Apologies received from: Jon Butlin, Dr Mike Hearne, and Cllr Jonathan Lester.

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

Emma Roberts substituted for Jon Butlin (Hereford and Worcester Fire and Rescue Service).

To receive any declarations of interests from members of the committee in respect of items on the agenda.

There were no declarations of interest.

To approve and sign the minutes of the meeting held on 4^th December 2023.

The board approved the minutes of the meeting 4 December 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 6^th March 2024 at 5.00 pm.

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

A question received from a member of the public and the response given, including a supplementary question and the response, attached as Appendix 1 to the minutes.

To receive any written questions from councillors.

The deadline for the receipt of a question from a councillor is 6^th March 2024 at 5.00 pm, unless the question relates to an urgent matter.

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

A question received from a councillor and the response given is attached as Appendix 2 to the minutes.

For the Health and Wellbeing Board (HWB) to receive the Annual Report of the HSAB.

The Independent Chair Herefordshire Safeguarding Adults Board presented a brief summary outlining the main contents of the annual report.

The Chair referenced the fall in the number of reported safeguarding concerns and asked whether this had meant that the overall number of concerns had fallen.

The Independent Chair Herefordshire Safeguarding Adults Board confirmed that this referred to the number of cases being drawn to the board’s attention had fallen.

The Chair asked what could be done to get more feedback from those involved in safeguarding concern cases.

The Corporate Director Community Wellbeing responded that some feedback in relation to the outcomes of safeguarding cases is followed up. Work is being done in an attempt to gather more feedback.

The Chair asked how understanding, in relation to Making Safeguarding Personal (MSP), is being improved across the wider sector.

The Independent Chair Herefordshire Safeguarding Adults Board answered that much of this is connected to the work of Talk Community and working with partners in the voluntary sector.

The Director of Public Health noted the desire for more safeguarding training within the voluntary community sector and asked if there is still a need for that.

The Independent Chair Herefordshire Safeguarding Adults Board answered that not enough data existed on that issue.

The Cabinet Member Children and Young People added that as the outgoing Safeguarding Adults Board Chair, engaging with service users, for the last several years, a number of different ways have been tried to engage with those people. The local authority has a desire to complement and supplement its own work in attempting to engage with service users. On the voluntary community sector, raised by the Director of Public Health, the annual report was presented to HVOSS and work is ongoing as to what a training offer may look.

The Independent Chair Herefordshire Safeguarding Adults Board noted that a small team is being put into place under the principal social worker to increase capacity to get feedback from users. Some work had been done with Healthwatch to try to get feedback, however, this didn’t get off the ground.

The Chief Officer Healthwatch responded that a process had to be used where the safeguarding team would get consent in mosaic at the end of their safeguarding case. However, not enough consented and access to those service users was not available.

The Vice-Chair asked about the timeliness of the report and whether it will be brought earlier in the year next year.

The Independent Chair Herefordshire Safeguarding Adults Board responded that it would be the aim of the Herefordshire Safeguarding Adults Board to bring the next annual report to the Health and Wellbeing Board in autumn. One of the main issues with report timeliness rests with national data sign-off which can take until December to occur.

The Vice-Chair asked the Chair of the Herefordshire Safeguarding Adults Board what his top worry was.

The Independent Chair Herefordshire Safeguarding Adults Board answered that his main concern rested with not knowing what was not known from potential  ...  view the full minutes text for item 58.

To provide the Health and Wellbeing Board an update on the progress of the Board’s strategic priority of ‘Best Start in Life’ (BSiL).

The Director of Public Health noted that the last draft for the implementation plans were brought in December for Mental Health and Best Start in Life. This is the first meeting in which an update on the progress of the implementation plan – Best Start in Life – will be presented. Updates on each implementation plan will alternate at each respective Health and Wellbeing Board meeting.

