Agenda and minutes

Health and Wellbeing Board
Thursday, 5 March 2020 1.00 pm

Venue: North West Surrey CCG, 58 Church Street, Weybridge, Surrey KT13 8DP

Contact: Amelia Christopher 

No. Item



    To receive any apologies for absence and substitutions.


    Apologies were received from Siobhan Kennedy - Catherine Butler acted as         substitute, Caroline Reeves, Joanna Killian, Dr Russell Hills, Simon White - Liz Uliasz acted as substitute, David Munro, Dr Elango Vijaykumar, Robin Brennan, Carl Hall - Cynthia Allen acted as substitute, John Ward and Jason Gaskell.







    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




            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.



    There were none.




Members' Questions


Public Questions





    The Joint Strategic Needs Assessment (JSNA) needed to be refreshed following publication of the new Joint Health and Wellbeing Strategy (JHWS) in 2019. The JSNA is a core part of the intelligence system capability.



    Liz Uliasz arrived at 1.14pm

    Helen Griffiths arrived at 1.14pm

    Rod Brown arrived at 1.20pm

    Frances Rutter arrived at 1.20pm



    Lucy Lynch - Public Health Registrar (SCC)

    Key points raised in the discussion:

    1. The Public Health Registrar introduced the report and noted that:

    ·         it was a statutory requirement to maintain the Joint Strategic Needs Assessment (JSNA), so a refresh following the publication of the new Joint Health and Wellbeing Strategy (JHWS) in 2019 was needed.

    ·         the refresh proposed using the 12 focus areas identified in the JHWS to frame the JSNA and support detailed action plans that address local needs.

    ·         central to renewing the governance of the JSNA was the avoidance of duplication - to be achieved by ensuring ownership of specific chapters by the relevant JHWS governance group with a coordinating operational oversight group - to meet in April 2020. That group would include representatives from the Council and other key organisations.

    1. The Chief Constable of Surrey Police stated that the force were happy to engage with the project particularly from a mental health aspect which formed a significant part of the force’s duty.
    2. Board members urged caution in the approach to prevent the formation of blind spots if the focus areas were too narrow, noting that it was important to recognise potential gaps in commissioning as issues change over time. The Public Health Registrar commented that while each chapter would include a horizon-scanning section within their focus area, the operational oversight group would also have a role in identifying new and emerging issues.
    3. A Member of the Board was concerned that vulnerable groups such as Looked After Children (LAC) and Care Leavers were scattered across various JSNA chapters which did not support the partnership in meeting their responsibilities for Corporate Parenting. In response, the Public Health Registrar explained that the four target population groups included one of ‘deprived and vulnerable communities’ but this was broad and not yet delineated. She added that a list of such groups was being developed and would be shared with population group champions for discussion. The developing list included LAC and care leavers. The intention was to develop infographic summaries of each population group/sub-group as required.
    4. A Member of the Board raised a concern regarding the difficulty in cross-system data collection on vulnerability and health inequality as many organisations held pockets of information and were not good at sharing it centrally. In response, the Public Health Registrar replied that in light of the Chairman’s earlier comment that the Health and Wellbeing Board would reaffirm itself as a ‘doing’ board, there were opportunities to improve the collation of data, across partners.
    5. In response to the Deputy Chairman’s query, the Public Health Registrar commented that the public health team were considering how the intelligence within the JSNA refresh would align with and complement the NHS England’s Population Health Management (PHM) system across Surrey Heartlands.
    6. Responding to a Member of the Board’s question, the Public Health Registrar explained that veterans were currently included one of  ...  view the full minutes text for item 7/20



    The Children’s Safeguarding Partnership in Surrey is a statutory body, which replaced the previous Safeguarding Board in October 2019. The Annual Report is being reported to the Health and Wellbeing board and sets out the final part of the old Board and the beginning of the new Partnership. Therefore, the attached report covers an 18 month transitionary period from April 2018 to October 2019. Simon Hart was appointed as the Independent Chair of the Board/Partnership in December 2018 and has overseen the transition.


