Agenda and minutes

Councillor Gareth Williams, Cabinet Member for Communities and Public Health, stated that this was the first Health and Wellbeing Board meeting of the 2020/2021 municipal year in a new unitary authority and therefore he was obliged to declare the Chair and Vice-Chair of the Health and Wellbeing Board. Given governance discussions over the last year with a view to looking at terms of reference and membership again next year, unless there were any objections, G Williams stated he would remain as Chairman and Dr Karen West would continue as Vice-Chair.

RESOLVED:  It was AGREED that Councillor Gareth Williams remain as Chairman and Dr Karen West continue as Vice-Chairman of the Health and Wellbeing Board.

The Chairman announced that the Coronavirus Act 2020 had allowed the Health and Wellbeing Board (HWB) to be conducted on-line and attended remotely by Members and officers.

The Chairman welcomed Councillors Mark Shaw, Cabinet Member for Children’s Services, Isobel Darby, Cabinet Member for Housing and Homelessness and Angela Macpherson, Deputy Leader and Cabinet Member for Adult Social Care.  The Chairman also welcomed Dr Nick Broughton, Chief Executive, Oxford Health NHS Trust and two new voluntary sector community (VCS) members; Martin Gallagher from the Clare Foundation and Katie Higginson from Community Impact Bucks (CIB).

The Chairman thanked the HWB members and their teams, the organisations, NHS, Adult Social Care, Children’s Services, VCS and Communities for their dedication to overcoming the virus.

Apologies had been received from Dr Karen West, Dr Sian Roberts, Dr Juliet Sutton, Dr Raj Bajwa and Dr James Kent.  Neil Macdonald, Buckinghamshire Healthcare NHS Trust (BHT) had also sent his apologies; Dr Tina Kenny attended in his place.

Jenny Baker, OBE, Chair, Healthwatch Bucks, declared an interest as she was also a trustee of CIB which was the holding company of Healthwatch Bucks.

Katie McDonald, Health and Wellbeing Lead Officer read out the following question which had been received from, a member of the gypsy and traveller community and Buckinghamshire resident:

I am a traveller living in Buckinghamshire, my family has been directly affected by Covid-19 as my husband is in the extremely vulnerable group and has been shielding throughout.  I am employed as a family support worker in a school so I am also acutely aware of the negative impact this has had as far as the education of my own children and others from the traveller/gypsy community. 

It has been extremely difficult for us as a family.  As a shielding family we have been entitled to support from the Government but this has not been forthcoming. We were told we were entitled to weekly food parcels and throughout the lockdown we have received only one government funded food parcel. I have one child of school age and she has been struggling to complete her home learning as expected throughout lockdown. We have no internet or computer and for weeks she struggled to do this using only her phone.

I have been contacted by traveller families who are concerned, not only about the safety of their children when they return to school  but also how the impact of the barriers to home learning they have faced will affect the long term education of their children. I am also concerned about the cramped and overcrowded conditions.

I want to ask the Health and Wellbeing Board if consideration has been given to the many traveller/gypsy families living in Buckinghamshire in the areas I have raised and recognition from professionals of the risks to the gypsy and traveller community.

K McDonald advised that she had spoken with the resident who had emphasised that she requested acknowledgement from professionals that the gypsy and traveller community be afforded the same focus and attention for their health and wellbeing outcomes as that of minority and ethnic groups and accountability for engagement with the gypsy and traveller groups also be taken.  The Public Health team had asked her to be involved in the listening exercise and behavioural insight work being carried out by the team. The question and full response would be appended to the minutes.  K McDonald highlighted the following points:

• The community hubs had been provided with the resident’s contact details in case there were any further food access issues.
• The Housing Team had sent a letter to all known Travelling and Roma community locations in April advising that they should contact their local housing department if families needed to self-isolate or if there were any issues with accommodation.
• The HWB was pleased that the resident’s daughter had been provided with a laptop; current government guidance now stated that all home learning would end this term and all pupils would be required to return to school in September 2020.
• The HWB was aware of mental wellbeing issues and was taking these seriously in recovery plans.

G Williams  ...  view the full minutes text for item 5.

