Agenda and minutes

Health and Wellbeing Board - Wednesday, 15 June 2022 2.00 pm

Venue: Woodhatch Place, Reigate, Surrey

Contact: Amelia Christopher 

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14/22

APOLOGIES FOR ABSENCE

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    To receive any apologies for absence and substitutions.

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    Minutes:

    Apologies were received from Gavin Stephens, Graham Wareham - Dr Ian McPherson substituted, Professor Claire Fuller, Professor Helen Rostill, Carl Hall, Jason Gaskell - Sue Murphy substituted, Fiona Edwards - Nicola Airey substituted, Lisa Townsend - Alison Bolton substituted, Borough Councillor Nick Prescot - Borough Councillor Hannah Dalton substituted, Michelle Blunsom MBE (rotational VCSE Alliance Board member).

     

15/22

MINUTES OF PREVIOUS MEETING: 16 MARCH 2022 pdf icon PDF 275 KB

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    To agree the minutes of the previous meeting.

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    Minutes:

    The minutes were agreed as a true record of the meeting.

     

16/22

DECLARATIONS OF INTEREST

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    All Members present are required to declare, at this point in the meeting or as soon as possible thereafter

     

    (i)      Any disclosable pecuniary interests and / or

    (ii)      Other interests arising under the Code of Conduct in respect of any item(s) of business being considered at this meeting

     

    NOTES:

     

            Members are reminded that they must not participate in any item where they have a disclosable pecuniary interest

            As well as an interest of the Member, this includes any interest, of which the Member is aware, that relates to the Member’s spouse or civil partner (or any person with whom the Member is living as a spouse or civil partner)

            Members with a significant personal interest may participate in the discussion and vote on that matter unless that interest could be reasonably regarded as prejudicial.

     

    Additional documents:

    Minutes:

    There were none.

     

17/22

QUESTIONS AND PETITIONS

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    Additional documents:

17/22a

Members' Questions

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    The deadline for Member’s questions is 12pm four working days before the meeting (9 June 2022).

     

    Additional documents:

    Minutes:

    None received.

     

17/22b

Public Questions

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    The deadline for public questions is seven days before the meeting (8 June 2022).

     

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    Minutes:

    None received.

     

17/22c

Petitions

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    The deadline for petitions was 14 days before the meeting. No petitions have been received.

     

    Additional documents:

    Minutes:

    There were none.

     

18/22

HEALTH AND WELLBEING STRATEGY HIGHLIGHT REPORT INCLUDING: APPROVAL OF THE NEW TERMS OF REFERENCE OF THE SURREY PREVENTION AND WIDER DETERMINANTS OF HEALTH DELIVERY BOARD pdf icon PDF 224 KB

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    This paper provides an overview of the progress of local shared projects and communications activity supporting delivery of the three Health and Wellbeing Strategy priorities as of 20 May 2022 with the priority population groups. The Highlight Report provides an overview of each Priority, describes what has been achieved in the previous period and how collaborative working has aided this progress. It also has a section on key items (‘In the Spotlight’).

     

    Changes to the outcomes of HWBS Priority 2 to be endorsed and the new Terms of Reference to the Surrey Prevention and Wider Determinants of Health Delivery Board are included for the Board’s approval.

     

     

     

    Additional documents:

    Minutes:

    Witnesses:

     

    Karen Brimacombe - Chief Executive, Mole Valley District Council (Surrey Chief Executives’ Group) (Priority One and Priority Three Sponsor)

    Liz Williams - Joint Strategic Commissioning Convener, Learning Disability and Autism, Surrey County Council and Surrey Heartlands ICS

    Alison Bolton - Chief Executive, Office of the Police and Crime Commissioner for Surrey (OPCC)

    Ruth Hutchinson - Director of Public Health, Surrey County Council

     

    Key points raised in the discussion:

     

    Priority One

     

    1.    The Priority One Sponsor noted that:

    ·         The updated Health and Wellbeing Strategy (HWS) was on the Healthy Surrey website.

    ·         Feedback from the Health in all Policies approach (HiAP) workshop in March was to ensure that the approach would be embedded through organisations and that needed to be given some consideration.

    ·         Referring to ‘In the Spotlight’ on health inequalities faced by people with learning disabilities in Surrey, highlighted the significant differences in life expectancy for males and females with and without a learning disability; understanding the systemic and unfair differences in health outcomes and access to services was crucial. The most notable health inequalities from the study were around type 2 diabetes, obesity, hypertension, the age of mortality and attendance to cancer screenings. She urged Board members to think about what their organisations can do to help.

