Agenda and draft minutes

Apologies for absence were received from Councillor Jeff Morgan and Shade Agboola (WCC), Russell Hardy (South Warwickshire NHS Foundation Trust and George Eliot Hospital NHS Trust), Councillor Marian Humphreys (North Warwickshire Borough Council), Councillor Julian Gutteridge (Nuneaton and Bedworth Borough Council) Jagtar Singh (viewing via webcast) and Dianne Whitfield (Coventry and Warwickshire Partnership Trust), Elizabeth Hancock and Chris Bain (HWW), Danielle Oum and Phil Johns (viewing via webcast) (Coventry and Warwickshire Integrated Care System and Integrated Care Board).

Councillor Jerry Roodhouse declared an interest as a Director of Healthwatch Warwickshire.

Draft minutes of the previous meetings held on 21 September and 17 November 2021 are attached for approval.

The minutes of the Board meetings held on 21 September and 17 November 2021 were approved as true records and signed by the Chair.

The Chair thanked Sir Chris Ham for his service and particularly the development of the Health and Care Partnership. She advised that Danielle Oum had been appointed Chair of Coventry and Warwickshire Integrated Care System (ICS) and as NHS Coventry and Warwickshire Integrated Care Board Chair Designate. The Chair congratulated Phil Johns on his appointment as Acting Designate Chief Executive of the Coventry and Warwickshire Integrated Care Board (ICB). It was noted that the formation of ICS’ had been delayed to 1 July 2022.

To present the findings from the Living Well with Dementia Strategy engagement process for consideration, comment and approval of proposed changes to the strategy, based on the feedback received.

Claire Taylor, WCC Commissioner presented the findings from the Living Well with Dementia Strategy engagement process. The Board was asked to consider the feedback and approve proposed changes to the strategy, based on that feedback.

The strategy was being refreshed for the next five-year period. Following a period of engagement from early September to the end of October 2021, the feedback had been collated into two reports, one capturing responses from 85 stakeholders and one from over 220 people living with dementia and their carers through a range of in-person engagement opportunities. The reports were being reviewed and the feedback would be used to further develop the strategy. The intention was to publish the strategy in Spring 2022. It would be a system document across health and social care in Coventry and Warwickshire delivered in partnership with the voluntary and community sector.

A presentation was provided to supplement the report giving a summary of the key findings from the engagement undertaken and how these findings would be used to develop the strategy and associated delivery plans.

Questions and comments were submitted, with responses provided as indicated:

• The Chair noted the robust consultation undertaken.
• Nigel Minns commented about the prevalence of dementia in black people and the minimal feedback from this cohort. Given the focus on inequalities, it was questioned if more could be done to target engagement and support. Joint work could be undertaken and often it was not about dementia specific services, but more about cultural appropriateness of services. An outline was provided of the methods used to engage and there was increasing data available, but more could be done.
• Councillor Roodhouse had expected a larger number of respondents. He referred to the changing demographics, the expectation of increasing dementia cases and need for more engagement. This was a slight disappointment, but the richness of the feedback was good. He then spoke on the priority of reducing the risk of dementia and dementia friendly communities, which there was a lack of awareness about. This could be a focus for the subsequent delivery plan, given the likely increase in dementia cases over the next 5-10 years. From feedback, he drew comparison to other services and the lack of public awareness of them. The Chair asked if HWW could assist in reaching some groups. He agreed and there was similarly an opportunity through elected members, parish, district and borough councils as well as the local ‘place’ groups. This could include a refresh of the dementia friendly communities and he reiterated the predicted increases in dementia cases.
• Sarah Raistrick spoke about links to health services and opportunities to engage and work collaboratively. She was pleased with the preventative aspects touching on early treatment of blood pressure and diabetes to reduce risks of vascular dementia. NHS services were monitored on the prevalence and diagnosis of dementia. Coventry and Warwickshire historically had a lower prevalence than would be expected. She touched on the targets for dementia diagnosis asking whether achieving this statistic was a  ...  view the full minutes text for item 2.

To consider the draft list of schemes to be funded from the Improved Better Care Fund (iBCF) for 2022/23. It is suggested that a further update be provided to the Board, following publication of the national Better Care Fund Policy Framework for 2022/23 or equivalent replacement.

