Agenda and minutes

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

The Chair welcomed all to the meeting.

Apologies were noted as above.

Replacement for the meeting was Dave Carr for Jacqui Old, Education and Children's Services, 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 14 November 2023.

Clare Platt, Health, Equity, Welfare and Partnerships, Lancashire County Council, provided a brief overview of the outcomes from the Joint Workshop between the Health and Wellbeing Board and the Lancashire Place Partnership which had taken place on 22 January 2024.

Key points from the workshop were as follows:

·  Positive session – recognising joint commitment/opportunities/risks

·  Commitment to joint meetings as appropriate

·  Areas of joint interest:

Ø  Better Care Fund (BCF)

Ø  'Healthy Communities'

Ø  Specific topics eg hospital discharge

·  Discussion re governance 'best practice'

·  Commissioning cycle elements – Assess, Plan, Do, Review

Ø  Health and Wellbeing Board responsible for Assess and Review (strategy)

Ø  Lancashire Place Partnership for Plan and Do (executive delivery)

·  Develop joint principles of relationship

·  Could frame Health and Wellbeing Strategy on 'life course'

·  Strengthen Voluntary, Community, Faith and Social Enterprise representation on the Health and Wellbeing Board

·  Assurance 'seldom heard' voices inform service design and delivery

·  Introduction of Chair's forum of which the first has taken place on 5 March 2024.

The Board noted that a draft schedule of informal joint workshops between Lancashire Health and Wellbeing Board and the Lancashire Place Partnership was proposed, to discuss the Better Care Fund as follows:

·  7 May 2024

·  3 September 2024

·  12 November 2024

·  11 March 2024

These meetings will take place prior to the formal meeting of the Health and Wellbeing Board, which will commence at 2.15pm on those dates, where the decision making regarding Better Care Fund will take place.

Resolved:  That the Board agreed to the proposed draft schedule of informal joint workshops that will commence at 1pm, prior to the Health and Wellbeing Board at 2.15pm.

To note the appointment of Asim Patel, Integrated Care Board, NHS as Deputy Chair of the Committee for the municipal year 2023/24.

Resolved:  That the Board noted that Asim Patel, Lancashire and South Cumbria Integrated Care Board had been appointed as Deputy Chair for the remainder of municipal year 2023/2024.

To agree the membership changes as detailed in the report.

Resolved:  That the Health and Wellbeing Board agreed:

(i)  That a representative from Voluntary, Community, Faith and Social Enterprise be added.

(ii)  That the reference to "The Leader of the Council" be amended to add the words "or their nominated representative", as is permitted by the relevant regulations.

(iii)  That the reference to Health and Wellbeing be removed from the title of the Executive Director of Adult Services and Health and Wellbeing due to reconfiguration within the Council.

(iv)  That reference to "The Chair of Healthwatch" be amended to add the words "or their nominated representative".

To receive the report and comment on the progress to date on the review and reset programme and support projects.  Also, to review and comment on the Quarter 3 Better Care Fund submission and receive and consider the Finance Summary Q3 Report.

Sue Lott, Adult Social Care – Urgent Care, Acute and Prisons and Margaret Ashton-Gray, Health and Social Care Integration Finance, Lancashire County Council provided a progress update of the Better Care Fund Reset work and actions taken since the last report.

The Board were informed that the Quarter 3 report had been submitted and was signed off by County Councillor Michael Green, Chair of Lancashire's Health and Wellbeing Board in his delegated capacity. The Board was requested to consider the report and ask any clarification questions. 

The report shows performance remains on track against the mandated Better Care Fund metrics, except for admissions to long term residential care, for which mitigating actions are in place.

Progress updates for various elements of the Better Care Fund reset programme are provided within the report and in the finance report and the Quarter 3 reporting template (circulated separately to Board members only), which included the current projects underway.

The Board noted that high level finance discussions continue between the Council and the Integrated Care Board, as the basis for building robust, evidence-based, joint financial decision making.

