Transcript

Good afternoon to you all. I will now ask that the livestream is started. Welcome to the meeting of the Health and Wellbeing Board being held on Monday, the 11th of March 2024. For those present in the meeting, if the fire alarm sounds, please leave the building by the nearest exit and proceed to the assembly area in the car park. The agenda papers and other relevant information for this meeting are available for public viewing on the Heritage Council website. The Council is streaming this meeting live on the Heritage Council YouTube channel and is making a recording. To ensure that the recording quality is maintained, please speak as clearly as possible. Keep background noise to a minimum. Please ensure that mobile phones and other devices are turned to silent. Others are permitted to film, photograph and record our public meetings, providing that it does not disrupt the business of the meeting. If there are any members of the public present who do not wish to be filmed or photographed, please raise your hand now so that any such person filming or photographing may be made aware. Voting will be undertaken by a show of hands in the room. Only committee members present may vote. For participants in the room, please use the microphones to speak, pressing the button on the right of the unit and speak directly into the microphone. We have a number of people in attendance as virtual participants. Can our requests that they use the raise hand function within the system if they wish to contribute? Item one, do we have any apologies for absence? We have received apologies from Councillor Lister, John Butler and Dr. Mike Herr. Thank you. Any names, substitutes? Emma Roberts is acting as a substitute for John Butler for the Harryford and Worcester Fire and Rescue Service. Before we go on to declarations of interest, just so that those who may be listening or watching on YouTube, can we just go around the room and introduce ourselves and state who we are representing. If I start with you, Henry. Hi, I'm Henry Merrick Smurgatroyd and the Democratic Services Officer for Harryfordshire Council. Matt. Sorry, afternoon everybody, Matt Pierce, Director of Public Health, Harryfordshire Council, Member of the Board. Julie Stevens, Public Health Lead, Harryfordshire Council. Hi, everyone. I'm Mohammad D'Soucy, Public Health Program Officer, Strategy and Partnership at Harryfordshire Council. Kristen Pritchard, Public Health Lead, Harryfordshire Council. Good afternoon, Chair. Pauline Crockett, Councillor, Health and Wellbeing, Scrutiny Chairperson. Good afternoon. I'm Frances Martin, Deputy Chair for Why Value Trust here, observing this afternoon. Thank you. Good afternoon. I'm Daryl Freeman, Director of Children Services. Good afternoon. I'm Hilary Hall, Corporate Director of Community Wellbeing and the Director of Adult Social Care. I'm Steve Brewster, CEO of Active Heritage here in Worcestershire, but here today is the VCS rep. Christine Price, Chief Officer of Health Watch, Harryfordshire, Member of the Board. David Mahavic, Executive Director for Strategy, Health and Equality and Integration at the Integrated Care Board and Member of the Board. Price for longest title. Jane Eyes, Manager and Director of Why Value Trust and Member of the Board. Councillor Carol Gandy, Cabinet Member for Adult's Health and Wellbeing. And those on the virtual screen, if we could start from the top. Yeah, Sue was having a Director of Strategy and Partnership, Herrfordshire and Worcestershire Health and Care Trust, and I remember the Board. Helen. Good afternoon, everyone. Hi, Superintendent Helen Way and the Global Police and Commander for Herrfordshire. Hayley. Hi, everyone. I'm Hayley Doyle, Assistant Director for All Age Commissioning. I can't read you after that. Adrian. Hello, everybody. I'm Adrian Griffiths, and I'm Strategic Finance Manager for Partnership and Integration for Herrfordshire Castle. We've got Emma, we've got Mary. Captain Newberry, Gallagher and Transformation Improvement Lead for Herrfordshire Castle. Have I introduced Emma? Yeah, and is it actual? Harper? Yeah, Harper. Harper likes to learn public health consultants and Herrfordshire Council. Ivan. Hi, everybody. I'm Ivan Powell, Cabinet Member for Children's Services from the Council. Is that Emma? Is that Emma? Emma Roberts, Head of Prevention for the Fine Rescue Service, I'm representing John Butler. All right, thank you, thank you. And Kevin. Oh, do we miss you out, Kevin? How could we miss you out? Sorry about that. And my apologies for not being in the meeting. Kevin Crohnton, Chair of the Abbott Safe Guardian Board and Member of the Board. But President, we're here today to present the report and the Council and the study. I've got to give my apologies for the rest of the meeting with a few personal issues to deal with and last week with my father-in-law being here. But I'll be here to present the report. Right, I'm sorry about that, but thank you for coming. Thank you. Right, item three is declarations of interest. Do any members wish to declare any table A or B or other interests in any agenda item? No declaration stated. Item four is the minutes and the minutes of the meeting held on the 4th of December, 2023 are included in the agenda park at pages 7 to 14 for approval. I move that the minutes subject to the amendment in the amendment as a correct record, all in favour? Any against? Any abstentions? No. So item five is questions from members of the public. And I'm really pleased to say that the first time certainly since I've been Chair and I don't know about the previous Chair, we have two questions which is really good and I will be encouraging others to be filtered in this direction going forward. So the first, if I'd like to turn to Henry, if you'd like to read out the first one. So we've received one written supplementary question from Anne Russell who has requested it to be read out on her behalf. It reads, While the council has cited evidence reviews suggesting water fluoridation is safe at permitted levels, many of those reviews did not specifically evaluate the potential neurodevelopmental impacts during key windows of vulnerability, like fetal development and early childhood. Given the emerging research indicating fluoride may be a developmental neurotoxin, even at relatively low levels of exposure, how does the council plan to thoroughly investigate and address these specific concerns before moving forward with the fluoridation programme that would involuntarily expose all residents, including pregnant women and infants? Mack, do you like to give a response? Well, thank you. So you've ever seen my original response to Ms. Russell's question. As yet, the health might be in board, hasn't made decision on fluoridation, but I know the board is supportive of that. But within my original question, there needs to be a process that needs to be followed in terms of a feasibility study and also a public consultation. So with all public health interventions, we'd review the evidence, keep up to date, look at what the science tells us, and that would inform our decision at that time. Also worth noting out, there's soon going to be a public consultation for fluoridation in the northeast of England, so that will provide another opportunity, even if you live outside the north of England to take part in that consultation. So that constituent is more than welcome to obviously feed into that consultation when it takes place. Thank you. We had a question from a councillor, but how did that councillor submit a supplementary? No, no supplementary questions received. So members of the committee should have received the question and the response given by the Director of Public Health. So we now move on to item seven, which is the Heritage and Save Guardian Adults Board Annual Report 22-23, and I would ask Kevin Crompton and Chair of Heritage and Save Guardian Adults Board, who is, as we know, is attending remotely to present the report. Thank you, Kevin. Thank you, Chair. So, obviously, some of the people who have read the reports, I just feel intrigued to put the remarks from me. Firstly, obviously to note that this report we're now nearly at the end of the following year, so apologies that the annual report didn't come to you sooner. I think a bit to do with transition. I took over the chair by April last year, then obviously elections, and it's taken us some time to just get back on. But the previous chair is in the room, should he wish to contribute to any stage. So I've got the key points. It said here earlier, and ironically, about a week ago, we have done our review of 23-24. So obviously, there's a lot moved on since this report. I think it's worth noting in the report, cut the key points to notice. Firstly, that I think this report dominated by the post-pandemic and the board getting back to more of a business as usual, but it is worth noting that in terms of national data, that performance data wasn't collected, it was a voluntary join the pandemic, so that the data in this report is 1920. But I can report, and when I bring this year's annual report, data is now back on track and we've literally just received about a week ago updated data, so which we can compare performance in the county with similar authorities. I think 0.7 for me is really important when it comes to safeguarding concerns. So the overall number fell, 47% of cases, the concern, the issue was in the individual's own home, and the abuser was known to the victim. And I think with a lot of self-funders in the system in error for chairs, the characters in the system, I think it's a challenge for the safeguarding board. How do you get line of sight on things that are actually happening behind the closed doors of people's houses? And this year we're having quite a lot of discussion about raising awareness in the community that as they're concerned about a vulnerable adult living near them to encourage people to check on them. For example, we're looking into that. I inherited some for this year, some intentions from the partnership prior to me, and work on transition of children who were exploited as they move into adulthood. And in fact, transition in general is a theme for the partnership and is being taken forward this year. The two projects mentioned in paragraph nine, the Census of Experience and Review of Rusty thing that has been completed, and unfortunately, this is like a trailer. The results we will be putting forward in the next annual report, but we had a presentation recently. In terms of the partnership, to be honest, everything is in place. If we have some challenges, they are identified in paragraph 10. Delivery of regular performance data, in particular multi-agency data, is still a challenge. And engagement with individuals, getting feedback from service users is also a challenge for us. Sorry if I bear with me, Chair. Sorry, colleagues. I have one dog in the room with me who just decided he wanted to scratch his bed, so apologies for the background noise. He has stopped there. Just on a little retry for this year, I say we've continued some very important work building on the 22-23 year. We have them follow up to the safeguarding adult review of individuals with multiple and complex needs, and we are looking at the whole theme of homelessness and rough sleeping again. Performance data is now more up-to-date and being refreshed, and one thing very interesting, I will share, is in terms of performance of adult social care and partners. The data is now being refined to pick up what you might call early help, an early help offer within the adult social care world. These previously have been on the system, been listed as no further action, but actually more refined data is showing that NFA doesn't mean no further action, it means they've been referred to other places. So there's some good news there. And one thing, again, I'll trail, there's a lot of work now being done on a self-assessment, which includes a self-assessment of the partnership and its effectiveness in preparation for a possible CQC inspection. That national, the inspection regime is now in place, and they could visit us at any time. But some issues are continuing on ongoing workforce issues, and workforce supply is an issue across social care for partners, adult social care capacity. And as I say, this getting a line of sight on what you might call hidden abuse, as I say, what's going on