Agenda and minutes

Andrea Brown stepping down, replacement to be confirmed (Nottingham and Nottinghamshire CCG)

Hazel Johnson to be replaced by Julie Hankin (Nottinghamshire Healthcare Trust)

Gill Moy to be replaced by Richard Holland (Nottingham City Homes)

RESOLVED to note the following membership changes:

·  Andrea Brown stepping down, replacement to be confirmed (Nottingham and Nottinghamshire CCG)

·  Hazel Johnson replaced by Julie Hankin (Nottinghamshire Healthcare Trust)

·  Gill Moy replaced by Richard Holland (Nottingham City Homes)

Andrea Brown

Sarah Collis (sent substitute)

Helene Denness

Julie Hankin

Jane Todd (sent substitute)

Alison Wynne (sent substitute)

None.

Meeting held 24/07/2019, for confirmation

The minutes were agreed as a correct record and signed by the Chair.

Report of the Director of Public Health

Dr Shade Agboola, Public Health Consultant Nottingham City Council, and Annie Tasker, Screening & Immunisation Manager NHS England, presented information on plans and initiatives to optimise uptake for flu vaccine, as per the slides published with the agenda. A number of points were also raised in discussion:

(a)  this year the plan is to get the message out early, work is underway to challenge misconceptions about the side effects of the vaccine and reframing them as evidence that the vaccine is working;

(b)  vaccines received in pharmacies are commissioned by NHS England and are managed by the Pharmacy Team. The Pharmacy Team are part of the membership of the Derbyshire & Nottinghamshire Seasonal Flu Planning Group and they work with the Seasonal Immunisation Team (SIT) to ensure that vaccines given by pharmacies are notified to GPs. Pharmacies are required to notify the GP of any vaccine given to an individual. Many practices have signed up to Pharm Outcomes, and this data is matched up and reviewed through practices. Every effort is made to ensure vaccines delivered in pharmacies are accounted for;

(c)  questions were raised about perceived vaccine shortage in some areas last year which only affected Nottingham, when the slight fall in uptake of the vaccine was seen nationwide, so it is not felt that perceived vaccine shortages had a significant impact on the fall in uptake in Nottingham as practices and stakeholders worked collaboratively to minimise the impact of this;

(d)  there may be some minor delays with the under 65s vaccine this year, due to the late identification of one of the Flu strains to be included in the vaccine which has resulted in minor manufacturing delays. There is no reason to believe there is insufficient supply overall. Planning involves consulting with local practices and ensuring they have all ordered enough of each type of vaccine, and have ordered from more than one supplier. Assurance is also sought from manufacturers, who have assured NHS England that they have contingency plans in place, including the use of alternative ports in the case of a no-deal exit from the EU;

(e)  uptake in schools is a particular challenge. The same tactics are used throughout the county, but uptake in city schools is lower, possibly due to higher levels of deprivation and different community makeup. An e-consent by text message scheme is being rolled out in Nottinghamshire and Derbyshire this year, which should help to overcome the biggest challenge of consent forms not being returned. Opt out consent raised as an option but this is not possible;

(f)  stakeholders are encouraged to promote Flu vaccines within their organisations with the main focus being on the eligible cohorts for free vaccines, and people who are front line Health and Social Care workers. Occupational Health vaccination responsibilities were explored - where employers may wish to promote Flu Vaccination and maintain a resilient workforce for those staff not currently eligible under the current eligibility criteria and everyone should be encouraged to get vaccinated even if they don’t qualify for a free vaccine;

(g)  NHS England will be cascading resources on the benefits of the vaccine shortly;

(h)  several Board members offered assistance in getting the message out on the importance of flu vaccination to their own organisations, and Councillors requested leaflets to have at their stalls at upcoming Older Persons events;

(i)  those with ill health who qualify for the vaccine (such as those with respiratory issues, renal issues or immune system issues) will be able to receive the vaccine in alternative health settings whilst receiving other treatments, and pregnant women will be offered the vaccine whilst receiving ante-natal care;

(j)  residents of care homes are a particularly challenging cohort which need targeting for the free vaccine, as they are particularly vulnerable to ill-health. The message needs to get through to care homes to be proactive and prioritise vaccinations early on in the flu season for all residents;

(k)  eligibility for the free vaccine for Health and Social Care workers has cause some confusion with the SIT receiving enquiries about the definition of a Health and Social Care Worker. At the moment, Health and Social Care workers should be vaccinated by their own GP or via Occupational Health schemes not in the healthcare setting in which they work, so for example if someone works at a GP surgery but is registered elsewhere they would have to receive the vaccine at their registered surgery. Acute Trusts are an exception to this as they offer this vaccination to Hospital Based Staff. Discussions are ongoing as to how to make this more efficient going forward;

(l)  health staff attendance at flu vaccine training has decreased year on year, and as a result some staff not as aware of the range of options available. Work is ongoing to improve knowledge.

