Report from the Chair of Health and Wellbeing Board (HWBB): Councillor Carol Runciman
1. This report provides an update on the work of the Health and Wellbeing Board since they last reported to Health and Adult Social Care Policy and Scrutiny Committee in February 2020. The Health and Wellbeing Board have met eight times since then and are due to meet again in mid-November.
2. Many of the discussions the HWBB have are ongoing and feature at more than one of its meetings. We receive many reports and presentations, some of which are for noting and information and some for action and progression. Rather than listing each report we have received this report provides a high level summary of some of the recurring themes we have discussed over the past 18 months.
Priorities for the Health and Wellbeing Board
3. In March 2020 the board agreed a supplementary document that sits alongside its current Joint Health and Wellbeing Strategy 2017-2022. This refocused our key priorities for the remainder of the strategy’s lifetime. However, it would be fair to say that just after this was written and published the pandemic took hold and the immediate need to respond to the Covid-19 situation became the priority within the health and social care system.
4. However the overarching life course approach of starting and growing well, living well, ageing well and mental health that are set out in the original joint health and wellbeing strategy 2017-2022 are still very much at the forefront of the board’s work. In April 2021 we held a workshop to again look at whether we need to revise our key priorities, particularly in response to the impact of Covid-19 and from this we took a report to the July 2021 meeting of HWBB. At this meeting the board agreed to take forward the following four priorities:
Priority 1: Repositioning the HWBB within the local health and social care system, and to confirm/develop the role we want the board to play in the new Integrated Care Systems (ICS). Within this the board also identified a need to further develop relationships with the Humber, Coast and Vale ICS and to ensure that York is speaking as one within the ICS. The HWBB should drive the strategic direction for the health and social care system at place level
Priority 2: Develop a 20 year strategy focused on reducing health inequalities in York. Further discussion is needed as to whether this will also be our next Joint Health and Wellbeing Strategy and what lifespan it should have; however there is a commitment to work across longer time scales then we have for our current strategy.
Priority 3: The first 1001 days (or more if there is a focus pre-conception as well) is seen as particularly important by the board. We will be creating a new Children’s and Young People’s Wellbeing Programme Board that will be led by our public health team. This will report to the HWBB and will replace the current YorOK Board. A workshop is planned for late October/early November and a report with a proposal for the new programme board will be considered by the Health and Wellbeing Board at their January 2022 meeting.
Priority 4: Developing co-production and listening on behalf of the HWBB to create a fundamental change in how residents can engage in a meaningful way across both the local and regional health and care system
Covid-19
5. We receive an update on the current situation in relation to Covid-19 at all of our meetings. This takes varying forms but started in March 2020 when the Director of Public Health provided an oral report to the board in relation to the emerging situation. From there the situation escalated rapidly. After a short hiatus, due to the pandemic, HWBB met again in July 2020 where they were made aware of the newly established Outbreak Management Advisory Board and the city’s Outbreak Control Plan. I am pleased to say that all partners around the HWBB table committed to working together to implement the plan.
6. Additionally we received a presentation on the impact of Covid-19 in North Yorkshire and York (Rapid Health Needs Assessment) which detailed four emerging priority areas, as of July 2020:
· Infection minimisation
· Mental health
· Healthcare access
· Prevention
7. We also considered the positives and learning that arose from the pandemic in terms of increased and effective partnership working; schools working together to manage risk and resources; increased community spirit and the remarkably quick and practical response to the pandemic from the voluntary sector which enabled the statutory sector to focus on those most needing support at a very difficult time.
8. In terms of the priority area around mental health, the Board received a presentation from Tees, Esk and Wear Valleys NHS Trust about the impact of Covid-19 on mental health and potential increases in demand for mental health services over the next 5 years. HWBB agreed to consider the potential impact and preparations within their own organisations and ways that they could respond to an increase in need for mental health services and to consider new opportunities for agencies to work together to meet increasing levels of need in mental health over the next 5 years.
9. We also heard from our voluntary sector colleagues who detailed the challenges people experienced during the Covid-19 pandemic from March to June 2020, and how organisations in York had responded.
10. At all of our meetings, the Director of Public Health for York, provides an update on the current situation re: Covid-19 which covers a variety of data including number of cases; hospital deaths; information around contact tracing and more recently an update on the vaccination programme.
11. We have also received a presentation focused on Long Covid to enable the board to understand the impact this is having on York residents and on health inequalities.
12. HWBB is a strategic rather than an operational board and does not get involved in the day to day response to the pandemic; however it is imperative that all board members are informed about what is happening across the whole health and care system to help us understand where the pressures and concerns are.
