Apologies for absence had been received from board members: Kevin Crompton (Independent Chair, Herefordshire Safeguarding Adults Board); Sue Harris (Director of Strategy and Partnerships, Herefordshire and Worcestershire Health and Care NHS Trust); Simon Trickett (Chief Executive, NHS Herefordshire and Worcestershire Integrated Care Board); and Tina Russell (Corporate Director for Children and Young People, Herefordshire Council).  Apologies had also been received from Liz Farr (Service Director Education, Skills and Learning, Herefordshire Council) and Councillor Pauline Crockett (Chair 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.

The following substitutes were noted: Hilary Jones (Head of Additional Needs) was present as the substitute for Tina Russell (Corporate Director for Children and Young People).

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

No declarations of interest were identified.

To receive and approve the minutes of the meeting held on 15 September 2025.

The minutes of the previous meeting were received.

Resolved: That the minutes of the meeting held on 15 September 2025 be confirmed as a correct record and be signed by the Chairperson

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

No questions had been received from members of the public.

To receive any accepted written questions from councillors.

No questions had been received from councillors.

[Note: For the efficient transaction of business, the item ‘Local Government Association Offer’ was considered before the item ‘Tackling Domestic Abuse Strategy Update’, but the original agenda order is maintained in these minutes for ease of reference]

The report provides an update on the publication of Herefordshire’s Domestic Abuse Strategy 2025-2028, outlining the governance arrangements and delivery mechanisms that underpin its implementation.

The Chairperson explained that full Council (minute 25 of Council, 10 October 2025, refers (link)) had invited the board to re-consider the title of the strategy to highlight prevention, hence the updated title ‘Tackling Domestic Abuse Strategy’.

Kayte Thompson-Dixon presented the slides 'Tackling Domestic Abuse Strategy 2025-2028' (link), under the headings: Introduction; Vision; Definition of domestic abuse; Understanding domestic abuse; Voices of lived experience; Priorities; Links to HWB priorities: best start in life for children; Links to HWB priorities: good mental wellbeing throughout life; Links to other priorities; and Governance and measuring progress.

The principal points of the discussion included:

1.           The importance of listening to people with lived experience was recognised and it was noted that the Lived Experience Advisory Network was a primary method of engagement.

2.           Training and development opportunities for operational staff was a key feature of the delivery plan.

3.           References were made to the White Ribbon network and to the IRIS programme; the latter offered specialist training and support for GP practices.

4.           It was noted that health and care partners, as anchor organisations, had an important role to play in raising awareness and promoting pathways into support.

5.           It was confirmed that the children and young people directorate was represented at the local partnership board and work was being undertaken proactively; for example, an event was to be held in early 2026 for teachers around the promotion of healthy relationships, early identification and prevention, and access to support services.

6.           An attendee commented on child victims of domestic abuse, the need for training for police and Crown Prosecution Service staff, and potential linkages between the strategy and the neighbourhood health agenda.

7.           Challenges around data collection across services were outlined, including the local picture in terms of child and adolescent to parent violence and abuse.  The Chairperson, referencing the ‘Demographic and Composition Population Features of Victim / Survivors in Herefordshire’ section of the strategy, noted that one of the recommendations of the strategy acknowledged that ‘More accurate data recording is required in the future to provide more meaningful insights’.  It was reported that a briefing paper on child and adolescent to parent violence and abuse had been circulated within the children and young people directorate to support staff to identify issues and related matters were highlighted in workshops.

8.           The Chairperson, referencing the ‘Demographic and Composition Population Features of Victim / Survivors in Herefordshire’ section of the strategy, noted that one of the recommendations of the strategy acknowledged that ‘More accurate data recording is required in the future to provide more meaningful insights’.

9.           Overviews were provided of work undertaken with: housing providers, including on emergency housing, safe accommodation, and enabling victims to remain safely in their own homes; West Mercia Women’s Aid, including helplines, refuge, support services, and educational programmes; and Cranstoun in terms of the male victims service.

10.        Attention was drawn to the statement ‘Between April 2022 and March 2023, 42 men attended the Men  ...  view the full minutes text for item 37.

An overview of recent developments under the National Neighbourhood Health Implementation Programme.  This provides an opportunity for the Board to consider local service delivery models in the context of Minor Injury Units (MIUs) and Neighbourhood Health Centres.

