Agenda and minutes

Keith Forster for John Pearce, Joy Evans for Amanda Healy, Wendy Quinn for Sue Jacques, Phil Innes for Steve Helps and Marie Smith for Lynn Hall.

Keith Forster for John Pearce, Joy Evans for Amanda Healey, Wendy Quinn for Sue Jacques, Phil Innes for Steve Helps and Marie Smith for Lynn Hall.

There were no declarations of interest.

The minutes of the meeting held on 1 September 2021 were agreed as a correct record and signed by the Chair.

Presentation of Director of Integrated Community Services, Durham County Council.

The Board received an update from the Corporate Director of Adult and Health Services and the Director of Integrated Community Services on Health and Social Care Integration progress (for copy see file of minutes).

The Director of Integrated Community Services, Michael Laing explained that the Heath and Care Bill had had its second and third readings in Parliament and recommended changes to partnership arrangements, with the Durham Clinical Commissioning Group (CCG) being abolished by April 2022, and with new arrangements being set up.  He added that there was a requirement on the Integrated Care System (ICS) for the North East and North Cumbria to come forward with a proposed constitution, to be approved or otherwise by NHS England by the end of December 2021.  He noted that subsequent to the agenda pack being finalised, a letter had been received from Sir Liam Donaldson, Chair of the ICS, noting that those discussions relating to structures were coming to their conclusion and that he was able to submit to NHS England a proposal of what the board would look like at the North East and North Cumbria level.  The Director of Integrated Community Services noted that the Board would have representation from four Local Authorities, statutory posts of Medical Director, Chief Executive and Director of Finance, representation from Primary Care and patient groups, such as Healthwatch.  He noted that place-based arrangements for County Durham were not yet finalised, with work ongoing, and noted Members had previously stated that there should be as much decision making and finance for County Durham as possible, with Officers working hard in that regard.

The Director of Integrated Community Services explained that the Chief Executive of the ICS Board had been appointed, Sam Allen, and once in post with Sir Liam Donaldson continuing as Chair, the Board would start to take shape with the appointment of non-executive Board Members.  He noted that after that, information around place-based arrangements would come forward and added that at the County Durham level, the Health and Wellbeing Board had expressed its desire to integrate services more closely, and Officers continued to work on nine workstreams.  He noted focus on discharge from hospital and crisis response, with those workstreams now having come to an end.  He reported that, in respect of crisis response the CCG had allocated additional funding to create a crisis response service, within two hours, to avoid hospital admissions from April 2022.  He added that how patients were discharged would also change in April in line with national requirements with staff on wards, predominantly Therapists, being able to access Local Authority care and would carry out an assessment on behalf of the Local Authority and the more complicated assessments that often held up a patient would then be carried out in a community setting. 

Councillor R Bell noted the number of representatives from Local Authorities would be four and asked whether they would be Officers or Elected Members on the IC Board, and with the North East and North  ...  view the full minutes text for item 5.

Report of Head of Integrated Strategic Commissioning, Durham County Council and NHS County Durham Clinical Commissioning Group.

The Board received an update report of the Head of Integrated Strategic Commissioning on the County Durham Commissioning and Delivery Plan 2020-25, presented by the Director of Integrated Community Services (for copy see file of minutes).

The Director of Integrated Community Services noted the County Durham Commissioning and Delivery Plan was in its third edition and focused on ‘starting well’, ‘living well’ and ‘aging well’ and was administered by the County Durham Care Partnership Executive which consisted of the CCG, the NHS Trust, the Local Authority, the Mental Health Trust and other partners.  He noted it had been delayed until autumn as a result of the pandemic and explained that the plan helped to shape commissioning decisions, understand where there was need, in respect of communities and individuals, and to use the collective resources and staff to meet that need.  He added that it was a complicated document, however, it was very comprehensive, and picked up all of the health and social care sector.

Resolved:

That the content of the plan be approved.

Report and Presentation of Director of Public Health, Durham County Council.

The Board received a report and presentation of the Director of Public Health giving an overview of the Domestic Abuse Act 2021, presented by the Strategic Manager, Public Health, Jane Sunter (for copy see file of minutes).

The Strategic Manager gave a detailed presentation, noting she was also Vice Chair of the Domestic Abuse and Sexual Violence Executive Group (DASVEG).  She noted changes to the statutory definition of domestic abuse, to include children and young people in their own right, new statutory requirements for Local Authorities to provide support to those arriving from another Local Authority area, a range of accommodation options and broader wrap around support.  She explained as regards opportunities in terms of a new Domestic Abuse Strategy, funding that was available and the timeline for the implementation of the legislative changes.

