To receive any apologies for absence, including notifications of any changes to the membership of the Committee.

Apologies were received from Councillor David Thomas, Councillor Bye, Councillor Tranter, Jo Williams, Director of Adult and Community, Pat Teague, Ageing Well Assembly, Chief Superintendent Roy Linden, Pat Harris, Healthwatch and Anthony Reilly, Devon NHS Partnership Trust.

In the absence of Councillor David Thomas, the Vice-Chairman of the Health and Wellbeing Board Matt Fox chaired the meeting.

Mike King attended in place of Paul Phillips for the Department of Work and Pensions.

To confirm as a correct record the Minutes of the Health and Wellbeing Board held on 14 December 2023.

The Minutes of the Health and Wellbeing Board held on 14 December 2023 were confirmed as correct and signed by the Chairman.

The Chairman confirmed that having received comments from Members of the Board, a response to the consultation on the development of a Devonwide Pharmaceutical Strategy had been submitted.

To consider the Devon, Cornwall and Isles of Scilly Health Protection Annual Assurance Report 2022/23.

(Note: to be presented by Julia Chisnell, Consultant in Public Health, Torbay Council and Mandy Guy, Public Health Specialist, Torbay Council).

Members noted the Devon, Cornwall and Isles of Scilly Health Protection Annual Assurance Report 2022/23 which was outlined by Mandy Guy, Public Health Specialist, Torbay Council.  The Board was informed of the key domains of health protection which were:

·         communicable disease control and environmental hazards

·         immunisation and screening

·         health care associated infections and antimicrobial resistance

·         emergency planning and response

The Board was pleased to note that post Covid-19 pandemic, the system had responded to a number of infectious outbreaks and particular high levels of disease during the year and that the Public Health team continued to work with partners to maintain and strengthen resilience planning, infection prevention and control arrangements across local settings including care, education and asylum.  There was a focus on supporting immunisation, health screening and response for refugees and asylum seekers.  A new action programme had been established with partners across Devon to increase uptake of vaccinations, with specific focus on MMR, school based vaccines, flu and Covid.  The priorities identified for 2023/24 included:

·         tackling climate emergency;

·         infection prevention and management;

·         vaccine uptake;

·         pandemic preparedness;

·         inclusion and inequalities;

·         continuous improvement in health protection;

·         work to support local strategic plans.

In response to questions, the Board was informed that it was important that health protection was not seen in isolation but as part of the Joint Forward Plan for Devon.  There was concern around significant pressure on prescribing antibiotics at hospital and how that linked with primary care.  It was essential to have notification of infection to be able to understand the reason for prescribing antibiotics.

It was recognised that building resilience was a longer term challenge particularly when considering socio-economic and climate emergency factors which were most likely to affect vulnerable individuals.  Protection work underway was targeted at communities most in need.

To consider the Torbay Joint Health and Wellbeing Strategy 6 monthly monitoring reports.

(Note: to be presented by Julia Chisnell, Consultant in Public Health, Torbay Council).

The Board noted the 6 monthly progress report on implementation of the Torbay Joint Health and Wellbeing Strategy.  Julia Chisnell, Consultant for Public Health, Torbay Council, informed the Board that the programme generally was largely on track.

Members were provided with a summary of progress by priority programme area relating to mental health and well-being; good start to life; supporting people with complex needs; healthy ageing; digital inclusion and were informed of changes in the data indicators since the previous report.

Members were informed that the data compliance issues in relation to the virtual family hub had been overcome and that although there was no recurrent funding for the Healthy Ageing programme, there was an ambition to expand the work across Torbay and South Devon to provide a prevention programme across the Local Care Partnership and bids would be submitted for funding opportunities as they presented.

Risks and issues were highlighted around supporting people with complex needs in terms of access to suitable and affordable accommodation which presented the greatest issue.  This was identified on the wider Council risk register.  Events had been scheduled to increase alignment with the alliance in terms of overall vision and objectives.  Members were informed that, in respect of digital inclusion, project funding had come to an end and the formal programme had been paused, however, work had continued at a reduced level to support people to improve their digital literacy.  The Digital Inclusion Network had been stood down due to insufficient engagement, although regular one-to-one meetings with key members were still taking place.

In response to questions, Members were informed that there had been a review of priorities and underpinning areas within the Strategy to check that there was still the right balance of objectives and that there would be an annual review in that respect. 

It was recognised that the issue of housing supply was outside the control of the Board and that the combination of providing good low level prevention services whilst also addressing high levels of specialist need remained a huge challenge.

By consensus the Board resolved that:

1.         the update on the Joint Health and Wellbeing Strategy be noted;

2.         the progress in delivery of the Joint Health and Wellbeing Strategy be noted;

3.         the updated risk in relation to the digital inclusion programme and the redesignation of digital inclusion as an underpinning programme be noted.

To receive a verbal update and presentation provided by Andrew Gunther, Principal Planning and Public Health Officer, Torbay Council and Jacqui Warren, Principal Climate Emergency Officer, Torbay Council.

A Greener Way for Our Bay Framework and Action Plan and the Consultation Website and Survey Response form can be found at:

https://torbaycouncil.ntropydata.co.uk/project/159b27a9-7fd1-489f-9678-f2bd8921c561

The Board noted the verbal update provided by Jacqui Warren, Principal Climate Emergency Officer, Torbay Council and Andrew Gunther, Principal Planning and Public Health Officer, Torbay Council.

By way of background, the Board was informed that the Torbay Climate Partnership (TCP), which consisted of 21 local organisations from across the public, private, community and voluntary sector, had been working together over a period of time to develop a coordinated approach to tackling climate change through a series of public engagement events.  In 2022, the Torbay Climate Emergency Action Plan (TCEAP) was developed which set out a roadmap for how Torbay would become carbon neutral and adapt to climate change.  In 2023 a consultation was held, engaging with communities and businesses, which produced mixed views.  As a result of this the Greener Way for our Bay Framework and Action Plan was developed which set out a balance between immediate actions and long-term strategies, accompanied by a series of short and medium term plans.  This would replace the TCEAP and align with the national target of achieving net-zero emissions by 2050. 

The Action Plan contained 29 priority actions with emphasis on 10 key themes to deliver in Torbay which would carry health and socio-economic benefits:

·         help more people live and work in homes and buildings that are energy efficient;

·         make sustainable transport and public transport more accessible and affordable;

·         ensure that roads and paths are safer and more accessible for cyclists and walkers;

·         reduce waste and increase recycling;

·         enjoy and protect our marine and natural environment;

·         help green our businesses and create new jobs with the environment at their heart;

·         ensure the community is at the heart of local action;

·         monitor progress and set up initiatives to celebrate success;

·         help everyone understand why change is needed and how sustainable choices will make a difference;

·         work with nature and the local community to prepare for a changing climate.

It was recognised that some interventions had benefits for both health and for reducing climate change.

The Board was informed that the two main areas of risk for Torbay related to health and the built environment.  This was mainly because Torbay had a predominately older population and therefore the risk of impact on health and wellbeing was increased by extremes in temperatures.  As Torbay was a coastal area, this also presented an increased risk to flooding, sea level rise and coastal erosion.

Members of the Board were informed that the Framework and Action Plan were currently undergoing consultation and health partners were invited to contribute.

To receive a presentation and update on the Joint Forward Plan.

(Note: to be presented Jenny Turner, Programme Director, NHS Devon).

Jenny Turner, Programme Director, NHS Devon outlined the submitted report which provided an update on the refreshed Joint Forward Plan (JFP).

The Board were reminded that the existing JFP for Devon was written in collaboration with partners across the health and care system and published in July 2023.  It set out how the health and care sector planned to meet the challenges facing Devon in response to the One Devon Integrated Care Strategy.  There was a requirement to refresh the plan by April 2024 in accordance with Government guidance and the Plan had been collaboratively reviewed and amended in places to reflect any change in priorities.  However, the Board were reassured that the JFP had not significantly changed from the version published in 2023, although the structure of the plan had been amended and the content reduced in response to feedback from a variety of sources such as Trust Boards and Health and Wellbeing Boards.

It was explained that the refreshed JFP for 2024/25 would be structured around three themes/priorities:

·         Healthy People;

·         Healthy, safe communities; and

·         Healthy, sustainable system

The new content for each programme described the key achievements in 2023/24; what people in Devon would see as a result of the programme and showed which of the Integrated Care Strategy aims the programme supported delivery of with removal of detailed action plans and milestones.  All the programmes outlined both short-term and longer term objectives to transform the way partners worked together across the system so that it would remain healthy and sustainable in the future.

Members commented that the Plan indicated that workforce would achieve a net (-)2% workforce change against the current establishment and this was not referenced later in the Plan.  In response, it was explained that the workforce programme outlined the need to enable the workforce to be more productive and efficient and how to strategically change some of the workforce roles.  The reduction of 2% was taken from operating plan guidance which would be available shortly.

By consensus Members resolved that the Health and Wellbeing Board:

1.         endorse the refreshed Joint Forward Plan;

2.         continue to support ongoing development of the Joint Forward Plan; and

3.         were satisfied that the Joint Forward Plan continued to take account of the current Health and Wellbeing Strategy for Devon.

To receive a verbal update provided by Derek Blackford, Locality Director (South and West), NHS Devon.

The Board noted a verbal update provided by Justin Wiggins, Head of Integrated Care (South and West), NHS Devon who advised that the South Local Care Partnership (LCP) continued to develop its programme delivery structure to progress implementation of the Joint Forward Plan.  A governance structure had started to emerge with core groups and sub-groups in development around delivery, engagement and emerging issues.

Members were informed that the current delivery and pace of the LCP development was in the context of urgent and emergency care (UEC), winter pressures and system financial pressures.  The South Unscheduled Programme Board was focussing on a range of priorities to alleviate UEC pressures, for example, high intensity users of Emergency Departments, discharge delays, admission avoidance, coordination of care, falls and frailty, urgent community response and end of life.  Population Health remained a key focus working with Public Health to:

·         build on the Joint Strategic Needs Assessment and One Devon Data Set to better understand the south population to support the identification of priorities;

·         launch and fund organisations to focus on population health and prevention needs;

·         develop support for individuals waiting for surgery who were most impacted by health inequalities and wider determinants.

The Board was informed that the South LCP had focussed on:

·         the Better Care Fund

o   details for planning submission for 2024/25 financial year were awaited with an expectation of having to refresh current demand and capacity plans for people being discharged from acute settings to ensure the right support was available in the community from residential care, recovery and rehab placements;

o   strong partnership work continued.

·         Population Health and Prevention

o   led by Public Health, a new South Devon profile was being created which built on key information from JSNA and utilised key intelligence from the Community and Voluntary Sector and primary care which would help to identify key health inequalities, which priority areas to focus upon together and for organisations to respond to identified challenges;

·         Community Services Review

o   work was being scoped to undertake the review with links to the primary and community section of the Joint Forward Plan, particularly focussed on integrated working;

o   in the context of the Better Care Fund across Devon ICS, work was being undertaken to better understand the use of community hospitals which would assist in the consideration of how to best secure rehab beds in the South from a range of providers including community hospitals and residential/community providers;

o   the Devon Unscheduled Care Board had requested a rapid review of NHS funded Adult Community Services focussing on current UEC intermediate care services for adults; equity of provision and outcomes; opportunities for improvement and efficiency; and opportunities to improve planning and coordination;

o   linking in with a Devon ICB review of community services, the LCP would be looking across the South to explore what further developments could be made and whether there was a need for a revised model and seeking to develop a new care model.

·         Engagement workstream

o   Focus on engagement and  ...  view the full minutes text for item 51.

To receive a verbal update provided by Chris Winfield, Associate Director for Strategy and Provider Partnerships, Torbay and South Devon NHS Trust and Kevin Dixon, Chairman, Healthwatch.

The Board noted a verbal update provided by Chris Winfield, Associate Director for Strategy and Provider Partnerships, Torbay and South Devon NHS Trust.  Members were informed that the next meeting of the Engagement Sub-Group was scheduled for 22 March 2024.

To receive a verbal update provided by Lincoln Sargeant, Director of Public Health, Torbay Council and Jo Williams, Director of Adult and Community Services, Torbay Council.

The Board noted a verbal update provided by Lincoln Sargeant, Director of Public Health, Torbay Council.

Members were informed that in relation to the Cost of Living, interest rates were lowering and some benefits had increased.  Warmer weather had led to less severe outbreaks of infections over the winter and as the acute risk was less, it had been downgraded accordingly.  In terms of underlying resilience, food insecurity remained an issue together with housing and the mental health impacts around that.  The Department of Work and Pensions (DWP) reported that the level of mental health issues were a key cause in people being unable to work and it was recognised that there was increasing pressure on the voluntary sector.

The Housing Support Fund was to continue although there was no detail as yet.  It was anticipated that a delivery plan would have to be submitted to DWP by April 2024 and it was hoped that the amount of funding offered would be equal to the previous year.  Local Housing Allowance had also risen but there had also been an increase in rental costs.  There was anchor work underway around steps to assist people back into work, identifying employment sectors and volunteering opportunities.

To receive an update on the Risk Register.

(Note: presented by Lincoln Sargeant, Director of Public Health, Torbay Council).

The Board noted the report on the Risk Register and the Director of Public Health confirmed that the Risk Register would be updated to include reference to the digital inclusion network (Minute 48).