APPENDIX A

NEWARK AND SHERWOOD DISTRICT COUNCIL

HEALTH TASK AND FINISH GROUP

Findings and recommendations of the task and finish group’s consideration of health issues affecting Newark and Sherwood

February 2013

FOREWORD

There have been enormous changes in the roles and structures of government bodies and in their capacity to deliver in recent years. The health scene has been particularly challenged by very fundamental change and is faced with complex resource issues. Whilst there may be arguments over the extent to which the government is sustaining the funding of the Health Service in its narrow sense, there can be no doubt that its wider provision is in funding jeopardy. It will, of course, always be the case in this area that the demand and need for resources grows faster than the capacity of the services to deliver, whatever government is in control. This is especially true of an aging population and Newark & Sherwood’s population is older than average.

The Localism Act has extended the District Council’s responsibilities and we now clearly have a general concern for the well-being of our communities. It was clear on this Task group that this concern was real and extended across any political divide. The Group worked effectively together, well supported by officers, to understand the changes that have occurred and are still to come, to listen to the evidence presented and interrogate it, and to engage with the concerns and issues presented by all the organisations we met, both statutory and voluntary. There was a real concern to ensure the most vulnerable were supported and to reduce the disparity of benefit.

The Purpose of this report is to respond to the opportunities that these radical changes may offer. We want the Authority to play a positive role in representing its people and in helping with the delivery of services that meet their needs. We may do this through being a critical friend, through helping with funding of specific projects and through ensuring our policies and practice across the Council complement and do not conflict with health purposes. We believe that there is a common understanding of the desirability of this, both within and beyond the Council, as evidenced by the Partnership Accord. We hope that the Council will respond positively to the ideas we offer and put these into swift action.

We would also like to record our thanks to all the organisations which came to talk to us, for their time, for their commitment to our communities, and for the difference they have already made.

Councillor David StaplesChairman of Health Task and Finish Group

Vice-Chairman of External Relations and Partnerships Overview and Scrutiny Committee

Councillor Paul HandleyVice-Chairman of Health Task and Finish GroupChairman of External Relations and Partnerships Overview and Scrutiny Committee

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EXECUTIVE SUMMARY

Amongst its many services and achievements, Newark and Sherwood District Council has a long history of addressing the social determinants of health. The Public Health (Control of Disease) Act 1984 gave local authorities wide ranging public health functions. Under the Health and Social Care Act 2012 significant new public health functions have become local authority (upper tier and unitary authorities) responsibilities that are complemented by the activities of district councils.

The Department of Health, in a briefing published in October 2012 titled “The new public health role of local authorities” describe their vision for public health in local government. The Council has a responsibility to continue to promote a social perspective of health.

The district’s health profile and Nottinghamshire Joint Strategic Needs Assessment identifies a range of health inequalities within the area and specific challenges. The NHS reforms provide a new impetus for partnership working with organisations such as the clinical commissioning groups (CCGs). Decision making is anticipated to be more locally based as 6 general practitioner led CCGs (Ashfield and Mansfield are combined) and a multi-disciplinary health and wellbeing board replace 2 primary care trusts (NHS Bassetlaw and NHS Nottinghamshire County). However, whilst locally there are promising signs, these reforms are in their early stages and are taking place at a time of austerity in public sector funding, rising living costs, declining household incomes, rising expectations and growing population including vulnerable elderly and isolated individuals.

The Council and its arms length housing company, Newark and Sherwood Homes Limited, have a track record of providing services that address the social determinants of health including housing, leisure and environmental health and these are complementary to NHS, social care, voluntary and community services and the care and support provided by individuals. These are set out in our Health and Wellbeing Delivery Plan.

The district council’s External Relations and Partnerships Overview and Scrutiny Committee (ERPOS) established a Health Task and Finish Group to consider these opportunities and issues and make recommendations. The Group’s remit included:

Developing an understanding of the changes within the NHS, commissioning intentions of the district’s CCGs and Nottinghamshire’s Health and Wellbeing Board

Considering the extent to which the commissioning plans will meet the needs of local communities, identifying potential gaps and liaising with funders regarding commissioning intentions and future service provision.

Considering what can be done from a social health perspective to prevent people becoming patients in the first place.

Working with the CCGs to identify opportunities for joint commissioning around specific shared priorities and groups of residents.

Formulating recommendations to ERPOS regarding health services, future commissioning projects and service provision.

Consideration of the implications of changes to hospital transport services (this was considered by ERPOS).

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Having considered key documents such as the district’s health profile, Nottinghamshire Health and Wellbeing Strategy and the CCG commissioning intentions and heard evidence from Newark and Sherwood CCG, Nottinghamshire County Council, Newark and Sherwood Homes Ltd, Hetty’s, CASY, Age UK, Think Children, Alzheimer’s Society and Newark and Sherwood Community and Voluntary Service, the Group recommend that:

1. The draft Health and Wellbeing Plan be recommended for endorsement by External Relations and Partnership Overview and Scrutiny Committee and Cabinet. The plan is then to be distributed to partners including the GP practices that are part of the district’s CCGs in order to highlight the alignment of our services with their strategies and commissioning intentions.

2.a That, given the importance of health to the community and, in particular, the Council’s strategic objectives relating to its “People” priority, a Health Working Party is established this year reporting to the proposed Customers and People Committee.

2b. The proposed working party should meet at least quarterly and be open to the public. The remit of the working party should include:

Reviewing performance of and significant policies and plans developed by East Midlands Ambulance Service (EMAS), the district’s CCGs, Sherwood Forest Hospitals NHS Foundation Trust and Nottinghamshire Health and Wellbeing Board for example the Director of Public Health’s the annual report.

Reviewing the implementation of the Council’s Health and Wellbeing Delivery Plan.

Maintaining an overview of the implementation of changes within the NHS and future commissioning intentions of the district’s CCGs and Nottinghamshire’s Health and Wellbeing Board

Monitoring general conformity with and proposing developments of the Partnership Accord for Health in Newark and Sherwood agreed by Council on 18 December 2012.

Considering the extent to which the commissioning plans will meet the needs of local communities, identifying potential gaps and liaising with funders regarding commissioning intentions and future service provision.

Considering what can be done from a social health perspective to prevent people becoming patients in the first place including relevant Council policies and practices.

Convening meetings of all relevant agencies to discuss health related issues, concerns, progress with initiatives, benchmarking service provision and local facilities, etc.

Working with the CCGs to identify opportunities for joint commissioning around specific shared priorities and groups of residents and acting as a critical friend drawing upon the Council’s community leadership role and networks.

Formulating recommendations to Customers and People Committee regarding health services, future commissioning projects and service provision.

2c. The working party should be made up not so much on political party lines as on an area and type of community basis – it should include councillors who represent rural

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villages, ex-mining communities and key settlements. The committee should include those who represent the Council on relevant health bodies and have the ability to co-opt appropriate non-voting external advisors invited from organisations such as Healthwatch, CCGs, voluntary and community organisations including Newark and Sherwood Community and Voluntary Service.

2d. Subject to the establishment of the Health working party, it is recommended that Child and Adolescent Mental Health, Dementia and Maternity services should form an early part of the work programme.

2e. That the appropriate Committee under the new constitution considers future and further funding of the district’s Family Intervention Project.

