Agenda and minutes

The Chairman will welcome those present to the meeting.

Dr Edward Rendell, Co-Chair of the Board welcomed everybody to the meeting.

Before the meeting began each Member of the Board, other Councillors and

officers who would be contributing to the meeting were given the opportunity to

confirm their attendance for those watching the live stream of the meeting.

Dr Rendell provided the following Chairman’s Announcements:

·       Wiltshire Pharmaceutical Needs Assessment

To receive any apologies for absence.

Apologies for absence were received from Elizabeth Disney, Stacey Hunter, Stephanie Elsy, Andrew Girdher, Kieran Kilgallen, Gareth Bryant, Tony Fox, Kevin McNamara, Cllr Ashley O’Neill, Douglas Blair and Laura Nicholas.

To confirm the minutes of the meeting held on 8 July 2021.

The minutes of the meeting held on 8 July 2021 were presented for consideration.

Decision - The minutes of the meeting held on 8 July 2021 were agreed as a correct record.

To declare any personal or prejudicial interests or dispensations granted by the Standards Committee.

There were no declarations of interest.

The Council welcomes contributions from members of the public. During the ongoing Covid-19 situation the Council is operating revised procedures and the public are able participate in meetings online after registering with the officer named on this agenda, and in accordance with the deadlines below.

Guidance on how to participate in this meeting online.

Statements

Members of the public who wish to submit a statement in relation to an item on this agenda should submit this is electronically to the officer named on this agenda no later than 5pm on 29 November 2021. State whom the statement is from (including if representing another person or organisation), state points clearly and be readable aloud in approximately 3 minutes. Up to three speakers are allowed for each item on the agenda.

Questions

Those wishing to ask questions are required to give notice of any such questions electronically to the officer named on the front of this agenda no later than 5pm on 25 November 2021 in order to be guaranteed of a written response. In order to receive a verbal response questions must be submitted no later than 5pm on 30 November 2021.

Please contact the officer named on the front of this agenda for further advice.

Questions may be asked without notice if the Chairman decides that the matter is urgent. Details of any questions received will be circulated to members prior to the meeting and made available at the meeting and on the Council’s website; they will be taken as read at the meeting.

There were no questions raised by members of the Public to be answered at this meeting.

To receive an update on the Integrated Care System (ICS) and to discuss proposals regarding a new meeting format.

The Board received an update and report from Lucy Townsend (Corporate Director of People, Wiltshire Council). The update covered the following matters:

·       It was explained that the reason for bringing the report to the Health and Wellbeing Board was due to the changing governance across BSW regarding developments of the ICS and ICA. Therefore a series of activities have taken place, which included consideration of how the Health and Wellbeing Board should operate in the future.

·       The report featured a number of recommendations with consideration of how the Health and Wellbeing Board would link to the placed based partnership, the Alliance. Additionally, there is an MOU and Terms of Reference agreement of the proposed statutory structures, which will be submitted to the NHS Partnership Board as well as the Wiltshire Council Cabinet in December; once signed off from both it will be suitable to go live in April 2022.

·       Regarding main considerations, there is emphasis on the new system, that the Health and Wellbeing Board will be the owner of the strategy for the all age population of health for those in Wiltshire. With a collective delivery and accountability, rather than solely individual accountability.

·       Regarding the workshops that have taken place, there have been positive statements regarding the values and behaviours that would be expected from partners with Terms of Reference taking in to account emerging membership on other place boards.

·       It was also noted that Healthwatch Wiltshire engages with the wider VCS in undertaking of this work, with an awareness that this may not be sufficient on its own, with consideration required on other mechanisms used to engage with partners.

·       Regarding meetings, there is a desire for less of a “show and tell” approach, with papers published in advanced to allow adequate time for challenge and support. Papers must also have a clear link to the joint Health and Wellbeing Strategy priorities.

In addition, the Board noted comments on the following matters:

·       It was queried what was meant by Healthwatch engaging with the wider VCS, as it was stated that this something that is already taking place and could result in resource implications if different is expected. It was clarified that the report was aware of what Healthwatch is currently doing regarding engagement with the wider VCS, and wanted to formalise links with the voluntary and community sectors.

·       It was queried whether the report is solely linking the public voice to the VCS rather than the wider care system. Clarity was provided that the intention is for public voice to be linked broader than solely the community sector and that public voice will be maximised to develop and deliver priorities.

