Agenda and minutes

Councillor Duggins (Leader of Coventry City Council) was appointed Chair for this meeting in Councillor K Caan’s absence.

Councillor Duggins welcomed everyone to the meeting.

There were no declarations of interest.

The minutes of the meeting held on 24^th January, 2022 were agreed as a true record. There were no matters arising.

The Chair, Councillor Caan, will report at the meeting

In the absence of Councillor K Caan the Chair’s Update was deferred.

To appoint Kirston Nelson, Chief Partnership Officer/ Director of Education and Skills and Danielle Oum, Chair of Coventry and Warwickshire Integrated Care System as Members of the Health and Wellbeing Board

The Board appointed Kirston Nelson, Chief Partnership Officer/ Director of Education and Skills and Danielle Oum, Chair of Coventry and Warwickshire Integrated Care System as Members of the Health and Wellbeing Board.

RESOLVED that the Membership documents be updated to include  Kirston Nelson, Chief Partnership Officer/ Director of Education and Skills and Danielle Oum, Chair of Coventry and Warwickshire Integrated Care System.

The Board received presentations in three parts for the discussion about Covid-19 Ongoing Response:

a)  Living Safely with Covid-19 

b)  NHS Capacity

c)  Vaccinating Coventry

The Board received a presentation by Allison Duggal, Director of Public Health and Wellbeing about Living Safely with Covid-19.  The presentation detailed:

·  Key metrics in Coventry

·  Decreasing rates in Coventry and Nationally

·  Testing changes and local Office for National Statistics (ONS) data

·  Promoting vaccinations

·  Contact Tracing ended on 24^th February, 2022 and Outbreaks would now be reported and managed

·  Schools and Adult Social Care settings still experiencing outbreaks but not at the same levels as previously

·  Vaccinations began for 5-11 year olds in Coventry this week and it was hoped that Coventry would manage high numbers as had been the case for vaccinating the elderly and vulnerable groups 

The Board received a presentation by Alison Cartwright, Coventry and Warwickshire CCG attending on behalf of Phil Johns to discuss NHS Capacity.

The presentation noted that we were now in the recovery phase and highlighted:

·  Delivery

·  The five work streams

·  Mental Health in high demand

·  Primary Care appointment data and restoring health checks

·  Hospital discharge rate was slower than ideal due to patents awaiting package of care/placement

The Board discussed

·  working with Scrutiny around reducing hospital discharge time which was more of a concern in Warwickshire than Coventry. 

·  Reduced waiting times with Physicians and the positive reduction in the backlog. 

·  There was an acceptance that patents were waiting too long but that in Coventry this was proportionate to the National experience.

The Board received a presentation by Alison Cartwright, Coventry and Warwickshire CCG attending on behalf of Phil Johns to discuss Vaccinating Coventry.  Members were updated on

·  Vaccination rollout for over 5’s and spring boosters

·  Community pharmacies

·  Engagement with lower uptake areas

·  Employees offer

·  Linking with events

·  Offer for the homeless community and asylum seekers

·  Focus on higher risk groups

·  Drop-in clinics to continue

·  Currently 48.8% of Coventry residents had received boosters and 81% of over 60s

·  Local Primary Care sites and Community sites offering immunisation

The Board discussed

·  Eligibility for boosters and the time between vaccinations

·  Communicating information about vaccinations to families and schools

It was noted that Headteachers had been briefed and immunisations were needed in sequence with specific times in between.

Presentation by Nadia Inglis, Consultant Public Health

The Board noted a presentation by Nadia Inglis, Consultant Public Health on Health Protection.  Local Health Protection had evolved and now included a Covid prevent and response section.  Health Protection was wider than the Public Health Team and huge progress had been made over the last few years. 

The update detailed:

·  responsibilities for commissioning including the Health Protection Strategy 2017-2021

·  priorities 2017-2021 and achievements

·  draft priorities 2022-23 including

·  Outbreak response

·  Migrant Health

·  Sustainability and Air Quality

·  Tuberculosis (TB) and Blood-borne Virus action plan

·  Infection Control Strategy

·  Screening and Immunisations

Update from John Gregg, Director of Children’s Services

The Board received a verbal update from John Gregg, Director of Children’s Services regarding Children in Crisis and Developments towards Children’s Integrated Health and Care.

Children in Crisis needed further multi-agency improvements, although developments had been made regarding understanding the issues.  Leaving care and capacity remained a challenge and Tier 2 Looked After Children Child and Adolescent Mental Health Service (CAMHS) was being recommissioned.

