To confirm the record of the meeting of the Rutland Health and Wellbeing Board held on the 13^th June 2017 (previously circulated).

The minutes of the meeting of the Rutland Health and Wellbeing Board held on the 30 June 2017, copies of which had been previously circulated, were confirmed as a correct record and signed by the Chair.

In accordance with the Regulations, Members are invited to declare any personal or prejudicial interests they may have and the nature of those interests in respect of items on this Agenda and/or indicate if Section 106 of the Local Government Finance Act 1992 applies to them.

No declarations of interest were received.

To receive any petitions, deputations and questions received from Members of the Public in accordance with the provisions of Procedure Rule 93.

The total time allowed for this item shall be 30 minutes.  Petitions, declarations and questions shall be dealt with in the order in which they are received.  Questions may also be submitted at short notice by giving a written copy to the Committee Administrator 15 minutes before the start of the meeting.

The total time allowed for questions at short notice is 15 minutes out of the total time of 30 minutes.  Any petitions, deputations and questions that have been submitted with prior formal notice will take precedence over questions submitted at short notice.  Any questions that are not considered within the time limit shall receive a written response after the meeting and be the subject of a report to the next meeting.

No petitions, deputations or questions were received.

To receive a report from Tim Sacks, Chief Operating Officer, East Leicestershire and Rutland Clinical Commissioning Group

A verbal update was received from Paula Vaughan, Deputy Chief Operating Officer, East Leicestershire and Rutland Clinical Commissioning Group.   During discussion the following points were noted:

a)    Sustainability and Transformation Plan now re-named Sustainability and Transformation Partnership.

b)    A paper was presented at the System Leadership Team meeting held on the 21^st September which gave an overview of the complex models of care in relation to the community hospital inpatient beds.

c)    The direction of travel has resulted in more beds for Rutland but the location of these beds had not yet been decided.

AGREED:

1.    The Board AGREED that more ‘concrete’ information should be presented at the next meeting.

2.    The Board AGREED that all Health and Wellbeing Boards need to be consulted with much earlier in the process rather than just being informed of what would be happening.

To receive an update from Tim Sacks, Chief Operating Officer, East Leicestershire and Rutland Clinical Commissioning Group

A verbal update was received from Paula Vaughan, Deputy Chief Operating Officer, East Leicestershire and Rutland Clinical Commissioning Group.   During discussion the following points were noted:

a)    The ‘General Practice Development Programme’ was a five year programme aimed at responding to the opportunities and challenges identified with the General Practice Forward View.

b)    This was a huge document produced by NHS England.  It was not very descriptive but it did outline the substantial investment available for primary care.

c)    The main aim of the programme was to ensure day-to-day access to primary care for all.

d)    Consultation with GP’s and patients would start in the near future in order to ascertain what they believed was needed i.e. what service(s) should be delivered/available to access etc.

AGREED:

1.    The Board AGREED that case study examples of access to primary care should be presented at the next meeting.

To receive a presentation from Mark Gregory, General Manager, Leicestershire, Rutland and Northamptonshire

A presentation was received from Mark Gregory, General Manager, East Midlands Ambulance Service NHS Trust.  During discussion the following points were noted:

a)    EMAS joined a trial called the Ambulance Response Programme (ARP) on the 19^th July 2017.

b)    Targets for ambulance response times have been amended.  Target for a Category 1 call had been 8 minutes, target was now to achieve an average of 7 minutes, with 90% of calls being answered within 15 minutes.  Target for a Category 2 call had been 8 minutes, target was now to achieve an average of 18 minutes, with 90% of calls answered within 40 minutes. These new targets are anticipated to be better aligned to improving the overall speed and quality of the emergency response.

c)    EMAS was working closely with colleagues in order to increase the access to alternative treatment sources for lower priority calls i.e. urgent treatment centres, crisis response vehicles.

d)    EMAS were considering a more robust educational programme in order to deliver prevention.

e)    Actual response times were now being sorted by county area and would be notified to all colleagues.

f)     A paramedic was not always the right person to treat a patient.  Alternative pathways such as community nurses were being investigated.

AGREED:

1.    The Board AGREED that Trish Crowson, Senior Manager in Public Health would arrange for the EMAS presentation to be presented to the Integration Executive Group.

2.    The Board AGREED that Mark Andrews would arrange a scoping meeting (RCC, EMAS, ELRCCG, Public Health, LPT, HealthWatch) to discuss prevention and alternative pathways.

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Mark Gregory left the meeting and Danah Cadman and Dr Tim Daniel joined the meeting at 3.00 p.m.

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To receive a report from Dr Tim Daniel, Consultant in Public Health Medicine,

Leicestershire County Council and East Leicestershire and Rutland Clinical Commissioning Group on the planned decommissioning of NHS provision of a number of current therapies for patients with low back pain, including acupuncture.

A report was received from Helen Mather, Planned Care Implementation Lead at Leicester City Clinical Commissioning Group and was presented by Dr Tim Daniel, Consultant in Public Health Medicine and Danah Cadman, Project Manager – Planned Care. 

