In the absence of the chair and vice-chair, the constitution makes provision that a chairperson can be created for just this meeting. It was therefore proposed and seconded that Councillor David Hitchiner chair the meeting.

The chair welcomed board members and attendees to the meeting.

Apologies were received from: Mandy Appleby, Councillor Pauline Crockett, Hilary Hall, Susan Harris, Mike Hearne, Jane Ives, Amy Pitt, and Simon Trickett.

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

Gillian Pearson acted as a substitute for Mike Hearne from Taurus Healthcare.

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.

There were no declarations of interest.

To approve and sign the minutes of the meeting held on 13 March 2023.

The board approved the minutes of the meeting of the 13th March 2023.

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 24^th April at 9.30 am.

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

No questions received.

To receive any written questions from councillors.

The deadline for the receipt of a question from a councillor is 24^th April at 9.30 am, unless the question relates to an urgent matter.

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

No questions received.

To share the Director of Public Health Annual Report 2022 with the Health and Wellbeing Board. The focus of the 2022 report is health and sustainable food titled “A recipe for healthy and sustainable food”.

Matt Pearce (Director of Public Health) provided an overview of the DPH Annual Report for 2022. The focus of the report was on healthy and sustainable food and to highlight the key challenges facing the county with recommendations for actions that may want to be considered as part of the report. The principal points included:

1.     As part of the report, the Director of Public Health wants to celebrate the great things that are going on in Herefordshire in promoting healthy and sustainable food.

a.     For example, the Herefordshire Food Alliance (HFA) is a key partnership of stakeholders from the public, private and voluntary sectors to look at how this agenda can be driven forwards.

2.     Food and diet are associated with developing chronic diseases with cancer and diseases of the circulatory system (such as heart disease and stroke) the leading causes of premature deaths in Herefordshire.

3.     Herefordshire has a higher prevalence of child and adult obesity compared to the national average.

4.     In addition, the environmental impact is significant and having a healthy environment is beneficial to people’s health and lifestyles.

5.     A shift to plant-based diets, sustainable, seasonal and locally sourced foods and a reduction of food waste can greatly reduce carbon emissions from this sector.

a.     Farming is an essential part of rural life and of Herefordshire communities’ prosperity, with 77% of Herefordshire land farmed.

6.     In Herefordshire, more than a third of black bin rubbish is food waste and its packaging. From 2022, local analysis found that 70% of food thrown away in Herefordshire was considered avoidable.

7.     Food insecurity is another key challenge to healthy and sustainable food with multiple factors affecting national food security and the resilience of food supply chains.

a.     Price and affordability are major determinants of the food that people choose to purchase, particularly for people on low incomes.

8.     In Herefordshire, there has been a 100% increase in the use of food banks over the last 12 months, reflecting the impact that the cost of food has had on residents.

9.     The Director of Public Health noted the opportunities that exist to promote healthy and sustainable food across the course of one’s life.

10.  In some of the studies, it has been found that more work needs to be done to support the eating habits of young children.

11.  There is good work ongoing with Herefordshire Council participating in the national School Food Standards pilot with work being done in order to raise the quality of food being delivered in schools across the county.

12.  The Healthy Start programme provides food for women who are pregnant and children up to the age of four, who are eligible. In Herefordshire, only 61% of eligible families claim the Healthy Start food vouchers, meaning that annually £154,000 of funds are going unclaimed.

13.  The proportion of adults in Herefordshire meeting the recommended 5-a-day is higher (62.7%) than rates in West Midlands (52.6%) and England (55.4%). However, 40% of our populations is still  ...  view the full minutes text for item 8.

To present the final draft of the Joint Local Health and Wellbeing Strategy 2023-2033 to the Board for approval. To propose a plan for next steps and taking forward the strategy for implementation.

The Director of Public Health provided an overview of the strategy and highlighted some of the key retentions and changes from the draft. The principal points included:

1.     There has been a strengthening of the type of community that is envisioned for Herefordshire to be in ten years and elaborated on the four ambitions to do this.

2.     The strategy maintains the same principles that the board previously agreed on prevention and health inequalities.

3.     The strategy strikes the right balance between the two core priorities – ‘best start in life’ and ‘good mental wellbeing throughout life’ – and supporting priorities including wider determinants such as housing, economy, and the environment.

4.     A framework for delivery has been added towards the end of the strategy which sets out a systematic process that can be utilised to work in collaboration with communities to design the intervention.

5.     A set of indicators have been added which are aligned with the integrated care strategy in order to monitor change from some of the outcomes and priorities identified in the Health and Wellbeing strategy.

The Director of Public Health also noted that as part of next steps for the strategy is the development of action plans which will be delegated to different partnership groups. One recommendation is that One Herefordshire owns the coordination oversight of the two core priorities. Additionally, ‘best start in life’ can be delivered through the Children and Young People Partnership and ‘good mental wellbeing throughout life’ can be supported by several groups including the Mental Health Collaborative and Adult Mental Health group. The intention therefore is to delegate those partnerships to develop those action plans and bring them back to the board in three-to-four months’ time.

Mary Knower (Public Health Programme Manager) acknowledged the incorporation of all the issues that the strategy covers and noted the future launching of the strategy at a formal event.

David Mehaffey praised the alignment of the strategy with the integrated care strategy. On the ‘best start to life’ it was asked whether there should be a broader time period as opposed to the five year period as stated in the strategy.

The Director of Public Health argued that the current five-year period should be retained because intervention within the first five years helps produce better longer-term outcomes.

Alan Dawson (Chief Strategy and Planning Officer) expressed his support for the strategy and noted that through the One Herefordshire partnership, a number of stakeholder organisations have come together to help co-design this work, both looking at the proposals around priorities and the outcome framework. The Wye Valley Trust have committed to include these priorities within the work plan of the One Herefordshire partnership which will form a key part of the Trust’s work over the next year. 

