Agenda and minutes

Venue: The Oculus, The Gateway, Gatehouse Road, Aylesbury, HP19 8FF

Contact: Sally Taylor 

Media

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Items
No. Item

1.

Welcome

Additional documents:

Minutes:

The Chairman, Cllr Angela Macpherson, Deputy Leader and Cabinet Member for Health and Wellbeing, welcomed everyone to the meeting and explained that some partners had joined the meeting remotely. 

2.

Apologies

Additional documents:

Minutes:

Sally Taylor, Democratic Services Officer, advised that there had been a change in membership; Dr Nick Broughton, Chief Executive, Oxford Health NHS Foundation Trust had re-joined the Health and Wellbeing Board (HWB) as Debbie Richards had left the Trust.

 

Apologies had been received from Robert Majilton, Deputy Chief Accountable Officer, Buckinghamshire Clinical Commissioning Group (CCG); Richard Nash, Interim Corporate Director, Children’s Services, Buckinghamshire Council (Simon James, Service Director, Education attended in place of Richard); Zoe McIntosh, Chief Executive Officer (CEO), Healthwatch Bucks; Dr James Kent - Chief (Accountable) Officer and Integrated Care Systems (ICS) Executive Lead; Dr Nick Broughton, CEO, Oxford Health Trust, (Tehmeena Ajmal, Interim Executive Managing Director, Oxford Health Trust attended in place of Dr Broughton); Cllr Anita Cranmer; David Williams, Director of Strategy and Business Development, Buckinghamshire Healthcare NHS Trust (BHT); Cllr Carl Jackson and Gill Quinton, Corporate Director, Adults and Health.

 

Note:  Martin Gallagher arrived at 9.45 am

Note:  Neil Macdonald left at approximately 11.40 am

3.

Announcements from the Chairman

Additional documents:

Minutes:

The Chairman advised that the aim for future meetings was to accommodate as many partners and members of the public as possible so there would be changes to the location and meeting dates; any changes would be published on the website and members of the Board would receive updated meeting invitations.

 

The Chairman announced that the Buckinghamshire Integrated Care Partnership (ICP) had nominated Neil Macdonald, CEO, BHT, as Vice-Chairman of the HWB as set out in the Terms of Reference.

 

The Chairman also welcomed Cllr Steve Bowles, Cabinet Member for Communities to the HWB.

 

4.

Declarations of Interest

Additional documents:

Minutes:

Dr Raj Bajwa, Clinical GP Chair, CCG, declared an interest for himself and on behalf of all the board members who worked in primary care, in the primary care components of the meeting. 

 

5.

Minutes of the previous meeting pdf icon PDF 582 KB

To agree the minutes of the meeting held on 22 July 2021.

Additional documents:

Minutes:

It was noted that the minutes of the meeting held on 22 July 2021 stated that the date of next meeting was 14 October 2021, however, this meeting was cancelled and re-scheduled to 18 November 2021.

 

Resolved:  The minutes of meeting held on 22 July 2021 were agreed and signed by the Chairman.

 

6.

Public Questions pdf icon PDF 388 KB

In order for a response to be provided at the November Health and Wellbeing Board, questions must be received by 9.00 am on Monday 15th November 2021. Any questions received after this deadline will be responded to at the following Health and Wellbeing Board meeting.

 

Additional documents:

Minutes:

The Chairman stated that the HWB encouraged public questions and welcomed public engagement.  Questions needed to be submitted by 9.00 am on the Monday before the meeting and ad hoc questions were unable to be taken on the day.  Cllr Katrina Wood and Cllr Mark Winn had submitted questions for this meeting which were read by the Chairman; the responses were read out by Jacqueline Boosey, Business Manager, Health and Wellbeing and appended to the minutes.

 

7.

Covid-19 - Cases in Buckinghamshire Update pdf icon PDF 2 MB

To understand the current position and the impact of long Covid-19 in Buckinghamshire

 

Dr Jane O’Grady, Director of Public Health, Buckinghamshire Council.

Neil Macdonald, Chief Executive Officer, Buckinghamshire Healthcare NHS Trust.

