Agenda and minutes

Apologies for absence were received from K Burrows, Dr J Carlton,  Prof C Clarke, D Gallagher, L Hall, P Innes, S Jacques, J Pearce, A Petty, L Robertson and L Taylor.

There were the following Substitute Members: N Appleby for A Petty; S Burns for D Gallagher; G Curry for S Jacques; M Pearson for P Innes; and M Smith for L Hall.

There were no Declarations of Interest.

The minutes of the meeting held 25 September 2023 were agreed as a correct record and signed by the Chair.

The Interim Strategic Manager – Partnerships, J Bradbrook noted that the new Chief Constable, Ms Rachel Bacon, was now in post with Durham Constabulary and she would be invited to become a member of the Board.  She added that alternative venues for meetings of the Board were being looked at for the future.

The Board received an update presentation from the Director of Public Health, Amanda Healy on her Director of Public Health Annual Report 2023 (for copy see file of minutes).

The Director of Public Health reminded the Board that the production and publication of an Annual Report was a requirement for Councils and that 2023 represented 10 years of Public Health within Local Authorities.  It was explained that the Report linked to the Joint Local Health and Wellbeing Strategy (JLHWS) with the influences on health and wellbeing, health and social care, healthy behaviours and the wider determinants of health.  It was added that the report also provided an update on the work that had taken place to address the four priorities in the JLHWS: making smoking history; enabling healthy weight for all; improving mental health, resilience, and wellbeing; and reducing alcohol harms.

Councillor R Bell noted the work and progress over the last 10 years and asked as regards future challenges.  The Director of Public Health noted the four JLHWS priorities, noting that while some changes may provide some quick wins, other areas would be longer term. 

Councillor T Henderson asked what partners could do to help ensure there was a continuous concerted commitment by all to improve health and reduce health inequalities.  The Director of Public Health noted partners were actively engaged through many mechanisms, including consultation such as “stopping the start”.  She added that the meetings of the Board also provided the opportunity for partners to hold each other to account.  She added as an example, the work in relation to 0-25 SEN with partners. 

F Jassat congratulated the Director of Public Health and her Team for all their work over the last 10 years, not least in respect of their work during the COVID-19 pandemic.  He added that leadership and partners should focus on social determinants and support should be sustained.  The Chair added that it was also important to remember the work that was done in our communities with people at the local level that makes an impact on health and wellbeing.  The Director of Public Health noted evidence showed that when work was done hand in hand with people, this led to better outcomes.  She added this was a challenge and noted the good work referred to within her report relating to the Family Hubs, working with Children and Young People’s Services and the Parent Panel to co-produce, working to best benefit local communities.  The Corporate Director of Adult and Health Services, Jane Robinson noted the County Durham Partnership event which saw the relaunch of the County Durham Community Champions to help get those key messages out into our communities.

Resolved:

That the Director of Public Health Annual Report 2023 be noted.

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

The Board received an update presentation from the Public Health Strategic Manager, Mick Shannon on the review of healthy weight approaches in County Durham (for copy see file of minutes).

The Public Health Strategic Manager noted the importance of people moving and considering how much they eat.  He acknowledged the impact of the pandemic on people’s behaviours.  He asked the Board for their thoughts on what they felt were key contributors to obesity.  Responses from the Board included: lifestyle choices; mental health issues; temptation from junk food; impact or side effects from medication or accidents; busy lifestyles; sedentary work and hobbies, such as working at a computer, playing computer games; cost of living impact; cost of access to some exercise; environment; and lack of cheap healthy food options.

The Public Health Strategic Manager noted issues that impacted included mental health and explained as regards food architecture and marketing and explained as regards evidence of pre-natal health issues, such as being overweight or smoking, having an impact on.  He explained as regards the change from the early part of the twentieth century, where the focus had been on tackling malnutrition, most often associated with poverty and the establishment of the welfare state.  He noted that now, those deprived areas were those suffering with the higher prevalence of obesity, with links to cheaper foods often being unhealthy and less nutritious.

The Public Health Strategic Manager noted the Healthy Weight Alliance met four times a year, with a significant amount of work having been carried out with local assets and key collaborators.  He noted mapping exercises and agreement to act across key partners.  He noted the example of the impact of hot foot takeaways, with 40 percent of children in County Durham leaving primary school overweight, and with 75 percent of adults being overweight.  He noted the impact of salt, with reduction in salt helping to reduce high blood pressure and associated impacts such as coronary heart disease.

