Agenda and minutes

Apologies for Absence were received from:-

Councillor Mustafa Malik    Assistant City Mayor Communities and Equalities

Susannah Ashton                East Midlands Ambulance Service, Divisional Director

Professor Azhar Farooqi     Co-Chair, Leicester City Clinical Commissioning Group

Angela Hillery                       Chief Executive, Leicestershire Partnership NHS Trust

Harsha Kotecha                     Chair, Healthwatch Advisory Board, Leicester and Leicestershire

Richard Mitchell                   Chief Executive, University Hospitals of Leicester NHS Trust.

Oliver Newbould                  Director of Strategic Transformation, NHS England and NHS Improvement

Professor Bertha OchiengIntegrated Health and Social Care, De Montfort University.

Martin Samuels                    Strategic Director of Social Care and Education

Members are asked to declare any interests they may have in the business to be discussed at the meeting.

Members were asked to declare any interests they may have in the business to be discussed at the meeting.  No such declarations were received.

The Minutes of the previous meeting of the Board held on 28 July 2022 are attached and the Board is asked to confirm them as a correct record.

RESOLVED:

The Minutes of the previous meeting of the Board held on 28 July 2022 be confirmed as a correct record.

The Chair will:

• Highlight some excellent work University Hospitals Leicester have delivered with Ellesmere.
• Give future notice that colorectal cancer survival will be on a future agenda of the Health & Wellbeing Board in relation to rates of survival one year after diagnosis in Leicester being the lowest in England, and ask members to liaise with their organisations regarding this work with a view to bringing actions to the relevant Health & Wellbeing Board that their organisation is able to commit to in order to improve colorectal cancer survival rates.

The Chair referred to the Project Search Opportunities for Children and Young People with SEND presented to the Board in October 2021 by the Head Teacher of Ellesmere College.  UHL had taken up the opportunity to take part in the scheme and had held a successful event before Christmas.  The students had gone through the programme and were working at UHL as part of the hospital team.  The process had all happened in three 3 months and had been a positive result for young people in this city.  It was important to highlight what the Board were doing, and the Chair thanked everyone involved and looked forward to more initiatives like this. 

The Chair also indicated that colorectal cancer survival would be on a future agenda of the Health & Wellbeing Board in relation to rates of survival one year after diagnosis in Leicester being the lowest in England.  Members will be asked to liaise with their organisations regarding this work with a view to bringing actions to the relevant Health & Wellbeing Board that their organisation is able to commit to in order to improve colorectal cancer survival rates.  It is important to promote increasing the levels of screening testing to national standards.  A Task Group would be looking at the factors at play affecting the uptake of screening and vaccination.

The Chair will ask the Board to provide a formal approval of the Better Care Fund (BCF) – noting that the plan was circulated in January 2022 and recirculated in December 2022, and members of the Board have had opportunity to make contact with the report authors with any questions in advance of this meeting.

The Board received Better Care Fund plan previously circulated in in the summer of 2022 and the recirculated in December 2022 and Board members had been given the opportunity to raise queries and make comments with officers prior to the meeting.

AGREED:-     That the Better Care Fund Plan and Action Plan be approved.

Katherine Packham, Consultant in Public Health, Leicester City Council, to present a report and a presentation which summarise the development of the Leicester Health Care and Wellbeing Strategy Delivery Plan (2023 2025), which was last considered by the Board on 28 July 2022.  The Board are asked to formally approve the Delivery action plan (2023 – 2025) for the six ‘do’ priorities of the Leicester’s Health, Care and Wellbeing Strategy.

Katherine Packham, Consultant in Public Health, Leicester City Council, presented a report and gave a presentation which summarised the development of the Leicester Health Care and Wellbeing Strategy Delivery Plan (2023 2025), which was last considered by the Board on 28 July 2022.  The Board were asked to formally approve the Delivery action plan (2023 – 2025) for the six ‘do’ priorities of the Leicester’s Health, Care and Wellbeing Strategy.

It was noted that:-

·         This strategy would be published on a microsite of Leicester City Council’s website. This microsite was in its final stages of development. The strategy contains 19 priorities.  These were divided into do, sponsor and watch categories, with the six ‘do’ priorities given highest priority.