3a. That elected member representation from the Council should be part of the following outside bodies:

Nottinghamshire Health and Wellbeing Board Newark and Sherwood Clinical Commissioning Group (Strategy

Group/Stakeholder Reference Group) Nottingham North and East Clinical Commissioning Group Nottinghamshire County Council, Health Scrutiny Committee Local Medical Practice User Groups Sherwood Forest Hospitals NHS Foundation Trust

3b. That elected members, appointed by the Council to any of the outside bodies listed in 3a above be required to update the Health Working Party referred to in Recommendation 2a or the proposed Customers and People Committee on a minimum of two times per year.

4. There needs to be a close link with Health Watch when it is fully set up – discussion about how this could work ought to be initiated with Nottinghamshire County Council.

5. That the Council’s lead officer for health issues should be the Director of Communities.

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Section 1: Introduction/Background

1.1 District Council’s context

1.1.1 Local authorities are faced with a continual challenge to do more with less. This challenge is more pressing given reductions in public sector funding following the Comprehensive Spending Review 2010. This resulted in the formula grant for Newark and Sherwood District Council being reduced by 28.8% or £2.97-million over the two year period 2011/12 and 2012/13. Taken together with the council tax freeze, this has resulted in a reduction in the council’s annual budget of more than £3-million.

1.1.2 The level of Government funding for 2013/14 has recently been announced. It indicates further reductions in external funding for local authorities in general and for district councils in particular and that the austerity measures are likely to continue to 2017/18.

1.1.3 Within this context, the Coalition Government’s Localism and Big Society concepts encourage innovative approaches to service delivery, a greater focus on outcomes and a smaller role for government at local, regional and national level in service delivery.

1.1.4 Local authorities have a range of legal powers that enable and encourage this change. The Localism Act will devolve greater powers to councils and neighbourhoods give councils a general power of competence and provide new powers to help save local facilities and services threatened with closure, and giving voluntary and community groups the right to challenge local authorities over their services. Meanwhile, the Open Public Services White Paper sets out the Government’s public service reform programme, which aims to ensure everyone has the choice and control of the services they use, by ending what they see as an old fashioned, top down, take-what-you-are-given model.

1.1.5 To achieve this, the White Paper sets out five principles for modernising public services:

Choice Decentralisation Diversity of provision Fairness Accountability

1.1.6 It is clear that over the next few years the Council will require more savings, be leaner and have less capacity, while the policy context signals a shift towards a more varied mix of service delivery and devolution with a sharp focus on economic growth. Accordingly, the Council’s role as a community leader may come increasingly to the fore.

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1.2 Newark and Sherwood District Council’s strategic priorities

1.2.1 On March 8, 2012, Council agreed its priorities for the period 2012 – 2016. These, in order of priority, are:

1. Prosperity2. People 3. Place4. Public service.

1.2.2 A number of strategic objectives were also approved and these form the broad thrust of activities that will help deliver the above priorities. These are set out in Appendix A.

1.2.3 The Department of Health, in a briefing published in October 2012 titled “The new public health role of local authorities” describe their vision for public health in local government. The Council’s Health and Wellbeing Delivery Plan (see Appendix B), including that of its arms length housing company, Newark and Sherwood Homes Limited, sets out the range of current activities that contribute towards health. There are other strategic issues that could be considered and these are set out below:

Prosperity: This implies a healthy and active workforce. The Council needs to ensure its population is physically and mentally well. Issues of healthy eating, physical activity, freedom from drug abuse and a positive sense of self are fundamental. The Council is already delivering some of this through its leisure centres and range of sporting and cultural development activities.

People: Self-evidently a concern for the welfare of our communities includes a fundamental concern for their health. The Council can demonstrate this through the Partnership Accord on Health in Newark and Sherwood, active scrutiny of health providers and the work of the Health Task and Finish Group.

Place: The Council should continue to be a champion for rural areas. It should also be concerned about the disadvantaged and ensure access to health care is good but also that the factors causing bad health are minimised e.g. planning policy and proliferation of fast food outlets in particular communities. The Council’s scrutiny of EMAS and its failure to address its relative poor performance in certain postcode areas demonstrates active community leadership.

Public Service: As a lower tier Authority, the Council has relatively more councillors with a closer knowledge of their smaller wards. This local knowledge is enhanced by connections with parish and town councils and other local groups. The Council should make more use of this to represent effectively the interests and needs of its communities. The Council should participate in supporting (e.g. Partnership Accord for Health in Newark and Sherwood) and monitoring the quality of health provision – this implies involvement in other agencies with a sharing of information within the Council and a Committee (or working party) set up to monitor performance.

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1.3 Emerging issues for consideration

1.3.1 The public sector landscape is continuing to change, with the only certainty seemingly being that there will continue to be fewer resources available in the immediate future. Against this backdrop, it is vitally important that the council is able to forge meaningful partnerships and relationships with stakeholders who can help the authority deliver the outcomes local people want and require.

1.3.2 The Council has a pedigree of partnership working. Through the Local Strategic Partnership, the Local Area Agreement reward grant was used to fund schemes such as the Family Intervention Worker and Street Pastors. The Bassetlaw, Newark and Sherwood Community Safety Partnership brings together a number of organisations to work together with local people to build safer and stronger communities. The Council’s housing management company, Newark and Sherwood Homes (NSH), was able to access £49-million of government money to improve the condition of tenants’ homes. Our community nutritionists work in partnership with the NHS to promote healthy diets and lifestyles.

1.3.3 But, while there have been some notable successes, partnerships could have gone further. While the Council has, for example, shared a number of posts with other authorities, it has not shared fully integrated services in the way some have.

1.3.4 Moreover, while the Council has commissioned partners, such as the Citizen’s Advice Bureau, to provide debt advice services in the district, it hasn’t to date jointly commissioned services with partners to deliver services and outcomes where there is a specific local need. The changes in the health service landscape present opportunities to look at this issue particularly with the new CCGs.

1.3.5 Alternatively, through the Localism Act and Open Public Services White Paper, the Council could choose to move away from direct delivery altogether in favour of devolving service delivery to town and parishes and community groups, or opening up services to alternative provision.

1.3.6 The Council and its arms length housing company set out the extensive contribution its services currently provide to maintain and improve public health in a Health and Wellbeing Delivery Plan (see Appendix B). These services are complementary to those of the NHS and social care. The Council has a track record of delivery demonstrated by several international awards in the United Nations 2009 International Awards for Liveable Communities (LivCom).

1.4 Establishment of the Health Task and Finish Group

1.4.1 In discharging its remit, the Council’s External Relations and Partnerships Overview and Scrutiny Committee has maintained an overview of reforms with the NHS and has been scrutinising significant local health organisations including Sherwood Forest Hospital NHS Foundation Trust, East Midlands Ambulance Service and the two shadow CCGs. Given the scale and potential impact of the reforms upon the district’s

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residents, the Committee, on the 4 July 2012, established a dedicated Health Task and Finish Group and its remit is attached at Appendix C.

1.4.2 The Committee felt that due to confidentiality issues the Task and Finish Group should convene “in camera” but that the group should publish a comprehensive record of its work and recommendations.

1.4.3 The Task and Finish Group includes the following councillors:

Cllr David Staples, Chairman, Labour Cllr Paul Handley, Vice-Chairman, Conservative Cllr Mrs Maureen Dobson, Independent Cllr Mrs Trish Gurney, Labour Cllr Julian Hamilton, Liberal Democrat Cllr Mel Shaw, Conservative

1.4.4 These councillors represent urban and rural parts of Newark and Sherwood and a range of political parties.

1.4.5 A number of external organisations provided briefings and presentations and the Group wish to formally thank those representatives for their contributions.