Councillor R Bell noted the Council had received £50,000 to employ a Domestic Abuse Coordinator and £1.61 million in terms of New Burdens Fund from the Department of Levelling Up, Communities and Housing (DLUCH) and asked how far the £1.61 million would go in terms of commissioning services and whether that was a one-off payment, whether it would be received annually, or if the Local Authority would be expected to manage funding ongoing.  The Strategic Manager noted that alongside the introduction of the Safer Accommodation Strategy and the development of the Domestic Abuse Strategy, there was also ongoing work with partners to identify more long-term mainstream funding. 

She noted that senior leaders across the Partnership had noted that in the past funding had come from a number of one off funding pots and therefore a commissioning strategy relating to domestic abuse work was being developed that would allow for the New Burdens funding to be taken on, as well as being able to set out a long-term vision in terms of funding.  She added that it would not just be in terms of what had been done historically, it would look at needed to be done to progress the agenda.

Councillor T Henderson asked as regards how the Authority and partners were promoting what a healthy relationship was to children and young people to ensure that they understood that domestic violence and abuse was unacceptable.  The Strategic Manager noted it was a priority area and explained that all school age children and young people had access to work that supported healthy relationships through the introduction of statutory relationship, sex and health education.  She added that colleagues in Public Health also worked very closely with Education Durham to ensure that schools had access to quality resources that tackled all aspects of domestic abuse, including the impact of coercion, control, emotional abuse and financial abuse in an age appropriate way.  She explained that the Local Authority was also working with partners in a more targeted way in terms of identifying vulnerable groups, especially children and young people, so that they had access to appropriate support, including enhanced support in safer accommodation.  She added that, as part of the  ...  view the full minutes text for item 7.

Report of Strategic Programme Manager, Integration, Adult and Health Services, Durham County Council.

The Board received a report of the Strategic Programme Manager, Integration, Adult and Health Services relating to the Better Care Fund Policy Framework and Planning Requirements 2021-2022 (for copy see file of minutes).

The Strategic Programme Manager, Integration, Paul Copeland noted the report gave a summary of the policy framework and planning requirements for the Better Care Fund (BCF).  He added that the Board would be aware that it was a national initiative for driving health and social care integration, in a way that supported person-centred care, sustainability, and sought to improve outcomes for people and their carers.  He explained that the BCF was launched in 2015 and established poolled budgets between the NHS and Local Authorities, with the aim to reduce the barriers often created by separate funding workstreams.  The Strategic Programme Manager noted that in 2021/22 there were minimal changes for the BCF, given the ongoing pressures associated with the pandemic.  He explained the policy framework outlined a 3.5 percent national uplift, with some variation on that figure in parts of the country, as in previous years.  He added that in County Durham it had been agreed by the Health and Social Care system for a 5.3 percent uplift.

The Strategic Programme Manager noted the main policy requirements for the BCF 2021/22 were largely unaltered and addressed at paragraph 12 of the report.  In relation to the Plan, he explained that considered of a narrative plan and a BCF planning template which outlined income and expenditure and national metrics.  He noted national metrics were outlined at paragraph 18 of the report and included: effectiveness of re-enablement of people at home 91 days after being discharged from hospital in receipt of re-enablement; permanent admissions of older people to residential or nursing home care; and three new metrics.  He added those three new metrics related to: avoidable hospital admissions; reducing length of stay for those in hospital longer than 14 and 21 days; and the proportion of people discharged home to their usual place of residence.

The Strategic Programme Manager noted that the BCF planning template and assurances did not coincide with the Health and Wellbeing Board schedule of meetings and as a result there was a request made for delegated authority for sign-off by the Chair and Vice-Chair of the Board, which was subsequently agreed.  He concluded by noting that the Plan was submitted to NHS England on 16 November 2021, with scrutiny to be via regional assurance by 7 December, followed by cross-regional assurance by 9 December and with final approval by NHS England by 11 January 2022.

The Chair asked if we could guarantee that County Durham would not lose any of the Better Care Fund and asked what we were doing to influence decisions at the regional level.  The Strategic Programme Manager noted he could not guarantee that County Durham would lose any of the BCF in the future, noting that while nothing would change for the 2022/23 year, he noted beyond that was not  ...  view the full minutes text for item 8.

Report of Director of Integrated Community Services, Durham County Council.

The Board received a report from the Director of Integrated Community Services which provided an update on Winter Planning Arrangements (for copy of see file of minutes).

The Director of Integrated Community Services gave a detailed presentation in terms of the demand pressures being faced, along with the measures being put in place to respond to these.  It was noted this included information as regards: surge and cold weather plans; increased demand in comparison to 2019; higher influenza infections and child RSV infections; social care; primary care; community services; acute care; mental health, the North East Ambulance Service (NEAS); Public Health; the Council’s Technical Services in relation to highways; vaccination; and working together.

The Chair noted that the Government had published guidance with extra funding to support additional capacity however, given the demand on services that the Director of Integrated Community Services outlined, he asked what Partners could do to ensure residents used the most appropriate care, for example promoting the use of local pharmacies instead of presenting to secondary care and Accident and Emergency.

The Director of Integrated Community Services noted that the first step was self-care, one looking after oneself and utilising the local pharmacy or GP where one felt unwell in the first instance.  He added that only then utilising acute services such as Accident and Emergency as appropriate.  He noted there were many services available to help care and keep people safe over the winter period without having to attend Accident and Emergency.  He noted one area for improvement was communicating with the public the options that were available in terms of staying well over winter and support such as urgent care, extended GP hours and mental health support were available.

The Associate Director of Operations, County Durham and Darlington NHS Foundation Trust, Wendy Quinn explained that, in terms of managing demand on Accident and Emergency, it was very important to note that the discussion around people not needing to attend Accident and Emergency had been had by many people and that spot checks had shown that a lot of sick people, that needed to be seen, were attending Accident and Emergency.  She added that while it would be preferable if they were not in Accident and Emergency for as long a period, those people needed to be seen.  She noted, however, that there was a number of people that could receive services elsewhere and that the Acute Trust worked closely with

Primary Care and Community Care colleagues in terms of alternatives being offered, including signposting people to different areas.  She added that was an area that was worked on very hard, to create capacity to see people, albeit not providing additional physical capacity, i.e., bed spaces.  She noted one of the alternative services, currently operating at Darlington, with work ongoing to create capacity at Durham, was same day emergency care.  The Associate Director of Operations noted that it had proven to be very successful, and it was accepted that while continuing to communicate as regards  ...  view the full minutes text for item 9.

Presentation of Director of Public Health, Durham County Council.

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

·        Covid-19, including

o   Overarching messages e.g., hands, face, space / testing / vaccinations

o   Areas of enhanced response to support the community engagement work

o   Beat Covid North East campaigns

o   Ongoing advice and information for children, young people and schools

·        Health harms

o   Tobacco

o   Breastfeeding

o   Physical activity

o   Mental health

o   Painkillers call to action

o   Better health at work

·        Autumn/Winter Covid 19 activity

o   Vaccine support

o   Testing

o   Covid Champions / Junior Champions

o   Outbreak support

o   Beat Covid North East

·        External campaigns

o   Stoptober

o   Alcohol awareness

o   Mental Health / Mental Health at Scale

o   Domestic Abuse

o   Flu

o   Physical Activity

o   Painkillers

·        Internal campaigns

o   Employee health and wellbeing

§  Staff wellbeing portal

§  Domestic Abuse champions recruitment

§  Menopause awareness

§  Better health at work

§  Staff wellbeing survey

Councillor T Henderson noted, in relation to the Painkillers campaign, that it was a hard message to get across to residents.  He asked how we were aligning agendas, for example with physical exercise, healthy weight etc to support those who are in regular or constant pain.  The Strategic Manager Outbreak Control noted there was a system wide response to the issue and noted the campaign that was highlighted within the presentation.  She added that one of the key objectives within the OGIMs (Objectives, Goals, Initiatives and Measures) as part of the County Durham Commissioning and Delivery Plan was to address and drive down the prescribing for painkillers and to have those discussions with Primary Care and GPs when prescribing painkillers as regards the potential addictiveness.  She noted the potential for co-referral into ‘Wellbeing for Life’ and working with the social prescribing link workers so that there was a holistic view of the person.  She added that prescribing reviews are in place with the Medicines Optimisation Team and through Primary Care services.  The Strategic Manager Outbreak Control noted that the Drug and Alcohol Recovery Service was also addressing the issue through their work, raising awareness, talking through issues of pain management with those see themselves as dependant upon the medication and where their story began and to look to address the wider health behaviours for that individual and potential options. 

She added there was a ‘waiting well’ service, funded by the COMF within the County Durham and Darlington NHS Foundation Trust, to support those health behaviours such as physical activity and weight management to help address pain and reduce dependence on medication.

Resolved:

That the presentation be noted.

Report Director of Commissioning Strategy and Development (Primary Care), NHS County Durham CCG and Director of Public Health, Durham County Council.

The Board received an update report and presentation from the COVID-19 Vaccine Inequalities Group, presented by the Chief Officer of the County Durham CCG, Dr Stewart Findlay (for copy of see file of minutes).