·         The six ‘do’ priorities were:-

o   Healthy Places: To improve access to primary and community health/care services.

o   Healthy Minds: To improve access for children and young people to mental health and emotional wellbeing services.

o   Healthy Minds: To improve access to primary and neighbourhood level mental health services for adults.

o   Healthy Start: To mitigate against the impacts of poverty on children and young people.

o   Healthy Lives: To increase early detection of heart and lung diseases and cancer in adults.

o   Healthy Ageing: To enable Leicester’s residents to age comfortably and confidently through a person-centred programme to support self-care, build on strengths, and reduce frailty.

·         Following the development day session an extra column had been added to the ‘Do Priorities’ page to include Outcome statements.

·         The other groups of priorities outside the 6 ‘do’ priorities were still important and would continue to be recommended e.g. digital access.  The focus would be on those groups with had the most impact on poor health.

·         The Summary of key actions were included in the report and work would now move to implementing the Action Plan.  The reporting of progress was not intended to be too onerous by making it an extra task.  Progress would be shared with the Board on a quarterly basis. 

In response to questions officers stated:-

·         Discussions had been held with asylum seekers and there was a high demand English courses and officers were looking to see if any funding was available to enable them to be provided to meet the demand.  It was recognised that digital access and social mobility for linguistic improvement would lead to big improvements.

·         A small core group would continue to meet including Council officers and the ICB and there were workshops for many projects already funded.  There may be some that might need extra funding for those not going so well.  The progress in a year was aspirational and we needed to know what we were doing was working for what we want to improve health equity and life expectancy.  It was not expected to see large shifts in a single year.

Board members commented that:-

·         In relation to digital literacy and access it was important to not make the link that if a person does not have English skills they can’t access services,  ...  view the full minutes text for item 85.

Rob Howard (Consultant in Public Health, Leicester City Council)  and Dr Ruw Abeyratne (Director of Health Equality and Inclusion – University Hospitals of Leicester NHS Trust) will provide a verbal update on the progress being made to tackle inequalities in maternal mortality faced by Black and Asian women in the City.

Rob Howard (Consultant in Public Health, Leicester City Council)  and Dr Ruw Abeyratne (Director of Health Equality and Inclusion – University Hospitals of Leicester NHS Trust) provided a verbal update on the progress being made to tackle inequalities in maternal mortality faced by Black and Asian women in the City.

It was reported that:-

·         There was a Task and Finish Group to look at what was available and what could be done to improve it.

·         Rob Howard came out of MBRRACE-UK report on research into perinatal morbidity and at deaths in ethnicity.  Although the numbers were relatively small the rates for women of black origin was 4 times higher than white women, of Asian origin twice as high and women of mixed heritage were three times higher.

·         Further work had been undertaken to categorise issues around attitudes, language, being dismissive of concerns and knowledge or lack of knowledge/assumptions about pain levels for ethnic women.  There needed to be better coding for data and more community based work.

·         UHL had undertaken a lot of work on the development of culture in the care process. Focus Groups had bene held to address the concerns and problems that were not understood and care of health and wellbeing in the challenging environment staff worked in. There was a need to recognise cultural competency and sensitivity to women and their families.  There were recurrent themes about trust and not being listened to and practitioners needed to change how these concerned were respond to.  There was a need to move from listening to concerns viewpoints towards showing practitioners had learned from what people had said.  Languages were a challenge and how this was utilised as a tool for care and allowed to be a barrier.  It was important to make applications acceptable to women and their families.  Collecting local data was essential and even though the numbers were a small a dashboard in development.

Members of the Board commented that:-

·         Ethnicity could independently affect mortality and morbidity. There was a need to change the determinations which were malleable.  Understanding the mortality in countries of origin and what could be learned from those countries to improve the situation was important.  We should not be insular when looking at the norms.  For example The advice in Japan was that it was acceptable for parents to sleep with children until they were 7 years old and the advice in the UK was that parents should not sleep with babies as this increased the risk of them dying.  This was not the experience found in Japan and evidence suggested that other issues such as the use of drugs and alcohol were more important contributory factors.

·         Work from this initiative could be applicable to other service areas.

·         It should be recognised that there was a need for individual change as well as a collective change.  Further consideration should be given to what counts as ‘black community’ as those of Afro Caribbean, Somali or Nigerian origins all had different complex issues.  There  ...  view the full minutes text for item 86.

Martin Samuels, Strategic Director for Social Care & Education, Leicester City Council, will introduce a report on the formation of the Children & Young People’s Collaborative involving the senior leaders for children’s services from the LLR.   The group has identified a number of key priorities for shared work in this area to ensure the needs of children and young people in the City are given equitable focus as the needs of adults in relation to their health and wellbeing needs.

