Agenda and draft minutes

At this point in the meeting, Members and co-opted members are asked to declare any disclosable pecuniary interest, or other registerable interest, they might have in respect of business on this agenda, if they have not already done so in advance on the Register of Interests. The disclosure must include the nature of the interest.

An interest must also be disclosed in the meeting when it becomes apparent to the member during the meeting.

[Please see attached sheet for further guidance for Members].

Board Members were invited to declare any personal, prejudicial or disclosable pecuniary interests, other than their standing interests, that they had in relation to the business on the agenda. None were declared.

To approve and sign the minutes of the last meeting of the Health and Wellbeing Board held on Wednesday, 24 July 2024.

Resolved: To approve and sign the minutes of the last meeting of the Health and Wellbeing Board held on Wednesday 24 July 2024.

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It was reported that there had been one registration to speak at the meeting under the Council’s Public Participation Scheme.

Lali Hewitson spoke personally about her experiences taking care of a 19-year-old with mental health difficulties, who had experienced psychosis since the age of eight. Ms Hewitson discussed her difficulties securing a CAMHS referral, and her concern that service providers, including health and social care practitioners had not taken their situation or her concerns seriously.

The Board requested a report on the work of the Humber and North Yorkshire Integrated Care Board. The purpose of this report is to:

a.   Set out current work to improve children and young people's health at a system and York place level by the Humber and North Yorkshire Integrated Care Board and the York Health and Care Partnership;

b.   Share proposals to build on this and to improve governance to strengthen and improve collaboration and partnership and evidence-based planning working across the health and care system. This will deliver improvement against priorities in key Integrated Care Board and York strategic plans;

c.   Ensure the Board is aware and can contribute to the development of forward plans to continuously adapt to change, taking bold action by trialling new and emerging ways of working to improve early intervention and access to services for those who need it, reduce waiting times, and improve outcomes. This will include addressing health inequalities for vulnerable groups and will ensure the voice of Children and Young People with lived experience informs developments, delivery, and improvements in provision.

The York Place Director introduced the item, including a PowerPoint presentation on Children and Young People’s Health in York, incorporating a one-page summary of the Integrated Care System (ICS) Strategy outlining the aims and outcome priorities, with representation from all sectors.

She also introduced the strategy of Core20PLUS5, which is an approach designed to drive targeted action in healthcare inequalities improvement; it was explained that “Core 20” referred to the 20% most deprived members of the population as identified by the Index of Multiple Deprivation, and the “Plus 5” referred to 5 population groups selected by the ICS, who were experiencing poorer than average health access, experience or outcomes.

Representatives from the Integrated Care Board, who had co-authored the report, then further discussed elements of the presentation in detail and responded to questions from the board.

The Programme Lead for Children and Young People's Mental Health, further elaborated on the Core20PLUS5 and presented a video entitled “Nothing About Us Without Us” discussing young people’s top four priorities for mental health:

1.    Young people led awareness-raising and training on the signs and symptoms of mental health problems, and issues impacting young people’s mental health, including LGBTQ+, racism, etc.

2.    Easier access to services.

3.    Young people leading on work and courses about children and young people’s mental health, to ensure their voices are heard, their lived experience is valued, and they are not “shrugged off” by professionals.

4.    Listen to young people more.

She stated that young people’s involvement with the development of the mental health strategy had been productive and successful.

The Senior Commissioning Manager Children and Young People discussed the offer for emotional and mental wellbeing using the “I thrive” model which was generally self-directed, with support and advice from specialist services such as York Mind, Beat (the National Eating Disorder Service) as well as Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), Child and Adolescent Mental Health Services (CAMHS), Improving Access to Psychological Therapies (IAPT), Wellbeing in Mind and the School Wellbeing Service (SWS). She explained that this model moved from signposting, through increasing levels of assistance and involvement.

She summarised how these services are employed, working with schools and social care, to facilitate good mental health for children and young people in York and discussed funding and challenges.

The Senior Quality Lead for Children and Young People at York Place discussed physical health and services focusing on the five vulnerable groups identified by Core20PLUS5; she advised the board:

·       That a post was being set up with funding from York Place, to enable children with asthma to live a normal life.

·       That continuous monitoring and support was being offered to children with Diabetes across the ICB.

·       That integrated bowel and bladder workshops in partnership with the Healthy Child Service were being established.

·       That significant work had been undertaken with therapies teams at York hospital to reduce long wait times for children with sensory/processing difficulties.

The board thanked the presenters for their report, noting the quality and comprehensiveness  ...  view the full minutes text for item 13.

This report provides an update to the Health and Wellbeing Board (HWBB) regarding the work of the York Health and Care Partnership (YHCP), progress to date and next steps.

