Agenda and minutes

To welcome all to the meeting, introduction and receive apologies.

The Chair welcomed all to the meeting and introductions were made.

James Fleet, NHS Lancashire and South Cumbria Integrated Care Board and Deputy Chair of the Health and Wellbeing Board was welcomed to his first meeting in-person.

Jacqui Old, Education and Children's Services, Lancashire County Council was also welcomed to her first meeting of the Board.

Apologies were noted as above.

Members of the Board are asked to consider any Pecuniary and Non-Pecuniary Interests they may have to disclose to the meeting in relation to matters under consideration on the Agenda.

There were no disclosures of interest in relation to items appearing on the agenda.

To agree the minutes of the previous meeting.

Resolved:  That the Board agreed the minutes of the meeting held on 19 July 2022.

There were no matters arising from them.

The Board were informed that notes from the informal meeting held on 6 September 2022 would be circulated in due course.

To receive an update and sign off of the Better Care Fund Plan 2022/2023.

Paul Robinson, Midlands and Lancashire Commissioning Support Unit and Sue Lott, Adult Social Care, Lancashire County Council presented the report and presentation (attached to the minutes) which provided an overview of the Lancashire Better Care Fund (BCF) Plan 2022/23.  Following approval from both Lancashire County Council and Lancashire and South Cumbria Integrated Care Board the plan was signed off by the Chair of the Board and submitted to the national Better Care Fund (BCF) team for the required assurance.  It was anticipated that the plan would receive national approval, and this expected shortly.

The Board noted that the three elements required for submission were:

(i)  The Plan Narrative (Appendix 'A' of the report) which details what is being done and what is planned to be done with the allocated monies.

(ii)  The Planning Template (Appendix 'B' of the report) which includes income (minimum requirements), expenditure plan and metrics.

(iii)  Intermediate Care Capacity and Demand analysis.

Further details on their purpose and contents can be found detailed in the report circulated with the agenda.

The Board received an update on the work that had been happening since the Health and Wellbeing Board workshop on 6 September 2022 with regards to the "reset" and were reminded that the Health and Wellbeing Board are the key accountable body, and that Lancashire County Council was working with one NHS body, the Integrated Care Board.  Following the workshop and with support of the regional Better Care Fund team in collaboration with the Integrated Care Board, colleagues' plans have been put in place to hold a Multi-Agency Better Care Fund workshop in early December 2022 to begin the process and provide the basis for early and improved planning for 2023/24.  The aim, for all partners, is to have in place a plan by April 2023 and an agreed approach to continued improvement on the use of the Better Care Fund.

It was also noted that the Health and Wellbeing Board would support the:

·  Review and reset the Lancashire Better Care Fund

·  Work with regional Better Care Fund support and Lancashire partners

·  Multi-Agency workshop early December 2022 and the:

·  Analysis of spend and opportunities

·  Timely and robust planning for 2023/24

·  Basis for a refocused Better Care Fund in Lancashire

Following the presentation, the following comments were noted that:

·  This was a good opportunity to invest collective resources in prevention and expand the scope to beyond Health and Social Care services.

·  The workshop was encouraged to discuss the previous point and present plans to the Health and Wellbeing Board on taking this forwards and using the Better Care Fund for upstream prevention as well as reducing the needs and work with Community groups and Voluntary, Community and Faith Sector where there are opportunities that previously have not been considered as part of the Better Care Fund.

·  It was a good opportunity to be ambitious and influence the clear metrics including in-hospital metrics.

·  That the Better Care Fund is different now, than in the past, the level of  ...  view the full minutes text for item 4.

To note the schedule of meetings for 2023/2024.

Resolved:  That the Board noted the schedule of meetings for 2023/2024 and were reminded that the venues (even though stated on the schedule that they would be held in County Hall) will continue to be held across different locations in Lancashire and members will be notified prior to each meeting.

To receive an update on the work that has taken place to date, how the wider engagement has been sought and to receive feedback.

James Fleet and Peter Tinson, NHS Lancashire and South Cumbria Integrated Care Board provided an update on the "Next Steps for Integrating Primary Care – Fuller Report, Developing our Lancashire and South Cumbria Delivery Plan" work that has taken place to date, how the wider engagement has been sought and feedback received.  An updated version of the presentation to that circulated with the agenda, was given at the meeting and is appended to these minutes.

Further information on the following can be found in the presentation:

·  Introduction from Dr Claire Fuller

·  Next Steps for Integrating Primary Care: Fuller Stocktake Report

·  Fuller: A reminder of the key themes

·  Fuller:  Recommendations in a nutshell

·  Neighbourhoods and Places

·  Local Context

·  Developing our Lancashire and South Cumbria Fuller Delivery Plan

·  Our Seven Themes

·  Key Deliverables

·  Six Products

·  Our Journey So Far…

·  Draft Lancashire and South Cumbria Fuller Delivery Framework

·  Things to Note

·  Key Feedback to Date

·  How to Feedback

Following the presentation a number of comments were received:

·  In terms of those areas that were further advanced, it was clarified that support will continue to enable those areas to continue to drive forwards at pace, whilst supporting the other areas to catch up consistently.  The aim around the Integrated Neighbourhood Team development is to look to reduce the variation that there currently is. 

·  There are resources available to develop a Leadership Development Programme for all of the Primary Care Networks and wider Neighbourhood colleagues.

·  Primary Care Networks stepped up throughout the pandemic and became a strong entity in the terms of the role that they played, and it is timely to look at how this can be built on and build on the connectivity and the relationships that have developed across partnerships.

·  To look at building on successful work already happening in Children's Services and to include Primary Care in that agenda with children and families and to understand population need, development of family hubs and how that can be built on in Lancashire, particularly in terms of Family Safeguarding which is multi-disciplinary and brings to the fore how complex issues are dealt with. 

