Agenda and minutes

The Chairman will welcome those present to the meeting.

Cllr Laura Mayes, acting Chair of the Board, welcomed all attendees 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 introduce themselves.

Cllr Mayes provided the following Chairman’s Announcement; that the roles of Healthcare Clinical Professional Director, Deputy Chief Operating Officer for the Avon and Wiltshire Mental Health Partnership, and a new representative for Wiltshire Health and Care had been filled by Gina Sargeant, Sarah Branton, and Shirley-Ann Carvill respectively. Additionally, Colonel Ricky Bhabutta OBE, the Regional Clinical Director for Central and Wessex Region – Defence Primary Healthcare, was also in attendance. Cllr Mayes welcomed them to the Board and looked forward to working with them in the future.

To receive any apologies for absence.

Apologies for absence were received from:

·       Cllr Richard Clewer

·       Kevin McNamara - GWH

·       Clare Thompson - GWH

·       Dr Edd Rendell - WLMC

·       Dr Andy Purbick - WLMC

·       Maggie Arnold – SWAC

·       Kate Blackburn - Wiltshire Council

·       Terence Herbert - Wiltshire Council

·       PCC Philip Wilkinson - OPCC

·       Naji Darwish - OPCC

·       Fiona Slevin-Brown – BSW ICB

·       Sarah Branton - AWMHP

·       Val Scrase – (HCRG)

·       Stacey Hunter - NHS

·       Cllr Ian Blair-Pilling

To confirm the minutes of the meeting held on 26 January 2023.

The minutes of the previous meeting of the Board held on 26 January 2023 were presented for considered. After which, it was:

Decision - The Board approved and signed the minutes of the previous meeting of the Health and Wellbeing Board held on 26 January 2023 as a true and 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.

Statements

If you would like to make a statement at this meeting on any item on this agenda, please register to do so at least 10 minutes prior to the meeting. Up to 3 speakers are permitted to speak for up to 3 minutes each on any agenda item. Please contact the officer named on the front of the agenda for any further clarification.

Questions

To receive any questions from members of the public or members of the Council received in accordance with the constitution.

Those wishing to ask questions are required to give notice of any such questions in writing to the officer named on the front of this agenda no later than 5pm on Thursday 23 March 2023 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 Monday 27 March 2023. 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 Committee members prior to the meeting and made available at the meeting and on the Council’s website.

The Chair announced that two questions had been submitted in time for verbal responses at the meeting and had been circulated within Agenda Supplement 1.

As apologies from Fiona Slevin-Brown had been received, David Bowater, Senior Corporate Manager, provided verbal answers for both questions and it was confirmed that full written responses would be provided to the questioners within 5 working days after the meeting.

Q23-01 – It was explained that the Integrated Care Alliance had committed to identifying opportunities to link with all local Health and Wellbeing Groups to identify further hyper local opportunities. Furthermore, Alan Mitchell, Chair of Healthwatch Wiltshire, agreed to attend the Warminster Health and Wellbeing Fair on 22 April 2023, as a representative from the Board.

Q23-02 – It was explained that an update on the Primary Care Network Estate Strategy would be provided at a future meeting of the Board and that a written response would be provided for the Calne Town Council within the week following the meeting.

To receive an update on the final Integrated Care Strategy.

William Pett, Associate Director of Policy & Strategy for the Bath and North East Somerset, Swindon and Wiltshire (BSW) Integrated Care Board (ICB), presented the final Integrated Care Strategy (ICS) to the Board. The item covered the following matters:

·       It was confirmed that the document included within the Agenda Pack had been slightly amended and subsequently approved and published by the ICB on the day of the meeting. However, it was emphasised that the structure and fundamentals of the ICS remained the same.

·       An overview of the ICS was given, reminding Members of the details of the vision, 3 objectives and Care Model. It was emphasised that the ICS would not go into specific details, those would instead be covered in the ICS implementation plan which officers were intending on publishing in June 2023.

·       It was explained that the ICS was not prescriptive and did not dictate how each of the populations in BSW should deliver the strategy over the next 5 years, but instead provided a guide for how partners should work together and the ICB’s expectations.

