Agenda and minutes

Health and Wellbeing Board - Wednesday 11 January 2023 1.30 pm

Venue: Committee Room 2, Shire Hall. View directions

Contact: Amy Bridgewater-Carnall  Senior Democratic Services Officer


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The Chair welcomed everyone to the first Health and Wellbeing Board meeting of 2023 and recognised that for many working within services across health and social care, this was a very busy time of year.


Councillor Bell went on to reiterate the importance of focusing efforts on delivering the priorities set out in the Health and Wellbeing Strategy and gave an overview of what had been agreed previously.  She highlighted the breadth of the discussion items on the agenda which demonstrated some of the work being undertaken to respond to these priorities and acknowledged how the Board’s aim was to improve the health and wellbeing of residents of Warwickshire.



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Apologies were received from Councillor Julian Gutteridge, Nuneaton and Bedworth Borough Council and Steve Maxey, Chief Executive of North Warwickshire Borough Council. 


Appointment of Vice Chair

The Board is asked to appoint a Vice-Chair.

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Councillor Bell reminded the meeting that it had been agreed at the September meeting to defer the appointment of Vice Chair to this meeting and went on to propose Danielle Oum (C&W ICS) and Chair of the Integrated Care Board, for the position.  Councillor Bell felt that Danielle’s position on the Integrated Care Board would serve well to ensure greater connectivity between the two partners.


No further nominations were forthcoming, therefore, having been proposed and duly seconded, it was


Resolved that Danielle Oum (Coventry & Warwickshire ICS) be appointed as Vice Chair of the Health and Wellbeing Board.


Members' Disclosures of Pecuniary and Non-Pecuniary Interests

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During the course of the meeting Councillor Roodhouse declared an interest as a Director of Healthwatch, Warwickshire.


Minutes of the Meeting of the Warwickshire Health and Wellbeing Board on 7 September 2022 and Matters Arising pdf icon PDF 148 KB

Draft minutes of the previous meeting held on 7 September 2022 are attached for approval.

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The minutes of the meeting held on 7 September 2022 were agreed and signed by the Chair as a correct record.


Chair's Announcements

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There were none.


Place Partnership Update pdf icon PDF 649 KB

The Health and Wellbeing Board will receive an update from the Place Partnerships.

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The Board received an update from Mannie Ketley, Chief Executive of Rugby Borough Council alongside Chris Elliott, Chief Executive of Warwick District Council, who joined the meeting virtually.  Mannie Ketley delivered a presentation to the meeting entitled ‘The Journey of Place’ which provided background information and an update on progress of the Place Priorities for the North, Rugby and South areas of the County.


Having introduced herself, Mannie Ketley advised that the presentation she was about to deliver contained a slight variation to the original document circulated and she would share a revised set of slides to members after the meeting.


Mannie Ketley took the Board through the presentation which included information on:


·       The Journey of Place – key milestones that each area had been through, starting in 2018 up to the present day;

·       An explanation of what the HWBB Strategy meant for each area including future development of implementation plans and working with the HWBB Executive Office Group;

·       Progress to date with the Place Partnerships including review delivery priorities, refreshing terms of reference and future engagement measures;

·       What the draft ICS Strategy said about Place, a summary of the four commitments and definitions as to how partners would work on priorities;

·       Lessons learnt from South Place Peer Review including highlighted strengths focus moving forward and key opportunities;


Warwick District Council’s Chief Executive, Chris Elliott addressed the meeting and reflected on the past few years working at ‘Place’ level.  He felt there had been a lot of buy in by organisations and representatives, with people joining together to deliver a common aim.  Chris Elliott went on to describe how projects were now starting to come through and beginning to make a difference, such as the community centre provision at Packmores in Warwick.


Mannie Ketley then introduced the final slide which described the latter part of the journey and how it might be possible for areas to prepare for the next steps.  She asked the Board to consider the resources that might be required and advised that there would be a meeting held next month with colleagues to discuss this and thoughts on how ‘Place’ was connected to the wider Integrated Care System.


Mannie Ketley thanked Danielle Oum for attending a Rugby Place Partnership meeting recently and hoped that further clarification could be sought as to what the two way communication would look like. She highlighted the need to deliver on shared objectives, avoid duplication of work and harness a coherent approach.  She concluded by reiterating the importance of trying to identify necessary change and how to make those changes ‘business as usual’.


The Chair thanked both Chief Executives for attending and delivering the update.  She felt this went a long way to reinforce the commitment to work with the Place Partnerships and to identify ways to improve the wellbeing of communities and drive forward strategies.


