Agenda and minutes

To welcome all to the meeting, introduction and receive apologies and to receive an overview of the community activities at St Mary's Community Centre.

The Chair welcomed all to the meeting and thanked the staff at St Mary's Community Centre for hosting the Board meeting and thanked officers from the Public Health team and Democratic Services for arranging the meeting.

Apologies were noted as above.

Janet Malone, Head of Community Events was invited to give a brief overview of what St Mary's Community Centre provides for the Community, which includes a food bank that feeds over 90 families most weeks, a furniture scheme, monthly community lunches, chat lounges, mums and toddlers group, pensioners group and a widows group, which are just a few that take place regularly at the Centre.  The Board noted that the Centre was one of the Warm Spaces in Leyland funded by Lancashire County Council.

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 15 November 2022.

There were no matters arising from them.

Clare Platt, Health Equity, Welfare and Partnerships, Lancashire County Council discussed with the Board the recently published national guidance for health and Wellbeing Boards in the context of a changed NHS landscape; and identified some initial implications for further consideration as detailed further in the report attached to this agenda.  As the guidance develops further, a better understanding will be learnt of the Boards responsibilities going forwards.

Sarah James, Lancashire and South Cumbria Integrated Care Board informed the Board that the Integrated Care Strategy has been developed up through the Integrated Care Partnership and is drawn from the Joint Strategic Needs Assessment, it fully lines up with the Health and Wellbeing Boards taking into wider considerations across Lancashire and South Cumbria and will be presented to this Board in March 2023 as well as a briefing on the wider context.  There will also be a whole system plan which will set out a 10-year vision for what the Integrated CareBoard expects from the NHS and its wider partners to work towards in Lancashire and South Cumbria.  It will incorporate what the NHS will do to respond to the Integrated Care Strategy, what it will do to respond to wider national challenges as well as setting out a three-year financial framework.  The Plan, which will have been responded to by the Strategy, will be presented to the Health and Wellbeing Board meeting in May 2023 where sign-off and endorsement will be requested.

The Board noted that Items 4 and 5 ran in conjunction with each other and the Chair requested that both presentations be received before discussions commenced for both items.

Following both presentations, the following points/comments were raised:

·  The Health and Wellbeing Board will need to maintain oversight of the Board itself of which the guidance helps clarify that there is a role for this forum which strategic and not entirely delivery, which is filled by the Place Based Partnership Board and there needs to be a longer-term view of the strategy in terms of the Health and Wellbeing Board.

·  The Board were asked to note the newly emerging themes and to commit to explore what the next steps for the Board should be with regards to the:

Ø  Joint Capital Plans

Ø  Care Quality Commission (CQC)

·  It was confirmed that the membership of the Board would be reviewed on a regular basis, however, at present, it was felt that no changes were required.

·  With regards to the workshops, it was noted that invites had been sent to County and District Councils, local community groups, colleges, Fire Service, hospices, NHS colleagues (Acute providers, community services, GPs and other providers) as well as others who have registered an interest.  Further work that is wanting to be built on is around residents' voices and people with lived experience, however currently the workshops are more aimed at professionals.

·  Details of the workshops will be forwarded on to members of the Health and Wellbeing Board following this meeting.

·  In terms of data throughout  ...  view the full minutes text for item 4.

To receive an update on the developing Place Based Partnership and its relationship to the Health and Wellbeing Board, following the last meeting of the Board in November 2022.

Sarah James, Lancashire and South Cumbria Integrated Care Board provided an update to the Health and Wellbeing Board on the Lancashire Place Based Partnership for information.  It included the progress made since November 2022, the establishment of the Interim Place Based Partnership Board and the next steps.

Following the discussion that was held at the last Health and Wellbeing Board meeting in November 2022 where an initial idea was presented to the Board on how the Integrated Care Board is looking to align some of the governance rather than duplicate it and the Board endorsed that an options appraisal be done around the consideration of the Health and Wellbeing Board becoming the focal point of the Place Based Partnership Board for Lancashire and South Cumbria.  The report provides further information:

·  Progress made since the last update (November 2022)

·  Interim Lancashire Place Based Partnership Board

·  Working with the Other Place Based Partnerships

·  Next Steps

The Board noted the workshops that were currently planned in localities in Lancashire (Centra, North and East) in January and February 2023, with wider partners, to review, iterate and generate shared ownership of the proposal and were encouraged to attend.

