Agenda item

Review ofdelivery of two of Joint Local Health and Wellbeing Strategy action plans with a detailed focus on two priorities: 

•Improving outcomes during maternity and early years 

•Improving mental health support for Children & Young People, Adults & Older People 

DrJane O’Grady, Service Director PublicHealth and Community Safety, Buckinghamshire Council.  

Donna Clarke, Service Director Buckinghamshire, Oxford Health NHS Foundation Trust. 

Heidi Beddall, Director of Midwifery, Buckinghamshire Healthcare NHS Trust.

Dan Flecknoe, Public Health Consultant, substituting for Dr Jane O’Grady, reported that this was an opportunity for the Board to review the progress on two of the priority areas within the Joint Local Health and Wellbeing Strategy which ran between 2022 and 2025. The aim of the Strategy was to use all resources available to improve the health of residents by reducing the inequalities between residents. The Strategy was split up into three key areas, Start Well, Live Well and Age Well.

The two updates at this meeting were for improving outcomes during maternity and early years and improving mental health support for children and young people, adults and older people. The action plans were dynamic and regularly updated.

Dan Flecknoe welcomed both Heidi Beddall, Director of Midwifery, Buckinghamshire Healthcare NHS Trust and Donna Clarke, Service Director, Buckinghamshire, Oxford Health NHS Foundation Trust.

Heidi Beddall emphasized the Health and Wellbeing Board Strategy 2022-2025 priorities for maternity and early years as:

• To reduce the proportion of women who smoke during (and after) pregnancy in Buckinghamshire.
• To improve school readiness in Buckinghamshire children, especially amongst the most deprived communities and
• To increase the proportion of babies that are breastfed from birth until 6-8 weeks old.

It was reported that there were two groups; the Start Well maternity and early years programme and the Healthier pregnancies steering group. Both groups were responsible for providing oversight of efforts by various partner organisations, involved in this area of work to improve outcomes and reduce inequalities during pregnancy, birth and the early years of childhood.

A full current work programme was in the action plan at Appendix A in the report. The two key projects in development were:

• Pre-conception health and service access/awareness pilot project. This aimed to address the health needs and service access challenges experienced by women of child-bearing age in Buckinghamshire, who were either of younger age, from a black or Asian background or who live in an Opportunity Bucks ward.
• Improving the educational/parenting support available to families in deprived areas.

The Board were asked to note the targets and actions set out within the report and in appendix A.

Mark Green commented that paragraph 3.4 in the report captured the actions being taken in relation to improving the attainment of children but felt that some of these needed to be strengthened relating to the take-up of the two-year-old funding as this would improve early years education resulting in better life chances.

The Chairman asked if this could be strengthened and supported through the educational skills or the health and wellbeing parts of the Bucks Opportunity programme across the Council as inequalities were explicit to all the themes.

Dan Flecknoe informed the Board that there was a big connection between the Opportunity Bucks areas and the preconception project and many other areas of work. Heidi Beddall added that when the data collated was looked at, it did not only look at specific areas but an overall proportionate improvement across all groups was considered.

Dr Rashmi Sawhney asked if there was an outcome framework and was it being regularly monitored. Heidi Beddall informed the Board that there was an outcomes framework with clear baseline data and targets set for each of the priorities and these were being monitored through a monthly programme Board. Once the early stages passed, this would be a quarterly programme Board.

The Chairman commented that there was no mention of primary care leads in the plan although primary care would be critical to delivery. Heidi Beddall commented that there was a real opportunity for the primary care involvement in this work to be strengthened. Dan Flecknoe added that any group that dealt with pregnant women, professional, or voluntary sectors, may have the potential to improve the health of women during pregnancy and the health of the pregnancy. Dan Flecknoe continued that the data being collected now would show the results in time to come.

Councillor Mohammed asked if the targets and aims were ambitious enough and if there was any benchmark being used and was informed that the outcomes framework included comparative data to ensure the targets had a level of ambition The goals set were deliverable but were also stretching.

Phillipa Baker commented on paragraph 2.6 in the report, which talked about family support in deprived areas or with children growing up in a chaotic or deprived family environment. Did partners feel that enough was being done to support families. Conversations were welcome on what was done to support families in Buckinghamshire and what more could be done.

Dr Rashmi Sawhney inquired if the location of service provision had been considered when looking at breastfeeding clinics such as deprivation areas, not just in hospitals. Heidi Beddall informed the Board that the current service was based at the hospital but was being used to test a model before rolling out in the wider community. The infant feeding support worker team had been increased and placed in a community where midwife clinics were already held so these could be a one stop shop approach, working towards including perinatal mental health support workers and tobacco dependency advisors in the team.

Councillor Hussain asked about what engagement had been done with the Opportunity Bucks wards, ten in total, six in High Wycombe, three in Aylesbury, and one in Chesham.