Danielle Oum (C&W ICS) addressed the meeting and felt the presentation showed how partners were working collectively across Coventry & Warwickshire and how this enabled  ...  view the full minutes text for item 2.


Coventry and Warwickshire Integrated Care Strategy pdf icon PDF 448 KB

To receive the annual report of the Integrated Care Partnership Strategy.

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The Board received a report which presented an interim care strategy, setting out how the assessed needs of the population could be met by the Integrated Care System (ICS).


Danielle Oum (C&W ICS) introduced the strategy on behalf of the Integrated Care Board (ICB) and recognised that a lot of the officers present had been involved in the development of the strategy, with work taking place in a relatively short timeframe and as a result of a fairly comprehensive engagement programme involving key stake holders, community and partners.  She described it as an alliterative process, the basis of a forward plan which would be worked on. It was noted that this had not been published yet, so this was the opportunity to make any suggestions or comments.


Danielle Oum referred to this being a new way of working for everyone and felt that the mission statement signed up to was a powerful ambition, encouraging individuals to take ownership of their own health and focus services where they were needed. The strategy set out the agreed priorities and she asked those present to consider what the HWBB would need to see with a Warwickshire focus, on a regular basis to ensure this was moving in the right direction of travel.


Councillor Judy Falp, representing Warwick District Council, welcomed the inclusion of priority 1 ‘Prioritising prevention and improving future health outcomes through tackling health inequalities’ which she hoped would go some way to individuals avoiding admission to hospital.


Councillor Roodhouse referred to the financial strain and challenges and queried the powers available to give support.  He did not want to just note reports and recognised that the prevention agenda was something that had committed investment. Councillor Roodhouse recognised the role of District and Borough Councils in the process and queried how the HWBB may address the pressure being put on NHS England.  He queried the powers that the Board had and how the discussions could culminate in actions for the benefit of residents.


Dame Stella Manzie (UHCW) noted the progress made and felt the key was a sharp focus, revisiting priorities and ensuring all individual organisations were aware of these.  She highlighted the need to ensure joined up working, thinking in multi-directional ways whilst continuing to deliver services under pressure.  Dame Manzie also reminded the Board that it was important not to spread officers too thinly, maintaining focus and embedding prevention.  She referred to the Improving Lives project which should change pathways for elderly people and those specifics could then be reported back.


Mannie Ketley highlighted the connection with her presentation reiterating that clarity was important to avoid micromanaging at Place level.


Chris Bain (HWW) recognised the amount of work that had gone into the strategy.  He felt that the connection with communities was needed with a system that was becoming more complex.  He advised that Healthwatch’s concern was where the patient’s voice could best be heard and in what form.  He queried the consultation mechanism and felt that to be  ...  view the full minutes text for item 3.


Director of Public Health Annual Report 2022 pdf icon PDF 64 KB

The annual report from the Director of Public Health is submitted for the Board’s consideration.

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Shade Agboola (Director of Public Health) presented her Annual Report, as required under Section 73B of the National Health Service Act 2006.  The theme of this year’s report was health and the rising cost of living and contained a number of recommendations which would require a concerted joint effort from health and social care partners across the Integrated Care System if they were to be achieved.


Shade Agboola introduced her presentation which focused on the theme of ‘Health and the High Cost of Living in Warwickshire’.  The presentation covered the following:


·       The picture of Health and Wellbeing in Warwickshire, including life expectancy and healthy life expectancy data;

·       Improvements made across areas of health including the uptake of services and determinants that affect health;

·       The Warwickshire Health Profile in 2022 – showing health performance and allowing comparisons between districts and boroughs;

·       The Rising Cost of Living, resulting in three main consequences – household energy costs, rising petrol and travel prices and the increase in the cost of goods;

·       The impact these pressures will have on people’s health such as the inability to afford healthy food, risk of obesity, missed medical appointments, housing impacts and homelessness;

·       Metrics used to model financial resilience across Warwickshire Households;

·       Cost of living index demonstrating the most vulnerable areas of the county;

·       Data evidencing the impact of housing, bills and the rising cost of living on health – this included the impact on physical health, mental health and wellbeing and the cost of the burden on the NHS;

·       Support being offered in Warwickshire such as Act on Energy and Warm Hubs with an increased number of people using food banks, reducing meal size and an uptake in free school meals;

·       The positive work being carried out by food pantries and residents accessing debt advice and being signposted to a range of resources;

·       Transport and travel, the impact on loneliness and social isolation, restricted access to work, education and green spaces;

·       The benefits of active travel and the support being offered in Warwickshire including schemes such as Choose How you Move and a number of funding sources from WCC.


