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 is attending on behalf of Dr Lindsey Dickinson, Chorley and South Ribble CCG and Dr Sumantra Mukerji, Greater Preston CCG

·  Dave Carr is attending on behalf of Edwina Grant OBE, Education and Children's Services, Lancashire County Council

Dominic Harrison, Director of Public Health, Blackburn with Darwen Council was also in attendance.

i)  Note the revised Terms of Reference and membership (Appendix 'A') agreed by Full Council on 16 December 2021.

ii)  Note the appointment of Chair as agreed at Full Council.

iii)  Agree the appointment of Deputy Chair.

The Board were informed that the Terms of Reference had been amended and approved at the Full Council meeting of the County Council on 16 December 2021 and that County Councillor Michael Green, Cabinet Member for Health and Wellbeing had been confirmed as Chair of the Board.

The Board noted that the Deputy Chair of the Board had previously been a representative from the NHS and going forward the new Terms of Reference remained the same, however as the NHS Reforms were still ongoing, it was agreed that Denis Gizzi, NHS would remain as the interim Deputy Chair of Lancashire Health and Wellbeing Board, until a formal appointment was received from the Integrated Care System Board.

Resolved:  That the Lancashire Health and Wellbeing Board:

i)  Noted the revised Terms of Reference and membership as set out in Appendix 'A' of the agenda and agreed by Full Council on 16 December 2021.

ii)  Noted the appointment of Chair as agreed at Full Council.

iii)  Agreed the appointment of Deputy Chair.

iv)  A formal note of thanks be sent to the former Chair of the Lancashire Health and Wellbeing Board thanking him for his services.

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 9 March 2021.

There were no matters arising from the minutes.

To receive a final update from the SEND Sub-Committee on the Accelerated Progress Plan and to agree the disestablishment of the Sub-Committee.

Julie Bell, Interim Director of Education, Culture and Skills, Lancashire County Council presented the final report of the Special Educational Needs and Disabilities (SEND) Sub-Committee which was requesting that it be disestablished as it has successfully achieved a good result.

There were five interventions that were in place for the Special Educational Needs and Disabilities (SEND) Service, and it was confirmed that sufficient progress had been made in all five areas in November 2021. 

It was noted that there had been a high level of challenge and that colleagues from the NHS had been extremely helpful in the proceedings and that collaboration working between the NHS and the County Council, both with officers and with Elected Members, had worked really well and as a result, positive progress had been achieved.

The Chair formally thanked everyone that had been involved with the Sub-Committee, particularly the excellent work of the officers and the Elected Members both past and present, who had worked hard to ensure that good results were now being achieved.  Julie Bell, County Councillor Phillippa Williamson, Leader of Lancashire County Council and County Councillor Jayne Rear, Cabinet Member for Education and Skills also echoed their thanks to all involved.

Resolved:  That the Lancashire Health and Wellbeing Board:

i)  Noted the report of the Lancashire Health and Wellbeing Board – Special Educational Needs and Disabilities (SEND) Sub-Committee from its meetings on 22 March 2021, 21 June 2021, 13 September 2021 and 30 November 2021.

ii)  Approved that the Lancashire Health and Wellbeing Board – Special Educational Needs and Disabilities (SEND) Sub-Committee be disestablished with immediate effect.

To note the feedback from the workshops and discuss the priorities and proposed next steps of the Board.

John Morrissy, Director of Organisational Development and Change, Lancashire County Council gave a presentation (attached to the minutes) to the Board following three workshops sessions that had been held during Autumn 2021 where engagement with key stakeholders took place on how the Board could be further developed and strengthened.

The presentation provided an overview of the outcomes from the workshop sessions and further information was provided on:

·  Recap and Feedback – Key themes and messages emerging from the workshop discussion.

·  Responding to Feedback – Strategic actions and initial continuous improvement priorities.

·  Operating differently – Suggestion that the Board should focus on three key elements:

  i)  Better Start in Life

  ii)  Healthy Hearts

  iii)  Healthy Minds

And in doing so, the Board should encourage all partners to ensure the Board are linking its priorities to all of the available policy levers.

·  Moving from ambition to delivery – Key requirements/elements that require resources to support the three key areas:

  i)  Board development

  ii)  System improvement

  iii)  Community engagement

·  Draft vision and purpose (based on staff/partners engagement so far)

·  Initial priorities for a Better Start in Life, Healthy Hearts and Healthy Minds:

Ø  Achieving the best start in life for all our children and young people.

Ø  Prevention and early detection of long term conditions and their root causes.

Ø  Promoting wellbeing in Lancashire's communities, workplaces and economy.

·  Governance and meetings – particularly place-based locations wherever possible, so that the Board can benefit from lived experience and successful examples.  Also the format of Board meetings going forward, should look at:

Ø  Bringing together data and analysis to illustrate an issue.

Ø  Experiencing examples of successful approaches.

Ø  Identifying rapid solutions which can be developed and scaled.

·  Proposed next steps:

Ø  Development of implementation plan and ongoing engagement.

Ø  Identify continuous improvement support capacity.

Ø  Refresh the Health and Wellbeing Board Strategy using the Joint Strategic Needs Assessment (JSNA) and the Health Equality Commission (HEC).

