Agenda and draft minutes

The Chair welcomed everyone to the meeting and outlined a revised agenda running order.  Councillor Bell reminded those present that the Joint Development Session arranged for 20 November 20024 would focus on Children & Young People and, subject to the Board’s agreement, would be held as a virtual session.

She also proposed that members of the Children and Young People Partnership and relevant scrutiny committees be invited.  Councillor Bell recognised that all sectors were under financial pressure but was keen that the objectives that partners had been working together on, did not get lost. 

Apologies for absence were received from Danielle Oum, C&W NHS Trust; Shade Agboola, Director of Public Health; Councillor Sandra Smith, North Warwickshire Borough Council; Russell Hardy, South Warwickshire Foundation Trust; and Chief Constable, Debbie Tedds, Warwickshire Police.

Councillor Jerry Roodhouse declared an interest in Healthwatch’s Annual Report as he was a director of Healthwatch Warwickshire.

To receive the minutes of the meeting held on 15 May 2024.

The minutes of the Health and Wellbeing Board held on 15 May 2024 were agreed and signed as a correct record.

The Chair highlighted that the Community Pharmacy Steering Group was due to publish the supplementary statement to the Pharmaceutical Needs Assessment (PNA). Although the document was not ready in time for today’s meeting and did not require formal sign-off by the Board, the Chair had requested that it be circulated after the meeting for information.

The Chair outlined her concerns relating to the national push for ‘pharmacy first’, as she did not feel this married up with the decisions made on the commissioning of new pharmacies, nor the closures across the local area.  She suggested that this issue be focused on and brought forward to the HWBB.

Councillor Bell acknowledged that planning work for the next PNA was underway and asked that the recent engagement work that Healthwatch Warwickshire had carried out with residents on the experience of pharmacies be included.  As Chair of the Board, she also requested that the new iteration of the PNA included a section outlining how the current PNA had informed and shaped decisions made by NHS England and the Integrated Care Board (ICB) via the Community Pharmacy Steering Group.  

Councillor Bell then invited partner representatives to provide a brief update on activities or challenges in their area.

Dianne Whitfield, Coventry & Warwickshire Partnership Trust provided an overview of the operational pressures being faced. 

• Within mental health inpatient services there had been effective management of bed pressures, with bed occupancy largely within expected ranges and zero inappropriate out of area placements made; 
• Neurodevelopment services continued to mirror national trends with demand outstripping capacity;
• Referrals into Children’s Directorate had been lower over the summer and the Day Service for Children and Young People had launched successfully;
• Winter planning had commenced for all services with meetings taking place with the ICB to agree areas of focus;
• Focus was on adult mental health and supporting acute partners to reduce pressures in emergency departments;
• Mechanisms for admission avoidance were being reviewed across all services ensuring capacity was flexible in key areas such as crisis teams, mental health and NHS 111 teams;
• The Mental Health 111 service had gone live, offering 24/7 access to crisis support through a single access point.

Duncan Vernon, WCC Public Health reminded Members that a Monkey Pox briefing had been circulated to them advising on numbers of reported cases, disease transmitters and rapid effective tests.  Work was continuing locally with sexual health providers and the NHS, including the requirements for adequate PPE.  There was still a stigma surrounding the diseases but access to rapid care was being encouraged along with information on NHS websites.

Pete Sidgwick, Director for Adult Social Care, advised that numbers continued to grow in all aspects of adult social care and the number of people needing support.  The discharge from hospital support continued to work well.

To receive and comment on the annual report from Healthwatch Warwickshire for 2023-24.

The Health and Wellbeing Board received the annual report from Healthwatch Warwickshire for 2023-24.  The report included examples of how Healthwatch Warwickshire had made a difference to the community and how their activities benefitted people living in Warwickshire.

The Chair asked that the Board consider how we respond to and address the matters of concern Chris’ report has highlighted around: mental health services, NHS Dentistry and Community Pharmacy and how else will we commit to using this information to inform the HWBB work, particularly for each ‘Place’. 