    2.    The Joint Strategic Commissioning Convener, Learning Disability and Autism, (SCC and SH ICS) noted that:

    ·         There was now a more granular picture of those who are on the learning disabilities primary care GP register and the health inequalities they face.

    ·         The recommendations within the learning disabilities report were being finessed and would drive programmes of improvement forward firstly at neighbourhood level, then at place and system level.

    ·         Data had been combined with that of Active Prospects who had been commissioned to construct a whole system approach to obesity for people with a learning disability; a second phase of work was being commissioned as a result of the analysis in the report and the discussions had in various forums, she thanked the Place Leader / Chief Officer - North West Surrey Health & Care Alliance for his work around the inequalities.

    ·         No one in Surrey would be left behind as whilst the analysis for the report had taken place against Surrey Heartlands data, Frimley colleagues would provide further recommendations and support.

    3.    A Board member queried whether any of the recommendations in the learning disabilities report addressed the pre-14 years age group for children and young people with learning disabilities and their broader wellbeing, as the annual health check started from the age of 14 years onwards.

    -   In response, the Joint Strategic Commissioning Convener, Learning Disability and Autism (SCC and SH ICS) noted that the recommendations in the report did not address the pre-14 years age group for children and young people with learning disabilities, the second phase of analysis would look at Educational, Health and Care Plans (EHCPs)to do a further deep dive and look at the pre-14 years pre-annual health check. Once produced, the revised set of  ...  view the full minutes text for item 18/22

19/22

PRIORITY 1: BETTER CARE FUND (BCF) REVIEW pdf icon PDF 243 KB

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    In December 2021 it was agreed that a review of the current Better Care Fund (BCF) programme be undertaken and the Health and Wellbeing Board is asked to agree the recommendations from the review.

     

     

    Additional documents:

    Minutes:

    Items 7 and 8 were taken before item 6.

     

    Witnesses:

     

    Liz Bruce - Joint Executive Director, Adult Social Care and Integrated Commissioning, Surrey County Council and Surrey Heartlands ICS

    Jon Lillistone - Assistant Director Commissioning Health, Wellbeing and Adult Social Care, Surrey County Council

     

    Key points raised in the discussion:

     

    1.    The Joint Executive Director, Adult Social Care and Integrated Commissioning (SCC and SH ICS) noted that:

    -       The Better Care Fund (BCF) is a mechanism through which to pool, share and target money into priority areas across health and care.

    -       Surrey’s BCF totalled approximately £110 million.

    -       The overall outcomes of the BCF review were that Surrey needed to: remain in a steady state this year, review the governance at a local commissioning level and establish a common governance framework, shift to prevention spend mapping and focus on prevention and early intervention, focus on health inequalities ensuring that the BCF reflects against the national guidance and Surrey’s refreshed HWS.

    -       A shift in the direction of travel was needed for Surrey’s BCF towards more strategic thinking and longer-term investment.

    2.    The Assistant Director Commissioning Health, Wellbeing and Adult Social Care (SCC) noted that:

    -       Emerging from the BCF review was: the importance of setting system-wide expectations and ambitions for the spend of the BCF, it had been identified that more work needed to be done to strengthen the approach around evidence gathering and impacts and outcomes - particularly important around addressing health inequalities - to share good practice on the management of the BCF at place-level and system-wide. 

    -       Community Equipment Services were a key part of the BCF spend system-wide with the majority of places spending around 20% of their budget on that, places spent around 10-12% of their funding on Community Connections Services relating to mental health early intervention, BCF spend was invested in core functions within adult social care and integrated teams within the health system; recognising those key parts of the system was needed for the future strategic plans.

    -       Having engaged with colleagues at place-level there was a strong desire to commit to system-wide priorities, whilst having a degree of flexibility.

    -       The interface with Surrey’s District and Borough Councils was critical as they were key delivery partners for many aspects of the BCF schemes, the Disabled Facilities Grant made up around 10% of BCF spend.

    -       The BCF was comprised of a complex set of relationships, but there were real opportunities to deliver system-wide ambitions.

    3.    The Chairman queried whether there was alignment within the system so that the BCF links in with the JSNA and the potentially increasing amount of Section 75 agreements following the Health and Care Act 2022, ensuring that there was a complete picture of what Surrey’s priorities were and how those would be funded.