Presenter: Dr Jane O’Grady, Director of Public Health

Buckinghamshire Public Health team have been at the forefront of the local response to the pandemic, providing epidemiological analysis and clinical public health expertise across the health and care system.  The Director of Public Health will present an overview of the impact of Covid_19 in Buckinghamshire, including what we know about the current situation and future impact at the meeting.

Recommendation: The Health and Wellbeing Board is asked to note and discuss the information covered in the presentation at the meeting.  

Dr Jane O’Grady, Director of Public Health, provided a presentation (slides  1-19 of the full slide pack appended to the minutes) and highlighted the following points:

• The first coronavirus case in the UK was identified on 31 January 2020.  The first death in the UK was on 5 March 2020.
• The first case in Buckinghamshire was identified at the beginning of March with the first death occurring on 9 March 2020.
• There had been approximately 1600 cases in Buckinghamshire with 383 deaths; however, the number of confirmed cases underestimated numbers as testing was limited early on in the pandemic.
• 72 new cases had been identified in the period 14-27 June 2020, however, the real number was likely to be four times higher due to people not coming forward for testing.
• Approximately one in five people diagnosed with Covid-19 became more seriously ill.  One in ten people were thought to be suffering symptoms for many weeks after the illness.

• A survey was being carried out in Buckinghamshire, on the impact of Covid-19 in Buckinghamshire, which would be circulated after the meeting; members of the HWB were asked to promote the survey as widely as possible, particularly to the less frequently heard groups.

ACTION:  Katie McDonald

• The recovery would be complex, the initial priorities were listed; further priorities would be recognised after the listening exercise.
• The Health Protection Board had been set up to prevent any resurgence in infections. 
• Work would be carried out with the Black and Minority Ethnic (BAME) community who were recognised as being at increased risk from COVID.
• A Covid-19 Mental Health Strategy Response Group had been established.
• The importance of social distancing as the virus was still circulating was stressed.

G Williams presented slides 20-22 on the work carried out by the Communities Team and highlighted the following points:

• Eight local support hubs had been set up by 23 March 2020 to respond to the Covid-19 crisis to provide support to shielded individuals with underlying health conditions.
• An explanation of the role of the community hubs, volunteers and the VCS.
• The partnership work with charity foundations to distribute nearly £1m to local groups to support community responses to Covid-19.

The following point was raised and discussed by members of the HWB:

• In response to being asked whether the local authority was receiving the pillar one (health settings) and pillar two (community setting) test and trace data, Dr O’Grady advised that the first download of the post code data had been received.  Some key data was missing, such as ethnicity, but Dr O’Grady expected the situation to improve and was expecting data on a weekly basis.

RESOLVED:  The Health and Wellbeing Board NOTED and DISCUSSED the information  ...  view the full minutes text for item 6.

The presentation at the meeting will provide detail on the Buckinghamshire Framework for place based recovery from Covid-19, the 3 R’s to Recovery (Reset, Resilience and Restoration) led by the Member Recovery Board and the Buckinghamshire Recovery and Restoration Health and Care Plans led by the Integrated Care Partnership.

Lead presenters: David Williams and Rodger Goodes (on behalf of Sarah Ashmead). The presentation will also include updates from the key leads from the NHS, Adult Social Care, Public Health and Children’s Services to outline how each organisation has managed in response to the pandemic and the key priorities for stepping up services, recovery and reset.

·       Recommendation: The Health and Wellbeing Board is asked to note and discuss the information covered in the presentation on the 7 July and consider the role the Health and Wellbeing Board should play in the next phase of Buckinghamshire’s recovery and response.