in people's homes. And quite an interesting statistic I pictured recently for the Community Safety Partnership about domestic abuse cases, and a small but worrying number of cases, which involve over 60s, one of whom has a form of dementia. And what was the partnership do we do about those, those incentives? So that's come on this year. I'll stop there for May. I'm happy to take questions. It's always difficult to be introduced in the report for a year when you work in the chair. I'll do my best to answer questions. Thank you, Kevin. I've got a couple points I wanted to raise, really. When you talked about item seven, the number of reported safeguarding concerns fell. You've got 47% of reported cases took place in the individual's own home. And 41% the abuser was known to the victim. So when we're talking about the number of reported cases falling, are you talking about the number of reported cases that were found to be worthy of following up, where there was abuse taking place? Because certainly the figures that you're quoting here, you say actually 41% the abuser was known to the victim rather than the accused abuser. So those figures chair on pages 16, 17, 80 of the report or 2829 thereabouts of the agenda. So it is an overall number of concerns that are reported as fallen right over those years. I'm trying to get the exact figure. So bearing in mind, this would be 1920 and data wasn't collected. So I'm just going through the report, apologies. It will be the overall number of referrals that's fallen. Okay, so it's not the overall number of cases where it has been proved that somebody has been abused. Now it's the proportion of those, so the overall number of cases being drawn to our attention fell. But of those cases drawn to our attention, those figures of 47-41 referred to those that were actually investigated. Okay, thank you. I was going to ask Christine, which comes back in about the issue around the difficulty in engaging with those who have been safeguarded. And what we can do to actually get a better feedback from those people? Yeah. Thank you, Chair. So in terms of any safeguarding inquiry, we will always seek feedback. And these are the ones that adults who should care investigate. We will always seek feedback to ensure that the outcomes that someone had set as part of making safeguarding personal, that we have achieved those outcomes for them. So there is some feedback in terms of that. And their overalls, so for word, satisfaction with the process of the inquiry, and that's obviously needs to be done sensitively. So we do get some feedback, I think, but I wouldn't like to say that it's comprehensive, and that is something that we have picked up as a board and want to do more work around. Okay. Okay, that's fine. And the other thing I was going to ask, Paige, 27 or 15, I don't know, where it says progress. It says that the making safeguarding personal continues to be a focus aboard. All of its have been conducted and findings, evidence that although MSP is embedded into statutory agencies, understanding across the wider sector requires improving. What plans do you have in place to do that? So, I think this is probably connected to all the work around talk community, and working with partners and the voluntary sector chair. Okay. And I think it is, it's as who is just said, feedback is asked, we ask people for feedback, it's encouraging more people to give that to us. And I think MSP is an ongoing thing that you're always working with organisations to try and make sure their approach is sensitive to a whole making safeguarding personal approach. Thank you. Matt. Yeah, thanks Kevin. It's just building on that. I know in some areas I've worked, the monitoring community sector often talk about wanting more safeguarding training. So, it's just building upon that, because obviously, talk community isn't the monitoring community sector itself, it's almost a vehicle for that. So, I was just wondering, is there still a need in that? And I was wondering whether that's come out in any sector, the BCS sector reports that we've been undertaking about that requirement of more safeguarding training and what that uptake is like, more broadly across the BCSE sector? I don't think we've actually got data on that. Matt, at the moment, or the college in the room may be able to help me. Okay, it might be a need then, we might need to look up. Yeah, it might. It's just just what I've experienced elsewhere, Kevin, that's also, I was just wondering if it's being born out in heritage as well. Okay, thank you. Yeah, Ivan. Just hoping to help out a little chair if I may. I'll just acknowledge I was the ag going safeguarding out of all chairs, Kevin has said. So, a couple of things on engaging with service users. For the last few years, several years, in fact, we've tried a number of different ways of engaging service users, and we did that for this reason. As the director has rightly explained, the service itself does engage with and seek feedback from those who are in need of safeguarding. But in fairness to the assistant director at the time, she also wanted some additional external engagement. To use the phrase, she didn't want to be seen only to be marking the local authorities' own homework. So, we've tried a number of attempts at that through the voluntary and community sector, through health watch, and a couple of other things. And I happen to be a member of the adult safeguarding board's chair's network nationally. It's not an easy thing to do. So, I wouldn't want board members to think that there is nothing going on. It is more that the local authority has a desire to do something that complements and supplements its own work. So, there's that point. Just to raise a small point, if I could, chair, just about the numbers, the 47 and 41%. The board did and continues to explore what that might mean for the profile of domestic abuse. There are, depends how you look at it, there are 10 or 11 categories of abuse that are recorded under the care act. One of those is domestic abuse, but there are also a number, for example, physical abuse, sexual abuse, emotional abuse, and financial abuse, which is perpetrated in your own home, and by somebody who is caring for you, arguably presents some domestic abuse. So, there is, and again, I discussed this nationally, there is a need to make sure that we understand the profile of that both locally, but regionally and nationally, too. So, just a couple of points, which I think are important. And then the last point referring to Matt's question about the voluntary community sector, I certainly annually presented the annual report to H-LOS, and there are conversations ongoing between the business unit and the voluntary community sector about what a training offer might look like. So, apologies for interfering, but Kevin's right. He's presenting the report for the period that I was chair, so hopefully that's helpful. That's fine, that's fine. Yeah, thank you, Chair, if I make that really helpful, and I do note from my notes of our review meeting last week, a small team has been put into place under the principal social worker to increase our capacity in terms of getting feedback from users, so within her is set up, there's a new focus. And I don't know that he's helped, but there was some work done with HealthWatch to try to get feedback, but for reasons not best known to me, and good intentions, it didn't quite get off the ground, but I'm always willing to look again at good ideas. Well, Christine's back in the room, so I can ask the question of Christine as to what actually went on. Yeah, so we had to use a process where the safeguarding team would get consent in Mosaic from people at the end of their safeguarding episode, and we just didn't get many people consent for us to follow up and take it on, and we can't really access people without that, so yeah, it was really down to people not wanting to do it. So, fine. Anybody else? Yeah, Jay. Thanks, Kevin. A couple of questions. It seems like referrals going down is a good thing, so I'm just checking with you, you think it is a good thing, and also in terms of the timeliness of the report from the year that's just about to finish, are we going to get it a bit earlier next year than I've got one of the questions you've answered those? Okay, so the second question is easy. Yes, I will be working on this year's annual report at the end of this month. I think it would be good to get it to your first health and well-being board, either last of the summer, that would be optimistic, but first one in the autumn. I think it's really important, and as I say, quite a lot of quite important things are now happening like up-to-date information and so on. So, sorry, your first question again, Jay was... It was, referrals are going down. Is that a good thing? Yeah. I'm going to say it's a difficult question to answer, isn't it? Because you don't know what you don't know. I think the data we've got this year also is important. We need to pick up this early help stuff. We need to have a proper self-assessment, understanding of what's happening out there, what is being done with individuals before they get to our referrals stage, before having to make a referral in. So, there's some interesting things in the 22-23 data that literally I've had half an hour to discuss in the last week, and I think when we bring an analysis of that data, I can bear in mind your question and discuss with other colleagues and give you a more informed view. So, we've got data from 2019-20, then the pandemic, and then you've only just got the new stuff, it's difficult to say. And, as I said, I think the interesting thing for me here is with a high degree of self-funders, the line of sight for agencies is not necessarily, in my view, the same as if you've got a high number being directly supported by, I say, local authority services are directly commissioned by. So, some interesting dynamics in this hand. There is, thank you. And then one last question, and it might be one for you to answer when you come back actually, you're still searching through the data, but what's your top worry? Oh, the top, that's, again, I think those that, that statistic from the community safety partnership about over 60s and domestic abuse, I worry about, as I say, you don't know what you don't know in this environment. So, I probably worry a bit about that. And then, probably, from the partnership's point of view, a lot of work being done from last year with continuing individuals with complex needs, where homelessness, drugs, abuse, etc., they come together. And, obviously, given my other role in the county, that transition from children, young people into adulthood, that would be, that would be, obviously, something I'm looking at. I want us to move forward on that joint exploitation strategy, old age exploitation strategy. Thank you, Kim. So, I think, so I've just made a comment in the chat. Yeah, can't see it there. Hilary. Look, I was just an email to you, Kim. Okay, thank you. Hilary. Do you want to share this? Yeah, no, all right. Yeah, good point. I've been saying that one of the, one of the issues around the timelances of report is that the National Data Sign Off takes, conveying takes through to November. So, that's a good point. So, but we'll look into that. I will let you know when, given that point from the moment, I'll let you know if that does impact on the time of the springing, the 23-24 report. Thank you. Hilary. Yeah, I just wanted to pick up on the question Jane said about the number of concerns. I think if you look at the graph at the bottom of page 17 of the report, the bigger question for me is the conversion from those concerns into actual inquiries, and then the, whether abuse is substantiated from those inquiries. I wouldn't want to stop people referring in concerns because actually that, that should be informing what we then do in terms of our awareness raising and potential work with voluntary sector and others, and talk community and others in terms of how we address some of those concerns, because they may not reach the threshold for safeguarding, but they're clearly the concerns that people have. So, I wouldn't, it's always a balance, isn't it? I wouldn't necessarily want to see that number reduce. I do want to keep an eye on that conversion between concern and inquiry, and then what's substantiated, but I think we can gather a lot of intelligence