(m)  the Chair concluded that there is still a lot to do, particularly with the 4-10 cohort, working more closely with the schools to re-in force the importance of vaccines. All partners need to work together, and be very firm with the message of the benefits of vaccination and myth-busting. The e-consent text message system for schools seems a very positive step, and a good use of technology to adapt to the way modern families communicate. If anyone has anything further to add, they can feed back directly to Dr Shade Agboola or to Annie Tasker.

RESOLVED to:

(1)  thanks Dr Shade Agboola and Annie Tasker for the information and note the presentation;

(2)  work together to promote the benefits and expel the myths of the flu vaccine;

(3)  receive an update on flu vaccine planning in 12 months’ time.

Natalie Baker-Swift, Programme Manager – Violence Reduction and Early Intervention, gave a presentation on the new Violence Reduction Unit. Any comments or feedback, which can be fed in to the new unit, are welcome. There is a strong emphasis on early intervention to tackle the root causes of violence. The unit is funded through to March 2020, and aims to build a long-term sustainable approach and develop a legacy. Funding has been set aside for Violence Reduction Units after March 2020, but it is not yet clear how much each Unit will receive. There are 18 in the UK. The Unit takes a multi-agency approach, and wishes to build on the success of the Knife Crime Strategy.

RESOLVED to thank Natalie Baker-Swift for the presentation, and note the contents.

Ian Curryer, Chief Executive at Nottingham City Council, and Dr Hugh Porter NHS Nottingham City Clinical Commissioning Group, gave a presentation to the Board, distributed with the first publication of the minutes. The following points were raised:

(a)  the crux of the partnership is to work differently to find savings. By taking a holistic and preventative view and working together to reduce duplication, the budgetary situation can be turned around;

(b)  there is now an ICP focussing on the City boundaries, which has been fought hard for. Nottingham City is the 4^th most deprived place to bring out children and (depending on which information is used) either the 8^th or 12^th most deprived place for adults, and does not align with the demographic of the rest of the County. The City faces different challenges than the suburbs;

(c)  the ICP is made up of Primary Care Networks (PCNs), which are healthcare “neighbourhoods” supporting between 30,000 and 60,000 patients. Nottingham’s PCNs are coterminous with some other geographical boundaries, such as those of Area Committees, but there is also a non-geographical University specific PCN to address the particular health needs of Nottingham’s student population;

(d)  Efforts need to be coordinated across the whole ICP, bringing partners together to think about how services can be delivered differently, and how the early intervention agenda can be incorporated into the Partnership. The key people who deliver change are those working on the ground, so a planned day-long workforce launch drop in event on 7 November will be crucial for getting the message of the ICP out to all participating colleagues. Funding has been received from the ICS to appoint a Programme Lead, funded for a year, with no financial drain on any of the partners. They bring national experience and expertise, and it is hoped the post can be extended past the first year;

(e)  one emerging joint priority is of positive mental health in schools;

(f)  there is an expectation that PCNs will be an integral part of the ICP priorities going forward and that all partners will be represented. The aim is to strengthen working relationships, build trust at all levels, agree priorities and engage the workforce;

(g)  the NHS Long Term Plan filters down to the ICS, who have to have a response to the Plan. It is important to remember that whilst the ICP will focus on local priorities, the Long Term Plan is national, so priorities may not always align;

(h)  the Health and Wellbeing Strategy is being renewed, and it is important for the Health and Wellbeing Board to work closely with the ICP, and consider how they can add value to the ICP and vice versa. When the terms of reference for Health and Wellbeing Board are next refreshed, the implications of working with and supporting the ICP should be properly considered;

(i)  the Chair concluded that the key message is of joined up partnership working, and that the ICP should continue to update the Health and Wellbeing Board on its work.

RESOLVED to:

(1)  thank Ian Curryer and Dr Hugh Porter for the update and note the contents;

(2)  invite a brief written update on the ICP to all future meetings of the Health and Wellbeing Board.

