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

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Email us at [email protected]. Call us: 0117 .... CSS commissioners were encouraged to work with Bristol Men

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

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


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1. Public Forum None 2. Declarations of interest None 3. Welcome, apologies and introductions 4. Minutes of the Health and Wellbeing Board 21 October 2015 Health and Wellbeing Board strategy refresh will be discussed in 2016.

Key Decisions 5. Children’s community health services re-commissioning. Presented by: Cllr Brenda Massey, Assistant Mayor, People and Becky Pollard, Director of Public Health, BCC What’s happened so far?  The contract for children’s community health services will be renewed from April 2017.  Since 2014, commissioners from 6 different organisations across Bristol, North Somerset and South Gloucestershire have been working together to develop the new contract.  Details of public engagement will be shared via a report which has been co-written by the commissioning partners and the Young People’s Reference Group (supported by Healthwatch Bristol).

[/] notify Young Healthwatch volunteers of the praise their involvement in the consultation received

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was the key feedback gathered during the consultation phase? Strong support for the proposed specifications Focus on early intervention, outreach and locally based services Need to manage expectations as the proposed service models are ambitious  Need to reduce the number of outcomes  There was a need to better understand the links to health and social care and education and how pathways will be developed  The importance of service integration The Care Forum is a charitable company limited by guarantee. Registered in England no. 3170666. Registered charity no. 1053817.

 How communication is key to everything Revisions to specification based on consultation:  Number of Lots reduced to four  Tier 4 CAMHS will be included in re-procurement  Ongoing work on individual specifications What      

will happen next? Nov-Dec 2015: Revise service model and specification Jan 2016: Sign off by Programme Board Jan 2016: Advert Jan-Sep 2016: Procurement Oct 2016-March 2017: Service Transition Phase Apr 2017: New Service

Comments during the H&WB meeting:  The consultation has been nationally recognised as an excellent example of public engagement in commissioning.  The animation created by Young People’s Reference Group/ Young Healthwatch volunteers was shown to the Board.  Healthwatch Bristol representative thanked the young people for being a joy to work with and gave examples of how through being involved in the process, the young volunteers have gained valuable skills. She encouraged the commissioners to continue to include the young volunteers in the next stages of the commissioning process. 6. Joint Strategic Needs Assessment 2015 – update Presented by: Becky Pollard, Director of Public Health, /BCC, Dr Joanna Copping, Consultant in Public Health, BCC and Nick Smith, Strategic Intelligence, JSNA and Consultation Co-ordinator, BCC

[ ] Discuss in HwB Advisory Group and adapt work plan accordingly.

Summary: For many health indicators Bristol ranks as one of the healthiest of the Core Cities but despite this, there are a range of indicators where Bristol does significantly worse than the England average. For example, life expectancy has shown a gradual improvement over the last 20 years, but for men, remains significantly below the England average. Crucially, even on indicators where Bristol overall performs

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well, there are differences within the city and for different population groups. There are very affluent areas of Bristol with very good health outcomes alongside areas that rank amongst the most deprived in the country, and often these areas have significantly poorer health outcomes. Further points:  Premature mortality rates are falling, but are still significantly higher than average for England. Half of such deaths are due to cancer (39%) and coronary heart disease (11%).  Poor diet, tobacco and obesity are the main causes of premature death.  Hospital admissions related to alcohol consumption are rising in Bristol. Alcohol-related hospital admissions are consistently higher than the national average. There has also been a rise in the number of referrals to alcohol treatment services in Bristol.  Bristol has the highest estimated rate of opiate and/or crack users of the core cities.  Bristol: high rates of Sexually Transmitted Infections and HIV late diagnosis.  23% of children live in poverty in Bristol.  Homelessness in Bristol is increasing.  In Bristol, 35.3% of social care service users say they have as much social contact as they would like, which is significantly lower than the national average (44.2%).  The number of years people are living in ill health has a vast range from 11 years to 31 years for females and from 10 years to 24 years for males. Bristol’s healthy life expectancy gap does not compare well with other local authorities - out of 149 local authorities in England for males Bristol is 27th worst and for females it is 23rd worst.  Generally, at a ward level the main causes of premature death tend to be the same. There are exceptions – in Ashley ward one of the main causes of death is accidental drug overdoses, in Cabot ward and Lawrence Hill alcohol related liver disease is one of the main causes of premature death and breast cancer is one of the main causes in Cotham and Stoke Bishop wards.  The proportion of Bristol children at school entry (23%) and end of primary school (34.8%) who are obese or overweight is similar to the national average but is a concern nationally.  Rates of dental decay for Bristol are similar to nationally but there is evidence of large inequalities across Bristol wards. The Care Forum is a charitable company limited by guarantee. Registered in England no. 3170666. Registered charity no. 1053817.

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An estimated 10% of children and young people may be experiencing emotional health problems at any time, and selfharm hospital admission rates in 10-24 year olds exceed the England average. Rates of early death from cancer are falling in Bristol, but are still higher than the national average. Screening coverage is low. 30,100 people in Bristol were newly diagnosed with depression over the last year. This is higher than the national average. Suicide rates are rising amongst socially disadvantaged people and middle aged men. There has been a rise in the percentage of people living in deprivation. Income deprivation affects 17% of people in Bristol. In Lawrence Hill income deprivation affects 36% of people and the figure is 35% in Filwood.

