Agenda and minutes

Apologies for absence were received from Mr M Adams, Mrs P Bell, Mr A Cummins, Ms D Earl, Mr D Eva, Mr K Jarrold (David Muir attended as substitute), Mr C Ranshaw, Mrs S Sanderson, Mr P Scott, Mrs L Simpson (Mr M Smillie attended as substitute), Ms G Steward (Dr D Roberts attended as substitute) and Professor 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 16 April 2021 (copy enclosed). 

RESOLVED,     that the minutes of the meeting of the Board held on 16 April 2021 be agreed as circulated and thereupon signed by the Chair.

To receive a joint presentation from the Director of Public Health (Cumbria County Council), North Cumbria and Morecambe Bay Clinical Commissioning Groups (copy to follow).

The Board received a detailed presentation from the Director of Public Health (Cumbria County Council), Chief Operating Officer (North Cumbria Clinical Commissioning Group) and Director of Planning and Performance (Morecambe Bay Clinical Commissioning Group) which illustrated a COVID 19 update.

The Director of Public Health highlighted that overall the summary of epidemiology was positive across the whole of Cumbria and the number of people in hospital had stabilised at low levels.  Members welcomed the positive update regarding care homes, education settings, hospitalisation and mortality rates. 

The Board was informed this was now becoming an endemic with serious harm likely to remain limited.  It was explained that it was thought further lockdowns were unlikely with testing and contact tracing remaining over the winter and potential routine vaccine boosters.  Officers emphasised it was anticipated that the autumn and winter would be challenging for the whole of the health and care services.

The Board drew attention to the future delivery of Public Health services in Cumbria, outlining the support which had been provided from district councils during the pandemic, and whether this was sustainable in the future.  During the course of discussion a suggestion was made regarding the potential need to refresh the Public Health Strategy or future roles and responsibilities. 

The Director of Public Health emphasised that the district councils had been essential during the response and fundamental to track and trace throughout the county, with a need for their continued involvement.  He explained that funding was available from the Contain Management Fund until the end of March with funding to district councils potentially being available for a short period of time beyond that date.  Officers explained that future health protection was being investigated and it was hoped this would be at a local level in future.

In conclusion it was highlighted that although the impact on the day to day services had stabilised there were significant pressures on the wider system including A&E, GPs, mental health community services and social care which, it was anticipated, would lead to a difficult winter period.  It was explained there would be a need to manage the ongoing pandemic alongside the additional pressures. 

The Board acknowledged and thanked all staff throughout the system for their continued support and dedication.

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 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 updated members following the announcement on 21 July 2021 by the Secretary of State for Housing, Communities and Local Government about his decisions, subject to Parliamentary approval, to implement the proposal for two unitary councils on an East-West geography for the whole of the administrative county of Cumbria, and not to implement the proposal for a single unitary council nor the two other proposals for two unitary councils for the area.

Members were informed that NHS England had set out options for boundary alignment in integrated care systems in specific geographies where upper-tier local authorities currently had to work across more than one ICS footprint. 

The Board noted that the Secretary of State intended to review the areas of Cumbria and North Yorkshire, as they would remain non-coterminous following the conclusion of MHCLG’s unitarisation process.  It was explained that those reviews would take place in two years, following the implementation, subject to parliamentary passage, of the Health and Care Bill.

Members discussed the matter and raised their concerns regarding the impact this could have on key services, highlighting the current resourcing issues and capacity for the future. 

During the course of discussion the importance of remaining focussed on the core responsibilities and objectives to deliver care in the future was emphasised.  Members emphasised that the Board was instrumental in the process to prevent fragmentation.  It was agreed this matter would be discussed in more detail at the next Development Session of the Board.

RESOLVED,   that

                          (1)          the Secretary of State for Housing, Communities and Local Government decision, to implement the proposal for two unitary councils on an East-West geography and the Secretary of State for Health and Social Care decision to review the Integrated Care Boundaries for Cumbria following the conclusion of unitarisation process be noted;

                          (2)          the Board’s development session in October be used to explore the implications of these changes.

To consider a report by the Independent Chair, Cumbria SEND Improvement Board and the Strategic Lead for SEND Improvement (Cumbria County Council) (copy enclosed).

The Board received a report from the Independent Chair, Cumbria SEND Improvement Board and the Strategic Lead for SEND Improvement which provided an update on the SEND Improvement Programme, highlighted key areas of progress in the delivery of the SEND Written Statement of Action (WSOA) as well as areas of challenge. 

Members also received a summary of the feedback from an informal meeting with the Department of Education and National Health Service England (DfE/NHSE) and provided an update on the inspection revisit. 

Members were informed that the work to progress the remaining actions set out in the WSOA had continued across the partnership since the last formal report to the Board, with a clear focus on:

•           Understanding population need and service performance.

•           Planning and commissioning services jointly which meet need .

•           Improving access to and delivery of services and provision.

•           Engaging, involving, and communicating with parent carers and young people .

•           Improving system guidance, processes, and support.

Officers explained that the actions in the WSOA continued to be implemented with performance across a range of statutory and local measures also being monitored.

The Board was informed that the Accelerated Progress Plans had been agreed and were now being implemented in support of the WSOA and aligned with the areas of significant weakness.  It was explained that those areas included areas of underperformance (quality of Health and Care Plans, completion of Annual Reviews and Health Visitor checks at 27 months), the delayed implementation of the ASD Pathway and the arrangements for transition from Children’s Services to Adult Social Care and Health Services.

A discussion took place regarding the extent of the improvements which were required and the acceptance amongst staff and organisations.  Officers, whilst highlighting the challenges, confirmed that as a system everyone realised the gravity and seriousness and had shown enthusiasm to improve services for children and young people. 

The Board, whilst welcoming the improvements to date, raised concerns regarding the ongoing silo working and transition from children’s to adults.  Whilst officers acknowledged the concerns of members they highlighted that good progress was being made with regards to collaborative working.  It was explained that the issues regarding transition from children’s to adults was largely due to statutory conditions but there was a strong focus on this.

During the course of discussion a concern was raised about the challenges for parents and carers due to their lack of involvement once a child reached 18 years old.  Officers, whilst acknowledging the concerns raised, explained this was the legal position due to confidentiality but agreed to look into the matter further.

Members welcomed the progress being made in engaging, involving, and communicating with parent carers and young people and highlighted in particular the services being commissioned collaboratively, with the involvement of parent carers to ensure they met the need as a good example.

The Chief Executive Officer for Healthwatch Cumbria in response to a question regarding the progress being made with parents and carers  ...  view the full minutes text for item 20.

To consider a report from the Executive SRO, New Hospitals Programme (copy enclosed).

The Board received a report regarding the Lancashire and South Cumbria New Hospitals Programme from the Executive SRO.

Members were informed that the Lancashire and South Cumbria New Hospitals programme was leading the local NHS response to the Government’s initiative to build 40 new hospitals by 2030.  It was explained that this offered a once-in-a-generation opportunity both to deliver world-class hospital infrastructure from which high-quality services could be provided and to bring significant wider economic benefit for the area.

The Board was provided with an overview of the recently published case for change along with an understanding of the background to the programme, context and current position. 

Members were informed that the Lancashire and South Cumbria New Hospitals Programme was aiming to address significant problems with the ageing hospitals in Preston (Royal Preston Hospital) and Lancaster (Royal Lancaster Infirmary).  It was explained there was also a need to invest in the infrastructure at Furness General Hospital in the context of its strategic importance and geographically remote location.

The Board noted that the condition of both hospitals had reached a critical stage; they were unable to accommodate more complex patient needs or new technologies and, without investment, buildings and services could fail.  Officers highlighted this could create a further adverse impact on patients’ deepening health inequalities and increase the burden of ill-health on the population. 

Members were informed that any adverse impact on services due to the quality of the estate at Furness General Hospital would have a deeper impact due to its geographical location.  It was explained that investment was needed to ensure its sustainability in this strategic context; other providers across the region would not be able to absorb the resulting increase in demand, impacting on their sustainability.

Officers highlighted that the poor condition of the hospital infrastructure was a structural barrier to recruit and retain the number of staff needed to deliver services.  It was emphasised that this was now a significant and increasing issue in the ability to operate effectively and to sustain a health service within the region.

During the course of discussion a question was raised regarding the future of Westmorland General Hospital (WGH).  The Executive SRO explained that WGH was not part of the national programme explaining that it continued to provide elective surgery together with mental health services and investment into the hospital would continue.  Members noted that Chorley and South Ribble Hospital was in the same position as WGH.

The Board discussed single occupancy rooms and noted that from a patients perspective positive feedback had been received supported by good evidence that this aided recovery.  It was explained that there were ongoing discussions and any views from the public would be welcomed on the matter.

The Board was informed that the next steps for the Programme were to undertake planned engagement on the Case for Change, develop a long list of options to respond to the Case for Change and appraise the long list to a short list of options.  Members highlighted  ...  view the full minutes text for item 21.

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 considered 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) which provided an update on Cumbria’s Better Care Fund (BCF) for Quarter 1 2021/22.

Members noted that at Quarter 1 there were no variances forecast against Winter Pressures schemes.  The Board asked whether any additional funding was expected and was informed that to?date no confirmation had been received but an update was expected imminently. 

During the course of discussion health colleagues emphasised the extreme operational pressures which services were currently experiencing and the pressure on the workforce, highlighting the importance of workforce plans.  The Board acknowledged their concerns and offered their help and support to try and ameliorate the situation. 

Members raised their concerns regarding the workforce and officers highlighted the need to recognise and reward people.  Officers raised particular concerns regarding recruitment and retention of social care colleagues explaining there was a need to provide a stronger career route to try and improve the situation.

The Board acknowledged there could be a major crisis during the winter period and agreed that further discussions would take place outside the meeting regarding recruitment and retention.

RESOLVED,     that the report be noted.

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

Members considered a report by the Director of Public Health which provided an update on the development of the Cumbria Public Health Alliance/Outbreak Engagement Board (PHA-OEB), its links to the Locality Forums and the mechanisms for ensuring two-way influence and dialogue between the Board and each locality through agreed strategic aims and locally identified priorities.

The Board welcomed the Five Year Plan from Active Cumbria and commended the good habits formed during lockdown agreeing they should be harnessed and encouraged post-lockdown.  A discussion took place regarding collaborative working with the district councils and officers confirmed that Active Cumbria had a good range of connections with their Leisure Services. 

Members discussed the inclusion of ICCs in this initiative and officers confirmed this had been undertaken at a strategic level.

RESOLVED,   that the following be noted:-

                          (1)       the update and any identified plans for future activity;

                          (2)       each item in the report includes reference to the pertinent section of the Cumbria Joint Public Health Strategy.

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

The Board considered a report from the Executive Director – People (Cumbria County Council) which set out the notes of the Informal meeting of the Cumbria Health and Wellbeing Board held on 2 July 2021 and asked that members formally agree the actions that were informally resolved at the meeting.

RESOLVED,   that the informal resolutions made at the Informal Virtual Meeting of the Cumbria Health and Wellbeing Board held on Friday 2 July 2021 (detailed in Appendix 1 of the report) be agreed.

To receive the Forward Plan (copy enclosed).

The Board received a copy of the Forward Plan and welcomed any feedback from members regarding the content of future meetings. 

Members suggested that the following items be added to the Plan:-

Ø   Workforce Feedback

Ø   Update on ICS

Ø   Update on Winter Pressures

The Board agreed that website links to various plans from other organisations would be circulated to members as necessary.

The Board noted that:-

(1)       the next Cumbria Health and Wellbeing Board Development day would take place virtually on Friday 22 October at 10.00 am. 

(2)       the next meeting of the Board would take place on Friday 3 December at 10.00 am at County Offices, Kendal.