Agenda and minutes

Apologies for absence were received from Councillors C Hood and T Henderson and J Pearce, Dr J Carlton, D Gallagher, S Jacques, B Kilmurray, L Robertson and P Innes.

The following substitutes were in attendance: S Burns for D Gallagher; R Cherry for P Innes; G Curry for S Jacques; P Shadforth for J Pearce; L Taylor for B Kilmurray.

There were no Declarations of Interest.

The minutes of the meeting held 22 March 2023 were agreed as a correct record and signed by the Chair.

A Petty noted a matter arising from the last meeting relating to the Veterans Needs Assessment.

She explained that Durham Constabulary did not routinely ask whether a member of the community was a veteran when they were in contact with them through the criminal justice system and therefore the information on the Police systems may only include where a veteran had self-declared.  She added that where a person did declare, information and signposting was offered.

Verbal update from the Corporate Director of Adult and Health Services, Durham County Council (DCC) and the Director of Integrated Community Services.

The Board received an update presentation from the Corporate Director of Adult and Health Services, Jane Robinson, Director of Integrated Community Services, Michael Laing (in the Chair) on progress relating to Health and Social Care Integration (for copy see file of minutes).

The Corporate Director of Adult and Health Services noted that since the last update as session had been held to take stock of the current position, with a project initiation document having been produced.  It was explained there would be a report to Cabinet and the Integrated Care Board (ICB) Executive in October.  She added that the Vision and Memorandum of Understanding (MoU) would be refreshed, and steps were being taken in terms of the Joint Committee, with reports to come back to the Board in due course.  She added reports would cover governance documents, including delegations to the Joint Committee, as well as those in reference to risk and financial reporting.

In relation to social care, the Corporate Director of Adult and Health Services explained the Care Quality Commission (CQC) was undertaking assessments in five Local Authority areas, and for further 20 Local Authority areas from September 2023, with the remaining Local Authorities to have their assessments in 2024.  She noted the work in progress with the Association of Directors of Adult Social Services (ADASS) and added that work progressed locally, and a further update would be brought back to the Board.

The Chair explained as regards the County Durham Care Partnership (CDCP) and looking at structure and form, with living and aging well partners, reflecting integration.  He noted the need for workstream, especially in terms of workforce integration, giving an example of the Durham County Council (DCC) Care Academy in terms of the work undertaken in respect of staff training and retention, and the Fire and Rescue Service in their prevention and outreach work.  He added that a workforce scope would come back to the Board.

In respect of the Better Care Fund (BCF), the Chair explained that the sign off would traditionally come back to the Board for sign off, however, the timings required did not align with meetings of the Board and therefore the Board were asked for delegated authority to be given to the Chair and Vice-Chair to sign off on behalf of the Board, this was agreed.

The Chair noted that there was a healthy process in County Durham, with the good joint working already in place being an exemplar of best practice.

Resolved:

(a)      That the update be noted.

(b)      That the Chair and Vice-Chair be delegated to approve the submissions in respect of the Better Care Fund, with a report to come back to the Board in due course.

Joint Report of the Head of Partnerships and Community Engagement, DCC and the Director of Public Health, DCC.

The Board received a joint report from the Director of Public Health and Head of Partnerships and Community Engagement, presented by the Senior Partnerships Officer, Jayne Watson on the final Joint Local Health and Wellbeing Strategy 2023-28 (for copy see file of minutes).

The Senior Partnerships Officer explained as regards the consultation that had taken place since the last meeting of the Board, including feedback on readability of the document from community champions.  The Board were reminded of the four areas of focus as the biggest contributors in terms of not achieving the vision of ‘County Durham is a healthy place, where people live well for longer’, being: making smoking history; enabling health weight for all; improving mental health, resilience and wellbeing; and reducing alcohol harms.  The Board were informed of the influence on behavioural risk factors, those factors accounting for 40 percent of people’s health and wellbeing.  It was added that links through health and social care via the Joint Committee and CDCP accounted for 15 percent of people’s health and wellbeing, with the remaining 45 percent being accounted for through the wider determinants of health.

The Chair thanked the Senior Partnerships Officer and asked the Board for their comments and questions.

The Director of Public Health, Amanda Healy noted the excellent development sessions that had taken place leading to a very clear strategy in terms of health and wellbeing priorities and how they supported people. 

She noted that data from the Joint Strategic Needs and Assets Assessment (JSNAA) fed into the Strategy, with issues in terms of tobacco and mental health being strengthened.  She noted that the document would be updated to ensure local images were used in the final document. 

The Corporate Director of Adult and Health Services asked as regards the action plans referred to in paragraph 25 of the report, whether these would be brought back to the Board.  The Senior Partnerships Officer noted that they would not be brought back together, but when the sub-groups present their updates to the Board as part of the cyclical reporting, they would bring their action plans / updates at that point in time.

