Agenda and minutes

Apologies for absence were received from Councillor J Allen, Dr S Findlay, Mike Forster, J Gillon, L Hall, S Jacques, F Jassat, Dr J Smith and S White.

S Caddell substitute for S White, M Smith substitute for L Hall, M Houghton substitute for J Gillon and S Lamb substitute for M Forster.

There were no declarations of interest.

The minutes of the meeting held on 21 January 2021 were confirmed as a

correct record and would be signed by the Chair.

The Chair referred to item 12 of the minutes of the meeting held on

21 January 2021 and confirmed that a joint letter on behalf of the Cabinet Member for Children and Young People's Services, Cabinet Member for Social Inclusion and Cabinet Member for Adults and Health and Chair of the Health and Wellbeing Board had been sent directly to the Secretary of State for Health and Social Care, Secretary of State for Housing, Communities and the Under-Secretary for Department for Work and Pensions lobbying for Government action against poverty issues in County Durham and levelling up across the Country.

The Board received a report of the Programme Manager at South Tyneside and Sunderland NHS Foundation Trust that provided an update on the status of Phase 2 of the Path to Excellence Programme, the learning from COVID-19 and the impact on the Programme (for copy see file of minutes).

The Programme Manager highlighted the main drivers for change that had been identified from involvement activity with staff, patients and stakeholders.

In response to a query from the Chair regarding communicating the consultation to residents in County Durham, the Programme Manager advised that early work had been carried out with residents in North and East Durham prior to the pandemic and moving forward would be working with stakeholders and representatives from Durham Healthwatch and Durham CCG who sit on the stakeholder panel to help advise on engagement within Durham residents to achieve the best opportunities.

Nicola Bailey suggested contacts in relation to community engagement in Durham and questioned the impact on the population from the East of the County who use Sunderland as their main hospital as a significant portion of elective work was moving to South Tyneside. The Programme Manager confirmed that there will be an impact associated with planned care, however there was no expected changes in terms of service provision for unplanned care for the residents of Durham and they would be able to access Sunderland Hospital as they do currently. She added that the travel and transport provider were looking at the impact on Durham residents and they were looking at using the Durham Treatment Centre to provide planned care more locally to minimise the impact.

Nicola Bailey then asked if discussions had taken place between County Durham and Darlington NHS Foundation Trust in relation to individuals who would prefer Durham to South Tyneside due to transport issues. It was noted that patient choice was still recognised and discussions on the potential impact would take place with Medical Directors in the following weeks.

Michael Houghton commented that Hartlepool residents also travel to different locations and advised that North Tees and Hartlepool NHS Foundation Trust would be taking part in the consultation and would contribute to the analysis outlined in the report.

Councillor Gunn referred to patient feedback in relation to changes that have been implemented in Phase 1 and asked if satisfaction levels had improved. It was noted that early evaluation showed patient satisfaction did not reduce and further detail would be produced on improved satisfaction levels which would be fedback to the Board.

Resolved: That the update be noted.

The Board considered a report of the Head of Partnerships and Community Engagement that presented the Joint Health and Wellbeing Strategy (JHWS) 2021-2025 for agreement (for copy see file of minutes).

The Strategic Manager (Partnerships) reported that since the draft strategy was presented to the Board in January 2021, a wider consultation on the JHWS had taken place from January 2021 to February 2021 which included public consultation via Durham County Council’s website, partner organisations, Overview and Scrutiny Committees, the Youth Council and patient reference groups. It was noted that the majority of responses received agreed with the priority areas set out in the strategy.

It was reported that an equality impact assessment has been undertaken on the strategy and the performance of the six high level objectives would be monitored and an update would be provided to the Board annually.

The Strategic Manager (Partnerships) requested that the Board ensure that the relevant strategic documents developed by partners are aligned to the Joint Health and Wellbeing Strategy and that partners share the document within their organisations and publish on their websites.

The Chair highlighted the importance of sharing the JWHS to provide an understanding of priorities and showcase the work in County Durham for the newly appointed Chair of Integrated Care Systems.

Responding to a query from S Caddell regarding a summary document, the Strategic Manager (Partnerships) advised that an easy read version had been developed for the consultation process and confirmed that she would look to develop a summary document and see how it would align with what has been done previously.