    Additional documents:


    Fiona Edwards arrived at 1.40pm

    Dr Claire Fuller arrived at 1.40pm



    Simon Hart- Independent Chair of the Surrey Children’s Safeguarding Partnership

    Key points raised in the discussion:

    1. A Member of the Board highlighted that 2018/2019 was a year of national change towards local improvement in children’s safeguarding with the move away from Local Safeguarding Children’s Boards towards the new Local Safeguarding Partnerships. She recognised the key work of the previous Independent Chair of the Surrey Safeguarding Children Board who put in place development arrangements for the Board and praised the work of the current Independent Chair.
    2. The Independent Chair of the Surrey Children’s Safeguarding Partnership summarised that the new local safeguarding Partnership was operational from October 2019.Unlike the Surrey Safeguarding Children Board (SSCB) which was convened solely by Surrey County Council, the Partnership was convened more widely with Surrey Police and the NHS, as it was important that safeguarding was underpinned by various agencies.
    3. He explained that the SSCB’s annual report unusually covered an 18 month period from April 2018 in order to give a full account of the Board’s activities over that extended period including the transition to the new Partnership arrangements. The key focus of the Partnership would be the Children’s Services Improvement Programme with oversight to embedding the new arrangements moving away from the Ofsted Priority Action Board towards the Partnership.
    4. He highlighted the following key strategic priorities of the SSCB which would serve as the foundation for the new Partnership:

    ·         the remodelling of the Early Help Services delivered and commissioned by Surrey County Council, with the new Early Help Hub established through a Children’s Single Point of Access (C-SPA).

    ·         reducing harm to children and young people from exploitation through contextual safeguarding which was an approach to safeguarding using children and young peoples’ experiences of harm outside of their homes.

    ·         children’s exposure to domestic abuse, which was a key issue underlying many of the serious case reviews. Following on from the SSCB, the Partnership was working closely with Surrey Police, social services and other key partnership groups such as the Community Safety Strategy to allow the escalation of concerns where necessary.  

    1. The Independent Chair noted that the new governance structure from the SSCB to the new Partnership received strong agreement from partners who in the past felt as though the SSCB considered large agendas too quickly. Whereas the Partnership had more focused agendas and was steered by the Executive Group. There would also be a reduction in the number of sub-groups in order to consider the commissioning approach more effectively.
    2. He stated that a core value for the Partnership was a child-centred approach and ensuring thatchildren’s voices and lived experiences were heard as they were integral to the decision-making process.
    3. He noted that the strong lead from the Council was vital to aid the Partnership’s focus on supporting children, families and young people to reduce the likelihood of them needing statutory services. As well as supporting the Partnership’s commissioning of serious case  ...  view the full minutes text for item 8/20



    Following discussions at the Health and Wellbeing Board and the Community Safety Board, this paper seeks approval for the merger of the Community Safety Board and the Health and Wellbeing Board.


    Additional documents:



    Amy Morgan - Policy and Programme Manager for Health & Social Care Integration (H&Sci) (SCC)

    Key points raised in the discussion:

    1. The Policy and Programme Manager noted that the merger was based upon developing a longer term approach to improving health outcomes and inequality across Surrey, after close working with the Office of the Police and Crime Commissioner and key stakeholders represented through the four new Members of the Board.
    2. She emphasised that greater connectivity across priority areas was vital to improving the lives of those with severe disadvantages and to address the wider determinants of health. Over the last three months, officers in the OPCC and SCC had worked with stakeholders, including the Community Safety Partnerships, to map the current work and statutory responsibilities of both the Community Safety Board and the Health and Wellbeing Board. Officers were able to provide assurance that the four major priorities of the Community Safety Board would be aligned with those of the Health and Wellbeing Board, which would ensure the delivery of the Surrey Community Safety Agreement (CCSA).
    3. The Health and Wellbeing Board was also developing stronger links to the Adult Safeguarding and Children Safeguarding Partnerships. The Surrey Adults Matter programme was a good example of how the Health and Wellbeing Strategy was responding directly to community safety-related concerns raised by the Adult Safeguarding Board.
    4. The Chief Constable of Surrey Police, was very supportive of the merger noting the national policing and health consensus on the importance of wellbeing which was exemplified at the 2019 Fifth International Law Enforcement and Public Health Conference.
    5. He summarised that: policing was more closely coupled with health - 70% demand of policing - than justice, that case work was increasingly complex, focusing on a range of issues to work out why someone committed a crime rather than simply who did it, active research to understand the causes of safety and wellbeing rather than the symptoms - personal resilience and control were key, that different and earlier intervention was required such as trauma informed policing and adverse childhood experiences, collective action across agencies was essential as there was a move away from individual territorial leadership.
    6. The Cabinet Member for Community Safety, Fire and Resilience positively reported that she had seen tangible progress on the ground through the use of Trading Standards community safety departments to identify hotspots of priority offenders to manage crime more intelligently and from a wellbeing perspective addressing the causes of criminal activity.
    7. The substitute for the Assistant Chief Officer of the Community Rehabilitation Company noted that it was important that probation and community rehabilitation remained represented on the Board, as reoffending and health were closely linked.
    8. Members were in agreement with the merger and noted that it was the first of its kind in the United Kingdom.



    The Health and Wellbeing Board:

    1. Approved the merger of the Community Safety Board and the Health and Wellbeing Board.
    2. Agreed for the new members from Surrey Police, Surrey County Council, South East Probation Services  ...  view the full minutes text for item 9/20



    The Surrey Health and Wellbeing Board (HWB) has a statutory responsibility to deliver a Pharmaceutical Needs Assessment (PNA) every three years. The Surrey PNA was last published in March 2018, but the PNA Steering Group reviews changes to the local population and local services annually to ensure no substantive changes to the PNA are required.


    Additional documents:



    Julie George -Public Health Consultant (SCC)

    Key points raised in the discussion:

    1. The Public Health Consultant provided a summary of the report, highlighting that the Board had a statutory responsibility to deliver a Pharmaceutical Needs Assessment (PNA) every three years.
    2. The last PNA was in March 2018 to which no substantive changes to the findings of that PNA were required on the advice of the PNA Steering Group which annually reviews changes to the local population and pharmaceutical services. The steering group identified gap in the provision. There have been four closures of community pharmacies in 2019, with alternative provision nearby. The large housing developments and rate of pharmacists per 100,000 were also considered evaluated.
    3. Future pharmacy provision would be reviewed through the 2021 PNA which would be brought to the Board in March 2021. That PNA would include the evaluation of the future requirements of large new housing developments and travel time using public transport - if possible - recognising the inequality in transport provision across communities.
    4. The Deputy Chairman was concerned as three out of the four closures in community pharmacies were in North West Surrey - the area in which she was Clinical Chair - and asked what other measurements were used to assess provision other than large housing developments and population size. Especially as in 2019/20 community pharmacies would be expected to commission two new services: the Community Pharmacist Consultation Service (CPCS) with community pharmacies as a first port of call for minor illnesses and Hepatitis C testing. In response, the Public Health Consultant commented that at present no other measurements were used, but explained that her team was working closely with the Surrey and Sussex Local Pharmaceutical Committee and other health colleagues to incorporate consideration of the requirements of the new pharmaceutical contract in the 2021 PNA.
    5. Responding to a Member of the Board’s query on the disparity in access between populations to community pharmacies, the Public Health Consultant replied that it was a challenge as a PNA Steering Group could only make recommendations on the acceptable level provision. Its remit did not include the way in which services were paid which can also affect pharmaceutical service provision. A recent judicial review concluded that drive time to a community pharmacy greater than thirty minutes was not good access.




