Agenda and minutes

Resolved – that the minutes of the meeting held on the 8^th June 2023 be agreed and signed by the Chair.

There were no declarations of interest on this occasion.

None received.

The Board received a report and presentation from Natasha Moody and Nicola Bromage on the Health in Early Life Priority Progress Update.

The HWBB strategy had a priority for ‘Health in Early Life’ which sought to improve health in pregnancy and infancy with a focus on reducing infant mortality.

The presentation noted the local picture of Infant Mortality, both at Staffordshire, Stoke-on-Trent and the West Midlands. It was noted that Stoke-on-Trent had the highest infant mortality rate in England, whilst Staffordshire was rated 25^th highest. Neonatal and Post-Natal mortality rates were shown to the Board.

The slides further showed the rates across the districts and boroughs within Staffordshire. The Board were informed that whilst there is a lag in the published data, the latest available being from 2021, the 2023 provisional data was promising in a reduction in rates of Infant Mortality.

The Board were shown modifiable factors which would impact on infant mortality cases in Staffordshire. This included:

-      Smoking during pregnancy

-      Poor nutrition

-      Pre-term and low birth weight of babies

-      Access to support from GPs, Midwives, Health Visitors and other key workers

Smoking in pregnancy was highlighted as the top risk factor in infant mortality. The County Council had commissioned a stop smoking in pregnancy service for several years which offered a 12 week behavioural support and NRT therapy to pregnant women who smoke, post-natal support for up to six months and a preventative offer to support Staffordshire Schools.

In a step to overcome infant mortality, a parent education programme, called ICON helped to aim prevent abusive head trauma and help people who care for babies cope with crying. ICON served to show that:

-      Infant crying is normal

-      Comforting methods can help

-      It’s OK to walk away

-      Never, ever shake a baby.

A co-ordinated whole system approach Staffordshire and Stoke-on-Trent was also in place to support breastfeeding. An infant feeding survey aimed at families was carried out to understand experiences and help inform future planning. A total of 752 responses were received. An action plan was in development following the analysis of the survey which had three key priorities:

-      Improve the awareness of and benefits of breastfeeding within the community and for parents

-      Increase the support to breastfeed particularly the first 10 days following birth

-      Embed infant feeding pathway so more people know and access timely help and support.

The Board were further informed of a whole family support system, called the Families’ Health and Wellbeing Service (0-19). This offered holistic support to the entire family with a number of mandated checks.

The Strengthening Families Team work with pregnant and post-natal people and provided more targeted support for children known to services. They provide a named health worker for each eligible family and focus on achieving high quality outcomes.

It was noted by the Board that whilst there was significant work underway to address varying modifying factors of infant mortality, the approach was somewhat fragmented and lacked  ...  view the full minutes text for item 10.

The Board received a report and presentation from Baz Tameez on progress within Healthwatch Staffordshire and in particular an update on the three deep dives undertaken:

-      Root causes of good and poor teenage mental wellbeing and health outcomes when you’ve been in care as a child

-      Access to primary care

-      Seldom heard groups

Healthwatch Staffordshire had been working with Healthwatch England to use a theory of change model to focus resources in areas in the deep dives where it was most needed. This sought to increase chances of successful outcomes, identify what was working and what wasn’t, so the approach could be adjusted and resources targeted.

The theory of change model also sought to measure and communicate the effectiveness of the work undertaken and evidence the outcomes achieved.

The methodology for the deep dives was presented to the Board, which included:

-      Face to face events

-      Surveys and questionnaires

-      Focus groups

-      Case studies

-      Social media

-      Desktop research; and

-      Partnership working

The slides further demonstrated the root causes of good and poor teenage mental wellbeing and health outcomes when you’ve been in care as a child. Healthwatch had been working with the County Council and the ICS to co-ordinate and contribute to the development of a new ‘Staffordshire Joint Mental Health Strategy’. This seeks to address and help improve the mental health and mental wellbeing of young people and uses six key outcomes identified from engagement activities.

Early key themes and recommendations showed that primarily young people prefer to have face to face appointments with the flexibility of other means to engage, the transition from Child Adolescent Mental Health Services into Adult Mental Health Services needed to be smoother, reducing the risk of vulnerable people slipping through the net and reducing waiting times by utilising more referrals to other providers.

The Access to Primary Care deep dive showed that 92% of NHS consultation took place at the GP and this was where Healthwatch was receiving the most feedback, along with dentistry. Feedback showed that one patient made over 210 calls over two days before they got through, but did get the treatment they needed once booked in.

Healthwatch had been supporting the ICS with their Primary Care Access Campaign in line with the new delivery plan, by promoting the Additional Roles Reimbursement Scheme (ARRS).

Early key themes emerging from patient feedback included:

-      Neurodiversity – reasonable adjustment was required for patients with communication needs

-      Cost of living was making it difficult to afford prescriptions and travel to appointments

-      Telephone access remained an issue for patients and found waiting times frustrating

-      Patient registration which were specific to Burntwood and East Staffordshire

-      Digital communication challenges including the use of the NHS App

-      Mixed views on patient experiences with NHS 111

The Board were informed of next steps on this deep dive which included the potential role of PPGs, supporting changes in local practices, the continuation of the work with  ...  view the full minutes text for item 11.

The Board received a presentation from Amanda Stringer on the Care Quality Commission Single Assessment Framework.

The presentation demonstrated the following areas of interest:

-      Providers

-      Integrated Care Systems

-      Local Authorities

CQC were suggesting that an assessment of a local authority would take around 20 weeks, with notice given to collate evidence including a self-assessment. Evidence would be primarily reviewed off site, with the on-site assessment taking two days and one day spent in virtual meetings. There would be an opportunity to review the report before it was published.

