Agenda and minutes

17.1     The minutes of the meeting held on 18 September were agreed as a correct record.

18.1     Apologies for absence were received from the following Members of the Board:

·         Dr Elizabeth Gill (substitute: Ashley Scarff)

·         Jessica Britton

·         Councillor Linda Wallraven

·         Deborah Tomalin

18.2     Apologies for absence were received from the following invited observers with speaking rights:

·         Mark Andrews (substitute: Mark Matthews)

·         Councillor Claire Dowling

·         Michelle Nice.

18.3     Reg Hooke, Independent Chair of the East Sussex Safeguarding Adults Board, also gave his apologies.

19.1     There were no disclosures of interest.

Notification of items which the Chair considers to be urgent and proposes to take at the end of the agenda. Any members who wish to raise urgent items are asked, wherever possible, to notify the Chair before the start of the meeting. In so doing, they must state the special circumstances which they consider justify the matter being considered urgently

20.1     There were no urgent items.

·         Report by the Safeguarding Adults Board Independent Chair

21.1     The Board considered a report on the East Sussex Safeguarding Adults Board Annual Report for 2017/18.

21.2     In response to questions from the Board the following key points were raised:

• The Safeguarding Adults Board is monitoring closely the increase in the number of incidents of abuse in residential care homes and mental health hospitals. The current view is that the increases are not yet statistically significant, especially because of the low baseline number of incidents. The Adult Social Care Department (ASC) is also working with the care sector to ensure staff are aware of safeguarding duties including through conducting safeguarding reviews. The completion of some of these safeguarding reviews conducted at individual care organisations may also explain some of the increase in reporting of safeguarding breaches as they have made staff more aware of the signs of abuse.
• The Board is due to launch a new self-neglect procedure to highlight to professionals the symptoms of self-neglect and provide pathways of support that they can offer to individuals. The Board is also continuing to promote awareness and details of the referral process to organisations and individuals who are more likely to come into contact with signs of self-neglect, such as hording.  e.g., the fire service, shop owners and carers.
• One of the challenges with benchmarking ASC data on abuse is that raising awareness of abuse leads to higher incidents of reporting. This makes it difficult to judge which local authority area is performing well. Consequently there is no national definition of the rate at which incidents of abuse should be reported. There is, however, regional and national networks that enable local authorities to discuss instances where particular safeguarding issues are increasing and compare best practice.

21.3     It was RESOLVED to note the report.

·         Report by the Director of Children’s Services.

22.1     The Board considered a report on the East Sussex Local Safeguarding Children Board Annual Report for 2017/18.

22.2     In response to questions from the Board the following key points were raised:

• There will be future workshops held on the Impact of Parental Health on Children and Young People. The issue of the impact of a parent’s mental health on children has been a focus of the Local Safeguarding Children Board for a while given the severe impact it can have.
• The Core Offer still commits East Sussex County Council to fund safeguarding activities. The 19/20 budget identifies some potential savings for the Children’s Services Department but they will not affect the safeguarding activity identified in the Annual Report.
• It is difficult to provide any link between poverty and the likelihood of safeguarding issues in children, due to there being so many other variables that contribute to safeguarding issues, for example, the quality of housing – which can lead to ill health through the presence of damp – and the amount of the household income spent on food for the child, e.g., the parents may choose to prioritise their child’s diet over their own.
• The prevention of criminal exploitation of children, such as through drug trafficking, is being addressed in part by East Sussex County Council, the police, and NHS organisations conducting monthly panels where concerns are raised about particular children at risk of any form of exploitation and plans are put in place to protect them. There have also been a number of successful actions to break up child exploitation gangs, although this often leads to the children being placed in secure accommodation for their own protection due to their often close relationship with their exploiters.

22.3     It was RESOLVED to note the report.

23.1     The Board considered the Annual Report of the Director of Public Health for 2018/19.

23.2     In response to questions from the Board the following key points were raised:

• In order to try and equalise health outcomes across East Sussex, the CCGs and Public Health Team may commission providers to offer more support to individuals from more deprived populations. This is due to the increased likelihood that they will have co-morbidities and be less likely to seek assistance proactively. For example, they may be offered the opportunity to access additional services when they receive an NHS Health Check.
• Housing has been part of the public health remit in the past and housing clearly has an impact on health outcomes, for example, whether the housing is properly heated and mould-free; whether the house is located in an area of high crime; and whether it is located within walking distance of amenities can all have an impact on health outcomes. The Director of Public Health has shortlisted housing as a topic to be looked at in depth as part of next year’s Report.
• Air Quality also plays a factor in health outcomes both outside and within buildings. Outside air can cause long-term health issues through pollution and short term issues during heatwaves, particularly on those with respiratory issues. Air quality within buildings is also important because people spend more time inside; lack of proper ventilation and the presence of damp or mould can cause issues to people’s health. More work will be done with colleagues in the district and borough environmental health teams and the Environment Agency to develop ways of tackling the issue, in consultation with the public.
• More investment is needed in preventative services across the health and care and wider public sector, for example, preventative services provided by East Sussex Fire and Rescue Service such as Home Safety Visits, can be very cost effective and successful in reducing accidental deaths.  Generally, however, it is difficult to commit funding to preventative services when outcomes for such services are often measured over a long period of time; and because several different activities may have an impact on a health outcome, proving return on investment for a particular preventative activity is very difficult. The Public Health Team will be calculating the return on investment of the services it commissions over the next year to determine whether more funding should be put into preventative services.
• The Public Health Team is currently looking into the reason for the sudden spike in the rate of admissions to hospital for alcohol specific conditions in under 18 year old girls in Hastings with the assistance of a whole range of partners.

