Agenda and minutes

To receive any apologies for absence received.

Apologies were noted from the following Members:

Mark Cubbon, Co-opted Deputy for Provider Representative: Acute Health Trusts

Michael Lane, Police and Crime Commissioner for Hampshire 

Ron Shields, Provider Representative: Community and Mental Health 

Sue Harriman, Co-opted Deputy for Provider Representative: Community and Mental Health 

David Radbourne, NHS England (Wessex) 

Amanda Lyons, Co-opted Deputy for Wessex Local Area Team of NHS England 

Dr Sarah Schofield, West Hampshire Clinical Commissioning Group 

Dr Nicola Decker, North Hampshire Clinical Commissioning Group   

Cllr Anne Crampton, District/Borough Council Member Representative  

Councillors Keith Mans and Roger Huxstep were present with the agreement of the Chairman.

All Members who believe they have a Disclosable Pecuniary Interest in any matter to be considered at the meeting must declare that interest and, having regard to the circumstances described in Part 3 Paragraph 1.5 of the County Council's Members' Code of Conduct, leave the meeting while the matter is discussed, save for exercising any right to speak in accordance with Paragraph 1.6 of the Code. Furthermore all Members with a Non-Pecuniary interest in a matter being considered at the meeting should consider whether such interest should be declared, and having regard to Part 5, Paragraph 2 of the Code, consider whether it is appropriate to leave the meeting while the matter is discussed, save for exercising any right to speak in accordance with the Code.

All Members who believe they have a Disclosable Pecuniary Interest in any matter to be considered at the meeting must declare that interest and, having regard to Part 3 Paragraph 1.5 of the County Council's Members’ Code of Conduct, leave the meeting while the matter is discussed, save for exercising any right to speak in accordance with Paragraph 1.6 of the Code.  Furthermore all Members with a Personal Interest in a matter being considered at the meeting should consider, having regard to Part 5, Paragraph 4 of the Code, whether such interest should be declared, and having regard to Part 5, Paragraph 5 of the Code, consider whether it is appropriate to leave the meeting while the matter is discussed, save for exercising any right to speak in accordance with the Code.

There were no declarations of interest.

To confirm the minutes of the previous meeting.

The minutes of the 2 July meeting were reviewed agreed.

To receive any deputations notified under Standing Order 12.

There were no deputations received.

To receive any announcements the Chairman may wish to make.

The Chairman made the following announcements:

·         The Chairman made Members aware of the Public Health, Adult Social Care, and Hampshire and Isle of Wight COVID19 Updates that have recently been shared at the HASC.  The Board is continuing to follow along closely and the Weekly COVID19 Hampshire Update is a useful source for the most up to date information.  

·         The Healthy Homes Survey has now been circulated as part of the Healthier Communities theme supported by the Board and the Chairman requested that Members share extensively with colleagues and organizations.

·         A report from the Autism Partnership Board analysing the data on the incidents of people with autism across HIOW has also been circulated and will likely be of interest to Members.

To receive an update on the impact of Covid-19 on health inequalities and risks in relation to Health and Wellbeing priorities.

The Board received a report from the Director of Public Health at Hampshire County Council and the Strategic Leadership Sponsor for the Board.  Members received an overview on health inequalities and risks, outcomes, approach in relation to the impact of Covid-19. 

The Integrated Care System plans going forward will consider inequalities and differences in health across population to best determine where to focus efforts.  Similarly, the Health and Wellbeing Board strategy aims to address inequalities and gaps based on age, gender, ethnicity, access to healthcare, disparities, etc. alongside the impact of Covid to work with communities to provide support and address poor outcomes.

In response to questions, Members heard:

Sophisticated risk assessment profiles considering age, ethnicity, gender, and underlying health issues are used to protect NHS colleagues and determine where and how they work.

Healthwatch colleagues understand the consideration of excess deaths and the importance of collaboration and support for the council in addressing any issues.  Current number of excess deaths are low and will need to be reviewed over a longer period.  Resources will be circulated to Board Members following the meeting.

The effect of the move to digital health care access and exploring how to further this work will be critical.  Unpaid carers have been struggling with increasing issues about lack of support and will need further help.  A further and recent report about informal carers will be circulated to Members following the meeting - 92 million hours of unpaid care were provided to people with needs across England, on top of routine unpaid hours, a truly astounding amount of time and dedication.

Health care has changed more in the last 6 months than over the last 20 years and this work has been of much value.  Good Wifi connection to access digital services will be key, ideally fibre optic to the front door especially in rural Hampshire.

Excess deaths not attributed to Covid in care home settings will be critically important to understand but will need to be reviewed over time.  Work has been commissioned with partners to better understand the situation and will be shared with colleagues.

While there were challenges with face to face engagement, the digital revolution has been inclusive and reached a broader population.  There is an increased awareness for identifying digitally excluded people and particular areas or pockets where deprivation is a factor, and an onus on organizations to reach out to these communities to address concerns in a joint up way.  

Connecting with groups harder to connect with due to excess Covid risks will be key to work through any resurgence.  Care services are open with a triage system in place and easier in many ways, but challenges remain with safe in-person visits.  Staff in primary care have also been reassessed and enabled due to the ability to work remotely with video consultations and access to patient records.  Work is being done to ensure that people are no longer afraid of trying to come forward and this must continue.

While there  ...  view the full minutes text for item 129.

To receive an update on the priorities and progress of the Starting Well strand of the Health and Wellbeing Strategy and the impact of the Covid-19 pandemic on progress in this area.

