Agenda and draft minutes

Councillor Izzi Seccombe and Nigel Minns (WCC), Julie Grant (NHS England and Improvement), Russell Hardy (GEH and SWFT), Polly Reed (Office of the Police and Crime commissioner) and Dianne Whitfield (CWPT).

David Eltringham (GEH), Becky Hale (WCC) and Sir Chris Ham (C&W Health and Care Partnership)

Councillor Roodhouse declared an interest as a director of Healthwatch Warwickshire.

Draft minutes of the previous meeting are attached for approval.

The Minutes of the Board meeting held on 7 July 2021 were accepted as a true record.

The Chair welcomed everyone to the meeting, explaining that some of the officers presenting reports would be joining remotely and she outlined the agenda content.

The Chair advised that an Integrated Care System (ICS) workshop for the Board would take place on 18 October and be facilitated by the Kings Fund. This would be followed by a presentation for elected members. She spoke of the pace of this work, the interviews for Chair of the ICS and the recommendation on appointment referred to the Secretary of State. This would shortly be followed by the recruitment process for the ICS Chief Executive.

To consider and endorse the Local Transformation Plan (LTP) for Children and Young People’s Mental Health and Wellbeing 2021-2022 - Rachel Jackson and Rob Sabin (WCC), Chris Evans (CWPT)

This item was introduced by Rachel Jackson and Rob Sabin of WCC, together with Chris Evans of CWPT.

The ‘Future in Mind’ review, released in 2015, set out a series of recommendations to improve outcomes for children and young people’s (CYP)         mental health and emotional wellbeing. The key principles of the review were set out within the report and reflected in NHS guidance and ambitions. This included a requirement for local areas to develop specific Local Transformation Plans (LTP) for CYP on an annual basis to demonstrate how the NHS ambition was       being fulfilled. The Coventry and Warwickshire CYP Mental Health and Emotional Wellbeing LTP had been updated for 2021-22 and was submitted for the Board’s endorsement. It had been developed collaboratively between the two local authorities (WCC and Coventry City Council), the CWCCG and CWPT.  The emerging ambitions were reported and had been included in the LTP delivery plan for 2021-22.  A copy of the LTP was appended to the report for consideration.

Rachel Jackson highlighted key sections of the report providing examples of the initiatives on early help and prevention, the eating disorder pathway, strengthening the multi-agency approach to services for CYP and digital services. Feedback was being sought from CYP in crisis to shape co-production of the service offer for 18-25 year-olds. Transition work was also planned.

There had been a number of challenges, with reference to system capacity demand for children in crisis, CYP presenting with more complexity of need, access to services, timeliness and effectiveness of service delivery. Similar capacity issues were reported for the eating disorder pathway. Reference to the additional difficulties caused by the Covid pandemic for children looked after, those with special educational needs and disabilities (SEND) and with the Youth Justice Service. The ability to engage with CYP and measure outcomes had similarly been impacted. These challenges had been taken on board in formulating the ambitions which were set out in the report.

Questions and comments were invited with responses provided as indicated:

• Reference to the outcome of the SEND inspection, which was awaited, the increases in SEN cases and the lack of real improvement in this area. Points about wider social issues, family issues and poverty, which required a partnership approach. The funding aspects were raised.
• Discussion about the governance process, the key lines of enquiry provided by NHS England and requirement for both this Board and that for Coventry to sign off the plan. Comment on the valuable local knowledge and opinions amongst Board members which should inform the process. These points would be made to NHS England.
• A view that there was a lack of support and funding for children in rural areas. It seemed from contact with school headteachers and parents of children that there was an issue to be addressed. Officers confirmed that any school could make a referral for CAMHS services. An outline was given of the other support available, including for professionals in schools. There were plans to expand the support teams piloted in  ...  view the full minutes text for item 2.

A presentation will be provided by Healthwatch Warwickshire on its Annual Report for 2020-21. A copy of the annual report is available here – Chris Bain

Elizabeth Hancock, Chair of Healthwatch Warwickshire (HWW) introduced this item. A presentation had been circulated with the agenda covering the following areas.

• Performance Report: How we are working
  • All staff working from home
  • Virtual board meetings
  • Telephone service to the public
  • Website enquiries; use of social media
  • Information on service changes (via website) updated regularly
  • Engagement strategy with all key partners implemented
  • Public engagement and outreach largely on a virtual basis
  • Surveys and projects delivered

• Performance Report: Activity May – July 2021
  • This comprised pieces of feedback, signposting people to partner agencies, increased social media profile and use of the HWW website as well as an increase in the HWW mailing list
• Our Influencing role May – July 2021
  • Attending 49 strategic meetings
  • Within this reference to the ICS and the closer work with Healthwatch Coventry
  • Project work which raised issues and highlighted concerns.

