At the beginning of the meeting, the Chair made an opening statement:

"The tram incident:
On Wednesday 9th November The tram from New Addington tram took the Sandilands corner at speed, left the track and overturned.
Seven passengers died; some passengers were injured, some shaken and shocked. The first ambulances were there in minutes. Croydon and Transport Police, Fire service, and Croydon Resilience team swung into action. Voluntary services gave support. Local people, John Ruskin School, and a nursery, none trained for a major incident rallied round to support the rescue teams through the night and the next few days. A book of condolences was opened. The Mayor of London came and promised support for those effected.

Croydon University hospital received 30 patients at A&E in a temporary accommodation. St Georges received some people including serious trauma cases. Some out-patient clinics were cancelled. The event touched the whole community of New Addington and many others in Croydon.

Can we please observe a minute's silence to remember the dead, their families and everyone touched by this terrible incident."

There followed a minute's silence for the victims of the tram incident on 9 November.

John Goulston mentioned that everyone should feel proud of the speed with which people worked and came together over the tram incident. A number of families visited Croydon University Hospital wanting to know what had happened and staff responded wonderfully in the difficult circumstances.

Rachel Flowers announced that a multi-agency group is looking at recovery procedures. "This was the first time an incident has occurred in Croydon with major injuries since the Health & Social Care Act 2012. Meetings are being held to find out what we can learn. The recovery went really well but it was new territory for many staff from various agencies working together. Teams are learning from the psychological first aid but we are at an early stage. NHS England and CCG are involved and we would welcome input from the emergency services and voluntary sector."

Cllr Maggie Mansell emphasised the importance of staff involved being well supported. Some of the police responders were new to the job and did very well.

Duncan McMillan stated that the officers who went to the scene learnt a lot from the experience. The police are building inexperienced staff back up. Young officers were much affected. The body recovery team has experience but borough officers are unfamiliar.

Councillor Mansell also reported on two other matters:

"STP:
The Sustainability and Transformation plans for the NHS 2020 have been published. The NHS and Local Councils have been meeting to work on the STP for South West London. There is general agreement on the direction of travel for the out of hospital services. This is familiar to all of us: accessibility of information, advice and self-help, supported by GPs, Pharmacies, social services and the voluntary sector. These matters have been discussed here and elsewhere. The future of Hospital services was not discussed publically. There is an engagement process, but the detailed work for SW London has not been done, so there are no plans and no options to discuss. What is clear is that the financial envelope within which the NHS planners are operating is severely constricted and does not match the increasing needs of the population.

The STP said that a saving could be made by reducing the number of acute centres from 5 to 4 but it would cost more to reduce to 3. More work needs to be done and NHS England (London) will engage with the public next year.

The Council leaders of Richmond, Kingston, Sutton and Merton wrote to NHS England (London) to express concern at the lack of public engagement on the acute services. The Croydon Leader and I wrote similarly but separately because Croydon has some unique characteristics compared with the others. That letter has been circulated to members.

We also wrote to the Secretary of State. Mr Phillip Dunne MP, Minister of State for Health, replied and I have subsequently written a longer letter. Both have been circulated to members. I recognise that some members of the committee are unable to discuss fiscal allocations because they are politically restricted or work for the NHS. My letter has pointed out the inadequacy of the funds provided for the NHS and social care and asked the government to allocate more money to the NHS and train more health staff now."

Cllr Mansell confirmed that correspondence will be circulated later today regarding the STP.

"Mental Health:
Members will remember that we agreed a strategy for mental health strategy in October 2014 to improve assessments and community services to reduce out of borough in patient placements. Since then concerns have been raised about access to CAMHS, and availability of talking therapies both of which have received a little finance from government. Concerns have also been raised as to whether Black patients are treated differently.

There have been other studies in Lambeth and elsewhere. I have discussed this with Cllr Tony Newman, Council Leader who has agreed that the H&WB should conduct a Review into the effectiveness of the Mental Health Strategy and services to the people of Croydon including the experience of Black people. It was also agreed that Cllr Louisa Woodley would conduct an initial review into the working of the joint strategy and report to the Cabinet and H&WB. We will then be able to consider what further investigations or we should take.

Thank you."

Councillor Maggie Mansell also mentioned that Stuart Routledge is retiring after many years of valued work in the voluntary sector. He was unable to attend this last meeting but was representated by Julia Powley, also from AgeUK.

The minutes of the meeting held on 19 October were agreed as an accurate record, apart from the following correction on page 4:

Originally the strategic planning authority came from the CCGs but it is now recognised that all providers should be involved. There are significant benefits in working together in order to deliver more effectively and we are looking at how to use commissioning support more effectively. Currently it is not appropriate for Croydon to look at a shared Chief Officer along with the other CCGs in South West London as Croydon is pursuing an Accountable Care Organisation approach. There is however no suggestion that Croydon is not working with the other CCGs - the future could look very different for strategic commissioning.

There were none.

There was none.

There were none.

Rachel Flowers introduced her report. 

The 2016 Director of Public Health Report focuses on social isolation and loneliness and identifies risk factors for these issues across the life course (pregnancy and early years, children and young people, working age, and retirement and later life).

