Agenda and minutes

Apologies had been received from Louise Bramble, Catherine Driscoll, Peter Pinfield and Shirley Webb.

Louise White attended for Catherine Driscoll and Simon Adams attended for Peter Pinfield.

None

To appoint a Vice-Chairman.

Due to the re-organisation of CCG roles, the position of Vice-Chairman of the Board had been vacant for some time. The Board supported the suggestion that Dr Anthony Kelly should become Vice Chairman of the Health and Well-being Board.

 Members of the public wishing to take part should notify Legal and Democratic Services in writing or by e-mail indicating the nature and content of their proposed participation on items relevant to the agenda, no later than 9.00am on the day before the meeting (in this case 9.00am on 24 February 2020). Enquiries can be made through the telephone number/e-mail address below.

None

The minutes were agreed to be a correct record of the meeting and were signed by the Chairman.

A District Council Member of the Board queried what responsibilities District Councils had around the Special Educational Needs and Disabilities. Louise White agreed to respond in more detail to the query after the meeting.

Simon Trickett explained that the agenda report gave the overall position in Worcestershire with the Long-Term Plan. There had been an evolutionary process over the last 3-4 years since the creation of the Sustainability and Transformation Partnership and a further update document would be produced later in the year.

He drew the Board’s attention to the work that was on-going with the setting up of the Integrated Care system (ICS). One of the main areas of focus in future would be the development of an outcomes framework which would be developed jointly with partners. Work was happening to establish the operational aspects of the Long-Term Plan, such as Primary Care networks where GP practices would work with the Health and Care Trust, social care providers, public health and in some circumstances housing staff.

The CCGs were working on their annual planning process at the current time and would return to Long Term Plan in April. A further update would be brought to the next meeting in May. The Year one operating plan was being produced and would give the priorities for the first year. The plan had looked particularly at Children and Young People, and prevention.

Consultation and engagement with communities had been a key priority throughout the STP and Long-Term Plan journey. Contributions had been received from Healthwatch as well as other partners and public events had taken place where Members of the public could ask questions. The communication process had worked with communities and the community sector partners to enable them to help shape what services would look like. All public consultation was set within the scene of the wider strategic direction of the plan.

It was believed that the Health and Well-being Board should use the long-term plan as an opportunity and see how its priorities fit within the aims of the Long Term plan and work with ICS towards achieving them. The Director of Public Health said this was an ideal time to be involved with the ICS as a new Health and Well-being Strategy would be implemented in 2021.

Various queries from Board Members were addressed:

·       it was acknowledged that workforce was the biggest challenge for the NHS – ensuring there were enough staff who were trained and qualified in the necessary areas. During the recent election campaign there were promises of extra 50,000 nurses and 6,000 doctors. It was hoped that people training in Worcester could be persuaded to remain in the County to work. There was a local Workforce Board which was well attended by local health and social care partners as well as the University.

·       Legal, Financial and HR implications associated with the Long Term Plan were not detailed in the report as the paper just gave a high level strategic view.

·       Community resilience and personal self-management was a large part of the Long Term Plan but public bodies had a responsibility to support people with their ability to self-manage their health, while at the same time accepting that this was not  ...  view the full minutes text for item 560.

Rachael Leslie explained that oral health did not just concern teeth but also the health of gums, mouth and throat. Oral disease had a wide impact on an individual’s health and well-being, but it was preventable and Public Health had a prevention duty to work to improve the health of the whole population and reducing health inequalities. The Public Health Ring Fenced Grant paid for the fluoridation of water supplies where it was fluoridated; around half of Worcestershire had fluoridated water.

An Action Plan had recently been written following the Oral health Needs Assessment which had been completed in 2017. Evidence showed that fluoridation was the number one way to protect teeth and there was strong evidence that teeth brushing schemes and promoting healthy food for young children was effective as well as raising awareness with domiciliary and nursing home staff regarding helping elderly people to maintain their oral health. Usually a combination of factors such as diet, stress, smoking and alcohol contributed to poor oral health.

Overall Worcestershire had low levels of poor oral health compared to other areas of the Country but within the County the areas which were fluoridated had generally better oral health. In areas with greatest deprivation people were more likely to have poor oral health. The Malvern Hills area was not fluoridated but still had good levels of oral health probably because good oral health routines had been taught by parents and maintained.  Poor oral health in children could result in extractions which would be traumatic for children and makes anaesthetic and operations necessary.

The Oral Health Action Plan concentrated on three populations: children, older people and those with learning disabilities. Actions were focussed on prevention, looking at what interventions should be invested in and organising a pilot of a supervised toothbrushing programme and reducing waiting times for children who needed teeth extracted.

In the following discussion various points were clarified:

·       Maintaining oral health was important as periodontal disease can affect other systems in the body.

