To receive any apologies for absence.

Apologies for absence were received from Councillor Coppinger, Prince Obike and Tracy Hendren.

To receive any declarations of interest.

The Chairman declared a personal interest as he was an independent healthcare consultant, infectious disease specialist and vaccines expert and he had formerly worked for Sanofi Pasteur. He was currently working as an adviser for the Vaccines Taskforce and Antiviral and Therapeutics Taskforce. Councillor Carroll declared this in the interests of full transparency and to highlight that should for any reason during the meeting, or indeed during future meetings, the Health and Wellbeing Board discussed anything directly related to Sanofi Pastuer’s business he would abstain from the discussion and leave the room as required.

To confirm the minutes of the meeting held on 18^th January 2022 and to consider any relevant actions from the meeting.

RESOLVED UNANIMOUSLY: That the minutes of the meeting held on 18^th January 2022 were agreed as a true and accurate record.

To receive an update from Huw Thomas.

Huw Thomas, Clinical Chair NHS Frimley CCG, said that the pandemic was not over. GP practices were open but were still operating differently, with strict safety, infection prevention and control measures in place. However, there had still been a significant number of cases seen in practices. There had been an increase in demand for all appointments, with more patients considering their condition to be urgent. There was a backlog of routine chronic disease management including diabetes, respiratory and heart disease. An ongoing effort was to offer preventative services and GPs had continued to manage people on waiting lists to access community and secondary care services. Workforce morale and retention was difficult under current measures, with capacity stretched across a number of services including vaccinations. There had been a lot of sickness absence from staff, both Covid and non-Covid related.

Caroline Farrar, Executive Place Managing Director CCG, explained what was happening to improve patient access. Capacity had been increased with £6 million being invested to provide around 59,000 additional appointments across Frimley from October 2021 to April 2022. There had been an increase in workforce capacity and the skills mix that staff offered, while additional premises capacity had also been released. Digital support was being utilised, ensuring that patients got the right care for their needs, while telephony systems had been upgraded to further increase capacity. Caroline Farrar said that it was important that GPs continued to engage and communicate with residents, primary care networks had been supported to improve this. Population health management had been used to ensure that those that needed additional support were targeted and reduced health inequalities. Primary care networks had been developed so that scale models of care were based on local population needs.

Caroline Farrar showed some data to the Board, outlining the increase in capacity of appointments over the past couple of years, along with the overall comparison of activity levels across Frimley.

Changes had been made to GP practices, appointments could be triaged which would allow GPs to determine if a patient needed to be seen in person or whether a virtual or phone consultation was more appropriate. Receptionists were being trained to allow them to direct patients in the right direction and free up time and resource for GPs. Additional staff had been brought into each practice to better support the practice, the best person would be connected to the patient and this would not always necessarily be the GP.

Caroline Farrar concluded by saying that more appointments were available in general practice than ever before, but more people wanted and needed appointments now than before the pandemic. Colleagues were working hard to improve capacity and appointments could therefore be triaged based on clinical needs and priorities. Additional appointments were available across RBWM, in Maidenhead, Windsor and Ascot.

Huw Thomas showed a piece of communication which had been advertised to patients to show them where they needed to go if they were feeling unwell.

The Chairman agreed that the pandemic was not  ...  view the full minutes text for item 295/15

To note the report.

Anna Richards, Consultant in Public Health, said that it had been agreed at the last Board meeting that there would be a focus on smoking.

Charlotte Fox, Public Health Programme Officer, explained that a Health Needs Assessment (HNA) had been undertaken on smoking in RBWM. There was a goal in the Corporate Plan to reduce the number of residents that smoked in the borough. There were three main aims of the HNA:

·         How many residents smoke and did it vary across different groups?

·         What services did residents have to support them to stop smoking?

·         Was there anything that should be done differently to help people to stop smoking?

Considering the evidence of best practise, all frontline health professionals provided brief advice to anyone that they came into contact with, who had been identified as a smoker. Services had an aim to treat 5% of the estimated population who smoked each year. Of those who accessed services for smoking cessation support, 35% or more should achieve a successful quit within 4 weeks. It was also recommended that behavioural support and pharmacotherapy was made available to adults that smoked.

The NHS Long Term Plan suggested that by 2023/24:

·         All people admitted to hospital that smoked would be offered NHS-funded tobacco treatment services.

·         The model would also be adapted for expectant mothers, and their partners, with a new smoke-free pregnancy pathway which included focused sessions and treatments.

·         A new universal smoking cessation offer would be made available as part of specialist mental health services for long term users of specialist mental health.

Charlotte Fox explained that different data sets had been used as part of the HNA, which could provide slightly different results depending on the data which was used. In RBWM, just under 10% of the population or 16,195 people, were currently smokers. This was 6,495 male and 9,700 female, with 77.7% being of white ethnicity. This data was caveated as it relied on clinical coding on GP records, which could be out of date if patients had not visited their GP for a duration of time. Therefore, the first recommendation of the HNA was to work collaboratively with Frimley ICS, Primary Care Networks and GPs to identify any current gaps to improve how smoking status data was recorded on patient records. After considering the data on who smoked and who needed the service, the second recommendation was to undertake targeted work with those residents and communities who had disproportionately high rates of smoking.

Considering the current service provision, a smoking cessation specialist practitioner provided behavioural support for adult residents. Pharmacotherapy was not currently provided and the service did not currently perform carbon monoxide validations for quits. The third recommendation of the HNA was to use evidence to start discussions and develop a costed appraisal to determine the health impact of providing pharmacotherapy with psychosocial support, balanced against the financial impact. In 2019/20, there were approximately 55 people in RBWM that set a quit date, with 73% achieving a successful 4  ...  view the full minutes text for item 296/15

To receive a presentation.

