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 Staples
Chairman of Health Task and Finish Group
Councillor Paul Handley
Vice-Chairman of Health Task and Finish
Group
Vice-Chairman of External Relations and Chairman of External Relations and
Partnerships
Overview
and
Scrutiny Partnerships
Overview
and
Scrutiny
Committee
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:
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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).
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:
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2c.
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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.
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
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:
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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:
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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.
2.
3.
4.
Prosperity
People
Place
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:
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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:
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1.5
District health profile 2012
Nottinghamshire Health and Wellbeing Strategy 2012-13
Nottinghamshire Joint Strategic Needs Assessment
Newark and Sherwood CCG Integrated Plan 2012-13
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.
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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
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
 Cardiovascular disease (heart disease
and diseases of the circulation)
 Diabetes
 Mental illness
 Respiratory disease (includes
smoking)
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Nottingham North and East CCG
 Smoking
 Obesity
 Diabetes
 Avoiding inappropriate admissions
 Chronic Obstructive Pulmonary
Disease (COPD)
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Dementia
End of life care
Early years development
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Trauma and Othopaedics
Depression
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.
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1.9
Partnership Accord for Health in Newark & Sherwood
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 Group
Newark & Sherwood District Council
Sherwood 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
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particularly for those that are joint funded and that may indicate a need for an
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.
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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
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:
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5.8
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.
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.
Page 15
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
Page 16
development. This could be an issue that is included in the work programme of the
proposed Health Working Party.
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.
Page 17
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:









2c.
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.
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
Page 18
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.
Page 19
APPENDIX A
Council’s Strategic Priorities
STRATEGIC PRIORITIES 2012-2016
PROSPERITY
Theme
Inward
investment
Business
growth
Employability
Infrastructure
Key sectors
Strategic Objective
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.
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.
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.
Coordinating and developing the management of infrastructure investment
through a re-focussed economic development function.
Developing an understanding of key sectors that are likely to bring faster
economic growth and sustainable job opportunities to the area.
PEOPLE
Theme
Older People
Young People
Vulnerable
Families
Strategic Objective
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.
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.
Extending Family Intervention work to try and prevent the most serious and long
term impacts on children.
PLACE
Theme
Maintain
Grow
Page 20
Strategic Objective
Ensuring a clean, green environment.
Helping to protect the district’s character, heritage and natural assets.
Leading the development of sustainable communities.
Develop
Driving improvements in the district’s physical and broadband infrastructure.
Increasing the amount of affordable housing.
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
Delivering our
statutory
duties
Developing
our
commissioning
approach
Localism and
devolution
Strategic Objective
Re-focussing our priorities where we can meet statutory duties effectively but at
a basic level.
Considering alternative ways of meeting our statutory responsibilities.
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.
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 & Enabling accessible data and decision-making.
transparency
Implementing a new governance model for the Council.
Community
Advocating key priorities for the community.
Leadership
Supporting community capacity for self-help.
Page 21
APPENDIX B
COUNCIL’S DRAFT HEALTH AND WELLBEING DELIVERY PLAN 2012-13
Page 22
APPENDIX C
DRAFT PROJECT SCOPE
HEALTH TASK AND FINISH GROUP
Background to the Issue
Terms of Reference
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.
 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 Yes. The health of Does it examine a No
area for the
the district’s
poorly
council?
population is
performing
reflected in
service?
the “People”
priority and
as
a
contributor
to economic
prosperity.
Is it a key issue for local Yes – district health Is it relevant to new Health and Social Care
people?
profile
Government
Act 2012
identifies
guidance
or
Page 23
issues
and
concerns are
evident
regarding
local health
service
provision.
legislation?
Will it be practicable to Yes
Will it result in
Yes
implement the
improvements to the
outcomes of the
way the Council
scrutiny?
operates?
Proposed Key Officers
Andy Statham, Director - Communities
Alan Batty, Business Manager – Environmental Health
Andy Hardy, Business Manager - Sports, Arts and Community
Development
Rob Main, Strategic Housing Manager
Leanne Monger, Business Manager - Housing Options, Energy and Home
Support
Ged Greaves, Business Manager – Policy and Commissioning
How will the work be Themed meetings including representatives from the CCGs and other
Undertaken?
service providers.
Key documents, Reports Initial background information prepared including:
and
Data
 District health profile
Required
 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 Group
Nottingham North and East Clinical Commissioning Group
INDICATIVE TIMETABLE
Proposal to Committee
Report to Committee
Report to Cabinet
Page 24
4 July 2012
21 November 2012
6 December 2012
APPENDIX D
HEALTH TASK & FINISH GROUP
11 JANUARY 2013
AGENDA ITEM NO.
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:






2.3
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.
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
Page 25
the 14th September 2012 Task & Finish Group. Members of the Group would identify
issues in different areas of the District.




2.4
Boughton
Collingham
Devon
Southwell
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.

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







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:

3.2

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
The Deputy Leader Councillor T Roberts attended the 14 th December 2012 meeting
of the Task Group.
Page 26
4.0
Summary of the Information Collected from the Organisations Attended
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.
Page 27
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:



4.2
Care of the Elderly
Children’s Assessment Unit
Long Term Care in a Respiratory Clinic
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

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

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
Page 28
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.




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)












4.5
Hetty’s
Page 29
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.














4.6
CASY







4.7
Established in 1996 by a small group of mums who had suffered the
affects of a loved one’s drug misuse.
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.
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.
Think Children

Page 30
Offers an early intervention service for children with emerging
emotional, social and/or behavioural issues.





4.8
Work with wide range of children dealing with issues such as
relationships, parental separation, bullying, bereavement and low selfesteem.
One to one sessions offered in familiar surroundings
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.
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




Page 31
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).
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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.
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.
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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
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:
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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:
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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.
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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 F
DISTRICT HEALTH PROFILE 2012
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