Agenda and minutes

The Vice Chairman, Neil Macdonald, Chief Executive Officer for Buckinghamshire Healthcare NHS Trust, acted as Chairman for this meeting due to Councillor Angela Macpherson, Deputy Leader and Cabinet Member for Health and Wellbeing, attending remotely.

N Macdonald welcomed everyone to the meeting and explained that some partners had joined the meeting remotely.

Rebecca Binstead, Senior Democratic Services Officer, advised that apologies had been received from John Macilwraith, Corporate Director for Children’s Services, Buckinghamshire Council; Dr Craig McDonald, Acting Children’s Clinical Lead, BHT and Robert Majilton Deputy Chief (Accountable) Officer Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (NHS BOB ICB).

Richard Nash, Service Director for Children’s Social Care, attended as substitute for John Macilwraith.

Councillor Angela Macpherson, Deputy Leader and Cabinet Member for Health and Wellbeing, welcomed Phillipa Baker. From October Philippa will be joining the Board as the Place Director for Buckinghamshire, representing the Integrated Care Board.

Councillor A Macpherson announced that the report on GP access and the impact of housing growth on GP access in Buckinghamshire, from Dr James Kent the Chief Executive of the Integrated Care System over Buckinghamshire, Oxfordshire and Berkshire, had been postponed to the meeting on 15 December 2022.

There were no declarations of interest.

To agree the minutes of the meeting held on 26 May 2022.

Resolved: The minutes of the meeting held on 26 May 2022 were agreed as an accurate record.

In order for a response to be provided at the September Health and Wellbeing Board, questions must be received by 12.00 noon on Friday 16 September 2022. Any questions received after this deadline will be responded to at the following Health and Wellbeing Board meeting.

The Vice Chairman stated that no questions had been received before the deadline of 12 noon on the Friday the week prior to the meeting. A question regarding the Pharmaceutical Needs Assessment had been received after the deadline and would be heard under the relevant item, as it had been previously noted during consultation and a response had been included in the corresponding report.

A review of the previous year’s activity, strategic priorities for this year and resident feedback.

Zoe McIntosh, Chief Executive, Healthwatch Bucks.

Zoe McIntosh, Chief Executive, Healthwatch Bucks, referred to the Quarterly Review and Annual Report in the agenda pack and raised the following:

• The social prescribing survey found that awareness of social prescribing was low, but people who had accessed the service were very positive about the benefits it could offer. The recommendations focused on raising awareness and how this could be achieved, such as targeting specific groups. Healthwatch was awaiting a response from Dr James Kent, Chief Executive, Buckinghamshire Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS), on these recommendations.
• Healthwatch had published 18 reports that had been received by the Health and Wellbeing Board and Commissioners. Recommendations to Commissioners were followed-up with after 6 months to review whether changes had been implemented.
• As a signposting service, Healthwatch had over 200 people come to them for advice and information. Common issues included access to dentistry and General Practitioner (GP) services.
• Priorities for 2023 had been identified as health and inequalities, primary care, and social care, with particular focus on dementia. A project regarding early onset dementia was planned for the next quarter.
• Healthwatch had witnessed an increase in feedback relating to pharmacies, which was likely due to increased footfall. There had been an increase of negative experiences in accessing pharmacies, however it was noted that they were more likely to hear from negative experiences than good ones.

It was noted the resulting recommendations from the social prescribing report included encouraging more GPs and Primary Care Networks (PCNs) to utilise their own websites to display and promote social prescribing. The Vice Chairman emphasised the importance of raising awareness in professional networks as well as public. It was agreed that Zoe McIntosh would share the details of the report for it to be distributed internally.

Action: Z McIntosh

The development of Buckinghamshire 'Place', the strategy and what this means for our residents

Matt Powls, Interim Executive Director of Place Oxfordshire and Buckinghamshire, Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS).

Rob Beasley, Interim Director of Communications and Engagement, Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS).

Rob Beasley, Interim Director of Communications and Engagement, Integrated Care Board (ICB), advised that the membership of the Integrated Care Partnership (ICP) Committee had been agreed and the first meeting was planned for late October. It was noted that the Intergrated Care strategy must be agreed by the end of 2022.

