Agenda and minutes

Health and Wellbeing Board - Wednesday 8 January 2020 1.30 pm

Venue: Committee Room 2, Shire Hall. View directions

Contact: Paul Spencer - Senior Democratic Services Officer 


No. Item



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Board Members

Councillor Jeff Morgan (WCC), Sarah Raistrick (Coventry and Rugby CCG), Jagtar Singh (CWPT), Councillor Sally Bragg (Rugby Borough Council), Julie Grant (NHS England and Improvement).


Other Apologies

Councillor Wallace Redford, Becky Hale and Gemma McKinnon (WCC Officers).



Members' Disclosures of Pecuniary and Non-Pecuniary Interests

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Appointment of Vice-Chair

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It was noted that this position rotated amongst CCG representatives and Dr David Spraggett would be Vice Chair of the Board for the next year.



Minutes of the Meeting of the Warwickshire Health and Wellbeing Board on 11th September 2019 and Matters Arising pdf icon PDF 254 KB

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The Minutes were agreed as a true record. In response to a question from Councillor Neil Phillips, it was confirmed that the commissioning intentions of Coventry & Rugby and Warwickshire North CCGs had been published.



Chair's Announcements

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The Chair welcomed new Board members, thanking those that had recently left the Health and Wellbeing Board for their service. He also introduced Shade Agboola, the County Council’s Director of Public Health.



Signed Minutes for 8th January 2020 pdf icon PDF 117 KB

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Development of the Health and Wellbeing Strategy 2020-25 pdf icon PDF 486 KB

Progress update – Rachel Barnes

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It was reported that the Health and Wellbeing Board has a statutory duty to develop a Health and Wellbeing Strategy (HWBS). This should translate findings from the Joint Strategic Needs Assessment (JSNA) into priorities, to help determine actions by partners, to address the wider determinants that impacted on health and wellbeing. The current JSNA would conclude in March 2020.


At its previous meeting the Board agreed to commence the refresh of the HWBS to align with key developments in the wider system, including the Coventry and Warwickshire Health and Care Partnership (CWHCP), the new five-year Health and Care Plan and the new Coventry HWBS for 2019-23. The HWBS also needed to have reference to the joint Coventry and Warwickshire Place Forum, including the Health and Wellbeing Concordat and strategic framework development.


The detail of the report outlined the process being undertaken for the refresh of the HWBS, giving an overview of the four key areas which gave evidence to inform this process:


·         What we have learnt from our current strategy;

·         What our communities are telling us;

·         What the data tells us; and

·         Feedback from senior leaders


In terms of next steps, analysis would take place of the findings from workshops, together with the stocktake of the current strategy and JSNA evidence to inform the development of the new strategy. This would be finalised after completion of the JSNA process. A further update on draft priorities would be provided to the Board in May 2020, with an aim to present a refreshed strategy in September 2020.


The Chair referred to the two Kings Fund events, to shape the draft HWBS, which had been well attended. A number of questions and comments were submitted, firstly on feedback from the current stakeholder events. There were a further eight events to be held and action plans would be produced for each area.  It was questioned how inequalities identified through the research would be prioritised and targeted. In addition to the high level HWBS, each of the three ‘places’ of Rugby, North and South Warwickshire would develop their own plans,  priorities and actions to address them at the place level. A further point was measurement and monitoring not just of improvements in for example academic success, but also the relative position to other areas and whether this was an improving or worsening trend. This point was agreed, with the need to monitor data locally and against comparable areas. It was welcomed that transport had been separated from road safety, as they had different impacts, for example in terms of isolation and mental wellbeing. With reference to the recent stroke consultation sessions, the importance of ‘lived experience’ and the patient voice was stated in informing priorities and providing a ‘sense check’. 




That the Health and Wellbeing Board notes the outcomes from the senior leader events and endorses the approach to refreshing the Health and Wellbeing Strategy.