·       It was explained that the Integrated Care Partnership (ICP) would monitor the ICS over time and would respond and make improvements or changes where necessary to ensure the delivery of a high quality service that targeted action and resources on those most vulnerable.

·       The aim was to provide more integrated services, responsive local specialist services, and would prioritise mental health support as much as physical health.

·       It was reiterated that the ICP first met in October 2022, and as such the ICS had been developed in a relatively short time frame. However, the ICB had mitigated such a constraint by engaging with the public and partners such as the BSW Health and Wellbeing Boards and Integrated Care Alliance (ICA), as much as possible during that time.

·       Members were informed that the intention of the ICS was that it would evolve each year based on feedback and performance monitoring and as such, it was not a finalised document.

During the discussion, points included:

·       The scope of the ICS was highlighted, and Members asked how people with complex disabilities would be supported within the strategy. It was emphasised that the ICS was broad in nature to reduce the complexity and length of the document and that the specificities would be addressed in the implementation plan. However, Members were reassured that across the BSW there would be particular focus areas targeting those in excluded groups, and that over time, feedback and updates on specific groups could be given at future meetings.

·       The importance of prevention and intervention was highlighted, and it was noted that the shift around funding was a challenging but crucial area of focus.

·       The proposed publication date of June 2023 for the implementation plan was raised alongside the aspirational and logistical challenges in delivering both the ICS and implementation plan documents in the short time frame.

·       The importance of continued and innovative engagement methods and making the documents as accessible and clear  ...  view the full minutes text for item 19.

To receive an update on the BSW ICS 5 Year Joint Forward Plan.

David Jobbins, Interim Deputy Director of Planning and Programmes for the BSW ICB, presented an update on the BSW ICS 5 Year Joint Forward Implementation Plan to the Board. The item covered the following matters:

·       An introduction and brief explanation of the plan was provided to Members whereby it was noted that the plan would help to address questions and present a guide for partners.

·       It was further explained that although there was a relative focus on how NHS organisations implement the ICS, the ICB were striving towards further setting out details for how all local partners would work collaboratively.

·       The three principles under which the plan was being developed in line with were described, which would work together to clarify and differentiate between place and system levels, the relationships between the levels, and outline the responsibilities of both.

·       It was reiterated that it would be a working document and would be refreshed annually, with this iteration predominantly focussing on 2023/24.

·       The short timescale until the proposed publication date in June 2023 was raised, and it was emphasised that the level of detail and specificity would change/grow as the document evolved year-on-year.

·       The structure of the plan was explored, and Members were encouraged to provide feedback, as other partners had been. It was explained that the structure was aligned to the 3 strategic objectives within the ICS.

·       The importance of place and people were emphasised, as they were the key to delivering a successful plan and strategy.

·       Appendices to the plan were noted as providing further detail as to its proposed delivery.

·       The topic of engagement was explored, and it was noted that engagement undertaken with partners would align together to ensure that there was no duplication and would be one of the main drivers of growth and change within the plan across the 5 years.

·       Members were informed of the Statement of Compliance process which needed to be completed by June 2023 by each of the Health and Wellbeing Boards across BSW to meet national timescales and requirements.

·       A table outlining the timeline of the plan to publication was displayed.

During the discussion, points included:

·       Further information was sought as to the ICB’s plans for resource allocation once the ICS and plan came into force, to which it was reiterated that further work was needed to finalise details and that these would become clearer and more specific as the ICS was internalised and developed in each annual review and refresh.

·       The short timeframe ahead of the proposed publication date.

·       Questions were asked as to how the plan would be driven as some areas/departments worked well alongside the ICB and ICA, and some were less integrated. It was further noted that conversations about how areas would deliver the aspirations of the ICS were important and needed to be focussed on, particularly on how to best utilise relationships with the ICA.

·       It was noted that although the plan wasn’t completely fleshed out, it did raise the immediate questions of how  ...  view the full minutes text for item 20.

To receive an update on the Wiltshire Joint Local Health and Wellbeing Strategy.

David Bowater, Senior Corporate Manager, presented the final Wiltshire Joint Local Health and Wellbeing Strategy (JLHWS) to the Board. The item covered the following matters:

·       Members were reminded of the Joint Strategic Needs Assessment, which was published in Autumn 2022 and followed by a workshop in December 2022, the results of which were taken through the steering group to aid in the development of the JLHWS which Members agreed to put out for consultation in the previous meeting.

·       The responses gleaned during the consultation period were summarised in Appendix 1 of the report and provided useful feedback which officers used to make minor adjustments to the JLHWS. However, Members were informed that the structure of the strategy with regard to the 4 themes remained unchanged, and it was highlighted that they aligned well with Wiltshire Council’s Business Plan and the ICS’ objectives and vision. 

·       It was explained that the JLHWS would inform commissioning plans for partners. Furthermore, the Statement of Compliance, as aforementioned for the ICS, and the ICA’s Work Programme, would be linked to and informed by this document and the commitments set out within it.

·       It was noted that the document would provide a further safeguard in ensuring accountability across the system, with the opportunity to incorporate the ICB Annual Report and to receive ICA progress reports against the commitments.

·       Members were informed that it was a medium-term strategy and allowed for the ability to respond to any changes made to the ICS, with the metrics being outcomes based. Furthermore, reviews and subsequent changes were being made across the system and processes which meant that there was a lot of flux at present, but with time they would settle and become embedded.

·       Thanks were given to those Members who had provided feedback and had aided in the development of the strategy.

During the discussion, points included:

·       The complexity of simultaneously running multiple strategies which were all interlinked. Members therefore noted the importance of ensuring that all progress reports/updates were as accessible as possible to ensure full understanding and engagement with the information.

·       It was suggested that the JLHWS was referenced within the ICS implementation plan to show the integration between the two.

·       The challenges of external political pressures on the ability to achieve the visions of the ICS, its implementation plan, and the JLHWS were noted, and the importance of focussing on the integration between services themselves as opposed to the strategy and related documents was emphasised.

·       The importance of supporting partners in having those conversations around changing cultures and implementing the strategies was stressed.

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

i)               The Board noted the feedback summarised in Appendix 1 and thanked all Boards, organisations and individual respondents for their input.

ii)             The Board approved the Wiltshire Joint Local Health and Wellbeing Strategy at Appendix 2 for publication.

To receive an update on the ICA Work Programme.

Clare O’Farrell, Deputy Chief Operating Officer at Royal United Hospitals Bath (RUH), gave an update on the Wiltshire Integrated Care Alliance (ICA) Work Programme. The update focussed on 2 key workstreams, namely: Neighbourhood Collaboratives, and Connecting with Our Communities. It was noted that these would both be refreshed to ensure that they aligned with the ICS, its implementation plan, and the JLHWS upon their publications. The following matters were then covered:

Neighbourhood Collaboratives:

·       The model of the workstream including its vision, purpose and membership, was briefly discussed and it was emphasised that there was a focus on using as little medical jargon as possible to increase engagement and understanding.

·       It was explained that the aim of the collaboratives was to help deliver the work of the ICA and other strategies to bring positive change, in order to develop and build vibrant neighbourhoods through strong engagement.

·       The features of a Neighbourhood Collaborative were then discussed, with emphasis placed on the importance of creating an inclusive and data driven approach that listened and responded to local and diverse voices and ensured continuity across services.

·       An update on the March 2023 steering group meeting was given, and it was highlighted that the group allowed for good and productive conversations.

·       It was noted that the ICA were striving to initiate conversations, and where possible, creating collaboratives across Wiltshire by the end of 2023, using existing sites/teams’ feedback to outline a more general approach that could be applied across the County.

·       Progress against the objectives was shown, with 3 highlighted for improvement/actions needed. It was highlighted that the ICA were at a point in which communications and an engagement plan could be started to help residents understand the strategies and see examples of existing collaboratives.

Connecting with Our Communities (CWOC)

·       The purpose of the CWOC group was outlined, namely, developing a ‘helicopter view’ of a good, strong approach and framework for supporting ICA staff in engagement with local communities and determining implementation details.