RESOLVED UNANIMOUSLY: That the order of agenda items was changed, so that the priority focus of the meeting was considered before the Terms of Reference for the Strategic Partnerships.

Hilary Hall, Executive Director of Adults, Health and Housing, said that the priority was based around championing mental wellbeing and reducing social isolation.

Joanne Cocksey, Clinical Phycologist, gave a presentation on the Phoenix Unit. This was a day hospital and home treatment service for young people between 12-18 years of age with moderate to severe and complex mental health disorders whose needs could not be met within community settings. The day programme consisted of a structured programme of therapeutic activities on site. The unit was open every day of the year, between 8am – 8pm Monday to Friday and 9am – 5pm at weekends and bank holidays. There was capacity for 16 young people at any one time, it was anticipated that eight would be on the day programme and eight on home treatment but this was flexible. The intensity of the support depended on the individual needs, with the aim of stabilising the individual to allow them to transition back into community care as soon as possible. The aim for the average length of stay was 12 weeks.

The Phoenix Unit could offer a number of services, including multidisciplinary assessment, medication initiation, dietetic advice and education support. Joanne Cocksey gave an example of the daily routine for an individual at the unit. A number of different groups were also run, for example a motivational and resilience group, a parent support group and a nutrition group. Joanne Cocksey gave some examples of case studies for individuals who had been through the service, the support they had received and how their journey had progressed through the service, along with some positive feedback.

Councillor Stimson said that she was really impressed, when young people left home parents had a lot less control. She asked if there was any scope for any other capacity at the service, for example other activities which could be offered to individuals.

Joanne Cocksey said that the service balanced the approach of meeting the needs of individuals while allowing families to stay together.

Anna Richards asked if there was anything that could be done earlier in the community to support these young people.

Joanne Cocksey said that early intervention was needed, the earlier the service was able to intervene the better chance of preventing health issues from occurring. The mental health support teams were being developed in schools to work with young people at an earlier stage, it was important to listen to young people and understand how they were feeling.

Kevin McDaniel asked about the workforce and if there were any concerns over the capacity of the service from the workforce side of things.

Joanne Cocksey said that the service was well resourced currently, looking at broader CAMHS support there were difficulties with recruitment as there was a big demand for services.

Deborah Nicholls, Physical Health Clinical  ...  view the full minutes text for item 297/15

To consider the report.

Hilary Hall explained that there was a proposal to set up two strategic partnerships, one for adults and one for children, this would give focus on the key strategies going forward. There were some specific strategies from an adult social care viewpoint which needed to be put in place for the new inspection and assurance process. The strategic partnership board was a forum where this could be developed. The Health and Wellbeing Board were asked to note the terms of reference, an update report would come back to the Board in six months time.

The Chairman said that the report was clear and detailed, he was happy with the proposal.

RESOLVED UNANIMOUSLY: The Health and Wellbeing Board was asked to:

a)    Note the terms for reference for the two Strategic Partnership Boards.

b)    Note that a progress report from each Board would come to the Health and Wellbeing Board in six months’ time.

To receive an update on the work of the Outbreak Engagement Board.

Hilary Hall gave an update on the Outbreak Engagement Board, which had been meeting monthly for the last 18 months. The Board ensured that there was good communication and engagement with residents, cases had continued to rise but without restrictions there was little that the Board could influence. The Outbreak Engagement Board was set up as a subgroup of the Health and Wellbeing Board, Hilary Hall asked if the Board should continue meeting, or if the frequency of meetings should be changed to reflect the situation.

The Chairman said that while the pandemic was not over, it was sensible to look at the frequency of meetings. If things changed drastically, more meetings could be scheduled but he did not want to stretch officer resources and time.

Hilary Hall said that she would look to amend the frequency of meetings, a more substantive update could be given at the Health and Wellbeing Board as a result.

ACTION – Hilary Hall to investigate changing the frequency of meetings of the Outbreak Engagement Board.

To receive an update on the strategies.

Hilary Hall said that the report had been circulated to Board Members.

The Chairman said it was pleasing to see the high performance of the Housing team in terms of output and also that the integration of services was delivering positive outcomes.

To hear an update on the Better Care Fund.

Hilary Hall updated the Board and said that the Better Care Fund (BCF) was a pooled budget between health and social care of around £13.8 million. The primary objectives were around:

·         Protecting adult social care.

·         Preventing hospital admissions.

·         Supporting people to live independently at home.

·         Reducing delayed discharges from hospital.

The BCF Plan was signed off at the end of 2021, RBWM had signed off the section 75 agreement. The planning guidance for 2022/23 had not yet been issued, even though the new financial year started at the end of the week. The indicators showed that the council was on track with the BCF. For example, on the indicator around reablement, the target was 87.5 and the council was currently at 86.5. On admissions to care homes, the council was on target. At the last meeting of the group, each target was discussed and the plan for next year was considered.

To discuss items which will be considered at a future meeting of the Board.

The Chairman said that if there were any items that Board Members would like to see added to the agenda, he was happy to consider them.

Councillor Stimson said an item on the climate partnership would be useful, particularly considering the link between health and wellbeing and climate change. She would forward on the information to Board Members so that they could consider if it was something that they would like to add to a future agenda.

The Chairman said that it sounded like a good suggestion.

·         Tuesday 12th July 2022 – 3pm - Zoom

·         Tuesday 18th October 2022 – 3pm - Zoom

The next meeting of the Board was scheduled to take place on Tuesday 12^th July 2022, starting at 3pm.