·       It was acknowledged that it was very complicated picture as to why not all areas were fluoridated and was affected by decisions made when Herefordshire and Worcestershire were one County; various technical reasons and policies in different water companies, counties and countries.

·       The process to introduce fluoridation could take several years and would involve consultation with the population.

·       One of the arguments against fluoridation was that it was considered mass medication and it was a chemical, even though it was only at 1 part per million and there was evidence that it was not harmful.

·       If instructions on toothpaste were followed and the correct amounts uses Fluorosis would not occur.

·       The focus was on Children in order to help with prevention. The Director of Children’s Services supported fluoridation and said they would want to do anything which was evidenced based which would help children.

·       There were complicated reasons why people in deprived areas suffered poorer oral health. Oral health could be affected by having a stable home environment  ...  view the full minutes text for item 561.

Rachael Leslie updated the Board on the Health Improvement Group, a sub-group of the Health and Well-being Board which focussed on local, district delivery of the Board’s priorities: keeping physically active at every age, reducing harm from alcohol and good mental well-being.

Presentations had been received from Bromsgrove and Wychavon regarding their Health Improvement Plans. Briefings had been received around child poverty, substance misuse, Early Help, Making Every Contact Count, Warmer Worcestershire and loneliness.

The previous HIG bi-annual report had encouraged a push to increase the scale of the activities done by the Districts and had also mentioned that attendance at HIG meetings had not been consistently good. Attendance at the meetings had improved over the last few meetings and consequently Districts had found out what was going on with health improvement and health promotion. New members had received an induction on the data which was available.

The Board discussed various areas:

·       The Substance Misuse Needs Assessment appeared to show that actions were not being successful in reducing problems: the numbers seeking help, numbers drinking alcohol at a level hazardous to health and deaths caused by drug misuse were increasing. It was explained that the Substance Misuse Needs Assessment set the scene for the current situation this then highlighted where further work was necessary although it should be noted that a new service had been commissioned for substance misuse from 1^st April. Outside the service which had been commissioned there was a primary prevention role in reducing alcohol use in the general population, a role which may need to be taken up by the STP.

·       It was agreed that a stocktake of existing plans and services should be considered by the Board along with looking at what could be done, what primary prevention could be implemented and whether existing services were working. This should link to mental health providers.

·       It was clarified that District Councils used HIG meetings to share ideas about what worked well with the individual District Health Improvement Plans.

·       Worcestershire Children First were happy for Public Health to take the lead with child poverty and WCF would support strategically.

·       Making Every Contact Count training would give staff the skills and confidence to have a brief, opportunistic conversation around improving lifestyles and could be delivered by a 30 minutes on-line training session, face to face or through train the trainer sessions. It was hoped that more training sessions could be organised for NHS organisations. Contracts with Voluntary Organisations and Social Care companies included the requirement that all staff should be MECC trained.

RESOLVED that the Health and Well-being Board:

a)     Considered and commented on progress made by the Health Improvement Group between June 2019 and December 2019, and

b)    Would ensure that each organisation represented by the Board plays an active part in the delivery of the Joint Health and Well-being Strategy and would fully participate in providing the necessary updates and information for the reporting of progress.

Andy Roberts, Cabinet Member for Children and Families, explained that Children and Young People’s Strategic Partnership Board was a sub-group of the Health and Well-being Board. At the previous meeting of the Partnership Board it had been discussed that although Ofsted had given a good rating for Children’s Mental Health Services, more could be done with Partnership Working and to help children in need onto the pathway to access services, especially Looked After children. It was hoped that all children entering into care should have a CAMHS assessment and more generally to improve the pathway for children to have access to CAMHS.

There was a request for senior system support for mental health services to be improved for children who were under the CAMHS threshold. The links to schools and services such as education psychology, health visiting and school nursing were important. There needed to better links between family front door, CAMHS and public health so that the patient pathway was seamless. The Healthwatch representative commented that they had received comments that lots of children were not ill enough for CAMHS but needed some help, therefore there was a considerable opportunity to invest to save.

RESOLVED that the Health and Well-being Board:

a)     Approved the proposed approach to improving mental well-being for children and young people, and

b)    Would ensure that senior system commitment is provided.

Dates for 2020

Public meetings (All Tuesday at 2pm)

·        19 May 2020

·        29 September 2020

·        17 November 2020

Private Development meetings (All Tuesday at 2pm)

·        31 March 2020

·        23 June 2020

·        20 October 2020

Dates for 2020

Public meetings (All Tuesday at 2pm)

·        19 May 2020

·        29 September 2020

·        17 November 2020

Private Development meetings (All Tuesday at 2pm)

·        31 March 2020

·        23 June 2020

·        20 October 2020

It was proposed that the session on 23 June be used to consider the next Health and Well-being Strategy.