Additional documents:

Minutes:

Dr Jane O’Grady, Director of Public Health, Buckinghamshire Council (BC), provided a presentation appended to the minutes.  Dr O’Grady stated that, so far, Buckinghamshire had had over 73,000 cases of Covid-19 and over 1,280 deaths; the cumulative case rate per 100,000 was lower than England but higher than the cumulative case rate in the South East.  Death rates had been lower than England and the South East average.  A map showed the number of cases per 100,000 in Buckinghamshire which were particularly high in the south of Buckinghamshire, Aylesbury and High Wycombe town centre areas.  Over the previous week Dr O’Grady highlighted a hot spot in the Wing/Bierton area which largely reflected the cases in school aged children and the parental age group.  Case rate graphs were shown for the different age groups for 0-18 year olds; there had been a peak which then dropped due to half term; there was a lag in the data and the case rates in school age children were rising again.  The adult age range graph showed much lower case rates than children in schools due to the vaccine take up; however, the 19-29 age bracket had started to rise again.  At the start of the pandemic, higher rates were seen in those living in deprived areas and front facing roles; however, in the latest week the trend had reversed and was now higher in the least deprived groups as the main place of the epidemic was in school age children who took it home to their parents.

 

New hospital admissions had decreased slightly and the number of hospital inpatients had plateaued.

 

A slide provided the number of deaths from Covid-19 during waves one and two; there had been 10 Covid-19 related deaths in Buckinghamshire during the last week which showed that the vaccine was preventing serious consequences and Covid-19 related deaths. The majority of adults had received two doses of the vaccine but there were approximately 60,000 unvaccinated residents who could end up in hospital.  Dr O’Grady urged everyone to have their first and second dose and also the booster dose which had shown to be very effective.  Inequalities in vaccine uptake were being addressed through outreach clinics to encourage vaccine take up. 

 

Dr O’Grady advised that the Office for National Statistics estimate 1.7% of the population had or had had long Covid-19 with one in five suffering significant limitation in their daily activities.

 

The Vice-Chairman, Neil Macdonald, added that a specialist hospital base for long Covid-19 had seen approximately 550 referrals between January and October 2021 and there were currently approximately 10-15 referrals per week.  It offered a combination of physicians, physios and psychologists.  Demographics attending were similar to the national demographic; mainly females in their 50’s; there was also a dominant pattern of people with a high body mass index (BMI) and pre-existing significant mental health issues.  There was no defined treatment for long Covid-19 apart from rehabilitation. BHT was participating in the ongoing research and it was expected that  ...  view the full minutes text for item 7.

8.

Partner Reports - Healthwatch Bucks Update pdf icon PDF 339 KB

Jenny Baker OBE, Chair of Healthwatch Bucks.

Additional documents:

Minutes:

Jenny Baker, Chair of Healthwatch Bucks, referred to the report dated September 2021 in the agenda pack, which provided information on the remote Mental Health Survey and the Direct Payment project.  A summary of the voices data had been included due to the HWB agenda item on Access to GPs/Primary Care Access in Buckinghamshire.

 

J Baker highlighted the following key projects in progress

 

  • A second report on the vaccination programme covering the period from April to June 2021 had been produced.   The first survey (January 2021 to March 2021) had 3338 responses and the second survey had 1205 responses. A total of approximately 4,500 responses had been received with 183 residents indicating they did not want the vaccine, some reasons were provided. 
  • Before Covid-19 and within its latest contract with BC, Healthwatch Bucks had agreed to discontinue the ‘Enter and View’ surveys carried out for care homes and replace it with a programme of visits to Community Opportunity Providers (previously called Day Centres) and the first report had been published.  Four visits had been completed and a further six would be carried out by the end of March 2022. 
  • Other live projects included comparisons of cancer services received before and after Covid-19, a year-long project with Oxford Health NHS Foundation Trust looking at access to mental health services; and working with the BHT to understand the experiences of people from South Asian communities accessing secondary care.

·       The five local Healthwatch teams in the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS) area were obtaining feedback on hospital waiting times via a survey which had closed the previous day and the findings would be brought to the next HWB.

 

The Chairman advised that the HWB would like to be kept abreast of the development and outcomes of projects planned and jointly undertaken by the five local Healthwatch teams, including Healthwatch Bucks. The Chairman also requested that the HWB publish and promote Healthwatch Bucks’ future plans and priorities to help the public to see how they could feed into its work.

