Meeting documents

Kevin Lavery, Integrated Care System Chief Executive Designate for Lancashire and South Cumbria attended for agenda item 6 – Integrated Care System – Development Report (minute no 6 refers).

Apologies for absence were received from Mr M Adams, Mrs P Bell, Mr R Chillery, Mr A Cummins, Mr J Duncan (Mr D Muir attended as substitute), Ms D Earl, Mr D Eva, Mr A Gardner (Ms H Fordham attended as substitute), Mr A Heritage, Mr P Scott, Ms L Simpson (Mr S Park attended as substitute), Mrs M Skeer and Mr M Thomas.

There were no disclosures of interest on this occasion. 

RESOLVED,     that the press and public be not excluded from the meeting for any items of business.

To confirm as a correct record the minutes of the meeting held on 4 March 2022 (copy enclosed). 

RESOLVED,     that the minutes of the meeting of the Board held on 4 March 2022 be agreed as circulated and thereupon signed by the Chair.

To receive a joint presentation from the Director of Public Health (Cumbria County Council), North Cumbria and Morecambe Bay Clinical Commissioning Groups.

The Board received a detailed presentation from the Director of Public Health (Cumbria County Council), Chief Operating Officer (North Cumbria Clinical Commissioning Group) and Director of Planning and Performance (Morecambe Bay Clinical Commissioning Group) which illustrated a COVID 19 update.

Members were informed of the number of cases measured by district and age and received a geographical comparison.  The Board noted there were low levels of the virus towards the end of May with a slight increase in cases during the last two weeks. 

The Board received an update on hospitalisation noting there were on average 10 cases per day across both Trusts in Cumbria with mortality rates still being recorded as relatively low.

Members noted that the vaccination programme in Cumbria was higher than the national average but that there were still a significant number of people who remained unvaccinated.  The Director of Public Health highlighted the lack of vaccination provision in West Cumbria was being investigated.  The Board was informed clarification was awaited with regards to a continued vaccination programme.

The Chief Executive Officer, Healthwatch Cumbria explained that Healthwatch Cumbria and Lancashire had been commissioned by the Integrated Care Boards to undertake a study of the vaccination programme and its accessibility to the public which would help to inform future decisions.

Members were informed that the impact of a potential 7^th wave was unknown but it was anticipated this would have a relatively low impact on health overall with problems on services remaining unclear. 

A discussion took place regarding possible future national control measures and it was anticipated this was very unlikely.  Members were informed that a significant amount of research had been undertaken during the lock down period with strong indications that this had been effective.  It was explained that data at a national level was being evaluated and would form part of the National Inquiry.

The Chair, on behalf of the Board, thanked the Director of Public Health for his exemplary leadership during the pandemic.

The Board welcomed the presentation and it was agreed that future updates would be considered with the Chair and Vice-Chairs of the Board.

To receive a presentation from the Chief Executive Designate of the Lancashire and South Cumbria Integrated Care System.

The Board received an update from Kevin Lavery, Integrated Care System Chief Executive Designate for Lancashire and South Cumbria.

Members were informed that the top priority was to strengthen social care; with a need to ensure there were strong partnerships between all sectors including health, local government, voluntary sectors and primary care, together with consideration of joint budgets to be effective.

The Board was informed of the increasing demands on the acute sector and the opportunities to improve quality, efficiency and effectiveness.  It was felt this was also a chance to change the system culture to collaborate and look at the system as a whole with the possibility of a move from contract systems to long?term partnerships with the various agencies to allow investment in resources.

The Chief Executive Designate highlighted the need to change the budget processes to enable a longer term approach with a view to implementing a 10 year plan with a three year budget.

During the course of discussion the need to investigate opportunities for the inclusion of the voluntary sector as part of the long?term perspective was highlighted.  The Third Sector representative welcomed this approach highlighting the need for stability to provide a service.

A discussion took place regarding Place Based Partnerships and it was explained these were being reviewed with a view to reducing them from five to four and basing them on local authority boundaries to enable more integration in the future.

The Board acknowledged the challenges and welcomed the proposals to move away from the mandatory contract culture.

In conclusion, the Chief Executive Designated outlined his commitment to work with the Health and Wellbeing Board in the future.

The Chair, on behalf of the Board, welcomed the update and looked forward to working together on the proposed 10 year plan.

