report, with an action group due to meet shortly to look at solutions

- Newbury College (NC) placements AKC conducted this report. She said that HWWB continues to work with students from NC with the next rotation of students coming in October. The work done by one student on Antibiotics will be put out by HWWB soon. AS praised all of the students work, including getting official use of the Teenage

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11. Homelessness

AS explained that the small population of the homeless in the area are not getting the care they need. HWWB is in talks with the CCG to improve this however AS said the CCG were currently unwilling to listen or react. AS explained that HWWB had brought the homeless issue to many staff within local health services a though after nearly 6 months nothing significant was done until HWWB went to the press. AS then explained that there is difficulty in homeless access to GP services, changing this will prevent A&E admissions and reduce the huge disparity in life expectancy of the homeless , currently 30 years less than the general population*. (http://www.bbc.co.uk/news/uk- 16272120 )

12. Enter and View Update

- Thatcham Court AKC updated the board and the audience members. AKC stated that the Thatcham Court report was now with the service provider.

- Prospect Park AKC said that an Enter and View visit with prospect park in Reading was set to happen in Autumn of 2017, currently there are 10 volunteers from HWWB set to take part. AS said that HWWB are working with 4 other local Healthwatches for this Enter and View. 13. Research and Community Engagement (CEP) AS/LC

AS said that HWWB are currently working with Recovery in Mind. HWWB are also working with the Family Resource Centre and are currently waiting for an update. West Berkshire Learning Disability Partnership (WBLDP) brought their application to CEP but it was felt that it wasn’t quite right and so they resubmitted it. AS stated the application was brought back and needed to be circulated among board members to see if it should be approved.

ACTION: Circulate the WBLDP application for CEP funding \among board members.

14. Community Engagement/Volunteer Update The Board members and audience were played a video about community engagement from March to September. AKC did this update and said that HWWB has been really active. There is a planned Community Engagement coming up in Pangbourne. HWWB currently has 21 volunteers including Nathan Pope who works on the HWWB website.

15. Strategic Transformation Partnership (STP) Accountable Care Sytem (ACS)

The Strategic Transformation Partnership Plan for our area (Buckinghamshire, Oxfordshire, Berkshire West/BOB) still hasn’t been made public.

AS said that ACS is working so patient files access will follow the patient around the local healthcare system. It will also reduce perverse incentives that unevenly fall on different parts of the health system and treat the overall spend as one amount, ‘the Berkshire West £’. It will allow more ‘back-office’ efficiencies, release more senior management time currently spent on repetitive board meetings.AF stated that there were national concerns over ACS bypassing consultations with the public. Recommissioning the way it works has involved very little public consultation.

16. West Berkshire Health and Well Being Board Update

AS said the voluntary sector, housing/planning have all been brought into consideration of the Health and Wellbeing Board. Housing and employment are integral to Health and Wellbeing. MV asked if transportation was included in relation to transport exacerbation of air pollution with impact on conditions such as asthma problems. AS responded saying that air pollution is there.

AS said one of the two key the Health and Wellbeing board priorities is focussed on alcohol harm reduction and is working with alcohol/substance harm reduction groups. This includes the ‘Blue Light’ Project which provides intervention for people who have been unable to break the habit.

AS states that public questions can be submitted to the HWBB on a range of issues prior to each meeting. 17. Mental Health Forum Updates

AS explained this is where the voluntary sector comes together with commissioners/providers. AS said a new structure has been recommended to include user and community involvement.

18. Brighter Berkshire (BB)

AF reported. Said BB are trying to get community participation, getting

V3 HWWB Mins of Board Meeting on 15 03 2017 draft 9 people into a room and start having a conversation about mental health.

AF commented on the work of the Suicide Prevention Action Group as it has community engagement, common sense solutions with a wider group of people meeting and they concluded they needed to review the protocol after someone takes their life. AF said this was an example of real change being made and that people who have experience need to be consulted to help change.

AF stated that for World Mental Health day ‘walk and talk’ events were taking place as well as a cycling event in September. AF also said that Berkshire Community Foundation partnered with Brighter Berkshire to open the funds and that anyone applying should not wait until the deadline. AF said BB action had taken a break over the summer but will begin again in term time. October 10th is World Mental Health Day 2017.

AF stated that it was arranged that Reading Football Club are hosting a World Record attempt for the biggest school lesson and it would be in mental health. There is also a secondary school song writing competition – using imaginative ways to promote mental health. 19. Healthwatch after 2018 – Sustainability

AS said that the Healthwatch structure is being continued as a national footprint. HWWB recommissioning is due in April 2018. 20. HWWB Board Meeting Locations & Structure

The board agreed this is to be discussed outside of this due to time LC/All constraints in this meeting.

ACTION: LC and Board to discuss meeting and location of next board meeting 21. Questions from the Public/Audience AS/Audience Member One audience member asked about the military covenant in health and whether there is anything she can do as a member of the public to get GP practices to contact Veterans to let them know what specialist military service is available. Especially concerning mental health. AS responded saying there are WB services available to Veterans through GP practices. The audience member responded saying she had already done so but knew of cases where military personnel come out of service and get put on a waiting list to receive treatment. AS suggests the audience member take this up with Adrian Barker, Patient and Public Engagement Officer of the Newbury CCG who was in the audience in order to clarify with the CCG what is available to Veterans. ASt from SEAP mentioned that SEAP now has funding to advocate after 3 years of gathering evidence on issues with Veteran healthcare, funded via the LIBOR fines.

ACTION: Question to be taken to the Newbury CCG

A different Audience member asked whether there has been any movement forward with the Local Account meeting. AS responded saying no and that it seems to have been delayed indefinitely. AS suggested that the audience member emails them.

An Audience Member asked where he could get the supporting papers on the website as he was unable to find them on the website. AS responded that they are all on the website if they are not specifically attached to the agenda, however this will be rectified. LC ACTION: Attach relevant Board Meeting Documents to the Agenda.

A different Audience member asked ASt what ‘Seap’ is. ASt explained that it is an organisation that deals with advocacy. The Care Act entitled a lot of people to be helped and supported. This includes mental health advocacy which is very important.

A different audience member from Action for Pangbourne Toilets (APT) that the toilets are reopening on 30th September because of community funding from organisations such as the Greenham trust. The audience member goes on to explain that local authorities are shutting toilets from blocks which haven’t been opened. AS suggests that the audience member from APT brings this up with the Health and Wellbeing Board who are holding a meeting on 28th September, 9.30am in the Council Chambers. 22. Meeting Close 12.45pm

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