A Healthwatch “Take” on the Health and Wellbeing Board meeting, 3 Feb 2016

For a useful summary of all the papers coming to the Health and Wellbeing Board (HWB) please go to the following link:  http://www.nottinghamshire.gov.uk/media/111920/feb-3-2016.pdf

A pre-meeting of the HWB had been agreed at the previous meeting in December. The issue was whether the Board should give a response to the NCCs budget reduction proposals. This was particularly relevant in the light of the possible social services budget reductions. There was debate between County Councillors as to whether the Board could give such a view. The County Council’s legal advice was that, as the HWB was a Council committee, it would not be possible to give a collective view. However individual organisations on the Board would be able to do so. Both Nottingham North and East CCG and Healthwatch Nottinghamshire had already submitted their views on the negative implications of more social services budget reductions.

Healthwatch made the concluding point that it would be detrimental if this apparent legal and constitutional limitation on HWB powers meant that that it would not be able to make recommendations on future, perhaps controversial, decisions concerning health and social care funding and planning.

Update on Progress by Healthwatch Nottinghamshire

Our update report received a good response. Positive comments were made on the work over the last year on the renal patients experience on the transport service and our choice of optician services for the Question of the Month. Two of the GP members expressed concerns about the statistical validity of some of our findings on the quality of GP services in terms of numbers of responses. A useful suggestion was made that Healthwatch could also use the findings from GPs’ and other survey feedback. This we will take on. We need to remember, however, that the experiences that Healthwatch gathers from patients is primarily qualitative rather than quantitative in nature.

Mental Health Crisis Concordat

This concordat across Nottinghamshire’s agencies concerned with mental health services has reduced the urgency of Healthwatch looking further into local crisis services. At least for the moment. Yesterday’s (15 Feb) announcement of the government’s response to the major report on inadequacies in England’s mental health services, I think, reinforces the position we have taken.

Key questions from Healthwatch were:

1. Did the new 111 mental health pilot service described in the Concordat require people phoning in for help to be already known to mental health services. If this were the case, it wouldn’t help large numbers of people in distress.

Answer: The pilot 111 line will take calls from all people. This is good news.

• One of the risks that the paper identifies is the current demand on psychiatric beds, issues around hospital discharges, and having to use beds outside of Nottinghamshire. What is happening to address this?

Answer: Nottinghamshire NHS Healthcare Trust is currently undertaking an audit on delayed discharge, bed capacity and the use of out of county psychiatric beds.

A Healthwatch “Take” on the 3rd December 2014 Health and Wellbeing Board (HWB)

(For view the NCC summary of the meeting go to: http://www.nottinghamshire.gov.uk/EasySiteWeb/GatewayLink.aspx?alId=470650)

Three reports triggered comments from your HWN representative on the Board – two of them were  concerned with mental health services, and the third being about the plans for delivering Nottinghamshire’s Health and Wellbeing Strategy.

Chief Medical Officer’s report on mental health (in England)

This came out in September and reports on the overall state of mental health in England.  Helpfully it takes into account a wide range of factors such as the stigma effect of mental illness, the risks associated with being out of work, the importance of high quality data on mental ill-health, and mental health services achieving parity of esteem with physical health services. That’s a more holistic way of understanding mental ill-health, much more useful than the traditional, more limited range offered by a purely medical model of mental ill-health.

But it was the first recommendation that I, and a number of others at the meeting, thought most needed challenging. This was:  “Well-being interventions should not be commissioned in mental health as there is insufficient evidence to support this”.

The obvious question to be asked (which I did) was – what sorts of preventative services are these, and are there any services like that operating in Nottinghamshire.

But nobody at the meeting quite had the answer to this.

Child and Adolescent Mental Health Services (CAMHS)

Concerns about these services have led to recent reviews, both nationally and locally. The recommendations from the one in in Nottinghamshire is therefore really important for young people over the next few years.

Healthwatch points: I drew attention to the County Council’s own children’s mental health and emotional wellbeing policy in which it says that that “half of people with lifetime mental health problems first experience symptoms by the age of 14”. That’s a worrying statistic! Clearly more needs to be happening to promote positive mental health initiatives at primary and secondary school level. I was pleased that the Board’s recommendation agreed:

“The Board requests a future report on the work planned and underway to promote mental resilience and prevent mental health problems in children and young people in Nottinghamshire”

Delivery of the Health and Wellbeing Strategy

Nottinghamshire’s Health and Wellbeing Board is having a peer challenge review of its functioning in the next couple of months. One question it will ask (I know because I have recently been on a peer challenge team in Derbyshire) is whether the Board’s leadership works well across the local system.

Healthwatch points:  My question to the Board was whether there were sufficient links between the Board and the various District based health and wellbeing bodies and their working groups. The general feeling was that there are good links established.