from those concerns, whether we have historically done that sufficiently, I'm not sure, but I think there's a lot of really good intelligence there that we should be gleaning, that is, as I say, doesn't necessarily meet that threshold for safeguarding inquiry, but there's still things there that we should be aware of and responding to in a partnership way. And can I say, another thing we've done recently, we have had a session with the group that are putting together this self-assessment, and I have to say one of the things we're trying to do, and whoever is trying to do, is capture really good examples of partnership working, and really good examples of the community working to help safeguard athletes, and I won't let you tell her, but there are some, I think, you know, about people in villages, people in post offices who've made this their business to look after a vulnerable couple, for example, and so on. I think there's a lot of good things being done through community, through communities, that you know, we sometimes don't spend enough time capturing that good stuff, and so we can actually celebrate some of the work that people do. Yeah, I would agree with you, Kevin, absolutely. Another question that I had was the evaluation of safe voice. Again, I think this is probably aimed at Christine, where you said it was not possible, as not being possible, due to the lack of service user participation. Can you elaborate on that a little bit? Yeah, so to get consent for us to follow up with the individuals who've been through a safeguarding process, we asked the safeguarding team when cases were closed to ask the individuals if they'd consent to be contacted about the experience, and basically not many people consented. So we maybe get one a month if that, which is not really that significant, and we can't do a lot more than that as an outside agency to know who are these people and to capture them at a time when they've come through the process when it happened. So I think there's probably more we could think about doing, but it would probably have to be done as part of the process within safeguarding the team that are doing the investigation. But then there's something about all the people going through the process, if it didn't meet a threshold, I don't know how we would capture any views on that. And I presume we don't know whether this is the same sort of problem across the country, really. I don't know, I'm not sure if Kevin would know. No. I suspect if you have hit this issue of consent, Christine, all the people have. But I can check in the next middle-end network meeting to ask whether this is a people issue. Yeah. The only other problem I was going to mention was that the training courses that you put on in the main have been really well attended. Again. Page 37, stroke 25. Yeah. Sorry, I've lost my, I'm sorry, I haven't got a split screen. Yeah, domestic abuse case, which was West Mercy Women's Aid. There was 107 people who attended that. And the trauma-informed practice, 164. And then you got fabricated in a Jewish deal in 167. I mean, they're quite big numbers. Yeah, they're good numbers, Jane. Yeah. A couple of them that, I think possibly we could have done, would have been nice to have more people there. But I think, you know, overall, it looks quite good. Yeah. Yeah. Anybody else? Because we have quite a lot of single agency training going on around safeguarding across the piece as well, which would be recorded by individual agencies. Right. I guess the question I will want to ask next year is given those numbers, what was the impact in terms of practice people's lived experience? I think that's that for me is always the question around when we do training and development. Does any, what changes as it made an impact? Certainly. And again, I know I'm going back on the brief, you know, my year as it were. But we did hear some really good stuff, which we'll report in next report on the impact of that work around homelessness and the way that the the teams have reviewed the way they're working. I think tickler note appointing getting a female member of the team has improved the engagement with when you find themselves homelessness or street sleeping. It's a really good work has come out of those projects that were a legacy from the last year's board work. Yeah. I agree with you. Absolutely. Does anybody else have any questions on the report? Right. Go back then. So the recommendation is that the health and wellbeing board considers the report and we now go to the vote. All those in favour? All those against? Any abstentions? Thank you. Thank you. Thank you for the conflict to be stressed here. You're virtual anyway. So you can't vote. Oh, there we go. If you're not there, you can't vote. I'll bear that in mind, sir. Thank you very much. Okay. Thank you. And thank you for your time to come. Item eight is the update to the board on the best start in life implementation plan and to present this map here. And I believe also Julia Stevens will support him with the Julian Young people in sexual health. Okay. Thank you, Chair. I'm only going to do a brief introduction. I'm going to hand over to Julia. So I think we last brought the draft implementation plans for our two priorities in December for mental health and for best start in life. So this is the first meeting where we're going to do a bit of a deep dive into the best start in life. And then it was agreed at the last meeting that every the next meeting will be mental health and alternate there therefore going forward. So it's really important, I think, to spend a bit of time on this because this is one of our health and wellbeing board priorities. So there are lots of papers in there, but it's split into four parts if you like. So I'll just give a brief overview and I said I hand over to Julia. The first is very much a summary paper, just detailing very much what I've just said. The second one is then about performance management framework. So a lot of this is common sense, but as you all know, the last health wellbeing strategy, we really wanted to make sure we put quite a robust kind of process in place for monitoring impact and implementation of the delivery plan. So that's really what the performance framework is all about, reporting by exception and highlighting to the board the key issues that we might need to address and unblock potentially a system leaders. There's then a covering note around the outcomes dashboard that we're still developing. So again, how we've identified the metrics, the key indicators in terms of monitoring that progress. And then the final report is about the outcomes dashboard itself, which again the board can use to monitor progress. So that's kind of the four areas of the report. I'm going to hand over to Julia to go into a bit more detail and then we're happy to take any questions. Okay, thank you Matt. Yeah, just to a brief overview for everybody, in a reminder, in case it might have slipped your mind, that the best start in life is a national program. So it's aimed at giving our children, not to five years, literally what it says on the tin, a best start in life. And working with partners across the spectrum with regards to making that happen in her effort year, we've got some really exciting developments which I'll talk about a bit later, operationally, which are really happening now in the community to make that really brings this plan to life. Whereas at the moment, you're looking at sort of paper versions and monitoring. I can give you a bit of flavor of what that really looks like in practice, which I think is really useful. So as Matt said, since December, when the paper was brought to you previously, between then and now, we have been working with various partners across the system to develop key targets against the actions. And I can safely say that we've got a selection of targets now, which we'll share with you at the next partnership board in September against the actions. And we've got lead professionals that are responsible for reporting on those targets. And I think we're 90% there now with regards to the targets and the lead professional that's going to be able to support delivery of and report that back to us, which obviously we will update you on. We've been developing a performance monitoring framework, which Matt mentioned with regards to how we're going to ensure that we're on track to deliver what we say we're going to deliver, how we're going to monitor it, and then the challenge or the pushback is to say, you know, where are we at with that? So what we've done is we're going to re-grate where we are at with our targets, Red Amber Green, very familiar, re-grating. And at the moment, we're already on some of those greens in regards to we're progressing really well with some of the targets that are already being rolled out or at least being implemented. So that's really positive. Some of the key things that I just want to bring to life, I think, from a plan which is on a page. But what does it look like in reality? So for example, a really exciting development is we've got our contracted provider of our North to 19 service, which is Y Valley Trust. They are going to be rolling out a four to six month oral health and weaning check for our youngsters. They did it as a pilot project a year or two ago, but we've developed that into the new service contract now. It forms part of this Best Art in Life implementation plan. And they are going to be doing that check universally to all our parents who have a baby for six months old. That's really about promoting oral health and weaning, healthy eating, etc. And equally, they're going to be rolling out a three year preschool check. So these are two additional health checks on top of the five mandated health checks that this service have done historically, that's really going to support the some of the outcomes for our children and people in order to give them the best start in life. So that's something very practically on the ground that we're going to be able to come back and feed back to you on how that's progressing. One of the other things is that we're developing a healthy schools and healthy talks framework. So that's going to be targeted at all our primary schools and all our high schools. So that's encouraging schools to be part of the framework, to be part of a Healthy School Initiative for Herrificia, really working to support schools, to support their pupils in health and well-being, tackling obesity, oral health, all sorts of things within that framework that they work towards and that we support them with and that again will link in with our public health nursing service that work very closely with schools and also really to support those pupils that really need and to support those schools that really need it because we know schools are suffering with regard to the support that they can get in tackling some of the problems that they have with their joining people's health and well-being. So that's another real example of a very practical project that's going to be rolled out. We're piloting five schools imminently in March and then in September we hope to offer it out to the broader school community and encourage take-up of that. So that's a really exciting and informative way that we can support our schools and our children and people. And just another thing to highlight, I obviously can't go through everything because we'd be here all day, so I've just picked out a few. The other one is that we're working with our special schools to take up supervised tooth brushing. So you might be aware that supervised tooth brushing was rolled out two years ago in Herifichia and I was told by many, many professionals that there was no way you were going to get schools and early years nurseries to take up supervised tooth brushing with the challenges that they already face with the work that they have to do for off-stead etc. And I can say that we have got 40 of our schools and earlier settings that now routinely do supervised tooth brushing with our children and some schools have come back to us and said can we roll this out across the whole school? So this is really a really good example of how public health have steered and encouraged and we know that this is an evidence-based practice that makes a difference. So although it's a long-term review, if you like, of how that makes a difference, we can't imminently say that a number