Agenda and minutes

The Chairman, Cllr Gareth Williams, Cabinet Member for Communities and Public Health, welcomed everyone for the meeting.

Apologies were received from  Dr Nick Broughton, Chief Executive, Oxford Health NHS Foundation Trust;  Tolis Vouyioukas, Corporate Director, Children’s Services (Gareth Drawmer, Head of Achievement attended in his place); Dr James Kent, Accountable Officer, Buckinghamshire Clinical Commissioning  Group (CCG) (Kate Holmes, Chief Finance Officer,  attend in his place); Robert Majilton, Deputy Chief Officer, Buckinghamshire CCG and Dr Raj Bajwa, Clinical GP Chair, Buckinghamshire CCG.

The Chairman advised that Councillor Martin Tett, the Leader of Buckinghamshire Council, provided a regular Covid-19 update and anyone could be added to the email circulation list – contact Si Khan.

1.7million people had recently been added to the clinically extremely vulnerable list and would be contacted regarding the Covid-19 vaccination. 

A White paper had been issued by the Government entitled “Working Together to Improve Health and Social Care for all’ and would be looked at in greater detail.  Gill Quinton, Corporate Director, Adults, Health and Housing highlighted some key points and proposed providing a report on the implications of the paper to the next meeting.

Dr Sian Roberts declared an interest as GPs were a provider in the vaccine roll out.

To agree the minutes of the meeting held on 10 December 2020.

RESOLVED:  The minutes of the meeting held on 10 December 2020 were AGREED as an accurate record.

Councillor Howard Mordue stated he was a ward councillor of Buckingham and provided a summary of the history of the proposed medical centre in Buckingham.  Councillor Mordue advised he wanted to bring the situation to the attention of the Health and Wellbeing Board (HWB) and requested an update on the current position of the project with the move to the integrated care system.  Kate Holmes, Chief Finance Officer, Buckinghamshire CCG, stated that work was being carried out on the project, the funding had been allocated and it would not be impacted by any of the changes, but it was subject to the approval of the NHS business case.  The following written response had been provided to Councillor Mordue after the meeting.

“We do not expect the fund allocation identified for new Primary Care facilities development in Buckingham to be affected by the move to ICS from CCG. However, the progress of the scheme is dependent on approval by NHS England of the final business case.”

A verbal update will be provided by Dr Jane O’Grady, Director of Public Health, on the Covid-19 cases in Buckinghamshire.

Dr Jane O’Grady, Director of Public Health, provided an update (see slides 2-6 in the slide deck appended to the minutes) on the pandemic since the last meeting in December 2020.  Dr O’Grady highlighted the following key points:

• Slide 5 showed a steep rise in cases which peaked at the beginning of January 2021; and had increased almost five-fold during December 2020 due to the new more infectious variant. 
• Entry into tier 4 and subsequently the national lockdown in early January 2021 had resulted in cases falling significantly. 
• The ‘R’ rate was 0.6-0.8 meaning the epidemic was gradually shrinking.
• The rate in Buckinghamshire was 135 per 100,000 which was higher than the South East England rate but slightly lower than the England average. 
• The highest case rates were in young adults; 21% were from the Asian population.  11% were in the 5-18 year age range. 
• Information from community sampling showed that only one in four cases was detected as some people are asymptomatic and, therefore, unaware they had COVID, others chose not to get tested. 

The live Covid dashboard was available on the Buckinghamshire Council website.

To be presented by Dr Jane O’Grady, Director of Public Health

Priority 1 – Keeping Residents Safe

The COVID-19 pandemic has now been a major focus of work across the health and social care sector for more than 12 months.  During that time both organisations and individuals have had to deal with unprecedented challenges in responding to the most significant public health crisis of the last hundred years. Events since the beginning of 2021 have made it clear that new challenges will continue to arise, even while the COVID-19 vaccination programme provides hope for ending the crisis.

Recommendations: Board members are recommended to note and approve the attached action plan update. Also, to agree to receive a further update at the July meeting.

Community lateral flow test service to help to control Covid-19

Buckinghamshire Council plans to provide a ‘rapid’ Covid-19 testing service on a twice-weekly basis for key workers in public-facing roles from early February. The service has to meet certain government-defined criteria to be eligible for central funding. The purpose is to help identify people who have no symptoms and yet have Covid-19 (and thus may be infectious) so that they can self-isolate and thereby help to break the chain of transmission.

Recommendations: Board members are recommended to approve the proposed service

Priority 1 – Keeping Residents Safe

Dr Jane O’Grady, Director of Public Health, advised that ‘Keeping Residents Safe’ was Priority One of the Health and Wellbeing Recovery Plan.  Dr O’Grady referred to the report in the agenda pack and stated that communication with residents, workplaces, schools and universities had been carried out to advise on the national guidance.  The new variant had been responsible for the surge of cases in the area; it was more infectious and may cause a slight increase in risk of death; however, later data might refute this.  There had also been the emergence of the South African variant which might make the vaccines slightly less effective and there had been a focus on surge testing in some counties.  Contact tracing continued in Buckinghamshire and lateral flow testing, for people without symptoms, was available.  There was a regional testing centre in Aylesbury for people with symptomatic disease in addition to mobile testing units around the county.  Several outbreaks had been responded to and support was being provided to the vaccination programme for Covid-19 as well as the flu vaccination programme.

