Agenda and minutes

None.

Minutes of the meeting held on 30 November 2022, for confirmation

The minutes of the meeting held on 28 September 2022 were confirmed as a correct record and signed by the Chair.

Minutes of the meeting held on 30 November 2022, for noting

The minutes of the Commissioning Sub-Committee, held on 28 September 2022, were noted.

Lucy Hubber, Director for Public Health, Nottingham City Council, delivered a verbal report and raised the following points.

(a)  the Health and Wellbeing Board has a statutory duty to assess the needs for pharmaceutical services in its area and produce a formal Pharmaceutical Needs Assessment (PNA), which is used to inform the commissioning process for pharmaceutical services. The Board published the PNA covering Nottingham City for 2022-25 in October 2022. This is updated through Supplementary Statements and an up-to-date list of pharmacies is published by Nottingham City Council Public Health each quarter;

(b)  the Board previously received quarterly updates related to pharmaceutical services in Nottingham City, but these have not been included in the forward plan on a regular basis. The recently published PNA provides an opportunity to reinstate quarterly updates to the Board;

(c)  it was proposed that quarterly updates would cover:

  i.  any significant changes to pharmacy provision from the information published in the PNA;

  ii.  any issues that the Board should be aware of regarding the capacity of pharmaceutical services;

  iii.  changes to the standards of pharmaceutical services, whether positive or negative.

Members of the Integrated Care Board (ICB) were asked to identify the appropriate member to provide the quarterly update.

Resolved

1)  to agree that the remit of the pharmaceutical services quarterly update would be to cover any significant changes to pharmacy provision from the information published in the Pharmaceutical Needs Assessment 2022-25; any issues that the Board should be aware of regarding the capacity of pharmaceutical services; and changes to the standards of pharmaceutical services, whether positive or negative.

2)  to ask the Integrated Care Board to identify the appropriate member to deliver the pharmaceutical services quarterly update to the Health and Wellbeing Board.

Update from the Nottingham City Place-Based Partnership

Rich Brady, Programme Director for Nottingham City Place-Based Partnership (PBP), presented a report providing an update on the key activity of the Nottingham City PBP in the last quarter. The following points were highlighted:

(a)  the Changing Futures programme, funded by the Department for Levelling Up, Housing and Communities (DLUHC),  is important for delivering the Joint Health and Wellbeing Strategy (JHWS) Severe Multiple Disadvantage (SMD) priority, which aims to ensure that people living in Nottingham City who experience SMD receive joined up, flexible, person-centred care from the right services, at the right time, and in the right place;

(b)  Changing Futures is funded by DLUHC up to the 31^st March 2024, and is running at capacity up to October or November 2023. There is a risk that the end of this funding will create a gap in support for people experiencing SMD and increase pressure on partner services;

(c)  a development session was held with HWB members on the morning of the 25^th January to review the Changing Futures programme and discuss plans for sustaining support for residents experiencing SMD once the current tranche of DLUHC funding ends. There was also a session with national government departments to look at funding solutions. Continued funding at a national level has not been ruled out, but the Board currently have to work on the assumption that it will end in March 2024;

(d)  the PBP are reaching out to non-traditional care partners, and have recently started working in partnership with supermarket chain Tesco. The Changing Futures Practice Development Unit (PDU) is delivering training to Tesco staff in Nottingham to establish Psychologically Informed Environments and support Trauma Informed Care in their teams. It is anticipated that all Tesco store managers and directors in Nottingham will have completed training by the end of January 2023, and Tesco are interested in extending this training further;

(e)  following a series of development sessions held between May – July 2022, in September the PBP Executive Team agreed a set of six ‘enabler’ programmes that aim to create the conditions for integrated work to happen more easily in Nottingham. All are led by at least two members of the PBP Executive Team, except for the Data Informed PBP programme. These can be discussed in more detail at future meetings;

(f)  at the ICB meeting on 12^th January 2023, Mel Barrett (PBP Lead), Dr Hugh Porter (Clinical Director), and Rich Brady (Programme Director) met with Board members to update on the work of the partnership and discussed how the Nottingham City PBP can further add strategic value, with the potential to take on greater levels of responsibility for the delivery of system priorities;

(g)  the PBP are running an ‘accelerated design event’ with the ICB, to focus on particular areas where the partnership can accelerate integrated care and support Integrated Care System (ICS) priorities and objectives. Key considerations will include deliverables in the Integrated Care Strategy (including JHWS priorities) and the ICB’s five-year plan;

(h)   the PBP Race and Health Inequalities (RHI) group, led by programme leads Clive Foster and Donna Sherratt, has designed a maturity matrix self-assessment tool aiming to support local organisations and services to address structures and processes that may be contributing to inequalities experienced by different communities in Nottingham;

(i)  the RHI maturity matrix was launched on the 12^th December 2022. Positive feedback has been received from organisations involved in the piloting stage. Colleagues from the Nottingham City Council Commissioning team spoke about it guiding changes to the language used by that team, and highlighting the need for better data on the ethnicity of different cohorts around the City. The matrix will continue to be rolled out throughout the year, and on the 11^th May 2023 there will be a summit to discuss the future focus of the RHI group;

(j)  HWB members congratulated Clive Foster for his appointment as a Member of the Order of the British Empire (MBE) in the New Year Honours for services to the Windrush Generation.