Rachel Briden, WCC Integrated Partnership Manager presented a report with the draft list of schemes to be funded from the Improved Better Care Fund (iBCF) for 2022/23. At the meeting in November, the Board had requested more involvement and engagement in the process. This report summarised the proposals, mainly for continuation of the existing schemes.

It was anticipated that the Better Care Fund Policy Framework would be replaced in 2022/23. However, details were awaited, and normal planning arrangements were continuing in the meantime. The funding settlement for 2022/23 was published on 16 December 2021 with an allocation of £15.1m. This represented a 3% increase from the previous year and was the first inflationary increase in four years. The financial implications outlined the assumed grant conditions, following those for previous years and permitted uses of this funding. It was noted that iBCF funding was temporary. Some funding was used to maintain statutory social care spending, and this would require replacement funding if the iBCF was withdrawn.

The report and appendices gave a detailed breakdown of the schemes and proposed changes from 2021/22 to 2022/23. It was suggested that a further update be provided to the Board, following publication of the national Better Care Fund Policy Framework for 2022/23 or equivalent replacement.

The following questions and comments were submitted:

• The extension of the hospital to home scheme was welcomed.
• Councillor Roodhouse was concerned about the annual nature of this funding and a number of bodies were making representations regarding this. With longer-term funding, programmes could be established to focus on such things as falls prevention. 
• On the hospital to home scheme, Councillor Matecki added about reducing pressure on the NHS, seeking to get patients home as early as possible. He asked about funding arrangements, ensuring collaboration as a system and the potential for NHS funding to be used to expand this service. Rachel Briden responded on the need to look at patient transport in conjunction with NHS partners. The Warwickshire Fire and Rescue Service (WFRS) was not able to expand its service much further without additional recruitment. Reference to the additional services provided on falls prevention and making the best use of WFRS to assist vulnerable people. 
• Nigel Minns reminded of the joint work on ensuring efficient systems to discharge patients from hospital. Only a small proportion (5%) of those leaving hospital required care at home. The biggest challenge was the care market and workforce aspects. Councillor Matecki picked up the financial aspects where services were not provided due to a lack of budget, but other services were having to spend excessively as a result. 
• Councillor Barker referred to changes in housing related support and the budget implications for district and borough councils which could impact on areas of support provided by them.  The Chair acknowledged there could be impacts on both NHS and Adult Social Care services. A dialogue was planned between councils to seek a solution.
• Phil Johns submitted support on behalf of the CCG for the proposals in the  ...  view the full minutes text for item 3.

An update to the Board on the impact of the recruitment and retention challenges currently being faced in the adult social care market, the workforce pressures within the children’s public health and children’s social care commissioned provision and the mitigations being undertaken. Board support is sought to the short-term actions and long-term options being taken locally to assist/improve recruitment and retention.

A comprehensive update was provided to the Board by Zoe Mayhew, Strategy and Commissioning Manager, Targeted Support and Integration. This was accompanied by a presentation, focussing on the service areas that were under most pressure. It covered the impact of the recruitment and retention challenges currently being faced in the adult social care (ASC) market, the workforce pressures within the children’s public health and children’s social care commissioned provision and the mitigations being undertaken.

Data was provided on the increasing staff vacancies for the country as a whole and reporting the position in Warwickshire. There were significant issues with recruitment and retention of front-line care staff across learning disability supported living schemes, domiciliary care services (including extra care housing and specialised supported housing provision), residential and nursing care homes. This was resulting in a commissioned care market that was unstable and at risk of not upholding consistency of service delivery and acceptable standards of quality.

The Council continued to passport the national funding to the commissioned provider market and in total £28million had been allocated since the start of the pandemic. There were three main funding streams concerning infection control and testing, workforce recruitment and retention and additional winter workforce funding. For the longer term, WCC was developing a workforce strategy to respond to the ongoing workforce pressures within the commissioned social care market and a first draft of this strategy would be available in April 2022.

Subsequent sections of the report looked in detail at each of the following areas:

·       Domiciliary Care

·       Residential/Nursing Care

·       Community Equipment Provision

·       Adult Social Care job vacancy and turnover rates

·       Children’s Public Health and Social Care Commissioned provision

The financial implications were reported. This included the inflationary uplift on salaries and an outline of how the workforce pressures within commissioned social care provision were likely to result in increasing costs for the County Council. In response to the challenges a number of short and longer-term solutions were proposed which were set out within the report.