The Integrated Care Board (ICB) were working on developing communications and an engagement framework, which was due to be received by the ICB on Tuesday 27^th September 2022. Pending approval, this aims to make full use of partner’s channels to communicate, consult and engage with a wider audience. R Beasley explained that they were also looking to expand the Citizens Panel.

The following key points were raised in discussion:

• That development of Integrated Care strategy would be built upon Health and Wellbeing Board strategies across Buckinghamshire, Oxfordshire and Berkshire West (BOB), to encourage a place-based localised approach.
• Councillor A Macpherson raised concerns over whether key documents and strategies would receive stronger place-based consultation. R Beasley provided reassurance that the ICP would be a partnership comprised of Local Authorities, Healthwatch, local trusts, volunteer and community organisations and its work would reflect this.
• It was queried how residents would be encouraged to contribute and understand the impact of the ICB. Gillian Quinton, Corporate Director Adults and Health, Buckinghamshire Council, emphasised that this was part of the ICB’s public facing responsibilities and the ICB need to articulate the benefits of health outcomes for the public as a result of ICB development. R Beasley stated that working as a partnership would allow the ICP to use their channels to reach as wide an audience as possible.
• R Beasley explained that the ICB were planning on developing an improved feedback system through their relationship with the Citizen’s Panel, via regular consultation, focus groups and engagement.
• David Walker detailed the challenge of addressing regional inequalities throughout the wider BOB geographical area and the importance of protecting resident’s provision.

Review and sign off of the refreshed Strategy, Action Plan and Action Plans on a Page.

Spotlight on Stoptober and how this links to the priorities in the Strategy.

Dr Jane O'Grady, Service Director Public Health and Community Safety, Buckinghamshire Council.

Councillor A Macpherson introduced the item by reminding members of the Health and Wellbeing Board meeting on Thursday 26 May 2022, whereby the proposal for the Board to focus on a limited number of key priorities in order to deliver long-term improvement in health in some of the most challenging areas was agreed. These priorities endorsed the Joint Local Health and Wellbeing Strategy life course approach and over the summer period of 2022, work had been undertaken to refresh the strategy. The Chair gave thanks to everyone involved, in particular the leads for the priority areas:

• Heidi Beddall at Buckinghamshire Healthcare NHS Trust and Dan Flecknoe from Public Health on their work on ‘Improving outcomes during maternity and early years’
• Donna Clarke at Oxford Health NHS Foundation Trust and Louise Hurst from Public Health on their work on ‘Improving mental health support’
• Sally Hone from Public Health on ‘Reducing the prevalence of obesity in children and adults’ and ‘Increasing the physical activity of older people’
• Tiffany Burch from Public Health on ‘Reducing the rates of cardiovascular disease’ and
• Dr Sarah Winchester from Public Health on ‘Improving places and helping communities to support healthy ageing’

Dr J O’Grady, Director of Public Health, stated that action plans were in development to reduce inequalities and gaps in health across the life course approach. Regarding mental health, the differential access and experience for ethnic minority groups was considered. The Board were informed of the planned work to co-design action plans with local communities and Voluntary, Community and Social Enterprise (VCSE) organisations.

Dr O’Grady referred to the papers in the agenda pack and noted the minor changes to the strategy including the priorities starting on page 33 of the agenda pack. It was explained that performance baseline measures would be presented to the Health and Wellbeing Board in December to help track progress.

Resolved: The Health and Wellbeing Board:

• Noted and agreed the refreshed Buckinghamshire Joint Local Health and Wellbeing Strategy as set out in Appendix 1.
• Noted and agreed the Action Plan as set out in Appendix 2.
• Noted and agreed the Action Plans on a Page as set out in Appendix 3.
• Noted and agreed that the Strategy is iterative and to contribute to the development of the action plans.

Dr O’Grady spoke about ‘Stoptober’ to support people to quit smoking. It was agreed the Health and Wellbeing Board alongside its partners issue a shared press release. This would be coordinated through the smoking cessation and tobacco control group.

