Agenda and minutes

The Chair welcomed everyone to the first virtual meeting of the Board.  Members then had a few moments silence to reflect on all those affected by the COVID 19 outbreak.

All of the above members and officers were present at the meeting.

Apologies for absence were received from Mr M Adams, Mr C Cox, Mr A Cummins, Mr J Hawker (Mr A Gardner attended as substitute), Ms H Horne, Mr G Jolliffe, Mr P Scott, Mrs L Simpson and Mr M Thomas.

There were no disclosures of interest on this occasion. 

RESOLVED,     that the press and public be not excluded from the meeting for any items of business.

To confirm as a correct record the minutes of the meeting held on 7 February 2020 (copy enclosed). 

RESOLVED,     that the minutes of the meeting of the Board held on 7 February 2020 be agreed as circulated.

To consider a report by the Independent Chair, Cumbria SEND Improvement Board (copy enclosed).

Members considered a report from the Independent Chair of the Cumbria SEND Improvement Board which provided a strategic update in relation to the SEND Improvement Programme.  This was the first update received since February 2020 due to the April 2020 Board cancellation as a result of COVID 19.

The report highlighted the impact of COVID 19 on the improvement programme of activity, provided a recap of the progress made to date in the delivery of the Written Statement of Action, and highlighted areas that required increased momentum and focus to secure the required transformation.

During the course of discussion officers raised concerns regarding the capacity to drive this work forward within the existing resource.  It was highlighted that whilst the work, particularly recently, to improve the emotional health and wellbeing of children and young people with SEND had been positive there had been some important areas of work which had experienced delay as an impact of COVID.  Members were informed that an action plan had been drawn up around the areas identified as requiring improvement.

A discussion took place regarding the development of a joint commissioning framework.  Officers felt positive regarding the strength of the partnership but raised their concerns regarding capacity highlighting the need for ongoing support and renewed commitment.  Members felt there was a need for investigations to take place regarding capacity issues.

Members were informed that the Independent Chair of the Cumbria SEND Improvement Board had highlighted that significant progress had been made and welcomed the Board’s support and drive. 

The Board discussed the potential increase in demand on services to support children and young people as restrictions were lifted and regular life returned, highlighting this was a collective responsibility for all agencies. 

The Cabinet Member for Children’s Services thanked everyone involved for the progress which had been made to date.

In conclusion Board members were requested to endorse and support the ongoing prioritisation and commitment of partners working together, to ensure the drive and capacity to secure the necessary improvements.

RESOLVED,   that

                          (1)          the update in relation to the SEND Improvement Programme of activity including: the impact of COVID 19 upon the programme of work, the progress made and the areas that require continuing focus be noted;

                          (2)          the continued priority and sustained commitment of lead partners to this programme of work across the partnership be restated.

To consider a joint report by the Executive Director – People (Cumbria County Council), Chief Operating Officer – North Cumbria Clinical Commissioning Group and Chief Officer - NHS Morecambe Bay Clinical Commissioning Group (copy enclosed).

The Board considered a joint report from the Executive Director – People (Cumbria County Council), Chief Operating Officer (North Cumbria Clinical Commissioning Group and Chief Officer (NHS Morecambe Bay Clinical Commissioning Group) which detailed the work that had been undertaken by partners to respond to the COVID 19 Pandemic.

Members were informed that in the early stages of the pandemic one of the overriding considerations was the impact that a large number of COVID cases would have on NHS acute services.  It was explained there was a fear that the NHS would be overwhelmed, therefore, leading to COVID and non-COVID patients being unable to be treated and resulting in an increase in negative outcomes.  It was highlighted that through collaborative working between the NHS and other care sectors the anticipated impact had been avoided.

Officers explained there was now a need to ensure there was sufficient capacity and resources for the next phase as well as the additional winter pressures - highlighting that challenges should not be under?estimated.

The Board was informed there had been a lot of supressed activity during the pandemic and, therefore, there was now a need to encourage individuals with long?term conditions to seek the necessary help otherwise this would result in longer-term impacts in terms of referrals and demand on healthcare.

Members discussed the significant impact of COVID on the residential and nursing home sector.  It was felt that as well as providing assurance about the activity that had taken place to date around COVID it was imperative that the real current fragility of the Health and Care sector in the face of a potential second wave, changes in health seeking behaviours, IPC constraints and reduced capacity, amongst other pressures were recognised.  It was highlighted there was a need for activities to ensure stabilisation in light of those ongoing issues that continued to have an impact.

The Board discussed the number of deaths due to COVID and how the bereavement and funeral challenges could impact on individuals.  Members also felt there would be significant consequences due to social isolation, anxiety and economic impacts and that psychological issues should be a priority for the Board in the future.

Members embraced the strong partnership working which had been undertaken, highlighting the invaluable critical support received from communities and third sector organisations and welcomed the continuation of this in the future. 

