The Integrated Meeting of the Health and Wellbeing and Health and Care Partnership Boards made a number of decisions, including agreeing to adopt the amended terms of reference for the Health and Care Partnership Board, noting the Good Care Conversation update, learnings from the Joint Strategic Needs Assessment (JSNA) and the Promoting Wellbeing Workstream update, and signing off on the Mental Health Promotion Strategy and the Pharmaceutical Needs Assessment 2024-2027. The Health and Wellbeing Board also approved the Quarter 2 Better Care Fund (BCF) report, while the Health and Care Partnership Board noted the Integrated Care Transformation Programmes update.

The Good Care Conversation

The Boards heard that following the initial stage of The Big Conversation engagement work, which began in 2023, Services had been working to embed the resulting data into the Health and Care Partnership. The Boards were presented with information on the key impacts of this engagement work to date. These included:

• The Good Care Framework, constituted by four themes: accessible, competent, person-centred, trustworthy, had been used to inform service design across the partnership and incorporated into commissioning processes.
• Healthwatch Waltham Forest had used the data to develop a strategy for improving vaccine uptake in the Pakistani community.
• The Borough's first Health Equity Alliance, delivered through Walthamstow Central Primary Care Network, had been initiated.
• A new project had been started to implement a designated Women’s Health Hub in the borough.
• The North East London Integrated Care Board had agreed a series of draft success measures based on the findings.

The Boards were also presented with information on the next steps for the Good Care Conversation. These included:

• Continuing to test the framework with local people.
• Undertaking targeted engagement work with seldom-heard communities, including those with learning disabilities, working-class men, children and young people and people who do not speak English as a first language.
• Engaging further with the borough’s Romanian community through a programme of Community Insight Researchers, trained by Healthwatch.
• Aligning their existing community insights data categories to the Good Care success measures to enable partners to measure the impact of any interventions over time.

The Boards discussed the findings of The Big Conversation, particularly the way that participative budgeting data had illustrated the priorities and expectations held by residents. There was some discussion around the low attendance at events aimed at engaging men and the need for future work to focus on those demographics and communities most affected by health inequalities. There was also some discussion on the key considerations for the Health and Care Partnership, including the need to move beyond organisational boundaries and facilitate smooth transitions of care between services.

Learnings from the JSNA

The Boards were advised that the latest Joint Strategic Needs Assessment (JSNA) highlighted the following areas of concern:

• The Romanian community in the borough was now as large as the Pakistani community.
• Life expectancy for men in Waltham Forest was lower than for women.
• Homelessness and poverty continued to inhibit health equity.
• 41.8% of Year 6 children were overweight or obese.
• Data suggested ‘hidden harm’ from alcohol consumption.
• Levels of vaccination had dropped.
• Waltham Forest was worse than the rest of London and England at diagnosing diabetes.
• There was a higher rate of diagnosed asthma and asthma admissions than London and England averages.

The Boards discussed how the JSNA data could be used to direct areas of focus in the health and care system moving forwards. This included discussion around the need for Services to engage with the Romanian community, and to take steps to anticipate and address the prevalence of hidden harm from alcohol consumption. The Boards also discussed how PCNs could use the data to optimise the primary care they delivered and to measure improvements at population level.

Promoting Wellbeing Workstream

The Boards were advised that the Promoting Wellbeing Workstream would now have a broader focus than its previous one on social prescribing and adult early help and that following a workshop, the following five priority areas had been identified:

• Strengthening the partnership with the voluntary and community sector (VCS) and faith groups, to promote health. This would include delivering the second phase of the VCS Leadership Group's programme, supporting Borough of Sanctuary initiatives, and launching the Community Health Champions programme.
• Mental Health Promotion. This would include refreshing the membership of the Better Mental Health for All Steering Group, mobilising the wellbeing cafés offer, delivering a carers' mental health campaign, recruiting and training new Community Health Champions, and planning the next round of social prescribing community chest grants.
• Locality Hub and Primary Care Spaces. This would involve the continued planning and development of the Locality Hub model, with stakeholder engagement and coproduction with residents and VCS partners such as Healthwatch, WF Women’s Network, and the Leyton Orient Trust. It would also involve developing proposals for using primary care spaces more effectively for wellbeing services and improving primary care access.
• Maximising Employment Support. This would include refreshing the action plan to establish a cross-borough Employment Group, with oversight of employability provision, and the establishment of an Integrated Placement Support (IPS) steering group to coordinate provision, referrals and employer engagement.
• Housing and Health. This would involve the Housing and Health Task and Finish Group continuing to identify actions that align with the health objectives of the Housing Strategy, including year one priorities. It would also involve the development of the PRS Strategy and Supported Housing Strategy, both of which are currently in the planning phase.

