Apologies for absence had been received from board members Ingrid Barker from the Gloucestershire Health and Care NHS Foundation Trust, Russell Hardy from the Wye Valley NHS Trust, and Simon Trickett from NHS Herefordshire Clinical Commissioning Group.  Apologies had also been received from Colin Merker from the Gloucestershire Health and Care NHS Foundation Trust.

The chairperson said that she would wish to see board members give this meeting appropriate priority and attend every meeting.  The chairperson asked board members if they would be prepared to commit to missing no more than two meetings in public per year and attending board members indicated that this would be acceptable to them.

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

Duncan Sutherland was present as a substitute for Ingrid Barker, and Joanne Alner was present as a substitute for Simon Trickett.

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.

Dr Tait reported that he had been selected as the chair designate for NHS Herefordshire and Worcestershire Clinical Commissioning Group.

To approve and sign the minutes of the meeting held on 14 October 2019.

The minutes of the previous meeting were received.

Resolved:  That the minutes of the meeting held on 14 October 2019 be approved and be signed by the chairperson.

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 Tuesday 4 February 2020 at 5.00 pm.

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

No questions had been received from members of the public.

To receive any written questions from councillors.

The deadline for the receipt of a question from a councillor is Tuesday 4 February 2020 at 5.00 pm.

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

No questions had been received from councillors.

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  ...  view the full minutes text for item 26.

To present the 2019 director of public health annual report and to seek the support of the board in implementing the recommendations.

The chairperson asked the director of public health to present the annual report, the key points of the presentation are summarised below:

a.         The consultant in public health and the intelligence team were thanked for their support in producing the annual report.

b.         This report focussed on rural Herefordshire and the often hidden levels of ill health and inequality in rural areas.

c.         Herefordshire was one of England’s most sparsely populated counties, with 42% of residents living in areas officially classified as ‘rural village and dispersed’ and 25% living in ‘very sparse’ areas.

d.         The population age distribution showed that there was a higher proportion of 45 to 79 year olds living in rural areas.

e.         The ageing population profiles in coming years would create significant demand on services, with opportunities but also challenges for people living in rural areas.

f.          It was important to reflect on the wider determinants of health and wellbeing, including housing conditions.

g.         The health and wellbeing of Herefordshire’s rural population was, on average, slightly better than those living in urban areas for many indicators, with the exception of the proportion of households in fuel poverty.  However, there were significant pockets of deprivation and poor health outcomes in rural areas.

h.         A comparison with all the local authorities in England illustrated that Herefordshire was particularly deprived in relation to ‘living environment’ and ‘barriers to housing and services’.

i.           Comparison of the types of deprivation showed that ‘indoor living environment’ and ‘access to services’ were higher in rural areas compared to urban areas of Herefordshire, and were amongst the most deprived in England.

j.           An overview was provided of the housing stock in Herefordshire, and significant challenges were noted in terms of thermal efficiency, affordability and social mobility.

k.         In view of the access times for residents to reach GP surgeries, further consideration was needed on the ways in which people would be able to access services in the future.

l.           The strengths of rural communities and the benefits of the natural environment for health and wellbeing were outlined.

m.        Road safety concerns could be a barrier to people walking and keeping active.

n.         Gypsies and Irish Travellers were represented more in rural areas than in urban areas, were more likely to experience the effects of rural inequality, and had poor outcomes in key areas such as health and education.  It was anticipated that the Talk Community programme would help to reach people more at risk of inequality.

o.         It was emphasised that the report did not capture everything that was happening to support the health and wellbeing of people living in rural areas but an overview was provided of some examples, including Herefordshire Council’s new County Plan, the Children and Young People’s Partnership Plan, Talk Community, the NHS Long Term Plan and Primary Care Networks, the Keep Herefordshire Warm scheme, the Fastershire Broadband Project, and the review of the Housing Strategy.

The chairperson welcomed the annual report.  As a general point to report authors, it  ...  view the full minutes text for item 27.

As part of the statutory function of the board the purpose is to review the better care fund quarter two and three performance reports and recommend any future improvements.

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

a.         It was a statutory function to review the better care fund (BCF) performance reports.

b.         To meet the national submission deadlines, the contents of the quarter 2 and quarter 3 performance reports had been approved under delegated authority by the director for adults and communities in consultation with the accountable officer of NHS Herefordshire Clinical Commissioning Group, and had been submitted to NHS England.  The board was invited to review the completed data.

c.         Attention was drawn to the following sections of the quarter three report:

·                     The metrics position: non-elective admissions was not on track to meet target, residential admissions was on track to meet target, reablement was not on track to meet target but there had been improvements, and delayed transfers of care was on track to meet target and significant improvements had been made;

·                     The high impact change model and the updates provided on the eight key areas; and

·                     The integration highlight which outlined the integrated model of care for adults requiring palliative and end of life care.

d.         It was reported that the Herefordshire BCF and integration plan 2019/20 had received approval and guidance was awaited for 2020/21.

The managing director of Wye Valley NHS Trust said that the board should not be unduly concerned about metric on reablement, being the ‘proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services’, as trying to meet that target in a selective way could be detrimental to the system flow.  The head of partnerships and integration commented on the significant investment in this area and the improvements being seen; it was predicted that this metric would be met by the end of the year.

In response to questions from the Leader of the Council on the schemes that comprise the section 75 agreement and the net forecast overspend of £1.939m, principally due to overspends in pool two (£0.669m) and pool five (£1.728m):

§    The head of partnerships and integration advised that overspend in pool two (additional voluntary contributions to BCF) related to residential and nursing care spend.

§    The director for children and families advised that overspend in pool five (children’s services) related to complex needs placements.  It was reported that there was an agreement in place which allocated underspend or overspend between the CCG (1/7^th), Herefordshire schools’ forum dedicated schools’ grant (3/7^ths), and the council (3/7^ths); it was noted that the partners had been notified.  He added that there had been underspend in previous years and work was being undertaken to look at the patterns of placements which were few in number but high in cost.

§    The managing director of the CCG confirmed that overspend would need to be managed within existing resources.

The chairperson requested that a breakdown of the schemes that comprise the section 75 agreement be circulated to board  ...  view the full minutes text for item 28.

The next scheduled board meeting in public is Monday 20 April 2020, 2.30 pm.

The following provisional meeting dates are suggested:

Monday 6 July 2020, 2.30 pm

Monday 7 September 2020, 2.30 pm

Monday 7 December 2020, 10.00 am

Monday 8 March 2021, 2.30 pm

Monday 7 June 2021, 2.30 pm

It was noted that the next scheduled board meeting in public was Monday 20 April 2020.

Provisional meeting dates for 2020/21 were also noted.