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Agenda and minutes

Venue: Committee Room 3 - Waltham Forest Town Hall. View directions

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No. Item




Apologies were received from Kim Travis (LBWF, Head of Litigations), John Coker (LBWF, Head of Housing Improvement; Board member), Dr Anwar Khan (WFCCG, Board Deputy Chair; Board member), Dr Tonia Myers (WFCCG, Board member & Clinical Director & Co-Chair Children’s Health & Wellbeing Sub Committee), Chris Neill (WFCCG, Chief Operating Officer), Darren Welsh (LBWF, Director, Housing), Selina Douglas  (Newham, Tower Hamlets & Waltham Forest CCGs, Managing Director), Lucy Shomali (LBWF, Director, Regeneration & Growth; Board member), Jane Mulligan (NHS Barking & Dagenham, Havering, Redbridge, Waltham Forest, Newham, Tower Hamlets, City & Hackney CCGs, Accountable Officer), Councillor Grace Williams (LBWF, Board member) and Councillor Khevyn Limbajee (LBWF, Board member)


Jane Custance attended as a substitute for Lucy Shomali.




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.


There were no declarations of interest.





The Chair indicated that there would be an update on mental wellbeing and end of life care in the meeting.


Item 18 - Mr Young updated the Board that Healthwatch were now represented in the joint meetings between Whipps Cross hospital and NELFT. Ms. Roberts-Egan said that there had been early indicators that more residents were dying in places of their own choice and complimented the work of Whipps Cross staff.


Mr Young added that the Council had signed the ‘Time to Change’ pledge and wanted to encourage partners to also sign up to the pledge. Mr Carter added that partners needed to lead by example and noted that the process to sign up to the pledge was quite simple.


Item 20 – Mr McDonnell noted the Board had wished for respiratory diseases to be one of the Board’s priorities, but since the last meeting, he had contacted the BMG regarding their position and they had indicated that it was not a priority. He added that he wished for a follow up conversation with the Board’s Business Management Group (BMG).

Mr Lobban said that he had spoken to Chris Neill, the Chief Operating Officer of the CCG. They had noted the challenges that the CCG faced about respiratory diseases and wished for more collaborative working.


Item 21 – Mr Young provided an update about how organisations can become ‘Dementia Friends’. To receive the same, free training Board members experienced, visit or email the Alzheimer’s Society local team and a staff member will deliver. Weekly sessions will soon be taking place at the Dementia Hub at Sidmouth House for anyone who would like to attend, including local businesses and community members. People can also become ‘Dementia Champions’ by completing a free day-long training that enables participants to then deliver Dementia Friends sessions within the community.


Ms Custance indicated that dementia had been identified as a theme as part of the update to the local plan but indicated that the plan needed to be designed with all residents in mind.


Item 22 – Ms Boon said that she could confirm that NELFT had been able to follow up on immunisations for babies not receiving BCG immunisation at birth through an out of hours service. She added that the service was not able to provide a universal offer for each child as NHS England sought to commission that from acute trusts. Mr Young said that there was private data on performance that BMG could request about the universal offer.




The minutes of the meeting held on the 20th March 2019 were approved as a correct record by the Board and signed by the Chair.




The Board;


a)    Agreed that the CGG brings a proposal to BMG to address how respiratory diseases could be considered by the Board, in light of the Board decision that it will not be one of the key priorities for 2019-21Agreed that Mr Young request that the BMG receive data on the universal offer.  ...  view the full minutes text for item 35.



Including revised terms of reference, future priorities, Healthwatch and Scorecard plans.


Additional documents:


Mr McDonnell presented the report. He highlighted the Board’s Terms of Reference, which had been written in consultation with Democratic Services. He also highlighted Section 4 of the report and indicated that it could be rewritten in plain English but asked if the Board was happy with the intent. He added that there would be regular updates from partners and the BMG on the priorities and updates from task and finish groups.  Mr McDonnell also explained what it meant for an issue to be a Board priority, including regular, more detailed discussions about progress at the Board, supported by the revised Scorecard.


Mr Gurney asked if health inequalities and issues with access have been considered as a priority of the Board. Mr McDonnell welcomed the challenge and said that health inequalities should be mentioned and would explore this.


Ms Roberts-Egan indicated the need for clinical representation at each meeting of the Board. Mr McDonnell said that the new directors were currently being confirmed and seem keen to work with new ideas and the Board. Mr Lobban said that he will speak to the new directors and confirm who will attend each meeting of the HWBB.




The Board agreed; 


a)    The Board’s Terms of Reference

b)    That Mr Lobban would speak to the new clinical directors about their representation at HWBB meetings.




Additional documents:


Mr McDonnell presented the report.