The presentation concluded with a number of recommendations, the first of which was an overarching proposal encouraging key anchor organisations to focus their expertise and capacity on building an inclusive, healthy and sustainable Warwickshire by focusing on:


Policy, Surveillance, Workforce Development, Making Every Contact Count and Access to services.


This was underpinned by three further recommendations focusing on housing, food and transport as follows:


·       Recommendation 2 – I recommend that housing, planning and health leads work together to prevent ill health caused by poor housing and living conditions.  This should include a commitment to prevent new homes from being built with an Energy Performance Certificate (EPC) rating of less than C and working with private and public landlords to ensure existing homes have an EPC of C or above, and are mould free.


·       Recommendation 3 – I recommend that to support children to have the best start in life,  ...  view the full minutes text for item 4.


Preventing Homelessness in Warwickshire Report - a multi-agency approach pdf icon PDF 115 KB

The Board is asked to note and support the content of the report and endorse the ongoing review of the action plan.

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The Board received a report and presentation from Isher Kehal (xx), and Angela Coates (Director of Housing at North Warwickshire Borough Council), which updated them on key actions for each workstream of the action plan developed to reduce homelessness in Warwickshire. 


Angela Coates addressed the meeting and outlined how far authorities had come by working together to tackle difficult housing issues.  She explained that the presentation would outline the progress made on the strategy that was signed off previously.  She also welcomed feedback on how the Board would like this to connect into future workstreams.


The presentation entitled Preventing Homelessness in Warwickshire: a multi-agency approach, 2021-2023’ included:


·       Background from the first conference in October 2018 to the Preventing Homelessness in Warwickshire Strategy endorsed in March 2021;

·       The Partners Involved;

·       An overview of Homelessness and Health services including support for the physical and emotional health of rough sleepers;

·       Work being undertaken to assist with Financial Inclusion including support to maximise income, managing debt and energy bills across the District and Borough Councils;

·       Homelessness and Young People;

·       Homelessness and Domestic Abuse;

·       Homelessness and Offenders; and

·       Next Steps including the approach to deliver strategic priorities and future refreshes of the Strategy and Action Plans.


Angela Coates explained that partners had pulled together to deliver services on the ground with much better collaboration with a real focus around prisons and rehabilitation.  She advised that the use of temporary accommodation had reduced in Warwickshire but there were still a number of challenges to be faced with rents increasing in the private sector and residents struggling on lower incomes.


Angela Coates expressed that a good relationship had been built with the resettlement board in relation to citizens fleeing Ukraine and those seeking asylum but stressed that this was an additional group that wanted to access the private rented sector and social housing.  She went on to outline the potential difficulties if Housing Related Support was lost which was a threat to supported housing and the current mechanism.  Angela concluded by commending her colleagues and as the Chair of the Strategy Group, requested the Board’s support to continue with the focus outlined.


The Chair applauded this work as a wonderful example of partnership working which was very encouraging.


Councillor Roodhouse recognised the issues relating to domestic abuse and highlighted that male suffering was more visible on the public radar than before.  He recognised the importance of joined up working with the use of clear data and referred to the level of positive work being carried out in his own constituency in Rugby, which was well appreciated.


Councillor Judy Falp thanked the officers for including case studies in their report which clearly showed how these issues impacted on residents.  She queried what else local authorities could do to work with private landlords and provided examples of residents desperate for help with poor living conditions or unaffordable rent.  Councillor Falp asked for confirmation as to whether officers were working with social landlords and raised a concern about the  ...  view the full minutes text for item 5.


Coventry and Warwickshire Suicide Prevention Strategy 2023 - 2030 pdf icon PDF 128 KB

The Board is asked to endorse the content of the Coventry and Warwickshire Suicide Prevention Strategy 2023-2030 and support the delivery of the strategic ambitions and local priorities.  It is proposed that a formal presentation of the Strategy and Delivery Plan be requested in March 2023.

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The Board received a report from officers which advised that, following completion of the NHS England (NHSE) funded national suicide

prevention programme in Coventry and Warwickshire (2018 – 2021), work had been underway to develop a new partnership work programme that set out a vision for suicide prevention in Coventry and Warwickshire until 2030.


The report was presented by Paula Jackson (Public Health Consultant) who provided an overview of the strategy.  The work had been led by Warwickshire County Council and Coventry City Council and dovetailed with the Director of Public Health’s Annual Report, which also highlighted the ongoing impact on mental health issues since the pandemic.  Paula Jackson asked that the Board endorse the new strategic approach to help tackle this distressing issue which was now the leading cause of death for those under the age of 35 and for men under 50.