The Board noted that when the engagement process has been completed, an update would be brought to a future meeting to discuss what the next steps would be in the Delivery Plan.

Resolved:  That the Health and Wellbeing Board engaged and gave     thoughts/comments on the Fuller Draft Delivery Framework and   process to date.

To receive details of the Health Equity Commission's recommendations and agree the future approach to their delivery.

Dr Sakthi Karunanithi, Public Health and Wellbeing and Clare Platt, Health Equity, Welfare and Partnerships, Lancashire County Council provided an overview of the Lancashire and Cumbria Health Equity Commission final report that has been published and presented to the relevant upper tier local authority.  This report follows on from the Health Equity Commissionreport on the draft recommendations that had been presented to the Health and Wellbeing Board at its workshop on 6 September 2022 by Dr Tammy Boyce, Institute of Health Equity.

The Board noted that the report attached to this agenda outlines the recommendations (Appendix A) identified in the Health Equity Commission final report which provides a reminder of the need to address health inequalities through action on social, economic and environmental drivers.  The Health and Wellbeing Board will act as the co-ordinating Board for implementing the local health inequalities recommendations as detailed at Appendix 'A'.  Further details can be found in the report and also in the presentation appended to these minutes which outlines the:

·  Context

·  Current Short-Term Health and Wellbeing Board Priorities

·  Best Start in Life

·  Health Equity Commission Recommendations (Appendix 'A')

·  Work in Progress

·  Proposed Approach

Following the presentation, the following comments were raised:

·  The connection between the Integrated Care Board, Integrated Care Partnership and the Health and Wellbeing Board is key, and each need to understand who is doing what, who is responsible for what and who has shared responsibilities and how to maximise the advantage of that.  Work still needs be done on how this is driven forwards for the people of Lancashire without duplicating and making the most of the resources available.

·  That the Health and Wellbeing Board is the right place for the Health Equity Commission work and the mapping process is key to it, in order of a baseline position where the Board knows what is being done well or overlapping in which case the Board can use its influence to address that.

·  At Recommendation 8, there are various areas that can be assigned easily and others in reality that may be difficult to deliver against, therefore it was recognised that further work around what can be delivered on and realise that other areas may not be realistic be carried out at this time.

·  It has evolved following discussions that from the 61 recommendations that they fall into three areas which are:

(i)  What can be directly controlled by the Board

(ii)  What the Board can influence through itself or other relevant Boards

(iii)  The Board can neither be in direct control nor influence locally

·  The Board needs to be clear of the extent of its influence.

Resolved:  That the Health and Wellbeing Board:

(i)  Endorsed the proposed approach to address the Health Equity Commission recommendations and identified those appropriate for inclusion in the refreshed Health and Wellbeing Strategy.

(ii)  Considered and agreed the leadership role of the Board in facilitating the actions to address health inequalities across Lancashire.

An item of Urgent Business may only be considered under this heading, where, by reason of special circumstances to be recorded in the minutes, the Chair of the meeting is of the opinion that the item should be considered at the meeting as a matter of urgency.  Wherever possible, the Chief Executive should be given advance warning of any Members' intention to raise a matter under this heading.

Developing the Lancashire Place – Our Proposition for Aligned Governance

The item of Urgent Business had been received and agreed by the Chair as there was a need to agree governance arrangements for the recently established Place Based Partnership in relation to the Health and Wellbeing Board.

Louise Taylor, Adult Services and Health and Wellbeing, Lancashire County Council and Sarah James, Health and Care Integration, NHS provided the context along with the attached presentation which outlines the proposal for new governance and requested the views of the Health and Wellbeing Board.

The Board noted that as a result of the major reform of the NHS, there has been some changes in the architecture of Lancashire and South Cumbria that has introduced an Integrated Care Board which manages the NHS spend and performance and has established an Integrated Care Partnership which is mainly between local government and the NHS and must involve and engage a whole range of other key partners on collaborative working to make a difference in Lancashire to Lancashire people.

The Board were asked as to whether the Health and Wellbeing Board could play a more prominent role in the new arrangements given that the Board exists and has a statutory responsibility to the Better Care Fund which was introduced to encourage the NHS and Lancashire County Council to pool its funds to decide where to collaborate and spend and particularly to support people in the community.  The Board were asked whether it could capitalise on that and produce a Joint Strategic Needs Assessment (JSNA) to make the Lancashire Health and Wellbeing Board the Place Based Partnership.  It would be the main collaborative space for agreeing its' strategic direction, priorities and assurance on delivery whilst delivery itself would take place through Central, East and North localities across Lancashire as well as at district and community level.

If taken forward, the Health and Wellbeing Board in its new role would have strategic direction around the Better Care Fund, the Health and Wellbeing Strategy and the delivery will be done within the localities due to the size, range and scope of the services within Lancashire and would need the strong delivery units to carry out the work.

Further detail was highlighted in the presentation attached to these minutes, which set out the timeframe for the proposed aligned governance as to how a move from the Health and Wellbeing Board to a Place Board discharging the functions of the Health and Wellbeing Board, to a full Joint Committee with delegated decision making.

Following the presentation, the following comments were made:

·  The focus needs to be on outcomes and there needs to be proportionate governance in place.

·  It will bring additional responsibilities to the Health and Wellbeing Board, which could mean additional time commitments and the willingness to take on these responsibilities and drive it forwards.

·  A review of membership would need to take place, however keeping it streamlined with key partners playing an integral part in order to set a strategic  ...  view the full minutes text for item 8.

The next scheduled meeting of the Board will be held at 2pm on Tuesday, 24 January 2023.  Venue to be confirmed.

The next scheduled meeting of the Board will be held at 2.00pm on Tuesday, 24 January 2023, venue to be confirmed.