Agenda and minutes

Please note: if the alarm sounds during the meeting, everyone should please exit the building via the way they came in, via the main entrance lobby area, and then the front ramp.  Please then assemble on the paved area between the side entrance of the cathedral and the roundabout at the Deanery Road end of the building.

If the front entrance cannot be used, alternative exits are available via staircases 2 and 3 to the left and right of the Council Chamber.  These exit to the rear of the building.  The lifts are not to be used.  Then please make your way to the assembly point at the front of the building.  Please do not return to the building until instructed to do so by the fire warden(s).

The Chair welcomed all parties to the meeting and asked them to introdcue themselves.

The Clerk explained the arrangements in the event of an emergency evacuation procecdure.

Apologies for absence were received from Julia Ross, Paula Clarke, Tim Poole, Janet Rowse, Zahra Kosar and Cathy Caple.

The Board noted that, following recent change in Cabinet Member responsibilities, Councillor Asher Craig had been replaced on the Health and Well Being Board  by Councillor Ellie King. It was also noted that the Cabinet title of the Chair, Councillor Helen Holland, had changed to Adult Social Care and Integrated Care System to reflect her additional responsibilities.

The ICP members of the Board were also welcomed to the meeting.

To note any declarations of interest from the Councillors.  They are asked to indicate the relevant agenda item, the nature of the interest and in particular whether it is a disclosable pecuniary interest.

Any declarations of interest made at the meeting which is not on the register of interests should be notified to the Monitoring Officer for inclusion.

There were no Declarations of Interest.

To agree the minutes of the previous meeting as a correct record.

The minutes of the meeting held on 28^th July 2021 were approved as a correct record and signed by the Chair subject to the inclusion of Vicky Marriott as being present.

Up to 30 minutes is allowed for this item.

Any member of the public or Councillor may participate in Public Forum.  The detailed arrangements for so doing are set out in the Public Information Sheet at the back of this agenda.  Public Forum items should be emailed to democratic.services@bristol.gov.uk and please note that the following deadlines will apply in relation to this meeting:-

Questions - Written questions must be received 3 clear working days prior to the meeting.  For this meeting, this means that your question(s) must be received in this office at the latest by 5pm on Thursday 14^th October 2021.

Petitions and Statements - Petitions and statements must be received on the working day prior to the meeting.  For this meeting this means that your submission must be received in this office at the latest by 12 Noon on Tuesday 19^th October 2021.

Members of the public who wish to present their public forum statement,

question or petition at the zoom meeting must register their interest by giving

at least two clear working days’ notice prior to the meeting by 2pm on

Monday 18th October 2021.

PLEASE NOTE THAT IN ACCORDANCE WITH THE NEW STANDING ORDERS

AGREED BY BRISTOL CITY COUNCIL, YOU MUST SUBMIT EITHER A

STATEMENT, PETITION OR QUESTION TO ACCOMPANY YOUR REGISTER TO

SPEAK.

There were no Public Forum Statements.

Mark Allen confirmed that:

·       a remote Teams meeting of the  Joint Health and Well Being Board was scheduled to take place on Thursday 28^th October 2021 and would discuss issues relating to Adversity and Trauma as well as the Integrated Care System

·       in November 2021, there would be the rearranged Joint Workshop with the Children and Young People’s Board would take place

·       On 16^th December 2021, the next formal Board meeting would focus on refugee health

RESOLVED  – that the Forward Plan be noted.

Sally Hogg and Mark Allen gave a presentation on the Mid Year Performance Report and made the following comments:

·       A summary was shown of health targets assessed against actions

·       The front page of the performance framework scorecard was shown

·       The six pillars of the workstream updates were shown with goals and themes from the One City Plan together with strategies and Work Programmes for Health and Prevention including a reduction in Childhood obesity

·       Following an introduction, information was provided on each goal with indicators for each

·       The Board noted the following colour indicators for each target – white indicates that information had not yet been received, green that it had been received and was improving (ie the number of women delivering children whilst also smoking), amber showed that progress had been made but not completed and red showed that it had stalled and/or was worsening

·       It was noted that there were lots of amber targets and some red in relation to Hospital Admissions drink

Board members made the following comments:

·       It was good to see that actions were being honed so closely to objectives

·       It was important to note that many of the targets had been knocked off track due to COVID-19 and work was now needed to get them back on track

