Apologies were received from Ingrid Barker, Russell Hardy, Jo Melling, Ian Stead, Councillor EJ Swinglehurst and Simon Trickett.

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

Christine Price attended for Ian Stead, Jo-Anne Alner attended for Simon Trickett and Duncan Sutherland attended for Ingrid Barker.

To receive any declarations of interests of interest by members in respect of items on the agenda.

There were no declarations of interest.

To approve and sign the minutes of the meeting held on 13 February 2018.

Resolved that:

the minutes of the meeting held on 13 February 2018 be agreed as a correct record and signed by the chairman.

To receive questions from members of the public.

Questions must be submitted by 5pm three clear working days before the day of the meeting, in this case by 5pm on Tuesday 25 September 2018. 

Please submit questions to: councillorservices@herefordshire.gov.uk

Accepted questions will be published as a supplement prior to the meeting.

There were no questions from members of the public.

To receive questions from councillors.

Questions must be submitted by 5pm three clear working days before the day of the meeting, in this case by 5pm Tuesday 25 September 2018. 

Please submit questions to: councillorservices@herefordshire.gov.uk

Accepted questions will be published as a supplement prior to the meeting.

There were no questions from councillors.

To review the better care fund (BCF) 2018/19 quarter one performance report and approve the integration and BCF plan 2018/19 refresh, as per the requirements of the national programme.

The head of partnerships and integration introduced the report and highlighted the key points. She noted that partners had agreed to invest improved better care fund (iBCF) funds in a number of new areas including a trusted assessor scheme, discharge to access model and to support improvements in the quality of care in care homes. It was recognised that substantial performance improvements were required to meet the new target in relation to Delayed Transfers of Care (DToC).

The case studies circulated as a supplement to the agenda papers were reviewed as examples of the impact the additional funds were expected to have.

In discussion of the report the board noted that:

·         there was no single area of weakness in Herefordshire care homes, key themes identified in inspections of homes were around recruitment and retention of staff, leadership and management not having a full understanding of what was required, poor care planning and the environment of some homes;

·         a nurse led, rapid improvement team employed by the CCG had been set up to provide hands on support and early intervention;

·         care homes in Herefordshire were generally run by smaller providers and work was taking place to improve partnership working and mentoring for weaker providers;

·         where homes were judged to be failing a condition could be imposed requiring that they work with an improvement partner;

·         the case studies provided were helpful in translating the work being undertaken to real life situations.

It was resolved that:

a)    the better care fund (BCF) 2018/19 quarter one report, at appendix 1, as submitted to NHS England was reviewed;

b)    the integration and BCF plan 2018/19 refresh, at appendix 2 and 3, as submitted to NHS England be approved; and

c)    the board determined there were no further actions it wished to recommend to secure future improvement in efficiency or performance at this time.

The draft Children and Young People’s Plan is presented to the Health and Wellbeing Board for the consideration of any recommendations to the Cabinet Member concerning the content of the Plan.

The director for children and families introduced the draft plan and highlighted the improvements made and achievements over the life of the previous plan. Many children and young people had been involved in developing the new plan. Consultation was now taking place and it was hoped that the final version of the plan would be approved by Herefordshire Council at the full council meeting in February 2019.

The children’s commissioning and contracts lead explained the engagement work that had taken place with children, young people, providers and parents in drafting the new plan. Efforts had been made to make the plan as concise and easy to read as possible. The plan had moved towards an outcomes based approach and four key pledges:

·         be safe from harm;

·         be healthy;

·         be amazing; and

·         feel part of the community.

In discussion of the draft plan the board noted:

·         it was important to join up work with children and work with adults to focus on whole family issues;

·         that the importance of making every contact count (mecc) should be highlighted;

·         that ‘family first’ was a local name for an approach to working with troubled families, with an expanded outcomes framework;

·         that the plan could be aligned with the local maternity services plan and that contact between the authors of the two plans should be encouraged;

·         that mental health was an important element, work was taking place with partnerships and would feed in to the plan and be translated to concrete actions;

·         that individuals from a travelling background had the poorest outcomes in Herefordshire and that particular efforts should be made to target and engage with this group;

·         that care should be taken when presenting figures in the plan as fact if they were not, for example the number of children and young people requiring support with their mental health or emotional resilience was an estimate based on national statistics, it was agreed that this would be reworded;

·         that schools would have a significant role to play in implementing the plan, it was noted that action plans would be developed under the main plan and that schools would be one of the partners involved;

·         that members of the board should take the outcomes in the plan back to their respective governance structures, publicise the plan as much as possible, ensure the outcomes were embedded in their own areas of work and regularly referred to;

·         that the plan should be more explicit about partnership work, but it was noted that the plan should not become too large a document;

·         that board members should identify barriers to the success of the plan and use their strategic weight to remove these.

Actions identified by the board included:

·         board members to take the strategic priorities identified in the plan and work to deliver them through the governance structures of their respective organisations;

·         board members to reference and encourage discussion of the strategic priorities identified in the plan in forums not specifically dealing with children and families to identify opportunities  ...  view the full minutes text for item 166.

To present the Director of Public Health Annual Report 2017 and to seek the support of the Health and Wellbeing Board in implementing the recommendations.

The director of public health introduced her annual report for 2017. Directors of Public Health have a statutory duty to produce an independent annual report on the health of their population. This report sits alongside the Joint Strategic Needs Assessment (JSNA). The director highlighted that:

·         the health and wellbeing of the population was generally improving although there were some areas of concern;

·         the areas of concern had been picked up in other related plans;

·         the key areas for action were obesity in both adults and children, children’s mental health, developing a strategic and coordinated approach to embedding community focused and strengths based approaches and how to build the resilience of health and social systems;

·         there was a need to look at priority groups across all plans and strategies and to embed health in all policies for example strengthening licensing conditions around fast food outlets and alcohol free zones;

·         there was a need to strengthen the embedding of making every contact count (MECC), for example anyone having contact with a family could have a conversation about access to dentists and reducing consumption of sugary drinks to promote good oral health;

·         an oral health plan and healthy weight plan were being developed;

·         building individual, family and community resilience would underpin efforts to improve childhood mental health;

·         the ageing well plan would look at sustainable health and welfare and what could be done around environmental changes and MECC with an aim to have people living in good health longer;

·         the strategic prevention board, which included representatives from the council, CCG and HVOSS would be working to embed prevention, this needed support from the health and wellbeing board.

In discussion of the report board members noted that:

·         organisations represented on the board should seek to support their own staff to live healthy lives and take a lead in embedding the practices recommended;

·         work was going on both locally and nationally with supermarket chains to promote fresh food and change how sweets were marketed;

·         care should be taken in the tone of communications and there should be a focus on practical things that could be done, it was recognised that there was no single solution to the issues but a lot of individual steps would contribute to overall improvement;

·         communication should be consistent and marketed in a non-preachy way;

·         environmental health would be included in future reports, the JSNA breakdown at local community level would identify particular areas to target and the Hereford City Plan would also be considered;

·         it was important to link together strategies and identify barriers;

·         key messages should be included in induction for new staff members in organisations represented on the board, including MECC training;

·         positive examples should be used in communications as case studies;

·         there was a need to work at grass roots level and give ownership to local communities;

·         business cases for projects such as the Hereford bypass should reflect the potential savings from improved public health;

·         that the board should consider a future workshop on environmental health impacts.  ...  view the full minutes text for item 167.