This edition of the report introduces a proposal developed by the Humber and North Yorkshire Health and Care Partnership which was discussed by the YHCP at their August meeting.

The report is for information and discussion and does not ask the Health and Wellbeing Board to respond to recommendations or make any decisions.

The York Place Director presented the report.

She discussed the success of the 30 Clarence Street Hub, the Conversation Café Forum and the announcement of the £2.4 million next phase of the Mental Health Hub, which had previously been embargoed due to the general election, and the pre-election period, which prevented central and local government from announcing any new initiatives. She discussed the Connecting our City Event, development of YHCP and the future work required to take the partnership forward including digital strategy and integration of teams.

She noted that Lord Darzi’s report on the state of the National Health Service in England highlighted some important issues, including an emerging need for seven new hospital wards in York for people aged 75 or over at a time when the hospital is closing wards due to staffing shortages, and there is simply no room to build new wards on the current hospital site.

The York Place Director stated that another key issue was that specialist staff were retiring across sectors, and many people were going out of area which a regional model would be a more effective solution for. The early intervention model would alleviate this to some degree, but major reform was needed.  Humber and North Yorkshire ICB discussed this in August, a month ahead of the Darzi report and as such had begun to formulate three areas of focus:

1.    Local Integrated Primary, Community and Social Care (including social based and de-medicalised mental health and neurodiversity services) – The ICB want people to be able to access primary, community, mental health, long-term conditions management, outpatients, social care and end of life care in a joined-up way that is local to their place.

2.    Mental Health Learning Disability and Autism – The ICB want people to be able to receive the specialist health and mental health services that they require least often when they need it, which may mean they are provided at scale and could be from a single location.

3.    Acute and Specialist services and care – The ICB want people to be able to receive best quality planned treatment in a timely way, this may require people to travel to receive access to health expertise in specific centres of excellence that maximise productivity and improve people’s outcomes.

The board asked about accessibility of GP surgeries and pharmacies, both with regard to current housing stock, and in view of the number of new housing developments planned, it was hoped that these new houses would also have access to services as a consideration of the planning process.

The York Place Director said that it was difficult to produce integrated care centres for all communities in a short space of time, but that this was a challenge that the partnership recognised and would look at as a long-term issue. She stated that future planning would most definitely consider access to care services, if necessary, via regular public transport.

The Chief Executive, York CVS stated that this report recognised the challenge  ...  view the full minutes text for item 14.

This report is for the attention of Board members, sharing a Healthwatch report which looks at the results of a survey exploring people’s experiences of accessing GP services within the city of York.

The Manager of Healthwatch York presented the report, which summarised the results of a survey exploring people’s experiences of accessing GP services within the city of York.

She stated that the intention had been to encourage open, honest conversations about access to primary care and thanked respondents to the survey which formed the basis of the report.

She emphasised that when visiting their GP, respondents overwhelmingly indicated they wanted a consistent point of contact who knew them and who they trusted. Patients with chronic conditions wished to have their doctor understand their condition, but not to attribute or link all health concerns to this condition.

She noted that this report and the other items on the agenda illustrated that capacity and demand were not currently in step with one another, but opportunities had been presented in this report, the urgent care report and the pharmacy report, which could be explored collectively by partners to develop a strategy for how the ideas might take shape.

She cited examples such as integrated Care Community hubs, changing roles for pharmacies and independent prescribing, better access to voluntary and community services to alleviate Health and Care Services and early intervention and prevention.

She noted that formal recommendations for the board had not been made in this report, but next steps had been proposed and the board’s views and suggestions on these would be welcomed.

The board commended the report.

Since this report was titled an “interim report” the board asked when the final report was due.

The Healthwatch Manager responded that what had been published reflected the full results of the surveys undertaken by Healthwatch, but it was titled an “interim” report at publication because further work on these results had not then been completed by Healthwatch, who sought to explore solutions. She added that they had since undertaken follow up meetings with those in primary care to explore how they might bring people and clinicians together and work on systemic improvements.

The board stressed the importance of people still coming forward for care, and not presenting late or avoiding doing so for fear of overburdening their GP as was suggested by quotes from respondents in the report. Despite the disproportionate pressure on GPs, who see 90% of all contacts, triage in this area has been a key innovation to ensure that those most in need are seen first and patients should contact their GP to allow for this rather than stay silent.

The board expressed concern about situations arising where a specialist/consultant advises that they will send something through to a patient’s GP, followed by a break in the flow of the service and a potential breakdown in communication at the patients end, resulting in confusion as to whether or not the GP has actually received this information. Residents have reported believing they had a prescription ready, only to find out this was not the case weeks later.

The Joint Chair of York Health and Care Collaborative responded to this, quoting the NHS  ...  view the full minutes text for item 15.