Venue: Remote - during Covid-19, watch live: https://www.surreycc.gov.uk/council-and-democracy/councillors-and-committees/webcasts
Contact: Amelia Christopher Email: firstname.lastname@example.org
APOLOGIES FOR ABSENCE
To receive any apologies for absence and substitutions.
Apologies were received from Dr Andy Brooks - Nicola Airey substituted.
To agree the minutes of the previous meeting.
The minutes were agreed as a true record of the meeting.
DECLARATIONS OF INTEREST
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.
The Chairman declared a non-pecuniary interest in item 7 as he was a previous chair of trustees of Shooting Star Children's Hospice and was currently a vice-president
QUESTIONS AND PETITIONS
The deadline for Member’s questions is 12pm four working days before the meeting (26 February 2021).
The deadline for public questions is seven days before the meeting (25 February 2021).
The deadline for petitions was 14 days before the meeting. No petitions have been received.
There were none.
This paper provides an overview of the local shared projects supporting delivery of the Health and Wellbeing Strategy against the milestones within priorities one, two and three as of January 2021. It highlights specific areas where work has been adapted and stepped up to respond to the impact of the pandemic and in response to the intelligence provided locally through the Community Impact Assessment and Rapid Needs Assessments which were presented at the December 2020 board meeting. A summary of progress is provided by project in Appendix 1.
Rod Brown - Head of Communities and Housing, Epsom and Ewell Borough Council (Priority One Sponsor)
Professor Helen Rostill - Director for Mental Health, Surrey Heartlands ICS and SRO for Mental Health, Frimley ICS (Priority Two Sponsor)
Rob Moran - Chief Executive, Elmbridge Borough Council (Priority Three Sponsor)
Sarah Haywood, Community Safety Policy and Commissioning Lead, Office of the Police and Crime Commissioner for Surrey (OPCC)
Key points raised in the discussion:
1. The Priority One Sponsor highlighted:
· Focus Area 3: Ensuring that everyone lives in good and appropriate housing - there were two cabins for Covid-19 symptomatic homeless people and also for winter shelter provision, the license would cease at the end of March but a larger site would be established on 1 April in Surrey Heath.
· There were 35 projects involving 44 people in the Priority, with real progress being made.
· The work within the Priority was overseen by the Prevention Board which was a productive multidisciplinary board.
· Focus Area 7: Living Independently - see item 7, report on Palliative and End of Life Care (PEoLC) Strategy 2021-2026.
· Focus Area 2: Supporting prevention and treatment of substance misuse, including alcohol and Focus Area 3: Ensuring that everyone lives in good and appropriate housing - Surrey had been shortlisted by the Ministry of Housing Communities and Local Government (MHCLG) for the Changing Futures Fund to help potential projects to address:
- enhancing and extending a pilot outreach service called Bridge the Gap to include clinical support and reach people in temporary and move-on accommodation.
- evidence to invest further and develop early intervention and prevention services such as cuckooing and Checkpoint Plus.
- innovative solutions to fill accommodation gaps across the wider system, including philanthropic, social and community solutions.
2. The Priority Two Sponsor highlighted:
· That overall the Priority remained rated Amber as Covid-19 had affected the delivery of workstreams.
· That there continued to be a high demand for mental health services with high levels of acuity, particularly in crisis services and bed-based services.
- There had been a rise in crisis services from 33% prior to the pandemic to 80% at present.
- There was an increase in children reporting poor mental health and eating disorders increased due to the lockdowns.
- There was insufficient supply to meet the demands to support children with poor emotional health and Surrey had called for a coordinated national response which had resulted in a response to improve access to bed-based services.
· Regarding mental health, Surrey and Borders Partnership NHS Foundation Trust (SABP) had set up a weekly Emergency Response team to identify pressure areas which were then escalated to the Surrey Heartlands Covid-19 Incident Management Group.
