Agenda item

Health and Wellbeing Strategy

To provide an opportunity for the Health, Care and Wellbeing Scrutiny Committee to review the progress and challenges of the Health and Wellbeing Strategy.

 

Minutes:

The committee considered a report on the Health and Wellbeing Strategy.

 

The principal points of the discussion are summarised below:

 

  1. The Public Health Principal noted that this was the first time that the Health and Wellbeing Strategy had been brought to scrutiny and provided a background on the strategy.

 

  1. In 2022, the council undertook an extensive consultation process with a range of groups, organisations and the public in an online survey. 960 responses were received to the online survey, including 17 from organisations. Representation was received from across the county and in terms of areas of deprivation.

 

  1. Together with the Joint Strategic Needs Assessment (JSNA) and the Children and Young People’s quality of life survey, all of the information was put together to create the HWB Strategy.

 

  1. There were two key priorities that were voted for across all the consultation and engagement: 1. Best Start in Life and; 2. Good Mental Health.

 

  1. The objectives of the strategy are underpinned by four ambitions:

 

                                               i.     Living in thriving communities

                                              ii.     Living in environments that are healthy and sustainable

                                             iii.     Opportunities for all to fulfil their potential

                                            iv.     People will be empowered to take control of their health

 

  1. There is a focus on prevention, working with and understanding our communities, reducing health inequalities, working as a whole system, and using evidence and outcomes to review progress and shape new programmes of work.

 

  1. The HWB Strategy is not only a council strategy but rather is a partnership strategy and the emphasis is on taking a partnership approach.

 

  1. The strategy was informed by a range of inputs including the 2021 JSNA, and the e Public Health Outcomes Framework (PHOF) which all local authorities sign up to reporting and recording data on. The PHOF is important, particularly in terms of the long-term approach for this strategy and provides robust data which is Herefordshire-specific. There is a time lag, however, and it can be difficult to demonstrate impact in real-time. These time lags make reporting impact more difficult to attribute to actions taken in the short-term.

 

  1. Work has been ongoing with the groups to begin developing a dashboard including long-term outcome indicators and some proxy indicators, drawn from across partner organisations. For example, on smoking cessation, as of December 2024, local data indicates that the proportion of mothers who were smokers at the birth of their baby has fallen to 6.2% compared to around 8.8% on the PHOF.

 

  1. As part of the strategy, the Herefordshire Together programme was developed across the two priority areas. Local communities and groups were awarded funding to take pieces of work forward. The full evaluation report will be due next month.

 

  1. One of the most successful achievements with the strategy are the two implementation plans for each of the core priority areas. In each of the two implementation plans, it was wanted to make sure that children enjoy good mental health, are protected from harm in their community, achieve their early milestones, and parents are well-supported during pregnancy and post-birth and access appropriate information, resources, and services.

 

  1. When looking at the implementation plans for both priorities, a lot of progress has been made and this helps provide an opportunity to review and rethink the implementation plans in relation to potential new areas of concern, areas of limited progress, for example.

 

  1. The Health and Wellbeing Board and One Herefordshire Partnership (1HP) are being reported to twice a year for each of the implementation plans. Therefore, there is a robust governance in terms of how actions are set out and the direction going forward.

 

  1. In relation to the partnership groups, there is a Best Start in Life Early Years partnership group which operates across children’s, NHS, education, and other partners. Similarly, the Good Mental Health group mostly focuses on adults but also has a standing item on children and young people’s emotional health and mental wellbeing.

 

  1. In terms of the Good Mental Health priority, there are four overarching goals:

 

                                               i.     People feel satisfied with life and have a positive sense of personal wellbeing.

                                              ii.     Individuals and families are able access appropriate mental health information and services when they need it.

                                             iii.     People feel safe from harm in their community.

                                            iv.     People feel connected to their community.

 

  1. The mental health priority is more difficult to measure and to develop programmes that are led by a single agency. A lot of the work is community based, what is going on in schools, and training.

 

  1. Through the implementation plan, there are a number of areas where significant progress has been made including the Prevention Concordat for Better Mental Health, and the Suicide Audit Group, for example.

 

  1. Looking ahead, it is intended to demonstrate more quickly the progress that it is being made so that this can be reported back to the Health and Wellbeing more quickly. It is intended that 1HP are worked with slightly differently so that a better dialogue can be ensured so that primary care colleagues are on board and that there are no issues coming through from general practice.