·       It was stated that the Joint Strategic Needs Assessment needs to be refreshed and though the Public Health Team lead on this, active participation will be required from partners in order to make the end product more valuable.

·       It was queried within the proposal what was meant by “Informal meetings should focus on professional development”. Clarity was provided that  ...  view the full minutes text for item 29.

To provide organisations of the Health and Wellbeing Board with an evidence-based approach to improving workforce health and wellbeing across agencies collectively.

The Board received a paper on a Public Health Workforce Campaign, presented by Kate Blackburn (Director of Public Health). The presentation covered the following matters:

• It was acknowledged that the role of the Health and Wellbeing Board is to bring together the political, clinical and professional leaders across the healthcare system to reduce health inequalities and improve the health of the wider population.
• The majority of the collective of staff live within the boundaries of Wiltshire, therefore presenting an opportunity to improve staff health as a starting point, before expanding to improve the health of the wider population.
• The paper provides all organisations within the Health and Wellbeing Board an evidence-based approach to improving workforce health collectively. It is known that good health and wellbeing is essential for successful and sustainable work places.
• Based on the population data of Wiltshire, risk factors commonly relate to areas such as smoking, drinking and cancer; however it is acknowledged that if there isn’t good mental health, physical interventions will not succeed. The first stage has therefore been recognised as improving health and wellbeing.
• It was acknowledged that though individual workplaces will have policies, more work needs to be done with the organisations of the Health and Wellbeing Board coming together.
• It was outlined that Step 1 focuses on emotional wellbeing and resilience, with Step 2 then focusing on lifestyle factors and interventions. There are a range of interventions and indicators that can be used to track progress, ultimately seeing how this links to the wider work and principles of the ICS and ICA.
• As one of the key BSW ICS tools, the Public Health team and Kevin McNamara are producing training in relation to making every contact count.

In addition, the Board noted comments on the following matters:

• The Chairman noted that though apologies had been received on behalf of Kevin McNamara; Kevin had stated that having read the paper the Great Western Hospital can commit to recommendations 1-3. Additionally, the Great Western Hospital has a Board endorsed Healthy and Wellbeing Strategy, which was agreed earlier in the year.

• Kier Pritchard endorsed and signed up to each recommendation from the Wiltshire Police perspective. It was stressed that for the Police, mental health and wellbeing is critical, with the Police constantly making use of staff surveys to evaluate workforce. Having seen increases in anxiety in the past 12 months, Wiltshire Police have signed up to a national Blue Light Together programme to help to preserve and increase mental health and wellbeing.
• Stephen Ladyman stated that Wiltshire Health and Care were happy to sign up to the recommendations, however noted that there is a need to make sure reporting is light touch. Kate Blackburn agreed that the reporting should be light and meaningful, whilst allowing the collective effort to be greater than an individually.
• Councillor Richard Clewer added that there is benefit to monitoring and reporting back, with reporting critical to handling any issues the Health and Wellbeing Board is looking to address. Councillor  ...  view the full minutes text for item 30.

To receive the annual Safeguarding Vulnerable People Partnership Report.

The Board received a presentation and report from Mark Gurrey (Independent Chair of the Safeguarding Vulnerable People Partnership). The presentation covered the following matters:

Background of the Safeguarding Vulnerable People Partnership

• A background of the SVPP was provided, with the formation of the SVPP taking place in February 2019, following the Sir Alan Wood Review (2016) and Working Together Report (2018).
• The SVPP replaced the Local Safeguarding Children Board (LSCB) and brings together the leads of Wiltshire’s services to develop a shared and equal responsibility for safeguarding arrangements.

An overview of the past year

• A Pan-Wiltshire Exploitation Sub-group was established in order to further support the response to exploitation and the contextual safeguarding approach.
• A review and restructure of the Safeguarding Adult Board as well as the Community Safety Partnership took place for improvement.
• A partnership approach was established for both statutory and non-statutory case reviews.
• The SVPP responded to the pandemic by using demand modelling to provide estimates on future demand to support response and future planning; a Covid-19 Safeguarding Review, which was a system-wide review of practice; as well as supporting frontline staff.
• The SVPP led the response to the Everyone’s Invited website.
• Practice was embedded in relation to rapid reviews on children who had died or been seriously harmed through abuse or neglect, with the National Child Safeguarding Practice Review Panel providing positive feedback.