The main highlights of the Quarter 3 report identified:

Schemes commissioned/overseen by Lancashire County Council:

·  Telecare (Scheme selected on Quarter 3 return)

·  Equipment and Adaptations (Scheme selected on Quarter 3 return)

·  Acute Staffing Teams (Scheme selected on Quarter 3 return)

·  Hospital Discharge Grant (Additional Discharge Fund) Lancashire County Council allocation

·  Disabled Facilities Grant

Schemes Commissioned by the Integrated Care Board:

·  Better Care Fund

·  Hospital Discharge Grant

Funding:

·  Better Care Fund

·  2022/23 Hospital Discharge Funding

·  Additional contribution from the Integrated Care Board for 2023/24

The Board were informed that the Better Care Fund national support team proposed three support offers that Lancashire agreed to take up. The support is provided as part of the overall Better Care Fund programme and is at no cost to the local system. The support offers to Lancashire cover three areas, with further details available within the report:

·  Leadership and Governance

·  Discharge to Assess

·  Intermediate Care Demand and Capacity Modelling

Following the presentation, discussion ensued, and comments provided as below:

·  Intermediate care redesign will change the way in which rehabilitation is offered, by combining the Crisis Support and Reablement Services, called the Short Term Care at Home Service, and metrics will be provided to understand the effectiveness of it.

·  The variation in avoidable admissions and falls were highlighted, to support prevention measures.  It was agreed that this information would be presented at a future meeting.

·  It was commended that the report captured the voices of the people of Lancashire. However this could be further improved by involving people more widely in redesign activity.

·  The proposed review of the Better Care Fund by the Integrated Care Board should help to understand spend in terms of value for money, outcomes and achievements, as the basis for improvement.

·  The overall Better Care Fund is £204 million, including £10 million additional contribution from the Integrated Care Board.

·  A reduction in numbers using telecare was highlighted. Officers to  ...  view the full minutes text for item 6.

To receive and discuss the progress made by the Combating Drugs and Alcohol Partnership in achieving the outcomes of the Government's 10-year drug Strategy and endorse the proposed 2024/25 plan in making further progress in addressing the harms caused by drugs and alcohol in Lancashire.

Lee Harrington, Public Health and Wellbeing, Lancashire County Council, provided a report which set out progress to date and gave an outline of plans for 2024/25.  The additional programmes proposed to be funded during 2024/25 were summarised in the report.  (A description of the following providers and their main areas of work can be found in Appendix 'A').

The Board noted that the Lancashire Drug and Alcohol Partnership, as a sub-group of the Health and Wellbeing Board, has been in existence for eighteen months and in that time has developed and sustained some positive changes for the people of Lancashire. 

The national 10-year Strategy 'From Harm to Hope' 2021 requires each upper tier authority to develop and sustain a Combatting Drugs Partnership with membership made up of key public and voluntary services in the county including, NHS, social care, public health, housing authorities, the Police and Crime Commissioner, prisons, and probation.  Partnerships must link with other strategic boards such as the Lancashire and South Cumbria Integrated Care Board, reducing reoffending boards, and community safety partnerships.  Lancashire chose to broaden the Partnership's remit to include alcohol along with illicit drugs due to the wide-ranging harms associated with it.

The Board were informed that additional resources have been given, through the Supplementary Substance Misuse Treatment and Recovery Grant, focussed on achieving:

·  Reduced likelihood of drug and alcohol related deaths

·  A reduction in drug and alcohol related reoffending amongst prolific offenders within local areas

·  Increase in the numbers of drug and alcohol users, especially offenders, engaging in treatment as well as increases in those achieving and sustaining recovery

·  Reduced costs for local health services and police forces due to lower health and crime harms, and lower costs to the criminal justice system (as fewer people are dealt with by the courts)

The strategy sets out several national targets and the Office for Health Improvement and Disparities (OHID) have set local (Lancashire) targets based on the national delivery expectations.

The programme is coming to the end of year two of the additional funding and in year three there is a significant increase in funding.

It was noted that for the next 12 months the focus will be on prevention, to address any gaps in primary, secondary and tertiary prevention.  Other objectives in terms of treatment are to reduce the caseload size and provide enhanced support.

The Board were informed that the vast majority of people who attend the Young People's Service, do not transfer for adult treatment, which is an indicator of success.

The Board welcomed Katie Egan, (Inspire/Change Grow Live (adult service)) and Ray Jones, (We Are With You (young people's service)), who shared outcomes and case studies of how lived experience is influencing the delivery of services in Lancashire.

Inspire/Change Grow Live is working with Primary and Secondary Care, resulting in:

·  30% reduction in hospital presentations

·  35% reduction in GP presentations

·  15% increase in women accessing support

We Are With You shared a case study of a 14 year old male,  ...  view the full minutes text for item 7.

