Agenda and minutes

The Chairman, Councillor Angela Macpherson, welcomed everyone to the meeting.

Apologies had been received from Councillors Anita Cranmer and Arif Hussain, and John Macilwraith, Corporate Director, Children’s Services, Buckinghamshire Council.  Errol Albert, Service Director, Children’s Services, attended in place of John Macilwraith.

Katie Higginson, Chief Executive Officer (CEO), Community Impact Bucks, and Michelle Evans-Riches, Programme Manager, Bedfordshire, Luton and Milton Keynes Integrated Care Scheme joined the meeting via MS Teams.

The Chairman reminded the Health and Wellbeing Board (HWB) members that there was an action taken forward from the previous meeting to provide a demonstration of the population health management tool.  This would be provided after the meeting had been closed.

There were no declarations of interest.

To agree the minutes of the meeting held on 22 June 2023 and review any outstanding actions from the previous meetings.

Rebecca Carley, Head of Business and Governance, confirmed that there were no outstanding actions from previous meetings.

Resolved:  The minutes of the meeting held on 22 June 2023 were agreed as an accurate record and were signed by the Chairman.

In order for a response to be provided at the September Health and Wellbeing Board, questions must be received by 9.00 am on Monday 18^th September 2023.  Any questions received after this deadline will be responded to at the following Health and Wellbeing Board meeting.

The Chairman advised that three public questions had been received: one from Alan Thawley and two from Mike Etkind, Chair, John Hampden Surgery Patient Participation Group.  The question from Alan Thawley was read out along with the summary response.     The questions from Mike Etkind would be covered under agenda items 8 and 9.  The detailed responses would be published on the website and appended to the minutes.

Question from Alan Thawley:  In light of the key importance of active travel, and more specifically cycling, in achieving the aims of the Health and Well-being strategy, and the fact that the cycling network is still incredibly patchy despite recent welcome additions to the county's safe cycling infrastructure, what can be done to make this a viable option for more people around the county in as short a time frame as possible, and is it possible for the health, climate change and transport portfolios to pool resources to front-load investment into this vital area, which still lags far behind our investment in roads?

Summary Response:  The Buckinghamshire Physical Activity Strategy recognises the importance of cycling and active travel in encouraging everyone in Buckinghamshire to move more and be more active, with a particular focus on those who are currently inactive. The Council’s Public Health team works proactively with other teams, such as Schools Sustainable Travel, Transport Strategy & Funding and Environmental Protection on initiatives to encourage active travel. It may be appropriate to direct your question to the upcoming Transport, Environment and Climate Change Select Committee meeting in February 2024 where an item on active travel plans and projects is due to be presented – if Mr Thawley wishes this question submitted to the Select Committee, he is advised to contact the Select Committee officer, Chris Ward, in the Council’s Democratic Services democracy@buckinghamshire.gov.uk.

A review of the work undertaken by Healthwatch Bucks over the past year.  This will include feedback on surveys with residents/users of local services.

Zoe McIntosh, Chief Executive, Healthwatch Bucks.

Zoe McIntosh, Chief Executive Officer, Healthwatch Bucks, provided an overview of the Healthwatch Annual Report 2022-2023 and stated that over the past year Healthwatch Bucks had heard from over 1300 people in Buckinghamshire on their experiences of health and social care, via project work, engagement work and the signposting service.  The top issues identified through signposting were access to general practice and NHS dentistry.  Zoe advised that Healthwatch Bucks’ role was to hold the system to account and it would not be possible without their volunteers which now totalled over 20; additional grant funding for a volunteer co-ordinator had been provided this year and would help grow and diversify the volunteer base.  The latest report was on community pharmacies; a similar project had been carried out in 2017 and the latest survey found that awareness of the services offered by community pharmacies had increased.  A number of recommendations were included in the report and responses had been received from Buckinghamshire Council and the Community Pharmacy Thames Valley Committee; a response was awaited from the Integrated Care Board (ICB).  Zoe stressed the importance of raising awareness and understanding of the role of the community pharmacies and the role that they can play in the work that was being carried out in primary care and requested that the ICB did not lose this insight as there was a lot to do in terms of engagement and involvement of the public.

The Chairman stated that Healthwatch Bucks had played an important part during the pandemic and that there were 10 ‘levelling up’ wards in Buckinghamshire focussed on areas of largest deprivation e.g., in Aylesbury, High Wycombe and Chesham.  There was a significant amount of work, not just across health, but across many aspects of the public sector in terms of focusing on people with the highest need and achieving better outcomes and reducing inequality.

The following key points were raised in discussion:

·   In response to a question from Dr Sian Roberts, Clinical Lead for Mental Health Learning Disabilities and Dementia for Buckinghamshire, on how Healthwatch Bucks decided what to focus on for the next year; Zoe advised that they looked at the feedback from the signposting service and also what was going on regionally across Buckinghamshire, Oxfordshire and Berkshire West (BOB).  Healthwatch Bucks also looked at the work plans for the HWB, scrutiny committees and Healthwatch England.

