Agenda and minutes

The Chair welcomed everyone to the last meeting of the Board in the life of Cumbria County Council.

Apologies for absence were received from Mr D Blacklock, Mr L Conway, Mr A Cummins, Mr J Duncan, Ms D Earl, Mr D Fillingham, Mr D Levy, Mrs S Sanderson, Mr P Scott, Ms L Simpson, Mrs M Skeer 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 16 December 2022 (copy enclosed). 

RESOLVED,     that the minutes of the meeting of the Board held on 16 December 2022 be agreed as circulated and thereupon signed by the Chair.

To consider a report by the Director of Place, North Cumbria, North East and North Cumbria Integrated Care Board (copy enclosed).

The Board considered a report by the Director of Place, North Cumbria, North East and North Cumbria Integrated Care Board (ICB) which detailed information on the development of the North East and North Cumbria Integrated Care Strategy.

Members were informed that the Health and Care Act 2022 required Integrated Care Partnerships (ICPs) to develop an Integrated Care Strategy (ICS) which detailed how the assessed needs of the population, as identified in joint strategic needs assessments (JSNAs), would be met by the exercise of functions by the ICB, partner local authorities and NHS England.

The Board was advised that locally the North East and North Cumbria ICP had agreed that this Strategy would provide an opportunity to set out ambitions for what could be achieved as an Integrated Care System.  Members noted this did not seek to replace or duplicate existing strategies and activity that was already underway in the system but to link them together.

Members were informed that the national expectation was for each system to publish its initial strategy by December 2022 whilst noting that this was not a statutory requirement.

The Board welcomed this ambitious Strategy but raised concerns regarding its success due to the dependence on fundamentals in society.  Whilst the concerns were acknowledged it was felt this set out a good premise and base for future achievements.

Members welcomed the inclusion of social care and felt this would provide an opportunity to work collaboratively to improve health and develop communities which would be accessible to everyone.  Officers confirmed there would be flexibility to ensure integrated work was undertaken with local authority colleagues.

A discussion took place regarding the imminent Local Government Reorganisation and how the Strategy related to the joint Health and Wellbeing and Public Health Strategies in the two new authorities.  It was explained that local determination would provide the opportunity to look at what was needed in North Cumbria.

RESOLVED,     that the final version of the North East and North Cumbria Integrated Care Strategy (detailed at Appendix 1 of the report) be noted.

To consider a report by the Director of Planning, Lancashire and South Cumbria Integrated Care Board (copy enclosed).

The Board considered a report by the Director of Planning, Lancashire and South Cumbria Integrated Care Board which provided information on the development of the draft Lancashire and South Cumbria Integrated Care Strategy and the next steps for further engagement and finalisation of the document.

Members were informed that locally the Integrated Care Partnership (ICP) had agreed that the Strategy provided an opportunity to set out ambitions for what could be achieved as an Integrated Care System (ICS).  It was explained that it aimed to outline, at a high level, the difference that could be made by working in an integrated way.  The Board was advised that it did not seek to replace or duplicate existing strategies and activity that was already underway in the system but sought to link them together by providing an overarching narrative about what changes were required and improve together.

Members were informed that a key priority was to ensure better support was in place for mental health needs, learning disabilities and/or autism, with a particular focus on improving access to support for those experiencing the greatest health inequalities.  The Board was advised that delivery would include a combination of existing plans as well as exploration of new approaches to ensure this was deeply rooted in everything undertaken.

A discussion took place regarding authority, responsibility and accountability and how effective scrutiny could be undertaken in a large geographical area.  Members were advised that ICBs had started to develop governance arrangements and whilst acknowledging the importance of the inclusion of elected members advised this would be further developed following Local Government Re?organisation.

The Board suggested that learning and development sessions take place following Local Government Re-organisation and it was agreed this would be considered as an action for the transition.

Members welcomed the Strategy and the commitment made to ensure place priorities properly reflected the needs of communities. 

The Board was informed of the requirements of the ICP and the ICS and the work to date on the draft, noting the final version would be presented to the ICP in April 2023 for formal agreement.

RESOLVED,   that

                          (1)          the current version of the Lancashire and South Cumbria Integrated Care Strategy be endorsed, noting that this will be further updated in the coming weeks to reflect feedback from partners and residents;

                          (2)          the final version of the Lancashire and South Cumbria Integrated Care Strategy which will be presented to the Integrated Care Partnership in April 2023 for formal agreement be noted.

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

The Board received a report from the Executive Director – People (Cumbria County Council) which provided an update on the outcomes following the recent Ofsted and Care Quality Commission joint revisit inspection of SEND services in our local area together with the Cumbria’s SEND Partnership response to the findings and the next steps to secure continuous improvement.  

Members noted that the inspection re-visit took place between 21 November and 8 December 2022 with its purpose to assess whether sufficient progress had been made in addressing each of the nine areas of concern raised at full inspection in 2019. 

The Board was advised that the Inspection Team had determined that the local area had made sufficient progress in improving seven of the nine concerns identified in 2019.  Officers explained that the two remaining areas required further work to secure the trust and faith which parents and carers had in services and the provision of support for emotional health and wellbeing of children and young people.

Members were informed that the SEND Partnership was working with the Department for Education and NHS England to agree a formal Accelerated Progress Plan (APP) for the two areas where further work was required.  It was explained that the action plan and supporting analysis would help the DfE and NHS England assess the action being taken to achieve the required improvement.  The Board was advised this must be submitted by 20 March 2023, with a progress review within six months of the revisit report being published.

The Board noted that local area joint SEND inspection revisit had focused on the experiences of children with SEND and their families when engaging with services in the local area, the quality of those services and equity of access and asked whether this included private schools and academies.  Officers explained the Authority was responsible for all children and were monitored through the Plan with scrutiny being provided through OFSTED.

During the course of discussion the problems encountered for Child and Adolescent Mental Health Services (CAMHS) due to the lack of resources was highlighted.  Members emphasised the importance of early help to try and avoid the need to access the Service.

Members were advised that CAMHS had the fasted growing number of referrals post the pandemic and had received an £11m investment for its development and improvement with additional funding still required for autism.  The Board was informed of the improved home care and support as well as the challenges regarding waiting times for elective patient referrals.  It was agreed the issues highlighted were across the organisation and there was a need for a collective partnership approach to improvement.

The Cabinet Member for Children's Services whilst acknowledging the two remaining areas which required further work and the need for continued monitoring thanked the SEND Improvement Strategic Lead and her Team for their support.

A discussion took place regarding the Government’s SEND review and officers welcomed the greater national focus whilst highlighting the significant financial challenges.

The Board noted that from  ...  view the full minutes text for item 43.

To consider a joint report by Lancashire and South Cumbria NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (copy enclosed).

(1)       Lancashire and South Cumbria

The Board considered a report which provided a progress update and next steps for the development and delivery of the Initial Response Services (IRS) across Lancashire and South Cumbria.

Members were informed that the IRS model had replaced the former START (Specialist Triage, Assessment & Referral Team) model in Pennine Lancashire and Central & West Lancashire, providing a more unified entry point to the range of Lancashire and South Cumbria Foundation Trust (LSCFT) mental health services and facilitated more efficient and responsive signposting of patients to the most appropriate service for their need.

It was explained that in both localities, the IRS model had resulted in an increase in initial referrals into services, including self-referrals, suggesting that services were more accessible with this new model.  Members were advised that the increased accessibility of IRS appeared to be reducing the level of crisis calls via Crisis Line numbers, with an increasing volume of routine calls into the IRS.

A discussion took place regarding further developments and timescales for delivery and members noted the modelling exercise had been undertaken using the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) digital dictation solution. 

Officers explained that whilst the Trust was aiming to launch the remaining IRS’ across The Bay and Fylde Coast ideally in Quarter 1 of 2023/24, gateway reviews were in place pre?launch, to ensure that the services were ready, particularly drawing on learning from the IRS launches in Pennine and Central and West. 

RESOLVED,   that the report be noted.

(2)       North Cumbria

The Board received a presentation from Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust regarding access and community CBU.

Members were informed of the improved access in the Adult Mental Health Access Hub noting that all referrals were received centrally with self?referral being available for patients previously seen by the Service with further self?referral options also being explored.

The Board was advised of the significant improvement in speed of access to services for patients with work across other areas to improve response times in all services for adults, including crisis and home treatment teams as well as the development of street triage.

Members were informed that in addition to the 24/7 crisis line further work was being undertaken with NWAS to deliver the national ask around the NHS 111 service to improve access to care and support.

The Board welcomed the positive progress.

RESOLVED,   that the update be noted.

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 which provided a summary of Cumbria County Council’s actions taken to support Cumbria’s most vulnerable residents during the current cost of living crisis.

The Board was informed the cost of living crisis posed a significant threat to public health and in response to this the UK Government had put in place a number of support measures, including the Household Support Fund and household fuel support payments.

Officers explained that monitoring the impacts locally had led Cumbria County Council to want to do more, leading to a succession of decisions at both Cabinet and Full Council meetings culminating in a total spend of £5m as detailed below:

•        £1.5m of funding direct to all schools, including free schools and academies, to ensure that no Cumbrian child goes hungry. This included £50k of match funding support to enable schools to access the Government’s National Breakfast Club Programme.

•        £0.5m to double the amount of the County Council’s school uniform grant to £50 for Primary age children and £100 for Secondary age children.

•        £1m of support for free school meal recipients during the school holidays - this covered all the holidays, including half terms, from summer 2022 and will include provision for this coming Easter holiday in 2023.

•        £0.5m top up into the County Council’s Ways to Welfare fund – this is a long running fund that supports those in severe financial hardship, which has seen unprecedented demand during this cost of living crisis.

•        £1.5m to allow other organisations to continue to provide support and advice in the face of unprecedented demand on their services, including Cumbria’s Citizens Advice Bureau Consortium, Cumbria Carers’ Association, and Cumbria Community Foundation.

On top of this £5m, further money was allocated locally via the County Council’s Local Committees providing much needed support to a whole host of vital community groups.

In conclusion it was hoped that the County Council’s activities in 2022-23 to address the cost of living crisis would act as a positive example moving forward, and with the ring?fenced £500k and contract in place to cover holiday free school meal vouchers over the Easter holidays 2023, the new unitary authorities would be able to begin 2023-24 with the impetus and resource to continue tackling the cost of living crisis and protect Cumbria’s most vulnerable residents.

A discussion took place regarding possible new ways in the future, such as access to allotments or cookery courses being available to try to reduce the impact on families.  Officers welcomed the short-term suggestions whilst highlighting longer-term solutions could include cold loans and home installation schemes which could have a long?term impact for the community.

The Chair drew attention to a recent update to the County Council’s Carlisle Local Committee from the Chief Executive of Carlisle and Eden Citizens Advice Bureau (CAB) which detailed the impact of the cost of living crisis.  Members were advised of the support provided for a number of years from  ...  view the full minutes text for item 45.

To consider a joint report from the Executive Director – People (Cumbria County Council), Director of Place (North Cumbria, North East and North Cumbria Integrated Care Board) and Director of Health and Care Integration (South Cumbria) (copy enclosed).

(copy enclosed).

Members considered a report which provided an update on Cumbria’s Better Care Fund (BCF) for Quarter 3 2022/23 together with an update on activities regarding future funding arrangements for 2023/24.

RESOLVED,   that the report be noted.

(copy enclosed).

The Board considered a report which provided a summary update on the activity of Adult Social Care Discharge Fund which was an addendum to the Better Care Fund policy framework.

Members were informed that on 18 November 2022 the Government had published documents that set out the detail of how the £500 million Adult Social Care Discharge Fund was to be distributed and the conditions of its use.

The Board noted that 60% of the funding was allocated to the Integrated Care Boards and 40% of it to local authorities and would be paid in two tranches.  Officers explained the second tranche was dependent on meeting the conditions of the funding and the completion of a plan and reporting templates whilst confirmed this had now been received.  Members were advised that Cumbria County Council was allocated £2.089m; Lancashire and South Cumbria ICB had pooled £1.982m from their allocation and North East and North Cumbria had pooled £1.359m from their allocation into the Cumbria pooled fund. 

A discussion took place regarding the Disabled Facilities Grants and officers confirmed this was part of the BCF and would be more integrated following Local Government Re?organisation as currently this was passported to the district councils.

The Chair expressed thanks and appreciation to the Commissioning Service Manager and welcomed receipt of the second tranche.

RESOLVED,   that the report be noted.

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

Members considered a report which provided an update on information previously supplied to the Board which outlined the new guidance on the relationship between Health and Wellbeing Boards and the new health and care architecture that was created by the Health and Care Act.

The Board was informed that following the meeting in December work had been undertaken between the Health and Wellbeing Board and the two Integrated Care Systems to understand how those responsibilities would be discharged.  It was explained that as a result of this there was greater clarity about how and when some of those issues would be discussed with the Health and Wellbeing Board.

Members noted that both Integrated Care Partnerships (ICPs) had consulted the Cumbria Health and Wellbeing Board on their draft Integrated Care Strategies - the North East and North Cumbria ICP draft was circulated for comment to Health and Wellbeing Board members for comment before Christmas and the Lancashire and South Cumbria ICP draft Integrated Care Strategy was considered at today’s meeting.

The Board was advised that in the guidance the expectation was that Integrated Care Boards (ICBs) would consult on the Joint Forward plan before publication and would normally take place before the beginning of the financial year.  However, for the first year of the new system architecture, the requirement to produce the Joint Forward Plan the timescales had been relaxed and both ICBs would be producing draft Joint Forward Plans with the intention of consulting Health and Wellbeing Boards before final publication in June which meant that the ICBs would need to consult the two new Health and Wellbeing Boards rather than the Cumbria one. 

Members noted that timetables for the publication of the other requirements contained in the guidance were still to be determined.

The Board suggested that the report be brought to the attention of the new Health and Wellbeing Boards following Local Government Re?organisation.

RESOLVED,   that the update on joint working between the Board and other parts of the health and care system be noted.

To consider a report from 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 provided an update on the development of the Cumbria Public Health Alliance (PHA), 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 Director of Public Health acknowledged the contribution of members of the PHA and thanked them for the work they had undertaken to support the public health agenda.

The Chair commended the work which had been undertaken during the pandemic by the Outbreak Engagement Board which had been established to accommodate the circumstances and suggested the new Health and Wellbeing Boards consider the establishment of a similar role.

RESOLVED,   that the following be noted:-

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

                          (2)          each item in the report relates 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 brief paper which accompanied a discussion item for the members at its final meeting prior to handing over to the new arrangements due to Local Government Re-organisation.

A number of members spoke positively about the work of the Board and the support of officers.  The Board felt a very strong sense of service had been provided to communities and all members had been equal partners due to its strong leadership and commended this to the new authorities.

The Chair personally thanked all members, Fiona Musgrave, Derek Houston and Lynn Harker for their support and wished everyone well for the future.