of children won't have cavities etc. It is a long-term process, but we know that if children brush their teeth twice a day, that makes a significant impact on their health of their gums and their teeth etc. So the fact that our special schools who have added complications and obviously added health complexities with the Jordan, they want to take it up as well. That's really good news and also forms part of obviously the best art in life action plan. So those are a couple of really, I think, really, I think the word is real examples of some of the practical stuff that this plan is delivering on the ground. Anything you want to add? Just just on the outcomes dashboard, I think it's quite useful just to bring the board's attention to that, so I think that's when it's four I think it is. These are some of the key metrics we've tried to bring together nationally published data that we have available through the public health outcomes framework and other data sets, but also local indicators that we have and metrics that deliver against some of those actions is to kind of bring them all together and we try to be quite selective with the indicators as well, so what data is actually indicative of the outcome that's going to deliver. So some might be quite direct in terms of what we commission in terms of the visits etc. Some might be more complex requiring multiple partners to influence whether that's mental well-being, whether that's childhood, obesity, etc. So it's worth just casting our eyes over those. Some of those might take a little bit of time to change, so they're not going to change over a period of 12 months and we know that and it will take longer, but it's something we really need to keep a watching brief on. Some might change sooner, but I think it's a really useful kind of oversight if you like, of the entirety of the program and what we as a board can look at and keep track of. But nothing more for me. Yeah Julia thanks, that's really interesting, particularly the thing about supervised toothbrush in there. I'd like to ask what is it you think made the difference so people were skeptical about the possibility of rolling it out. I'd love to take some messages back across the other side of the border into Worcestershire and see if we can develop some of the learning there because obviously Children's Oral Health is one of the main ICS strategies that we've got for all children across here from Worcestershire. Thank you. Yeah actually Worcester have contacted us with regards to how are you doing it because there are challenges over there. I think one of the things is that we've got really good relationships with our schools and early as providers. Some of the some of the teams that work in public health that deliver this used to work in children's, so we've got contacts already so I think that helps. And I think the approach, I think schools and nurses very much think that it's a very time consuming activity on top of something that they're already doing and rolling out. Where when they realize that you don't necessarily have to have water involved you know they think that they're going to take 30 children to the toilets to brush their teeth and all the hand washing processes. Where in fact you don't have to you can sit round the table and you've been you know spitting to a paper towel and there's a whole process for doing it very quickly doesn't involve water. And I think once they once they realize that it doesn't take a long time it can be done very quickly very efficiently and it's just integrated in part of the school day or the nursery day then they will run with it and then of course word of mouth because parents absolutely love it. They like the fact that it's another selling point for the school or nursery that they are doing this and that has encouraged more children to come to their nursery because they're specifically doing that intervention. So I think it's a win-win but happy to have further conversations with you with regards to that. I mean I fully support it as the organization that's now responsible for dental commissioning. There's absolutely no substitute for prevention is there and good healthy teeth so we fully support you and like to work with you as much as we can to ensure that's successful. Can I just make one other comment as well? The framework as a whole I think it's really clear and it was fantastic to see the direct alignment to the integrated care strategy that we signed off last year. I was just going back through the plan on the page and all the kind of priorities that we've put down there and they're all there so we've got a really clear alignment and mechanism here for monitoring our 10-year long-term strategy as a system going forward. So just sort of endorse that and support that as well. Thank you. For all it's all I wanted to make. Firstly your enthusiasm is very infectious I think and I can't imagine anybody that's going to refuse you because you are such an enthusiastic person and I think that presentation to us was very very good and the way that you've explained how schools can do this without using water etc. I think it is really good. So thank you. Oral health for me has been a bit bugbear ever since I was in the camera of the council back in 2015 so I know that we've now it appears have got two new dental practices opening in April and just wondered if someone could tell me where they will be. I think I might have to pass over to Harpo to answer this question. Who's on the call? Hi thanks Julia. So we're still having those conversations where the locations will be. I think that data and that information is available now and chair so I can get that for you. I'm not sure on the exact exact location at the moment. If you could let me know I will be very grateful Thank you. Yes I will. Thank you. I think the way that this has been laid out with regards to the our priorities is very clear and I think easy to read for anybody and it's really been laid out really well. I'm very impressed with it as well. So thank you for that. I don't think there's any, I don't think just read is there. I don't think there is. No, no, no, no, no, yeah, not yet. So yeah I mean I think, well I mean if you look at the, to be fair, if you look at the dashboard obviously then we have got some recognised regarding dental and and when not doing so well on children overweight and vaccinations, MMR etc. And the number of children in care immunizations is, is not as good as it perhaps could be. Do we, what care pro to all we on this? So it's picked up by the corporate parenting board and there's a piece of work going on at the moment around immunizations and also dental health checks for children in care but certainly something that the corporate parenting board are very focused on at the moment. Going back to the MMR, I mean I know there was a question by a council regarding the measles issue in the meeting. We obviously have sort of certain groups of people that are hard to reach and what plans do we have to go out to them to get their children vaccinated rather than rely on them coming to us? Yes I think, I think there's various different programmes going on across the county to do that. So I know there's a bit of a national recall system at the moment so GP surgeries are being told kind of who they can actually send letters out. That's a good question in terms of the seldom heard and how we reach those in those rural communities. I think that's something probably I don't have the answer to unless David does but I know Rob might help consultation in public health, he'd probably have a bit more of an idea about how we're going about doing that. David are you familiar with? Yeah a little bit but not as much as perhaps should be but we've put a lot of emphasis across both counties into prevention outreach services as we call them where we're taking services out into the community and sort of I keep on to say talk well-being but is it talk well-being? It is, yeah so I get confused sometimes. The Maylord Centre opening for example the High Street, we've also got a van that goes around out into communities, goes to the agricultural market to engage with farming communities. You know we can take services out into communities and we do certainly do some vaccination work. I know we've been doing Covid vaccinations through outreach services so I don't know whether there's an opportunity. I believe that you did Covid vaccinations for sort of Romany people and I just wonder where you were doing the same for them with MMR. I would have to check specifically on MMR. It seems like an o-brainer to me that where we've got sites that we should be trying to access them and get them those children vaccinated. Yes indeed the complication which is there's always a complication on these things isn't there, is the governance and the medical legal arrangements around who's covered to vaccinate for what in certain environments. So general practices can vaccinate all sorts of people. We've got special arrangements for Covid vaccinations but I'm not sure about whether MMR and other similar vaccines are covered by the same arrangements because it's kind of a national, there's a national contract for some of these things so that I can't answer specifically I have to come back to you on that one. Yeah I'm pretty sure there's some work going on because I've raised this very point myself so what we can do is maybe note that as an action and we can bring that back to the board and confirm or follow up after. I'll just do that. I comment really rather than the question so when I was on leave when this came to the one ownership partnership so this has been my first opportunity. Yeah it's tricky. I was tricky, tricky now in the cold and so it's been my first opportunity to have a really good look at it and I understand I'm really impressed. I think it's come on such a long way. There's obviously a lot of planning, all of the actions and the targets that have been brought together. It's all really clear so really really well done and then just one point of detail in terms of particularly childhood obesity. Has that improved? So that figure for 22, 23 for 45 year old which is 19.4 because I thought the last time I looked at this data actually we were at if not higher than national average and we look like we are below. So has that already improved but it may be I'm just remembering some data. We've got it on the agenda as well but Kristen are you able to cover that specific point? Yeah so I think later on the agenda we have a presentation specifically looking at this but that's fine. Yeah so I think we're very much following the national trend so the trend has come down slightly and we are following that trend since Covid years so it does look on a dying word. Yeah it's just that the benchmark is you know we are I mean it's three percentage points but it's all worth having isn't it? Yeah I don't think we're statistically significantly higher which is what we were. I can't just add on that because I've looked at this previously when we did ICB board deep dive into health and qualities. The correlation between deprivation, deciles and childhood obesity is frankly, you know it's almost directly correlated isn't it? More deprived communities have more childhood obesity than less deprived communities and so that's a real another one of those kind of targeted intervention groups that we should be trying to work with. Yeah I think the interesting thing is that we have a lot of people who are going to be in the hospital and they're going to be in the hospital. so you can see the video. you [BLANK_AUDIO] [BLANKAUDIO] [BLANKAUDIO]

