Agenda and minutes

The Chair, Councillor Dine Romero, Cabinet Member for Children, Young People and Communities welcomed everyone to the meeting.

Members of the Board and officers introduced themselves.

To elect a Vice-Chair of the Health and Wellbeing Board.

RESOLVED that Paul Harris be elected Vice-Chair of the Health and Wellbeing Board.

The Democratic Services Officer will draw attention to the emergency evacuation procedure.

The Democratic Services Officer drew attention to the emergency evacuation procedure.

Apologies had been received from

Cara Charles-Barks, Chief Executive, RUH

Rachel Pearce, NHS England Area Representative

Amritpal Kaur, Healthwatch,

Sophie Broadfield, Director of Sustainable Communities, B&NES

Alice Ludgate, Bath University,

Sara Gallagher, Bath Spa University

Jayne Davis, Bath College

Joss Foster, Director of Strategy (RUH) attended as substitute for Cara Charles-Barks.

At this point in the meeting declarations of interest are received from Members in any of the agenda items under consideration at the meeting.

(a) The agenda item number in which they have an interest to declare.

(b) The nature of their interest.

(c) Whether their interest is a disclosable pecuniary interest or an other interest (as defined in Part 4.4 Appendix B of the Code of Conduct and Rules for Registration of Interests).

Any Member who needs to clarify any matters relating to the declaration of interests is recommended to seek advice from the Council’s Monitoring Officer or a member of his staff before the meeting to expedite dealing with the item during the meeting.

Sue Poole declared an interest in the agenda item concerning Healthwatch update and confirmed that she would leave the meeting before that item was considered.

There were no public questions or statements.

To confirm the minutes of the above meeting as a correct record.

RESOLVED that the minutes of the meeting of 27 September 2022 be approved as a correct record and signed by the Chair.

Graham Sabourn (Head of Housing, Bath and North East Somerset Council) to give a presentation on Health and Wellbeing and housing issues.

(40 minutes)

Graham Sabourn and Ann Robbins gave a presentation on Housing and Health and Wellbeing issues as summarised below:

Housing, Health & Wellbeing

·  Well established causal relationship between physical housing defects and poor physical health outcomes.

o  Estimated £2.5b annual cost to NHS.

o  63,000 excess winter deaths (1/3 due to cold homes).

·  Developing evidence that non-physical housing factors can also have a significant and negative impact on mental health and wellbeing.

o  Harder to quantify but linked to depression, stress and anxiety.

o  Control, autotomy, status & empowerment all affected and linked to health & wellbeing.

Local Housing Challenges

·  Supply challenges

o  Older poor-quality housing

o  Large (and unbalanced) private rented sector

o  Large numbers of HMO

o  AirBnB usage (2,000+ units) having impact

o  Land limited

·  Affordability challenge

o  12.4x lower quartile house price to average earnings

o  78% of all first-time buyers unable to afford an average terraced property

o  £1,200 mean 2-bed rent (LHA £847)

·  Demand challenges

o  6,000 households on Homesearch & 474 homes available (2021/22)

o  58 households in temporary accommodation (100% increase in 3 yrs)

o  Trend of complication: homelessness casework, disabled adaptations, rough sleeping all getting more complicated & resource intensive

o  Challenging financial climate

More Homes

·  Enabling activities:

o  Delivered 1,848 affordable homes in past 10yrs

o  Facilitating delivery of 100% AH schemes

o  Enhanced Empty Property CPO/enforced sale process

o  Refreshing housing needs evidence base to support Local Plan update (

o  Developing overarching Housing Strategy

·  Direct Delivery

o  B&NES Homes Programme, comprising supported housing, shared-ownership & social rent

o  26 units completed, 21 on site, 208 in medium-term pipeline

o  Energy efficient: Shared-ownership EPC A rated EPC; Grosvenor House reduced energy consumption by over 40%; Theobald air-source heating

·  Supported Housing

o  Pemberley Place Extra Care Scheme; 72 flats mixture of social rent & shared-ownership

o  Delivered 24 units of accommodation for former rough sleepers; on site for 14 units of temporary accommodation; working up planning application for 16 units for LD clients

o  In partnership with Adults, Children & Families developing Supported Housing Strategy