1.4.6 The Group also referred to the following background documents:

District health profile 2012 Nottinghamshire Health and Wellbeing Strategy 2012-13 Nottinghamshire Joint Strategic Needs Assessment Newark and Sherwood CCG Integrated Plan 2012-13

1.5 Summary of the NHS reforms under the Health and Social Care Act 2012

1.5.1 One of the most significant areas of change in the public sector is in health following the Health and Social Care Act 2012. From April 2013, groups of GPs and other key healthcare professionals will be responsible for around 80% of the healthcare budget in their area and will plan and pay for services for the local population. These groups will be called CCGs (CCGs), (formerly known as GP Consortia) and will buy services from the hospitals, ambulance service and community service providers.

1.5.2 There are two CCGs covering Newark and Sherwood – Newark and Sherwood CCG and Nottingham North and East CCG. In Nottinghamshire, budgets have already been devolved to CCGs so that they are responsible for local commissioning decisions.

1.5.3 The CCGs will cover all GP practices in their area, and they will each have a governing Board who will be responsible for making decisions about healthcare. The Board will include GPs, nurses, hospital doctors, other healthcare professionals such as physiotherapists and patient representatives.

1.5.4 Local leadership for public health is at the heart of the new public health system. Upper tier and unitary authorities have new responsibilities to improve the health of

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their populations. Upper tier councils will be supported in this by the existing expertise within district councils. In addition, the changes have also seen the creation of Health and Wellbeing Boards (HWB), to set a health and wellbeing strategy that provides guidance to CCGs on commissioning as well as a partnership vehicle in which to consider needs and services beyond the boundaries of each individual CCG, to support improvement in public health and achieve efficiencies and greater effectiveness in delivery.

1.6 The relationship between a CCG and the Health and Wellbeing Board

1.6.1 Each CCG has a seat on the Health and Wellbeing Board (HWB).

1.6.2 CCGs will be supported and held to account by an independent NHS Commissioning Board. The HWB can resort to the NHS Commissioning Board should local difficulties occur.

1.6.3 The diagram at Appendix E illustrates the relationship between elements of the reformed NHS structure.

1.7 Current local state of the transition

1.7.1 Many aspects of the NHS reforms are due to take effect from 1 April 2013.

1.7.2 The Health and Wellbeing Board is in shadow form at Nottinghamshire County Council: Joint strategic needs assessment published Health and wellbeing strategy published Former PCT public health team now transferred to Adult Social Care, Health and

Public Protection, and based at County Hall, West Bridgford.

1.7.3 The 2 CCGs covering Newark and Sherwood district have: developed commissioning plans that have been considered by the Health and

Wellbeing Board Developed their governance structures and are seeking authorisation from the

Department of Health

1.7.4 The CCG commissioning themes are:

Newark and Sherwood CCG Nottingham North and East CCG Cardiovascular disease (heart disease

and diseases of the circulation) Diabetes Mental illness Respiratory disease (includes

smoking) Dementia End of life care

Smoking Obesity Diabetes Avoiding inappropriate admissions Chronic Obstructive Pulmonary

Disease (COPD) Trauma and Othopaedics Depression

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Early years development Dementia Care Home admissions End of life Targeting early years Children and Adolescent Mental

Health services

1.7.5 The Group identified that the 2 CCGs are showing promising signs, evidenced by consultations and partnership summits, accessible websites, service developments such as PRISM and a willingness to engage with local authorities. Whilst the CCGs are in the initial stages of transition, there appear to be gaps in the commissioning themes relating to measures addressing the social determinants of health e.g. housing. It is important that the Council is able to use its community leadership role to protect and promote the health of its local residents.

1.8 Social determinants of health

1.8.1 The social determinants of health are summarised in the following diagram:

1.8.2 The Council’s health and wellbeing delivery plan provides an indication of the types of services and interventions that address the social determinants of health and these are complemented by the extent of services provided by the community and voluntary sectors and by individuals particularly carers. The Group identified that many of these services are in jeopardy or coming under increasing pressure due to factors such as rising demand, reducing funding and increasing costs. These are further explored later in this report at Section 6 and 7.

1.9 Partnership Accord for Health in Newark & Sherwood

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1.9.1 In December 2012, the Council, Newark and Sherwood Clinical Commissioning Group and Sherwood Forest Hospitals NHS Foundation Trust gave their full support to the following partnership accord:

“We commit our organisations to maintaining: High quality primary and secondary health care for the people of Newark &

Sherwood. A strong and positive future for Newark Hospital within the Sherwood

Forest Hospitals NHS Foundation Trust. Accessible and safe healthcare experiences for patients across Newark &

Sherwood District that are as close to peoples' homes as possible.

We will work together, with our partners, patients and the public to deliver these commitments.”

Newark and Sherwood Clinical Commissioning GroupNewark & Sherwood District CouncilSherwood Forest Hospitals NHS Foundation Trust

1.9.2 There are a range of other important healthcare services. Work to further develop and implement the Accord should be undertaken and this should include consideration of other relevant NHS bodies such as EMAS and Nottinghamshire Healthcare NHS Trust.

Section 2: Reformed NHS structure

2.1 There are a wide range of organisations within the current and reformed NHS structure. A simplified local structure from April 2013 is set out in Appendix E together with a brief description of key organisations.

Section 3: Future health role of Newark and Sherwood District Council

3.1 The district council, amongst its many activities, has a track record of service provision that addresses the social determinants of health and conforms with the Department of Health’s vision of the public health role for local authorities. The extent of these services, and of its arms length housing company, are set out in the Council’s health and wellbeing delivery plan (see Appendix B). These services align with all of the commissioning themes set by the Nottinghamshire Health and Wellbeing Board and the 2 CCGs covering the district.

3.2 However, many of these services are often discretionary in nature and could be at risk due to public sector funding reductions and local policy changes. It is important that the Council is able to demonstrate the value and impact of its services particularly for those that are joint funded and that may indicate a need for an

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ongoing monitoring role for officers/councillors and continued community leadership.

3.3 The high profile coverage of issues regarding Newark Hospital, Sherwood Forest Hospitals NHS Trust and East Midlands Ambulance Service demonstrate a need for regular performance monitoring of health service providers at a local level and of the community leadership role of elected representatives. The case for this role is amplified given the scale of reforms within the NHS and within the EMAS estate. For example, the Task and Finish Group identified significant underperformance and variations in performance when scrutinising EMAS performance information and that this level of data did not appear to be routinely monitored by the EMAS Board.

3.4 Similarly, scrutiny of performance is also justified by the extent of health inequalities across the district and within local communities. This level of monitoring is important due to pockets of deprivation often being masked by ward or district level statistics and because population changes arising from housing development may exert new pressures.

3.5 The Department of Health document “The new public health role of local authorities” states at page 6:

“To assist directors of public health in fulfilling this health protection role we recommend local areas consider setting up a health protection forum or committee, possibly linked to the health and wellbeing board, for example as a sub-committee of the board.

Such an arrangement would help ensure that all key organisations met regularly, shared information and planned effectively.”

3.6 The Health Task and Finish Group was mindful that health services are currently regulated, inspected and scrutinised by a range of bodies such as Monitor, Healthwatch, etc and that providers will have a complaint system. The proposed Health working party would not seek to duplicate these but serve as a critical friend.

Section 4: Proposals

4.1 Democratic deficit

4.1.1 The Group identified what it believes to be a democratic deficit within the emerging NHS structure especially in respect of district council representation on CCGs, the Health and Wellbeing Board, Sherwood Forest Hospitals NHS Foundation Trust and EMAS NHS Trust. At a time of great change and anxiety regarding the scale of the reforms and local provision, there is a strong case for ongoing community leadership from elected representatives.