We do know adults, so don't we, we have the biggest for adults. Adult abuse is about 30% it'll take, and then adults overweight will be still nearing 70%, so it's quite significant numbers, yeah. [BLANK_AUDIO] So between 10 to 11, at 30%, and having it to adults, we'll double that again. Yeah, so reception to year six, nationally, we always see a doubling preference for obesity, and then adults, it's about 30% in year six, isn't it? What we've got in front of us, so yes, a bit more when adults, it goes up. But the biggest, I mean, at the end of the day, prevention, that's why the best starting life is actually really important if we can get the nought to five years right. Then obviously we prevent those in reception year from becoming overweight or obese, so it's really important we get that right to begin with. And then clearly something's happening between the ages of 45 and 10 to 11. And it's not just schools, and I don't want it to come across as it is schools, actually it's why there's a societal problem here that we need to address. But clearly it's something that we will probably see over the coming years. Some of these children moving to adult herd, early diagnosis of type 2 diabetes and those kind of things, so it's something we really need to get on top on, both locally and nationally. So, not, it's not those facilities, but the health services, you know, are they prepared, are they prepared? On sort of type 2 diabetes, it's coming their way, or has come their way. And all the associated issues around part problems, et cetera, et cetera. As a result of this increasingly large number of people who are getting larger and larger. Jane, what a matter to this, are we prepared, I would probably say we are preparing, we are sighted on it, we do a lot of work, a CVD is going to be a cardiovascular disease. Prevention is going to be a big focus this year, doing a lot of work on kind of free diabetes, trying to identify patients, part of the national obesity kind of reduction program. Could we do more, yes, absolutely. We could do more collectively as a health system and, you know, wider partners. But we recognize it's a major problem, and it's a big part of our long term planning. Yeah, I'm going to say, I mean, if it carries on at the rate that it's at, then there's no doubt that we won't be prepared for it. We won't be able to either fund or have the workforce to deal with that level of demand. But that's why the prevention agenda here is so really, so really important. I can just give the example of firms, that lots of people know John Bonette, and he won't mind me telling the story who's our communications manager. But he was a man who was in type 2 diabetes, and took up running. And he's now fit and healthy, his diabetes reversed. And these things are possible in secondary prevention as well as primary prevention. So it's why that prevention agenda is so important. And that's a trust. Do you ever do a sort of an audit on the people that are coming through your door, as in patients, as to what percentage of them, their issues are related to their diet or. I mean, causality is quite difficult to prove in every way, isn't it? But we certainly have coded information on the number of people who are diabetic, the number of people who are morbidly obese, so we have coded information on that. Any other questions? No? Okay, we move to the report then, we move to the vote then. All those in favor, any against and the abstentions? Okay, we move on to item 9, which is the Better Care Fund, quarter two, quarter three reports. And to present this item, we've got Maria Galaga, transformation improvement lead for community wellbeing, who is attending remotely, yeah. And Haley Doyle, service director, all age commissioning, also attending remotely. And we're over to Maria. Hi, yeah, how do you hate this issue? Yeah, I'm going to start if that's okay. Okay. And then we'll also bring in each of you, and quickly see if that's okay. That's fine. So if it was careful. Yeah. So you will be aware that the National Better Care Fund team determined the national reporting requirements forward better care fund, and this year, the 23, 24 year, there was no requirement to provide a court one report and put the deadlines and the dates for submission were set by the national team as Monday to deadlines. So the quarter two, quarter three reports have already been approved by the director of community wellbeing, Hilary, and the accountable officer within heritage and Worcester Icy Bay. So that we're able to submit in accordance with the national deadlines. So today is really an opportunity for the board to note the contents of the report and identify any further actions that you wish the team to consider to improve performance and feedback towards on those reports. So the templates that you will see at Pendix 1 and 2, they are national templates that require us to complete in those formats in line with the best careful and national conditions. So the quarter two report this time focuses on a summary of changes around demand and capacity plans and also gives some updates against the metrics and quarter three collects the information against the metrics and our ambitions as well as an update on our spend. So the data is set out and key elements set out within within the report and in relation to our performance on a number of the metrics, but there are some key things that really wanted to highlight for the discussion today. So we are, as a system undertaking a considerable amount of work against all of the better care fund schemes, but some of the key things to highlight the focus remains on being able to support people at home and to be at home for longer with avoiding either hospital missions or avoiding the need for longer term care. So we continue to work on this area and you may remember that we noted in our last presentation to help them well be involved at the Council weren't barking on work around further developing their secondary framework for home care and pleased to say that over the last two quarters we've seen significant movement in relation to our home care market. We've increased capacity with new entrants new providers to that home care and framework and we've seen the waiting list now reduced to just seven people as of last week. So that's from a position in the middle of last year where we had over a hundred people on the waiting list, so that's been a really positive move. What that means in terms of the system is that we are able to meet need quicker and respond quicker, but that should start to enable further flow through the system and we'll just at the point where we're hoping to see those changes come through. That also helps us with our position in relation to overstays within home first and moving those overstays onto their longer-term packages of care. So that's been a significant change since we last attended health and wellbeing board. Within that though we are seeing an increased acuity, so we know that some of the people that are coming through for home care are requiring a high number of hours than in previous trends. So we are seeing increased acuity and complexity coming through that process in terms of delivering more hours to fewer people in some cases because of the increased complexity, so that trend is continuing. We have also been working across the system with our ICB colleagues around our discharge to assess services and you will note from the data that we are still on a journey with our re-ablement services in terms of driving improvements and ensuring that people remain at home 91 days after discharging to re-ablement or rehabilitation. So we're still on an improvement journey with that, but we are as a system as we've been having something called a discharge to assess sprint, which is where we've initiated a significant program of work to address the challenges that we've seen through our discharge to assess services. That is including a complete review of all of our pathways. It includes with working with hospital teams from winter discharge, occupational therapists, teams, our re-ablement offer and the pathways through the community access team in service and then a review of our home first and hillside services, commonly delivered by Hooper. We have had an increase in commissioning capacity to work very closely with Hooper to try and make some of those changes and work very much alongside Hooper and our ICS colleagues in the redesign of service specifications for both homes first and hillside. That work is continuing at present and will be reporting into the discharge to assess board from next week. We also have a system as a system, I've identified that there continues to be issues with the data and how we record data and how we get a real accurate picture of our discharge to assess data and we are now appointing a data specialist that will be hosted by Taurus and have a first draft of what we need to include in a discharge to assess dashboard, which will enable us to better track services, et cetera going forward and that work is ongoing. We have worked closely with Hooper about improving the capacity in home first and Hooper have reviewed a number of their processes and functions and we should seek capacity in the home first service to start to increase from next week following a number of changes and consultation with staff teams delivering the re-ablement service via home first. So that work continues with us working together both as character partners and across the ICS for printed and looked at those changes. So significant amount of work underway but still some areas that we need to address and improve to be on track to meet our end of year targets and we'll be updating you at the end of year in relation to those targets that are not currently on track as we move forward. We do see that the Better Care Fund represents significant investment in our core services and we continue to work together to make sure we have a joint approach to our re-ablement particularly and maximising that re-ablement capacity. The Better Care Fund partnership group has been re-established and is meeting regularly that now we'll report directly into the Integrated Care Executive and then upwards to one-hair of the trip forum in relation to our governance and performance monitoring going forward. So some real positive changes since last time came to board but still some improvements to make around our re-ablement offer. I'll hand over to Adrian to talk about our finances and relations of Better Care Fund. Thanks, Haley. There's not a great deal to say about finances up to the end of quarter three in respect to BCF services, you'll see from the summary table in the report that the five pools that make up the Better Care Fund are very close to breakeven running a slight less than half of per cent underspend up to the end of December. The position has worsened a little bit over the last couple of months as you might expect some of the services are demand driven and those are busy months but I think the final year report will show that it out turns on or very close to plan again and there aren't. There are some pressures on pool budgets that are outside of the Better Care Fund specifically but again we're working to mitigate those pressures and I don't think we'll be far away from the end of the financial year. Other than that, there's not a lot to say other than going forward 2024/25 won't require a full Better Care Fund plan. The current plan we're reporting on here is the first year of a two year plan but there is a need for a refresh of the plan and in particular the financial plan. We haven't yet had the policy framework or planning guidance or requirements from Department of Health for that but I sit on a kind of national forum for Better Care Fund where we meet regularly with Department of Health colleagues and as part of that I had a request last week for us to participate in testing the templates both for the year end reporting and for the plan refresh and usually when those requests come out it suggests that the planning guidance isn't far behind so we may get it by the end of the month which will mean that we'll then be doing year end and year end report and next year's plan refresh all in the same timeframe which is less than ideal but as those of you that have done this for a while will be well aware that the planning guidance tends to come out any time between March and September so earlier is better because we're actually setting a plan towards the start of the financial year we're actually talking about so it may well be at the next meeting or probably more likely at the end of the summer we will be back not only with the year end report but this year's refresh plan as well. So just one of the other areas to know which is referenced in the report is that in terms of our longer term care for residential and nursing care and we are working with the market to look at and this was a cabinet decision at the end of February to look at lock or correct arrangements for our longer term residential and nursing care beds going forward primarily the reason around this is that we do have capacity in the market in terms of sourcing longer term care but we remain having challenges around the affordability of that care so this will move to an additional arm to our commission in terms of block book derangements as well as the framework arrangements for spot purchase and to support the overall system. A general question to Jay really when someone comes in we're talking about discharge to assess right when it's all comes in to hospital whether it be as a planned admission for a not or whatever or as an emergency at what stage do you determine the level of taking very long that it's probably a fairly straightforward process what level what stage do you determine the decision to understand what will be required and that person is discharged? In a way the principle of discharge to assess is you don't do that in the hospital you do that as a later stage so you discharge with support and then during those few weeks of support you then determine what the long term care requirements of that individual are so so yes of course we have to do some work to make it to make the discharge safe but in terms of what those long term care requirements are and that's something that's discharged to assess is what it says on patently you're discharging them to assess them for their long for their long term leads if that makes sense so what about someone that's saying for example it's a short so if so for example someone that's gone in with a hip replacement if you like so he's going to require some form of support in the short term because they may either have somebody at home that isn't capable of doing so or they may be alone or they may have stairs or they may have difficulty getting there from the house when would you when when would you make that assessment and pass that information on to adult social care that this is what is required for this person work is elective care and it should be as part of their their planning process particularly something like a hip replacement you'll do a lot of that work up up front to be at pre-ops stage yeah it would be would be up and then obviously you have to then you know make sure things are as you expect them to be at the at the point of discharge and we believe that that happens now I wouldn't say completely consistently but that's the that's the approach because that would obviously would help if it did wouldn't it because then in theory adult social care would have in place what is required once that person is ready to be discharged so you're not having that person staying in a bed just waiting for um that package we put in place which might be for sure for a planned elective care I mean the approach is that's all done up front I mean the complexity we have is with those generally who've come in as an emergency so there hasn't been an expectation that they've come in and those the patients who tend to get more stuck in the system the sorts of things that Haynes was just talking about thank you thank you thank you so so first of all thank you Hayley for that broader context that you gave as you as you presented because there's a lot of that there isn't sort of quite in the in the in the paperwork and I know how much work's been done and how much progress you've made so so thank you for that I think it's it's really positive and it's really encouraging particularly the things around the home care market I mean that's significantly different you should say to where we were where we were last year um I think um I guess the the comments I'd make though would be um because you've you talk quite a lot Hayley about doing things with the ICS and I think when you said doing things the ICS really what you mean is that we're doing this as partners in Herifordshire because this is something that's been delegated from the ICB to us so I think it's just it's just a terminology question and for and for me it's about what do we think will be different in 12 months time so I think it's all the work that we're doing that you and John and Hillary are leading on that that that we understand so in 12 months time what do we think is going to be different from where we are now which which includes all of those things that you talked about but also what are the metrics that we're going to be measuring because what we are reporting here are the national ones and I think Adrian's made the point a number of times they're actually not particularly helpful in many ways these metrics they've been around for a very long time they you know they aren't telling you everything that we need to know about the outcomes we're getting from the investment in the in the better care and and the value for money that we're getting from from those pathways so so I think why I would really like to see as part of that report that comes back I'm not sure I agree with you Adrian actually when you sort of said it's not ideal doing you know closing down this year and next year planning together I think that's exactly what we want to do is we understand this year and we and we do next year's plan so I think I think what would be really good to see is is that broader plan with a broader set of metrics that we say we are going to reporting those through into into our into our heritage year integrated care executive and and one heritage partnership and that would be good to see those reflected here so it's it's a broader set of things than just the national indicators because I think they are they're not adequate for our purpose particularly in terms of say outcomes and and value for money and general systems really yeah that's that's why I'd like to recommend. Thanks Jane yes so the data analyst that will be hosted by Charles will be leading on those wider metrics in terms of what we've been pulled on so as I said this initial draft around what that dashboard needs to look like but we can bring that back here as well as it's about yeah so yeah I'd like to specifically request that we also apply health inequalities lens to the dashboards as well so we don't just look at global population numbers we look at the different elements of health care inequalities whether that's deprivation whether that's ethnicity whether that's any other group people have got underlying health conditions learning disabilities housing issues except we have a proper look through a health inequalities lens so we understand exactly where we'll have the biggest bang for our buck if you like on the interventions in response to what the data is telling us. Can I just add the are the voluntary community sector helping deliver this plan in any context? So don't currently have a commission service through better care fund delivering specifically on the discharge to assess services but we work closely with the talk community through all of the various options there and the voluntary community sector are very much linked into our prevention offer community activities etc in the communities. Would there be potential for them to be more engaged or better positioned to support help? Definitely that's something we can explore how we do that yeah. It's just organizations like AGK would work in this space as well and offer a wider services that they do as part of their day job and I think some of the offer is sometimes underappreciated and not necessarily valued because it's not directly delivering a certain funding stream but the wraparound services I mean I know they've been involved in getting people home from discharge and actually supporting them really integrate back at home so I think there's more here from the voluntary sector. I know you're reporting against a very specific template and there's not necessarily a room to recognize the role of the voluntary sector within quite prescriptive templates but there's definitely a role and there's definitely added value here from the broader sector that isn't necessarily captured in this report. Thank you I would agree with you I think I think that the templates very narrow that doesn't help doesn't give the full picture. I think there is much more we should be doing in terms of how all of the different partners and organizations come together and support in this space beyond just those services that are commissioned because actually as you've rightly said there's lots of people doing lots of work here and communities do lots of work and it's how we pull that together and describe it in a better way I think because we tend to focus on either the statutory services or the services that we commission as she is a much broader remit of organizations that we need to recognise them and harness frankly and and also there will be organizations which you wouldn't immediately think could support in this in this area that we also need to work with so I take on board I think it's something that we need to be much better at doing. Just add to that not regarding the better care fund but when we were setting up the rough sleeper accommodation and we obviously went to a number of voluntary organizations to support us in that occasion and following the setting up of that I wrote to each of those organizations thanking them for their contribution and a lot of responses that I got back was we were really pleased to do this and we would really like the opportunity to be asked more often and I and I fed that back to Hilary and said you know we sort of all we tend to go to the ones we always go to and we don't think about the others that we do it we did on that occasion but we hadn't perhaps in the past and they were really keen to help us so I think you're absolutely right we then there is no there is scope out there within the voluntary sector with work that they're already doing but work that they're prepared to do that we just don't pick up on and we need to do that so thank you for raising that and you can put that in as a recommendation as well what recommendations have we got Henry right so I've noted down that a interventions dashboard to be brought back to the board as an item with a focus on health inequalities is proposed by David yeah I'm not quite sure it's an interventions dashboard I think it's a it's a broader set of metrics on top of the nationally required ones and I think those those will be defined by the working group that's working on it and they'll bring back their recommendations for how we which metrics we use to make sure so we're getting good outcomes and good value for money thank you that's great and was really anything else anybody else note any other recommendations that were there right then that's a recommendation all those in favor of that recommendation along with the report thank you anybody against any abstentions so we now move on to item 10 which is the most appropriate agency and Sue Harris director of strategy and partnerships of her she was to health and care trust representing the trust remotely will present the report thank you so yeah no problem and I will invite Helen in as well afterwards if that's okay the police perspective it's a very short paper but I know that this was discussed some months ago by the board so it was really just to give you some assurance on how actually some of this is translating and in delivery of frontline services and some of the learning that we've undertaken together so what the paper covers is the fact that we've got in her future the inter-agency monitoring group and that brings colleagues together as a really great opportunity then to look at the MAA impact and actually use case studies to explore whether we think there are gaps what we could be doing differently our protocols being followed etc so it's very well attended and always is and you will see it's a broader meeting than just the health and care trust in the police it's got the ambulance service learning and development reps and mind so bringing together that whole piece around the way in which we are delivering mental health care across the county so from an NHS point of view this is not a policy that is causing us huge amounts of concern we have now found ways where if it's actually in in real time so out there on the front line if there was a concern either way that the the organization does need to call out the police we have escalation points and these inactive very quickly and then we got the appropriate response most of the time and then we reflect on those particular issues as they occur to think do we need to change any of our processes and structures so for two organizations I think this is working well operational colleagues say that we're still learning and testing and heading your views and that would be appreciated but you'll see as well there's actually a review last week obviously that's too early for us to abort anything concrete through to the board this time but why would you expect the findings to come through and provide that assurance that I've obviously wanted to give you to verbally and I think for most of us think we it is about learning when we are increasing and escalating risks that we're doing that in the most appropriate way and actually I think we have examples where when historically we have done that in the NHS when actually the public should have been an NHS response earlier or we should have done more before being in the police so I think there's and obviously the police have reflected the same way back that they've often gone out to things that really they're not well placed to respond to either so we're getting under the bonnet of it we've got real time monitoring and risk management and then we've got the review that will formally look across all of the pathways because this isn't just mental health it could be any mental health presentation so equally out there with adult social care and white value trustworthy for example so hello Nadib if you wanted to come in yeah thanks so to be honest that's a really comprehensive update of where we are there's not a huge amount that I can add just so that for everybody's aware most appropriate agency was implemented by West Mercia in April of last year following a successful implementation of a similar model in Humberside and in very brief summary it is all about the police not deploying two incidents where we have no statute for duty so it doesn't just include health mental health related stuff it includes things like I don't know road closures for potholes you know so it's a really broad policy subsequent to that obviously the national right care right person policies has come in and effectively that underpins all of the all of the approaches that we're seeking to take through most appropriate agency like Sue said we've got an escalation process in place all of the people across the relevant agencies locally briefed you know quite some time ago now in relation to the implementation in the early stages and we've worked through improving the way that we work together through that escalation. Sue's right has been learning on both sides of both sides that makes it sound adversarial doesn't it but it's been learning by all agencies involved they will no doubt continue to be to be learning but from my perspective that that review and escalation process works effectively. The reviewers were in last week that review is being led from the police perspective by my colleague and detective superintendent Leanne Lowe I don't know what the timescales are for the conclusion of that review but if there's a requirement to come back and brief health and lobbying board once we have that information then either she or I will be happy to do so. Any questions? No? Well thank you very much for both of you for the update and we look forward to the results of the review. Therefore basically we are noting the update and just voting that we support we don't update all those in favor and that's it thank you very much thank you we now move on to any other business and we've got two items the first one is from Harper which is a verbal update on oral health which we've covered really universally earlier on but that doesn't stop you Harper from having your say on the matter thank you. Thank you Chad. I think that there's not a whole item top of the notes that have been shared. One was a reply to the relationship between oral health and childhood obesity that was brought up and brought a couple and about two boards ago and the report there kind of shares there is an association between oral health and childhood obesity but the causation and data isn't quite there at the moment there is stronger evidence between adult obesity and poor oral health but childhood obesity the date is not quite there at the moment but there is some form of association found with the literature and should I pause there before I run to the second bit. Anybody want to ask any questions up to now? No? Okay carry on Harper. And the second question that was I think asked by yourself chair was around fluoride varnishing and whether that's offered by dental practices and I took this back to the oral health improvement board and we had a lengthy discussion around fluoride varnishing and so for those that aren't where fluoride varnishing can be applied to both baby teeth and adulty by dentists but the process involves the varnish having quite high levels of fluoride on the surface and that can be put and that can be put in teeth twice a year and that prevents decay and the recommendation is at the moment it's quite strongly recommended for children adults who are at high risk of tooth decay and in friendship we've asked when asked a local health or health improvement board and it was recognized that more can be done to publicize and fluoride varnishing and at the moment we're a little bit unaware of how much fluoride varnishing is being offered so one of the actions that was taken from the board is to start looking at that data and that data is supplied by the NHS Business Services Authority BSA and at the next oral health improvement board we're going to see how many dental practices are essentially claiming for that service so we can see how many fluoride varnishing services have been applied in her aperture and from there that will feed into part of the plan on how we can publicize this a bit more across the county. All right thank you anybody got any questions? All right we're now there move on to Kristen to give snap plate on childhood obesity which to a degree we also covered in the wrong place. Thank you and yes there's a short couple of slides attached to this agenda item so this is in response to a question raised at a previous board meeting and I'll just run over a couple of points so the latest data for 2022-23 indicates that in her aperture 19% of children in reception were overweight or obese rising to 35% in year six and we can see there's a long-standing pattern of obesity doubling during primary school as indicated there and slide three just shows the impact of deprivation on weight whilst there's little correlation in year six in our local data there's a more noticeable link with the year six data and that's in line with the national trend and slide five and her aperture proportion of overweight and very overweight or obese children has followed the English trend with a peak scene in 2021 data and then a slight downward trend in the last year's data. I'm happy to take any questions. I've just got one question which is probably very parochial really because it's my ward or part of it is my ward on your slide which shows 18 reception children as children measures been. Essentially the reception class children who are overweight are very overweight. Mortemaw ward which is up in the top left hand corner is showing I think at 23.3 to 34.8% but then when you get to year six it's down it's the bottom. So is that saying that suddenly from reception they've gone from being very overweight to year six they become below the right at the very bottom of being of overweight? No what it is saying is that a higher proportion of reception year children are overweight and very overweight in that area but in year six there's a lower percentage they become thinner. No there are... It's the same time period isn't it? It's very old isn't it? I looked at the others and well actually there's a couple that bromiards has also changed but most of the others are fairly very much to say oh no they're not actually. They are all quite changeable. I've got to get on to my people in Mortemaw ward with overweight reception class children. Particularly with our data and heritage it is quite changeable you will notice looking at maps like that yeah they are very changeable and you see the other thing about it is that Mortemaw ward is not a particularly deprived area either. No but if you look at slide seven so that's our three years pooled data you will notice that our some of our more deprived areas are highlighted there in both maps. Can I come in here? Yeah I mean with her literature talking quite small numbers there's a lot of air ability. I think the key message is that for quite a significant proportion children who are overweight and very overweight I don't know I'd like to use a word of beef because it creates stigma. I thought the slide on deprivation is quite worrying when actually one in two children year six and I'm most deprived ward overweight or very overweight you know compared to one in four with the most affluent ward so I think that is quite worrying. On a positive and I published research in this area we know that actually about 16% of children who are obese at reception year actually go to a healthy weight at year six so it changes possible only for a small minority of children but there are some opportunities there so some real challenges but some already fantastic work going on across the county I think and obviously this data it's a real world-class you know database in terms of how we can kind of target our support talking about healthy schools earlier. Let's try and focus on those areas where we know there might be substantial challenges yeah numbers are small so David oh sorry I'm happy to go after Jane but yeah I mean I was looking at that same that same chart the 51% under 26% and the fact there's very very little difference at reception class. Do we know why that difference is is there any evidence out there that says what might explain that position and therefore what we could do about it between the ages of kind of you know five years old and in the end of my life in terms of the gaps between affluency and deprivation of reception yeah so why it's pretty flat so they get to school and there there's no significant variation by deprivation when they leave school it's a it's doubled I'm just trying to understand it yeah I don't know obviously as children get a little bit older there's more autonomy in their food choices and whether families you know with less income although it might be more staple diets between ages kind of 0 to 5 but between 6 to 11 children become a bit more demanding and peer pressure and all kind of stuff it's not I don't have a straight answer being quite honest but I think it's quite it's complicated but yeah that's something we can look into unless anyone else has any ideas no because it is complicated because my ward is not it's not an area of deprivation and yet at reception for years they are overweight and then by year six they are not and then conversely you've got a section of bromiard where which again I wouldn't accept was a significant area of deputation where they are not particularly overweight when they enter reception but they are more overweight at year six so it's the other way around and I mean there are certain areas where it doesn't matter which age you look at there's a problem but there are certain anomalies in in other parts of the county and I wonder whether in some of the more rural parts of the county which is where I represent where the part of it is is the morality of it and the fact that the farming community tend to be a sort of they they they're hearty eaters I mean they are they are hearty eaters really what I was thinking is it raises the question about whether there is an issue about independent access to unhealthy foods for so much of a certain age you know is it easier in some parts of the county to access unhealthy you know fast food process food than in other parts of the county and therefore whether that affects it but I'm still I guess the issue about just taking deprivation and isolation is that IMD 1 and 2 can be dotted around all over the county they're not necessarily focused in one area so you're right I mean it's more complicated we're not going to solve it this afternoon are we but I think you know there's 150 determinants of obesity you know it's complex issue so kind of saying it's one of those 150 that calls and so that is really difficult and let's not say it's you know insurmountable but I guess it's you know maybe there is something about some insight work in some of these areas to really understand the challenges are there themes coming out in