23.3     It was RESOLVED to

1) note the report; and

2) congratulate on the style and content of the Annual report of the Director of Public Health 2018/19.

·         Report by Executive Director of Health Watch East Sussex

24.1     The Board considered a report on the East Sussex Healthwatch’s Havens Listening Tour.

24.2     In response to questions from the Board the following key points were raised:

·         Despite the heavy regulations and regular testing of the Newhaven Energy Recovery Facility (ERF), and the resulting improvement of the air quality in the vicinity (due to it replacing businesses carrying out polluting activities such as burning tyres), Healthwatch picked up on a perception from Newhaven residents that it was causing health issues. In addition there was a feeling of distrust of public authorities due to the placement of the facility in the town against the objections of local residents.

·         Residents also expressed concerns about possible pollution caused by the Port Access Road and industrial developments at the East Quay affecting health outcomes. It is hoped, however, that this development, undertaken as part of the town being a designated enterprise zone, will bring greater employment opportunities thereby reducing levels of deprivation.

·          High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG) has a good understanding of the health needs of patients in the Havens area. The CCG welcomes the approach taken by Healthwatch as it brings to life the data that the CCG has collected over the years. The CCGs are also undertaking a number of measures to improve access to GPs, which was a major concern of residents, such as improving recruitment and retention of GPs and other healthcare staff; and greater access to appointments through the primary care extended access service. The CCG is also aware of concerns about mental health support for children and young people, another concern of residents, and a Sussex-wide independent review of children and young persons’  emotional health and wellbeing services (including Child and Adolescent Mental Health Services (CAMHS)) is underway across the health, social care and community and voluntary sector.

24.3     It was RESOLVED to:

1) note the report; and

2) monitor progress on the report recommendations.

·         Report by the Chief Executive

25.1     The Board considered a report on the outcomes of the Health and Wellbeing Board workshop held on 12 October and the recommended changes to the role and membership of the Board.

25.2     The Board proposed the following amendments or clarifications to the draft terms of reference:

• Clarify whether county councillors will be appointed to the Board according to political proportionality, noting that the Membership of the Board is determined by the Leader of the Council and not according to political proportionality legislation..
• That the Board’s terms of reference are flexible enough to ensure that they take account of the evolving governance arrangements of the Clinical Commissioning Groups (CCGs).
• That oversight of the prevention agenda is included in the roles and functions of the Board.
• The terms of reference should take account of any potential conflict of interest arising from NHS providers now being full members of the Board and the Board potentially taking on commissioning functions of the East Sussex Better Together Strategic Commissioning Board (ESBT SCB).
• The Board’s priorities would need to take account of the potential that CCGs may have nationally mandated priorities placed on them.

25.3     It was RESOLVED to endorse the proposed changes to the Health and Wellbeing Board,  its operation and terms of reference as set out in paragraphs 2 and 4 of the report.

·         High Weald Lewes and Havens Clinical Commissioning Group (CCG)

·         Eastbourne, Hailsham and Seaford CCG

·         Hasting and Rother CCG

26.1     The Board considered updates from the three NHS Clinical Commissioning Groups (CCGs).

Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EHS CCG)/ Hastings and Rother CCG (HR CCG)

• All eight CCGs in the Sussex and East Surrey Sustainability and Transformation Partnership (STP) have a single accountable officer.
• The CCGs are likely to hit their financial control total for 2018/19 and receive their Commissioner Support Funding (CSF) and are working collaboratively with other East Sussex organisations to develop financial sustainability plans for 2019/20.

High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG)

• The CCG is expecting to hit its financial control total for 2018/19 and receive its CSF.
• The CCG is prioritising the management of health and care systems over the winter period and has been seeing the expected increase in demand on the system.
• The CCG is beginning to plan for the 19/20 financial year including how it manages contracts with providers, i.e., moving away from transactional ‘payment by results’ contracts and towards more outcomes-based contracts that incentivise health and social care organisations to work together to improve a patient’s experience and provide better value for money.