 

  1. It is intended that the implementation plans be revised so that a record of achievements are kept succinctly without bloating the document further.

 

The slides presented by the Children’s Centre Services Manager are outlined below (in italics), with the principal points noted below.

 

A The Children’s Centre Services Manager presented:

 

Early Help Offer – overview including Best Start in Life Offer

 

a.1 It was clarified what services are provided to reach out to different people in relation to the council’s Early Help offer.

 

Talk Community Offer

 

a.2 It was clarified what list of initiatives that Talk Community are doing with children and families in the community.

 

The Future – Strengthening Early Support for Families

 

a.3 Moving forward, Talk Community are having a bigger input into the children and families’ agenda including the recruitment of Children and Families Community Development Officers.

 

Children’s Centre Services Targeted Offer

 

a.4 Every time that work is done with a family one-to-one, who have level 3 needs and who need a multi-agency approach, within that piece of support there will always be a consideration of their health and wellbeing.

 

a.5 Therefore, as well as the targeted support that is offered, there are opportunities for children to learn and develop and help their parents to give them the best start.

 

Children’s Centre Services – First Steps offer

 

a.6 First Steps is a flag-ship service that is offered to new parents under the age of 21 who have identified vulnerabilities. This service provides extra support to help them get onto the journey of parenting.

 

a.7 This is done in partnership with health visitors, midwifery colleagues, and a national learning provider.

 

a.8 It was noted that in some cases, new parents gain their confidence and do not complete the whole journey provided by the First Steps service.

 

Feedback from families

 

B The Head of Service Early Help presented:

 

Families First Partnership programme

 

b.1 As part of the new Families First Partnership programme are two parts, Family Help and Multi-Agency Child Protection Teams.

 

Family Help – providing supportive and welcoming services to families

 

b.2 Family Help will merge the strengths of targeted early help and section 17 (Children in Need) work. This has already begun with some early help family support workers (FSW) moving into social care teams to be doing that work with children and families in most need.

 

b.3 It was noted that as part of the restructuring, some of the teams are now located in Leominster, Ross, and in Plough Lane.

 

b.4 The name of the child protection/court teams has changed to safeguarding and support which is more restorative for families.

 

b.5 The programme also talks about the establishment of a Family Help Lead Practitioner role which has already been in place in Early Help where the family decides who is going to be the lead person when they have an assessment and who will be the lead person holding all the other agencies together in supporting them.

 

Family Help – Where are we in Herefordshire?

 

b.6 As part of the work with the whole family, there are 8 weekly review meetings with lead professionals as well as officers from the council.

 

b.7 The council also commissions a targeted service, delivered by Vennture, so that families have a choice if they do not want to be supported by the council at the early help stage.

 

Next Steps – Family Help

 

b.8 It was clarified what the council will be doing going forward in providing family support.

 

The principal points of the subsequent discussion included:

 

  1. The Cabinet Member Adults Health and Wellbeing commented that the Health and Wellbeing Strategy is a significant piece of work with a lot of objectives as to the improvement of lives of children and adults. In general, a lot of this work falls on public health and few members of the public and councillors recognised the extent of the work that goes on in the background by public health. It was added that it is probably easier to deal with the Best Start in Life because there is some control over that in the local authority, in comparison to mental health.

 

  1. The Chair welcomed the new Director of Public Health, who noted that she previously worked regionally in public health and in public health at Gloucestershire County Council. The Director of Public Health added that priorities of the HWB Strategy will be key areas of focus for public health for the population of Herefordshire.

 

  1. In response to a question about how effectively the strategy translates into actions and measurable results, the Public Health Lead – CYP and Sexual Health noted that in relation to oral health, there is a problem with 0–5-year-olds with the number of cavities. There are over 45 schools in Herefordshire that have signed up to supervised toothbrushing, many of which are in deprived areas. A lot of work has been done around supervised toothbrushing which has seen positive results in prevention. It was added that the prediction for those children currently will be better learned when the results from the oral health survey are received by the end of the Summer/early Autumn. In relation to the recruitment of dentists into Herefordshire, the establishment of two new dental practices in the county is in place.

 

  1. The Cabinet Member Adults Health and Wellbeing noted that the work being done in the schools is positive. However, where there is a problem is in relation to access to dental services in which people in rural areas do not have adequate transport links to dental practices.