The Director of Children’s Services at Hampshire County Council provided an update on the priorities and progress of the Starting Well strand of the Health and Wellbeing Strategy and the impact of the Covid-19 pandemic on progress in this area. Members heard:

While services are holding up well through the response to Covid, new trauma and a range of other factors have been leading to family breakdown.

In reviewing the Starting Well priorities with Covid-related challenges, universal services were not always in place and thus there were fewer collective eyes on children.  Families did not always have the support or help they would have usually had and rather than receiving early assistance, children are now becoming visible  having suffered serious harm.  

With schools and nurseries currently open, the number of referrals will now continue to rise.  The cohort entering the system from April to August was distressing to witness but social workers worked diligently to help them.  Universal services will now be able to identify families needing help early on.

Emotional wellbeing issues at school did not quite play out as anticipated.  Many children have enjoyed the last 6 months and there was less repair of trauma, but more anxiety about returning to school full time – a slightly different and new worry.  

An action plan based the impact of Covid will determine priority areas and picking up on key issues with a joint delivery partnership, including self-harm tool kits, school surveys, websites with resources and training, etc. 

In tackling wider issues, reducing wait times for treatment, acute setting colleagues for paediatric psychiatric liaison services, prevention and early help models and mental health support teams in schools have been prioritized in keeping with the NHS long term plan.  Work continues to bring in young people and family voices to bolster bids for increase in mental health support and provide link programmes between the voluntary sector, mental health, and schools. Partnership with young people for digital offers and how to best connect them to services, digital options, and Child and Adolescent Mental Health Services (CAMHS) solutions in addition to face to face meetings. 

Physical education in schools, maternity smoking cessation, encouraging breastfeeding, strong referral pathways and tools to support people remain priorities alongside existing Covid challenges.  

In terms of codesign and collaboration, working well together requires doing so consistently and timely with a focus on the action plan for an effective joint commissioning board with strategic commissioning priorities, positive feedback,  formalizing work to be completed and refining by partners.  

Work in mental health pathways slowed down during lockdown due to Covid priorities but are now approaching being business as usual and with improvements in those pathways.  The Isle of White is represented in these arrangements as well.  The decision-making body and forum around continuing care is embedded with all partners for effective care commissioning, packages, and managing care support markets collectively together. 

Next steps are now being considered in developing a different approach of how these packages are funded.  ...  view the full minutes text for item 130.

To receive a report on the risks and the impact of Covid-19 on physical activity levels across Hampshire with particular attention to inequalities the physical activity sector.

Members received an update from Energise Me representatives on the impact of Covid on physical activity, with a focus on inequalities and modifiable actions in linking the risks to the general population in terms of exercise and obesity.  Members heard:

In terms of the context for existing inequalities, research has focused on local voices and looking at what was happening at the local level in disadvantaged communities, with work continuing through and after the Covid period.  As an organization and sector making connections to people, building trust with targeted groups and providing funding to help them build activity into their own lives.  The social prescribing application was successful in taking part across the region to match supply and demand, to innovate around people experiencing disadvantage, and provide benefit from physical activity with further recruitment underway with support of regional partners.

Covid exposed fault lines in society and research confirms the same - physical activity levels are lower for disadvantaged people.  Getting people moving would help with some of these challenges.  The map shared translates numbers pre-Covid, but it is unclear if those numbers will increase going forward and a new data drop is expected in March.  Currently mapped are those points where organizations and partners stepped in to create a message, but case studies indicate that it is not always easy.  

Highlights from cases studies depict various situations.  While lack of outdoor space can be an issue, using free NHS applications was up 92% and downloaded by 850,000 people nationally.  People in the work force can be encouraged, if they are able, to help others.  In some cases, such as online classes for wheelchair dances, going online made it easier to access due to no travel and channel efforts into the classes at home.  Some have even gone international, a positive aspect of Covid.  Online offers will remain but in person activities will pick up.  

Place based work continues in Hampshire and while things can appear one way on paper, in speaking to the community in some cases it was contradictory – people loved where they lived and were happy to stay and be part of it, but perhaps green spaces existing but didn’t allow for playing ball, being active, etc.  Finding ways to work around these challenges would help take the work forwards.

Local communities are connecting, and the approach is key to helping people care for themselves and get fitter.  Improved mental health is a significant benefit that goes along with physical fitness.  

In response to questions, Members heard:

The question of why some people exercise and some do not, remains at the heart of the issue.  

A recent consultation has taken place regarding transport and cycling benefit for communities and their health and wellbeing, but concrete results will require a system approach.  Ideally physical activity ought to be built into people’s days so as not have to make a separate decision.  

A focus on active travel, working with partners to bring travel within the  ...  view the full minutes text for item 131.

To review anticipated future business items and progress on actions for the Health and Wellbeing Board.

Members considered anticipated future business items and progress on actions for the Health and Wellbeing Board.

There was a request to include strategic transport colleagues at the next meeting to discuss arrangements, implications on physical wellbeing and influencing future plans.

Considering physical activity as a bigger issue and a general discussion was suggested.

The Health and Wellbeing Strategy ranges across age groups and can span the strategy.  How different organizations take responsibility for delivering on the strategy, how to share the work being done and at scale from parishes upwards is critical.  Board Members must go back to their organizations, action the work, and provide updates.  

The Board received a request for the Modernizing Our Hospitals Programme on the next agenda.

The next Health and Wellbeing Board meeting will take place on 10 December 2020.

The meeting ended at 12:36pm.