Agenda item

This paper gives a brief overview of the status of projects in the Health and Wellbeing Strategy implementation plans. Rather than detailing performance as originally intended, it indicates where projects have been impacted by the COVID 19 pandemic leading to delays in some areas. It also highlights where projects are continuing as normal or with a different focus, often as a result of the impact of COVID 19.

Witnesses:

Phillip Austen-Reed - Principal Lead - Health and Wellbeing (SCC)

Sponsors:

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)

Key points raised in the discussion:

1. The Chairman explained that due to the challenges posed by Covid-19, the report does not provide a detailed performance of the priorities but rather highlights the impacted areas. The pandemic has brought to the foreground the vulnerabilities faced by many, such as the forty-thousand shielded residents and the increased use of food banks. This had impacted the local priorities and so there was an opportunity to review the delivery of the Health and Wellbeing Strategy against to ensure its priorities remain appropriate and relevant whilst linking with the restoration and recovery work.
2. The Principal Lead - Health and Wellbeing outlined that the status of the projects within the three priorities in rated from red to green, highlighting areas most impacted as a result of reduce to resource or need for greater partnership work.
3. Positively, over half of the projects were continuing and adapting under the current situation, such as:

·         The creation of a Homeless Multi-Agency Group to support Borough and District Councils in response to the Government directive to provide accommodation to the homeless:

-          In response, a Board member commented that Covid-19 had magnified the housing shortage issues. All eleven Borough and Districts Councils responded to the directive to accommodate all rough sleepers aiding delivery of the Homelessness Reduction Act 2017 and personal plans were being made for people moving on. District and Boroughs were having meetings with the Ministry of Housing, Communities and Local Government to identify the particular needs of each rough sleeper as well as the solutions and funding needed. Despite some boroughs and districts not having sites to move people on to after the temporary accommodation, the use of Bed and Breakfasts, hotels, the Government preventing evictions in the private sector and triage support from health colleagues on who to prioritise for certain types of accommodation ensured that the directive has been largely met to date.

-          Responding to a Board member query, it was discussed that there were tensions with commercial hotels putting rough sleepers in temporary accommodation and them wanting to return to business as usual particular in Guildford and Woking. Half of those rough sleepers had been moved out of those hotels in Guildford and assurance was provided that the tensions would be managed in conjunction with MHCLG. There had been a recent more flexible approach by hotels after discussions with MHCLG, who were looking at capital funding and asking councils to look into their procurement solutions, in which Surrey was aided by the LRF.

-          A Board member was reassured that the Government was working proactively with councils on the long term issues surrounding rough sleepers and would consider potential funding from the Office of the Police and Crime Commissioner to help on that matter.

·         The positive work regarding domestic abuse, there was a new Domestic Abuse Executive Group:

-          The Priority 1 sponsor noted that he had been involved in various activities in response to Covid-19, including helping to manage the emergency response and setting up a community hub. There were mixed messages concerning the increase in domestic abuse, but it was noted that survivors were waiting until pandemic is over before reporting so data was being modelled to meet that demand after lockdown.

-          An attendee noted that the Executive Director for Children, Families and Learning (SCC) was chairing the Domestic Abuse Executive Group. Across the voluntary and community sector, Boroughs and Districts, Surrey Police and the Office of the Police and Crime Commissioner there was an increase in users to refuge services as well as an increase in domestic violence within assessments of children and in adult social care. In line with modelling which showed an increase in domestic violence that occurs after significant incidences such as the pandemic, the rise over the next year would need to be addressed in conjunction with refuge providers to add additional refuge capacity to Surrey.

-          The Chairman noted that Surrey had been asked to participate in a Channel 4 documentary in the next couple of weeks to showcase its work on tackling domestic abuse.

·         A virtual wellbeing hub and virtual safe haven had been developed for mental wellbeing support and adaptation to the community mental health offer:

-          The Priority 2 sponsor commented that the emotional wellbeing of people and psychological impact of the pandemic were at the centre of the recovery work and the multi-agency approach was encouraging as all were taking responsibility for mental health.