The Board discussed:

·  Training

·  Listening to the Voice of the Child in an Adult centric system

·  Long term Investment in Mental Health a comprehensive offer from birth to 25

·  Improvements to care for Young People with Learning Disabilities including Autism

·  Crisis Community Care

·  Care closer to home

·  Where, who and what the future requirements involve 

·  Preventative and Universal offer plans

·  Early intervention needed

RESOLVED that

1)  further information be provided about:

a)  The requirements of the Integrated Heath and Care Plan for

Young People (what, where and who)

b)  The long-term plan for a comprehensive offer/investment in mental health from birth to 25 years

c)  Improvements to care for young people with learning disabilities

d)  Care closer to home

e)  Crisis Community Care

2)  The Autism Plan and Investment be circulated and discussed further

Joint report of Allison Duggal, Director of Public Health and Wellbeing and Rachel Chapman, Consultant Public Health

The Board received a presentation from Allison Cartwright on behalf of Rachel Chapman, Consultant Public Health who had provided a report on Coventry and Warwickshire Integrated Care System Health Inequalities Strategic Plan.

The Coventry and Warwickshire Integrated Care System (ICS) was required to provide a ‘Health Inequalities Strategic Plan’ to NHS England/Improvement (NHSE/I) by 28th April 2022.  The plan must set out a locally agreed strategic approach for addressing health inequalities based on a recognised model of health and must include the NHS health inequalities priorities, as set out in the NHS Long Term Plan.  The plan should be Place-based and should involve the local Director of Public Health.  It had to be owned by decision making bodies within the developing ICS.  A programme of engagement was underway with partners and key NHS workstreams to develop the plan.  The local plan would build on existing work which aimed to embed consideration of and action on, health inequalities in all areas and focus on working with local communities.

A programme of engagement with key partners to further shape the plan, based on the Core20+5 model and embedded within the wider population health management approach, was taking place between November 2021 to April 2022.  The draft Coventry and Warwickshire Health Inequalities Strategic Plan would be shared with NHS England/Improvement by 31st March 2022, who were expected to provide feedback prior to a final version being adopted locally from the end of April 2022.

In January 2022 the shadow Integrated Care Board (ICB) agreed 8 principles for the plan:

·  Addressing Inequalities was core to and not peripheral to the work of the C&W ICS

·  Strategic Plan would be based on the King’s Fund model of Population Health

·  Built around the Core20+5 health inequalities framework

·  Evidence-based approach

·  Encourage innovation

·  Community co-production

·  Embed reducing health inequalities across all ICS work

·  Reducing inequalities is key to decisions on the prioritisation and allocation of resources

The King’s Fund model of Population Health included the impact of the wider determinants, individual behaviours, places and communities as well as health and care on people’s health.  It was already embedded as an approach within the system, it was well recognised by partners and was the basis for the Health and Wellbeing Strategies for both Coventry and Warwickshire.  Use of this model prompted the system to consider the breadth of influences on inequalities and to act beyond the health and care domain to achieve sustainable impacts.

The Core20+5 framework had been developed by NHSE/I to support the reduction of health inequalities at a system level. 

·  “Core20” was the 20% most deprived areas as defined by Index of Multiple Deprivation nationally.

·  “Plus” was specific groups identified locally who experience poorer than average health outcomes but may not be captured within the Core20.  For Coventry and Warwickshire these were proposed to be transient and newly arrived populations, including homeless, gypsies and travellers, boaters, refugees, and asylum seekers.  In addition, for Coventry, people who were on long term sickness benefit would be considered  ...  view the full minutes text for item 53.

Report of the Deputy Chair, Dr Sarah Raistrick, Coventry and Warwickshire CCG

The Board received an oral update on the Marmot Partnership Group’s Call to Action from Sue Frossell, Consultant Public Health, to accompany her joint written report with Dr Sarah Raistrick, Deputy Chair, Coventry and Warwickshire CCG.  The Marmot Partnership Group’s ‘Call to Action’ campaign across Coventry and Warwickshire aimed to encourage businesses and organisations to make changes to improve health and reduce health inequalities.

The report noted that as a Marmot City since 2013, Coventry was the only one out of the initial seven cities to remain as a Marmot City, reflecting the on-going commitment to a long-term, partnership approach.  In recent years, many others have joined, such as Greater Manchester, Newcastle, Gateshead, Bristol and Somerset.  An academic evaluation of our Marmot City approach was published by University College London (UCL) in 2020.  Additionally, the Director of Public Health Annual Report called ‘Bridging the Health Gap' was published in 2019.

At the Coventry Health and Wellbeing Board meeting on 27th July 2020, it was agreed that the Marmot Partnership Group would take the strategic lead on supporting the system to address health inequalities relating to COVID19.  This had resulted in the development of the health inequalities Call to Action in recognition that reducing inequalities can only be achieved by the joint efforts of organisations and businesses across the city.

