Agenda and minutes

With respect to agenda item 9 (Food Justice), the Chairman of the Health and Wellbeing Board explained that it had not been possible to finalise the report in time for this meeting and he had agreed that it would be presented at the next Board meeting (18 February 2019).

With respect to agenda item 16 (Kent and Medway Five Year Plan), owing to the upcoming general election and the implications of purdah, the Chairman of the Board explained that unfortunately NHS colleagues were unable to present this report on this occasion. The plan would be presented to the Board at the earliest opportunity.

With agreement of the Board agenda items 10 (Joint Special Educational Needs and Disability Strategy), 11 (Medway Local Transformation Plan for Young People’s Emotional Health and Wellbeing 2019/20) and 12 (Draft Medway Children and Young People’s Plan 2019-2024) were considered first.

Apologies for absence were received from Board Members Councillors Etheridge and Maple and the NHS Medway Clinical Commissioning Group (CCG) representative Ian Ayres.

Apologies for absence were also received from invited attendees James Devine (Chief Executive, Medway NHS Foundation Trust), Helen Greatorex (Chief Executive, Kent and Medway NHS and Social Care Partnership Trust) and Dr Caroline Rickard (Kent Local Medical Committee).

To approve the record of the meeting held on 10 September 2019.

The record of the meeting held on 10 September 2019 was agreed and signed by the Chairman as correct.

The Chairman will announce any late items which do not appear on the main agenda but which he/she has agreed should be considered by reason of special circumstances to be specified in the report. 

There were none.

Members are invited to disclose any Disclosable Pecuniary Interests or Other Significant Interests in accordance with the Member Code of Conduct. Guidance on this is set out in agenda item 4.

Disclosable pecuniary interests

There were none.

Other significant interests (OSIs)

There were none.

Other interests

The Chairman reminded the Health and Wellbeing Board that Stuart Jeffery, Deputy Managing Director of NHS Medway CCG, had previously disclosed that he had been selected as a prospective parliamentary candidate.

This report asks the members of the Health and Wellbeing Board to identify how they and the organisations that they represent can encourage the system to improve health and wellbeing with respect to the future state describe for theme 2 of the joint health and wellbeing strategy: enabling our older population to live independently and well.

Discussion:

The Health and Wellbeing Board considered a report which focused on the second theme of the Joint Health and Wellbeing Strategy (JHWS) ‘Enabling our older population to live independently and well’.

It was highlighted that over the next five years, the population of people aged over 65 was expected to increase by 10% and the population of people aged over 85 years was expected to increase by 18%. As a result, it was considered that there would be a significant increase in demand on health and care services.

Board Members were asked to consider how they and the organisations that they represent could encourage the system to improve health and wellbeing with respect to the future state described for this theme, as set out as set out at Appendix A to the report.

The following comments were made:

·         Connections with the community: it was recognised that links should be made to existing community assets and activities, examples provided included chatty cafés and the recently launched chatty bench.

·         Comparators: with reference to Appendix A to the report, box 1 ‘current state’ it was noted that no comparative data was provided. It was explained that such data was published on the Council’s website within the Joint Strategic Needs Assessment (JSNA).

·         Future reporting: clarification was sought as to whether a report would be presented to the Board in the future which sets out the findings of the Board in relation to box 4, of Appendix A to the report. Board Members were advised that if requested, a report could be brought back.

·         Enabling individuals to stay healthy and well: it was recognised that individuals in their 50s who would in time become the population cohort under consideration should be supported to remain healthy and well. It was suggested that the Three Conversations Model could support this aim.

·         Clinical Strategy: The Board was advised the Integrated Care Partnership (ICP) were developing a Clinical Strategy which would be underpinned by the JSNA. This could be presented to the Board if requested.

Decision:

The Health and Wellbeing Board commented as set out within the minute how they and the organisations they represent could encourage the system to make changes that will improve health and wellbeing with respect to theme 2 of the Joint Health and Wellbeing Strategy. 

This report provides the Health and Wellbeing Board with an update on key Joint Health and Wellbeing Strategy (JHWS) indicators.

The Health and Wellbeing Board considered an update on key Joint Health and Wellbeing Strategy (JHWS) indicators. The Board’s attention was drawn to the indicators set out in section 3.3 of the report.

The following issues were discussed:

·         Childhood obesity – with reference to the life course, a Board Member asked when it was most important to intervene. In response, the Director of Public Health explained that if children remained overweight in their adolescent years, it was more likely that they would be obese in their adult years. As a result, it was considered that there was a narrow window to intervene and there was a need for ‘whole system approach’ to tackling childhood obesity. It was noted that a report would be presented to the Board on this matter at their next meeting on 18 February 2019.

·         Parental response to feedback from the National Child Measurement Programme (NCMP) – with reference to anecdotal evidence, a Board Member explained that parents whose children had been identified as being overweight had reported feeling guilt. It was noted that it was difficult to tell a parent and their child that the child was overweight, particularly as individuals working in the health and care system might also struggle with their own weight. In response, the Director of Public Health referred to the Making Every Contact Count (MECC) approach which aimed to increase confidence and knowledge of professionals in engaging with the public. The Director of Public undertook to provide the Board Member with the data in relation to the uptake of weight management interventions by parents following receipt of a letter indicating that a child was overweight.

·         Increasing workforce confidence - in response to further questions and comments concerning actions organisations could take to increase the confidence of their workforce with regards to weight management, the Director of Public Health recognised that more work was needed in this area. However, it was noted that organisations could sign up to the Medway Workplace Wellbeing Awards which included taking action to encourage healthy eating and healthy weight. A number of GP practices had signed up to the award scheme.

·         Healthy workforce – in response to comments regarding encouraging healthier workplaces, the Director of Public Health explained that work to promote health and wellbeing at Medway Council was ongoing. He noted that health checks had been offered on site and there was a health monitor available for use by all employees. With respect to Medway Foundation Trust, it was explained that the hospital was increasingly providing healthier food alternatives. However, it was recognised that the work patterns of clinical staff made healthy choices less accessible.

·         Wider determinants - it was recognised that environmental factors such as safe walking routes impacted on weight management and that it was important to build patterns of healthy behaviour in children. In response, the Board was advised that the Council had secured funding through the Housing Infrastructure Fund (HIF) bid which might assist, particularly on the Hoo peninsula.

·         Currency of data  ...  view the full minutes text for item 400.

Directors of Public Health (DsPH) have a statutory requirement to produce public health reports. These reports are the DsPH’s professional statement about the health of the local community. The 2018-19 focuses on mental wellbeing across the life course in Medway.

The Health and Adult Social Care Overview and Scrutiny Committee considered this report on 15 October 2019. The comments of this Committee are set out in section 5 of the report. This report will be presented to the Cabinet on 17 December 2019.

Discussion:

The Health and Wellbeing Board considered a report which presented the latest annual report from the Director of Public Health entitled ‘Healthy Minds, Healthy People: Wellbeing across the life course Medway’.

The following issues were discussed:

·         Distinction between mental wellbeing and mental illness - the Deputy Chief Executive, Director of Partnerships and Strategy for the Kent and Medway NHS and Social Care Partnership (KMPT) welcomed the distinction between mental wellbeing and mental illness at different stages of life. He recognised the importance of extending the understanding of mental health and wellbeing within the community and the range of interventions which could provide support to individuals. It was particularly important that individuals were supported to help themselves. To that end, he explained that consideration was being given to developing a recovery college in Medway which would support individuals to self-manage their mental health and wellbeing within the community. The Director of Public Health explained that the Annual Public Health Report (APHR) provided information about services, support and community assets in Medway that supported residents to achieve and maintain good mental wellbeing.

·         Reducing stigma - in response to comments and questions concerning the stigma associated with mental health, the Director of Public Health explained that Medway had been awarded Time to Change Hub status which worked to end mental health stigma in Medway. There were also a number of Wellbeing Champions focussing on mental health within the workplace. He encouraged all organisations on the Health and Wellbeing Board to help reduce the stigma surrounding mental health.   

·         Communication of the annual report - concerning a question in relation to communication of the APHR, the Board was advised that a minor amendment would be made to the annual report to reflect the importance of place shaping in line with the City of Culture bid, the report would then be presented to the Cabinet for approval. Once approved the report would be published on the Council’s website and promoted. The report had been presented to the Health and Adult Social Care Overview and Scrutiny Committee and the NHS Medway CCG Governing Board.

Decision:

The Health and Wellbeing Board:

a)    noted the comments of the Health and Adult Social Care Overview and Scrutiny Committee set out at section 5 of the report; and

b)    noted the Annual Public Health Report, including its findings and recommendations.