He highlighted the indicators showed the breadth of the topics considered by the Board. He added that there had been no surprises on the flagged issues such as SEN EHC plans, CAMHS referrals and immunisation rates. He said that there was a move towards performance and progress in the priority areas. Mr McDonnell added that the indicators gave a sense of focused work.


Ms Roberts-Egan noted that children’s health was still a concern but had seen improvements. She indicated that there had been changes to the funding for SEND Mr McDonnell said that the Board had not had a recent stock take and it was agreed to bring this to the next Board meeting. Mr Young added that the BMG would also look at the governance of children’s health and wellbeing work.


Ms Boon said that the indicators did not properly represent CAMHS and the pressures on the service. Mr McDonnell replied that the indicators for CAMHS had been developed two years ago, and were appropriate at the time, but agreed they didn’t reflect more recent pressures. Ms Bart asked if there could be an update from CAMHS at each meeting. Mr McDonnell replied that the BMG could consider this.


Ms Roberts-Egan suggested that the scorecard could link with issues such as violence reduction. The Chair added that there needed to be a creative approach to reports.




The Board agreed; 


a)    SEND would come as an update item to the next Board meeting




For all priorities/groups please focus on (a) what has and has not been achieved; (b) learning; (c) the potential to bring about transformational change and (d) what remains / looking forward.



The Chair introduced the item and asked the authors to share the highlights and areas of further work for each priority.





Mr McDonnell introduced the priority, noting the achievements that had been made. He highlighted the improvements in dual-diagnosis pathways, a new contract with Change, Grow, Live (CGL) for alcohol and drug services which addressed a need in the borough, the Antisocial Behaviour strategy and closer working with the Council’s Licensing team.


He indicated that work had begun on an alcohol strategy in Barts Health Trust, development of the substance misuse role within the violence reduction partnership and further work with the Licensing team. Officers had also been looking at further work around primary prevention, which was endorsed by Ms Boon. Ms Roberts-Egan added that other issues such as domestic violence and exploitation were also linked to alcohol and drugs.





Mr Carter introduced the priority highlighting the work that had been done by the Board in July 2018 with high priority groups. He noted the achievements made including; the Time to Change hub, digital mental wellbeing funding for the next three years, Kooth (a mental health support service for children and young people) and the mental health charter. He said that there would be a continued focus on mental health wellbeing services, prevention and treatment.


The Chair indicated that the funding received showed the how important the issue was being perceived nationally. Mr McDonnell said that the challenge was to come up with ways to use the funding that were practical and transformative. Ms Roberts-Egan asked if there were ways to support parents directly through channels such as social media.


Ms Flinders asked if the mental health charter included colleges and those not in school. The Chair said that this could be a recommendation.





Mr Carter introduced the priority noting that this was a broad area and highlighted that the Council had achieved the UNICEF baby friendly accreditation, promoted World Breast Feeding week and looked to introduce the Breast-Feeding Welcome scheme. He also highlighted the HENRY integrated offer and funding for the Healthy Early Years programme. Mr Carter added that the Enjoy Waltham Forest team had also promoted more residents and children to walk and cycle in the borough. He concluded that there was still a need to refresh the strategy over the coming months.


Ms Bart asked if those involved with delivering the HENRY offer were qualified nurses. Mr McDonnell said that they were dieticians and nutritionists and not district nurses but would bring back more information to the Board. Ms Roberts-Egan added that the Council wished to ensure that the services that are commissioned by them deliver the best services for residents.


Mr Barker asked if there had been any scope for environmental ideas in the Local Plan, such as the use of more Play Streets. The Chair said that this had been an identified gap.





Mr Young introduced the priority, noting that there had been a more detailed report submitted to the Board previously. He highlighted the achievements in the report and the case study on palliative care, which demonstrated positive proactive changes in Whipps Cross Hospital, which had also seen a reduction in suicide.


The Board praised the work of those who worked in end of life care noting the broader view that had been created and difficulty of working in that scenario. The Chair noted that this work had been putting family and support around the person.





Mr Young introduced the priority, he highlighted the All Age Disability Partnership Group and noted that there had been a lot of achievements in a short period of time and was now looking at a better systematic approach.


Ms Bart said that a broad audience had been engaged, there had been several issues that had been acknowledged but the group had approached the work positively. The Chair noted that issue of low attendance had been raised. Mr Young said that the group would report back to the Board.


The Chair then asked the Board to agree on the final priority of the Board. The BMG had suggested either diabetes or substance misuse as the priority needed to represent the population need.


