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

Apologies were received from Nancy Meehan, Director of Children’s Services, Torbay Council; Alison Hernandez, Police and Crime Commissioner; Anthony Reilly, Devon NHS Partnership Trust and Sarah Newham, Department for Work and Pensions.

Acting Superintendent Nigel Yelland attended in place of Chief Superintendent Roy Linden.

Chris Winfield and Chris Knights attended in place of Adel Jones, Torbay and South Devon NHS Foundation Trust.

Sharon O’Reilly attended in place of Jo Williams, Director of Adult and Community Services.

To confirm as a correct record the Minutes of the Health and Wellbeing Board held on 8 September 2022.

The Minutes of the Health and Wellbeing Board held on 8 September 2022 were confirmed as a correct record and signed by the Chairwoman.

The Chairwoman referred to the current membership and the Board held no objection to the suggestion that co-opted members could become full members of the Board.

To consider the Peninsula Protection Annual Report 2021/22.

Members noted the Peninsula Health Protection Annual Report 2021/22 which was outlined by Julia Chisnell, Consultant in Public Health with Torbay Council.  The Board was informed of the key considerations which were:

·         Health protection

·         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 as a result of assistance from Outreach Teams and community engagement in promoting vaccination clinics, vaccination uptake had improved.  Cancer screening had been on a recovery trajectory following the pandemic and was now back to pre-pandemic levels.  However, more in-roads were required in respect of MMR vaccinations as uptake needed to improve.  Currently the statistics showed a 91% uptake in the last quarter, falling to 87% currently.  This was being treated as a priority with a focus on school age vaccinations.

In response to questions, the Board was informed that with the increase in cancer screening there were challenges to be addressed but that these were manageable at present and that NHS England and NHS Trust colleagues were working together to address these challenges.

It was recognised that there were pressures on the NHS generally and that the NHS and Public Health continued to work together to resolve those pressures particularly in relation to waiting lists.

Progress on actions detailed in the Peninsula wide priorities for 2022/23 will be included in the next annual assurance report.

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

The Board noted the second 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 was 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 September 2022 report.

Risks and issues were highlighted in respect of the ageing programme and digital programme funding which was coming to an end.  A case was being developed in respect of the ageing programme and the digital funding programme was cutting back its delivery as the current fixed-term funding ends in March 2023.  The networking aspect of the programme will continue but for 2023/24 there will be no commissioned delivery programmes to support people to get online. 

More work on cross cutting areas would be carried out over the next few months, bringing people together to improve connections between these areas of work and the health and wellbeing agenda.

In response to questions, Members were informed that refugees and migrants were being supported and that there was extra work in relation to the mental health programme to address the mental health concern.  A difficulty identified was how long migrants or refugees stayed in the area and this could affect their route of support. 

Members were reassured that mental health was covered in the overall Strategy and a lot of work was being undertaken with faith communities and skills resources training, for example and there were a lot of opportunities for change.  

To consider the Building a Brighter Future (Torbay and South Devon NHS Foundation Trust Strategy) report.

The Health and Well Being Board received a presentation from Torbay and South Devon NHS Trust. 

The Strategic Outline Case for £497 million had been submitted to the New Hospital Programme national team for consideration.  Meanwhile, site enabling plans were being progressed so that the estate would be ready for construction as soon as possible.

Members were informed that the four key principles within the Strategic Outline Case were:

·         reprovision of medical beds and emergency surgery beds in the hospital;

·         separation of planned and unplanned services;

·         non-clinical services to be moved off the hospital site;

·         emergency department and same day emergency care services to be completely upgraded.

The Board were updated in relation to funding; what the site could look like and plans for that; current key milestones and progress achieved over the last 12 months, which included a new acute medical unit, new endoscopy unit and new theatres.  Next steps were outlined and the team were working hard to ensure allocation of funds were confirmed following which the aim was to complete the site enabling full business case by June 2023.

In response to Members questions it was confirmed that the vast majority of key services would be unaffected by the acute services review.  However, if there were other service shifts, they would be taken into account.  A lot of work had been done around capacity modelling and not making the hospital too small for future needs.  The bed modelling already carried out required input from community colleagues to ensure that there were facilities for enabling discharge and levering use of digital technology so that patients could be managed closer to their home.  At present the model proposed 350 medical beds although there was other bed capacity on site that could potentially be used, but not necessarily for acute provision.

Accommodation for key workers had also been considered and off-site solutions were being explored.  Concerns were raised that managing traffic flow around the site would present a challenge and assurance was given that this was considered in the planning.

In respect of the site, net carbon standard was a compulsory requirement to meet environmental building standards.  There would still be a fossil fuel heated element and although there would be upgrade work on a concentrated area, there was also an aspiration to become net zero carbon across the site, however, this would not be achievable straight away.

By consensus the Board resolved:

1.         the contents of the report were noted;

2.         confirmed its continued support of Torbay and South Devon’s New Hospital Programme;

3.         that a further update should be provided to the Board in 12 months’ time following which 6 monthly updates will be provided.

To consider the One Devon Integrated Care Strategy report.

The Director of Public Health, Lincoln Sargeant and the Deputy Programme Director, NHS Devon, Jenny Turner outlined the submitted report and provided a presentation.

The Board were informed that the One Devon Interim Integrated Care Strategy had been developed on behalf of the One Devon Partnership by the Devon Plan Working Group.  The Partnership brought together the NHS, local authorities, the voluntary sector and other partners across Devon.

Existing Health and Wellbeing Board strategies were considered when creating the Integrated Care Strategy which reflected work and engagement carried out over time with people in the community. Twelve key challenges had been identified for Devon and the Strategy provided a broad direction of travel in addressing these.

Integrated Care Boards and partner trusts had a duty to prepare a draft Joint Forward Plan in response to the Integrated Care Strategy before the start of 2023/2024. The Joint Forward Plan Guidance specified that the date for publishing and sharing the final Plan is 30 June 2023, however it was likely that this would be achieved earlier.

The draft Joint Forward Plan outlined how the 21 strategic goals would be delivered and cover four broad areas:

·         Mental Health, Learning Disability and Neurodiversity;

·         Primary and Community Care Model;

·         Acute Services Sustainability Programme

·         Children and Young People Care Model;

In respect of the report Members commented that:

·         the content for children and young people while focused on education did not include much on children’s health services such as mental health.  However, it was recognised that the Integrated Care Strategy consider health in its broadest sense and that the Joint Forward Plan would provide more detail on health services;

·         clarity was needed around how safeguarding fits into the overall strategy and plan;

·         the workforce difficulties faced by the NHS in Devon and wider challenges such as employment opportunities for residents are two separate issues;

·         what would change as a result of the plan in terms of outcomes for local people?

·         community engagement and involvement were essential and should also include the parent/carers’ forums;

·         how would the plan’s performance be monitored going forward and what role would Torbay’s Health and Wellbeing Board play in that?

Overall, Members welcomed the draft plan and its strategic goals which presented an opportunity for change where that was needed. It was noted that an event was planned for 23^rd March for members of the 3 Health and Wellbeing Boards in Devon to review the details of the Joint Forward Plan.

By consensus Members resolved that:

1.         the draft Joint Forward Plan takes proper account of the Joint Local Health and Wellbeing Strategy;

2.         the minutes of the Board meeting on the 9 March 2023 will constitute the response in writing of the Health and Well Being Board and its opinion in respect of (1).

To receive a verbal update in respect of the Integrated Care Board and Local Care Partnership business programme.

The Board noted a verbal updated provided by Derek Blackford, Locality Director, South & West, NHS Devon Integrated Care Board.

Members were informed that the One Devon Partnership were attempting to better understand partnerships in the wider system and there was more work to be done in that respect including the One Devon Integrated Care Strategy.  The work on behalf of Torbay and South Devon could be improved and it was important to understand all of the good work which was already underway.  The question was whether enough support has been provided for people to network and to understand what the Integrated Care Board and Local Care Partnership was attempting to deliver and that would be the focus of efforts moving forward.  There would also be a focus on whether the Local Care Partnership for South Devon and Torbay had included all the right stakeholders and communities, to identify those who were missing and should be included.  Thought was also being given as to how to raise the profile of what the Local Care Partnership was attempting to deliver and amplify the value in what it was trying to achieve.  It was essential to have the right support and priorities and work would be taken forward within the Joint Forward Plan.

To receive a verbal update on the Turning the Tide on Poverty and Cost of Living work programmes.

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

Members were informed that the Council adopted a strategic approach in terms of supporting the most vulnerable and most at risk from adverse events like the pandemic and cost of living crisis.  The focus over the winter had been the cost of living crisis and the Council had done a lot of work together with partners on implementing a series of measures to ameliorate fuel and food poverty such as the provision of ‘warm banks’ and food banks.

There were good insights into how best to begin to address the wider issues and  interesting opportunities for the future with development around the food strategy with expanding provision through fixed and mobile food banks to developing more social supermarkets.

Work had been carried out recently with Torbay Council, South Devon College and the Torbay and South Devon NHS Trust as major public sector employers in Torbay.  A staff survey had been carried out which provided valuable insights around the challenges faced by staff and how the employers could respond better, particularly for those on lower incomes. 

There was positive news in that the Council had received confirmation of £2.4 million from the fourth round of the Household Support Fund and had been allocating that funding in a manner to reach a wider range of people who are struggling to make ends meet.  There is a Cost of Living Incident Management Team that meets fortnightly and were now discussing how to move from crisis stage to address medium and longer term considerations in order to build resilience for individual, families and communities.

It was recognised that further funds were being allocated to help social supermarkets and food alliances to assist more people in the community who do not qualify for other support or benefits.