Apologies for absence had been received from Chris Baird and Stephen Vickers (Herefordshire Council), Ingrid Barker (Gloucestershire Health and Care NHS Foundation Trust), Jo Melling (NHS England and NHS Improvement), Russell Hardy (Wye Valley NHS Trust) and Simon Trickett (NHS Herefordshire Clinical Commissioning Group).

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

Duncan Sutherland was present as a substitute for Ingrid Barker.

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 8 July 2019.

The minutes of the previous meeting were received.

Resolved:  That the minutes of the meeting held on 8 July 2019 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 Tuesday 8 October 2019 at 5.00 pm.

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

No questions had been received from members of the public.

To receive any written questions from councillors.

The deadline for the receipt of a question from a councillor is Tuesday 8 October 2019 at 5.00 pm.

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

No questions had been received from councillors.

[note: agenda item 9 (minute 18), Integrated Care System and One Herefordshire, was considered next, but the original agenda order is preserved here for ease of reference]

To review the draft strategy with a view to ensuring it is effective in encouraging those who arrange the provision of any health or social care services in Herefordshire to work in an integrated manner for the purpose of advancing the health and wellbeing of the people of Herefordshire, and supports integration.

The assistant director all ages commissioning presented the draft strategy and explained that, following consideration of an early iteration at the 5 March 2019 meeting, a joined up approach had been taken to the further development of the strategy by NHS Herefordshire Clinical Commissioning Group and Herefordshire Council.

It was reported that this was the first sustainability and transformation partnership footprint strategy for Herefordshire and Worcestershire and one of the aims of the strategy was to improve the Herefordshire rate of dementia diagnosis (58%) to the nationally targeted rate (67%); some of the reasons why people avoided diagnosis, particularly in rural communities, were outlined.

An overview was provided of the work of Dementia Friendly Leominster, Herefordshire Dementia Action Alliance, and Talk Community.  The need to deliver the strategy cohesively and proactively was emphasised, with attention drawn to the delivery plan.

It was reported that the strategy would be considered by cabinet on 28 November 2019.  The individuals, groups and organisations involved in the development of the strategy were thanked.

The cabinet member - children and families commented on the establishment of Dementia Friendly Leominster and its ongoing work in the community.  The assistant director all ages commissioning said that the initiative had been incredibly supportive of the dementia agenda.  The chief executive commented that it was a challenge and opportunity to extend the model to Hereford and the other market towns, and noted the importance of improving awareness and understanding of dementia.

It was reported that Gloucestershire Health and Care NHS Foundation Trust was developing proposals for revising its delivery model for dementia care to improve quality of life and reduce demand on the system in terms of urgent and emergency care.

The vice-chairperson commented that the strategy had involved significant effort and drew attention to the guiding principles of ‘preventing well’, ‘diagnosing well’, ‘supporting well’, ‘living well’, and ‘dying well’ in the context of helping people to plan for the future and before a time of crisis.

Resolved:  That the board has reviewed and supports the draft Herefordshire and Worcestershire Living Well with Dementia Strategy 2019-2024.

To approve Herefordshire’s better care fund (BCF) and integration plan 2019-20.

The head of partnerships and integration reported that the better care fund and integration plan 2019-20 had been submitted, as per the requirements of the national programme, with the agreement of the director for adults and communities and the Managing Director of NHS Herefordshire Clinical Commissioning Group, as delegated by the board.

It was reported that there were minimal changes from the previous plan, it reflected the local approach to integration, and the national conditions and metrics had remained the same.  The board was advised that significant improvements had been made in terms of discharge and reducing delayed transfers of care.  Attention was drawn to the financial summary 2019/20 (agenda page 62).  It was noted that a regional assurance process was being undertaken and initial feedback suggested that the plan was likely to be approved.

The board acknowledged the work that had gone into the plan and thanked the officers involved.

Resolved:  That the Herefordshire better care fund and integration plan 2019-20 be approved.

To provide an update and overview of the developing Integrated Care System and One Herefordshire.

The Director of Strategy and Transformation for NHS Herefordshire Clinical Commissioning Group (CCG) and One Herefordshire, and Joint Programme Director for the Herefordshire and Worcestershire Sustainability and Transformation Partnership (STP) [hereafter referred to as ‘director of strategy and transformation’] was invited to update the board on the Integrated Care System and One Herefordshire.  In response to a question from the chairperson, the director of strategy and transformation clarified that the purpose of the item was to bring the proposals to the board for discussion and approval, rather than as a formal public consultation.

The director of strategy and transformation delivered the ‘Integrated Primary and Community Services’ presentation, starting with the slide ‘The NHS Long Term Plan’.  Questions and comments from attendees included:

1.           The chairperson drew attention to paragraph 4 (agenda page 138) of the covering report, ‘The plan commits funding to the networks for additional resources …’, and questioned how much funding was being committed for Herefordshire and how this compared to Worcestershire.  The director of strategy and transformation said that there was a national funding formula which would support a range of activities and provision of staff in the Primary Care Networks over the next five years.

2.           Referring to paragraph 9 (agenda page 139), ‘As part of the development of STPs into ICSs the local ‘place’ will need to be developed…’ the chairperson questioned the stage that the local system was at and the role of the health and wellbeing board.  The director of strategy and transformation commented on the work of the One Herefordshire integration programme and considered that partnership working was relatively mature compared to some other areas, although there was more work to be done.  Local ‘place’ was seen as being coterminous with the health and wellbeing board boundaries and there was a strong role for the board as convenor of the system, particularly given its links with prevention, wellbeing, and local accountability.

3.           The director of public health commented on the need to reflect on the roles of the system partners as ‘anchor’ organisations, including opportunities in terms of healthy workforces and the climate change agenda.  The director of strategy and transformation suggested that this could be a future topic for the board and noted that addressing inequalities and prevention were key threads in the work being undertaken.

4.           The Managing Director of Taurus Healthcare commented on the distinction between Primary Care Networks and general practice, and the vision to engage with communities and the prevention agenda.  The vice-chairperson noted the importance of education and addressing the broader determinants of health and wellbeing.  The cabinet member - children and families added that eating healthily was also a key factor.

5.           The chief executive said that, as explored at a recent meeting of NHS and local authority leads across the Midlands, there was a clear need for the NHS to work with local authorities in the co-shaping of the plan.  Therefore, the starting point needed the joint development of a long term plan for  ...  view the full minutes text for item 18.

The scheduled dates for board meetings in public are as follows:

Monday 9 December 2019, 2.30pm

Monday 10 February 2020, 2.30pm

Monday 20 April 2020, 2.30pm

The scheduled dates for board meetings in public were noted as follows: Monday 9 December 2019, 2.30pm [note: this meeting was withdrawn subsequently]; Monday 10 February 2020, 2.30pm; and Monday 20 April 2020, 2.30pm.