A presentation welcoming feedback on the draft version of the Herefordshire Health and Wellbeing Strategy ahead of the final version sign-off later in the year.

Matt Pearce (Director of Public Health) provided an overview of the draft Health and Wellbeing Strategy in order to invite comments from the board on the draft strategy. The principal points included:

1. The strategy focuses on a prevention-first approach; community empowerment; reducing inequalities; workforce and integrated ways of working; and outcomes of the strategy.
2. In addition to primary priorities (good mental health and wellbeing), there are a number of secondary/supporting priorities which emphasise the important role that is played in people’s overall health and wellbeing.
3. There are four identified goals that also reflect the wider factors that determine people’s health and wellbeing. These include:
   1. Thriving communities
   2. Healthy and Sustainable Places
   3. Opportunities for all
   4. Healthy People
4. The strategy also talks about what does a priority mean and there still needs to be further discussions as to how these are reported including the potential of the HWBB holding dedicated sessions to explore the priorities in more detail, in addition to reports being brought back to the board to report on whether these priorities are being delivered.
5. The two main priorities of the strategy are:
   1. Best start in life for children
   2. Good mental wellbeing throughout life
6. The two priorities reflect the ten-year period of the strategy and thus underline high-level outcomes.
7. The next step, once the strategy has been ratified, is to delegate to partnerships beneath the board to align existing work within the integrated care system and primary care networks. Ultimately, the intention of the strategy, in its current form, is to therefore emphasise the key-level outcomes going forward.
8. Against those two primary priorities and the six supporting priorities, there is consideration about how delivery of these priorities sit across the system (p20 of strategy).
9. There are high-level outcomes included within the strategy alongside the strategic outcomes, primary outcomes, and secondary outcomes. There needs to be some refinement in the coming weeks to fully understand what the impact will be.
10. In terms of governance, there has been discussion with partnerships regarding who owns the strategy and there have been early conversations with One Herefordshire Partnership potentially having oversight and holds the delivery groups to account.
11. The next steps of the strategy are ongoing consultations with partners and sign-off of the strategy on 27^th April. There are scheduled feedback sessions with the public on the 28^th and 30^th April, in addition to continuous engagement with the public going forward.

Councillor Pauline Crockett (Chair of the board) thanked the Director of Public Health and Mary Knower for the engagement consultation. The Chair then proceeded to ask members for comments and questions on the strategy.

Councillor David Hitchiner asked the director for clarification regarding ‘prevention and early intervention’ on page 10 of the draft strategy. The Director of Public Health explained that primary, secondary, and tertiary prevention are primarily associated with health and focused on preventing disease. The intention was to frame the three tiers of prevention across the wider sense of health including housing, the environment, lifestyle etc. and therefore encapsulate a broad definition of prevention. Mary Knower (Public Health Programme Manager) agreed with this explanation and restated the aim to emphasise that health and wellbeing goes beyond just thinking about what public sector services provide.

Christine Price (Chief Officer, Healthwatch Herefordshire) enquired about where the mental health priority will be driven at the next stage of the strategy.

The Director of Public Health noted that there were three identified partnerships on delivering the mental health agenda between the ICS mental health collaborative and local mental health groups including the Adult Mental Health Partnership, and Children and Young People Emotional Wellbeing Partnership. The director said that there needs to be a conversation about how to deliver that priority between these existing partnerships.

Christine Price also commented that more needs adding to the strategy from other partners as currently it reflects only the work of the local authority. The Director of Public Health acknowledged this point.

Hilary Hall (Corporate Director Community Wellbeing) noted her support for the strategy but raised concerns pertaining to some of the language on page 15 of the strategy including the use of ‘secondary priorities’, and how this could downplay the importance of these priorities in delivering the ‘primary priorities’. There was the suggestion that some of the language regarding the strategy’s ‘goals’, ‘priorities’, and ‘principles’ could be simplified in order to make it clear what is meant by each term.

David Mehaffey agreed with the sentiment expressed regarding the language of ‘secondary priorities’ and suggested the use of ‘supporting’ or ‘enabling’ instead of ‘secondary’ in order to underline that such priorities are not separate from others. Additionally, David Mehaffey expressed his support to the overall approach underpinning the strategy and how this links to the Integrated Care Strategy.

Councillor Diana Toynbee asked about how much can be done locally to reduce waiting lists and how much is out of the local authority’s control.

David Mehaffey noted that reducing waiting lists is a high priority and that all is being done to achieve this.

Jane Ives (Managing Director Wye Valley NHS Trust) noted that lack of bed capacity and theatres were key reasons behind high waiting lists for patients. The managing director noted that a business case was recently agreed to build a new elective surgical hub on the Hereford hospital site which would increase bed and theatre capacity, subject to national approval, and expected to open by May 2024.

The Director of Public Health added that the focus of the strategy is on ‘upstream’ issues that help to prevent problems from arising in the first place and thus to reduce demand on the NHS.

The Chair underlined the importance of the health and wellbeing side of the strategy including the significance of factors such as housing, environment, and employment on people’s lives that is weaved throughout the strategy.

In addition to the report recommendations, the board agreed that the language of ‘secondary priorities’ should be changed to ‘supporting priorities’ and that the language regarding the ‘goals’, ‘priorities’, and ‘principles’ are clearly defined to help deliver the core priorities of the strategy which are aligned with the emphasis of the strategy on wider health and wellbeing issues such as housing and the environment.

The recommendations were proposed, seconded, and approved unanimously.

Resolved:

a)    That the Board consider the report and note its progress.

b)    That the Board consider its response to the draft and suggest changes for consideration as appropriate.

c)    The language of ‘secondary priorities’ is changed to ‘supporting priorities’ and the terms ‘goals’, ‘priorities’, and ‘principles’ are clearly defined in the strategy.

d)    That the health and wellbeing aspect of the strategy is continuously emphasised to support these priorities.