Dr Stewart Findlay introduced himself and explained in addition to his role as Chief Officer of the County Durham CCG he was also an Associate Medical Director of the County Durham and Darlington NHS Foundation Trust and the Primary Care Director of the COVID-19 Vaccination Programme across the North East and North Cumbria.

He referred the Board to the comprehensive report within the agenda pack and highlighted that the vaccination programme was the most powerful weapon we had to fight against the pandemic.  He noted good uptake in general in County Durham and the region, however, there were still some hard to reach groups where special measures had been taken to get out to those groups.

Dr Stewart Findlay noted that it had been shown that there was now a need for three vaccinations, with the first two being eight weeks apart which appeared to be the optimal gap.  He added that protection appeared to wane by around 20 percent after around six months and therefore a third dose was needed for full protection, similar to Tetanus and Polio vaccination schedules for children.  He emphasised that it was important that people came forward for their boosters to help prevent measures such as further lockdowns, citing Austria as an example where previous low vaccination uptake was now resulting in strict lockdowns.

He explained that a multiagency group had looked at inequalities across the County and noted there had been a number of ways looked at in attempting to address the issue.  He noted the rapid development of systems when looking to roll out vaccinations and that there were a number of groups that were picked up including refugees, homeless and Gypsy, Roma and Travellers groups. 

Dr Stewart Findlay explained that the aim had been to vaccinate 70 percent across all groups, difficult when dealing with those hard to reach groups.  He noted that there still were a large number of unvaccinated across the County and those tended to be more likely to attend hospital and potentially an ITU bed.

Dr Stewart Findlay noted that initially it had been thought the majority of vaccinations would be given via the large vaccination centres, however, that had been quickly changed to a more local level via Primary Care Network sites, and then via individual GPs and community pharmacies.  He added that momentum was built upon with pop-up clinics, such as at Durham University, and the roll out of the MELISSA Bus out to help reach the homeless and worked with North Yorkshire to work to roll out vaccinations at Appleby Fair.  He noted the success and popularity of the bus, with over 5,000 vaccines delivered via the MELISSA Bus.  Members were asked to note the figures in terms of vaccine uptake.

Councillor T Henderson asked if there was any update  ...  view the full minutes text for item 11.

Presentation of Director of Public Health, Durham County Council.

The Board received a report and presentation from the Director of Public Health which provided an update on the COVID-19 Local Outbreak Management Plan, presented by the Strategic Manager Outbreak Control (for copy of see file of minutes).

The Strategic Manager Outbreak Control gave a detailed presentation which included: highlighting dashboard information; vaccine uptake information; continuation of the ‘hands, space, face’ message; information on test and trace being delivered locally; work with care homes and the university; support of local access to lateral flow testing; 77 bids relating to the Contain Outbreak Management Fund, representing £24 million to be spent by March 2022; COVID-19 Community Champions; and single points of contact.

Councillor R Bell left the meeting at 2.51pm

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

Michael Laing

1.     Why is it not a requirement for people to wear masks at both indoor and outdoor events?

From 19 July 2021, there was no longer a legal requirement to wear face coverings in indoor settings or on public transport. Lifting restrictions does not mean the risks from Covid have disappeared, we have moved to an approach that enables personal risk-based judgements. No situation is risk free, there are actions we can take to protect ourselves and others around us. The public are therefore recommended to continue to wear face coverings in crowded and enclosed spaces where they meet people they don’t normally meet. 

In respect of businesses, venues and workplaces - employers must complete a risk assessment and take reasonable steps to manage risks to the health and safety of their workforce and customers in their workplace or setting, including the risks of Covid. Businesses can require or encourage customers, clients, or their workers to wear a face covering.

Joy Evans

2.  Why is the vaccine I’ve received for my booster Jab (Pfizer) a different make to the one for the first two doses (Astra Zeneca)?

Most people will be offered a booster dose of the Pfizer/BioNTech vaccine or Moderna vaccine. You will be offered the right vaccine for you, which may be the same or different from those you had before. This can help increase protection and means your booster dose may be different from the vaccines you had for 1st and 2nd doses.  Some people may be offered a booster dose of the Oxford/AstraZeneca vaccine if they cannot have the Pfizer/BioNTech or Moderna vaccine.

Dr Stewart Findlay

3.  People are getting confused about time periods between booster jabs and the time you have to wait before a Covid vaccine if you have tested positive for Covid. Can you explain this?

These are two separate issues.  In terms of the booster jab it must be at least 6 months, 182 days to be precise, between your 2nd jab and the booster jab. 

However, from 8 November 2021, the National Booking System will allow you to pre-book your booster appointment a month  ...  view the full minutes text for item 12.