(k)  During questions and comments from Board Members the following additional information was highlighted: support is continuing for Primary Care Networks, including a recent session with a focus on digital inclusion and exclusion, which was well-attended. There are a large number of Primary Care projects working at neighbourhood level using fairly limited core resources, reliant on bringing partners together around shared goals;

(l)  the government has announced an independent review into oversight of ICSs, even though they have only been statutory since July 2022. The review is being chaired by former Health Secretary the Rt Hon Patricia Hewitt, who is currently Chair of NHS Norfolk and Waveney ICB. Dr Kathy McLean, Independent Chair of Nottingham and Nottinghamshire ICS, has been asked to chair the ‘autonomy, accountability and regulation’ work-stream for this review;

(m)the PBP are making progress with their programme focused on care leavers;

(n)  byy the next meeting on the 29^th March 2023 it will have been a year since the Joint Health and Wellbeing Strategy (JHWS) was agreed, and the PBP will deliver an update report;

(o)  part of the ‘accelerated design event’ will be to explore what is needed from partners, not just the ICB, to grow the PBP into a central organisation supporting residents in the City around health and wellbeing issues;;

(p)  adverse childhood experiences are a key driver of SMD. It is estimated that the majority of adults facing SMD in England (around 85%) have experienced childhood trauma. Information about the work of Children’s Integrated Services was circulated before Christmas and the current work with adults experiencing SMD will have an impact on the experiences of their children. Once the adult-focused part of the SMD programme is stabilised it will be important to focus on early life experiences in order to tackle health inequalities, and look for the most impactful opportunities for reflective intervention across individuals’ lives;

(q)  Board Members discussed the importance of understanding the purpose and audience of any communications – whether to help service providers understand how the system is working differently, or to communicate to residents the complexities that sit behind their care;

(r)  as an NHS body the ICB has its own Communications team, and has a statutory duty around communication and engagement. The Corporate Director for People recently met with ICB Communications Leads to look at opportunities for co-operation;

(s)  the ICB is launching a Citizens’ Panel using Nottingham City as a test case, before rolling it out across Nottinghamshire in future years. The aim is for 800 participants across the City. Nottingham Community and Voluntary Service (NCVS) has provided links with colleagues in the Community Champions team;

(t)  it is important to look for further opportunities to engage the patient voice and provoke genuine conversations among citizens and between citizens and services. Healthwatch have made proposals to the ICB in terms of what they would like to see around engagement and empowerment of residents. Healthwatch underlined the importance of engaging citizens in a way that avoids re-traumatising them when talking about adverse experiences, and then in knowing how to use that engagement to make productive changes.

Resolved to note the update from the Nottingham City Place-Based Partnership;

Interim verbal update

Lucy Hubber, Director for Public Health at Nottingham City Council, provided an interim update as the Joint Health Protection Board (JHPB) has not met since the last update provided to the Health and Wellbeing Board in November 2022. The following points were raised:

(a)  winter saw high rates of Covid-19, influenza, and other respiratory infections. The autumn booster programme for Covid-19 vaccinations, which began in September 2022, is coming to an end. Nottingham is roughly in line with national vaccination rates, but would aspire to get very high coverage. Data shows a high coverage of Covid-19 and influenza vaccinations in older groups. Next winter, there will not be a significant separate Covid-19 vaccination programme;

(b)  Group A streptococcus (strep A) diagnoses are coming down after a spike in December, and Nottingham has not a significant problem with invasive strep A over the winter;

(c)  the JHPB has been working to increase uptake rates of childhood immunisation, in cooperation with the City Locality team in the ICB, primary care partners, and NHS England partners. There are national challenges around diphtheria and polio immunisation, where uptake rates are a lower level than expected. It is important to reflect on structural barriers created by the system, as well as any other barriers to uptake;

(d)  the JHPB has been looking at recommissioning sexual health services, working closely with ICB colleagues responsible for HIV treatment to deliver a full sexual health programme. Colleagues are working with service users and residents with lived experience to ensure services meet our community’s needs in an accessible way;

(e)  the JHPB are looking at work around tuberculosis (TB), to make sure there are systems and processes in place for more vulnerable members of the community around management of TB. This includes accommodation to support them if they need it for successful treatment, as treatment is critical to prevent the emergence of drug-resistant strains of TB;

(f)  During questions and comments from Board Members the following additional information was highlighted: primary care colleagues are to be congratulated for managing the anxiety around Strep A and the demand on services it has generated. Reduced media reports around strep A have reduced the level of panic;

(g)   On 2^nd December 2022 the UK Health Security Agency (UKHSA) issued guidance for health care professionals to have a lower threshold for prescribing antibiotics to children presenting with symptoms of strep A. This guidance is still in place and will impact on services as people return for further antibiotics throughout the year;

(h)  members discussed the importance of a strong steer to health care professionals not to maintain this low threshold once this guidance is changed, and for the importance of Comms to reinforce the message not to overuse antibiotics due to the risk of antibiotic resistance. 

Resolved to note the update from the Joint Health Protection Board.

Updates from Board Members

Board Members provided the following updates:

(a)  an update from Catherine Underwood, Corporate Director for People, Nottingham City Council, on the current work being carried out by the Council’s Children’s and Adults’ Services was appended to the agenda;

(b)  Jules Sebelin, Chief Executive of Nottingham Community and Voluntary Service, provided an update on work through the Robin Hood Fund to help citizens experiencing financial hardship. In the week before Christmas 2022, following good private and public donations, the Fund was able to distribute £10,000 through St Ann’s Advice Centre for supermarket vouchers to help Advice Centre clients, and £10,000 to the foodbank network through Hope Nottingham. The next phase will look at providing support to small organisations and community groups suffering with increased costs.

Resolved to note the updates from Board Members.

The Board noted the Work Plan, and noted the addition of the Pharmaceutical Needs Assessment at the next meeting.

29 March 2023

Wednesday 29^th March 2023 at 1.30pm.