Healthwatch Norfolk Board

16th October 2017

10.00 – 12noon

Healthwatch Norfolk Boardroom Suite 6, Elm Farm Dairy, Norwich Common, Norfolk, NR?? OSW

AGENDA

1. No. Item Items for Action (A), Information (I), Discussion (D), Presentation (P)

Time Mins. Page A,I,D

Part I – Public Board Meeting

2. 1. Questions from the general public 10.00 5 D

3. 2. Apologies for absence 10.05 I

4. 3. Declarations of Interest 10.05 I

4. Minutes of the meeting held on 17th July 2017 (paper attached) 10.05 5 A

5. Matters arising not covered by the agenda 10.10 5 D

6. 6.1 6.2 6.3 6.4 6.5 6.6 6.7

CEO Report (Incorporating STP Update) Intelligence report (paper attached) Engagement report (paper and verbal) Updated risk register (paper attached) Quality Control Sub Group Draft Minutes (attached) Finance Sub Group Draft Minutes (attached) Mental Health Sub Group Minutes

10.15 10.25 10.35 10.45 10.55 11.00 11.05

10

10

10

10

10 5 5

P/I/D I P/D/I I I/A A/I/D A/I/D

7.0 General Correspondence received (verbal) 11.10 5 I

8. Any Other Business – Please provide the Chair with Items for AOB prior to the Meeting’s commencement.

11.10

9. Dates of future Board meetings Monday 16th October 2017 – HWN Offices, Wymondham Monday 15th January 2018 – HWN Offices, Wymondham

Part II – in camera The Chair asks that representatives of the press and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest. Section 1(2) Public Bodies (Admission to Meetings) Act 1960.

1. 2. 3.

Draft minutes of Part II Board Meeting held on 17th July 2017 (paper attached) Finance Discussion –Letter to Communities Committee and Update following Committee Recommendation Any Other Business

11.15

11.20

11.50

5

30 5

A A I

Apologies should be sent to Healthwatch Norfolk Administration Officer, Sonia.miller@healthwatchnorfolk.co.uk, telephone 01953 856029 Distribution:

Trustees For information William Armstrong Robert Ashton Dianne Butterfield Diane DeBell Ann Donkin Graham Dunhill Helen Jackson Mary Ledgard David Trevanion

Ceri Sumner Maureen Orr Linda Bainton Tom McCabe

Minutes of Board Meeting – Part I

Monday, 17th July 2017

Attendees: William Armstrong (WA) – Chair Robert Ashton (RA) Diane DeBell (DDB) Ann Donkin (AD) Graham Dunhill (GD) Helen Jackson (HJ) Mary Ledgard (ML) David Trevanion (DT) Officers in attendance: Alex Stewart (AS) – Chief Executive Judith Bell (JB – Operations Manager Sonia Miller (SM) - Minutes Steph Tuvey – item 6.3 only F Gibbs (FG)- item 6.4 only

1. Questions from the general public

No questions were submitted from the general public.

2. Apologies for absence

Apologies were received from Dianne Butterfield

3. Declarations of Interest

None

4. Minutes of the meeting held on the 24 April 2017

The minutes of the Healthwatch Norfolk (HWN) Board meeting held on 24th April 2017 were agreed as a correct record.

5. Matters Arising (not covered by the agenda)

Item 5: Pressure Ulcer Report – AS will look at the follow up on this report. Admiral Nurses – HJ said this needs to be kept under review after 18 months and AS said that he would ask Zena Aldridge to keep us informed. ACTION: AS to follow up on Pressure Ulcer report and speak to Zena Aldridge CVD Report – AS said that responses had been received and AS is working through the recommendations. A further follow up will take place in 6 months. Social prescribing is on the STP agenda and this report will be used when looking at this.

6. 6.1

CEO Report

WA welcomed AS back after his absence since surgery.

The report had been circulated prior to the meeting together with the Operations Plan. AS thanked Ann Stephens for all her work with the Engagement Team. She will be leaving at the end of August to take up a teaching post and also to Joel Watkins who will also be leaving at the end of August to continue his studies in Scotland. AS also welcomed Chris Andrews, who will take over the position of Engagement Manager and Victoria and Rosie who have joined the team for a summer internship. AS also welcomed Rachel back from maternity leave. WA welcomed Chris to Healthwatch Norfolk. Operations Plan: AS said that funding for the Norfolk Carers Council is due to end and recommended that HWN continue its partnership with CNN and contribute a further £5625 towards the running costs and that this money be taken from the grant that was awarded to HWN by NHS England’s Emergency Care Network for the study HWN undertook in relation to people in mental health crisis attending A&E services. The Board agreed to this funding until March 2018 and will consider future work with them after this. AS also pointed out that due to funding cuts next year HWN would be looking at bids for funding. AS has recently met with the Big Lottery Fund and is seeking £493,000 over three years. HWN received three highly commended awards at the recent HWE Conference: two in relation to work on the Veterans Project and one in relation to the collaborative way in which we work across boundaries. AS thanked Ed, Judith and Sonia for their work on these. AS said that he had updated the Operations Plan for the first 3 months of work carried out at HWN and will produce this once a quarter as an overview. ML asked who would be carrying out the refinements to the IT systems in relation to commissioners and providers access to feedback on our website. AS said that Fennie and Steph would be working on this and have recently installed an IPad at Thorpe Medical Practice with the support of LHM and the Practice Manager in order to provide this access to patient feedback. AS confirmed that the annual showcase would take place on the 3rd October at The Forum.

