30 01

Minutes from the twenty-ninth meeting of the Public Health Wales Board
Date of meeting:30 January 2014
Venue for meeting: Cwm Taf University Health Board, Ynysmeurig House, Navigation Park, Abercynon
Version: 1

Present:

Professor Sir Mansel Aylward / Chair
Professor Peter Bradley / Executive Director of Public Health Development
Dr Carl Clowes / Non Executive Director
Mr Mark Dickinson / Executive Director of Planning and Performance
Mr Huw George / Interim Chief Executive
Ms Tamira Rolls / Interim Executive Director of Finance
Mr Terence Rose / Non Executive Director
Dr Quentin Sandifer / Executive Director of Public Health Services
Mr John Spence / Non Executive Director
Professor Gareth Williams / Non Executive Director

In attendance:

Ms Rhiannon Beaumont-Wood / Director of Nursing
Mr Matthew Coe / Wales Audit Office
Mr Keith Cox / Board Secretary
Mrs Ruth Davies / Director of Workforce and Organisational Development
Ms Eleanor Higgins / Corporate Governance Manager
Ms Nicola John / Executive Director of Public Health, Cwm Taf University Health Board
Ms Angela Jones / Consultant in Public Health, Cwm Taf local public health team
Renata Leonardi-Jones / Unison representative, Public Health Wales
Mr Chris Lines / Director of Communications
Dr Aideen Naughton / Designated Doctor, Safeguarding Children’s Service
Mr Chris Orr / Business Support Manager
Ms Sara Thomas / Consultant in Public Health, Cwm Taf local public health team
Stephanie Wilkins / Unite representative, Public Health Wales

Apologies:

Professor Simon Smail / Non Executive Director

PART A

1. / Welcome andapologies for absence
The Chair welcomed all in attendance to the twenty-ninth meeting of the Public Health Wales Board.
Apologies were received from Professor Simon Smail.
The Chair informed the Board that Mr John Bullivant from the Good Governance Institute would be observing the meeting to assist in developing a Board development programme.
The Chair welcomed representatives from the Public Health Wales Partnership Forum who have been invited to attend Board meetings. Ms Stephanie Wilkins was attending to represent Unite and Ms Renata Leonardi-Jones was attending to represent Unison. The Chair explained that Unite and Unison would be sharing a seat on the Board and that they would alternate their attendance at meetings. A second seat has been offered to the BMA who has not yet confirmed its attendance. Until confirmation has been received from the BMA Ms Wilkins and Ms Leonardi-Jones will attend meetings together.
2. / Declarations of interest
No declarations of interest were received.
3. / Minutes from Public Health Wales Board meeting held on 21 November 2013
a)Approval of minutes
The minutes (paper 29 01) from the last meeting of the Public Health Wales Board were approved, with a few minor amendments, as an accurate account of the meeting.
Decision:Minutes from the last meeting of the Public Health Wales Board were approved.
b)Actions:
MrKeith Cox provided the Board with an update on actions which were marked as ‘in progress’. Further information on each action is provided in the action table at the end of the minutes.
The following actions were discussed in detail:
Action 25.07 Arrange for committee responsible for the link between Betsi Cadwaladr University Health Board and Quthing, Lesotho to provide a presentation to a future Board meeting.
Mr Cox advised that there are a number of initiatives underway in Public Health Wales in relation to international work and that this item would be linked to a meeting where wider discussions on international work were taking place.
Mr Huw George advised the Board that the Director of Nursing, Ms Rhiannon Beaumont-Wood, had recently returned from a study tour of Uganda and had prepared a report which would be shared with Board members.
Action: circulate report from Director of Nursing’s study tour of Uganda with Board members
Action 27.07 Executive team to re-visit process for ensuring Public Health Wales is adequately represented at events.
Mr Chris Lines informed the Board that he had developed a ‘forward look’ email, which is being circulated weekly and which provides Board members with a list of events being organised by Public Health Wales, events being organised by other organisations, and any expected communication matters. The Board welcomed this new approach.
Action 28.09 Professor Bradley present evidence from four nations review of e-cigarettes when available.
Professor Bradley explained that the expert panel which was to be convened by Public Health England in the autumn had been delayed until the spring. Professor Bradley would keep the Board updated on progress.
c)Matters arising
Ms Stephanie Wilkins queried whether any further work had been done in relation to Mr Terence Rose’s comment on page 5 of the minutes about his disappointment in the low number of laboratory staff who had attended the Public Health Wales staff conference. Mr George explained that there were a number of ongoing pieces of work looking to ensure attendance includes a full representation of the organisation. Ms Wilkins suggested that the events should be subject to an Equality Impact Assessment to ensure representation and Mr Chris Lines agreed that this was something he would look into.
Action: consider completing an Equality Impact Assessment for attendance at Public Health Wales events to ensure a full representation from across the organisation
Dr Quentin Sandifer advised the Board that he was in discussions with the Scientist and Research forum staff group about a research and development event which could be organised across the organisation. The group has requested a prominent input from the Board.
4. / Chair’s report
Sir Mansel Aylward CB presented the Chair’s report (paper 29 02).
Sir Mansel informed the Board that the local government Non Executive Director post had been advertised and information circulated to local authority Chief Executives.
He also updated the Board that the Health and Wellbeing Best Practice and Innovation Board would be producing an final report which he would circulate to Board members, when available.
Action: circulate Health and Wellbeing BestPractice and Innovation Boardfinal report, when available
Sir Mansel also informed the Board that he had met with Janet Pardue-Wood from MIND Cymru to discuss the recommendation made in the Health Improvement Review in respect of Mental Health First Aid. Sir Mansel confirmed that there was not any current evidence to show hard, tangible outcomes from the Mental Health First Aid programme. Sir Mansel had agreed that Public Health Wales would work with the Mental Health First Aid programme to formulate a way forward in regard to an approach to improving mental health along the life course.
Sir Mansel provided the Board with an update on correspondence he had with Sanofi Pasteur MSD about a shortage of the Shingles vaccine, which had been experienced by some GP practices before Christmas. Sanofi Pasteur confirmed that the shortage had been rectified. The Board agreed that this presented a wider communication issue for the public health system.
Action: circulate copy of correspondence between Sir Mansel Aylward and Sanofi Pasteur MSD to Board
5. / Interim Chief Executive’s report
Mr Huw George presented his Interim Chief Executive’s report (paper 29.03).
Mr George informed the Board that he had received assurances from managers that they will work towards achieving an 80 per cent compliance rate in statutory training by the end of March 2014.
6. / Cwm Taf local public health team
Ms Nicola John, Executive Director of Public Health for Cwm Taf University Health Board, provided the Board with an update on public health delivery in Cwm Taf University Health Board. She was joined by Ms Angela Jones and Ms Sara Thomas who are both Consultants in Public Health working in the local public health team.
Ms John gave the Board an overview of the strategic direction and shared priorities for the team. Ms Jones and Ms Thomas provided the Board with some examples of local delivery including smoking, immunisation, obesity, alcohol, sexual health, mental health, the inverse care law programme and maternity.
Discussion focused on local and national data and the Board was informed that discussions had begun to look at local modelling and providing a framework for local data to feed into national data. Professor Gareth Williams emphasised that national data can be enhanced by local data and the sharing of understanding is important in this process.
Ms Rhiannon Beaumont-Wood queried whether the local team were making use of health visitors and school nurses in delivering public health. Ms John explained that she would welcome involvement with health visitors and Ms Beaumont-Wood suggested that the contribution that health visitors can make to delivering public health should also be strengthened through the implementation of the Health Visiting strategy for Wales being led by the Chief Nursing Officer.
Dr Carl Clowes mentioned that he was pleased to see the levels of deprivation in the area are reducing and emphasised the importance of sharing these solutions with other health boards. He also emphasised the importance of having a close working relationship with the Welsh Government.
