The Health and Wellbeing Board of Richmond upon Thames Council met on 26 November 2020, and reconvened on 10 December 2020, to discuss the council's response to COVID-19, review the Child Deaths Overview Panel report, and consider progress on the Richmond Health & Care Plan. Decisions were made to note the COVID-19 partner responses, support the dissemination of learning from child safety reports, and to continue encouraging partners to work collaboratively to address obesity.

COVID-19 Partners Response

The Board received an update on the wide-ranging responses to COVID-19 from various partners. Adult Social Care (ASC) has been working to discharge hospital patients rapidly and is reviewing its services to continue offering support post-pandemic. A winter plan has been developed, and a facility at Teddington Hospital was prepared for COVID-positive patients, though it has not yet been needed.

Public Health has focused on local contact tracing and lateral flow testing, supported the establishment of COVID marshals, and appointed an interim health protection consultant. They have also been assisting schools and universities with their responses, and reported no positive cases in care homes for staff or residents.

Achieving for Children (AfC) has maintained a near-normal service, with statutory child protection operating effectively. However, there has been an increase in cases requiring social work intervention, linked to rises in domestic violence and family breakdown. AfC is also providing quality assurance for home learning for self-isolators and support for children's emotional health, with a winter grant fund to assist children on free school meals.

The voluntary sector has experienced continued high demand for services, supporting individuals with complex needs and providing food assistance. Unpaid carers for people with dementia are under particular strain, and there are widespread concerns about mental health, with increased anxiety, depression, and longer waiting lists for counselling. Reduced face-to-face contact has led to feelings of exclusion for some, particularly those without digital access.

The Clinical Commissioning Group (CCG) is running campaigns to encourage residents to access NHS services and use NHS 111. Preparations for the COVID-19 vaccination programme are underway, with a focus on flu immunisations beforehand. Mental health services and access to psychological therapies, largely digital, are a priority. The CCG is confident in a successful bid for transformative mental health funding, and GP practices are experiencing higher patient demand than the previous year. The 50-64 age group has begun receiving flu vaccinations, and the COVID-19 vaccination programme is described as exceptionally challenging.

Healthwatch has adapted its working methods during the pandemic, publishing a mid-year review and a report on dentistry. They have seen significant website traffic for information on services. The Board was informed of two national allergic reactions to the COVID-19 vaccine, which occurred in individuals with a history of severe allergies. Models of delivery for the vaccine will need to adapt, and a prioritisation scheme considering risk factors, including ethnicity, is in place, utilising software to identify vulnerable patients. There is some public reluctance and misinformation regarding the vaccine, with historical concerns in Richmond about anti-vaccination sentiment stemming from the MMR vaccine. The Richmond Health & Care Partnership Board is identifying sites for the vaccination programme, and applications have been made to suspend parking restrictions around Primary Care Network (PCN) sites. Vaccination for care home staff is a priority.

The Board resolved to note the COVID-19 related programmes of work delivered by partners during this period.

Child Deaths Overview Panel Report 2019-20

The Board was presented with the Child Deaths Overview Panel report for 2019-20. In 2018/19, there were 25 deaths, with 9 in Richmond, and the majority being male. In 2019/20, there were 13 deaths, with 10 in Richmond. As the presenting officer was unable to attend the reconvened meeting, members were asked to submit any questions to the Health and Wellbeing Board Partnerships Manager, who would forward them to the report author and circulate responses.

The Board resolved to note the learning from the Child Death Overview Panel annual reports and to support the Partnership in disseminating learning to partners and the general public regarding child safety.

Richmond JSNA Update

Dr Nike Arowobusoye, Consultant in Public Health - Adults, Social Care and Health Care, introduced the update on the Joint Strategic Needs Assessment (JSNA). Modifications to the JSNA process were made due to the demands of addressing COVID-19. The JSNA Strategic Group agreed to postpone the delivery of the first draft by one quarter, from July to November 2020. Face-to-face meetings were suspended, and while online meetings took place, the process was streamlined due to COVID-related pressures on delivery partners. Most sections have a working draft, and permission was sought from the Board to present the final draft in late 2021, allowing partners to comment beforehand.