4.1.2 The district council should have representation on CCGs (it should also be advocating that CCGs be co-terminous with District Councils) through both Officer and Member

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routes. The member link could be through the 3 or 4 PRISM localities or through the Stakeholder Group.

4.1.3 The Representation on the Nottinghamshire Health and Well-being Board is helpful if fortuitous but undermined by a failure to consult with ERPOS and develop a Council strategy e.g. EMAS.

4.1.4 Similarly, the representation on Sherwood Forest Trust NHS Foundation Trust is an isolated attendance and issues are not routinely shared with Council.

4.1.5 There needs to be a close link with Health Watch when it is fully set up – discussion about how this could work out to be initiated with Nottinghamshire County Council.

4.2 Policy development and improvement

4.2.1 The Council needs a forum within which ideas, concerns, knowledge and information regarding local health services can be shared. This is probably best established as a working party but should be made up not so much on party lines as on an area and type of community basis – the working party would work best with representatives who understand the needs of rural villages, of ex-mining communities, of the key settlements etc. rather than according to the matrix i.e. 5 Conservatives, 4 Labour, 1 Liberal Democrat and 1 Independent. It also needs to include those who serve on health bodies. It could also initiate an annual or sixth monthly meeting of all relevant agencies to discuss issues, concerns progress etc and perhaps recommend the joint or sole commissioning of projects.

4.2.2 The working party could also monitor the delivery and impact of the Council’s health and wellbeing delivery plan, the district’s CCG commissioning plans and local initiatives commissioned by the health and wellbeing board e.g. public health funded projects.

4.2.3 Given the Council’s community leadership role, the forum could also take soundings from local voluntary and community groups on the state of the district’s health economy and raise issues with relevant bodies such as service commissioners and Health Watch.

4.2.4 The Council is currently preparing to introduce a new form of governance. As part of the development of a new constitution and given the importance of health to the community and the Council’s strategic priorities, consideration should be given to the inclusion of a Health working party reporting to the proposed Customers and People Committee.

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Section 5: A diverse district with particular needs

5.1 The District of Newark and Sherwood, at over 65,000 hectares, is the largest in Nottinghamshire and is situated in the northern part of the East Midlands Region.

5.2 Adjoining the District to the west are the Nottingham and Mansfield conurbations; whilst Lincoln lies to the north-east and Grantham to the south-east.

5.3 Newark & Sherwood has a population of approximately 114,800 in 44,800 households (Census 2011) and since 2001 has seen significant growth (8%). Mirroring the national picture, the proportion of the District's population that is of retirement age, or that resides in a single person household, is significant and likely to grow further. The District has a relatively low percentage of its population originating outside of the United Kingdom, however there is a long standing and diverse Gypsy and Traveller community.

5.4 The settlement pattern of the District is dispersed, given its large rural nature, and ranges from market towns and large villages to smaller villages and hamlets. The main towns of Newark, Southwell, and Ollerton & Boughton act as a focus for their own communities and those in the wider area, whilst the larger villages function in a similar role for their immediate rural areas.

5.5 Outside of this however, services are limited and some higher level and specialist facilities are only found in larger urban areas adjoining the District. Public transport services are limited outside of the main centres and routes, and as a result accessibility to employment and services is more difficult in rural areas.

5.6 In general terms the quality of life within the District (assessed against crime, employment, education, environmental, health, housing and accessibility indicators) is good. The best overall ratings are found in Southwell and villages within the Nottingham Fringe. Those areas with the lowest assessments of quality of life tend to be within Newark and the former mining settlements of the West where crime, education and health indicators appear to be those most affecting quality of life.

5.7 The district health profile attached at Appendix F indicates:

Deprivation is lower than average however 4,085 children live in poverty. Life expectancy is 8 years lower for men and 6.8 years lower for women in the

most deprived areas than the least deprived areas. An estimated 19.3% of adults smoke and 24.1% are obese. 15.7% of year 6 children are classified as obese Levels of GCSE achievement were worse than the England average in 2009/10. The rate of road injuries and deaths is almost double the average.

5.8 Other health related data indicates that the district has a significantly higher proportion of its economically inactive residents with long term conditions or retired than the regional and national average.

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Section 6: Consideration of specific projects

6.1 Given the ongoing austerity measures, rising demand and increasing population, there is a shortage of funding to meet needs and expectations. The evidence of the voluntary agencies clearly identified this in terms of the withdrawal of services e.g. Think Children working in many fewer schools. There are also schools that do not engage with such agencies and do not appear to see the mental and emotional welfare of their children as part of their responsibility.

6.2 There are also long-standing gaps in provision – mental health care for adolescents and children, support for victims of drug abuse and abusers, and threats to existing provision for the elderly and the abused. There has also been a failure of the medical services to understand or attempt to address the social causes of illness – housing, low self-esteem etc. The establishment of CCGs offers an opportunity to try and address some of these issues and using GPs and their teams to identify, refer on and even prescribe for such issues e.g. prescriptions for exercise with the leisure centres, for learning with adult education.

6.3 The Council needs to support and extend services that are seen to be meeting needs and use its funding to co-commission work with the CCGs in a well-thought out and purposeful way which enables us to understand the impact of what is done both on an individual and community basis. The experience of the community budgeting pilots shows that if enough resources are carefully and effectively targeted, the Council could transform the culture in some parts of Boughton, Clipstone or Newark and thereby facilitate individuals, families and communities to believe that they have a more positive future.

6.4 The Task and Finish Group noted that, given the complex, strategic and multi-agency

nature of health issues, a senior officer would be required to direct the Council’s ongoing activities, involvement with health organisations and provide a central steer. The Group recommend that this is within the remit of the Director of Communities.

6.5 Family Intervention Project

6.5.1 The Task and Finish Group highlighted the important work being undertaken by this Nottinghamshire County Council service. Newark and Sherwood Local Strategic Partnership have provided additional but time limited funding for additional capacity. The Group recommend that consideration is given by the appropriate Council committee to the ongoing funding and development of this service.

6.6 Child and Adolescent Mental Health

6.6.1 The Task and Finish Group were impressed by the services such as Think Children and CASY that are operating in the district. However, concern was expressed that not all schools were engaging with the services despite having access to funding such as the Pupil Premium and the impact that mental health issues can have upon future development. This could be an issue that is included in the work programme of the proposed Health Working Party.

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6.7 Dementia

6.7.1 The Group noted from information supplied by Age UK and Alzheimer’s Society that dementia is becoming more prevalent in those in their 50’s. Given the age profile of the district’s population and it’s rurality concern was expressed at the reduction of low level services and potential corresponding increase in intensive crisis support and pressure on hospital beds. This could be an issue that is included in the work programme of the proposed Health Working Party.

6.8 Maternity Care

6.8.1 Members noted from the Joint Strategic Needs Assessment that not all groups in society have the same outcomes and there remains a gap nationally between routine and manual groups and the England average in indicators such as infant mortality. Future commissioning interventions will aim to reduce the gap in infant mortality and improve health outcomes for mothers and the next generation.

6.8.2 Local maternity services are provided by Sherwood Forest Hospital NHS Foundation Trust and are rated as “excellent” by the Independent Healthcare Commission. They are one of only two East Midlands Trusts with the highest rating of “best performing”.

6.8.3 The Trust has one of the highest percentages of natural births in the country, one of the lowest caesarean rates at just 15% and a home birth rate way above the national average.

6.8.4 The birthing and maternity units are based at King's Mill Hospital and include a pregnancy day care unit, antenatal clinic, maternity ward (antenatal and postnatal), the Sherwood Birthing Unit and the neonatal unit. The Early Pregnancy Assessment Unit (EPU) is situated within the King’s Treatment Centre.