some areas compared to other parts of the county you know that could be a piece of work I mean if you look at if you look at the my husband Harvey I would discuss about this when we were on our holidays if you if you look at the the market towns and the cities across the country you if you want to have a takeaway at 11 o'clock at night or whatever you don't even have to get out of your house and drive your car or walk to the takeaway you can just pick up the phone and it's delivered to you so it's even less exercise now than there was when you had to actually go to the takeaway to actually buy your food and stand and wait for it to be cooked whereas in the rural areas of herifice here that facility is not available um yeah it just isn't available so that is an instance where certainly market towns and and city the city there will be much greater access to fast food at any any hour of the day than there is in the rural areas Jane um in terms of uptake of um the opportunity to be weighed at school is there any difference by area of the numbers who are refusing I don't know I'm looking at actually the numbers the numbers who are refusing to be weighed I understand that's an increasing problem but I am but I don't know I think we're really lucky locally our uptake has been really high for quite a number of years even during the covid period where we were only required to measure a really low number I think it was 25% we managed 75% so our uptake figures are really good it's usually around 98% super that's that's really good so we we've got the we've got the right measurement and unequal I was just fascinated by this slide on um the reception there's no difference between deprivation and then you say five years later um there really is I mean that that just I think you said Matt you know we used to do some more work around that because we must be able to do something in those you know in um in one and two to make that look more like four and five if we understand what the if we can understand what the drivers are about why it's it's so different then yeah I mean there's so much research been done there and everyone's struggling with the whole problem this isn't just isolated to her that's not so we can't do anything about it I think you know that you know the evidence now it's whole system approaches it's kind of multiple different things focusing on it right in obesity um but it's trying to focus on what are those key things not to focus on so you know that's something we need to work together as a board if that's something we're really concerned about we've got notifies as our you know one of our priorities that's probably where we should focus our attention in the first instance plus not to say lots of other things we can do and also there's bigger things wider partners transport infrastructure economy schools you know all these kind of opportunities can help with this it's how we kind of leverage that support. Anybody else got any questions? Yes just to just to mention the the Healthy Tots program which is aimed at our earliest nurseries when we think that 9% of our 3 and 4 year olds are accessing the 15 hours pre-child care the universal 15 hours pre-child care in nurseries the Healthy Tots program is a real opportunity where we can dictate the criteria within the framework so we can for a nursery who's going to sign up and work through that framework we're in a position where we can really steer their healthy eating policies there's no guidance in earliest nurseries around food there is in schools there isn't in nurseries so we can really kind of don't like to use the word dictate because you want to bring people along with you but we I think we were in a position where we can really influence the menus in nurseries you know just saying that they don't have squash or you know they don't have biscuits a break time and they limit you know thirsty cakes and things like that the people bring in for children but by being part of the program we we can really support the nurseries because that's one thing that we do hear a lot from nurseries is that you know they don't have control over what the children bring in their lunchbox they might have a policy but the parents obviously don't always listen to it or stick to it or they do their own thing and offer that involves crisps and chocolate bars and fizzy drinks and all sorts of things so so there's a real hope that by implementing the healthy tops program and working with those settings we can really drive best practice any eradicate in some cases fizzy drinks and squashes and chocolate bars and whatever in those establishments and you know and a large portion of our three four four-year-olds are accessing those provisions that's all thank you anybody else Steve probably worth the discussion outside the meeting but we're piloting something in Worcestershire called off to an active start and happy to have a conversation with you about what that actually is that ties in with that sorry just taking the V6 have to offer my day job hat on basically fine fine Hillary did you want to say something no no anybody else no okay so we moved into the um we can't vote on this because it's under any of this this because so we just note to the reports okay and then we move to the work program so we've had we've got the work program in front of us um the June money is pretty full in fact it's very full do we think all of these items are going to actually come to the June program um it's hard to say because some papers and some reports have to be deferred for their particular reasons some are withdrawn naturally but yes June is looking pretty full yeah can I say Chad I don't think the child death over you panel reports going to be coming any more I think that's going to be going to the safeguarding board I think that's been agreed now if we're all comfortable with that so that would take one off I know the orders of strategy is coming so it is a fairly full it is a fairly full meeting so perhaps we could make a plea that the reports are as concise as possible that's all we can do really um if we move back to the third of May private development session had a number of suggestions haven't we yeah it's just worth noting on that second page there are potential ideas for the development sessions that are listed there and so brought to this board meeting for the members to consider so does anybody have a a burning desire for any one of those items to be considered first one with the dress navy um yeah I don't think that's going to be ready towards the end of this year so I think I'll probably have to roll that one out for the next one but we could do that in the future okay yeah yes um prevention has come up a lot um not just this meeting but previous meetings so perhaps a focus on prevention and a previous year as a broad brush that sounds fine so fine Christine I don't um disagree but uh I was thinking that that would make sense alongside the community paradigm and I would have preferred that to come slightly later when we've got the program manager for the paradigm in place right but happy to take them separately if you think that would be better David there's a third complication I'd like to introduce into this thought process as well is that often whilst they're not directly aligned there's quite a strong link between prevention and health inequalities in that yeah if we focus our prevention in the right way as a big impact on health inequalities so having them as separate items might be a more complex one so maybe if it was kind of community paradigm prevention and health inequalities as a themed intervention themed approach then that might make sense but not on the third of May no does anybody have any it sounds like a number of those things need to come a little bit later I mean it depends on availability of staff but people understand in shipping that stands as hospital mortality indices and some of the other mortality indices I think that nature is already there and available and we'll and we'll and we work on it so if if she's old and Chris Beaumont and others are available then we could certainly do that and just give people a broader understanding that would be that perhaps we could be the first one as a start and see how we go from there yeah I've also had an email from the food alliance which Matt and I were discussed about and I don't know whether you want to some say screws them into the health and well-being board meetings or whether we would put them into one of these workshop sessions yeah I'm just trying to catch up now so in turn are we suggesting mortality for the development session that we've done some work on excess mortality we could bring in terms of what that data is telling us it needs a bit more work but I think we'd probably be ready by May is that we're saying that we're saying that ahead of prevention and community power because they're not going to state it's a good thing to speak at that time I just a question what is heritage a local plant is that the county plant or are they different plans but no let's see that's what would be the plan for development across heritage here going forward to 2041 which will replace the present. Daddy of all plans yeah and I don't think that's that's not going to be ready to be considered for May the third yeah it's just that fit with the wider determinants piece do they fit together with the wider determinants yeah just on that point it might be worth just to be visiting the timescale for the local plants I think the board would probably want engagement throughout the development of the local plan would be my advice so we can actually influence what goes in it from a health perspective so we probably we find out what that date is Christine I didn't answer your point share about the food alliance so I'll leave it up to the board that was previously a priority for the board food and sustainable food whether the board feel they want to spend a session on that whether the board of development you know I'll leave it up to others well if we if we start off with the the um mortality one which is because that's the first one with with sort of trialed if you like see how that one goes and then we look just at that one or the next meeting to see what then has come forward because the local plan probably will have been a lot further forward by then prevention and community paradigm will be later this year yeah okay yeah okay baby can I just check we're talking about Friday the afternoon of Friday the third of May for development that's the date that would be that's been suggested yes there has been some queries about that as to whether that's too close to the bank holiday because it is a beginning of the bank all weekend I was thinking more just Friday afternoons and not the best time for development sessions from my experience if it's involving a yeah so in terms of finding people's availability Friday the third of May was the best date for the vast majority of people any earlier than that and it was starting to be quite hairy you know I can revisit the dates but Friday the third was the soonest date that worked for the vast majority of people so they out all the Friday are they well no I don't think they are enough to check but I don't think they are no I was I was aiming for dates that were most beneficial for most people accepting of course people's availability close to the time may be not there yeah I think the the issue with it was raised regarding the third of May was the fact that it was near the bank holiday and that some people might be going away because of the bank holiday um I don't think at the time anybody raised it as an issue because it was a Friday um the July one is it is the July one is a Wednesday yeah they're all different days so I think it's just unfortunate that that was the only date really in May that we could could do it's always tricky isn't it I'm not going to just look at it but it was it was okay but it's not now yeah that was the problem with scheduling these development sessions it was difficult to pinpoint dates where it was you know the best outcome for everyone but again I can repeat I can look through the dates again you know we we could issue a poll that could do it all poll for um April well ideally May and see what the best possible date is okay yep okay yeah right so that's it then so the date of the next meeting is the 10th of June um I formally closed the meeting um