Apologies for absence were received from the following board members: Stephen Brewster, Jon Butlin, Cate Carmichael, David Mehaffey, Christine Price, and Tina Russell.

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

The following substitute board members were present: Anna Davidson for Jon Butlin, Rob Davies for Cate Carmichael, Dr Andy Watts for Christine Price, and Simon Trickett for David Mehaffey.

To receive any declarations of interests of interest in respect of items on the agenda.

No declarations of interest were made.

To approve and sign the minutes of the meeting held on 10 June 2024.

The minutes of the previous meeting were received.

Resolved:  That the minutes of the meeting held on 10 June 2024 be confirmed as a correct record 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 10 September 2024 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 10 September 2024 at 5.00 pm, unless the question relates to an urgent matter.

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

No questions had been received from councillors.

To update Health and Wellbeing Board members on Herefordshire’s Better Care Fund (BCF) Integration Plan 2024-25 and seek formal Health and Wellbeing Board approval.

The Service Director All Age Commissioning provided an update on the Herefordshire’s Better Care Fund (BCF) Integration Plan 2024/25, the principal points included:

i.             The BCF Integration Plan 2023-25 had been approved by the board in 2023, minute 35 of 25 September 2023 refers.

ii.            The refreshed plan included updates to elements of the metrics and to the spending plans, but there was no requirement for a separate narrative plan submission.

iii.          Due to the need to meet the national timeline, retrospective approval was sought for the BCF Integration Plan 2024/25.

iv.          The plan had been signed off by One Herefordshire Partnership, Herefordshire Council, and Herefordshire and Worcestershire Integrated Care Board.  The West Midlands Assurance Panel had recommended the plan for approval.

v.           The Department of Health and Social Care had flagged the intention for additional metrics around discharge and reablement for 2024/25, but these had not yet been published.

vi.          Funding for the BCF had increased by £2.6m for 2024/25 but funding of £2.3m utilised in 2023/24 was not available in 2024/25.  Consequently, the net increase was not sufficient to meet inflationary increases in recurrent commitments, and reductions in expenditure were necessary to deliver a balanced plan.  An overview was provided of the work being undertaken collaboratively to address the pressures.

vii.         The board was advised that planned changes to demand and capacity were considered realistic but could be challenging to deliver.

viii.       It was noted that the One Herefordshire Integrated Care Executive would continue to monitor performance.

The Chairperson drew attention to the following:

·             The BCF 2024/25 Update Template (agenda page 27) showed each line of income and expenditure as being identical, but the total showed a difference of £1; it was later confirmed that this was a result of rounding within the automated template.

·             It was acknowledged that the narrative plan had not been updated but reference to Talk Community ‘Super hubs’ (agenda page 95) was no longer relevant.

Comments from board members included:

1.           Simon Trickett considered that it had been a proactive and successful year due to the health and social care teams leading it.  The challenges were noted but there was assurance that there was capacity and capability to manage the financial pressures.  It was reported that a Point Prevalence Audit was to be conducted shortly, looking at patients and service users on a given day to understand where they were on their journeys; it was suggested that an update could be provided in due course.

2.           Dr Andy Watts questioned whether there were metrics for feedback from service users in terms of the quality of discharge planning and about what happens in the days immediately following discharge.  The Corporate Director Community Wellbeing said that feedback was captured later in the process, but consideration could be given to a systematic approach.

3.           In response to a question from the Vice-Chairperson about the level of confidence in achieving productivity improvements, the Service Director All Age Commissioning commented on ongoing work to increase capacity, including  ...  view the full minutes text for item 19.

To provide an update on the progress of the action plan for the Board’s strategic priority of “Best Start In Life”.