The Board discussed the following areas:

• Councillor Roodhouse spoke of the excessive hours being worked by care staff currently and the lack of recognition they received for their service. A difficulty was people leaving care for better rates of pay elsewhere. The challenges for care staff were increasingly complex in supporting older, frailer people. Providers welcomed the initiatives but were unclear how this would be coordinated over such a large number of organisations. WCC could do more on visibility and career progression. Previously there was a coordinated programme working with universities to provide a pathway from care into health services, but this seemed to have ceased. His view was the market was brittle, that the frail, older people needed more specialist care and yet staff were being paid a minimum wage whilst working long hours. The need to use of agency staff overnight was a further concern. He asked how the initiatives would be rolled out.
• Zoe Mayhew gave an outline of the process used to respond in a  ...  view the full minutes text for item 4.

NHS England and NHS Improvement will provide an update on the position of dental services.

Nuala Woodman with support from Alison Lee and Claire Walters of NHS England and NHS Improvement (NHSE/I) provided an update on the position of dental services in Warwickshire. This comprised a written briefing as background and a presentation with high level information. The briefing included the following sections:

• Introduction
• Dental charges
• Impact of the pandemic
• Restoration of services and recovery initiatives
• Vulnerable groups
• Oral health and inequalities
• Children’s access
• Out of hospital provision (including urgent dental care, domiciliary care, dentures, secondary and community care)
• Staffing issues (including collaborative working with local dentists, PPE / Fit testing and Covid & outbreaks in dental settings)
• Opportunities for innovation including digital

The presentation highlighted key areas from the circulated briefing. It also updated with more recent data on general dental activity in the midlands and the local position compared to normal levels of service. Due to the restricted services during the pandemic, a year’s worth of activity had been lost access over the last 20 months.

Questions and comments were submitted, with responses provided as indicated:

• Councillor Roodhouse advised that this item was discussed at HWW board. The British Dental Association (BDA) and others were critical of the unrealistic targets imposed given the challenges around cleaning and changing the air between patients, making those targets unachievable. HWW was receiving a lot of enquiries about access to NHS dentists. It was understood that around one in ten dentists were likely to cease providing NHS services this year. HWW would write formally to the Chair of this Board to set out its concerns and was considering writing to NHSE too. There was a perception that the safety requirements weren’t recognised by central government in setting the service targets.
• The Chair acknowledged the points raised, adding that private patients were still able to receive six-monthly check-ups and routine treatments where NHS patients were not.
• Councillor Matecki asked if the 85% of the normal service level was the optimum, given the cleaning requirements. Moving forwards, he asked if there would be a lessons learnt at some point and whether the aim was to achieve previous service levels fully. Nuala Woodman confirmed that this was the safe minimum level. There were exception arrangements and each practice was considered individually, with monitoring of how they were managing. Support was being provided to practices for example where there had been a Covid outbreak amongst staff. The aim was to return to the full provision by April 2022. However, there were unknowns about the pandemic.
• Nigel Minns asked if the treatment of private patients at the expense of NHS patients was the issue of registration and not having the same obligation as a GP doctor. He asked about the treatment backlog for dentistry and how long the measures proposed would take to address the backlog. Nuala Woodman confirmed there was data for secondary care and further community dental service waiting times. This was not about money, but having staff and available premises. The solutions included longer working hours and weekend appointments. However,  ...  view the full minutes text for item 5.

The Health and Wellbeing Board is asked to consider the requirements for a Coventry and Warwickshire Health Inequalities Strategic Plan, local priority population groups for the Strategic Plan, the progress made to date and support the implementation of the Plan.

The Health and Wellbeing Board was asked to consider the requirements for a Coventry and Warwickshire Health Inequalities Strategic Plan, local priority population groups for the Strategic Plan, the progress made to date and support the implementation of the Plan.

The draft plan was required to be submitted to NHS England and NHS Improvement by 22 March 2022. It must depict a locally agreed strategic approach for addressing health inequalities within five nationally determined clinical priorities, covering maternity care, early cancer diagnosis, severe mental illness, chronic respiratory disease and hypertension. It also had to show this work was embedded within a broader approach to reducing health inequalities within Coventry and Warwickshire. A programme of engagement with partners and key NHS workstreams was underway to shape the Strategic Plan and ensure the approach took into account the needs and inequalities within each of the three Warwickshire ‘Places’ (Warwickshire North, Rugby and South Warwickshire).

The five national clinical priorities were set out within a ‘Core20+5’ model. The model required focused efforts to improve health access and outcomes for those living in the most deprived 20% of the population. There was evidence to show the inequalities in health outcomes, life expectancy and in terms of maternal deaths and morbidity amongst some ethnicities. The five clinical priorities were primarily focused on secondary and tertiary prevention approaches. Overall, life expectancy in Warwickshire was above the national average. However, there was variation by deprivation and gender with data provided in the report and appendix to demonstrate this.

A key area was determining the local priority population groups and the following were recommended:

·       People from black and minority ethnic groups

·       Transient communities (homelessness, gypsies, travellers, boaters and newly arrived communities)

·       People living with disabilities (physical, sensory and/or neurological)

·       Older people experiencing rural isolation

Within Warwickshire 6.5% of the population, approximately 38,000 people, lived in the most deprived 20% of areas nationally (based on the indices of multiple deprivation). There was a need locally, to broaden the scope beyond the most deprived national quintile in order to adequately address the disproportionate impacts the pandemic had caused on ethnically diverse communities within Warwickshire. Data was provided to demonstrate this. Subsequent sections of the report expanded on the rationale for selecting each of the proposed local priority population groups.

The Board discussed the following areas:

• The Chair asked the Board to focus on the proposed ‘Plus’ areas which could be varied as several aspects within the report had to be included.
• Sarah Raistrick asked if the proposed areas were data driven and there would be tangible outcomes and improvements from the targeted resources. From an NHS perspective there would be measurement of the results, but for residents it was important that the resultant improvements could be demonstrated too. She reminded of her earlier points about children and in this report, after maternity there was quite a gap before any of the health conditions referenced affected children. She suggested selecting a priority that was universal to Warwickshire’s population. This could then  ...  view the full minutes text for item 6.

To inform the Board of the recommendations emerging from the Domestic Abuse Joint Strategic Needs Assessment and encourage partner organisations to consider how they can individually and collaboratively respond to those recommendations.

An update to inform the Board of the recommendations emerging from the Domestic Abuse Joint Strategic Needs Assessment and encourage partner organisations to consider individually and collaboratively how they could respond to those recommendations.

To provide an update from each place-based Health and Wellbeing Partnership in Warwickshire.

The Board received updates from each of the three place-based Health and Wellbeing Partnerships in Warwickshire.

The annual report for Warwickshire Safeguarding is submitted for the Board’s consideration.

The annual report for Warwickshire Safeguarding was submitted for the Board’s consideration.

The Board will receive an update on progress of the delivery of Warwickshire’s Health and Wellbeing Strategy 2021-2026. It is asked to endorse the outcomes framework dashboard, a progress monitoring tool.

The Board received an update on progress of the delivery of Warwickshire’s Health and Wellbeing Strategy 2021-2026.

An update on the timescales for the delivery of the Pharmaceutical Needs Assessment.

An update on the Pharmaceutical Needs Assessment which identified local needs for pharmacy provision, gaps in service or unmet needs, and sought to highlight any services that community pharmacies could provide to address those needs.

The Board will receive an update on the work to implement ‘health in all policies’ in Warwickshire.

The Board received an update on the work to implement ‘health in all policies’ in Warwickshire. The aim was to embed health and wellbeing into all decision making, and to promote understanding of the impact that policies and programmes of work could have on health and wellbeing.  

The joint Coventry and Warwickshire Place Forum held an online development session in November. This report updates the Board on the key areas discussed.

A report back on the joint Coventry and Warwickshire Place Forum online development session in November 2021.

An update on the Forward Plan for the Health and Wellbeing Board.

An update on the Board’s forward plan, detailing proposed agenda items for its formal meetings and the focus of the workshop sessions. The next Board meeting would be held on 4^th May and would include an item on the special educational needs and disabilities written statement of action.