Apologies were received from: Jon Butlin, Councillor Ivan Powell, and Mark Yates.

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

Lorraine Baker acted as a substitute for Susan Harris to represent Herefordshire and Worcestershire NHS Trust.

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 26^th June 2023.

The board approved the minutes of the meeting 26 June 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 20^th September 2023 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 20^th September 2023 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.

Recommendation: That board members consider candidates and appoint a vice chairperson in accordance with section 2.8.10 of the constitution.

Resolved: That Jane Ives (Managing Director, Wye Valley NHS Trust) be re-appointed vice-chairperson of the board for the remainder of the municipal year.

For the Health and Wellbeing Board (HWB) to consider the revised terms of reference at appendix 1 and provide comments before recommending the changes to Council.

Matt Pearce (Director of Public Health) gave a brief overview of the proposed Terms of Reference which includes some changes to the membership of the committee.

The recommendation was proposed, seconded, and approved unanimously.

Resolved that:

a)    The Health and Wellbeing Board considers the revised terms of reference at appendix 1 and provides comments before being ratified by Full Council.

To update Health and Wellbeing Board members on Herefordshire’s Better Care Fund (BCF) Integration Plan 2023-25 and seek formal Health and Wellbeing Board approval.

Hilary Hall (Corporate Director for Community Wellbeing) provided an overview of the Better Care Fund (BCF) Integration plan 2023-25.

Simon Trickett (Chief Executive, NHS Herefordshire and Worcestershire ICB) thanked the Corporate Director and officers for the work in providing the plan. It was noted that approval has been received from NHS England which represents a national approval process. It was raised that work still needs to be done regarding local arrangements and specifically, over the next twelve months, it was noted that there is an overreliance on spot-purchasing placements and instead clarity needs to be established about longer-term arrangements which are better for patients and service users.

The Corporate Director for Community Wellbeing agreed that there should not be an overreliance on spot-purchasing. It was also raised that enabling more people to come home and be supported in their own homes rather than moving into residential and nursing care is appropriate.

Jane Ives added that through the resources that exist, efficiency and effectiveness can be driven by having a much more local ownership of the problem. More work needs to be done but this is an exciting first step in the right direction.

The report recommendations were proposed, seconded, and approved unanimously.

Resolved that:

a)    The Herefordshire Better Care Fund 2023-25 narrative plan (Appendix 1), planning template (Appendix 2) and the ICB Discharge template (Appendix 3) be approved; and

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

A report by West Mercia Police to share with the Health and Wellbeing Board a new policy and procedure referred to as ‘Most Appropriate Agency’ (MAA).

John Campion (West Mercia Police Crime Commissioner) provided an overview of the Most Appropriate Agency (MAA) report produced by West Mercia Police. The points under item 24 of the MAA report were referred to in asking for feedback from board members.

Kevin Crompton asked what the mechanism is for multiagency decision making and where is the conversation for agencies to decide whose remit it is to respond to a certain situation.

The Police Crime Commissioner responded that there is no multiagency function in West Mercia, however, part of the solution may include the development of a new forum which makes it easier for the right response to be made to a person in need.

The Chair asked if there will be confusion as to who people should contact in certain situations.

The Police Crime Commissioner responded that while the police are very accessible, not all emergency services are in that position. It is for the partners to sort out how demand is re-routed not necessarily the person in need.

Lorraine Baker (Service Lead) noted that there is an escalation policy in place with the police to request the police deployment to assist with certain situations, particularly with relation to mental health.

Superintendent Helen Wain (West Mercia Police) added that the escalation policy is available should agencies feel that the decision taken by the police is not correct. There are monthly meetings with A+E and mental health services at which these issues are discussed.

Simon Trickett noted the success of the pilot in Humberside and is confident in the strength of local partnerships to make a success of this policy.

The Police Crime Commissioner added that going forward how the different processes, budget cycles, and commissioning of services are aligned and how gaps are addressed where they exist.

Jane Ives noted that Herefordshire, as a small county with small public services, needs to be more flexible with how public services work together.

The Police Crime Commissioner agreed that Herefordshire is unique, however, this provides opportunities where partners can collaborate and work closely together. At present, the route map does not exist to make that happen enough of the time on such particular issues.