6.2 STP Update

AS said that he had been approached by ITN to take part in a documentary around the STP, particularly public health social prescribing element and its

impact on peoples’ health – saving money and recognising the cost of social prescribing. This documentary has been commissioned by the College of Medicine and HWN is one of three HW to be approached. A 4 minute news film will be produced and showcased at the College of Medicine. It is proposed to make this film in August/September and the Board would need to give a response by Friday. There is a cost of £16,150 which could come from the STP budget. AS circulated a paper with the details of the proposal to those present. Board members raised concerns regarding the cost of this and questioned how this would be used/where it would be broadcast and how it would benefit the people of Norfolk. The general feeling was that the Board would require more information about this before agreeing to this sort of spend. The Board agreed that they were not content to sanction this as they felt that there was inadequate information being provided by ITN. However, the Board agreed that we should review this type of opportunity with the STP group and perhaps have a strategy for this type of approach in the future. STP Public Meeting - WA ran through the programme for the evening and said that he would give an introduction to the meeting. He said that he would also point out that NHSE have not been able to send a representative to attend the meeting. It is expected that there will be some demonstrations from the NHS Action Group and Mental Health Campaigners prior to the meeting outside before joining the meeting. AS said that he would ask the STP Executive to provide written answers to the questions raised to be put onto our website. A video will also be taken of the meeting. AS said that it would also be useful to contact the graphic facilitator to be used again (as with SAM’s report) to provide an image of the meeting and discussions.

6.3 Priority Projects – GP Phase 2 (paper attached)

Steph Tuvey outlined the content of this report to the Board. She said it was a follow up to the initial piece of work talking to GPs and patients. The second phase involved talking to 6 organisations and 31 professionals about their experiences of working with general practice. There were clear frustrations between primary and secondary care and written communication. Relationships could be improved, particularly as the mental health service is difficult for GPs to navigate. The use of different IT systems also causes issues with staff not having sufficient information in front of them to treat patients. The main recommendation of the report is to improve the IT systems – what is used and how.

HJ said that further recommendations should be pulled out, Mental Health and primary care services and a supplementary document produced to highlight these other points. It was agreed that ST would put this together ACTION: ST to produce a supplementary document highlighting further recommendations. The Board complimented ST on an excellent report. AS said that the STP Executive should read this report and use the research contained in it. A copy has also been given to Patricia Hewitt. AS also said that when the report is sent to the Trusts further issues would be pointed out to them for them to address individually. The Board agreed to approve the report with the supplementary information to the Trusts.

6.4 Intelligence Report

FG presented this report. The data is similar to that produced for the previous meeting. Her main concern was that 206 comments over a 6 month period have been collated into 6 bullet points and feels this is not responding to the views of the public. FG asked the Board to consider how they would like this report to be presented to make it more meaningful. The Board felt it was a good report and reflected the work carried out by the engagement team. ACTION: The Board will consider how they would like the report presented and pass their thoughts directly to FG.

6.5 Engagement Report - verbal

No report was given.

6.6 Updated Risk Register (paper attached)

It was pointed out the Item 2. – Forward financial planning should now be green. The Board agreed that this should be green.

6.7

Quality Control Sub Group (draft minutes)

The QC Sub Group minutes (22 6 17) were approved.

6.8 Finance Sub Group (draft minutes)

JB said a set of accounts for last year had been circulated to all members of the Sub Group and comments and amendments made – the final edition is now available at this meeting.

The Board agreed to approve the accounts to be formally adopted at the AGM.

7.0 General correspondence No correspondence had been received.

8. Any Other Business

None.

9. Date of Next Meetings Monday 16th October 2017 – HWN Offices, Wymondham Monday 15th January 2018 – HWN Offices, Wymondham

W J Armstrong …………………………………………… Date………………………………….