The Public Health Lead - CYP and Sexual Health provided an update on progress of the action plan for the board’s strategic priority of ‘best start in life’, the principal points included:

i.             Attention was drawn to the Implementation Plan 2023-25 (Appendix 1) which identified the Red, Amber, Green status for each action.

ii.            Following the recommissioning of the Public Health Nursing Service, the 0-19 service was represented at each Primary Care Network (PCN) partnership board, reflecting ongoing work to establish an integrated approach.

iii.          To support oral health, two new NHS dental practices had been secured (one had opened in Commercial Street, Hereford and the other was in development at Saxon Hall, Hereford), a tooth-brushing programme continued to roll out to 43 education settings, and 4-6 month oral health and weaning workshops were being delivered in localities.

iv.          It was reported that there were challenges to be explored through the Children and Young People Partnership Board in relation to the development of a cross-sector dashboard and with ensuring that the voices of families and children were incorporated across actions and plans.

v.           It was also reported that the action to ‘broaden the early help / start for life offer within the community’ was Red rated pending the outcome of a Talk Community review.

Comments from board members included:

1.           The Chairperson welcomed the new dental practices but emphasised the need to improve access in the rural areas, potentially through mobile dental services.

Later in the discussion, the Cabinet Member Children and Young People questioned whether the new dental practices provided all the capacity that was needed.

Simon Trickett confirmed that it was the Integrated Care Board’s role to commission dental services, acknowledged that the two new dental practices were a start from a low base, and said that creative solutions were needed, especially given the needs of rural populations.

2.           In response to point made by the Leader of the Council about the importance of a healthy diet for oral and general health, it was confirmed that the tooth-brushing programme promoted healthy eating, and an overview was provided of the healthy schools and healthy tots programmes.

3.           Further to point v., the Chairperson questioned the reasoning for any delays associated with the Talk Community review given the continuation of existing hubs.  The Corporate Director Community Wellbeing said that the matter related to early help services and this point would be raised with the Corporate Director Children and Young People.

4.           Further to point iv, the Cabinet Member Children and Young People noted the opportunity for detailed focus and discussion on the challenges through the Children and Young People Partnership Board, and partners were encouraged to explore the issues within their respective organisations.

5.           The Vice-Chairperson commented on the positive feedback about the health visiting service, the potential to be more ambitious with the board’s strategic priorities by involving all sectors in the county, and the linkages between the ‘best start in life’ and ‘good mental wellbeing throughout life’ priorities.  ...  view the full minutes text for item 20.

The purpose of this report is to update the Health and Wellbeing Board on the recent Government Smoke Free Generation plan and the actions taken to work towards achieving a Smoke Free Generation (SFG) in Herefordshire.

The Public Health Lead - Substance Misuse / Tobacco reported on the Smoke Free Generation Plan announcements and related actions in Herefordshire, the principal points included:

i.             An item on Tobacco Control had been considered by the board in 2022 following the publication of ‘Kahn Review: Making Smoking Obsolete’, minute 58 of 26 September 2022 refers.

ii.            The government had announced ‘Stopping the start: our new plan to create a smokefree generation’ in October 2023, with the Tobacco and Vapes Bill introduced in the House of Commons in March 2024.

iii.          Related developments in Herefordshire were outlined, including the ‘swap to stop’ scheme, additional staffing capacity in the healthy lifestyles service, the roll-out of a ‘train the trainer’ package to widen the swap to stop offer, an initiative to raise awareness of the risks of vaping to young people through the Healthy Schools programme, and enforcement activities through the Trading Standards Team.

The key points arising from the debate included:

1.           The Leader of the Council questioned whether the focus should be on tackling nicotine addiction given the harmful effects associated with smoking, vaping and other forms of ingestion.  The Public Health Lead - Substance Misuse / Tobacco explained that the swap to stop scheme provided vape kit vouchers to support more adult smokers to make a quit attempt and this was intended as a short-term intervention, with nicotine levels reduced incrementally.

2.           The Consultant in Public Health drew attention to the fact that smoking prevalence in adults working in routine and manual occupations (28.6%) remained much higher than the general population (12.2%).

3.           Sue Harris, noting paragraph 8 of the report which identified that adults with severe mental illness (40%) and long-term mental health conditions (28.2%) were more likely to smoke than the general population, outlined tobacco cessation initiatives at the Stonebow Unit in Hereford and the offer of annual health checks through GPs.

4.           The Talk Community Health and Wellbeing Manager emphasised that the swap to stop scheme followed the government’s advice and guidelines.

