To receive apologies for absence.

Apologies for absence had been received from board members: Dr Mike Hearne (Herefordshire General Practice); Councillor Ivan Powell (Cabinet Member Children and Young People, Herefordshire Council); and Tina Russell, Corporate Director for Children and Young People (Herefordshire Council).  Apologies were also noted from Councillor Crockett (Chairwoman of the Health, Care and Wellbeing Scrutiny Committee).

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

It was noted that Dr Lauren Parry intended to substitute for Dr Mike Hearne; Dr Parry was unable to attend ultimately due to clinical duties.

To receive any declarations of interest from members of the board in respect of items on the agenda.

No declarations of interest were identified.

The board was advised that Councillor Gandy had been involved in a vehicular collision earlier in the day and, whilst present to participate as a board member, had vacated the chairperson role for this meeting only.  Jane Ives was elected as chairperson.

To receive and approve the minutes of the meeting held on 17 March 2025.

The minutes of the previous meeting were received.

Resolved:  That the minutes of the meeting held on 17 March 2025 be confirmed as a correct record and be signed by the Chairperson.

To receive any accepted written questions from members of the public.

Appendix 1 to these minutes includes a question that had been received in advance of the meeting and a supplementary question that was read out.  In view of the member organisations represented, an exception was made to the usual treatment of questions and board members discussed the matter during the meeting.  The key points included:

i.        Due to uncertainty about the continued placement in the Morrisons supermarket car park in Hereford, options had been explored with NHS England about a sustainable site for the mobile breast screening unit.  It was commented that the Asda supermarket car park had been identified as a viable option, subject to securing the funding for utilities from NHS England.

ii.       There was a brief discussion about SpaMedica, an independent sector provider of cataract treatment, currently located in the Asda supermarket car park.

iii.      Board members spoke in support of a central location for the breast screening unit and the intention to recall women that had missed appointments during its temporary relocation in Ross-on-Wye.

To receive any accepted written questions from councillors.

No questions had been received from councillors.

The board is asked to note formally the publication of the 2024 Joint Strategic Needs Assessment (JSNA) Summary, which collates the latest strategic level understanding of the health and wellbeing needs of Herefordshire’s population.  It also aims to ensure the JSNA is used to inform the strategic planning and commissioning of relevant services pertinent to addressing the building blocks of good health and wellbeing by the council, NHS and other stakeholders.

The Director of Public Health presented the slide set ‘Joint Strategic Needs Assessment 2024’, including the slides: JSNA parts and process; JSNA 2024 Summary: contents and use; Recommendations of paper; and Facilitating effectiveness: Communication & engagement plan.

The matters discussed by the board included:

1.           The importance of the JSNA to understand the factors that affect the health of the population and the ongoing work with the Primary Care Networks on localised footprint analysis, particularly to inform the neighbourhood health model.

2.           The JSNA Summary 2024 was commended for its comprehensiveness and readability.

3.           Attention was drawn to the statement (JSNA Summary 2024, page 23) that ‘Although life expectancy has increased over recent decades, both nationally and locally, healthy life expectancy has not. This means that more people are spending more years of their lives in poor health…’.

4.           Additional participation in the JSNA Strategic Partnership Group was encouraged, including representation from the voluntary and community sector.

5.           Assurance was provided that the JSNA was used actively by the Safeguarding Children Partnership and the Safeguarding Adults Board.

6.           The top seven risk factors for disability in Herefordshire (JSNA Summary 2024, page 27) were noted and it was emphasised that the board should challenge itself about what could be done at local level over the next ten years.

Resolved:  That

a)      The publication of the 2024 JSNA Summary (Appendix 1) as the shared understanding of the overall health and wellbeing needs of Herefordshire be noted;

b)      The findings of the JSNA be considered in the development of priorities and future health and wellbeing strategies;

c)      The JSNA Summary be used within member organisations and other system networks; and

d)      Member organisations be encouraged to engage with the JSNA Strategic Partnership Group to develop a joint intelligence forward plan.

NHS partners (Integrated Care Boards (ICB) and all NHS Trusts in the ICB’s geography) are required to produce a Five-Year Joint Forward Plan (JFP).  The Health and Wellbeing Board is asked to reconfirm its endorsement of the refreshed plan given the updates that have been included in 2025/26 iteration, and to agree any amended wording to its supporting opinion as necessary.

David Mehaffey presented the ‘NHS Five Year Joint Forward Plan 2025/26 - 2029/30, Driving the shift upstream to more prevention and best value care in the right setting’, and made comments about: the interconnections between the Joint Local Health and Wellbeing Strategy, the NHS Five Year Joint Forward Plan, and the Integrated Care Strategy; and the main changes between the original publication of the NHS Five Year Joint Forward Plan in June 2023 and the refreshed plan, as identified in paragraph 6 of the covering report (agenda page 87).

The matters discussed by the board included:

1.           With attention drawn to theme 6, ‘High quality, patients centred services: learning disability and autism care’, references were made to the ‘digital flag’ programme (indicating that reasonable adjustments are required for an individual in the patient record) and to the Oliver McGowan Mandatory Training programme (enabling the NHS workforce to better support people with a learning disability and autistic people).  The Chairperson said that Wye Valley NHS Trust found the digital flag to be helpful and training was provided to staff by a learning disability nurse but acknowledged that there was more work to be done.

2.           The Joint Forward Plan would continue to be refreshed on an annual basis, so would be updated to reflect the 10 Year Health Plan for England, once published, in the 2026/27 iteration.

3.           The position with temporary closures of minor injuries units in Herefordshire, with Simon Trickett commenting that Wye Valley NHS Trust had not found a way to provide safe care with appropriate and suitably qualified staff, and there was a need for consideration to be given to the long-term future for those services.

Resolved:  That the updates that have been included in 2025/26 iteration be noted and the refreshed plan be endorsed.

There is currently a national programme, initiated by the Department of Health and Social Care (DHSC) and NHS England, to reduce the scope of responsibilities for Integrated Care Boards (ICBs), and subsequently the size of the organisations.  This initiative will require NHS Herefordshire and Worcestershire Integrated Care Board to reduce it’s running costs by 43% from the 2024/25 outturn, by the end of the 2025/26 financial year.  A verbal update on the latest position regarding this work will be provided at the meeting.

Simon Trickett provided a verbal update on emerging national changes which would affect Integrated Care Boards (ICBs).  The key points included:

i.             It was expected that the government would publish the NHS 10 Year Health Plan in July 2025 which would set out fundamental changes to NHS administration.

ii.            Plans to abolish NHS England had been announced in March 2025, with functions to be brought back within the Department of Health and Social Care (DHSC).

iii.          Integrated Care Boards would have to reduce their size and running costs by 50% on average; the figure for Herefordshire and Worcestershire was 43%, equating to £12m per annum.

iv.          The ‘Model Integrated Care Board Blueprint v1.0’ had been published in April 2025 which set out the role ICBs would play in the future as strategic commissioners, with local NHS trusts more accountable for the quality of services and the outcomes that they deliver.

v.           A key policy driver was reducing the variability in size of the ICBs; there were 42 in England currently.  Alongside this, the English Devolution White Paper set the intention to reform local government and align public service boundaries.

vi.          Pending the emergence of Strategic Authorities, a proposal had been submitted to DHSC and NHSE for a strategic cluster to be formed to share leadership and management arrangements involving NHS Herefordshire and Worcestershire ICB and NHS Coventry and Warwickshire ICB.

In response to a question from a board member, Simon Trickett commented on the need for ICBs to pursue commissioning that delivers the preventative agenda, as well as encouraging services to do more to manage existing conditions to prevent further deterioration.  It was emphasised that the demand curve had to be shifted, with attention given to the wider determinants of health.  The Chairperson commented on the value of the collaborative approach through the One Herefordshire Partnership and, noting the pressures on urgent care and emergency departments, said that this shift was in the interests of everyone.

A board member said that the voluntary and community sector should be part of co-design and co-production of services to support upstream interventions.

In response to a comment by a board member, Simon Trickett acknowledged the key role and responsibilities of the NHS in terms of safeguarding.

In response to a question from a board member, Simon Trickett outlined the assessment process and management of NHS Continuing Healthcare, both currently and historically.

The Director of Public Health commented on the need to explore how services were configured at a neighbourhood level.

Resolved:  That the verbal update be noted.

To provide an update on the progress of the implementation plan for the board’s strategic priority of ‘Good Mental Wellbeing (GMW) throughout Lifetime’.

The Public Health Lead – Mental Health introduced the slide set ‘Update on Good Mental Wellbeing’ and reported that the Adult Better Mental Health Partnership Board had been accepted as a signatory to the government’s ‘Prevention Concordat for Better Mental Health’.

The following participants provided case studies: Charlotte Brant and Kate Ford about the Assertive Outreach Team / Community Healthy Lifestyle Group; Milly Boylan about @the Hub; and Judith Gardner about Open Arms Kington.

The Chairperson noted the benefits of hearing about the practical delivery of local projects and the need for the board to challenge itself about its future ambitions.

Resolved:  That report and appendices and progress to date on the Good Mental Wellbeing (GMW) priority be noted.

The Herefordshire Suicide Prevention Strategy is brought to the attention of the board for information.

The Public Health Principal introduced the item, noting the extensive partnership work that had been undertaken, and the Public Health Lead – Mental Health presented the slide set ‘Herefordshire Suicide Prevention Strategy’, including the slides: Engagement; Strategy aims; and Our commitments.  It was reported that the Herefordshire Suicide Prevention Working Group would be meeting later in the week to develop an action plan to take the commitments forward.

In response to a question, the Public Health Lead said that the previous strategy had resulted in positive actions and that new resources, including data from the Real-time Suspected Suicide Surveillance system which went live in 2024, would enable more targeted work.

Resolved:  That the strategy, as an action supporting the priority of good mental wellbeing throughout life, be noted.

To review and approve the Better Care Fund (BCF) reporting for 2024/2025.

The Corporate Director for Community Wellbeing introduced the BCF reporting for 2024/25 and made the following comments: due to the national submission timetable, the returns had been approved by the Corporate Director and the accountable officer of the Integrated Care Board; Herefordshire had reported in each quarter that all of the national conditions and national metrics had been met; and the BCF ended the financial year with a small underspend overall but attention was drawn to the overspending on Additional Discharge Funding.

Resolved: That

a)      The Better Care Fund (BCF) 2024/25 quarterly reports at Appendices 1, 2, 3 and 4, submitted to NHS England, be approved; and

b)      The ongoing work to support integrated health and care provision that is funded via the BCF be noted.

To update Health and Wellbeing Board members on Herefordshire’s Better Care Fund (BCF) Plan 2025/26 and seek formal Health and Wellbeing Board approval.

The Corporate Director for Community Wellbeing introduced the BCF Plan 2025/26 and made the following comments: the new BCF objectives aimed to support the shift from sickness to prevention, and from hospital to home; the key changes from previous years were highlighted; the plan had been developed collaboratively and had the support of the One Herefordshire Partnership; and it had been a challenge to bring the planning on budget in line with the funding available, particularly in view of national changes, inflationary pressures, and predicted levels of demand.

In response to questions about the ‘Key changes since the previous BCF Plan’ section (agenda page 315), the Corporate Director provided clarifications about the funding of operational social work teams and Talk Community services from the council’s base budget, with the BCF funding repurposed towards long-term adult social care placements.  Consequently, there was limited additional funding to increase investment in prevention, community resilience or admission avoidance.  It was noted that the voluntary and community sector may be able to assist with prevention, but this would require some level of investment.

The Chairperson welcomed the focus on outcomes and noted that the ambitions to reduce emergency admissions, discharge delays, and long-term admissions aligned well with the recently published ‘Urgent and emergency care plan 2025/26’.

Resolved:  That

a)           The Herefordshire Better Care Fund 2025/26 Narrative Plan (Appendix 1), Planning Template (Appendix 2) and the Capacity and Demand Template (Appendix 3), submitted to NHS England, be approved; and

b)      The ongoing work to support integrated health and care provision that is funded via the BCF be noted.

To consider the work programme for the board.

The updated work programme for the board was considered.

Resolved:       That the updated work programme be agreed.

The note the date of the next scheduled board meeting in public, Monday 15 September 2025, 2.00 pm.

The date of the next scheduled meeting in public was confirmed as Monday 15 September 2025, 2.00 pm.

Jane Ives reported that the September 2025 meeting would be the last meeting before retirement from her role as Managing Director of Wye Valley NHS Trust; Sarah Shingler, current Chief Nursing Officer of NHS Worcestershire Acute Hospitals NHS Trust, had been appointed as the next Managing Director.