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No. Item




Apologies for absence were received from Linzi Roberts-Egan (LBWF, Deputy Chief Executive, Heather Flinders (LBWF, Divisional Director Children and Families), David Kilgallon (LBWF, Director of Learning), Anwar Khan (WFCCG, Chair & Health & Wellbeing Board Vice-Chair), Zebina Ratansi (Barts Health, Director of Nursing & Governance), Dr Tonia Myers (WFCCG, Clinical Director), Jane Milligan (NHS England),  Kelvin Hankins (WFCCG, Associate Director), Ceri Jacob (NHS England), Sharon Yepes-Mora (WFCCG, Associate Director), Darren Welsh (LBWF, Director of Housing), Lucy Shomali (LBWF, Director Regeneration and Growth), Gordon McCullough (Community Waltham Forest, CEO) and Daniel Phelps (LBWF, Divisional Director Early Help).




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.






The minutes of the meeting held on 12 September 2018 were approved as a correct record and signed by the Chair.





Brenda Pratt, Associate Director of Health and Social Care Integration and Better Care Together Programme Lead, introduced the report and gave the board a brief overview of the Managed Network of Care and Support, the progress it had made and the challenges it faced. Ms Pratt described how the Network had been designed by the health care community and various partners had been engaged with its progress over the past three years. The main aim of the Network was to connect residents to the right care and support in the first instance and ensure an individual and person-centred approach to care. It aims to introduce a new tier of provision not in the system traditionally and will be a systemic way of coordinating support built around individual needs. Ms Pratt also described how a single IT system that would manage all referrals into the Integrated Support Offer (ISO) was being worked on that should ensure everything is aligned and that there will be no gaps in provision.

The Chair raised a question around the Wellbeing @ Home team and whether there was an even spread across the borough and what this meant for more deprived areas. Ms Pratt answered that there was flexibility and scope to move the team around the borough to where they were needed. Ms Pratt explained that they were looking to provide a standardised team offer across all three areas within the borough and establish support teams with sufficient team levels, experience and expertise that were sustainable.


Althea Bart, Healthwatch Waltham Forest, had concerns regarding patient involvement and raised questions around the capacity of the voluntary sector to play a role and be engaged with the network. Ms Pratt explained that there would be future engagement at team evaluations which would include forums with resident’s that will lead into the network design. There was then discussion around the complexity around supporting workers in a multi-agency way and what the plans to support multi-agency working were.


There was discussion around employment needs and support and how there was a Department of Work and Pensions (DWP) partnership under development that would help support the core need  of employment but would hopefully also recognise other needs, such as training or mental health requirements, and be able to feed back into the network. Beverly Gayle, DWP, stated that there had been discussions as to how the DWP could be more involved but that they needed to be more plugged into what the needs are locally to have a better idea of what a resident requires, so there would be ongoing work to get to that stage.


Joe McDonnell, Director of Public Health, had questions around community provisions, such as charities and church groups, and how they fit into the model and also around if someone had a low level primary care need, where they would fit in the system. Ms Pratt referred to the diagram of services on page 25 agenda pack and to the connecting communities’ circular diagram  ...  view the full minutes text for item 4.



Additional documents:


Sally Burns, Consultant in Public Health, introduced the report and gave an overview of the draft suicide prevention strategy for Waltham Forest and its objectives, which were in line with the national strategy, and asked that the Board endorse it to be used in the Borough. Ms Burns also asked the Board if it could give any steer on work with high risk groups and bereavement support that could be fed into the strategy. Ms Burns explained that a presentation on the draft strategy had already been made to the Health Scrutiny Committee.


Ms Burns then described the current work on mental health in Waltham Forest and also gave an outline of the local picture regarding suicide rates and demographics – notably that the suicide rate in the borough is lower than both the wider London and national average, but that the highest rate of suicide is amongst 40-44 year old men, which is similar to the national trend.

The Chair asked if faith organisations had fed into the strategy. Ms Burns answered that the strategy was well linked with many organisation groups and that faith groups had been communicated with around the development of the strategy, but there was definitely scope to go further. She also explained that there was an arrangement with the Samaritans, but that, again, there was room for further consultation. Ms Bart suggested that there was significant work that could be done with smaller groups who could need extra engagement and advice due to barriers to accessing support, such as with faith groups that believe suicide to be a crime.