Ms John reiterated the importance of Public Health Wales and the local teams working together. The discussion focused on integrating staff working centrally in Public Health Wales with staff working in the local teams. Ms John suggested that central staff could spend one day a week or month based in the local team to learn about local issues. National staff could spend time with local staff to learn local issues and help understanding of national issues. The Board agreed that integrated working with central and local teams would become more important as resources get tighter. Ms Ruth Davies informed the Board that the Workforce and OD team were looking at enabling plans for moving people around the organisation in order to facilitate learning across directorates, divisions and teams.
Ms John also discussed the reporting against tier 1 targets with the Board. Some tier 1 targets are contributed to jointly by health boards and Public Health Wales and performance against these targets is not currently reported. Mr Mark Dickinson explained that the Public Health Wales Quality and Delivery Framework has an undertaking for Public Health Wales to report tier 1 targets, for example, thepercentage of smokers being treated by smoking cessation services and the CO validated 4 week quit rate. However, this data is not currently available consistently across Wales, so it not yet reported. There are also further discussions underway with the Directors of Public Health to agree whether the figures should be reported nationally or by health board area.
The Board agreed to consider the issues discussed with Ms Nicola John in relation to the integration of national and local working and reporting against tier 1 targets. The Board will receive an update in 12 months time.
Action: consider the issues discussed with Ms Nicola John in relation to integration of national and local working and reporting against tier 1 targets and; the Board will receive an update in 12 months time
7. / Safeguarding Children Service
Dr Aideen Naughton attended to provide an update on the Safeguarding Children Service.
The Board heard about a number of achievements for the Safeguarding Children Service which included the establishment of a Safeguarding Children NHS Network; the development of a Quality Outcomes Framework; development of training resources; improving patient safety through child practice reviews; and improving quality of services through revision of 'Procedural Response to Unexpected Deaths in Childhood’(PRUDiC).
Discussion focused on the development of a Quality Outcomes Framework for Safeguarding Children. Professor Simon Smail had provided Sir Mansel Aylward with a message that he welcomed the development of the Quality Outcomes Framework, but queried where the resources would come from. Dr Naughton agreed that the outcomes framework was ambitious and that there were no readily available resources, but saw the need for the Safeguarding Children Service to be more focused and more challenging.
The Board also discussed the need for the Safeguarding Children Service to maximise the use of co-production and Dr Naughton confirmed they are in the process of developing a network.
Sir Mansel Aylward was pleased to see that most of the recommendations he made in his report into safeguarding children services in NHS Wales are being taken forward.
8. / Draft integrated medium term plan
Sir Mansel Aylward introduced the draft integrated medium term plan (paper 29.04). He explained that the paper was still very much in draft form and that the Board was not asked to approve the paper. Board members were, instead, asked to comment on the style and content of the draft plan.
Mr Huw George informed the Board that the draft plan would be submitted to the Welsh Government on Friday 31 January 2014 with a covering letter from Mr George explaining what further work was needed and providing assurance that Public Health Wales would not require transitional funding in the next two years. The Welsh Government would provide feedback to Public Health Wales by the end of February and a final plan would be presented to the Board for approval at the Board meeting on 27 March 2014.
Mr George explained that further work will include a section on how Public Health Wales plans to link with health boards across the public health system in Wales; inclusion of the work being undertaken on prudent healthcare, following the announcement by the Minister for Health and Social Services at the Welsh NHS Confederation conference; and a description of how Public Health Wales will link with key Welsh Government policy issues.
The Board acknowledged the large amount of work which had gone into producing this draft of the integrated medium term plan. Board members did, however, agree that the plan needed to develop further before the Board would be in a position to approve it.
Mr Keith Cox suggested that the Board may need to spend some time during the informal Board meeting in February discussing the integrated medium term plan in more detail.
Action: arrange for Board to discuss integrated medium term plan at informal Board meeting in February
9. / Performance reports
a) Finance performance report
Ms Tamira Rolls presented the month 9(paper 29.05) finance performance report. The Board was informed that Public Health Wales remains on target to break even and savings targets have been achieved.
Ms Rolls brought the Board’s attention to the public sector payment policy compliance. Ms Rolls explained that it was unlikely that Public Health Wales would meet the 95% target for non NHS invoices (by number) by the end of the financial year. This has been reported to the Board as an ongoing issue resulting from a low level of compliance in the early part of the financial year.
The Board was pleased to note that the underachievement of savings targets was no longer considered a risk to the organisation.
Mr Huw George informed the Board that the Welsh Government was appreciative of the financial position in Public Health Wales and the continued reporting of a break-even position along with the commitment to brokerage funds back to the Welsh Government.
Ms Stephanie Wilkins explained to the Board that staff were also appreciative of working within an organisation which is consistently reporting a break-even position.
The Board noted the current financial position.
b) Quality and delivery framework performance report
Mr Mark Dickinson introduced the quality and delivery framework performance report (paper 29.06). Mr Dickinson explained that the development of the paper was led by the planning and performance directorate and was evolving each time it was presented to the Board.
Professor Peter Bradley brought the Board’s attention to the performance of smoking prevention and cessation services. There has been a reduction in performance for some indicators. Professor Bradley explained that he had produced a report on what actions had been taken by the service in the past six months to improve performance, which is available to the Board. There is also initial evidence to show that there has been a change in the type of people accessing the service towards people who are more addicted, which are harder to treat and also a drop in the number of people accessing the service, in common with the rest of the UK. The drop in numbers is partly attributable to the increased use of e-cigarettes. Mr Terence Rose queried whether CO testing would pick up individuals who have replaced smoking cigarettes with e-cigarettes. Professor Bradley responded that the testing would still pick up the use of nicotine. He explained that this was part of a much wider debate which was ongoing and a huge issue which needs to be addressed as part of smoking prevention and cessation services.