Agenda and minutes

The Chairman, Councillor Gareth Williams, welcomed everyone to the meeting.

Apologies were received from Dr Karen West, Vice-Chairman and  Clinical Director, Buckinghamshire Clinical Commissioning Group (CCG); Neil Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust (BHT); Tolis Vouyioukas, Corporate Director, Children’s Services, Simon James, Service Director, Education attended in his place;  Dr Nick Broughton, Chief Executive, Oxford Health NHS Foundation Trust, Debbie Richards, Managing Director, Oxford Health NHS Foundation Trust attended in his place.

Juliet Sutton, Clinical Director Children's services Buckinghamshire CCG and Councillor Angela Macpherson, Cabinet Member for Adult Social Care, joined the meeting a little after the start due to prior commitments; Francis Habgood, Independent Safeguarding Joint Chair, joined the meeting for item 12 – Safeguarding Board Annual Reports.

There was no announcement from the Chairman.

Dr Raj Bajwa declared an interest in Item 8; The Integrated Care Partnership (ICP) Update, the Covid Vaccination Roll Out Plans due to being a GP.

To review and agree the minutes of the meeting held on 6 October 2020.

Katie McDonald, Health and Wellbeing Lead Officer, stated that the work programme had been taken forward and all specific actions had been completed.  In relation to the action under Item 11 - Update on Joint Health and Wellbeing Strategy Engagement, Happier, Healthier Lives - a shared plan for Buckinghamshire; a workshop had been held and the information received had been fed back to the partners.

RESOLVED:  The minutes of the meeting held on 6 October 2020 were AGREED as an accurate record.

The Chairman advised that a question pertaining to maternity ward visiting had been received by the Health and Wellbeing Board; the issue had been resolved and the response had been sent to the resident.  The question was not read out during the meeting but, as stated by the Chairman, had been included in the minutes for information.

Question

The anxiety experienced by women undergoing pregnancy was being dramatically compounded by the existing Covid restrictions at Stoke Mandeville hospital. Partners were not able to join any of the scans (in the case where the 12 week scan fell before that specific restriction was lifted) or consultant appointments and may be excluded from the labour ward at the point during early labour when critical decisions may be needed.

Now that the broader lockdown restrictions had been lifted, it would seem an appropriate time to reconsider these draconian policies and, in particular, better reflecting the counterbalance of the importance of emotional support at all times for the expectant mother. Would the committee support positive action to address this deeply unsatisfactory position?

Response

Since the beginning of the pandemic Midwifery had undertaken risk assessments of all clinical areas with the intention to support presence of partners in maternity as far as possible. Whilst lockdown had lifted, the restrictions within tier 2 remained stringent.

The Head of Midwifery had confirmed that partners were no longer restricted on admission for assessment in labour/early labour. The maternity unit also had partner presence during induction of labour for 12 hours a day and 2 hour visiting in the afternoon for partners.

With regard to presence at scans and outpatients there were several factors to consider and it was a little more complicated. Partners were currently being accommodated at 12 week scans. Unfortunately this was not possible at all scans.  This was due to the size and design of the scan rooms being only just adequate to maintain social distancing as well as making sure the Trust was still able to provide scans in accordance with clinical need and the national screening programme.  This was not intended to be discriminatory; the risk assessment recommendation was based on the length of scan time (the 20 week scan was considerably longer increasing the length of exposure time to staff); and it was recognised that the 12 week scan was an important moment for women and partners to visualise their baby for the first time).

To be presented by Dr Jane O’Grady, Director of Public Health and Katie McDonald, Health and Wellbeing Lead Officer.

The Health and Wellbeing Recovery Plan is part of Buckinghamshire’s 3R’s recovery framework and the oversight for planning and delivery of this action plan sits with the Health and Wellbeing Board.

Related Joint Health and Wellbeing Strategy Priority:The Health and Wellbeing Recovery action plan supports the delivery of the priorities (start well, live well, age well) set out in the Joint Health and Wellbeing Strategy refresh, Happier Healthier Lives – A Plan For Buckinghamshire.