It was suggested that linking in with existing primary care programmes such as flu clinics, utilising primary care websites, and issuing media for rotating waiting room screens would help reach a wider audience. Recognising that the current cost of living crisis may be making it more difficult to quit, it was suggested that incorporating financial saving messages may be helpful. Councillor A Macpherson proposed advertising Stoptober to those in the health and local authority workforce.

Action:  All – To send any ‘Stoptober’ ideas to  ...  view the full minutes text for item 9.

The Joint Strategic Needs Assessment (JSNA) is a joint statutory obligation of Local Authorities and NHS Integrated Care Boards in England.  The purpose of the JSNA is to improve the health and wellbeing outcomes of the local community and reduce inequalities for all ages.

Tiffany Burch, Consultant in Public Health, Buckinghamshire Council.

The Vice Chairman welcomed Tiffany Burch, Public Health Consultant. T Burch identified the purpose of the Joint Strategic Needs Assessment (JSNA) as improving health and wellbeing outcomes of the local community and reducing inequalities for all ages. It was noted that the JSNA would help with monitoring progress, identify changing priorities and monitoring emerging trends.

T Burch informed the Board that a new JSNA website would be launched, hosted on the Buckinghamshire Council website. The purpose of this would make it easier for the public to access information in one area and be more accessible.

In the discussion that followed, the Vice Chair enquired into how the development of the ONS Health Index impacted the JSNA. T Burch advised that the JSNA utilised a wider range of social determinate factors to provide more detailed data and fill in gaps of information not covered by the ONS Health Index. It was stated that the aim of the JSNA was to make it easier to access local, national and regional information in one place.

In response to an enquiry into how joint working across BOB would be achieved, it was stated that a longer-term aim was to develop an ICB common set of needs assessment across BOB.

Resolved: The Health and Wellbeing Board:

·       Noted and agreed the proposed focus topics as outlined in the JSNA workplan.

·       Committed and agreed to the delivery by all partners of new and updated JSNA content and priorities.

The Better Care Fund (BCF) is a national vehicle for driving health and social care integration using pooled budgets.  Each Health and Wellbeing Board area is required to submit a BCF plan to NHS England for assurance on 26th September 2022.

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

This item was presented by Colette Kavanagh, Head of Service Integrated Commissioning, Buckinghamshire Council, as substitute for Tracey Ironmonger, Integrated Commissioning Service Director, Buckinghamshire Council. C Kavanagh referred to the report in the agenda pack and noted the changes to the fourth condition to the Better Care Fund (BCF) Policy Framework. It was noted that the national BCF team had asked for an intermediate care demand and capacity plan for Buckinghamshire to be submitted in order to identify what support systems were needed.

C Kavanagh proposed that the BCF undertook work to look at the impact of the BCF in relation to inequalities and welcomed the Health and Wellbeing Board to help identify and steer priority areas.

The following key points were raised in discussion:

• Councillor A Macpherson suggested that the BCF looked at 9 most deprived wards identified through Opportunity Bucks, to focus funding and deliver health improvements.
• Dr Jane O’Grady enquired into the scope of the project. It was confirmed that the BCF contributed to many core services and the scope had yet to be defined.
• It was suggested that referring to the Health and Wellbeing Strategy would be useful in terms of looking at experiences and opportunities for mental health services for deprived areas and ethnic communities.
• The Vice Chairman stated that it would be interesting to see what the provisions of care and services looked like within BCF mapped wards. It was suggested that the BCF could look at service speed experienced outside of the BOB partnership.
• Dr Raj Bajwa, Clinical GP Chair, confirmed that targeting this resource towards populations of deprivation, regarding inpatient experience, could be achieved.
• Dr Rashmi Sawhney, Clinical Director for Health Inequalities, raised the topic of digital poverty.

Action:  C Kavanagh – To follow up on scope of inequalities project with Dr Jane O’Grady and bring back to HWB

The Vice Chairman reminded the Board of the Olympic lodge joint programme, which was planned to run additional capacity in October 2022. It was stated that this was above and beyond the scope of the BCF.

