The meeting was largely concerned with monitoring the implementation of the council's existing policies and the performance of a number of the council's programmes. The meeting received progress reports on work relating to drug and alcohol use, mental health, learning difficulties, autism, domestic abuse, violence against women and girls, and the provision of better care for vulnerable adults.

Drug and Alcohol Use

The meeting received a report on progress in implementing the Hertfordshire Drug and Alcohol Strategy (2019-2024).

The strategy is overseen by the Drug and Alcohol Strategic Board, which is chaired by Sarah Perman and Catherine Akehurst.

The key achievements of the strategy in the last quarter were:

• The completion of a draft of the aims and objectives for the strategy. The draft was developed following a public consultation which ran from 16 September to 8 November, and focus groups with service users and carers in October.
• The completion of a co-occurring Mental Health and Substance Use workshop, which took place on 9 October 2024.

Upcoming activities include:

• Presenting the draft strategy to the Drug & Alcohol Strategic Board – 12 December.
• Presenting the strategy at Public Health Management Board – 7 January.
• Presenting the strategy at the Public Health & Community Safety Cabinet Panel – 30 January.
• Presenting the strategy at Full Cabinet – 24 February.

Risks to the Strategy

The report identifies two key risks to the strategy.

Firstly, the report notes:

Ending of Government grant funding from April 2025 will impact on treatment provision, drug testing on arrest and Naloxone provision so need to consider how numbers in and into treatment are managed.

The report notes that an exit strategy has been agreed which will see the projects that were previously funded by the grant being funded directly by the council until the end of the financial year. The report argues that this will allow time for alternative funding to be secured. The report also notes that no decision has been made by the Department of Health and Social Care (DHSC) about whether the grant programme will be funded after the next financial year.

The report also highlights the risks posed by the rise in the use of synthetic opioids:

The changes in the Taliban and their destruction of poppy fields leading to the rise synthetic opiods and the associated risk of overdose and death to drugs users

The report argues that this risk is being mitigated by the development of a synthetic opioid action plan, and notes that the council’s toxicology lab now has the capability to screen for a range of different synthetic opioids.

Performance of the Drug and Alcohol Strategy

The report identifies 3 priority areas for the strategy: breaking supply chains, improving the quality of drug and alcohol treatment, and reducing the number of people using drugs and alcohol.

The report lays out a number of ways in which the strategy is attempting to break drug supply chains. These include:

• Increasing the number of County Lines being dismantled by police.
• Improving the identification and targeting of high harm drug lines.
• Continuing to fund the Supplemental Substance Misuse, Treatment and Recovery Grant, Housing related Grant and Rough Sleepers Grant for a third year.

The report identifies a number of ways in which it is improving drug and alcohol treatment:

• Increasing the number of people accessing treatment.
• Improving the quality of treatment.
• Improving support for people with co-occurring mental health and substance use issues.
• Increasing the distribution and use of Naloxone.
• Improving the availability of information on drug and alcohol services for residents and professionals.

The report lists a number of measures aimed at preventing drug and alcohol use, including:

• Empowering schools and professionals to better understand drug and alcohol use.
• Empowering children and young people to make healthy choices.

Mental Health, Learning Difficulties and Autism

The meeting considered a report on the work of the Mental Health Learning Disabilities and Autism (MHLDA) Programme Board and the Health and Care Partnership.

MHLDA Partnership

The key achievements of the MHLDA Partnership in the last quarter were:

• The MHLDA Health and Care Partnership has become a sub-committee of the Integrated Care Board (ICB).¹ Finance & Commissioning and Quality & Performance sub-committees are being established.
• The Co-Produced All Age Autism Strategy ² is due to be presented to the December meeting of the Health and Wellbeing Board. Work has begun on developing delivery plans for the strategy.

This refers to the '06 Item 5 Hertfordshire All Age Autism Strategy 2024-29' document that was included in the meeting pack.

Learning Disabilities & Autism

The report noted that:

• Inpatient numbers for the Transforming Care cohort are broadly in line with expectations.
• The 2023/24 LeDer report is being prepared for publication.

Adult Mental Health

Key achievements in Adult Mental Health during the reporting period included:

• The completion of an NHS England-mandated rapid review of Intensive and Assertive Outreach practice.
• The Crisis Care Partnership Board received a draft of the interim evaluation report for the Mental Health Urgent Care Centre.
• Continued implementation of the Right Care Right Person scheme.