The Public Health Lead CYP and Sexual Health presented the update. The principal points included:

1. Since December, work has been ongoing with various partners to develop key targets against the actions. Lead professionals are responsible for responding to each of those targets. 
2. A performance monitoring framework has been developed which focuses how performance remains on track to deliver targets, how to monitor it, and the challenges that exist.
3. For the new 0-19 service, Wye Valley Trust are the contracted provider and will be rolling out an oral health and weaning check. This will be a universal check and promotes good oral health and weaning alongside healthy eating.
4. A healthy schools and healthy tots framework is being developed and will target all primary schools and all secondary schools. Pilot settings have been identified and from September, it will be offered out to the broader school community.
5. Work is ongoing with special schools to take up supervised tooth brushing with further opportunities to extend roll-out being explored.

The Director of Public Health commented on the outcomes dashboard and highlighted the attempt to bring together nationally published data that is available through the public health outcomes framework and local indicators and metrics that are available.

The Executive Director Strategy and Integration ICB asked what made the difference with roll-out.

The Public Health Lead CYP and Sexual Health responded that strong relationships between schools and early-years providers have helped to establish communications.

The Executive Director Strategy and Integration ICB added that the framework as a whole is clear and is good to see the direct alignment to the integrated care strategy, which was signed off last year.

The Chair praised the work being done and asked where the two new dental practices, opening in April 2024, are going to be located.

The Consultant in Public Health responded that he would let the Chair know about the locations of the two new dental practices following the meeting.

The Chair asked what work is being done on immunisations in relation to children in care.

The Corporate Director CYP responded that this is picked up by the Corporate Parenting Board and there is work ongoing around immunisations and dental health checks.

The Chair asked what plans are in place to vaccinate children in hard to reach groups.

The Director of Public Health answered that there are a number of programmes in place across the county including a national recall system where GP surgeries are told as to who they can contact.

The Executive Director Strategy and Integration ICB added that a lot of emphasis has been placed across both Herefordshire and  ...  view the full minutes text for item 59.

To review the better care fund (BCF) 2023/24 quarter two and quarter three reports, as per the requirements of the Better Care Fund (BCF) programme.

The Service Director All Age Commissioning presented the item. The principal points included:

1. The Quarter 2 report focuses on a summary of changes in demand and capacity plans and provides updates against metrics. The Quarter 3 report collects the information against the metrics and ambitions in addition to an update on spend.
2. As a system, a lot of work is being undertaken against all of the BCF schemes. The focus remains on supporting people at home to avoid hospital admissions or the need for longer-term care.
3. Over the last two quarters, significant movement has been seen in relation to homecare market with increased capacity, new entrants and new providers to that homecare framework. The waiting list has reduced to only seven people last week.
4. Increased acuity is being seen with a higher number of hours required for those coming through homecare.
5. Work has been ongoing across the system with ICB colleagues around discharge to assess services.
6. Discharge to Assess ‘sprint’ is a significant programme of work to address challenges overseen in Discharge to Assess services including a complete review of pathways such as working with hospital teams at point of discharge, occupational therapy teams, reablement offer, and pathways through the community access team service.
7. There has been an increased commissioning capacity to work closely with Hoople to make changes and work alongside Hoople and other ICS colleagues in the re-design of the service specification for both Home First and Hillside. That work continues and will be reporting into the Discharge to Assess Board from next week.
8. Issues continue with data recording when capturing an accurate picture for Discharge to Assess data. A data specialist is being appointed who will be hosted by Taurus.
9. Work has been close with Hoople and capacity in the Home First service will begin to increase following a number of changes and consultation with staff teams delivering the reablement service via Home First.
10. The BCF partnership group has been re-established and is meeting regularly and will report directly into the Integrated Care Executive and upwards to One Herefordshire Forum in relation to governance and performance monitoring going forward.

Adrian Griffiths (Business Partner) noted that the five pools which make up the BCF are very close to break-even running up to the end of December 2023. At the end of the summer, it is likely that the year-end report will be ready and this year’s refreshed plan.

The Service Director All Age Commissioning added that in terms of longer-term care for residential and nursing care, work is being done with the market to look at block book arrangements for longer-term residential and nursing care beds. There is capacity in the market to source longer-term care, but challenges remain around the affordability of that care.

The Chair asked at what stage is the decision made to determine what level of care a person requires.

