Healthwatch Bristol summary of the Bristol Health and Wellbeing ...

Healthwatch Bristol summary of the Bristol Health and Wellbeing Board October meeting Healthwatch Bristol has a seat on the Health and Wellbeing Board to represent the view of people living in Bristol. We have been asked by members of the public to produce a quick summary of the meeting. If you would like to share your feedback about health and social care services in Bristol, please contact us using the details at the end of this summary. Purpose of the Health and Wellbeing Board Since the Health and Care Act received Royal Ascent in April 2012, the council has been working locally to make the required major changes to health and care services in Bristol. One of these is to set up a Statutory Health and Wellbeing Board. The main purpose of this new board is to join-up commissioning and services across the NHS, social care, public health and voluntary sector to benefit the health and wellbeing of local people. For more information about the Bristol Health and Wellbeing Board, visit: http://tinyurl.com/ovdlb2o

Healthwatch Bristol is your voice on the Health and Wellbeing Board and we want to hear from you. Email us at [email protected] Call us: 0117 2690400 See more at: www.healthwatchbristol.co.uk

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Minutes from previous meeting Ellen, Healthwatch Bristol, asked the board if the agreed letter had been sent to First regarding the Callington Road hospital bus service. The board responded that the letter has been sent and a response is awaited.

Key Decisions – none on this occasion Better Care Bristol a) Governance Report b) Performance Report Presented by: John Readman, Strategic Director – People and Jill Shepherd, Chief Officer, Bristol CCG (and colleagues) What is Better Care?  The NHS Five Year Forward View sets out seven models of care which are critical in making a step-change to deliver integrated services. The Better Care Fund is part of how the NHS Five Year Forward View will be delivered.  The Better Care Fund (BCF) was formerly known as the ‘Integration Transformation Fund’ and was announced by the Government in 2013.  BCF aim is to transform the provision of integrated health and social care services by creating a single pooled fund to incentivise NHS and LA to work together to focus on the needs of patients and service users. How is Better Care being delivered in Bristol?  Better Care Bristol (BCB) was formed in January 2015.  BCB has three programmes of work: - We will help you to help yourself be well (includes: wellbeing, prevention, addressing inequalities, giving advice and guidance) - We will provide care in the right place (eg. care at home, spending less time in hospital) - We will support you to be independent for longer (eg. giving ongoing support after discharge from hospital)  A new governance structure for BCB has been developed, consisting of the Better Care Commissioning Board (Commissioners Only) and the Better Care Bristol Joint Transformation Board (Commissioners and main providers) with specific areas of responsibility for delivery of Better Care. How is Better Care Bristol performing?


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BCB performance is assessed via metrics such as ‘To reduce the number of people that are admitted into hospital as an emergency’ BCB only met one of the five metrics that are measured this quarter. BCB has put in place immediate, medium term and long term plans to improve performance. BCB state that the majority of their work has focused on improving discharge. They will continue with these projects, but also have projects in place to reduce admissions into hospital.

Tell me about some of the BCB projects improving discharge from hospital! Integrated Hospital Discharge Hub (IHDH)  IHDH is a BCB project with three pathways for discharge from hospital.  Pathway 1 = Home with support  Pathway 2 = Community Rehabilitation Bed  Pathway 3 = Complex Assessment Beds  Home is the default care setting for patients without rehabilitation needs. Home Care  BCC launched a new model for home care in August 2015 which uses four providers each with a no refusal clause in their contract which should ensure a zero wait for homecare and decrease number of bed days. However, current staff and capacity issues mean new providers are only picking up half of all work. Tell me about BCB projects that will help prevent admission to hospital! Majority of work to date has focused on discharge; BCF report states the need for focus on preventing admissions. BCB has developed three programmes to reach this aim. 1) Wellbeing Partners  Train young people to be health champions (trained by Public Health and Centre of Sustainable Energy). The young people who will be selected are those who would not normally enter the H&SC workforce. 2) Social prescribing and primary care framework  City wide approach to social prescribing  Develop a social prescribing pathway for primary care (report due November 2015) 3) Design Team – currently finalising the areas of focus, but will be around:  Healthy Neighbourhoods (Multi-speciality teams)  Community Ward (Primary care and acute working together)  Identifying people in Sheltered housing (social care and primary care)


CQC thematic review – integrated care of older people Presented by: Bevleigh Evans, Better Care Programme Director (p81) The Care Quality Commission (CQC) is carrying out a themed review exploring ‘how does the integration of care affect older people’s experience.’ What topics will be covered by the review?  Ways services share information  How people using services feel about how co-ordinated their care is and whether this makes a different to experience and outcomes Who will be included in the review?  People who have broken the neck of their femur  People following a stroke Healthwatch Bristol will also be involved in the review.

