Agenda and minutes

The Chairman will welcome those present to the meeting. In addition, the following announcements will be made:

Cllr Richard Clewer, 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.

Cllr Richard Clewer provided the following Chairman’s Announcement that further winter discharge funds would be available in the form of £600m for next year and £1bn in 2024-2025.

To receive any apologies for absence.

Apologies for absence were received from Helen Jones, Nicola Hazle (AWP), Maggie Arnold, Gary McDade (HQSW), Cllr Jane Davies, Kate Blackburn (DPH), Suzanne Wigmore, Dr Edd Rendell, Dr Andy Purbick.

To confirm the minutes of the meeting held on 8 September 2022.

The minutes of the meeting held on 8 September 2022 were presented for consideration.

Decision - The minutes of the meeting held on 8 September 2022 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 19 January 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 23 January. 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 Integrated Care Strategy.

The Board received a presentation from Richard Smale (Director of Strategy and Transformation, BSW Integrated Care Board). The item covered the following matters:

·       It was outlined that the following three key documents must be produced:

i)       Integrated Care Strategy – Developed by the ICP by 31 March 2023

ii)     Integrated Care Implementation Plan – Developed by the ICB by 30 June 2023

iii)    Operating Plan 2023/2024 – by 31 March 2023.

·       It was outlined that currently there are many strategies, and the Integrated Care Strategy would bring together elements from individual strategies whilst trying not to add complexity or duplication.

·       The status of local Health and Wellbeing Strategies was outlined as well as the lead support responsible for production.

·       It was outlined that there is a lot of consistency across the local Health and Wellbeing Strategies in terms of the key themes that have been identified.

·       The emergent priorities for the B&NES and Wiltshire Health and Wellbeing Strategies were discussed and how the sentiments were shared.

·       It was stated that the thoughts of the Board would be welcome for feedback and that this would assist the strategy as it was still in draft form and would be generated over the coming months.

Comments were received in relation to the following points:

·       It was stated that currently there are a lot of strategies currently within the NHS and that there seems to be a lot of plans but not a lot of direction.

·       The deadline of March was emphasised with a need to bring partners together in agreement so that a direction could be set.

·       It was suggested that the report was medical heavy and that would be a challenge for those working in social care and wider public health elements. The importance of having plans as well as strategies was stressed.

·       The importance of language was discussed, with it acknowledged that different areas have differing definitions.

·       It was suggested that to have a direction would be helpful for the Board whilst in transition to understand and articulate the problem is that is looking to be solved.

·       It was questioned what the strategy would look like in five years’ time as well as the importance of what priorities are able to be formed out of data.

·       It was questioned how a member of the public would be able to notice a difference, how would it be possible to describe the difference through a public rather than service lens and how would it be possible to know whether something had been achieved in five years.

·       It was suggested that government guidance be considered in relation to what is expected from the ICS, with the guidance initially clear about prevention work to take demand out of the system.

·       It was suggested that the strategy is an opportunity to take a step back and think long term, rather than being reactive.

·       In April 2023 BSW would be responsible for pharmacies and dentists, it could therefore be an opportunity to use this area  ...  view the full minutes text for item 6.

To discuss the draft Local Health and Wellbeing Strategy.

The Board received an update from David Bowater (Senior Corporate Manager). The item covered the following matters:

• It was noted that the Wiltshire JSNA had been updated and published in Autumn 2022 and that this had informed the development of the draft JLHWS as well as the feedback from the workshop which took place on 1 December 2022. Additionally, it included input from a steering group that incorporated public health, social care, NHS and Healthwatch Wiltshire representatives to shape its structure and priorities.
• It was outlined that the JLHWS was a statement of medium-term goals and would work and be consistent with the themes within the Council business plan as well as linking to delivery through the Wiltshire Integrated Care Alliance.
• The strategy would feed through into the Integrated Care Strategy and Joint Forward Plan and would be an iterative process with due regard to other strategies and would evolve over the following 6 weeks to provide improved accountability for delivery from Board partners against objectives.
• The next steps were outlined in Appendix 2 as well as the meetings and deadlines. Individual partners were encouraged to take the strategy as well as the survey through their Boards with a view to bringing the strategy back to the Health and Wellbeing Board for the March meeting alongside the latest ICS strategy.
• The JLHWS would have a 10-year timeline but could be revisited within that timeframe should the Board need to.
• Attached to the minutes was the consultation survey on the Wiltshire health and wellbeing strategy, which was encouraged to be shared with others as appropriate with responses to be sent to David.bowater@wiltshire.gov.uk  by 15 March 2023.

Comments were received in relation to the following points:

·       Positive feedback was received for the report, with emphasis placed in reference to young people and the report’s reference to the first 1000 days of a child’s life.

·       It was questioned whether greater emphasis could be given to partners such as the military.

·       It was suggested that on page 90 of the report that staff are added to the discussion around how the current health and care system is under pressure as staff are currently confused by the ongoing change.

·       It was suggested that it would be helpful to know where extra money would be placed if there was to be any, to which it was clarified that from a Council perspective this would be included within the budget.

·       The private sector and landlords were identified as a big issue, with there being a lot of transient people who do not feel connected to their local community due to having to move around regularly.

·       It was suggested that in relation to the diagram on page 81 of the agenda, that there would be something to be gained from a similar diagram that considered wider determinants that drive health and care need.

·       The use of data was discussed, how it could be used to identify trends in the future.

·       It was stated that the strategy could be  ...  view the full minutes text for item 7.

To receive an update on the Integrated Care Alliance Work Programme.

The Board received an update from Emma Higgins (Associate Director – Wiltshire ICA Programme and Delivery Lead). The item covered the following matters:

• An update was provided in relation to the Wiltshire ICA, with it noted that a Partnership Committee had been established with two meetings having taken place. Over the coming months the Alliance priorities and work programme would be refreshed and that there was set to be a committee meeting in January.
• The interim delivery areas for 2022-2023 were outlined.
• The ICA work programme for 2022/2023 was outlined with specific reference given to the Alliance Neighbourhood Collaboratives programme and the Connecting with Our Communities programme. Progress updates were provided for both programmes as well as the expected and desired outcomes.
• The principles for the ICA refreshed transformation plan were outlined, which had arisen through development work which had taken place.

Comments were received in relation to the following points:

·         It was suggested that hospital flow had had now been a problem for 2 years, with 57 people currently stuck in the RUH A and E department, though they are fit to go home. It was questioned whether it was known what was stopping each patient from leaving, to which it was clarified that it was pathways of care that was preventing discharge, though the condition of each individual patient was known.

·         It was suggested that the ICS is well sighted of the immediate crisis and that there were other various forums across the ICB where urgent emergency care was being addressed. Additionally, a half-day workshop was set to take place for the Health Select Committee, where scrutiny would be applied to look at the whole system issue.

·         It was suggested that though it is known what pathway of care a patient is on, it can be complex regarding why a patient is or is not ready to be despatched. Additionally, the government is helping to maximise capacity to gain a stronger understanding of the issue.

·         Innovative work is being conducted from BSW in coordination with SWAST, Acute Care providers and community care to look at ambulance calls to determine those who need an ambulance and those who could be dealt with differently using a range of options available.

·         An accommodation centre has recently started in the Great Western Hospital, which has consequently seen less use of ambulances as well as the use of care coordinators to provide prevention and intervention.

·         It was stated that the ICA had been conducting a Discharge Communications Project to discuss discharge with populations and how best individuals can remain out of hospital.

·         The importance of educating people to call GPs rather than 111 was stated as well as the use of technology. Additionally, hospital discharge can sometimes be delayed by the provision of data from the hospital to the ward.

·         It was stated that currently the ICB has a chronic state of escalation and that this has consequently caused problems. It was acknowledged that prevention and early intervention offer long term opportunities for  ...  view the full minutes text for item 8.