Sue Boon, NELFT, Integrative Care Director – Waltham Forest, suggested that there could be a greater focus on Eastern European communities in the strategy, as they were a high risk group, and had questions around analysis on methods and location of suicide. Ms Burns answered that there were often trends in method which were different based on age. Mr McDonnell explained that there were two clear main methods, hanging and overdose, and that choice of method may go some way to explaining why male suicide figures were higher. He stated that in Waltham Forest there was no clear location. Ms Burns also clarified that most people who commit suicide were not in contact with any services. She also stated that there had been an increase in self-harm reports among younger age groups, so while there were certain demographics that had statistically higher rates of suicide, it was important to not lose focus on other groups also.


Dr Aswani raised a question around follow up from Whipps Cross Hospital when someone presents with attempted suicide to Accident and Emergency (A&E), and what happens next. Ms Boon clarified that there would be a psychological referral immediately after presenting with a suicide attempt, and that this would be available 24 hours a day and assured the Board that there was a tightly followed follow up system in place.

There was discussion around the link with the alcohol  ...  view the full minutes text for item 5.




Jonathan Cox, Consultant in Public Health, introduced the report and provided the Board with an overview of the contents of the Joint Strategic Needs Assessment (JSNA) and described how a number of its documents were undergoing a refresh. He explained that there was now a template being used for work on the chapters to ensure consistency and quality. Mr Cox explained that there had been a programme of work around the development of the JSNA process this year which had been managed by a steering group and that the process was now working more effectively which meant there would be accelerated progress on the remaining chapters. He also explained that they had moved to an in-house digital solution to publishing and were hoping to have some live JSNA content in early 2019.


The Chair raised a question around how it could be ensured that the JSNA will be used by the right people to its full potential. Mr Cox answered that there was ongoing identification of relevant stakeholders and that core stakeholders had added value to the relevant chapters and that any findings had, and would, be taken to the appropriate service areas. The Chair asked about whether there was consistent representation at meetings to which Mr Cox replied that they were getting the engagement and representation needed.

Dr Ken Aswani asked about the usefulness of the JSNA to other partners, specifically around differences in need based on locality and different risks to different population groups. Mr Cox answered that the chapters look to pick up variation in risks and outcomes and look at issues such as inequality and how services respond in different areas. He explained that ongoing intelligence and insight gathering will help them to improve the JSNA. Mr McDonnell further explained that the JSNA is a living document and it would be possible to go back and add, remove and edit parts as it evolves so specific inequalities can be addressed as they are identified.


Helen Davenport raised a question around the inclusion of loneliness support, development and prevention in the JSNA and about what Waltham Forest could expect to see regarding government funding around loneliness. Mr Cox agreed that loneliness needed greater consideration as it was a huge risk factor on morbidity and suggested it could be prioritised. Mr McDonnell stated that loneliness and social isolation had its own chapter and would be picked up at the JSNA steering group. Regarding funding, Ms Pratt answered that there was some money from the IBCF that would go towards reducing isolation. The Chair requested a written response on government funding for loneliness.


The Chair stated she was happy to note the progress of the JSNA.


Action: the inclusion of social isolation and loneliness as a separate JSNA chapter to be explored by Joe McDonnell (Director, Public Health) as well as any issues about financial resources and the link to the new Connecting Communities work.





The Board was given a brief update on where various indicators were on the RAG rating and were informed that the information for Q2 was now included in the report. There was discussion around potential scorecard and indicator development work.

The Chair raised a question around domestic violence referrals and the fact they were marked as red on the Scorecard. Mr McDonnell answered that domestic violence referrals from health services had been discussed recently at SafetyNet and remarked that the number of referrals was lower than expected.





Additional documents:


Children’s Healthy Weight Update

Sally Burns, Public Health Consultant, gave the Board an update on the progress of the Children’s Healthy Weight Task and Finish Group and its action plan. Ms Burns informed the Board that the National Child Measurement Programme (NCMP) had a very high uptake in the borough and stated that this showed that levels of childhood obesity are very high in Waltham Forest – 23% versus 22% nationally in reception and 39% versus 34% in year six. Ms Burns stated that this was clearly a challenge for the task and finish group in itself and covered further challenges to the action plan, such as the lack of capacity within the dietetic team to work on weight management programmes with young people, and the limited uptake of the boroughs Play Street scheme. 