Bristol CCG commissioning intentions Presented by: Justine Rawlings, Head of Strategic Planning, Bristol CCG What are commissioning intentions? Each year the Clinical Commissioning Group set out the key topics that they will focus on over the next year. Bristol CCG are about to announce their commissioning intentions for 2016/17 and came to present them to the H&WB. Bristol CCG have chosen their key areas in the context of the Five Year Forward View, Primary Care Co-commissioning Integration, Better Care Bristol, health inequalities as laid out in the Bristol Joint Strategic Needs Assessment and the financial challenges faced by NHS. The full details will be published on Bristol CCG website at the end of October and there will be a process of consultation. What are the key areas in Bristol CCG’s commissioning intentions?  Better Care Bristol (CCG expect all providers to participate in Better Care and promoting self-care across the system)  Long Term Conditions and End of Life Care  Planned Care  Cancer  Mental Health and Learning Disabilities  Children and Maternity  Medicines management

Urgent care winter resilience scheme


Presented by: Judith Brown, Operations Director, Bristol CCG and Lucy Parsons, Urgent Care Resilience Programme Manager, Bristol CCG (p83) What are urgent care winter resilience schemes? The urgent care winter resilience schemes are those schemes in place to support Bristol’s Urgent Care System through winter 2015-16. They include:  Seven day services (services that meet the needs of patients seven days a week)  Addressing pressure on children’s services  NBT 4 hour performance  Discharge to Access (D2A)  Admission avoidance schemes Give me some examples! Examples of projects include: winter communications packages and campaigns; admission avoidance beds at John Wills House Nursing Home and South Bristol Community Hospital; Rapid Emergency Assessment Care Team (REACT) provided by BCH; BrisDoc; The Sanctuary (alternative to emergency departments for mental health patients); Urgent Care Centre at South Bristol Community Hospital; British Red Cross front-door service.

Preventing illness by tackling cold homes Presented by: Phillip Morris, Centre for Sustainable Energy (CSE) What did CSE bring to the H&WB?  CSE seeks H&WB’s support to fulfil Bristol Green Capital objective on fully implementing NICE guidance on decreasing health impacts of living in a cold home.  The NICE guidance includes 12 detailed recommendations but these can be boiled down to the following key points: 1. Cold homes are a health issue. Substantial evidence shows living in an underheated home is bad for people’s health. Making homes easier to keep warm can improve the health and wellbeing of vulnerable groups and reduce the pressure on health and social care services. 2. Health and wellbeing boards must act. HWBs should: develop a strategy to address the health consequences of cold homes. Planning should include identifying relevant providers of support from all relevant sectors. 3. Every contact must count. Identifying and supporting people at risk are the responsibility of all those services that come in contact with vulnerable people, particularly the health service.


4. A single point of contact. All relevant organisations, sectors and interest groups should be included in this, but to reduce complexity and costs, there needs to be a single point of contact so that anyone who comes into contact with vulnerable groups can easily refer people for support. The single point of contact should provide access to a variety of services to improve housing energy performance, help households reduce their fuel costs and improve their ability to manage their heating. Is there a single point of contact in Bristol? Bristol’s three leading VCS organisations for reducing cold homes are: CSE, Talking Monday and West of England Care and Repair (WEC&R). Aim to develop a single point of access called ‘Action on Cold Homes Network.’ What did CSE recommend the H&WB to do?  Develop a strategy to address the health consequences of cold homes in Bristol.  Enable the commissioning of a single point of contact cold homes referral service. Identify where this can be actioned and any requirements to make a further business case.  Supporting implementation by ensuring that all parts of the Health Service refer into the service.  Enable data sharing so that the patients that would benefit most from the support can be identified and supported. What did the H&WB say? There was support for the services CSE are providing and an agreement that it is important to address cold homes and the impact on health and wellbeing. It was suggested that CSE work with projects such as Discharge2Access and Bristol Aging Better to reach vulnerable people in Bristol.