The following points/comments were raised in discussion:

• Reference was made to the impact on children’s mental health and the older population and the importance to link to corresponding plans for economic recovery and growth.  Martin Gallagher, Chief Executive Officer (CEO), The Clare Foundation, advised that work was being carried out with several organisations such as the Citizens Advice Bureau and emphasised the importance of collaboration as the problems could perpetuate for a long time to come.
• The complexity of the mental health issues for some children was challenging all systems; however, the schools had been working well with the Children’s Service but there was concern over the mental wellbeing of children for the future.
• The partnership work was welcomed but Healthwatch Bucks raised concerns about the eastern European community who could be missing out on the communications. 
• The increase in rates of domestic abuse was highlighted along with the number of residents facing financial insecurity. 
• There had been an increase in frailty; LEAP had distributed approximately 10,000 activity packs to older people. 
• Social isolation had been a key issue before Covid-19 and had been exacerbated by the pandemic. 

Gareth Drawmer, Head of Achievement, advised that the mental health issue was on the agenda and the service had been working to deliver the national return package.  All schools had received three sessions of training to help identify young people struggling with mental health issues.  The Service had also funded a programme to support senior leaders and teachers in schools in order to cope with supporting the children’s issues and were considering a further package on wellbeing. 

RESOLVED:  Board members noted and approved the action plan update and agreed to receive a further update at the July meeting.

Community lateral flow test service to help to control Covid-19

Dr Andrew Burnett, Interim Assistant Director of Public Health, referred to the report contained in the agenda pack and advised  ...  view the full minutes text for item 8.

Update on vaccination roll out – a presentation will be provided by Kate Holmes, Chief Finance Officer, Buckinghamshire Clinical Commissioning Group.

Health and Care Survey – A verbal update will be provided by David Williams, Director of Strategy, Buckinghamshire Healthcare NHS Trust.

Update on impact of COVID-19 on Health Provision (including cancer) – a verbal update will be provided by Andrew McLaren, Divisional Chair of Surgery and Consultant Surgeon, Buckinghamshire Healthcare NHS Trust.

Kate Holmes, Chief Finance Officer, Buckinghamshire CCG, provided a presentation (see slides 11-16, appended to the minutes).  K Holmes advised that the vaccination programme was being led by the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System with Buckinghamshire Council supporting the process.   There was a mixed model for delivery, which consisted of hospital hubs, GP led locations, community pharmacies and mass vaccination centres.  The Pfizer and Astra Zeneca vaccines would be offered to the nine priority groups agreed by the Joint Committee for Vaccines and Immunisations; the target had been met to offer the vaccine to all those in cohorts 1-4 by 15 February 2021 and the programme had moved on to cohorts five and six.  All nine cohorts should be completed by May 2021.  Approximately 6,000 residents had recently been identified as ‘shielded’ and would be contacted regarding their vaccination.   A community transport hub was in place, Community Impact Bucks provided support where needed and the Community Engagement Team were linking with voluntary groups.  The vaccine supply was on a ‘push’ model and was working well.  Targeted communication was key to promote a positive take up of vaccinations and the message remained that the NHS would contact residents and social distancing rules still needed to be followed even after vaccination.

The following key points were raised in discussion:

• Following a query on whether GPs were contacting patients with underlying health conditions; K Holmes clarified that letters had been sent to the over 65s to invite them to book at a mass vaccination or community pharmacy site and GPs would contact patients who were extremely clinically vulnerable.
• It was confirmed that cohort six was extremely large and that people needed to be patient and wait to be contacted.
• Dr Zaib was working proactively to increase the vaccine uptake amongst the black, Asian and minority ethnic (BAME) community.
• The role of the volunteers was recognised; there had been a fantastic response from the community with 86 volunteers having been mobilised.
• It was confirmed that carers came under cohort six.

Vaccine Equalities Sub-Group

Dr Jane O’Grady, Director of Public Health, referred to slides 7-10, appended to the minutes and advised that the sub-group had been set up to address potential inequality of uptake of the vaccine.  The sub-group would look at the data and monitor the uptake of the vaccine in Buckinghamshire in the nationally agreed priority groups and make recommendations on what was required to address inequalities in COVID-19 vaccine access and uptake. A range of activities were being carried out and behavioural insight approaches had been used to support the vaccine programme.

The following points were raised in discussion:

• It was noted that key groups e.g. rough sleepers were being encouraged to register with a GP, but a mobile unit would be beneficial.
• After being asked if the voluntary, community and social enterprise section (VCSE) had been involved in the sub-group; Dr O’Grady confirmed that the sub-group had carried out work with the Community Engagement Team and the  ...  view the full minutes text for item 9.