To receive an update on the use of additional discharge funding.                                                                          

The Board received an update from Helen Mullinger (Commissioning Manager). The item covered the following matters:

• It was outlined that the Wiltshire Locality had been granted approval for proposed schemes to support hospital discharges during the winter period December 2022- March 2023. This ‘Adult Social Care Discharge Funding’ of £4,265,220 was a pooled fund and would be governed under the existing Section 75 agreement.
• It was stated that schemes had been devised working closely with ICB colleagues to meet the criteria and support the system which was struggling with extreme pressure.
• Several schemes had been in place over Christmas and New Year, with significant outputs already identified and further people recruited and interviewed with several Care Act Assessments and backlogs cleared.
• Further attention was drawn to the announcement that further winter discharge funds would be available in the form of £600m for next year and £1bn in 2024-2025, however it was not yet known what the criteria for this would be with, the potential for some pilot ideas to take place as well as planning for next winter.

Comments were received in relation to the following points:

·       In the week following the meeting of the Health and Wellbeing Board, there would be an ICA meeting to discuss how additional funding could come into Wiltshire and how best this could be used to move towards a sustainable situation away from an escalation model.

·       It was stressed that it would be positive for such funding to have maximum flexibility in terms of how it can be used, with previous examples having had a lot of conditions attached.

·       It was suggested that those present had been suffering from a funding model which had not been fit for purpose as without funding, decisions are unable to be made.

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

i)                The Wiltshire Health and Wellbeing Board noted the allocation, spend and regular monitoring of the BCF winter discharge funds.

To discuss the Military Covenant and implications of statutory guidance for health and care.

The Report attached to the agenda, was introduced to the Board by Will Oulton (Corporate Support Manager), with it outlined that the Military Covenant is astatutory duty which brings the care of the Armed Force Community to the attention of local health partners. Additionally, that a new statutory duty commenced in autumn 2022 for healthcare, housing, and education providers to have due regard to the Covenant and statutory guidance had been published to inform this.

Bernadette Knight (Veterans Health Care Alliance) was in attendance and was invited to speak regarding the report. Bernadette raised the following points:

·       It was outlined that the Military Covenant had been strengthened to ensure that NHS provider organisations would comply with the overarching principles of the Covenant and therefore ensure that individuals with military status were not disadvantaged and were able to have improved healthcare access.

·       The Office of National Statistics published in 2022 that 1/25 people in England have a military status and that such data was important as without knowing the population, NHS providers would be unable to conduct an effective needs assessment.

·       An overview of the Veterans Health Care Alliance was provided, with it noted that the Southwest was most compliant in terms of providers working to the 8 standards outlined to the Health and Wellbeing Board: with 90% of providers meeting standards.

·       The work conducted by the Great Western, Salisbury and Royal United Hospitals was detailed, with it noted that each hospital was at different stages of development, with benefits such as improved discharge identified.

Comments were received in relation to the following points:

·       It was stated that the military was of critical importance to the DNA of Wiltshire, with there being around 32,000 veterans and 20,000 serving personnel and their families living in Wiltshire.

·       The importance of the Covenant as a legal duty to the ICB was stressed, with the need for assurance and evidence required to meet this duty.

·       Jason Goodchild (Ops Manager for Defence Primary Healthcare in Wessex) stated the importance of the Covenant with examples cited of the importance of identifying military personnel to ensure that wrap around care can be provided. Additionally, the issue of soldiers often being recruited and housed in areas that had not been built for the need was highlighted.

·       Reference was drawn to a Healthwatch report produced in 2020 on the experience of military families with health and social care, which identified that military families experience the same problems as other families in Wiltshire but even more so due to moving around. Dentistry was identified as a significant issue.

·       A further update from ICB on this issue later in the year would be welcome.

