To update the Health and Wellbeing Board on the work to improve health and wellbeing through the Herefordshire and Worcestershire Sustainability and Transformation Partnership (STP), and its local delivery mechanism the ‘One Herefordshire’ transformation programme.

To confirm the strategic priorities for the board's focus as an output of a workshop held in November 2017 identifying priority health and care themes.

The One Herefordshire director of transformation presented the paper, making the following key points:

·         The Herefordshire and Worcestershire sustainability and transformation partnership (STP) was part of the national NHS programme, and Herefordshire was represented on the regional board by the director for adults and wellbeing.

·         The purpose was to deliver the ‘triple aim’ of improved population health and wellbeing, high quality services, and financial sustainability and efficiency.  

·         STPs were being encouraged to progress towards becoming integrated care systems. These were intended to be place based and to focus on providing a wellbeing service to keep people well but being available to support when unwell.

·         The developments presented significant cultural changes with closer working with partners.

·         One Herefordshire was the delivery mechanism for Herefordshire, and started with the health and social care elements and working closely across the public sector, initially focused on adults and looking holistically at the individual in their own surroundings.

Responding to a question from the vice-chair about the functioning of the system in the context of reductions to the public health budget, it was explained that this was about the wider approach across the system where wellbeing was everyone’s business. The principle of ‘making every contact count’ was essential to the prevention agenda and to prioritising resources. An example to illustrate the approach was around smoking cessation, which should be picked up by any professional in contact with an individual, captured in public messages and extended to employers in promoting healthy workplaces. These were the areas to establish the best approach to target in a co-ordinated way.

The director for adults and wellbeing pointed out that public health grant was set to reduce to £8million over the next few years and would eventually be phased out completely, as it would be subsumed into the council’s wider revenue. It was therefore less helpful for it to be a ring fenced grant because it did not represent the reality of what was spent by the overall system on public health, so it was imperative that all expenditure made by the council, and indeed wider partners, had positive impact.

The incoming director of public health added that the public health grant was a small concern and the key message was about the whole picture and where influence was needed.

The CCG accountable officer commented that gradual reorganisation within the system was an opportunity to reconsider the relationship with neighbours, especially with Worcestershire, moving from a transactional relationship to a consensus. It was hoped that a new culture would help to bring about the changes. There were risks but also some opportunities so it was important to take the opportunity to deliver the changes that were needed. Although it was not an easy concept to explain, the key was to bring providers into the way of working to move to a partnership based approach, where all took responsibility for the system as a whole achieving the triple aim, rather than one of commissioner and provider. 

The chairman noted that the key objective was how to move forward, to use resources wisely and look at the service for the individual.

The director for adults and wellbeing commented that it was a complex environment in the context of national activity and the Herefordshire and Worcestershire footprint and the recommendations were concerned with ensuring that the health and wellbeing board was the statutory forum to set the direction for the system through the joint strategic needs assessment and the health and wellbeing strategy.  Herefordshire controlled its own destiny so this forum should be at the top of the arrangement. Within this, the board needed to consider its membership and, as a function governed by the council, set this formally within the council’s constitution.  The board’s focus was the key priorities that it had identified and it should be clear that these areas have significant impact on the level of wellbeing experienced by people, but also recognise that they are the drivers for demand on health and social care services.

Getting this right would set the system on course to provide high quality care as a direct relationship.

The chair of the CCG spoke in support of this.  Herefordshire was part of the wider system and these were the issues that were important and relevant here and were what the health and wellbeing board needed to focus on as they remained relevant.

In response to a question about membership of a refreshed health and wellbeing board, the director for adults and wellbeing draw attention to the minimum membership that was set out in statute.  In additional, it was appropriate for membership to represent the statutory providers so it was proposed to extend the membership to the two main NHS trusts, Wye Valley NHS Trust and 2gether NHS Foundation Trust, represented by their chairs.  In terms of making this a formal arrangement, the proposal would need to be put to full council as a recommendation for a change to the council’s constitution.

In response to a question from the vice-chair about whether to include Taurus Healthcare in representing GP providers, it was explained that this had been considered but that it was recommended to contain membership of the health and wellbeing board to statutory organisations. Taurus continued to be represented on the One Herefordshire group which would feed into the health and wellbeing board.

A member sought assurance that the health and wellbeing being board workshops would be arranged to enable partners’ contributions to feed into the decisions taken by the health and wellbeing board. It was clarified that output from workshops would be presented to formal meetings of the board in order to maintain and deliver the board’s business around its priorities. 

Discussion took place regarding the appointment of the vice-chair due to concern that there was potential for one organisation to be over-represented in chairmanship of the board, which could reduce the board’s effectiveness. This was not considered to be desirable so the board would need to ensure this was avoided, either through mandate or co-operation.  Board members were broadly supportive of a council chair and CCG vice-chair arrangement, although it was noted that the personal attributes the individual brought to the vice-chair role were just as important as the organisation they represented.

It was also noted that the membership proposals meant that the CCG board’s lay member would no longer be a member of the health and wellbeing board but assurance was provided that the member would participate in the workshops and so would continue to contribute.

RESOLVED

That:

a)    The health and wellbeing board’s strategic priorities for  2018/19 be agreed as

·         Dementia (including end of life)

·         Childhood obesity (including impact on dental health)

·         Fuel poverty

·         Supporting local communities to help their residents remain healthy and independent; and

b)    That the health and wellbeing board membership and structure proposals be approved for submission to the council’s audit and governance committee for progression as a recommendation to full council to amend the council’s constitution. The proposals, in summary, being

·       to include as formal members, the chairs of the Clinical Commissioning Group, Wye Valley NHS Trust and 2gether NHS Foundation Trust

·       to change the number of members for Healthwatch and the Clinical Commissioning Group to one member each, represented by the chairs of those organisations

·       that the chair of the Clinical Commissioning Group (or their substitute) be appointed vice-chair of the Health and Wellbeing Board

·       to provide a governance structure that will provide the system leadership to deliver the transformation programme.