Recommendations:

• The Health and Wellbeing Board is asked to receive an update on the Health and Wellbeing Recovery plan and the plans for publication of the Joint Health and Wellbeing Strategy in early 2021 at the meeting.
• The Health and Wellbeing Board is asked to approve the action plan for year one included in this report.
• Health and Wellbeing Board members are asked to commit to delivering the action plan and provide regular updates to the board on progress.
• The Health and Wellbeing Board is asked to receive an update on two priority areas. Keeping residents healthy (supporting healthy behaviours) and Promoting Mental Health and Wellbeing at the meeting.

Dr Jane O’Grady, Director of Public Health, provided a presentation (slides 1-12), appended to the minutes, and highlighted the following key points:

• The data covered the period 29 November to 5 December 2020.
• Buckinghamshire was in tier 2; the tier level was due to be revised on 16 December 2020 as legislation stated that tiers were reviewed fortnightly. 
• The tier level was determined by the all ages weekly infection rate; the over 60s weekly infection rate; test positivity; trend and rate of growth; hospital pressure and other local factors.
• Slide 3 provided the weekly detection rates and tiers; locations on the dotted line were where the case rate had remained the same; a location above the dotted line indicated that rates had fallen; locations shown below the dotted line were where rates had increased.  The distance of the location from the dotted line indicated the level of increase or decrease. 
• Slide 4 showed the impact of the second lockdown on Buckinghamshire.  A reduction in the number of cases would have been expected until 9 December 2020; however, the cases started to increase before the end of the lockdown.  Buckinghamshire had entered and exited lockdown at almost the same level; lockdown had worked but the key message was that cases were already on a steep incline and there was concern that the rates would escalate dramatically.
• Slides 5-8 showed the rates for the legacy council areas. 
• Slide 9 was a ‘heat map’; the darker the purple colour the higher the rates. 
• The excess deaths had crept up in weeks 47-48.
• There was a new interactive website which provided the data – visit www.buckinghamshire.gov.uk/covid-dashboard.

Katie McDonald introduced the Health and Wellbeing Recovery Action Plan which had been included in the agenda pack and was part of the wider Buckinghamshire Plan; there were ‘three R’s to recovery’ – reset, restore and resilience.  K McDonald explained that the Health and Wellbeing Board (HWB) had oversight of the recovery plan which set out the framework for Buckinghamshire in terms of the social, economic and environmental challenges which had occurred from the COVID-19 pandemic.  At the start of the year, the HWB had started developing its Joint Health and Wellbeing Strategy Action Plan and the Board agreed that it would align its first year of delivery with the Recovery Plan, therefore the action plan linked across with the Integrated Care Partnership recovery plans.  K McDonald emphasised that the action plan was at a draft stage and encouraged further input from partners before it was published in the New Year. It had been agreed that the HWB would be presented with a different section of the plan at each meeting in order to monitor the success of the action plan.  K McDonald asked the HWB to support the action plan; a revised version would be circulated in the New Year.

Sarah Preston, Public Health Principal, provided a presentation (slides 13-16), appended to the minutes, on two healthy behaviours actions that were included in the year one  ...  view the full minutes text for item 7.

·       Winter Planning and the Covid Response - A verbal update on will be provided by Neil Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust and Gill Quinton, Corporate Director, Adults, Health and Housing, Buckinghamshire Council.

·       The Covid Vaccination Roll Out Plans and how the Health and Wellbeing Board can Support -A verbal update will be provided by Robert Majilton, Deputy Chief (Accountable) Officer, Buckinghamshire Clinical Commissioning Group (CCG); Louise Smith, Interim Director Primary Care and Transformation, Buckinghamshire CCG; and Richard Barker, Corporate Director, Communities, Buckinghamshire Council.  