· Following the Mental Health Summit last November, an independently chaired Mental Health Partnership Board was established - see item 8: Improving Mental Health Outcomes, Experiences and Services In Surrey. The Partnership Board looked to at ensuring good mental health and reducing health inequalities, as well as benchmarking and best practice, supported by the Centre ... view the full minutes text for item 5/21
The current set of Health and Wellbeing Strategy (HWBS) metrics were finalised following the launch of the strategy in May 2019. These have been updated within the strategy dashboard to reflect the latest available data and some examples are referenced where there have been more significant changes in these current outcome measures. The latest available update is largely from 2018/19 due to national publishing schedules so does not factor in the expected impact that the pandemic will have had.
Alongside updating the data, a review the current HWBS metrics is proposed. This is intended to better reflect the impact of the pandemic and ensure the additional local work that is in progress, including the work relating to health inequalities, is incorporated and reviewed longer term by the Health and Wellbeing Board and its member organisations.
Ruth Hutchinson - Director of Public Health (SCC)
Key points raised in the discussion:
1. The Director of Public Health (SCC) noted that:
· The Surrey 10 Year Health and Wellbeing Strategy (HWBS) metrics were finalised following the launch of the strategy in May 2019 and had since been revised and condensed into thirty-eight metrics which were publicly available online via the Tableau dashboard on Surrey-I.
· Many of the indicators were updated annually whilst others could be refreshed on a more frequent basis.
· There had been some significant change in some outcomes which would be reviewed by the relevant priority oversight board or groups as well as the need to review the Key Performance Indicators (KPIs).
· Presented a screenshot of the dashboard, categorised by the three Priorities, the Focus Areas and Population Groups with various indicators, graphs showing the trend overtime and the comparison with other areas such as the South East and England.
· The over-arching metrics of life expectancy and healthy life expectancy were measured every three years, highlighting the 2017-2019 data for England, the South East and Surrey for men and women which had increased. However in Surrey there was a significant gap of over ten years for women and men between healthy life expectancy and life expectancy which varied between wards.
· Provided an example of smoking rates in routine and manual workers in Priority One in which there was a continued decrease in overall prevalence but there had been an increase in smoking amongst routine and manual workers in Surrey compared to the South East and England.
· Work was underway to review and align the Surrey-wide HWB outcome metrics with more granular data: the Surrey Index, the Local Recovery Index and the Local ICS Health Inequalities Indicators (part of the NHS recovery workstream post-pandemic), the metrics would be updated in 2021 to also include community safety.
2. A Board member noted the need to update the metrics and sought reassurance that they would not be changed as the importance of metrics was to track change through consistent measuring.
- In response, the Director of Public Health (SCC) noted the need to review the current metrics to ensure a systematic approach by the priority delivery boards and the use of contemporaneous data, and would ask her colleagues in the priority boards to emphasise that approach.
Michael Wilson CBE joined the meeting at 2.42pm
3. The Board member further noted that changing the results towards more positive outcomes in some areas would be difficult, however the decrease in the percentage of people with learning disabilities in settled accommodation was within the scope of public authorities to tackle quickly.
- In response, the Director of Public Health (SCC) noted that delivery of the metrics was a mixed picture so it was vital to align the metrics with the KPIs as part of the delivery of the HWBS.
1. Noted those areas where we are seeing change in outcomes reported and ensure priority delivery boards have oversight, specifically where there ... view the full minutes text for item 6/21
The Strategy sets out the collective ambitions we want to
achieve across Surrey Heartlands as an Integrated Care System (ICS)
to improve palliative and end of life care for our
Dr Charlotte Canniff - Surrey Heartlands CCG Chair and HWB Deputy Chairman
Vicky Stobbart - Guildford and Waverley Director of Integrated Partnerships and Executive lead for PEoLC, Surrey Heartlands CCG
Katherine Church - Joint Chief Digital Officer, Surrey County Council and Surrey Heartlands Health and Care Partnership
Dr Sian Jones - Guildford & Waverley GP Representative, Surrey Heartlands CCG
Sreya Pokkali - Research and Engagement Officer, Surrey Heartlands Health and Care Partnership
Key points raised in the discussion:
1. The Deputy Chairman noted that living independently and dying well was a focus area under Priority One of the HWBS, noting the item at the June 2019 Board on the End of Life Care Partnership Project which was tasked with bringing together all services across Surrey that were involved with end of life care and palliative care. Its aim was to work collaboratively across the system and partners to improve the experience of Surrey’s citizens.