The presentation highlighted the importance of aligning the new strategy with national guidance and contained statistics of the suicide rates in Coventry and Warwickshire. In addition, the presentation outlined:


·       A zero approach to suicide, stating what the strategy hoped to achieve – there was a focus on inequality, creating safter communities and sharing data and learning;

·       The collaborative approach was detailed starting with strengths, outlining those groups at risk such as alcohol and drug users and those in financial difficulty;

·       How the strategy would work and the proposed governance model;

·       Implementation of the strategy showing what was already being done and what the Council planned to do in the future;

·       The two year delivery plan included providing a clear training programme for frontline staff, using realtime surveillance and identifying trends; and

·       The next steps in the process from endorsement of the strategy and a Suicide Prevention Conference in Spring 2023.


The Chair thanked the officers for a clear and concise presentation.


Russell Hardy (SWFT and George Eliot Hospital NHS Trust) addressed the officers and recommended a colleague of his at the George Elliott Hospital who worked with individuals following the loss of a baby, men in particular and offered to share his contact details should they find it helpful.


Chris Bain (HWW) noted that the data had been broken down into male and female categories but queried if any further investigation had been undertaken into specific groups.  He also asked how involved the officers were with regards to working with schools and colleges.


The officers explained that they worked with the local university as part of the prevention network, focusing on the mental health of children and young people and self harm.


In response to the data query, officers advised that the information was gathered following an audit of suicides since 2021.  This had been broken down by gender, occupational groups, location in county, deprivation base.  However, there was not a lot of information regarding ethnicity which, as one of the limitations of the data, was being addressed nationally.  Members noted that there was a lot more to do to understand the local picture.


Chris Bain  ...  view the full minutes text for item 6.


JSNA Prioritisation Programme pdf icon PDF 114 KB

To consider the outlined proposed thematic Joint Strategic Needs Assessment (JSNA) workplan for October 2022 to November 2024 and support the development of future needs assessments.

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The Board received a report from officers which provided an overview of the Joint Strategic Needs Assessment (JSNA) Prioritisation Process undertaken to establish a new workplan for 2023/24, along with key findings.


Duncan Vernon (Public Health Consultant) introduced the report and presentation, alongside his colleague Michael Maddocks (Public Health Principal).  The presentation covered:


·       Background of the JSNA – it’s purpose and representatives of the Strategic Group in Warwickshire;

·       A timeline of the journey so far since it’s beginnings in 2013 through to the Needs Assessments already completed and the culmination of the current work programme;

·       The Prioritisation Process Overview detailing the steps taken from the collection of a list of needs assessments, through discussions and finally to sign off;

·       An overview of the matrix and scoring levels, showing level of need and vulnerability;

·       The proposed workplan including a production timeline and its integration with other work streams;

·       Specified and Non-specified timelines side by side; and

·       A Final Proposed Workplan, advising of the plan to undertake additional ‘JSNA Bitesize’ which would be published on the website.


Duncan Vernon explained that the engagement of citizens and patients was key and in each case, effort had been made to engage broadly, whilst also looking at information from past engagements.  This allowed officers to triangulate what the important issues were, whilst working together.


Councillor Holland thanked the officers and queried how this fitted in with the first item on the agenda, relating to Place Partnerships.  In response, he was advised that officers worked closely with the ICB and it was noted that as places developed, the data also evolved with feedback being received and taken on board as the journey progressed.


Councillor Roodhouse queried the data relating to exploitation as he felt it would be higher than that.  He also asked for clarity on the category relating to people aged 65+ and the increased risk of dementia.  He was mindful of the growing older population and increasing frailty, and loneliness and isolation and wondered if those issues would be taken into account in the review.


Russell Hardy (SWFT and George Eliot Hospital NHS Trust) also addressed the points made regarding the over 65 category stating that if you took maternity and paediatrics out of the equation, 80% of acute beds were occupied by people over the age of 65’s and in Warwickshire only 20% of the residents were over 65.  He therefore, felt that if this proportion of the population could be kept healthier, in their own homes for longer and remain out of hospital it could revolutionise financial envelope that health services were operating in.


Duncan Vernon explained that throughout the JSNA processes officers tried to take a wider perspective on health.  He recognised that social isolation was one of the critical points and using the previous JSNA schematic from 2016, would be mapping trends and taking insights from that to see how the situation had changed.  He reiterated that building partnerships was critical, working around hospital discharges in Warwickshire, the use of  ...  view the full minutes text for item 7.


Coventry and Warwickshire Health and Wellbeing Forum pdf icon PDF 76 KB

To receive an update on the presentation and discussions that took place at the first meeting of the Coventry and Warwickshire Integrated Health and Wellbeing Forum (formally the Place Forum).