This report provides the Health and Wellbeing Board with a brief summary of the content of the public health green paper ‘Advancing our health: prevention in the 2020s’. This consultation document was published in July 2019 with consultation ending on the 14 of October 2019.

Discussion:

The Health and Wellbeing Board considered a report which provided a brief summary of the content of the public health green paper ‘Advancing our health: prevention in the 2020s’. The key focus areas of the green paper were set out paragraph 2.3 of the report. It was noted that the consultation on the green paper closed on the 14 October 2019. The consultation submission was set out at Appendix 1 to the report.

Decision:

The Health and Wellbeing noted the report.  

This report will provide details of the food poverty action plan as requested by the Health and Wellbeing Board at their meeting on 10 September 2019.

Report to follow.

With respect this item the Chairman of the Health and Wellbeing Board explained that it had not been possible to finalise the report in time for this meeting and he had agreed that it would be presented at the next Board meeting (18 February 2019).

Medway Council and Medway CCG have consulted on a Joint Special Educational Needs and Disability (SEND) five year Strategy. This Strategy, which is attached at Appendix 1 to the report, sets out the Local Area’s vision, guiding principles and the key areas of development that will be the focus for Medway’s children and young people with SEND over the coming five years.

The Strategy was considered by the Children and Young People Overview and Scrutiny Committee on 3 October 2019, and the comments are set out at section 7 of the report. Following consideration by the Health and Wellbeing Board, the Strategy will be presented to the Cabinet on 19 November 2019 for consideration and final approval.

Discussion:

The Health and Wellbeing Board considered a report concerning the Joint Special Education Needs and Disability (SEND) Strategy, which had been co-produced with local area partners, parents, carers and young people in response to feedback from the Medway Local Area SEND Inspection in 2017.

There were seven joint strategic priorities, set out at paragraph 2.4 of the report and there were also a series of principles for all services across partners and agencies to deliver these priorities; these were set out at paragraph 2.5 of the report.

The following issues were discussed:

·         Value for money – a Board Member commented that the need to ensure value for money was not included within the strategic priorities. This was of particular concern owing to the potential risks associated with joint working. The Head of Integrated 0-25 Disability Services considered that joint working would reduce duplication and ensure that intervention was timelier and therefore would generate greater value for money.

·         Inclusion – a Board Member recognised that there were significant challenges associated with SEN inclusion within mainstream schools in Medway. It was explained that the number of children with an Education, Health and Care Plan (EHCP) educated in mainstream schools within Medway was below the national average. In addition, there was a comparatively high rate of exclusions of pupils with SEN.

To address these challenges, the School Improvement and Challenge Team had undertaken a targeted programme with head teachers and SEN coordinators at schools with the highest rates of exclusions to upskill them and increase their confidence to meet the needs of pupils with an EHCP or pupils in need of SEN support. This had significantly reduced exclusion rates. A second phase of this programme had recently commenced. This programme included 25 schools and involved reviewing best practice; developing champions of inclusion within schools; and bringing together a network to support and challenge.

·         Prioritisation – in response to a question about how actions were prioritised in light of finite resources, the Head of Integrated 0-25 Disability Services explained that there were short, medium and long term actions within the action plan.

In the short term, the partnership would regularly review high cost placements to ensure that they met the needs of children and were value for money. Over the longer term, there was an aspiration to develop an ‘ordinarily available’ document which would set out what support schools should provide. This would be developed with schools and health partners.

It was considered that this document would drive standardisation and upskilling of the workforce which in turn would better support pupils to remain in mainstream schools and reduce the need for special schools and placing children out of area and within high cost placements.

The Director of People – Children and Adults Services added that the Council also jointly commissioned specialist services from NELFT and Medway Community Healthcare (MCH). The quality of the services provided by these organisations were closely monitored in partnership with NHS Medway Clinical Commissioning Group (CCG).

Decision:

The Health  ...  view the full minutes text for item 404.

The Local Transformation Plan (LTP) is refreshed annually. The Health and Wellbeing Board is asked to note the Plan for 2019/20, which has been reviewed by NHS England and will have been published on the Council’s and CCG’s website by 31 October 2019. This report also updates the Board on progress with embedding Medway’s Young People’s Wellbeing Service.

