Agenda and minutes

Carl Blackburn, Meena Kishinani, Anne Bristow, Matt Bell, Glynis Rogers and Margaret Ashworth.

The Board noted the appointments of Councillor M Worby and Councillor L Reason as Chair and Deputy-Chair of this Board respectively.

Members of the Board are asked to declare any personal or prejudicial interest that they may have in any matter which is being considered at this meeting.

The Chair declared a personal interest in matters which may be discussed in meetings of this Board as she is also Chair of the NHS Barking and Dagenham Board.

Agreed, subject to the inclusion of Matt Bell, Carl Blackburn, Meena Kishinani, Tim Baggs, Paul Sinden and Councillor Twomey in the lists of those present.  

Saba Gondal presented the At a Glance report which was updated since the publication of the agenda (and published as Supplementary 1) and stated that there were reports of underperformance of three Health and Wellbeing Strategy priority groups.

Matthew Cole presented the underperformance report for Immunisation, for which he is the Priority Group Lead and highlighted the following points:

• The area of underperformance was ensuring people of all ages are aware of the benefits of immunisation (the percentage uptake of immunisations) specifically 2 Cohorts within the year 5 age range.

• There was a recovery plan for MMR 2 and pre-school booster.
• Work was being done with GPs to improve rates and one of the initiatives employed was sending out birthday cards encouraging parents to bring their children in for immunisation.

Dr Mohan stated that GPs were seeing resistance from parents to bring their children in for immunisation but that practice managers were working hard to address the issue as well as the data recording.

The Chair asked whether the coordination between health visitors and children centres was proving effective and Matthew Cole suggested that a report looking into this could be submitted to the Board, which the Board agreed to.

Councillor Reason asked whether the Borough’s immunisation rates were below the national average to which Matthew Cole responded that although the Borough’s rates have significantly improved, we were still below average on MMR2 which needed to be improved to 90%.  Nationally London has the lowest rates and significant effort has been put into improving immunisation across the capital. Improvement was seen in all areas last year and these now need to be maintained and built upon up to the 90% target.

The report outlined the action plan over the upcoming months to help improve the Borough’s screening and immunisation rates, which was noted by the Board.

Matthew Cole presented the underperformance report for Healthy Eating , for which he is also the Priority Group Lead and highlighted the following points:

• The areas of underperformance were:

o  Improve quality and choice of healthy eating options in commercial food outlets in the Borough through education, planning, zoning and licensing. 

o  Increase prevalence of breastfeeding and support transition through weaning onto healthy foods.

• There were ongoing challenges in facilitating the breast feeding coverage data collection into the RIO (child recording) system from GP Practices. 

The Chair stated that it seemed recording data should be a simple matter and questioned what the barriers to this were. Dr Mohan stated that he was the only GP in the Borough who did new born birth checks to babies born at home. When there is an opportunity, GPs ask their patients about breastfeeding, in particular the six week check. However, in addition to GPs there was a range of people who could record this data and there needed to be some coordination as to who will record it. The Chair requested that to help record this data, a system be arranged to coordinate the information held  ...  view the full minutes text for item 119.

Sharon Morrow as part of her verbal report on the Quality, Innovation, Productivity and Prevention (QIPP) Plan made the following points:

• QIPP builds on existing PCT strategy plans.
• Over the next two years the challenge was to focus on productivity in the context of GP commissioning.
• In terms of accountability, this Board was in place and its role would be to have an overview and suggest ways to improve service quality.
• There is a five year plan which sets out the case for change.
• Clinical changes will be based on local need.
• The aim of QIPP was to improve opportunities, quality of services and patient experience.
• The sign-off process was outlined in section 5 of the QIPP document in the agenda pack for the Board’s information.

Helen Jenner stated that there was no mention of safeguarding in the QIPP Plan and asked whether there was an opportunity to register this comment to which Sharon Morrow stated there was.

Karen Ahmed stated that the process around QIPP seemed to have taken place very quickly and that there needed to be an opportunity for local authorities to comment. Sharon Morrow stated that it has been acknowledged that there was limited consultation as the process was driven through the Sector; however, as better relationships were built with local authorities, they would be able to have more impact in 2012/13.

