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 introduce themselves.

Dr Rendell provided the following Chairman’s Announcements:

·       Regional Webinar

To receive any apologies for absence.

Apologies for absence were received from Douglas Blair, Philip Wilkinson, Cllr Richard Clewer, Marc House, Tony Fox, Tracey Cox, Stacey Hunter, Andrew Girdher, Sue Harriman, Terence Herbert, Dr Nick Ware, Suzanne Tewkesbury, Laura Nicholas, Val Scrase, Christina Button and Kieran Kilgallen.

To confirm the minutes of the meeting held on 2 December 2022.

The minutes of the meeting held on 2 December 2021 were presented for consideration.

Decision - The minutes of the meeting held on 2 December 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.

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 24 March 2022 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 Tuesday 29 March 2022. 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.

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

To receive an update on the feedback from the Inequality Workshop as well as the Alliance Programme. – Please note that a report for this item will be published as a later agenda supplement.

The Board received an update from Elizabeth Disney (Wiltshire Locality Chief Operating Officer) and Lucy Townsend (Corporate Director of People, Wiltshire Council).

Alliance Work Programme Update and Inequality Workshop Feedback

The update covered the following matters:

• A timeline was provided outlining the development of the Wiltshire Alliance.
• An update was provided on the agreed priorities of the Alliance for 2021/2022, with progress reviews provided of each project.
• An update was provided on a recent Alliance Development Day which took place on 17 March, which had a theme of focusing on inequality within the Wiltshire Alliance (ICA).
• Attention was drawn to the agenda pack, which featured feedback from the Health and Wellbeing Board workshop, which had a focus on inequalities.

Comments were received in relation to the use of existing data to predict future trends, to which it was clarified that such approaches currently take place with predictive modelling in operational health and social care services as well as with a longer-term lens of population health management. Demographic growth was cited as a way of predicting demand change, with it noted that other layers of data can be added such as cost of living to provide further depth of analysis.

In addition, it was questioned where within the work there was an emphasis on children and young people, to which it was clarified that though the slides focused more on adult services there is a requirement to look at children. Furthermore, it was noted that when looking at population health management, the lens of children and mental health could be used.

Another layer for analysis was discussed as being the cost-of-living crisis and how might this increase demand for services. Through understanding what the demand might be like, there would be the opportunity to change how health care services are offered through the ICS. It was also acknowledged that in order to provide more layers of data, organisations need to be brought together in order to understand local populations.

BSW Inequalities Strategy 2021 – 2025

The update covered the following matters:

·       Context was provided in regard to the Inequalities Strategy, with the aim to provide a framework for system activity to reduce health inequalities.

·       A summary of the strategy was provided, which included a three-phase approach.

·       The NHS Core20Plus5 approach was outlined to the Board, which was designed to support Integrated Care Systems to drive targeted action in health inequalities improvement.

·       Implementation of the BSW Inequalities Strategy was outlined, with the three phases equating to short-, medium- and long-term visions.

Comments were received in relation to how Core20plus5 could have an important impact on healthcare inequality and how it had been produced on data to identify where the biggest difference could be made, with areas not in isolation to others, such as the cost-of-living crisis and mental health in the pandemic. Kate Blackburn also noted that there is hope of Wiltshire Public Health to be a national pilot area, with a programme of training taking place through the BSW  ...  view the full minutes text for item 42.

To receive an update on the Board Membership as well as ICS Developments. – Please note that a report for this item will be published as a later agenda supplement.

The Board received an update from Elizabeth Disney (Wiltshire Locality Chief Operating Officer) and Lucy Townsend (Corporate Director of People, Wiltshire Council). The update covered the following matters:

• An overview of the Integration White Paper was provided, with the aim of joining up care for people, places and populations. The vision for the White Paper was also discussed with emphasis on a shift towards prevention.
• Four key areas of work within the White Paper were outlined with an aim to have shared outcomes, which will be implemented in April 2023 following a consultation period.
• Integrated Care Partnership Expectations were outlined as well as a timeline of indicative dates.
• An overview of the BSW Integrated Care System (ICS) was provided along with a diagram to explain each individual component of the ICS along with their specific roles.
• Recent ICS developments were highlighted to the Board.

Comments were received in relation to how the average person in Wiltshire will notice the difference in the service they received. It was stated the ICS developments and White paper would provide the formal architecture to connect with communities as well as providing platforms that clear existing challenges and the legalities of sharing budgets. A worked example was provided, which included the funding of Better Care staff and their enablement to provide outreach services which started during the pandemic but has now been funded to continue. An overlying theme of shifting to prevention was stated, with an emphasis on providing the right care at the right place and time in order to improve services and to prevent necessary escalation. It was also noted that though the population won’t notice an impact day to day, they will be able to see impacts such as the work taking place in Trowbridge.

Furthermore, long term it was expressed what an impact could be on providing equal opportunities for populations, such as those in Trowbridge, with people experiencing better opportunities through better health. This in turn could eventually lead to the Trowbridge population starting to change the cyclical factors of deprivation.

It was also stated that shared a shared sense of accountability and budget would make sense with reduced budgets whilst trying to manage demand in a preventative way, with it recognised that prevention plays a key role from a policing perspective. It would therefore be positive to identify success factors and a framework of shared outcomes, with a focus on high impactive outcomes in order to ensure that they are measurable.

