Agenda and minutes

Apologies for absence were received from Cllr J Allen, N Bailey, D Brown,

R Chillery, J Gillon, Cllr O Gunn, L Jeavons, Dr D Smart and Dr J Smith

Cllr M McKeon for Cllr O Gunn, J Parkes for J Gillon and K Wanley for D Brown

There were no declarations of interest.

With an amendment to a spelling error to change the name of a substitute member from Naokami to Nedkarni, the minutes of the meeting held on 30 January 2019 were agreed as a correct record and signed by the Chair.

J Robinson, Corporate Director of Adult and Health Services informed the Board that a report on the County Durham Health and Social Care Plan will be presented to Cabinet on 13 March 2019 which will provide an update on the integration of health and social care in County Durham.  A progress update on the development of the integrated strategic commissioning function will be provided to the Board in due course. It was highlighted that a lead elected member network will be in place over the coming weeks.

Resolved:

That the update be noted.

The Board considered a report and presentation of Dr S Findlay, Chief Officer, Durham Dales, Easington and Sedgefield and North Durham Clinical Commissioning Groups and Chair of the County Durham Integrated Care Board, which presented the Durham Health and Wellbeing System Plan 2019/20.  The plan outlined an approach to the development of a five-year Durham plan which considers the recently published NHS Long Term Plan (for copy of report and presentation see file of minutes).

Dr S Findlay informed the Board that Appendix 2 is part A of the plan which focuses predominantly on adults. Part B, which is the children’s element of the plan will be presented in May 2019.

In response to a question from the Chair, M Houghton, Director of Commissioning and Development, explained that a planning group has been established and partners are represented. Work will be undertaken to ensure key priorities are aligned with the County Durham Vision.  A Healy, Director of Public Health commented on the high level of detail in the plan which will help to inform the longer-term Health and Care Plan.  M Houghton outlined that a workshop is being planned to focus on the longer-term plan with members of the Health and Wellbeing Board and Adults Wellbeing and Health Overview and Scrutiny Committee.

Resolved:

The Board:

a)    Noted the approach to the development of the long-term Durham System Health and Wellbeing Plan outlined in the report.

b)    Noted that a Durham System Plan for Children will be presented in May 2019.

The Board received a presentation from S Jacques, Chief Executive, County Durham and Darlington NHS Foundation Trust, on the County Durham and Darlington Local A&E Delivery Board Winter Planning Arrangements (for copy of presentation see file of minutes). 

The presentation included details on the following:

• System wide expectations
• Content of the winter plan and contributors
• Christmas and New Year arrangements
• Overview of performance and next steps

Cllr McKeon commented on the comparatively mild winter and the effect of this on performance, asking if the main pressure points had been identified. S Jacques responded that there had been an emphasis on improved collaborative and operational working to alleviate pressure, particularly at the point of entry to hospital.  There were no issues in relation to delayed discharges.  Jane Robinson highlighted that the one-off monies received had helped this winter but there was still concern due to the delay in the Social Care Green Paper.

It is acknowledged that this winter has seen contributing factors such as the milder weather conditions and the two-day bank holiday. One of the main pressure points for Durham emergency department is the lack of physical space.  A formal debrief will take place on 14 March and the findings will be brought back to the Board.  Dr S Findlay, added that bed capacity is another pressure point and there are initiatives in place to improve this, including Teams Around Patients and the further development of services within the community.

A Healy, Director of Public Health referred to the importance of the work undertaken to implement dedicated flu vaccination programmes across organisations.  It was also noted that flu had hit the area at a later period than last year.

In response to a question from Cllr McKeon on the complexity of admissions,

S Jacques responded that, in general, admissions are becoming more complex and it is important that the health and care system work closely together with prevention and early intervention being a key part of the process.

The Board received a report of the Primary Care Commissioning Manager (Dental) NHS England, presented by T Robson, Local Dental Network Chair, which provided an update on NHS general dental services and access in Durham, including the challenges faced by general dental practices and initiatives being taken forward to support sustainability and transformation (for copy of report see file of minutes).

B Jackson expressed concern that although 52% of dental practices have the capacity to accept new patients for urgent treatment, 34% of practices had not provided information.  T Robson explained that when calling NHS 111, those in need of urgent dental treatment are provided with contact details for an emergency dental service and, in addition, they are signposted to routine dental practices. 

In response to a question from the Chair on the recruitment challenges for dental service providers, T Robson replied that factors such as the increasing desire for flexible working and age demographics are impacting on the number of dental practitioners.

