Agenda and minutes

Apologies for absence were received from Councillors J Allen and O Gunn, and  Dr S Findlay, J Gillon, L Hall, B Jackson, S Jacques, J Pearce and S White

C Cunnington-Shore for B Jackson, G Curry for S Jacques, C Wallace for R Chillery and M Smith for L Hall

There were no declarations of interest.

The minutes of the meeting held on 29 January 2020 were agreed as a correct record and signed by the Chair.

The Chair informed the board that this was Dr Smart’s last meeting and she thanked him for his contribution and expertise that had been invaluable to the work undertaken.  She wished him well for his retirement.

The Board received a report of the Interim Corporate Director of Regeneration and Local Services, Durham County Council that gave an update on the progress made in relation to Durham County Council’s business case for county wide selective licensing and that informed of the consultation (for copy see file of minutes).

The Housing Team Leader and the Project Co-ordinator, Housing Solutions, Durham County Council gave a detailed presentation that highlighted the following:-

·        What is selective licensing

·        Criteria

·        Why selective licensing

·        Private rented sector map

·        PRS statistics

·        Proposals

·        Designations

·        Map of all areas included in the proposals

·        Anti-social behaviour

·        House prices

·        Deprivation

·        Licence conditions and fees

·        Penalties

·        Consultation

·        Next steps – consultation, analyse results, feedback, Cabinet to make a decision

Further to questions from the Director of Public Health, the Housing Team Leader confirmed that there would be specific criteria in relation to deprivation via access to services.  They were also looking at this from the landlord’s point of view and would explore the possibility of tenants training.  The conditions would also include aspects of health and wellbeing such as ensuring repairs were carried out promptly and that tenants were not living in damp conditions.

The Chair asked for confirmation on the length of time of the proposals and was informed that it would be per property for a period of 5 years.

The Chair was concerned about people living in damp houses, fuel poverty, the health of residents and would like to see these being addressed and measures put in place, especially for families and those living with long term medical conditions.  She urged all partners to take these proposals back to their own organisations for comment.

The Strategic Manager, Partnerships would provide a response to the proposals from this board.

Resolved:

(i)   That the report be noted.

(ii)  To promote the Selective Licensing consultation and encourage feedback.

The Board considered a report of the Head of Partnerships and Community Engagement, Durham County Council that presented the draft Joint Health and Wellbeing Strategy (JHWS) for 2020-25 (for copy see file of Minutes).

The Strategic Manager Partnerships informed the board that both the Children and Young People’s and Adults, Wellbeing and Health Overview and Scrutiny Committees had been supportive of the approach within the strategy, with the latter committee commenting on mothers who smoke and active travel.  She went on to advise of the vision and the six strategic objectives.  She outlined that a review would be undertaken in 12 months’ to ensure that the aims in the new County Durham Vision 2035 and the recently published Marmott 10 Year Review were fully reflected in the Board’s Strategy

Resolved:

That the Joint Health and Wellbeing Strategy 2020-25 be agreed.

The Board received an update on the health and social care integration arrangements from the Corporate Director of Adult and Health Services, Durham County Council.  She advised that Sarah Burns had started in her role as the Head of Integrated Commissioning. Lesley Jeavons, Director of Integrated Community Services would retire from her post over the next few months and a recruitment process to this post would commence shortly.  Neil O’Brien had been appointed as the clinical officer for the Central Integrated Care Partnership.

The Board received a joint report of the Corporate Director of Adults and Health Services, Durham County Council, and Chief Officer, Durham Dales, Easington and Sedgefield and North Durham Clinical Commissioning Groups that advised of the County Durham Place Based Commissioning and Delivery Plan for 2020-25 (for copy see file of minutes).

The Head of Integrated Commissioning informed the board that this was the first place based commissioning and delivery plan, recognising the interdependencies of what all partners carried out.  She outlined the statutory requirements that needed to be delivered whilst focusing on the outcomes.  There would be a focus on prevention and wellbeing and partners could hold each other to account.  A summary document for external users would be produced and the plan would be a live document which would be refreshed on a six monthly basis, with input from a wider range of stakeholders.

The Director of Public Health congratulated all involved in producing the plan as a tremendous amount of work had been undertaken with all partners.

The Head of Strategy and Corporate Affairs, North Tees and Hartlepool NHS FT said that the plan was very clear and was fully aligned with a focus on acute care and prevention.  The Trust fully supported the plan.

Resolved:

That the County Durham Place Based Commissioning and Delivery Plan 2020-25 be agreed.

The Board received a report of the Head of Strategy & Corporate Affairs, North Tees and Hartlepool NHS Foundation Trust that set out the recent refresh of the corporate strategy for the North Tees and Hartlepool NHS Foundation Trust (for copy see file of minutes).

The Head of Strategy and Corporate Affairs gave a detailed presentation that highlighted the following:-

·        Local context

·        The future – Integrated Care

·        Where we are as an organisation

·        Our Vision – ‘We will provide the best healthcare for everyone within our population’

·        Our Values – Collaborative, Aspirational, Respectful, Empathetic

·        Joining up Our Strategies

·        ‘Excellence’ as our standard

·        Our Corporate Strategy

Further to a question from Dr Smart about recruitment, the Head of Strategy and Corporate Affairs advised that the Trust were working very closely with universities in terms of recruitment over a period of time.  In relation to broader international recruitment a clearer picture would be seen over the next 18 months.

The Chair asked how many residents in the east of the county access North Tees and Hartlepool and was advised that across both CCG (Clinical Commissioning Groups) areas approximately 5600 patients had attended for emergency services over a 12 month period but he would feedback on specific breakdown by geography.