Resolved: That the Joint Health and Wellbeing Strategy 2021-25 be agreed.

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.

It was noted that a governance review would be taking place in relation to integrated arrangements across the County and the suggested approach had been endorsed by Cabinet and the CCG. A presentation would be provided at the next meeting outlining the new arrangements regarding the creation of the County Durham Care Partnership Executive and a range of Associated Partnership Boards.

The Corporate Director of Adult and Health Services referred to comments in relation to the integrated care system and the publication of the White Paper. She advised that Alan Foster, Executive Lead for the North East and North Cumbria’s integrated care system had been invited to attend the next Health and Wellbeing Board meeting where the Board can discuss the White Paper implications and seek assurances on how the integrated care system will interface with the place based arrangements within the County.

Michael Laing advised that focus would be on changing procedures and structures in preparation for the new White Paper arrangements. Practical work in relation to services would look at restarting the integration programme which involves examining the success of TAPS. He added that feedback from GP Services showed they are highly valued and there was a demand to look at how Trusts, GPs and CCG colleagues continue to work together to reduce hospital admissions. Further development on the work programme would be reported to a future meeting.

Nicola Bailey highlighted the White Paper implications in relation to the County Durham CCG as they will cease to exist after April 2022. It was noted that the CCG would be focusing on delivering key issues over the next year which will be reported to the Board.

Councillor Gunn welcomed the update and highlighted the importance of ensuring residents are informed of the new arrangements. Michael Laing advised that the communication plan had been strengthened with more information reaching the public. He added that the new arrangements would include a forum of partners to help communicate to constituencies as service user involvement was particularly important.

Resolved: That the update be noted.

The Board received a report of the Director of Public Health that provided an update on the work taking place within the strategic priorities in the Joint Health and Wellbeing Strategy (JHWS) (for copy see file of minutes).

The Director of Public Health gave a presentation that focused on the three strategic priorities of Starting Well, Living Well and Ageing Well which included:

·           Breastfeeding;

·           Improving Children’s Oral Health;

·           Suicide Prevention;

·           Working with Vulnerable Groups;

·           Mental Health and Vulnerable Older People;

·           Domestic Abuse;

·           Workplace and Population Health.

Sharon Caddell gave an update on the Domestic Abuse and Sexual Violence Executive Group (DASVEG). She advised that in addition to ongoing work around health needs assessments and budget prioritisation, they would also be looking at the coordinated community response model and the forthcoming domestic abuse bill focusing on engaging partners, civil society and grassroots groups.

Resolved: That the update be noted.

The Board received a report of the Joint Head of Integrated Strategic Commissioning for County Durham CCG and Durham County Council, and Director of Commissioning Strategy and Delivery (Digital, Mental Health and Learning Disabilities) County Durham CCG that provided an update in relation to local delivery and progress of the Transforming Care Programme, incorporating an overview of progress on the Joint Health and Social Care Learning Disability Commissioning Strategy and the Think Autism Strategy for County Durham (for copy see file of minutes).

The Strategic Partnership Manager, Learning Disabilities and Transforming Care Commissioning Lead, Durham and Tees Valley and the Strategic Commissioning Manager, Learning Disabilities and Mental Health provided an update on key areas in relation to inpatient trajectories, community developments, accommodation provision and long term commitment plans.

The Chair asked how service users with learning disabilities and autism have adapted to technology as part of the service provision and what level has face to face contact been maintained. The Strategic Commissioning Manager advised that integrated teams were encouraged by how well service users had adapted to technology with the support of providers and carers to help maintain social interaction with family and professionals throughout the pandemic. Integrated teams have also used technology in relation to general contact, assessments and reviews, however face to face contact has continued when circumstances have required.

Councillor Gunn commended the efforts of providers, carers and integrated teams who have adapted to the use of technology to maintain contact with services users with learning disabilities and autism during the pandemic. She referred to the autism awareness week and suggested that contact be made with the Durham County Youth Council to involve them in the work being done to help raise awareness with young people.

Nicola Bailey agreed with Councillor Gunn regarding connecting with young people and added that there was investment in community voluntary sector services and investment in employment of young people with autism and learning disabilities.

