Agenda and draft minutes

The Chair welcomed everyone to the first meeting of 2024 and referred to the immense pressure local health services were experiencing, combined with planned industrial action resulting in further disruption.

Apologies were received from Councillor Penny O’Donnell, Emma Daniells, Deputy Police and Crime Commissioner and Councillor Sandra Smith, North Warwickshire Borough Council.

However, the Chair welcomed Police & Crime Commissioner, Philip Seccombe and Chief Constable Debbie Tedds of Warwickshire Police. 

Councillor Timm Willis substituted for Councillor Adam Daly, Rugby Borough Council.   

None.

To approve the minutes of the meeting held on 6 September 2023.

Councillor Bell proposed the minutes of the meeting held on 6 September 2024 and advised of the following actions:

There had been a request for data from Trusts in relation to numbers of children and adults in hospital with mental health needs.  It had been suggested that this be picked up by Overview and Scrutiny as it was more relevant to their role however, the Chair felt this was information that would still be valuable to the Board and asked for an update on a future agenda.

An additional action had been a request for the ICB to provide an update on the ‘voice of the patient’.  A comprehensive report was due to be considered by the ICB Board in March and therefore an item would be added to the HWBB forward plan for May 2024.

A request had also been made to the ICB for the national action plan for GP’s to be circulated.  This would be included in the HWBB Bulletin in March 2024.

In addition, Gemma McKinnon provided an update from the Community Pharmacy Steering Group on closures across Coventry and Warwickshire.

Councillor Marian Humphreys and Councillor Jim Sinnott requested that their attendance be added to the minutes.

Councillor Bell welcomed Jeremy Gould to his first meeting as interim chair of UHCW, following the stepping down of Dame Stella Manzie.  Councillor Bell also advised that Sue Noyes would be appointed as the substantive Chair as of 1 February 2024 and looked forward to welcoming her to future meetings.

The Chair also provided an overview of the recent internal changes to the WCC Executive Team, the impact this had on some of the HWBB representation and welcomed all officers to their new roles.

Councillor Bell then invited provider representatives to deliver updates where necessary.

Catherine Free, George Elliot Hospital, addressed the meeting and gave a description of how busy the first two weeks after Christmas were, combined with the industrial action from junior doctors.  She praised the work of partners in the community recovery service whilst they dealt with the challenge of high bed occupancy.

Adam Carson, South Warwickshire University NHS Foundation Trust, echoed the challenges being experienced and recognised the good partnership working taking place.  He noted the difficulties in discharging out of area patients but felt that some improvement could be seen now.

Jerry Gould, UHCW, described recent weeks as extremely busy with numbers of patients having to wait over an hour at a manageable level.  The hospital had expanded fourteen wards with extra beds but recognised the difficulties being experienced with ambulances waiting outside for lengthy periods.

Diane Whitfield, Vice Chair CWPT provided an overview of the positive work underway despite the recent industrial action, with acute services running routine clinics.  She updated the meeting on recent Health Service Journal Awards, the exploration of community referrals for NHS talking therapies and peri-natal services and the good levels of feedback from the recent ‘I Want Great Care’ programme.

Pete Sidgwick, WCC, advised that the Adult Social Care and Health service was under pressure, with community providers feeling significant pressure as well as hospitals, however he felt that providers were supporting and managing demand.  He felt that demand would remain high for the next few months.

To consider and endorse the 2023 Annual Report of the Director of Public Health and the recommendations within it. 

Shade Agboola, Director of Public Health, introduced the report and provided a presentation focusing on the health impacts of domestic abuse.

This was the third annual report in Warwickshire since Shade had taken up the role and she thanked everyone involved for their input which included a range of partners across the system.

Whilst the Council was required to produce a report each year, the theme to focus on could be chosen and, having asked widely, it had been agreed that this years theme would focus on Domestic Abuse.  This built on previous Council publications such as the Violence Against Women and Girls (VAWG) strategy (2023-2026).  Shade explained that the report told a fictional story of a character named Mia and her experience of domestic violence.  The story was told through the words of those surrounding her and the services involved and was reflective of real-life domestic abuse experiences.

The report included data on the local picture of domestic abuse within Warwickshire and provided a range of recommendations for 2023.  Following feedback on previous reports, an update on progress of the 2022 recommendations was also included.

Diane Whitfield referred to the figure advising that only 8.3% of domestic abuse recorded crimes resulted in a positive outcome and asked if there was any further information on why some recorded crimes did not progress.  In response, Chief Constable Tedds explained that there were a number of reasons why a victim may not seek to continue with an investigation and assured that the Police were very mindful to listen to the voice of the victim.  She advised that they worked closely with the CPS and agreed to report back to the Board via a briefing note.

Councillor Holland queried the reference to resources in the recommendations, specifically in relation to primary school meals, as he had hoped that this issue could have been acted on more quickly from last year, despite the timings in relation to budget setting.  Councillor Bell reminded Councillor Holland of the progress made with regards to Free School Meals and referred him to the section of the report outlining the actions taken since last year.

