Agenda and minutes

To receive any apologies for absence.

Apologies for absence had been received from Jane Scattergood and David Levy.

To receive details of any changes in membership.

Councillor Clarke had attended as a substitute.

To receive declarations of interest by members of any interests on respect of items on this agenda, and to consider any dispensations.

Members may however, also decide, in the interests of clarity and transparency, to declare at this point in the meeting, any such disclosable pecuniary interests which they have already declared in the Register, as well as any other registerable or other interests.  

There were no declarations of interest.

To consider whether the press and public should be excluded from the meeting during consideration of any item on the agenda.

RESOLVED: - That the press and public not be excluded during the consideration of any items on the agenda.

To consider the minutes of the previous meeting held on 15^th September, 2023 (copy enclosed).

RESOLVED: - that the minutes of the previous meeting held on 15 September 2023 be agreed with the following amendment:

To add that Councillor Hanley raised his concerns in regards to their being no representation from North Cumbria ICB on the agenda.

To receive a report on the Lancashire and South Cumbria Dental Access and Oral Health Improvement Programme

Leanne Fawcett the Dental Delivery Assurance Manager presented a report on the Lancashire and South Cumbria Dental Access and Oral Health Improvement Programme.

She stated that Access to primary care NHS dental services were challenged nationally and locally due to five key factors:

• Reduced care during the pandemic

• Worsening oral health of the population

• Funding

• Dissatisfaction with the national contract

• Workforce challenges

The Lancashire and South Cumbria dental access and oral health improvement programme aimed to address the current challenges facing NHS dental services. Outcomes achieved through the programme were constrained by national factors outside of local control and they required close working with local authorities to reduce the local oral health disease burden.

The committee were provided with an overview of the primary care dental services as well as information on their delivery and performance.

They were informed that since the pandemic a large amount of contracts had been handed back.

She provided information on the dental access and oral health improvement programme aimed to improve dental access to members of the population with the greatest oral health inequalities, by using objective measures to help prioritise the limited flexibilities available to the ICB to invest funds in the areas of Lancashire and South Cumbria with the greatest needs.

The committee were informed of recent contract closures in the area which included: -

- Avondale Dental Practice in Grange-over-Sandes closed 31 March 2023

- {my}dentist Dental Practice in Dalton closed 31 March 2023

- BUPA Dental Practice in Barrow closed 30 June 2023

Pathways commissioned to support patients who had access challenges:-

Pathway 1: Urgent care within 24 hours for anyone in dental pain. Triage and treatment was available when needed. Access via local dental helpline 0300 1234 010. (Cavendish Dental Practice, Barrow; Cumbria Dental Practice, Barrow; MINT Dental Practice, Windermere; Bridge Dental Practice, Kendal, Sedbergh Dental Practice, Sedbergh)

Pathway 2: For patients who did not have a regular dentist and had undergone a recent urgent dental care intervention and been referred for ongoing follow-on care of this urgent intervention. (Cavendish Dental Practice, Barrow; Cumbria Dental Practice, Barrow)

• Level of provider engagement in new pathways was lower in this area that elsewhere. Feedback had been requested but not forthcoming. The smaller provider model was likely to be a factor.

The committee discussed the report.

It was agreed that a report be taken to cabinet highlighting the issue that the 2006 contract needs reviewing.

RESOLVED: - To note the report.

To receive an introduction report on Healthwatch.

Lindsay Graham and Kate Rees presented the Healthwatch Westmorland and Furness Introduction.

They informed the Committee that Healthwatch Cumbria was established in April 2013 as part of the implementation of the Health and Care Act 2012. However, in line with the Local Government Reorganisation on the 1^st April 2023, Healthwatch Cumbria dissolved and two new Healthwatch had been created, Healthwatch Westmorland and Furness and Healthwatch Cumberland.

A key role of HWWaF was to champion the views of people who used health and care services in Westmorland and Furness, seeking to ensure that their

experiences informed the improvement of services. HWWaF were constantly

listening, recording, and reporting on the views of local people on a wide

range of health and care issues, ensuring that people in the county were able to express their views and have a voice in improving their local health and care services.

This presentation provided an insight into the first six months of HWWaF. By

clarifying what they did to effectively champion the views of local people,

highlighting the key areas of work that they had undertaken this year so far,

sharing the top three issues they were currently hearing about and lay out their work plan for 2023 – 2024.

The Committee discussed the presentation.

RESOLVED: - To note the report.

To receive a report from the Director of Public Health.

Katrina Stephens the Director of Public Health presented the report on Public Health Priorities in Westmorland and Furness.

She stated that Local authorities’ statutory responsibilities for public health services were set out in the Health and Social Care Act 2012. Local authorities have, since 1 April 2013, been responsible for improving the health of their local population and for public health services including most sexual health services and services aimed at reducing drug and alcohol misuse.

Some Local Authority public health functions were mandated within the Act, meaning local authorities must provide them, including:

• 0-5 Healthy Child Programme (Health Visiting)

• National Child Measurement Programme

• NHS Health Checks programme.

• Open access sexual health services

• Public health advice to NHS commissioners

• Providing information and advice regarding health protection arrangements against threats to the health of the local population, including infectious disease, environmental hazards and extreme weather events.

• Improving the oral health of the local population.

The Act also described a range of other public health functions which Local

Authorities may choose to provide, including drugs and alcohol, stop smoking and school nursing services. Local authorities must take the action that they

decide is appropriate to improve the health of the people in their areas.

Every local authority with public health responsibilities must employ a specialist Director of Public Health (DPH) – appointed jointly with the Secretary of State for Health – who was accountable for the delivery of their

authority’s duties.

