Agenda and minutes

Councillor Nicola Heaton (other Council business)

Councillor Sally Longford (leave)

Candida Brudenell – Strategic Director for Early Intervention

Chief Superintendent Steve Cooper (Nottinghamshire Police)

Ruth Hawkins (Nottinghamshire Healthcare Trust) – Simon Smith substituting

Jean Sharpe (Department of Work and Pensions) – Andrew Twigger substituting

Vikki Taylor and Stephanie Cook (NHS England)

Doctors Marcus Bicknell, Hugh Porter and Ian Trimble declared an interest in item 4 ‘Sexual Health in Nottingham City’ (minute 41) as general practitioners dealing with patients with sexual health issues, but this interest did not prevent them from speaking or voting on the item.

Doctors Marcus Bicknell, Hugh Porter and Ian Trimble declared an interest in item 5

‘Health and Wellbeing Strategy Alcohol Misuse Priority update’ (minute 42) as general practitioners dealing with patients with alcohol misuse issues, but this interest did not prevent them from speaking or voting on the item.

The Board confirmed the minutes of the meeting held on 29 October 2014 as an accurate record and they were signed by the Chair.

Alison Challenger, Consultant in Public Health, introduced a report and presentation on sexual health in Nottingham City, making the following points:

(a)  sexual health is a key public health issue for Nottingham City. It has a young and diverse population, with 21% of its citizens in the 16-24 age group;

(b)  rates of sexually transmitted infection (STI) and HIV are higher in Nottingham City than the national average in England, and there is a clear correlation with socio-economic deprivation. STI rates are increasing in England as a whole;

(c)  improving sexual health is driven through the Nottingham Plan to 2020, the Children and Young People’s Plan, the CCG Commissioning Strategy, the Teenage Pregnancy Strategy, Public Health services commissioning, the Sexual Health Framework for England, the Joint Strategic Needs Assessment. There are several specific indicators in the Public Health Outcomes Framework – under 18 conceptions, Chlamydia diagnosis in people aged 15-24 and people presenting with HIV at a late stage of diagnosis;

(d)  teenage conception rates, while still higher than the national average, have fallen very significantly, through co-ordinated multi-agency prioritising. Chlamydia diagnosis rates among the young people have also improved, however late stage HIV diagnosis rates have remained stubbornly high;

(e)  while a majority of sexual health services are commissioned by the Local Authority, CCGs and NHS England also commission specific elements of sexual health services. Commissioning and provision arrangements needed to be closely co-ordinated to ensure high-quality, integrated services;

(f)  next steps and key priorities going forward included completing the review of sexual health services and drawing up options for procurement, improving access to HIV testing and supporting the development of Sex and Relationship Education in schools.

The Board agreed that sexual health was a key individual and public health issue for Nottingham citizens, and raised the following points:

(g)  a Board member expressed concern that Nottingham City continued to perform poorly across a range of indicators, and that there was no room for complacency;

(h)  lots of prevention and treatment work was targeted at Nottingham’s large student population, and more was needed. Data was not collated on a student/non-student basis;

(i)  the sub-Saharan African community (both recently-arrived and settled) is a key target group for treating HIV, but it was acknowledged that there wasn’t a clear evidence base for HIV in this community. There was also support for targeted HIV testing and agreement that there should be no testing without consent;

(j)  good progress was evident in chlamydia diagnosis rates, but more needing doing to engage young men on the issue;

(k)  in reviewing sexual health services provision, there is a particular focus on ensuring ‘handover’ between services, so that Nottingham citizens had a seamless experience in accessing different elements of service provision;

(l)  the Board welcomed the high levels of engagement by partners through the Strategic Sexual Health Group.

RESOLVED to

(1)  to acknowledge the importance of sexual health as a key individual and public health issue for Nottingham citizens;

(2)  note the key areas for development and to request that the Board’s comments be used to inform the progression and delivery of local sexual health interventions;

(3)  continue to work to facilitate collaboration between organisations to comprehensive, non-fragmented high quality services appropriate to local need.