Matthew Cole suggested that in future there would also need to be more engagement with local people in the development of the QIPP as per NHS guidance but there is a need this year to appreciate the very tight timelines in putting the QIPP together.

The Chair referred to the summary of savings and asked whether the savings would be made across contracts, to which Sharon Morrow stated that they would be. The Chair also asked how the impact of QIPP on this Borough would be measured. Sharon Morrow stated that the GP consortium would be used and there was a process in place to report the impact to the Board.

The Chair stated that as this Board would be a “shadow” board for two years, there was a good opportunity to make it work. It was important to make it clear that the function of this Board would be to have an overview and to comment on initiatives such as QIPP; however, scrutiny would be a function reserved by the Health and Adult Services Select Committee.

Matthew Cole delivered a presentation on the Public Health White Paper, Healthy People, Healthy Lives, which was issued by the Government in December 2010.  The Government is consulting on its proposals, and the discussion at the Health & Wellbeing Board will shape the Barking & Dagenham response.

Members’ comments and questions around the role of GPs and Public Health evidence are summarised as follows:

Role of GPs:

•  Are the incentive payments linked to the particular health needs of the locality, or set nationally or regionally? (Could be split payment)

•  Are QOF payments overly focused on adults – with B&D’s changing demography, this could miss some critical issues

•  Incentive payments- It’s not all about the money; quality and access are critical for delivery in B&D

•  Need to ensure there will be GP input into wider commissioning strategy as well as the JSNA

•  Quality of data provided to GPs is critical in order that they can get to grips with their issues

•  How will we measure the ‘level and quality of health advice provided to patients’?

–  Patients’ Survey?

–  Patient representation on Consortium Board?

•  Cross-fertilisation between Health and Wellbeing Board & Consortium Board?

•  Performance across groups of practices versus individual practices

•  Dialogue between GPs and ward councillors

2. Public Health Evidence

•  Do people understand the systems and protocols for sharing information and intelligence?

–  They are in place, but there are questions

•  Need to use clear language in publishing data, and to assist people in being able to understand what we are being transparent about

•  Not to prioritise publication of indicators at the expense of professional practice (school league tables cited as an example)

•  Need clarity of understanding about what we need to achieve in order to have the impact we are after

–  Do we sometimes go for the easier target?

•  Wellbeing: what people think about their lives – how do we get useful, realistic measures?

•  Is the good evidence base of ‘health’ focused on ‘medical model’ interventions?

–  Can local government bring a more social science approach?

–  Can this rebalance our focus between health and wellbeing?

•  Needs analysis very high-level

–  Do we need more rich analysis of, for example, a school community?

Mark Tyson presented a report on the Health & Social Care Bill which received its Second Reading in the Commons on 31 January 2011. He asked members to note the contents of the report and highlighted the following points:

• The Local Government Group is keen to ensure that Health & Wellbeing Boards have ‘teeth’, with a call for Health and Wellbeing Boards to have equality in statute with the National Commissioning Board and for the relationship between Public Health England and Health and Wellbeing Boards to be equally defined.  This would mean that the duty would fall on both Boards to support all partners to do their business in a joint up way.
• It welcomes the removal of Scrutiny from the Health & Wellbeing Board’s remit, and its retention by local authorities.
• Local authorities and commissioning consortia will have a duty placed on them to have regard to the latest assessment (Joint Strategic Needs Assessment) and strategy (Health & Wellbeing Strategy) in exercising relevant functions.
• Overlaps between consortia should be avoided
• The Bill was set to receive royal assent in July, however there is a chance this may shift.

Mark Tyson stated that the draft forward plan within the agenda pack for this meeting was provided to give members an idea of the sort of items that would come before the Board over the coming year and give them an opportunity to suggest topics which could be discussed by the Board.

21 March 2011 at 2.00 pm

Chamber, Town Hall, Barking

Noted, that the next meeting would be on 21 March 2011 at 2 pm in Barking Town Hall Chamber.

Matthew Cole asked the Board to endorse the Borough’s application to be an early implementer for Health and Wellbeing Boards. The Board endorsed the letter of application and Mark Tyson was tasked with organising the signature and forwarding the letter.

The Chair stated that the with the exception of the next meeting, meetings of this Board should be held on Tuesdays at 6.00 pm.