Following the presentation, details of the discussion that took place are noted at Item 4.

Resolved:  That the Health and Wellbeing Board noted the update on the     development of the Lancashire Place Based Partnership.

To review the progress of the three key priorities on the Health and Wellbeing Board:

i)  Best Start in Life

ii)  Healthy Hearts

iii)  Happier Minds

Ruksana Sardar-Akram (Best Start in Life), Aidan Kirkpatrick (Healthy Hearts) and Fiona Inston (Happier Minds), Public Health, Lancashire County Council provided an update on the work to address the three key Health and Wellbeing Board priorities and updated on the associated milestones and performance.

Best Start in Life

Ruksana Sardar-Akram, Public Health and Mel Foster, Education Improvement, Lancashire County Council provided an update on work that has been happening since the initial report that was presented to the Board on 10 May 2022.

The priorities for Best Start in Life are:

i)  Infant Mortality

ii)  School Readiness

iii)  Adolescent Mental Health

Further detailed information can be found in the report.

The Board noted the Performance Review (Appendix 'A') for Best Start in Life and were informed that some areas had shown improvement since the last report and other outcomes are still poor.  There is a reduction in Infant Mortality which is the lowest it has been for 15 years, and Lancashire is currently in comparison to the national average.  Local variations are also detailed in the performance review and whilst some districts are well above the national average, others are still poor, and work continues to improve these district outcomes.

Mel Foster, Education Improvement, Lancashire County Council gave a brief update on the 2-year-old offer, even though the offer is for 2, 3 and 4 year olds, 2-year-olds are Lancashire's most vulnerable children.  Therefore over the past 12 months, there has been targeted work on this age group, which has resulted in a positive news story seeing a 14% increase in uptake from Spring 2021 to Spring 2022 (data only published annually in Spring).  Lancashire is above the England average and in line with the North West average for the first time.  Lancashire's growth was also higher even though it is in line with the North West, the growth was actually higher which is really positive.  There are still a number of priority areas that need continued focus on including Pendle which has the lowest district take up and has been for some time, however, there was success still in that area as there was a further 21% take up from the previous year from 60% to 81%.  The other areas that remain a priority are Preston, Hyndburn, Rossendale and Burnley.  There is a multi-agency approach to targeting these areas and work is being carried out closely with internal colleagues in Children and Family Wellbeing Service and Children's Social Care to ensure those vulnerable groups and those known to Children's Social Care are accessing those places.  Again an increase has been seen in children look after, children in need and children on child protection plans accessing places, however there is still more work to do in those areas.  Close work is also being undertaken with health colleagues and other wider partners on the school setting infrastructure which again is a multi-agency approach to improving outcomes.  The detailed analysis of the School Readiness (Early Years Placement Uptake) was  ...  view the full minutes text for item 6.

To endorse Lancashire's Alcohol and Drugs Needs Assessment and associated action plan to agree how the Board can best support it.

Fiona Inston, Public Health, Lancashire County Council outlined to the Health and Wellbeing Board the progress made and next steps for the Lancashire Alcohol and Drug Partnership following the publication of the National Drug Strategy in 2021.  Further detailed information can be found in the report attached to the agenda.

The Board noted that an Alcohol and Drug Partnership had been formed in Lancashire and first convened in July 2022.  It is anticipated that the membership will engage and work with wider partners.  It has also been agreed that the new partnership will report to the Health and Wellbeing Board.

The national strategy required that a Local Joint Needs Assessment (Appendix 'A') be completed by November 2022 and the draft was presented at the Lancashire Alcohol and Drugs Partnership in November 2022 and was approved at the Partnership meeting on 14 December 2022.

The Board were provided with some highlights from the Joint Local Needs Assessment which includes that:

·  There are 4500 adults in drug treatment services. 

·  There is a significant about of unmet need for people using those services. 

·  The ambition is that by 2025 based on the baseline figures from 21 to 22, there will be an additional 2181 people through treatment services and that is the target that is being set nationally and to support some of the action additional funding has been received c £15 million over the next three years to supplement the work that is done in drug and treatment services.

·  The Family Needs Assessment worked in consultation with local partners where an action plan for delivery was formed which has 40 actions that are cross cutting across the three key priorities of the strategy.

·  The plan is to update the Partnership Group around the key action points, including:

Ø  Workplaces and how they support employers with treatment services.

Ø  How to address some of the stigma.

Ø  Education around alcohol eg underage sales, working with the trade and Trading Standards, however most young people get their alcohol from their parents, so work needs to be carried out with the parents around that.

Ø  There are eight Community Alcohol Partnerships across the County, and the ambition is to have one in each district across Lancashire.

Ø  Discussions also need to take place with people who are not access treatment services to understand the barriers.

Ø  How to work with the prison and probation service?

Ø  How to influence the national policy for licensing?

Following the presentation, the following comments/issues were raised:

·  The Joint Needs Assessment captures the 12 Lancashire Districts however there are references to other neighbouring Districts ie Blackpool.

·  A query was raised as to how substance misuse was ascertained in terms of canisters.  It was agreed that Fiona Inston would seek further clarification regarding this and reply to County Councillor Cullens outside of the meeting.  A request was also made to highlight particular hotspots also.

·  Visits are planned for Year 9 pupils to speak about drug and alcohol misuse as  ...  view the full minutes text for item 7.

To receive an update following the workshop to "reset" the Better Care Fund in Lancashire including:

·  2022/2023 Better Care Fund Approval

·  Better Care Fund Reset Planning

·  Adult Social Care Hospital Discharge Fund Plan and Reporting

Paul Robinson, Midlands and Lancashire Commissioning Support Unit, NHS and Sue Lott, Adult Social Care, Lancashire County Council updated the Health and Wellbeing Board following the workshop to "reset" the Better Care Fund in Lancashire.  Further detailed information can be found in the report.

The Board were reminded that there was a spend of £174 million across Lancashire and within that it covers a minimum spend from the Integrated Care Board allocation of just under £70 million on NHS Commissioned Out of Hospital services and just under £40 million on Adult Social Care services spend. 

The plan was approved nationally at the end of December 2022 and the approval letters sent shortly after that.  There has been no reporting requirement other than to the Health and Wellbeing Board at a national or regional level, however, it is expected that there will be an end of year reporting requirement, which will be presented to this Board when available.

The Board noted that a Section 75 agreement was required that covers the management of the Better Care Fund. This is an agreement under section 75 of the NHS Act 2006 and is the mechanism by which the funds across health and social care and manage the Better Care Fund itself.  The pool itself is hosted by Lancashire County Council and ways are being explored as to how the tool can be better used in managing the money across health and social care.  There is a slight delay in the sign off of the agreement due to the Adult Social Care Discharge Fund, however it will be signed of by 31 January 2023.

The report to the Board covers two aspects:

i)  Better Care Fund Reset

ii)  Adult Social Care Discharge Fund

In terms of the Better Care Fund reset, a workshop was held on 1 December 2022 and the outcomes/themes/next steps from the workshop are detailed further at Appendix 'A'.

A steering group has been established and will meet monthly to oversee the programme of work and to focus initially on interim governance setting and the parameters of how to review the spend across the Better Care Fund.  The Board will receive the framework at a future meeting.

With regards to the Adult Social Care – Discharge Support Fund as the Health and Wellbeing Board it has oversight and accountability for the spend within the plan.  The fund was announced in September 2022 and formally confirmed towards the end of November 2022.  The plan had to be submitted by 16 December 2022 and formally signed off by the Chair of the Health and Wellbeing Board, Chief Executives of the Integrated Care Board and the Local Authority and the Local Authority, Section 151 officer.

The support fund itself is a national £500 million fund and it is to be used to support timely and safe discharge from hospital into the community, reducing the number of people delayed in the hospital who are awaiting social care and includes those people on the  ...  view the full minutes text for item 8.

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.

Prevention in Health and Social Care – Committees – UK Parliament

This item of Urgent Business had been received and agreed by the Chair, as the Government had recently launched an inquiry with a call for submissions until 8 February 2023 on the Prevention in Health and Social Care – Committees.

Resolved:  That the Health and Wellbeing Board:

(i)  Noted that the inquiry had been launched on the Prevention in Health and Social Care – Committees.

(ii)  Agreed that Dr Sakthi Karunanithi draft a response with colleagues and share with members of the Health and Wellbeing Board before submitting it, by 8 February 2023.  It was also noted that the response will also feed into a system wide one too nationally.

The next scheduled meeting of the Board will be held at 2pm on Tuesday, 7 March 2023, venue to be confirmed.

The next scheduled meeting of the Board will be held at 2pm on Tuesday, 7 March 2023, venue to be confirmed.