Action:  J Baker/J Boosey

 

The Chairman thanked Jenny Baker and acknowledged the importance of the work of Healthwatch Bucks in hearing the voices of the community.

 

Resolved:  The Health and Wellbeing Board members noted the findings of the report.

 

9.

Integrated Care Partnership Update pdf icon PDF 570 KB

Better Care Fund bi-annual update

Tracey Ironmonger, Service Director, Integrated Commissioning, Buckinghamshire Council.

 

Systems Winter Planning

Caroline Capell, Director of Urgent and Emergency Care, Buckinghamshire Integrated Care Partnership (ICP).

 

 

 

 

 

 

 

Additional documents:

Minutes:

Better Care Fund (BCF)

Tracey Ironmonger, Service Director, Integrated Commissioning, BC, advised that the Better Care Fund (BCF) started in April 2013 to strengthen integration and, more recently, to enable recovery post-Covid-19 and help residents maintain their independence.   There was a national requirement to submit the annual BCF plan and this had been carried out on 16 November 2021.  The plan had been shared with the Integrated Commissioning Executive Team, lead officers in BC and the CCG.  It was recognised that it was not the ideal approach as it did not allow engagement but, due to Covid-19, this financial year and last financial year, national planning guidance was released very late. 

 

The BCF funding totalled just over £42m; a breakdown and information on the initiatives/schemes funded had been provided in the agenda pack.  The latest national guidance focussed on hospital discharge and there were a number of new metrics.  The BCF plan had been produced by a range of stakeholders across the system and demonstrated that the workplan reflected local priorities including the ICP, Better Lives Strategy and the Joint Health and Wellbeing Strategy.  It had been hoped that the planning guidance would look forward for two or three years but this was not the case.  A local review of the BCF had started in order to be able to provide an earlier opportunity for the HWB and other relevant forums to look at the focus of the BCF and the priorities being worked on.

 

The Chairman stated that it was encouraging to see partner input and suggested that it could be broadened further, for example, to include the Housing Team at BC and possibly hospitals that were out of the county.

 

The following key points were raised in discussion:

 

  • The Vice Chair, Neil Macdonald, stated he understood the issues faced in respect of timing and the BCF and welcomed the planned review.
  • In response to whether there was a market or pathway for the setting of the reablement metric which was well below the figure of 87% currently being obtained; T Ironmonger advised that the outcomes were unusual last year due to Covid-19.  T Ironmonger had looked at the metrics, historic information and benchmarking performance against the South East and other authorities and advised that the targets were more reflective of ‘business as usual’.  T Ironmonger stated she would review the metrics for next year.  N Macdonald recommended that reablement learning should be captured. 
  • T Ironmonger confirmed that an evaluation of what had been carried out would be undertaken as part of the local review.  The review would also consider if there was wider opportunity for integration.

 

 

Resolved:  The HWB:

·       Formally approved the 2021-22 Better Care Fund (BCF) plan for Buckinghamshire.

·       Noted the update provided on the BCF including the budget for 2021-22, schemes funded and metric trajectories.

·       Delegated authority for development of Buckinghamshire’s BCF plans to lead officers for Buckinghamshire Council Integrated Commissioning and Buckinghamshire Clinical Commissioning Group. This included allocation of BCF expenditure, trajectories for locally set  ...  view the full minutes text for item 9.

10.

Access to GPs/Primary Care Access in Buckinghamshire pdf icon PDF 517 KB

Jessica Newman, Head of Primary Care, Buckinghamshire Clinical Commissioning Group.

Additional documents:

Minutes:

The Chairman advised that she had requested this agenda item due to the amount of correspondence, which she, and other local members, had received regarding difficulties in accessing not only face to face appointments, but also access over the telephone.  The Chairman stated that she wanted to explore the current situation and the actions being taken to address concerns.  The Chairman welcomed Jessica Newman, Head of Primary Care, Buckinghamshire CCG and Debbie Breen, Primary Care Director, Berkshire, Buckinghamshire and Oxfordshire Local Medical Council (LMC) to the meeting.