2. The Guildford and Waverley Director of Integrated Partnerships and Executive lead for PEoLC (SH CCG) noted that:
· Her role as executive lead was based upon the development of the Palliative and End of Life Care (PEoLC) Strategy 2021-2026, ensuring that all voices were heard and that it captured the collective ambition of partners and citizens.
· The Strategy was centred on the importance of personalised care that was planned in partnership with the individual and their caregivers, which was particularly important during the pandemic.
· The care that someone received at the end of their life had the power to bring comfort and peace, it was vital to get the approach right as the experience of end of life care may have a profound effect on the bereavement process and future trust in health and care services.
· In Surrey there were 10,000 deaths every year, every single person counted, end of life care should be coordinated, personalised, and compassionate.
· From initial discussions emerged the PEoLC Strategy Development Reference Group to work on the Strategy and work was underway to co-produce it, and there were many examples of excellent care provided by services across Surrey as well as honest reflections about areas where it had not gone well.
· The five-year strategy and the high-level outcome measures reflected the ambitions to deliver change. The strongest theme to emerge from the engagement exercise was the significance of the person, including their circle of support, and sharing information so that everybody has a clear understanding of the person's wishes and needs.
· Further high-level outcomes included dying with dignity, that care was provided in the community where possible and after-death families were supported.
· There had been an incredible response in the development of the Strategy, over twenty organisations had been involved in scoping, drafting and designing, with over thirty members of the monthly PEoLC Strategy Development Reference Group.
· It was clear that across Surrey there was a real dedication and commitment to wanting to get the Strategy right.
· She was pleased to have the support of the Surrey Heartlands Research and Insights ... view the full minutes text for item 7/21
This report provides an update for the Health and Wellbeing Board on:
i) the mental health pressures being experienced by residents - exacerbated by Covid-19 and the associated control measures;
ii) the consequent increased demand on and challenges being faced by the mental health system;
iii) the issues and concerns arising; and
iv) the steps being taken in response and in preparation for a post-Covid-19 period, to ensure improved mental health outcomes, experiences and services for Surrey residents.
Alan Downey - Independent Chairman, Surrey Mental Health Partnership Board
Key points raised in the discussion:
1. The Independent Chairman of the Surrey Mental Health Partnership Board explained that:
· The Partnership Board had two meetings so far noting some overlap between membership of the Partnership Board and the Health and Wellbeing Board.
· Work was progressing well, thanking Partnership Board members and the project team led by the Deputy Chief Executive (SCC), and the Partnership Board would continue to meet every three weeks over the next six months.
· It was clear from the first two meetings that there was a strong and shared commitment to make progress in improving mental health outcomes in Surrey and to tackle the obstacles which had prevented past progress in some areas.
· He echoed the comments by the Priority Two Sponsor that mental health had never been more important, particularly given the context of the pandemic which had highlighted health inequalities.
· The key points from the first meeting were that there was a strong desire to see a more preventive approach in dealing with mental health issues, through prevention and early intervention, and the importance of building on wider community assets, schools, families and workplaces not just looking to the public sector to solve all of the problems.
· It remained vital to listen carefully to those who experienced mental health issues and to listen to their families and carers.
· At the most recent Partnership Board the draft key lines of enquiry were reviewed and once finalised those would form the basis of the workshops, interviews and focus groups over the next few weeks.
· Although there was shared commitment to make progress, there were some differences of view about priorities, the language used, about how best to involve and to reach people who experienced mental ill health.
· A set of jointly agreed actions, an implementation plan, and priorities would need to be developed; the first stages of implementation would start in May followed by a progress review in August.
· The success of the Partnership Board would depend on the willingness and the determination of those involved to set aside organisational interests and to work cooperatively across organisational boundaries.