Chris Bain addressed Members and began by thanking them for the opportunity to present the annual report.  He also took the opportunity to thank certain individuals who had supported the work including Robin Dorling, Liz Hancock and Councillor Jerry Roodhouse.  He reminded the meeting that Healthwatch Warwickshire had been started in 2014, with four guiding principles which he outlined for members.  He also recognised how far they had come, with discussions taking place now that would not have been commonplace ten years ago.

In delivering the presentation, Chris Bain covered Operational Priorities for 2024/25 which included improving care over time for all individuals, enabling continuous engagement with local people and strengthening the Healthwatch Warwickshire Team.

Between May and July 2024, Healthwatch received 527 pieces of feedback about local services including the top ten themes discussed relating to GP’s.  Feedback relating to local hospitals was also received which included ambulances and paramedics and the loss of pharmacies across the County.

Feedback was broken down by theme and communication remained a key factor in patient’s experiences.  Many recognised that verbal explanations regarding treatment were important and positive comments often mentioned the conversations patients or visitors had with porters, reception staff and ambulance crews.

Chris Bain acknowledged that dentistry remained a huge problem across the UK with people unable to get an NHS appointment in Rugby or Stratford upon Avon.  The drive to move NHS services digitally, remotely or via the telephone may not be the most effective route resulting in digital exclusion.

The presentation also outlined the challenges facing the fragile Adult Social Care market and the subsequent impact on people with delays to assessments, finances and carers.  Carers were recognised as being a vital link in the chain and if their needs were not met, they would be ineffective.  Many were emotionally and physically exhausted and struggling to understand some of the complex information being given to them.

Other matters of concern outlined were Mental Health services and Community Pharmacy.

Chris concluded by recognising the new arenas in healthcare including the ICB, ICP and Warwickshire Care Collaborative, many of which had not been in existence ten years ago.  Warwick University were also highlighted as a research collaborative.  Members were encouraged to get in touch if they knew anyone who may wish to join Healthwatch as a volunteer as the organisation moved forwards.

Councillor Maggie O’Rourke, Rugby Borough Council, thanked Chris for an interesting report although she felt that the new health system was complex  ...  view the full minutes text for item 2.

An update report detailing the feedback from the Better Care Fund Regional Assurance Panel and performance against the national Better Care Fund metrics.

The Chair advised that this agenda item would be considered under the update items of the agenda for the following reasons.

At the time of writing, the Better Care Fund (BCF) Plan for 2024/25 was still to be approved by the national team. This was because of a funding shortfall related to Pathway 1. Despite consideration by the Care Collaborative Committee, a resolution to this had not been made and therefore the BCF Plan remained yet to be approved.  

The Chair felt it was important that the Board felt assured of the work being undertaken by the Care Collaborative, particularly when it pertained to an item such as the BCF, which the HWBB had a duty to approve. She therefore proposed that a Care Collaborative update be received on a regular basis and asked if members would support this addition to the forward plan.

Becky Hale, Executive Director for Social Care & Health, assured Members that officers were working closely with the ICB and the three acutes to help reduce demand and manage additional funding.  Officers had hoped to bring forwards the updated plan today, however, this would be shared as soon as practicable.

Members noted that this was a very complicated process and were assured that key officers would attend future meetings to answer any queries.

Resolved

That the Health and Wellbeing Board

1)     Notes the feedback from the Better Care Fund Regional Assurance Panel as part of the national assurance process; and

Notes performance against the national Better Care Fund metrics.

A report detailing an update on activity relating to the Joint Strategic Needs Assessments, the proposed Early Years Integrated Delivery Plan and the outcome of the universal free school meal feasibility study and pilot evaluation.