In response to a query regarding plans for people in specialised commissioning services and people who need to transfer to generic accommodation, the Strategic Partnership Manager advised that there was a need for infrastructure development to be able to respond to some of the challenges. She was confident with the work proposed across the system, however they were dealing with individuals with very complex needs who may not need to be in hospital but need community provision to be able to support them safely.

The Chair thanked the Strategic Partnership Manager and Strategic Commissioning Manager for a comprehensive report and urged partners to support Autism Awareness Week.

Resolved: That the update be noted.

The Board considered a report and presentation of the Director of Public Health that provided updates on the health protection assurance arrangements in County Durham, implementation of the health protection action plan and the indirect effects of the COVID-19 pandemic that has impacted on relevant work programmes (for copy of report and presentation see file of minutes).

Chris Alan, Public Health Consultant gave a presentation and provided an update on the following activity:

·        Key achievements;

·        Screening;

·        Immunisations;

·        Outbreaks and communicable diseases;

·        Strategic regulation interventions;

·        Preparedness and response to incidents and emergencies;

It was noted that additional funding had been secured to build capacity to address additional needs arising from the pandemic and the EU exit. The team will be involved in developing a multi partner place based approach to tackle issues and build cohesion within communities.

Councillor Gunn raised concerns in relation to the abolition of Public Health England and the creation of the new National Institute for Health Protection. She asked about the potential impact of the changes on health protection across the County. The Director of Public Health advised that the Regional Director of Public Health England had been invited to attend the next Health and Wellbeing Board meeting to provide an update on the position. The Chair wrote to the Secretary of State for Health on behalf of the Board seeking assurance of what the National Institute of Health Protection would consist of and what it would mean locally, however no response had been receive as of yet. She added that the Association of Directors of Public Health were also concerned and would continue to seek assurances to preserve the close relationships and expertise in the North East.

In response to a query regarding screening programmes, the Public Health Consultant explained that regular assurance reports are received from NHS England regarding improvements on screening programmes. He advised that the breast screening programme will have recovered by the end of the year and NHS England plan to have workshops on inequalities with regards to cancer screening programmes which will include stakeholders from the Local Authority and CCG’s.

The Chair commented on the impact that lockdown has had on air quality during the past year. It was noted that data from Environment Protection and Transport showed that nitrogen dioxide in the air had reduced in the North East by 27% since 23 March 2020 and a similar level of reduction had been reported in Durham.

Resolved:

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

(ii)    That performance for all childhood immunisation programmes in County Durham exceeds both standards and national averages be noted;

(iii)   That broad assurance that effective processes are in place for each of the key strands of health protection activity be noted;

(iv)   That further assurance in relation to flu and COVID-19 vaccination be supported;

(v)   That assurance on the transfer of Clinical Commissioning Group (CCG) and Public Health England (PHE) functions including health protection and screening and immunisation programmes and emergency response be supported;  ...  view the full minutes text for item 10.

The Board considered a report of the Director of Strategy and Delivery - Primary Care, County Durham CCG that presented the final draft of the County Durham Primary Care Commissioning and Investment Strategy 2020/21-2021/22 which takes into consideration feedback received from the Board and Healthwatch County Durham (for copy see file of minutes).

The Chair referred to the Integrated Care System becoming a statutory organisation and asked how to ensure the primary care sustainability and investment would not be affected in County Durham. Nicola Bailey advised that primary care would be managed in two different ways with the national core contract delegated to CCG's and would be at a level outside of County Durham. The primary care development and leadership of primary care network directors would be place based at local level.

Resolved:

(i)     That the report be noted;

(ii)    That changes made to the document in light of feedback received from the Board and Healthwatch County Durham be noted;

(iii)   That the County Durham Primary Care Commissioning and Investment Strategy 2020/21-2021/22 be endorsed.

The Board received a report of the Director of Public Health that provided an update on the COVID-19 Community Champions programme since the programme launch at its meeting on 24 November 2020 (for copy of report and presentation see file of minutes).

Karen McCabe, Strategic Manager gave a presentation detailing the main aims of the community champions programme and detailed key elements within the wider engagement and communication strategies.

It was reported that since the launch, 95 people had expressed an interest in the programme. 85 people were actively engaged in the programme with 48 champions and 37 champions plus and plans were being developed to link with younger champions in the future. The Strategic Manager gave details of the modules that are provided in the online training programme and noted that modules were currently being developed in relation to vaccination and testing.

