Agenda and minutes

Apologies for absence were received from Councillor Allen, N Bailey, D Brown, L Buckley, R Chillery, Dr S Findlay, J Gillon, B Jackson, V Mitchell, J Pearce and S White.

P Acheson for J Gillon, J Murray for L Buckley, A Smith for R Chillery and R Turnbull for D Brown

There were no declarations of interest.

The minutes of the meeting held on 30 July 2019 were agreed as a correct record and signed by the Chair.

The Board received an update on the Health and Social Care Plan.

Dr Smith provided an overview of the work taking place regionally at Integrated Care Partnership level including collaborative working between Durham, Sunderland and South Tyneside.  In addition, there is work taking place at a local level for Durham’s population. Dr Smith outlined that the merger of the Durham CCGs had been approved by both boards.

The Corporate Director of Adult and Health Services, Durham County Council added that the North East and North Cumbria integrated care system had held a number of workshops with NHS HR directors.  Areas of commonality included wellbeing and workforce and any areas that can be taken forward at scale will be part of the ICS plan.  A forthcoming Cabinet paper would consider the integrated commissioning function with an implementation date from April 2020.

Resolved:

That the update be noted.

The Board considered a report of the Strategic Manager Partnerships, Transformation and Partnerships, Durham County Council that presented the Health and Wellbeing Board Annual Report 2017/18 for agreement (for copy of report see file of Minutes).

The Strategic Manager Partnerships highlighted the initiatives that had taken place to achieve the strategic objectives in the Joint Health and Wellbeing Strategy and gave some examples across the following priorities:-

·        Children and young people make healthy choices and have the best start in life

·        Reduce health inequalities and early deaths

·        Improve the quality of life, independence and care and support for people with long term conditions

·        Improve the mental and physical wellbeing of the population

·        Protect vulnerable people from harm

·        Support people to die in the place of their choice with the care and support that they need

Future challenges were also highlighted and the continued threat of cuts to Public Health funding.

The Director of Integrated Community Services said that this highlighted the volume of work that the Board were involved in and played a part in.  She added her concerns regarding the Public Health funding.  With regards to the good news stories included within the annual report she asked if there would be any press releases and suggested that some quotes from the partners would be good to incorporate.

Councillor Gunn thanked officers for a good report that served as a reminder of what had been carried out in the last year.  She praised the valuable work of the board, working in partnership and agreed that a press release would highlight to residents that we were trying to make life better for them.

Resolved:

(i)           That the Health and Wellbeing Board Annual Report 2018/19 be agreed.

(ii)          That the timeline and next steps outlined in the report be noted.

(iii)         That the intention to include more performance information in the Annual Report to demonstrate the impact, be noted.

The Board considered a report of the Director of Learning Disabilities and Mental Health Commissioning, North Durham Clinical Commissioning Group that provided an update in relating to the progress against the Transforming Care Programme and local implementation (for copy of report see file of Minutes).

The Director of Corporate Programmes, Delivery and Operations highlighted Table 1 of the report showing the number of patients within the CCG in commissioned inpatient care and those with specialised commissioning inpatient care.  He went on to inform the board about health check arrangements and about the dedicated resources in relation to people with learning disabilities and autism through the Durham Darlington and Tees Mental Health and Learning Disability Partnership.  These would help to improve the quality of life for individuals and in some cases would result in savings which were re-invested back into the community provision.

Referring to the health inequalities, the Corporate Director of Adult and Health Services asked if there was anything that the Health and Wellbeing Board could do to support this area of work.  The Director of Corporate Programmes, Delivery and Operations referred to details in the report in respect to the STOMP programme (Stopping The Over Medication of People with a learning disability) and agreed to circulate the report for information.

Linked to that the Right Care, Right Place Delivery Lead added that TEWV were working with some Primary Care Networks regarding health checks and how we could support that.  The Corporate Director of Adult and Health Services said how important it was to also support from a social care perspective.

The Director of Integrated Community Services commented that it is important to build resilience within the community and to support people in their own homes for as long as possible. This is something that is being discussed with Primary Care Networks and the Voluntary and Community Sector. In addition, supporting people with learning disabilities into employment is a key area of focus.

Councillor Gunn asked what assurance was in place from a safeguarding perspective for inpatients with a learning disability and asked for further information about specialised commissioning arrangements.  The Director of Integrated Community Services responded that the County Durham Safeguarding Partnership were involved in this work and that in relation to a recent safeguarding issue highlighted through the media, all patients had been reviewed, and that the Adult Care Service had been asked to undertake a review to look at residential provision within the County and also those people who are placed in residential services out of County. 

From a specialist commissioning perspective, the Director of Corporate Programmes, Delivery and Operations said that it was very expensive as it is for those people who have very complex needs and that only a certain amount of provision is available to accommodation individuals.

The Director of Public Health said that it was important to look at how we reach the most vulnerable groups and incorporate this into the wider plan.  Screening, immunisations and sexual health should all be available  ...  view the full minutes text for item 7.

The Board received a presentation of Corporate Director of Adult and Health Services, Durham County Council and Public Health Advanced Practitioner, Durham County Council that provided an update from the North East and North Cumbria Integrated Care System of Reducing Smoking in Pregnancy – a health and social problem (for copy of report see file of minutes).

The Corporate Director of Adult and Health Services highlighted the presentation as follows:-

·        The North East and North Cumbria team

·        Scale of the problem nationally

·        The local cost of smoking in pregnancy

·        Scale of the problem – the local challenge

·        Using the Yale Methodology

·        Selecting the Strategy

·        Building the products

·        Creating our implementation plan

The Public Health Advanced Practitioner highlighted the following:

·        What are we doing in County Durham to reduce tobacco dependency in pregnancy?