The Chair stated that consideration of the report would be deferred to a future meeting as Martin Samuels was unable to attend the meeting to present the report.

Chris Burgin, Director of Housing, Leicester City Council, will give a presentation setting out the increasing challenges of helping complex housing applicants and tenants, housing them and the need for Housing services and Health services to work together to ensure Health services pathways are accessible and timely for those people going through Homelessness and those complex and vulnerable people in Housing. 

Chris Burgin, Director of Housing, Leicester City Council, give a presentation setting out the increasing challenges of helping complex housing applicants and tenants, housing them and the need for Housing services and Health services to work together to ensure Health services pathways are accessible and timely for those people going through Homelessness and those complex and vulnerable people in Housing. 

During the presentation it was noted:-

·         There was increasing homelessness, there was a lack of suitable housing to meet challenging and more complex needs and the health and wellbeing of citizens was affected.

·         There was a lack of truly affordable housing and the low levels of house building since 1969 meant there was a lack of houses to meet demand. Less than 10% of private rented properties were not available to those on benefits.

·         People could be homeless if they had nowhere to stay and were living on the streets, they could also be considered homeless even if they had a roof over their head.

·         The homeless population had a life expectancy of 43 years. On average men and women who were homeless at or around the time of their death lived 31 years and 38 years fewer than the average.  Homelessness was associated with tri-morbidity, a combination of physical ill health with mental illness and drug or alcohol misuse.

·         Mental illness was a cause and a consequence of homelessness. 70% of homeless service users in England had mental health problems. Deliberate self-harm, including suicide, was 7 times higher than that of the general population. 

·         Homeless people were over-represented attenders in A&E. A homeless drug user admitted to hospital was 7 times more likely to die over the next 5 years than a housed drug user with the same medical problem. Without early intervention homeless children and young people were likely to enter such a cycle.

·         There were now over 5,000 people facing homelessness in Leicester.

·         A case study gave an outline of what impact a person with complex needs could have on neighbours and they ways in which the Tenancy Management and STAR services could help over a period of time.

·         The Housing Service had a strong offer of services, support and interventions to assist people suffering or threatened with homelessness.  The service’s motto was that one needed to sleep on the streets and whilst every effort was made to assist people, some didn’t accept help. There were over 200 people currently in temporary  accommodation.  It was known that people who were rough sleeping had frailty levels equivalent to an 89 year old.

·         The initiatives housing services were undertaking were fully outline in the presentation.

·         It was considered that housing and health services must commit to doing more together if the response to homelessness was to be to be successful, including joint financial support where health issues were concerned.

Following the presentation the Board Members commented that:-

·         There may need to create a Task and Finish Group to look at the issues involved as homelessness affected all  ...  view the full minutes text for item 88.

Sarah Prema, Chief Strategy Officer, Leicester, Leicestershire and Rutland Integrated Care Board to present a report setting out the roles and responsibilities of the Integrated Care Boards which replaced Clinical Commissioning groups in July 2022.

Sarah Prema, Chief Strategy Officer, Leicester, Leicestershire and Rutland Integrated Care Board (ICB) to presented a report setting out the roles and responsibilities of the Integrated Care Boards which replaced Clinical Commissioning groups in July 2022.

In view of the time pressures for the meeting, Sarah Prema stated that she would be happy for paper to be noted.  The core responsibilities were set out in paragraph 2 of the report and the legal duties were outlined in paragraph 5 and these were similar to those of the previous Clinical Commissioning Group.  The wider role of the ICB within the Integrated Care System and the role of the ICB for specific areas within that were shown in paragraph 7. 

The Chair commented that the ICB had been in existence for 8 months and it would evolve over time as it developed.  

AGREED:      That the report be noted and future updates be submitted when necessary.

Helen Reeve, Senior Intelligence Manager, Public Health, Leicester City Council to present a report which summarises the Pharmaceutical Needs Assessment following its development since it weas last discussed at the Board on 28 July 2022.

Helen Reeve, Senior Intelligence Manager, Public Health, Leicester City Council presented a report which summarised the Pharmaceutical Needs Assessment (PNA) following its development since it weas last discussed at the Board on 28 July 2022.

It was noted that the PNA had been consulted upon and had been considered at the Council’s Health and Wellbeing Scrutiny Commission last week where it had been well received.   

The Chair thanked everyone involved in progressing the PNA and taking it through the consultation process.  The report had been published in the Autumn of 2022 and Board members were invited to contact Helen Reeve if they had any questions or observations.