P Sutton asked as regards the reading age of the document, the Senior Partnerships Officer explained that the DCC Communications Team and the DCC Consultations Team had assisted when drafting the document and it was noted that the reading age was that of age 9.  It was agreed that a final check would look again at the readability.  It was agreed that further work would take place on the design of the gender-neutral figure.

The Chair noted that the final sign off with those design tweaks would be for the Director of Public Health in conjunction with the Chair and Vice-Chair of the Board. 

Resolved:

(a)      That the Joint Local Health and Wellbeing Strategy 2023-28 be agreed.

(b)      That the final designed version, which will contain localised images, be published on the County Durham Partnership website.

Joint Report of the Corporate Director of Adult and Health Services, DCC and the Director of Public Health, DCC.

The Board received a joint report from the Corporate Director of Adult and Health Services and Director of Public Health, presented by the Director of Public Health and Public Health Strategic Manager on the Health Protection Assurance Annual Report (for copy see file of minutes).

The Board noted the responsibilities under the Health and Social Care Act 2012 for the Director of Public Health to discharge a Local Authority’s public health functions.

It was noted the main areas of Public Health activity included: screening programmes; immunisations; communicable disease control and outbreaks, and antimicrobial resistance; strategic regulation interventions; and preparedness and response to incidents and emergencies. 

The Board noted achievements and areas for improvement and collaborative work undertaken.

The Corporate Director of Adult and Health Services noted the role and responsibilities of the ICB and asked as regards what interface there was in terms of preparedness and protection measures. 

The Public Health Strategic Manager noted the regional footprint of the ICB and underlying interface between Local Authorities and the ICB.  She explained in terms of specific issues, DCC was lead on antimicrobial resistance.  The Director of Public Health thanked the Joint Head of Integrated Strategic Commissioning, Sarah Burns for her help in identifying clinical leads and input into the health protection.  She added that the ICB

had a new role as a Category One responder for Emergency Planning,

Preparedness and Response.  She noted that the Local Health Resilience Partnership has been stood back up, noting partnership carried out some learning from COVID-19 and had completed the annual NHS assurance process with NHS England.

The Chair noted as regards the sexual health service and issues in terms of ensuring awareness campaigns were backed up with an appropriate frontline capacity, citing the recent Mpox outbreak.  The Public Health Strategic Manager noted that the figures in County Durham were below both regional and national averages and noted that the issues were being monitored and work was ongoing in respect of prevention.

Resolved:

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

(b)      That the report provides broad assurance that effective processes are in place for each of the key strands of health protection activity be noted.

(c)      That the areas for improvement and further assurance be noted.

(d)      That the revised health protection governance arrangements aligning the robust Covid assurance arrangements with wide health protection governance be noted.

Report of the Joint Head of Integrated Strategic Commissioning, NENC ICB.

The Board received a report of the Joint Head of Integrated Strategic

Commissioning for the North East and North Cumbria ICB (NENC ICB) and DCC, Sarah Burns on the NENC ICB GP Contract Changes update 2023-24 (for copy see file of minutes).

The Chair noted that GP Services were the bedrock of how healthcare worked in the UK. 

The Corporate Director of Adult and Health Services asked as regards communications linked with the changes, for example many people were unaware they could make appointments digitally.  The Joint Head of Integrated Strategic Commissioning noted there was local advertising within GP Surgeries and at local customer access points, including help with navigating the NHS app.

G Curry noted that in terms of communication and strategy, there were examples of good work in relation to urinary tract infections (UTIs) linking with Pharmacies and she felt that would be good model to built upon.  The Director of Public Health noted the positive work and asked as regards Social Prescribing Link Workers.  The Joint Head of Integrated Strategic Commissioning noted that they had proven to be very popular with both patients and GPs and the model of ‘wellbeing for life’ was being looked at locally.

P Sutton asked as regards funding and any risk in terms of only 30 percent being passed on.  The Joint Head of Integrated Strategic Commissioning noted that the challenge in terms of demand on GPs for appointments was recognised and noted while there was a risk, there were a number of local initiatives, including 111 services.

The Chair asked as regards consultation with the public on the issue, Members and local patient groups and Healthwatch.  The Joint Head of Integrated Strategic Commissioning noted that plans were tested with local Patient Participation Groups and explained that national requirements were quite tight in terms of timescales.  She noted that working with Healthwatch could be looked at and noted that feedback from GPs had only been received yesterday, with the main points being concerns that primary care was being stretched, and that alternate signposting was welcomed.  She noted that the Local Medical Committee would be asked for their views.

Resolved:

That the report and presentation be noted.

Report of the Corporate Director of Children and Young People’s Services, DCC.

The Board received a report of the Corporate Director of Children and Young People’s Services, presented by the Strategic Manager (SEND Strategy, Assessment), Paul Shadforth on the SEND Strategy 2022-24 – One Year On (for copy see file of minutes).

