To ratify the outcomes of the health and wellbeing board review, agree the board format and make recommendations for the future working arrangements including membership, the vision, priorities and cross-cutting themes.

The chairperson invited the head of partnerships and integration to introduce the report, the principal points included:

1.         A series of workshops had been held with board members and system representatives which had informed the review and the proposed future working arrangements.

2.         Subject to approval by the board, consequential changes to the constitution would be recommended to the audit and governance committee for consideration, prior to submission to full Council.

3.         The review had been undertaken in view of the recent NHS Long Term Plan and the council’s emerging corporate plan – ‘County Plan 2020-24’. 

4.         It was identified that, at a time of continuous change, the health and wellbeing board should be an anchor of place, providing leadership and stability.

5.         The report proposed an updated vision for the board, ‘Herefordshire residents are connected into communities to be resilient; lead fulfilling lives; are emotionally and physically healthy and feel safe and secure’.  The vision was underpinned by five priorities, and eight cross-cutting themes.  It was commented that the vision recognised the importance of working closely with communities and upstreaming prevention.

6.         It was proposed that representatives of other partner organisations be added to the core membership of the board, with the intention to invite further consultative representatives to participate at certain sessions on specific areas of focus.

7.         In order to build the board’s future work programme, it was suggested that the council and the CCG be invited to identify areas of transformational change and key developments in their respective commissioning plans, with some suggested areas identified in paragraph 15 (integrated urgent care pathway, Primary Care Networks, stroke services, and mental health services).

8.         Working groups would be established to consider certain topics and to develop delivery / action plans.

The chairperson expressed her thanks to: board members and other workshop attendees for their hard work on the review; the head of partnerships and integration for facilitating the meetings and for co-ordinating the new arrangements; and Hannah Dalton and Liam Hughes who supported the workshops on behalf of the Local Government Association.

The managing director of the CCG commented that: the workshops had been helpful; the reasons for the suggested areas identified in paragraph 15 were unclear; services for children and young people had been a key topic of discussion; and the five priorities should shape the board’s work going forward.  In response, the head of partnerships and integration advised that one of the roles of the board was ‘Reviewing whether the commissioning plans and arrangements for the NHS, public health and social care (including Better Care Fund submissions) are in line with and have given due regard to the health and wellbeing strategy’ [Constitution paragraph 3.5.24 (g)], so there was a need to be cognisant of those commissioning plans, and the suggested areas involved high priority matters.

The vice-chairperson said that the suggested areas could be viewed from the perspective of children and young people, and he outlined some of the issues that could be included within scope.  The cabinet member - children and families spoke in support of exploring issues for children and young people in greater depth.

The director for children and families commented on the merits of the board being apprised of work of the children and young people’s partnership, the safeguarding partners’ board, and the safeguarding adults’ board.  It was noted that duplication should be avoided and decisions should be taken at an appropriate level to deliver positive outcomes for the people of Herefordshire.  It was reported that partners had held a session recently on early help for children, involving representatives from local schools, which had highlighted the importance of prevention in the context of the whole family.

The director for adults and communities considered that the council and the CCG, as the major commissioners, should present their commissioning plans.  He also felt that the board should not concentrate on too many matters at once, and supported an initial focus on early help for children; he added that urgent care could be another area of focus in due course.

In response to a question, the head of partnerships and integration said that the intention was to maintain formal board meetings in public and occasional board development sessions in private, and to supplement these with workshops on areas of focus involving relevant consultative representatives from other partner organisations and community groups.

The director of public health: supported a focus on children but noted the wider context of families and communities; commented that, as well as being commissioners, the partners were employers and should consider their roles as anchor organisations; the board needed to hold the system to account in terms of tackling inequalities; and, drawing attention to the priority ‘supporting our residents to eat well, drink safely and get active’, reported that a paper would be presented to cabinet shortly on Herefordshire becoming a ‘sustainable food county’ and the board may wish to be involved in an associated summit.

The non-executive director of Gloucestershire Health and Care NHS Foundation Trust, in addition to welcoming the work undertaken to date and the focus on priority areas, suggested that the wider determinants of health and wellbeing, such as housing, should be considered.

The chair of Healthwatch Herefordshire said that it was also important for the board to look at what was happening in relation to the Herefordshire and Worcestershire Sustainability and Transformation Partnership (STP).

Other attendees commented on: other determinants of health and wellbeing, such as environment and nutrition; the need for appropriate challenge; and the benefits of a holistic approach.  The director for adults and communities anticipated that the expanded board membership and refreshed working arrangements would help the whole system to come together and make a difference.

The chairperson made a number of points, including:

i.           In view of the constitutional requirement and the new vision and priorities, it was considered an appropriate point to ask the council and the CCG to bring their commissioning plans and arrangements for the next twelve to eighteen months to the next board meeting in public.

ii.         The board should not duplicate the work of other groups but there was a need for the system leaders and key stakeholders to explore challenges, identify solutions, and take action collectively. 

It was agreed that the first area of focus should be on early help for children and the director for children and families would lead on the development of the workshop.

The Leader of the Council suggested that healthy weight could be a future topic.

iii.        Further to the comments made during the apologies for absence agenda item, the chairperson suggested that the attendance and substitution arrangements could be clarified in the constitution.

A board member advised that, with responsibility for the delivery of Herefordshire’s mental health and learning disability services transferring from April 2020, there was a need to reallocate board membership from Gloucestershire Health and Care NHS Foundation Trust.  The board was introduced to the executive director of strategy and partnerships for Worcestershire Health and Care NHS Trust (and STP communications and engagement lead), who explained that the chief executive or the chair of the trust would welcome an invitation to the board in due course.

Resolved:  That

(a)       The new vision, priorities, cross-cutting themes, and membership for the health and wellbeing board be supported;

(b)     The proposed working arrangements be recommended to the audit and governance committee, with a view to seeking full Council approval for the new board membership;

(c)     Herefordshire Council and the Clinical Commissioning Group be asked to bring their commissioning plans and arrangements for the NHS, public health and social care for the next twelve to eighteen months to the next board meeting in public;

(d)     Consideration be given to the attendance and substitution arrangements for the board in the council’s constitution, potentially including:

(i)      the expectation that board members should not normally miss more than two board meetings in public in a year;

(ii)     that any substitute will be a senior representative from the constituent organisation or service, with delegated authority to act on behalf of that organisation or service in relation to the activity of the board; and

(iii)    that the board member will notify the chairperson of the reason for absence and confirm the named substitute, ideally a week in advance of the meeting.