Chair

Agenda item: 6.1

Report on: CEO Report

Author: Alex Stewart

Date: 16 November 2017

1. Introduction

The purpose of this report is to provide Board Members with a range of information on

matters which are pertinent to Healthwatch Norfolk. This report is providing updates on

the following: -

Staffing

Sustainable Transformation Partnership

Mental Health Crisis Care Conference

Flu Vaccinations

Enter and View Visits

2.0 Staffing

The Interns provided a valuable resource to HWN over the summer months and were

involved in a variety of project work from the Pharmaceutical Needs Assessment through

to following up recommendations from the Pressure Ulcer Report. Funding permitting, we

will continue to look to recruit Interns on an annual basis.

Apprentices – unfortunately the apprenticeship programme has not worked for HWN.

Whilst we managed to recruit, the candidate felt unable to continue due to the nature of

the work that HWN is involved in.

Engagement Officer – Jordan Carroll started working with HWN on the 11th September. He

has already been actively involved in engagement events around the County.

3.0 Sustainable Transformation Partnership

The STP Board sub-committee has agreed to work with the Communications and

Engagement Leads to front another 3 events across Norfolk in November/December 2017.

The events will be running in west, east and central (venues to be confirmed) and we will

invite participation from our respective memberships, patient groups etc. The plan is for

simple facilitated meetings, up to 80 people at each, with each event running for two and a

half hours.

For primary care, we will focus on exploring experience of primary care and looking ahead to

new ways of working as per the forward view. The acute services review will be linked to the

14 week programme which includes patient engagement, on cardiology, urology and

radiology.

Once confirmed, a detailed plan will be circulated. It is hoped that this will be an excellent

start to sorting out a more detailed engagement programme as the work streams progress in

2018.

Workstream Updates

Cancer- There is still no news as to whether the partnership has been successful in

receiving additional transformation funding (revenue and capital) for Cancer

Services across the STP Footprint. Some Trusts have received additional top sliced

funding to achieve the 62 day target which NNUH have met for the first time this

year. This amount will be deducted from the partnership’s final STP allocation.

Maternity- The programme is on track to produce an LMS plan by October 2017.

Urgent and Emergency Care- The STP Urgent and Emergency Care Board, which

covers the 3 local A&E Delivery Boards has now met and the second meeting is due

at the end of this month. The role of the Board is to deliver a more coherent

approach to urgent and emergency care across the STP, reduce unwarranted

variation and deliver the targets set out in the National Urgent and Emergency

Care Delivery Plan. Funding of £425k has been secured to support deliver

trajectories where we need more support and the funding has been nominally

allocated to the following subject to sign off by NHSE;

£260k Additional Falls Vehicles in East and West (PYE)

£90k to support increase in CAS for NHS 11 from 40% to 50%

£70k (including on costs) for an STP UEC Programme Manager

Demand Management- There is a detailed Remedial Action plan (RAP) in place to

get back on target by October 2018. The plan remains completely reliant upon the

whole system owning and delivering the plan.

Mental Health- On track with main projects however the bid to Deliver Core 24/7

standards in NNUH for A&E Liaison was only partly funded by the National Team,

with funding of £485k against a bid of £1.5million. Commissioners have agreed to

part fund the shortfall and the partnership has submitted a plan which starts in Q4

later than originally planned to offset the remaining shortfall. However there

remain no firm plans for West Norfolk and Gt Yarmouth & Waveney, which is

causing significant issues. Housing for mental health patients and homelessness is

also becoming a real issue and it has been proposed that the Executive Team

receive a presentation in relation to the Housing Strategy.

Prevention, Primary and Community - Several meetings have taken place

between Executive colleagues over the last 2 months to progress the development

of the work stream. In July, a Primary Care Development outline strategy was

presented and agreed by the Executive which is now being translated into a

delivery plan, led by the Director of Primary Care. The most pressing plans are

those for developing integrated neighbourhood teams and primary care hubs, with

closer working with Primary Care, Estates and ICT.

4.0 Mental Health Care Crisis Conference

Following the successful publication of the work that was commissioned by NHSE around

people in acute crisis accessing A&E; HWN are hosting a conference sponsored by NHSE on

the 7th November at Dunstan Hall. The event is an opportunity for providers, service users

and commissioners to meet together to discuss the report and propose new ways of

working in order to improve services for those in crisis.

5.0 Flu Vaccinations

Free flu vaccinations are available for certain groups who are at risk because of a variety

of different conditions. Historically, they were only provided by GP Practices. Following a

pilot project offering the service at local pharmacies, supermarkets etc. and a review and

evaluation by HWN, the service provision was enhanced and NHSE recommissioned a wide

variety of service providers to make it as accessible for the public as possible.

Sadly, several practices across the East of England (including Norfolk) have put up

misleading posters as pictured below. HWN has made representation to NHSE expressing

concern that not only is the poster incorrect but it is inadvertently pressurising patients

into thinking that GP Practices are the only provider that can deal with flu vaccinations.