Public Health Funding

Local authorities received a ring-fenced public health grant to be used to deliver their public health functions. In spending the grant local authorities must have regard to the need to reduce inequalities between the people in the

area; and the need to improve the take up of, and outcomes from, its drug and

alcohol misuse treatment services.

The annual public health grant for Westmorland and Furness is £7,995,146.

At £35.40 per head of population, this is one of the smallest grants per head

of population in the country (England average is £68.10).

Public Health Services

The majority of the Council’s mandated public health functions were delivered through commissioned services. Historically, most of these services had been commissioned for the whole of Cumbria by Cumbria County Council.

Through LGR contracts had been maintained, or extended, to ensure stability of service provision. As contracts reach the end of their terms there was an opportunity to review existing commissioning arrangements to ensure they

best met the needs of Westmorland and Furness and the opportunities which existed for a new authority. It should also be noted however, that many of these services were specialist and clinical in nature and that for some commissioning on a Cumbria-wide, or larger geographic footprint, may still be

beneficial.

As many contracts reached the end of their current terms in the next two years the review of existing services and contracts was a high priority for the Public Health team to ensure that they had high quality services  ...  view the full minutes text for item 27.

To Receive a report from the Director of Public Health.

Katrina Stephens the Director of Public Health presented a report on the Development of Westmorland and Furness’ Joint Strategic Needs Assessment (JSNA) and Joint Local Health and Wellbeing Strategy (JLHWS).

She informed the committee that Health and Wellbeing Boards had a statutory duty to develop both a JSNA and a JLHWS for their local community.

The most recent Cumbria JLHWS was published in 2019 by the Cumbria Health and Wellbeing Board and had a ten-year lifespan. However, since 2019, both the national and local health and social care landscape had changed significantly. The Westmorland and Furness Health and Wellbeing Board had been newly established following local government reorganisation. There had been very significant health, social and economic impacts on the community associated with, and following, the Covid-19 pandemic. Furthermore, the Health and Care Act 2022 resulted in significant changes to the health and care system architecture with the establishment of Integrated Care Systems (ICSs).

The geographical area of Westmorland and Furness was not coterminous with the boundaries of a single ICS. South Lakeland and Furness were included within the boundaries of the Lancashire and South Cumbria ICS, whereas Eden fell within the footprint of the North East and North Cumbria ICS. In 2023, both Lancashire and South Cumbria and North East and North Cumbria had published system-level Integrated Care Strategies.

The focus of the JLHWS remained on the delivery of activity at place and within local communities to improve health and wellbeing. There was a need for Integrated Care Strategies and JLHWSs to be complementary to ensure

alignment of activity across the system and at place.

The production of a new JLHWS for Westmorland and Furness therefore provided a real opportunity to develop an evidence-based and partnership driven strategic approach to improved health and wellbeing of the local

population and reducing inequalities.

Joint Strategic Needs Assessment

The JSNA provided an assessment of the current and future health and social

care needs and assets of the local population, including population health data, the impact of inequalities and impact of the wider social determinants on health and wellbeing, and provided evidence to inform the JLHWS. The JSNA would also contribute to the development of future ICS strategies.

There was no nationally agreed format for the structure of a JSNA and each

assessment was unique to the local population. Guidance indicated that JSNAs were an ongoing process that should include both qualitative and quantitative data sources. Development of the JSNA involved a collaborative partnership approach between Westmorland and Furness Council, both Lancashire and South Cumbria and North East and North Cumbria Integrated Care Boards, Westmorland and Furness Healthwatch and Cumbria Voluntary and Community Sector Organisations.

To facilitate timely development of the JLHWS, a summary JSNA would be

produced in 2023 to provide a comprehensive overview of health and wellbeing needs and assets in Westmorland and Furness. The summary JSNA would draw on existing nationally and locally published data and would be structured using a life course approach to include chapters on population demographics,  ...  view the full minutes text for item 28.

To receive a report from the Strategic and Scrutiny advisor on the forward plan and draft work programme.

David Stephens presented the Forward Plan and Draft Work Programme.

He reported that the relevant items from the current Forward Plan of Key Decisions, 1 June 2023 – 30 September 2023 had been attached as an appendix to the report.

Members had been asked to consider the excerpts from the Forward Plan identified as relevant for the Health & Adults Overview and Scrutiny Committee and decide whether they should be reflected in the Committee’s work programme.

Future iterations of the Forward Plan could be used to identify potential areas

for scrutiny activity or where further information sharing was required.

He informed the Committee that the Award of Contract for Domestic Abuse Supported Accommodation had been added to the forward plan and he could liaise with the Director if the Committee were interested.

The draft Work Programme had been attached as an appendix to the report. This was an initial draft for consideration based on the recommended topics for consideration proposed by the previous Cumbria Health Scrutiny Committee and CCC Adults Scrutiny Board, it was for this Committee to discuss and further develop.

He advised that a report on the Place Based arrangements in the Eden area as part of the North East and North Cumbria ICS was also on the work programme for January.

He also added that the Scrutiny Regulations and guidelines would be finalised at the end of January 2024.

The draft scope for Assistive Technology Scrutiny Review had been attached at appendix 3 and had been produced in consultation with the Chair and key

officers, Members were asked to consider and agree the scope and indicate

whether they would like to participate in the Scrutiny Review Group.

RESOLVED: -

1.    To Note the Cabinet Forward Plan

2.    To Note the Work Programme

3. To Agree a draft Scope for Assistive Technology Scrutiny Review