Agenda and minutes

The Chairman welcomed all to the meeting.

Apologies for absence were received from Dr Raj Bajwa and Dr Rashmi Sawhney, Buckinghamshire, Oxfordshire and West Berkshire (BOB) Integrated Care Board (ICB).

Michelle Evans-Riches, Programme Manager, Bedfordshire, Luton and Milton Keynes Integrated Care System and Catherine Spalton, Head of Communications and Engagement, Buckinghamshire Council joined the meeting via MS Teams.

John Macilwraith, Corporate Director-Children’s Services joined the meeting at 2. 24pm.

Councillor Angela Macpherson, Chairman and Cabinet Member for Health and Wellbeing and Deputy Leader, Buckinghamshire Council, thanked Sally Taylor, Democratic Services, for her support to the Board and welcomed Shilpa Manek, Democratic Services. The Chairman also thanked Gill Quinton for all her work on the Board and welcomed Craig McArdle, Corporate Director for Adults and Health at Buckinghamshire Council. The Chairman informed the Board that The Clare Foundation, one of the VCSE partners, that they were stepping down from the Board and thanked them for their contributions over the previous three years and reassured the Board that she was keen to retain the voluntary and community representation as it was an important part to delivering the Strategy.

ACTION FOR J BOOSEY: The Board membership and Terms of Reference would be updated and brought to a future meeting

There were no declarations of interest.

To agree the minutes of the meeting held on 15 December 2022 and review any outstanding actions from previous meetings.

Resolved: The minutes of the meeting held on 15 December 2022 were agreed as an accurate record and were signed by the Chairman.

In order for a response to be provided at the December Health and Wellbeing Board meeting, questions must be received by 9.00 am on Monday 27 March 2023. Any questions received after this deadline will be responded to at the following Health and Wellbeing Board meeting.

The Chairman was pleased to inform the Board that the public questions from the December meeting had been shared on the Health and Wellbeing website.

The Chairman informed all that the approach was being modified to focus on high quality responses to questions asked. Going forward, the number of questions would be limited to one per person or organisation, per meeting. A maximum of three questions would be read out at a meeting and those relevant to an agenda item would be prioritised. All questions received from the public would receive a full written response after the meeting.

The Chairman informed the Board that three questions had been received for this meeting and took the opportunity to thank partner organisations around the table who had worked hard to coordinate responses.

Mike Etkind, Chair, John Hampden Surgery Patient Participation Group, Member of Mid Chiltern Primary Care Network Patients Group and Member Engagement Steering Group of former Clinical Commissioning Group had submitted a question which would be responded to under Item 8 on the agenda.

The question and the summary response was read out for the two remaining questions from Dementia Action Marlow and All Together Community. A full response would be sent to the organisations, published on the website and appended to the minutes.

The question and the summary response was read out for the two remaining questions from Dementia Action Marlow and All Together Community. A full response would be sent to the organisations, published on the website and appended to the minutes.

Review of the work undertaken by Healthwatch Bucks over the previous quarter, this will include feedback on surveys with residents/users of local services and an opportunity to look at upcoming surveys.

Zoe McIntosh, Chief Executive, Healthwatch Bucks.

Zoe McIntosh, CEO Healthwatch Bucks, firstly updated the Board on the social prescribing experiences report which had been presented at the last meeting. Responses had now been received from Buckinghamshire Council and the ICB. Both responses had been welcomed and were available in full on the Healthwatch Bucks website.

A report had recently been published on support available for people living with early onset dementia and their carers. This was also available on the website along with a joint response from Buckinghamshire Council and the ICB. This had been discussed at the Dementia Strategy Group and the Health and Social Care Select Committee. The report showed that the support was not readily available which had formed the basis of the recommendations.

Finally, the Strategic Priorities for the year had also been published. The priorities were set by assessing many factors such as comments from the public in previous years, national and local NHS and social care issues. This year the focus would be on primary care, particularly community pharmacies as there had been an increase in feedback, social care with a focus on hospital discharge, were keen to hear more from children and young people about their experiences of accessing health and social care and focus on health inequalities and hearing more from people who were facing these.