6.8.5 Locally, The Sherwood Women's Centre at Newark Hospital provides comprehensive facilities for antenatal and postnatal care, including ultrasound.

6.8.6 The Group did not have time to thoroughly consider local maternity services and this may be an issue that could be included in the work programme of the proposed Health Working Party.

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Section 7: Recommendations

The Group recommend that:

1. The draft Health and Wellbeing Plan be recommended for endorsement by External Relations and Partnership Overview and Scrutiny Committee and Cabinet. The plan is then to be distributed to partners including the GP practices that are part of the district’s CCGs in order to highlight the alignment of our services with their strategies and commissioning intentions.

2.a That, given the importance of health to the community and, in particular, the Council’s strategic objectives relating to its “People” priority, a Health Working Party is established this year reporting to the proposed Customers and People Committee.

2b. The proposed working party should meet at least quarterly and be open to the public. The remit of the working party should include:

Reviewing performance of and significant policies and plans developed by East Midlands Ambulance Service (EMAS), the district’s CCGs, Sherwood Forest Hospitals NHS Foundation Trust and Nottinghamshire Health and Wellbeing Board for example the Director of Public Health’s the annual report.

Reviewing the implementation of the Council’s Health and Wellbeing Delivery Plan.

Maintaining an overview of the implementation of changes within the NHS and future commissioning intentions of the district’s CCGs and Nottinghamshire’s Health and Wellbeing Board

Monitoring general conformity with and proposing developments of the Partnership Accord for Health in Newark and Sherwood agreed by Council on 18 December 2012.

Considering the extent to which the commissioning plans will meet the needs of local communities, identifying potential gaps and liaising with funders regarding commissioning intentions and future service provision.

Considering what can be done from a social health perspective to prevent people becoming patients in the first place including relevant Council policies and practices.

Convening meetings of all relevant agencies to discuss health related issues, concerns, progress with initiatives, benchmarking service provision and local facilities, etc.

Working with the CCGs to identify opportunities for joint commissioning around specific shared priorities and groups of residents and acting as a critical friend drawing upon the Council’s community leadership role and networks.

Formulating recommendations to Customers and People Committee regarding health services, future commissioning projects and service provision.

2c. The working party should be made up not so much on political party lines as on an area and type of community basis – it should include councillors who represent rural villages, ex-mining communities and key settlements. The committee should include those who represent the Council on relevant health bodies and have the ability to

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co-opt appropriate non-voting external advisors invited from organisations such as Healthwatch, CCGs, voluntary and community organisations including Newark and Sherwood Community and Voluntary Service.

2d. Subject to the establishment of the Health working party, it is recommended that Child and Adolescent Mental Health, Dementia and Maternity services should form an early part of the work programme.

2e. That the appropriate Committee under the new constitution considers future and further funding of the district’s Family Intervention Project.

3a. That elected member representation from the Council should be part of the following outside bodies:

Nottinghamshire Health and Wellbeing Board Newark and Sherwood Clinical Commissioning Group (Strategy

Group/Stakeholder Reference Group) Nottingham North and East Clinical Commissioning Group Nottinghamshire County Council, Health Scrutiny Committee Local Medical Practice User Groups Sherwood Forest Hospitals NHS Foundation Trust

3b. That elected members, appointed by the Council to any of the outside bodies listed in 3a above be required to update the Health Working Party referred to in Recommendation 2a or the proposed Customers and People Committee on a minimum of two times per year.

4. There needs to be a close link with Health Watch when it is fully set up – discussion about how this could work ought to be initiated with Nottinghamshire County Council.

5. That the Council’s lead officer for health issues should be the Director of Communities.

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APPENDIX A

Council’s Strategic PrioritiesSTRATEGIC PRIORITIES 2012-2016

PROSPERITY

Theme Strategic ObjectiveInward investment

Creating a core inward investment offer to enable a credible range of partnership activity to be supported including the development of local private sector ambassadors to advocate on behalf of the local area and encourage new investment.Developing and marketing the area as a destination and a place to invest.

Business growth

Developing a loan and equity scheme for local businesses to improve the availability of investment in the form of loan finance or equity finance and help encourage local business growth.

Employability Developing interventions that will help to connect those in need of work with the economic opportunities that arise e.g. recruitment schemes, apprenticeships, graduate trainees and placements.

Infrastructure Coordinating and developing the management of infrastructure investment through a re-focussed economic development function.

Key sectors Developing an understanding of key sectors that are likely to bring faster economic growth and sustainable job opportunities to the area.

PEOPLE

Theme Strategic ObjectiveOlder People Refocusing the housing strategy on supported housing for older people reflecting

the needs of different customer groups.Increasing support for activities which engage isolated older people in their community.Extending First Contact work and improved energy efficiency standards for new supported housing.

Young People Supporting dependent families to become wage-earning through measures to address child poverty.Working with the private sector to provide apprenticeships and opportunities for 16-24 year olds not in education, employment or training.

Vulnerable Families

Extending Family Intervention work to try and prevent the most serious and long term impacts on children.

PLACE

Theme Strategic ObjectiveMaintain Ensuring a clean, green environment.

Helping to protect the district’s character, heritage and natural assets.Grow Leading the development of sustainable communities.

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Driving improvements in the district’s physical and broadband infrastructure.Increasing the amount of affordable housing.

Develop Exploring options for increasing recycling.Consider ways of making better use of the current housing stock.Setting standards and developing masterplans to improve places and communities.

PUBLIC SERVICE

Theme Strategic ObjectiveDelivering our statutory duties

Re-focussing our priorities where we can meet statutory duties effectively but at a basic level.Considering alternative ways of meeting our statutory responsibilities.

Developing our commissioning approach

Implementing a commissioning approach to review and re-set priorities and to enable devolution of services to take place.De-commissioning services which are no longer a council priority.

Localism and devolution

Developing clear and supportive policies to enable devolution of services to town and parish councils and to set standards for devolved services.Looking at new ways to generate income.Enabling neighbourhood planning within the context of the district’s Local Development Framework.

Customers Developing more online transactions and self-service.Engaging customers in service design and commissioning.

Openness & transparency

Enabling accessible data and decision-making.Implementing a new governance model for the Council.

Community Leadership

Advocating key priorities for the community.Supporting community capacity for self-help.

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APPENDIX B

COUNCIL’S DRAFT HEALTH AND WELLBEING DELIVERY PLAN 2012-13

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APPENDIX CDRAFT PROJECT SCOPE

HEALTH TASK AND FINISH GROUP

Background to the Issue The district’s health profile identifies a range of health inequalities within the area and specific challenges. The NHS reforms provide a new impetus for partnership working with organisations such as the CCGs. The Council has a range of functions and activities that have a direct and impact on the health of its residents including housing, leisure and environmental health. ERPOS agreed to establish a task and finish group to consider these opportunities and issues and make recommendations to ERPOS.

Terms of Reference Developing an understanding of the changes within the NHS, commissioning intentions of the district’s CCGs (CCGs) and Nottinghamshire’s Health and Wellbeing Board

Considering the extent to which the commissioning plans will meet the needs of local communities, identifying potential gaps and liaising with providers regarding commissioning intentions and future service provision.

Considering what can be done from a social health perspective to prevent people becoming patients in the first place.

Working with the CCGs to identify opportunities for joint commissioning around specific shared priorities and groups of residents.

Formulating recommendations to ERPOS regarding health services, future commissioning projects and service provision.

Consideration of the implications of changes to hospital transport services.

Suitability for Scrutiny – Which of the Following Criteria Does it Meet?Is the issue a priority

area for the council?

Yes. The health of the district’s population is reflected in the “People” priority and as a contributor to economic prosperity.

Does it examine a poorly performing service?

No

Is it a key issue for local people?

Yes – district health profile identifies

Is it relevant to new Government guidance or

Health and Social Care Act 2012

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issues and concerns are evident regarding local health service provision.

legislation?

Will it be practicable to implement the outcomes of the scrutiny?

Yes Will it result in improvements to the way the Council operates?

Yes

Proposed Key Officers Andy Statham, Director - CommunitiesAlan Batty, Business Manager – Environmental HealthAndy Hardy, Business Manager - Sports, Arts and Community

DevelopmentRob Main, Strategic Housing ManagerLeanne Monger, Business Manager - Housing Options, Energy and Home

SupportGed Greaves, Business Manager – Policy and Commissioning

How will the work be Undertaken?

Themed meetings including representatives from the CCGs and other service providers.

Key documents, Reports and Data Required

Initial background information prepared including: District health profile Nottinghamshire Health and Wellbeing Strategy Briefing paper highlighting role of housing within health Briefing paper on reforms to the NHS Newark and Sherwood Clinical Commissioning Group Integrated

Plan

Possible Interviewees Newark and Sherwood Clinical Commissioning GroupNottingham North and East Clinical Commissioning Group

INDICATIVE TIMETABLE

Proposal to Committee 4 July 2012Report to Committee 21 November 2012Report to Cabinet 6 December 2012

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APPENDIX D

HEALTH TASK & FINISH GROUP AGENDA ITEM NO. 11 JANUARY 2013

SUMMARY OF THE HEALTH TASK AND FINISH GROUP MEETINGS

1.0 Background

1.1 At the 4th July 2012 meeting of the External Relations and Partnerships Overview and Scrutiny Committee the Committee agreed to establish a Task and Finish Group to consider the Health Agenda. Members felt that due to confidentiality issues the Task and Finish Group should convene in camera. At that meeting Members also requested that the Deputy Leader of the Council be invited to a future meeting to provide an update of the work of the Health and Wellbeing Board.

2.0 Project Scope

2.1 The Health Task & Finish Group agreed a project scope Appendix A to the report. The following background to the issue was agreed: ‘The district’s health profile identifies a range of health inequalities within the area and specific challenges. The NHS reforms provide a new impetus for partnership working with organisations such as the CCGs. The Council has a range of functions and activities that have a direct and impact on the health of its residents including housing, leisure and environmental health. ERPOS agreed to establish a task and finish group to consider these opportunities and issues and make recommendations to ERPOS’.

2.2 The Terms of Reference for the Task & Finish Group were as follows:

Developing an understanding of the changes within the NHS, commissioning intentions of the district’s CCGs (CCGs) and Nottinghamshire’s Health and Wellbeing Board

Considering the extent to which the commissioning plans will meet the needs of local communities, identifying potential gaps and liaising with providers regarding commissioning intentions and future service provision.

Considering what can be done from a social health perspective to prevent people becoming patients in the first place.

Working with the CCGs to identify opportunities for joint commissioning around specific shared priorities and groups of residents.

Formulating recommendations to ERPOS regarding health services, future commissioning projects and service provision.

Consideration of the implications of changes to hospital transport services.

2.3 The Group agreed that the information already collected three years ago by the Policy team at that time be collated for the following four wards and be forwarded to

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the 14th September 2012 Task & Finish Group. Members of the Group would identify issues in different areas of the District.

Boughton Collingham Devon Southwell

2.4 The Task & Finish Group compiled a list as follows of all the organisations which the Group should engage with. A letter be sent to the organisations enquiring whether they collect information on health and welfare.

Say Yes to Newark Hospital CVS CCG Sherwood Forest Hospital NHS Foundation Trust EMAS Newark and Sherwood Homes Age UK Councillor T. Roberts – Representative Think Children County Social Care CASY

3.0 Work Undertaken

3.1 Seven meetings of the Heath Task & Finish Group have taken place which has included a number of organisations which the Task Group has engaged with as follows:

Clinical Commissioning Group (CCG) – Assisitant Chief Operating Officer, Lisa Green

Newark and Sherwood Homes – Director Newark and Sherwood Homes,

Stephen Feast Age UK – Mr C Salter Community and Voluntary Service (CVS) - Mrs V Gardiner Alzheimer’s Society – Ms H Byrne and Ms M Holt Hetty’s – Ms D Knowles CASY – Ms F Bush and Ms E Houghton Think Children – Ms S Havermass Dr K Allen - Consultant in Public Health

3.2 The Deputy Leader Councillor T Roberts attended the 14 th December 2012 meeting of the Task Group.

4.0 Summary of the Information Collected from the Organisations Attended

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4.1 Clinical Commissioning Group (CCG)

The national drive is for service provision to be thought of at a local level. PCTs were too big to fulfil this requirement and this is the reason that the CCGs have been established as they currently are, to enable them to act in a local capacity.

There are 4 CCGs in Nottinghamshire. When looking at large contracts the 4 CCGs work as one contracting team with one leader. This is to ensure a consistent approach across the CCGs. There are 3 directors with a team under them who work for all the CCG teams.

In relation to clinical influence, there is not such a hierarchy between surgeons and GPs as believed. Both have different skill sets. They sit together on the clinical congress, meeting on a monthly basis to decide key issues (quality of service provision; next key priorities) working together to improve patient care and service provision. They are able to challenge hospital wards who they think are keeping patients too long as savings are noted to be coming from patients being cared for out of the hospital environment. The biggest pressure on services at the moment was illness due to the time of year.

Councillor Hamilton noted that there was no mention of monitoring on the CCGs website. He also commented that the intended £20B savings nationally on the NHS was too high and unachievable. Lisa Green advised that financial stewardship and planning was closely monitored and robust.

Lisa Green advised that the next meeting of the Stakeholder Group was to be held on Tuesday, 18th December 2012 and had extended an invitation for Councillor Staples to attend.

Lisa Green further advised that the PRISM (north locality team) would commence on Monday with the integrated care programme, looking at health, mental health and social care within the community. They would work closely with GPs and district nurses.

Members were advised that Sherwood Forest Hospitals had agreed to open the Friary Ward at Newark Hospital and that this would be available to elderly patients in the Newark and Trent areas.

When this pilot had been evaluated and felt to be working correctly, the opening of beds at Bishop Court in Ollerton and a venue in Southwell would be considered. It was hoped that this would enable care to be provided in Newark rather than Lincoln and Kings Mill.

Staff at the ward would consist of: 1 ward manager; 6 nurses; 11 support workers together with physiotherapists.

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Provision of a paediatric unit at Newark Hospital was also under consideration together with the possible commissioning of a paediatric consultant to extend the hours of service. This would provide a more child friendly environment and surroundings.

Consideration was also being given to the provision of a cardio respiratory clinic unit on the ground floor of the hospital.

It was considered that the above provided 3 areas of development:

Care of the Elderly Children’s Assessment Unit Long Term Care in a Respiratory Clinic

4.2 Newark and Sherwood Homes

Stephen Feast confirmed that Newark and Sherwood Homes held detailed data about their tenants, which included information regarding any disabilities the tenant may have. It was confirmed that in terms of what Newark and Sherwood Homes currently contribute regarding Health and Wellbeing, they provided the most suitable accommodation that was available to the tenant.