    -       In response, Assistant Director Commissioning Health, Wellbeing and Adult Social Care (SCC) provided assurance that alignment was underway including linking in with the broader prevention spend mapping work underway system-wide.  ...  view the full minutes text for item 19/22

20/22

PRIORITY 2: MENTAL HEALTH INVESTMENT FUND pdf icon PDF 229 KB

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    In January 2022 Surrey County Council announced as part of the county’s No One Left Behind agenda, an extra £8m of focused investment in Early Intervention and Prevention mental health interventions in Surrey.

    Senior Officers from across the system have met to draft the proposed criteria and principles for consideration by the HWB and elected Members at the Adults and Health Select Committee.

     

    Additional documents:

    Minutes:

    Witnesses:

     

    Liz Bruce - Joint Executive Director, Adult Social Care and Integrated Commissioning, Surrey County Council and Surrey Heartlands ICS

    Kate Barker - Joint Strategic Commissioning Convener, Children and Young People, Surrey County Council and Surrey Heartlands ICS

    Sinead Mooney - Cabinet Member for Adults and Health, Surrey County Council

     

    Key points raised in the discussion:

     

    1.    The Joint Executive Director, Adult Social Care and Integrated Commissioning (SCC and SH ICS) noted that:

    -       The £8 million early intervention and prevention in mental health investment via a 1% uplift in Council Tax, supported the delivery of the Surrey County Council’s strategic priority of ‘No one Left Behind’.

    -       Ensuring clarity in the bidding process and its criteria, implementation plans and outcomes was vital; so that those with mental health needs receive better outcomes.

    2.    The Chairman noted that Surrey Heartlands ICS had also contributed £4 million and the Community Foundation for Surrey had provided some match funding.

    3.    The Joint Strategic Commissioning Convener, Children and Young People (SCC and Surrey Heartlands ICS) noted that:

    -       Public accountability and co-production regarding the Mental Health Investment Fund (MHIF) was fundamental, there was a commitment to use the resources to translate the outcomes already co-designed through the mental health alliance and the independent networks into measurable outcomes for residents.

    -       The aim was for the funding process to be inclusive, building on the successful Contain Outbreak Management Fund (COMF) process.

     

    Dr Russell Hills left the meeting at 3.04 pm.

     

    -       The report sought the Board’s support on the proposed criteria, principles and governance framework, so that it is assured that the co-designing process would contribute to the outcomes in the HWS. With short-term investment those proposals would enable innovation with measurable outcomes in relation to mental health identification, early intervention and prevention and that business intelligence evidence would be used to measure what the costs would be to reduce the demand on statutory services, to understand the lived experience of residents and to look at the long-term cost to sustain good innovation.

    -       Whilst the scope of the proposed investment covered all ages, teenage suicide was a key focus as was the mental health and wellbeing of men aged 18 to 30 years, support for those with eating disorders, carer support for families, and support in schools and community settings.

    -       Support had been provided from Democratic Services in outlining the governance processes, ensuring that there is the appropriate accountability on the spending decisions around the MHIF. Spending might commence in autumn following approval through the governance bodies within Surrey County Council, the ICSs and the VCSE partners.

    -       Ensuring alignment with partners and administrative support would be crucial.

    -       The Board was to consider how it would contribute to future decision-making concerning the MHIF, how it would like to be kept informed of the developing outcomes and whether there was any additional evidence required for assurance that the proposals would align with the HWS.

    4.    The Cabinet Member for Adults and  ...  view the full minutes text for item 20/22

21/22

JOINT STRATEGIC NEEDS ASSESSMENT (JSNA) REFRESH, PROGRESS AND NEXT STEPS pdf icon PDF 587 KB

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    The process for refreshing Surrey’s Joint Strategic Needs Assessment (JSNA) is well underway and, now that we are acclimatising to ‘live with COVID-19’, updating the JSNA has moved on from a period of adaptation to business as usual. To be the valuable planning resource it is intended to be, the production of the JSNA must now receive fresh engagement from system partners, and resource must be carefully coordinated and balanced against parallel strategic commitments.

    Additional documents:

    Minutes:

    Witnesses:

     

    Ruth Hutchinson - Director of Public Health, Surrey County Council

     

    Key points raised in the discussion:

     

    1.    The Director of Public Health (SCC) introduced the report and noted that:

    ·         At the next informal Board meeting there would be an item on the Surrey-wide Data Strategy of which the JSNA forms a part of.

    ·         The JSNA was a continuously updated document and had been around for over a decade.