The Board highlighted the support received from the Strategic Co?ordination Group and asked that their thanks and appreciation be passed onto Andy Slattery and the Group for their involvement.

RESOLVED,   that the work undertaken across partners in Cumbria to respond to the COVID Pandemic be noted.

To receive a presentation from Healthwatch Cumbria (copy enclosed).

The Board received an informative presentation from Healthwatch Cumbria detailing information regarding a survey which had been undertaken during the COVID Pandemic on how people were coping.

Members were informed that social isolation had been highlighted as an issue and concerns were raised regarding the lack of access to IT.  It was felt those young people needed extra support to ensure they were not digitally excluded.  The availability of 100 mobile phones with credit was highlighted as a positive example with regards to connecting digitally but it was felt this only captured a very small minority of those who needed support.

Officers confirmed that the survey would continue into the recovery phase with the next iteration being about the provision of help and support.  It was highlighted there was a need to work in partnership to shape the next verison.

RESOLVED,   that the presentation be noted.

To receive a presentation from the Multi-Agency Intelligence Cell Lead (Cumbria County Council) (copy enclosed).

Members welcomed a presentation from the Multi Agency Intelligence Cell Lead regarding the impacts of COVID 19 and felt this would help shape the whole recovery process.

The Board noted the impact on the education and attainment of all children was still to be explored but that an increase in inequalities was expected.  Members were informed that preparations had begun and pressures had been identified with schools regarding the new Autumn Term to ensure support was available. 

RESOLVED,   that the presentation be noted.

To receive a report from West Cumbria (Allerdale and Copeland) Youth Council (copy enclosed).

The Board received a report from the West Cumbria (Allerdale and Copeland) Youth Council regarding a survey which had been undertaken during the COVID Pandemic.

Members welcomed the reassuring trend that the majority of people claimed to have been following social distancing guidelines with nobody reporting having a total disregard for the rules.

During the course of discussion concerns were raised regarding 43.7% of young people who did not have reliable access to the internet.  Members highlighted the additional challenges this brought for young people and suggested this should be investigated further. 

RESOLVED,   that the report be noted.

The Board welcomed all three informative and valuable presentations.  It was suggested that going forward there was a need to connect with other partnerships across the county for support.

To consider a joint report by the Executive Director – People (Cumbria County Council), Chief Operating Officer – North Cumbria Clinical Commissioning Group and Chief Officer - NHS Morecambe Bay Clinical Commissioning Group (copy enclosed).

The Board considered a joint report from the Executive Director – People (Cumbria County Council), Chief Operating Officer (North Cumbria Clinical Commissioning Group and Chief Officer (NHS Morecambe Bay Clinical Commissioning Group) which set out the recovery structures that had been put in place in Cumbria in order to start to rebuild after COVID.  It was explained that as part of those countywide structures it had been agreed that existing strategic partnerships and delivery mechanisms should be utilised as much as possible to ensure that any measures were embedded as ongoing practice.

Members were informed that following on from that decision the Health and Wellbeing Board would be responsible for co-ordinating recovery for the areas that fall under its remit.  The Board also recognised that the NHS had put in place national and regional response and recovery structures.  It was noted that taking both of those into account, the report set out and asked for agreement on the structures that the Health and Wellbeing Board would put in place to fulfil this role. 

The Board noted that whilst the countywide incident response structures were moving to address recovery the real current fragility of the Health and Care sector needed to be recognised and form a core part of ongoing activity to ensure stabilisation.  Members highlighted that it should be recognised that COVID was still circulating and that measures to control its spread and deal with its impact would need to be an ongoing consideration within the Health and Care system.

Members were informed that the proposed areas of work would form the two pillars that underpin the overarching recovery work of the Health and Wellbeing Board to COVID.  It was explained that Pillar 1 would include Wellbeing and Pillar 2 the Sustainability of the Health and Care System.

It was emphasised to members that there was a clear commitment to continue the countywide arrangements.  Officers explained that from a sustainability perspective capacity in the NHS was still an issue.  Members were informed that A&E activity and hospital admittances were now almost back to where they were prior to the pandemic and there was now a need to prepare for winter and a potential second wave of COVID. 

A discussion took place regarding the Strategic Recovery Co?ordinating Group (SRCG) which was activated on 18 June and the RAG was stood down.  Members noted this would help to facilitate and enable recovery of Cumbria from the COVID-19 pandemic, focusing on the impacts at community and countywide level, and the opportunities to reimagine and rebuild a better future for the county, its places, and communities.  It was felt there was a need to facilitate an approach to recovery in Cumbria that included community voices, build community resilience and, therefore, support communities to thrive.

Members welcomed the report and whilst acknowledging the geographical complexity of the county, highlighted that the continuation of strong relationships with the third sector were crucial in the recovery process. 