Healthwatch information included in JSNA:  Section 11: Public Feedback – this section was written by HwBristol and is included in full.  Page 47: “Feedback from service users via Healthwatch indicates that accessing healthcare appointments or information about services and waiting times are key concerns for some.”  Page 83: “A new survey commissioned by Bristol Healthwatch regarding LGBT Health Needs is due to be published at the end of 2015. The results from this survey will be included in future JSNA reports.” Plans for future format of JSNA: In future, the JSNA process will adopt a different approach as standard working with all partners to go into more detail on priority topics, and to recommend actions. This will be on a rolling 3-5 year programme to be aligned to recommissioning timescales and priority areas. Comments during the H&WB meeting: Healthwatch Bristol representative at the H&WB suggested that the H&WB strategy, JSNA priorities for future chapters and Healthwatch Bristol quarter topics were planned to coincide with each other. The H&WB were in support of this suggestion. 7. Public health budget update Verbal update. Presented by Becky Pollard, Director of Public Health, BCC The Care Forum is a charitable company limited by guarantee. Registered in England no. 3170666. Registered charity no. 1053817.

The Government’s Comprehensive Spending Review (November 2015) means that local authority public health spending will be required to deliver average annual real-terms savings of 3.9% over the next five years. Councils will be required to develop new ways to deliver public health and to deliver efficiencies in this area. Public Health England will continue to support local authorities in this process. 8. Adult social care community support services commissioning Presented by: Netta Meadows, Service Director, Commissioning, BCC, Lucia Dorrington, Service Manager, Joint Commissioning, BCC

[/] notify Dominic Box, The Hive

Summary:  Community Support Services (CSS) in Bristol are adult social care support services for adults (18 years+) with learning disabilities, mental ill health and physical and sensory impairments delivered within community settings or at home.  CSS were last re-commissioned in 2008/9.  CSS are currently in the consultation phase for recommissioning.  CSS aim to promote maximum independence, physical and mental well-being, social interaction, choice and control for those with statutory assessed eligible social care needs.  Services currently include Accommodation Based Support (supported living), Community Outreach; Day Opportunities; and Carers Sitting Services.  CSS currently include over 100 providers and provide 23,000 hours of support a week to approximately 1,000 service users. £15million per year is spent on CSS.  To bring CSS expenditure back in line with budget, this commissioning is required to reduce cost by between £1-2m. This needs to be done alongside ensuring quality services. Timeline: Early 2016: Strategy shaped and finalised based on consultation feedback Spring 2016: Tender process Autumn 2016: Contract award

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Autumn 2016-Spring 2017: Transition phase Comments during the H&WB meeting: Healthwatch Bristol representative commented that Healthwatch invited Bristol City Council CCS commissioning team to facilitate a workshop with adults with Learning Disabilities at a Wellbeing Day organised by The Hive. The key comments participants made were:  general satisfaction with CSS;  upset about unavailability of college places for adults over 25 years with Learning Disabilities;  desire for more options and support to get into and remain in volunteering and employment;  unreliability of public transport. Healthwatch Bristol representative stressed the importance of commissioners of CSS to look outside of the CSS themselves and consider the impact that education and training, employment and volunteering and transport have on CSS service users. The commissioners acknowledged these points and said they had received similar feedback during the consultation phase. CSS commissioners were encouraged to work with Bristol Mental Health to consider how both sets of services could work together. 9. Sexual health re-procurement To be presented by: Becky Pollard, Director of Public Health and Barbara Coleman, Service Manager, Public Health, BCC

[/] notify Dean/TCF

Summary:  Commissioning sexual health services became a mandatory function of the local authority in April 2013. The value of the services is such that under EU procurement law we are required to put the services out to tender to ensure LA are getting best value for money. LA are currently in the “pre-procurement” phase of the process and draft specifications are being consulted upon between November 2015 and January 2016. Following this consultation, re-commendations will come to the Health and Wellbeing Board on 17th February 2016 for a key decision on whether to re-procure the services. Consultation:

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LA commissioned Healthwatch to set up and run a number of focus groups between November and January to get the views of particularly hard to reach groups. Additional events have been set up for potential and current providers on 16th December. The Care Forum is also hosting an event for providers on 9th December.

Comments during the H&WB meeting:  The commissioners said that responses to the consultation from young people has been low. Healthwatch Bristol representative said that Healthwatch Bristol and The Care Forum have promoted the consultation via social media and contacted youth groups in Bristol, but that, due to the tight deadline (before January), arranging face-to-face sessions has been difficult.  There was a discussion about the viability of potential providers, including GPs, being able to set up new and innovative ways of working in the timeframe of the recommissioning.  It was agreed that the possibility of an extension to the timeframe will be discussed. 10.

Any other business

Personal Medical Service review: Healthwatch Bristol notified the Board that 1683 signatures have been received via several petitions from PEGs of South Bristol GP Practices about the Personal Medical Service review. Healthwatch Bristol sought and has received responses from NHS England and Bristol CCG which have been shared with the PEG.

[ ] notify Pat

[/] notify Callington Road Hospital public transport: The Board has not received BIMHN a response from First regarding the termination of the Callington Road bus service (the Board has received a letter of acknowledgment). The Healthwatch Bristol Representative informed the Board that Bristol Independent Mental Health Network hosted a forum which was attended by First at which they discussed potential solutions to the issue. The Board will re-contact First and ask for a response. Mental health services: there was a discussion about access issues to mental health services and support and concern that people were being subjected to multiple assessments. Healthwatch Bristol Representative said that the feedback gathered by Healthwatch

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supported this observation and that there was a need for more support for people for whom IAPT services are not suitable, but who do not meet the criteria for intensive mental health services.

The Care Forum is a charitable company limited by guarantee. Registered in England no. 3170666. Registered charity no. 1053817.