·       It was emphasised that the groups were not about starting afresh, but rather a more asset-based approach, listening and learning to local voices and building on what already exists.

·       It was noted that a large-scale workshop had been undertaken alongside a membership refresh, and the challenge of ensuring the right partners were included was highlighted.

·       A progress overview was given and the Engagement Advice Framework, colloquially called the ‘Otter’s Den’, was discussed and it was noted that it was a challenging forum that provided constructive feedback and support.

·       The next steps of the group were then outlined, and it was explained that it was a parallel programme of work that would underpin the collaborative programme of work, and was a place where partners could go to further understand any specifics and provide feedback where appropriate.

During the discussion, points included:

·       Members highlighted the importance of the group in improving residents’ quality of life, and it was noted that it would be the right place to discuss piloting different ideas and how to  ...  view the full minutes text for item 22.

To receive an update on the Children’s Community Health Services.

The Chair informed attendees that since the publication of the agenda, officers had stated that they were unable to feasibly give a full update, therefore the agenda item would be brought forward to a future meeting of the Board.

To receive an update on Wiltshire’s SEND Strategy.

Cate Mullen, Head of SEND and Inclusion, and Kai Muxlow, Commissioning Manager – Specialist Services, provided an update on the Special Educational Needs and Disabilities (SEND) and Inclusion Strategy. It was explained that the update would cover the progress made against the 6 priority areas and the plans for the next iteration of the strategy. The following matters were then discussed:

·       The vision of the strategy was outlined, and Members were informed that it was a local area strategy, not just a Council led strategy, therefore partners and stakeholder services were involved in its development.

·       It was explained that feedback had been gathered from young people, families and other interested parties in Wiltshire such as schools, and the Public Health Department, with particular emphasis on the Wiltshire Parent Carer Council (WPCC) who were noted as having the ability to share and gather information from a large reach of families.

·       The 6 priorities that were coproduced for the existing strategy were then outlined and explained and officers provided further details and progress updates on each.

·       It was noted that progress against each of the priorities was discussed within each bimonthly SEND Board meeting.

·       The development of the ‘Growing Up and Moving On’ guides were particularly highlighted as a big piece of work under Priority 6: Well Planned Transitions, whereby feedback was gained through a variety of methods, such as an event held in October 2022 for young people aged approximately 14+, alongside a planned employment engagement event for Spring 2023.

·       The different areas for development were then outlined, with Members informed that each priority was subject to both internal officer and SEND Board level scrutiny.

·       It was highlighted that there was a very broad scope and level of need across children and young people with SEND and therefore, it was a constant challenge to understand how to seek and capture all of their voices.

·       Members were informed that a waiting list initiative was underway in Wiltshire with regard to the high demand experienced nationally for neurodivergent assessment processes. Furthermore, it was highlighted that the continued monitoring and support for parents and children/young people during the Education Health Care Plan (EHCP) process was a significant amount of work which presented resource challenges.

·       It was explained that as SEND was a complex area, the strategy would help to guide and build the confidence of all schools across Wiltshire in understanding local and national drivers and expectations.

·       It was further explained that it was important for the strategy to align with other plans across the Council, such as ensuring that officers built and maintained solid relationships with housing developers when considering new housing estates to ensure that there were adequate SEND provisions in place.

·       As the strategy was initially launched on the brink of the first national lockdown in Spring 2020, inevitable delays impacted on the ability for officers to drive forward certain areas of work.

·       It was explained that significant progress had been made with regard to Central Government SEND plans, such as  ...  view the full minutes text for item 24.

The next meeting is being held on 25 May 2023, starting at 10.00am.

The date of the next meeting was confirmed as 25 May 2023, starting at 10.00am.

The likely agenda items for the next meeting were detailed and Members were informed that as part of the next, or a future meeting’s agenda, officers were intending to bring workshop items to the Board. Members were asked to contact David Bowater with any comments or suggestions for topics that Members would find helpful.

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

There were no urgent items.