The Marmot Partnership presented a paper to the Health and Wellbeing Board on 25th Jan 2021 regarding the development of a system-wide ‘Call to Action’ campaign, initially focussing on the role of businesses in the reduction of health inequalities, but also asking Health and Wellbeing Board organisations to begin to consider how their individual organisation could act in two specific ways to enable a system-wide approach to reducing general health inequalities within communities:

i.  a robust review of HR equality polices and processes using a recognised tool and 

ii.  embedding a social value approach. 

The ‘Call to Action’ Campaign requested all organisations to take action to make a difference. The report included an infographic for businesses regarding how health inequalities were avoidable, differences in health outcomes due to the conditions in which we live, grow and work, examples of what could be changed, the impact on the workforce and communities and benefits to businesses.

To launch the campaign an online promotional event was held in June 2021 attended by Sir Michael Marmot and Sir Chris Ham championing the campaign and the need for businesses to do more.  Understandably, businesses had a raft of challenges to focus on, such as supply chain disruption, increasing costs and skills and recruitment difficulties. The approach was to both continue to work on this ‘Call to Action’ but also to seek out ways to become more effective and continue to:

•  Ask businesses to make a commitment to take one or two suggested actions, evolving as the project progresses.

•  Raise awareness of health inequalities and what that means to businesses, offering 1-2-1 consultation sessions where requested.

•  Work with Economic Development to provide links/referrals  ...  view the full minutes text for item 54.

Report and presentation of Pete Fahy, Director of Adult Services and Housing

The Board received a progress report and presentation from Pete Fahy, Director of Adult Services, on Improving Lives for Older People through the system transformation programme across health and care.

The report noted the first phase of the programme work was aimed at improving outcomes for older people.  Expressed in activity terms, the levels of acute attendances, emergency admissions and emergency re-admission for adults over 65 in Coventry were considerably higher than those of comparator organisations.  This had been the position for a number of years and although improvement programmes and initiatives had been deployed to improve the position overall performance had not changed significantly. 

In order to tackle these issues an in-depth diagnostic of urgent and emergency pathways for older people in Coventry had been undertaken by operational improvement specialists Newton.  The diagnostic work had identified a range of opportunities to reduce emergency department attendances, which in turn had the potential to reduce the number of non-elective beds required through reduced admissions and shortened length of stay, leading to improved outcomes for older people in Coventry.  Outside of the hospital setting opportunities to improve the approach to admission avoidance and supported discharges (people that needed care and support immediately following a hospital stay) had also been identified.  A summary of the work completed in the diagnostic phase was attached as an appendix to the report. 

Although the key metrics the work was aimed at improving, were in relation to acute activity, it was very much a system issue across all aspects of primary, community, acute and social care for which the diagnostic had clearly shown that there was an opportunity to bring about improvements to the existing pathways.

The four key organisations involved – University Hospital Coventry and Warwickshire (UHCW), Coventry and Warwickshire Partnership Trust (CWPT), Coventry and Warwickshire Clinical Commissioning Group (CWCCG) and the City Council had committed to entering into a design phase which was currently underway.  The purpose of the design phase was to co-design and test with operational leads and front line staff, a set of sustainable solutions to the opportunities identified in the diagnostic.  The design approach would ensure the buy-in and commitment of the staff that was fundamental to making change happen should the programme proceed to implementation. 

Progressing the programme of work was a key priority area for the Coventry Care Collaborative and provided one example of how organisations were working together to find new ways of improving outcomes for the people of Coventry.  Although the focus of the work was people aged 65+ any improvements in pathways should also have an impact on people of different ages that use those pathways.

The opportunities presented through the diagnostic phase were such that all four organisations committed beyond the diagnostic to the current ‘design’ phase.  Nothing had been committed to beyond the design phase at this point, which was expected to conclude in May 2022.

There were no specific recommendations or decisions for Coventry Health and Well Being Board at this point.  However,  ...  view the full minutes text for item 55.

Report and presentation of Andy Hardy, University Hospitals Coventry and Warwickshire

The Board received a report and presentation from Andy Hardy, University Hospitals Coventry and Warwickshire, on the University Hospital Draft Organisational Strategy for 2022-2030 ‘More than a hospital’.

The report detailed the proposed next steps to building better health together.  Thoughts and views had been sought on amending the current strategic triangle with a refreshed strategic triangle detailed in the report.  The proposed vision now referred to communities and became, ‘to be a national and international leader in healthcare, rooted in our communities’.  The fundamental purpose was to deliver the best possible care for local communities and to achieve this the three interconnected purposes below would enable continual improvement in local care.

1.  Local integrated care

Collaborating with partners to integrate services, improve population health, and tackle health inequalities.

2.  Research, innovation, and training

Developing the next generation of health and care professionals, and leading research and innovation to improve patient outcomes.

3.  Being a regional centre of excellence

Developing our strongest specialties to meet the needs of a broader population.

