Agenda and draft minutes

The Chair welcomed everyone to the meeting.

Apologies for absence were received from Councillor Jerry Roodhouse, Sue Noyes from UHCW, Elizabeth Hancock from Healthwatch Warwickshire, Russell Hardy from SWFT, Catherine Free and Jenni Northcote of GEH NHS Trust, Mannie Ketley, Chief Executive of Rugby Borough Council and Gemma McKinnon from WCC.

Adam Carson attended on behalf of SWFT and Ryan Coffey attended from GEH NHS Trust.  Jerry Gould attended on behalf of UHCW.  Jo Southam  attended in place of Gemma McKinnon from WCC.

There were none.

To approve the minutes of the meeting held on 10 January 2024.

The minutes of the Health and Wellbeing Board held on 10 January 2024 were agreed and signed as a correct record.

Councillor Jim Sinnott to be added to the record of attendance.

Matters arising

The Board received an update from Danielle Oum, Coventry and Warwickshire Integrated Care Board in relation to the patient voice/working group.  It was confirmed that there is a task a finish group in place to look at the system wide gap analysis of community activity.  It was confirmed that the ICB had outlined scope and that a citizen advice working group will finalise the project outline.

The Chair confirmed that the national action plan for GP’s had been circulated as requested.

In relation to the requested update on the incontinence service, it was confirmed that an update had been received at the Adults OSC so the information will now be circulated to this board.

Councillor Bell invited provider representatives to deliver updates where necessary.

Justine Richards, Chief Strategy Officer University Hospital Coventry and Warwickshire confirmed that the service is very pressurised in terms of emergency flow across the hospital.  The service is ready for the electronic patient records (EPR) launch on 15^th June 2024 which is a significant moved for the organisation.

Diane Whitfield, Vice Chair, Coventry and Warwickshire Partnership NHS Trust (CWPT) confirmed that there is a huge challenge for the service and demand is increasing across the board.  In particular, the demand for children’s mental health services is extremely high with a focus on emergency and urgent pathways.

Ryan Coffey, Programme Manager Gorge Eliot Hospital NHS Trust confirmed that a new ward was recently opened at Gorge Eliot.  It was further confirmed that there is an extremely high level of demand, higher than winter across the Trust which has caused a significant challenge with flow and ongoing management of patients.  It was noted that there have been high levels of out of area patients, primarily from Worcestershire and Birmingham.  Work is underway to look at why this support for other trusts is needed.  It was noted that the hospital is currently undergoing an unplanned CQC inspection of general medicine. 

Pete Sidgwick, Director of Social Care and Support confirmed that the team is in preparation for CQC assurance.  Work is also underway in developing a social care strategy as well as supporting acute trusts to manage flow.  Work continues to support people within the community.

Dr Shade Agboola, Director of Public Health confirmed that the service is busy.  It was noted that the team is working with the UK Health Security Agency in relation to the increase in cases of whopping cough and to support the communities impacted.

Following a question in relation to the impact of the support from the council in manging that flow, it was confirmed that the help is a co-ordinated effort from many places, and it is helping across the area.

Emma Daniells, Deputy Police and Crime Commissioner confirmed that the increase in crime has been slight, but that burglary of dwelling is one area of concern.  It was noted that the calls to 101 have increased over the last couple of months especially last week when the weather improved.  There are new processes in place with new high-tech investments that support the triage service.  This has meant that the performance level has remained static despite the increase in calls.  It was confirmed that the HRMC inspection is expected later in the year.  It was further confirmed that morale of the force is good, and that recruitment is good; with many positions now filled and training underway. 

Right call right person – ICB – four sections.  Primarily to support people suffering with a mental health crisis reach the right person and the right time.  Police lady to provide a briefing note to members of the board with all the information.

Chris Elliot, Chief Executive, Warwick district council  ...  view the full minutes text for item 1(4)

To receive verbal updates from the place-based Health and Wellbeing Board Partnerships.

The Chair welcomed Steve Maxey, Chief Executive, North Warwickshire Borough Council and Ryan Coffey, Chair of Warwickshire North Place who highlighted the following points to the Board.

1. Play area refurbishment.  Timed well with the change in the weather and the ongoing concern of childhood obesity.

2. One current key focus is integration to maximise capacity in each area and improve service delivery.

3. A review is underway in relation to the actions from 23/24 action plan and to confirm those for 24/25.  The general consensus was that the programme is on the right event.

4. The North Place Programme highlights the priorities identified and it was confirmed to include access to mental health support and support for healthy lifestyle choices.  It is a live programme so will be updated as programmes start and finish. 