Discussion:

The Health and Wellbeing Board considered a report which provided details of the 2019/20 Medway Local Transformation Plan (LTP) for Young People’s Emotional Health and Wellbeing. It was explained that the LTP had been reviewed by NHS England was currently undergoing some final amendments to meet key lines of enquiry expectations as set out in paragraph 2.3 of the report. An update on the progress of new Medway Young Persons’ Wellbeing Service (MYPWS) was also provided and set out in detail at section 3 of the report.

The following issues were discussed:

·         Self-harm and suicide prevention – in response to a question with respect to early intervention, the Head of Partnership Commissioning, Resources and Youth Justice explained that focussed work had been undertaken in schools in relation to suicide prevention which had received positive feedback. Examples included the SAFE project and a mindfulness programme within primary schools.

·         Health and wellbeing lead – a Board Member suggested that within the school leadership team there should be a health and wellbeing lead much like there would be a safeguarding lead. The Head of Partnership Commissioning, Resources and Youth Justice recognised that there had been a positive shift in school leader engagement and he was keen to work more closely with schools. In an upcoming meeting with primary school head headteachers, he undertook to raise this suggestion.

He also explained that the Council and its partners had been successful in securing funding for a range of interventions in schools such as restorative justice and positive behaviour support, but he recognised that there was a need to focus on targeted delivery within schools. To that end, he explained that together with the School Improvement team, a framework for delivery of interventions in schools was under consideration.

·         Personal, Social, Health and Economic Education (PSHE) – The Director of Public Health explained to the Board that good practice had been embedded within schools though Medway’s exemplar PSHE programme. It was further explained that Medway Schools now had a full complement of mental health nurses who would be a point of contact on aspects of health and wellbeing. The Director of Public Health advised the Board that he could provide a fuller update on the PHSE programme if requested and undertook to provide a Member with a briefing on the award which had been received for the programme.

·         Support for parents – with respect to a question concerning support for parents in relation to emotional wellbeing and identifying early signs within the family setting, the Head of Partnership Commissioning, Resources and Youth Justice explained that the LTP did include a focus on support for parents. He explained that further work was needed to provide parents with advice and guidance on where to access support to manage their children’s needs.

·         Young offenders – a Board Member recognised that many young people on the edge of criminality had mental health issues but that the Child and Adolescent Mental Health Service (CAMHS) threshold was high. In response, the Head  ...  view the full minutes text for item 405.

This report provides the Health and Wellbeing Board with the outcome of the consultation on the draft Children and Young People’s Plan, which was reported to the Board in February, prior to consultation. The Plan has also been considered by the Children and Young People Overview and Scrutiny Committee.

Discussion:

The Health and Wellbeing Board considered a report which presented the outcome of the consultation on the draft Children and Young People’s Plan, which was reported to the Board in February 2019, prior to consultation. The Director of People – Children and Adults Services explained that since publication of the agenda, the lifespan of the Plan had been reduced to two years, as opposed to five years, to align with the Council Strategy.

Board Members commented that the Plan was well structured, had taken account of engagement and generally proposed sensible measurements. Members highlighted some points for consideration as follows:

·         With respect to Appendix 2 of the report, ‘Medway Children and Young People’s Plan on a Page’, it was noted that some of the measures which would determine how we would know if we had made a difference were unqualified. It was suggested that the direction of travel be included in these measures.

·         With respect to Appendix 3 of the report, ‘Medway Children and Young People’s Plan: What does good look like’, it was suggested that benchmarking data be included.

The Director of People – Children and Adults Services explained that progress updates would be presented to both the Medway Safeguarding Children Partnership as champions of the Plan and the Children’s Improvement Board. He undertook to include comparable data from Medway’s statistical neighbours within these progress updates to facilitate benchmarking.

Decision:

The Health and Wellbeing Board agreed to send their comments on the updated draft Medway Children and Young People’s Plan, as set out at Appendix 1 to the report, to the Cabinet.

The Care Quality Commission (CQC) is inviting Health and Wellbeing Boards in England to self-assess and tell them whether each respective local system to support children and young people with mental health problems matches the recommendations made in their ‘Are we listening?’ report. Appendix 1 to the report sets out the proposed submission for consideration by the Health and Wellbeing Board.

Discussion:

The Board considered the proposed response to the Care Quality Commission (CQC) request for local systems to self-assess support for children and young people with mental health problems against the recommendations set out within in their ‘Are we listening?’ report.