Better Homes

·  Regulation & Enforcement

o  Enforcement of housing conditions across 33,000 rented homes

o  Proactive HMO Licensing scheme

o  Improved 364 properties through enforcement action

o  Commissioning house condition survey & post 2023 licensing position

·  Adaptation Services

o  Deliver, commission or fund range of adaptation services: disabled facilities grants; hospital discharge service; rails contract; home improvement agency.

o  Recently incorporated the Community Equipment Store providing specialist community equipment to residents.

o  Urgent repair grants

·  Affordable Warmth

o  Energy at Home Service provides advice, signposting and financial assistance to low-income residents.

o  Work with Public Health team and Sustainability team on promotion and targeting to vulnerable groups

o  With BCC/SG successful HUG bid to assist 170+ households living in fuel poverty (£3m for B&NES).

Happy and Healthy Lives

·  Housing Options

o  2,000 approaches p.a. with 40-50% homeless/threatened with homelessness

o  60% of prevention duties successful helped by Homefinders & Supported Lodgings Scheme

o  Households in temporary accommodation increasing (100% increase in 3 years to  ...  view the full minutes text for item 31.

To approve the amended Health and Wellbeing Board Terms of Reference.

(5 minutes)

Becky Reynolds reported that the amended terms of reference had been circulated to members of the Board for comment and in principle agreement prior to approval by Council on 10 November.

It was noted that members of the public were not participating in HWB meetings and there may be issues that needed considering such as venues and accessibility to improve engagement.  Paul Harris, Kate Morton and Laura Ambler undertook to discuss this issue in more detail.

Paul Harris questioned whether quoracy should be reconsidered at a future review.  It was noted that members had the opportunity to send substitutes from their organisation if they were unable to attend.

The Board RESOLVED to;

1.  Note the proposed changes to the Health and Wellbeing Board’s Terms of Reference, which include changes to the Board’s vision and membership in particular.

2.  Note the addition of the Bristol, Swindon and Wiltshire Integrated Care Board to its membership, as part of the statutory requirements of the 2022 Health and Care Act.

3.  Approve the updated Terms of Reference for the B&NES Health and Wellbeing Board.

Paul Scott (Associate Director and Consultant on Public Health) to update on the BSW Inequalities Strategy which will be presented to the January meeting of the board.

(5 minutes)

The Board RESOLVED to;

1.  Note that the BSW Inequalities Strategy will be on the agenda for the January meeting of HWB.

Paul Scott (Associate Director and Consultant in Public Health) to present the strategy

(20 minutes)

Celia Lasheras gave a presentation on the Drug and Alcohol Strategy as summarised below:

Alcohol and Drug Abuse impacted on a wide range of local priorities:

·  Health, Wellbeing and Social Care

·  Prosperity and Attainment

·  Criminal Justice

National Strategy:

·  From Harm to Hope: A 10-year Drugs Plan to Cut Crimes and Save Lives was published by the Central Government in December 2021. The strategy committed the whole of government and public services to work together to:

o  Break drug supply chain

o  Deliver a world-class treatment and recovery system

o  Achieve a shift in the demand for recreational drugs

·  The national Alcohol Strategy also committed to combine nation-wide interventions and policies with locally developed approaches to reduce harmful drinking and the impact on the population.

Funding for local areas:

·  Supplemental Grant Funding (2022 – 2025) £950,438. Supplementary to the treatment grant, which would help improve B&NES drug and alcohol treatment and recovery systems.

·  RSDATG (2022 – 2024) £1,393,508. Focussed on improving access and engagement of rough sleepers or those at risk of rough sleeping engaging with drug and alcohol treatment.

Translating national strategy to local needs

·  High levels of drug and alcohol related hospital admissions

·  High levels of people not in treatment

·  Drug-related death rate now above national average

·  Increasing complexity (mental health and social needs)

·  An ageing treatment population with increasing long-term conditions

·  Children in need assessments identify parental substance use disorder as a factor (21-23%)

Development of the Strategy

·  B&NES Drug and Alcohol Partnership Group

·  Consultations:

o  Online consultation for stakeholder networks

o  Focus groups with adult service users and front-line workers

o  Online and paper feedback from young people with P28

o  Stakeholder events at Bath Council in July and September

o  Engagement events with housing, education, treatment services

o  Strategic forums

·  Multi-agency collaborative work

Core Vision:

·  To work together to enable people from B&NES to grow up and live free from the harms of substance use.

Core Aims:

·  To focus on prevention alongside early intervention, and support those that experience difficulties with substance use by having an effective treatment and recovery support system.

Priorities:

1.  Reduce demand for substances in the B&NES population

2.  Support more adults and young people to access and benefit from treatment and recovery services

3.  Prevent and reduce harms from drugs and alcohol, including preventing drug and alcohol-related deaths

4.  Support the health and social needs of adults and young people with complex lives

Next Steps:

1.  Action planning to deliver the strategy (in process)

2.  Implementation will be overseen by the Bath and North East Somerset Drug and Alcohol Partnership with supporting governance

3.  Outcomes for monitoring the strategy and action plan will be informed by national guidance (awaited 2022), with locally agreed indicators informed by the priorities and data discussed

The Board were asked to champion the strategy within their organisations to ensure that it did not sit in isolation to other work programmes.

The Board RESOLVED to;

1.  Approve the B&NES Drug and Alcohol  ...  view the full minutes text for item 34.

Mary Kearney-Knowles/Suzanne Westhead to introduce the BCSSP Annual Report

(10 minutes)

Mary Kearney Knowles drew attention to the BCSSP Annual report and asked members to email any queries or suggestions to her/Suzanne Westhead. 

The Board RESOLVED to;

1.  Note the Annual Report and Executive Summary for the BCSSP.

2.  Forward any queries or suggestions of additional areas for consideration for BCSSP to Mary Kearney Knowles and Suzanne Westhead.

Gary Guest (Programme & Project Manager) to give an update on the Better Care Fund

(5 minutes)

Suzanne Westhead and Laura Ambler gave an update on the Better Care Fund and drew attention to the following:

·  The Government had confirmed that the £500 million Adult Social Care Discharge Fund would be pooled into local Better Care Fund plans and Section 75 agreements.

·  Funding would be provided through grants to Local Authorities (40% of the national fund) and allocations via ICBs (the remaining 60%).

·  Use of funding would be agreed locally between the ICA and Local Authority.

·  The money would be released in two tranches, the first in early December and the second in January.

·  ICBs would need to confirm the agreed distribution of their allocations across the HWBs in their area via submission of 2 plans:

§  ICB Level – Used to confirm how funding allocated to ICB’s would be distributed across the HWB BCF plans that the ICB contribute to

§  HWB Level – Used to confirm how the funding in each HWB’s BCF would be spent and the expected activity.

·  Submission deadline for plans had been set as 16^th December 2022.

·  The NHS B&NES, Swindon and Wiltshire allocation was confirmed as £6,247,209.87 and the allocation to the B&NES area would be agreed locally.

·  The B&NES Council allocation was £608,127.

·  The money needed to be spent by the end of March 2023 and there were proposed schemes in place.

It was agreed that Paul Harris be included in future discussions with Suzanne Westhead and Laura Ambler about proposed schemes.

The Board RESOLVED to:

1.  Note the Better Care Fund Update.

Fedalia Richardson (Health and Wellbeing Strategy Manager) to give an update presentation on the Health and Wellbeing Board strategy

(30 minutes)

Fedalia Richardson gave a presentation on the Health and Wellbeing Strategy Update.  She advised that draft priorities had been informed by the first phase of consultation, feedback from engagement sessions and the Strategic Evidence Base.

Draft Priorities:

1)  Improving access to health services

2)  Mental health and emotional wellbeing of children, young people and adults

3)  Low-income families (housing, food security, fuel poverty, access to education, training and skills)

4)  Chronic disease prevention with a focus on the four main behavioural risk factors (tobacco smoking, physical inactivity, unhealthy eating, and the harmful use of alcohol)

5)  The health and wellbeing needs of rural communities (inequality and different accessibility needs, isolation and loneliness)

6)  Improved quality of life for people with dementia (this priority may change as the needs of older people coming through the engagement process and SEB are further explored)

7)  Access to nature and leisure facilities

Next Steps:

1)  The Health and Wellbeing Strategy Steering Group will provide feedback on the identified priorities.

