Agenda and minutes

To receive any apologies for absence.

Apologies for absence were received from Dr Lorraine O’Donnell, Dr Patrick Kearns, Dr Steven Michael, Dr Andrew Wilson and Superintendent Claire Jesson.

To provide an opportunity for Members and Officers to declare any disclosable pecuniary and non-pecuniary interests in any item on the agenda.

There were no declarations of interest.

To approve the minutes of the meeting held on 27 September 2022.

RESOLVED:

That the minutes of the meeting held on 27 September 2022 be confirmed as a correct record.

In accordance with paragraph 2.24 of the Council’s Committee Procedure Rules and Appendix on Public Speaking, set out in the Constitution, a total period of 15 minutes is allocated for members of the public to put questions to the committee on any matter relating to this agenda. Each member of the public will be allowed up to two minutes each to speak, and the Chair will have discretion to vary this where they consider it appropriate.

Members of the public wishing to speak are required to provide notice of this at least three clear working days’ in advance of the meeting.

There were no public speakers.

To consider a report which outlines the statutory guidance the Department of Health and Social Care issued for the publication of an Integrated Care Partnership (ICP) Strategy by December 2022. 

The board received an outline of the Integrated Care Partnership (ICP) Strategy which was due to be published by December 2022. The strategy would be updated during 2023 - 24 to reflect updated Strategic Needs Assessment (JSNA) information and revised national guidance which was expected in June 2023.

The Strategy would be used to inform priorities which would have clear implementation plans aligning to community engagement activities between Place plans, HCP Strategy and ICB Forward View.

The draft strategy would be circulated to all stakeholders for comments and feedback which would help form an interim document which would be considered by the HCP Board at the end of December.

Board members provided comments and feedback in respect of

·         Tackling the wider determinants of health – Board members felt that these should include unemployment, mental health and housing.

RESOLVED:

1)    That the Cheshire East Health and Wellbeing Board endorses the approach taken to developing the Cheshire and Merseyside HCP Strategy.

2)    Feedback will be provided on any material changes recommended to the draft strategy document, in order that the HCP Board can approve publication of the Strategy on 22 December.

To receive an update on winter planning for 2022/2023.

The board received a winter planning update which detailed the plans that had been put in place to manage the increased activity during the Winter period. The plans been developed in partnership with Cheshire East system partners across the place and considered the impact and learning from last winter, as well as learning from the system response to Covid-19 to date.

The key elements of the winter plan included:

•        Business intelligence modelling and forecast planning

•        Operational resilience

•        Contingency planning

•        Mitigations to address identified gaps

•        Escalations triggers and appropriate oversight and assurance

•        Modelling and Numbers

•        Monitoring Performance

•        Capacity and Investment

Members provided feedback and comments in respect of:

-       Alert system discharge – could it be more effective in alerting the public as it does affect people’s behaviour

-       A longer term plan in changing the offer to the public

-       The need to communicate to the public what is meant by virtual wards, care at home and positive experiences

-       The focus on stopping people going in to hospital is welcomed

RESOLVED:

That the Winter Planning update be noted.

To receive a verbal update on the Cheshire East Health and Care Partnership.

Mark Wilkinson, Cheshire East Place Director provided the board with an update on the Health and Care Partnership (HCP) and NHS Cheshire and Merseyside’s team in Cheshire East.

The HCP board had met in early November and would continue to meet bi-monthly. A recruitment process was underway to appoint a chair for a twelve month period. The board was making progress on its structures with a significant  number of staff expected to be slotted into teams towards the end of December. Since the last meeting of the Health and Wellbeing Board Dr Andrew Wilson had been appointed as Place Clinical Director.

The key issue discussed was the reintroduction of maternity services to Macclesfield District General hospital which had been suspended at the start of the pandemic. The risks identified with this included staffing levels and beds, which had been used for other patients since the maternity provision had been closed.

It was noted that there was more work ahead to push for maximum delegation of responsibilities to places. The Health and Wellbeing Board would play a crucial role for setting the vision at the Cheshire East level and addressing the wider determinants of health.

RESOLVED:

That the update be noted.

To receive an update on key priorities within the Domestic & Sexual Abuse Strategy that relate to ‘Health Settings’ and ‘Complexity’.

The board received a report which provided an update on the key priorities within the Domestic & Sexual Abuse Strategy that related to:

Health Settings – Applying the Health Pathfinder toolkit;

Complexity – The establishment of a strategy, including shared resources, to tackle the most complex cases across substance misuse, mental ill health and domestic abuse.

There had been a gap identified within the Health Pathfinder toolkit in respect of the lack of provision for the IRIS programme, a specialist domestic violence and abuse (DVA) training, support and referral programme for GPs.

IRIS had been positively received elsewhere and board members would welcome, and support this model in Cheshire East to address the existing gap in provision.

RESOLVED: That:-

The Health and Wellbeing Board endorse implementation of the Pathfinder Toolkit and delivery of the recommendations outlined in the report.

To receive the ‘Living Well in Crewe’ report.

The board received a report of the Cheshire East Increasing Equalities Commission, a multi-partner group who had considered what would help improve the health outcomes and life chances of the people in Crewe. The report included recommendations for all partner organisations within Cheshire East on approaches which could be considered to improve outcomes for residents of both Crewe and the whole of Cheshire East.

Board members provided comments and feedback in respect of:

-       There were much wider implications other than health to be considered, for example, in the Place directorate, and should be taken on board by all partners who work in Crewe.

-       Whilst the recommendations were clearly supportable it was felt that they were quite generic and could be more specific, and that this plan should be seen as a launch pad.