Roger Goodes, Service Director, Policy and Communications, presented slides 24-27 on behalf of Sarah Ashmead, Deputy Chief Executive.  R Goodes highlighted the following points:

• The overarching approach to recovery across Buckinghamshire would be  focused on the following:

• A Member Recovery Board would lead the work aligned to existing partnerships through which the following partnerships would play a leading role:

David Williams, Director of Strategy, (BHT), and David Williams, Deputy Director of Quality (NHS), Buckinghamshire Clinical Commissioning Group presented slides 28-38, and highlighted the following points:

• The recovery model focussed on working in partnership as a health and social care system on behalf of the communities and patients.
• There were two over-arching groups; the Health Protection Board and the Clinical Harms Board.
• The recovery process would be long and complex and the way in which care would be delivered had changed; the Service would need to provide a flexible approach for patients to access care.
• Work had been undertaken to understand the potential clinical harm due to patients not having accessed care during the Covid-19 pandemic.
• The Buckinghamshire Clinical Harms Steering Group had been established to identify what could be carried out to mitigate the risk.
• Plans were being developed in preparation for a spike in the number of Covid-19 cases.  It was a complex piece of work involving colleagues from Public Health and other partners; any learning would be shared.
• The primary care, acute and community recovery approach had commenced.
• Routine operations had re-started.
• Treatment of urgent and cancer patients had continued throughout the pandemic.
• Community hospitals were re-opening.
• Out-patient appointments were re-starting.
• Support was being provided to the care home sector.
• All staff would be tested regularly for Covid-19 and would also have an anti-gen test.
• Referrals had reduced dramatically but were now at 75% of expected level.
• A & E attendance was now at 90% of expected level.
• There was a national campaign to promote that the NHS was ‘here and open’.
• The backlog of cancer patients who needed an operation would be cleared by the end of August 2020.
• All patients on waiting list had been contacted, reviewed and prioritised.
• If a second wave occurred it was likely that other services would be able to continue.

The following points were raised and discussed by members of the HWB:

• It was noted that the rapid setting up of the Olympic Lodge, which had provided extra capacity, had been achieved due to the partnership work across the organisations.
• A huge amount of encouraging  ...  view the full minutes text for item 7.

Lead Presenters:

·       Jenny Baker – Chair, Healthwatch Bucks and Miguel Souto – Interim Chief Executive, Healthwatch Bucks

·       Martin Gallagher – Chief Executive Officer, The Clare Foundation

·        Katie Higginson – Group Chief Executive Officer, Community Impact Bucks 

Miguel Souto, Interim Chief Executive, Healthwatch Bucks presented slides 58-61 of the all-in-one slide pack and highlighted the following points.

• Healthwatch Bucks approached both statutory and non-statutory providers to offer support at the start of the crisis by providing information for the public to stay safe during this period; they also acted as a conduit for information for providers or commissioners to reduce the anxiety people were having around local services.
• Healthwatch Bucks gathered feedback and escalated any issues to commissioners, providers and Healthwatch England.
• The work programme was reviewed to include projects to capture people’s experiences during the Covid-19 pandemic and the following surveys were carried out:

• Early feedback from patients showed issues over prescription delays and anxieties over vulnerable people not being on the official shielding list.
• There was also lack of clarity over government and local guidance.

• There been over 500 responses to the survey on the overall impact of the pandemic and more detail would be available next month.
• The next steps in supporting the recovery would be to:

Martin Gallagher, Chief Executive Officer, The Clare Foundation, and Katie Higginson, Chief Group Executive, Community Impact Bucks presented slides 62-64 and highlighted the following points:

• Approximately 17-18 charities had come together with the Council to form a VCS Taskforce at the start of the pandemic to co-ordinate and support the needs of the county.
• Many charities faced a cut in their income stream but many organisations had found funding from other sources; overall the sector had lost approximately £1bn.
• An incredible amount of work had taken place to coalesce the needs of the residents in Buckinghamshire.
• Community Impact Bucks had worked alongside Public Health to gather insight from the voluntary sector as part of the rapid Health Impact Assessment.  The report had shown the voluntary sector organisations had deep concerns about the way that health inequalities had widened through the pandemic and feared that the gap would grow. The need for clear accessible, culturally sensitive services which took account of language barriers had been identified.  The lack of accessible information had increased the fear of accessing health services when needed.  There was a need for support for family carers, both adult family carers and young carers who had taken on additional responsibility through lockdown and were likely to need additional catch up support from schools. 
• Many vulnerable people, who were most in need, did not have online  ...  view the full minutes text for item 8.

