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.

Replacements for the meeting were as follows:

·  Denis Gizzi for Dr Lindsey Dickinson, Chorley and South Ribble Clinical Commissioning Group and Dr Sumantra Mukerji, Greater Preston Clinical Commissioning Group

·  Gary Doherty for Karen Partington, Lancashire Teaching Hospitals Foundation Trust

·  Tracey Cookscowen for Caroline Donovan, Lancashire Care Trust

·  Victoria Gibson for Stephen Ashley, Lancashire Safeguarding Adult's Board and Lancashire Children's Safeguarding Assurance Partnership.

Dominic Harrison, Director of Public Health, Blackburn with Darwen Council gave his apologies for this meeting and Councillor Mohammed Khan, Chair of Blackburn with Darwen Council Health and Wellbeing Board was in attendance.

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 meetings.

Resolved:  That the Board agreed the minutes of the meetings held in January and July 2020.

To note the action updates from the previous meeting and the forward plan for future meetings.

Clare Platt, Head of Service Health, Equity, Welfare and Partnerships, Lancashire County Council, updated the Boards on actions from the previous meetings and also the forward plan.

Work has been carried out with regards the review of the Health and Wellbeing Board, with discussions being held with Democratic Services, however due to the current pandemic, this has been on hold and will be kept on the action plan to be revisited.

All other items are either included in the forward plan or on the agenda today.

To receive an update on Lancashire's response to the pandemic.

Dr Sakthi Karunanithi, Director of Public Health, Lancashire County Council gave an update on COVID-19 in Lancashire and highlighted the key issues/risks in the system and also provided an outlook for the next few weeks.

As can be seen across the world, there has been a resurgence of cases and what Lancashire is seeing is that the first wave has levelled off.  However, there are flare-ups within care home settings and other establishments and there are also signs of infections within household settings in parts of Lancashire.

There are a couple of breakthroughs in the form of a vaccine which will possibly be available early next year and which further information is still awaited, and  the other new development is drugs and medicines which keeps evolving.  What is currently being seen across Lancashire, is that there has been a clear shift in the demographic of the pandemic from older people to the younger working aged groups. 

Daily data is provided which is more precise and aids the actions taken from the results of the Test and Trace programme so that Local Authorities can make decisions from the data relevant to their areas and communities which are more localised than the national picture.

Two key themes that will help through the next phase of the virus are:

i)  Messaging, more dynamic and aligned with local agendas and engage with the local public.

ii)  The effectiveness of Test and Trace and support for self-isolation especially when the furlough scheme stops.

Mental health and wellbeing is a key theme across all age groups as an issue which needs to be addressed now.  Longer term there are three fixed points that are a cause for concern:

i)  As the lockdown lifts and new powers are given, what changes will happen to the pandemic curve is the immediate issue and there are starting to be localised outbreaks already.

ii)  When more businesses, particularly schools, colleges, universities start to reopen, if the virus is contained and the outbreaks are controlled those settings will not become places of transmission.

iii)  Winter - if the points above are not fully under control there will be significant winter pressures. If the situation with the virus changes for the worst or is not kept under control as it is now, this will cause huge additional pressures in the winter.

The situation in terms of the outbreaks in Pendle and Blackburn with Darwen are different, in that Pendle saw a recent two day spike in infections and Blackburn with Darwen have seen a sustained increased level of cases.  Both of them are beyond the usual outbreak management situation so a broader plan has been activated and agreed by the Lancashire Outbreak Engagement Board, the Health Protection Board and the Lancashire Resilience Forum structures to look at that broader plan; and in essence involves community engagement and increased test and trace in areas which have seen outbreaks.  The testing regimes have been broadened to include members of the public that may not  ...  view the full minutes text for item 5.

To receive feedback from surveys carried out by Healthwatch on peoples' experiences of the impact COVID-19 is having on local people.

Sue Stevenson, Chief Operating Officer, Healthwatch Lancashire, provided the Board with the key findings from a survey which is being carried out in Lancashire on the "Impact of Covid-19" by Healthwatch.  The survey was co-developed with partners and carried out on behalf of all four Healthwatch services that exist across Cumbria and Lancashire.

Findings from the questionnaire were detailed in the presentation which was circulated with the agenda

https://council.lancashire.gov.uk/ieListDocuments.aspx?CId=825&MId=10347&Ver=4.

Version 1 of the survey was created as a 'temperature check' to find out how people were feeling and coping during the initial days of the pandemic.  Version 2 concentrated on emerging themes and concerns, such as mental health, carers and the financial impact of the pandemic and Version 3 which is currently 'live' is similar in focus to Version 2, however, views are also being sought about leaving lockdown and the lifting of restrictions.  From the responses to the different versions of the survey, a number of reports have been created and the Board were encouraged to read them

https://healthwatchlancashire.co.uk/coronavirus-survey-reports/. 

Researchers at Healthwatch have commented that they have never been involved in surveys where people have been so open to describe their experiences as they have during the pandemic.  Although the pandemic has caused upheaval and affected almost everyone in some way, there have been positives come from this experience too such as community spirit, less stress, less pollution and many others as detailed in the presentation.  From Version 3, early findings from the survey was that currently 28% of people responded had experienced a medical issue during the pandemic, however avoided consulting a medical professional about it and Healthwatch is minded that this was something the Board needed to take account of, coupled with those that were on waiting lists, where those lists had now increased and where services had currently stopped.

An interesting finding from Version 2 of the survey was that 82% of people who have had a phone or video consultation have found it a positive experience, liking the convenience of them and that they happened on time.  Community hubs have been another positive and absolutely integral to the response and people who have been furloughed have been wanting to get involved and help others which in turn lifted community spirits.

