Agenda item

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.

 

 

 

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 recommendations would be shared and scrutinised.

4.    A Board member noted that regarding prevention and early intervention in screening, often people with a learning disability do not get accessible letters or invites, or their experience going into clinics for screening does not work well for them; and asked about how the accessibility requirements were met for those with learning disabilities in Surrey.

-     In response, the Joint Strategic Commissioning Convener, Learning Disability and Autism (SCC and SH ICS) noted that there was an accessible letter generating ability on the learning disability website, which would be refreshed enabling primary and secondary care colleagues to add details into the website; analysis on the previous uptake was underway. She would look to liaise with the Board member on her experience of the matter from the previous system she worked at.

-     The Vice-Chairman noted that according to the data in North West Surrey, the uptake of the cervical smear was significantly below the target for women with learning disabilities. A piece of work looked at that cohort and the reasons why they were not coming forward, which led to the provision of delivering a service on a Saturday because many of them required a carer to take them to an appointment. She noted that accommodating those with learning disabilities required a bespoke process or for easy-read invites to be provided. That screening pilot would be reviewed to see whether it could be extended to other screening programmes.

-     The Joint Strategic Commissioning Convener, Learning Disability and Autism (SCC and SH ICS) noted that a lead was working closely with the Cancer Alliance to try and improve the uptake of the cervical screening offer. Another issue concerned the accessibility of buildings and the availability of hoists. Having the granularity of data across different levels in the system would help drive improvements and reduce the mortality gap.

-     The Chairman referred to a Board member’s comment in the meeting chat, noting that tackling obesity would be a key area of focus given the impact on blood pressure and diabetes, and that historically some areas of screening for women with learning disabilities have been challenged with more need for support around cervical and breast screening by learning disability nurses to support learning disability residents and their carers.

5.    A Board member referred to waiting well and asked whether that was specifically linked to learning disabilities within the Priority. She noted that Healthwatch Surrey had undertaken a small-scale survey in Surrey about how residents are experiencing being on waiting lists for elective care and Healthwatch England had published a broader survey on the impact of waiting and support provided. The findings were that those with multiple disadvantages faced a significant impact on the length of waiting time and the likelihood of cancellation. She asked what was known about people in Surrey with learning disabilities, how were they faring on waiting lists and how the impacts were tracked; elective care was not a choice and waiting had a huge impact on people's ability to function and those around them.

-       The Vice-Chairman noted that elective care describes the people who were waiting for an outpatient appointment, a surgical procedure or a diagnostic. She noted that Surrey Heartlands ICS about nine months ago had looked across all its health inequality domains - including learning disabilities - and did not identify anyone in those groups that were waiting any longer than the already unacceptable wait for everybody. The Covid-19 pandemic had exacerbated the waiting lists. An action had been taken away from the elective care board to refresh that work. Taking a broader view was needed of those with health inequalities who do not come forward to access services and therefore are not on the waiting lists.

-       A Board member noted that regarding the Communities service, a piece of work was underway with the newly formed Community Link Officers, part of their remit would be to find out what issues there were in communities such as around health. He suggested that the officers could gather intelligence around waiting lists for people with learning disabilities or multiple disadvantages.

 

Priority Two

 

(Priority Three and Approval of the new Terms of Reference of PWDHDB were discussed before this)

 

6.    The Joint Strategic Commissioning Convener, Learning Disability and Autism (SCC and SH ICS) (on behalf of the Priority Two Sponsor) noted that:

·         Referring to the changes to the Priority Two outcomes:

-       Outcome one had been amended to clarify that it covers all ages: ‘Adults, children and young people at risk of’ and with depression, anxiety and ‘other’ mental health issues access the right early help and resources.

 

Alison Bolton left the meeting at 2.44 pm.

 

-       Outcomes two around the emotional wellbeing of carers and three around isolation remained the same.

-       The proposed fourth outcome ‘Environments and communities in which people live, work and learn build good mental health’; had been aligned with the Mental Health Improvement Plan, retaining a strong focus on primary prevention which was critical.

-       The report included a suggestion for a Priority Two Working Group to be established, ensuring an integrated approach with workstream one of the Mental Health Improvement Plan around early intervention and prevention.

7.    The Chairman highlighted the process underway to create a single mental health delivery board that would be chaired by Jonathan Perkins - Lay Deputy Chair at NHS Surrey Heartlands CCG. He noted the two different aspects to mental health, the prevention and early intervention agenda covering item 8 for example, and the more medicalised solutions and the work of Mindworks Surrey and Surrey and Borders Partnership NHS Foundation Trust (SABP). He noted that building on the recent conversations, work underway through various forums and support officers in place, it was the right time to focus on the practical delivery aspects around improving mental health. 

8.    Regarding the proposed fourth outcome, a Board member noted that for children and young people the environments where they learn is predominantly in schools and early education; she highlighted that point so that when discussing item 8, that important relationship with Surrey’s schools is noted. 

 

Priority Three

 

9.    The Priority Three Sponsor noted that:

·         Extra capacity by the Public Health team (SCC) had been provided to deliver Priority Three and the HiAP approach.

·         Referring to the ‘In the Spotlight’ on the Community Safety Assembly event in Surrey in May which was well attended, there were three main aims around data, shared and holistic response as outlined in the report.

·         The afternoon session of the event focused on the Community Safety Agreement (CSA) and the key themes were vulnerability, community harm and community empowerment. Feedback from the three interactive sessions around the CSA were around investment, knowledge and data sharing, the accessibility of services and community problem-solving.

 

Joanna Killian left the meeting at 2.32 pm.

 

10.  The Chief Executive (OPCC) highlighted that the Police and Crime Commissioner for Surrey (PCC) had found the event to be valuable, input from colleagues was being collated and it was a good opportunity to see community safety colleagues together in person. It was hoped that a report would be provided at the next public Board meeting and the PCC intended to hold another similar event in the autumn.

11.  The Chairman and a Board member commended the event, and the Board member noted that attendees identified the close correlation between feeling safe in one’s community and being able to enjoy good health such as being active, or elderly residents not being obstructed by cars on the pavement. She noted that regarding the Surrey Corporate Parenting Board, care leavers were engaged with regularly and they recognised the correlation between their wellbeing and good mental health and feeling safe in their communities.

12.  The Chairman noted that it would be good to bring that report following the CSA event in May back to the Board - and the Community Safety Board - to ensure that there are more agenda items on community safety going forward.

 

Approval of the new Terms of Reference of the Surrey Prevention and Wider Determinants of Health Delivery Board (PWDHDB)

 

13.  The Director of Public Health (SCC) noted that:

·         The PWDHDB had oversight of Priorities One and Two, following the HWS refresh the PWDHDB’s terms of reference had been refreshed and the Board was asked to provide approval.

·         The refreshed terms of reference and scope and principles reflected the strengthened focus on health inequalities and wider determinants of health and the importance of working with communities, the membership had been revised with extra representation from those working in communities and places and colleagues representing the wider determinants of health.

·         Place-based representatives were being engaged with and reviewed to see how the link between what happens at the PWDHDB and the delivery at place could be maximised.

·         The frequency of the PWDHDB had been moved from quarterly to six-weekly to ensure delivery and to have meaningful discussions particularly around Priority Three.

14.  The Chairman provided reassurance around the terms of reference noting that the different responsibilities had been mapped, with the PWDHDB sitting alongside the Integrated Care Board (ICB) and the Integrated Care Partnership (ICP).

15.  The Vice-Chairman noted that as the role of the Joint Chief Medical Officer was developing, clinical leadership would be delivered in a number of the priority programmes such as around cardiovascular disease (CVD); referring to the singular clinical lead representative, she asked whether the membership could be strengthened to include the system clinical leads against those high priority programmes.

-       In response, the Director of Public Health (SCC) noted that those roles would be essential, particularly around CVD as the prevention work had been aligned to the work in the CVD workstream.

-       The Vice-Chairman added that rather than having separate prevention plans for each health problem such as CVD, it would be good to think about how a single holistic prevention plan is presented for Surrey’s residents.

16.  A Board member noted that although there was a representative of Voluntary Community and Faith Sector (VCFS) she could not see representation for people with lived experience on the PWDHDB which was important. She explained that Healthwatch held the contract for adult carers alongside the local Healthwatch contracts, and if useful Healthwatch Surrey could provide user voice representation to the PWDHDB.

-       In response, the Director of Public Health (SCC) noted Healthwatch Surrey’s offer and would liaise with the Board member. 

17.  A substitute Board member queried whether the VCFS representation would be via the VCSE (Voluntary, Community and Social Enterprise (VCSE)) Alliance.

-       In response, the Director of Public Health (SCC) confirmed that the above was her understanding.

18.  The Chairman acknowledged the importance of ensuring that the right voices were on the PWDHDB.

 

RESOLVED:

 

1.    Noted progress against the three priorities of the Strategy in the Highlight Report.

2.    Endorsed the changes to the outcomes of Priority 2 of the Health and Wellbeing Strategy.

3.    Approved the revised Terms of Reference of the HWB’s Prevention and Wider Determinants of Health Delivery Board.

4.    Would utilise the link to the refreshed Health and Well-being Strategy to increase awareness through their organisations to elicit support for reducing health inequalities (as per findings of the HWB Health in All Policies workshop, March 2022).

 

Actions/further information to be provided:

 

Priority One

 

1.    Board members will look to see how their organisations can help concerning the findings in report on the health inequalities faced by people with learning disabilities in Surrey.

2.    The Joint Strategic Commissioning Convener, Learning Disability and Autism (SCC and SH ICS) will share the revised set of recommendations in due course concerning the report on the health inequalities faced by people with learning disabilities in Surrey.

3.    The Joint Strategic Commissioning Convener, Learning Disability and Autism (SCC and SH ICS) will liaise with the Board member (Joint Executive Director, Adult Social Care and Integrated Commissioning, SCC and SH ICS) on her experience of ensuring accessible letters and invites to or experiences at screening appointments from the previous system she worked at.

4.    The Joint Strategic Commissioning Convener, Learning Disability and Autism (SCC and SH ICS) will look to liaise with the Board member (Cabinet Member for Communities, SCC) on his suggestion on intelligence gathering around health via the newly formed Community Link Officers. 

 

Priority Three

 

5.    The Chief Executive (OPCC) and Police and Crime Commissioner for Surrey will look to provide the report following the Community Safety Agreement event in May back to the Board - and the Community Safety Board - at the next public Board meeting.

 

Approval of the new Terms of Reference of the Surrey Prevention and Wider Determinants of Health Delivery Board (PWDHDB)

 

6.    The Director of Public Health (SCC) will look at the inclusion of multiple system clinal leads on to the PWDHDB’s membership as opposed to a singular clinical lead representative.

7.    The Director of Public Health (SCC) will liaise with the Board member (Chief Executive, Healthwatch Surrey) on providing user voice representation on the PWDHDB via Healthwatch Surrey.