·       This was a very helpful way of presenting performance information

·       The One City Children and Families project had built an Equalities Framework to build inclusion and had been recently launched on Monday 18^th October 2021. Board members commented on how this project could be incorporated into scrutiny and how particular groups such as the ICP’s could help to develop it. Reference was made to the presentation of the Integrated Care System at the last Board meeting and its connection to other work areas such as the Institution of Mental Health Framework

RESOLVED –

(1)   that the list of actions arising from the Mid-Year Performance Report be revisited at the next HWBB meeting

ACTION: Mark Allen/Sally Hogg to add to agenda for Thursday 16th December 2021 formal Board meeting

(2)  that the One City Belonging Strategy be circulated to all HWBB members ACTION: Jeremy Livitt

(3)  that an inquiry event concerning the One City Belonging Strategy be held with partners to assess the direction of travel and to ensure HWBB is held to account ACTION: Ann James to arrange, Mark Allen and Sally Hogg to support as required

Christina Gray gave a verbal report on this item and made the following points:

·       All relevant data is set out on the website

·       Some process issues had been discovered concerning data at the NHS Wolverhampton Laboratory which had been closed since this had been identified on 12^th October 2021. An investigation into this problem had been started by the Security Agency. However, only a few tests form Bristol had been sent to this laboratory. All individuals affected by this had been contacted by Test and Trace

·       Rates were rising across the country and this had impacted local rates. PCR testing had dropped steeply in the last few weeks

·       Bristol currently had 436 cases per 100,000 which was now at the England average, although below the South West average (BANES, Wiltshire and Swindon were peaking at higher rates than Bristol)

·       The virus continued to circulate widely and the highest rates was amongst younger age groups

·       Organisations and individuals were being encouraged to take voluntarily the necessary measures to reduce the infection rates, such as washing hands thoroughly and frequently, as well as ventilation

·       Individuals would be encouraged to take the booster jab when called to do so as immunity was already waning

·       Vaccination rates were already improving with over 70% of people having received their second vaccination

The Boatd were then shown a short film concerning measures being taken to encourage vaccination rates.

In response to a members’ question, Christina Gray indicated that the roll out of vaccinations for 12 to 15 year olds was being carried out by the Child Health Immunisation Service but was taking place quite slowly. The most vulnerable were being targeted first. The programme was taking place with the consent of parents and would be a rolling programme.

RESOLVED  - that Christina Gray checks to see whether the video shown to HWBB members can be shared on social media. ACTION:  Christina Gray

Viv Harrison gave a presentation updating the Board on the Joint Strategic Needs Assessment (JSNA) Annual Report and made the following comments:

·       A package of work had been carried out to assess the health and care needs of the population

·       Members’ attention was drawn to a report that was presented to the Board in January 2021 which set out the implications and future direction of the Health and Well Being profile of Bristol

·       A rolling programme of measures was being introduced which contained sections on living conditions and priority groups. Partners had been sent updated bulletins with the latest information

·       A piece of work was in progress to create locality level profiles

·       The Integrated Care Partnerships set out data profiles with the population and its needs. AN example of the format used was provided showing a population profile with maps at the bottom. There was also included a set of indicators comparing each locality with the rest of Bristol

·       The summary of the Health and Well Being profile from January 2021 included data gathered pre-pandemic – all no later than 2019. Analysis showed that Bristol had a high health burden in comparison with other core cities

·       Key statistics showed that deaths under 75 were no longer decreasing and also showed increasing numbers of obesity and self-harm amongst young people. Figures for patients who smoked had also increased, although the rates of smoking amongst those who were pregnant had decreased and was dropping in the most deprived quintiles. Nevertheless there remained 500 parents within this category which showed marked inequalities. More collaboration with neighbouring Local Authorities as needed in this area

·       Existing priorities still remained key priorities. However, COVID was now also a key indicator and the impact of long COVID needed to be considered. There is scope for further alignment to strengthen the focus on inequalities

Board members made the following comments:

·       It was important to address this issue through ICP’s. Information from the census would inform ward profiles and ensure these issues were tackled at locality level

·       A very similar presentation had been given by South Gloucestershire Health and Well Being Board. It was important to engage ICPs in developing the work of the HWBB and help in preparing the JSNA Action Plan

·       The survey had identified a lot of issues about depression being connected to people’s concerns about housing

·       It was important to remember that health outcomes were the result of wider determining factors. For example, parents who smoked could have an impact on those children and their lifetime health risks.