·   Councillor Zahir Mohammed, Deputy Cabinet Member for Health & Wellbeing, stated it was encouraging to see an increase in awareness in the role of community pharmacies but noted there was still a gap; had a similar exercise been carried out across the country?  Zoe advised that other Healthwatch areas had done so and that their reports were available online and agreed that there was much work to do in this area.

·   Errol Albert, Service Director, Children’s Services asked what was being carried out to raise awareness within the black and ethnic minority communities within the levelling up wards.  It was agreed that this was a question to  ...  view the full minutes text for item 7.

An update from the Buckinghamshire Executive Partnership, including the Health and Care Integration programme and use of inequalities funding update.

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

Neil Macdonald, Vice Chairman and Chief Executive Officer, Buckinghamshire Healthcare NHS Trust, explained that the Buckinghamshire Executive Partnership (BEP) was where the CEO and senior officers of the statutory organisations came together to deliver shared agendas, particularly relating to the Health and Wellbeing Strategy.  The report to the HWB was a regular update report for information.  Neil reported that there had been positive progress on the integrated discharge teams and the building of pathways out of hospital into the community and preventing re-admission.  However, more progress was needed on Special Educational Needs and Disabilities (SEND) and children’s services, particularly to improve access for vulnerable children; this was a collective responsibility across health, mental health, physical health, primary care and the Council.

The Chairman then read out the public question from Mike Etkind.

Question - Will there be any co-production involved in the primary care deep dive referred to in the paper for agenda item 8 (particularly engagement with patient participation groups)?

Summary Response - The Buckinghamshire Deep Dive into primary care was a deep dive undertaken in the context of wider work underway across Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS) to develop a Primary Care Strategy for the system.

The Primary Care Strategy being developed across the BOB ICS is engaging widely with partners. Local HealthWatch teams are involved and a clear part of their role is to ensure patient participation groups (PPGs) are engaged.

The Chairman stressed that it was good to engage with the PPGs, adding stakeholder engagement did not always include communities and members of the public or of the diverse range of service users.  The Chairman made a plea that any strategies being developed were mindful of that and highlighted that co-production was extremely important.

The following key points were raised in discussion:

·   David Walker, Chair of Oxford Health, advised that Oxford Health was rolling out community hubs for high street presence and improved integration of voluntary sector, local authority and mental health community provision in Oxfordshire and thought there could be some synergy in Buckinghamshire.  Neil agreed that the voice of mental health could be stronger at the BEP and how it linked into the programme for re-generation of the high street was critical and added that the BEP would be delighted to work with Oxford Health.  The Chairman stated that mental health was woven into the HWB strategy and advised that there was an initiative, in its early stages, called ‘health on the high street’ in Aylesbury and that this was the type of initiative which needed to be available at in the levelling up wards.

·   Zoe McIntosh, CEO, Healthwatch Bucks, did not think the ICB would say that the Primary Care strategy was being co-produced as the principle of co-production started too late in the day, however, the deep dive that took place at the BEP did look at patient feedback and experience.

·   Philippa Baker, Bucks Place Director, BOB ICB, thanked Zoe for Healthwatch Bucks’ report on pharmacies; a  ...  view the full minutes text for item 8.

Caroline Capell, Director of Urgent and Emergency Care, Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board.

The Chairman read out the question from Mike Etkind and the summary response.

Question - Will there be any co-production involved in developing the comprehensive public engagement plan referenced in the executive summary of the winter plan? 

Summary Response - There will be two plans across the Winter period, The BOB ICB Winter Communications Plan, and the local Buckinghamshire System Plan. Both will be co-produced with partners and key stakeholders across the Buckinghamshire System.

Caroline Capell, Director of Urgent and Emergency Care, Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB), reported that the Buckinghamshire Health and Care System winter plan focussed on managing the anticipated challenges across our emergency and urgent care footprint across Buckinghamshire.  It was recognised that there would be five key challenges:

·   An increase in access to same day care

·   Reducing admission levels

·   Increasing capacity across the whole system

·   Reducing delays to discharge

·   The overall management of surge

The plan had been developed from lessons learned from last winter.  The system now had access to a forecast tool which used historic data in order to anticipate peaks in demand; an ED peak was expected at the end of October.  The team would also be looking at comparing performance in order to manage improvement throughout the winter by focussing on specific actions.  All patients self-presenting at Stoke Mandeville Hospital (SMH) would now follow an urgent treatment care pathway, which would operate 24/7 to ensure the right patients were sent to either urgent care or emergency care. The forecast model also anticipated a spike in ambulance activity in January and initiatives would be focussed where demands were anticipated.  The data would be refreshed to identify potential new peaks and national performance and demand would also be monitored.  The team had been working closely with mental health colleagues and the 111 service would be going live with a direct link for mental health patients.  There was also a psychiatric liaison support available at the front of SMH Emergency Dept and this would remain throughout the winter.  Escalation reports are provided daily to NHS England for assurance.  The team was working closely with Adult Health services to help facilitate discharge and admission avoidance work.  Escalations would be managed through an OPEL Framework which would change as pressures increased/ decreased.   The escalation processes included a structure including gold, silver and bronze teams to continue as normal to manage periods of surge across the whole Bucks system.

The Chaiman thanked Caroline for her summary and mentioned that the Buckinghamshire winter plan supported the Frimley winter plan but did it support the Milton Keynes winter plan?  Caroline confirmed that this was an omission, the team worked with colleagues from Bedfordshire, Luton and Milton Keynes colleagues and the plan would be updated.

Action:  Caroline Capell

The following key points were raised in discussion:

·   Katie Higginson had received feedback from two local charities, AGE UK Bucks and Carers Bucks who were affected by winter.  Both organisations would welcome engagement to create the winter  ...  view the full minutes text for item 9.

Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board Verbal Update

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

Bedfordshire, Luton and Milton Keynes (BLMK) Integrated Care Board

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

Philippa Baker, Buckinghamshire Place Director, BOB ICB, advised that the information below was from the publicly available papers relating to the ICB Board.  A lot of what was done in BOB had been covered during the meeting e.g., winter planning, the Primary Care Strategy etc.  Philippa highlighted the following:

• The impact of industrial action on the system; there had been 10 periods of action between December 2022 to July 2023, and they were currently experiencing junior doctors and consultants taking action on same day for the first time.  The action was having a huge impact and it had been a challenging time.  
• The South Central Ambulance Service (SCAS) electronic patient record system suffered a cyber-attack on 19 July 2023 and patient reports were currently being provided on paper and impacted the whole of BOB. 
• Seven BOB services had been recognised in the Health Service Journal awards. 
• The Integrated Care Partnership (ICP) met with local authority leaders on 8 August 2023 to confirm their commitment to the development of the BOB ICP and future meeting dates had now been set to consider progress made against the joint forward plan. 
• There had been several changes in leadership; Hannah Iqbal had joined as Chief Strategy and Partnerships Officer, Raj Bamber, as Interim Chief People Officer, Sarah Adair was stepping up as Acting Director of Communications and Engagement and Victoria Otley-Green would be joining the Executive Team in October as the new Chief Digital and Information Officer replacing Ross Filton. 
• NHS England had asked all Trusts to review their processes and culture following the Lucy Letby trial.  There would be a redoubled focus on safety and culture.

Michelle Evans-Riches, Programme Manager, Bedfordshire, Luton and Milton Keynes (BLMK) ICB, stated that page 71 of the agenda pack provided a summary of the ICB Board meeting on 30 June 2023.  The Denny Review had identified four main issues as a result of a literature review, workshops and one to one sessions in the community.  The Board were considering the final report and Michelle would provide a response at the next HWB meeting.

An employment seminar had been held in July 2023 and identified key cohorts of people that were not in employment or had difficulty sustaining employment; the findings were on the website.   Quarterly workshops would be held; the next one was in November 2023.

The following key points were raised in discussion:

• The Chairman stated she was fascinated to read about the session on employment and inequalities as much off the subject matter had synergies with work taking place in Buckinghamshire and suggested that officers could link in with Michelle. 
• Philippa commented that she was interested in the Denny Report and health inequalities funding as the ICB was looking at health inequalities in Buckinghamshire as a priority.  Michelle advised that the Denny Report was published on their website and that she would share the link and make contact with Philippa.

Action:  Michelle Evans-Riches

• Errol Albert also asked who he could link with to discuss  ...  view the full minutes text for item 10.

A review and recommendations for the operational arrangements for the Health and Wellbeing Board.

Rebecca Carley, Head of Business and Governance, Buckinghamshire Council.

The forward plan had been included for information.  Rebecca Carley confirmed that the following items would be added to the forward plan for the meeting in March 2024:

·       An update on the Transfer of Care Hub

·       An update on the implementation of the winter plan

The ICB Estate Strategy would be removed and replaced by the Primary Care Strategy.

Action:  Rebecca Carley

Zoe McIntosh asked the HWB members to complete the stakeholder survey which had been circulated by Rebecca.

A demonstration will be provided for information.

Mark Sellman, Chief Information Officer, Frimley Health NHS Foundation Trust

Jeremy Drake, Chief Information Officer, Buckinghamshire Healthcare NHS Trust

This item was not required as the demonstration was provided after the meeting closed.

Thursday 14 December 2023 at 2.00 pm in the Paralympic Room, The Gateway, Aylesbury.

14 December 2023 at 2.00 pm in the Paralympic Room, The Gateway, Aylesbury.