A question arose around the findings on social prescribing, with 25% of responses coming from carers and whether this could be broken down into localities.  Sue felt that there were a number of supplementary questions from the findings, that, collectively the Health and Wellbeing Board and Healthwatch could explore in more detail going forward as we start to move to the next phase of the pandemic.

Resolved:  That Sam Gorton, Clerk to the Health and Wellbeing Board be   added to the   distribution list to share information on this survey   and future surveys and findings, so members of the Board can   share within their networks. If any members wished to be added   directly to the distribution list, please email

  sue@healthwatchcumbria.co.uk.

To receive an update on the impact of COVID-19 on children and young people's mental health.

Dave Carr, Head of Service, Policy, Information and Commissioning, Lancashire County Council, updated the Board on the evidence of impact of the COVID-19 pandemic had had on children and young people's emotional wellbeing and mental health and that are still continuing to emerge. The report also provided:

·  An overview of the emerging evidence of impact

·  Details of some of the significant elements of Lancashire's local system response

·  Plans for moving forward in the short term

·  Recommendations to ensure a continued support and improved system-wide response.

There were strong indications that the pandemic had had a negative impact on the emotional wellbeing and mental health of many children and young people in Lancashire, who have already required extra help or may do so in the future. Partners have made significant changes in arrangements to better support children and young people but there was much more to do. It was proposed that Partners in Lancashire continued to look forward to delivering the NHS Long Term Plan and wider strategy for children and young people’s emotional wellbeing and mental health, maintaining and enhancing current provision, but in doing so addressed the expected significant longer term impacts of the COVID-19 pandemic.

Among the sources of evidence detailed in the report which was circulated to members of the Board were the findings of a rapid review which had been undertaken nationally by the Anna Freud Foundation, along with further evidence which was provided by the Co-SPACE project which was again was undertaken at a national level by Oxford University which tracked the mental health of school-aged children and young people aged 4-16 years throughout the COVID-19 crisis.  Summaries of both these studies were detailed in the report attached to the agenda.

Evidence shows that more young people have sought support during the lockdown period, and will continue do so as the impact of COVID-19 continues to affect the way that young people live their lives. Equally, for those young people who have found it easier spending more time away from their school environment, the prospect of returning may be challenging.

With regards the Local System Response during COVID-19, many services have continued to operate to provide support for children and young people with many changing their offers to deliver more online and telephony based services and increased the use of technology, as well as continuing face to face contact if required.

There has been a huge amount of resource made available to support children and young people's emotional wellbeing and mental health and this can be found on the Lancashire and South Cumbria Healthy Young Minds Website (https://youngminds.org.uk/training/mental-health-training/) which has been expanded to include COVID-19 specific resources alongside the planned launch of information, advice and resources to support children, young people, parents/carers and professionals identify and manage emotional wellbeing and mental health issues.

As discussed at this Board, Child and Adolescent Mental Health Services (CAMHS) 0-19 service provision (which previously stopped at 16 years of age) has changed in order to address the  ...  view the full minutes text for item 7.

To receive a brief outline of the challenges faced by Lancashire Care Homes during the pandemic and the support that has been made available.

Louise Taylor, Executive Director for Adult Service and Health and Wellbeing and Lisa Slack, Head of Service, Quality, Contracts and Safeguarding Adults, Lancashire County Council provided the Board with an update on the impact of COVID-19 on care homes in Lancashire.

The purpose of the report was to highlight the challenges faced by care homes during the first phase of the pandemic and outline measures taken by the county council with the Lancashire Resilience Forum partners to support the sector.

The report outlined the engagement from the start of the pandemic.

The impact of the COVID-19 pandemic on the care home sector in Lancashire has been significant. Using information gathered daily from each care home, the County Council, with the assistance of the Lancashire Resilience Forum, has been able to respond to support care homes across a range of areas. The focus of the support has changed as the pandemic has progressed; the priority always to ensure care homes are able to continue to deliver safe care.

Highlighted to the Board that, whilst nationally there had been a strong focus on care homes, the three Pan-Lancashire Authorities had looked at 'all' care, not just for older people, it included those that were also vulnerable. The key priority had been, because care providers have been under immense pressure, it was felt that it was important to let care providers care for the people they were supporting.  Therefore as Authorities the decision was taken to protect them from what has been significant and ongoing change and to carry that responsibility for them.  Ways in which this has been done and are continuing to do are as follows:

i)  Instituted a daily welfare call to all care providers (Blackburn with Darwen and Blackpool were also doing the same).  There are over 600 providers in the county council, however they have all been contacted daily, 7 days a week to give them direct support.  This continues to be the means through which the Council gets intelligence from the care market that can inform the work that Public Health are doing, in understanding where the pressure lies and also hot spots and maybe where things are potentially starting to escalate.

ii)  A purposeful decision to purchase personal protective equipment (PPE) for care providers with no discrimination for those that were self-funded and those that were funded by the Local Authority as PPE is intrinsic to good infection prevention control.

iii)  Another key way of keeping people safe is to understand if they have the virus as not everybody who has the virus will necessary show symptoms, therefore, testing has been critical and continues to be.

iv)  Some families have requested that care be temporarily removed for relatives due to the risk of spreading infection, so by stepping back not to provide that help, there has been an incredible burden within families who have themselves become the carer.  As a sector, there has been continued support to those carers throughout this pandemic and as part of  ...  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.

There was no urgent business.

The next scheduled meeting of the Board will be held at 2pm on 8 September 2020.

It was noted that the next meeting of the Board would take place on Tuesday, 8 September 2020 at 2pm.  The meeting would be held virtually.