Due to the receipt of apologies for absence from the chairperson and the vice-chairperson, the first matter of business was to elect a chairperson for this meeting, in accordance with paragraph 4.1.10 of the council’s constitution.

Councillor Paul Rone was elected as chairperson for this meeting.

Apologies for absence had been received from Councillor Lester, Ingrid Barker, Jane Ives, Ian Stead, Dr Ian Tait and Simon Trickett.

To receive details of any member nominated to attend the meeting in place of a member of the board.

The following substitutes were noted: Duncan Sutherland for Ingrid Barker; Christine Price for Ian Stead; and Jo-anne Alner for Simon Trickett.

To receive any declarations of interests of interest in respect of schedule 1, schedule 2 or other interests from members of the board in respect of items on the agenda.

No declarations of interest were made.

To approve and sign the minutes of the meeting held on 1 October 2018.

The minutes of the previous meeting were received.

Resolved: 

That the minutes of the meeting held on 1 October 2018 be approved and be signed by the chairperson.

To receive any written questions from members of the public.

For details of how to ask a question at a public meeting, please see:

www.herefordshire.gov.uk/getinvolved

The deadline for the receipt of a question from a member of the public is Wednesday 27February 2019 at 5.00 pm.

To submit a question, please email councillorservices@herefordshire.gov.uk

The questions received and responses given are attached as appendix 1 to these minutes.

To receive any written questions from councillors.

The deadline for the receipt of a question from a councillor is Wednesday 27February 2019 at 5.00 pm.

To submit a question, please email councillorservices@herefordshire.gov.uk

No written questions had been received from councillors for this meeting.

To provide a update on the implementation of the recommendations of the director of public health annual report 2017 as agreed at the October 2018 health and wellbeing board meeting.

The director of public health provided an update on the implementation of the recommendations of the director of public health’s annual report 2017, as agreed at the 1 October 2018 meeting (minute 167 refers).  The key points included:

Recommendation 1: Strengthen our approach to embedding health in all policies, strategies and commissioned services

Public health had been working with planning, licensing and other areas of the council to ensure that health issues were considered in policy development and decision making.

Recommendation 2: Work with Herefordshire’s health and wellbeing board and other partners to develop a comprehensive oral health plan to tackle issues of poor oral health in children…

The oral health needs assessment was progressing well and should be published at the end of May 2019.

Recommendation 3: Work with Herefordshire’s health and wellbeing board and other partners to develop and implement a healthy weight plan which focuses on reducing obesity in children…

The children and young people scrutiny committee was congratulated on its dental health and childhood obesity spotlight review which had brought together a range of organisations to explore these issues.  Work on the healthy weight plan was progressing, including mapping.  Some targeted weight management programmes were being offered through schools and an assessment of school meal provision was to be undertaken.

Recommendation 4: Work with partners to develop a co-ordinated approach which focuses on what people can do to take care of themselves and build individual and community resilience…

Increased focus on working with communities, including the roll out of ‘Let’s Talk Community Hubs’ and embedding ‘Making Every Contact Count’ across the system, were helping to build community resilience.

Recommendation 5: Work with our partners to develop an ageing well plan, which responds to the findings in the ageing well needs assessment and the deep dive analysis of the problems of cardiovascular disease and hypertension.

This plan was being developed and should be completed by June 2019.

Recommendation 6: Develop the Healthy Living Network (HLN) to enable community and voluntary organisations, businesses, partners and residents to champion actively health and wellbeing improvements in their area.

The HLN had recruited 39 different organisation and 79 people had been trained to date, with further activity planned to support community networks and recruit more members.

Recommendation 7: Work with schools and early years settings to better understand the underlying issues impacting on children’s mental health and self-esteem and embed evidenced based interventions to promote resilience and good relationships.

Alongside other initiatives, a parenting programme was being rolled to promote children’s mental health, build confidence, and provide access to the right support.

Recommendation 8: Develop a sustainable health and social care service in Herefordshire by maximising the opportunities to reduce demand on services in the first instance.

The benefits of the prevention agenda and strengths-based model of working to improve health and wellbeing and reduce demand on social care were noted.  Developments included the multi-agency domestic abuse strategy, locality profiles, and improving the uptake of NHS health checks.

In response to  ...  view the full minutes text for item 174.

[Note: The Homeless Link Health Needs Audit item was considered next, but the original agenda order is preserved in these minutes for ease of reference]

To agree future arrangements for the delivery of, and outputs from, Herefordshire's joint strategic needs assessment (JSNA).