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

i)                The Wiltshire Health and Wellbeing Board noted the information presented on the implications of the new Armed Forces Covenant Duty;

ii)              The Wiltshire Health and Wellbeing Board noted Wiltshire Council’s assessment of how it is meeting its commitments as a signatory to the  ...  view the full minutes text for item 10.

To receive an update on the Workforce Health Campaign and the results of activity taken by local organisations 12 months on.

The Board received an update from Rachel Kent (Consultant in Public Health) The item covered the following matters:

• It was outlined that in December 2021 the Health and Wellbeing Board had requested that collectively, the organisations of the Board partake in a work force wellbeing campaign.
• A focus of the Mental Health and Wellbeing of Workforces was chosen, with organisations encouraged to go away and then report back once 12 months had passed.
• It was detailed that with Appendix 1 of the report, nine out of eleven organisations had provided feedback, which had focused on mental health training to recognise the early signs of mental and ill health: as well as first aid and suicide prevention training.
• It was noted that Wiltshire Council has introduced Mental Health Advocates, with was demonstrated within the followingvideo.

Cllr Ian Blair-Pilling (Cabinet Member for Public Health, Leisure, Libraries, Facilities Management, and Operational Assets) then spoke to the Board regarding the next steps of the campaign, which included the following points:

• It was questioned what amongst all the systems in place would be the verification that the work conducted is working?
• Though two of the eleven organisations had not reported back to be included within the Appendix, there was nothing to suggested that they hadn’t conducted any work towards the campaign.
• The following options for possible next steps were outlined to the Board:

i)       To carry on with the campaign with a mental health focus.

ii)     To focus on another area such as smoking reduction, reducing obesity or reducing substance abuse.

iii)    To identify another aspect to build the resilience and capacity of workforces.

Comments were received in relation to the following points:

·       The Chairman noted that from a Wiltshire Council perspective, the campaign had made a positive impact and there are other areas of work going on that, such as a piece of work around community conversations that would report back in 6 months’ time, which the board could benefit from hearing about.

·       From a Great Western Hospital perspective, it was suggested that mental health had been embedded and there was a desire to now focus on physical activities as this was a big challenge for public health.

·       It was stated that representatives from the voluntary sector would like to be included in the campaign, with it acknowledged that some organisations have mental health training and champions. Additionally, it is positive to share and learn from information and materials and that there is a huge workforce within the voluntary sector who could promote such a campaign.

·       It was suggested that regarding the template it is difficult to separate out both mental and physical health and that a broader approach would be welcomed.

Following the conclusion of the discussion, the Wiltshire Health and Wellbeing Board agreed for the focus of the Workforce Health Campaign to be smoking cessation. With it the outcome of the campaign to be brought back to the Board in 12 months’ time to see what had been embedded within organisations.  ...  view the full minutes text for item 11.

The next meeting is being held on 30 March 2023, starting at 9.30am.

It was agreed that the next meeting of the Health and Wellbeing Board would be on 30 March 2023, starting at 09.30am.

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

Safeguarding Vulnerable People Partnership (SVPP) Annual Report Submission 2021-2022.

The Board received a presentation from Lucy Townsend (Corporate Director People). The item covered the following matters:

• It was outlined how the SVPP had responded to its priorities for 2019-2020, including areas such as Safeguarding Under 1s, Domestic Abuse and Criminal Exploitation.
• The development and impact of the SVPP was outlined, how communication had improved with partners, improved oversight and governance of multi-agency safeguarding training through the creation of a Practice Development Group as well as working closer with schools, colleges, and early years settings through an Education Safeguarding Committee.
• System assurance of the SVPP was detailed, from both a children and adult’s safeguarding perspective, as well as practice reviews that had taken place in relation to both children and adults.
• The SVPP Strategic Priorities for 2023/2026 were outlined as well as Golden Threads to be developed.
• It was noted that the SVPP Annual reports could be accessed via the following link as well as that the 2021-2022 report attached to the minutes.

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

i)                The Wiltshire Health and Wellbeing Board noted the report provided.