Lewis Etoria, Head of Communications and Engagement for NHS Nottingham City Clinical Commissioning Group, gave a presentation on the local implications and consultation programme surrounding the NHS Long Term Plan. Updated slides were distributed with the first publication of the minutes. Further comments were provided by Ajanta Biswas from Healthwatch, who carried out a lot of the engagement work:

(a)  a large amount of digital engagement too place, alongside face to face engagement from Healthwatch. Over 600 out of 1,000 responses were from community outreach face-to-face engagement. The engagement aimed to ascertain whether local people support the themes and aims of the Long Term Plan;

(b)  further conversations and engagement are required around digital innovation in healthcare. Those not comfortable with increased use of technology may need further help;

(c)  there is a huge amount of support for frontline staff and compassionate for the perceived stress and pressure they work with;

(d)  many citizens would rather be offered the best option, trusting the clinical expertise of professionals, rather than be offered choice in their healthcare. Often patients may feel overwhelmed if offered choice, especially after a diagnosis of a serious illness. Health literacy and communication is very important;

(e)  it is important to listen to this engagement, both as a Board and as a health system. The NHS is good at innovation and ideas, but change can feel uncomfortable;

(f)  some Board members felt that engagement with the BME community was lacking, and that as they were under-represented in this initial consultation, the health needs of the BME community may not be adequately addressed.  The consultation was not as representative as desired, and further thematic engagement would be targeted to make sure all demographics and communities are reached at an appropriate balance;

(g)  the biggest challenge will be the disconnect with the perception of technology. One ambition of the Long Term Plan is that within five years, there will be 30% fewer face-to-face outpatient consultations, which inevitably means some will be held digitally. When engagement shows people are uncomfortable with this kind of provision, but that is the national target, it is difficult to find a balance. It is important to help and support people through such changes, and not be perceived to be ignoring the outcome of consultations.

RESOLVED to thanks Lewis Etoria and Ajanta Biswas for their presentation, and note the contents.

Report of the Head of Legal and Governance

RESOLVED to:

(1)  add the Nottingham City Council Portfolio Holder with a remit covering adult social care as a voting member of the Health and Wellbeing Board Commissioning Sub Committee;

(2)  amend the Health and Wellbeing Board Commissioning Sub Committee Terms of Reference accordingly.

Report of the Director of Public Health

RESOLVED to note the Joint Strategic Needs Assessment Annual Report.

Report of the Director of Public Health

The Board wished to note that the Plan is an excellent and detailed piece of work, and to thank colleagues involved in its creation.

RESOLVED to note the Nottingham City and Nottinghamshire Suicide Prevention Strategy 2019-2023.

The following Board member updates were noted:

Third sector

A recent meeting of childhood sexual abuse survivors wished to know when the City Council would respond to recommendations. An action plan would be signed off by partners at the end of September, and taken to a meeting of Executive Board on 15 October.

Health and Social Care are due to co-present at the next Provider Network meeting, which shows positive integrated working at an ICP level.

Healthwatch Nottingham and Nottinghamshire

None.

NHS Greater Nottingham Clinical Commissioning Partnership

The recently discussed proposed merger CCP - discussed proposed merger of CCGs is still progressing.

Wendy Xavier, Managing Director of the ICS, is stepping down. Dr Andy Haynes (currently the Medical Director) is stepping up to be Managing Director, so the ICS will now be clinically led. The CCP extended their thanks to Wendy for her work in the role.

Nottingham City Council Corporate Director for Children and Adults and Director of Social Services

As distributed with the agenda.

Alison Michalska, who is retiring from her role as Corporate Director for Children and Adults shortly, extended her thanks to the Board, and the Board thanked Alison for her contributions as well.

Provisional GCSE results show a great success for Nottingham City Council’s children in care, with a 20% increase in children in care receiving five or more good GCSEs.

Nottingham City Council Director of Public Health

As circulated with the agenda.

Age Friendly Nottingham have asked that all partner organisations sign the Older Persons pledge (https://docs.google.com/forms/d/e/1FAIpQLSfG8kK7H78NVRJLke1L_PvNfuU9L6nkRRVXyWKtNkjGfhfapg/viewform), and mark the United Nations International Older Persons Day (https://www.un.org/en/events/olderpersonsday/) in an appropriate way for their organisation.

RESOLVED to:

(1)  include an item updating the Board on what has changed in response to the IICSA Action Plan on the forward plan for the March 2020 meeting;

(2)  note the forward plan, as amended.

The Chair asked that all members review the action log and ensure they were aware of outstanding actions.

The Board wished to thank Grant Everitt and Karan Kaur for their hard work in writing the new chapter.

RESOLVED to note the new Joint Strategic Needs Assessment Chapters Severe Multiple Disadvantage.

Opportunity for citizens to ask questions relating to matters within the Health and Wellbeing Board’s remit.

The maximum amount of time allocated to questions and responses is 30 minutes.

There were no questions from citizens, however a representative from the Alzheimer’s Society made the following contributions:

(a)  the item of flu vaccination was very informative, and will be fed back to the Alzheimer’s Society to see if there’s anything they can do to further encourage take up of the vaccine;

(b)  the Alzheimer’s Society has recently produced some guidance on the NHS Long Term Plan from a dementia perspective. Their commitment to the NHS Long Term Plan ties in with the Fix Dementia Care campaign.