    1. The Board approved the 2020 PNA Supplementary Statement, on the advice of the PNA Steering Group.
    2. The Board would publish the approved Supplementary Statement on and by 31 March 2020.


    Actions/further information to be provided:

    The Board will publish the approved Supplementary Statement on and by 31 March 2020.




    The report gives an overview of progress, risks and issues relating to the Health and Wellbeing Strategy implementation plans, including areas where progress is being made, as well as highlighting several projects which require a Senior Project Lead to progress. The report also includes the outcomes dashboard, which is now public and is due an annual refresh in June to review any changes to outcomes.

    Additional documents:




    Rod Brown - Head of Housing and Community at Epsom and Ewell District Council (Priority 1)

    Giles Mahoney - Director of Integrated Care Partnerships at Guildford and Waverley Clinical Commissioning Group (CCG) (Priority 2)

    Rob Moran - Chief Executive of Elmbridge Borough Council (Priority 3)

    Ruth Hutchinson - Interim Director of Public Health (SCC)




    Amy Morgan - Policy and Programme Manager for Health & Social Care Integration (H&Sci) (SCC)


    Key points raised in the discussion:


    1. The Priority 1 sponsoroutlined the key issue across all three priorities as included in the annex on project diagnosis highlighting several projects which were missing a Senior Responsible Owner (SRO) to progress. One Red rated area without an SRO was Surrey-wide cardio-vascular diseases (CVD) prevention and the overall CVD prevention approach had not been agreed across partners.
    2. The project diagnosis was a vital health check on various key projects and successes in Priority 1 included:

    -          increasing the local uptake of childhood immunisations to 95% of the population which wasreached in two weeks.

    -          a Planning and Health Forum was established in which health and planning officers met to help embed health and wellbeing into planning policies.

    -          regarding Surrey Adults Matter, an approach had been agreed with all key system partners and work was beginning with frontline agencies. A newly recruited Senior Partnership Manager would aid that area.

    1. He noted that although there were many professionals working hard across all three priorities, it was difficult to identify SROs to take on specific projects and the priority sponsors were working closely with the Policy and Programme Manager (H&Sci) on the matter.
    2. The Priority 2 sponsorsimilarly stated that it was difficult to identify SROs in some areas within that priority.He summarised the current progress on:

    -          the recent Surrey Mental Health Planning meeting composed of system partners across Surrey Heartlands and Frimley Health ICS aligning mental health with the Surrey Health and Wellbeing Strategy.

    -          the draft First 1000 Days Strategy was being finalised and would shortly be shared with system partners for feedback.

    -          the Dynamic System Purchasing Arrangements were established for Supported Accommodation aiding supported living for people with a mental health problem.

    -          Pocket Parks which were small plots of land often in urban spaces which provide green spaces to aid wellbeing physical and mental health of the communities using them, supported by the Royal Horticultural Society Garden Wisley and initiatives in Epsom and Ewell.

    1. He explained that a key risk within the priority was developing community resources to support a consistent Surrey-wide approach to social isolation. Projects included work on social isolation in Surrey Downs, a mental health centre of excellence in Woking and Social Prescribing intergenerational mentoring pilots in Guildford and Waverley which secured a funding of £750,000. Those pilots were volunteer led in which volunteers spent time with those over 65 who sought company.The Priority 3 sponsor and Chief Executive of Elmbridge Borough Council indicated that he would be  ...  view the full minutes text for item 11/20



    At the September Health and Wellbeing Board, Members agreed to develop a Social Progress Index (SPI) for Surrey to measure real lived experience of residents, focusing on social and environmental outcomes only. This will provide a helpful measure of ‘fulfilling potential’ in Surrey to help understand how individuals are living and progressing within District and Borough Wards and who is being left behind.




