Agenda and minutes

Apologies for absence were received from Denise Frodsham, Dr Lorraine O’Donnell, Dr Matt Tyrer, Claire Williamson, Dr Andrew Wilson and Isla Wilson.

Mark Groves attended as a substitute for Louise Barry.

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 24 January 2023.

RESOLVED:

That the minutes of the meeting held on 21 January 2023 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 the Joint Local Health and Wellbeing Strategy and Five-Year Plan 2023-2028.

The Board considered the refreshed Joint Local Health and Wellbeing Strategy and Five-Year Plan 2023-2028 which would underpin the work to reduce inequalities and improve health and care service provision over the next five years.

The Strategy took into account the NHS Cheshire and Merseyside Integrated Care Board and the Cheshire and Merseyside Integrated Care Partnership, the formal recognition of the ‘Place’ being coterminous with the local authority geography and the Care Communities operating at a local ‘neighbourhood’ level. It summarised the challenges faced as a system. There was focus on the wider determinants of health in recognition of the impact that those have and the need for the Health and Wellbeing Board to galvanise partners to work in partnership to address those. In addition, it set out the challenges for health and care providers and the aspirations to work together to improve services and outcomes for residents/patients through a more integrated approach.

The feedback from the public engagement undertaken in January 2023 demonstrated a good level of support for the vision, strategic outcomes and model of care.

Guy Kilminster was thanked by board members for his hard work in creating the document and the Board acknowledged that the challenge going forward would be how to deploy resources to those areas where there was greatest need and impact.

RESOLVED:-

That the Joint Local Health and Wellbeing Strategy and Five-Year Plan 2023-2028 be approved.

To consider the Cheshire East Digital Inclusion Plan 2023-2026.

The Board considered the refreshed Cheshire East Digital Inclusion Plan. The draft Plan was influenced by pre-engagement conversations with the public and voluntary and community sector organisations. The draft Plan was subject to a public engagement exercise which had resulted in the broadening of the second of the three cohorts identified to include the digitally inexperienced.

It was proposed that the enhanced Cheshire East Digital Inclusion Task Force (CEDIT) who had drafted the plan would be renamed to the Cheshire East Digital Inclusion Partnership and would include a broader membership and would continue to feed in to the Cheshire East Health and Wellbeing Board to ensure it had a place in the system.

The benefits to being digitally enabled were set out within the Plan but in summary could lead to amongst other things: improved health and wellbeing; being better connected socially; assisting with education, learning or work (including securing employment); being able to access information, guidance and advice and to benefit from savings deals on services and shopping.

Further work would be undertaken on the draft implementation plan and further support provided for those people who through ill health or disability could not or were no longer able to access services online. The ongoing rollout of Connecting Cheshire would assist with improving access to broadband for those living in rural areas.

RESOLVED:That:-

1.    the refreshed Cheshire East Digital Inclusion Plan be approved.

2.    the Health and Wellbeing Board support the proposal that the Delivery Plan is implemented through the Cheshire East Digital Inclusion Partnership.

3.    the Health and Wellbeing Board agree to have oversight of the progress made in delivering the action plan.

To receive a presentation on the Green Spaces Social Prescribing Pilot.

The Board received a presentation on Greenspaces for Wellbeing which was a partnership between ANSA, the NHS, Cheshire East Council, Everybody Health and Leisure and the voluntary sector. The aim of the partnership was to improve the overall health and wellbeing of the local communities and reduce inequalities through the wider use of community assets including green space.

A 12 week wellness programme was part of an offer with a wide range of nature-based interventions to suit different needs along with five ways to wellbeing which included

1.    Connect – nurture connection and provide an inclusive and welcoming environment.

2.    Be active – enable people to get active through health walks, gardening and habitat management.

3.    Take notice – encourage people to take notice of nature through creative activities, identifying wildlife and nature surveys.

4.    Keep Learning- Create learning opportunities from identifying wildlife to horticultural skills, growing food and making crafts.

5.    Give Back – Help people to contribute their time to meaningful activities that help nature, boost sustainability, and improve parks and open spaces.

Referral pathways would be through clinicians/health workers, practice staff, trusted partnerships (Pharmacy/LA), community organisations and self-referral.

Pilots had commenced in the Crewe and Macclesfield District and data would be analysed with a view to expanding the scheme across the borough. Health care professionals who had trialled the scheme had provided positive feedback and 100% would recommend the scheme to patients or community members.

Board members welcomed the scheme, acknowledging the benefits the scheme would provide. Although there was a desire to include parents with children and young people within the scheme the current model was not set up to do that and more funding and consideration of the model was required. However, the proposal to extend the scheme to care leavers was agreed and will be taken forward.

RESOLVED:

That the presentation be noted.

To consider the Public Health Annual report for publication.

The Board considered the Public Health Annual Report for 2022. The report highlighted the need for a sustained and coordinated response to climate change across Cheshire East. Addressing climate change could have the potential to: improve health and wellbeing and address inequalities; to improve quality of places and green infrastructure; and increase economic productivity and growth.

The report outlined the steps already being taken locally and recommended that continual progress be made to meet the pledge to make Cheshire East a carbon neutral borough by 2045 through:

·         Continual progress to meet the pledge to make Cheshire East a carbon neutral borough by 2045 through:

·         Public sector leading by example

·         Working in partnership with NHS, businesses, voluntary sector to ensure that climate change and sustainability was a priority for all

·         Developing multi-agency integrated sustainable policies across different sectors and departments

·         Ensuring that policies address both climate change and health inequalities

·         Engaging all stakeholders and public through information campaign and consultation exercises

·         Monitoring and evaluating the implementation of policies and strategies

·         In response to the recovery from the pandemic it was important to build on some of the positive changes seen during the response to the pandemic, such as the choice to work from home, enhancing the local opportunities for active travel and the reduction in traffic and air pollution.

RESOLVED: That:-

The Public Health Annual Report and the Executive Summary be approved for publication.

To consider the alternative proposal to approval of JNSA review for publication and also of the JSNA work programme.

The Board considered a report which outlined an alternative proposal to approval of JSNA reviews for publication and also of the work programme. The proposal was for the responsibility for sign off of the reviews for publication and of the work programme to be delegated to the Cheshire East Council Executive Director of Adults, Health and Integration or the Director of Public Health and to approve the work programme approval process.

After the information was presented to the Executive Director of Adults, Health and Integration or the Director of Public Health it would then be shared with elected members and a two week window would exist during which time any concerns or issues could be raised. After that (assuming no concerns are raised) it would be published on the website.

The process would enable more timely production and publication of JSNA reviews, enabling more prompt action across Cheshire East Place to improve health and wellbeing and address inequalities.

RESOLVED: That:-

The proposal to update the Joint Strategic Needs Assessment (JSNA) approval process and the work programme, in which responsibility for approval of the reviews and the work programme for publication will be delegated to the Cheshire East Council Executive Director of Adults, Health and Integration or Director of Public Health be approved.

To consider the Poverty JSNA for publication.

The Board considered a report which outlined the findings and recommendations of the Cheshire East Poverty JNSA.

The Poverty JSNA had been completed as part of the 2022/23 JSNA work programme and following approval it would be added to the suite of current JSNA products on the Cheshire East Council JSNA website.

Key findings from the review included:

• The most deprived areas in Cheshire East were seen within Crewe and Macclesfield, but also within smaller areas of Congleton, Alsager and Handforth.
• People in households with disabilities, single parents, and single adults without children were more likely to experience poverty, there was also regional evidence to suggest that people from certain ethnic groups were more likely to experience food insecurity.
• Across Cheshire East, many food banks had seen an increase in demand. Decreases in food donations had also been seen. Food banks often support young men and single parent households.
• The condition of housing stock as well as access to affordable accommodation were challenges. There were currently thousands of applications for social housing.
• Residents with lived experience who use food banks reported that experiencing food poverty was extremely stressful and isolating. People might be reluctant to seek support due to a sense of stigma.

Following Board members comments officers reported that:

-       There were some challenging recommendations, specifically around housing and long-term unemployment but that there were some very actionable recommendations as well. It would be important to  be championing the messages around the JNSA and information sharing and making residents aware.

