To consider the main theme of the meeting, including:

·         Children’s Partnership Conference

·         Integrated Care including a film of patient journey – our Locality Access Point and cluster Multi-disciplinary Team arrangement

·         Population Health Management in Windsor

Anna Richards, Head of Public Health, said that the Board had considered each area of the strategy in detail at every Board meeting. The four areas were:

·         Investing in the borough as a place to live to reduce inequalities

·         Targeting prevention and early intervention to improve wellbeing

·         Championing mental wellbeing and reducing social isolation

·         Coordinating integrated services around those residents that needed it most

Anna Richards said that this meeting would focus on the final priority area, there were a number of speakers who would speak around this theme.

Lin Ferguson, Director of Children’s Social Care and Early Help, said that there had been a few meetings of the new children and young people strategic partnership. The first few meetings had been considering the terms of reference and what the membership of the partnership should look like. The idea was to have a conference bringing together all organisations to consider how they could work in a more integrated way across the partnership. The conference had taken place last week, it was well attended and had provided one of the best opportunities to get together since the pandemic. Plans would be developed to bring forward the key priorities for the partnership, how organisations would work together going forward.

The Chairman asked what some of the key themes were from the conference and how would this be developed into an action plan.

Lin Ferguson said that the mental health of young people was a key theme throughout the day. Conversations about what was meant by collaboration and integration were important, everyone had a view and the partnership was a good place for these conversations to take place. Educational achievement was also a key priority, the partnership needed to bring all of the information together into an action plan.

Kevin McDaniel considered the discussion in the previous agenda item around OPAF, there were plans for an adult’s services conference to be held in September.

Jenny Plummer, Community Integration Manager, said that integrated care was part of the Frimley Integrated Care System and was present in the three localities that made up East Berkshire. The structure enabled community health teams, adult social care and community organisations to work together. The Locality Access Point was based in the Town Hall and the team sat together, both virtually and face to face, and it was funded through the Better Care Fund. For the cluster, monthly virtual meetings were held. These were designed to support the more complex residents and was closely aligned with the primary care network. Support was ideally aimed at any adult who had more than one health and social care need. The Locality Access Point was open Monday to Friday, 9am – 5pm. Residents were given a two hour contact time for urgent queries, or 48 hours for a non-urgent response. All referrals were welcome and referrals were not declined without action. The integration of services allowed the team to provide holistic support, residents were put at the forefront of the approach and allowed for a more timely and proportionate response. Information sharing meant that team members had access to digital records across social services and health organisations. The main aspiration of the Locality Access Point was to prevent hospital admissions and improve the quality of life and experience of residents.

Jenny Plummer explained that referrals could be made through a number of partner organisations. Gaps in need were identified and information was shared with professionals already involved in care, to ensure a joined up approach.

Jenny Plummer shared a video of the integrated care service in action. The video was available to view on YouTube here: https://www.youtube.com/watch?v=ffGXhBos-RM

Ben Byrne outlined a number of projects that were supported by integrated care. There had been a significant amount of positive feedback received from the service.

The Chairman thanked Jenny Plummer and Ben Byrne for the comprehensive presentation, he asked that the video link and slides were shared with Board Members after the meeting.

ACTION – Mark Beeley to share the link to the video and the slides after the meeting.

Ed Harrison said that population health management used data to identify patient cohorts and ensured that preventions were targeted towards these cohorts. During the trial period, a cohort had been picked up of patients aged between 35-49 years old, who recorded having a high blood pressure and had a diagnosis of obesity, diabetes or hypertension. A process map was used to outline the intervention process and this was done in collaboration between the primary care network and RBWM staff.

ACTION – Mark Beeley to circulate the slides after the meeting.