Agenda and minutes

Apologies for absence were received from J Gillon, V Mitchell, S White and J Illingworth

LB was present as substitute for J Gillon, S Caddell for S White and JM for J IIlingworth.

There were no declarations of interest.

The minutes of the meeting held on 24 November 2020 were confirmed as a correct record and signed by the Chairman.

The Board received a verbal update from the Corporate Director of Adult and Health Services supported by the Director of Integrated Community Services on Health and Social Care Integration progress.

The Board were advised of three practical items in terms of integration, the first being that they were currently working on a discharge team and deploying therapists into GP practices to assist with rehabilitation following discharge. The second was a joint piece of work with Primary Care, Community Services to equip District Nurses to allow them to assist with the COVID-19 vaccination programme.

The Board were also updated on the recent consultation exercise ‘Integrating care: Next steps to building strong and effective integrated care systems’ and advised that Alan Forster had been invited to a future meeting.

Resolved: That the update be noted.

The Board considered a report of the Head of Partnerships and Community Engagement which presented the draft refresh of the Joint Health and Wellbeing Strategy (JHWS) 2021-2025 for comment (for copy see file of Minutes).

The Strategic Manager (Partnerships) explained that JHWS had developed in March 2020 to cover a one year period, whilst further work was undertaken to ensure that the Strategy considered the County Durham Vision 2035.

She further explained that COVID-19 had made a huge impact on how Durham County Council and its partners delivered services, especially health and social care services, ensuring that vital services remained accessible to those who needed them. This had been addressed through joint action and working together with partners and it was positive to note that actions contained within the current strategy had supported this approach during these unprecedented times.

The Strategic Manager went on to highlight the life course approach taken by the Board through the three strategic priorities. She further noted that the six objectives included in the JWHS 2020-2025 were to be monitored and evaluated each year.

The Strategic Manager (Partnerships) explained that wider consultation on the JHWS would run from January 2021 – February 2021, followed by final sign off of the JHWS by the Health and Wellbeing Board on 18 March 2021.

Discussions ensued regarding the consultation process and the value of engaging with young people across a wide geographical area and age group so that a diverse range of opinions were gathered.

Resolved: That the Draft JHWS 2021-25 be agreed for wider public consultation.

The Board considered a report and presentation of the Director of Public Health, County Durham which provided an update on work taking place within the three strategic priorities in the Joint Health and Wellbeing Strategy (JHWS) (for copy see file of Minutes).

The Board noted the presentation which provided details on:

·      Cutting the cost of the school day – understanding the scale of child poverty and providing practical help to schools to support those children and aim to reduce child poverty.

·      Unintentional injuries – addressing child safety, including training of 350 practitioners.

·      Mental Health Support Teams in Schools – Comprehensive approach, range of interventions across education settings and services for 0-25 years enhanced during the pandemic.

·      Suicide Prevention – Small numbers reported through monthly data surveillance although a slight increase during November 2020.

·      Tobacco Control – Smoking prevalence in County Durham is 17%, higher than both the regional and national figure.

·      Link Worker Activity – Converted plan of action and assessments

·      Physical activity and workplace health – Work ongoing on the development of a draft physical activity strategy to help tackle physical inactivity across County Durham.

Resolved: That the content of the report and presentation be noted.

The Committee received a report of the Director of Public Health for County Durham that presented the Annual Report for 2020 (for copy see file of Minutes).

The Director of Public Health gave a detailed presentation on the Annual Report that focused on the following: -

·       Health and wellbeing across County Durham

·       Response to COVID-19

·       Approach to Wellbeing

·       The Taylor’s Community

·       How we have worked with partners to impact on the Health and Wellbeing of residents living in County Durham

·       Update on the seven public health strategic priorities

·       A focus on the following strategic priorities and recommendations for their future work:

i)      Good jobs and places to live learn and play

ii)     Every child to have the best start in life

·        Update on recommendations from 2019

·        A set of recommendations based on the two priority areas of focus.

The Director of Public Health highlighted that COVID-19 had been the major focus in the last year, highlighting the importance of the role of Public Health in protecting the public from infectious diseases whilst supporting and improving their health and wellbeing.  The pandemic had highlighted health inequalities which would inform future transformational work such as the COVID related ill health project. She agreed to come back to a future meeting to update on progress, the focus of which would be upon:

·       High quality drug and alcohol services

·       Better quality of life through integrated health and care services

·       Promoting positive behaviours

·       COVID-19 recovery

Councillor Gunn added that she wished to commend the report as she felt that it brought together so much information which allowed the Board to focus on other areas of work which was extremely valuable. She further added that the reference to the Taylor family really helped its messages resonate and thanked the Director of Public Health and the team for pulling it together.

Resolved: That the 2020 Annual Report be received and noted.

The Board considered a joint report of the Corporate Director of Adult and Health Services and Dr Stewart Findlay, Chief Officer, County Durham Clinical Commissioning Group which provided an update on Better Care Fund (BCF) Policy Statement published on 3 December 2020 (for copy see file of Minutes).

