Agenda item

This paper provides an overview of the progress in the delivery of the Health and Wellbeing Strategy (HWB Strategy) as of 19 February 2024. The Highlight Report itself, in a new, more accessible, web friendly format, provides:

·         An overview of activity against Health and Wellbeing Strategy’s Summary Implementation Plan projects and programmes, describing what has been achieved with the Priority Populations and against the Priorities/Outcomes.

 

·         Identifies new data, insights and challenges that have arisen. 

 

·         The progress of the review of the Joint Strategic Needs Assessment (JSNA) chapters.

 

·         Communication activity associated with the HWB Strategy’s Priority Population and Priorities/Outcomes.

 

Witnesses:

 

Karen Brimacombe, Chief Executive, Mole Valley District Council (Surrey Chief Executives’ Group) (Priority 1 Sponsor)

Adam Watkins, ICS Senior Programme Manager - Long Term Planning Delivery, Surrey Heartlands ICB

Ruchika Gupta, Clinical Director - Long Term Planning Delivery, Surrey Heartlands ICB

Professor Helen Rostill, Deputy Chief Executive Officer, Surrey and Borders NHS Foundation Trust and SRO Mental Health, Frimley ICS (Priority 2 Co-Sponsor)

Sara Saunders, Interim Health Integration Policy Lead, Surrey County Council

Mari Roberts-Wood, Managing Director, Reigate and Banstead Borough Council (Priority 3 Sponsor)

Nikki Roberts, CEO - Surrey Coalition of Disabled People

 

Key points raised in the discussion:

 

Priority 1

 

1.    The Priority 1 Sponsor noted that the workshop held in November focused on partnership working in support of Looked After Children to promote healthy weight, an action plan to be developed at March’s workshop. Active Surrey held the Active Schools Conference in November which explored how more positive relationships could be created with children and young people; gender equality was also discussed. The Surrey Anti-Social Behaviour and Community Harm Reduction Partnership had completed a Noxious Smells (cannabis) Framework, which helped partners to work together to stop gangs supplying drugs to neighbourhood dealers. There had also been work on improving information and resources around dementia. The Surrey Joint Carers Programme had co-designed new emotional well-being and mental health services for young carer champions. There were also some funding sources to help improve the health and wellbeing of unpaid carers.

2.    The ICS Senior Programme Manager - Long Term Planning Delivery (Surrey Heartlands ICB) detailed the spotlight item: ‘Surrey Heartlands Diabetes Network’:

·           the vision was to improve the lives of people of all ages living with or at risk of developing diabetes across Surrey Heartlands.

·           the focus was on prevention and early identification, partnership working was key and included the all-age Diabetes Network to inform strategy and deliver improvement against identified national and local priorities.

·           topics discussed at January’s Diabetes Network were: diabetes in care homes, the NHS diabetes prevention programme, improving awareness and reach, medicines optimisation.

·           the Diabetes Network’s meeting later in the week has a spotlight on Learning Disability Mortality Reviews and would look at partners’ work around the impact of diabetes for people with learning disabilities and or autism. Other areas of focus: the digital weight management programme, structured education with a pilot working with people from South Asian communities and work with Diabetes For South Asians (DoSA) and Active Surrey.

3.    The Clinical Director - Long Term Planning Delivery (Surrey Heartlands ICB) provided further detail on the spotlight item:

·         the team was working to get a locally commissioned service for diabetes agreed for the primary care teams, to help improve identification and risk stratification of patients with diabetes, using a proactive register management tool to address the three treatment targets: controlling blood pressure, cholesterol and sugar levels.

·         working closely with children and young people (CYP), there was a pilot in East Surrey looking at the transition of CYP into adulthood.

·         the Alpha Research pilot with schools, for 3 to 13 year olds, used a finger prick test to determine their risk of developing type 1 diabetes.

·         hoped to learn from the work by colleagues in Bedford, Luton and Milton Keynes with Diabetes UK in trying to target healthy living advice for pregnant patients and those seeking advice on preconception; adapting tools in multi-languages and sharing the information more widely via the Baby Buddy app.

·         work with Surrey Minority Ethnic Forum (SMEF) via workshops in delivering the message on prevention, healthy lifestyles and blood pressure.

4.    The Vice-Chair thanked officers for their work and noted that they covered other long-term conditions so could provide a similar presentation to the Board in the future if needed covering the network of services available. Noted the huge amount of work by partner organisations regarding the prevention and treatment of long-term conditions and ensuring that services are delivered consistently.

5.    A Board member flagged that regarding primary prevention, there was an item on May’s Informal Board agenda regarding Active Surrey and the Physical Activity Strategy, now at the mid-point of its implementation there were positive outcomes. Noted that many colleagues would have been involved in the stakeholder events for the Food Strategy, healthy weight was key to that; noted the need to continue to work across the population, whilst targeting.

6.    The Chair praised the range of initiatives across ages and demographics and asked if the pilots are successful, whether the learning would be rolled out across Surrey. The Clinical Director - Long Term Planning Delivery (Surrey Heartlands ICB) hoped that would be the case, noting that many of the pilots were in the early stages, also using best practice from other systems was crucial. Some of the pilots relied on limited funds, so creativity going forward was key to ensure that programmes would be sustainable. The Chair noted concern about the limited funding, as prevention was fundamental so there needed to be a consideration about how the initiatives are supported long-term.

7.    A Board member offered support from the academic sector to help with identifying the appropriate people to undertake the research and to help identify available funding.

8.    A Board member asked how people with lived experience were being involved and other than SMEF, had other organisations been involved; had CYP been involved in the co-design to ensure appropriate messaging. The Clinical Director - Long Term Planning Delivery (Surrey Heartlands ICB) explained that the Surrey young representative worked with Diabetes UK and the Surrey youth work service, listening to the voices of CYP. Currently SMEF and Active Surrey were being worked with closely, was open to working with other organisations to incorporate lived experience. The ICS Senior Programme Manager - Long Term Planning Delivery (Surrey Heartlands ICB) noted that the work in Ashford and St. Peter's Hospitals and DoSA was co-designed with the community, using lived experience about how and where to effectively deliver structured education sessions. Someone had been chosen to be part of University Hospitals of Leicester work to co-design what improved digital support for people from South Asian communities living with diabetes looks like.

9.    A Board member noted that many of those people living with long-term conditions would have carers, asked how those with lived experience from a carer’s perspective were being involved and supported; offered her help alongside the Joint Carers Programme team. The ICS Senior Programme Manager - Long Term Planning Delivery (Surrey Heartlands ICB) noted that needed to be developed across the long-term conditions programmes. The team had linked in with the carers programme in Surrey around opportunities such as the re-procurement of diabetes retinal screening services. He was happy to liaise with the Board member - and other colleagues - around using the work and connections developed through the carers programme to inform the next steps and building in the psychological support element further.

 

Priority 2

 

10.   The Priority 2 Co-Sponsor noted that the anonymous First Steps to Support phoneline pilot launched in January in Guildford, initially targeting three Key Neighbourhoods and was now scaled across the borough. Several workshops had been held launching the Wheel of Wellbeing across Merstham and Walton South. The Workforce Wellbeing Standards programme had been soft-launched, starting with three businesses then upscaling to fifteen per quarter. The men’s mental health offer delivered through Mentell had been extended to the end of August. Another one hundred mental health first aiders had been trained, with a focus on those working with the Gypsy, Roma and Traveller communities and with asylum seekers. The national Service Development Funding for suicide prevention was due to end in March, there was a business case around how to continue supporting that programme. A bid would be submitted to the Department for Environment Food and Rural Affairs to continue the funding for green social prescribing, focusing on community-based initiatives, for primary care nature interventions to work alongside the GP Integrated Mental Health Service, supporting high intensity users and embedding nature interventions into mental health secondary care pathways. The Secretary of State would be visiting the new therapy garden at St Ebba's Hospital for children and adults with learning disabilities, developed by the community and funded through the Green Health and Wellbeing programme.

11.   The Interim Health Integration Policy Lead (SCC) detailed the spotlight item ‘Mental Health Investment Fund (MHIF): Round 2 awards’:

·         compared to round 1, the round 2 MHIF awards had a wider geographical spread and higher average monetary value of each award at £257,000 compared to £51,000. The average duration of round 1 was 17 months compared to 29 months for round 2. It had taken around two years for most of the funding to be allocated, £5.3 million would be released this year.

·         noted the analysis regarding the Priority 2 Outcomes and Key Neighbourhoods where there was a fairly equal distribution across those, with a slight over-representation in Reigate and Banstead. Regarding the Priority Populations only one out of the twenty-four schemes focused on supporting older people in care homes. Over 60% of the funding was spent on CYP and families, 35% to adults and 4% to older adults.

·         noted that the Surrey-Wide Commissioning Committees in Common (CiC) agreed that the joint executive sponsors have the responsibility to oversee the allocation of the remaining funds to be done at pace.

 

Dr Pramit Patel joined the meeting at 2.37 pm.

 

12.   A Board member queried what the consultation process would be regarding round 3 of the MHIF funding, ensuring that there is adequate time so that partnership input could be meaningful and asked what the timescale would be for its allocation. The Interim Health Integration Policy Lead (SCC) noted that the agreed recommendation at the Surrey-Wide CiC was that delegated authority be given to set the principles within which the funding would be allocated using partnership working to understand the needs of residents, not to define the specific process. Noted that there was a strong desire to allocate the remaining funding at pace so residents could benefit.

13.   A Board member noted caution around pace, that to allocate the remaining funding properly for round 3, co-production takes time to ensure meaningful applications by charities. Noted that round 1 and round 2 had short lead in times, which prevented the co-production of meaningful projects and often applications were not put in. The Vice-Chair noted that it was a balance between the right speed of allocation - affecting the ability of partners to co-produce - and the effective impact on residents. The process would need to be devised and would be tested with partners, acknowledged the need to work at pace.

14.   A Board member noted that the MHIF money had been centred around the voluntary sector and that should be celebrated. Noted that a lot of the MHIF money was also centred around particular areas of the county. Queried whether there would be development across the county, particularly for the First Steps to Support phoneline and sought assurance that there would be funding to continue some of the projects beyond the pilot duration. The Priority 2 Co-Sponsor could not currently provide that assurance, as it depended on the outcomes of the phoneline pilot. Regarding longer term funding, consideration was needed around the case for change and the investment request and its source. A Board member added that it was essential that the work around the phoneline is robustly evaluated, responding to the outcomes.

15.   The Chair recognised the need to robustly evaluate all the initiatives yet stressed that some of those had the potential to replace business as usual programmes where there is not the same level of evaluation as to their effectiveness in outcomes across agencies, that needed to be resolved.

16.   A Board member noted that the First Steps to Support phoneline had been overdue and the figures showed the need in Guildford. Noting the challenging financial situation, if not able to fund the service going forward for example the danger was setting something up and then taking it away which would increase the pressures on charities; the Board must do all it can to support that service.

17.   The Chair noted the constant need for charities to fundraise and asked whether there was help for them to find alternative funding to keep them going particularly if pilots are funded for one year. A Board member noted that what would be most helpful was certainty about what the project would be, about the commitment and timescale, then that would help fundraising. Noted that setting up a pilot and service which would later be lost damaged confidence in donors and supporters.

18.   A Board member welcomed the targeted funding to CYP in the MHIF round 2 and assurance given around the CYP Emotional Wellbeing and Mental Health Strategy. Noted feedback from parents and young people that the extent of emotional wellbeing and mental health problems was increasing at a faster rate than the services could meet the need. Recognised the hard work across the county through the funded programmes, but noted the need to consider what more could be done by the Board to encourage greater targeting of resources into that area. Prevention at a young age helped establish a positive lifelong trajectory of better emotional wellbeing and mental health.

 

Priority 3

 

19.   The Priority 3 Sponsor referred to the outcome around community safety that ‘people are safe and feel safe’, the Office of the Police and Crime Commissioner for Surrey (OPCC) had successfully bid to the Home Office for two-year funding for a multi-agency domestic abuse perpetrator programme in Surrey. The programme’s aim was to improve victims’ safety by reducing the risk posed by stalking and domestic abuse perpetrators - as well as children and adolescents who use violence/abuse in their relationships - and to prevent reoffending. The Surrey Against Domestic Abuse Partnership launched its Steps to Change programme which was a virtual hub which would coordinate a multi-agency and trauma informed approach to end abusive behaviours. Surrey County Council and partners had set out plans to eliminate road collisions resulting in deaths or serious injury by 2050, encouraged all to take part in the consultation ending next week on the new draft Surrey RoadSafe Vision Zero Strategy being developed.

20.   The CEO (Surrey Coalition of Disabled People) detailed the spotlight item ‘Access to food banks’:

·         disability comes with additional costs such as: heating, insurance, equipment; for every £100 a disabled person’s spending power is £67.