6.0 Enter and View Visits

The Operations Manager has worked with trained volunteers to start an initial round of

Enter and View Visits into care homes. To date, three visits have taken place and the

follow up reports have been well received by Care Home Managers who have an

opportunity to comment prior to report publication. Copies of the reports are available on

the HWN website.

Healthwatch Norfolk Feedback: July – September 2017

Agenda item: 6.2

Report on: Board Intelligence Report

Author: Fennie Gibbs

Date: 16 October 2017

Key themes arising…

Access to services: 144 reviews regarding appointments/opening hours (97); referral to treatment time

(26); transport/location (16) and information/advice in order to access services (5).

Staff: 94 reviews noted staff attitudes which were largely positive (84%). Training was mentioned 4 times

and mixed in nature and 5 individuals left review which detailed lack of staff.

Treatment and Care: 93 reviews were coded with this theme with 24 relating to

administration/organisational elements. 24 reviews – some positive, some negative – about waiting times

once in the service; 14 mentioned the environment/facilities, 14 about prescribing/medication (largely

negative), 12 surrounding diagnosis (again, largely negative) and other reviews about discharge (3);

food/hydration (1) and cleanliness (1).

Commissioning: As ever, we received several reviews about gaps in services (14) and 4 relating to

fees/charges.

Rights: Involvement/shared decision making was noted in 12 of the 17 reviews about rights, with two

thirds being negative in nature. Other reviews mentioned issues around equality (3); consent (1) and the

complaints process (1).

Above: Average star ratings for each service type. This includes the NHS Choices data. Top right: Themes coded against each review, minus the NHS Choices data.

Intelligence Updates: We have recently turned on a function on our website to enable service providers – who have said that they would like – to receive a weekly summary email

detailing the reviews we’ve received with quick links, so they can respond to the review, should they wish. This will hopefully elicit more “right to respond”

replies from service providers. Already, we can see there has been an improvement on numbers of replies surrounding this, with 63 replies in this reporting

period, compared to 10 in the three months prior to enabling the function.

We are in the process of installing a widget on a local GP surgery’s website and will pilot this partnership. A widget is an online tool which will be embedded

onto a provider’s site. It contain our logo and enables patients to leave feedback about said service, which will feed through to our database.

We will be conducting a three month long partnership pilot with Carers Matter Norfolk, after which time, a full evaluation will be conducted to enable us to

have a better understanding of resources – staff time, money etc. – that would need to be factored into similar partnership working, with the view also to

package our services, including the dashboard, for income generation.

Carers Matter Norfolk: The newly commissioned county-wide service to support

unpaid carers aged 16+ caring for someone aged 18+

Carers are the heart of everything they do at Carers Matter

Norfolk

The service has been developed and will continue to evolve in

response to what matters to Carers

Who are Carers Matter Norfolk?

Voluntary Norfolk: Promotes, supports and develops

volunteering and the work of voluntary organisations and their

contribution to achievement of individual wellbeing

Carers Council for Norfolk: User-led organisation providing the

independent voice of carers

Family Carers Net: Created by carers, for carers

Norfolk & Suffolk Care Support Ltd: Supports the quality of

training and service provision in the adult social care sector in

Norfolk

Adult Social Care Survey – ACSC - (annual survey): Proportion of people who use services who find it easy to find information about services:

73.2% (Norfolk), which is similar to the national average (73.1%) and better than last year’s

findings (71.2%)

Overall satisfaction of people who use services with their care and support: 61.2%

(Norfolk), compared to England’s average of 62%. Overall satisfaction seems to have

decreased year on year.

Survey for Adult Carers – CS - (biennial survey): Satisfaction of support or services received from Social Services in the last 12 months, for

the carer and the person they care for:

o Extremely/very satisfied: (Norfolk) – 37.1%; (England) – 40%

o Quite satisfied: (Norfolk) – 29.2%; (England) – 32%

Have you found it easy of difficult to find information and advice about support, services or

benefits, in the last 12 months?

o Very/fairly easy to find: (Norfolk) – 62.6%; (England) – 64.2%

One third of carers are not satisfied with the support or services received from Norfolk County Council and over one third of carers have not found it easy to find information about support, services or benefits for them or their cared for.