For her first report, the new Director wanted it to be asset based - something ordinary people can do to improve the isolation of individuals.  It is evidence based - linked around data.  The photographs reflect Croydon's community.  It was presented at Cabinet and is now going through the process of sharing it.  Board members were encouraged to look through the report and 'do one more thing' to further improvements.

Cllr Yvette Hopley: It was well reported in the Croydon Advertiser and will be something the public will understand.  How will monitoring performance be indicated in the future? 

Rachel Flowers:  It is about describing the health of the population.  This is a snapshot of what is happening in Croydon.  We wanted to make it readable and helpful for people in the future.

Cllr Patricia Hay-Justice:  It is an excellent report.  A major concern is mental health.  The cuts make it difficult for individuals to be motivated.  We need to expand on plans for mental health and older people in the community.  Depression can occur regardless of individuals' financial situation.

Rachel Flowers:  The report is around what we can do not about the services we provide.  Acts of kindness to support those around us, particularly with mental health issues, can help.  People coming together to worship together will help their social isolation.  People can pop in to see their neighbours and ask if they can help with shopping or invite them in to share a meal.

Cllr Callton Young:  It is a great paper.  How will the information be disseminated?

Rachel Flowers: It emphasises how we can talk about it.  Each tip can be printed off.  Dissemination is an important part.

John Goulston: Being overweight is a huge issue in both young people (e.g. one in four 5 year olds) and adults (2 out of 3).  How do we address this?

Rachel Flowers:  We have an increasingly obese population.  It is about where they work, schools they attend, how they travel etc.

Cllr Mansell:  The whole issue is covered in the Croydon Congress report.

The Board NOTED the report.

Rachel Flowers briefly summarised the report.

This report provides feedback on the 10th meeting of Croydon Congress, held on 21 June 2016. The theme of the Congress was Social Isolation and Loneliness. The aim was to raise awareness and change attitudes and behaviours of people and organisations in the borough, and to better equip the community to take an active role to address the issue. A crucial element now to be developed, is understanding the extent to which local agencies in the public and voluntary sector are able to facilitate and enable these aims. This outcome is aligned with key priorities identified by the Health and Well-being Board and the Opportunity and Fairness Commission, and supports the Independence and Liveability themes within the Corporate Plan.

A round-table discussion followed, covering the theme of Social Isolation:

The Health & Wellbeing Board has been asked to lead the development of an action plan to tackle social isolation in Croydon.  The plan will be for the whole Local Strategic Partnership, so actions could be taken forward by other partnerships, including Safer Croydon, Children & Families, Economic Development etc.

Each table had to identify a small number of high level actions:

For each of the following life stages, what actions should we include in our plan?

• pregnancy and early years
• children and young people

Table 1

• Social isolation the product of a modern democratic society which is financially secure
• Slogan: Stop minding your own business
• Pop Bus refurbished
• Talk Bus being discontinued - should be continued
• Be alert and mindful of social isolation

Table 2

• Need for opportunities for people to get out - clubs, pubs
• Campaign: The pub is a hub
• Day centres
• Council invest to save
• Walk and talk - elders go round parks etc
• Cook and taste
• Retirement plans - helpful tips

Table 3

• Pregnancy and early years - services well covered with midwives - health visitor contact - phone calls to follow up?
• 100 different languages - pro-active approach - communities together rather than different cultural groups
• Children and young people - support via schools, after-school clubs, youth groups - can't afford? - grants

Cllr Hay-Justice:  There is lack of support for people in sheltered housing - volunteers are needed to hold regular lunch clubs

Cllr Mansell: It is important to develop social resilience in young people.
 

The draft action plan will be brought back to the Board when further developed.

Rachel Flowers introduced the report.  Matt Phelan (Public Health Principal), Anita Brako (Public Health Principal) and Jack Bedeman (Public health registrar) highlighted the key points.

The Live Well Croydon programme aims to:

• Make it easier to access the relevant services for weight management, alcohol screening and smoking cessation
• Redesign and integrate these services into one

The following issues were raised:

• It is about empowering people to find services to address these issues.
• How will Public Health promote the Health Impact Assessment (HIA)?
• Communication and engagement - how will people who are isolated engage with the website?
• How will success be measured?
• Who is using the app and how can we ensure the most needy get the best use of it?
• It is important for all agencies to work together on communication.
• How will the impact on patients across the borough and on pharmacies and GP practices be assessed?
• It is vital that the outcome is a reduction in work is achieved
• The website has generic information - it needs to be more local

Rachel Flowers: We worked closely with partner agencies.  There is a formal process around the HIA.   We would like to support other organisations preparing HIAs.  There is a need for consideration around 'what if?' in dealing with vulnerable people.

Matt Phelan:  Every time someone has clicked or downloaded from the website can be tracked.  The Council has not had lifestyle data by post codes before.  We can also reach out to Facebook and Twitter communities.  It will be important how we work with voluntary and community sectors to raise the profile.