Case Reviews relating to children

• Since June 2018, the SVPP have made 10 notifications to the Child Safeguarding Practice Reviews national panel. Consequently 8 Rapid Reviews have taken place, including 6 featuring Under 1s, which is in line with national statistics.
• Additionally, a Thematic Review into the Significant Physical Abuse in Under 1s has taken place.

Priorities and next steps

• Work is being conducted in relation to safeguarding Under 1s and in an effort to streamline work, it has been agreed that the best lead for this work is the CCG across their own footprint. An Under 1s sub-group is therefore going to be developed to look at both local and national cases.
• Domestic Abuse (being led under the Community Safety Partnership), is a major safeguarding theme and there is a need to respond to the new Domestic Abuse Act.
• Exploitation and contextual safeguarding work will continue to progress having started in the past year.
• Regarding adult safeguarding, work is being done around mental health and learning disabilities, and the extent to which these needs are recognised and responded to.
• The SVPP wants to look at the leadership and cultures within partner organisations in order to consider the current systems under which safeguarding work is conducted.

Wider Developments

• New requirements have been put in place to define and develop the independent scrutiny in a robust and widespread manner of the SVPP.
• The DFE has provided funding for a post in order to develop a new approach to the collation and analysis of intelligence of data.
• The SVPP is seeking to continue with its partnership approach to practice reviews and to then embed the  ...  view the full minutes text for item 31.

To receive an update from Healthwatch Wiltshire.

The Board received a report and update from Stacey Sims (Manager, Healthwatch Wiltshire) Zoe Millington (Wiltshire CIL) and Amanda Attwood (Mental Health Forum). The item covered the following matters:

Work around Autism spectrum conditions

·       Joint work was conducted with the Wiltshire Service Users Network (WSUN) in late 2020/2021, with 2 surveys ran for people with Autism spectrum conditions and then one for their carers. The surveys gained feedback from 102 people, which included the experiences of service users, highlighting that people had felt that they didn’t get enough support in terms of their condition. Potential solutions to improve experiences were suggested, such as an easy-to-read directory of services offered as well as site maps and additional staff training.

Wiltshire Mental Health Open Forum

• The Forum was established in July 2020, ran jointly between Healthwatch Wiltshire, mental health service users and the Avon and Wiltshire Mental Health Partnership NHS Trust (AWP). The Forum runs monthly and offers a space for service users as well as those who support them, to speak directly to those running mental health services, allowing them to get involved in the designing of services whilst identifying potential gaps. The Forum also created a resources list which having been downloaded over 400 times,  sharing information about the local support available.
• Over the past year, the Forum has met 12 times with a guest speaker each time, averaging an attendance of 25 people, which with the feedback provided has helped to shape 4 services.

The future of mental health support

• Healthwatch Wiltshire has hosted workshops with the Wiltshire Centre for Independent Living (CIL) as well as the Wiltshire Parent Council; with 3 sessions were held online, in Banes, Swindon and Wiltshire. The workshops identified prevention as a key theme; a need for local communities to utilise local assets; for support to be provided on a variety of platforms in a timely, realistic and sustainable manner; with support provided co-produced and strengths based.
• Since the workshops, a number of recommendations have been identified and a number of organisations have reached out to share experiences through a workshop specifically for organisations. The feedback provided was similar to what was presented from those with lived experiences and a report is now being produced.

Evaluation of Wiltshire Council’s Advice and Contact Service

• A survey was sent out by the Advice and Contact team to callers, as well as the completion of telephone interviews. A mystery shopping exercise was also completed, with volunteers making calls to the Advice and Contact team based on 5 differing scenarios. In total the survey received feedback from 44 people.
• Overall 63% of those surveyed were very satisfied or satisfied with the service, however some were dissatisfied in follow up support or the advice and information given.
• As a result Healthwatch have since worked with the team to produce a checklist to add consistency to calls.

In addition, the Board noted comments on the following matters:

• It was clarified that in regard to the Forum, there is no  ...  view the full minutes text for item 32.

To receive the Child and Youth Voice Mental Health Consultation.

The Board received a report from Sara James (Service Manager for Quality Outcomes Children and Families) and Joe Sutton (Youth Voice Lead Worker). The item covered the following matters:

·       It was outlined that 175 young people had taken part in a survey regarding what they thought of the services available to them, which was then presented to leaders of Wiltshire Council before agreeing which actions need to be taken forward. The survey aim was to ensure that the voices of young people are listened to, seeking to improve access around the delivery and access of mental health wellbeing services for young people.