·        A challenging ambition

·        Work since January 2019

·        What else needs to be done

·        What is needed

On answering a question from Dr Smith, the Public Health Advanced Practitioner advised that Shildon was chosen as it had a good community base and was identified in the top areas for women smoking in pregnancy, alongside Newton Aycliffe, Coundon and Willington as areas to focus upon.  She went on to confirm that the service were trialling this in a small area and would roll out to other areas with a high prevalence.

The Director of Public Health, Durham County Council commented that this was an in-depth piece of work that had made a huge difference, and that the approach could be used for other issues.  The Corporate Director of Adults and Health Services explained that the group had identified a whole range of other areas where the same methodology could be applied.  The Director of Corporate Programmes, Delivery and Operations, CCG advised that discussions had taken place with regards to severe mental illness and the service were looking to adapt this methodology.

Resolved:

That the presentation be noted.

The Board received a report from the Director of Public Health that provided the findings of the Alcohol CLeaR Peer Assessment on local alcohol partnership work and the action plan developed in response to the recommendations within the peer assessment report (for copy of presentation see file of minutes).

The Director of Public Health outlined that she would bring a report to a future Board meeting that outlined the impact of minimum unit pricing on County Durham, particularly those who are heavy drinkers.

The Chief Executive of County Durham and Darlington NHS Foundation Trust asked if Fresh and Balance formed part of the work being carried out and was advised that they were part of the assessment process. 

In response to a question from Councillor Gunn, the Director of Public Health confirmed that the findings would be shared with a wider audience.

Resolved:

(i)           That the contents of the report be noted.

(ii)          That the update at a future meeting on actions on harm due to alcohol be received.

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

·        Alcohol

·        Tobacco

The Board received a report and presentation of the Right Care, Right Place Delivery Lead, Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) that gave an overview of the Right Care, Right Place programme and that outlined short term care actions within County Durham (for copy see file of minutes).

The presentation highlighted the key drivers for change and the next steps over the next 3-4 months, including having a clear vision to build upon and linking in with key partners. 

The Director of Integrated Community Services commented that she was supportive of practical testing but asked that the service look and consider the existing footprint of the Teams Around the Patients (TAP)/Primary Care Networks which was a current operable system.  The Right Care, Right Place Delivery Lead agreed that this was critical and conversations had already taken place with TAP colleagues and that they would build on what was already in place.

Resolved:

(i)           That the contents of the report and the direction of travel as it affects County Durham be noted.

(ii)          To agree how the Board should be involved in the programme.

(iii)         That further updates as the programme progresses be received.

The Board considered a report of the Independent Chair of the Durham Local Safeguarding Adults Board (LSAB), which presented the Annual Report 2018/2019 (for copy see file of minutes).

The SAB Business Manager highlighted the work carried out with service users, Healthwatch and the Safeguarding Partnership.  She informed the board that 30,000 members of staff had now accessed training in respect to safeguarding and 80 organisations had accessed information at shared events. She advised that there was now wider membership with the inclusion of the Probation and Prison Services and further links to Tees Valley Community Rehabilitation Company with a focus on the service user and looking at drivers around sexual exploitation. 

The SAB Business Manager advised that they were keen to hear the voice of the practitioner, carry out audit activities and deep dives within the next year, together with strengthening arrangements with the advocacy provider.

The Director of Integrated Community Services thanked the manager and the business unit for the superb work carried out and their professional and committed approach.

Resolved:

That the annual report be received.

The Board considered a report of the Independent Chair of Durham Safeguarding Children Partnership that presented the final report of the Local Safeguarding Children Board (LSCB) prior to transitioning to the new partnership arrangement known as the Durham Safeguarding Children Partnership (DSCP) (for copy see file of Minutes).

The Independent Chair highlighted the achievements against 2018/19 LSCB priorities, JTAI (Joint Targeted Area Inspection) recommendations, action plan and achievements and the transition from LSCB to DSCP.  He informed the board that domestic abuse continued to have a significant impact of a child being subject to a Child Protection Plan and that neglect continued to be the most frequent reason for them being on a Plan.

The Strategic Manager Partnerships advised that the one-year review following JTAI would outline the progress and impact of the actions undertaken.  The Independent Chair thanked the Business Unit and the Strategic Manager as they had ensured that the partnership was working to fulfil the vision and values.

Councillor Gunn commented that there had been an improvement since the transition and that business as usual and the JTAI issues had continued to be progressed.  She found the development days during the transition very helpful and congratulated the Independent Chair and the business unit for making the transition as smooth as possible whilst dealing with some crucial issues.

The Chair agreed that the Independent Chair’s expertise had been invaluable throughout the process.

The Independent Chair advised that the Child Death Review Annual Report would be presented to a future Health and Wellbeing Board meeting which would identify any modifiable factors for consideration and lessons learned.

Resolved:

(i)           That the content of the report be noted.

(ii)          That the Annual Report for 2018/19 be received.

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

·        Mental Health

·        Flu

With regards to mental health, the Director of Corporate Programmes, Delivery and Operations, Clinical Commissioning Groups advised that the service had introduced an online access to counselling service for 11-18 year olds, and this early intervention had been rolled out to all schools.

The Director of Public Health challenged Board members to be Flu Champions which was agreed. It was also agreed that the Director of Public Health would co-ordinate a joint report for the next meeting which would identify what all partners were doing in relation to flu planning arrangements in HWB organisations.

The Strategic Manager, Partnerships, Durham County Council advised the board that the County Durham Partnership were launching their new vision for 2035 on Friday 25 October 2019 at an event which would have a focus on culture, health and wellbeing.