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The update from the Coventry and Warwickshire Health and Wellbeing Forum was taken as read and, having received no comments or questions, was noted.


Better Care Fund - Update, Planning for 23/24 and Adult Social Care Hospital Discharge Fund pdf icon PDF 121 KB

To note the progress of the Better Together Programme in 2022/23, provide feedback on the proposed schemes and support the plan approved under delegation by the HWBB Sub-Committee on 16 December 2022.  It is suggested that a further update will be provided, following publication of the national Better Care Fund Policy Framework for 2023/24.

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Dame Stella Manzie (UHCW) addressed the meeting and asked whether the Board wanted her, Russell Hardy or Diane Whitfield to comment on the general situation affecting healthcare overall, particularly on the NHS side.  She advised that from a University Hospital Coventry & Warwickshire (UHCW) perspective there were obviously big challenges but she wanted to emphasise the huge efforts being made not to cancel elective procedures, some had had to be cancelled but the numbers were relatively small compared to the scheduled procedures in place.  She recognised that whilst the situation was a big concern for everyone involved, she assured the Board that all hospital trusts were valiantly trying to ensure they minimised the cancellation of elective care.


Russell Hardy fully supported the comments made and took the opportunity to apologise to Warwickshire citizens for the access challenges they had experienced over the last few weeks.  He felt it was important to recognise this and to assure that there were programmes going on to make sure lessons were learned and, despite the challenges, would ensure that next year the system was in a much better place.


Assistive Technology and the Integrated Care Record pdf icon PDF 113 KB

To receive updates on improving and increasing the offer of assistive technology to Warwickshire residents; and the Integrated Care Record.

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Russell Hardy (SWFT and George Eliot Hospital NHS Trust) felt that this was a wonderful opportunity.  He referred to the system used in Scandinavia whereby all domiciliary care visits were undertaken using Assistive Technology.  He recognised that the work detailed in the report was very positive and referred to Danielle Oum as a real advocate of the digital agenda.  He concluded by stating that keeping focused on that would be a positive move forwards.


The report was taken as read and, taking on board the comments received, was noted.


Warwickshire Hospital Discharge Community Recovery Programme pdf icon PDF 61 KB

To receive an overview of the proposed Warwickshire Hospital Discharge Community Recovery Programme.

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The report was taken as read and, having received no comments or questions, was noted.


Children and Young People Partnership Update Report pdf icon PDF 98 KB

To receive an update on the progress made by the Children and Young People Partnership, including an update on health visiting.

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The update was taken as read and, having received no comments or questions, was noted.


Health and Wellbeing Board Sub-Committee pdf icon PDF 72 KB

To note the minutes of the Health and Wellbeing Board Sub-Committee meetings held on 22 September and 16 December 2022.

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The Chair referred to the minutes of the two sub-committees that had taken place in September and December 2022.  She provided an outline of what had been agreed and the minutes were noted.  Councillor Bell advised that the short term funding received for hospital discharges had to be spent between now and the end of March 2023 with a report back to the Board due in the future.


Forward Plan pdf icon PDF 75 KB

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

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The Chair introduced the item and suggested a few additions to the forward plan.  Councillor Bell felt that it would be prudent for the Board to look at the ICB’s delivery plan and consider what it meant for the HWBB.


She also proposed that an item on ‘Access to Healthcare’ be provided at the next meeting, indicating what was being done in acute and primary health care areas. See where we are and what was being done to address issues.


Councillor Bell also felt that, in light of the Director of Public Health’s annual report, the Board should look at where this fitted into the HWBB future agenda.


Russell Hardy (SWFT and George Eliot Hospital NHS Trust) addressed the meeting and highlighted that the Better Care Fund had been hampered by delays in the funding arriving.  He felt that as a ‘lessons learned’ piece, ideally this should be looked at as it would be good to know when funding was arriving and noted it should be in everyone’s calendars.


Nigel Minns (Strategic Director for People) concurred that it had been frustrating, highlighting that spending approval had only been received yesterday for the current financial year 2022/23.  He advised that officers had to take the stance that approval would be forthcoming and did not delay in allocating spending.  He agreed that it would be beneficial if approval could be received before the start of the financial year it was due to be spent in.


The Chair advised that at present the item on the Better Care Fund was labelled on the agenda as an update item but she would keep this under review and would move it to the discussion items section if necessary.


It was agreed that the following be added to the forward plan:


·       Access to Healthcare – an overview of what was being done in acute and primary health care areas;

·       Integration of the Director of Public Health report and the HWBB agenda;

·       Preventing Homelessness in Warwickshire Report - a multi-agency approach – 6 month update



The Chair thanked everyone for attending the meeting.



The meeting ended at 16:11.