Agenda and minutes

To note any apologies for absence

The following apologies for absence were noted at the meeting:

Angela Potter

Chief Superintendent Jane Probert

Professor Mark Pietroni

Ananthakrishnan Raghuram (deputising for Mark Pietroni)

Cllr Stephen Davies

Deborah Lee

Gail Pasquall

Mark Walkingshaw

Guy Stenson

Peter Williams

Bob Hodges

Peter Tonge

Chris Witham

To confirm any declarations of interest on matters being discussed at the meeting.

Please see note (a) on the cover sheet of the agenda.

No declarations of interest were made at the meeting.

To note and agree the minutes of the Health and Wellbeing Board meeting held on 17 January 2023

The minutes of the Gloucestershire Health and Wellbeing Board meeting held on 17 January 2023 were noted and confirmed as a correct record of that meeting.

To consider any written public questions about matters within the powers and duties of the Board. The deadline for the receipt of written questions for the meeting on 28 March 2023 is 10.00am on Tuesday 21 March 2023            

Please send any questions marked for the attention of the Chief Executive to Jo Moore at email address: jo.moore@gloucestershire.gov.uk 

No public questions were submitted for consideration at this meeting.

To consider any written member questions about matters within the powers and duties of the Board. The deadline for the receipt of written questions for the meeting on 28 March 2023 is 10.00am on Tuesday 21 March 2023            

Please send any questions marked for the attention of the Chief Executive to Jo Moore at email address: jo.moore@gloucestershire.gov.uk 

No member questions were submitted for consideration at this meeting.

An update on development of the NHS Gloucestershire Integrated Care Board (ICB) 5-year Joint Forward Plan (JFP).

6.1 Dan Corfield, (Associate Programmes Director for the NHS Gloucestershire Integrated Care System), gave a detailed update on behalf of the NHS Gloucestershire Integrated Care Board (ICB), on the requirement by the ICB to produce a 5-year Joint Forward Plan (JFP). Please refer to the attached slide-show presentation presented at the meeting for details of the update. The presentation included a summary of the information considered by the Board at its meeting on 17 January 2023.

6.2 It was reaffirmed that, in accordance with the Health and Care Act 2022, the ICB, (along with partner NHS trusts and NHS foundation trusts), was required to prepare a 5-year joint forward plan (JFP), prior to the start of each financial year. The plan to be refreshed each year.

6.3 The JFP to focus on the following 4 key elements:

a)    To improve the outcomes of the population’s health and healthcare

b)    To address inequalities in outcomes, experience and access

c)    To Enhance productivity and value for money, and

d)    To assist the NHS support broader social and economic development requirements

6.4 In accordance with the requirements of the Health and Care Act 2022, the ICB must inform the Health and Wellbeing Board of the steps the ICB proposes for implementation of the Joint Local HWB Strategy (JLHWS). The HWB to consider a draft version of the forward plan, for which the ICB must consult with the HWB on whether the plan has taken proper account of the relevant JLHWS.

6.5 Following an appropriate period of consultation, the HWB has the right to respond to the ICB on the process for submission. On formal submission of the draft forward plan to NHS England, the ICB must include a statement from the HWB on whether it agrees the JLHWS has been properly taken into account during the development of the joint forward plan.

6.6 Noting JFP guidance https://www.england.nhs.uk/long-read/guidance-on-developing-the-joint-forward-plan/ published in December 2022, members were advised of the timescales for development and publication of the Gloucestershire JFP 2023. It was noted that the proposed approach for producing the JFP was based on the 5-year aims and milestones taken from NHS transformation programmes, (to reflect the ‘pillars’ of the new ICP Strategy). Engagement and consultation had been conducted in line with the ICP Strategy process in order to avoid potential duplication and engagement fatigue.

6.7 Publication of the final version of the JFP to be published at the end of June 2023. Any comments from the HWB to be included in the final (published) version of the JFP. The draft version of the plan to be endorsed at a confidential ICP Board meeting on 29 March 2023 before submission to NHSE on 31 March 2023.

6.8 To prepare for the final period of engagement during the period April and June, members were asked to note the update and provide any feedback on the revised structure of the plan, including alignment of the plan with the Health and Wellbeing Strategy. The Health and Wellbeing Board was asked  ...  view the full minutes text for item 6.

To consider revised Terms of Reference for the Gloucestershire Health and Wellbeing Board and Health and Wellbeing Partnership.

Siobhan Farmer, Director of Public Health, (Gloucestershire), outlined proposed changes to the terms of reference for the Gloucestershire Health and Wellbeing Board, (in alignment with the terms of reference of the Gloucestershire Health and Wellbeing Partnership).

Referencing changes to the governance and structure of local NHS bodies introduced by the Health and Care Act in 2022, it was explained that the Act did not extend to include changes to the statutory duties of Health and Wellbeing Boards, thereby resulting in a potential overlap in the roles and responsibilities of Integrated Care Partnerships (ICP) and Health and Wellbeing Boards (HWB).

Recognising the potential impact of the situation on coterminous areas, (areas with the same geographical boundaries), the Department of Health had subsequently published Health and Wellbeing Boards Guidance in November 2022, stating that:

“In the few areas where the ICP and HWB are coterminous, (cover the same geographical boundaries), it may be appropriate for the HWB and the ICP to have the same members. This can be done, for example, by one part of the meeting formally being of the HWB, and the other part of the ICP. However, both have different statutory functions, which each will be required to fulfil.”

It was confirmed that, initially, this option had been discounted locally, based on the understanding it would not be permitted under the new legislation. Upholding concerns about poor governance and lack of clarity in the delivery of integrated health and care, members recognised the merits of aligning the terms of reference of the Gloucestershire HWP with the HWB and agreed this was a sensible approach.

Outlining proposed changes to the membership of the HWB and amending the quorum of the HWP, (amended from a minimum of 50% of members required at HWP meetings to a minimum of one quarter of the membership from a minimum of 4 voting member organisations), the Health and Wellbeing Board supported the proposals, (as set out in the appendix to the report), and agreed that the proposals be submitted for consideration by the Gloucestershire County Council’s Constitution Committee, and subsequently, Full Council, for integration into Section 3 of the Council’s Constitution.

To evaluate (deep dive) the Early Years Strategy.  

Beth Bennett-Britton, (Public Health Consultant), and Sarah Hylton, (Head of Early Years), gave a detailed presentation on the ‘Best Start in Life’ work-stream. For details of the presentation, please refer to the attached slide-show presentation presented at the meeting.

Referencing the importance of physical, intellectual and emotional development, and work to reduce inequalities as being fundamental to a person’s life course, members were asked to consider data from the ‘school readiness indicator graph’ and evidence to support the value of social spending investment in a child’s early years as having the greatest impact.

Responding to feedback from a range of cohorts, the following objectives had been included in the Best Start in Life and Early Years Strategy Action Plan.

Objective 1: Increase the number of children benefitting from early intervention and support, where needed

Objective 2: Reduce inequalities for those aged 0-5

Objective 3: Ensure clear information on services and support is available and accessible, including to those families who may be less likely to access support and who may need it the most

Objective 4: Promote health and wellbeing

Acknowledging some of the challenges impacting on progress, the Health and Wellbeing Board was asked to:

·         Uphold the ‘Best Start in Life’ work-stream as a priority

·         Continue to advocate for non-stigmatising, accessible support, to enable early intervention through Family Hubs and community capacity building

·         Adopt a life-course approach to reducing inequalities

Responding to questions, it was confirmed preparation work with reception teachers was being undertaken to breach some of the gaps in children’s pre-school development.

Chris Spencer, Executive Director of Children’s Services, (Gloucestershire), commended the level of progress that had been made in the past year and welcomed the preparatory work being undertaken with schools. Dame Gill Morgan, Chair of the Integrated Care Board, (ICB), reinforced the value of investing in a person’s early years and supported the comments made by the Executive Director of Children’s Services. Stating ‘there was still considerable work to do’, Dame Gill conveyed the commitment of the ICB to address pressures on the system, including arranging a Children’s Services/ICB event prior to the September Board meeting.

Enquiring how momentum would be maintained, a member was informed that, as a national issue, there was a wealth of training being offered. This did not, however, avoid the issue of under-funding and the need for more resources. Cllr Carole Allaway-Martin suggested board members lobby for funding and the suggestion was noted.

Helen Gentles from Healthwatch Gloucestershire reflected on the county’s positioning in comparison with other regions and suggested that this was something that could be worked on and improved. It was agreed the county could be better placed in terms of outcomes and performance, but, nevertheless, progress was being made. 

The update was noted.

To agree Health and Wellbeing Board Deep Dive items 2023/24

It was confirmed that the next Board meeting would be held in July.

Items suggested for consideration at the July meeting included an update on the Healthy Lifestyles Strategy and work to progress Action for Adverse Childhood Experiences (ACEs), (specified traumatic events occurring before the age of 18 that linked to poorer health and social outcomes in a person’s life).

A review of the Health and Wellbeing Board Plan would be required in July.

In noting the items suggested at the meeting, members were asked to provide input on the suggestions and to consider what other items they might like to consider at the July meeting?