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Agenda and minutes

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No. Item




In the absence of the Chair, Councillor Clare Coghill, Councillor Naheed Asghar was appointed Chair for the meeting. 





Apologies for absence were received from Councillor Clare Coghill (Board Member, LBWF), Terry Huff ( Board Member, Chief Officer, WFCCG), Ceri Jacob (Board Member, NHS England), Lucy Shomali (Board Member, Director, of Regeneration and Growth, LBWF), Helen Davenport (Director of Nursing, Quality and Governance (WFCCG), and Zebina Retansi (Director of Nursing and Governance, Whipps Cross Hospital).




Members are required to declare any pecuniary or non-pecuniary interests they or their spouse/partner may have in any matter which is to be considered at this meeting. Interests are defined on the inside cover of this agenda.


No declarations of interest were made.





The minutes of the meeting held on 2 October 2017 were agreed as a correct record and signed by the Chair.


Matters Arising


Appointment of Substitutes


Neil Young reported that he had written to appropriate Board Members reminding them of the importance of appointing substitutes to attend Board meetings when they themselves are not available.


Minute 16


Neil Young has explored suitable opportunities for the Chair to visit the Lime Tree GP Surgery.


The Board noted that the CCG’s Bed Audit Group report was not ready for the meeting. Linzi Roberts-Egan asked that the report be submitted as a priority agenda item for discussion at the next Board Meeting on 21 March 2018.


Minute 21


It was noted that a further report on the global immunisation IT system and in particular ways of capturing immunisation data given concerns about immunisation take-up would be presented to the Board in due course.


Minute 22 


Heather Noble advised that no enquiries had been received from Board members concerning her report on End of Life Care at Whipps Cross Hospital.





Joe McDonnell presented a report on the Health and Wellbeing Scorecard for Q3 (July – September 2017) which provided an overview of performance across the three themes derived from the Health and Wellbeing Strategy and drew attention to the key findings.


The Board focused their attention on the following indicators where performance was worse than target.


Mental Health Referrals from Schools


Councillor Grace Williams was concerned that similar to the previous quarter there were fewer referrals from schools to CAMHS than expected. It was not however clear whether the data related to two quarters or one and Joe McDonnell was asked to clarify the position given the impact of school holiday closures on the figures. Arising from discussion the Board felt that it would be appropriate to undertake a review of the mental health support currently being provided to schools in order both to ensure that potential referrals to CAMHS are identified at an early stage and where considered appropriate quality referrals are made to assist young people who have difficulties with their emotional or behavioural well-being. The Board asked for a briefing at a future meeting. The Board was also reminded of capacity issues within CAMHS which have impacted upon waiting times for assessments and looked forward to the submission of CAMHS Transformation Plan.


Smoking Quitters


Dr. Ken Answani drew attention to the continuing performance below target on this indicator and his expectation that this pattern was likely to be on-going given the transition to the new service model and the reduction in the available budget. He was concerned about the resultant consequences and questioned whether enough was being done to discourage smoking including public health approaches to the problem.


The Board was reminded of the background to the decision to re-commission the Stop Smoking Service with effect from September this year with its significantly lower performance targets than the previous service and noted that as a result a more global approach is being adopted and more work is being done around national smoking cessation campaigns.


The Board recognised the importance of investment in this area and the need to explore creative ways of accessing alternative funding to provide behavioural support for people wishing to stop smoking.


Flu Vaccine Uptake


Although the trend is generally upward, concerns were expressed that uptake is still below target for vulnerable groups and particularly for over 65s. It was suggested that this could be because of the under reporting of data. Nevertheless the Board wanted ‘at risk’ groups to be encouraged to come forward.


Housing Completions – Affordable Homes


Whilst noting the increase in the number of completions in Q3 compared with Q2, Councillor Grace Williams suggested the Board should also be looking at performance on dealing with overcrowded housing accommodation.


The Board asked that Darren Welsh (Director of Housing) attend the next meeting to provide an update on the work being done in this area.




The Board:


(a)      noted the Health and Wellbeing Scorecard and agreed to continue to use it  ...  view the full minutes text for item 5.



(a) Children’s Healthy Weight

*(b) End of Life Care

*(c) Drug & Alcohol and

*(d) Mental Health

RAG-rating and narrative on progress (challenges, barriers and next steps)

*Selected by the Healthwatch Health & Wellbeing Forum: detailed feedback will be brought to the meeting by Althea Bart (Manager, Healthwatch Waltham  ...  view the full agenda text for item 6.


Consideration was given to a report of Neil Young, Strategic Board Coordinator, LBWF.


Suzanne Elwick explained that the purpose of the report was to update the Board on the progress made by the three Priority Action Groups that developed out of the local authority’s strategic needs assessment in the second quarter and to identify the challenges for the groups dealing with – Drugs and Alcohol, End of Life Care and Children’s Healthy Weight.


