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.

A new Board member was welcomed to the meeting:

·  Councillor Jayne Nixon replacing Councillor Viv Willder, Fylde Coast, Lancashire Leaders Group

Replacements for the meetings were as follows:

·  County Councillor Keith Iddon replacing County Councillor Geoff Driver, Lancashire County Council

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

·  Ben Norman for David Russel, Lancashire Fire and Rescue Service

Additional apologies were received from Blackburn with Darwen Council

·  Dominic Harrison, Director of Public Health

·  Councillor Mohammed Khan, Chair of Health and Wellbeing Board

Observer for the meeting:

·  David Flory, Independent Chair, Independent Care System, Lancashire and South Cumbria.

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 8 September 2020.

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

Resolved:  That the action sheet and forward plan was noted by the Board.

Any future items for the forward plan should be submitted to Sam Gorton, email sam.gorton@lancashire.gov.uk.

To receive an update from the SEND Sub-Committee and to agree the revised Terms of Reference.

Sarah Callaghan, Director of Education and Skills, Lancashire County Council updated the Board following the first Health and Wellbeing Board, Special Educational Needs and Disabilities (SEND) Sub-Committee which was held on 24 September 2020, where the Accelerated Progress Plan (APP) would be monitored at each meeting, as well as at the monthly Special Educational Needs and Disabilities Operations Group and progress would be reported to the Special Educational Needs and Disabilities Partnership Board and at each Health and Wellbeing Board. The Department for Education case lead for Lancashire would also attend a meeting of the Special Educational Needs and Disabilities Operations Group every six weeks.

The Accelerated Progress Plan will be presented recurrently to the Special Educational Needs and Disabilities Sub-Committee of the Health and Wellbeing Board for scrutiny and challenge. At the first meeting of the Sub-Committee it was agreed that a baseline position for each of the five areas of improvement be presented to facilitate this process. A required outcome of the activity which was taking place to improve leaders’ view of the local area was to create a data dashboard; this would be shared and reported against at each Special Educational Needs and Disabilities Sub-Committee meeting.  It would also consider the progress and impact at its meeting in December 2020 prior to the next meeting of the Health and Wellbeing Board and all subsequent meetings.

Progress on the Accelerated Progress Plan will be reviewed formally by the Department for Education and NHS England/Improvement (E/I) after six months and twelve months; there will be no further Ofsted/Care Quality Commission revisit inspections. 

In addition, following a review of the Terms of Reference at the initial Special Educational Needs and Disabilities Sub-Committee it was proposed to remove the officers from the membership who would report to the Sub-Committee and be accountable for delivering the improvements.

Resolved:  That the Health and Wellbeing Board:

(i)  Noted the Accelerated Progress Plan (APP) submitted to the Department for Education (Appendix 'A') to address the five areas where it had been judged that sufficient progress had not yet been achieved;

(ii)  Noted the establishment of the Special Educational Needs and Disabilities Sub-Committee of the Health and Wellbeing Board, which met for the first time on 24 September 2020;

(iii)  Received a verbal update on the progress of actions in the Accelerated Progress Plan due to be completed at the end of October 2020.

(iv)  Approved the revised Terms of Reference for the Lancashire Health and Wellbeing Board – Special Educational Needs and Disabilities Sub-Committee as set out in Appendix 'B' of the report.

To note the work undertaken by the pan-Lancashire Child Death Overview Panel (CDOP) during 2019/20, which includes key findings from child death data, progress made on last year’s recommendations (2018/19), partnership achievements, and priorities and recommendations for 2020/21.

Ruksana Sardar-Akram, Interim Public Health Consultant, Lancashire County Council presented the report which updated the members of the Health and Wellbeing Board of the work undertaken by the pan-Lancashire Child Death Overview Panel (CDOP) during 2019/20, which included key findings from child death data, progress made on last year’s recommendations (2018/19), partnership achievements, and priorities and recommendations for 2020/21.

During the 2019/20 reporting year, the Child Death Overview Panel (CDOP) was notified of 108 child deaths (20 Blackburn with Darwen (BwD) residents, 6 Blackpool residents and 82 Lancashire residents) that were in line with Working Together to Safeguard Children definition and therefore considered by the Pan-Lancashire CDOP.  The total number of unexpected deaths in children was 36 in 2019-20, with the Sudden Unexplained Death in Childhood (SUDC) Service recording the lowest number of deaths in 2019-20, since the service began in 2008.