Shade Agboola supported the comments from the Chair and advised that a review had taken place, a working group established and officers were currently scoping a pilot scheme in a north Warwickshire school.  However, she noted the lack of synergy between some recommendations and budget setting.

Councillor Roodhouse raised the correlation between alcohol consumption and coercive behaviour, querying if any work had been carried out focusing on this.  He also asked about the availability of safe spaces, such as churches or libraries, how the Council was working in partnership with organisations to advertise these and how he hoped to see more work in this area.

Shade confirmed that there was a clear correlation between alcohol and domestic violence and whilst she was not sure of the percentage of admissions, further exploration work was being carried out as part of the VAWG strategy.  In relation  ...  view the full minutes text for item 2.

A report for discussion and approval, setting out recommendations for different organisations and the Care Collaborative.

Michael Maddocks and Rosie Fforde introduced a report outlining the Joint Strategic Needs Assessment (JSNA) relating to Healthy Ageing.  The assessment sought to analyse the current and future wellbeing needs of the older adult population to inform the commissioning of health, wellbeing and care services.

The presentation included a lot of information and data related to healthy ageing and gave an overview of the following:

·       What is a JSNA – purpose, responsibilities and approach;

·       Why healthy ageing – local rationale and national context;

·       Approach to JSNA – Definitions, scope and engagement;

·       Key points – Strategic implications from JSNA;

·       Recommendations – for Health and Wellbeing Board and from JSNA; and

·       Next steps – Publication and dissemination.

Officers explained how older adults made up a growing part of the population and tended to have more health and care needs.  An overview of the national context was given with the Healthy Ageing Consensus Statement from 2019 alongside the Chief Medical Officer’s Annual Report 2023.

Rosie Fforde outlined the engagement tools utilised to gather the views of residents including story circles, focus group style sessions and a County wide survey.  Key points from the JSNA concluded the presentation, with prevention highlighted as an important thread, to improve quality of life, reduce inequalities and ensure the sustainability of services.

A number of queries were raised by Members of the Board and responded to by officers as summarised below.

Councillor Humphreys enquired about the incontinence service which she had been fighting for years for and supported the comments made about changing attitudes towards ageing as many older residents were working in the community volunteering.

Russell Hardy highlighted that by 2035 there would be more people over 65 than in the working population.  He proposed that by working together, organisations could make Warwickshire the easiest place to volunteer, providing benefits to the individuals and as part of the economy.

Councillor Roodhouse welcomed the vision of friendly ageing communities and referred to some good examples in other parts of the country.  He encouraged coalition of strategies to ensure they delivered strong outputs and fed into one another.

Councillor Bell acknowledged that this issue had been discussed for a number of years and was now being lived in real time.  She asked the ICB if there was any news on the incontinence information being brought forwards.  In response, Danielle Oum agreed to take this away and report back as she was not sure how far along the work was.

Rosie Fforde agreed that volunteering should be recognised and this had been included in the 25 recommendations being put forward, along with encouraging age friendly employers.  In response to Councillor Roodhouse, she referred the meeting to the next steps to move the work forwards and assured that many conversations would be taking place.

Chris Bain of Healthwatch welcomed the JSNA and referred to his previous work with Age Concern England.  He reiterated that the response to ageing was not just about access to services but access to society.  He advised  ...  view the full minutes text for item 3.

To receive an overview from Foundation Group Hospitals new Directors; Adam Carson (SWFT) and Catherine Free (GEH).

Russell Hardy introduced Adam Carson, Managing Director of South Warwickshire University NHS Foundation Trust and Catherine Free, Managing Director of George Eliot Hospital NHS Trust, who were in attendance to deliver presentations on their trusts and outline future plans.

Russell provided some background as to how the foundation group had started when he and a colleague had been asked to help at Wye Valley.  It had been recognised that there was no facility in place for providers to share best practice and the work had resulted in setting up joint teams to learn from one another.  This work had continued with George Eliot Hospital and latterly Worcester Acute.  Whilst all of the organisations were still legally autonomous, they had a committee in common as well as joint teams covering a wide range of issues.

Catherine Free addressed the meeting and delivered a presentation on Warwickshire North Place Clinical Strategy.  She advised that the ambition was to become a diagnostic centre of excellence, ensure patients received same day emergency care, deliver integrated care without barriers and improve clinical outcomes by tackling health inequalities.

She went on to outline the Improvement Journey so far, the different phases of development, addressing waiting list backlogs and the work undertaken to reduce vacancy rates amongst staff.

Catherine explained that the trust had identified five ‘big moves’ to underpin the work including creating resilience in the domiciliary care marketplace and embedding prevention in every service.  In summary, she advised that there was a genuine commitment to excel at patient care and whilst finance may be challenging, the trust had a track record for delivering.  In conclusion, they were a sustainable organisation with much to offer the local population.