The Corporate Director of Adult and Health Services advised that on 3 December 2020 the Government announced that areas would not be required to submit plans for assurance in 2020-21 and instead roll forward schemes from 2019-20 where appropriate following local agreement.

She went on to highlight the national conditions for the Better Care Fund in 2020-21 and detailed the seven main programmes within the local BCF which focussed on health and social care initiatives which facilitated and enabled integration and closer working between the NHS and Durham County Council.

Resolved: That the Board

(a) Note the contents of the report

(b) Ratify the continuity of provision

(c)  Delegate authority for the allocation of expenditure for the BCF 2020-21 to lead officers.

(d)           

The Board considered a report of the Chair of Adults Wellbeing and Health Overview and Scrutiny Committee which presented the key findings and recommendations of the Adults Wellbeing and Health Overview and Scrutiny Committee’s review report focusing on GP Services in County Durham (for copy see file of Minutes).

Councillor J Robinson, Chair of Adults Wellbeing and Health Overview and Scrutiny Committee explained that the Review was undertaken in 2019 following concerns about the potential cumulative impact of a number of proposed applications to review, merge or close GP branch services across County Durham during 2018/19.

The working group met 6 times and evidence was collected from North Durham and  DDES CCG; North East Ambulance Service NHS FT; Care Quality Commission; County Durham and Darlington Local Medical Committee, DCC Public Health, Planning Policy and Transport teams; NHS England’s 2018 GP Patient Survey and reports by County Durham Healthwatch into Care Navigation; Access to GP Services survey and GP Enter and View visits.

The key findings of the review informed the proposed 9 recommendations as detailed within the report and a service response from NHS County Durham CCG is also included with in the report at para 31.

In conclusion Councillor Robinson added his thanks to members, officers, and partners for their valuable contribution to the review process.

Councillor Allen asked how the Board could ensure a consistent service across the County which should in turn improve patient experience. In response Councillor Robinson advised that this was for the Health and Wellbeing Board to determine as part of the levelling up agenda for healthcare across County Durham. He noted that the move to a single CCG for Durham would help, but less clear was the potential impact of the ongoing consultation on Integrated Care Systems and their future role in Commissioning arrangements currently undertaken by CCGs. In respect of the latter issue, it was essential that any resources required were earmarked for County Durham and based upon its health need and deprivation levels and retained within Primary Care in Durham.

He further referenced the report which highlighted the need for a consistent approach to communications and message management, in respect of how the community access primary care and this should consistent across County Durham as is training and development of primary care staff.

F Jassat, County Durham Clinical Commissioning Group welcomed the report and thanked the Adults Wellbeing and Health Overview and Scrutiny Committee for the review undertaken. He assured the Board that the CCG had received and considered the recommendations and found it to be visionary. He advised that the CCG would undertake a review of the recommendations contained within and report back in 6 months’ time.

Dr S Findlay, County Durham Clinical Commissioning Group also noted his thanks, adding that the cross-party support for primary care was encouraging. He went on to comment that COVID-19 had catapulted technology within the health service and many aspects of primary care would change forever as a result including the impact upon  ...  view the full minutes text for item 10.

The Board considered a report of the Managing Director, County Durham Sport which  provided an update in respect of the approach to system stewardship (physical activity) in order to contribute to the improvement of health inequalities (for copy see file of Minutes).

Councillor Allen referred to the Active Shildon and Valleys schemes and asked whether it was intended to roll this out to other areas of the County. In response, M Rhodes, Managing Director advised that the project at Shildon and Valleys had taken a place-based approach to tackle inequalities under a control method of a 5-year funded programme. It was acknowledged expanding this to other areas would be increasingly important over the next 10 years.

The Chair, Councillor L Hovvels asked whether there was any known impact yet of COVID-19 on physical activity. In response, M Rhodes advised that COVID-19 had widened the inequalities gap and therefore providing and promoting low cost exercise options would be extremely important in targeting the lower socio-economic groups, whilst also meeting the demand for increased choice.

Resolved: That the content of the report be noted.

The Board considered a report of the Head of Transformation, Durham County Council, which provided an overview of the most recent welfare, economic and poverty indicators for the county and the progress of the Council and its partners’ efforts to address and alleviate poverty including a summary of the actions to respond to the negative financial impacts experienced by residents as a result of the COVID-19 pandemic, and the poverty action strategy and plan (for copy see file of Minutes).

The Head of Transformation picked on some of the key highlights contained in the report including; the work to support children and families with initiatives such as holiday activities and ways to make the school day more affordable and vouchers issued during October half term. Work to support those seeking employment through the employability team and the impacts of welfare reform and COVID-19 on the County and its residents. Initiatives taken over the last 12 months were further detailed within paragraph 55 onwards of the report for information.