Councillor Penny Anne O’Donnell introduced the report in her capacity as Chair of the Children and Young People Partnership (CYPP).  The report provided an update from the Children and Young Partnership on activity related to the Joint Strategic Needs Assessments.

The report also provided details on the proposed Early Years Integrated Delivery Plan as well as the outcome of the universal free school meal (FSM) feasibility study and school pilot evaluation.

Councillor Penny Anne O-Donnell referred to the published JSNA and drew Members attention to section 4.1 of the report which detailed the sub-structure of the CYPP, how the working groups fed into the process and how updates would be received.

Sharon Kindred, Strategic Manager for Early Years, introduced herself and outlined the Early Years Integrated Delivery Plan.  She provided further information on the ‘Best Start’ priority and the LGA Early Years Remote Peer Review.  Members received a detailed presentation which covered Interdependencies, Areas of Focus and how the integrated membership provided for clear links across the teams.  The future planned work included bi-monthly meetings to identify progress, establishing working groups for Children in care and School Readiness and updates to the CYPP and HWBB.

Councillor Jerry Roodhouse thanked officers for the report.  He advised that, having spoken to Head Teachers of local primary schools, there were still concerns about new starters being ready for school.  He recognised that many families were under pressure and queried how the holistic picture could be addressed within the delivery plan.  In response, Sharon Kindred explained that discussions did take place to identify those families in need of support via early help channels.  However, she recognised that further conversations were needed and agreed to take this back to the next meeting in October to firm up how this could be fed in.

Councillor Marian Humphreys commended the report and noted its ambition.  She felt that it was important to capture the early years support and, whilst there was a lot of work to do, felt the staffing numbers could be limiting.

Nigel Minns, Executive Director for Children & Young People, addressed Members and gave an update on the Free School Meals pilot undertaken at Michael Drayton Junior (MDJ) school in Hartshill.  He explained that this had raised some logistical challenges such as kitchen expansions, changes to dining times and numbers of kitchen staff required.  The pilot was funded from the Tackling Social Equalities fund for two terms with the intention to seek £24,000 funding from local businesses.  The evaluation of the pilot showed that the scheme had very positive outcomes including behaviour improvement, however, the head teacher had not been successful in securing future funding. 

The conclusion drawn from the review and pilot was that tit was not feasible to provide free school meals to all primary school pupils at the present time.  The estimated cost of funding the scheme annually within Warwickshire was approximately £18.4million and it had been concluded that it was not feasible in the current economic climate.

Councillor Margaret Bell was  ...  view the full minutes text for item 4.

To receive and comment on the Warwickshire Education Strategy 2024 – 2029 and its priorities.

Rachel Jackson, Head of Education Strategy & Transformation presented the report which outlined the Council’s strategic focus for the next five years.  The strategy had been approved by Council on 23 July 2024 and was now part of delivery in service.

Rachel Jackson outlined the purpose of the strategy and expanded on the direction and focus, strategic links, coordinated responses to challenges and transformation.  She also advised how the strategy fitted into the seven areas of focus detailed in the Warwickshire County Council plan.

The presentation covered the four Education priorities which included Best Start, SEND & Inclusion, Sufficiency & Admissions, and Strong Systems. Members noted the similarities between the HWBB priorities including the aim and ambitions, along with details on how the strategies linked to the ICS strategy.

Councillor Sue Markham highlighted the anomaly of some data within the document which changed from numbers to percentages and requested consistency where possible.

Councillor Penny-Anne O’Donnell welcomed the report and was pleased to see the higher number of children in care achieving a strong pass rate in English and Maths.  She asked for clarification on the number of EHCP’s that had been referred to tribunal. At a later point in the meeting, Nigel Minns confirmed that approximately 2.7% of EHCP’s were referred to tribunal.

Councillor Penny-Anne O’Donnell also queried whether the standardisation of the Eleven Plus exam had resulted in an increase of applications to mainstream schools.  In response, Nigel Minns advised that the Council has seen a small rise in the number of enquiries from parents of children in independent schools in the summer but this had not resulted in an actual increase in applications.