The self-assessment to date included assessing needs, supporting people to live healthier lives, equity in experiences and outcomes, care provision integration and continuity, partnerships and communities, safe systems pathways and transitions, safeguarding, governance management and sustainability, learning improvement and innovation, with strengths and areas to work on identified against each assessment criteria.

Garry Jones queried whether an overall rating would be provided, similar to that of OFSTED, despite recent learning from inspections at schools. Amanda confirmed that an overall rating would be provided but a full report would identify how this position had been reached.

Richard Harling asked a question to the Board, what help and support would be needed to make an informed representation.

Councillor Jessel supported the comments made by Garry and noted the impact that a rating would have on staff, confidence of service users and the ability to recruit.

Councillor Sutton queried if a self-assessment would be completed and shared beforehand to demonstrate awareness of any issues present. Amanda confirmed this was in place and regularly updated and tested with partners.

Resolved – that the presentation be noted.

The Board received a report and demonstration from Emma Sandbach on the development of the Joint Strategic Needs Assessment for Staffordshire.

Since the last report, a JSNA steering group had been established to oversee the development of the assessment. The group had representatives from key local organisations including the County Council, ICB, District and Borough Councils, MPFT and Stoke-on-Trent City Council.

A working group that met on a more regular basis had also been established, which supported the development of the content of the JSNA chapters. The initial chapters would follow a life course approach, including an initial focus on population demographics, starting well, living well and ageing well. Due to the complexity of the piece of work, it would be necessary to complete the JSNA in phases, and it would become an iterative process to be continually updated and augmented as data sources evolved.

To date, detailed mapping had been undertaken on the data requirements for the population demographics chapter. This included collating all requirements for data indicators, sources, dates, geography, etc. A detailed mapping for the Ageing Well section had also been started.

The working group would be asked to scrutinise the various datasets and indicators to be included in each chapter which would ensure that members of the group with expertise in data or in the subject would be confident that the right information is included.

The first draft of the demographics chapter would be available to view in October 2023, and a further update report would be brought to the Board in December 2023.

Resolved – that the Board support the development of the Joint Strategic Needs Assessment 2023 and note the timescale for its development.

The Board received a report from Rose Cororan on the Staffordshire Better Care Fund.

The 2023-25 BCF Policy Framework required the submission of BCF Plans by the 28^th June 2024, to include a narrative plan and an expenditure template, capacity and demand, as well as ambitions and delivery plans for BCF metrics. Plans were expected to be assured by the 8^th September 2023.

Staffordshire’s plans had been completed and were approved by the Health and Wellbeing Board Chair on the 27^th June, under delegated authority. Plans were subsequently submitted.

The total ICB ASC Discharge Grant allocation for 2023/24 was £5.148m, and £9.837m for 2024/25. The current proportion split used in the submission to each HWB area was 72% Staffordshire and 28% Stoke-on-Trent, which was not consistent with the adult population of the Integrated Care System which was 78% Staffordshire and 22% Stoke on Trent. This meant that of the £5,148m and £9,837m allocated in 2023/24 and 2024/25 respectively Staffordshire would receive only £3,706,560 and £7,082,640 compared to our fair shares of £4,015,440 and £7,672,860, a shortfall of £899,100 over two years. The Council had requested that the apportionment of the ICB’s ASC grant allocation in 2024/25 was reviewed to redress this imbalance.

Resolved – that the Board (a) note that the 2023-25 BCF Policy Framework was published in April 2023 which required the submission of BCF Plans by 28^th June 2023;

(b) Note that the Staffordshire 2023-25 BCF Plans had been submitted, including a narrative plan, expenditure template, capacity and demand and ambitions and delivery plans for BCF metrics;

(c) Note that the expenditure plans for the 2023/24 and 2024/25 SCC and ICB Adult Social Care Discharge Grants had been agreed, and were detailed in tables 2 and 3 of the report; and

(d) Note that the current proportion split of the ICB ASC discharge grant to each Health and Wellbeing Board area was not consistent with the adult population of the Integrated Care System, and that the Council had requested that the apportionment of the ICB’s ASC grant allocation in 2024/25 was reviewed to redress this imbalance.

The Board received a report for information on the comparative health metrics and performance indicators update on the Health and Wellbeing Board Strategy.

At the Board meeting in March 2023, to support the monitoring of the strategy, baseline data was provided. For each of the four priority areas, a priority lead was assigned with agreement that each priority area would be the focus for discussion in more depth at a different quarterly meeting, including discussion of the associated metrics/indicators. The lead officer for the Good Mental Health priority had suggested that further metrics ma be added to their area.

Since the March meeting, discussions had taken place and one further metric was added: ‘New referrals to secondary mental health services for those under 18 years of age’.

Resolved – that the Board note the contents of the report.

Due to the non-attendance of the Staffordshire Police representative for the meeting, this item was not considered, but assurance had been given to the Chair that an appropriate representative would be sent to the December meeting to provide an update.

The Board held a discussion on the item and what Right Care, Right Person meant, and sought to clarify engagement events that had taken place with various partners.

Councillor Jessel asked that the Board request that partners are kept fully informed and provided with a demonstration on how the system would work before the initial go-live in February.

The Board noted the following items for consideration at their December meeting:

-      Good Mental Health Priority Progress Update

-      Staffordshire and Stoke-on-Trent Adult Safeguarding Board Annual Report

-      JSNA Update

-      Right Care, Right Person

Resolved – that the Forward Plan be received.

Resolved – that the date, time and venue of the next meeting (Thursday 7^th December 2023 at 2:00pm in the Oak Room, County Buildings, Stafford), be noted.

Resolved - That the public be excluded from the meeting for the following items of business which involves the likely disclosure of exempt information as defined in the paragraph of Part 1 of Schedule 12A (as amended) of the Local Government Act 1972 as indicated below.