Children and Young People's Mental Health

Developments in Children and Young People’s Mental Health included:

• The most recent expansion of Mental Health in School Teams in St Albans and Dacorum have begun their training and have begun working with the first group of schools.
• NHS England has issued implementation guidance for Urgent and emergency mental health care for children and young people.
• NHS England have published plans to improve inpatient quality care. These include further delegations of commissioning responsibility to local areas for Tier 4 inpatient beds.

Hertfordshire Dementia Strategy

The report noted that work on implementing the Hertfordshire Dementia Strategy is continuing. In particular, work is ongoing on embedding the reconfigured Hertfordshire Memory Support Service and Hertfordshire Dementia Accreditation Scheme.

Domestic Abuse and Violence Against Women and Girls

The meeting considered a report on the work of the Hertfordshire Domestic Abuse and Violence Against Women and Girls Executive Board. The Board is responsible for delivering the Hertfordshire Domestic Abuse Strategy (2022-2025), developing a multi-agency response to Violence Against Women and Girls (VAWG) in Hertfordshire, and managing the funding for these programmes. The Board is chaired by Sarah Perman.

Impact of the Programme

The report states that the Hertfordshire Domestic Abuse Strategy was recently evaluated and that a new multi-agency funding model has been introduced for the programmes managed by the board. The report also expresses concern about the long term security of funding for the programme:

Multi-agency funding arrangements are in place for services commissioned under the Hertfordshire Domestic Abuse Strategy (2022-2025). There are long-term funding implications, including for Independent Domestic Violence Advocates (IDVA) and Independent Sexual Violence Advocates (ISVA) due to Ministry of Justice and Central Government funding. Partners are working together to look at long-term sustainable funding.

Achievements in the last Quarter

The key achievements of the Board in the last quarter were:

• Completion of a refresh of the Joint Strategic Needs Assessment on Domestic Abuse and Safe accommodation. The published assessment is available on the council’s website.
• Implementation of recommendations to improve Multi-Agency Risk Assessment Conference (MARAC) processes in Hertfordshire.
• A Joint Targeted Area Inspection on domestic abuse and children was carried out by Ofsted, HMPP and the Care Quality Comission. The inspection found that the service was performing well.
• A new sub-group has been set up to improve and coordinate the response to children, young people and families experiencing domestic abuse

Upcoming Activities

The report lists a number of activities that the board will undertake in the coming year:

• A procurement process will begin for a new advocacy service for victims of VAWG. The new service will launch in September 2025.
• Work will begin on developing a new county-wide, multi-agency strategy to tackle Violence Against Women and Girls in Hertfordshire. The strategy is due to launch in November 2025.
• Development of One Stop Shops will begin. The shops will be based across the county and will provide support to VAWG victims. Support provided will include housing, legal support and counselling.

Risks to the Programme

The report identifies 3 key risks to the programme:

• Increases to national insurance may negatively impact the voluntary sector, and may result in a reduction in the number of support workers that domestic abuse services are able to provide.
• Home Office funding for the Chrysalis Centre may be coming to an end in the new year, meaning that the amount of support available to help perpetrators of domestic abuse to change their behaviour may decrease.
• There is concern about the level of funding that will be available from the Office of the Police and Crime Commissioner (OPCC) for the provision of Independent Domestic Abuse/Sexual Violence Advocacy. It is feared that a reduction in funding could reduce the programme’s capacity.

Better Care Fund

The meeting considered a report on the work of the Better Care Fund (BCF) Board. The Board has responsibility for overseeing the implementation of the Better Care Fund in Hertfordshire, and is jointly chaired by Chris Badger and Tom Hennessey.

Purpose of the Better Care Fund

The Better Care Fund (BCF) is a programme that exists to encourage health and social care organisations to work together more closely. The BCF requires Integrated Care Boards and Local Authorities to pool their budgets and to develop a joint plan for how that money is spent. According to the report, the Better Care Fund has:

helped Hertfordshire deliver integrated health and social care that improves quality of life for our residents. The BCF programme supports local systems to successfully deliver the integration of health and social care to achieve person-centred care, sustainability and better outcomes for people and carers.

