Agenda and minutes

The Board is requested to formally approve Councillor Stephen Williams, Chair of the Public Health and Communities Policy Committee, who has been nominated to be Chair of the Bristol Health and Well Being Board for the 2024/25 Municipal Year.

The Clerk requested that the Health and Well Being Board elect Councillor Stephen Williams (Chair of the Public Health and Communities Policy Committee) as Chair of the Health and Well Being Board following agreement between the political groups.

RESOLVED – that Councillor Stephen Williams be elected chair of the Health and Well Being Board for the 2024/25 Municipal Year.

The Board is requested to formally approve Councillor Lorraine Francis, Chair of the Adult Social Care Policy Committee, who has been nominated to be Vice-Chair of the Bristol Health and Well Being Board for the 2024/25 Municipal Year.

The Chair requested that the Board elect Councillor Lorraine Francis (Chair of the Adult Social Care Committee) as Vice-Chair of the Bristol Health and Well Being Board as agreed between the political groups.

RESOLVED – that Councillor Lorraine Francis be elected Vice-Chair of the Health and Well Being Board for 2024/25 Municipal Year.

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 requested everyone present to introduce themselves.

Attendees were also reminded of the emergency evacuation procedure.

Apologies for absence were received from: Board Members - Hannah Woodhouse, Mette Jakobsen, Carl Tams (Suzy Giullari substituting), Rebecca Dunn (Sarah Naddin substituting) Officers: Penny Germon and Carol Slater.

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.

RESOLVED – that he minutes of the meeting held on Wednesday 31^st July 2024 were agreed as a correct record and signed by the Chair.

Matters Arising

The Board noted outstanding actions concerning the Plan on a Page and Population Health Outcomes.

              Integrated Care System -Wide Approach to Weight

              The Board noted outstanding action for this item.

ACTION: Presentation by Sally Hogg – Work Priorities on the impact of a lack of suitable food options for disadvantaged families that could lead to problems for children with unhealthy weight – add as an item to a future Development Session – Mark Allen-Richardson to arrange

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 25^th July 2024.

Petitions and Statements - Petitions and statements must be received two working days prior to the meeting.  For this meeting this means that your submission must be received in this office at the latest by no later than 12pm on Monday 29^th July 2024.

Members of the press and public who plan to attend a public meeting at City Hall are advised that you will be required to sign in when you arrive and you will be issued with a visitor pass which you will need to display at all times.

Public Forum was received from Frances Robertson in respect of Agenda Item 10: Local Community Concerns – Planning Provision.

The Chair advised that, as he had only recently been nominated for this role, he had not yet attended a meeting of the ICP. However, he had been briefed by officers on recent items that had been discussed.

He advised the Board that, whilst this had been a relatively quiet period, there had been discussion on three issues: (1) Children’s Health Improvement at  workshop (2) the ICB’s 2040 Strategic Vision launch (3) A Mental Health Strategy and Action Plan

The Board noted the representatives from their body who attended ICP and ICB meetings.

Christina Gray introduced this report and made the following comments:

·       The PNA (Pharmaceutical Needs Assessment) had been undertaken jointly with South Gloucestershire and North Somerset Councils and had been completed in October 2025

·       The PNA was a responsibility of HWBBs and needed to be reviewed every three years

·       The process involved market analysis and a required methodology

·       If the PNA was carried out across all three Local Authorities, it would make better use of the total resources available. Therefore, the HWBB was requested to give officers authority to undertake this work on a joint basis

·       Joe Poole expressed support for this process on behalf of the ICB Board

In response to members’ questions, Christina Gray confirmed that the document would still address the individual needs of each Local Authority but would enable greater efficiency by avoiding duplication by separate LA’s. She confirmed that various groups would need to be involved ie pharmaceutical groups. Since in house analytics would be used, there would be no additional cost and more creative solutions could be found if required.

RESOLVED  - that the HWBB approves the recommendations contained in the report.

ACTION:

(1) note the Board’s statutory responsibilities

(2) approve the recommended approach for delegating, updating and reviewing the Bristol PNA, as set out in sections 3, 4 and 5 of this report.

c) note the Board’s statutory requirement to sign-off and publish the final version of the PNA before 1 October 2025.

Rachel Metcalfe/Christina Gray to take action as appropriate

In introducing this item, the Chair noted the Public Forum statement by Frances Robertson concerning the refusal by NHS England to approve the application for a pharmacy on the former Boots site in Southmead. He explained that, since the location for this site was close to his ward, he had received numerous representations concerning this.

Christina Gray advised the HWBB that a RIA (Rapid Impact Assessment) had been made following a review of two pharmacy closures in Southmead and Hartcliffe.

Rachel Metcalfe gave a presentation on this issue and made the following points:

·       The RIA was part of the HWBB’s responsibility to review any decisions made concerning closures

·       There had been an application by the Health Care Consultancy to re-open two pharmacies in Southmead and Hartcliffe in February/March 2024 but these applications had not been approved by NHS England

·       The RIA showed two maps, one with the pharmacy present and one without. Details were provided of the difference in walking distance for both locations – for example, In relation to the Hartcliffe Pharmacy a 7/8 minute walk would now be a 20 minute walk

·       The decisions did not take into account the inequalities aspect of these cases since Hartcliffe was in one of the most deprived areas of Bristol and the lack of pharmacy provision would impact access particularly for those with disabilities

·       The HWBB Was recommended to consider writing to the NHS Regulatory body to highlight these concerns (jointly with the Health Scrutiny Committee)

The HWBB made the following comments and officers responded as required:

·       Whilst Page 27 of the report stated that every resident in Bristol would be within a 20 minute drive of a pharmacy, this did not take into account the fact that some residents did not have access to cars or of people’s ability to walk. Since some areas were hilly (for example parts of Westbury-on-Trym), walking to a pharmacy could involve going up and down a steep hill

·       Whilst there had been previous attempts to challenge the assumptions upon which the decision was based (ie the closure of the Lawrence Weston Wellspring Healthy Living Centre), these had been unsuccessful

·       The issue of topology as a factor and of alternative provision being in high streets not in high streets were further issues that needed to be drawn to the attention of NHS England

·       There was a need to challenge the current national metric itself as a concept since it did not take into account all the intricacies involved in this issue. In addition, a key concern was the new Community Diagnostic Centre (CDC) as a key aspect of the role of the assessment within new legislation

Whilst it was noted that the HWBB could not address the specific pharmacy application, it could challenge NHS England about some of the wider assumptions made as part of the assessment of the criteria.

involved.

ACTION:

(1)  Joe Poole (ICP Representative) to find out if the ICB can be consulted on the decisions made by NHS England concerning  ...  view the full minutes text for item 10.

Jamie Mahood gave a presentation on this item in Mette Jakobsen’s absence and made the following points:

·       The definition of Adult Social Care was important to establish how engagement with communities would take place

·       A vision had been established following workshops with those involved in care and support as part of a wider care and support network. Details of this were outlined

·       The assessment had indicated the importance of certain issues to those consulted such as friendships and romantic love. The importance of listening and providing real choices was outlined

·       The requirements of the provider were set out such as being kind and using resources wisely

·       This was a simple statement of how the providers of the service wished to engage as part of the co-design

Board members made the following comments and Jamie Mahood responded as appropriate:

·       The language in the vision was clear and resonated. It could assist in explaining to users what is involved in the process

·       This was a very aspirational model and would be dependent on resources being used wisely

·       It would not be possible to provide a gold standard service. There was a need to provide appropriate support for communities to enable people to thrive

·       A piece of work had been carried out approximately a year ago involving 10 focus groups. It was important to acknowledge the involvement  of voluntary groups in the process

·       Plans were being put in place to develop community capacity and community anchor organisations as part of a community engagement process.

ACTION:

(1)         take note of the Vision for Adult Social Care

(2)         share the vision for Adult Social Care with their communities of   interest

All HWBB Partners to share the Vision for ASC with communities of interest – Mette Jakobsen/Jamie Mahood to oversee

Paul Flood introduced this report and made the following points:

·       The BCF (Better Care Fund) had been in place for about 12 years to support health and social care work and to bring them closer together. Its purpose was to help ensure people received care in the right place from the right people at the right time

·       The HWBB’s attention was drawn to the 2024/25 BCF Plan including the Section 75 agreement with recommendations for sign-off, oversight and assurance

·       Following work carried out between BCF and Local Authority colleagues, BCF had signed off on the plan for national cross regional collaboration

·       There would be a system-wide review, following which there would be an assessment of the discharge of the BCF which was likely to be considered for 2025/26

·       As part of a large uplift in the discharge grant for 2024/25, there would be an additional 8 investments during that financial year. This grant could not be used for supporting core activity but purely for re-ablement and hospital discharge

·       A link worker would provide support for patients for timely advice and sign posting for non-statutory and community based services

·       A short term domicillary service acted as a bridging service with built-in systems benefits to ensure that providers were enabling services rather than carrying them out

·       The deployment and performance management aspects of the service required careful monitoring in view of the large financial sums involved

·       Some final discussions were taking place with the legal team to regularise the number of Section 106 agreements with the signature pending by 2023/24 and a target date for completion for 2024/25 by September 2024

Board members made the following points and Paul Flood responded as required:

·       The architecture for a performance monitoring framework and proportionality was already in place. Regular meetings were taking place to ensure key issues were addressed such as stronger linkage to show cost avoidance and cost savings

·       The contracts reflected volume and input and subject to the type of work and capacity, provided an opportunity for path finding

·       There is a very high level of monitoring activity for this area of work. Whilst some work could be provided to the HWBB throughout the year as part of this work, it was important to avoid the HWBB becoming too heavily focused on monitoring rather than strategy, since the former was a key role for the newly established Adult Social Care Policy Committee

ACTION:

(1)         note that performance management of the BCF will be carried out by the Adult Social Care Policy Committee

(2)         that an update report be brought to a future HWBB Board meeting after 6 months to assess the BCF’s impact and feed into a qualitative discussion on this area of work – Paul Flood

Cindy Mann and Vicky Marriott gave a presentation on this issue and made the following points:

·       This project had been volunteer led by Healthwatch with support from BNSSG

·       Engagement took place with people in BNSSG from the 20% most deprived neighbourhoods in England (South Bristol and coastal communities of Weston-super-Mare in the BNSSG area)

·       The project focused on specific groups at risk of poorer than average access and outcomes from healthcare, including poor digital access, people with serious mental health difficulties, people with learning disabilities, recent migrants, recent mothers in deprived areas, homeless and traveller communities

·       Details were provided of the Core20 PLUS 5 project which focused on the five barriers that created health inequalities - lack of proper maternity care, serious mental health, chronic respiratory disease, early cancer diagnosis and hypertension case -finding

·       Discussions took place with 118 people with local needs in South Bristol (Hartcliffe, Withywood and parts of Knowle) and Weston-super-Mare around the Healthy Living Centres with the most need.

·       The Board noted the reasons for people giving up accessing health care – including a lack of local physiotherapy provision with many in these groups having to travel to North Bristol NHS Trust to obtain support, the impact of transport cuts, difficulties of obtaining timely GP appointments, a lack of training for some receptionists in providing initial screening for callers to a surgery

·       The recommendations to the Board included more flexible triage systems, requesting more flexible appointment times and focusing resources on training for some staff

·       Certain organisations were acknowledged as the only means of providing services to certain groups such as travellers and van dwellers ie Compass Centre and Health Visitors Centre

·       The greatest barrier was the means of access. If there were better access, there would be fewer delays

·       The limitations of research were provided and included the time allocated and understanding barriers for adults with the 5 conditions which demonstrated the need for access to activities (Core 20PLUS 5 as listed above)

·       Key areas for the HWBB to concentrate on included connectivity with ICS, an encouragement for effective leadership, tackling inequalities, establishing a more precise picture of need, ensuring resources were allocated proportionately with need and attracting the workforce to areas of the highest need including training support for staff

There then followed a brief discussion concerning what the next steps should be following this research.

It was noted that there had always been a tension between acute and long term care, in addition to the differing needs of different demographic areas ie Weston-Super-Mare where substance abuse was very high. There was an acknowledgement that some receptionists needed greater training in the most appropriate and effective means of acting as gatekeepers to GPs without being required to make an approximate diagnosis.

The Board noted key issues arising out of the discussion such as inequalities and public transport and which also required the involvement of the ICB.

ACTION:

(1)         Joe Poole (ICP Representative) to discuss the issue of health inequalities in the Primary Care Networks  ...  view the full minutes text for item 13.

Grace Davies introduced this report. The Board received a presentation from Ped Asgarian and Lucy Tordo-Gillingham and made the following points:

·       The context was provided for the Bristol Good Food Plan with 6 core elements or working themes

·       A brief overview was provided of the One City Food Equality Strategy which had been launched in June 20222 including the definition of food equality and the 5 key priority areas – Fair Equitable Access, Choice and Security, Skills and resources, a Sustainable Local Food System and Food at the heart of decision-making

·       A 3-year action plan had been launched in 2023 Food Justice fortnight

·       The report provided 5 case studies with different priorities and themes and local data insights. This included recommendations on actions to focus on the incoming year and primarily sourced organisations

·       It was noted that part of Feeding Bristol included management of a community element. The report included case studies on inequalities and indicated progress on the majority which was a very good start since it was still in the early stages of the plan

·       Examples of good practice includes shaping places for healthier lives, provision of a household support fund and a Bristol local food fund, co-producing solutions with CYP, Lush Greens (who provided locally grown ethical food in the Whitchurch area and worked with local food banks to provide food for the community) and food disaster planning (cross sector collaboration with both Universities and providing information on how to better prepare for future disasters)

·       Approximately 100 organisations had received funding last year and provided local food including distribution

·       The project needed secure funding arrangements, effective communication and a joined-up approach (how to work with neighbouring Local Authorities such as BANES)

·       The Board was requested to approval the 1^st Year Progress Report to enable a more joined-up approach

The Board noted key issues such as healthy weight, tackling diabetes and the development of the allotment service (including the food growing community, food for schools and children, transport and the local provision of food). It was further noted that VOSCUR would be a key element of this work, as well as the role this work played in helping mental health and supporting acute hospital provision.

RESOLVED  - that the report be noted.

In view of the lack of time for proper discussion, this item was deferred to a future meeting – either a Development Session and/or formal Board Meeting (to be discussed further) and placed near the beginning of the relevant agenda(s)

ACTION: Katie Porter/Celia Marshall (to bring report back)/Mark Allen-Richardson (to schedule as required)

Hugh Evans gave a verbal report on this item to the Board and made the following points:

·       Six Local Authorities in the North and South West regions had received notice of the intention of the CQC to undertake an adult social care assurance inspection including in the South West region – Gloucestershire on 2^nd September 2024, BANES on 9^th September 2024, Wiltshire on 23^rd September 2024 and South Gloucestershire on 30^th September 2024 with North Somerset and Bristol likely to be inspected in early October 2024

·       This would be subject to confirmation very shortly with details of a pre-meeting approximately 4 weeks in advance to provide certain advanced information required by the CQC

The next formal Board meeting is scheduled to be held at 2.30pm on Thursday 24^th October 2024 in the Bordeaux Room, City Hall, College Green, Bristol.

The Board was advised that the next formal Board meeting was scheduled to take place at 2.30pm on Thursday 24^th October 2024 in the Bordeaux Room, City Hall, College Green, Bristol.