 

  1. In relation to a question about the use of Fingertips as a data collection service, the Director of Public Health noted that Fingertips is a national tool that enables the council to compare with similar local authorities as well as the rest of the region and nationally. Therefore, it is a robust data set. However, it was added that there is a time lag with the data available through Fingertips so the availability of local data was emphasised.

 

  1. In response to a question about council provision of housing and financial help as part of Family Help, the Head of Service Early Help noted that the Children’s Help and Advice Team (CHAT) have the telephone helpline and would sign post families to help that is available including Housing Solutions and Talk Community. If families have very specific needs, there could be the offer of an assessment of all their needs and targeted support with potentially a family support worker helping them on a family one-to-one basis.

 

  1. Responding to a question on Best Start in Life and Good Mental Health going to be the priorities for ten years and if they are going to change, how does that happen, the Public Health Principal commented that the strategy is set for ten years and the implementation plans are live documents. Therefore, the whole strategy is under constant review. The initial data was developed from consultation and engagement that was previously collected before developing a new commissioned service for the health visiting school nursing work. New information is always being collected and is being fed in to the strategy. It would be for the Health and Wellbeing Board to make a decision on the strategy’s priorities and whether they should change.

 

  1. In response to a question about who is triangulating back the success/failure of the individual sets of four aims of the two priorities back to the overall objectives as set out at the beginning of the strategy, the Public Health Principal noted that there is existing data that can be used to rate the success/failure of the aims as set out in relation to the two core priorities and that there are other opportunities to bring in new data including, for example, Talk Community who now sit in public health which will make it easier to triangulate data to further help assess the progress of the strategy.

 

  1. The Public Health Principal also emphasized the significance of integrating qualitative data with quantitative data to evaluate the strategy's progress toward its primary goals. It was noted that established trajectories help guide the strategy's direction, allowing for adjustments if necessary.

 

  1. The Corporate Director Community Wellbeing added that while the two core priorities in the strategy are set, as part of reviewing, that focus could be switched away toward other areas.

 

  1. The Public Health Programme Officer – Strategy & Partnership noted that new data on vaccination for children was recently received which is encouraging and underlines the work that partners are doing. For example, amongst children up to 24 months of age, the rate of vaccination was 94.7% for Quarter 3 of 2024/25.

 

  1. The Cabinet Member Adults Health and Wellbeing commented that in between public Health and Wellbeing Board meetings, workshops would be held to concentrate on specific issues such as obesity, for example.

 

  1. In relation to a question about access to green space, the Cabinet Member Adults Health and Wellbeing clarified that the Community Open Space grant exists for building/improving buildings to allow health and wellbeing activity to participate that otherwise would not happen.

 

  1. In response to a question about provision under the First Steps programme, the Children’s Centre Services Manager commented that whilst targeted support cannot be provided universally, if a family had other vulnerabilities such as being out of work, for example, then they would qualify for that support.

 

  1. Responding to a question about the impact of social media on children, the Public Health Lead Mental Health noted that social media is referenced frequently through engagement with schools and school staff. It is a focus for the healthy schools programme to build resilience and to do the preventative work around safe usage and who to go to if issues arise.

 

  1. In relation to mental health support for older people, the Public Health Lead Mental Health added that throughout the Mental Health Needs Assessment, it was noted that there is a lack of data around the mental health of older people. A lot of the work that Talk Community does helps to address isolation and loneliness in rural communities.

 

  1. The Public Health Lead - CYP and Sexual Health highlighted that public health have commissioned a 0-19 public health nursing service. This involves school nurses operating drop-in sessions with every high school in the county once a week.

 

  1. In response to a question about what mechanisms are in place to update the committee on progress against the implementation milestones, the Public Health Principal thanked the committee for the opportunity to inform scrutiny and receive questions and concerns from members. She noted that she would be happy to bring back the implementation plans for the two core priority areas and suggested in the following year when more information is available and the dashboards are developed further.

 

The draft recommendation was then read out by the Statutory Scrutiny Officer, and the following resolution was agreed by the committee.

 

Resolved:

 

That Herefordshire Council:

 

  1. Demonstrates in its delivery plans how the work public health undertakes relates to the strategic vision and four ambitions of the Health and Wellbeing Strategy.

 

Supporting documents: