Agenda and minutes

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Mayor Rees took the Chair and welcomed all those present and led introductions.

Apologies received from Julia Ross and Terry Dafter

Matthew Bazeley substitutes for Andrea Young

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.

None

Cllr Holland thanked members for the opportunity to co-Chair the Health and Well Being Board and stressed the importance of collaborative working as the public do not see a separation between health providers. HH looks forward to working with members to progress this work.

The Mayor welcomed new members and spoke about the ability of the HWB to provide meaningful and proactive leadership rather than reacting to health consequences.

Vicki Morris of HealthWatch was given a vote of thanks for her contributions to the Health and Well Being Board during her tenure. She is replaced by Morgan Daly.

Any member of the public or Councillor may participate in Public Forum. 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 on agenda items - 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 5 pm on Thursday 21 March 2019

Petitions and Statements on agenda items - 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 12.00 noon on Tuesday 26 March 2019

The following items of Public Forum were received:

Agenda Item 4: Proposed Amendments to HWB Membership

PS4.1 – Adult Social Care and procurement issues - Mike Campbell

Agenda Item 7: One City Plan and discussion of future HWB Strategy

PS7.1 Health and Wellbeing of Blind and Partially-Sighted People in Bristol - Alun Davies

PS7.2 Adult Social Care Tendering – Andy Burkitt

PS7.3 Knife Crime and Street Violence – Andy Burkitt

Board welcomed Alun Davies statement and the proposal for greater engagement with Blind and Partially Sighted People.

JJ proposed that items relating to health services including procurement and tendering, would best be received within a Bristol Health Scrutiny forum.   Members agreed that the option of a Bristol Health Scrutiny Forum should be established.   The role of the HWB should be about system transformation and leadership. 

Members agreed that serious street violence was a public health priority and confirmed it is included in the One City Plan. Level of violence in Bristol is not comparable to some other cities at the moment but it is important to prevent it from escalating.  

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

The Minutes of the meeting held on the 24^th October 2018 were confirmed as a correct record.

Including the LGA support offer towards the development of HWB

(Jacqui Jensen)

This item was led by Christina Gray, the new BCC Director of Public Health, who was formally welcomed by members.

The current HWB Strategy documentation is reaching its end date.  The purpose of the Board and the Strategy is to address significant health challenges facing this board.  Bristol has entrenched health inequality. The 10 year health gap identified in 1996 remains, even with overall life expectancy increasing. Healthy life expectancy has decreased. People living in deprived wards can expect 30 years of ill health. The Health and Wellbeing Strategy should be the means to deliver on health inequality.  CG drew attention to two existing plans – the One City Plan and Healthier Together both of which provide opportunities to address Health and Wellbeing

CG introduced a draft plan on a page as a framework which captures the Boards Statutory Duties and the opportunities within the two local plans.   The grey boxes are the HWB statutory responsibilities. There are six strategic pillars. The first pair is around achieving One City Plan objectives. The second pair is about better together: improving outcomes and integrated systems. The last pair is about oversight. A performance  dashboard would be  developed to measure progress against the plan.

·       Members welcomed the clarity and focus that the plan on a page brings to HWB. The One City Plan has set health targets for each year which also helps. These targets can flex based on ongoing developments.

·       The voluntary sector can contribute to these headlines, but will need clarity about what they can do, be realistic about scale and is keen to co-design to add value. The plan has clear ‘to dos’ which will facilitate discussions with stakeholders.

·       There is a lot of existing work on integrated care system, including social prescribing and locality networks, which should be active from July.

·       Population health management is critical to these objectives to identify needs within a locality and to deliver in integrated way. Remember that there are other health stakeholders not on the HWB, e.g. NHS England, so think about what they deliver.

·       Shortcomings of the HWB previously include partners reporting business as usual to each other rather than adding value. The plan provides specifics, which is important to attract interest and funding.

·       The dashboard would be critical to monitoring progress and identifying issues

Members agreed the general approach of the plan as a way forward. Members also agreed to have development sessions running alongside HWB meetings. There was acknowledgement that not all members may be able to attend these development meetings, but would send suitable substitutes.

ACTION OH schedule development meetings, running on alternate months to the HWB

Presentation and film clips from the “This Girl Can Move” campaign

(Robert Wooley / Sally Hogg)

Sally Hogg led a presentation of the ‘This Girl Can Move’ campaign, showing pregnant women and young mothers exercising. These photos are currently on exhibition at Southmead and St Michael hospitals. They will be displayed at GP surgeries soon. About 1.3m women in UK are not meeting their physical exercise goals compared to men. Some communities, e.g. Somali women, find it hard to access exercise / sport groups. This campaign comes from Sport England. It is an unexpected resource that produces good health outcomes. Chronic pain is frequently linked to lack of exercise.

Members discussed how the HWB could increase the impact of this campaign, including distributing through workforces, improving mental health with exercise, promoting via schools and governors, and via midwives and health visitors.

ACTION OH to circulate link to video to HWB

Themed discussion

(Jacqui Jensen)

Jacqui Jensen led a presentation and discussion on Adverse Childhood Experiences.   The intention is to have an ACE aware city, one that is conscious about the trauma early adverse experiences can cause across a lifetime. All ACEs are worse in the south of the city. There are strong links between ACE and indicators of development. 47% of people have one ACE, 9% have 4 or more. Rate of diagnosis of long term disease is more prevalent in adults who have experienced a high number of ACEs. There is currently a lack of support for adults who are not parents, homeless and those supported by commissioned services. There are around 50 services represented in task and finish groups working on ACEs. There is lots of interest and practice out there that we can build on. The One City Plan has a health thread through it to prevent ACEs. It is important to establish resilient communities that can break the pathology of ACE so it is not an intergenerational issue. We are working closely with partners in Wales who have put considerable resources into this. We need to establish the case for change, the resources we can save if we prevent these crises happening in the first place. We are working on bid for health integration via big lottery to get a health economist that can do this. There are formulas on parenting programmes that can be drawn on but we need people better knowledge to deliver.

The following points were made in discussion:

·       Resources are tied up in crisis management, it is an enormous cost that needs pushing back. There is a lot on physical health in the ACE presentation, but mental health has a big impact. The actions required would be very similar though. Particular attention should be given to parenting while having mental health issues

·       Almost all social work cases have domestic abuse in them. This affects emotional and mental health.

·       Young carers should be considered in this as they are under high stress

·       Asylum seeker / refugee families also have high needs

·       ACE can have many sub-categories, but strategy should be sticking to basics that can be widely applied to maximise impact

·       Awareness of ACE is in the One City Plan but can be brought forward. For example, people understand that DV is bad, but not that it could increase your risk of diabetes.

·       Serious violence in young people due to a lack of service provision. Desperate youths who think they don’t have a future and rely on gangs for meaning. Not providing services now means greater cost in future. We want to be preventative. We do not want to end up like London, Glasgow or Rochdale. We are learning from them. For example, the creation of a serious violence exec group or health providers making interventions when a young person is seriously injured to bring them out of gangs. We are constantly fighting against mobile technology being used by gangs.

·       Information sharing will be vital to tackling  ...  view the full minutes text for item 39.

Verbal update on the STP

(Julia Ross, Robert Wooley)

Robert Wooley gave a verbal update on the STP, including some recent achievements.

·       Primary care networks are being developed within localities.

·       The Long Term Plan requires a focus on prevention.

·       A citizen panel is being developed with 700 individuals so far and with a target of 1000. It is important that these panels are representative of the population. Eurocities have just reported on 20 citizen panels.

·       There is a formal public consultation about services in Weston Super Mare. 

·       The NHS long term plan requires a move towards ICS (Integrated Care Systems). Bristol North Somerset South Gloucestershire Clinical Commissioning Group (BNSSG CCG) is working with national team to get early involvement and have formally applied to be an ICS. The benefit is access to transformation funding. A big issue is how we get funds to pump prime services and switch service models. We have to produce 5 year plan by this summer, which needs to get solid alignment with the One City Plan.

The Forward Plan was briefly discussed, but will be revisited soon in light of the new strategy and plan on a page.

Summary of Actions

CG observed that it would be helpful to have a Bristol Health Scrutiny function.  This matter to be raised with the Scrutiny Team

OH schedule development meetings, running on alternate months to HWB

OH to circulate ‘This Girl Can’ video

OH to circulate Adverse Childhood Experiences slides / videos