Agenda and minutes

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

The Chair welcomed all to the meeting and thanked the staff at Skelmersdale Library for hosting the board meeting, staff at the Youth Zone for a tour of the premises, officers from the Public Health Team and Democratic Services for arranging the meeting.

Apologies were noted as above.

Replacements for the meeting were as follows:

County Councillor Jayne Rear for County Councillor Sue Whittam, Lancashire County Council

Dave Carr for Edwina Grant OBE, 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 8 March 2022.

There were no matters arising from them.

To note the NHS appointment to the role of Deputy Chair of the Health and Wellbeing Board.

The Board were informed that the current arrangement for Deputy Chair was continuing with Denis Gizzi, whilst confirmation from the NHS was still awaited in light of NHS structural reform locally.

To discuss one of the three Board priorities – Best Start in Life, with a focus on effective collaboration to address the issues that improve school readiness, including the importance of speech and language.

Ruksana Sardar-Akram, Interim Public Health Consultant, Lancashire County Council presented the outline strategy for achieving the best start in life for children and families across Lancashire.

The Board noted that comparing local indicators with England averages, the health and wellbeing of children in Lancashire is generally worse than England.  Therefore, setting the foundations for health and wellbeing during pregnancy and in the early years is crucial to ensure that every child in Lancashire is given the best start in life possible.  To do this, a collaborative approach is required alongside plans to target inequalities, especially in the first 1001 critical days from conception.  Further details of the outline strategy for achieving this for children and families in Lancashire and the next steps for best start in Lancashire were set out at Appendix 'A' attached to the agenda.

It was highlighted to the Board that the best start in life national review identified six actions:

Ensuring families have access to the services they need:

i)  Seamless support for families: a coherent joined up Start for Life offer available to all families.

ii)  A welcome hub for families: Family Hubs as a place for families to access Start for Life services.

iii)  The information families need when they need it: designing digital, virtual and telephone offers around the needs of the family.

Ensuring the Start for Life system is working together to give families the support they need:

iv)  An empowered Start for Life workforce: developing a modern skills workforce to meet the changing needs of families.

v)  Continually improving the Start for Life officer: improving data, evaluation, outcomes and proportionate inspection.

vi)  Leadership for change: ensuring local and national accountability and building the economic case.

The Board were informed that the data on children and young people in Lancashire identifies that:

·  Inequalities exist, with many child indicators in Lancashire worse than England.

·  Some children have poorer health outcomes than others.

·  Inequalities exist at district level and in Lancashire's most deprived areas.

·  There is a need to address the wider determinants such as child poverty, educational attainment, school readiness is key.

·  School readiness in Lancashire is below England, with a reduction in girls being school ready shown in the latest data.

Children achieving a good level of development at the end of reception is significantly worse than the England average.  Lancashire is 69.2% compared to 71.8% in England in 2018/19.

In terms of best start in life and 1001 critical days, support starts very early on from conception, pregnancy and birth and targeting those families early.

Further local variation data that was included in Appendix 'A' in relation to:

·  Pregnancy and infancy

·  School age health

·  Poverty and Looked After Children

·  School Readiness

It was outlined to the Board, as to why school readiness has been chosen as a key priority outcome for best start.  It was noted that uptake of the 2-year-old nursery offer varies in each district with Lancaster (95%) with the best take up and Hyndburn (76.4%) the lowest take  ...  view the full minutes text for item 5.

To receive proposals for Family Hubs in Lancashire and the associated Growing Up Well Digital programme and to consider the opportunities for working in partnership, including with local communities, to ensure that the potential benefits of the Family Hubs model are realised.

Dave Carr, Director of Policy, Commissioning and Children's Health, Lancashire County Council provided the Board with a report on family hubs.  They were informed that these are a way of joining up locally, to improve access to services, the connections between families, professionals, services, and providers, and putting relationships at the heart of family help. Family hubs can include both physical locations and virtual offers, with a range of services for families with children of all ages, with a great Start for Life offer at their core.  Further information on Family Hubs was detailed in the report.

Lancashire County Council has submitted a bid for £1m to the Department for Education for Transformation funding to support the establishment of a network of Family Hubs across the County.  The outcome of the bid is expected to be known shortly after the local elections in May 2022.  If successful, the funding will run to March 2024, providing a project team and support to undertake consultation, engagement and design work at a local level across Lancashire to help move to a family hub mode, including over 50 family hub buildings.  The funding would include very little capital monies and would not cover the costs of family hub services themselves.

The Board were informed of the core universal services that must be delivered as part of the model and Lancashire's vision which are detailed further in the report.

The Board noted that the Family Hubs and Growing Up Well Digital programmes present many opportunities for working better together in partnership and, if they are to achieve significant positive benefits for children and families, need the support and engagement of partners and stakeholders from across the children's system.

The Growing Up Well programme is supported by the Department for Education, which has identified key information sharing "pain points" experienced by practitioners and is informing the development of national and local solutions which will help people to work better together.

The Board noted that within Lancashire, a proof concept has been undertaken to join up various datasets, including from Early Years Teams, Early Help Teams, Children's Social Care and Education, to help inform a system wide-business case for the implementation of a digital Information sharing service.  The final outputs from the proof of concept are expected in May 2022. 

Following the presentation, the following points/issues were discussed:

·  It was queried as to whether the early help offer would be utilised as part of the Family Hubs to ensure that there was no duplication.  The Board noted that in parts of the County there was already provision in place and to build on what is available, with further work required in other areas.

·  Working with local communities and with district colleagues, NHS and GPs is important as they are closest to their communities

·  It was suggested that Family Hubs should be branded as a partnership to help ensure that people understand what they are and what they offer.

·  It was noted that there was also an  ...  view the full minutes text for item 6.

To receive the Lancashire Better Care Fund End of Year Report for 2021/22.

Paul Robinson, Senior Programme Manager, NHS Midlands and Lancashire Commissioning Support Unit presented the report on the Lancashire Better Care Fund End of Year Report 2021/22.  The approval of the Lancashire Better Care Fund 2021/22 was ratified by the Health and Wellbeing Board at its meeting on 8 March 2022.

The Board noted that the report reflects a period of significant volatility within the Health and Social care system.  It shows that the Better Care Fund plan has continued relatively unchanged from the previous year and has support the Covid pandemic response.

They were also informed that whilst the Better Care Fund conditions have been met, financial performance was as planned and there had been significant successes achieved in its delivery and the report highlighted significant challenges and potential tensions across health and social care as each respond to high demand, increasing costs and factors such as challenging workforce planning and market development.

It was outlined that performance as measured through the Better Care Fund metrics was mixed and skewed due to the pandemic response.  A longer-term view of the performance was required to see true impact.

Also detailed in the report was the Better Care Fund respondents to the end of year questionnaire approach having highlighted Successes and Challenges in delivering the Better Care Fund that can be used in the ongoing discussion on the aspiration of better integration of health and social care.

The Board noted that the national conditions have been met, as addressed in the report circulated with the agenda.

The Board were presented with the new set of Better Care Fund metrics introduced in 2021/22.  The broader summary including exploration of the challenges faced and achievements made in addressing the new set of metrics is provided at Appendix 'A'.  The Board were asked to note that following discussion with Louise Taylor (Executive Director for Adult Services, Health and Wellbeing, Lancashire County Council) residential care admissions were not on track to meet target, with residential care admissions per 100,000 population over 65 years of age at 732.6.  The reasons for this included the effects of the pandemic and being wary of allowing residents to enter care homes, home care availability and a backlog.

Following the presentation, the Board highlighted the following points/issues:

·  There has been a significant uplift in the number of attendances of Lancashire Fire and Rescue via Telecare systems which is welcomed, as this is hopefully preventing somebody entering the health/social care system. However, it was queried whether the £6m funding was sufficient or whether there should be further work looking at the expansion of the Telecare system across Lancashire.  Paul Robinson commented that advice has been received and there would be an increase in funding of 5.66% in the Clinical Commissioning Groups (CCG) minimum contributions to the Better Care Fund, and that this should be reflected in increase with each element.

·  A request was made by the Board for a development session to provide them with greater insight into the Better Care  ...  view the full minutes text for item 7.

To receive an update on the Pharmaceutical Needs Assessment.

Dr Sakthi Karunanithi, Director of Public Health, Lancashire County Council provided an overview of the purpose of the Lancashire Pharmaceutical Needs Assessment (PNA) 2022 together with an update on the current development of the PNA prior to a formal public consultation taking place later this summer.

The three Health and Wellbeing Boards across pan-Lancashire have a statutory responsibility to push and keep up to date a statement of the needs for pharmaceutical services of the population in its area.

The Board noted that decisions on whether to open new pharmacies are made by the local NHS England team and when making the decision NHS England is required to refer to the local Pharmaceutical Needs Assessment.  As these decisions may be appealed or challenged via the courts, it is therefore important that pharmaceutical needs assessments, both in their content and in the process of their construction, comply with regulations and that mechanisms are established to keep the Pharmaceutical Needs Assessment up to date. 

In accordance with these regulations, the Pharmaceutical Needs Assessment must be updated every three years and the 2022 version is currently being prepared for publication later this year.

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

·  It was queried as to whether the assessment considered the lack of pharmacy provision at weekends.  The Board were informed that it did consider this as well as driving times and they are both considered when pharmacy changes are happening.

·  Concern was also raised, regarding access to emergency prescriptions and collection from pharmacy.  Dr Sakthi Karunanithi, Director of Public Health, Lancashire County Council agreed to submit this as a concern into the consultation, however it was noted that there was always a 24-hour pharmacy available if people do attend an out of hours appointment.

·  There was a query regarding a change of hours to a pharmacy that had happened without notice, with no details provided about the emergency pharmacy provision.  Dr Sakthi Karunanithi agreed to raise this on behalf of the Board.

·  There was a query regarding public engagement in the needs assessment.  The Board were informed that there was a number of modes of engagement being planned, including digital sources. It was agreed that the consultation plan would be shared with members of the Board.

Resolved:  That the Health and Wellbeing Board:

(i)  Endorsed the continued development of the Lancashire Pharmaceutical Needs Assessment 2022.

(ii)  Noted the proposed public consultation that is due to take place during July/August.

(iii)  Receive the final version of the Pharmaceutical Needs Assessment once completed in early Autumn 2022.

(iv)  That the Consultation Plan be shared with members of the Health and Wellbeing Board.

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 19 July 2022.  Venue to be confirmed.

The next scheduled meeting of the Board will be held at 2pm on 19 July 2022.  Venue to be confirmed.