 

J Newman provided an update on the figures in the agenda pack. The activity figures had continued to improve in terms of total appointments of all types being offered in primary care both nationally and in Buckinghamshire.  56.3% of the appointments in Buckinghamshire in September 2021 were face to face; the total number offered in September 2021 was higher than in September 2019 and was a promising outcome.  J Newman stressed that the activity was not equal to face to face appointments and some appointments needed to be remote for many reasons.  The ‘Improving Access and Supporting General Practice’ document had been published recently and was being referred to as the Winter Access Fund.  The process, in conjunction with the Primary Care Network (PCN), the LMC, the urgent care teams at the CCG and BHT, had started the process to decide on how the funding of £7.4m would be distributed to the BOB ICS until March 2022.  There were three main areas of work:

 

  • Supporting all practices to increase their capacity and resilience.
  • To increase capacity using a primary care hub model, particularly in the evening.
  • Acceleration of national initiatives, particularly telephony solutions and the community pharmacy access service.

 

Dr Raj Bajwa, Clinical GP Chair, CCG, stressed the importance of the topic and that there had been significant discussions in the NHS, media and government in recent months.  Dr Bajwa advised that practice activity had returned to pre-pandemic levels; the number of same day appointments had increased.  Approximately 350,000 Covid-19 vaccinations had been delivered, mainly off site, and the largest flu vaccination programme, working with the pharmacies, in NHS history.  The service had continued to deliver the majority of long-term condition care including mental health conditions which have been especially prevalent.  It had also provided the ongoing management of patients waiting for specialist appointments and procedures whilst dealing with the pandemic.  Every patient contact took longer due to the need to use personal protective equipment (PPE) and decontaminate equipment and rooms.  Staffing pressures had existed due to absence with Covid-19 and the isolation requirements for those who had been in contact with Covid-19.  The level and range of activity had only been possible by following NHS England’s triage model which ensured every case was clinically assessed and signposted appropriately.  There had been a long standing mandate from NHS England to increase the use of technology and recognition that primary care needed to be updated and become more flexible.  Before the pandemic, progress was  ...  view the full minutes text for item 10.

11.

Engagement Strategy pdf icon PDF 398 KB

Cat Spalton, Head of Communications and Engagement, Buckinghamshire Council.

Additional documents:

Minutes:

The Chairman advised the HWB that she had requested this item as she felt the way in which the Board engaged with the public and communicated its priorities could be improved.  It was important to ensure that the material contained in the agenda pack was understandable to the general public without the use of too many acronyms.

 

Cat Spalton, Head of Communications and Engagement, Buckinghamshire Council, acknowledged that the communications items discussed in item 10 were noted and would be reflected back to communications colleagues.

 

The previous two years had highlighted how significant communication and engagement was in influencing behaviour and the understanding of health and wellbeing issues.  C Spalton stated that she was proud of BC and its partners in the role that they had contributed in helping to keep residents safe and support and protect colleagues in the NHS.  C Spalton also highlighted how the pandemic had enabled further development of the partnership relationships.  The purpose of the report was to build on partnership working, raise the profile of the HWB and make it easier and more accessible for the public to engage with the issues discussed.  Looking ahead, work needed to be carried out to co-ordinate and co-produce a communications strategy that aligned with the HWB strategies.  There was a requirement to produce a communications strategy at ICS level but it is also recognised that at local level it may also be necessary to re-visit the communications mechanisms to ensure that residents were involved in initiatives and services and C Spalton had suggested reinstating the ‘Getting Bucks Involved Steering Group’.

 

The following key points were raised in discussion:

 

  • A comment was raised that changing behaviour was complicated and that there were many avenues for communication in the county.
  • The Chairman thought that the suggestion of a HWB newsletter that could be posted on social media was a good idea. It was highlighted that, before lockdown a one page infographic had been produced and could be a quick fix.

 

The Chairman recommended that the next step was for the working group to be established.  The Chairman emphasised that she did not want communications to be ‘dumbed down’.  The agenda items were very important but needed to be understandable to the public.

 

Resolved:  The Health and Wellbeing Board:

 

·       Agreed to the short-term quick wins for raising the profile of the work of the Board for the next six months and to suggest and agree further quick win suggestions.

·       Agreed to the creation of a co-produced overarching communications strategy and related communications plans to support the Happier, Healthier Lives strategy by April 2022.

  • Noted the planned reinstatement of the Getting Bucks Involved steering group in relation to engagement, in addition to the platforms that could be made available across the partnership.