The current project would be reported on at the next meeting. It focussed on talking to people who were deaf and hard of hearing and their access to primary care.

The Chairman welcomed John Meech, Chairman of Healthwatch Bucks, who was in attendance. The Chairman commented that the Council was also looking across the entire pathway of dementia and working closely with all. The Chairman asked if there were any joint areas of work across the Healthwatch and BOB network. It was reported that Healthwatch were very keen on collaborating the joint working but were currently awaiting confirmation on funding from the ICB.

Other Members commented that the recommendations were very practical and could be taken forward and that the discharge item was very timely.

The development of Joint Forward Plan and the Integrated Care Strategy in Buckinghamshire, Oxfordshire and Berkshire West

https://yourvoicebob-icb.uk.engagementhq.com/bob-integrated-care-partnership

Philippa Baker, Buckinghamshire Place Director, Buckinghamshire Oxfordshire and Berkshire West Integrated Care Board

Robert Bowen, Deputy Director of Strategy, Buckinghamshire Oxfordshire and Berkshire West Integrated Care Board

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

An update on strategic items in Bedfordshire, Luton and Milton Keynes (BLMK) Integrated Care Board (ICB) and the BLMK Health and Care Partnership

Michelle Evans-Riches Bedfordshire, Luton and Milton Keynes (BLMK) Integrated Care Board.

The Integrated Care Strategy was presented at the beginning of the public engagement, which ran between December 2022 and January 2023. Plenty of feedback was received from individuals and from across the integrated care system. A number of changes were made to the proposed Strategy; the 18 priorities identified in the draft were simplified, now a focusing on only five strategic themes; Start Well, Live Well, Age Well, Promote and Protect Health and Quality and Access. The inclusion of palliative and end of life care and the ambition to work collectively across the partnership.

The amended Strategy was signed off by the ICP as a clear strategy for the next five years, on behalf of all the partners; local authorities, NHS organisations, voluntary sector including Healthwatch.

Thanks was extended to Dr Jane O’Grady for her instrumental amount of work on the Strategy and to Rob Bowen for all the work completed at a considerable pace with minimal resources.

The response for the public question from Mike Etkind was read out by the Buckinghamshire Place Director, Philippa Baker.

The Chair confirmed that the concerns about the reach into the community and the language used would be addressed in the near future.

The Integrated Care Strategy was noted by the Board.

The Joint Forward Plan (JFP) is the NHS delivery plan for the Integrated Care Strategy, balanced with other mandated operational NHS commitments. This is currently being developed. Work to date has resulted in draft delivery plans for system-wide services. These should all reflect the relevant priorities of the Integrated Care Strategy with continuous themes through the plan to do more with respect to prevention and tackling inequalities. The JFP also included four challenges that need to be addressed through more system wide, collaborative working. These had been the subject of a recent workshop that brought together input from across system partners and would be reflected in the draft of the JFP to be shared imminently. The Health and Wellbeing Board had engaged in the JFP development through specific members.

The Board would be informally consulted on the draft version in April 2023 providing an opportunity to feedback on the JFP. The HWB also has a formal opportunity to provide an opinion on how the Joint Forward Plan takes account of the local Health and Wellbeing Strategy. This input is expected in June 2023.

The Buckinghamshire Place Director, Philippa Baker, informed the Board that the Joint Forward Plan was designed to support place-based partnership working and decision-making.  This type of working was already underway, for example partners had come together to take decisions around how to invest national discharge funding. There would be more joint decision making around integrated areas of work going forward.

Partners were also working to establish Place based partnership arrangements across the three parts of BOB ICB: Buckinghamshire, Oxfordshire and Berkshire West. In Buckinghamshire, Terms of Reference had been drafted for the Buckinghamshire Executive Partnership, which would be meeting for the first time formally in May. The  ...  view the full minutes text for item 8.

Outcomes of integration work over the last year, plans for next year, and what this means for the experience of people using health and care services in Buckinghamshire.