In relation to the nursery place funding, Councillor Marian Humphreys asked if objectives could be imposed with regards to readiness.  She felt that many youngsters starting reception did not have sufficient life skills such as toileting or the ability to dress themselves.

Councillor Barker asked for clarification on the sufficiency strategy, where schools were placed and why.  Nigel Minns responded and advised that the Department for Education quality assured the strategies each year.

The school choices parents could make were also discussed.  Councillor Barker felt that parents would want to go to school most local to them, enabling them to walk there and reduce car journeys.  Nigel Minns advised that parents could rank their choices, but they did not always choose the school closest to them, choosing other schools for a range of reasons.

Resolved

That the Health and Wellbeing Board notes the priorities of the Warwickshire Education Strategy 2024 – 2029 and works with colleagues and partners to support its delivery.

A report detailing the progress of the current JSNA work programme along with proposals for the future direction of travel.

Kate Rushall (Public Health Manager) outlined the paper which covered both the current and future Joint Strategic Needs Assessment (JSNA) work programme.  She advised of the two most recent assessments; Healthy Ageing; and Empowering Futures.  Both of these had been more interactive and were available on the Council’s website.

The current work programme was detailed with two assessments currently ongoing; Adults Living with a Learning Disability; and LTBTQ+.  Kate Rushall described the future work programme principles which would result in fewer JSNA’s, but that officers were aiming to look back at past assessments and themes to enhance insights.  It was hoped this would allow for more time for interpretations with a more interactive approach and online outputs.

From April 2025 future work would include the development of three life course dashboards; Children’s, Adult’s and Healthy Ageing.  Previous JSNA’s would be used to provide a real picture of experiences across the life course.  Officers recognised that they needed to engage the right partners and groups from the outset and a project plan would be developed shortly to provide more detail on delivery.

Michael Maddocks addressed the meeting and explained how the team would demonstrate the impact of JSNA’s, identifying three areas to measure impact.  With regard to the Pharmaceutical Needs Assessment (PNA), Members noted that this was due to be published by October 2025, with the HWBB having a statutory responsibility to produce it.  Working jointly with Coventry, this would facilitate joint working with the ICB and would reflect the established governance of the Coventry and Warwickshire Community Pharmacy Steering Group.

The Chair welcomed the proposed direction of travel and was pleased there would be a focus on impact.  She recognised how much work went into creating the JSNA’s resulting in a huge array of data being produced.  She therefore outlined the recommendations as laid out.

Resolved

1)     Notes the update and progress of the current JSNA work programme;

2)     Endorses the proposed direction of travel for the future JSNA work programme from 2025 onwards, acknowledging a more detailed project plan will need to be developed; and

Approves the proposal to develop the 2025 Pharmaceutical Needs Assessment (PNA), a statutory responsibility of the Health and Wellbeing Board, jointly with Coventry, under the established governance of the Coventry and Warwickshire Community Pharmacy Steering Group.

To note the minutes of the Health and Wellbeing Board Sub-Committee meeting held on 13 June 2024.

The minutes of the Health and Wellbeing Board Sub-Committee held on 13 June 2024 were noted.

To note the Forward Plan of work for the Health and Wellbeing Board and consider any further additions.

The Board considered the Health and Wellbeing Board Forward Plan and noted the future items to be considered.

As discussed at the outset of the meeting, the Chair requested that a report into Pharmacies be added to the work programme.  She also advised that there was new Sexual Health contract in operation across the County and an update on progress could be also be added.

Councillor Maggie O’Rourke referred to the urgent care review in Rugby and requested an update on where this was in the process and if there were Terms of Reference that could be shared.  Becky Hale advised that this was a county wide review.

Chris Bain advised that a review of the NHS by Lord Darzi was due to conclude and be published in due course.  It was agreed that a link to the publication would be circulated.