Richard Hornby, Community Champion outlined his experience in the role and provided feedback from sharing messages within the community.

The Chair thanked all the volunteers who had helped to safeguard the residents of County Durham. She highlighted the importance of ensuring communities continue to be connected when COVID-19 restrictions start to lift. The Strategic Manager advised that community champions were a valuable resource in the community and the programme was moving at the pace of the pandemic. The Programme Lead was looking to introduce guest speakers to attend meetings in relation to physical and social interaction and discuss the impact and concerns from lockdown. Richard Hornby added that issues leading out of the pandemic were discussed at the last champions meeting and it was envisaged that there would be more engagement regarding related issues such as mental health concerns, loneliness, exercise and financial wellbeing. 

Resolved: That update report and presentation be noted.

The Board received a report and presentation of the Corporate Director of Adult and Health Services and Director of Public Health that provided an update on the progress to date of the academic evaluation of the County Durham Approach to Wellbeing in conjunction with Teesside University (for copy of report and presentation see file of minutes).

Cat Miller, Approach to Wellbeing Programme Manager gave a presentation outlining the initial findings from the programme evaluation and plans for the next phases. Five key themes were identified in the findings in relation to:

·        Understanding the wellbeing approach;

·        Challenges to engaging with and using the wellbeing approach;

·        The impact of the wellbeing approach so far;

·        Developing the wellbeing approach;

·        Suggestions for implementation.

It was noted that the general consensus from the evaluation feedback was positive and it was felt that the approach was a useful way to encourage people to think differently and think about the wider impact that intervention has on others.

Resolved: That the report and presentation be noted.

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

·        COVID-19

·        Alcohol

·        Mental Health

·        Healthy Start

Resolved: That the presentation be noted.

a.    Local Outbreak Control Plan: Progress Update

b.    Questions from members of the public and stakeholders

The Board received a 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 of presentation see file of minutes).

The Director of Public Health advised that the outbreak control plan would now move to a local outbreak management plan and would be reported to the Health and Wellbeing Board in June 2021.

It was noted that the vaccination programme was progressing extremely well within County Durham with 95% of people over 80 having received the vaccination. COVID-19 cases had reduced to 70 per 100,000 and localised outbreaks were being managed through early detection and intervention.

The Director of Public Health advised that the below responses to questions from members of the public and stakeholders would be published on the Council’s website following the meeting:

1.    What is the Test and Trace payment progress?

JANE ROBINSON

Test and Trace Support Payments scheme brought in to help people on low incomes who are unable to work from home while they are self-isolating.

As at 28 February 2021 we have received and processed 1793 standard applications and 1099 discretionary applications (for those earning less than £20,065 with less than £500 in savings) – so far awarding £298,500 for the main scheme and £70,000 for discretionary payments.

2.    What is the eligibility for vaccines for “frontline” voluntary services?

MICHAEL LAING

The work of the voluntary sector has been highly valued during the Covid pandemic. The voluntary sector provides a wide range of services including the delivery of health and social care to vulnerable people and support to the general population.

The Government’s Joint Committee on Vaccination and Immunisation (JCVI) issued guidance on 30 December 2020 setting out the priority groups for vaccination. These apply to the voluntary sector and are based on evidence about the mortality rates and risks of vulnerable people and occupational groups. Voluntary sector staff providing “frontline” health and social care are in priority group 2.

Other voluntary sector staff and volunteers would receive vaccinations in line with the JCVI guidance

3.    When can people can go further afield for travel?

SHARON CADDELL

The ‘stay at home’ rule will end on 29 March, but many restrictions will remain in place, and people should continue to work from home where they can and minimise the number of journeys they make where possible, avoiding the busiest times and routes.

Travel abroad will continue to be prohibited, other than for a small number of permitted reasons, and holidays abroad will not be allowed, given that it will remain important to manage the risk of imported variants and protect the vaccination programme.

The government launched a new taskforce to review global travel which will report on 12 April.

4.    How can we access community Lateral Flow Device (LFD) Testing?

AMANDA HEALY

In line with the roadmap out of lockdown we are offering free LFD testing to the following groups.

·                     If you can’t work from home and your workplace doesn’t  ...  view the full minutes text for item 15.