Dr Joanna Baschnonga, Programme Director, Adults and Health, Buckinghamshire Council.

The Programme Director for Health and Care Integration, Joanna Baschnonga, presented the paper, concentrating on the discharge programme. It was reported that this was a turning point for the programme on improving hospital discharge in Buckinghamshire. The papers set out the ambitious plans for the next year. The three key milestones to highlight were:  the implementation of an integrated discharge team in June (a patient focussed team that brings together the hospital discharge team and social workers to improve the patient experience); implementation of short-term bedded hubs and an intermediate care centre over Summer, and a new transfer of care hub in October (a new team that would coordinate discharges more effectively and improve the overall experience and in planning of discharge).

These changes are expected to help patientsto return home more quickly and avoid readmission.

The Chairman commented that it was a very frank paper with lots to do and it was promising to see progress in some areas. The Chairman asked what the difference was between the June and October actions for the patient and could October be accelerated. It was explained that June was about the integrated discharge team, working on wards with patients, discussing and planning discharge with the patient and their family to make it a better and clearer experience, reducing anxiety and the stress. October was more about the back-office function around co-ordinating discharge, making decisions about which pathways patients progress along, and oversight on timeliness, safety and quality.  

Dr Sian Roberts commented that better support in the community would be really helpful but may lead to more failed discharges. Would this be captured and monitored? The Board were reassured that this would be monitored as part of the performance indicators.

The Vice Chairman commented that it was a tough programme, and it would be beneficial for the Board to see what a multi-year programme looked like and it was confirmed that this would be presented.

The Chairman asked if the patient experience was being improved and was reassured that the process was being mapped, real customer journeys were being looked at, workshops were being run, all to understand the patient perspective.

The focus of Healthwatch for the next year was patient discharge and this would show an improvement in experience.

The Chairman thanked the Director for the paper. The Board noted the paper.

A review of the progress on delivery of Joint Local Health and Wellbeing Strategy action plans with a detailed focus on two priorities:

·       cardiovascular disease prevention and

·       reducing the prevalence of obesity and increasing physical activity

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

Cardiovascular Disease

Tiffany Burch, Consultant in Public Health Medicine, Buckinghamshire Council.

Reducing the prevalence of obesity and increasing physical activity.

Sally Hone, Public Health Principal, Buckinghamshire Council.

The Chairman welcomed Tiffany Burch, Consultant in Public Health, and promoted the inequalities infographic shared with all Board Members. This is a tool that shows the entire life course and the inequalities across it in Buckinghamshire.

Dr Jane O'Grady commented on the inequalities infographic which is also available on the website, and requested that the Board promoted the better points scheme, a leaflet was also given to all Board members.

The Strategy has been developed. The action plans are being developed by partners with the intention to present a rolling programme of the action plans. The plan is to give regular updates on the action plans. At this meeting, there was an update on cardiovascular disease and Obesity. The next meeting would provide an update on Early Years and Mental Health work.

ACTION FOR J O’GRADY and J BOOSEY: Add to Forward Plan

Tiffany Burch, lead for CVD and smoking cessation (which is a key risk factor for CVD) explained that the work is overseen by the CVD Prevention Working Group which consists of a wide range of partners that meet monthly to discuss the action plans.

The opportunity was taken to focus on three areas of good progress over the last twelve months and three areas that needed further work. 