A further example of joint working was cited by Alison Ryan, who stated that joint working has allowed acute services to move four children off of the list for oral surgery having moved patients to where the capacity is. Recruitment is also being explored as a way of creating apprenticeships to recruit into social care with possibilities of moving into higher esteem health care.

A point was raised regarding the consequences of prevention, which would have to be planned for, as currently there isn’t the facilities to look  ...  view the full minutes text for item 43.

To receive a presentation on the Wiltshire Community Safety Partnership (CSP) Draft Strategy from Assistant Chief Constable Mark Cooper, Chair of the Wiltshire Community Safety Partnership. – Please note that a report for this item will be published as a later agenda supplement.

The Board received a presentation from Assistant Chief Constable Mark Cooper, Chair of the Wiltshire Community Safety Partnership.

Wiltshire Community Safety Partnership (CSP) Draft Strategy

The presentation covered the following matters:

• An overview of the Community Safety Partnership (CSP) was provided, with it noted that the CSP is required by law under the Crime and Disorder Act 1998 (2007 regulations) to produce a three-year strategy.
• Two focuses of “Keeping our communities safe” and “Protect vulnerable people from harm” were outlined with how the CSP seeks to address priorities, as well as cross-cutting themes.
• It was clarified that the work of the CSP includes road safety.

Comments were received in relation to how the cost-of-living crisis will have a dramatic affect on communities, with there likely to be a higher level of deprivation and risk of harm with inequalities likely to grow. It was noted that the Board needs to take the moment as an opportunity to create a preventative space to focus on the best level of delivery to improve the population, with information drawn from the CSP and JSNA. It was also suggested that the presentation was relevant to the Health and Wellbeing Board in the way of how wider aspects affect individuals and that prevention could be an area for investigation, potentially through the means of a workshop. This linked in with prevention and partnerships being used collectively in order to identify risks earlier in order to divert people away from statutory and secondary services in mental health. Additionally, learning points can be taken from the CSP and SVPP, with existing functions available being used to unpick conflicting ideas and priorities.

It was also questioned how would the JSNA and CSP work get brought together with data mapping on top, with it noted that nationally there hasn’t been data modelling yet on specific areas. It would be a matter of working together to understand each partner’s priorities in order to produce an output with limited resources.

From harm to hope: A 10-year drugs plan to cut crime and save lives

The presentation covered the following matters:

• An overview of the 10-year drug strategy was outlined, which had been produced by central government.
• Information was provided in regard to “Op-Scorpion” which had the aim of making the Southwest a hostile environment for drug dealing and anti-social activity. This also reflected changes that had been seen to the county line model during the pandemic. At time of reporting over 300 acts of safeguarding and referrals had taken place with those vulnerable offered outreach services.

Comments were received in relation to how it was positive to see tangible results from “Op-Scorpion”. Additionally that drugs remain a key issue that sits at the centre of harm and exploitation and that it was recommended as being a core focus for the Health and Wellbeing Board with opportunities for partnership work. In addition, it was clarified that support was in place for those who had been coerced into criminal activity with exploitation seen  ...  view the full minutes text for item 44.

To receive a presentation on the Wiltshire Pharmaceutical Needs Assessment from Sammer Tang (Specialist Registrar in Public Health).

The Board received a presentation from Gemma Brinn (Consultant in Public Health). The presentation covered the following matters:

• The Health and Wellbeing Board has a statutory responsibility to develop and update the Pharmaceutical Needs Assessment (PNA) as mandated by the Health and Social Care Act 2012.
• The PNA is a tool used to identify what is needed at a local level, in order to support the commissioning intentions for pharmaceutical services and to form the basis for determining market entry to the pharmaceutical list.
• A Wiltshire Pharmaceutical Services Steering Group was set up to guide the development of the PNA, with a draft document signed off on 17 February 2022 with statutory consultation scheduled to start form April 2022 for 60 days. The final PNA would then return to the Health and Wellbeing Board in September.
• The key findings of the PNA were outlined to the Board.

Comments were received in relation to how the PNA is a real opportunity to consider what pharmacies mean geographically and to different levels of services in the community. It was also noted that the BSW care model has a desire to provide services as close to home as possible and that there is an opportunity through the ICS to think about what services could be offered in future as pharmaceutical commissioning becomes part of the ICS. The importance of offering preventative and proactive services as also stressed.

In addition, a query was received about prescribing pharmacies, to which the Chairman clarified that though there are strict prescription rules, there is a minor illness scheme coming into Wiltshire and Swindon which would allow for more ability for pharmacies to prescribe. Further information was also provided that all graduate pharmacists will now have the right to prescribe, therefore increasing opportunities for pharmacies to issue. Furthermore, it was stated that there have been an increasing number of pharmacists working in GP practices throughout the network.

A question was received in regard to why the PNA doesn’t include mental health, to which it was clarified that the population reviewed in the PNA is all encompassing, with no specific groupings or needs; this could however be an area for future development.

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

i) That the Board agrees the draft PNA and to proceed to statutory consultation.

The next meeting is being held on 16 June 2022, starting at 9.30am.

It was agreed that the next meeting of the Health and Wellbeing Board would be on 16 June 2022, starting at 09.30am.

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

As Chair of the National Autistic Society, Stephen Ladyman informed the Board that next week would be World Autism Acceptance Week and that those in attendance should inform their organisations.

On behalf of the Board, Cllr Laura Mayes thanked Dr Edd Rendell for his work for the Board with this meeting being his last in role.