Dan Flecknoe advised the Board that targeting was done when the women accessed the service. The service was being prioritised for women from the Opportunity Bucks wards. Early education support was being targeted by working closely with colleagues that led on early education to look at early years setting withing the Opportunity Bucks wards to ensure that enough support was given to develop them to be as high quality as they could as there was good evidence that it helps to offset or mitigate some of the disadvantages that could start accumulating in a child's life when parents did not have the resources to give educational support at home and to advance qualifications. This would entice staff to stay in the positions. The Maternity Voices Partnership had also been consulted and had been instrumental in reaching out to the communities and hearing the lesser heard voices particularly in Wycombe with the Pakistani and Kashmiri communities and understanding their needs through various groups.

The Chairman summed up the discussion, and the Board noted the significant work carried out towards the targets and actions set out in Appendix A. There had been plenty of support from partners in the room and offers to strengthen the work.

Action:  Mark Green to support engagement from Children’s Services with respect to the strengthening of education attainment

Donna Clarke, Service Director, Oxford Health NHS Foundation Trust, introduced the action plan that addressed health inequalities across all three age ranges, particularly concentrating on communities with poorer outcomes and access to mental health services. This was done by working across health systems, addressing individuals’ holistic needs with new and targeted approaches to address inequality including those living in more deprived areas, people from certain ethnic groups and those with serious mental illness. Mental health was equal to physical health, and poor mental health actually impacted physical health. This work also linked very closely to the Opportunity Bucks work being done and challenged some of the traditional boundaries around collaborative working. Donna Clarke continued to explain that the action plans contributed to meeting the overall Start Well and Live Well objectives, and these would be reported to the Board. However, the plans were dynamic and were being developed further.

David Walker, Oxford Health NHS Foundation Trust, commented on the importance of mental health in schools and the interface between school nursing, a public health function, and mental health support.

David Walker commented that in Oxfordshire, the County Council had decided to open school nursing and other health functions for children to competitive tender. Currently, Oxford Health provided the service in schools, but if it was provided by a private provider, this would diminish the opportunity to tie the services together. Dan Flecknoe informed the Board that the school nursing function was part of the Healthy Child Programme, which local authorities had a statutory responsibility to commission. Buckinghamshire Council was currently out to tender for the Healthy Child Programme, a legal process where the specifications were written very carefully emphasising on the needs of collaboration across the system and integrated working to give the best benefit in terms of mental health support amongst the necessary aspects of school nursing.

John Meech commented that from a patient view, the process, school nursing function, and mental health support were all in one, one issue, so working collaboratively was essential.

Louise Hurst, Public Health Consultant, Lead of Mental Health Team made a few specific points:

• Taking Therapies had a good grasp on inequalities and provided a model that all could learn from for other services. The model was very data driven, focussed on good quality data, analysing the data to understand who was and wasn't accessing services and how services were performing for different groups and then looking to do something about it.
• The relationship between physical and mental health, people with severe mental health illnesses had a much lower life expectancy than the rest of the population, and that was partly driven by physical health conditions. There was an annual physical health check programme delivered through primary care. The programme had run well being delivered locally but could do better, so programmes were in place to increase the proportion of people getting a physical check carried out and getting the correct support.

Philippa Baker, ICB Place Director, supported the comments made and asked to discuss the model used for other areas of work.

Dr Raj Bajwa asked if the correct level of importance had been given to integration and collaboration in the tender process for when the decisions were made and was informed that the concerns of the Board would be expressed to the commissioning team.

Dr Karen West asked when it came to mental health in schools, how much involvement would there be for people on waiting lists for newer, more diverse pathways, as support required whilst waiting for diagnosis was crucial, especially for families. Inequalities played a large part again as some people knew how to access support and others were unaware. Donna Clarke informed the Board that if a child attended a school that the team were covering, then they would be able to access that support as any other child. There was currently support being given to people on the waiting list as the waiting lists were too long and a plan was in place to reduce them and get more timely access.

Dr Sian Roberts informed the Board that almost 50% of children in Buckinghamshire schools had support and 100% had CAMHs support but not always at school.

Mark Green commented that of the 48% of schools that had mental health support, 90% of those were in the Opportunity Bucks wards. Mark Green asked what thoughts had been given to how to capture the qualitative information that showed that the action taken had improved the individual experiences. Donna Clarke explained that this was still in the process of being worked out as it was very important to capture the outcomes. Dan Flecknoe added that a new school survey for the autumn term had been designed. The survey would cover areas such as mental health issues, substance abuse, situation at home and the amount of sleep children were getting, both at primary and secondary level. The results would be presented to the Board at the end of the year.

The Chairman thanked all presenting for the reports, and everyone involved in putting them together.

Resolved:  The Health and Wellbeing Board noted the targets and actions set out within the reports and appendices.