Apologies for absence had been received from board members: Sue Harris (Herefordshire and Worcestershire Health and Care NHS Trust); John Hobbs (Herefordshire Council); Tina Russell (Herefordshire Council); Dr Lauren Parry (Herefordshire General Practice); and Councillor Ivan Powell (Herefordshire Council), whose apology was notified during the meeting.

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

The following substitutes were noted: Naomi Keeling for Sue Harris; and Liz Farr for Tina Russell.

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

No declarations of interest were identified.

To approve and sign the minutes of the meeting held on 18 May 2026.

The minutes of the previous meeting were received.

Resolved:

That the minutes of the meeting held on 18 May 2026 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.

To provide a summary update on neighbourhood health progress in Herefordshire.

Dr Nigel Fraser introduced the report and delivered the presentation 'Herefordshire Neighbourhood Health' (link).  The main points included:

i.             The population of Herefordshire was older and ageing faster than the national average.  Combined with the dispersed geography, this created challenges for service delivery.

ii.            Herefordshire was one of 43 sites participating in the National Neighbourhood Health Implementation Programme.  Attention was drawn to the vision statement ‘Together we're creating a Herefordshire that is the best place to grow up, thrive, grow older and die well - enabled by Integrated Neighbourhood Teams, empowered communities, where the person's goals or needs are prioritised’.

iii.          The local model of care focused on earlier identification and coordinated support for people at greatest risk, with neighbourhood response teams and a single point of access to provide alternatives to hospital admission where appropriate; work was underway to extend the single point of access to a 24-hour, seven-day service.  Dr Fraser estimated that reducing hospital admissions by around five each day could eliminate corridor care at the County Hospital.

iv.          A bid had been submitted through the national neighbourhood health centre estates programme, using a hub-and-spoke approach suited to Herefordshire’s rural geography; Nelson House in Hereford was identified as the central hub.  An overview was provided of the development work being undertaken within the Primary Care Networks.

v.           Eleven delivery workstreams had been established, supported by enabling work on estates, digital and data, and finance and contracting.  Dashboards were being developed to monitor metrics and outcomes.

vi.          Emergency admissions for Herefordshire patients had reduced during 2025/26 (down 3%) but this had been offset by increased activity from Powys (up 6%).

vii.         The Integrated Care Board (ICB) had made £1.5m available for Neighbourhood Health in Herefordshire, with business cases being developed for the single point of access hub and for the expansion of preventative and proactive care.

The principal discussion points included:

1.           The Chairperson noted that local people would welcome the reopening of community hospitals.  Sarah Shingler reported that a strategic review of community hospitals was nearing completion.  The intention was for the hospitals to develop as local hubs, while retaining appropriate inpatient and ambulatory services, with voluntary sector space.  Later in the meeting, it was clarified that the review was expected to be completed by September/October 2026, with a view to implementing changes from March/April 2027.

2.           The Chairperson highlighted rural transport and access constraints, including the absence of evening bus services.  Dr Fraser acknowledged the model would need to take account of Herefordshire’s dispersed population.

3.           The Chairperson sought assurance about cross-border arrangements for residents using services in Powys and about activity to address discharge delays associated with patients from Wales at the County Hospital.  Sarah Shingler outlined discussions with the Welsh Government and Powys Teaching Health Board, including strategic work on admission avoidance and discharge-to-assess pathways; financial matters continued to require national-level discussion.

4.           The Leader of the Council made the following observations: preference was expressed for wording such as ‘living well to the  ...  view the full minutes text for item 7.

To provide an update on one of the key priorities in The Best Start in Life (BSiL) Strategic Plan, namely a Good Level of Development (GLD) in children aged 5 years.

Zoe Clifford introduced the report in the context of the Herefordshire Joint Local Health and Wellbeing Strategy 2023 - 2033 priorities (‘Best Start in Life’ and ‘Good mental wellbeing throughout life’), the Government’s policy paper ‘Giving every child the best start in life’, and the Regional Director of Public Health Midlands Report ‘Advancing Together Faster: The Critical Six for 2026’.  Liz Farr and Julia Stephens delivered the presentation ‘Best Start in Life: Good level of development’.

Attention was drawn to the following:

i.             The Early Years Foundation Stage Profile was a statutory assessment completed at the end of Reception year against 17 Early Learning Goals.

ii.            Good Level of Development (GLD) was a key national indicator of how well children were prepared for learning at Key Stage 1, covering expected standards in: personal, social and emotional development; physical development; communication and language; literacy; and mathematics.

iii.          The national ambition was for 75% of children to achieve GLD by 2028.  In 2024/25, 72% of Herefordshire children achieved GLD compared with 68.3% nationally; Herefordshire had been set a target of 80% by 2028. 

iv.          For children eligible for free school meals, 51.7% in Herefordshire achieved GLD compared with 51.3% nationally; the local target was 57.2% by 2028.  Only 19.7% of children with any special educational needs reached the benchmark.

v.           Public Health commissioned the Public Health Nursing Service to deliver health reviews, including the child readiness review at two-and-a-half years and, as an additional provision in Herefordshire, a child/school readiness review at age three.  It was noted that GLD could have a significant impact on adult life.

vi.          A case study highlighted the implementation of the Solihull Approach to provide consistent support and guidance for parents, practitioners, and families, involving workforce training and expanded access to parenting programmes.

vii.         Overviews were provided of initiatives aimed at narrowing the gap in outcomes for disadvantaged children, as well as other work undertaken by the Early Years Improvement Team.

viii.       The value of the home learning environment, quality childcare, and group-based interventions was highlighted.

ix.          The partner organisations were invited to consider how they might support employees who are parents and carers, advocate for the early years agenda, and encourage volunteering and mentoring.

Zoe Clifford noted that, although Herefordshire performed above the national average, a significant gap remained for children eligible for free school meals, and that improvement to the home learning environment could help reduce inequalities.

Jo Newton emphasised the importance of direct interaction between parents and children.  Julia Stephens reported that Best Start in Life work included encouraging parents to reduce their use of phones and other devices where this displaced conversation and interaction with children.

The Leader of the Council questioned whether the board should act itself, in addition to monitoring progress.  Liz Farr highlighted the comparatively low level of funding for Herefordshire schools and early years settings, and the ongoing need to advocate for fairer funding and sufficient specialist provision for children with complex needs.

Resolved: That  ...  view the full minutes text for item 8.

The purpose of this briefing is to provide an overview of the scale and impact of gambling-related harms, outline the aims, approach and key actions of the gambling harms prevention project, and its alignment with wider public health and community safety priorities. It will also present current understanding of harm, identify key challenges, risks and opportunities for further development, and seek the Board’s feedback, challenge and support to strengthen delivery and overall impact.

Zoe Clifford introduced the report, noting that public health teams were now tasked with addressing gambling-related harms as part of their responsibilities.  Claudia Ciurleo delivered the presentation ‘Gambling Harms’.

The briefing outlined the range of in-person and online gambling activity and the potential impacts of problem gambling on employment, finances, housing, relationships, physical and mental health, and wider family and community wellbeing. Key points included:

i.             Approximately £33k of first-year funding in Herefordshire was anticipated from the statutory gambling levy.

ii.            Predictors of gambling participation and harm were noted but these were based on national assessments and there was a need to understand the picture locally.

iii.          Modelling suggested that more than 18,000 Herefordshire residents may fall within lower or moderate Problem Gambling Severity Index risk categories and more than 3,000 within the highest category.

iv.          Current support for Herefordshire residents was largely national or regional, with limited local face-to-face provision. 

It was reported that a Gambling Harms Needs Assessment was being developed to strengthen the evidence base, map provision and gaps, identify vulnerable people already in contact with services, develop stronger partnership working, and embed gambling harms awareness and support into existing services.

The Chairperson commented on changing patterns of gambling, particularly increasing online participation and targeted advertising, including campaigns aimed at women.

The Leader of the Council noted the difficulty of identifying problem gambling where activity took place privately online.  It was suggested that the council could engage with local betting shops and operators.  Claudia Ciurleo said that the intelligence team had been tasked with mapping gambling establishments, and that engagement with operators could form part of the work being developed.

Jo Newton highlighted potential safeguarding implications of problem gambling and commented on the proposed introduction of Financial Risk Assessments to identify customers who may be experiencing financial difficulties.

Stephen Brewster noted that voluntary and community organisations might encounter the consequences of gambling through mental health and debt support, and offered to help gather information from the sector. 