Christine Oliver and Alex Castle Castle-Clarke of the Nottingham Crime and Drugs Partnership (CDP) introduced a report and presentation, giving an update on progress against the actions in the Health and Wellbeing Strategy to address alcohol misuse. Ms Oliver and Mr Castle-Clarke highlighted the following points:

(a)  alcohol misuse has a very broad impact on health and wellbeing, ranging from physical and mental ill-health to domestic violence, anti-social behaviour and violent crime;

(b)  the proportion of adults drinking at harmful levels is reducing significantly, and numbers of citizens completing alcohol misuse treatment programmes are up slightly. However, alcohol-related hospital admission levels are increasing, against the national trend, although there has been a change in the way such admissions are recorded;

(c)  a city-wide Public Space Protection Order has been introduced to combat street drinking and confiscations of alcohol are up significantly. The city-centre Saturation Zone has been expanded;

(d)  a Lifeline Family Service is in place to support families and carers and family support and engagement is embedded in the City’s specialist treatment model;

(e)  students and young people were being targeted to address alcohol misuse. Measures included having student alcohol clinics at both universities, Fresher’s Week outreach, and  DrugAware delivering education on alcohol harm in Nottingham schools;

(f)  5 premises have been closed through licensing action since April 2014, there is a city-wide Super Strength Free campaign in place and work is ongoing with the Portman Group to draw up a best practice membership scheme;

(g)  the CDP is supporting national campaigns, including Local Alcohol Action Areas, DrinkAware projects and helping tackle Foetal Alcohol Spectrum Disorder. Nottingham is now a Home Office Alcohol ‘Mentor Area’.

During discussion, the Board made the following points:

(h)  Mr Castle-Clarke confirmed that those delivering the Strategy are mindful of the need to address alcohol misuse among older and wealthier citizens, and acknowledged that harmful drinking among these groups was more difficult to detect;

(i)  a Board member expressed the view that there were fewer Police objections in outlying wards, which made licensing measures less effective in helping curb alcohol misuse;

(j)  alcohol harm reduction is firmly embedded in Nottingham, but the statistics, especially on alcohol-related hospital admissions, are so at variance with Core Cities comparators that there must be a counting/information collation issue involved;

(k)  discretion is applied when considering street drinking – the powers are not intended to address social, non-problematic drinking in public settings;

(l)  there is an issue with illicit alcohol within certain communities, and there is also organised crime involvement in the provision of ‘fake’ alcohol produce.

RESOLVED to note the update.

Noel McMenamin, Governance Officer, introduced a report of the Head of Democratic Services, asking the Board to note changes to the individuals nominated to represent their organisation on the Board and to recommend to amendments and voting rights to Full Council.

Mr McMenamin made the following points:

(a)  Changes to the Board’s membership to reflect appointments, replacements and restructures have been taken under delegated authority by the Acting Corporate Director of Resources, and are for noting only;

(b)  The Board have to recommend additions to its membership and changes to voting rights to Full Council for approval;

(c)  The governance arrangements for establishing a Health and Wellbeing Board Commissioning Sub-Committee as outlined in the report were not finalised, and revised proposals will be submitted to the next Health and Wellbeing Board meeting.

In the brief discussion which followed, a Board member suggested that the Board’s terms of reference could be refreshed to reflect explicitly its oversight of the Better Care Fund. Dr Chris Kenny also asked to be kept informed of changes to governance arrangements.

RESOLVED to

(1)  note the following changes to individuals nominated to represent their organisation on the Health and Wellbeing Board:

a)  Dr Marcus Bicknell replacing Dr Arun Tangri as one of the NHS Nottingham City CCG representatives;

b)  Ruth Hawkins replacing Michele Hampson as Nottinghamshire Healthcare NHS Trust representative

c)  Jean Sharpe, District Operations Leader for Nottingham City and Conurbation, replacing Annette Pottinger as JobCentre Plus representative

d)  Leslie McDonald, Executive Director, Nottingham Counselling Centre replacing Sarah Collis as Nottingham Third Sector Health and Wellbeing Provider Forum representative