Chris Bain, Chief Executive of HWW then spoke on the following areas:

• Published reports:
  • Annual Report (a statutory requirement)
  • Dentistry in Warwickshire
  • Carers – understanding your health and wellbeing needs
  • Context on the core functions of HWW and the added value from identifying trends and emerging priorities, leading to the above reports.
• Carers survey highlights
  • This was in response to growing enquiries from carers about their needs. There was recognition of the effort and emphasis of support for carers in Warwickshire, both from WCC and the voluntary and community sector. Plans to revisit the exercise in the Spring of 2022.
  • 239 people had responded to the survey and key data was provided from the analysis undertaken. 
• Dentistry survey highlights
  • A continuing issue first identified in May 2020
  • Calls to 53 dental practices which showed variance in the number taking NHS patients.
  • A particular issue in the Stratford and Rugby areas where none of the 20 practices offered NHS services; approximately half of those in other areas offered NHS services.
  • The position seemed to be deteriorating and there were long term implications for oral health, including cancer.
  • The requirements for cleaning and ventilation were restricting capacity.
  • It was considered that dentistry should be commissioned locally, and this was planned as part of the ICS arrangements, but had recently been delayed until April 2023.
• Looking forward - showing the top four areas people had contacted Healthwatch about, both from enquiries and the annual report. This showed increasing concerns in regard to mental health. Access to GPs and dentistry remained a problem too.
• Future Priorities
  • Strategic direction after Covid19
  • The future for patient groups/standing conference
  • Patient voice in integrated care systems
  • Projects:
    • NHS111
    • Diabetes
    • NHS administration
    • Deafness and accessing care services
    • Lived experiences of people with learning disabilities
    • Health and social care forum

The following questions and comments were submitted:

• On the carers’ strategy, a question on next steps how to take the findings, explore these issues further and secure meaningful outcomes as a partnership. HWW was working with the Carers’ Forum and voluntary sector partners. An aim to co-design the support that carers needed. There was an emerging  ...  view the full minutes text for item 3.

A combined presentation to the Board from the North, Rugby and South Health and Wellbeing Board Partnership’s and NHS Place Executive’s for Warwickshire - Nigel Minns and Gemma McKinnon (WCC), Chris Elliot (WDC), Anne Coyle (SWFT), Mannie Ketley (RBC), Katie Wilson (WCC) and Steve Maxey (NWBC)

Dr Shade Agboola, WCC Director of Public Health introduced this item. It comprised a series of presentations showing the progress made by the North, Rugby and South Health and Wellbeing Board Partnerships and NHS Place Executives. She provided context on the places and the different speakers involved which was a testament to the partnership working on the place agenda. A recap was provided on the Health and Wellbeing Strategy adopted in March 2021.

The following slides were provided:

• Warwickshire’s population health framework, describing the collective long-term strategic ambitions, areas of immediate focus and the four quadrants of focussed activity, which should improve health outcomes in Warwickshire. Each of the place plans was based on this model.
• A slide showing the reporting arrangements, including the direct link from each place into the Health and Wellbeing Board. Each comprised a place partnership and place executive, with the arrangements varying to suit each area and its priorities.
• The partnerships forward plan.

Steve Maxey gave a presentation on behalf of the North Place, which covered the following areas:

• North population health framework.
• Progress on Partnership priorities.
• Governance arrangements for Partnership and Executive.
• North Place Project SITREP for September 2021:

o   Place Executive priority view – wider determinants of health

o   Place Executive project view – wider determinants of health

• Reference to the housing initiatives and those related to hospital discharge.
• An area of challenge concerned the merger of the CCG, impacting on some aspects of data available at the place level. This was being worked through with the CCG. Shade Agboola asked for examples of the data that was no longer available, so this could be investigated. Sarah Raistrick similarly asked for specific examples and felt the data should be available.
• A further concern was the need for replacement of a public health consultant for the north area. Shade Agboola gave a brief outline of the temporary public health cover being provided and would be speaking with Steve Maxey later in the day regarding the recruitment of a replacement consultant. This was a joint post and required input from the ICS.
• Salmah Mahmood, Place Programme Manager at GEH spoke of the good partnership work that was taking place, bringing place plans together and looking at further areas for integration and joint opportunities.

Katie Wilson of WCC Public Health and Blair Robertson of UHCW gave a presentation on the following areas:

• Population health framework – shared priorities across both the place partnership and delivery group, using a task and finish approach to address priorities.
• Progress on the following priorities:

• In focus:

An update will be provided on future items for the Board and Joint Place Forum Meetings – Gemma McKinnon

The Board gave consideration to its forward plan of items.

Resolved

That the Health and Wellbeing Board notes its forward plan.