Responding to a question from A Healy, Director of Public Health, as to what measures are in place to increase access to NHS dentists, T Robson responded that work in being undertaken, for example, an early start initiative is taking in place in Middlesbrough, specifically targeting the under 5s.

Councillor McKeon asked if recruitment could be improved through actively encouraging young people to consider dentistry as a career.  T Robson replied that there are plans to increase the number of dental schools however this will be a long-term project and it may take up to 10 years for these young people to complete their training and join the workforce.

Resolved:

That the report be noted.

The Board considered a report and presentation delivered by K McCabe, Advanced Practitioner for Public Health, which provided an update of work carried out by County Durham Healthy Weight Alliance (for copy of report and presentation see file of minutes).

The presentation included information on the following:

·         The National Child Measurement Programme

·         Childhood Obesity Plan

·         Supporting Healthy Weight in County Durham including the Active 30 campaign

K McCabe explained the Active 30 initiative and presented a short video by Byerley Park primary school who are participating in the campaign. The campaign encourages children to achieve 30 minutes of physical activity every day.  There are also similar programmes to achieve 10 or 20 minutes of physical activity. The video showed how children and staff have benefited, with children reporting feeling more positive and staff observing improvements in the children’s concentration and teamwork as well as improvements both physically and mentally.

K Wanley of County Durham and Darlington Fire and Rescue Service acknowledged the good work being carried out in schools, however, he expressed concern that reportedly 25% of 4-5 year olds in County Durham have excess weight and he asked whether there is engagement with pre-school children.  K McCabe explained that one of the key themes identified by the Healthy Weight Alliance is to begin conversations earlier in a child’s life in relation to weight.  She added that there is also a need to focus on older children, with unhealthy weight in childhood often leading to weight issues in adulthood. 

The Chair commented on the importance of work done by health visitors to encourage parents to develop healthy eating habits at the early stages of a child’s development.

Councillor McKeon referred to vulnerable children and families and asked how the service is ensuring that they reach these groups.  K McCabe replied that the Healthy Weight Alliance is committed to reaching vulnerable groups adding that it is clear that, within the schools that have not yet pledged to join Active 30, there will be vulnerable families, therefore there will be further promotion of the campaign to encourage those schools to participate.

L Buckley commented on the link between healthy weight and emotional wellbeing.  The Director of Public Health commented that it is vital to join all these elements together, going forward.

Resolved:

The Board:

a)  received the update report

b)  agreed to continue to provide commitment to and support for on-going work of County Durham Healthy Weight Alliance.

The Board considered a report and presentation of the Director of Public Health, presented by C Woodcock, Strategic Manager for Public Health, which provided an update on the Mental Health at Scale project (for copy of report and presentation see file of minutes).

The presentation included information on:

• Priorities for 2018-20
• The LGA Prevention at Scale Programme
• Workforce and the Employer Pledge
• Design Council
• Time to Talk Day

B Jackson commented that although it is clear that a great deal of work is being done within the workplace, he asked what provision exists for those who are not in employment.  The Strategic Manager explained that this particular programme is specifically designed for the workplace, however, support is provided to those not in employment through colleagues in Regeneration and Local Services and other agencies, such as work done by the mental health centre, Waddington Street. Whilst the programme has a specific focus on workforce mental health, the service is mindful that health and wellbeing requires a holistic approach.  For example, the CREE network (Men’s Sheds) which encourage communities to help each other stay well.  

J Robinson, Corporate Director of Adult and Health Services referred to the noticeable change in awareness that has resulted from initiatives such as the Time to Talk Day which has received very positive feedback.  The aim is to maintain this momentum and continue to promote good mental health. The Director of Public Health commented on how valuable the assistance of the Trade Unions has been in supporting frontline staff.

The Chair suggested that the promotion of good mental health should be a feature of inductions for staff and elected members.

Resolved:

The Board:

a)    Noted the contents of the report.

b)    Agreed to champion good mental health and support key elements of the project such as improving workforce mental health, as leaders in their respective organisations.

c)    Committed to delivering the Time for Change employer pledge.

The Board noted a presentation by A Healy, Director of Public Health, on the following public health campaigns (for copy of presentation see file of minutes):

• Alcohol
• Tobacco
• Stay Well This Winter
• Time to Talk

Resolved:

That under Section 100(A)(4) of the Local Government Act 1972, the public be excluded from the meeting for the following items of business on the grounds that they involved the likely disclosure of exempt information as defined in paragraph 3 of Part 1 of Schedule 12A of the Act.

The Board considered a report of A Healy, Director of Public Health which presented a summary of Pharmacy Applications received from NHS England in accordance with the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (for copy see file of minutes).

Resolved:

That the report be noted.