·         Additional support for local suicide prevention plans and new healthy schools approach:

-          A Board member queried the national publicity about suicide rates rising, asking about levels of suicide in Surrey. In response, it was noted that a county-wide Suicide Prevention Strategic Group had been set up. The Consultant in Public Health added that it was complicated to get timely information relating to suicides from the coroner. Surveillance was crucial and they were working with Surrey Police to set up an early warning system. A data feed was being received weekly on unexpected deaths at home such as suicide and drug overdoses. The earlier increase in those deaths that coincided with the Covid-19 peak had returned to previous levels.

-          It was noted that Surrey Police were involved in many cases of unexplained deaths, the Chief Constable had a daily log of significant incidences which has seen more unexplained deaths during the pandemic. Regarding attempted suicides, the Consultant in Public Health noted that they were looking at whether information from hospitals could be sourced relating to poisonings or trauma which would not show up in police data.

4. The Principal Lead - Health and Wellbeing noted that impacted areas would likely slow the achievement of outcomes in the short to medium term and collaboration was key as part of the recovery work. As part of this the Surrey Heartlands’ Recovery Strategy – current thinking’ Annex to the report was noted. The recovery work on the Community Impact Assessment and the Joint Strategic Needs Assessment (JSNA) - item 6 - included intelligence on target populations which was vital and his team will be liaising further with the three priority sponsors on the matter to inform how best to approach building in the learning from this.
5. The Priority 3 sponsor noted that people leading fulfilling lives had been affected adversely by the pandemic with many focus areas impacted, however it is likely that there would be significant links to the recovery plans that are evolving.
6. A Board member summarised Surrey Heartlands’ ‘Recovery Strategy - current thinking’ presentation, noting that there were a number of pieces of restoration work including starting up those health services that had been stood down due to the pandemic. Challenges included the fact that Covid-19 was still live and Personal Protective Equipment (PPE) supply issues. There were large changes to front line delivery such as the use of digital to deliver health care, capturing those changes was key to develop the current strategies. It was important to have a county-wide view across health and social care, incorporating target populations and standardising health inequalities.
7. The Deputy Chairman commented that the pandemic had accelerated positive work, previous barriers such as digital transformation had been removed and discharge processes were more efficient, greater Borough and District Council partnership work established during the pandemic must be maintained. These were areas that were included in the work programmes within the priorities under the Recovery Board for Surrey Heartlands.
8. The Deputy Chairman explained that the End of Life Care programme was ongoing with support from an executive health lead and Surrey County Council lead, looking at county-wide strategy to come back to the Board for sign-off.
9. The Chairman endorsed the current partnership work, including the excellent coordination work of the LRF. It was noted at the recent regional health call, that Surrey was an exemplar of partnership working between the health system and local government.
10. A Board member stressed that is was important to ensure that public patient service user feedback formed part of the partnership work. Many members of the public had embraced the quick changes and those who risked being left behind must be central to the developing recovery work. In response to a Board member query regarding the recovery work mandated at a national level versus local prioritisation, it was explained that the JSNA work gathered intelligence in Surrey to address local priorities and could be used to measure behaviour changes such as greater personal responsibility over health, as well as the RCG’s Surrey CIA and local partnership work, whilst adhering to national directives.

RESOLVED:

1. Noted the changes in the Health and Wellbeing implementation plans with some areas impacted or changing focus.
2. Ensured that the strategy priorities and associated focus areas were considered by partners represented at the Health and Wellbeing Board, as plans were put in place locally to support recovery.
3. Considered any implications on the delivery of the strategy and how work could be maintained through recovery as a high priority, particularly where projects have been refocused relating to the pandemic.
4. Considered the need to further prioritise any areas of the strategy and considered whether additional projects not currently in the scope of the strategy were needed to meet specific needs resulting from the pandemic, based on the developing elements of the Community Impact Assessment.

Actions/further information to be provided:

1. The Public Health team will liaise further with the three priority sponsors over the plans to progress the priorities, focus areas and projects. 
2. The county-wide strategy for the End of Life Care programme under Priority 1, will be brought back to the Board for sign-off in due course.

RESOLVED: