Agenda and minutes

Apologies for Absence were received from:-

Susannah Ashton                East Midlands Ambulance Service, Divisional Director.

Ben Bee                                Area Manager Community Risk, Leicestershire Fire and Rescue Service.

Professor Andrew Fry         College Director of Research, Leicester University

Rupert Matthews                 Leicester, Leicestershire and Rutland Police and Crime Commissioner.

John MacDonald                 Chair of University Hospitals of Leicester NHS Trust.

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

Professor Bertha Ochieng Integrated Health and Social Care, De Montfort University.

Dr Avi Prasad                       Place Board Clinical Lead, LLR Integrated Care Board.

Sue Tilley                              Head of Leicester, Leicestershire Enterprise Partnership.

Andy Williams                      Chief Executive, LLR Integrated Care Board.

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 26 January 2023 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 26 January 2023 be confirmed as a correct record.

The Chair will:

·         Outline the scope of this special winter-focussed meeting.

·         Cite any reports which might have needed to be postponed to enable this meeting to focus on winter issues.

The Chair reported on a visit earlier in the week to the A&E department at Leicester Royal Infirmary and thanked the Chief Executive and Senior Offciers for their help and assistance.  She had met the operations team and was impressed by the focus on the flow of patients and their safety as they were processed through the department.  Although the unit had the look of a portacabin on the outside, once inside in the unit it was like any other ward in the hospital.  Although some patients were moved to other parts of the hospital late at night, that was due entirely to their clinical and care needs and was undertaken when it was considered to be in their best interests.  It was pleasing to see the whole system was working well together with the ambulance service and others involved in the patients care.

Rehana Sidat (Founder/CEO -Jamila’s Legacy) will give a presentation on the work and remit of the local non-profit organisation, Jamila’s Legacy, which support and educate communities and organisations in mental health and well-being.

Rehana Sidat (Founder/CEO -Jamila’s Legacy) gave a presentation on the work and remit of the local non-profit organisation, Jamila’s Legacy, which supported and educated communities and organisations in mental health and wellbeing.

During the presentation it was noted that:-

·         Jamila’s Legacy was a non-profit organisation that offered advice, advocacy, support, a listening service, self-care activities and training to individuals interested in maintaining their own mental health well-being and supporting others.

·         Jamila’s Legacy had been bringing people together to increase mental health awareness and deepen understanding since 2015.

·         It had been working at a community and grassroots level, engaging with ethnic minority communities, and had developed an understanding of their needs, barriers and challenges. It was good that schools were talking about mental health but it was not enough.  During a recent presentation most people when asked talked about mental illness and not mental health.  Mental health was not just about diagnosis it was also about being mentally well and healthy as well

·         Stigma and shame around mental health still existed and in some

·         ethnic minority communities there could be additional barriers and challenges to opening up or seeking help due to family and community expectations and/or some cultural norms and beliefs.

·         In the City there were higher levels of poor mental health than the national average reported in 2018.  Locally people were on the CAMHS waiting for 18 months to 2 years or were waiting a year for an appointment with a counsellor.

·         The number of people with long-term mental health problems was significantly higher than the average across England.

·         Mental health disorders in children and young people were also higher than England’s average.

·         Greater energy was needed to be put into prevention, rather than waiting until people reach crisis point.  Education was provided so people could take control and know what they needed to do

·         The project’s vision was to normalise mental health conversations and create a society where people with mental health problems were accepted, valued and felt they belonged.

·         The mission was to educate, build confidence and empower people with mental health problems so that they were well informed of their rights and choices, were able to maintain their own mental wellbeing and become confident self-advocates.

·         The project had been set up with nothing and no building etc but had support and knowledge.  Cafes and the University gave free space and cafés gave free drinks to people who came.  Volunteers received no payments or travel expenses, and they offered support and help for nothing.  The project collaborated with public, voluntary and business sector organisations.  The Women’s Mental Health Wellbeing project funded by the national lottery, the Mental Wellbeing offer was provided by John Lewis and men from ethnic minority groups were encouraged to come forward in safe environment because of the cultural stigma on mental health.

·         The project had supported 1,200 people last year but there was infrastructure to support the small number of people involved.  There also used to be a lot of  ...  view the full minutes text for item 100.

Rachna Vyas (Chief Operating Officer, NHS Leicester, Leicestershire and Rutland) and colleagues will give a presentation on some of the key initiatives which have been developed and delivered during the winter months to manage the increasing pressure on services.

Rachna Vyas (Chief Operating Officer, NHS Leicester, Leicestershire and Rutland) and colleagues gave a presentation on some of the key initiatives which have been developed and delivered during the winter months to manage the increasing pressure on services.

The LLR health and care community has been working in partnership to plan for and deliver services through a difficult period of seasonal pressures and at a time of unprecedented industrial action across the public sector.