·       In summary, the feedback presented that young people would like an accessible, coordinated and joined up approach from services, so that they don’t have to wait. Additionally, there was desire for the availability of drop-in centres in local communities to support mental health, as well as providing an opportunity to meet others for peer-to-peer support. Young people voiced that there is a need for a need for access to timely mental health support as well as for a reduction in waiting times.

In addition, the Board noted comments on the following matters:

·       It was stressed that there is an importance of the Health and Wellbeing Board being aware of what can and cannot be delivered in order to avoid making empty promises.

·       It was questioned whether young people, had raised any concerns about physical exercise, as it is known physical exercise can increase mental wellbeing. Joe Sutton responded that one of the best recognised support mechanisms by young people was music and that when young people seek support, they feel as though they have gone past the point of such things as exercise.

·       Lucy Townsend asked whether mental health could potentially be taken further through ICA ownership as a priority.

·       Councillor Richard Clewer agreed that there is a need to understand priorities, as well as capacity and the critical issues that need to be addressed before reaching the conclusion of priorities. Empirical and anecdotal evidence is needed in order to understand what should be prioritised.

·       Councillor Gordon King spoke in agreement with Lucy Townsend that mental health is a subject that the ICA should take leadership on, to ensure that resources are in place and that the health and wellbeing of the population is future proofed.

·       Gillian Leake raised that a list of easily accessible mental health support is available on the Young Healthwatch website.

Decision – The Wiltshire Health and Wellbeing Board accepted the following recommended proposals:

i) To hear the voice of children and young people and give consideration to their concerns and ideas for improvement regarding access, delivery and outcomes of services for mental health and wellbeing. Additionally, to develop an action plan.

To receive the Wiltshire Better Care Fund (BCF) Plan for the period of 2021/2022.

The Board received a report from Helen Jones (Director of Procurement and Commissioning, Wiltshire Council) and Melanie Nicolau (Programme Lead for Adult Commissioning, Wiltshire Council). The item covered the following matters:

·       A joint plan from Wiltshire Council and the BaNES, Swindon and Wiltshire CCG, for a pooled budget was presented, under the name of the Better Care Fund.

·       It was outlined that the focus of the plan is to enable people to remain independently well at home and then in the event of hospital admission allowing for a return home as soon as possible.

·       It was acknowledged that though the plan has been signed off by the Chairs of the Health and Wellbeing Board, it was brought to the meeting for any further information and questions.

·       The plan is a demonstration of the work that has taken place across the health and wellbeing system over the past 18-months, including continued investment in out of hospital services, significant investment in home first reablement as well as the development of a new service, the Wiltshire Support at Home Team.

In addition, the Board noted comments on the following matters:

·       Concern was raised regarding no mention of the public voice within the report. Though it is referenced that the development of services is evidenced based, it was queried whether local people have been asked whether these are the best outcomes for them. It was clarified that in all service development conducted, there has been focus on the needs of individual needs of service users, with inclusion of co-production as well as the voice of the user. An example was provided of the Reablement Team, who consistently receive feedback to enable them to improve the service offered.

·       It was acknowledged that this is the first time that Better Care Fund has been used in the way that it has for work in mental health and learning disabilities. Additionally, a piece of co-production is taking place with the Wiltshire CIL and the Wiltshire Parent Carer Council regarding the voice of the person, transitions and how it feels to move through services.

·       Feedback from the Royal United Hospital was provided, that their experience of Wiltshire using the Better Care Fund has been proactive and agile, especially when dealing with pinch points.

·       Reassurance was provided in regard to the Wiltshire Council reablement service, that every person and their family who goes through the service are asked about their experiences, with quality-of-life measures used to evidence impact with approval scores above 90%.

Decision – The Wiltshire Health and Wellbeing Board accepted the following recommended proposals:

i) Approves the BCF plan.

The next meeting is being held on 10 February 2022 starting at 10.00am.

The date of the next meeting is 10 February 2022 at 10:00am.

Any other items of business which the Chairman agrees to consider as a matter of urgency.

It was observed that there was little comment or question regarding the Safeguarding Vulnerable People Partnership (SVPP) Annual Report item. Partners in attendance were therefore asked to ensure that they are confident in the safeguarding within the organisations that they’re representing, as well as whether the SVPP is sufficiently addressing areas of concern that they are seeing.