The Boards discussed the scope of the Workstream, particularly whether it should include work surrounding babies, children and young people, and how the priority areas that had been identified could be aligned with the Big Conversation findings. The Boards resolved to approve the renewed focus of the Promoting Wellbeing programme, including its Terms of Reference, and to accept the five priority areas that had been proposed. It was also agreed that a distinct new Health and Wellbeing Strategy would be developed to align with these priorities, with updates on this work to be brought to the Boards at regular intervals.

Mental Health Promotion Strategy

The Boards heard that work on the Mental Health Promotion Strategy had commenced earlier in the year, with the Health and Wellbeing Board agreeing the high-level themes, approaches and actions that would comprise it. The Public Health team then drafted a strategy, which had since been reviewed by several Boards and forums, including the Mental Health Transformation Board and the Children and Young People’s Mental Health Board. The Boards were advised that following this, several priority groups had been identified for the first year of the strategy: expectant and new parents and families, unpaid carers, people living with long-term conditions, and black men. The Boards were also advised that the strategy had been renamed from 'mental wellbeing' to 'mental health promotion' as this better reflected its aim of preventing mental health problems and conditions.

The Boards discussed the focus of the Strategy, including the need to address the impact of financial insecurity on mental wellbeing and to develop targeted messaging. The Boards resolved to sign off on the Strategy, with the next phase of work involving its publication and promotion.

Better Care Fund quarterly report

The Boards heard that the Better Care Fund (BCF) was a joint fund between the local authority and the Integrated Care Board, and that under national conditions set by NHS England and the Department of Health and Social Care, an annual plan was required, reported against on a quarterly basis. The Boards were advised that the Quarter 2 BCF report had already been reviewed and signed off by the Health and Wellbeing Board Chair in order to meet the reporting deadline and that the meeting schedule for 2024/25 would better align with the quarterly reporting deadlines.

Integrated Care Transformation Programmes

The Boards were provided with an update on the progress of the Community Integrated Care Programme, which builds on the aims of the Integrated Care Strategy. The Programme Director highlighted three key areas:

• Home First: supporting people to leave hospital and facilitating their onward journey through recovery and rehabilitation at home.
• Care Closer to Home: proactively using data to enhance care delivery, especially for those with long-term conditions.
• Centre of Excellence: delivering care for those with complex needs within or close to their homes using primary, community and secondary care.

The Boards were advised that:

• A new Home First model, utilising a Frailty Virtual Ward, had been established on 1 November 2023 to support people who had been acutely unwell to transition out of hospital.
• Services were working to develop a risk stratification tool incorporating two dashboards – a NEL ICB view for aggregate data and a clinician view.
• The rapid response service was performing well.

The Boards noted the report and the performance framework that was presented.

Pharmaceutical Needs Assessment

The Boards were advised that all Health and Wellbeing Boards are statutorily required to publish a Pharmaceutical Needs Assessment (PNA) every three years. They were also advised that the PNA serves two main purposes:

• To assist NHS England in evaluating applications from new or existing pharmacies
• To help commissioners decide on services that community pharmacies could offer

The Boards were advised that the Waltham Forest PNA 2024-2027 had concluded that:

• Waltham Forest is well served in relation to the number and location of pharmacies.
• There is good access to all pharmaceutical services, including Essential, Advanced, Enhanced and Other services.
• No gaps in the current and future provision of these services have been identified.

The Boards discussed the PNA and the responses to the patient and public survey that had been undertaken. They signed off on the PNA and agreed to delegate authority to the PNA Steering Group to identify whether any changes in the availability of pharmaceutical services necessitate a supplementary statement; or whether changes in demand are so significant as to require a new PNA.