Health Protection Strategy 2017-21 pdf icon PDF 161 KB

Progress update – Nadia Inglis

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Nadia Inglis, Public Health, WCC introduced this item. It was reported that the Health Protection Strategy (HPS) was an overarching strategy that encompassed a wide range of multi-agency programmes and strategies. Itset out the partnership approach, specific aims and seven priorities for health protection activities across Coventry and Warwickshire for 2017-2021. The HPS supported the local authority statutory duty to “ensure there were plans in place to protect the health of the population”.


Progress against the strategy was monitored by the Coventry and Warwickshire Health Protection Committee and when required by the two health and wellbeing boards. Action plans and work-streams/partnership boards were in place, working to support the seven priority areas. Progress against the priorities was summarised in a table within the report and a link was provided to the health protection dashboard.


As a partnership approach it required commissioning of some frontline services and programmes. Individual commissioners or organisations agreed and procured those services within their organisation’s agreed financial capacity and they were the responsibility of that commissioning organisation. There were also options for partners to apply for external funding to support some of the strategy objectives.


A presentation was provided to supplement the HPS report, pulling out the key messages. The slides covered the following seven priority areas:


·         Air quality

·         Hepatitis B/C

·         Tuberculosis

·         Screening and immunisations

·         Infection control

·         Emergency planning

·         Excess winter deaths


Questions and comments were invited. There were concerns about air quality, with points raised about the need for effective communication and partnership working with districts and borough councils, to avoid duplication. The monitoring of particulate matter and air quality monitoring in more rural areas was discussed, specifically for the North of Warwickshire. It was confirmed that there was some monitoring equipment in that area and endeavours were being made to engage with the Borough Council. Reference was made to an air quality management zone located close to a school in Nuneaton. There was concern that despite numerous strategies, there was no evidence of infrastructure changes being implemented and school children were walking through this area twice daily. The points raised were acknowledged.


The fall in take up of MMR immunisation was raised, with officers explaining the range of actions being taken in conjunction with Public Health England, CCGs, local GPs and engagement work in areas of low immunisation. It was questioned if there was lower take up in some communities, for example BME groups and traveller communities. The Director of Public Health advised that the local data followed the national trend and there were a range of factors which contributed to lower immunisation rates. It would require work with the GPs and clients in areas where there was a low take-up of immunisation. There were differing views amongst board members about the ability of traveller communities being able to access GP practices and a need to ensure all communities had access to immunisation.


The HPS was physical health focussed and it would be good for future refreshes of the strategy to balance physical  ...  view the full minutes text for item 3.


Promoting Health and Wellbeing through Spatial Planning pdf icon PDF 452 KB

Guidance document for endorsement – Gemma McKinnon

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This item was introduced by Emily Fernandez, Public Health, WCC. The report stated the importance of the environment we live in, both in improving and protecting the health and wellbeing of our communities. This included through providing opportunities to be physically active, connect with others, as well as support for specific vulnerable groups through design.


A guidance document was submitted for the Board’s consideration and which was aimed at policy and strategy makers. Engagement had taken place with a number of groups, and feedback had been incorporated into the circulated document.


A number of questions and comments were submitted, with responses provided as indicated:


·         It was questioned if the engagement had included builders and developers.

·         There was a balance and viability argument, competing demands for contributions and it was questioned how much weight this guidance carried when compared to other planning guidance.

·         A good working relationship had been established with district and borough council planners. There was a need to be proportionate, recognising the financial viability of each development.

·         There was no power to require developers to cooperate and it was more about collective influence.

·         The guidance was evidence based and sought to inform planners and developers, identifying health impacts from development. It was asked who would undertake the health impact assessments. These needed to be undertaken by the developer and then be reviewed by planners.

·         Several board members recognised the value of the document and the positive working between health and planners.

·         There was a greater emphasis placed on health aspects now. It was important that district and borough councils take on board this guidance when reviewing their core strategies and the upcoming consultations on local plans provided a further opportunity.