Zoe Clifford identified the Crisis and Resilience Fund as another possible source of insight.

Dr Nigel Fraser suggested that brief gambling-risk questions could potentially be incorporated into established health checks.  Claudia Ciurleo said this aligned with the aim of making every contact count.

Liz Farr confirmed that gambling risks were covered within secondary-school personal, social, health and economic education, and offered links with secondary headteachers.

Sarah Shingler suggested that the partner organisations could also strengthen awareness within workforce health and wellbeing arrangements.

Resolved:  That the contents of the briefing paper be noted.

Action:        Partner organisations to consider what contribution could be made through their own services and workforces to the developing Gambling Harms Needs Assessment.  Relevant contact details to be circulated to board members.

To update the Health and Wellbeing Board (HWB) members on the Herefordshire’s Better Care Fund (BCF) End of Year 2025/26 performance template and seek formal Health and Wellbeing Board approval.

Hilary Hall updated the board on the Better Care Fund (BCF) 2025/26 year-end position.  The main points included:

i.             All national BCF conditions had been met.  The 2025/26 plan had been approved by NHS England with a local condition requiring a delivery plan to achieve metric goals.

ii.            Performance was in line with the targets in terms of emergency admissions to hospital for people aged 65 and over, and long-term admissions to residential care homes and nursing homes for people aged 65 and over.  The target for average length of discharge delay for all acute adult patients had not been achieved.

iii.          Progress had been made in strengthening integrated working, including Discharge to Assess processes, multidisciplinary team working, and stronger partnership governance.

iv.          The BCF ended 2025/26 with an overspend of £2.208m, principally relating to hospital discharge, with additional pressures in Deprivation of Liberty Safeguards (DoLS) and Approved Mental Health Professionals (AMHP), and safeguarding.  The cost pressure had been met by additional contributions to the pooled budget by Herefordshire Council and Wye Valley NHS Trust.

In response to questions from the Chairperson about the overspends in DoLS and safeguarding, Hilary Hall explained that the pressures reflected increased demand and local capacity constraints, including the use of agency staff.

Resolved:  That

a)           The Better Care Fund 2025/26 end-of-year report, as submitted to NHS England, has been reviewed and approved retrospectively by the board; and

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

To update Health and Wellbeing Board members on Herefordshire’s Better Care Fund (BCF) Plan 2026/27 and seek formal Health and Wellbeing Board approval.

Hilary Hall introduced Herefordshire's Better Care Fund (BCF) Plan 2026/27 and the associated narrative plan and numerical template submissions.  The plan supported priorities to help people remain independent, strengthen Home First and reablement, improve hospital discharge and flow, and reduce avoidable demand on hospital and long-term care services.

The overall BCF funding allocation had increased by approximately £0.584m compared with 2025/26, but the uplift did not fully meet inflationary and demand pressures.  The plan therefore included agreed mitigations, while significant risks remained around workforce capacity, care market provision, and discharge demand.

It was reported that 2026/27 reflected the first phase of national BCF reform, requiring a clearer shift to demonstrating impact through integrated, neighbourhood-based delivery.  Herefordshire’s BCF funding was structured around three core workstreams: discharge, flow and system co-ordination; intermediate integrated care; and prevention, carers and community support.

Resolved:  That

a)           The Herefordshire Better Care Fund 2026/27 Narrative Plan and Numerical Template, as submitted to NHS England, have been reviewed and approved retrospectively by the board; and

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

To consider any items for inclusion in the work programme for the board.

The work programme for the board was considered.  Attention was drawn to the private workshop for board members to be held on Monday 28 September 2026.  Jo Newton reported that the Herefordshire Safeguarding Adults Board had commissioned work on a Complex Lives Strategy, using case studies and lived experience to inform its development, and suggested that the emerging work could be considered at the workshop.  Zoe Clifford welcomed the proposal as part of the planned consideration of existing mechanisms for hearing lived experience.

Resolved:

That the updated work programme be agreed.

There will be a workshop for board members on Monday 28 September 2026, 1.00 pm.

The date of the next scheduled board meeting in public is Monday 26 October 2026, 2.00 pm.

The date of the next scheduled board meeting in public was confirmed as Monday 26 October 2026, 2.00 pm.