· As part of the review a relational diagnostic was included which would tease out the strengths and the weaknesses in relationships across the mental health and the care system in Surrey.
2. The Chairman looked forward to receiving that data on the progress of the work at the next Board.
1. Noted the significant demands, issues, concerns and performance associated with the mental health system in Surrey, particularly arising from the additional pressures created by Covid-19, and the impact this is having on Surrey residents.
2. Approved and supported the range of multi-agency work going on and being initiated to address the situation, including through the Surrey Heartlands Mental Health Partnership and Improvement Board.
3. Would receive a further report on the issue of mental health outcomes, experiences and services in Surrey in June.
Actions/further information to ... view the full minutes text for item 8/21
In developing the Surrey Health and Wellbeing Strategy in 2019 we identified the vital role that community engagement and development would play in delivering on our 10-year goals to improve health and wellbeing through a more preventive approach and addressing wider determinants. A range of fantastic community focused initiatives and approaches have since been progressed across our partnership, most notably in the form of the ongoing response to Covid-19. This has given extra energy to our shared ambition to engage with and empower communities, and a number of key opportunities have been identified to build on progress to date. Work is already underway across the partnership to make the most of these opportunities and through the spring and summer we will also create a roadmap for embedding the empowerment of communities into our longer-term efforts to improve health and wellbeing and address health inequalities.
Marie Snelling - Executive Director of Communities and Transformation (SCC)
Key points raised in the discussion:
1. The Executive Director of Communities and Transformation (SCC) shared:
· Three key points that had resonated most strongly in the recent discussions about the work with a variety of partners:
- That work done by individual organisations or as a system of public agencies, needed to be done alongside the communities served; recognising the need to harness the multitude of talents, ideas and capabilities.
- That better engagement with Surrey’s communities and empowerment depended on assisting them and partners to continue to strengthen collaboration, coordinate responses, to share insights and challenges; the continued evolution of the Council’s leadership and culture was vital.
- That the rhetoric around empowering communities needed to be put into action, building upon the examples referenced in the report and through Covid-19 recovery it was an important time to harness the renewed ambition in the system to drive the empowerment of Surrey’s communities in a tangible and sustainable way to narrow health inequalities.
Professor Helen Rostill left the meeting at 3.25pm
· That based upon her experience, she noted that she did not think it would be easy for a number of reasons:
- Making it real would challenge some of our traditional ways of working, including our decision-making and established processes.
- That it required a relentless focus on outcomes for people, meaning the need to put aside preconceptions and organisational barriers.
- That acknowledgement of where approaches were not working well was vital as well prioritising innovation to take a wide and organic approach to community engagement.
- That by combining the large ambitions set out in the report with some pragmatic action, there would be a real impact for Surrey’s communities.
Dr Claire Fuller joined the meeting at 3.28pm
2. A Board member noted the need to bear in mind the structures already in place that could help support some of the work, such as VCFS organisations. He noted that the extent to which communities are empowered could take the system in uncomfortable directions but that was not necessarily a bad thing.
- In response, the Executive Director of Communities and Transformation (SCC) recognised that the VCFS was vital to the work and recognised that some of the work could be uncomfortable but it was vital to be willing to understand the need for it.
3. A Board member referred to the section in the report on ambition regarding the difficulty in engaging with some communities effectively, noting that through the pandemic the Community Impact Assessment (CIA) and the work through the BAME Alliance and other networks, the issue of trust in big public sector organisations was highlighted. He noted that current work on engagement around the vaccination programme and the work within PCNs was an opportunity to build trust and the need to connect workstreams and conversations to look at successes and failures around engagement potentially linking the work on devolution and the future integrated system. ... view the full minutes text for item 9/21
The Surrey Health and Wellbeing Board (HWB) has a statutory responsibility to deliver a Pharmaceutical Needs Assessment (PNA) every three years. The PNA was delayed from 2020 to 2021 due to resources being diverted to the Covid-19 pandemic. The full Surrey PNA was last published in March 2018. This is regularly supplemented by the PNA Steering Group which reviews changes to the local population and local services annually to ensure that no substantive changes to the Pharmaceutical Needs Assessment are required. The attached report provides a supplementary statement to the 2021 Pharmaceutical Needs Assessment which reports no substantive changes are required to the findings of the 2018 Pharmaceutical Needs Assessment.