Whilst demand had stabilised through the start of Q4 23/24, all parts of the system remained busy in terms of both acuity and demand. This trend spanned primary care, NHS111, Clinical Navigation Hub, home visiting, urgent care services, acute services and social care services.  Despite pressures, the LLR system has continued to deliver innovative services, grounded in true partnership; the presentation highlighted some of the key services delivered over the winter period. Colleagues from across health and care service, represented on the LLR Winter Board, would present these highlights, along with plans for further developments in 2023/2024.

During the presentation it was noted that:-

·         The Winter Plan focused on 20 key activities which were outline in the presentation.

·         The Urgent Care Response was the only system in the country that looked at falls, made sure that people hade food at home, why falls occurred and what services patients could link into.  It was an holistic approach and a person centre approach.  It was intended to grow and develop it this year and embed it within the system.

·         The Urgent community response service for Leicester City had a 100% response rate within 2 hours, with the vast majority of people kept safely in their place of residence, using a holistic checklist of care. 

·         Patients could access these services through any health and care professional.

·         This model had been used to develop the UCR model for LLR and formed the basis of the national specification.

·         About 100 patients per week being supported in their place of residence through a ‘virtual ward’.  There was very positive patient feedback, with pathways live for cardiac and respiratory illness.  There was further development of pathways to support frailty and intermediate care and an opportunity to work with LA monitoring services such as pendant alarm services etc.

·         The LLR unscheduled care hub was a team represented by all services including social care, ambulance, UHL and LPT.  It took 30-40 patients off ambulance lists every day as it assessed and supported patients in their own place of residence.  It was being rolled out across the country because of its success.  Nobody was denied a service, if they didn’t want this service they would be admitted to hospital. 10 of the patients were mental health.  There was also the nurse and paramedic in triage car available to use.

·         Initiatives in place to support discharges from UHL included a partnership approach between the Council and health to assess how best to get patients the right care at the right time, based on local insights and knowledge.  ...  view the full minutes text for item 101.

Ivan Browne (Director of Public Health, Leicester City Council) and Rob Howard (Consultant in Public Health, Leicester City Council) will give a presentation on the whole council approach which has been taken to tackle the cost-of-living crisis, the key elements of activity being undertaken, and outline the Fuel Poverty Programme.

Ivan Browne (Director of Public Health, Leicester City Council) and Rob Howard (Consultant in Public Health, Leicester City Council) gave a presentation on the whole council approach which has been taken to tackle the cost-of-living crisis, the key elements of activity being undertaken, and outline the Fuel Poverty Programme.

Leicester City Council (LCC) had adopted an incident management team (IMT) approach to tackling the cost-of-living crisis. The presentation looked briefly at key elements of activity being undertaken, and outlined the Fuel Poverty Programme.  The Council had taken a whole council approach to the crisis, aligning with its Anti-Poverty strategy, coordinating activity across the authority, and ensuring that people were able to easily access support. Cells across the authority had been addressing cost-of-living issues, providing support to citizens through a variety of workstreams, and highlighting broader issues within the core IMT meetings.

The Council also worked closely with key external partners and community groups to provide wider support coverage and engagement.  Horizon scanning within cells allowed upcoming issues to be recognised and

where necessary addressed by IMT.  Current upcoming issues included a likely increase in Council Tax, pressure on Commissioned Services, and pressure on Advice Services.  The cost of living support offer continued to evolve, and remains accessible and robust.

The Council were working in partnership with National Energy Action (NEA) and had introduced a Fuel Poverty Programme.  The impacts of fuel poverty on health were widely recognised, and Leicester had relatively high levels of fuel poverty. The Fuel Poverty Programme aimed to tackle the issues at hand through three workstreams; an advice service, training, and education.

The Advice service has been soft launched within the Council’s Housing Division. And a further rollout of the service would be coming soon.

The Training workstream would extend the reach of the programme by embedding energy advice and qualifications into front line services and communities.  The Education workstream would raise awareness of energy efficiency at home and at school, initially targeting children in years 5-11 through tailored sessions delivered within schools.

The presentation set out factors and initiatives on all issues involved.

The asked Board members who were part of large organisations to give thought on how the message out.  There was a need to work with large employers’ workforce to get this message out.

It was suggested that based upon the experience of the Anti-Poverty Strategy organisations should train members of staff to be energy advisors.  The discharge of people to cold home was a massive issue and could be used as a catalyst of conversation for fuel poverty.  It was known that many people were turning off appliance to save fuel and many were now living in cold houses, and this could result in many people being see by all areas of the system as a result.  Many organisations such as the Police had staff who could be entering cold premises and could provide much needed information for possible interventions.

RESOLVED:-            Officers were thanked for the presentation and Board members were asked  ...  view the full minutes text for item 102.

Jagjit Singh-Bains (Head of Independent Living, Leicester City Council) and Beverley White (Adult Social Care Lead Commissioner, Leicester City Council) will give a presentation on:-

•   Integrated Crisis Response Service support to the Unscheduled Care Coordination Hub (with a focus on case studies and impact).

•   Commissioning support to the independent sector – covering the new night care offer and payments to enable provider decision making capacity at weekends.