RESOLVED – that the presentation be noted.

The Chair introduced this item and made the following points:

·       A major part of the role of Integrated Care Providers (ICPs) was to ensure the Memorandum of Understanding was completed. This set out important principles and the need for a culture change in approach

·       The pandemic had revealed the importance of ensuring services were grown to meet the needs of the community

·       Once the service goes live in April 2022, it would need to develop in its own way

·       A recent workshop had helped to develop a fruitful relationship between the HWBB and the LGA

Stephen Beet made the following additional points:

·       Following recent recruitment, Jo Hall, Steven Rea and Sharron Norman had been appointed in full time delivery Director roles for each of the ICPs

·       ICP Governance rules had now been agreed and would apply across the ICS

·       The HWBB would have an important role in setting the role of the ICPs and in the ICS. Strategy and the target Operating Models (TOMs) were key aspects of this

·       Since the last Board meeting there had been a recent session with local Councillors including Julian Ross who had attended to discuss ICS Development and the role of ICPs as part of a breakout meeting

The Board received verbal updates from each of the ICP Representatives as follows:

Rhian Loughlin (ICP – Inner City and East)

In assessing key priorities for delivery, discussions had taken place about two months ago. A TOM for Community Mental Health was being developed and would be signed off on 2^nd November 2021.

The uptake of vaccinations was being improved and was focused on under 40s and communities with a current low uptake in the inner city area.

There was also work taking place concerning children’s mental health and ensuring a healthy weight (through the wellbeing network). In addition, work was being strengthened with community partners in relation to the “Ageing Well” programme.

Kerry Joyce (ICP – North and West)

Work was taking place in care homes in relation to autism and resolving any areas of conflict in the delivery of the service. Integrated Personal Care Teams were carrying out work fundamental to individual’s needs and operated in a co-ordination/liaison role.

Recent workshops had identified the need to embed practice in workstreams to address a Design Council challenge to address difficulties of access and co-ordinated care. The focus on preventative support would enable a momentum of change to develop.

Eloise Wyke (ICP – South)

Steven Rea and Josie New had recently been appointed to roles in this ICP area.

JSNA data was key in helping assessments in areas such as Mental Health, Drug and Alcohol Misuse and Domestic Violence in particularly deprived wards such as Filwood , Withywood and Stockwood.

An Asset based approach was being developed to provide early support to individuals. Integrated Care Teams provided a trusted assessment of the complex needs of individuals. In Year funding was helping to enable roles to ensure community connector funding for roles to support Mental Health  ...  view the full minutes text for item 10.

Stephen Beet made the following verbal presentation for this item:

·       Over the last few months, social care had faced some serious challenges which had affected the workforce capacity of the service

·       The number of vacancies had increased from 7% to 10%

·       The end of lockdown had coincided with issues such as the growth in the workforce for amazon and supermarkets, Brexit, continuing poor pay and a lack of development opportunities. Jobs in the social care sector were tough jobs and were not attractive to people. In addition, the growth in the number of people waiting for elective surgery had resulted in an increased number of people with disabilities and more complex care needs

·       In addition, there was a requirement for mandatory vaccines for care homes from 11^th November 2021. The government was also exploring a requirement for mandatory vaccines in all care settings

·       Discussions were taking place with the voluntary sector to help with recruitment drives

·       Whilst in the short term, it would be difficult to get the workforce to meet the current demand, work was being carried out in the long term to improve the wellbeing and to support carers including the use of new technology to assist them, in their work

·       Nevertheless, there remained a big challenge in this area for the coming winter period. Discussions were taking place with the LGA, the Association of Directors of Social Care, Skills for Care and colleges to address this problem

The Chair noted that these difficulties emphasised the need for a greater focus on prevention as well as ensuring that jobs in this sector were well valued.

RESOLVED – that the report be noted.

Alison Hurley, Gerry Bates (SIRONA) and Kate Markley gave a presentation on this item and made the following points:

Alison Hurley

OFSTED had carried out an inspection of the SEND service and had identified five areas of weakness in a ratified written statement of action.