-       Whilst it was felt that Crewe was a good place to start, other areas did need to be looked at.

-       Whilst life expectancy was a clear indicator so were the years people spend in poor health.

-       Whilst the plan was evidence based it was not a plan for action and implementation so the next step needed to be incorporating it in to the priorities and actions of the Health and Wellbeing Strategy Delivery Plan.

-       Resources needed to be identified to enable the actions to be delivered.

-       Sought assurance that the Health and Wellbeing Board would have confirmation that the evidence base had been tracked and mapped.

Dr Atkinson and the team were thanked for the comprehensive report and the board looked forward to seeing actions being put in place.

RESOLVED: That the Health and Wellbeing Board:

1.                 Note and support the recommendations within ‘Living Well in Crewe’ report.

2.                 Agree that the report be used as a source document in the development of the Joint Health and Wellbeing Board Strategy

To consider a report which seeks approval for the approach to developing the Cheshire East Joint Outcomes Framework.

The board received a report which outlined the multi-phased approach to developing a Cheshire East Joint Outcomes Framework. This would be used in conjunction with the Joint Strategic Needs Assessment (JSNA) and relevant integrated Care system and national tools to:

-       Inform and monitor health and care transformation towards closer integration and summarise progress in relation to the Place Plan through a Joint Outcomes Framework

-       Optimise primary, secondary and tertiary prevention and wellbeing

-       Address inequalities

At Cheshire East Place level considerations included:-

-       Phase one - Health and Wellbeing Strategy refresh and Place Plan – focusing on the mid to long term outcomes.

-       Phase two - Development of a Place-level delivery plan aligning with the proposed care models.

Consensus was that the Joint Health and Wellbeing Strategy 2018-2021 priorities remained appropriate and that the additional priority relating to children, which was outlined in the Cheshire East Place Plan 2019-2024, should be added. Therefore the priorities for the Joint Health and Wellbeing Strategy refresh would be:

-       Create a place that supports health and wellbeing for everyone living in Cheshire East

-       Ensure that children and young people are happy and experience good physical and mental health and wellbeing

-       Improve the mental health and wellbeing of people living and working in Cheshire East

-       Enable more people to Live Well for Longer in Cheshire East.

A consensus building event would be arranged to finalise a list of ten key indicators which would take place in the new year.

The board agreed that the approach was a good way forward and although there were challenges ahead if it was done right then it would drive forward prioritisation.

RESOLVED: That the Cheshire East Health and Wellbeing Board:

1.    Considered the proposed multi-phased approach to developing a Cheshire East Joint Outcomes Framework.

2.    Considered the range of indicators proposed for Phase 1 of the framework (Appendix C) and would contribute to a consensus building event to finalise a list of ten key indicators.

3.    Noted that shift in the Phase 1 indicators, which focus on very high-level outcomes, is likely to be very gradual.

To receive the Cheshire East Safeguarding Children’s Partnership Annual Report 2021-2022.

The board received the report which provided an update on progress against the Cheshire East Safeguarding Children’s Partnership priorities and its plans for 2022/23.

The annual report presented covered the period from April 2021 to March 2022 and related to the progress made against partnerships priorities prior to a  recent joint area targeted inspection (JTAI). Following the inspection the outcomes were published in a letter in September 2022. Key findings and priority actions were included, along with the strengths of the partnership. The Partnership accepted the findings and had publicly apologised for the gaps in the collective work to protect children and young people.

One area highlighted for improvement which had been identified as a strategic oversight need was in respect of exploited children. An independent person had been appointed to review the partnership arrangements and make recommendations for improvement. An independently chaired improvement board had also been established to be responsible for the partnership’s written statement of proposed action, scrutinising challenge, and improvement work.

The report highlighted the priority areas which included neglect, emotional health and wellbeing and child exploitation. It was acknowledged that there was a requirement for a fresh and more dynamic report and specifically the voice of the children and young people needed to be stronger. 

RESOLVED:

That the report be noted.

To receive the new Children and Young People’s Plan for 2022-26.

The board received the Children and Young People’s Plan 2022-26 which had been developed with Cheshire East Youth Council and the Children and Young People’s Trust which included representatives from children and young people, and staff from a range of agencies across the partnership. The plan set out the partnerships’ ambition to improve outcomes for children and young people over the next four years.  

The board heard that following feedback that early help and prevention was important to children and young people, an additional outcome had been added to the plan.

The board welcomed the report and agreed that the voice of the children ran through the report.

In respect of Members comments and feedback officers reported that

-       The next action for the Children’s Trust Board which was co-chaired with young people would be to refresh the terms of reference to review how to articulate, demonstrate, monitor how it is held accountable for its actions and outcomes. An action plan would be developed which would be brought periodically to the Health and Wellbeing Board.

-       The young people’s voice on physical health would be taken back as a recommendation

-       The plan would align  to the overall Health and Wellbeing strategy, but as a standalone chapter.

RESOLVED:

The Health and Wellbeing Board endorse the Children and Young People’s Plan, 2022-26.

To receive an update on the activities of the Cheshire East All Age Mental Health Partnership Board.

The board received a progress update on the activities of the Cheshire East All Age Mental Health Partnership Board which included a pre-consultation survey and face to face forums. Initial feedback from those events focused on the wider determinants of mental health such as employment, physical health, housing and the cost of living.

Some of the key themes in relation to mental health services that arose included more accessible, better information and promotion of services, entry criteria for some of the services, waiting times, more flexible service offers and crisis support around children and young people.

A draft strategy plan would be developed next year and would be brought back to the Health and Wellbeing Board to be endorsed. There was a request that the pressures as well as the positives be included in the report.

RESOLVED:

That the update be noted.