The Public Health Strategic Manager explained noted that assessment of the impact of any work was evidence based, looking at key areas: systems leadership; long term systems approach; health promoting environment; community engagement; focus on inequalities; life course approach; monitoring, evidence, evaluation and innovation.

The Public Health Strategic Manager asked how the Board could help support healthy weight key priorities.

The Director of Public Health noted the Healthy Weight Declaration, with the Board signing up to the declaration.  The Head of Integrated Commissioning, Sarah Burns noted that continuing to work together in partnership was important, so each organisation can influence where it can, for example the Council being able to look at issues such as planning and leisure provision.  She noted the excellent work of School Sports Champions in encouraging young people to move more.  The Senior Policy Officer, Steph Rich noted the importance of recognising that working across County Durham meant working in many different types of areas, noting that for example, those living in rural areas were more reliant on private motor vehicles  ...  view the full minutes text for item 6.

Report of the Strategic Housing Manager, Housing Solutions, DCC.

The Board received an update presentation from the Housing Manager, Marie Smith on Housing and Health (for copy see file of minutes).

The Housing Manager noted that over 2022/23 Housing Solutions had delivered against the former Joint Health and Wellbeing Strategy (JHWS) priorities of starting well, living well and aging well.  The board noted elements for starting well included adaptations for children, target hardening, a young person’s joint protocol.  It was noted elements relating to living well included: disabled adaptations grants, fuel poverty, selective licensing, rough sleeping, resettlement of refugees and supported housing.  In terms of aging well, it was noted there had been work undertaken in relation to the Council’s new build programme, new housing for older people and a needs-based Accommodation Programme Board.  She explained that housing was a key determinant to health and wellbeing and that access to housing, improving housing and the home environment were key to improving health outcomes for individuals, families and the elderly.  She concluded by noting that Housing Solutions have delivered a number of key projects to assist with

improving the health of the population of County Durham and that future annual updates would align to the new JLHWS 2023-28.

Resolved:

That the report and presentation be noted.

Report of the Corporate Director of Regeneration, Economy and Growth, DCC.

The Board received an update presentation from the Housing Manager and Senior Policy Officer in relation to homelessness and rough sleeping and the draft County Durham Housing Strategy (for copy see file of minutes).

The Senior Policy Officer noted the consultation on the Principles and Priorities Paper that had taken place June through to August 2023, with feedback informing the draft strategy which would be consulted upon 30 October through to 18 December 2023.  She noted that following feedback, and any appropriate changes, the finalised strategy would be adopted in Spring 2024. 

Members of the Board noted that the Housing Strategy Vision was that: ‘By 2035 County Durham will be a place that has good quality homes that meet the needs of existing and future residents that they can afford.  The provision and quality of housing will support economic growth, contribute to improved health, and create and maintain sustainable, mixed and balanced communities.  People will live long and independent lives within connected communities’.

The Senior Policy Officer noted the updated and amended principles and priorities, as set out within the presentation, with additional focus on community safety, sustainable and safe communities, supporting health and wellbeing, energy efficiency and creating safe, accessible, prosperous and sustainable places to live.

The Housing Manager reminded the Board that it was a statutory requirement for Local Authorities to produce a Homelessness and Rough Sleeping Strategy and noted that the new draft strategy differed from previous strategies in that there was a more detailed evidence base to inform the strategy, as well as including a review of the housing needs across a range of cohorts to identify gaps and service offer.  She added that it was clear which landlords needed to be engaged with to assist in homeless prevention and access to the supply of accommodation.  She noted key points to note were that around 7,500 people contact the housing service each year claiming homelessness, and of which 2,500 were accepted as being homeless, in line with legislation.  She added that the main reasons for homelessness were end of private rented tenancy, domestic abuse and

parent/friends no longer willing to accommodate.

The Housing Manager noted that the draft Homelessness and Rough Sleeping Strategy priorities were to:

1.       Prevent people becoming homeless

2.                 Improve access to and supply accommodation

3.                 Ensure the appropriate support is available for people who are

          homeless (work with partners to build resilience in people)

4.                 Reduce rough sleeping

The Housing Manager noted the next steps, in terms of the ongoing consultation through to 18 December, with final approval in March 2024, the establishment of a Homelessness Forum and development of a delivery plan.