It was confirmed that the clinical and social side were linked.

4.3 Age UK and Alzheimer’s Society

Dementia is not just an older people’s condition but was starting to become more prevalent in those in their 50’s and a small proportion of those in their 40’s.

Communities have different expectations and needs and access services in different ways.

Relationships between those involved in the commissioning process were positive.

There was scope to enhance the relationship with parish councils. The CCG’s had the “right” priorities and focus. Whilst there are a range of services within the district, some low level

services had become unsustainable or were in challenging positions due to changes in funding.

Whilst volunteers may offer their time for free there are still necessary costs such as training, CRM checks, supervision and management to be funded.

The reduction of low level services may lead to an increase in those needing intensive support due to crisis, potentially leading to hospital admission which increases pressures on hospital beds.

There was some evidence that day care provision was resulting in a mix of clients that may not be beneficial.

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Many local facilities such as village halls are not equipped to meet the needs of local dementia services.

A peripatetic service may be worthwhile considering. The brokerage function with social services is an area for further

exploration with Nottinghamshire County Council. Sharing of vehicle fleets could result in clients having greater access to

services at a lower cost.

It was suggested that a recommendation could be forwarded to Sherwood Forest Hospitals NHS Foundation Trust asking whether it would be possible for an Alzheimer’s support service to be operated at an empty ward within Newark Hospital. The service could be commissioned by Newark and Sherwood CCG and delivered by an organisation such as the Alzheimer’s Society.

4.4 Community and Voluntary Service (CVS)

the CVS were working closely with the CCG to plug the gaps. PAL’s – Patient Advice Liaison Services, CVS had been commissioned by

the CCG to run that service for the next 3 years. They were the first in the country to do this.

A funding advice service was also run by the CVS. Networks for parent carer’s which was a new service were run which was

a contract with the CCG. CVS had a Patient & Public Community Engagement contract with the

CCG. Work was undertaken with the diverse communities and aimed to work

with the young community. Hitting crisis point regarding the elderly, the Dementia Summit

highlighted the lack of support for carers within the district. The need to explore Faith Groups, to provide support for carer’s. The CCG advised that Memory Assessment Clinics, which were

commissioned through Public Health, were being opened at Ollerton and Rainworth getting people diagnosed at an early stage.

It was reported that mental health affects 1 in 10, Nottingham benchmarked as a low investor within that area. The CCG were looking to increase those services as mental health was one of their seven strategic areas for improvement.

Obesity and Diabetes – two additional nurses and a consultant had been commissioned for the district.

Integrated Care Team to be in place by December 2012 in the west of the district Edwinstowe and Clipstone practice to use risk strategy for dementia patients.

4.5 Hetty’s

Established in 1996 by a small group of mums who had suffered the affects of a loved one’s drug misuse.

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Offers support to over 250 families per months in 4 districts in North Nottinghamshire.

Commissioned by Nottinghamshire’s Recovery Partnership to offer individual support to families and to ensure that families are considered within a drug or alcohol user’s recovery journey.

Telephone support line offered 7 days per week from 9am to 7pm. Initial calls often crisis calls, some borderline Samaritans. One to one support provided. Specialist kinship care support provided. Group support provided. Family mediation provided. Complementary therapies provided. Educations sessions within prisons and probation provided. Use of volunteers and student social workers to enable service provision. Referrals from professionals e.g. GPs received. Volunteers have been out into the community over the past 2 years to

assist street drinkers at Christmas time.

4.6 CASY

Established in 1999 to fill the gap in the provision of this type of counselling for 9 to 25 year olds.

Counselling provided for those suffering from depression, anxiety, anger, behavioural difficulties, bereavement, family break-up, domestic violence and abuse.

Referrals via GPs, CAMHS, probation, parents, carers, schools and other health and support organisations (or self referral).

Service provided across north Nottinghamshire (mainly NSDC but recently 8 schools and 4 community venues in Lincolnshire).

Work undertaken in schools and at the “Your Space” venue in Newark. 64 counsellors – 19 paid sessional counsellors and 45 volunteer

counsellors. High level of support and training provided to counsellors: safeguarding

training; enhanced CRB checks; clinical supervision; peer supervision; ongoing continuing professional development both internal and external.

4.7 Think Children

Offers an early intervention service for children with emerging emotional, social and/or behavioural issues.

Work with wide range of children dealing with issues such as relationships, parental separation, bullying, bereavement and low self-esteem.

One to one sessions offered in familiar surroundings

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Benefits are: increased confidence/self esteem; belief that take responsibility for own actions; emotional resilience on ability to cope; ability to reflect on situations rather than reacting inappropriately; encouragement to join in education; development of positive relationships; bridge the gap between home and school.

Despite funding cuts in 2011/2012: 361 children supported in 54 schools. 95% of children continue to show improvement 3 months after sessions

ended.

4.8 Summary of Charities

The constant theme running throughout the discussions was the continuing difficulties being experienced due to cuts in funding for the organisations. Referrals were not decreasing but the organisations ability to provide their service was under increasing pressure.

Members noted that in many circumstances the work of the charities prevented children from being placed in care which would have far greater financial burdens on budgets than the cost of the financial support to the charities.

Members were impressed by the work undertaken by the charities and were shocked by the level of cuts they were facing. They noted that these types of charities were historically underfunded and resourced.

They commented that some schools were reluctant to try to access the services provided and that given their budget constraints this was likely to worsen with pastoral care of students suffering the greatest effect. They agreed that it was crucial that schools should be able to access this type of provision when needed.

4.9 Dr K Allen – Consultant in Public Health

Big proportion of role is spent on working with CCG on commissioning services.

In order to ensure provision in each area, account must be taken of each areas differing health issues which can lead to community based services.

Each health authority area had to inform the Dept of Health what their annual spend was with the figures being taken from the old PCT spend. Dept of Health then calculated each areas allocation. Large decrease in funding but degree of optimism that further reductions will not follow for at least 3 years.

Health & Wellbeing Boards would welcome working with local authorities in the promotion of health and wellbeing (specific mention of working towards the issue of child poverty).

Both NSDC and N&SH have a Health & Wellbeing Delivery Plan. When complete, this will be circulated to the Health & Wellbeing Board and the CCG.

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More cohesion and partnership working was required between all organisations, working towards a common goal.

Confirmed that CCG will commission district nurses, community midwives and health visitors.

New working arrangements had led to the fracturing of the provision of child services.

Noted that it would be beneficial if all services could work together at a local level.

Under the Health & Wellbeing Board were a ‘shadow’ board until April 2013 following which the Board would have a definite role to play.

New processes in relation to the provision of health care were very complicated.

It was hoped that a central point to answer queries on the new working arrangements could be created.

Sitting under the main Board were 5 other Groups/Board. Of the 7 District’s within Nottinghamshire, only 2 representatives were

permitted on the (Shadow) Board. Beneficial if ERPOS and Full Council were kept briefed of ongoing discussions

and decisions. Also that ERPOS feed comments to NSDC’s representative (Councillor Roberts) prior to his attendance at meetings.

Query raised as to whether there was any possibility that NCC would allow more representatives.

Noted that NCC had been reluctant to allow more than 1 representative as to allow each District Council to be representative would mean the Board was too large. Balance needed to be struck.

Noted that ERPOS had held discussions with EMAS but there was no certainty that these had been taken forward be NSDC’s representative.

Noted that the NSDC representative did not just represent NSDC but all 7 district councils.

Noted that there were two NCC Health Scrutiny Committees. (i) South Nottinghamshire and the City. (ii) Rest of the County. They scrutinise the day to day decisions made by the Board. (Gave the recent changes at Ashfield Community Hospital as an example).