(2)  note that the Nottingham City Council posts of Director for Adult Provision and Health Integration and Director for Family Community Teams no longer exist and have therefore been removed as non-voting members of the Health and Wellbeing Board;

(3)  recommend to Full Council that membership and voting arrangements for the Health and Wellbeing Board are amended to:

a)  add the Nottingham City Council Strategic Director for Early Intervention as a non-voting member of the Health and Wellbeing Board; and

b)  add the Nottingham City Council Director for Adult Social Care as a voting member of the Health and Wellbeing Board (taking the director for adult social services vote), leaving the Nottingham City Council Corporate Director for Children and Families with one vote (as the Director for Children’s Services).

Sally Seeley of Nottingham City Clinical Commissioning Group introduced the report in her capacity as Vice-Chair of the Nottingham City Safeguarding Board, making the following points:

(a)  it is a statutory requirement that the Nottingham City Safeguarding Children Board produce an Annual Report setting out performance against key objectives and priorities for action. Nottingham City has produced an Annual  Report for the Safeguarding Adult Board as a matter of good practice, but this will become a statutory requirement from April 2015;

(b)  the Annual Report has already been considered at Commissioning Executive Group and will inform strategic commissioning plans, and the Overview and Scrutiny function has also commented on the report;

(c)  the report highlights positive progress in respect of the development of the early help offer, the introduction of the single assessment framework, threshold protocol and learning and development framework. In relation to adults, effective local responses to the Winterbourne Review and Francis reports have been secured, monitoring the implementation of the Mental Health Capacity Act  and Deprivation of Liberty Safeguards (DoLS) have taken place, while the impact of personalised budget on safeguarding risk and safeguarding in residential and nursing home provision has been managed;

(d)  trends informing the Board’s work going forward include increases in the number of children with child protection plans, increased children referral rates and numbers of children in care, increased adult safeguarding alerts and DoLS referrals and the levels of adult safeguarding alerts in residential and care settings exceeding those in the wider community. Additional challenges are expected to emerge with the roll-out of the inspection regime and the increased focus on Child Sexual Exploitation.

RESOLVED to agree the Nottingham City Safeguarding Children Board and Adult Safeguarding Partnership Board Report 2013/14.

Dr Chris Kenny, Director of Public Health, Nottinghamshire County and Nottingham City, introduced a report recommending that the Health and Wellbeing Board sign the Children’s Trust’s Children with Disability Charter.

Dr Kenny explained that the Charter featured 7 key statements committing to standards of engagement, early and strong integration and cohesive governance and leadership. Committing to the statements will support improved access to services for vulnerable children, young people and their families. Dr Kenny also thanked all the Local Authority and Clinical Commissioning Group colleagues who had worked on rolling out the Charter.

RESOLVED to endorse the Children with Disability Charter and for the Chair to sign the Charter on behalf of the Health and Wellbeing Board.

RESOLVED to note the Forward Plan, subject to cancellation of the meeting scheduled for 29 April 2015 – see minute 48 below.

Ruth Rigby and Donna Clarke of Healthwatch Nottingham provided an update on the organisation’s latest developments and current work:

(i)  Healthwatch Nottingham has introduced a new ‘Trip Advisor’ style website, allowing citizens to provide feedback on a range of NHS services, resulting in a ‘star-rating’ for services;

(ii)  the Healthwatch database uses thematic coding to provide analysis and present findings in user-friendly formats, such as visual dashboards;

(iii)  Healthwatch has seen a significant increase in detailed experiences received in the period October - December 2014. The primary negative experiences reported were around waiting times and experience of treatment and care, while experience of treatment and care and staff, including staff attitudes, were the most common positive feedback reported;

(iv)  primary access, care homes’ quality and safeguarding, young people’s Mental Health and the development of ‘lay leaders’ to inform service design are key priorities for Healthwatch Nottingham.

The Board welcomed these developments. In response to a Board member’s question, Ms Rigby confirmed that service providers did not as yet have a ‘Right to Reply’ to comments on services, but that this was being explored.

Alison Michalska, Corporate Director of Children and Adult Services, gave the following update:

(i)  Staffing Changes

Steve Combs is the new Head of Children in Care.

Clive Chambers is Head of Safeguarding Quality Assurance.

Tajinder Madahar is Interim Head of Extensive and Specialist Services.

Shelley Nicholls is Interim Head of FIP and YOT Services.

Aileen Wilson is Interim Head of Early Help.

Within Early Intervention, Christine Oliver and Tim Spink are Interim Directors, while Katy Ball and Colin Monckton are now Directors.

Mark Andrews and Peter Moyes have left Nottingham City Council.

(ii)  Budget

Work to finalise the Council’s budget for 2015/16 continues. Budget proposals totalling £21.8 million have been identified, and a further £5 million in savings need to be found. The Council remains committed to balancing the budget, supporting the most vulnerable and focussing on jobs and growth.

(iii)  Peer Review of Adult Social Services

The 3-day Peer Review of the Adult Safeguarding Board and Homecare Services in November 2014 identified the need to strengthen arrangements for the Adult Safeguarding Board to comply with the Care Act, and this is being taken forward.

(iv)  Nottingham City Schools

All 7 secondary schools placed in Special Measures in November 2014 are making ‘reasonable progress’ towards improvement, and there is an ongoing focus on improving standards, behaviour and attendance.

(v)  IT developments

A Requirements Specification for a new Social Care IT system has been produced, and the CareFirst and Castle systems are being changed and improved to meet the recommendations of the Safeguarding Inspection and needs of the Care Act.

(vi)  Child Sexual Exploitation

Nottingham City is to host a visit from the Department of Communities and Local Government on Child Sexual Exploitation, and outcomes will be reported to a future meeting of the Health and Wellbeing Board. 

Dr Chris Kenny, Director of Public Health, informed the Board that there were 2 national Public Health campaigns currently taking place, addressing ‘Dry January’ and smoking. A ban on smoking in private vehicles is expected later in 2015, while lobbying is ongoing on introducing plain packaging for tobacco products. A Public Health Forum event on the link between Health and Housing will take place on 11 February 2015.

Dawn Smith, Chief Officer, Nottingham City Clinic Commissioning Group, gave the following update:

(i)  the ‘Forward View into Action: Planning for 2015/16’ planning framework guidance is now published. For the first time, guidance covers the entire NHS and Appendix 1 to the written update highlights issues particularly impacting on partnership working between Health and Wellbeing board members. The planning guidance will inform a refresh of Year 2 of the CCG’s 2-year plan, as well as longer term planning within its 5-year Forward View;

(ii)  NHS Funding allocations for 2015/16 have been announced, with Nottingham City CCG receiving a revised programme uplift of almost 3%. The increase comes with conditions, including increasing mental health funding to address parity of esteem, moving systems reliance funding recurrently into CCG baselines, and meeting funding surplus and contingency thresholds;

(iii)  Primary Care Co-commissioning: the CCG has been successful in moving to the next stage of its bid to take on delegated commissioning arrangements for primary medical services on behalf of NHS England. The submission will now be considered by a Regional Moderation Panel. The process will require some amendments to the CCG’s Constitution;

(iv)  the CCG has released a short DVD drama. ‘Think before you dial’ is aimed at 11-16 year-olds, and will be shown across all 22 secondary schools in Nottingham City. The film informs and engage young citizens about NHS services and costs, and encourages young people to take pride in the NHS

Helen Jones, Director of Adult Social Care, provided a brief verbal update on Nottingham City’s response to the Care Act. The Act comes into force on 1 April 2015 and a major Every Colleague Matters event will take place from 9 to 13 February 2015 to raise awareness of the Act and its implications. The event isopen to everyone working within the Children's and Vulnerable Adults Workforce in the City of Nottingham (including Local Authority, Health, Police, Voluntary, Private and Independent Sector). The key risk remains the potential funding settlement shortfall from 2016/17 onwards. National guidance has been delayed and levels of uptake remaining uncertain.

RESOLVED to note the updates.

RESOLVED to cancel the Board meeting scheduled for 29 April 2015.