Implementation of the Neighbourhood Health Framework

Joanne Hodgetts briefed the board on recent developments, the main points included:

i.             Publication was awaited of the neighbourhood health guidelines.

ii.            There was a requirement to produce an Interim Strategic Neighbourhood Health Plan by April 2026 and an underpinning interim Operational Plan by September 2026, with attention drawn to the key considerations for each plan.

iii.          ‘Fit for the future: 10 Year Health Plan for England’ included an ambition of ‘establishing a Neighbourhood Health Centre in every community across the country’ and, whilst the archetype was under development nationally, this would support the discussion around current assets and services, such as the future of minor injury units.

iv.          Further guidance was expected on Better Care Fund reform.

v.           An overview was provided of a review into the governance structure, functions and form of One Herefordshire Partnership, resulting in the establishment of two boards: One Herefordshire Health and Care Partnership Board; and One Herefordshire Neighbourhood Health Delivery Board.

vi.          It was proposed that a time-limited multi-agency task and finish group, involving members of the Health and Wellbeing Board, would be convened to support the development of the neighbourhood health plans for Herefordshire.

vii.         Work with the National Neighbourhood Implementation Programme team was outlined, including activities with stakeholders.

The principal points of the discussion included:

1.           The Chairperson expressed a view that the framework and potential operational footprints were suited to urban rather than rural areas, and highlighted the need for flexibility to address the needs of local communities.  Joanne Hodgetts commented on the benefits of collaborating with the national team and with other rural local authorities.

2.           The Leader of the Council noted that Herefordshire identified localities (e.g. market town and rural hinterland), rather than neighbourhoods.

3.           Zoe Clifford commented on the need to build upon what was already in place and to think creatively about addressing the priorities of local populations.

4.           Stephen Brewster welcomed the engagement with the voluntary and community sector and the approach to co-production.

5.           The Chairperson commented on a recent visit to Herefordshire by the Chief Medical Officer, acknowledging the challenges in the county but also the significance of good community spirit.  The Vice-Chairperson added that strong partnership working was another defining feature locally.

Prevention

David Collyer presented the slides 'Neighbourhood Health - How can this new approach drive prevention?' (link), under the headings: Why prevention is important?; Return on investment; Why choose cardiovascular disease? (CVD); Premature mortality from stroke, Herefordshire / Premature mortality from cardiovascular disease across England; 9 modifiable risk factors are responsible for 90% of the cases; Understanding CVD need at Neighbourhood level; CVD mortality; CVD admissions; Significantly higher mortality and admissions (hot spots); Tertiary prevention; Secondary prevention; Primary prevention’; Tobacco breaks hearts; Smoking cessation – cross-cutting prevention; There are opportunities for prevention at every stage of the CVD ‘pathway’; and Questions?

Board members made the following points:

a             David Mehaffey commented on the potential benefits of pre-operative smoking cessation and weight loss  ...  view the full minutes text for item 38.

The Health and Wellbeing Board have agreed to refresh the Health and Wellbeing Strategy in 2026.  In preparation for this, the Local Government Association have provided an offer of support for the Board to assess ways of working.  The purpose of this paper is to present the offer available to the Board.

Zoe Clifford reported that, given developments in terms of neighbourhood health and the intention of the board to refresh the Health and Wellbeing Strategy (minute 24 of 15 September 2025 refers (link)), the Local Government Association (LGA) had provided an offer of support for the board to review its ways of working.

Steve Bedser, a contractor working with the Partners in Care and Health Programme commissioned by the LGA, was invited to speak.  The main points included: the programme supported health and wellbeing boards across the country, at no cost to the host organisation; the work would be tailored to the local place; a sample of stakeholders would be consulted to understand relative strengths and weaknesses; a workshop with board members would be facilitated; and support would be available for the rest of the municipal year.

Board members considered the review to be timely and welcomed the offer of support.

Resolved:

That the offer of support from the Local Government Association to review ways of working, in preparation for the Health and Wellbeing Strategy refresh later in 2026, be accepted.

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

Hilary Hall introduced the annual report of the Herefordshire Adults Safeguarding Board (HSAB), the main points included:

i.             There was a statutory requirement to send the annual report to the chair of the local health and wellbeing board.

ii.            The annual report had been approved by HSAB in October 2025.

iii.          The core duties of the HSAB included the publication of a strategic plan, the publication of the annual report, and conducting safeguarding adult reviews.

iv.          16 referrals for potential reviews had been received in 2024/25, compared to 5 in 2023/24.  5 referrals had met the criteria for review and were in progress or complete, with one published.

v.           Data indicated that the proportion of people who use services who feel safe remained higher in Herefordshire in comparison to the West Midlands average and all England average.

vi.          The number of safeguarding enquiries had fallen but this may reflect changes in triage process.

vii.         The majority of individuals involved in safeguarding concerns were female (58%), and the most common location where abuse occurred was in a person’s own home (54%).

viii.       Challenges related to the staffing capacity of partner agencies were noted.

ix.          Priorities were being reviewed for the next strategic plan cycle to start in April 2026.

Noting that the term of the current Independent Chair of HSAB would end in March 2026, the Chairperson requested that the thanks of the Health and Wellbeing Board for the excellent work undertaken by Kevin Crompton be put on record.

Resolved:

The HSAB Annual Report 2024/25 and the effectiveness of the arrangements for safeguarding adults in Herefordshire be noted.

The purpose of this report is to share the 2025 Health Protection Assurance Forum’s (HPAF) Annual Report with the Board.  This serves to update the Herefordshire Health and Wellbeing Board on health protection system performance, achievements, and risks for 2025, as well as areas of development for 2026.

Rob Davies presented the slides 'Health Protection Assurance Forum Annual Report 2025' (link), under the headings: Report overview; Key achievements; Example: ‘what good looks like’ audit; Challenges and risks; Future focus; and Questions.

The Chairperson drew attention to the following:

i.             Referring to the future focus ‘to secure a new breast screening site in Hereford City’, it was noted that an assurance had been sought about the intention to recall people that may have missed appointments during the temporary interruption in service provision in Hereford (minute 6 of 9 June 2025 refers (link)).

ii.            A potential error was identified in the annual report sentence ‘In 2024-2025 Turning Point received 956 referrals into service, this is 16% more than the previous year (153 in 2023-24)’. 

[Note: it was confirmed subsequently that this should read ‘In 2024-2025, Turning Point received 1,121 referrals, representing a 5% increase compared with 2023–2024, when the service received 1,065 referrals (a rise of 56 referrals).’]

There was a brief discussion about workforce cohorts eligible for the seasonal flu vaccination.

Resolved:

That the health protection system performance, achievements, and risks for 2025, as well as areas of focus for 2026 be noted.

To update the Health and Wellbeing Board (HWB) members on the Herefordshire’s Better Care Fund (BCF) quarter 2 performance template 2025-26 and seek formal Health and Wellbeing Board approval.

Hilary Hall updated the board on the Better Care Fund (BCF) quarter 2 performance template 2025/26, the main points included:

i.             As per national requirements, the quarter 2 performance template had been submitted on 11 November 2025, and retrospective approval was sought from the board.

ii.            The BCF Delivery Plan had been approved by the National Team which incorporated a revised Discharge to Assess (D2A) Model.

iii.          Data showed that the system was on track to meet the goals for the national metrics ‘Emergency admissions to hospital for people aged over 65 per 100,000 population’ and ‘Long-term admissions to residential care homes and nursing homes for people aged 65 and over per 100,000 population’.  The system was not on track to meet the goal for the metric ‘Average length of discharge delay for all acute adult patients’ and an overview was provided of the D2A Action Plan.

iv.          It was reported that the BCF was overspent by £0.901m at quarter 2, due to overspending on services facilitating hospital discharge (£0.714m) and services for Deprivation of Liberty standards and Approved Mental Health Professionals (£0.206m), offset by small amounts of underspending in other services.  It was noted that savings and mitigation plans were in place but there were rising demand-led pressures.

Resolved:  That

a)      the Better Care Fund (BCF) 2025/26 quarter 2 report at Appendix 1, as submitted to NHS England, be approved retrospectively; and

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

To confirm the dates of future meetings and consider any items for inclusion in the work programme for the Board.

The dates of future formal meetings in public were identified, as follows:

Monday 9 March 2026, 2.00 pm

Monday 18 May 2026, 2.00 pm

Monday 13 July 2026, 2.00 pm

Monday 26 October 2026, 2.00 pm

Monday 25 January 2027, 2.00 pm

Monday 24 May 2027, 2.00 pm

It was noted that board members would also meet informally for workshops / board learning and development sessions.

Resolved:      

That the dates of future meetings be confirmed and the updated work programme be agreed.