July – September 2017

People engaged with at engagement events How we gathered views

Where we gathered views (engagement)

People who shared their experience with us

Agenda item: 6.3

Report on: Board Intelligence Report – Communications & Engagement

Author: Fennie Gibbs

Date: 16 October 2017

Events visited: July - September 2017

27 in total…

o Libraries – 9

o Information days – 5, for example

the Carers Information Day at The

Forum

o Hospitals – 3

o Markets – 2

o NSFT Roadshow – 2 days

o Flu Clinic – 1

o Garden centre – 1

o Leisure centre - 1

o Norwich Riverside

o Norwich PRIDE

o Bridge+

In Focus: Communications

In the past three months, we have really stepped up our communications game, since Chris Andrews has started with us as Engagement Manager and Rachel Morris has returned to Healthwatch Norfolk as Communications Officer. Some highlights detailed below:

TV/Radio July… Healthwatch Norfolk were mentioned 18 times in separate bulletins/channels

TV: BBC Look East

Newspaper (print): Evening News, Eastern Daily Press (EDP)

Newspaper (online): Evening News Online, EDP24

Radio: BBC Radio Norfolk, Future Radio

This resulted in a potential reach of 877,000 across the East of England.

Topics included: STP public meeting, GP report (Part two), Sector response to GP report

August…

Healthwatch Norfolk were mentioned 17 times in separate bulletins/channels

Newspaper (print): Evening News, EDP

Newspaper (online): Evening News Online, EDP24

Radio: BBC Radio Norfolk, Future Radio

This resulted in a potential reach of 377,000 across the East of England.

Topics included: Mental health crisis report, Alex Stewart’s commentary on Antek Lejk’s

appointment to the STP, Healthwatch Norfolk and Stand Easy’s veteran study

Social Media – Twitter/Facebook July…

Twitter: Profile visits – 1451, Tweet impressions (number of times that our tweet could be seen) –

30.9k, Mentions = 89, New followers - 22

Facebook: Total page likes – 518, Total reach - 3404

August… Twitter: Profile visits – 826, Tweet impressions – 26.2k, Mentions – 41, New followers – 26

Facebook: Total page likes – 530, Total reach - 3299

Above: The panel at the STP Public meeting in July 2017.

Agenda Item: 6.4

Report on: Risk Register

Author: Judith Bell

Date: October 2017

Things that may impact upon success of HWN

Likelihood x consequence

score

Possible mitigations Increasing Risk/Decreasing Risk/No change in risk rating

1. Insufficient financial reserves to deal with substantial proposed funding cuts.

4 x 4 = 16 Ongoing review of expenditure and forecast budget for 2018-19 by Finance Sub Group. Sourcing alternative funding opportunities.

→

2. Poorly defined and poor delivery of HWN role in consultation/engagement around Sustainability and Transformation Plan (STP).

3 x 5 = 15 Continual dialogue with all STP stakeholders.

Ongoing review of resources within HWN to deliver as HWN role is defined.

→

3. Failure in timely delivery of quality outcomes by organisations who are successful in bids for projects resulting in potential damage to HWN reputation.

2 x 4 = 8 Ongoing robust monitoring of project delivery by Quality Control Sub Group. Letter of agreement now includes clause relating to financial penalty should the project be delayed

→

4. Failure to respond promptly and appropriately to media requests following publication of Care Quality Commission (CQC) Reports that are not shared in advance with HWN.

4 x 2 = 8 Discussions continue at local and regional level with CQC representatives – joint lobbying with other stakeholders

→

Agenda Item: 6.5 HWN Board – Quality Control Sub Group

Minutes of meeting held 4th October 2017 at HWN Offices Wymondham

Present: David Trevanion (DT) – Chair, William Armstrong (WA), Alex Stewart (AS),

Judith Bell (JB), Mary Ledgard (ML), Sonia Miller – minutes

1. Apologies – None

2. Minutes of Last Meeting

Point 3. Matters Arising - ML said that when HWN were considering using

external people for project work, we should interview them to confirm their

skills etc. before committing to taking them on.

3. Matters Arising - None

4. Scoping Paper for Autism Services Project

Steph Tuvey (ST) joined the meeting.

DT thanked Steph for the scoping paper outlining the key lines of enquiry

and asked her to explain her findings.

Steph explained that autism is a very complex area in Norfolk and covers a

wide spectrum of needs. It is currently being discussed at the HOSC

meetings and the All Age Autism Strategy for Norfolk is also being prepared

and the information in the HWN report will feed into this.

Waiting times for a diagnosis is a key area of concern in Norfolk and the

service is currently looking at how changes can be made to this. Adults with

autism also have difficulty in accessing any services.

HWN will focus on working with parents/carers of children with ASD as there

is currently no post diagnosis support available in Norfolk. HWN will find

out what support they need, their concerns and how they would like the

support delivered. There is also a lack of understanding in schools and by

GPs on how to make referrals – HWN will look to increase awareness of what

support is available.

DT asked how HWN will explore what information and knowledge is available

at GP surgeries – have they received any training? ST said that HWN would

talk to staff at surgeries, attend Practice Managers meetings, undertake

Enter & View visits to look at the environment and talk to parents and

carers. ML said that there is an “information pack” which is used for

dementia patients and there could be something similar made available for

GPs/parents/carers.