·       Health and Care Survey – to be presented by David Williams, Director of Strategy, Buckinghamshire Healthcare NHS Trust.  The report provides an analysis of a community survey into health and care services in Buckinghamshire which the HWB Board endorsed at its meeting in July 2020. The analysis will be used to inform the future development of services.

Recommendation: The Health and Well-Being Board is asked to note the analysis of a community survey which will be used to shape the development of health and social care services in Buckinghamshire.  The Board is asked to note further work in focus groups and one to one interviews during December 2020 to provide additional engagement especially from BAME communities and disadvantaged groups.

David Williams, Director of Strategy, BHT, reported that the hospitals were at the peak of the second wave in terms of admissions; there were 65% of the number of cases seen at the peak of the first wave which was resulting in pressures on bed capacity as Covid-19 patients had to be kept separate in the hospital and in intensive care.  Some wards had been closed due to Covid-19 outbreaks but routine patients were still being seen throughout the services.  During the first wave, elective surgery and outpatients were ceased but this had not happened during the second wave.  98% of patients with suspected cancer were seen within two weeks of referral and 85% received treatment within 62 days.  D Williams stressed that the NHS was open and anyone with symptoms or health concerns should seek support from their GP; acute services would see patients as normal.  A separate unit had been opened to reduce the backlog of cataract patients.

Winter plan – Direct appointments were now being made via calls to NHS 111 to direct patients to the most appropriate service and avoid over-crowded waiting rooms; it had been successful and would grow over time.  A new same-day emergency care centre had opened next to the A&E unit for patients in need of a multi-disciplinary assessment; this made more space in the A&E department for seriously ill patients.  D Williams thanked colleagues across the system that had assisted in getting patients home as quickly as possible.  Frontline staff were being tested for Covid-19, using lateral flow tests, in order to identify asymptomatic staff that would then have to isolate.

The following points were raised in discussion:

• In response to being asked how long it would take to reduce the backlog of cataract patients to an acceptable level; D Williams stated that it would take at least 6-12 months and that it was critical to keep the Covid-19 infection rate down to avoid ceasing routine surgery.
• D Williams confirmed that anyone who needed an urgent operation would have one; however, the largest areas of awaited surgery were hip and knee replacements.
• The Chairman asked if BHT had extra surge capacity.  D Williams stated that there was additional capacity available at Amersham Hospital for rehabilitation but acknowledged that there was only a finite number of beds for acutely ill patients and if Covid-19 numbers rose they would have to look at routine surgery and divert beds and staff to the seriously ill.

Adult Social Care Winter Planning and Winter Resilience - Gill Quinton, Corporate Director, Adults and Health, advised that their role was to support resilience of the whole system, including the acute sector and primary care, by supporting people to live at home, to help avoid hospital admissions and to support people to get home quickly if they were hospitalised.  Care homes received a weekly newsletter and were supported with additional personal protective equipment (PPE) and training in the use of PPE. Care homes were provided access to  ...  view the full minutes text for item 8.

To be presented by Katie McDonald, Health and Wellbeing Lead Officer.

This reportprovides members with an update on progress with projects identified as part of the system wide approach to social isolation started in 2019.

Recommendations: The Health and Wellbeing Board is asked to receive the update on the Social Isolation projects and approve in principle the proposals for progressing the project. 

Katie McDonald, Health and Wellbeing Lead Officer, stated that the report included in the pack, provided an update on the progress of the social isolation project which had been agreed in December 2019.  Task and finish groups had commenced in January and February 2020, but had to pause due to Covid-19, and had re-grouped in September.  A multi-agency workshop had identified potential quick wins e.g. the development of the Bucks Online Directory which had been updated and relaunched in 2020 to support the COVID response and the opportunities to link with the new Community Boards as well as the fantastic work of the voluntary sector.  The report also outlined proposals to be taken forward, some of which had been reconsidered due to the pandemic.  There was social isolation across all age groups; the Health Impact Assessment had shown that 23% of respondents said they were lonely and socially isolated. The report proposed that the multi- agency task and finish group continue to develop a screening tool incorporating new learning and aligning with MECC (Make Every Contact Count) principles. It was proposed that the ethos of the community led projects also be taken forward utilising the learning from the Design Council; while  sharing new research and learning  across the system with the  potential of setting up a multi-agency social isolation forum to ensure that stakeholders and the community boards were linked to best practice and shared learning. 