    ·         Due to the Covid-19 pandemic starting in February 2020, the Board in June 2020 decided to refresh the JSNA approach and Community Impact and Rapid Needs Assessments were produced in autumn 2020 to support recovery.

    ·         The JSNA Operational and Oversight Group was re-established in July 2021, the Government’s ‘Living with COVID-19’ plan was published in February 2022 and the first round of refreshed JSNA chapters would be published from June 2022. 

    ·         The Board sits above the JSNA Operational and Oversight Group which had a broad membership across Surrey and provided a robust process, below sat the JSNA Working Group which looked at the mechanics of the JSNA; below that sat the Chapter Delivery Groups.

    ·         As there were forty chapters in the current JSNA there was a period of prioritisation to refresh key chapters first, assessment criteria looked at the priority population groups, the chapters most out of date, health inequalities and the impact of the Covid-19 pandemic.

    ·         Priority One: the current JSNA chapters were sorted under the five outcomes of the Priority - those outlined in black sat across the outcomes - so gaps could be identified.

    ·         Priority Two: there was a new proposed chapter under outcome four ‘loneliness and social isolation’.

    ·         Priority Three: there was a new proposed chapter on ‘digital inclusion’.

    ·         The refresh of the JSNA sought to mirror the HWS.

     

    Rachael Wardell left the meeting at 3.30 pm.

     

    ·         There were a number of chapters underway in line with the timetable and the aim was to produce at least four chapters by the end of quarter 2 and in total ten new refreshed chapters by the end of the year.

    ·         Producing a new chapter took around three months due to legislative requirements about what needs to be in the JSNA; co-produced by multiple partner organisations including the voices of lived experience, using up-to-date empirical evidence.

    ·         Stakeholder workshops were held and chapters were produced system-wide, clear roles and responsibilities ensured broad ownership, the host board would sign-off the relevant JSNA chapter.

    ·         Outlined the five recommendations and regarding the fifth it was important to ensure that when a chapter is produced that it would be used and promoted system-wide through communications.

    2.    A substitute Board member sought clarity that the way that the refresh of the JSNA was being approached would pick up some of the direction of travel within the ICB legislation such as around having more granular data down to smaller place and community-levels, would it make closer links with the wider determinants of health, and would it be future-facing so it was predictive.

    -       In response, the Director  ...  view the full minutes text for item 21/22

22/22

INTEGRATED CARE SYSTEMS (ICS) UPDATE pdf icon PDF 177 KB

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    The Board is asked to note the update provided on the development of the Integrated Care Systems (ICS) - Surrey Heartlands and Frimley.

    Additional documents:

    Minutes:

    Witnesses:

     

    Dr Charlotte Canniff - Joint Chief Medical Officer for Surrey Heartlands ICS

    Nicola Airey - Executive Place Managing Director, Surrey Heath (NHS Frimley CCG)

     

    Key points raised in the discussion:

     

    1.    The Vice-Chairman (Joint Chief Medical Officer for Surrey Heartlands ICS)highlighted that concerning the Surrey Heartlands ICS, the transition work continued in Surrey Heartlands ICS regarding the establishment of its ICB on 1 July 2022.

    2.    The Executive Place Managing Director, Surrey Heath (NHS Frimley CCG) highlighted that concerning the Frimley ICS, the Executive Director for Children, Families and Lifelong Learning (SCC) would be joining the Frimley ICB as a county council voice representing Children's Services.

    -       In response, the Chairman understood that the Local Authority Organisation partner members would rotate between Hampshire County Council and Surrey County Council in the case of the county council partner member.

     

    RESOLVED:

     

    Noted the report on the development of the Integrated Care Systems (ICS) - Surrey Heartlands and Frimley - including the Integrated Care Board (ICB) and the Integrated Care Partnership (ICP).

     

    Actions/further information to be provided:

     

    None.

23/22

2022/23 NHS SYSTEM OPERATIONAL PLANS - SURREY HEARTLANDS ICS AND FRIMLEY ICS pdf icon PDF 245 KB

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    The report describes the Surrey Heartlands ICS and Frimley ICS response to the 2022/23 NHS Priorities and Operational Planning Guidance.