(Bill left the meeting)

DT said that there is a new school recently opened in Norwich – The Wherry

– which a special school for children with autism – it would be useful to

make contact with them to talk to staff, and possibly pupils about their

experiences.

GY&W do have a referral pathway and a support service for those waiting

for a diagnosis – HWN will talk to those involved with this provision.

ML said that it would be useful to involve Family Voice and Carers Matters

Norfolk in this project research. Also Tony Darwood (volunteer) has good

knowledge of autism.

5. Follow up activity:

Integrated Community Equipment Service & Pressure Ulcer Project

Sam Revill (SR) joined the meeting.

SR said that the two summer interns working at HWN assisted with collating

the information from surveys/questionnaires sent to the care homes.

HWN followed up with care homes about the concerns that were highlighted

regarding the knowledge/training of staff regarding pressure ulcer care and

also the sharing of information by community nurses with the staff in the

care homes.

They surveys showed that 80% of care home staff had received some training

on pressure ulcers over the last year. There is no requirement for care

homes to train their staff in this specific area. Communication between

community nurses and care home staff has also improved.

The sub group agreed that these findings should be shared with NCC and JB

took this information to recent meeting at NCC.

Reablement Services

The interns also did some desk-based research on this project.

HWN looked at the expenditure on and provision of reablement services

since November 2016.

The findings showed that NCC are spending less on this service and the trend

is downwards. However, the Adult Social Care Committee paperwork shows

that some CCGs have invested funds into this service themselves.

There have been savings made within this services, but the sub group felt

that perhaps the eligibility criteria for the service may have changed in

order to reduce the number of people receiving this service.

6. Project update on GP Out of Hours & NHS 111 Priority Project

SR said that desk research had been carried out, meetings with stakeholders

and service providers and engaging with people with hearing loss

SR has taken this results from this research back to Deaf Connexions and

prepared a brief project plan which they will deliver on our behalf,

particularly looking at people with hearing loss accessing the out of hours

service. Deaf Connexions will provide HWN with the expertise, and possibly

accompany HWN, to visit some GP surgeries and community bases who

provide an out of hours service.

HWN will also carry out Enter & View visits to surgeries and communities to

assess the service and also ask people who have a hearing loss to carry out

some visits (experts by experience) to visit the out of hours service and

feedback their experiences to Healthwatch.

SR will also carry out a mystery shopping exercise and hold a workshop to

talk to people in the deaf community about their experiences and then

produce a summary report, together with the British Sign Language

Association, which will then go onto the HWN website.

ML suggested that it would be worth checking whether those running the out

of hours service bases operate an appointment system.

7. Scoping Paper for Dentistry in West Norfolk Project

Fennie Gibbs joined the meeting (FG)

FG handed out the scoping paper and a summary sheet to those at the

meeting and summarised the key lines of enquiry.

Concerns about dentistry services in West Norfolk arose from intelligence

HWN had received, together with other sources, RAF Marham and Public

Health, national data sources.

The focus will be on how children and young people access the service,

which is poor is West Norfolk compared to other CCG areas. HWN will be

looking at why access is difficult – accessibility, transport, waiting lists, NSH

Choices website being updated. This will be done in the form of a survey

and feedback will be provided to dentists.

DT asked what the phrase “distance decay” meant – FG explained that this

was if a member of the public lived a long way from a service they are less

likely to visit regularly.

DT and ML said they would read through the scoping paper and come back

to FG with any further comments.

8. Any Other Business - none.

9. Date of next meetings

3rd January 2018

4th April 2018

4th July 2018

3rd October 2018

Agenda Item: 6.6 HWN Board – Finance Sub Group

Minutes of meeting held 4th October 2017 at HWN Offices, Wymondham

Present: William Armstrong (WA) – Chair, Alex Stewart (AS), Judith Bell (JB), David

Trevanion (DT), Graham Dunhill (GD), Sonia Miller – minutes

1. Apologies – none.

2. Minutes of Last Meeting (22/6/17)

The minutes had been circulated and were agreed as read.

3. Matters Arising

None.

4. Financial Activities and Balance Sheet to date Reports

Financial Activities:

JB explained that these figures had been prepared over a few days so there

may be slight variances due to amounts being entered via Quick Books.

The figure shown in Payroll Expenses is the total salary costs, i.e. net salary

plus on costs. When Larking and Gowen produce the quarterly figures the

net salary, on costs and pension are allocated in different columns.

The figures show a total income of £249,611 – with governance costs

£247,599.

Net income is -£11,355 however this does not include £36,000 income due

for the Mental Health project carried out on behalf of NHSE, which will

therefore negate this loss.

Balance Sheet:

This sheet details the current bank balances.

Savings are held in 5 separate accounts, therefore protecting HWN

investments. Despite current low interest rates the committee were happy

with the investments made.