The Chair noted the challenges surrounding dental hygiene and how the strategy confronts this issue.

The Director of Public Health acknowledged the issue of dental hygiene as a priority that falls under the strategy’s ‘best start in life’ priority  ...  view the full minutes text for item 9.

To note the sexual violence strategy and to contribute to its delivery.

Dr Frances Howie (Consultant in Public Health) provided an overview of the Sexual Violence Strategy. The report is the work of the Herefordshire Community Safety Partnership (CSP) and various statutory partners have worked alongside the CSP including the police, probation, and the NHS, in addition to working with non-statutory partners including the Herefordshire Women’s Equality group. The strategy covers a five-year period and has an action plan which works with partners across the system in the implementation of the strategy. The principal points included:

1.     Sexual violence is an activity that is mostly perpetrated by men on women.

a.     98% of people who report sexual violence report that the perpetrators are male.

2.     Sexual violence is an underreported crime in terms of it going through to the criminal justice system.

3.     Data shows that reported offences are still higher post-Covid than pre-Covid.

4.     There is evidence that shows what works in tackling sexual violence, including working with perpetrators to change their behaviour.

5.     The strategy sets out a common vision where everyone lives free of the fear, threat, or experience of sexual violence.

6.     There are three areas of focus: prioritising prevention; supporting victims and survivors and pursuing perpetrators.

7.     In taking this forward, there is a commitment to:

a.     Working together to prevent sexual violence.

b.     Increasing community awareness of sexual violence, challenging victim blaming language and behaviours and believing victims and survivors.

c.     Challenging attitudes that lead to sexual violence (e.g. gender inequality) by working with community settings such as schools and businesses.

d.     Listening to victim and survivor voices to inform development and delivery of services.

e.     Ensuring that all victims and survivors can, and know how to, access specialist support when and where they need it. Lifelong support should be available and responsive to triggering life events.

8.     The next steps for the strategy are to actively manage the action plan; the Sexual Violence Sub-group of the CSP has now moved to a quarterly basis; and remaining committed to the vision where everyone lives free of the fear, threat, or experience of sexual violence.

Councillor Diana Toynbee praised the work of the strategy and acknowledged the concern that sexual violence is underreported. It was noted that there is concern with relation to the police, particularly in response to recent news stories, and it is important to keep holding police colleagues to account. Furthermore, involvement with schools was emphasised in order to teach about related issues to have appropriate training and guidance. There also needs to be some focus on the ways in which roles need to be filled and what resources are needed to help reduce waiting lists that victims and survivors face.

The Director of Public Health thanked Dr Howie and the CSP for the work and noted that within the new Health and Wellbeing strategy under mental health, one of the outcomes is for people to feel safe from harm in their communities. Relating to schools, the Director of Public Health  ...  view the full minutes text for item 10.

To update members of the board on the ICP’s progress towards establishing the ICS Strategy and provide assurance that there is strong alignment with the JLHWS that is being considered at the same meeting, and to inform members on the development to date of the JFP and to outline how the HWB will be asked to engage in development of the JPF before its publication in June.

David Mehaffey provided an update on the Integrated Care Strategy and NHS Joint Forward Plan. The Integrated Care Partnership (ICP) met and approved the Integrated Care Strategy on 26^th April for publication, with minor amendments to be made. Publication will not take place until after the elections in accordance with NHS guidance. The principal points included:

1.     The strategy is strongly aligned with the Health and Wellbeing Strategy with a ‘best start in life’ priority present in the Integrated Care Strategy.

2.     Best start to life covers living, ageing, and dying well, in addition to preventing ill health, premature death, and vulnerable causes.

3.     Mental health and wellbeing, the second core priority of the Health and Wellbeing Strategy, runs through all of the priorities in the Integrated Care Strategy.

4.     Mental health covers mental health in children, adults, and preventing suicides.

5.     The ICP meeting on the 26^th April raised the importance on mental health and the new collaborative and focusing on the relationship with the voluntary sector and the change in the way of commissioning to attempt to move away from a purely medical model.

6.     The Joint Forward Plan (JFP) is a single document that is jointly owned by the ICB and the three NHS Trusts in the ICS area. This will form the response to the Integrated Care Strategy.

7.     The Health and Wellbeing board will be asked to consider the JFP in a development session at the end of May with a substantially complete document provided by 19^th May.

8.     The specific request of the board will be to form an opinion on the extent to which the JFP addresses the priorities set out in the Health and Wellbeing Strategy.

9.     The JFP will consequently be marked and reviewed by NHS England as part of an assurance process.

The Chair asked about the inclusion of waiting lists in the update report and whether it will be covered in the future.

David Mehaffey confirmed that specific trajectories are in place to cut waiting lists with the intention to tackle the long waits that some people have had to experience. The next phase is to bring down 78 week waits to 65 week waits and to get back to 18 week waiting lists in the long-term future.

Councillor Diana Toynbee asked what the relationship is between the ICB, NHS England, and the Department of Health and how accountability works.

David Mehaffey stated that the Department of Health is the government department that allocates resources to NHS England. NHS England then allocates the vast majority of its resources to the 42 ICBs across the country but retains some services itself for things that are best managed on a national scale including some very complex surgeries and military health, for example. Accountability, locally, for NHS services, is the ICB and elected members who then have an accountability to NHS England in the Midlands region who in turn are held accountable by the national NHS for their regional  ...  view the full minutes text for item 11.

An opportunity for the board to review and populate the work programme for 2023-2024.

The board had no proposals.

The next scheduled meeting is 26 June 2023, 14:00-17:00

The next scheduled meeting is 26 June 2023, 14:00-17:00.