     

    Additional documents:

    Minutes:

    Witnesses:

     

    Nicola Airey - Executive Place Managing Director, Surrey Heath (NHS Frimley CCG)

    Dr Charlotte Canniff - Joint Chief Medical Officer for Surrey Heartlands ICS

     

    Key points raised in the discussion:

     

    1.    The Executive Place Managing Director, Surrey Heath (NHS Frimley CCG) highlighted that concerning the Frimley ICS:

    -       Post submission NHS England and Improvement (NHSEI) had requested some updates to the System Operational Plans, Frimley ICS would be submitting an improved position about elective recovery; it would reach the 104% target partly due to a baseline adjustment rather than additional activity. Frimley ICS would be submitting a balanced financial plan, some additional money had been received from NHSEI but that did not cover the full deficit and different assumptions had been made about how that financial gap would be closed.

    2.    The Vice-Chairman (Joint Chief Medical Officer for Surrey Heartlands ICS) highlighted that concerning the Surrey Heartlands ICS:

    -       The report described the developing System Operational Plan which recently had some significant changes, for example the submission of a balanced financial plan was proving difficult, given that there was a significant recovery target and that would require Surrey Heartlands ICS to make some difficult decisions which were being worked through; it was likely to be a key piece of work for the ICB going forward. 

     

    RESOLVED:

     

    Noted the 2022/23 NHS System Operational Plans for Surrey Heartlands ICS and Frimley ICS submitted in April 2022.

     

    Actions/further information to be provided:

     

    None.

     

24/22

SURREY LOCAL OUTBREAK ENGAGEMENT BOARD - UPDATE

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    The Board is to receive a verbal update on the work of the Surrey Local Outbreak Engagement Board (LOEB), which is a sub-committee of the Surrey Health and Wellbeing Board. The LOEB is a member-led Board created in response to the COVID-19 pandemic, which leads the engagement with local communities and is the public face of the local response in the event of an outbreak.

    Additional documents:

    Minutes:

    Witnesses:

     

    Sinead Mooney - Cabinet Member for Adults and Health, Surrey County Council

     

    Key points raised in the discussion:

     

    1.    The Surrey Local Outbreak Engagement Board (LOEB) Chairman (Cabinet Member for Adults and Health, SCC) noted that:

    ·         At the last public LOEB meeting on 21 April 2022, in line with the move towards business as usual nationally the LOEB had been stood down and all future meetings are hold invites to be cancelled unless required.

    ·         The Surrey Local Outbreak Management Plan (LOMP) version 17 was published on 19 May 2022 and reflects the Government's ‘Living with COVID-19’ plan and incorporates all the new guidance published on 1 April; a national Contingency Framework was expected to be published in June and the LOMP would be revised to reflect that.

    ·         Planning was underway for a Surrey County Council and Surrey Local Resilience Forum COVID-19 debrief session, following that a Lessons Learnt report would be produced and circulated to partners.

    ·         Preparations for the COVID-19 public inquiry continued, and Surrey County Council was working with Surrey Heartlands ICS and other system partners, to establish the relevant processes ahead of the inquiry; the final terms of reference for the inquiry are yet to be published.

    ·         The Surrey COVID-19 Intelligence Summary was now published fortnightly on a Tuesday.

    ·         The Office for National Statistics estimated that the percentage of people testing positive for COVID-19 increased slightly in England in the week ending 2 June 2022; it was estimated that 1.5% of the population in England and 1.5% of the population in the South East had COVID-19.

    ·         Up to 12 June 2022, 85% of people aged 12 plus and Surrey have received the first dose of the COVID-19 vaccination, 81% of people in Surrey had received the second dose, 67% of people aged 12 plus in Surrey had received a booster or third dose of a vaccination.

    ·         COVID-19 hospital admissions had increased in Surrey and remained steady in England, with 134 in Surrey hospitals between 30 May to 5 June 2022.

    ·         It was never too late to book a COVID-19 vaccination.

    2.    The Chairman noted that there had been a slight rise in COVID-19 infections and noted the expectation that there might be an offer of a fourth booster vaccine from September. He hoped that there would not be another major outbreak and therefore it was important that that the LOEB remained in place in the background. He thanked the LOEB Chairman and LOEB for its good work over the past two years.

     

    RESOLVED:

     

    Noted the verbal update on the work of the Surrey Local Outbreak Engagement Board.

     

    Actions/further information to be provided:

     

    1.    The Lessons Learnt report once produced will be circulated to partners: Health and Wellbeing Board and the LOEB.

25/22

DATE OF THE NEXT MEETING

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    The next meeting of the Health and Wellbeing Board will be on 28 September 2022.

    Additional documents:

    Minutes:

    The date of the next public meeting was noted as 28 September 2022.