5. Budget v Actual and Budget Forecast Reports

JB produced spreadsheets showing Budget v Actuals and a Forecast sheet.

JB explained the notes relating to the following:

Other Income - £36k not yet paid by NHSE for UEC Network Mental Health

project. Also £20,612 consists of £8k PPV, £2800 SNCCG Dementia Training

Evaluation, £5211 NNAB, and £4600 Norwich CCG from Jan ’17.

Bank Charges – refund received £485.

Insurance – the premium is paid for the whole year. Saved £380 by sourcing

alternative quotes.

Rent & Rates – includes annual site charges of £5484 paid in Q1.

Legal & Professional Fees – Q2 includes £460 for Gp Life Cover arrangement

fee and £900 set up for Pensions auto enrolment.

Net Salary & Payroll Expenses – JB includes this total under Payroll

Expenses and L & G quarterly figures split NI, Pensions, net salary.

Projected Salary Spend – under budget £59k

DT said that it is difficult to understand the payroll expenses figures

presented on the spreadsheets, although found the separate sheet detailing

the actual and forecast salary costs very helpful. This shows a saving due to

a reduction in staffing and other changes. JB said that she would speak to

Larking Gowen to see if she could receive training to produce the figures in

the same way as them (i.e. splitting net salary, NI, pension) to make the

figures clearer. JB said that she would continue to produce a separate

sheet detailing the salary costs.

JB explained that there are also differences in the way the budget was

prepared in previous years (i.e. project costs were not included).

ACTION: JB to speak to L&G re training & continue to produce separate

sheet detailing staffing costs for the committee.

6. Future Funding & Income Generation

AS said that he had recently received information that cuts to HWN funding

would take place from April next year, not in 18 months as previously

advised. There will be a meeting at NCC next week to discuss future

funding.

AS and WA met with Margaret Dewsbury, Chair of Communities Committee,

last week to discuss HWN concerns.

AS outlined the detail to the meeting:

Current Income: £458k (2017/18) & theoretically for 18/19

However:

£238k (DH ring-fenced funding)

£100k (PH funding)

_____

£338k TOTAL for 2018/19

Current Running Costs:

2017/18 - £527k forecast

Potential deficit for 18/19 - £189k

Current Reserves:

£25k - Barclays savings

£87k - Cambridge savings

£60k - Charity Aid Foundation

£60k - Nationwide savings

£100k - Current Account

_____

£332k TOTAL

Therefore:

Reserves £332k

Deficit £189

Reserve balance £143

ERGO: Insufficient reserves to fulfil HWN Reserves policy & Charity

Commission Regulations.

AS said that he would prepare a letter today (for WA to sign) and email to

the committee for approval, to send to the Communities Committee, by the

end of the week, outlining a proposal from the Finance Committee

regarding our future funding.

The proposal would be to have phased cuts over 3 years:

Year 1 - 25%

Year 2 - 50%

Year 3 - 75%

The letter will also highlight the following:

Empathise with need to find savings

Ongoing cuts since inception

Independent – patient/carer/user voice, reports have led to change

Involvement in range of partnering organisations representing

“consumer voice”

Concerns – reduction in quality and potential for destabilisation and

possible loss of key staff.

Solution proposal:

Staggered approach

Recognising that we can source other monies but takes time to do

The NCC Communities Committee is meeting again in November and it is

proposed that Alex, Judith, Sam and Chris will meet (18th Oct) to discuss

what recommendations they will make as a result of the funding changes

and sustain the current workforce and work in the future to carry out

effective work to represent the voice of the public regarding the services in

Norfolk.

The Finance Committee will meet again on the 1st November to discuss the

proposals put forward from the Senior Management Team.

WA pointed out that these cuts were undermining HW’s independence and

HWE should be challenging the DoH to take forward the concerns of HW

across the country.

ACTION: AS to prepare letter to send to NCC

AS to advise the Board of the position via email after the

meeting

AS to ask Chris to prepare a press release to be issued when

the meeting takes place next week

7. Date of next meetings

1st November – additional meeting

3rd January 2018

4th April 2018

4th July 2018 – WA unavailable

3rd October 2018

Agenda Item: 6.7 MENTAL HEALTH SUB GROUP MEETING

10 – 12.30 - TUESDAY, 26th SEPTEMBER 2017

1. Apologies

Gary Page, Debbie White, Jeff Stern, Tony Woods

Present:

Bill Armstrong (Chair), Alex Stewart, Judith Bell, Helen Jackson, Mike Clemo,

Robert Ashton, Marcus Hayward, Sheila Preston, Dr Sophie North,

2. Notes of meeting held 25 July 2017

Mazars report (unexpected deaths) there had been no response from Debbie White

re. sharing the executive report that had gone to the Board of NSFT.

ACTION MH said he would follow this up.