I still think there may be more mileage to be gained in bringing closer together local District based activity across the County with the health and wellbeing priorities that we now have.

A Healthwatch “Take” on the 3rd Sept Health and Wellbeing Board (HWB)

(For a brief NCC summary of the meeting go to: http://www.healthwatchnottinghamshire.co.uk/?attachment_id=2007)

Presentation of Healthwatch Nottinghamshire’s Annual Report (2013-4) and Business Plan (2014-5)

This was an important discussion for us to see how the members of the Board viewed Healthwatch Nottinghamshire (HWN) over the previous year and also what they thought of our role on the Board itself. Here’s what they had to say:

• Much positive comment from the HWB Chair, Cllr Joyce Bosnjak, on the contribution that HWN had made to the work of the HWB. This was reassuring to hear.
• One of the GP CCG leads asked about whether there was an overlap between the work of HWN and the work of GP practices’ Patient Participation Groups (PPGs); also whether HWN could assist PPGs in getting more younger people on the groups. B we are developing some ideas on what could be done about this. Watch this space.
• Is there a role for HWN in assisting Clinical Commissioning Groups (CCGs) in having their different communities participate in the commissioning process.
• We heard about the Youth Council in Gedling and the possibility of having a HWN “champion” amongst the members.
• Concern from a Rushcliffe Councillor that HWN avoid unnecessary duplication with other engagement work being undertaken locally. N.B It’s our policy to avoid doing engagement work when other bodies are doing the same thing.
• The HWB was reminded that HWN had asked the HWB Implementation Group to monitor the impact on health and wellbeing of the budget reductions that the local authority and NHS are now subject to.

2014 Care Act

This Act is being described as the biggest shake-up of social care for decades so it is most definitely going to have huge impacts on service users. There were two issues I wanted to raise for Healthwatch:

• Was the government intention in the Act to Integrate health, social care and housing just adding to the list of previous legislation on integration that has not had any meaningful impact. Does the care Act have any additional “teeth”?

This is important because housing is key for much of the success of community care. Just to prove this point, two other papers came to this Board. One was on adults with learning disability returning to Nottinghamshire from Winterbourne View requiring amongst other things good housing.  Social services commissioners are finding it very difficult to find appropriate housing. A second paper, the new Nottinghamshire mental health strategy, again raises the importance of planning for housing for adults with mental ill-health.

The answer to the question was that the integration of housing with social care and health  would be up to local partnerships to plan for. So – I’m sorry to say – it appears that it may have no more teeth than previous legislation! Let’s hope I’m proved wrong!

• The second issue was raised by the Chair herself. She, like Healthwatch Nottinghamshire and other members of HWB, expressed concern that the Government has under-estimated the costs of the reforms and that the funding allocation to Nottinghamshire will be insufficient.

Health and Wellbeing Strategy

This is now completed and being rolled out. It’s been proposed that each of the 20 priorities have a “champion” member of the HWB. I think that this is a good idea for the HWB.  But it puts me as Chair of Healthwatch Nottinghamshire in a situation of a possible conflict of interest if, say, an area of service that I was “champion” for was to be reported as an issue for HWN. I am going to decline, therefore.

Joint Strategic Needs Assessment (JSNA)

This will be on-line shortly.  It’s looking good for people and groups to navigate through to find the resources or information they’re interested in.  HWN has said that it would be involved in the planning of the JSNA at key stages of its development.

Communications from the Health and Wellbeing Board

The new summary paper that comes out after every HWB meeting is now in use (See the link to it above). I made the point, previously made, that there needs to be better cross-referencing of communications messages between the HWB strategy and the work of the 3 transformation boards, maybe even sharing of communications resources! Also that the Nottinghamshire public needs to be helped to understand what all this means to them – in digestible and in plain English format!

Nottinghamshire Mental Health Strategy

This has had extensive consultation.  It now looks to have the right priorities and has identified key gaps in services that will need to be addressed.

The points I made were that the other report referred to – Nottinghamshire Children and Young People Mental health and Emotional Wellbeing Strategy 2014-16 – is very difficult to find anywhere.  It need to be better publicised, alongside this strategy. Secondly, I informed the HWB that Healthwatch Nottinghamshire will be running a survey later this year on adult mental health services, focusing on access to psychological therapies and crisis services across the County.

Report back on the HWB Stakeholder event with the Voluntary and Community Sector, 9 June 2014

This had been a really useful get-together of all the main players in the VCS across Nottinghamshire. Lots of good suggestions made. I asked about one of the suggestions, which was about the importance of maintaining the connections and flows of info across the VCS. My concern was that Budget cuts being made by the County Council in the VCS might weaken those links. But Cllr Bosnjak was clear that that area remains a priority for the Council.