Councillor R Bell entered the meeting at 10.41am

The Chair asked what assurances there were in terms of sufficient resources being available, and invested in the right areas, to meet increasing demand and provide the best possible outcomes for young people with SEND.  The Strategic Manager noted that there was investment in the right areas, for example Educational Psychiatrists, however, noted that a lot of the provision was across specialist services.  He noted that County Durham had the highest placing in Special Schools and understood the demand and whether such was the correct option for a young person.  He explained that children and young people had been asked and they had noted ‘anxiety’ if specialist provision was 20-30 miles away.  Young people also said that having friends has a huge impact on their wellbeing.

The Board requested that an update on Delivering Best value (DVB) be brought to a meeting ahead of the next annual SEND update.

Resolved:

(a)      That the progress made against the SEND Strategy be noted.

(b)      That the update provided in relation to SEND developments be noted

(c)      That the consideration of areas of partnership activity which could be strengthened to better support children and young people with SEND needs be noted.

Report of the Joint Head of Integrated Strategic Commissioning, NENC ICB.

The Board received an update report of the Joint Head of Integrated Strategic Commissioning for the NENC ICB, presented by the NHS Strategic Partnership Manager, Learning Disabilities and Transforming Care Commissioning Lead, TEWV, Donna Owens (for copy see file of minutes).

Councillor R Bell referred to the target of no more than 30 adults per million and no more than 15 under 18-year-olds per million being cared for in inpatient settings by March 2024 and asked how confident were Officers that this target would be achieved.  The NHS Strategic Partnership Manager, Learning Disabilities and Transforming Care Commissioning Lead explained that a loss of workforce post-COVID and a shift in terms of the percentage of those with a primary diagnosis of Autism, however, she was confident that the pace of change in CD was good, working with the ICB and ADASS.  The Corporate Director of Adult and Health Services noted that the case studies had been helpful, and the Chair noted that there was always a balance in terms of looking at those that would need long-term inpatient care.

Resolved:

(a)      That the progress made with plans for new community services for people with the most complex needs including the use of the Community Discharge Grant, which will support the Transforming Care objectives over the next year and in the longer term be noted (including the case studies in Appendix 2).

(b)      That the Board receive further regular updates to retain oversight of the Transforming Care agenda.

Report of the Joint Head of Integrated Strategic Commissioning, NENC ICB.

The Board received a report of the Joint Head of Integrated Strategic

Commissioning for the NENC ICB and DCC on the Draft County Durham Plan 2023-24 (for copy see file of minutes).

The Chair noted that Councillor C Hood had noted that it was vitally important that County Durham as a ‘place’ was able to respond to the plan to meet the demands of County Durham and asked how we could respond to the ’Durham’ element.  The Joint Head of Integrated Strategic Commissioning noted responses could be directed via her and added there was work ongoing in terms of stakeholder events.  The Chair and Councillor R Bell noted that the Plan was the deliver plan for County Durham and that it was very important that it responded to the needs of the County.  The Director of Public Health noted that some regional level issues were not included, however, the Local Authority led on some of the issues, such as suicide prevention.  She noted that it was important to match those issues up and to ensure that indicators and monitoring was at an appropriate place and not duplicated.  A Petty noted that guidance noted alignment with Joint Local Health and Wellbeing Strategies.

Resolved:

(a)      That the draft plan be noted, with any suggestions to be included in subsequent submissions.

(b)      That the timescales for completion and local governance process be noted.

(c)      That final sign off by delegated authority of the Chair / Vice-Chair be agreed.

Presentation of the Director of Public Health, DCC.

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

It was noted that Councillor Cathy Hunt would front Fresh’s campaign which would be starting on 19 June.

Councillor R Bell asked about Covid updates, the Director of Public Health noted that prevalence was low, however, there would be targeted campaigns for boosters in Autumn.

A Petty noted that the County Durham Partnership event would focus on Mental health and asked if consideration should be given to re-establishing our Mental Health Pledge on the day.

The Board noted that questions could be directed to the Director of Public Health should any members require additional information on the key campaigns.

Resolved:

That the information contained within the presentation be noted.

That under Section 100(A)(4) of the Local Government Act 1972, the public be excluded from the meeting for the following items of business on the grounds that they involved the likely disclosure of exempt information as defined in Paragraph 3 of Part 1 of Schedule 12A of the Act.

Report of the Director of Public Health, DCC.

Report of the Director of Public Health, DCC.

The Board considered two reports of the Director of Public Health which presented summaries of Pharmacy Applications received from NHS England in accordance with the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (for copy see file of minutes).

Resolved:

That the reports be noted.

Report of the Director of Public Health, DCC.

The Board considered an update in relation to Local Pharmaceutical Committee Boundaries, noting a new Local Pharmaceutical Committee from 1 April 2023 being the Community Pharmacy North East Central, incorporating the former Community Pharmacy County Durham and Sunderland Local Pharmaceutical Committee (for copy see file of minutes).

Resolved:

That the report be noted.