Healthwatch York Reports
13. We have received a number of reports from Healthwatch York and these are as follows:
· Changes to repeat prescriptions (March 2020)
· Support for people with experiences across homelessness, mental health, substance misuse, and offending [commissioned by York Multiple Complex Needs Network] (October 2020)
· Urgent Care Rapid Appraisal Report [commissioned by NHS Vale of York Clinical Commissioning Group] (October 2020)
· Listening to BAME people about health and social care services in York (January 2021)
· Healthwatch York Annual Report (July 2021)
· Healthwatch York Report: NHS Dentistry: A Service in Decay? (September 2021)
14. Members of the HWBB welcomed the reports and agreed to respond to the recommendations within them.
15. In terms of Healthwatch York’s report on NHS dentistry. The HWBB were very concerned about the difficulties York residents were having accessing dental treatment. Whilst access to dental services is a concern nationally the HWBB did not feel that we should be complacent about this and we should not presume that it will be addressed by others. A lack of good quality, regular and affordable dental treatment leads to health inequalities for our residents and puts further pressure on an already overloaded health and social care system.
16. I am aware that this scrutiny committee is also concerned about this and would welcome any work they do to improve the situation for our local residents.
17. HWBB agreed to start a process of lobbying for change and reform of the way NHS dental contracts are commissioned with the Director of Public Health agreeing to take the lead on writing to the Chief Dental Officer and/or the Minister for Health in the first instance.
York Health and Care Collaborative
18. In October 2020 we received our first report from the co-chair of the York Health and Care Collaborative (YHCC). The HWBB and the YHCC share have a shared objective of improving the health and wellbeing of the population of York. The YHCC is unique in bringing together providers and commissioners of health and social care services with the voluntary sector as a means of working on joint priorities. As such it will contribute to the delivery of the Joint Health and Wellbeing Strategy and be instrumental in leading the implementation of the NHS Long Term Plan in York. It was therefore important that we establish an effective working relationship between HWBB and YHCC. To do this HWBB agreed that the co-chair of the YHCC should become a HWBB member and that HWBB should receive quarterly reports from the Collaborative.
19. HWBB received further reports from YHCC at their meetings in March 2021 and July 2021 and these provided updates on their priority areas of:
· Prevention
· Ageing Well/frailty
· Multi morbidity
· Mental health
· Covid 19 preparedness and resilience
Health and Wellbeing Board’s Mental Health Partnership
20. In January 2021, the Independent Chair of the HWBB’s Mental Health Partnership provided a progress report to the board. This provided us with an update on the work they have been undertaking on the Northern Quarter Project (now known as Connecting Our City) and an application for Community Mental Health Funding which has since been progressed. As chair of the HWBB, I have been invited to attend Mental Health Partnership meetings and I have been doing so when I am able.
21. In May 2021 we received an update on the mental health summit held in March 2021 and the actions arising. At this time it was still fairly early on in terms of implementing these actions. I will ask for a further update on this to be included in the partnership’s next report to the board scheduled for our January 2022 meeting.
Health and Wellbeing Board’s Ageing Well Partnership
22. In May 2021 we received a report from the HWBB’s Ageing Well Partnership; they are focusing on two areas of work:
· Age Friendly York Project
· Developing a Dementia Strategy for the city
23. There have been several changes in chairship for this partnership since last reporting to this committee and it is currently being led from within the Council’s Communities Team. We will expect a further update report from them in May 2022 but prior to that we expect to receive the dementia strategy at one of our meetings.
The Health and Care System in York
24. At the board’s meeting in March 2021 a presentation was received which focused on the future of the health and care system in York, including consideration of closer working and increased integration. This included the work partners have undertaken locally to prepare the system in York to respond to forthcoming government legislation.
25. In York this has led to the creation of the York Health and Care Alliance which is chaired by the Leader of City of York Council. This will enable York to retain greater decision making powers which would otherwise default to the Integrated Care System (ICS) at regional level.
26. New arrangements will come into force nationally in April 2022 and we need to spend the time between now and then building the partnership; understanding vision and the roadmap for health and care at ‘place’ level in York; including the role that the HWBB has to play in this.
27. HWBB receive an update report from the Alliance at all of their meetings and this includes minutes of their meetings.
Other
28. In the past 18 months the HWBB has also:
· Endorsed the York Tobacco Control Plan 2020 to 2025
· Endorsed an approach from partners in York to base future changes within the health and care system on linked data and intelligence on population health need.
· Received regular update reports on the Better Care Fund (BCF) as the HWBB is the accountable body for this
· The future direction of York early years partnership’s collaboration with Nesta
Next Steps
29. Much has happened over the past 18 months and from the meetings we have had it is clear that we need to focus on progressing the following over the next 12 months:
· Continue to progress the four priorities identified at paragraph 4 of this report;
· Consider if there is anything further the HWBB can do to influence a change to NHS dental commissioning so that all residents can access affordable dental treatment when they need it
· Undertake a review of our Terms of Reference that take account of the emerging health and social care landscape; NHS reforms and the newly identified priorities for the board
· Plan for a refresh of the Joint Strategic Needs Assessment and for the preparation of a new Joint Health and Wellbeing Strategy
· Further develop the HWBB relationship with ICS and York Health and Care Alliance
· Progress is being made on the implementation of the Henry Programme and a report will be coming to scrutiny about this in January 2022.
Cllr Carol Runciman
Chair of Health and Wellbeing Board
October 2021