The Vice-Chair responded that Discharge to Assess does not involve that decision-making in the hospital but rather at a later stage during support and  ...  view the full minutes text for item 60.

For the Health and Wellbeing Board (HWB) to receive an update on the work between West Mercia  Police and Herefordshire and Worcestershire Health and Care NHS Trust in relation to the Most Appropriate Agency policy.

The Director of Strategy and Partnerships and Superintendent Helen Wain presented the item. The principal points included:

1. The MAA was implemented in April 2023 following the successful implementation in Humberside.
2. Its aim is for the police not deploying to incidents where there is no statutory duty for them to do so.
3. The interagency monitoring group brings colleagues together to look at the MAA impact and use case studies to explore whether there are gaps and whether things can be done differently.
4. There are escalation points where the police can be involved with the most appropriate response applied.
5. The national Right Care, Right Person (RCRP) policy has come into effect and underpins all of the approaches that are being sought under MAA.

Resolved

That:

a)    The Health and Wellbeing Board notes this update.

To receive any other items of business.

The Consultant in Public Health presented a short briefing on the association between childhood obesity and oral health and gave an update on the provision of fluoride varnishing in dental practices across Herefordshire. The principal points included:

1. There is an association between childhood obesity and oral health, however, the causation data is not available at present.
2. There is stronger evidence between adult obesity and poor oral health.
3. A lengthy discussion was had with the Oral Health Improvement Board around fluoride varnishing. Fluoride varnishing can be applied to both baby teeth and adult teeth by a dentist and the process involves the varnish having high levels of fluoride on the surface which can be applied on the teeth twice a year to prevent decay.
4. The recommendation is for children and adults, at high risk of tooth decay, to have fluoride varnishing. More can be done to publish fluoride varnishing and one of the actions taken by the Oral Health Improvement Board was to look at the data which is supplied by NHS Business Services Authority (BSA).
5. At the next Oral Health Improvement Board meeting, it will be reported as to how many dental practices are claiming for fluoride varnishing services and that will help feed into the plan for greater publication across the county.

The Public Health Lead Mental Health presented a short item on childhood obesity. The principal points included:

1. The data for 2022/23 indicates that in Herefordshire, 19% of children in reception are obese rising to 35% in Year 6.
2. There is a longstanding pattern of obesity doubling in primary school.
3. The Herefordshire proportion of overweight/very overweight/obese children has followed the English trend, with a peak seen in 2021 data and then a slight downwards trend in last year’s data.

The Director of Public Health noted that there is a significant proportion of children who are overweight or very overweight. It is worrying that 1 in 2 children in Year 6 in the most deprived wards are overweight or very overweight. Positively, about 16% of children who are obese at reception year go to a healthy weight at Year 6. Therefore, whilst there are real challenges, there are some real opportunities that exist in this area.

The Executive Director Strategy and Integration ICB suggested whether there is an issue about access to unhealthy foods among certain age groups in some parts of the county.

The Director of Public Health added that obesity is a complex issue and that there are 150 different determinants of obesity. It may be useful to do some insight work in some of these areas to understand the challenges and themes that may address obesity in certain parts of the county.

The Vice-Chair asked whether there is any difference amongst uptake of those being weighed and those refusing to be weighed at school.

The Public Health Lead Mental Health responded that uptake figures are high with about 98% being weighed at school.

The Public Health Lead CYP and Sexual Health added that the Healthy Tots  ...  view the full minutes text for item 62.

To consider the work programme for the committee.

The board considered the work programme. The main points in relation to potential ideas for development sessions were:

1. For the development session in May, a theme on mortality in Herefordshire would be useful for the board to explore.  
2. A focus on prevention would be useful.
3. There is a strong alignment between prevention and health inequalities. Community Paradigm, prevention, and health inequalities as a themed approach may be useful for a session after the May date, potentially in July.

Action:

1. To share a Doodle poll with members to confirm the May date for a Private Development Session.

The next scheduled meeting is 10^th June 2024, 14:00-17:00.

The next scheduled meeting is 10^th June 2024, 14:00-17:00.

The Chair formally closed the meeting.