The Board agreed a number  ...  view the full minutes text for item 65.

To consider a report by the Director of Public Health (Cumbria County Council) (copy enclosed).

Members considered a report by the Director of Public Health (Cumbria County Council) regarding the COVID 19: Outbreak Control Plan.  Officers explained that as part of the national recovery plan for COVID, upper tier local authorities were required to publish a local Outbreak Control Plan. 

The report outlined the approach that had been taken in Cumbria and asked the Health and Wellbeing Board to approve the Plan (Appendices 1 and 2 of the report) and the measures contained within it to prevent, control and manage COVID-19 incidents and outbreaks, if and when they emerged.

The Board was informed the Plan was centred around 7 themes:

Ø   Care homes and schools

Ø   High risk places, location and communities

Ø   Local testing capacity

Ø   Contact tracing in complex settings

Ø   Data integration

Ø   Vulnerable people

Ø   Local Boards.

During the course of discussion concerns were raised regarding the sharing of information and the lack of clarity about the decision?making process regarding local lockdowns.

The Board noted the PIan would continue to be developed highlighting this was a partnership approach and welcomed contributions from all partners.

The Chair, on behalf of the Board, asked that thanks and appreciation be conveyed to all officers involved in the Plan.

RESOLVED,   that the Outbreak Control Plan (referred to Appendices 1 and 2 of the report) be approved.

To consider a report by the Executive Director – People (Cumbria County Council) (copy enclosed).

The Board received a report from the Executive Director – People (Cumbria County Council) which informed members that the Coronavirus Act became law on 25 March 2020.  It explained that the Act temporarily amended certain statutory duties of the Local Authority under the Care Act and updated members on the use of the powers in the Act.

Members were informed that the Easement should be enacted only when all other measures had been exhausted, and for the shortest possible time.  It was explained that any decision to enact Easement could only be in consultation with and on the recommendation of the Director of Adult Social Services and the Principal Social Worker; the Portfolio Holder and Chair of the Health and Wellbeing Board would also be consulted and the local CCGs, MP(s) and DHSC informed.

RESOLVED,   that the following be noted:-

                          (1)          Cumbria County Council has not enacted the easements and is committed to taking all practicable steps to maintain pre-amendment Care Act provision to Cumbrian residents;

                          (2)          a system to keep this position under close review is in place, as is a process for consideration of easement should circumstances require this; (as detailed at para 4.7 of the report).

To consider a joint report from the Executive Director – People (Cumbria County Council), Chief Operating Officer - North Cumbria Clinical Commissioning Group and Chief Officer - NHS Morecambe Bay Clinical Commissioning Groups (copy enclosed).

The Board received a report which provided an update on Cumbria’s Better Care Fund (BCF) and also financial and activity reporting. 

It was explained that under Section 5 there were some sections where some data was not available for this quarter, this included benchmarking data and also information regarding Delayed Transfer of Care (DToC).  Members noted that the collection and publication of DToC data had been paused to release capacity to support the COVID pandemic.  It was highlighted there was also some data that had clearly been impacted by the COVID outbreak such as Non-Elective Admissions, however, it was expected that the greater impact across all reporting metrics would be seen in Quarter 1 of 2020-21.

The Board was informed that due to timings the Quarter 4 submissions to NHSE would be done via the delegations that were in place.  It was explained that currently full details of submission requirements for 2020-21 had not been released but it had been indicated these would be a “light touch” approach, given the pressures related to the COVID-19 pandemic.

RESOLVED,   that the report be noted.

To consider a report by the Director of Public Health (Cumbria County Council) (copy enclosed).

Members considered a report from the Director of Public Health (Cumbria County Council) which asked the Board to note the changes to the timescales to the production of the Pharmaceutical Needs Assessment.

The Board noted that the Pharmaceutical Needs Assessments were due to be renewed and published by local authority health and wellbeing boards in April 2021 but due to current pressures in response to the COVID-19 pandemic, the Department of Health and Social Care had announced that the requirement to publish renewed Pharmaceutical Need Assessments would be suspended until April 2022.  The health and wellbeing boards would retain the ability to issue supplementary statements to respond to local changes and pharmaceutical needs during this time. 

Members highlighted the invaluable contributions which community pharmacists had made throughout COVID 19 and welcomed the telephone appointments and pharmacy referrals which had contributed to reduced demand on the acute sector. 

RESOLVED,     the change to the timetable for the production of the Pharmaceutical Needs Assessment be noted.

The Board noted that:-

(1)       the next Cumbria Health and Wellbeing Board Development day would take place on Friday 2 October at 10.00 am (venue to be confirmed).

(2)       the next meeting of the Board would take place on Friday 4 September at 10.00 am (venue to be confirmed).

The Chair, on behalf of the Board, thanked all officers involved in the success of the first remote meeting and apologised for the technical issues which had been encountered during the preparations.