The Board noted the actions taken to date in progressing each of the Groups’ work plans as set out in the report and explained in more detail at the meeting and arising from discussion highlighted a number of key points including:


  • the importance of a multi-agency approach to dealing with issues and to maximise the involvement of all interested groups in developing more user friendly strategies.
  • the need to provide substance misuse support services to families to avoid problems escalating and to draw up preventative action plans.
  • the importance of engagement with midwives in the campaign to increase breast feeding rates and drawing upon parental support in addressing children’s weight .



The Board:


(a)      noted the report; 

(b)      looked forward to receiving further update reports to enable them to review 

    the progress being made on a rolling quarterly basis; and


(c)     asked that the Chairs of Priority Task and Finish Groups be invited to

  attend Health and Wellbeing Board meetings





(Q1) What is your ask of the Board and its partners in the strategy?

(Q2) Please outline which areas of the strategy present the greatest risks to progress?

*Selected by the Healthwatch Health & Wellbeing Forum: detailed feedback will be brought to the meeting by Althea Bart (Manager, Healthwatch Waltham Forest)  ...  view the full agenda text for item 7.


Stella Bailey introduced this report which summarised the substance misuse strategy being developed to ensure effective interventions are in place to prevent problematic use of alcohol and drug substances across all age groups. The report updated the Board on the consultations that have taken place to date with stakeholders and gave details of the further consultations planned early in the New Year.


In her presentation Stella Bailey emphasised that the profile of substance misuse in the borough is complex and reflects the changing nature of the borough. Whilst the data showed that by the age of 15 the number of young people in Waltham Forest reported to having had an alcoholic drink or trying cannabis was significantly lower than the national average, the prevalence of alcohol and drug use by adults in Waltham Forest was much higher than the national average but showed signs of decline compared with previous years. The key statistics showed that 34% of the adult population in Waltham Forest is estimated to be abstinent compared to 17% nationally.  A positive sign for the borough however was the decrease in the number of hospital admissions for alcohol and drug related conditions from higher than the national average in 2012/13 to below the national average in 2015/16.  Sheila Bailey also spoke of the need for local retailers of alcohol and tobacco products to be responsible businesses.


In their discussion of the report the Board highlighted the link between youth violence and drug use and emphasises the importance of using every available opportunity to provide young people with the advice and support they need to build resilience against substance misuse. Dr. Myers commented that it was important that school pupils were made aware of the health risks associated with drug and alcohol misuse and that the available treatment services were promoted.  Board members also recognised the need for sensitivity given the differences of approach in some community groups to the use of alcohol and drugs and were interested to know whether there was any information available on gender and age usage.




The Board welcomed the progress made in developing the substance misuse strategy and recognised the responsibilities of all sections of the community in ensuring the delivery of its aims and objectives.




(Q1)What is your ask of the Board and its partners in the strategy?

(Q2) Please outline which areas of the strategy present the greatest risks to progress?

*Selected by the Healthwatch Health & Wellbeing Forum: detailed feedback will be brought to the meeting by Althea Bart (Manager, Healthwatch Waltham Forest)  ...  view the full agenda text for item 8.


Russell Carter, Public Health Consultant, presented a progress report on the

development of a new Mental Wellbeing Strategy for Waltham Forest in line with the Health and Wellbeing Strategy which calls for increased efforts to improve population mental wellbeing alongside efforts to deliver effective mental health services.


The report summarised the steps taken to date and the actions proposed to deliver the strategy objectives set out below:


·         Improve awareness of mental health issues among the general population to reduce stigma and discrimination


·         Develop understanding across all sectors in the borough of the wider determinants of mental health and wellbeing and identify opportunities for work to reduce risk factors for poor mental health.


·         Propose new approaches to promoting mental wellbeing in the

     population including the’ 5 ways to wellbeing’ and the promotion of

     good sleep patterns.


·         Identify opportunities and actions for early intervention in those who are struggling with their mental wellbeing in order to prevent future mental ill- health.


·         Propose a standardised set of measures and tools for measuring mental wellbeing and evaluating the impact of services and projects across the borough.


The Board discussed the report and raised several issues.


Althea Bart reported that the presentation made to Healthwatch on the new strategy was well received. She enquired what the role of the voluntary sector would be in taking the strategy forward. Russell Carter made it clear that the voluntary sector was key to the delivery of the strategy’s aims particularly by raising awareness of mental health issues among hard to reach groups. This together with the sector’s work on social prescribing to access support on a range of social issues was considered vital in helping people with their mental wellbeing.


Of particular interest to members of the Board was the issue of employment and the workplace environment as a key determinant of mental wellbeing. The Board was concerned that this was a growing problem given current employment practices including the introduction of zero hours contracts and felt the provision of mental health support particularly for small businesses was an issue that might usefully be addressed.


The Board was pleased that the strategy being developed was very much focussed on early intervention and prevention and endorsed the view that the Action Plan should target support on people who are most vulnerable to developing mental health difficulties.  The Board recognised the importance of putting available resources into preventative services as suggested by the Director of Public Health and agreed with him the need to take action where possible to desensitize the stigma that exists among the general population and particularly in schools around mental health issues.