During discussion the following points were noted:

a)    The three clinical commissioning groups across Leicester, Leicestershire and Rutland planned to decommission a number of interventions for the treatment of lower back pain, with or without sciatica, in line with National Institute for Health and Care Excellence (NICE) guidance published in November 2016.

b)    As from the 1^st November 2017, the following services would be better integrated into a pathway offered to patients:

·         Self-Management

·         Exercise

·         Psychological therapy

·         Combined physical and psychological programmes (multidisciplinary biopsychosocial “functional” rehabilitation)

·         Return to work programmes

·         Radiofrequency denervation

·         Epidural

·         Spinal decompression

c)    As from the 1^st November 2017, the following services would not be offered to patients:

·         Orthotics

o   Belts or corsets

o   Foot orthotics

o   Rocker sole shoes

·         Manual therapies

o   Traction

o   Manual therapy e.g. massage, spinal manipulation and mobilisation carried out by chiropractors, osteopaths and physiotherapists

·         Acupuncture

·         Electrotherapies

o   Ultrasound

o   Percutaneous electrical nerve stimulation (PENS)

o   Transcutaneous electrical nerve simulation (TENS)

o   Interferential therapy

·         Pharmacological interventions

·         Spinal injections (facet joint injections, trigger point injections, prolotherapy)

·         Spinal fusion

d)    The number of Rutland residents directly affected by the decommissioning of acupuncture and other treatments (currently either receiving or awaiting treatment) would be less than 20 patients, but the overall population of residents who would be accessing the range of new services in the future (based around exercise/return to work and self-management etc.) would be considerably larger as non-specific low back pain was a common condition in the community.

e)    An 8 week engagement period, starting from the 25^th September 2017, would be held in order to gain views on what impact the removal of these services would have on patients and what additional support would be needed.

f)     The alternative services provided would be commissioned by Rutland County Council through Public Health so a plan of ‘joined up’ working would be required.

AGREED:

1.    The Board AGREED that Miles Williamson-Noble would contact Dr Tim Daniel in order for details regarding the changes to be displayed on Healthwatch Rutland’s website.

2.    The Board AGREED that Dr Tim Daniel would contact Mike Sandys to discuss the plan for joint working.

3.    The Board NOTED the change to the NHS funded treatments that would be offered to patients with lower back pain, in line with NICE guidance.

4.    The Board NOTED the timeline for public engagement and how patients would be informed of the implications.

---oOo---

Danah Cadman and Dr Tim Daniel left the meeting and Bernadette Caffrey joined the meeting at 3.22 p.m.

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To receive a report and presentation from Bernadette Caffrey, Head of Early Intervention, SEND and Inclusion

A report was received from Bernadette Caffrey, Head of Early Intervention, SEND & Inclusion and a presentation was given to the Board.  During discussion the following points were noted:

a)    Ofsted inspection carried out from the 10^th to the 14^th July 2017 and focused on three key areas:

1. The effectiveness of the area in identifying the needs of children
2. The effectiveness of the area in assessing and meeting needs
3. The evidence of improved outcomes for children and young people

b)    The inspection findings and subsequent report found that the strengths significantly outweigh the areas for development and the report is exceptionally good when compared to other Local Authority inspections.

c)    A SEND Strategic Group had been established to drive the key actions and which comprises school representatives, health commissioners and parent /carer representatives.

d)    Key actions would include developing provision to enable children to be educated and enjoy family life closer to home and to improve the communication regarding the local offer.

e)    Placement contracts re being reviewed to get the best quality provision for children and families and best value for money service for the Council.

f)     It was noted that funding for employers to engage young people and adults with SEND will be withdrawn but what effect, if any, this would have on Rutland citizens was unclear.

AGREED:

1.    The Board NOTED the recommendations for future action.

---oOo---

Bernadette Caffrey left the meeting at 3.39 p.m.

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To receive a verbal update and presentation from Mark Andrews, Deputy Director for People

A verbal update was received from Mark Andrews, Deputy Director for People and a presentation was given to the Board.  During discussion the following points were noted:

a)    Delayed Transfers of Care (DToC’s) have been rising for some time.

b)    A new national target had been set to ensure that 3.5% or less of available hospital bed capacity was lost to discharge delays on any given day.

c)    This national target figure had not been distributed equally across all counties. Instead each county’s target was set from their DToC figure from February 2017 as this had been deemed a bad month for DToC figures.  However, Rutland had a very good month in February 2017 when it came to their DToC figure.  This had resulted in Rutland being set a completely unachievable DToC target figure.

d)    ADASS were petitioning against NHS England’s target setting and the LGA had withdrawn support from the BCF framework due to disagreement with the target process. Seventy local authorities were in the same position as Rutland.

e)    RCC was trying to engage NHS England in dialogue regarding a proposal to set the DToC target figure on the quarterly average figure.

f)     Two options:

1.    Agree the unachievable DToC target set by NHS England and risk future I-BCF funding, or

2.    Refuse the unachievable DToC target set by NHS England and risk current funding and programme continuity.

AGREED:

1.    The Board AGREED to hold RCC’s position, refuse the unachievable DToC target set by NHS England BUT to continue negotiations with them. 

2.    The Board AGREED that Cllr Clifton would ask Sir Alan Duncan to raise the matter in Parliament.

a)    Miles Williamson-Noble informed attendees that the Cambridgeshire and Peterborough Clinical Commissioning Group over-spend had been capped.  This had resulted in no patients being seen by services in under 12 weeks.  Paula agreed to monitor the situation and notify the Board.

b)    A Health and Wellbeing Board Development Session had been arranged for Tuesday, 31^st October 2017, 2.00 – 4.00 p.m. in the Council Chamber.

The next meeting of the Rutland Health and Wellbeing Board will be on Tuesday, 5^th December 2017 at 2.00 p.m. in the Council Chamber, Catmose.

Proposed Agenda Items:

1.         Leicester, Leicestershire and Rutland Integrated Points of Access   Programme - report from Mark Dewick, Programme Manager for Leicester, Leicestershire and Rutland Integrated Health and Social Care Points of Access Project

The next meeting of the Rutland Health and Wellbeing Board would be on Tuesday, 5^th December 2017 at 2.00 p.m. in the Council Chamber, Catmose.