 

12.

Director of Public Health Annual Report - Domestic Violence and Abuse pdf icon PDF 516 KB

Dr Jane O’Grady, Director of Public Health, Buckinghamshire Council.

Additional documents:

Minutes:

Dr Jane O’Grady, Director of Public Health, Buckinghamshire Council, provided a presentation appended to the minutes.  Dr O’Grady highlighted the size of the problem and emphasised that domestic abuse suffered from huge under-reporting. Abuse could take many forms and it was estimated that 21,000 adults were affected per year; approximately 57 per day and accounted for 15% of all crime in Buckinghamshire. The cost of the consequences of domestic abuse in Buckinghamshire, using national estimates, was £687m.  Between 2011 and 2020 there had been 15 domestic homicides.

 

Highlights:

 

  • Anyone could be at risk of domestic abuse but there was increased risk for those with disabilities, women and those with mental health issues.
  • Dr O’Grady stressed the need for improved data collection to understand the use and need of the Services.
  • More focus was required on the perpetrators.
  • Domestic abuse had a huge impact on victims resulting in, e.g., poor physical and mental health, the ability to work and attempted suicide.
  • Covid-19 had resulted in a rise in domestic abuse as people were trapped at home.
  • It was estimated that 1 in 5 homeless women was due to domestic abuse.

 

There was a massive impact on children, in Buckinghamshire:

 

  • There had been approximately 2,400 referrals for a children’s social care assessment where domestic abuse was a primary concern in 2021.
  • Domestic abuse accounted for almost a quarter of children’s social care referrals.
  • Domestic abuse was the primary reason for half of the looked after children in 2021.
  • There was a higher risk in harmful long term consequences as the children were more likely to abuse alcohol and become victims of perpetrators.

 

Prevention was key:

  • The Domestic Abuse Board was in place.
  • Shared training with partners was required.
  • Clear and accessible referral pathways were required.
  • Intervention for perpetrators. 

 

Dr O’Grady raised the following questions with the HWB members:

 

  • What is your role in prevention, affecting wider social attitudes, bystander training?
  • What is your role in awareness raising and identifying instances of domestic abuse?
  • What training do your staff have? Is it sufficient, evidence based, comprehensive? Do staff know where to refer?
  • How do you support people with domestic abuse and other issues? How do you support your staff experiencing domestic abuse?
  • How many domestic abuse champions do you have in your organisation and where are they?
  • What data do you have that could help tailor services?
  • How can we support the work of the Domestic Abuse Board?

 

The following key points were raised in discussion:

 

·       The Chairman recommended everyone to read the Director of Public Health Domestic Abuse annual report if they had not already done so. 

·       Cllr Steve Bowles advised that it was a statutory duty for BC to have a Domestic Abuse Strategy and it was evidence-based and developed using a country-wide needs assessment and co-designed with the new Domestic Abuse Board.  The next steps for the Domestic Abuse Board were to draw up an action plan; Cllr Bowles offered to report back on the progress to the HWB. 

Action:  ...  view the full minutes text for item 12.

13.

Any Other Business

Joint Health and Wellbeing Strategy

Update on the Start Well action plan 

David Williams, Director of Strategy and Business Development, Buckinghamshire Healthcare NHS Trust.

 

Update on the Age Well action plan

Jacqueline Boosey, Business Manager, Health and Wellbeing, Buckinghamshire Council.

 

Additional documents:

Minutes:

Age Well Action Plan

Jacqueline Boosey, Business Manager, Health and Wellbeing, advised that a workshop had been held in October 2021 with partners in attendance from across the Voluntary and Community Sector, the NHS and adult social care colleagues to identify key strategies and priorities.  The draft action plan would be shared at the next HWB meeting in January 2022 for sign off. 

 

Start Well Action Plan

Simon James, Service Director, Education, also advised that a workshop had been held and there would be a substantive item at the next meeting.  There would be four key goals; school readiness, mental health in children, vulnerable children and supporting the community.

14.

Date of next meeting

27 January 2022

Additional documents:

Minutes:

27 January 2022.  The meeting was expected to be face to face in line with current legislation.

 

15.

For information pdf icon PDF 149 KB

The work programme has been included for information.

Additional documents:

Minutes:

The work programme had been included in the agenda pack for information.