5. The Clinical Strategy is due to be renewed towards the end of 2024/early 2025.

6. The Kings Fund Population Health model is being used to help identify Warwickshire North priorities.

7. Current achievements of the North Place Partnership include – Cardio vascular disease checklist which was shared with the Board.  It helps to identify and the engage with people with a risk of cardio disease who aren’t already on a programme of care.  It was confirmed that just over 1000 checks have been carried out so far with 260 being then referred onto a primary care pathway.  The full impact of this project will be shared at a future meeting.

8. The Board received a monthly snapshot shared via a presentation in relation to volunteering and learnt that over 750 hours of volunteer intervention time has been given to patients. Including over 50 hours of volunteer time getting medicine delivered during March 2024. 

The Board noted that there are still issues and that it is important to remember that there are still challenges.  There is a need to monitor how place projects are carried forward.  One area of concern is capacity; fewer people are able to attend meetings and that has to be noted. 

The Chair welcomed Chris Elliot and Adam Carson (co-chairs of the South Place) who presented the following highlights –

1. Over the last 12 months there has been a review of governance and place plan priorities in line with the establishment of the ICB.  The revised place structure is now in place. 

2. New priorities have been put in place including the cost of living and the impact it has across all communities; other priorities include climate change and the impact on respiratory health; and mental health.

3. Work has started on collecting £20k from each of the organisations but there is now a pot of money in place; this allows the pooling resources.  Discussions are underway on the best way to use the money to support the priorities identified.

4. Lillington in Leamington has a collection of projects currently underway, including the new health hubs.  UKSPF money has been used to support some of these local projects including a new GP’s surgery.  Health and equalities funding has been used to introduce  ...  view the full minutes text for item 2.

To receive an update from the Health and Wellbeing Board Executive Group meeting held on 18 January 2024.

Becky Hale Executive Director for Social Care and Health, drew the Board’s attention to the following points –

1. The group met in January 2024 to review the proposed plan and ensure that everything that need to ne included was included.

2. The creation of effective links and the citizen voice were areas that were considered key.

3. The report includes updated information in relation to the delivery plan.

4. The group is proposing a focus on the best start in life (BSiL).  There is a lot to connect across agencies to ensure this is a priority across Warwickshire.  Consideration is needed with regards to the relationship between the executive and where decisions are being made.

The Chair thanked Becky Hale for the overview and welcomed the recommendation included in the report.  It was noted that there is a real distinction between identifying a situation/concern and then creating a real delivery programme that can be closely monitored.  There must be a focus on getting a concrete plan in place.  It was put forward that the group could learn from the Place Partners and create real outcomes that can be measured.  The Chair thanked the executive group for all their work and the update given at the meeting. 

To consider the new structure of the Public Health service within Warwickshire County Council and the range of activity being undertaken in 2024/25.

Shade Agboola, Director for Public Health Warwickshire provided an update on the new structure of the Public Health service and the range of activities being undertaken to deliver on the service’s responsibilities.  The following points were highlighted to the Board.

1. There is a 2 year pilot in place where directorates within Warwickshire County Council have been split into two.  The two new Directorates are Social Care and Health and Children and Young People.

2. Work in relation to Inequalities & Public Health Commissioning is being led by Jane Coates.  Paula Jackson is leading on work in relation to mental health.  There is currently one vacancy for a post working on Health Protection & Health Care but recruitment is currently underway,

3. With regards to the list of prescribed and non-prescribed functions of the service, it was noted that more clarity needed; in particular in relation to the prescribed functions that must be delivered and have grant conditions attached to them.  The Board noted that there is not a budget to be able to invest in every area that we would like to.

4. In relation to the agenda for change payments, the Board noted that this is a very tricky area to achieve a shared understanding of.  The Public Health grant doesn’t cover what may need to be paid out in contracts.  Added complexity came from the redesign of contracts to make the system more consistent and therefore reduce administration.

Following a question from the Chair, it was confirmed that performance targets for the service are both national, and against neighbouring authorities. 

Following a question in relation to the funding of wellbeing coaches that go to GP surgeries, and if it is value for money, it was agreed that this would be looked into after the meeting and details circulated to the Board.

After a further question in relation to which services are most at risk from de-funding.  It was agreed that Dr Agboola would seek confirmation of the details and then be able to share the information with the Board.  It was confirmed that value for money is a key area for review across all non-prescribed projects; and then realigned where needed.  Part of the review will be to consider the impact on residents and if a change in service provision would have a negative impact further down the line.

A follow up question was asked as to who decides of prescribed/non prescribed projects with a concern that drug and alcohol services seem to be non-prescribed.  It was confirmed that grants received come with conditions relating to prescribed/non prescribed projects.  The terminology seems to have change recently and the service is asking more questions.  Drugs and Alcohol is described as non-prescribed, but we have been told, that alongside receiving an additional grant, this service must be provided; it cannot be defunded.  It is not always clear. 

This report provides an overview and impact of the Better Care Fund, along with performance against national metrics and the changes outlined in the addendum published in March 2024.