Dr Naheed Rana - Consultant in Public Health (SCC)
Key points raised in the discussion:
1. The Consultant in Public Health (SCC) noted that:
· The Pharmaceutical Needs Assessment (PNA) determined the local need for pharmaceutical services and was used to inform decisions on whether to allow new pharmaceutical services to be introduced in a given area based on need through the market entry process.
· The PNA helped inform other activities with ICP colleagues around primary care, long term care management and urgent emergency care provision.
· The Health and Wellbeing Board had a statutory responsibility to deliver the PNA every three years with the last full PNA published in March 2018. The publication of the next PNA was delayed from 2021 to 2022 due to Covid-19.
· Annually the PNA Steering Group reviewed changes to the local population and local services in order to advise whether there were substantive changes to be made to the PNA; if not a Supplementary Statement was produced.
· The PNA Steering Group met and agreed the 2021 Supplementary Statement, noting that:
- there were a large number of housing developments planned in Surrey in the coming decade, namely in Epsom and Ewell, Guildford, and Mole Valley.
- interventions under Covid-19 and national lockdown caused significant disruption to community pharmacies, slightly mitigated through an increase in telephone and online consultations as well as an amendment to scheduled pick-ups.
- it concluded that no new pharmacies or pharmaceutical services were required at present, and that an in-depth needs assessment into the impact on health inequalities for those more vulnerable populations, service access and housing developments would be undertaken in the 2022 PNA for approval by the Health and Wellbeing Board - drafts would be circulated to Board members.
2. The Deputy Chairman asked about the process around the objective needs assessments for more pharmacies, noting that Surrey was down by about twelve pharmacies per 100,000 population, particularly as Covid-19 would have changed the way pharmacies faced the public, and asked whether footfall for pharmacy access had increased as a result of primary care becoming more digital. She also asked whether Surrey would develop an objective needs assessment or whether that was happening nationally.
- In response, the Consultant in Public Health (SCC) explained that although national guidance allowed a delay in publishing the next PNA, Surrey had already started the work on an in-depth needs assessment.
- The Consultant in Public Health (SCC) explained that the benchmark was that there should be one pharmacy per 100,000 population, however that excluded the online and telephone consultations and the other online provisions in place and an analysis was underway by NHS colleagues to capture the change in accessibility, noting digital exclusion.
- The Consultant in Public Health (SCC) explained that at present additional pharmacies were not required, however it was vital to complete the in-depth needs assessment swiftly through the PNA Steering Group, with key partners and following national guidance, welcoming Board member input.
- The Deputy Chairman added that ... view the full minutes text for item 10/21
This paper introduces the planned areas of spend for Surrey’s 2020/21 Better Care Fund submission. The Better Care Fund is a local single pooled budget that facilitates integrated working between health, social care, and wider partners. Whilst the submission of a formal Better Care Fund plan is not required by NHS England, Annex 1 provides information of the Better Care Fund schemes commissioned in Surrey, to allow oversight and sign-off from the Health and Wellbeing Board. The attached Annex will also be submitted to NHS England for assurance.
Simon White - Executive Director for Adult Social Care (SCC)
Key points raised in the discussion:
1. The Executive Director for Adult Social Care (SCC) noted that:
· There were twenty-seven days’ worth of activity in the Submission that the Board could influence as Better Care Fund (BCF) arrangements had been delayed as a result of the pandemic; hoping that the planning processes next year would be quicker so the Board could have a greater chance to influence the spend.
· Local providers had been engaged with through each of the Local Joint Commissioning Groups (LJCGs) and noted three additional areas of expenditure:
- Persistent overspend on the local equipment store - sourced to current levels.