Great progress had been made with the community initiative to increase residents checking and understanding their blood pressure. Two GPs, Dr Amanda Bartlett in High Wycombe and Dr Tony Gillman in Aylesbury, were instrumental in supporting this action and ensuring that GP colleagues were happy with the blood pressure information and advice shared with residents. Secondly, a pilot programme is ongoing in a faith community that is at higher risk of cardiovascular disease. It is going very well and was created using behaviour science to ensure residents are supported to take healthy actions. This is now being rolled out to other faith groups. From 17 May there will be health kiosks in the Aylesbury and High Wycombe libraries. These tools assess a range of health measures. 17 May is also World Hypertension Day, so partners are encouraged to promote this day. Blood pressure monitors will be available for residents to ‘check out’ from Aylesbury, High Wycombe and Micklefield libraries. The packs will include simple information on how to look after yourself and what to do if the blood pressure was high. Ongoing work with Parish Councils and Community Boards is working really well. There are now 13 smoke-free parks and playgrounds in the county. The plan is to increase this next year to ensure that there was at least one in every Opportunity Buckinghamshire Ward. Thirdly, a scheme has been produced to increase the capacity in the four priority primary care networks to increase their ability to deliver the NHS Health Check. This is a programme for CVD Prevention in people aged 40 to 74 years. This is going well with the number of health checks increasing.

The three areas that need further momentum are the need  ...  view the full minutes text for item 10.

*Trigger warning - these pages contains references to themes of suicide and self-harm which some individuals may find distressing*

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

Louise Hurst, Public Health Consultant, Buckinghamshire Council.

Dr Jane O’Grady explained that mental health was a very important theme to this Health and Wellbeing Board and there was a multi-agency suicide prevention plan and the reason for presenting it was because everyone has a role to play in understanding and helping to prevent suicide and mental ill health.

Louise Hurst, Consultant in Public Health, informed the Board that the action plan had been prepared by the multi-agency suicide prevention group which was Chaired by Public Health and attended by many partner organisations.

Every year at least fifty people died in Buckinghamshire by suicide. The effects of which were profound on their families, friends, colleagues and their communities. The rate of suicide had been steadily increasing nationally. There were concerns that the cost-of-living crisis may have an impact on the number of deaths as financial difficulties, debt and unemployment were serious risk factors for suicide, and more middle-aged men were at risk than women. Suicide was preventable and the action plan concentrated on the initiatives. A Suicide Bereavement Service had been launched in July 2022, called Amparo. This was a new confidential service open seven days a week offering support to anyone, of any age, affected by suicide. The website for the service is amparo.org.uk. The council also currently offered assistance through the Helping Hands team offering financial support and the Saving Lives Fund, which delivered projects with voluntary and community sector groups including Talkback and Wycombe Youth Action, targeting men and boys to be able to identify the signs as a high-risk group.

The Board were informed that thirty percent of people who died by suicide saw their GP, two weeks before they died for other issues. It was important for GPs, colleagues in primary care and employers to be alert to the risk factors and signs for suicide and what to do in those instances. However, a large number of people had had no contact at all with health or social care. Employers could play a key role in addressing the stigma around mental health and financial wellbeing in the workplace. Buckinghamshire Council have a Champion the Change programme which is delivered by Bucks Mind. Employers could sign up to the Champion the Change pledge to address stigma in the workplace and through doing that, they received access to a range of resources to help them challenge stereotypes in the workplace. Finally, suicide first aid training was also available. The dates would be launched through Bucks Mind for anyone who was employed by charities, community groups or public sector and for volunteers and people working with those experiencing difficulty around cost-of-living, free of charge.

The question was asked if schools and other educational establishments were being engaged as young children had been impacted by the pandemic and the Board were informed that they were and pre and post-vention guidance was available to schools as a tool to support them, reduce the risk of suicide and consider the support that could be put in place for  ...  view the full minutes text for item 11.

Performance measures recommended to review the successful delivery of the strategy.

Jacqueline Boosey, Business Manager - Health & Wellbeing, Buckinghamshire Council.

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

A performance dashboard was being developed with partners and public health colleagues. This should enable all to track the progress of the Strategy in terms of a few key indicators. The more detailed outcomes and progress would be measured behind the scenes in the themed action plans. A few high-level indicative indicators had been presented to the Board. All were collectable and had been agreed by partners. Some information on mental health was still being awaited from the Mental Health Trust.

Resolved:  The Board noted and endorsed the performance dashboard and it would be presented to the Board annually.

ACTION FOR J BOOSEY: Present to Board annually

To be confirmed.

The date of the next meeting was still to be confirmed.