To consider a report by the Executive Director – People (Cumbria County Council) (copy enclosed).

The Board considered a report from the Executive Director – People (Cumbria County Council) which provided an update regarding children and young people’s emotional wellbeing and mental health (EWMH) and recent developments of the Cumbria Children and Families County Oversight Group (The Group) and relevant priorities.  Members also noted the current system challenges and responses to address as part of a system?wide approach.

The report highlighted that the Board had acknowledged that children and young people’s emotional health and wellbeing was a key shared priority area for Cumbria and committed to a higher level of involvement, scrutiny and direct support for the multi-agency whole system work underway to address current challenges and improve mental wellbeing outcomes.

Members noted that in recognition of the changing landscape for health, care and local government organisations in Cumbria the Children and Young People EWMH System Oversight Partnership Group (The Group) was formed at the request of Cumbria’s Children’s Trust Board (now Cumbria Child and Family Partnership (CCFP)).  It was explained that the role of the Group was to help to provide oversight, support, and challenge across the system in Cumbria to help promote prevention and early help and to encourage consistency of access to quality services and interventions for all children and young people in Cumbria.

The Board was informed that children and young people had been impacted disproportionately in terms of emotional and mental health as a result of the pandemic.  It was explained that furthermore, those vulnerable groups of children and young people who were already facing additional challenges and higher levels of adverse circumstances, had been exposed to increased and amplified EWMH and other health inequalities as a result.

Members noted that the previous 12 months had focussed on bringing partners together, identifying the challenges and needs, and setting key priorities.  During the course of discussion a suggestion was made that the three long?term priorities should be included as short to medium?term.

The Chair highlighted this matter was a key priority for the Board and drew attention to waiting times and access to services as a major concern.  Whilst acknowledging the concerns regarding resources the Board asked how waiting lists could be reduced to an acceptable level whilst taking into consideration an increase in requests for the service post?COVID. 

Officers, whilst highlighting this was a joint approach from a number of organisations, acknowledged the demand for services had increased.  It was explained there had been additional investment and resources with the majority of referrals to Specialist CAMHS being assessed and treatment commencing within the national NHS target of 18 weeks from referral to treatment.  Members raised concerns regarding the availability of support whilst waiting for treatment and officers confirmed there were systems in place to provide this.

The Board noted the change in referrals with the latest data indicating more than 500 referrals per month.  Officers explained the referrals were for a range of conditions including eating disorders, ADHD, mental health, emotional support and psychosis and  ...  view the full minutes text for item 7.

To receive a presentation by the Chair of the Cumbria Mental Health Partnership Board (copy enclosed).

The Board received a presentation which detailed proposals to establish a Cumbrian Mental Health Partnership Board (CMHPB).

Members were informed that the countywide Mental Health Concordat was established in 2019 as the acute provider landscape changed to provide a strong and cohesive mental health voice to the most senior leaders across the county.  It was explained that the first priority was to examine and improve working relationships between the NHS and Cumbria Constabulary; the Concordat had also given the 3rd sector a powerful link into senior decision makers across the county.

The Board noted that as this was now a time of considerable structural change in terms of ICS; ICP; Place and local authorities a Long Term Plan would ensure that mental health and emotional wellbeing would remain a national strategic priority.

Members were informed of the objectives and indicative key priorities for 2023/25 which included:-

Ø   delivering on the primary and community mental health transformation programmes; ensuring improved access, outcomes and strong links with other multi-agency community services;

Ø   target mental health promotion and prevention within communities most at risk of poor mental health, suicide and self-harm;

Ø   working with people with multiple and complex needs such as homelessness, addictions, alongside mental health concerns;

Ø   ensuring all services recognised the impact that trauma or psychological and social adversity has on mental health;

Ø   continue to improve timely access to mental health crisis services, support and ensure that people receive a compassionate response;

Ø   ensure older people were able to access information, support and appropriate treatment that meet their needs;

Ø   improve the physical health of people with serious mental illness.

The Board was informed that, if agreed, the next steps would include a partner mapping exercise to ensure all that lines of reporting flow into the CMHPB, a detailed Terms of Reference would be developed and a set of key strategic objectives and priorities be proposed.

The Chief Executive Officer for Healthwatch Cumbria offered support and asked that moving forward what plans were in place for people with lived experience.  Members were informed that whilst people with a living experience were involved this had been challenging.

