Agenda, decisions and minutes

Apologies were received from Michael Jones (Divisional Director, EMAS) and Chief Superintendent Ashley Tuckley,(Northamptonshire Police) 

Apologies were received from Michael Jones (Divisional Director, EMAS) and Chief Superintendent Ashley Tuckley,(Northamptonshire Police) 

None received

None received

No declarations were made.

The Chair invited thosewho wished to do so to declare interests in respect of items on the agenda.

No declarations were made.

RESOLVED that:  the Health and Wellbeing Board approved the minutes of the meeting held on 5 July 2022

RESOLVED that:  the Health and Wellbeing Board approved the minutes of the meeting held on 5 July 2022

RESOLVED that:  The Health and Wellbeing Board notes the Action Log

The Chairman introduced this item (copies of which had been previously circulated) which gave details of actions that had been and were yet to happen. He reported that all actions from previous meetings were complete with the exception of Steve O’Brien and Sam Fitzgerald to discuss opportunities for a PhD student.

Dr O’Brien stated he had had a discussion with Sam Fitzgerald regarding a possible PhD student based in the South of the country but they had not yet had a general discussion and would do so at a later date.

RESOLVED that:  The Health and Wellbeing Board notes the Action Log

RESOLVED that:  the Health and Wellbeing Board:

a)    Notes progress of the Integrated care Partnership Strategy development; and

b)    Notes the progress of the Integrated Care Partnership North Place development.

At the Chairmans invitation the Director of PLACE, North Northamptonshire

Council provided an update on the development of the Integrated Care

Partnership (ICP) strategy in Northamptonshire highlighting the following:

·         The draft strategy would bear consolidation of an existing strategies across the system.  A lot of engagement was being undertaken as part of it.

·         The strategy was based on the Joint Strategic Needs Assessment (JSNA) summary and linked to the ‘Live Your Best Life’ 10 ambitions and the Outcomes Framework

·         The North Place Development Delivery Group had met and decisions made by them were detailed in the report.  This group enabled  development and mobilisation of the Local Area Partnerships and Community Wellbeing Forums. 

In answer to a concern that the papers referred to the Northamptonshire ICP Board but in fact it was not a board it was confirmed that It was indeed a partnership and the language used in the paper would be amended to reflect this. 

The following was also noted:

·         It was important to not just undertake the consolidation but also to get moving with the formation of ICP arrangements and have an input at an early stage into the draft strategy as the final strategy which had to be submitted in December 2022.  Further work was required in particular to the ICP membership  

·         An important part of this was the emerging strategy and officers had received feedback that they were slightly further ahead than many others in this so they were in a good position. 

·         Although members still needed to be appointed to the ICP the Director of Adults, Communities and Wellbeing had been given some suggestions for members from voluntary sector organisations. 

·         Local Area Partnerships were more about understanding, adapting and designing solutions in the local community.  Different functions would be delivered by different organisations or collaboratives and in some areas services might be delivered through a collaboration of various organisations.

RESOLVED that:  the Health and Wellbeing Board:

a)    Notes progress of the Integrated care Partnership Strategy development; and

b)    Notes the progress of the Integrated Care Partnership North Place development.

RESOLVED that:  the Health and Wellbeing Board:

a)    Agrees publication of the ICP JSNA summary including additional data where possible.

b)    Endorses the first iteration of the ICP Outcomes Framework to present for approval to the Integrated Care Partnership Board; and

c)    The Director of Public Health to circulate the Grampian Mental Health offer to the Board.

At the Chairman’s invitation a Consultant in Public Health provided an update

on the work of the JSNA highlighting the following:

·         As part of the JSNA the summary update was very much a consolidation of the existing joint needs assessments that had been published with some up-to-date data.  This should be run in tandem with a summary of exercises and data collated by the Strategy Development Board. The pack of engagement and qualitative data was currently being developed.

·         The executive summary identified some of the challenges and strengths of the county in terms of natural assets and a strong community and voluntary sector. 

·         Communities continued to experience inequalities across the county.  Particular interest was given to communities that identified with an ethnicity or communities with shared interests. 

·         They struggled in some aspects of health inequalities data.  For example, there was a lack of black women in maternity services in Northamptonshire.  They did not know what was driving this but were working on it. 

·         Another area of challenge was the fact that Northamptonshire had an ageing population but also a really fast-growing population across the county in all age groups.  That created more pressures on services which was a known challenge. 

·         A key factor in terms of preventing ill health and promoting health and wellbeing was in providing safe, affordable and good quality housing.  They had received a lot of feedback from communities that identified feeling safe on the streets and the amount of litter on streets as a real issue rather than some of the health problems like blood pressure that they could suffer from. 

·         North Northants was a real outlier in terms of emergency admissions to hospital for heart disease and for COPD.  They were not an outlier for diagnosis of or death from these conditions.  So they were doing well at treating them but not so well at preventing patients from entering hospital.  This was an area the partnership as a whole could really add some value and she looked forward to working together as a partnership on reducing admissions. 

·         Community engagement was a pack that pulled together existing things.  They had not undertaken a full consultation process with the community as that was to come. 

·         The JSNA was a starting point for them to build a set of shared outcomes that would measure whether they had delivered against the strategy. 

·         Whilst they had very little time to engage with stakeholders it had taken place over the summer.  They had spoken to all public sector agencies across the county and the voluntary sector.  Some had continued to give more detailed feedback after the pack was published to the Health and Wellbeing Board so version 7.1 was still a working document. 

·         One of the challenges was the fact that it was shared around 10 ‘Live Your Best Life’ ambitions.  If one of the ambitions was to improve timely access to services the outcomes were tied to waiting times which wasn’t really an outcome.  Each of the ambitions had a  ...  view the full minutes text for item HWB/7

RESOLVED that:

a)     the Health and Wellbeing Board delegated responsibility for signing off the final plan to Councillor Helen Harrison and the Director of Adults, Communities and Wellbeing;

b)    The BCF plan 2022.2023 be brought back to the next meeting; and

c)    The draft narrative of the BCF Plan 2022/2023 to be circulated to the Board for feedback before submission. 

At the Chairman’s invitation, the Assistant Director of Adult Social Services provided the following update on the development of the Better Care Fund (BCF) plan for 2022/2023.highlighting the following:

·         New guidance had been received and they were to submit a planning template and narrative plan by the end of September.  They were currently working through the matrix on it. 

·         The BCF Plan was accompanied by the narrative plan which set out the outcomes and objectives.  There were 2 new objectives in the new guidance; to enable people to stay safe and well in their own home and to provide the right care in the right place at the right time.  The majority of these would be delivered through the iCAN programme. 

·         Timeframes for the health and wellbeing board and the submission of the narrative plan were tight so they were seeking today to delegate final approval to Councillor Helen Harrison, the Director of Adults, Communities and Wellbeing, North Northants Council and the Chief Executive, NHS, Northamptonshire Integrated Care Board.

The Director of Adults, Communities and Wellbeing, North Northants Council stated because of the all the reorganisation that had been taking place in North Northants Council there wasn’t a massive change in the narrative plan or the performance matrix that The Assistant Director of Adult Social Services had alluded to.  The guidance had not been received until the summer so they ended up with a short timeframe in which to do anything.  They had submitted a draft of the narrative plan and had received some feedback. 

The Deputy Chief Executive, Northamptonshire Healthcare Foundation Trust stated there was a need to have reassurance that the delivery stakeholders were involved prior to the sign off.  It would be good to think about the length of stay metric as it waa s a key driver for the flow in hospitals.

The Assistant Director of Adult Social Services stated there had been a lot of work into the narrative plan.  All of the key stakeholders had been engaged.  Chief Operating Officers would discuss the matrix to ensure everyone was comfortable with it. 

RESOLVED that:

a)     the Health and Wellbeing Board delegated responsibility for signing off the final plan to Councillor Helen Harrison and the Director of Adults, Communities and Wellbeing;

b)    The BCF plan 2022.2023 be brought back to the next meeting; and

c)    The draft narrative of the BCF Plan 2022/2023 to be circulated to the Board for feedback before submission. 

RESOLVED that: the Health and Wellbeing Board:

1)    Supports the broad direction of travel set out in the iCAN collaborative case for change and the ambitions and intentions to improve the experience of people; and

2)    Notes the decision notice of North Northamptonshire Council and support

the proposed approach to continue with the direction of travel for the iCAN

collaborative development, whilst the council corresponds with the ICB Chair and Chief Executive Officer (CEO) to identify mutually agreeable ways to provide assurance and political oversight satisfactory to the Executive of the Council

At the Chairman’s invitation the Director of Adults, Communities and Wellbeing at North Northants Council briefed the Board on the work to transform the iCAN programme into a collaborative.  This was effectively iCAN Programme, re-instating the case for change which had been presented to partner organisations across the county. Councillor Helen Harrison confirmed the North Northamptonshire Council Executive review the case for change and were supportive of the direction of travel.  Some challenges around governance were voiced, as many of the services within the iCAN collaborative were the responsibility of elected members, but no elected members were included in any of the governance elements of the collaborative.  There was a need to ensure residents were treated fairly in the way iCAN funding and services were provided.   Concerns were also raised that there be no clear direction of how the iCAN collaborative would fit into the ICP. 

Members of the Health and Wellbeing Board commented as follows:

• The Deputy Chief Executive Northamptonshire Healthcare Foundation Trust would have a chat with Councillor Harrison regarding democratic representation that was required.
• Model services were supposed to be presented to the GP Board in July but they were not for various reasons.  It was a long process but the path was being laid as they went through a number of engagement routes.  Reassurance was also given that iCAN forms part of the BCF which the Health and Wellbeing Board has responsibility for governance and oversight of the BCF. Something could be built into the Executive Forum to ensure elected members had a role in the decision making. 
• The focus on health care provision through to mental health and the ICP would be different depending on the territory involved.  The next issues to be worked through on iCAN were funding, budgets and accountability.  They would need to work out where there were the opportunities to fund some things through a collaborative. 
• A large number of GP practices had been involved in the development of the iCAN collaborative,  It was recommended to have plenty of governance across different providers to provide clarity and track and ensure care people received was safe.
• The iCAN collaborative is aimed at over 65’s, but consideration is needed for those under this age bracket with comorbidity living in the community

and should iCAN be more about the emergency care collaborative rather than over 65’s.   

• Intermediate Care Team had a big role to play in iCAN and is an all age service.  How the team was segmented the team which was all age and fundamental to the success of iCAN.  
• PLACE was emerging in the Integrated Care System operating model and were not yet fully functioning but just emerging.

RESOLVED that: the Health and Wellbeing Board:

1)    Supports the broad direction of travel set out in the iCAN collaborative case for change and the ambitions and intentions to improve the experience of people; and

2)    Notes the decision notice of North Northamptonshire Council and support

the proposed approach to continue with the  ...  view the full minutes text for item HWB/9

RESOLVED that:  The Health and Wellbeing Board ratify and endorse the Health Equality Grant  Memorandum of Understanding

At the Chairman’s invitation the Chief Executive of Voluntary Impact Northamptonshire (VIN) (via Teams) briefed the Board on the Health Equality Grant stating they had been successful in obtaining lottery funding of £448,000 over the next 3 years.  This equality grant would help embed the voluntary sector into the Integrated Care System (ICS) as the voluntary sector would be able to pilot some projects around health inequalities across the county once the Local Area Partnerships (LAPs) were established.  Guidance suggested there should be a Memorandum of Understanding (MoU) between the ICS and voluntary sector, detailing a shared set of responsibilities and processes as the voluntary sector were important players in the ICS especially around collaboratives and delivery.

In answer to queries on the update the following was confirmed:

• The grant would not be co-ordinated in isolation.  Organisations such as Citizens Advice and Northamptonshire Community Foundation would be invited to be part of the group so it would be a collaborative thing.
• It was very important that advocacy and leadership would be part of the health equality grant. 
• The Chief Executive of ViN would discuss who the partners should be with members of the Health and Wellbeing Board outside of the meeting.
• The Integrated Care Board (ICB) should be the statutory body signing up to this on behalf of the NHS. 

Finally, the Chief Executive of ViN thanked the Director of PLACE, North Northamptonshire Council for all the assistance she had provided in obtaining the lottery funding. 

RESOLVED that:  The Health and Wellbeing Board ratify and endorse the Health Equality Grant  Memorandum of Understanding

RESOLVED that:

a)     the Health and Wellbeing Board notes the update; and

b)     the ICB update be removed as a standing agenda item.

At the Chairman’s invitation the Chair of NHS Northamptonshire Integrated Care Board (ICB) updated the Board highlighting that they were no longer in shadow form, had a Chair and a Chief Executive Officer, 4 executive officer and 4 non-executive officers.    As was usual in the NHS they were under extreme pressure in terms of winter planning, handovers and elected care.  It was felt they had been slow in terms of children and young people but they were beginning to move on that.  The data on mental health had massively changed over the years.  There was a fourth aim within the ICS which was what was the NHS contribution to the local economy, the aim of the Chair of the ICB is to ensure prevention and contribution to the local community is part of what the ICS is trying to do.  Despite all these pressures though it was felt they were in a good place with chief executives from the North and West Northamptonshire Councils on the ICB, aiding in making decisions on how NHS money is spent   and assisting to hold them to account. 

The Chief Executive of NHS, Northamptonshire ICB stated this has been a standing item on the agenda whilst they transitioned,and proposed the ICB update be removed as a standing item and he would ensure key items were fed into the agenda each time.  Work would start on collaboratives and how they worked and connected with he ICB to really make a difference.  As already stated there was massive pressure brought on by winter planning.  A financial challenge also existed as a result of the COVID Pandemic. 

Members of the Health and Wellbeing Board commented as follows:

·         It was noted that many things were addressed when it became too late.  So it was asked if planning for Winter 2023 could be brought to this Board and the Community Wellbeing Forums earlier in the year.  People needed to be involved sooner.

·         It was noted there were also great pressures in mental health,primary care and community care there was a need to remember as a partnership, the next six months would be challenging.  There was a need to be clear about what the priorities were before additional pressure was placed on people who provided a service and who might be already undertaking something else and therefore at risk of being overburdened.

RESOLVED that:

a)     the Health and Wellbeing Board notes the update; and

b)     the ICB update be removed as a standing agenda item.

RESOLVED that:  the Health and Wellbeing Board:

1)    Notes the Integrated Care Board’s Draft Community Engagement Framework; and

2)    Supports the ongoing development of the Framework and its priority programmes to ensure they embed across health and care

At the Chairman’s invitation the Director of Communications at Northamptonshire Health Foundation Trust (via Teams) introduced the communications framework to the Board noting the following:

·         A number of colleagues in the room had been involved with the process and would continue to work on it.  

·         It was about bringing shared ambitions to life; abut listening to people in the communities.

·         It was about involving and listening to a vast breadth of communities in the area.  How they worked together was crucial in the shared working framework as were the links they created for working together. 

·         There were more people to involve and it remained an organic piece of work.  It set the co-design framework and direction of travel, they wished to build on good practice in the shape of an integrated cared system and partnerships aligned with people in the communities already involved.

·         There was a short timeframe in which to launch it.  There was a need to keep conversations going.

·         The feedback was that the framework should be clear and responsible, and they would review their impact of the ambitions and values on an ongoing basis by listening to residents and communities.

·         The themes emerged on how to work together on the framework.  They were looking to aligning it with the strategy.

·         They would share intelligence with the Board and the outcome should be good practice.  

·         Some of the core projects would align with the four priorities of an ICS. 

·         It was important that residents trust us and that we can build a trusted relationship with communities, in order to maintain transparency and accountability. 

·         We need to socialise the framework and align it with our strategic themes and structures.

·         We were working closely with the Directors of Public Health, emerging structures of the partnership and the ICB. 

·         We were developing a phased programme of work to inform the emerging strategy development activity.  Looking at what the data said, what do the people say and what needs to be done.

·         Phase 1 was sharing what we already know.  Phase was 2 looking at aligning with the emerging strategic priorities and phase 3 was to share intelligence with partners to address gaps.  Phase 4 was ensuring discussions for engagement for the ICB forward plan and phase 5 was reviewing what was going well and what could be improved upon. 

·         Thanks was given to members of the community who had contributed to development of the strategy. 

RESOLVED that:  the Health and Wellbeing Board:

1)    Notes the Integrated Care Board’s Draft Community Engagement Framework; and

2)    Supports the ongoing development of the Framework and its priority programmes to ensure they embed across health and care

RESOLVED that:  the Health and Wellbeing Board:

1)    notes the report on the Northamptonshire People’s Board; and

2)    would receive a later update providing data to be better able to identify gaps in provision.

At the Chairman’s invitation, Dr Steve O’Brien (University of Northampton) introduced the report stating there had been a brief discussion around the ongoing system work around recruitment and retention of staff Without the right people to perform them the best of systems would not work very well. Over the next 6 months the system will be under increased pressure to deliver services and staff will be needed to deliver services.  A cross system programme was being used that talked about how to recruit staff, as well as retention structures. The Northamptonshire People’s Board has a staff database across the system highlighting vacancies to inform where the issues are.  They knew where they needed people. 

The Director of Public Health stated that collaboration with the University of Northampton was assisting them to grow their own staff and keep them.  They could provide courses locally that helped local people stay where they lived. 

The University of Northampton representative stated there had been a big boom on recruitment of students to their health and social care courses during the pandemic and they were doing lots to keep people in the system.  A number of students had also come from overseas on public health programmes and there was a need to retain them in the system.  A lot of the health and care courses were reliant on placements for students; work had taken place with Health Education England to increase the number of placements available. 

The Director of Public Health stated the facilitation of return to work of older staff with flexibility of work options to ensure they were confident in their skills.  There had also been a tendency in this country to turn down medical students who were not as experienced from this country and then employ people from abroad.  There was a need to explore placements in primary care and other settings to ensure more local people were employed and less reliance was held on people from abroad.

The following was also noted:

• There had been less people in various health settings such as health visitors in the last 7 years and there was a need to be clear about who was needed and where. 
• The Council’s Corporate Leadership Team had recently had discussions on how to support staff not just the low paid ones who were visiting food banks.  We need to consider how to support these staff and communities to ensure people did not go sick because of overwork or a lack of support. 
• There was a need to move from being a pandemic driver discussion to supporting staff, particularly in view of the cost-of-living crisis that was currently being experienced. 
• Sometimes the process of applying for a post was more involved than the level of the position required.  Local authorities and the NHS were major employers in the area and maybe their applications could be made easier to complete.
• Some good work was being undertaken in schools and maybe some data on this could be presented to a future  ...  view the full minutes text for item HWB/13

At the Chairman’s invitation The Director of Public Health (North Northamptonshire Council) stated he felt it would be useful to discuss what had happened in the first half of the year and what was still to come.  In the spring they had still dealt with the end of the pandemic so some things had taken a back seat.  At the same time there had been the need to keep the show on the road.  In the summer there had been the disaggregation of the public health teams between the North and West Councils.  Post 1st October there would be public health teams in the North and West but some countywide functions would still be undertaken. 

It had not been business as usual.  Public health had been taken out of the responsibility of local authorities in 1974 but now it was again under the responsibility of local authorities.  Many things had changed during the years when the Council had not been responsible for Public Health and there was a need to ensure it was complicit throughout the whole council.  This had begun and he had spoken with the Director of Adults, Communities and Wellbeing, North Northants Council and would continue to build on the work of public health through the pandemic.  There were 3 main vehicles for delivery 1, focus on PLACE, 2 an asset based approach to community development 3, community oriented primary care. 

There being no further business the meeting closed at 4.05pm.