To receive the presentation.

Kevin McDaniel gave a presentation and spoke about the third priority, which was to target prevention and early intervention to improve wellbeing. People were good at reacting to things that had happened because the impact could be seen, but less good at investing in preventing things from happening in the first place. There were three types of prevention; primary, secondary and tertiary. For every £1 invested in prevention, the return could be around £14 saved across the rest of the healthcare system. Research showed that prevention was a long-term game, some benefits came through in a year or two, but it could be as long as 15-20 years before some benefits of prevention were seen after the initial investment had been made. Considering the RBWM Corporate Plan, two of the main objectives in the plan linked to prevention:

·         Investing in prevention and intervene early to address problems before they escalated.

·         Promoting health and wellbeing and focus on reducing inequalities across all areas.

Kevin McDaniel outlined the gap in expected progress at school between those children living with financial deprivation, compared to the rest of the cohort. There was early help available to young people, for example there was a ‘starting well ambition’ across the Integrated Care System which had funded community led projects for young people. Family Hub services had been refocused on hard to reach groups, while edge of care services provided help to families to allow them to deal with the pressures experienced in everyday life.

Prash Patel said that when looking to make patients lives better, it often started at the reactionary level. He felt that RBWM was ahead of the curve when it came to ensuring that prevention was a focus, the idea of getting prevention into communities would allow it to be more prosperous in the long term. It was clear where the problems were but it could often be difficult to achieve changes in these areas. Prash Patel considered the film Jaws, where the impact of the shark attacks on the community could have been prevented if a preventive approach had been taken, but this would not have been easy to do. Prevention was a leap of faith, long term goals meant that the outcome would not be known for a significant number of years. Broad stroke targeting had its place but Prash Patel felt that there needed to be innovation to discover the inequalities in communities and understand exactly what they needed. The council had the tools to look at these inequalities at a ward level and this would allow prevention to be implemented in the right areas. One particular issue in RBWM was the ageing population, who could be using resources in both primary and secondary care. If frail members of the community could be identified, interventions could be offered. This was currently being trialled in primary care. Other innovations included using opportunistic screening at vaccination centres across the borough. Prash Patel concluded by explaining that it was important for health leaders, clinicians, public health colleagues and local authority representatives to work together on prevention across the borough.

The Chairman said it was important to take an integrated approach to prevention, there needed to be a proactive approach. One example was the launch of mental health teams within RBWM schools. Prevention was a critical principle and it needed to be delivered as a core reality. An ageing population was a good thing but the health service needed to be aware of the additional resources that would be required.

Caroline Farrar, Executive Place Managing Director CCG, said that the Population Health Management Development Programme had two main objectives, accelerating changes to care delivery and advising the systems infrastructure. This would allow the CCG to take more preventive steps. Population Health Management was the practical arm of prevention, it was about using health data to work with local communities so that preventions could be designed and targeted effectively. The programme had currently one introductory session and would be resumed shortly, it had been paused over winter due to pressures on the service.

Ed Harrison said that there was an exciting opportunity to use the Population Health Management programme. Cycling lanes coming to Windsor could see improvements to the number of residents that chose to cycle, the council needed to ensure that things in the borough were easily accessible by bike. Smoking support was variable from each service, this was a crucial area of self-care. Self-care weeks and programmes were something that the primary care network was keen to engage in. Edward Harrison said that when he worked in Bracknell Forest, there was a self-care week which worked well and helped to raise awareness.

Anna Richards said that the public health team had established a smoking cessation service in the borough, a health needs assessment had recently been taken around smoking to better understand what the needs of residents were. There was in general a low prevalence of smoking in RBWM, but in some communities it was higher and RBWM needed to support these individuals. Anna Richards said that she was happy to discuss the needs assessment with Edward Harrison.

The Chairman suggested that it would be good to have an item on smoking cessation at the next meeting of the Board.

ACTION – Item on smoking cessation to be added to the agenda for the next meeting of the Health and Wellbeing Board.

Councillor Stimson said that she in favour of partnerships between health and wellbeing, and sustainability and climate change. Looking at sustainable development goals, Councillor Stimson said that she would love to work with people in this area along with schools in the borough. There were so many issues with inequalities that many people did not realise.

Prash Patel said that targeting children in the right way was key. He was intrigued to know how communities could be motivated in the right way.

The Chairman suggested that different things needed to be tried. One example was around vaccine confidence, it was important to understand the reasons behind hesitancy which could often show a lack of trust for government institutions. The correct information and context could then be provided to encourage those to take up the vaccine and have confidence in coming forward. The Chairman suggested that a structured workshop could take place around the issue and could be discussed with Anna Richards and Hilary Hall.

ACTION – Councillor Carroll to discuss the issue with officers and determine whether a structured workshop should take place to discuss the issue.

Councillor Rayner agreed with the points that had been raised on cycling in the borough. The council was looking at how cycling could be improved, Councillor Rayner suggested that she could put Edward Harrison in contact with the relevant Cabinet Member and lead officer at RBWM to discuss his ideas. Councillor Rayner said that a healthy lifestyle should be encouraged in RBWM, there was a cycle hub run at the Swan pub in Windsor which ran local routes from the pub. She supported the idea of a workshop to explore these ideas further.

Prash Patel felt that this was a good outcome as a result of the discussion on this topic.

Anna Richards said that the impact of Covid had led to a number of good conversations with communities, which had not occurred prior to the pandemic.