Rachel Briden, Integration Partnership Manager provided a summary of the report included in the agenda packs, along with a copy of the presentation.  The report provided an overview of what the Better Care Fund (BCF) is, how it works, how it is funded, areas of focus and current work.

The following points were highlighted to the Board.

1. A better care plan will agree on how the mandatory funding from the ICB is spent with some going to the local authority. 

2. A 2-year plan for the BCF is in place after being agreed and signed this off by the Health and Wellbeing Board.

3. An 28^th March 2024 an addendum to the Better Care Fund was agreed and this year’s plan will include an uplift in the finance.  The original plan included indicative financial planning.  There are still agreements to be finalised at this point but will be presented to the board when appropriate. 

4. The Board was asked to note that National Policy Framework only applies to the pooled budget but includes, £17.2 million helps to fund the out of hospital collaborative, £9.2 million towards domiciliary care costs and £6.9 million community equipment contract.

5. Significant blocks of money fund core services through the BCF and have been in place since 2015.

6. 61% of the budget goes towards supporting core services that may have been affected by defunding through the NHS

7. It was confirmed that the reablement service is up to 6 weeks for patients.  There is a very high success rate for this, and the number of people still requiring long term support after 6 weeks is minimal with the average length of the support is 5.5 weeks.

A report requesting approval of the JSNA, support for its dissemination within member organisations, and encouraging its use in the planning and commissioning of relevant services.

Michael Maddocks, Programme Manager (JSNA) and Kelly Hayward, Public Health Service Manager presented the report to the Board and confirmed that there is a live dashboard that members can access which will be continually developed to build interactive and up to date information.  The live dashboard will be regularly updated with new content continually added to it.

The menu on the dashboard will take you to the high impact areas.  Each area’s page has an introduction page and highlights the key messages for each area.  Information is also available on how they data is collected and used.  Information also includes a set of principles and a much more manageable number of high level recommendations.  It will also allow partners to respond to child health needs.

It was noted that there is a sub-group monitoring the progress of the JSNA and driving the system approach of supporting the commissioned services.

Recognising the impact and value of the health surveillance and making sure that every contact count course; officers will ensure this is used as a tool across the service.

It was confirmed that the creation of the live dashboard was done with the engagement with range of different colleagues to create the most effective dashboard possible.

The Chair made a request that the Board receives regular feedback from this service and that the Children and Young People’s Partnership Board also monitor the progress.

To receive and consider the recommendations from the Menopause Task & Finish Group, following the reports’ recent approval at Adults Social Care & Health OSC.

The Board was updated that the task and finish group for the Menopause Services has recently presented the report to the Adults Health and Social Care Overview and Scrutiny Committee.  The Board thanked those involved in the review and noted that Warwickshire is now a leading authority in this area.

The Chair thanked all the members and officers who were involved in the project.  The ICB has been asked to formally respond to this; they have responded that they are meeting the NICE guidelines, but it is likely that the guidelines aren’t right.

It was further confirmed that Healthwatch Warwickshire are now working with a group of men because of the work done by the task and finish group.

It was agreed that the adults overview and scrutiny committee will continue to monitor the recommendations made.

To receive a report updating Members following the joint development session held on 8 January 2024.

The Board received and noted the report which provided an update following the joint development session held on 8 January 2024.

A report advising the Board on the progress made by the Partnership since the last update.

The Board received and noted the report advising the Board on the progress made by the Partnership since the last update.

To receive and note the Warwickshire Safeguarding Annual Report 2022-2023.

The Board received and noted the Warwickshire Safeguarding Annual Report 2022-2023.

An update on the publication of the Coventry and Warwickshire Living Well with Dementia Strategy 2024-2029 and the progress made on the first year of delivery.

The Board received an update on the publication of the Coventry and Warwickshire Living Well with Dementia Strategy 2024-2029 and the progress made on the first year of delivery.

The Chair requested that the Board receives updates on the strategy and is given an opportunity to review the action and delivery plans.

A report advising on the delegation of responsibility for Primary Pharmacy, Optometry & Primary and Secondary Dental Services from NHS England to the Coventry and Warwickshire ICB taking effect from on 1 April 2023 and the processes outlined for the management and governance of these arrangements.

The Board received a report advising on the delegation of responsibility for Primary Pharmacy, Optometry & Primary and Secondary Dental Services

from NHS England to the Coventry and Warwickshire ICB taking

effect from on 1 April 2023.

It was agreed that it would be useful, when the ICB is ready, that the ICB is invited to the board to provide an update.  It was acknowledged that having only just been given these services, so it is too early at this point.  A review towards the end of the year was suggested.

Healthwatch Warwickshire asked that patient and public engagement is considered as part of the service delegation.

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

The Board considered the Health and Wellbeing Board Forward Plan for

2023/24 and noted the future items to be considered.