Apologies were received from: Hilary Hall, Dr Mike Hearne, Councillor Jonathan Lester, Councillor Ivan Powell, Simon Trickett, and Mark Yates.

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

Nisha Sankey 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 27 April 2023.

The board approved the minutes of the meeting 27th April 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 21^st June at 9.30 am.

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

No questions were received.

To receive any written questions from councillors.

The deadline for the receipt of a question from a councillor is 21^st June at 9.30 am, unless the question relates to an urgent matter.

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

No questions were received.

To review the better care fund (BCF) year-end 2022-2023 report, as per the requirements of the programme.

Hayley Doyle (All Age Commissioning) provided an overview of the Better Care Fund year-end report 2022-23. The principal points included:

1.  There are three ambitions that are not on track to meet the planned performance by the end of the year:
   1. Avoidable admissions to hospital:

                                               i.     The planned performance at year-end was 1,106 against a metric of 605

                                              ii.     A programme of admission avoidance including virtual ward and urgent care programmes are being implemented currently and the development of an approach to integrated long-term conditions management is envisioned to help improve future performance.

                                               i.     This relates to the percentage of people who are discharged from acute hospitals to their normal place of residence.

                                              ii.     The metric was set at 91.6% but was not met with data showing a year-end total of 90%.

                                             iii.     There is a key lack of capacity within Herefordshire’s re-enablement and home care markets and the ability to discharge patients from acute beds to home, in a timely manner, has seen some patients being transferred to community hospital beds or to discharge to assessed beds in the community.

                                            iv.     This has been necessary in order to release acute bed capacity within the hospital, however, work is being done to improve in this position.

                                              v.     There has been further recruitment to vacancies within the home first team and the re-enablement service provided by Hoople and this position has increased at the latter end of 2022/23 with Hoople moving toward full recruitment across those service areas.

                                               i.     This relates to the proportion of older people who are still at home 91 days after discharge from hospital into re-enablement/rehabilitation services.

                                              ii.     The metrics show that Herefordshire failed to meet this target with a figure of 70.8% against a target of 80%.

                                             iii.     The CQC registered re-enablement service was transferred from Herefordshire Council to Hoople in June 2022 and there were some reporting issues due to staff changes at this time. This has impacted some of the data collection but have since been addressed.

                                            iv.     Reporting has improved in the remaining quarters in 2022/23 with the percentage of individuals remaining at home 91 days after leaving the service averaging around 78% for the latter quarters.

                                              v.     The issues in the recording in quarter 1 have impacted upon the overall year percentage. Therefore, there are some nuances around the accuracy of data which have been since corrected. Nevertheless, the re-enablement service are experiencing an increase in the complexity of patients being taken on by the service which has an impact on the results in this area.

                                            vi.     Work continues to be done as a local authority with Hoople to improve this position.

2. Overall, the Better Care Fund pools represent a significant increase in investment in core services and there are a number of areas where by end of year, the system can be successful in reaching planned ambitions and improving outcomes for people who receive services.
3. The Better Care Fund approach is  ...  view the full minutes text for item 20.

To provide an update on progress against the children’s services improvement plan.

Darryl Freeman (Corporate Director for Children and Young People) gave a brief introduction to the Children’s Services Improvement Plan. The principal points included:

1. The Improvement Plan follows the inspection by Ofsted last summer where Children’s Services in Herefordshire were rated as inadequate.
2. Thereafter, a statutory direction followed in addition to the appointment of a children’s commissioner.
3. The improvement plan was agreed by Children’s Scrutiny and Cabinet in December 2022 and was submitted to Ofsted.
4. Progress against the improvement plan is primarily monitored by the improvement board as there is no governance role for the Health and Wellbeing Board, however, some of the elements of the improvement plan have connections to the wider Health and Wellbeing Board agenda.
5. The improvement board meets six-weekly and an update will be provided in addition to a thematic review which covers looked-after children.
6. Progress is also monitored by Ofsted and they have commenced a programme of monitoring visits, the first of which was in March 2023 and the feedback report was published in June 2023.
7. In the first monitoring visit, the focus was on the front door multi-agency response to risk in which good feedback was received by Ofsted with regard to progress that had been regarding the multi-agency response and the multi-agency safeguarding hub.
8. Within the same report, there’s also a reminder that there is much more to do to improve the consistency of the quality of the practice, particularly of the quality of assessments in that particular visit.
9. Ofsted were returning later this week to focus on child protection.
10. The visits from Ofsted will form a regular pattern for the next couple of years.
11. Children’s Services have been in decline for many years and improvement to a standard of ‘good or more’ will not happen overnight. Rather this will be a 2-3 year improvement plan activity.
12. The general direction of travel continues to be positive and the vast majority of activities are on track and the impact of the activity are now being measured. A lot of work is being done to change systems and processes, including IT systems, and it takes time to see the impact of that and the difference it makes with children and young people.
13. Gail Hancock (Service Director Improvement) and her team have started to provide some impact measures for the future.
14. Recruitment remains the single greatest challenge and to recruit experienced social workers is a particular challenge in Herefordshire.

The Corporate Director for Children and Young People then invited questions and comments from members of the board.

Jane Ives asked the Corporate Director how much the current rating of the service as ‘inadequate’ is impacting on the ability to recruit

The Corporate Director answered that the two are inextricably linked and that the competitiveness of Herefordshire’s offer including quality of supervision, stability of leadership and management will help make a difference.

The Director of Public Health noted that the link to the Health and Wellbeing Strategy and in particular, the ‘Best Start in Life’ provides an opportunity  ...  view the full minutes text for item 21.

To provide members of the Health and Wellbeing Board (HWB) an update to the One Herefordshire Partnership.

Jane Ives provided an update on the One Herefordshire Partnership. The principal points included:

1. What the One Herefordshire Partnership is.
2. There are joint appointments from Herefordshire Council, Wye Valley NHS Trust, NHS Herefordshire and Worcestershire, GP Leadership Team, and System NED which form the partnership.
3. The partnership meets weekly which helps keep decision-making frequent and agile to ensure that decisions are made quickly.
4. The partnership translates the national strategy into something practical and pragmatic which is deliverable and is assessed against KPIs and objectives that holds the partnership to account.
5. The Clinical Practitioner Forum (CPF) is chaired by Mike Hearne and has a responsibility for the GP leadership team and meets once a fortnight.
6. The Integrated Care Executive’s responsibility holds the partnership responsible and accountable for the objectives that the partnership intends to deliver.
7. Therefore, the ICE will scrutinise the partnership how money is invested, whether it is making a difference, and whether it is good value for money.
8. The partnership and the CPF have an established way of working whilst ICE is a little less mature and is expected to gain momentum later this year.
9. ICE meets monthly as it is able to be less agile than the other partnerships/forums.
10. There are joint partnerships between the different organisations which emphasises real partnerships between stakeholders.
11. The partnership operates learning forums including ‘Transformation Tuesday’ and ‘Safety in Sync’ which emphasises the work that is being done as well as the help that is needed going forward.
12. In terms of achievements, the One Herefordshire Partnership has integrated its GPs and Community Integrated Response Hub which delivers a 2-hour response.
13. There has been a lot of work done in care homes which delivers high levels of personalised care and support plans that has reduced admissions by 30% and falls by 15%.
14. There have been numerous PCN developments including health inequalities priorities such as adverse childhood experiences, cancer screening, vaccine hesitancy, childhood obesity, and fibromyalgia.
15. Urgent care has a much more integrated redesign plan which has been agreed and drafted.
16. A lot of work has been done regarding ambulance turnaround times over the winter.
17. Value for money is important and the Chief Financial Officers meet regularly to look at a set of financial principles that are developed and agreed among themselves and they are starting to look at how money can be managed in different ways.
18. Workforce partnership working is the biggest challenge and there are a number of things being done to tackle this including work with Hoople to support them to make the difference to recruitment in the Wye Valley Trust.
19. With respect to the partnership’s priorities for the coming year, these include a number of priorities such as PCN development, Integrated Urgent Care, Health and Wellbeing Strategy priorities, planned care, workforce, working with communities, and working well together.