-       The outcomes framework would set out the things that would be measured to demonstrate that the objectives were being achieved.

-       The next step would be to decide on the prioritisation tool which would identify those activities that would be prioritised and give the biggest impact.

In respect of questions raised in relation to long term unemployment and the number claiming benefits it was agreed that a written response would be provided outside of the meeting.

RESOLVED:-

That the Poverty JSNA and the recommendations outlined in the report be approved for publication

To consider the proposed changes that are recommended from the LGA facilitated review of Cheshire East Health and Wellbeing Board’s roles and responsibilities.

The Board received a report which outlined the proposed changes that were recommended following a Local Government Association (LGA) facilitated review. In June 2022 the LGA were asked to support the Cheshire East Health and Wellbeing Board to review its role and responsibilities and ensure that it was fit for purpose with the introduction of Integrated Care Systems and Integrated Care Boards. Work had been underway since July 2022 with three workshops held to inform the recommendations set out within the report.

A number of recommendations had come out of the review work which were designed to ensure that the Board could fulfil its statutory responsibilities effectively – providing strategic leadership, driving integration and reducing inequalities.

The recommendations included:

·        That the membership of the Board be widened to include additional representatives of the Council’s Place Directorate; a representative of housing providers; a representative of community pharmacy and a representative of the business sector.

·        That named individuals take the lead as senior responsible owner for each of the four Strategic Outcomes set out in the Joint Local Health and Wellbeing Strategy, and that if these individuals are not already members of the Board, they also join its membership.

·        That a Reference sub-group be established to review certain ‘standard’ reports and escalate to the Health and Wellbeing Board any matters of concern.

·        That the ‘Informal meetings’ of the Board are used to meet with other local Boards and Partnerships to discuss how we can work together more effectively to deliver the strategic outcomes set out in the Joint Local Health and Wellbeing Strategy.

RESOLVED: That:-

The recommended changes to the membership and ways of working of the Health and Wellbeing Board be approved.

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.

At the last meeting of The Health Care Partnership Board items for discussion included:

-       A presentation received from Care Communities. It was intended to focus on a different area at each meeting.

-       The endorsement of the Joint Local Health and Wellbeing Strategy

-       The approval of the Social Action Charter which set out the terms of its engagement with the voluntary community, faith, and social enterprise sector.

-       A proposal to establish a quality and performance group which would enable the development of a place-based understanding of the quality of the health and care services that were delivered.

-       A presentation on a programme of work called Sustainable Hospital Services which looked at the challenges in East Cheshire Trust in maintaining a viable range of acute hospital services on the Macclesfield site.

More general updates with the Partnership included:

-          Home first collaboration – non recurrent sums of money had been received that had been provided across the winter period and those additional non recurrent allocations that had come from the government through the local authority would help to strengthen health and social care with the overall aim of accelerating discharges from hospital.

-          The Integrated Cared Board (ICB) initiated work on accountability and delegation.

-          Commissioning budgets were forecasting deficits for 2023/24. This was mirrored across the whole of Cheshire and Merseyside. Financial planning for the next year would remain a significant focus.

Developing the Cheshire and Merseyside Five Year Joint Forward Plan

The Board received a presentation which outlined the plans related to implementing the strategies as a health and care system, both at Place and Cheshire and Merseyside level.

In respect of the joint forward plans, there would be a particular role for the Health and Wellbeing Board as the ICB was required to involve each Health and Wellbeing Board and in June comments would be invited on the joint forward plan.

There was an ongoing piece of work in respect of the strategic objectives as they could be fairly broad and include lots of different things underneath them. A review of the data would identify where outcomes were the poorest.

A workshop had taken place to look at the overall priorities. Public engagement would continue and the ICB board would be doing  further work to endorse the draft forward plan by the end of March.  The plan would then be considered by the Health and Wellbeing Board at its next meeting.

Board members fed back their views which included:

-          It was positive that there was the desire to tackle health inequalities and address the wider determinants of health.

-          Resources should be allocated at place level

-          It would be sensible for the budget to be set in advance.

RESOLVED:

That the update and presentation be noted.