During the course of discussion attention was drawn to the Learning Disability Partnership Board which had not met for some time and a suggestion was made that this be re?established. 

The Board agreed that the Assistant Director - Integration and Partnerships would discuss the children’s aspect directly with the Group Director - North Cumbria, Cumbria, Northumberland, Tyne and Wear Trust.

A discussion took place regarding the potential effects of Local Government Reorganisation and although future arrangements regarding the Board had not been determined it was highlighted that this should not prevent the current work being continued.

RESOLVED,   that

                          (1)          the current Mental Health Concordant evolves into a Cumbrian Mental Health Partnership Board (CMHPB);

                          (2)          the CMHPB reports into the Cumbria Health and Wellbeing Board;

                          (3)          ongoing work continues to shape the accountability and governance for the CMHPB into the two ICSs;  ...  view the full minutes text for item 8.

To consider a report by the Director of Public Health (Cumbria County Council) (copy enclosed).

The Board considered a report by the Director of Public Health (Cumbria County Council) which provided a brief update on the progress of the Lancashire and Cumbria Health Equity Commission (HEC).

Members were informed there had been a delay in the HEC publishing its report and recommendations and it was now anticipated this would take place in June/July 2022.

The Board emphasised its concerns regarding the delay highlighting the effects this had on the community. 

RESOLVED,   that

                          (1)          it be noted there has been a delay in publishing the report and recommendations of the HEC;

                          (2)          the HEC report and recommendations will be presented at the next Board development session;

                          (3)          a substantive discussion take place at the next Health and Well-being Board development session on the recommendations of the HEC and agree the local priorities.

To consider a report by the Director of Public Health (Cumbria County Council) (copy enclosed).

Members considered a report by the Director of Public Health (Cumbria County Council) which provided a brief update on the work of the Health and Wellbeing Board Inequalities Task and Finish Group.

RESOLVED,   that

                          (1)          a report describing the work undertaken by the Task and Finish Group containing recommendations for the Health and Wellbeing Board Recovery Priorities will be presented at the next Board development session;

                          (2)          a substantive discussion take place at the next Health and Wellbeing Board development session on the recommendations of the Task and Finish Group for agreement on the Health and Wellbeing Board Recovery Priorities.

To consider a report by the Director of Public Health (Cumbria County Council) (copy attached).

The Board considered a report by the Director of Public Health (Cumbria County Council) regarding the Pharmaceutical Needs Assessment (PNA) 2022.

Members noted that the purpose of the PNA was to assess local needs for pharmacy provision, to identify any gaps in service or unmet needs, and to highlight any services that community pharmacies could provide to address those needs.

The Board was informed that in line with published guidance from Department of Health and Social Care and specifications of the NHS regulations, the PNA Steering Group had collated and analysed a wealth of data that had been considered and reported.  It was explained that the analysis would suggest there was currently adequate provision of pharmaceutical services in Cumbria; details of where improvements to provision could be made were given within the draft PNA for each district.

Members were informed that health and wellbeing boards must consult specified bodies as set out in Regulation 8 of NHS Regulations at least once during the process of developing the PNA with a minimum of 60 days for responses.  Officers recommended that this PNA draft (referred to at appendices 1 and 2 of the report) was approved by the Cumbria Health and Wellbeing Board for progression to consultation with public and those specified bodies.

A query was raised by the Third Sector representative as to the meaning of questions 9 and 10 in the Service User Survey and it was agreed the Director of Public Health would respond direct.

The Board noted it was, therefore, recommended the sign off for publication was delegated to the Director of Public Health in consultation with the Chair and Vice Chairs (if appointed) of the Board in case a final version was not available for the next Board meeting.  It was explained that this would ensure the PNA could be published by 1 October 2022 as set out in the Regulations.

RESOLVED,   that

                          (1)          this PNA draft (appendices 1 and 2 of the report) is approved by the Cumbria Health and Wellbeing Board for progression to consult with the public and bodies specified in the Regulations;

                          (2)          the sign?off for publication is delegated to the Director of Public Health in consultation with the Chair and Vice Chairs (if appointed) of the Board in case a final version is not available for the next Board meeting.  This will ensure the PNA can be published by 1 October 2022 as set out in the Regulations.