Jagjit Singh-Bains (Head of Independent Living, Leicester City Council) and Beverley White (Adult Social Care Lead Commissioner, Leicester City Council) gave a presentation on:-

·         Integrated Crisis Response Service support to the Unscheduled Care Coordination Hub (with a focus on case studies and impact).

·         Commissioning support to the independent sector – covering the new night care offer and payments to enable provider decision making capacity at weekends.

During the presentation it was noted that:-

·         Carers Retention Grant Scheme could be used for carers who had to take time off work and travel from another area and had to incur other costs.  Small grants could be paid for travel and microwaves etc.

·         Other schemes available were Night time care at home, staffing of out of hours in the independent sector supported through back office support from the local authority and a hardship fund.

·         The impacts of support were

o   40% reduction in numbers of staff leavers

o   Increased capacity - 21% increase in number of additional hours

o   0 providers requiring emergency response due to workforce issues

o   0 providers handing back packages

o   Reduction in staff absence levels

o   Reduction in hospital admissions

o   Reduction in awaiting care from 43 to 12, and presently 0

o   Positive feedback from workers

·         The Reablement Service was the main service provider for the majority of hospital discharges with a same/next day discharge (8am to 10pm x 7 days).

·         Reablement also helped to bridge packages that were ready for discharge but the domiciliary care provider was unable to start immediately.

·         The Integrated Crisis Response Service (ICRS) operated 24-7 with a 2 hour response and had a key focus on hospital avoidance.

·         The impact of the reablement service had been:-

o   Reablement supported 75% of all hospital discharges

o   Over 1,142 people had been supported over the last 12 months

o   Up to 60% required no ongoing support

o   Up to 90% continued to live at home 91 days later

o   ICRS core activity remained at 90% hospital avoidance

o   Over 5,500 people were supported over the last 12 months

o   Up to 82% required no ongoing support

o   Over 1,500 fallers were supported with only 8% being conveyed into hospital

The Chair was pleased that the CQC rated the service as outstanding.  When the discharge money became available many health services bought additional care home beds butt the City did not and looked at what it should be spent on to achieve best results.

The Board members commented that:-

·         There was a good agenda of partnership working and it may be useful to look at what the key ingredients were and re focus on good quality leadership, money and rigorous evaluation.

·         Indicating that the national system did not provide the best solution for the City and having its own solution was applauded.  Listening to the views of front-line staff to achieve best outcomes was to be commended.

·         The level of trust and confidence between partners in Leicester was high and it made a huge difference.  ...  view the full minutes text for item 103.

Martin Samuels (Strategic Director for Social Care & Education, Leicester City Council) will present 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.

Martin Samuels (Strategic Director for Social Care & Education, Leicester City Council) presented 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 had identified a number of key priorities for shared work in this area to ensure the needs of children and young people in the City were given equitable focus as the needs of adults in relation to their health and wellbeing needs.

It was noted that:-

·         Demand in services for children young people across LLR had increased significantly especially in families affected by the pandemic.  Financial distress and mental health in 17- 23 year olds had worsened.

·         Early intervention was being successful in preventing families having to access the health system and they had been provided with support elsewhere in education services.  Post Covid there had been a 10% increase in EHCP and mental health impacts upon the system, education and home etc.

·         The Director of Public Health and the Strategic Director of Social Care and Education were representative on that Collaborative group and would report back to the Board when necessary.

·         It was felt that when people made presentations to the Board they should consider issues relating to children and young people in their presentation.

·         There were good links at officer level in the services taking part.

·         It was of concern that in a question in the trusted adult survey showed that 50% of those having poor mental issues had no trusted adult to support them.

·         Although there were increasing demands the different organisations involved had limited resources, staff and funds but partnership working had shown the system were doing good things.

RESOLVED:-            Officers were thanked for the report and asked to report back to the Board as necessary on issues arising out of the Children & Young People’s Collaborative and a further update be provided in 6 months time.

Sarah Prema (Chief Strategy Officer, Leicester, Leicestershire and Rutland Integrated Care Board) will give a presentation outlining the direction of travel for the ICB Five Year Forward Plan.

Sarah Prema (Chief Strategy Officer, Leicester, Leicestershire and Rutland Integrated Care Board) submitted a report and presentation outlining the direction of travel for the ICB Five Year Forward Plan. 

RESOLVED:-            That the contents of the report and the presentation be noted and that if Board members had any further comments to make, these be discussed with Sarah Prema after the meeting.

The Chair to invite questions from members of the public.

No questions from members of the public had been received.

To note that meetings have 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 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 were scheduled to be held in Meeting Rooms G01 and 2 at City Hall unless stated otherwise on the agenda for the meeting.

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

The Chair stated that this would be the last meeting she would be the Chair and she thanked everyone on the Board that had contributed to its work and had developed the Board’s partnership approach to making progress to improve Health and Wellbeing. 

The Chair declared the meeting closed at 12.01pm.