The Board:


(a)      noted the engagement process to date and the action proposed in the development and delivery of the Mental Wellbeing Strategy;

(b)      endorsed the objectives and high level approach of the strategy; and

(c)      supported the development and delivery of an Action Plan to deliver the strategy’s objectives including engaging with appropriate groups.




(Q1) Please update the Board on progress since the last report six months ago. Any there any remaining challenges or barriers that the Board and its partners can support you to address?

Additional documents:


Consideration was given to a report of Andy Beckett, Director of Development (LBWF) and Kelvin Hankins, Assistant Director of Contracting (WFCCG) on the current position concerning the Statement of Action which the local authority and Waltham Forest CCG were required to submit to Ofsted/CQC following their joint inspection in January 2017.

The Board noted the action taken by the CCG in response to the three areas of weakness identified by the inspectors relating to their services and responsibilities as outlined in the report and were advised that the Statement of Action was signed off by the CCG and LBWF and submitted to Ofsted/CQC on 3 July 2017. The Board was advised that Ofsted/CQC had confirmed that the Statement of Action was fit for purpose on 13 July 2017 but had made three recommendations to further strengthen the Local Area Partnership’s ability to meet its responsibilities for disabled children and young people under the Children and Families Act 2014. The Board further noted that the combined plan is being monitored by the SEND Board and also by the DfE and NHS England with further quarterly meetings planned in December and March next year. The Board received feedback from the latest monitoring meeting held in October.


The Board:

(a)      thanked the officers for the report and noted the continuing progress made in responding to the concerns raised by Ofsted/CQC; and

(b)      agreed to receive a further update report after the final monitoring meeting in March with Ofsted/CQC.




(Q1) Please outline the PNA consultation plans, including any risks or asks of the Board and its partners


Consideration was given to a report of Jonathan Cox, Public Health Consultant updating the Board on the progress made in the preparation of the new Pharmaceutical Needs Assessment (PNA) which the Board is required to publish by 1 April 2018 assessing the adequacy of current pharmaceutical services in the borough and future provision.


The Board noted the work undertaken by the PNA Steering Group established to oversee the process and the consultation plan and were very interested to receive a summary of the key findings to date.


Of particular interest to Board members was the impact of population change on and accessibility to pharmaceutical services; current local variations in the use of pharmaceutical services; and the potential for reducing demand on urgent and primary care services as a consequence of enhanced community-based healthcare.




The Board:


(a)      noted that the draft PNA has concluded that the current provision of pharmaceutical services is adequate and that they have adequate geographical spread;

(b)      noted that the findings of the statutory consultation on the draft PNA will be reflected in the final PNA; and

(c)      agreed to give further consideration to the draft plan at its next meeting on 21 March 2018 with a view to the final plan being published  by 1 April 2018.





The Board received a report on the WFCCG’s work in supporting GPs to develop Patient Participation Groups (PPGs) in their practices over the past two years and the future steps proposed.


The work included:


·         a series of recommendations put forward by the Patient Association to support the development of PPGs in GP practices in Waltham Forest;

·         the development of a Local Standard on how to run a PPG;

·         the recruitment of six persons to sit on the CCG’s Patient Reference Group;

·         the publication of a PPG Newsletter; and

·         three annual public engagement events.



The Board noted the report.





The Board considered recommendations put forward by the Commissioning for Prevention Group (CfG) for spending the £500,000 Section 106 money set aside for health prevention initiatives.


The Board noted the proposed criteria against which the funding should be prioritised and the nine priority areas identified for funding as set out below:


·         Children’s healthy weight

·         Mental health and wellbeing

·         Air quality

·         Excess winter deaths

·         Workplace health

·         Diabetes

·         Substance misuse

·         Violence prevention

·         Hypertension

The CfG has reviewed funding proposals for projects under the ‘excess winter deaths’ and ‘hypertension’ categories and asked the Board to approve the following funding requests:-


Fuel Poverty Project to support 100 local residents                  £50,000

who are fuel poor and living in cold or damp homes


Community blood pressure monitoring project in 5                    £10,000                                       

wards in the south of the borough


The CfG will be reviewing further proposals for Section 106 funding under each of the above categories which have a lasting and sustainable impact.



            The Board:

   (a)     noted the list of high level priorities proposed by the

              Commissioning for Prevention Group for spending Section

              money on prevention;

   (b)    approved the funding proposal for the fuel poverty project;

(c)    approved the funding proposal for the community blood pressure

        monitoring project; and

(a)      highlighted the importance of monitoring the impact of the prevention projects.







No items were raised



What has the Board done today that makes a difference to Waltham Forest residents?


Board Members were invited to provide feedback on what the meeting has achieved for Waltham Forest residents.


Councilllor Grace Williams wanted to know more about the voluntary sector’s role in mental health services and how it can be involved more effectively.


Althea Bart spoke of the significant joint work being done in the borough and how the various agencies can work together successfully.


Members generally felt that business interests should be encouraged to become involved with the Board’s activities and felt that the attendance at the Board’s meetings of further education providers, college representatives, the police, and housing and sports and leisure service representatives might also be helpful.