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 on post-operative outcomes.

 

b             Stephen Brewster noted the importance of physical activity and commented on opportunities to amplify messaging around neighbourhood health through the voluntary and community sector.

 

c             The Vice-Chairperson suggested that leaders within One Herefordshire could consider smoking cessation targets within their own organisations.

 

d             The Leader of the Council commended the presentation, noted the success of smoking cessation interventions, and commented on the need for emphasis on the crucial role of nutrition in health outcomes.

 

e             There was a brief discussion about vaping, acknowledging that it could be an effective tool to quit smoking but vapes were not recommended for non-smokers.

 

f              Zoe Clifford noted that the neighbourhood health programme provided opportunities to explore prevention more broadly, including the roles of health and care partners as anchor organisations.

 

Minor Injury Units

 

At the discretion of the Chairperson, Councillor Ed O’Driscoll was invited to speak.  Councillor O’Driscoll provided an overview on his own experience of a medical emergency, including: personal decisions about transport to hospital due to wait times for an ambulance and leaving too soon due to pressures in the Emergency Department; diagnosis of a heart attack through a GP surgery; waiting for a bed for a number of days; a surgical procedure in Worcester; and rehabilitation in Ross-on-Wye.  Councillor O’Driscoll commented on discussions with health professionals and considered that pressures could be reduced dramatically if minor injury units (MIUs) were reinstated.  Comments were also made about: the significant uplift in housing growth in the county; people being advised to travel to facilities in other areas but many lacking access to transport; the strength of public feeling about MIUs, demonstrated by a petition in Ross-on-Wye; and questions in relation to the robustness of the data which influenced decisions to close the MIUs at Leominster and Ross-on-Wye.  Councillor O’Driscoll urged board members to look carefully at how MIUs could be brought into use back across the county.

 

Sarah Shingler said that: having spoken to colleagues since joining Wye Valley NHS Trust in September 2025, it was understood that demand at the Leominster and Ross-on-Wye MIUs was around one patient per hour at the point the decision was taken to close the MIUs temporarily; senior health professionals had been relocated into the Emergency Department; non-admitted performance (i.e. seeing and treating Emergency Department patients within four hours) was described as very good, although challenges remained around admitted performance due to bed flow issues; and the neighbourhood health model sought to move more services into community settings.

 

In response to questions from Councillor O’Driscoll:

 

·             Sarah Shingler said that, in comparison to Herefordshire, Worcestershire struggled with non-admitted performance, hence the variation in commissioning decisions; and

 

·             David Mehaffey clarified that the reference to ‘one patient per hour’ was based on an average of six to eight patients being seen each day within a unit open for eight hours.  It was reported that, since 2019, more appointments were being offered through GP practices, enhanced access hubs, and remote health services.  It was noted that neighbourhood health would provide opportunities to explore the best use of health and community facilities around the county, and how to provide care close to or in people’s own homes.

 

There was a brief discussion about level of public awareness about the range of services available within Primary Care Network areas.

 

Councillor O’Driscoll requested further details about the figures.

 

Councillor O’Driscoll, referencing the full Council motion on MIUs (minute 62 of 7 March 2025 refers (link)) and support via social media, emphasised the extent of local concern and re-iterated a view that the reinstatement of the MIUs could alleviate pressures on the County Hospital.  Councillor O’Driscoll added that any permanent closure of a facility should be subject to public consultation.

 

Sarah Singler reported that a strategic review of community hospitals was being commissioned, in line with the neighbourhood health programme.

 

The following resolution was agreed by the board.

 

Resolved:  That

 

a)      the new requirements set out in the draft National Neighbourhood Health Framework, including the requirement to produce an Interim Strategic Neighbourhood Health Plan by April 2026 and an underpinning interim Operational Plan by September 2026, be noted;                                                                                 

 

b)      the proposed approach to develop these plans in partnership and review the membership be endorsed;

 

c)      Health and Wellbeing Board members be identified to lead and attend the task and finish group for strategic plan development;

 

d)      the progress to date with the National Neighbourhood Health Implementation Programme (NNHIP) be noted;

 

e)      further progress updates be provided at future Health and Wellbeing Board meetings, enabling the provision of strategic direction as required; and

 

f)       the proposed change in One Herefordshire Partnership governance structure, functions and form be endorsed and the establishment of the Herefordshire Health and Care Partnership Board and the Herefordshire Neighbourhood Health Delivery Board be noted.