In answer to whether the new processes were ready to deliver in April 2013; it was noted that some CCG had made significant progress and were an improvement on the previous PCT.

The Health & Wellbeing Board considered that their approach should be countywide. Each CCG were represented and had the ability to put in representations as to what they considered was needed for their area.

Noted that it was difficult for these representations to be challenged as they were of a clinical nature.

Noted that there appeared to be a lack of communication between the PCT, the CCGs and Sherwood Forest Healthcare Trust.

Noted that Andy Statham sat on a Strategic Partnership Group (Newark North and East Area). This was made up of 4 local authorities. The Health & Wellbeing Delivery Plan reflected all the public health priorities with the

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exception of teenage conception which was beyond its remit. The Plan contained additional information not in the public health priorities.

Following an unsuccessful tender process, NCC were to provide a grant for a company to set up a Nottinghamshire Healthwatch organisation based on the successful Derbyshire model.

Noted that the new arrangements were overly bureaucratic. It was noted that only MONITOR that the Trust would be answerable to and

that this would leave many groups and organisations frustrated. Noted that it was essential that all organisations must communicate. Members requested a copy of NCC’s Management and Committee Structure

so they could see how the Board sat within their structure. Noted that there still appeared to be some gaps in the structure as to how

the Boards, sat under the main Health & Wellbeing Board, would develop relationships with other departments e.g. housing.

Query raised as to whether there would be any benefit in all groups having an annual meeting. Noted that this would be better served if clear goals and aims were set.

5.0 Additional Suggestions from the Task & Finish Group

5.1 A member commented on a meeting attended at Melton Mowbray which covered health and the implications of the welfare reforms. It was suggested that the Council hold a seminar in partnership with the CVS to provide training and help. It was also suggested that Andy Burton from Bassetlaw District Council be invited as a speaker.

5.2 Andy Statham commented on the Health delivery plan which was just being finalised by the District Council, it was suggested that the next seminar could be around Healthy Living/Lifestyle theme and would be a good opportunity to showcase the District Council’s report.

5.3 The Stake Holder Reference Group was raised in terms of elected Members of the District Council securing a seat on the Group. It was agreed that the item be formerly placed on the Stake Holder Reference Group agenda, that the District Council would like three seats for elected Members to cover the North, West and South of the district.

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APPENDIX E

NHS FRAMEWORK UNDER HEALTH AND SOCIAL CARE ACT 2012

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Nottinghamshire Health and Wellbeing Board

The following Terms of Reference were approved at the Nottinghamshire County Council meeting on the 31st March 2011:

a) To prepare and publish a Joint Strategic Needs Assessment of the population of Nottinghamshire.

b) To prepare a Health and Wellbeing Strategy based on the needs identified in the Joint Strategic Needs Assessment and to oversee the implementation of the strategy.

c) To ensure that commissioning plans have due regard to the Joint Strategic Needs Assessment and the Health and Wellbeing Strategy.

d) To promote integrated working including joint commissioning in order to deliver cost effective services and appropriate choice. This will also include joint working with services that impact on wider health determinants.

The membership of the Board comprises:

the Leader of Nottinghamshire County Council the Deputy Leader of Nottinghamshire County Council (Chairman of the Board) Cabinet Member for Finance and Property, Nottinghamshire County Council One Member from the County Council’s Labour Group One Member from the County Council’s Liberal Democrat Group One representative from two District Councils the Director of Adult Social Services, Nottinghamshire County Council the Director of Children’s Services, Nottinghamshire County Council the Director of Public Health a representative of Local HealthWatch one representative of each of the GP Consortia within the county (expected to be

the lead GP) a representative from the NHS Commissioning Board a representative of the PCT Cluster

Currently, the district council representatives are Councillor Roberts from Newark and Sherwood District Council and Councillor Hollingsworth from Gedling Borough Council.

Newark and Sherwood CCG

In March 2011, Newark and Sherwood CCG was identified as one of 40 GP Commissioning Pathfinders. It covers 15 GP practices and 127,000 register patients.

Key CCG Board members are: Roger Pafford, Board Lay Chair Dr Mark Jefford, Clinical Lead Dr Amanda Sullivan, Chief Operating Officer

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Further information such as Board agendas, reports and minutes can be found on the CCG’s website at: www.newarkandsherwood.nhs.uk Board meetings are open to the public.

The Council’s Chief Executive is a member of the CCG’s Strategy Group.

Nottingham North and East CCG

NNE covers 21 GP practices with a total registered patient population of approximately 145,000 which is 21.5% of the registered population of Nottinghamshire. It includes the communities of Lowdham, Epperstone and Farnsfield.

Key CCG Board members are: Dr Tony Marsh (Board Chair and Clinical Lead) Sam Walters - Chief Operating Officer

Further information about the CCG such as Board members and its aims can be found on the CCG’s website at: www.nnecpbc.nhs.uk/ Board meetings are not currently open to the public.

The Council’s Director of Communities is a member of the CCG.

Sherwood Forest Hospital NHS Foundation Trust (www.sfh-tr.nhs.uk/)

This is the main local acute hospital trust providing healthcare services for people in and around Mansfield, Ashfield, Newark, Sherwood and parts of Derbyshire and Lincolnshire. It’s hospitals include:

King's Mill Hospital Newark Hospital

Councillor David Payne is the Council’s representative.

Nottingham University Hospital NHS Trust (www.nuh.nhs.uk/)

This Trust is one of the biggest and busiest acute NHS Trusts in England, employing 13,000 staff. It provides services to over 2.5 million residents of Nottingham and its surrounding communities. It also provide specialist services to a further 3-4 million people from neighbouring counties each year.

The Trust is made up of Queen’s Medical Centre, Nottingham City Hospital and Ropewalk House.

Queen’s Medical Centre – the emergency care site (where our Emergency Department is located)

Nottingham City Hospital – this is where the Cancer Centre, Heart Centre and stroke services are based and where planned care and the care of patients with long-term conditions is provided

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Ropewalk House –a range of outpatient services are provided here, including hearing services

Nottinghamshire Healthcare NHS Trust (www.nottinghamshirehealthcare.nhs.uk/)

The Trust provides integrated healthcare services, including mental health, learning disability and physical health services.

Over 8,800 staff provide these services in a variety of settings, ranging from the community through to acute wards, as well as secure settings. The Trust manages two medium secure units, Arnold Lodge in Leicester and Wathwood Hospital in Rotherham, and the high secure Rampton Hospital near Retford. It also provides healthcare in 12 prisons across the East Midlands and Yorkshire.

East Midlands Ambulance Service NHS Trust ( http://www.emas.nhs.uk/ )

East Midlands Ambulance Service NHS Trust (EMAS) provides emergency 999, urgent care services for the 4.8 million people within Derbyshire, Leicestershire, Rutland, Lincolnshire (including North and North East Lincolnshire), Northamptonshire and Nottinghamshire.

It employs over 2,700 staff at more than 70 locations, including two control rooms at Nottingham and Lincoln, with the largest staff group being accident and emergency personnel. Accident and emergency crews respond to over 776,000 emergency calls every year.

Community Paramedics and Emergency Care Practitioners have enhanced skills, meaning that more and more people can be treated in their own homes if a hospital visit is not required.

To help meet national performance targets, EMAS is developing plans to revise its estate with the introduction of hubs and community ambulance points. The outcome of the detailed review and extensive consultation are anticipated in March 2013.

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APPENDIX FDISTRICT HEALTH PROFILE 2012

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