    Satyam Bhagwanani - Head of Analytics and Insight (SCC)

    Amy Morgan - Policy and Programme Manager for Health & Social Care Integration (H&Sci) (SCC)

    Simon Hart - Independent Chair of the Surrey Children’s Safeguarding Partnership


    Key points raised in the discussion:

    1. The Head of Analytics and Insight introduced the report and explained that the Social Progress Index (SPI) aligned to the Board’s third priority of all fulfilling their potential.
    2. Fundamental to the SPI was the collaboration between the SPI Working Group with the Social Index Imperative, to which there would be a workshop in March bringing together multi-agency data owners across the county. With the aim to agree Surrey’s choice of indicators for the SPI, providing a holistic view of Surrey and the wider determinants of health inequality.
    3. An early version of the SPI would be shared with the Board in June and the full SPI would be completed by summer. The Head of Analytics and Insight noted that it was an ambitious timeline and the main risk was data collection from many partners, urging Board members to support the quick signoff on data where possible.
    4. Responding to Board members’ queries on the purpose of data collection, the Head of Analytics and Insight replied that the SPI would be outcomes focused by evaluating where populations were at across the county and at ward level, economically, socially and environmentally. The Chairman added that the SPI ensured the objective identification of the top ten areas of deprivation within the county, with multidisciplinary teams to provide a range of solutions for different areas - which would overlap and develop some of the Board’s KPIs.
    5. A Member of the Board noted that the SPI was piloted in Elmbridge which identified regional solutions there but was concerned that ward level data collection would be more complex. In response, the Chairman noted that obtaining ward level data was crucial as he cited the example of the difference in life expectancy between certain wards in Waverley. A Member of the Board added that despite a very high percentage of good GCSEs results in Surrey schools, schooling in deprived wards was comparably poor and he stated that schools should be a beacon of opportunity and not a mirror of deprivation.
    6. The Policy and Programme Manager discussed that from a public health perspective, the SPI would be an important step in mapping out health inequality, highlighting areas where there was good or bad access to community facilities.
    7. The Chairman commented that one important initiative of the Council was the £100 million Community Investment Fund to support key initiatives, recognising the shifting narrative of public health being community led.
    8. The Independent Chair of the Surrey Children’s Safeguarding Partnership took a proactive interest in assisting the SPI, noting the importance of including safeguarding.



    The Board members would:

    1. Emphasise the SPI ambition within partner organisations.
    2. Secure executive level agreement/support to share data.


    Actions/further information to be provided:

    Board members will emphasise the SPI ambition within partner organisations and secure executive  ...  view the full minutes text for item 12/20



    The next public meeting of the Health and Wellbeing Board will be on 4 June 2020.


    The Board noted that its next meeting would be held on 4 June 2020.


    Any other business:


    The Interim Director of Public Health, provided the Board with an update on Coronavirus (COVID-19) noting the recent cluster of four positive cases in Surrey and West Sussex. Public Health England (PHE) had made good progress in contacting anyone who had been in close contact with the individuals to provide them with necessary advice. She noted that the country was still in the ‘contain’ phase of the outbreak but likely to move to ‘delay’ soon.

    Board membersadded that:

    • they were seeing frequent suspected cases in their GP surgeries but swabbing all patients was not current policy.
    • councils in Surrey were actively working through emergency planning procedures.
    • three schools in Surrey had been closed recently for a brief time for deep cleaning.


    Members were provided with a handout detailing the Board’s response to the survey on Surrey CCGs regarding the delivery of the joint health and wellbeing strategy which was developed across key organisations within Surrey. It signalled an important shift to a more preventative approach, addressing root causes of poor health and wellbeing and not simply focusing on treating the symptoms, setting targets for the next ten years. NHS East Surrey CCG, North West CCG, Surrey Downs CCG and Guildford & Waverley CCG were all part of Surrey Heartlands Integrated Care System and as of 1 April 2020, would become one CCG, named Surrey Heartlands CCG. 





    Meeting ended at: 3.07 pm