The Chair thanked Jane Ives for the presentation and asked whether people in Herefordshire knew that the partnership was better prepared going forward.

David Mehaffey noted that with respect to ambulance response times,  ...  view the full minutes text for item 22.

To update the Health and Wellbeing Board on the implementation of the new Joint Health and Wellbeing Strategy

The Director of Public Health provided a brief report on the Joint Local Health and Wellbeing Strategy to update the board on the strategy. The principal points included:

1. The strategy was endorsed by the board in April and a new version of the strategy is being developed which should be available by end of June.
2. Work has been taking place on governance on the two core priorities including the best start in life which the Children and Young People partnership will be accountable for the delivery.
3. A workshop was held last week to work through what issues should be focused on the most – including child obesity, trauma informed practice, and access to NHS services.
4. An early-years partnership group sits below that as a sub-group which works on what best start in life looks at.
5. Some of the existing groups will be absorbed in the Children and Young People partnership which will help consolidate some of the governance and help deliver the children improvement priority going forward.
6. With respect to mental wellbeing, there is an mental health collaborative where two groups lead on mental wellbeing – 1. Adult Mental Health partnership, 2. Children Emotional Health partnership board.
7. The Adult Mental Health partnership is currently an advocacy sharing best practice networking but are keen to be more action-oriented and develop a delivery plan for mental wellbeing.
8. A following workshop for that partnership will take place on the 6^th July.
9. The Children Emotional Health partnership will feed into the Children and Young People partnership and focuses on the NHS long term plan.
10. The aim is to bring a draft plan to the board later in the year on both of the strategy’s priorities including the identified resources to support those priorities with a plan that can be regularly monitored which the One Herefordshire partnership will have oversight over.
11. The Mental Health collaborative executive approved funding for a suicide prevention coordinator who will be appointed and will sit in the public health team.
12. An outcomes framework is being looked at for the two core priority areas which focuses on logic models including what the intended outcomes are, what the indicators are, and what actions are wanted to deliver these.
13. The Health and Wellbeing Strategy event is taking place on July 12^th at Hereford Racecourse and will cover what the strategy entails, past achievements, and how to deliver the two core priorities within the strategy.

The Chair noted it was good news to have someone appointed as a suicide prevention coordinator.

The Director of Public Health commented that there was also work to appoint a partnership and strategies officer to support the work of the board and wider networking with the primary care networks to help drive work going forward to meet the priorities of the board as well as providing a systematic approach.

The recommendation was proposed, seconded, and unanimously approved.

Resolved that:

a)    The Board to note progress to date on work to deliver the strategy.

To consider the work programme for the committee.

The Chair asked whether the August workshop would be too soon for a session on rural health.

The Director of Public Health recommended that the session could be used to discuss the Joint Strategic Needs Assessment.

The board was happy with the recommendation made by the Director of Public Health.

The Director of Public Health wanted oral health as an update to be added to the agenda for the September board meeting.

The Chair asked if there were any items that could be moved to the December meeting.

The Director of Public Health stated he would take that away and review the work programme for future meetings.

David Mehaffey suggested that the mental health collaborative item could be moved to the December meeting.

The Chair responded that the mental health collaborative could be moved to the December meeting and that an item on oral health update could be included in the September meeting.

Any other business.

No other business was raised.

The next scheduled meeting is 25^th September 2023, 14:00-17:00.

The next scheduled meeting is 25th September 2023, 14:00-17:00.