There are two core objectives for the Better Care Fund:

• Enable people to stay well, safe and independent at home for longer.
• Provide the right care in the right place at the right time.

Impact of the Fund

The total Better Care Fund Budget in Hertfordshire is £493.624m. This consists of:

• £248.666m for 47 joint NHS and Local Authority schemes
• £58.2m for the Social care pooled budget, £34.6m of which was provided by the NHS and £23.6m of which comes from the Improved Better Care Fund (iBCF).
• £15.258m for the Additional Discharge Fund. £4.652m of this had been spent by the end of September.

Achievements in the last quarter

The key achievements of the Better Care Fund Board in the last quarter were:

• The Board completed a review of its terms of reference, clarifying the division of responsibility for mental health and the Hertfordshire Equipment Service between the BCF Board and the Integrated Care Board.
• The Board confirmed that it will continue to fund the Active Ageing service until the end of September.
• Two mandatory reports were submitted to NHS England.

Challenges

The report identifies a number of challenges facing the board. These include:

• The different Early Intervention Vehicle models in use across Herts & West Essex.
• The need to improve the visibility of Advanced Care Plans. The report notes that a digital solution is being explored.
• High levels of reliance on Discharge to Assess beds in South and West Hertfordshire.
• The Integrated Discharge Service in hospitals has seen an increase in demand for Residential and Residential Dementia beds.

Upcoming Activities

Upcoming activities for the board include:

• Planning for the 2025/26 Better Care Fund, which will be undertaken jointly between the ICB and HCC. An early paper is due to be presented to the Better Care Fund Board in December.
• Preparing the NHS England Q3 report, which is due at the end of January 2025.
• Commencing the 2024/25 BCF End of Year reporting process, which will take place between March and May 2025.

Risks to the Programme

The report identifies two key risks:

• The risk that significant changes to BCF funding mechanisms result in BCF schemes becoming underfunded.
• A lack of transformation funding for social care prevents the system from exploring opportunities for new schemes, pilots or initiatives. This may result in an inability to sustainably manage demand and meet the changing needs of residents.

Children and Young People's Commissioning Board

The meeting received a report on the work of the Children and Young People's Commissioning Board. The board is jointly chaired by Jo Fisher and Sarah Hannington.

Priorities

The key priorities for the board are:

• Listening and responding to the voice of children and young people, their parents and carers.
• Expanding early intervention and prevention services to respond to the increasing acuity and complexity of needs
• Developing locally delivered services to ensure children and young people can access the right support at the right time
• Ensuring that services meet the varied and diverse needs of the population of Hertfordshire and are targeted on those impacted by inequalities
• Responding to the climate crisis by seeking sustainable and responsible solutions

The board's priorities for 2024/25 are:

• The best start in life
• Prevention of school exclusion
• Delivery of attendance duties
• Family Safeguarding approach
• Monitoring of the s75 agreement
• Progress of the SEND Priority Action Plan for children with SEND
• Development of the Family Hub approach

Funding

The report notes that funding for the s75 agreement has been agreed for 2024-2026.

Meeting Agenda Items

The report lists a number of the topics that had been discussed at recent board meetings. These included:

• Post SEND inspection learning
• Early Help redesign
• Core 20 + 5
• Opening of Cherry Tree Cottage provision
• Rollout of childcare support and wrap-around childcare programmes
• Recommissioning of the Family Support Service
• An update on the children’s s75 agreement for overnight short breaks
• The revised Family Centre Service specification
• Sustaining the Hertfordshire multi-agency Family Safeguarding model
• Diagnosing learning disabilities
• The review of cognitive assessments
• The changing role for Hertfordshire's Health and Care Partnerships
• Progress of the SEND Priority Action Plan
• Damp and Mould action plan
• The impact and engagement with children, young people and families

Governance

The report notes that a decision was made to change the terms of reference and membership of the Hertfordshire Children’s Commissioning Committee. The committee will now be a smaller system commissioning and provider Director meeting to allow for information sharing and joint working / problem solving on the key priorities.

Risks to the Programme

The report identifies 3 key risks to the programme:

• Financial pressures may reduce opportunities for service development and improvement.
• The workforce may not have sufficient capacity to fully engage in partnership working.
• It may be difficult to demonstrate achievements and impacts across such a broad range of priorities.