The Board approved the 2024/25 update to the 2023-25 Better Care Fund (BCF) Plan¹, noted the 2023/24 BCF Return and noted the update following the BCF Strategy Workshop held in February 2024. They also agreed that the Health and Wellbeing Board (HWB) and the Surrey Heartlands Integrated Care Partnership (SHICP) would in future operate with one streamlined membership, with agendas designed so that they run concurrently in one meeting.

Surrey Tobacco Control

The Board heard a presentation on the Surrey Tobacco Control Strategy, which was launched in October 2023. Smoking continues to be a leading cause of ill health and early death in Surrey. There are an estimated 113,000 smokers in Surrey, representing 11.9% of the population.

The Board was informed that, although the proportion of smokers in Surrey has been declining, there are still significant inequalities in smoking prevalence. For example, the prevalence of smoking is much higher among routine and manual workers, people in treatment for substance misuse, Gypsy, Roma and Traveller communities and people experiencing homelessness. Smoking is estimated to cost Surrey £950 million per year.

The Board also heard that the government has doubled the amount of funding for local stop smoking services for the next five years. This means that Surrey will receive an annual grant of £1.1 million to support an additional 15,000 smokers to set a quit date.

The evidence showed that only 6% of smokers would use local stop smoking services, so the programme has sought to increase demand through local mass media campaigns using behaviour change approaches and building on the tobacco programme in acute trusts and across maternity services.

Green Health & Wellbeing Programme

The Board also heard a presentation on the Green Health & Wellbeing Programme². This programme is funded by Surrey County Council and aims to improve mental health and wellbeing by increasing time spent in green spaces. One of the projects funded by the programme is Dose of Nature.

Dose of Nature is a mental health charity which offers a ten-week nature prescription programme. It has two hubs in Surrey, one at Dapdune Wharf in Guildford and one in Richmond. The Guildford hub was commissioned by Surrey County Council in 2022. In its first year, the Guildford hub received 80 referrals and achieved high levels of engagement. There was an average seven point reduction in measures of anxiety and depression among participants. The programme also led to qualitative improvements in participants' wellbeing, and a reduction in demand for GP Integrated Mental Health Services.

The Board heard that the Dose of Nature programme has struggled to attract long-term funding. It will receive limited funding from the Department for Environment, Food and Rural Affairs for one year, and other funding sources are being reviewed. The Board discussed the need for a more sustainable funding model for green health initiatives.

Surrey Sexual Health Programme

The Board received an update on the Surrey Sexual Health Programme. The programme aims to provide access to high-quality sexual health services, reduce sexual health inequalities and achieve positive sexual wellbeing for all. The Board heard about three specific areas of focus for the programme:

• Chlamydia: The programme is focused on testing young women for chlamydia, as they are at the greatest risk of reproductive harm from untreated infection. The chlamydia detection rate for women aged 15-24 years old in Surrey has increased in 2023 and is at its highest level since 2012. The programme aims to continue to test the right people and reach more people by targeting the 21 Key Neighbourhoods, promoting pharmacy access and working with organisations that support young people to deliver effective communications through social media.
• Teenage Pregnancy: The programme aims to reduce teenage pregnancy rates in Surrey by working with partners to address the wider determinants of health, such as education and a young person's early life experiences. The programme has developed a prevention action plan which focuses on: leadership support, understanding data, targeted communications and prevention work, expanding contraception support in non-clinical settings and relationship and sex education in schools.
• HIV: The programme aims to prevent new cases of HIV, increase testing, ensure people living with HIV receive effective treatment, and reduce stigma. A pilot has been undertaken to provide point-of-care testing for HIV, which provides instant results. The programme aims to roll out point-of-care testing more widely across Surrey.

The Board discussed the need to involve people with lived experience in the design and delivery of sexual health services.

Health and Wellbeing Strategy Index and Scorecard

The Board noted the significant progress that has been made to add over 20 new indicators to the Health and Well-Being Strategy Index. The Index is a tool for measuring progress against the Health and Wellbeing Strategy’s priorities, outcomes and priority populations. It uses publicly available data and is available at county, district and borough, ward, and PCN levels.

The Board also reviewed the Health and Wellbeing Strategy Scorecard, which is a high-level snapshot of the data in the Index. The Scorecard is produced annually and highlights areas where significant changes in performance or progress have been observed.

Joint Strategic Needs Assessment (JSNA): Multiple Disadvantage

The Board considered the draft recommendations of the developing JSNA chapter on Multiple Disadvantage. The JSNA chapter was co-produced with Surrey’s Changing Futures Lived Experience Recovery Organisation (LERO)³. The chapter explores the experiences of people facing overlapping issues such as mental health needs, substance use, homelessness, domestic abuse and contact with the criminal justice system. It identifies 11 recommendations for system change, focusing on the need for improved partnership working and a more person-centred approach to service delivery.