The consultant in public health summarised the proposed changes to the JSNA process and outputs as follows:

a.         One of the statutory functions of the health and wellbeing board was to produce a JSNA of the health and wellbeing needs of Herefordshire and its residents.

b.         The current approach included the production of a summary report which was refreshed every year and published on the ‘Facts and Figures about Herefordshire’ website.

c.         It was proposed that the annual document be replaced with a summary report every three years and the JSNA be repositioned as a live resource, supported by quarterly intelligence bulletins.

d.         As there had not been time to consider priorities during a board member workshop, it was suggested that the identification of priorities for analysis and understanding for 2019/20 and beyond be delegated to a workshop involving partner organisations.

The consultant in public health and the intelligence unit team leader responded to questions, the key points included:

1.         Population health profiles would form part of the JSNA resource and work was being undertaken on smaller, locality profiles.

2.         The ‘Facts and Figures about Herefordshire’ website would be rebranded ‘Understanding Herefordshire: people and places’ to reinforce its repositioning as the JSNA and evidence base hub.

3.         The current annual report was resource intensive to produce and many strategic indicators did not change significantly year-on-year.  The revised approach would enable greater focus on the analysis and understanding of the data, in a more real-time way.

4.         Different boards took different approaches, but it was considered that the new arrangements would complement the focus on localities and assets.

5.         It was anticipated that the changes would release some capacity in the team, potentially to support discrete pieces of work going forward.

6.         Jo-anne Alner expressed her appreciation for the frailty integrated care pathway.  It was confirmed that such documents would still be produced, with the director of public health adding that there would be opportunities for other organisations to upload documents to the website, subject to quality assurance.  It was noted that the new JSNA Delivery Group would comprise those responsible for the production of evidence and intelligence across the whole system.

Resolved:  That

(a)      The proposed move to a three-yearly summary, supplemented by a live JSNA in the form of the new Understanding Herefordshire website and quarterly bulletins, be approved;

(b)      The key areas for analysis and intelligence for the 2019/20 JSNA be delegated to a workshop involving partner organisations and the outputs be circulated to board members; and

(c)     The director of public health be authorised, following consultation with the CCG chief officer and relevant cabinet members, to determine in-year changes to the key areas for analysis and intelligence.

To review the better care fund 2018/19 quarter two and three national performance report, as per the requirements of the programme.

The head of partnerships and integration reported on the better care fund 2018/19 quarter two and three national performance report and drew attention to the following matters:

a.         Due to the national submission deadlines, the quarterly reports had been submitted and the board was invited to note the completed data.

b.         The report reflected national conditions and metrics, and the requirement to implement the High Impact Change Model for Managing Transfers of Care. 

c.         The board was advised that Delayed Transfers of Care had been peer reviewed recently and there were key programmes in place to support the system, including the implementation of a trusted assessor model, appointment of an integrated discharge lead, and an integrated discharge team function.

In response to a question, the director for children and families explained that the forecast in the ‘Section 75 Agreement Finance Summary 2018/19’ for ‘Total Pool 4 – Children’s Services’ related to children with complex needs and any underspend would be returned to the agencies that contributed to the pooled fund.

Resolved: That

(a)      the better care fund quarter two and three performance reports, as submitted to NHS England, be noted; and

(b)     there were no further actions that the board wished to recommend to secure improvement in efficiency or performance at this time.

To inform the board of the results of Herefordshire’s Homeless Link Health Needs Audit and to consider the recommendations arising from the audit.

The consultant in public health presented the results of Herefordshire’s Homeless Link Health Needs Audit, with attention drawn to the following:

a.         The audit was identified as an action in Herefordshire’s Homelessness Prevention Strategy 2016-20.

b.         The health inequalities faced by people who were homeless were considerable, with greatly reduced average life expectancy compared with the general population; over 30 years lower for men and 40 years lower for women.

c.         The audit was undertaken between December 2016 and February 2018, with 102 audits completed through face-to-face interviews by undertaken by Home Group, Supported Housing for Young People Project (SHYPP) and the council’s outreach service.

d.         The key findings were summarised, including background information, physical and mental health conditions, drug and alcohol use, and access to services.

e.         The rough sleeper outreach worker outlined two case studies which highlighted the complexities: the first demonstrated that access to mental health services were often vital for people who were homeless; and the second demonstrated that the provision of accommodation had to be complemented by a willingness to engage and support to address mental health and addiction issues.

f.          The recommendations were outlined, and it was suggested that a workshop be held to examine care pathways.  The audit would be published on the JSNA website, with the intention of repeating it again in three years.

Duncan Sutherland welcomed the audit and commented on the importance of breaking down silos and taking a pro-active approach.  An overview was provided of an integrated initiative in Bristol that was achieving impressive results and it was recommended that consideration be given to the submission of a bid to the Homes England ‘Move On Fund’ to increase the availability of move-on accommodation.

The chief executive emphasised that expressions of commitment had to be backed up by actions to support vulnerable people.  Noting that 25% of respondents had spent time in prison, it was suggested that the Ministry of Justice could be involved in the development of creative initiatives and solutions.  It was acknowledged that the issues were profoundly challenging for any community, especially where people rejected help, and some practical shape was needed to take this work forward.

The director of public health said that the audit was a good piece work, it reinforced the need to focus on community resilience, the workshop should result in an action plan, and the board had an important role to play in holding lead agencies to account.

The cabinet member children and families suggested that opportunities for community work could be explored to help homeless people reengage with the wider community.

Jo-anne Alner supported a workshop to identify and overcome barriers to healthcare and other services, noted that a new mental health crisis line was being developed, and re-iterated a commitment to consider representation on the Herefordshire Homelessness Forum.

Dr Hearne said that the workshop should explore care pathways from the perspectives of homeless people and then make recommendations at network and strategic levels to deliver the changes needed.

Resolved:  ...  view the full minutes text for item 177.

To review Herefordshire and Worcestershire dementia strategy and endorse the high level actions set out for 2019-2024.

The clinical programme manager of the CCG gave a presentation on the Herefordshire and Worcestershire ‘Living Well with Dementia Strategy 2019-2024’, the principal points are summarised below:

a.         The purpose of the new strategy was to set out a shared vision for a collaborative approach across both counties, with each county having its own action plan.

b.         Improving the health and wellbeing of people affected by dementia was a shared priority health outcome area for both counties and there were similarities, particularly between south Worcestershire and Herefordshire, in terms of challenges around dementia diagnosis and geography; the four CCGs were underperforming against the national target for dementia diagnosis.

c.         The strategy had been informed by the Older People’s Needs Assessment, local partnership events, a public survey, and feedback from service users, carers and a range of other stakeholders.

d.         The vision was that ‘in Herefordshire and Worcestershire people with dementia can live well through the following guiding principles: preventing well; diagnosing well; supporting well; living well; and dying well.

e.         The key messages and challenges that had emerged during a series of workshops were outlined.

f.          It was estimated that around 12,500 people were living with dementia in Herefordshire and Worcestershire, and this was expected to rise to around 20,000 people by 2025.  Consequently, there was a need to pool resources and share learning in order to achieve the best possible outcomes.

g.         A further engagement event was to take place during the following week to explore the high-level actions and to consider the immediate priorities.

h.         A five-year plan was considered realistic and would provide time to drive the culture change required and achieve longer-term outcomes.

The director for adults and communities said that the work was positive overall but, whilst there had been engagement with a range of stakeholders, more could be done to engage with the local authorities in the two counties, especially given the finite management resources available to attend individual events.  Concern was expressed about potential risks in terms of governance processes and ensuring that plans were relevant to the localities in which they were to be implemented.  The director added that there was a lot of strategy development happening locally which needed to be aligned; for example, the economic development strategy could contribute directly towards shaping dementia friendly communities.

Jo-anne Alner emphasised that the Herefordshire and Worcestershire Sustainability and Transformation Partnership did not operate in isolation, commented on the various engagement opportunities, and reiterated that each county would have its own action plan.

Resolved: That

(a)      the draft Herefordshire and Worcestershire Dementia Strategy 2019-2024 be noted; and

(b)      partner organisations be recommended to take the draft strategy through their governance systems for consideration and approval.

The following provisional meeting dates for 2019/20 are suggested:

Monday 8th July 2019, 2.30pm

Monday 14th October 2019, 2.30pm

Monday 9th December 2019, 2.30pm

Monday 10th February 2020, 2.30pm

Monday 20th April 2020, 2.30pm

Provisional meeting dates for 2019/20 were noted, with the next scheduled meeting on Monday 8 July 2019.