These were identified as:

·       a lack of accountability for leaders at all levels

·       a lack of a timeline assessment

·       a dysfunctional health and care process

·       a lack of quality

·       High rates of persistent absence leading to a breakdown in the trust with parents and carers

The need for rigorous community monitoring had been highlighted by NHS England. The first monitoring visit had identified a number of successes in the last 18 months including an improvement in the accuracy of data available, ensuring meaningful participation and consistency of service and the development of an Adult Health Care Plan.

The service had been significantly impacted by COVID which still needed further embedding. There remained a high level of absence of staff with parents and carers continuing to feel excluded.

Although 81 new places had opened across the city with Phase 2 opening in two to three weeks’ time, a stronger foundation was required to build resilience across the city. Whilst the majority of users were getting an enhanced strategy, there was an increase in waiting times.

A new SEND Action Plan was being co-produced with partners and would include a written statement of action.

Gerry Bates

The waiting list for community paediatricians had now been reduced with 82% being seen in 18 weeks, a big increase from 17% last year. The medical needs of users were being identified earlier.

There had been difficulties when children were seen remotely as they needed to wait for a black of therapy, including occupational therapy and speech and language therapy.

There was a need to ensure early identification led to significant progress on health visiting and an assessment to ensure intervention took place soon and signposting led to the required support.

There had been an unprecedented increase in the demand for early intervention and support. There had also been a big increase in diagnosis of autism via the User X Project.

Following an assessment of people’s experience at both ends of the process, a number of prototypes were being developed to ensure less presentation and triage and more development concerning health care through a new team.

Statutory Assessments – there had been a big increase nationally and also locally in comparison to Bristol’s statistical neighbours. Board members were shown a graph indicating work that had been carried out in this area and with a resource that had been significantly increased since 2018. It nevertheless faced a challenge in meeting the demand that had been increasing and which continued to place the system under pressure.

Kate Markley – FLORA (Families, Local Offer, Resource and Advice)

The Board noted that earlier in the pandemic they had engaged with parents in difficult to reach communities. FLORA had been set up to identify health visitors  ...  view the full minutes text for item 12.

Kathryn Hamilton presented this report and made the following points:

·       There remained a great deal of work to medicalise tobacco addiction and ensure that it was not treated as a lifestyle choice

·       The rates of tobacco addiction were starting to increase again and the costs remained high. There was also an impact on mental health since 40% of mental health patients smoked

·       The aim was for all Health Trusts to be smoke free in terms of acute maternity provision and its impact on mental health

·       Vaping was assessed as a useful tool to stop smoking. Whilst the recording of smoking was improving, getting people to quit remained a challenge

·       The Ottawa model had been developed 5 years ago and was a systematic approach. This had extended across all of Canada to over 100 hospitals and had helped to reduce mortality

·       Some outcomes were encouraging. One fifths of smokers had quit three months later

·       A consultation involving 500 people had been carried out by the University of Bristol. Designated outdoor vaping areas had been set up as a method of communicating behavioural nudges and provision of training for staff was being carried out to help with this

·       As part of a next step, the Treating Tobacco Dependence Working Group would be set up, mapping current activities and assessing aims to develop a strategy

·       Various options for helping people stop smoking included designating vaping areas, selling e-cigarettes and improved training for staff

·       Further education was required concerning vaping and its assistance in treating dependency on tobacco. Focus groups would help in this process, together with signage and nudging techniques

·       Details of the methodology were set out and of collaboration between the University of Bristol and HWBB

·       The Board were requested to support the proposed approach

Board members made the following points:

·       There was a need to engage primary care on this issue

·       Manchester produced training videos on this issue, including a move away from enforcement towards cessation support

·       It was important to find ways of transmitting these conversations into the community to those hard to reach groups which were usually the most difficult to engage

·       This was a welcome shift in approach

RESOLVED –

(1)         that the recommendations contained in the report be approved

(2)         that progress in this area continue to be monitored and appropriate discussions take place with the BRI and other relevant groups in the applicable community and education settings

ACTION: Andrea Dickens/Kathryn Hamilton

The next formal Board meeting is scheduled to be held at 2.30pm on Thursday 16^th December 2021 in the Council Chamber, City Hall, College Green, Bristol.

It was noted that the next formal Board meeting is scheduled to be held at 2.30pm on Thursday 16th December 2021 in the Council Chamber, City Hall, College Green, Bristol.