·         the report last year detailed how the cost of living situation was disproportionately affecting disabled people, views were collected via an online survey and 97% said they had been negatively impacted, 43% were no longer able to meet the needs of their impairments, disabled people were five times more likely to be at risk of food insecurity and one in four disabled people had missed a meal because they could not afford it.

·         in 2022, 45% of Coalition members polled reported that they had gone without food and the Trussell Trust reported that more than six in ten working age people referred to food banks in early 2020 were disabled.

·         between July 2022 and July 2023 443 disabled households received £250 worth of food vouchers from the Coalition as part of the Government's Household Support Fund. A survey was conducted around the difficulty in accessing food support: 32% had accessed food banks, food clubs and or community cupboards, 62.5% were unable to find information about those services easily and 72% were unaware of what food support was available locally. Accessibility, the referral process, the stigma and transport were identified as barriers; 95% required home delivery.

·         worked closely with Public Health to increase the amount of Household Support Fund money available for disabled people. There is now: a map of the local food banks and food sources of support, a disabled person’s support coordinator and funding for people to use taxis to food banks.

21.   The Priority 3 Sponsor noted that there were other food support offers such as food clubs and many charge a small annual fee to access the produce and that helped remove the stigma. There were also community fridges available.

22.   A Board member referred to community fridges which helped tackle food waste and noted that different thinking was needed about the responsible use of food in the wider system, making it a collective issue.

 

Tracey Faraday-Drake left the meeting at 2.59 pm.

 

23.   The Vice-Chair wondered how that could be triangulated, noting that as a GP for over twenty years in Spelthorne she did not know where the food club or community fridge was, she asked where she could find that out. The Chair added that many councillors would like to have that information mapped. The Priority 3 Sponsor noted that the information on community fridges and food clubs was searchable on Google and was available on Surrey’s borough and district council websites. Acknowledged the need to consider how that information is communicated and would highlight that to the Surrey Chief Executives’ Group, feeding back to the Vice-Chair who offered support in unblocking that barrier and the Chair.

24.   A Board member noted that the point about where people go for information was wider than the community fridges, suggested that it would be useful to look at that more holistically and that was in line with feedback to Healthwatch Surrey about not knowing where to go to get support across the voice services. The Chair noted that the issue about not knowing where to go to access support and not knowing that certain types of support are available would be looked at; noted the need to be more proactive and to use various channels available to target across the demographics. Noted the importance of initiatives where possible to be countywide so they could be easily promoted. A Board member added that it was crucial to consider the single source of truth about what the information is as the devolution of information across places created more outlets without a control over what the quality and the use of the information is.

25.   A Board member noted that it is impossible for everybody to know everything all the time, noted that the way people behave was to look for information when they need it. It was important to recognise and use the amount of social capital at place level, noting the work around towns and villages and how to coordinate at a local community level with third sector partners. Noted that at a future Board meeting it would be useful to discuss local area coordination.

 

RESOLVED:

 

1.    Would use the Highlight Reports and Engagement Slides to increase awareness of delivery against the HWB Strategy and recently published / upcoming JSNA chapters through their organisations.

2.    Noted the opportunities/challenges including:

-          The Office for the Police and Crime Commissioner for 24/25 and 25/26 has made an allocation for the Changing Futures/Bridge the Gap programme but further sustainability funding is still required from further system partners.

-          SCC funding has also been secured through Transformation & Design for a further 12 months for the fuel poverty programme co-ordination.

-          Changes in funding for suicide prevention previously highlighted (including training) is creating a significant risk to continued delivery of projects by VCSE providers in the county.

-          The HWB Strategy Index continues to progress work on indicators; a scorecard/annual review will come to the June HWB meeting to allow time for a comprehensive suite of indicators to be finalised and included.    

 

Actions/further information to be provided:

 

1.    The ICS Senior Programme Manager - Long Term Planning Delivery (Surrey Heartlands ICB) will liaise with the Board member - and other colleagues - around using the work and connections developed through the Joint Carers Programme to inform the next steps and building in the psychological support element further.

2.    The Priority 3 Sponsor will highlight to the Surrey Chief Executives’ Group, the need to consider how the information around community fridges and food clubs is communicated to partners including GPs and councillors, feeding that back to the Vice-Chair and Chair. 

3.    The Chair will liaise with the Public Health team to address the issue about people not knowing where to go to access support and not knowing that certain types of support are available.