Rachel Flowers:  We are continually reviewing the website.  It is a tool to support people not a signpost to primary care, unless that is needed.  It is about a different way of working.  The challenge is when to launch.  This is a work in progress.  We will provide an update in 6-8 months. 

Insp Duncan McMillan agreed to liaise with Andy Opie to assist communications through the Safer Neighbourhood Partnership.

The Board NOTED the direction of travel of the programme.

Rachel Flowers introduced the report. 

Health protection includes infectious diseases, chemicals and poisons, radiation, emergency response and environmental health hazards.  The Croydon Health Protection Forum (HPF) was established in July 2015 with the purpose to have a strategic overview of health protection matters and with the aim to provide assurance to the Director of Public Health that arrangements in place to protect the health of residents, are robust and implemented appropriately to local health needs. The health protection issues discussed at the Forum include adult and children immunisation programmes, and national screening programmes.

There were no questions.

Rachel Flowers summarised the report.  It is a statutory requirement for the Health & Wellbeing Board to develop a PNA.  The report provided an update on its development.

Andrew McCoig commended the report.   There are four LPS sites (Local Pharmaceutical Service).  The LPS contract ends in March and the East Croydon Medical Practice will be the urgent care hub.

The Board NOTED the report.

Paula Swann gave a summary of the report.

The report is an update on the progress of the OBC Programme towards a 10 year contract to develop an Integrated Health and Social Care system for the over 65s population in Croydon.

• Over 65s programme - different way of working and contracting to improve outcomes
• To develop an integrated Health and Social Care system for the over 65s population in Croydon

The following issues were raised:

• It is an important programme for joint working.  It gives headway in meeting Croydon's responsibilities to make services better for most people.
• Concern about the delivery of the service - not a one fix fits all
• How does it work with the size of the borough?
• With underfunding, managing financial risk is pivotal.   7 Commissioners need to work together to manage the risk. 
• Increasingly ageing population
• Investing in new ways of working but will it be enough? 
• Must not underestimate the size of the challenge.
• Both young and old populations are growing - these are the main users of the NHS.

Paula Swann:  We are not looking after people as well as we could do and not in most appropriate setting.  In many cases people can be supported at home but they are being admitted into hospital.

The Board NOTED the report.

The new Chief Executive Officer of Healthwatch Croydon, Jai Jayaraman, introduced the report.

Context:

• Based on primary research - the living experience of what people said
• About people facing real hardship
• Interviewed 105 people

Key findings:

• Access to services - to many refugees and asylum seekers, healthcare was not a priority
• Little access to mental health care
• Women refugees, particularly Tamil, waited over a month when they requested to be seen by a female GP
• Lack of awareness of interpreting services
• Tamil community pleased with care in hospitals and treated with dignity and respect

Cllr Mansell:  It is important all refugees and asylum seekers are welcomed and treated with respect.

The following issues were raised:

• Emphasis made on mental health services welcomed. 
• Concerns about young people under 18 - they worry about whether they can remain when they are 18.
• There are some good examples of good practice.  Ian Lewis (in children's services) got some excellent practice on what is happening in primary care. 
• Croydon is well ahead of the curve in terms of what we have done but there is further dialogue to be had around how we continue.
• Due to having the Home Office here, Croydon staff do have extra experience.
• Over the last decade Croydon has improved dramatically but we cannot recruit GPs at the moment
• It is in their own interest for individuals to learn English - providing interpreters is very expensive
• The interpreting service exists and does not necessarily need to be increased. It is important that refugees are aware of what they can access
• Children are concentrated in the north of borough but the support is not there
• We have become very good at community dependency but need to help people integrate and become self sufficient
• Important to emphasise that the gender of a GP is not a concern in an emergency. It cannot be an expectation

Paula Swann: Healthy London Programme - distributing card for homeless people about care services.  There is a lack of understanding about what services can be accessed.  There is E-learning for NHS receptionists and we have developed a commissioning guide for CCGs. 

The Board NOTED the report

The report summarised work undertaken by the health and wellbeing board executive group since the last meeting of the board on 19 October 2016.

There were no questions.

The Board RESOLVED to:

• Note work undertaken by the executive group since the last board meeting on 19 October
• Note risks identified at appendix 1.
• Agree revisions to the board work plan for 2016/17 in section 3.4. 

There were none.

NHS Croydon Clinical Commissioning Group (CCG) is asking local people to have their say on the following proposals:

• Proposed changes to prescribing in Croydon to reduce the prescribing of gluten-free foods, vitamin D for maintenance, baby milk and self-care medications. Visit the website: www.croydonccg.nhs.uk/news-publications/news/Pages/NHS-in-Croydon-seeks-views-on-prescribing-changes.aspx
• Foxley Lane Women's Service to change the services currently provided at this women's mental health service in Purley. Visit the website: www.croydonccg.nhs.uk/news-publications/news/Pages/Seeking-views-on-Foxley-Lane-Women%E2%80%99s-Service-in-Purley-.aspx

The engagement process for both of these ends on Friday 6 January 2016. 
 

There will be a seminar on 25 January 2017 focusing on dementia.

The next Health & Wellbeing Board meeting is on Wednesday 8 February.