Bristol Carers Strategy re-fresh 2015-2020 Presented by: Lucas James, Mother, carer, Bristol Carers Network representative and member of the Carers Strategy implementation Group A joint strategy for supporting carers has been co-produced by Carers, Bristol City Council, Bristol Clinical Commissioning Group and voluntary sector organisations that provide services for or have an interest in carers. What does the strategy include?  The strategy covers the whole of Bristol and is written for all carers so includes adult carers, young carers, young adult carers, sibling carers and parent carers


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The purpose of the strategy is to outline Bristol’s vision and outcomes for carers, which is based on the National Carers Strategy. Additionally, Bristol carers suggested the following overarching statements to set the vision for Bristol.

What are the key areas the strategy will focus on? The strategy outlines 3 main areas of work to achieve those outcomes: Targeting specific groups  Carers from black and minority ethnic communities  Young carers and young adult carers  Carers of people with mental ill health  Carers of people with dementia Implementing the Care Act and the Children & Families Act Focusing on four specific areas:  Personalised breaks from caring  Support for carers at times of change, including preparation for adulthood  and end of life  Appropriate support in an emergency  Information and advice, including benefits and financial issues The strategy will be implemented through an action plan, developed by partners including carers, and the plan will be overseen by the Carers Strategy Implementation Group (CSIG) How many people are carers?  1 in 10 of us is a carer  2011 Census: 40,100 carers live in Bristol; 9,000 of those provide more than 50 hours of care a week; 860 of those are under 16 years of age; 2,700 are between 16-24 years of age; 8,300 are over 65 years of age  economic value of the contribution made by carers in the UK is £119bn per year What policies are in place to support carers?  National laws and guidance from Government regarding carers is: the Care Act 2014, the Children and Families Act 2014, National Carers Strategy refresh 2014 (Department of Health)  Local Polices and Strategies: - Joint H&WB strategies (prioritises youth carers and carers of people with dementia) - Bristol City Council’s Corporate Plan 2014-2017 - Supporting Carers Through Change Protocol - Living Well with Dementia in Bristol 2011-2015


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CCG Strategic Priorities (carers support highlighted as a key priority for 2015/16) UHB Carers Strategy 2013-16: Carers as Partners in Care NBT Carers Strategy 2015-2017 Hospitals Joint Carers Charter Better Care Bristol Bristol Mental Health Strategy

Health and Wellbeing Strategy re-fresh Presented by: Kathy Eastwood, Service Manager – Health Strategy, BCC Current H&WB strategy produced September 2013 and has 10 priorities. A refresh of the H&WB strategy is proposed in order to create a more focussed strategy with a stronger governance on the delivery of the outcomes. Who will be involved in the strategy refresh?  Strategy Lead at CCG  Public Health, BCC  Health Strategy, BCC  Adults and Children’s Commissioning BCC  Place representative  VCS representative  Healthwatch What themes will be included in the strategy refresh?  Community resilience  Integration  Prevention and early intervention  Tackling health inequalities

20 mph speed limits in Bristol Presented by: Dr Adrian Davis, Public Health and Transport Specialist, Public Health team, BCC Why has Bristol implemented 20mph speed limits on residential streets?  The 20mph scheme was piloted in Bristol 2010-11 and a city-wide role out happened in June 2012.  20mph speed limits reduce number or crashes and injuries, motorised traffic speed and volume.  There has been an increase in waling and cycling in pilot areas.  Review of 20mph speed limits likely to be in 2016.


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Cost of implementing 20mph programme is £2.3million over 3 years. This has been funded through Cycling City and Local Sustainable Transport Fund. In 2013 in Bristol road traffic fatalities and serious injuries totalled 12 people killed and 94 people seriously injured. Using Department of Health costings, this would have cost approximately £40 million.