Ivan Browne commented that when it was discussed at the Health and Wellbeing Scrutiny Commission had referred to the provision in the west of the city and whilst there was provision in the area that met the criteria, as that part of the City was developed the pharmacy provision would need to be addressed.

The Chair commented thanked everyone involved for producing this good piece of work.

AGREED:      That the Board note the conclusions and recommendations in the report and asked that the comment made above to improve the PNA be taken into consideration.

Sarah Prema, Chief Strategy Officer, Leicester, Leicestershire and Rutland Integrated Care Board, to present a report on the draft Integrated Care Strategy which has been developed by the LLR Health and Wellbeing Partnership, and outline the engagement process with Health and Wellbeing Boards.

Sarah Prema, Chief Strategy Officer, Leicester, Leicestershire and Rutland Integrated Care Board (ICB), presented a report on the draft Integrated Care Strategy which has been developed by the LLR Health and Wellbeing Partnership, and outlined the engagement process with Health and Wellbeing Boards.

It was noted that:-

·         The ICB are required to develop an Integrated Care Strategy.

·         The first draft of the strategy was presented to the LLR Health and Wellbeing Partnership in December 2022. It was agreed that further engagement would take place with the three Health and Wellbeing Boards in LLR in the first quarter of 2023 to gain feedback with a view to getting a final strategy approved and published by the latest Autumn of 2023.

·         A number of workshops had produced the initial draft for engagement purposes, and it was proposed to produce the final version by the end of summer and autumn allowing for the local elections in May 2023. 

·         The purpose of the Strategy was to reassure the wider public on how the ICB was seen to be operating within a clear framework. 

Members of the Board commented that:-

·         That whilst the Strategy was ambitious and impressive, there was no reference to prevention measures which were equally important.  What percentage of the system’s budget would be allocated to prevention measures as it was considered that without funding prevention measures the Strategy would not achieve it targets as the system would always be responding to firefighting measures.  The need to change the current factors affecting health had to be accepted as well as a commitment to make changes.  Given that the health and social care budgets had been cut drastically in recent years did the Strategy model the realities that would stumble the system to deliver the target, otherwise the same discussions would be repeated in future years and faith and trust would be lost in those delivering services.

·         The Strategy was seen as an expression of the wider partnership with the ICB and a platform to sponsor and promote pieces of work, one of which would need to be the cost of living crisis.  There should be respect for the challenges of each place within the LLR footprint as they differed in each health Boards area.

·         It was suggested that the Strategy should make reference to the detailed plan put in place for Health and & Wellbeing for the City and other areas and that that the 5 Year Strategy also needed to link into this report so that those issues could also be addressed.

·         It was felt that the Strategy was silent on the ambitions of partners, young people, mental health prevention etc and illustrations requiring high level financial forecasts.

In response to the issues made by Board Members officers commented that  prevention should not be viewed as making changes and improvements in 5 or 10 years’ time.  There were issues such as the statistics for people dying younger than the national averages where early intervention can have a significant impact in short periods  ...  view the full minutes text for item 91.

The Chair to invite questions from members of the public.

No questions from members of the public had been received.

To note that future meetings of the Board will be held on the following dates:-

Thursday 16 March 2023 – 9.30 am

Meetings have also been arranged for the following dates in 2023/2024 which will be submitted to the Annual Council in May 2023.  Please add these dates to your diaries.  Diary appointments will be sent to Board Members.

Thursday 29 June 2023 – 9.30am

Thursday 21 September 2023 – 9.30 am

Thursday 18 January 2024 – 9.30am

Thursday 18 April 2024 – 9.30 am

Meetings of the Board are scheduled to be held in Meeting Rooms G01 and 2 at City Hall unless stated otherwise on the agenda for the meeting.

The Board noted that future meetings of the Board would be held on the following dates:-

Thursday 13 October 2022 – 9.30 am

Thursday 2 February 2023 – 9.30am

Thursday 13 April 2023 – 9.30 am

Meetings of the Board are scheduled to be held in Meeting Rooms G01 and 2 at City Hall unless stated otherwise on the agenda for the meeting.

The Chair commented that the next meeting would have a winter themed focus together with the item on the 5 Year Forward View.  Officers would write to Board members on the theme to see how everyone could contribute with reports relating to the topic.

There were no items of Any Other Urgent Business to be considered.

The Chair declared the meeting closed at 11.59am.