Following the presentation, comments received from members of the Board, were that in terms of structure and the current COVID pandemic, which has raised further concerns with Long COVID, mental health, loss and grief within communities as well as economy, would this be something the Board could pursue.  It was noted that the priorities identified were immediate, whilst still in the pandemic and that there will be a continuous programme of work on understanding how health and wellbeing has been affected over the last two years, in particular the economy and environment and will require a joint action approach of which, this is just the start of it.

County Councillor Sue Whittam, Lead Member for Health commented that it was clear from the workshops that people wanted a fresh approach to the Board and that visiting communities and districts, to witness some of the work in practice and see the outcomes that are going to make a real difference to residents in Lancashire would be beneficial in the Board moving forwards.

David Blacklock, Healthwatch Lancashire indicated that they would  ...  view the full minutes text for item 6.

To receive the annual report of the Director of Public Health 2021/22 and support the high-level recommendations contained within it.

Dr Sakthi Karunanithi, Director of Public Health, Lancashire County Council presented the Annual Report 2021-22 to the Board.  The report (Appendix 'A' in the agenda pack) details an analysis of key indicators of health, outcomes and equalities in Lancashire.  It was noted that the Annual Report would also be presented to Lancashire County Council's Cabinet on 3 February 2022 and Full Council on 24 February 2022.  Dr Sakthi Karunanithi, Director of Public Health also thanked the Public Health Team for the Annual Report as well as wider partners who had also been involved in the compilation of it.

Directors of Public Health have an annual duty to describe the state of health and wellbeing and highlight challenges and point to areas of collective actions as a society and continue to promote good health and prevent illness and deaths.  The Board were informed that how healthy somebody was, is determined by a wide range of factors, ie 20% is influenced by the NHS, health care and clinical services and 80% is determined by the wider/social determinants of health.

It was reported that there are two key measures that are globally recognised to describe the health of society and how it is distributed within communities:

i)  Life expectancy at birth

ii)  Healthy life expectancy at birth

In Lancashire the life expectancy at birth for:

i)  Females is 82 years

ii)  Males is 78.3 years

And for healthy life expectancy for:

i)  Females is 62 years

ii)  Males is 60 years

This highlights that 75% of your life is spent living healthily with 25% not in good health, which is a stark realisation.

The Board were informed that throughout the COVID pandemic is has highlighted how intrinsically health and economy are linked and it is imperative to be prepared for responses to future threats and to reduce inequalities in Lancashire.  The immediate priority in Lancashire is school readiness and cuts across shared goals, whilst not losing focus on issues such as overweight and obesity in children.  During COVID it was noted that the community effort in Lancashire in communities, voluntary community and faith sector (VCFS), volunteers rose to the challenge to help each other in times of need which recognised the value of the VCFS colleagues that are helping to improve health and wellbeing and will continue to embrace that and support the sector.

It was highlighted that there were three "E's" that were key levers to improving health and wellbeing more than anything else and they are:

i)  Education

ii)  Environment

iii)  Economy

The Board also noted that alliances and partnership working on mental health had already commenced with various programs across Lancashire and also working with employers to address the issues surrounding mental health.

It was outlined to the Board, the key findings detailed in the covering report and the six high level recommendations included in the Annual Report which were:

i)  Adopt a health in all policies approach to reducing health inequalities across Lancashire.

ii)  Work more closely with wider  ...  view the full minutes text for item 7.

To engage in a strategic discussion on recovery from the pandemic and developing a longer term health and wellbeing strategy.

Denis Gizzi, Deputy Chair of Lancashire Health and Wellbeing Board, NHS led a strategic discussion on the approach to care, health and wellbeing which is just the start of a much broader conversation engagement with partners and stakeholders.

The Board were informed that discussions have been taking place with different people in various meetings over the last two years as the pandemic was being managed and that there are three parts to those discussions:

i)  Context – what has been learned from the last 18 months – 2 years.

ii)  Consider what can be done better together and move forward.

iii)  What third party essential requirements would be needed to do it and do it well.

It was suggested that as a system it needs to get better at predicting risk by using data and science to ensure there is organised and structed action in the way in which services fit together to ensure better quality and outcomes for residents in Lancashire.  There is also the prediction of model of care so that it is structured in such a way that it delivers a better quality of care overall and be much more prescriptive around that system of care and if all those suggestions are balanced, and the resources are available, there would be a more structured, organised, systematic process of care planning.

Following the update, it noted that from a longer term strategic approach there is something about how this links with the broader digital strategy across the Integrated Care System and how it is embedded within that.

As a Board, it was suggested as to whether it should be driving this or using its' influence in the wider partnership.  It was felt that the Board should not own this itself, however it should be setting the scene and setting the strategy and holding the system to account for sticking within that strategy.

The Board noted that having a good understanding in the analysis of different segments of the population and how there needs to be a "prescribed" set of care, one of the things that Lancashire Health and Wellbeing Board is ideally placed is to champion what really matters for someone's health and wellbeing and is captured as part of the care plan such as housing, education and employment.

Resolved:  That the Lancashire Health and Wellbeing Board engaged in a strategic discussion on recovery from the pandemic and looked at ways of developing a longer term health and wellbeing strategy.

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 received.

The next scheduled meeting of the Board will be held at 2pm on 8 March 2022 in Committee Room 'C', County Hall, Preston.

The next scheduled meeting of the Board will be held on Tuesday, 8 March 2022 at 2pm in Committee Room 'C', County Hall, Preston.

As discussed previously in the meeting, the venue for the next meeting, may be elsewhere in the County and will be confirmed to members as soon as possible.