2)  The Health and Wellbeing Strategy Team will meet with key partnership groups to sense-check the draft priorities.

3)  The Health and Wellbeing Strategy Team will meet with colleagues within the public health team and council to:

  i.   discuss whether these are the right priorities

  ii.   discuss interventions already in place to tackle identified priorities

Board Members raised the following comments:

1.  Kate Morton stated that the priorities should not be seen in isolation, e.g., there was a crossover between mental health and a number of other priorities.

2.  Mary Kearney-Knowles suggested that there was a need to look at what individual organisations and the ICB did differently and how resources could be moved around e.g., to support children and young people.  She suggested identifying 3 areas and looking at current impact and then reviewing this at a future date.

3.  Richard Smale referred to the ICB transformation work which was looking at how to deliver services differently.

4.  Cllr Dine Romero suggested that social prescribing should be a future agenda item for the Health and Wellbeing Board.

The Board RESOLVED to;

1.  Note the findings from the public consultation and feedback from stakeholder engagement sessions with third sector organisations.

2.  Note the proposed priorities for the new Joint Health and Wellbeing Strategy 2023-2030.

Becky Reynolds (Director of Public Health) to present the Public Health Annual Report 2021-22

(10 minutes)

Becky Reynolds gave a presentation on the contents of the Public Health Annual Report 2021-22 as summarised below:

Chapter 1 – Impact of Covid 19

Summarised the far-reaching impact of the pandemic on the population, giving voice to local people and organisations that responded to the challenge.

Chapter 2: The Health of Children, Young People and Families

An overview of health and wellbeing indicators, summarising challenges including the impact of COVID-19 and the cost of living crisis, and providing examples of action taken to improve the lives of children, young people and families and reduce inequalities.

Chapter 3: The Importance of Our Places

Gives examples of innovative ways in which partners have worked together to further strengthen health and wellbeing through developing the places in which we live.

Chapter 4: Recommendations:

1)  Implement the B&NES Living Safely and Fairly with COVID-19 Plan

2)  Further strengthen the targeted action to support children, young people and families outlined in the Children and Young People’s Plan

3)  Ensure that the new B&NES Local Plan and the B&NES Economic Strategy that are being developed, both maximise their potential to reduce inequalities and make it easier for people to live healthy lives

4)  Update and implement the B&NES Health and Wellbeing Strategy, ensuring it has a strong focus on addressing inequalities

5)  The NHS to increasingly embed prevention and inequalities action into its priorities, and be helped to increasingly support social and economic development in B&NES

6)  All partners of the Health and Wellbeing Board, the Integrated Care Alliance, and the Future Ambitions Board, commit to and deliver on action to improve health and reduce the inequalities that previously existed and have been highlighted as a result of the pandemic

Indicators

·  The report contained a list of indicators taken from Public Health Outcomes Framework and other key sources

·  Indicators were particularly chosen to show the areas of greatest challenge

·  These would inform identification of priorities in the Joint Health and Wellbeing Strategy

The following comments were raised by Board Members:

1.  Val Scrase referred to the indicators in relation to hospital admissions for children and young people and stated that Health providers had identified this as an area of concern.

2.  Paul Harris commented that the report did not refer to long covid and asked how this would be addressed.  It was noted that there were long covid clinics in B&NES, but in terms of looking forward, the Local Authority would need to consider how to support people suffering from long covid.

3.  There was only 1 positive indicator listed.  There were other positive indicators, but the report focused on areas for improvement.

4.  The report would need to feed into the ICA to consider the implementation of the recommendations and Laura Ambler undertook to speak to Becky Reynolds about how the priorities would flow into the wider system.

The Board RESOLVED to;

1.  Receive the report.

2.  Support dissemination and implementation of the recommendations in the report.

To note the update in relation to the Healthwatch contract.

The Board noted the Healthwatch Contract Update.

ACTIONS ARISING FROM THE MEETING