A verbal update and a presentation will be provided on the current situation of Buckinghamshire schools by Gareth Drawmer, Head of Achievement and Learning, Buckinghamshire Council.

Gareth Drawmer, Head of Achievement and Learning, provided a presentation (see slides 17-23 of the slide deck appended to the minutes).  G Drawmer advised that schools had been partially open since 6 January 2021 for children with Educational Healthcare Plans (EHCPs), the vulnerable and for children of critical workers.  There had been higher attendance at primary schools and special schools than the previous lockdown and the numbers were still rising gradually.  The categories of pupils attending school were shown on slide 19; there were approximately 6,000 pupils of critical workers which was a significant increase since May 2020 but was in line with the national data.  Children entitled to free school meals had received their meals via local and national voucher schemes and these would continue until the children returned to school.  All schools had ensured pupils had access to remote education; funding had been received from the Rothschild Foundation for the supply of devices to children aged 4-6 years.  The Service was ensuring that all the legislation was met for children with special educational needs (SEND) to ensure they had all the requirements for learning.  The schools were managing a delicate situation; there was an increasing number of children on site and expectations during this lockdown with regard to remote learning had significantly increased.  The Service was managing concerns around the Union’s requirements to ensure staff were safe on site.  No schools had closed, but occasionally a decision had been made at a local level to restrict access for some children due to pressure of numbers; children of critical workers were prioritised.  Peer-to-peer support for teachers was promoted and coaching sessions were provided along with a twice weekly huddle for head teachers. 

The Chairman thanked the Rothschild Foundation for the funding and clarified that all children who required a device should have one.  4G dongles were provided to households without internet access.

The Health and Wellbeing Strategy and the Health and Wellbeing Annual Report will be presented by Si Khan, Business  Manager, Health and Wellbeing,  Buckinghamshire  Council.

The Health and Wellbeing Board members will be recommended to approve the Health and Wellbeing Strategy and to agree the approach to monitor the progress on actions identified for the priority areas – Start Well, Live Well, Age Well.

The Health and Wellbeing Board members will be recommended to approve the Health and Wellbeing Annual Report.

Si Khan, Business Manager for Health and Wellbeing, stated that the recommendations were for the board members to:

·      Approve the Joint Health and Wellbeing Strategy.

·      To agree the approach on how assurance would be provided against progress on actions identified in the three key priority areas – Start Well, Live Well and Age Well in the Joint Health and Wellbeing Strategy.

·      To approve the Health and Wellbeing Annual Report.

S Khan advised that in order to provide the Board assurance on progress being made against the high-level actions included in table two of the strategy, a detailed action plan would be developed with clear measurables that lead officers will need to report progress against.

The following points were raised in discussion:

• The Chairman summarised the work carried out by the Health and Wellbeing Board, captured in the annual report, during the year and stated that good progress had been made.  S Khan confirmed the report would be designed and then circulated via email to Board members and also added to the website.
• Councillor Angela Macpherson, Cabinet Member for Adult Social Care, mentioned that the strategy did not contain a high prominence of the work carried out around physical and learning disabilities and felt it would be helpful if this information was included.  The members of the board agreed that the report should be amended and recirculated by email.
• The HWB had a commitment to making residents aware of its work and it was agreed that an infographic summary be produced for promotion/circulation.

ACTION:  Si Khan

• A member of the board suggested, and it was agreed, that the three cross-cutting themes be incorporated into the work plan for the year.  S Khan added that action plans would be developed for each of the priority areas.  It was also agreed that a deep dive on mental health be included on the work plan.

ACTION:  Si Khan

RESOLVED: 

·       The Board approved the Joint Health and Wellbeing Strategy subject to the inclusion of information on the work undertaken on physical and learning disabilities.

·      The Board agreed the approach on how assurance would be provided against progress on actions identified in the three key priority areas – Start Well, Live Well and Age Well in the Joint Health and Wellbeing Strategy.

The Board approved the Health and Wellbeing Annual Report.

To be presented by Saiqa Khan, Business Manager, Health and Wellbeing.

Si Khan, Business Manager for Health and Wellbeing requested that she be notified of any items to be included on the workplan by email.

The Healthwatch Bucks update is included for information.

Zoe McIntosh, Chief Executive, Healthwatch Bucks, advised that Healthwatch Bucks had received approximately 250, mainly positive, responses to the survey on the vaccination rollout.  The site-specific feedback was being passed to the vaccination cell for information on a weekly basis.   Healthwatch Bucks were carrying out several other projects; in particular, one was based on mental health and people's experience of online mental health support.  Qualitative research into digital exclusion was also being carried out on residents who could not, or had difficulties, accessing GP appointments online and the barriers they had faced.

The Chairman thanked everyone for all their hard work on behalf of the residents of Buckinghamshire.

Thursday 1 April 2021.

1 April 2021.