RESOLVED:  The Health and Wellbeing Board RECEIVED the update on the Social Isolation projects and APPROVED in principle the proposals for progressing the project.

To be presented by Katie McDonald, Health and Wellbeing Lead Officer.

Katie McDonald, Health and Wellbeing Lead, requested that the Board members provided her with any final comments on the Health and Wellbeing Recovery Action Plan.  The Board also needed to agree which priorities would be focussed on at future meetings.

ACTION:  Si Khan

K McDonald also highlighted that the HWB had committed to providing data and holding workshops with the Community Boards to help them identity health and wellbeing priority areas for inclusion in their own action plans. 

The Chairman advised that Katie had a new role in the Localities team; he thanked her for her hard work and added that he was looking forward to working with Si Khan, Business Manager for the HWB, in the future.

The update report from Healthwatch Bucks has been provided for information.

Zoe McIntosh, Chief Executive, Healthwatch Bucks, advised two reports would be published before Christmas; ‘Open for Business’ and ‘The Care Homes Report’.  The Chairman commented that the ‘Coronavirus Community Voices’ report and the ‘Your Experiences of Services during the Coronavirus Outbreak’ had six recommendations in each.  Z McIntosh confirmed that there had been positive feedback from the service providers and that the recommendations would be followed up.

Jenny Baker OBE, Chair, Healthwatch Bucks, commended the Healthwatch team as it had been a challenging time for everyone but a lot had been achieved during lockdown.  The allocated funding had been used sensibly and would be used even more productively going forward to avoid duplicating research.  The Chairman agreed that co-ordination was important, particularly in the planning of surveys.

The Safeguarding Board Annual Reports are provided for information.

Recommendation:                                 

·       For the Board to note the progress made by the Buckinghamshire Safeguarding Children Partnership and the Buckinghamshire Safeguarding Adult’s Board during the last year.

The Chairman welcomed Sir Francis Habgood, who advised he had been the Independent Chair of the Adults and Children’s Safeguarding Boards since August 2019.  He emphasised that he did not represent any of the single agencies that sat on either the Partnership or the Board but represented the partnerships, the communities and all the organisations served to ensure that people were safeguarded in Buckinghamshire.  The legislation on the structure of the children’s partnership had changed; it had moved from a board to a partnership and the three statutory partners (the local authority, CCG and the Police) had equal and joint responsibility.  The Adult Safeguarding Board was a statutory partnership co-ordinated by the local authority and the arrangements had been reviewed before Sir Francis became the Independent Chair. 

There was now a single business unit which helped in delivering some of the key issues, particularly, the transition from childhood to adulthood and common themes.  A learning and development plan had been implemented which set out the responsibility of the Partnership and the Board and how it would support the delivery of key training and awareness raising.  The business plans had been published for both Boards on the new websites.  A performance framework would be developed to monitor the number of referrals, quality and audit of the Boards.  Case reviews would be carried out in order to learn from when things went wrong. Making safeguarding personal was particularly relevant for adults but the principle of understanding the impact from a baby to an adult and the family concerned was important. 

Sir Francis stressed the importance of the links between the different partnerships in Buckinghamshire, i.e. the Safeguarding Partnerships and the Board, the HWB, The Community Safety Partnership and the new Domestic Abuse Board which would be set up in April 2021.  Regular meetings would ensure that common themes were identified and that it was understood which board was responsible for particular issues.  Sir Habgood acknowledged the effect of Covid-19 and advised that mental health was also a key issue in the safeguarding environment.

The Chairman thanked Sir Francis for his hard work and for imposing rigour on the Safeguarding Boards.

Thursday 18 February 2021.

Thursday 18 February 2021.