Resolved: The Health and Wellbeing Board:

• Noted and approved the Buckinghamshire Better Care Fund Plan for 2022-2023.
• Continued to delegate the authority for the development of Buckinghamshire’s BCF plans, allocation of expenditure and proposed metrics trajectories for plans to the Integrated Commissioning Executive Team (ICET) with the provision that the membership of the ICET be reviewed along with the accountability, governance and reporting process due to the transition from the Clinical Commissioning Group to the Integrated Care System.

The Pharmaceutical Needs Assessment (PNA) is a statutory obligation of Health and Wellbeing Boards in England.  This report is to update the Health and Wellbeing Board on the 60-day technical consultation and the final stages of Buckinghamshire’s Pharmaceutical Needs before it is published on 1 October 2022.

Matt Powls, Interim Executive Director of Place Oxfordshire and Buckinghamshire, Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS).

Tiffany Burch, Consultant in Public Health, Buckinghamshire Council.

Note: the running order for this agenda was changed and item 12: Pharmaceutical Needs Assessment was taken after item 10: Joint Strategic Needs Assessment.

Councillor A Macpherson introduced the item by explaining that every Health and Wellbeing Board is required to undertake a Pharmaceutical Needs Assessment (PNA). In Buckinghamshire, the work is undertaken by a multidisciplinary group. Any decisions on where to locate pharmacies will be taken by the NHS, however one of the pieces of evidence they will consider is the PNA.

Matt Powls, ICB Interim Executive Place Director, referred to the papers in the agenda pack and highlighted the recommendation found in the Buckinghamshire Pharmaceutical Needs Assessment (PNA) 2022-2025 that no improvements or better access were identified in the lifetime of this PNA.

A draft version of this PNA was published online for technical consultation for a 60-day period during 23 May and 24 July 2022 and a general response to feedback had been published within the report. M Powls stated that feedback had been received from members of the public affiliated with the Berryfields geographical area requesting a pharmacy. In response, additional analysis had been undertaken to investigate this, however the recommendation remained the same.

It was noted that a question from managing director of Jardines pharmacy had been received by the Health and Wellbeing Board. Tiffany Burch gave a response which can be found in the agenda pack starting on page 324.

The Vice Chairman welcomed Gary Elton, Treasurer Bucks Local Pharmaceutical Committee. G Elton concurred with the conclusions of the PNA and reported that pharmaceutical colleagues were content that national guidelines and processes had been followed in production of this PNA. It was stated that any applications made to NHS England for a new community pharmacy must pass a series of tests outlined in the Pharmaceutical and Local Pharmaceutical Services Regulations 2013. G Elton stated that a pharmacy contractor could dispute a decision through NHS Resolution and be re-assessed. It was emphasised that a PNA assesses need in a given location, not desirability.

Councillor A Macpherson gave assurance that if planning permission was granted for additional housing developments, the steering group could reconvene and reconsider.

In response to an enquiry on the expanded role of community pharmacies and it’s effect on the workforce, it was confirmed that contractors were asked about capacity and it was found to be a concern.

Resolved: The Health and Wellbeing Board:

• Noted the Executive Summary, full Pharmaceutical Needs Assessment and the 60-Day Consultation report.
• Agreed for the report to be published in line with legal requirements.
• Delegated any final responsibility for approval of the PNA following this meeting to the PNA Steering Group.

Jacqueline Boosey, Business Manager, Health and Wellbeing, advised that the forward plan would be updated to link more closely with the Joint Local Health and Wellbeing Strategy refresh. It was noted that three workshops would be held with partners and relevant organisations in 2023.

J Boosey informed the Health and Wellbeing Board that the website would be launched at the end of October 2022, containing key messages from the Board and its partners.

Action: J Boosey

Councillor Steve Bowles, Cabinet Member for Communities, promoted the Community Safety Consultation which would run until 16 October 2022 and was open to anyone living or working in Buckinghamshire. Residents were encouraged to help the Safer Buckinghamshire Board develop and implement an action plan to reduce crime in Buckinghamshire. A link to the survey is available on the Your Voice Bucks website here.

15 December 2022

Thursday 15 December 2022 at 2.00pm in the Oculus.