The Director of Public Health was pleased to see the links between the vision and the plan.  The Head of Strategy and Corporate Affairs said that the synergy and links could be seen all throughout the document.  He added that actions plans with Stockton, Hartlepool and County Durham working with the Health and Wellbeing Boards would knit together and help focus on the wider prevention.

Resolved:

To support the Trust’s overall vision for the next five years and to acknowledge the collaborative efforts that were already evident as a provider and key partner within the locality.

The Board received a report of the Director of Commissioning, Strategy and Development, Durham Dales, Easington and Sedgefield CCG and North Durham CCG that provided an update around workforce sustainability and that gave an understanding of the impact on schemes put in place (for copy see file of minutes).

The Director of Commissioning, Strategy and Development stated that a number of developments had taken place since the NHS England announcement in February, including:-

·        Recognition in favour of GP partnership model of key components of general medical practice

·        Increase in training places available

·        Career start succession in County Durham – with GP fellowship to stay in the local area

The Director of Commissioning, Strategy and Development referred to the Overview and Scrutiny Committee review group set up to look at the sustainability of GP service provision across County Durham and that these new announcements could change the position of the final recommendations.

The Chair was encouraged by the recent government pledge to have 6000 new GPs recruited by the end of Parliament however noted that if they were in training this would take time to get them into posts.  The Director of Commissioning, Strategy and Development said that there was a positive change as the number of medics coming out of training had increased.  There had also been an adaptation of the skills base in the GP practice and patients adapting to being seen by trainee GPs and First Contact Practitioners and Advanced Nurse Practitioners.

The Deputy Head of Safeguarding, Harrogate and District NHS Foundation Trust informed the board that funding for student nurses and student health visitors would cease and they would have to self-fund.  She was concerned that this could result in a huge decline and agreed to prepare a paper for the next meeting showing the implications of that and what was being done regionally.

Resolved:

That the report be noted.

The Board received a report of the Director of Public Health, Durham County Council that presented a consensus statement in relation to County Durham’s approach to vaping (for copy see file of minutes).

The Director of Public Health advised that this consensus statement had been produced to alleviate the mixed messages and give clinical support to vaping when trying to quit smoking.  The message was clear that non-smokers should not start to vape and that it was much less harmful to vape for those trying to stop smoking.  It was recognised that in the longer term more research was required and this would continue to be monitored.  Passive vaping was a concern and could be added to the statement before circulating.

The Assistant Chief Fire Officer asked about the law on smoking in public places, including vaping as this was included in their policy.  The Director of Public Health would check this and report back but noted that a lot of workplaces included vaping as part of their support for stopping smoking programmes.  The Assistant Chief Fire Officer would also like some guidance on smoking inside of buildings to assess the risks.

The board discussed the different policies in place at partner organisations and agreed that the message should be consistent.  Dr Smart said that people were addicted to nicotine and that smoking is still considered to be an unsociable habit.

The Director of Public Health said that vaping was 95% safer than cigarette smoking.

Resolved:

That the content of the vaping statement be agreed with the addition of points on passive vaping, and to cascade the statement to relevant services.

The Board received a joint report of the Corporate Director of Adult and Health Services and the Director of Public Health, Durham County Council that shared details of a case study in using the County Durham Approach to Wellbeing (for copy see file of minutes).

The Head of Commissioning, Durham County Council gave a detailed presentation that highlighted the following:-

·        Wellbeing approach – people and place and supporting systems

·        Commissioning

·        Project Alliance Model

·        Project Alliance Contracting

·        Where we are in our thinking

The Director of Integration applauded the approach taken and reported that from an integration perspective, Provider Alliance approach had been created, led by Sue Jacques and was part of the County Durham Care Partnership.   It was also agreed important to have mental health providers on board.

The Strategic Manager Partnerships, Durham County Council advised of the appointment of Cat Miller to the Wellbeing Programme Manager post who would be able to provide support through the process.

Resolved:

That the use of the Approach to Wellbeing in this case study and the opportunity it has brought to encourage greater community engagement and co-production in the development of new services be noted.

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

·        Dry January

·        Mental Health

·        Flu

·        Cervical screening

In addition to the health campaigns, the Director of Public Health gave an update on the Coronavirus. There were 373 national cases with 6 deaths and 7 cases in the North East reported.  The virus was identified in December and experts were working on it and learning how it is spread.  Partner organisations were working together and updates were provided daily.  She assured the board that this issue was receiving focussed attention by partners.

The Director of Commissioning, Strategy and Development, Durham Dales, Easington and Sedgefield CCG and North Durham CCG gave an update and confirmed that both the County Durham and Darlington NHS FT and both CCGs had set up Coronavirus centres.  The 111 service has been scaled up and an advice line had been set up to take pressure off the system.  In primary care, patients who booked appointments online were being triaged first and practices were trying to set up video consultations.

The board discussed the importance of reaching vulnerable people and how to safeguard them.  The Director of Integrated Community Services assured the board that vulnerable people were known due to the Teams around the Patient/Primary Care Networks and that links had already been established to prioritise who was at risk.

The Board received a joint report of the Director of Public Health, Durham County Council and Director of Corporate Programmes, Delivery and Operations, County Durham CCG's that provided a summary of the 2019/2020 update of the Children and Young People’s Mental Health Local Transformation Plan and that sought agreement and approval prior to the required NHS England submission of the plan on 31 March 2020 (for copy

see file of minutes).

Dr Smart gave an update on the yearly assurance document and progress made against the five year plan.

Resolved:

(i)   That the report be noted.

(ii)  That the plan be agreed and endorsed.