- Investments had been in mental health, community connection services and in collaborative re-enablement partnerships, which originally had been funded using the Winter Pressures grant. The conditions of the improved Better Care Fund (iBCF) grant had been met and so CCGs were contributing £76.7 million - the total funding across Surrey’s health and social care system was £99.2m.
- It was possible that the Discharge to Assess funding introduced during the early stages of the pandemic would be transferred into the BCF.
2. A Board member asked what would happen to the LJCGs in light of the Government White Paper: Integration and innovation: working together to improve health and social care for all, in which CCGs would be subsumed into statutory Integrated Care Systems (ICSs) in 2022.
- In response, the Executive Director for Adult Social Care (SCC) noted that although going forward funding could be discussed in relation to the Surrey Heartlands and Frimley overarching systems, many of the initiatives such as Winter Pressures were place-based. The matter could be discussed at the next Commissioning Collaborative.
- A Board member added that it would be useful to discuss the matter at the LJCGs as they were a helpful forum for joint conversations about place-based community focussed work and noted the importance of having a funding stream regarding local commissioning.
Actions/further information to be provided:
1. The Executive Director for Adult Social Care (SCC) will look at discussing the issue of funding at the next Commissioning Collaborative in light of the
Government White Paper and Board members to look into raising the matter at the LJCGs.
SURREY LOCAL OUTBREAK ENGAGEMENT BOARD - UPDATE
The Board is to receive a verbal update on the work of the Surrey Local Outbreak Engagement Board (LOEB) including the Vaccination Programme. The LOEB is a formal sub-committee of the Surrey Health and Wellbeing Board. It 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.
Mrs Sinead Mooney - Cabinet Member for Adult Social Care, Public Health and Domestic Abuse and LOEB Chairman (SCC)
Jane Chalmers - COVID Director, Surrey Heartlands CCG
Key points raised in the discussion:
· The COVID-19 Response - Spring 2021 roadmap out of the current lockdown for England issued by the Government on 22 February 2021. It was a four-step plan and before taking each step, the Government would review the latest data on the impact of the previous step against four tests:
- The vaccine deployment programme continues successfully.
- Evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated.
- Infection rates do not risk a surge in hospitalisations which would put unsustainable pressure on the NHS.
- Our assessment of the risks is not fundamentally changed by new Variants of Concern.
· That local contact tracing had been successful in Surrey, the combined national and local contact tracing of cases across Surrey was 87% of cases - higher than the national average. Surrey had been invited to participate in a hot spot pilot beginning on 3 March, whereby positive tests in Woking, Runnymede and Spelthorne would be wholly traced using local contact tracing teams.
· Individuals contacted by Test and Trace were asked whether they required support, offered through the British Red Cross, Surrey County Council and District and Borough Councils.
· The Council’s Public Health and Education colleagues continued to provide support to schools that remained open for vulnerable children and the children of critical workers during national lockdown; from 8 March schools would be open for all pupils on site.
· Care homes remained a key area of focus, noting the success of the vaccination programme, as well continued lateral flow and PCR testing for residents in line with the national guidance.
· Regarding asymptomatic testing there were four main test sites in Staines, Woking, Ewell and Redhill, as well as twenty-five pharmacies in operation. Current demand was lower than expected so would be reviewed and individuals and residents were urged to book a test for those that met the criteria.
· The success of the vaccination programme was down to the partnership effort across the whole of Surrey Heartlands, supported by Surrey County Council, Borough and District Councils, volunteers and organisations such as Surrey Police.
· 335,000 residents of Surrey Heartlands had at least one vaccination or 28% of the eligible population.
· All Older Adult Care homes had been visited at least once and good progress was being made in the vaccination rollout concerning more vulnerable residents.
· The programme was a marathon not a sprint. It was anticipated that there would be an uplift in vaccine supply in the near future which would mean that sites could run seven days a week for the foreseeable future.
· That eligible individuals would continue to be contacted directly.
DATE OF THE NEXT MEETING
The next meeting of the Health and Wellbeing Board will be on 3 June 2021.
The date of the meeting was noted as 3 June 2021.