Consultation was undertaken with partners from: the Youth Justice System; the NHS Medway Clinical Commissioning Group (CCG); a number of Medway Council Divisions involved in providing services and support to children; and NELFT, the provider of children’s mental health services in Medway. All partners were invited to self-assess following the criteria set out in the CQC questionnaire and the responses were set out at Appendix 1 to the report. Commentary of the proposed response was included in the main body of the report.

Board Members were informed that this was a rapid assessment and it was considered that the responses received might reflect a lack of understanding in relation to the ‘Are we listening?’ report, rather than indicating services were not meeting the needs of local children. It was suggested that given more time, fuller responses might have been received. Some Board Members expressed a view that the data was difficult to interpret and a Board Member suggested that a qualitative assessment might yield more meaningful responses.

Decision:

The Health and Wellbeing Board considered the report together with the proposed response to the CQC self-assessment set out at Appendix 1 to the report and agreed to send them and comments of the Board to the CQC.

The draft Medway Joint Adult Learning Disability Strategy 2019 - 2024 (attached at Appendix A to the report) has been co-designed with a range of stakeholders including people with learning disabilities and their families and carers. It sets out the vision for reducing inequalities and improving outcomes for people with learning disabilities in Medway. The Strategy directly highlights existing inequalities and details how through the ten priorities people with learning disabilities will be supported to live the life they choose; with the support they need in their local community. 

This report was considered by the Health and Adult Social Care Overview and Scrutiny Committee on 15 October 2019, the comments of this Committee are set out in section 5 of the report. Following consideration by the Board, the Strategy will be submitted to Cabinet for consideration and final approval on 17 December 2019.

Discussion:

The Health and Wellbeing Board considered a report which presented the Draft Medway Joint Adult Learning Disability Strategy which had been co-designed with a range of stakeholders including people with learning disabilities and their families and carers. Ten priority action areas had been developed which if addressed would improve the life chances of people with learning disabilities in Medway; these were set out in paragraph 2.3 of the report.

With reference to the aging population in Medway, a Board Member sought clarification in relation to the support available for adults with a learning disability if their carer passes away. In response, the Head of Partnership Commissioning, Resources and Youth Justice recognised that this was a key issue that needed to be addressed. He explained that the Strategy aimed to ensure that individuals with a learning disability were supported to live independently. Increasing opportunities for independence was a key outcome from the consultation with stakeholders.

In response to a question concerning inclusion, the Head of Partnership Commissioning, Resources and Youth Justice recognised that the number of adults with a learning disability in employment in Medway was below the national average. Action was being taken to improve access to employment, including developing internships. 

Decision:

The Health and Wellbeing Board:

a)    noted the comments of the Health and Adult Social Care Overview and Scrutiny Committee set out at section 5 of the report; and

b)    commented on the draft Strategy as set within the minute prior to its presentation to Cabinet for approval.

The report advises the Health and Wellbeing Board of the forward work programme for discussion in the light of latest priorities, issues and circumstances. It gives the Board an opportunity to shape and direct the Board’s activities.

Discussion:

The Democratic Services Officer introduced the work programme report and drew the Board’s attention to the recommended amendments to the work programme set out at paragraphs 2.2 to 2.6 of the report.  

Decision:

The Health and Wellbeing Board agreed the work programme attached at Appendix 1 to the report, subject to:

a)    adding a report on obesity as a whole systems approach to the agenda for 18 February 2020;

b)    adding a report on the future arrangements of the Kent and Medway Joint Health and Wellbeing Board to the agenda for 18 February 2020;

c)    provisionally adding a report on the Integrated Care Partnership (ICP) Plan to the agenda for 18 February 2020;

d)    adding a report on organ donation to the agenda for June/July 2020; and

e)    deferring both the Kent and Medway Adult Safeguarding Board Annual Report and Medway Safeguarding Children Board Annual Report to 18 February 2020.

The NHS Long Term Plan, published in January, sets out the future of healthcare over the next 10 years. To respond to this, the local area is required by NHS England to prepare and implement a local plan to cover the next five years. The draft five year plan set out within the Exempt Appendix for discussion by the Health and Wellbeing Board.

With respect this item, owing to the upcoming general election and the implications of purdah, the Chairman of the Health and Wellbeing Board explained that unfortunately NHS colleagues were unable to present this report on this occasion. The plan would be presented to the Board at the earliest opportunity.