3. Mental Health Concordat Protocol

BA explained this was on the agenda as a member of public had called into

question HWN position in signing the Concordat. The member of public had

outlined issues relating to his son’s mental health care that he said demonstrated

that the aspirations of the Concordat were not being achieved.

AS said that the partner organisations are all trying to achieve the aspirations and

it is correct that we should sign up.

SP expressed concern that when asking questions of NSFT about “what themes are

emerging,” answers are not forthcoming.

WA said HWN needs to attend next Concordat meeting and ensure our report on

Mental Health Crisis is presented to them on agenda. SP suggested a carer is

needed at meeting if not already present.

MH agreed and said NSFT wish to include more service users in the shaping of their

services and ask them what they want. He said that there are developments such

as the Crisis Hub as an alternative to A&E. MH is keen to identify people to help

formulate new processes.

ACTION JB to put the member of public in touch with MH to participate in

improving services.

4. Introductory discussion highlighting the needs of displaced people in mental

health crisis

(a) Background statistics – Dr Sophie North

(b) Cultural sensitivity

(c) Language translation services

(d) Outcomes – way forward, e.g. education protocol, named point of Reference

etc.

HJ introduced this item saying she had been involved with “City of Sanctuary” –

supporting refugees and asylum seekers and their mental health needs. HJ

explained that there are issues around having appropriate pathways for crisis

situations – the police often end up as lead agency and because of cultural issues

this is not ideal.

HJ said there is no formal treatment pathway for PTSD in Norfolk.

HJ said this is a highly vulnerable group (small numbers) in city and some have very

specific needs. City Reach link them into GPs but the Sexual Health Unit had been

recommissioned and therefore referrals to psychology unit are not happening as

previously was the case.

AS asked who commissions City Reach. (CCG or Specialist Support Unit?)

HJ presented a case study to illustrate the situation.

MC said that most young people arrive in this country alone. If they are 16 and

under they go into foster care, and if 16-18 they go into Local Authority supported

accommodation.

MC said that the average GP practice is not well versed in mental health issues of

asylum seekers, and culturally it may be difficult for individual to speak about MH

issues. Social worker support is variable due to resourcing issues of the Local

Authority. Often they are frightened to talk if they have not yet had their asylum

status approved – as they fear being sent back.

Dr SN reiterated that PTSD has no referral pathway. The PTSD Leaflet sent by

Wellbeing Service is inappropriate - e.g. it talks about it being good to be at work

which is not appropriate for asylum seekers.

MH said that the Wellbeing Service is intended for the “high volume/ lower level”

Mental Health issues.

MH said there should be funds from LA to deal with this. HJ said she believes the

funds available are for Syrian refugees only and not for others and this is only

available for very limited numbers.

HJ said that what would be helpful/responsive would be:

-Access to services in times of crisis

- Access to treatment of PTSD

- A funded member of staff to work with this group to help.

HJ said there had been haphazard help through GUM clinic and from UEA

psychologists.

MC raised issue of funding to MH services being disproportionately allocated to

dementia services.

AS said there is a need to take the case to commissioners and explain that failure

to act results in £X costs to NHS /social care.

AS suggested there should be a simple case presentation at the regional CAMHS

forum and also presented to QSG - where the report is able to demonstrate failure

in system delivery (but would need comprehensive report.)

It was mentioned that there are Issues re CBT treatment of PTSD when there are

language issues. MH said they have been seeing an increase in INTRAN service for

CBT. Dr SN said that evidence narrative exposure can be helpful.

AS advised that HWN are hosting a conference on Mental Health Crisis on 7th

November to discuss the findings of the HWN recently published Mental Health

Crisis report.

HJ asked about crisis café. MH said he is excited about Crisis Hub plans.

HJ asked if MH wants a voluntary sector representative to attend meetings about

the Crisis Hub plans. MH said carers and users are involved with these plans.

HJ offered to find a service user to be involved with Crisis Hub plans.

MH said that a pilot is needed to evidence savings and show clear outcomes that

can be measured. HJ said that even when there is clear evidence, lack of funds

can mean it is not supported.

HJ said that what is needed is people with specialist knowledge of these issues

that can represent/advocate for this group.

MR offered to raise this with a member of staff who is responsible for “hard to

reach groups” - Ravi Seenan

Actions/Ways forward:

- AS meet with SN and MC outside of this meeting to formulate potential further

actions

- MC to provide info to HWN and MH re JB to attending the IN Group meeting (MC

to provide more info) from Nov onwards

- 7th Nov conference to discuss MH Crisis report- could include section on this

issue SN and MC asked if could present on the issues. MC and SN are both

available (include a service user) HWN to arrange this.

- HWN to clarify who commissions City Reach.

Date of next meeting – 10 am 21.11.2017