·         Every planning application required an environmental impact assessment and this had been strengthened recently through legislation. Each district and borough council could use supplementary planning guidance.

·         Improved dialogue between public health and environmental health could assist.

·         The financial value of the development could provide a lever for additional contributions in some developments.

·         Ensuring that the health aspects were always considered by planners when determining planning applications, would help to improve population health.

·         A point was made on the comparative impact of poor air quality against those associated  with unhealthy lifestyles and deprivation, on life expectancy. The report did illustrate inequalities across the County and these would be a focus for the health and care partnership and in other strategies and fora. The approach proposed was considered to be the best way forward to ensure that indicators of poor health and health outcomes associated with poor spatial planning were equally considered.

·         The Health and Wellbeing Board could recommend that all district and borough councils worked consistently to give the same message to developers on the importance of health.

·         It would be useful to analyse the difference in life expectancy associated with good and poor housing development and the impacts for health and social care in regard to issues such as isolation and obesity. Whilst costs and profit margins could  ...  view the full minutes text for item 4.


RISE pdf icon PDF 124 KB

Update on the Local Transformation Plan Year Four refresh for approval - Becky Hale

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It was reported that five-year transformation funding was made available to clinical commissioning groups operating within Local Transformation Plan (LTP) areas. For the Coventry and Warwickshire LTP area, funding of £1.7m was allocated per year across the area.


Details were provided of the governance arrangements and NHS England required each LTP area to submit an annual refresh of their local plan, with an expectation that health and wellbeing boards were sighted on the refreshed plan and acted as one of the signatories to the document. The report included an appendix on the Coventry and Warwickshire year four refresh of the CAMHS Local Transformation. It detailed the progress, set out priorities for year five along with a detailed action plan.


Year two of the LTP coincided with the start of the new Warwickshire Children and Young People’s Emotional Well-being and Mental Health service for 0-25 year olds, known as Rise. The new service had a two-year implementation period which ended in August 2019.  The service was now in year three of the contract and this LTP detailed the progress made. In July 2019, the LTP’s priorities had been reviewed to reflect progress made, and ensure they aligned with national guidance.


Whilst there had been great progress in several areas including the reduction in waiting times for specialist services and services for children in crisis, there had been several areas of slippage with the Rise implementation plan. These areas of slippage had been incorporated into the draft priorities and action plan. The draft priorities for 2019/20 were reported. 


There were concerns about the waiting times for ASD and autism which were up to three years. This was a recognised issue and a number of areas of work were ongoing, including the development of an all age autism strategy. It was not just about diagnosis and of importance was the support available for the child or young person, their families and schools. This would require a multi-agency approach. Referral rates for the area were far higher than would be expected for comparative areas.


Russell Hardy emphasised these concerns, asking what workforce would be needed to get the waiting lists to an acceptable standard. There were recognised staffing challenges within the NHS generally and in this area specifically. He noted the hard work being undertaken by staff. It was viewed that there was insufficient detail on workforce in the document and that this issue should be ‘called out’ by the Board. Mr Hardy added that the board had a role to recognise challenges and provide support. By making Warwickshire an attractive place to work it could help to address the current workforce challenges.


Officers explained that the report had been compiled to respond to NHS key lines of enquiry and more detail could be provided on workforce. The provider, CWPT was undertaking work on demand for services, clinical capacity and the gap between them. There was a particular capacity issue for autism. The Chair added that such an assessment of staffing challenges would be  ...  view the full minutes text for item 5.