The Board resolved to note the progress of the JSNA to date, to acknowledge the revised deadline for the first draft, and to agree to the new timeline for the first draft to be presented to the Health and Wellbeing Board in early 2021.

Progress in Delivering the Priorities of the Richmond Health & Care Plan 2019-2021

Vicki Harvey-Piper, Director of Strategy & Partnerships (Kingston & Richmond), presented the progress report on the Richmond Health & Care Plan 2019-2021. The plan was reviewed in July and amended due to COVID-19, with nine additional priorities identified, including a focus on a whole-system approach to address obesity.

Under the Start Well priority, mental health for children has seen significant investment, with resources for schools and an online counselling service proving popular. Support for children with Special Educational Needs and Disabilities (SEND) continues, with a SEND partnership board overseeing progress and a SEND improvement plan agreed. Efforts to reduce childhood obesity through school-based activities are ongoing.

For Live Well, the focus is on reducing health inequalities for people with learning disabilities, promoting mental health, and managing long-term conditions. Progress has been made towards improving annual health checks for those with learning disabilities and mental health conditions, though this has been impacted by the pandemic, with a recovery plan in place. Social prescribing is progressing well, with link workers recruited. A significant piece of work in South West London addresses the management of long-term conditions, with a dedicated GP clinical lead for people with learning disabilities. Public Health is promoting social prescribing and has launched the Richmond Active Fund grant as part of the cultural offer.

In Age Well, ASC is formalising hospital discharge processes with health colleagues and acute trusts, embedding Home First principles. Whole-system support for care homes is a priority, with a multi-agency programme continuing post-COVID. Support for unpaid carers is also a focus, with a communication campaign on local services and encouragement for carers to get vaccinated. The carers' online assessment has been updated. The three council day centres in Richmond reopened in August and remain operational. Learning from the community wellbeing hub is being incorporated, and a Front Door hub pilot has been launched to trial new working methods. Prevention and support for people with dementia are being addressed through collaboration with service providers and partners, with a dementia council champion identified and a service directory published. Paid carers are eligible for the flu jab free of charge, and the dementia diagnosis rate remains stable. Obesity is a central strategic concern.

The emphasis on partnership working was welcomed, with over 900 social prescribing link worker referrals and 18 link workers currently in post. The Board was encouraged to discuss the use of link workers with PCNs and to ensure timely communication of deliverables for publicising. The Board expressed support for the systems approach and its role in holding it to account. The HWB Partnerships Manager will draft an action plan for unpaid carers.

The Board resolved to note the progress of the Richmond Health & Care Plan, to continue encouraging health, care, and wider system partners to work across traditional boundaries, and to discuss how partners could work more closely together to address levels of obesity across the population.

Communications Update

Ellie Firth, Head of Communications, presented the communications update. Messages regarding COVID-19 have been disseminated through the council's website and social media, alongside weekly videos from the Leader. Other key health messages on smoking, domestic abuse, and mental health have also been communicated, with close collaboration with universities and the NHS. A podcast with Kingston Hospital discussed the second wave of COVID-19 and personal experiences, featuring interviews with clinicians. National messages and communications regarding Christmas and the rapid flow testing programme have also been shared.

NHS campaigns encouraging the use of GP and NHS 111 services are being supported, and the national social media campaign on flu vaccines has been publicised. The COVID-19 vaccination programme will be promoted next year in line with national guidance, with input from London Councils. Plans are in place for an annual resident feedback survey next year, and Healthwatch patient surveys have been promoted. Messages from the NHS and CCG will continue to be shared. The Board acknowledged and thanked the communications team for their work in promoting the HWB's activities.

The Board resolved to note the communications and engagement activity.

Integrated Care Systems Response

The Board discussed the response to the Integrated Care Systems (ICS) consultation as an emergency item due to the January 2021 deadline. Comments were requested from Board members to be sent to the HWB Partnerships Manager by Wednesday 6 January 2021 for consideration in the council's response.