Adam Carson delivered his presentation, which covered:

The range of acute services provided across Warwickshire;

The trusts ranking from the CQC and NHS Oversight Framework;

Becoming a University Trust in 2022;

Awarded Top 5 best acute Trusts as part f NHS Staff Survey 2022.

The Trusts objectives for 2023/24 were outlined along with how these would be delivered.  Recruitment and retention remained a large challenge and the trust was focusing on growing and developing its workforce. 

Adam explained the current priorities and referred to the level of development work taking place at the Warwick Site.  This was multi-phased with phase 1 due for completion in January 2025.  He recognised the disruption this was causing, especially in relation to car parking and noted the new Lillington Health Hub and redevelopment of the Ellen Badger site.

Work with Place Partners continued, particularly in relation to prevention and how the trust could collaborate on priorities such as mental health, wellbeing, climate change and the cost of living.  In summary, Adam felt the Trust had a strong track record for innovation and improvement and hoped to continue integrating services and partnerships in a challenging financial landscape.

Councillor Bell thanked both Managing Directors for their presentation and was encouraged to hear their future plans and ideas for working with communities.

Chris Bain of  ...  view the full minutes text for item 4.

To consider a report providing an update on progress against key areas of focus in the Better Care Fund Plan for 2023-25, along with progress against national metrics and preparations for 2024/25.

A presentation was received from Rachel Briden, Integrated Partnership Manager which provided an update on progress against the key areas of focus in the Better Care Fund Plan for 2023-25.  The report also advised on progress against the national metrics and preparations for 2024/25.

Rachel Briden outlined the quarterly report and signposted Members to key areas including performance, the positive outcomes of the Community Recovery Service and the move to Community Integrator arrangements.

She reminded the meeting of the recommendations in last year’s report with funding aimed at supporting older people in the community to help avoid admittance to hospital where possible.  Paragraph 1.7 of the report also provided an update on changes to the discharge to assess model helping to support more timely discharges into temporary ‘step down’ beds.

With regard to recommissioning the Integrated Community Equipment Service, Rachel highlighted that the current providers contract was due to expire in August this year and a new service provider would be transitioned in.  Further information was outlined in paragraph 1.18 but the aim was to prevent admission, facilitate discharge from hospital and keep people independent in their own homes.

In a summary of performance, the Board were advised that quarters 1 and 2 were better than last year with a drastic improvement in emergency admissions due to a fall.  Section 2 of the report gave an update on the improved Better Care Fund, the schemes funded since its inception in 2017 and the draft list of schemes to be continued in 2024/25.  Rachel advised that there was no national inflationary increase to the improved Better Care Fund allocation planned and so individual scheme budgets could not be uplifted. The ICB and WCC were working through the list of schemes to be funded at present, and this would be confirmed shortly.

Councillor Marian Humphreys raised the issue of the level of support provided on discharge from hospital as some of her constituents had been experiencing difficulties and some processes did not seem to be working as well in the community as it had been hoped.  Becky Hale encouraged Councillors to share the details of such cases so they could be looked into on an individual basis and used to inform improvement.

The Chair acknowledged the importance of coordinated working between acute settings and the value of all community partners.

Resolved that the Health and Wellbeing Board;

1)    Notes the progress of the Better Together Programme in 2023/24 and the updates provided on the key areas of joint focus in the Better Care Fund plan for 2023-25;

2)    Notes performance against the national Better Care Fund metrics; and

Supports the plan for schemes to be funded from the Improved Better Care Fund in 2024/25.

To receive an update report from the Place Based Partnerships outlining the different approaches taken by Warwickshire North, Rugby and South Warwickshire.

The Chair reiterated the importance of understanding what each of the individual Place Partnerships were undertaking and the challenges being faced.  She proposed that an update be added as a discussion item at the next meeting in May.

A report advising the Board on the progress made by the Children and Young People Partnership since the last update in September 2023.

The Chair reminded the Board that the Children and Young People Partnership was a subgroup of the Board, focusing on mental health, health and health visiting.  She advised that the group would update the Board on the work being undertaken at the next meeting.

To consider a report detailing the support available for carers, locally and nationally, along with progress on the development of the Warwickshire All Age Carers Action Plan.

The Board were reminded that an update had been circulated on 4 January 2024.

To receive the Forward Plan of items for consideration by the Health and Wellbeing Board in 2024.

Councillor Bell advised that, as discussed earlier in the meeting, the following items would be added to the forward plan for the meeting in May 2024:

·       ‘Voice of the Patient’ update from the ICB following the ICB Board meeting in March 2024;

·       Feedback from the Health and Wellbeing Board Executive Group on 18 January 2024;

·       Update from the ICB on pharmacy, optometry and dentistry commissioning transfers;

·       An update from the Children and Young People Partnership; and

·       Health and Wellbeing Board Place-based Partnerships.

Closed meeting at 15:36