The ability to deliver outstanding care was dependent on improving quality, supporting people, investing in digital technology and data insights, and promoting sustainability. These cross-cutting enabling strategies related to the three purpose elements of local integrated care, being a regional centre of excellence and research, training and innovation.

The final Organisational Strategy for 2022-2030 would be shared with the Board at the end of April, 2022.

Report of Kirston Nelson, Chief Partnership Officer/ Director of Education and Skills

The Board received a report from Kirston Nelson, Chief Partnership Officer/ Director of Education and Skills which was an update on the outcomes of the Coventry and Warwickshire Place Forum held on 9^th March, 2022.

The report noted that an online development session for Coventry and Warwickshire Place Forum (the two Health and Wellbeing Boards) was held, with around 40 members attending.  The meeting was chaired by the Health and Wellbeing Board chairs, Cllr Margaret Bell and Cllr Kamran Caan, and facilitated by Nigel Minns (WCC) and Kirston Nelson (CCC).

This was the last meeting of the Place Forum in its current guise, pending the new statutory governance arrangements to be established for the Integrated Care System.  It was an opportunity to reflect on the Place Forum journey to date and share proposals for future arrangements.  It was noted that the Place Forum, which had been meeting since December 2017, had prepared the local authorities for the new statutory Integrated Care Partnership (ICP).

A number of presentations were shared and discussed the last meeting of the Place Forum including:

·  Integrated Care Systems (ICS) update and Statutory Integrated Care Partnership.  An update on progress in the transition to a statutory ICS and proposed governance arrangements, including recommendations for the new Integrated Care Partnership reflecting feedback from the previous meeting of the Place Forum and its role in developing an Integrated Care Strategy for the ICS.

·  Health and social care integration, the joining up of care for people, places and populations. Reflections on the recently published White Paper on health and social care integration at place level, and its implications for Coventry and Warwickshire.  The scope of the White Paper covered proposals on: shared outcomes; leadership, accountability and finance; digital and data; and the health and care workforce and carers.

·  System Health Inequalities Plan: An update on progress with the 5 year strategic inequalities plan for the ICS that was a requirement of NHS England.  Feedback from the separate Health and Wellbeing Boards on early proposals was addressed in the latest iteration of the plan.  The plan had a particular health and care system focus, in the context of wider system action around the population health model.  A draft plan must be submitted to NHSEI by the end of March, with final submission by end of April.

·  Digital Transformation Strategy.  A presentation on the draft ICS strategy for data and digital transformation, which was currently subject to consultation.  Coventry and Warwickshire were working with NHSX as a national trailblazer for creation of a system-wide digital strategy. Members discussed the value of integrated data in generating actionable insights and the opportunities to improve population health through joined up data and digital healthcare delivery.  Concerns around digital inclusion and implications for the workforce were shared.

·  Healthy Communities Together programme update.  A partnership between Grapevine Coventry and Warwickshire, CWPT and Coventry City Council, was one of 4 partnerships to be funded through this national programme (led by The King’s Fund and the National Lottery  ...  view the full minutes text for item 57.

Update from Phil Johns, Coventry and Warwickshire CCG and Danielle Oum, Coventry and Warwickshire Integrated Care System as

The Board noted a presentation from Danielle Oum, Coventry and Warwickshire Integrated Care System on Developing an Integrated Care System.

The presentation recognised the national move to bring health and care organisations together into Integrated Care Systems (ICS).  The legislative proposals by the Government for a new Health and Care Bill would build on recommendations in the NHS Long Term Plan.  This would establish statutory ICS in each STP/ICS footprint.  The proposals were currently proceeding through parliament at committee stage in House of Lords and the earliest a statutory ICS would be established was July 2022.

An ICS could:

·  Break down the barriers between organisations

·  Join up health and care more effectively to make a difference to people’s lives

·  Address the “wider determinants of health” such as poor housing or socio-economic problems

·  Bring the right resources from across organisations to tackle public health issues such as obesity

The aims of the ICS were:

·  Improve outcomes in population health and healthcare

·  Tackle inequalities in outcomes, experience and access

·  Enhance productivity and value for money

·  Help the NHS support broader social and economic development.

The Vision and how this would be achieved were detailed in the presentation.  The system vision in practice included improving access to services with an Elective Accelerator Programme:

·  Working without barriers across the System to restore elective care services and find new ways of delivering care

·  20% increase in new appointments across Coventry and Warwickshire and a 10% increase in follow up appointments between April and July 2021

·  New ways of delivering care

o  Additional services in the community

o  Increased capacity and reducing time spent in hospital through new teams

o  Improved the links between GPs and hospitals to reduce need for referrals

o  Reduced inequalities by more holistic prioritisation

The three layers of the Integrated Care System were system, place and neighbourhood and a slide showed the current view of how the system could fit  together.

Any other items of public business which the Chair decides to take as matters of urgency because of the special circumstances involved

There were no additional items of public business.