Coventry and Warwickshire Health and Care Partnership pdf icon PDF 265 KB

Update report on the Health and Care Partnership plus a position statement from the three Place Partnerships (WN, SW and Rugby) – Professor Sir Chris Ham and Duncan Vernon

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A report was presented by Sir Chris Ham on the Health and Care Partnership, who gave a  verbal update on current activity. The report covered the following areas:


·         Five Year Plan

·         Cancer

·         Digital

·         Medicines Optimisation

·         Operating Plans

·         Urgent & Emergency Care

·         Frailty

·         Planned Care

·         Service Improvement Schemes Population Health

·         Voluntary Sector Engagement Primary Care Networks


Duncan Vernon, Public Health, WCC then gave a position statement from the three health and care place partnerships for Rugby, North and South Warwickshire. A document with further information would be circulated after the meeting. The Chair reminded of the Board’s direction that the three place partnerships would undertake the local work and not to form numerous sub-groups.




That the Health and Wellbeing Board notes the updates.



Feedback from the Place Forum pdf icon PDF 351 KB

A summary of the November meeting and Year of Wellbeing progress – Rachel Barnes


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Rachel Barnes, Health and Wellbeing Delivery Manager reported on the November Place Forum, held at UHCW. The session had included population health and the year of wellbeing, plus engaging speakers. She outlined plans for the next place forum on 3 March at Friar Gate, Coventry. Jane Coates, Year of Wellbeing Delivery Manager thanked those who had attended the event on 4 December, speaking about the frontline practitioner event held later that day and giving an outline of the topics covered in both sessions. In terms of next steps, there would be a rebranded ‘Wellbeing for life’ campaign and an evaluation would be undertaken to determine the legacy from the year of wellbeing. Thanks were recorded for the work undertaken in raising the profile of health and wellbeing. The Chair spoke of the legacy report and the work to embed and mainstream health and wellbeing.




That the Health and Wellbeing Board notes the updates.



Joint Strategic Needs Assessment (JSNA) pdf icon PDF 328 KB

Implementation of the place-based approach – Duncan Vernon


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Duncan Vernon, Public Health, WCC presented this update, confirming the completion of the first two waves of the Joint Strategic Needs Assessment (JSNA) and development of their action plans. Delivery of wave three was underway. The report included next steps, the forward plan and potential opportunities to make best use of this rich data. A board member expected that funding would be allocated to meet the priorities identified in each area. A plea was made for support to enable smaller voluntary and community groups to complete applications and be able to access such funding. The Chair agreed that application forms should be appropriate to the levels of funding being sought.




That the Health and Wellbeing Board notes the update.



Child Accident Prevention pdf icon PDF 918 KB

Update from the multi-agency steering group on progress – Shade Agboola


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Liann Brookes-Smith, Public Health, WCC introduced this update from the multi-agency steering group.




That the Health and Wellbeing Board notes the update.



Drugs and Alcohol Update pdf icon PDF 518 KB

Position statement for the Board – Rachel Jackson

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Rachel Jackson, Public Health, WCC presented a position statement. A board member noted the number of young people aged under 18 admitted to hospital following alcohol consumption. There were questions about partnership activity to address for example the sale of alcohol to minors. Officers explained the close links to the community safety partnership and between the service provider, Compass and George Eliot Hospital. Nigel Minns added that the sample size was significant, but it was small enough to allow for individual cases to be examined. It would be useful to undertake an analysis to give learning for the future.


A request was made for information on the location of accessible clinics and the services they provided. Such details would be provided to all Board members.






That the Health and Wellbeing Board notes the update.



Warwickshire Better Together Programme (BCF) pdf icon PDF 245 KB

Progress update - Becky Hale


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Nigel Minns, Strategic Director for People Group gave this update. In future, this update could be circulated separately, rather than being included on the formal Board agenda. He added that the iBCF funding submission for 2019/20 had been agreed earlier in the day.




That the Health and Wellbeing Board notes the update.



Forward Plan pdf icon PDF 111 KB

Rachel Barnes

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Forward Plan


The Board reviewed its Forward Plan and noted the additional items added since the last meeting.




That the Forward Plan is approved.



Any Other Business (considered urgent by the Chair)

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