Jane Ives responded that in relation to the first bullet point under item 24 of the report, partners do not fully understand the implications of the policy for themselves from both a strategic and an operational perspective. Broad conversations do need to take place with the partners.

The Chair asked regarding Humberside, what are they doing differently to what Herefordshire is doing now and what can be learned from Humberside.

The Police Crime Commissioner responded that the Humberside partnership was set up as a partnership around the shared problem of demand not being met in the right place. The way they set up their project is very different to how it started in West Mercia.

Simon Trickett added that working with the community is important to ensure that there is a self-sufficiency and people can help look out  ...  view the full minutes text for item 36.

This report updates the Health and Well-being Board on the work of the Oral Health Improvement Partnership Board since the last report to Board (September 2022).

HarpalAujla (Consultant in Public Health) presented the update on the work of the oral health improvement partnership board. The key points included:

1. The Oral Health Improvement Partnership Board aims to deliver on the recommendations made in the Health Needs Assessment published in 2019.
2. The board was restarted in 2021 and meets quarterly and is chaired by the Public Health consultants.
3. Key areas of development are good activity at system level including new dental service called the ‘golden hello’. For children and young people, the ‘Time to Shine’ programme continues to improve children’s oral health and a ‘Brush, Book, Bed’ pack has been made available via libraries and aims to give every child aged 3 a pack including a toothbrush and book.
4. However, decay in children aged 5 has risen from 33.6% in 2012 to 38.7% in 2022.
5. There are areas which could be focused on for further improvement including fluoride varnishing and fluoridation of the water supply.

Simon Trickett added that the golden hello initiative will provide two new dental services in Herefordshire. It was asked whether water fluoridation could be discussed further.

The Director of Public Health noted that water fluoridation would be beneficial to improving children’s oral health but that there was not enough clarity on how this can be achieved.

The Chair commented that rural areas of Herefordshire whereby public transport is limited, getting to a dental practice is very difficult. The use of a mobile dental unit could be used to help those who find it difficult to travel to dental practices.

Stephen Brewster asked if there was a correlation to the childhood obesity data in terms of whether the hotspots are the same.

The Director of Public Health responded that there was not enough evidence to suggest there was a direct correlation. This is an area that can be followed up going forward.

The Leader of the Council asked if there was any focus on drinks other than water that may be harming oral health and what advice is being given to families.

The Director of Public Health answered that some work is being done regarding the development of the healthy setting standards for early years and the wider promotion of healthy drinking.

The Chair asked whether it was still the case that fluoride varnishing is offered in dental practices and whether that is sufficiently publicised as available.

HarpalAujla responded that it fluoride varnishing is still being offered and carried out by dental practices.

The Director of Public Health added that, in terms of publicising fluoride varnishing, this would need to be taken away and looked at by the Oral Improvement Partnership Board.

Christine Price (Healthwatch) asked Simon Trickett of the ICB whether there are opportunities for commissioning different ways of providing services which aren’t traditionally seen by dentists.

Simon Trickett commented that dentistry was commissioned nationally until 1^st April 2023 when it was devolved down to local level. The incentive to help with set up cost was part of  ...  view the full minutes text for item 37.

This report presents a brief review of the launch of the Joint Local Health and Wellbeing Strategy event which took place on 12 July 2023.

The Director of Public Health gave a summary of the launch event which was held in July. Participants helped contribute to the delivery of the strategy’s two key priorities and these are currently being written up in delivery plans that are due to come to the Board in December.

The Chair noted that she received positive feedback from councillors about the event and this underlines the need to do more to reflect the positive work that is ongoing in Herefordshire. It was recommended that an annual event is held.

Resolved that:

a)    The Health and Wellbeing Board is invited to reflect on the conference and any lessons that can be learned to inform future events.

b)    An annual Health and Wellbeing event is held.

To consider the work programme for the committee.

The Chair asked the board if members wanted to hold a private development session in November. No requests were received to do so.

The next scheduled meeting is 4 December 2023, 14:00-17:00.

The next scheduled meeting is 4 December 2023, 14:00-17:00.