Agenda and minutes

Apologies for absence were received from the Chair, Councillor Rachael Blake, Kathryn Singh, (Rosie Johnson deputised), Steve Shore, Laura Sherburn, Peter Dale, Paul Tanney, Superintendent Shaun Morley and Paul Moffat (Mark Douglas deputised).

The Vice Chair, Dr Crichton conveyed the Board’s congratulations to Richard Parker, Chief Executive of Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust, on being awarded an OBE for services to sustainable care in the Queen’s New Year’s Honours List.

(A period not exceeding 15 minutes for questions from members of the public.)

There were no public questions asked at the meeting.

There were no declarations of interest  made at the meeting.

The Board’s attention was drawn to the Public Question at the last meeting, and those members who had not yet provided Mr Tim Brown with the relevant information on Workforce Diversity were urged to do so.

RESOLVED that the minutes of the meeting of the Health and Wellbeing Board, held on Thursday 15th November, 2018, be approved as a true record and signed by the Chair.

Members considered a report that provided an update with regard to the work of the Steering Group in delivering the Board’s work programme, and also provided a draft Forward Plan for the Board to work to.

A number of updates were provided to Board on the following issues that had been discussed by the Steering Group since the last formal meeting, with some focus placed on the following:

The NHS Long-term Plan

In terms of this, the Board were informed that work was now being undertaken, in order to ensure that a local plan for 2019/20 was published by April 2019, with a 5 year plan available by autumn. A joint strategy was being developed and more information on this would be available at a future meeting.

Gambling

With regard to gambling, it was noted that greater support was now being made available to younger gamblers, and the Young Gamblers Education Trust, was offering training to ensure that staff dealing with young gamblers had the adequate tools to address the issue.

Well North / Well Doncaster

The Annual Report was attached to the agenda papers which provided an update of all work undertaken during 2017/18. Progress was being made, and the Place Plan was being embedded to bring about further improvements.

New Mental Health Support in schools and colleges, with faster access to NHS Care

This was an issue on which a number of comments were made during the course of the discussion, with Members welcoming this support. Councillor Fennelly particularly, was pleased to see this as she commented that it seemed that mental health problems were emerging at an early age more and more, and it was imperative that there was adequate support in schools. The Board were informed that Doncaster had driven the national agenda with regard to this issue and were looking to build on this success more and more. There were currently 7 CAMHS workers and with this initiative there would now be an additional 14 which was a huge support to children and young people.

The minutes of the SY&B Shadow Integrated Care System Collaborative Partnership Board Meeting held on 19 October, 2018 were attached for the Board’s information, along with a Forward Plan for the Health and Wellbeing Board that plotted in the different work streams they would be looking at in the coming year, and would be updated as and when required.

RESOLVED that the Board noted the update received from the Steering Group and agreed the Forward Plan attached at Appendix A to the report.

Further to discussions held at November’s Health and Wellbeing Board, a paper was presented to the Board along with a presentation, which provided an update on the work to address the challenge of cancer within the Borough.

Cancer, as a disease, was increasing year on year and for anyone born after the year 1960, it would affect 1 in 2 people, with over 200 different types of cancers affecting individuals, their lives and their families, in differing ways with varying outcomes.

Whilst the number of people affected by cancer was higher than ever, Members noted that the number of people surviving, was also higher, with more people being diagnosed at an earlier stage with upwardly improving outcomes. The Board were informed that there was a much greater awareness now of factors which could contribute to the cause of cancer, including smoking, obesity, alcohol, as well as living healthy lifestyles, and avoiding sun damage or other carcinogens. Additionally, there were preventative measures such as the HPV Vaccine offered to young girls which could offer protection against illnesses that could later change into cancer.

Whilst screening was a relatively new initiative, and the tests were not undertaken specifically to detect cancer, they could be used to diagnose changes that may lead to cancer at a later stage and were therefore a useful tool.

There was a lot of work being done across Doncaster, and the ‘Be Cancer Safe’ scheme was doing a lot of work in raising awareness in people with regard to noting signs and symptoms, as well as highlighting the access to screening which would increase the number of people diagnosed at an earlier stage. Additionally, there were currently 2811 cancer champions across Doncaster who would use their experience and knowledge to support those with Cancer and it was hoped that more would be recruited in the future.