Councillor R Bell noted that the County Durham Housing Strategy was being developed to consider housing issues across County Durham and asked how confident Officers were that relevant partners were engaged in the process and would help us to understand, identify and promote local solutions underpinned by community engagement.

The Housing Manager noted that the consultation was  ...  view the full minutes text for item 7b

Verbal update by the Corporate Director of Adult and Health Services, DCC.

The Corporate Director of Adult and Health Services gave a verbal update in respect of ongoing regional work relating to housing. 

She explained as regards the work via the Association of Directors of Adult Services (ADAS), explaining she was the Lead Director for the Region, and the work as a result of the Care Act and links to the North East and North Cumbria Integrated Care Board (ICB).  She noted topics included partnership working, co-production, developing programmes of investment, opportunity and new models for housing.  She noted the Northern Housing Consortium conference in June that had looked at key areas such as decent warm and dry homes and those with complex needs.

Resolved:

That the verbal update be noted.

C Curry left the meeting at 11.10am

Presentation of the Director of Director of Integrated Community Services, County Durham Care Partnership (CDCP).

The Director of Integrated Community Services, and Vice-Chair to the Board, M Laing gave an update presentation on winter planning arrangements and preparedness (for copy see file of minutes).

The Board noted as regards lessons learned from last winter, noting that while COVID cases had been far fewer, there had been wider ‘spikes’ in demand.  The Director of Integrated Community Services noted priority areas for 2023-24 included: government directives; Accident and Emergency waiting times; hospital discharge; funding; and managing pressures together with system leadership via the Local Accident and Emergency Delivery Board. 

The Interim Strategic Manager – Partnerships suggested that ‘workforce’ was the topic for the upcoming Health and Wellbeing Board development session scheduled for 27 February 2024, the Board agreed.

Councillor R Bell asked what work could be done to prevent people presenting at Primary Care.  The Director of Public Health noted that planning groups were multiagency and noted the example of ‘welcome spaces’, an extension of ‘warm spaces’ and that data had shown where the most at risk were and that targeting those who were at greater risk in winter was important.  She added that County Durham Together looked at how the community could support each other, working with AAPs and included working alongside local and national campaigns.  The Director of Integrated Community Services noted work to support carers, the work of Age UK County Durham in supporting communities, providing wellbeing checks, hot meals and encouraging people to be good neighbours. 

He noted the invaluable work of the community and voluntary sector within County Durham in the work that they do to support our communities.

Councillor T Henderson asked what partners could do to support the winter pressure plans.  The Director of Integrated Community Services noted that it was important that partners were involved in the planning and, while executing the winter plan, remained flexible to meet any challenges.  He added that it was important to focus on the most vulnerable, with the majority being older people on their own in their own homes.  He added that it was always important to communicate to people to help them to have patience and understanding where waiting time increase due to the winter pressures.  He noted that patients were seen in order of need and that alternatives, such as community pharmacies, were often quicky for those who were not so ill.

The Chair noted the changes to community pharmacy opening hours and asked if this had impacted on the numbers presenting to Accident and Emergency.  The Director of Integrated Community Services noted that the impact was not yet known, however, noted that in rural areas and areas with poor public transport, pharmacies were often relied upon in helping reduce demand on Primary Care.

Resolved:

That the presentation be noted.

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

The Board received a report and presentation from the Public Health Practitioner, Lucy Wilkins on the County Durham Sexual Health Strategy (CDSHS) (for copy see file of minutes).

The Board were reminded that the Health and Social Care Act 2012 mandated Local Authorities to commission a range of open access, sexual health services to meet the needs of their local population.  The Public Health Practitioner noted the CDSHS met this requirement and set out a range of ambitions aimed at improving people’s sexual health and reducing health inequalities in County Durham.  She added that the strategy had been subject to a six-week consultation, which had informed the development of the following five priority areas and the ambitions:

1.       Relationships Education, Relationships, Sex and Health Education    across the lifecourse

2.       Teenage conceptions, pregnancy and support for young parents

3.       Contraception

4.       Sexually Transmitted Infections and HIV

5.       Reproductive health

It was noted the next steps were to develop a multi-agency implementation plan, to continue to utilise the Approach to Wellbeing, to regularly review progress and to report annually on the CDSHS.

