Agenda and minutes

Apologies for absence were received from Mr D Blacklock, Mr L Conway, Mr A Cummins, Ms C Donovan (Mr R Chillery attended as substitute), Ms D Earl, Mr D Eva, Mrs F Musgrave, Mr A Gardner, Mr J Lawlor (Mr D Muir attended as substitute), Mrs S Sanderson, Ms L Simpson (Mr S Park attended as substitute), Mrs M Skeer, Dr V Taylor 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 10 September 2021 (copy enclosed). 

RESOLVED,     that the minutes of the meeting of the Board held on 10 September 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.

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 explained the current position regarding epidemiology together with data regarding new cases per district including hospitalisation and mortality figures.

The Board received a positive update regarding the vaccination programme in Cumbria.  Officers explained this was almost 100% for those aged over 80 with mainly clinical reasons for those who remained unvaccinated; there were also good rates of take?up for those aged over 65.

Members were informed that the Omicron variant had been identified on 23 November with approximately 500 cases (confirmed or probable) in the UK.

A discussion took place regarding the effectiveness of ventilating buildings.  Officers explained there was an increased acceptance that COVID was airborne, therefore, ventilation was important.

In conclusion it was explained the future looked uncertain, highlighting the challenges with regards to staffing and emphasised that it was anticipated winter would be more challenging than expected.

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

RESOLVED,   that the presentation be noted.

To consider a joint report and presentation by 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 report and detailed presentation 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 gave an overview of the pressures that were facing the health and care system and the collaborative response.

The Board was informed that the COVID-19 pandemic had placed significant additional risks and pressures on the health and care system.  It was explained, however, that there were also historic challenges and new pressures caused by increases and changes to patterns of demand and reductions in capacity which the health and care system had routinely managed.  Members noted the current situation was unprecedented given the sustained and increasing levels of high demand and reduced capacity whilst acknowledging demands were likely to increase over winter with resultant need for robust contingency arrangements and effective management of unscheduled and planned care activities. 

Officers emphasised that the need for integrated planning to address those challenges was critical.  It was explained that partners had been collaborating to ensure work was undertaken to promote independence, support people to remain at home and avoid premature admission to long?term social care and acute hospitals.  Members noted that wherever possible patients would be discharged home or closer to home, in a safe and timely manner, with the appropriate health and social care support.

The Board was informed that work had also been undertaken to analyse and address the impact within the wider community including impacts on unpaid carers and their support over this period.  It was explained there was also recognition of the extreme pressures the COVID-19 pandemic had placed on some care providers and the heightened need to monitor and support the care market through this challenging period.

A detailed discussion took place regarding the care sector and members were informed that ‘Proud to Care’ webpages had been developed to support recruitment across the care sector.  It was explained that a streamlined recruitment process had been put in place for Cumbria Care to try and reduce the time taken by 60% to have people in post.  Members noted that a Sub?Group had also been established to work with the voluntary and provider sector to support social care market recruitment; this included six local groups linking into Department for Works and Pensions support

The Board noted that Cumbria had well-established governance processes to support this with escalation and contingency processes within organisations and co?ordinated across the health and care systems by the Accident and Emergency Delivery Boards.  It was highlighted that in order to address those issues, considerable work had been undertaken across the North and South Health and Care Systems; this had built on the work that had already been initiated as part of the improvement processes which had been put in place to address the historic challenges faced by the health and care system in Cumbria. 

A discussion took place regarding the provision of mental health services in  ...  view the full minutes text for item 32.

To consider a report by the Strategic Lead for SEND Improvement (Cumbria County Council) (copy enclosed).

The Board considered a report from the Strategic Lead for SEND Improvement which provided an update on the delivery of the SEND Written Statement of Action (WSOA) and the recently developed Accelerated Progress Plans (APPs) together with feedback from the last formal monitoring meeting with the Department of Education and National Health Service England (DfE/NHSE). 

Members received a positive update on the thematic partnership working groups noting that they met regularly to progress the work.   

During the course of discussion members raised their concerns regarding the arrangements for transition from Children’s Services to Adult Social Care and Health Services highlighting the need for partnership working and challenge.

RESOLVED,     that

                            (1)       the progress in relation to the Written Statement of Action, the Accelerated Progress Plans, and the feedback from the DFE/NHSE meeting in September 2021 be noted;

                            (2)       the Board continue to receive progress reports on the Written Statement of Action and the three Accelerated Progress Plans (APPs) (as detailed in paragraph 6.0 of the report).

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

The Board considered a report from the Director of Public Health (Cumbria County Council) which detailed the background, purpose and development of the Lancashire and Cumbria Health Equity Commission.

Members were informed that the Commission aimed to bring Lancashire and Cumbria up to date following the pandemic, by using evidence to demonstrate where the biggest health inequalities were, examine what worked and make clear how best to govern for health; as well as invest and take priority actions in the short, medium and long term.

The Board noted the representation on a Steering Group which had been established to support whole-system implementation of the HEC Panel recommendations for legislation, policies, and initiatives.

Members were informed that Health and Wellbeing Boards and their associated Directors of Public Health were asked to support the HEC and work across their local areas with their partners and local communities to paint a picture of the needs of local partners and their communities in relation to health inequalities; this would be collated to evidence and inform the Commission.  Officers explained that following the announcement of the HEC it was agreed that the Board’s Inequalities Task and Finish Group would lead on collating the evidence for the ‘HEC ASK’ on its behalf.

Members were informed that evidence had also been collated by the two Health and Care Partnerships in South Cumbria and the North Cumbria Place-Based Partnership (PBP).  It was noted that the Board’s evidence submission had been presented to the HEC Panel by the Director of Public Health (Cumbria County Council) on 29 November 2021.

Members noted that each partner had been asked to submit a written response on behalf of their communities to the questions in the HEC’s ask by 30 November 2021; the Inequalities Task and Finish Group had provisionally approved the submission of the draft report to the HEC, pending full approval by the Board.

The Board was informed that following the HEC Panels and written evidence submission it was aimed to have a draft report late January/February for partners to consider.  Officers highlighted that due to ongoing organisational changes in the regions, reporting was still to be ratified; early discussion was that it would be fed back to the Lancashire and South Cumbria Place Based Board, the North Cumbria CCG and the Health and Wellbeing Board.  It was noted there would also be an opportunity for partners to respond to the draft which would inform the final report and recommendations by UCL Institute of Health Equity (Michael Marmot’s Unit at UCL).

A discussion took place regarding the HEC and members highlighted the numerous previous similar schemes which had taken place and been unsuccessful due to lack of funding.  The Board emphasised the importance of community development and the need to look at long?term issues and welcomed the commitment and partnership approach from a number of organisations other than statutory partners and looked forward to its success.

RESOLVED,   that

                          (1)          the consultation report be noted;

                          (2)          the reports  ...  view the full minutes text for item 34.

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

The Board received a report from the Director of Public Health regarding the Pharmaceutical Needs Assessment (PNA).  Members noted the purpose of the PNA was to assess local needs for pharmacy provision, to identify any gaps in service or unmet needs, and to highlight any services that community pharmacies could provide to address those needs.

Members were informed that the last PNA agreed by the Board was published in March 2018 and there was usually a requirement to publish a revised assessment within three years of publication of previous assessment.  It was explained, however, that in light of the COVID-19 pandemic and subsequent pressure on resources NHS England had extended the deadline for publication of the PNA to October 2022.

The Board noted that the PNA Steering Group was being initiated to collect the necessary information and revise the needs assessment within the timelines as detailed in the report.

Members drew attention to the increased use of existing pharmacies, highlighting their move to a clinically orientated profession in order to alleviate pressures on other health services.  The Board raised their concerns that they may become overwhelmed and asked whether in the short-term there should be an extension of pharmaceutical services.  Officers acknowledged that the current circumstances needed to be addressed and agreed to investigate this matter further.

RESOLVED,   that the timings planned to produce the next PNA be noted.

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

The Board considered a report from the Director of Public Health (Cumbria County Council) regarding the Joint Strategic Needs Assessment Process (JSNA), a statutory duty of the Board along with the Pharmaceutical Needs Assessment (PNA) and the Joint Health and Wellbeing Strategy (JHWS).

Members were informed that the purpose of the JSNA and the JHWS was to improve the health and wellbeing outcomes of the local community and reduce inequalities for all ages.  Officers explained that in April 2018 the JSNA process was simplified into 3 elements, data with Cumbria Observatory, links to available tools to prevent duplication and deep dive needs analysis.

The Board noted that due to capacity during the COVID-19 pandemic response the element of data and tools within the observatory had been the main element available and throughout the last 18 months the data had been updated with latest available information.

Members were informed that to support the local area coordination of supporting understanding of need a detailed needs assessment relating to Special Educational Needs and Disabilities (SEND) had been developed and published on the Observatory website as well as a SEND Mental health and wellbeing Deepdive.  The Board noted that an interactive dashboard of associated data had also been published on the Cumbria Observatory website.

The Board was informed that the ongoing impact of COVID-19 had been considered throughout via impact assessments and now further consideration needed to take place of how the JSNA information was to be updated to reflect any impact.  It was anticipated the production of a summary for up?to?date context during Quarter 4 2021/22 would be feasible; based on previous feedback this would be in a format that ensured the data was easy accessible.

Members noted that the continuous process approach to the JSNA continued but felt there was opportunity to refresh and ensure the process was sustainable and efficient across partners.

RESOLVED,     that the SEND needs assessment, SEND emotional health and wellbeing needs assessment and SEND dashboard as additions to the suite of JSNA documents be noted.

To receive a joint verbal update from the Chairs of the Clinical Commissioning Groups.

The Board received a joint presentation from the Chairs of the Clinical Commissioning Groups (CCGs) for North and Morecambe Bay which outlined the Integrated Care Systems in Cumbria, the current situation and timelines, guidance issues and perspectives from both areas.

Members were informed that the CCGs would not exist as they were currently structured and that Integrated Care Boards (ICBs) would come into force from 1 April 2022; with the current roles and responsibilities of the CCG being passed to the ICBs (including public engagement and consultation). 

The Board was informed that the place base developments were well advanced noting that the detail of the strategic narrative was still outstanding but would be delivered by March to coincide with the financial delegation.

A number of concerns were raised regarding the new structure from the Local Authority, NHS Trusts and the future funding for third sector organisations.

It was agreed that this matter would be discussed at a future meeting.

RESOLVED,     that the update be noted.

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 Groups (copy to follow).

The Board considered a report from the Executive Director – People, Cumbria County Council, Chief Operating Officer, NHS North Cumbria CCG and Chief Officer, NHS Morecambe Bay CCG which provided an update on Cumbria’s Better Care Fund (BCF) for Quarter 2 2021/22. 

Members raised concerns regarding the longer?term future for the BCF noting that currently it was agreed between the Local Authority and CCGs; it was anticipated this would be delegated to Place Based Partnerships in the future.

RESOLVED,   that

                          (1)          the report be noted;

                          (2)          the Better Care Fund planning submission and narrative to NHS England & Improvement made under the delegated arrangements be approved.

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

The Board considered a report from the Executive Director – People (Cumbria County Council) which informed members that on 2 November, the Department of Education (DfE) had published a prospectus for the Family Hubs Transformation Fund and sought applications for transformation funding from local authorities that did not currently have family hubs, and that wished to transform to a family hub model of service delivery, with a commitment to open family hubs by March 2024.  It was explained there was an expectation that local authorities worked in partnership with relevant local organisations and partners using a multi-agency approach.

Officers explained that part of the funding was to make services more holistic and available within communities with a particular emphasis on older children.

Members were informed that in order to demonstrate widespread support, the DfE required all applications to be approved and have the full support of Director of Children’s Services, Director of Public Health, Director of AdultServices and the Chair of the Local Health and Wellbeing Board.

Members were informed that the deadline for the application was 17 December 2021, therefore the bid was not available for presentation at the Board meeting.

RESOLVED,     that the submission process be noted and a report be made at a future meeting of the Board setting out the bid.

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

The Board considered a report by the Director of Public Health (Cumbria County Council) which gave 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.

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 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. 

It was suggested that Chair and Vice?Chairs consider whether further discussions should take place at future Development Sessions of the Board on System Response to Pressures and Integrated Care Systems.

The Board noted that:-

(1)       the next Cumbria Health and Wellbeing Board Development day would take place on Friday 28 January 2022 at 10.00 am at a venue to be agreed.

(2)       the next meeting of the Board would take place on Friday 4 March 2022 at 10.00 am at Cumbria House, Carlisle.