New ways of working were being developed all the time, with different pathways created and explored, and improvements continually being made and the NHS Long-term Plan had a number of actions it was working towards including the following:-

·         75% diagnosis at an early stage from 2028

·         Rapid diagnostic centres

·         Lung health checks and low dose CT scans

·         Faster diagnosis, with 28 day targets

·         Genome testing for all cancer patients, starting with children

·         New radiotherapy proton beam facilities

Following what was a very informative and in-depth presentation, the Chair invited any questions or comments from the members of the Board. A brief discussion ensued where Members asked for any clarity on any of the points, figures or statements contained within the documents presented.

RESOLVED that the Health and Wellbeing Board note the report and accompanying presentation with regard to Cancer Updates

Members considered a presentation that proposed the bringing together of a number of actions which would look to improve mental health services for people in Doncaster. The proposed Improvement Plan was not a replacement of the individual plans currently in place, but complementary to, and would bring together a more joined up approach of working over a five year period.

The work undertaken would look to provide patients with the tools for better self-management, earlier identification of their deteriorating mental health and the access to support for coping with, and recovering from mental illness.

The Prevention Concordat for Better Mental Health was a national consensus statement that would look to transform the health system by increasing the focus on prevention of mental health. By ensuring that there was more joined up way of working and commissioning, it would allow for a more holistic approach, which would not only focus on people’s needs but also recognise the determinants that affected mental wellbeing. The seven points of the Concordat were outlined in depth during the course of the presentation, with the Board asked to support this by endorsing the concordat through the agreement and signing of it by the Chair or Director of Public Health.

The Plan organised across several themes, which aimed to make it accessible, concise and easy to read:-

·         Living Well – Community led support and low level early intervention

·         Access to appropriate services

·         Holistic Care and Support

·         People with Complex / bespoke needs

·         Suicide Prevention

There would also be information relating to outcomes and needs, and governance and assets aspects, all of which would be integral to the delivery of the Mental Health Improvement Plan. The Plan would be a live document and would be updated on a regular basis to ensure it was developed and monitored accordingly.

Members were supportive of the approach, particularly in relation to the elements relating to children and families, as there often proved to be gaps in providing the support needed to children coming from troubled homes. It was a piece of work that would transition gradually, and although a lot of work was still needed the Board was hopeful this would happen with greater joined up working. Members commented that the focus on prevention was key, as it was important to look at the roots of mental health and they were continually learning from the work carried out in relation to the complex lives agenda in working towards more successful ways of dealing with family rooted issues.

There was acknowledgement that whilst prevention was key, the bigger picture was a huge challenge and joint commissioning and better partnership working was needed in order that the mental health agenda could be driven forward.

Members were happy to support the Concordat and Mental Health Improvement Plan, and were assured that their concerns would be noted, and as the document would be a live document, it could be adapted and moved forward when changes were needed.

RESOLVED that the Board endorsed the Better  ...  view the full minutes text for item 44.

A presentation was given by Dr Victor Joseph and Dr Shazia Ahmed, which gave an overview of the progress made on addressing health protection matters in Doncaster.

Health Protection was a key issue and one of the main contributing factors to improving the long term health of the people in Doncaster by ensuring services were in place to prevent a number of different illnesses and diseases, as well as ensuring that environmental problems such as air quality were addressed in order to alleviate issues that could later lead to serious health problems.

A number of key actions were highlighted during the course of the presentation in order to provide more information to Members, these being as follows:-

Air Quality:-

There had been a piece of joint work undertaken between Doncaster Council’s Public Health and Environmental Health, with the Air Quality Steering Group working on  a number of issues, which resulted in the production of a refreshed Air Quality Action Plan.

Seasonal influenza:-

It was reported that analysis had been undertaken by the Public Health Team to determine how the uptake of flu vaccination could be improved in order to protect the health of the residents of Doncaster. It was noted that there had been a targeted drive of the flu vaccination within Doncaster’s care homes and this had helped towards the achievement of 77% of Doncaster’s population living in care homes taking up the vaccine offer. The target set nationally, was currently 75%, so in terms of that, Doncaster had shown good progress. However, work was still being undertaken in order to ascertain the differences between people living in different areas across the Borough.

MMR Vaccine:-

Analysis of the uptake of the MMR vaccine had been carried out across different areas and GP Practices across Doncaster in order to identify the areas where the uptake of the second dose was lower in order to address this problem. This would look to alleviate potential outbreaks or epidemics of Mumps, Measles or Rubella, all of which could result in serious health complications.

Tobacco Control:-

This was a key area of work for Public Health, and the vision was to eventually create a Smoke free generation in Doncaster. This however, was a long-term goal, and currently the target was looking more specifically to reduce smoking rates from 19.8% to 10% or less by 2022. A number of key themes were being worked on to achieve this, with the introduction of smoke free environments, training on the risks of smoking, Support for smokers trying to stop and the effective enforcement of smoking in smoke free places and the sale of illicit substances which were both cheaper and more harmful.