To consider a joint report by the Executive Director – People (Cumbria County Council), Chief Operating Officer - North Cumbria Clinical Commissioning Group and Chief Officer - NHS Morecambe Bay Clinical Commissioning Groups (copy enclosed).

The Board considered a joint report from the Executive Director – People (Cumbria County Council), Chief Operating Officer (NHS North Cumbria CCG) and Chief Officer (NHS Morecambe Bay CCG) which provided an update on Cumbria’s Better Care Fund (BCF) for Quarter 4 2021/22 together with an update on the end of year 2021?22 BCF submission and BCF uplifts for 2022?23.

RESOLVED,   that

                          (1)          the contents of the report be noted;

                          (2)          if timing does not allow consideration of the required BCF submissions by the Board, then the Executive Director – People be given delegated power, in consultation with the Chair and Vice?Chairs (if appointed) of the Board, to make the submission.

To consider a report by the Director of Public Health (Cumbria County Council) (copy enclosed).

The Board considered a report by the Director of Public Health (Cumbria County Council) which gave an update on the development of the Cumbria Public Health Alliance/Outbreak Engagement Board (PHA/OEB), its links to the Locality Forums and the mechanisms for ensuring two-way influence and dialogue between the Board and each locality through agreed strategic aims and locally identified priorities.

Members were informed that recent guidance had been received which set out a National Combating Drugs Outcomes Framework and included the requirement to establish a Combatting Drugs Partnership which would be discussed further with the Chair and Vice-Chairs of the Board.

RESOLVED,   that the following be noted:-

                          (1)          the update and any identified plans for future activity;

                          (2)          each item in the report includes reference to the pertinent section of the Cumbria Joint Public Health Strategy.

To consider a report by the Executive Director – Corporate, Customer and Community Services (copy enclosed).

Members considered a report by the Executive Director – Corporate, Customer and Community Services which set out proposed changes to the membership of the Cumbria Health and Wellbeing Board following the Health and Care Act 2022 receiving royal assent.

The Board was informed that the Act abolished the Clinical Commissioning Groups and transferred their powers and responsibilities to the relevant Integrated Care System Integrated Care Board.  It was explained that, therefore, the two Integrated Care Boards (ICBs) had the right to appoint a person to the Cumbria Health and Wellbeing Board.

Members noted that over and above the statutory minimum requirements, the Cumbria Health and Wellbeing Board had taken the position, that in order to maximise representation from health partners, its membership would include two nominations from each eligible health body.  It was, therefore, proposed that the two ICBs be invited to nominate two representatives to the Cumbria Health and Wellbeing Board.

The Board was informed that the current Constitution sets out that the two Chairs of the Clinical Commissioning Groups will be Vice?Chairs of the Cumbria Health and Wellbeing Board.  It was explained that as such positions would no longer exist form 1 July 2022, it was proposed that the vice chairs be drawn from representatives from health organisations which cover North Cumbria and South Cumbria.

A discussion took place regarding an invitation to future Board meetings being extended to Shadow Authority Executive members responsible for Health.  The Chair explained that any member could attend future meetings as an observer and welcomed Shadow Authority Executive members.  It was agreed that the Chief Executive of South Lakeland District Council would provide officers with contact details of Shadow Members to allow an invite to be extended to them.

The Board then discussed an invitation being extended to the Health and Wellbeing Board Development sessions; whilst the Chair agreed they could attend as observers he highlighted the induction programme which was in place for the Shadow Authorities.

The Chair drew attention to the demise of the two Clinical Commissioning Groups resulting in the loss of the two current Vice?Chairs of the Board.  He expressed his personal thanks, and those of the Board, to the two current Vice?Chairs highlighting their positive contributions which had evolved into a valued working partnership.

The Vice?Chairs thanked both members and officers and wished them well for the future.

RESOLVED,   that the Board notes and comments on the proposed changes to the membership of the Board as set out in the report.

To receive the Forward Plan (copy enclosed).

The Board received a copy of the Forward Plan and welcomed any feedback from members regarding the content of future meetings. 

Members agreed that an item regarding the cost of living crisis would be considered at a future Development Session of the Board.

The Board noted that:-

(1)       the next Cumbria Health and Wellbeing Board Development day would take place on Friday 22 July at 10.00 am at Cumbria House, Carlisle.

(2)       the next meeting of the Board would take place on Friday 9 September 2022 at 10.00 am at Cumbria House, Carlisle.