Ms Burns highlighted the need for the childhood obesity strategy and action plan to be reviewed in 2019 and covered two pieces of ongoing work that may provide opportunities to tackle the problems faced; a school ‘super-zones’ project pilot and putting in a bid for the childhood obesity trailblazer programme grant.


The Chair raised a question regarding the need for 1:1 sessions with the dietetic team. Ms Burns responded that group work was currently being looked into which would hopefully improve capacity issues.


The Chair stated that the Play Streets scheme would be a missed opportunity if it was not utilised especially with the current emphasis on Borough of Culture and how that could play into the narrative. Councillor Grace Williams agreed and stated that there was much more Waltham Forest could do with both and to promote Play Streets. Councillor Williams further discussed the Life Chances Commission and how it could be key to improving child obesity levels through collaborative work with parents, schools and wider partners.



Alcohol and Drugs

Stella Bailey, Senior Public Health Strategist, introduced the report. Ms Bailey described how there was a high level of unmet need in Waltham Forest, based on the number of drug and alcohol dependent users actually using treatment versus estimates. Ms Bailey also described how when the service model changed to an integrated system there was a drop off in referrals, especially alcohol related.


A question was raised around how the integrated service was seen by alcohol and drug users and to what extent there was a correlation between the integration of services and drop off of use nationally. Simone James, Service Manager Change Grow Live Waltham Forest, answered that the integrated system was a change in culture and meant more partnership working. Regarding the perception of the service, Ms James answered that it was difficult to answer regarding the correlation to the drop off in referrals, but it had been seen nationally, not just in the Borough. Ms James discussed the stigma surrounding drug use and suggested this may have affected the number of alcohol users choosing to use an integrated service.


Dr Ken Aswani raised a question around whether the correct pathways were being  ...  view the full minutes text for item 8.



Additional documents:


Neil Young, Strategic Board Coordinator, informed the Board that the annual report was, apart from some work on examples around sub-committees, near completion. Mr Young also informed that Board that there was work looking into changing the way the annual report is prepared.





Mr Young stated that a paper with information and thoughts on development work for the Board was in progress, and would be ready and taken to the Board at the March 2019 meeting.




Verbal update from Suzanne Elwick.


Suzanne Elwick, Head of Strategic Partnerships, gave the board a brief verbal update on cross-cutting work. Ms Elwick discussed the recent Safeguarding Adults Review undertaken by the One Panel, which had a focus on the multi-agency approach to a current case of ‘cuckooing’. A panel was in place to review the findings, but it was explained that a criminal case was still ongoing so the review could not be published until that had closed, hopefully by February 2019.


Ms Elwick also informed the Board of a serious case review that was in progress and would be going to the Safeguarding Children Board in February 2019.


Ms Elwick also briefly covered work being done on modern slavery and self-neglect. Ms Elwick discussed the Bite size guides on issues that would be available on the Waltham Forest Strategic Partnerships website and urged the Board to sign up to the spotlights bulletin.





It was suggested that an update from the NHS London Estates Board comes to the March meeting.





The Chair asked the Board to think about what it had achieved and expressed that she felt, through the development work the Board had undertaken recently, that they were now clearer on sharing visions and beneficial expertise.

The Board felt that there was more to be done around loneliness and regarding publicising changes and developments around social care to residents.

The Board appreciated the challenges around an integrated system approach and felt that working towards a holistic service was the way forward, but that there was more to be asked regarding how partners could support us

The Board also discussed how it may work going forward – whether this may be to continue to target a wide variety of topics, or whether it would be more efficient to focus its time and energy into one or two elements that may reap greater results.


The Chair then asked if there was any other business. Ms Bart informed the Board of an ongoing piece of work around urgent care which she hoped to provide a report on in April 2019. This would include a deep dive into mental health and housing. The Chair fully supported this work and asked in what way the Board could support it. Ms Bart stated that she appreciated the cooperation.