Title: Healthwatch Bucks Success and Renewal (Annual Report to the Health and Wellbeing Board)

Presenter:  Jenny Baker OBE, Chair Healthwatch Bucks

The presentation at the meeting will provide the Health and Wellbeing Board with an update on the work of Healthwatch Bucks and key elements of performance for the financial year 2019/20.

To access Healthwatch reports and results for 2019-20 please visit the website: https://www.healthwatchbucks.co.uk/category/results/

Recommendations: Key recommendations for the Board and its members are:

• To note the work and achievements of Healthwatch Bucks in 2019/20
• To note Healthwatch Bucks plans and priorities for 2020/21 
• To consider how Healthwatch Bucks can further help the Health and Wellbeing Board and health and social care providers improve people’s health and wellbeing, especially during recovery from Covid-19.

Jenny Baker OBE, Chair, Healthwatch Bucks advised that the Healthwatch Bucks Annual Report should have been presented at the meeting in March 2020 but unfortunately it was cancelled.  The Annual Report 2019/20 was accessible on https://www.healthwatchbucks.co.uk/category/results/.

J Baker referred to slide 72 of the pack which showed the ways in which organisations couldwork together to improve health and wellbeing in Buckinghamshire.  J Baker emphasised that, particularly during the Covid-19 recovery period, Healthwatch Bucks were able to help by capturing people’s voices to ensure they were at the heart of decision making.  Healthwatch Bucks had excellent contacts, particularly with the under-represented groups and could help prevent ‘re-inventing the wheel’.  J Baker asked the HWB members to remind users that Healthwatch Bucks existed as a key player to make the system better in Buckinghamshire and could be commissioned.

RESOLVED:  The Health and Wellbeing Board:

·        NOTED the work and achievements of Healthwatch Bucks in 2019/20

·        NOTED Healthwatch Bucks plans and priorities for 2020/21

CONSIDERED how Healthwatch Bucks could further help the Health and Wellbeing Board and health and social care providers improve people’s health and wellbeing, especially during recovery from Covid-19.

·       Buckinghamshire Integrated Care Partnership (ICP) Engagement Programme: Working together to improve health and social care in Buckinghamshire

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

·       Communication and Engagement across the ICP

Presenter: Kim Parfitt, Head of Communications – CHASC/CCG/ICS.

David Williams, Director of Strategy, Buckinghamshire Healthcare Trust referred to the report on pages 9-26 in the agenda pack.  D Williams summarised that the theme of the meeting had been to understand the patient experience of care during the Covid-19 pandemic and to work with communities to co-design and change new ways of working that suited patients’ circumstances.  Work would commence over the summer on the three areas below:

• Reducing health inequalities: improving health for vulnerable groups and people living in deprived areas.
• Community services: organisations working together to promote independence and deliver care in people’s homes and communities.
• Keeping People Safe: delivering services differently to prevent the spread of infections.

D Williams advised that an update would be provided at the meeting in October 2020.  All organisations would be made aware of the process and ways in which to contribute.

RESOLVED:  The Health and Wellbeing Board AGREED to SUPPORT the Buckinghamshire ICP approach to engaging communities about changes related to health and social care.

Presenter:  Katie McDonald, Health and Wellbeing Lead Officer.

Katie McDonald, Health and Wellbeing Lead Officer, referred to slides 84-86.  The draft Buckinghamshire Health and Wellbeing Board Terms of Reference had been updated at a development session in January 2020 and were included in the agenda pack for approval.  K McDonald asked for any comments before the Terms of Reference document was uploaded to the website. 

The priorities for the Joint Health and Wellbeing Strategy had been agreed at the Health and Wellbeing Board Development session in January 2020; discussions had taken place with partners in light of Covid-19 and priorities and actions had been added to align with recovery plans.  The online consultation would take place  for 5 – 6 weeks starting in September; final sign-off would be carried out in December 2020 with publication in early 2021.

The Pharmaceutical Needs Assessment publication deadline had been extended by a year and was now due in April 2022; discussions would take place towards the end of 2020 in relation to setting up the steering group.

It was agreed that the ‘Winter Plan’ should be added to the agenda for the next meeting.

Tuesday 6 October 2020 (pre-meet at 9.15 followed by the meeting at 10.00 am).

Tuesday 6 October 2020.