The Chair noted that mental health was a key priority as the Board could then focus on preventative work, she noted that addressing diabetes was important, but was a clinical issue and could be limiting as it did not affect the whole population of the borough. Ms Bart indicated that diabetes did affect the BAME communities disproportionately and would need a clinical steer. Mr Lobban indicated that there would need to be clinical representation from the CCG. The Chair added that this was the same with cancer diagnosis within the BAME communities.


Ms Flinders said that topics such as healthy weight and mental health was more in the scope of the work of the Board, she suggested the topics of healthy living, health poverty and other health determinates. Mr McDonnell asked how the CCG would approach this priority. Mr Lobban replied that it would need appropriate representation from the CCG on joint priorities between the NHS, Council and other partners. The Chair noted that multi-agency work would impact more on a priority such as healthy living and asked the Board if they were happy to recommend it as a priority.


Mr McDonnell also suggested the substance misuse could also be considered as it was also a cross-cutting priority.




The Board:


a)    Noted the report

b)    agreed the recommendations set out in the report

c)    that Mental Health and Healthy Living be recommended as priorities for the Health and Wellbeing Board alongside Substance Misuse






Additional documents:


Mr Lobban introduced the item noting that the presentation that was given at the Healthwatch Forum and Patients Reference Group. He gave the Board the context around the CCG. The CCG had single management team that reported to the Director of Commissioning. He highlighted to the Board the Commissioning priorities and projects set out in the report. He indicated that there was more work to done around children’s commissioning.


Ms Bart noted that the presentation to the Healthwatch Forum had triggered involvement and debate with those who attended and responded to concerns, but there had been a different reception from the Patients Reference Group. She suggested the presentation could include more debate.


Mr Lobban presented the recommendations to the Board noting that work had begun on each of the individual timescales. He added that regarding the second recommendation, the programmes had gone to the Better Care Together group and they would report back to the Board. The Chair suggested that for the final recommendation that the Board needed to acknowledge that commissioning overlapped and think of partners to be involved with the work of the Board.




The Board:


a)    agreed the recommendations set out in the report

b)    that an update to the Board is provided to a future meeting of the Health and Wellbeing Board.




To review report recommendations.

Additional documents:


Councillor Richard Sweden, Vice-Chair of the Health Scrutiny Committee, presented the report to the Board. He highlighted the importance of homelessness services in the borough stating, that intervention significantly reduced the service costs to the Council per person. He also noted the sources that had informed the report who included King’s College London, Branches and Feet on The Streets.


Councillor Sweden wished that some of the responses to the recommendations made by the Health Scrutiny Committee should be reconsidered considering the evidence given by the organisations consulted by the Committee. He also felt that some of the responses had not addressed the recommendations made.


Ms Roberts-Egan said that with the new leadership in the CCG there was an opportunity to go back to them and give them a chance to reflect on the recommendations. She also noted that the report would then need to go back to Cabinet. Ms Boon added that homelessness had been identified as a new indicator.

Mr Lobban agreed that there was an opportunity with the new leads and that the CCG needed to provide a response as the recommendations cut across several areas. Ms Bart noted that regarding the issue with GP referrals that there had been a clash between the CCG and GPs.


Mr McDonnell asked if the response to the first recommendation was acceptable to the Board. Mr Lobban said that he would take a response back to the CCG in advance of Cabinet. The Chair said that there should be an agreement in principle in place before Cabinet. Mr Young suggested that the Board meet with the new CCG leads to receive a response from them. Mr Lobban said that it needed to be clear which recommendations needed a response. Councillor Sweden suggested that Andrew Spragg, the Scrutiny Officer could inform him.


The Board:

a)    noted the report

b)    agreed that the CCG respond to the recommendations of the report



ANNUAL REPORT 2018-19 pdf icon PDF 678 KB

Additional documents:


Mr Young presented the item noting that this would be moved to the first meeting of the following year. He had been speaking to Mr McDonnell and Brenda Pratt about sub-committee work.


The Board noted the Annual Report




Verbal update on One Panel, Safe & Well Month and Learning and Improving Practice Forum, including multi-agency audits.


Mr Young said that a poster on priorities would be updated and circulated to the Board. He noted that June was the Safe + Well month and asked partners to inform their teams of this and to support front of line staff on the priorities.





The Chair asked the Board to note this item as it was for information only.


The Board noted the report.





The Chair said that items for the next Health and Wellbeing Board would include:


·         Adult Death Review

·         Joint Strategic Needs Assessment

·         Children’s Health stock take




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


The Chair asked the Board what they felt had been achieved from the meeting to improve the lives of Waltham Forest residents.


The Board noted the selection of important priorities focused on every resident, the challenges raised by responses to the Health Scrutiny Committee recommendations, resourcing mental health services, the Board planning to stock take children’s health and raising awareness of health inequalities in access to healthcare.