Councillor Gunn passed on her thanks to the team and Councillor Surtees, Portfolio holder for their work on this issue. She noted that there were many layers to poverty, and it was concerning to see increased numbers of children living in poverty. She therefore felt that a comprehensive government plan to tackle this issue across the whole country was required urgently.

In response Councillor Surtees referred to the increasing uncertainty faced by many families in County Durham and the impact hardship has upon mental well-being. She noted her concerns regarding future funding and welcomed the comments made by Councillor Gunn above.

Councillor Hovvels agreed that a letter should be sent to the government lobbying them for action and suggested that this should be done so with the support of the Board’s partners.

Resolved: That the content of the report and progress update be noted.

The Board considered a report of the Director of Public Health, which presented the 2019/20 County Durham and Darlington Child Death Overview Panel (CDOP) Annual Report (for copy see file of Minutes).

The Director of Public Health explained that during the period 20 child death reviews were considered by the CDOP and of those 20 cases, there were modifiable factors in five deaths with seven factors identified which had been put forward into the plan for further work including:

·      Raising awareness regarding Signs & Indicators of Acute Illness in Children

·      Children with Chronic Medical Conditions

·      Accidental Deaths

·      Neonatal Deaths

She went on to highlight areas within the CDOP where good practice could be drawn upon and noted developments in 2019/20.

Discussion took place regarding how the Board could assist the work of the CDOP and the Director of Public Health noted that a co-sleeping campaign was currently being developed as identified as a modifiable factor and was one which the Board could advocate to help prevent in the future.

Resolved: That the Board note the

(a)      content of the annual report and the developments planned for 2019/20 and beyond.

(b)      importance of the work of the raising awareness campaigns to recognise and respond to children showing signs of an acute illness and also the raising awareness through existing campaigns regarding bike safety as these issues were identified as modifiable factors in child deaths reviewed by the Child Death Overview Panel during this period.

(c)      the work ongoing to develop thematic reviews through a merged CDOP with other CDOP areas in the North East region.

The Board considered a detailed update and presentation of the Director of Public Health which provided details of COVID-19, Mental Health and Help us to help you alcohol campaigns (for copy see file of Minutes).

With regard to the alcohol campaign the Director of Public Health explained that this annual campaign from NHS England and NHS Improvement sought to ease, among other things the winter pressures on our healthcare system by directing people to the most appropriate resource for their needs. This also ran alongside Dry January, which despite the challenges faced in terms of getting people signed up because of remote ways of working, a good take up to the campaign had been seen across the county.

Resolved: That the content of the presentation be noted.

a.    Local Outbreak Control Plan: Progress Update: Presentation of Director of Public Health, Durham County Council

b.    Questions from members of the public and stakeholders

The Board considered a report and detailed presentation of the Director of Public Health which provided an update on the COVID-19 response and the COVID-19 Local Outbreak Control Plan (for copy see file of Minutes).

The Director of Public Health reported that the rate across County Durham had now reduced, although numbers were still high and the number of deaths was also starting to reduce however there was a lag in the reporting of these numbers. She went on to explain that the new variant detected in the UK was around 70% more transmissible and this strengthened the importance of the key messages of hands, face, space.

An update was further reported in respect of the Local Health Protection Assurance Board whose key purpose was to lead, co-ordinate and manage work to prevent the spread of COVID-19. The Director of Public Health explained that the spike detection tool had been developed to identify localised outbreaks and allowed for a mobilised community response to any such outbreaks and would also be utilised in education, care home and workplace settings.

The Director of Public Health in relation to the vaccination programme noted that as of 6 January 2021, 28,000 vaccinations had been administered.

In response to questions submitted by members of the public.

When there are spikes in the community transmission, do we know the reasons – for example there was a recent spike in Durham City prior to the Christmas break?

The Director of Public Health explained that the outbreak in Durham City was known to be non-student related and had been found to be from broader community transmission. It was noted that similar outbreaks had been seen in Annfield Plain and South Moor.

S Caddell asked whether County Durham were close to opening a mass vaccination site, the Director of Public Health advised that work was ongoing through discussions with NHS England and partners and it was hoped that a conclusion on this matter would be reached soon.

What is the current situation in County Durham regarding visits to Care Homes?

The Corporate Director Adult and Health Services recognised the importance of the connections from allowing residents and their families to be able to visit and visiting should be supported where it's possible to do so in line with the national guidance. It was also important that within the care home environment appropriate measures to manage any risks were undertaken and to strike a balance between the benefits of visiting on the well-being and the risk of transmission based on a dynamic risk assessment. However, for all care homes except in the event of an active outbreak outdoor visiting should be enabled and in exceptional circumstances visits should be enabled where that's safe and practical to do.

She went on to explain that it was extremely important that the guidance was followed by care home providers and it's also important to note that in the event of an outbreak in a care home visiting should stop immediately.  Support and advice  ...  view the full minutes text for item 15.