The Board was also provided with updates in terms of screening and immunisation, and a number of figures were provided on these, as well as the issues raised above, for Members to consider.

Following the presentation, the Chair afforded Members of the Board the opportunity to ask any questions of the  ...  view the full minutes text for item 45.

The Health and Wellbeing Board considered the Doncaster Safeguarding Children’s Board (DSCB) Annual Report for 2017/18. The report covered the work undertaken by the Board for the 2017/18 financial year and looked to identify any emerging themes for the first quarter of 2018/19.

As well as the Health and Wellbeing Board, it was noted that the report would be considered by the Mayor of Doncaster and the Chief Executive, as well as the Schools, Children and Young People Panel and the Children and Families Strategic Partnership Board who would all look to hold the DSCB to account when and where required.

The report had been prepared by John Woodhouse, the new Chair of both DSCB and the Doncaster Adults Safeguarding Board (ASB) along with Rosie Faulkner, Board Manager. The report produced was now a lot more concise and streamlined, concentrating on the key points that the readers needed to know. Points mentioned included the following:-

·         Concerns relating to smoking in pregnancy;

·         Suicide in Young People;

·         Self-Harming and Mental Health Issues in Children and Young People;

·         Criminal Exploitation

·         Child Protection and CSE

·         Links between the DSCB and the ASB

A discussion followed on a number of the issues raised within the presentation, whereby the Board discussed these points in greater depth including what was being done in all elements of these points, this being prevention, protection, and future safeguarding. There were Sub-Groups in place that would look at a number of issues and good work had been undertaken across the Board’s remit with many positives identified. For example, the Child Sexual Exploitation Group had now widened its remit to incorporate criminal exploitation, and were building on the good work they had done to date.

 A number of key areas identified for the DSCB to look at in the coming year hoped to build on the progress made to date. These were outlined on page 66 of the report and would allow partners to remain focussed and work on improving practice.

The Health and Wellbeing Board noted that the recent Ofsted inspection into Children’s Services judged the service to be good, which was clear evidence of the good work being undertaken to improve services for children, and whilst there were still many challenges ahead, these were offset by the many improvements that had been made.

RESOLVED that the Health and Wellbeing Board note the key findings from the Doncaster Safeguarding Children’s Board.

The Board received a paper that proposed to develop the role of Anchor Institutions to develop Inclusive Growth in Doncaster, which was a result of the development of Doncaster’s new Inclusive Growth Strategy. This strategy had six drivers for growth and looked to capture core parts of the Doncaster Growing Together Plan that was already influencing inclusive growth. Therefore, this would look to improve the quality of place, improve skill, support business growth and ensure opportunity reached the borough’s most vulnerable people

For each driver the role of Doncaster’s anchor institutions is highlighted and work was now underway to develop Doncaster’s approach in order to maximising the impact of anchor institutions on inclusive growth  by creating wider social value through their activities. One aspect of this was to utilise their purchasing power and commissioning processes in order to drive growth at a local level.

Following the presentation of the paper, the Board were invited to comment on the proposals and put forward any suggestions of how this could be taken forward.

The Board welcomed the Paper and it was felt that it was an issue that was certainly at the forefront of people’s minds and could be built upon. The appointment of Hall Cross School as England’s first ‘Foundation School for Health’ was highlighted as its contribution to this issue could be huge. This would see the school working with the local NHS provider to develop opportunities for students who wished to pursue a career in the health service.

A number of other positive points were noted as part of the discussions that ensued, with Dr David Crichton and Jackie Pederson highlighting the proposal to appoint a workforce lead in terms of the ‘Grow your own’ work being undertaken, which would look to connect with local communities and promote the breadth of careers available within the health service.

Additionally, the potential of being linked to the teaching hospital also opened up more avenues for the development, and transfer of knowledge and skills.

A number of other potential areas to explore were highlighted, including utilising the Apprenticeship Levy, as there was the option that this could be used as a mechanism to enable Anchor Institutions by increasing its potential impact.

The Chair proposed that the next step in terms of moving this agenda forward, would be to present the proposals with regard to the roles of the anchor institutions, to the Doncaster Integrated Partnership, in order to allow for informal and dedicated discussions.

RESOLVED that the discussions held by the Board with regard to the proposal to promote inclusive growth through anchor institutions be noted.