The key findings from the JSNA chapter are:

• Ways of working: The chapter highlights the fragmented nature of care for people experiencing Multiple Disadvantage, due to siloed working across the system. Statutory services are often only equipped to assess and treat what is considered to be a person's primary need.
• Feeling abandoned: The chapter identifies gaps and unmet needs in service provision. The impact of limited access to mental health services is highlighted, as this can often intensify a person's mental health challenges. The chapter also explores how the housing and accommodation support system can be better designed to meet the needs of people experiencing Multiple Disadvantage.
• Misheard and misunderstood: People experiencing Multiple Disadvantage commonly experience stigma and judgement due to a lack of understanding of the issues involved. The chapter highlights the need for a culture change and increased understanding of trauma and psychologically informed approaches.
• One size does not fit all: The chapter highlights the need for bespoke support which recognises the interconnected nature of Multiple Disadvantage. There is a need for a shift from medical to relational models of support, which are outcomes-led.
• Overcoming hurdles: The chapter identifies numerous barriers which prevent people from accessing support services, such as thresholds and eligibility criteria. These barriers can often exclude people from accessing the help they need.
• Under pressure: Strategic challenges such as funding cuts can disrupt the delivery of services and create discord between partners. Current commissioning structures do not always foster flexibility, choice or innovation. The chapter explores how funding could be redistributed or restructured to support service stability, longer-term strategic planning and improved outcomes.

The draft recommendations from the JSNA chapter are:

1. Strengthen governance structures by establishing a Multiple Disadvantage Partnership Board: The chapter recommends establishing a Partnership Board with representation from local partners and people with lived experience. The Board would agree a system-wide definition of Multiple Disadvantage and oversee the implementation of the chapter's recommendations.
2. Develop a five-year strategy for multiple disadvantage: The chapter recommends developing a five-year strategy to address the issues identified in the chapter and achieve sustained change at individual, service and system levels.
3. Improve system-wide data collection and sharing protocols: The chapter recommends adopting a Population Health Management approach to data collection and sharing, in order to better identify people at risk of experiencing Multiple Disadvantage. This would support priority action and prevention planning.
4. Ensure people experiencing multiple disadvantage are placed at the centre of strategic decision-making processes and involved in the design, commissioning, co-production, and evaluation of services: The chapter recommends ensuring people with lived experience of Multiple Disadvantage are integral to decision-making across the system.
5. Invest in early intervention and prevention solutions to reduce the prevalence, duration, and impact of multiple disadvantage: The chapter recommends investing in early intervention and prevention approaches across all stages of the life course, to reduce the incidence and impacts of Multiple Disadvantage. The chapter emphasises that the prevention of Multiple Disadvantage is a whole-system responsibility.
6. Prioritise embedding a cross-cutting Trauma Informed Approach at individual, service, and system levels: The chapter recommends prioritising the embedding of a Trauma Informed Approach across the system. This would require a collective, system-wide culture change.
7. Ensure that key health and care services are commissioned in a way that promotes partnership and integration through the adoption of commissioning best practices for people experiencing multiple disadvantage: The chapter recommends reviewing commissioning models to ensure they address the needs of people experiencing Multiple Disadvantage. It highlights the importance of working at pace to embed innovative best practice.
8. Redistribute existing funding to provide a range of integrated, accessible, relational, and person-centred services for people facing multiple disadvantage: The chapter recommends redistributing funding to support the delivery of a range of integrated and accessible services, which adopt a relational rather than a medical approach.
9. Ensure that people experiencing multiple disadvantage are offered a diverse range of mental health services with improved ease of access, flexibility and better outcomes: The chapter recommends offering a diverse range of mental health services to improve ease of access and flexibility for people experiencing Multiple Disadvantage. This would help to reduce barriers to access.
10. Conduct a comprehensive review of commissioned substance use services in Surrey to ensure people affected by multiple disadvantage have access to high quality, effective, person-centred alcohol, drug and recovery services: The chapter recommends undertaking a review of commissioned substance use services in Surrey to ensure the transparency of funding availability. It also recommends finding ways to redistribute and restructure funding streams to maximise outcomes.
11. Improve ease of access to housing and accommodation support and ensure sufficient housing options for people experiencing multiple disadvantage: The chapter recommends improving access to housing and accommodation support. It also recommends improving planning for winter provision and increasing investment in rough sleeping solutions.

The Board discussed the draft recommendations and agreed to review them in detail outside of the meeting. They also agreed to support the dissemination of the chapter’s findings and recommendations once it is published.

Integrated Care System (ICS) Updates

Surrey Heartlands ICS

The Board received an update on the activities of Surrey Heartlands ICS. The Board was informed that the ICS has begun planning its second system expo, which is likely to be held in the autumn. The expo will provide an opportunity to bring together a wide range of partners from across the Integrated Care System and discuss the progress being made to deliver the ICS strategy.

Frimley Health and Care ICS

The Board also received an update on the activities of Frimley Health and Care ICS. The Board was informed that the ICS is working on a refresh to the design and operation of the Integrated Care Partnership. The ICP will continue to focus on the effective delivery of its three core functions, which are:

1. To provide oversight and approval of the ICS Strategy creation process and the impact of its delivery
2. To provide a formal environment for the consideration of the wider determinants of residents' health outcomes
3. To help nurture and evolve shared vision and values as partner organisations and local leaders

The Board was also informed that the ICS has completed the first refresh of the Frimley NHS Joint Forward Plan for the period 2024-2029, and has recently concluded the production of its Operational Plan for 2024/25.

The Board was also informed that the Frimley ICS has been selected by the DWP to be a pilot site for the national “Work Well” programme. The programme will provide support to help local residents get back into employment, where poor health has been an inhibitor to doing so.