The Director of Public Health thanked the Public Health Practitioner and all those who had worked in the CDSHS for their excellent work.

Councillor T Henderson asked if we received any objections to the delivery of this topic in primary, and secondary schools.  The Public Health Practitioner noted the work of the Relationships, Sex and Health Education (RSHE) Network to help equip those in schools to be able to explain the rationale behind the education being provided, so that parents can understand the approach.  She added that it was about safe and healthy relationships, to help provide information for schools and to normalise the language around the topic.

M Graham noted that most parents would read ‘RE’ as religious education, and consistency to use RHE or RSHE to differentiate would be important.

The Corporate Director of Adult and Health Services noted this first CDSHS was very accessible and added her thanks to those of the Director of Public Health to the team for all their hard work.  The Public Health Practitioner noted that a lot of work had been undertaken with young people to ensure the language used was that which young people would actually use and understand.

Resolved:

(i)              That the report and presentation be noted;

(ii)            That the Board ratify the County Durham Sexual Health Strategy

2023 – 2028.

Verbal update by the Director of Public Health, DCC.

The Director of Public Health gave a verbal update in relation to water fluoridation.  She noted that the Oral Health Strategy was one that was considered by the Health and Wellbeing Board, as well as Overview and Scrutiny, and the commitment to water fluoridation was set out within the strategy.  She noted changes since the pandemic in terms of the Secretary of State, however, reiterated that Government still supported water fluoridation, especially in the North East, as a complimentary strategy, with a 12-week consultation due to commence before the end of 2023, with implementation in 2024.

Councillor R Bell asked as regards any updates from Government, with the Director of Public Health noting that the Department of Health had representation on our Regional Group looking at the issue so we would be receiving information in that regard.

Resolved:

That the verbal update be noted.

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

The Director of Public Health presented a report relating to the new plan launched by the Department of Health and Social Care on 12 October 2023 ‘Stopping the Start - a plan to create a smokefree generation’.  She noted that new legislation was being consulted in this regard, including on issues such as youth vaping.

The Chair noted that tobacco control is one of the four key priorities of the Health and Wellbeing Board and asked what we do practically in this regard.  The Director of Public Health noted the strength of our Tobacco Alliance and the work of NHS Partners and the community and voluntary sector.  She reminded the Board of the video presented at the last meeting, where County Councillor C Hunt spoke about her experiences with illness as a result of smoking. 

She noted the pooling of resources through FRESH and the ability of Local Authorities and the ICB to also pool resources in terms of campaigns, such as reducing smoking during pregnancy which remained a key challenge.

Resolved:

(i)       That the report be noted;

(ii)      That the Board endorse the proposals highlighted within the DHSC as     a plan for Stopping the Start – planning for a Smokefree generation; 

(iii)     That the Board support the roll-out of the consultation process across         the system to ensure the voice of smokers, ex-smokers, professionals,        young people and their families are heard in relation to the proposed

          legislation. 

Councillor R Bell left the meeting at 11.50am

Report of the Director of Integrated Community Services, CDCP (For Information).

Director of Integrated Community Services noted the Better Care Fund, Quarter 2 Submission, noting delegated authority was being sought for the Chair and Vice-Chair to sign off the submission in due course.

Resolved:

(i)       That the contents of this report, and the Quarter 2 BCF

          submission, which was submitted to NHS England on 31 October

          2023 (Appendix 2) be noted;

(ii)      That delegated authority be given to the Chair and Vice-Chair on

          behalf of the Health and Wellbeing Board for the agreement of future           Better Care Fund submissions required by NHS England;

(iii)     That Better Care Fund performance updates at Health and Wellbeing    Board be received at future meetings for information.

(For Information).

Director of Integrated Community Services noted the report was attached to the agenda papers for Board Members’ information.

Resolved:

That the report be noted.

Presentation of the Director of Public Health, DCC (For Information).

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).  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.

The Interim Strategic Manager – Partnerships noted that, as previously discussed, there was ongoing consultation as regards the Climate Emergency Plan 2024-27 and Board Members would be provided with the link to be able to respond.