The report also highlighted the key progress and achievements and thus highlighted the key themes that included co-sleeping and inappropriate sleeping, which continue to be prioritised with sub-groups and partners on this topic.  Further details are found detailed within the report.

Resolved:  That the Health and Wellbeing Board:

i)  Noted the update and priorities identified.

ii)  Sought confirmation from each organisation that Child Death Overview Panel (CDOP) forms are returned within the statutory three week deadline and are completed as fully as possible, including details of father or other male carers in the household, before they are submitted to Child Death Overview Panel (CDOP). (The CDOP Business group monitors this on a monthly basis. Whilst there have been measureable improvements over the course of the year, there are still gaps in information which are being followed up).

iii)  Assured themselves that there are relevant interagency initiatives in place to reduce the prevalence of modifiable factors, identified in the under one population including:

·  Safe sleeping

·  Risk factors for reducing premature births including:

·  High body mass index (BMI) (including healthy diet and physical activity)

·  High blood pressure (linked to high BMI)

·  Smoking

·  Alcohol use

·  Substance misuse

·  Domestic violence

·  Mental health

·  Diabetes (often linked to BMI)

·  Lack of physical activity

To note the agreed spending plan for the COVID-19 Grant and Winter Pressures grant and the additional winter capacity Lancashire County Council's funding model.

Louise Taylor, Executive Director of Adult Services and Health and Wellbeing,

Lancashire County Council outlined the funding arrangements as detailed in the report, to support additional health and social care winter capacity in Lancashire to the Board.

The need to respond to the COVID-19 pandemic had seen the suspension of the Advancing Integration governance arrangements in Lancashire.  To enable decisions to be made on the use of funding allocation of the Winter Pressures grant and the additional COVID Grant monies the Out of Hospital cell of the Lancashire and South Cumbria NHS Command and Control Structure has been used as it contains the required level and breadth of NHS and social care representation.  That body has agreed the plan for the use of the above grant monies with a continued emphasis on increasing capacity in core community/intermediate care services and whilst continuing to support people to stay or return to their own home.

There was a potential need for a further £4.3m for continuation of the externally commissioned services for a further six months.  This is to be considered further.

The Board was reminded that it was the accountable body for the Better Care Fund and the Winter Fund, both of which come as an annual grant.  Each year the Council and Clinical Commissioning Groups determine how the winter funds will be spent and, as expected at this time of year how it can be stepped up, as well as increasing capacity to ensure meeting the extra demand which, this year, has equally had to take account of the ongoing pernicious nature of the COVID pandemic and its impact on Lancashire's vulnerable population.

The Better Care Fund, is spent collaboratively with the Clinical Commissioning Groups and this tends to be on services that are referred to as intermediate care – services that allow the Authority to keep people safe and supported at home with care provision if that is necessary, or to step people down if they have been in hospital and feel that they have an ongoing need when they are discharged.

In addition the Council has also allocated some of its COVID grant that has been received from Government to supplement the arrangements to ensure there is adequate capacity at this extremely critical period.

Resolved:  That the Health and Wellbeing Board recognised the validity of the decision making process, under current arrangements, and supported the spending plan as outlined in the report.

To note the report which provides details of the Lancashire County Council Adult Social Care winter plan for 2020-21 and the additional capacity that will be mobilised to meet the anticipated demand.

Sue Lott, Head of Service, Community North and County Acute and Prisons, Lancashire County Council outlined the details of the Council's Adult Social Care Winter Plan for 2020-21 (Appendix A on the agenda item) and the additional capacity that would be mobilised to meet the anticipated demand.  The Winter Plan 2020-21 would be considered by Cabinet on 5 November 2020.  Further context around the plan were detailed in the report circulated with the agenda and the presentation covered the following in more detail:

Winter Planning   -  Context

-  Funding

-  What is in the Plan

-  Next Steps

Following the presentation, it was noted that a range of key issues had been considered and planned for during the winter.  In terms of designated settings, the Authority had been asked by the Department of Health and Social Care to consider identifying care homes across the County that would be prepared to accept people from hospital who were tested positive for COVID-19.  Contact had been made with all providers across County asking if they would be willing to be considered and be able to demonstrate that they could appropriately segregate people so that if they were accepting COVID-19 positive individuals that they were not increasing the risk of transmission to other residents.  They then have to go through an inspection by the Care Quality Commission (CQC) who carry out an on-site inspection.  There was also national as well as local concern with regards insurance for the purposes of accepting this level of responsibility.  As of 3 November 2020, there were two facilities that had already been visited by the Care Quality Commission in Lancashire.  As this was a moving picture, when there was a more definitive position, Louise Taylor agreed to circulate the list to Board Members, of the homes who would be actively accepting people with that designated status.

Work was also continuing with Blackburn with Darwen Council, Blackpool Council and the NHS on an agreed specification that it was clear on what would be expected as the commissioning organisations and equally what enhanced support any provider would receive from the Authorities and the NHS services.  Some forecasting had taken place to know how many homes might be required and it is about getting the right spread across the County.

The Council's day centres are opening their facilities back up and have supported the independent sector with some financial support.  The policy on day centres has been revised to maintain day centre provision during the period of any further restrictions.  It had also been agreed by the Lancashire Resilience Forum that day centres were going to be prioritised for the testing pilot to ensure that a regular testing regime can be undertaken by staff.

Resolved:  That the Health and Wellbeing Board:

i)  Noted the report.

ii)  Supported the ongoing work of Adult Social Care to ensure that vulnerable people who needed social care support across the winter period and throughout the pandemic, received the right support at the right time.

iii)  ...  view the full minutes text for item 8.

To receive an update on the current situation and what has happened since the last Board meeting.

Dr Sakthi Karunanithi, Director of Public Health, Lancashire County provided a current overview on the COVID-19 outbreak.

The Board was signposted to the single source of weekly updates for Lancashire's COVID-19 statistics, which can be found via the following link: https://www.lancashire.gov.uk/covidweekly/.  The Board were informed that if they had any further questions or requirements in terms of data, to contact Dr Karunanithi, email Sakthi.karunanithi@lancashire.gov.uk.

Lancashire is currently in Tier 3, which is a local area level – very high.  Early signs were that the number of new cases reported every day has started to slow down, however this was also combined with fewer people coming forward for tests, which was a slight concern.  The main areas affected in Lancashire are the more deprived areas in the East of the County, as well as in Preston and West Lancashire.  The age groups most affected were older, younger and middle aged individuals; although reducing in the younger age groups, whereas it was still on the upward trend in those with other complications and the over 60s.

There is about two to three weeks gap between the cases rising and the hospital admission rate changing.  The capacity in hospitals was increasingly challenged, impacting on other work to support both physical and mental health.

There is more testing capacity being made available under local influence, in discussions with NHS and Directors of Public Health, and more on the spot testing, particularly for people who are asymptomatic.  This is starting to be rolled out with specific groups of staff within the care sector, police and fire services and the plan is to roll it out to wider groups.

Plans for the vaccination programme will commence with specific groups on a small scale before the beginning of 2021 and then roll out more widely. 

There needs to be continued hard work to reduce the high level of infection to as low as reasonably possible, and that will depend on a number of things:

i)  Community consent and people following the advice, particularly those who are symptomatic or are positive, to support them to remain at home.

ii)  Protecting the vulnerable.

iii)  Case finding, testing, isolation, tracing – more capacity for testing and a successful tracing programme.

iv)  Vaccination programme plan.

v)  Enforcement.

Current concerns are the end of term migration of students going back to family homes for the festive season.

A query was raised about people not getting tested. There appear to be a number of reasons for that, which are:

·  Concerns around isolation

·  People having caring responsibilities

·  Being the key wage earner

·  Lack of support to stay at home.

The Board was asked to encourage people to come forward for testing and ensure that there is support available through the district hubs and the NHS to support those that are isolating.

Resolved:  That the Board noted the update.

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 were no items of urgent business received.

The next scheduled meeting of the Board will be held on Tuesday, 19 January 2021 at 2pm, format to be confirmed.

The next scheduled meeting of the Board will be held on Tuesday, 19 January 2021 at 2pm, via Microsoft Teams.