To discuss the findings and the work to mitigate vaping sponsorship in sport stadia.

Paula Hawley-Evans, Consultant in Public Health, Lancashire County Council provided a report following a previous report to the Board on 5 September 2023 entitled 'Tackling Illicit Vapes and Youth Vaping in Lancashire'. There had been concern expressed about vaping companies sponsoring sports stadia and the impact this may have on young people vaping.  The report identified the work that is being doing to mitigate vaping sponsorship in sport stadia and understand how widespread such sponsorship is. 

The Board noted that there is limited sport stadia sponsorship by vaping companies and acknowledges that, where there is sponsorship, those sponsors are undertaking mitigating actions to ensure products are not endorsed by children. Some sport stadia have gambling sponsorship, and Public Health will continue to work to develop positive health messages with stadia in line with the Healthy Stadia Concept.

Following the presentation, the discussion highlighted:

·  Sportspeople are seen as role models and are advertising gambling, alcohol, fast food and vaping.

·  The need to further develop educational initiatives around vaping and the dangers of it.

·  The need to work more collaboratively with sports organisations such as the English Football League and form new alliances with companies.

·  There may be an opportunity to utilise influencers and new technology platforms in raising awareness.

·  Commercial organisations target more deprived communities and people who may be more vulnerable.

·  The need to carry out further positive messaging with community sports clubs and the football league.

Resolved:  That the Health and Wellbeing:

(i)  Discussed the findings and the work to mitigate vaping sponsorship in sport stadia.

(ii)  Requested the Public Health team continue to address concerns around gambling, alcohol, vaping, fast food etc. through liaison with appropriate agencies such as the English Football League.

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.

To endorse the proposed system wide review of the Better Care Fund by Lancashire and South Cumbria Integrated Care Board and participate in the review as appropriate.  The Board will also receive the reviews and associated action plans identified in the report at future joint meetings with Lancashire Place Partnership.

Lisa Roberts, Lancashire and South Cumbria Integrated Care Board provided an update on a paper that the Health and Wellbeing Board had endorsed in November 2023. The Board noted that the Integrated Care Board was proposing to commission a system wide review of the Better Care Fund, in order to maximise joint funding across the Integrated Care Board and local authorities. This will complement a review of the current status of the Better Care Fund, a predictive modelling tool and support in relation to Better Care Fund leadership, decision making, governance arrangements and financial modelling, requested by the County Council and commissioned by the Local Government Association.

The Board were briefed on Appendix 'A' as attached to the agenda, on the work that will be commissioned by the Integrated Care Board.

The report was taken as an item of urgent business as funding had only recently been agreed by Lancashire and South Cumbria Integrated Care Board, and the work specified must be expedited before the next meeting of the Health and Wellbeing Board in May 2024, to ensure it appropriately informs future planning.

Following the presentation, the discussion highlighted:

·  The work will complement what is already in place.

·  Once the specification has been agreed there will be a working group overseeing the work, with representatives from each of the four 'Places'.

·  Assurance was sought that the work will provide significant change in how the funding model works.

·  It was noted that there may be areas of work that are currently funded through the Better Care Fund, may not fully meet the aims and objectives and potentially should be funded from other budgets; and there are other projects which could be funded by the Better Care Fund that are currently not.

Resolved:  That the Health and Wellbeing Board:

(i)  Endorsed the proposed system wide review of the Better Care Fund by Lancashire and South Cumbria Integrated Care Board.

(ii)  Participates in the review as appropriate.

(iii)  Received the reviews and associated action plans identified in the report at future joint meetings with Lancashire Place Partnership.

(iv)  Requested that the review consider the lived experience of Lancashire's residents, to influence the future plan and to identify how it will ensure more preventative programs of work.

(v)  Requested that the review considered how it will also focus on children and young people as part of the preventative approach.

The next scheduled meeting of the Board will be held at 2pm on Tuesday, 7 May 2024, venue to be confirmed.

The next scheduled meeting of the Board will be held at 2.15pm on 7 May 2024 and venue to be confirmed.  Members will also be invited to attend the informal workshop prior to the meeting, alongside members of the Lancashire Place Partnership, to discuss the Better Care Fund from 1pm-2.15pm.