5.           Dr Andy Watts expressed support for actions towards achieving a smoke free generation.

6.           Anna Davidson noted the potential benefits of smoking cessation from a fire prevention perspective. 

The Cabinet Member Children and Young People commented on the need to promote home fire safety checks throughout the county.

Resolved:  That

a)      the board welcomes and supports the Smoke Free Generation plan announcements;

b)      the board welcomes the report and supports a renewed emphasis on tobacco control work to reduce smoking prevalence across Herefordshire;

c)      member organisations are asked to promote and engage in activity to work towards the Smoke Free Generation in Herefordshire; and

d)      board members are asked to support and engage with a new Tobacco Control Alliance and the resulting Tobacco Control Plan, with reports provided annually to the board.

To update the Health and Wellbeing Board on the work of the Herefordshire Community Safety Partnership.

Superintendent Helen Wain introduced an update on the work of the Herefordshire Community Safety Partnership (HCSP) and highlighted the following:

i.             In addition to the priorities of ‘Domestic Abuse’ and ‘Violence Against Women and Girls’, carried over from the Community Safety Strategy 2021-2024, the agreed priorities for 2024-2027 included ‘Misue of Drugs’ and ‘Neighbourhood Crime’.

ii.            The HCSP had also agreed cross cutting themes of ‘Serious Violence’, ‘Serious Organised Crime’, ‘Prevention’, and ‘Community Engagement’.

iii.          A detailed review of the HCSP had been completed in 2023 and a revised governance structure had been implemented, as shown in the agenda supplement, including sub-groups aligned to the priorities, and changes to the terms of reference, scope and membership of the Multi Agency Tasking and Coordination Group (MATAC).

iv.          Information was provided in relation to funding allocated from the Office of the Police and Crime Commissioner, West Mercia Serious Violence duty grant funding, and the Home Office funded hotspot programme.

v.           Information was also provided in relation to Domestic Homicide Reviews, challenges in establishing a multi-agency data set to support crime profiles for the county, and intra youth serious violence findings.

vi.          It was noted that a new Community Resilience Team was being created within Public Health.

In response to questions from Dr Andy Watts, Superintendent Wain said: the HCSP had not met since the rioting in the UK during the summer; a hate crime sub-group reported into MATAC; there had been a reduction in the reporting of hate crime which needed to be understood, with engagement with relevant groups; and references were made to the Prevent and CONTEST strategies.

Resolved:  That the update report be noted.

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

Kevin Crompton, Independent Chair of the Herefordshire Safeguarding Adults Board (HSAB), introduced the annual report of the HSAB and commented on the following:

i.             The HSAB had been working productively and collaboratively to understand the impact of its work and to be a learning partnership.

ii.            Work was ongoing to build on the multi-agency approach to the safeguarding front door and on transitions for those moving from child to adult services.

iii.          It was noted that comparisons with different authority areas were difficult but the fact that 91.3% of service users felt that the services provided made them feel safe and secure was considered a good indicator of positive outcomes.

iv.          A decrease in the number of safeguarding concerns over the reporting period by 34% was attributed to a change in the referral process; all referrals were being triaged prior to being sent to the safeguarding team.

v.           The staffing capacity of partners remained a challenge, particularly given volatility in referral numbers; for example, there had been five referrals for Safeguarding Adults Reviews in 2023/24 and ten to date in 2024/25.

vi.          It was considered that the Community Wellbeing Directorate had good infrastructure to support vulnerable people, with specific references made to Talk Community and to rough sleeper initiatives.

The Vice-Chairperson said that the report demonstrated that good partnership working that was being undertaken and thanked the Independent Chair for their contribution.  The Chairperson welcomed the increase in the percentage of service users that felt safe and noted the need to keep the momentum going.

Resolved:  That the board has considered the HSAB Annual Report 2023/24 and discussed the effectiveness of the arrangements for safeguarding adults in Herefordshire.

To consider the work programme for the committee.

The Chairperson drew attention to the updated work programme for the board.

Resolved: That the updated work programme be approved.

The next scheduled meeting is 9 December 2024, 14:00-17:00.

The date of the next scheduled meeting in public was confirmed as Monday 9 December 2024, 2.00 pm