Health & Wellbeing Board Minutes

Date:
Wednesday, 25th November, 2020
Time:
2.00 p.m.
Place:
Remote meeting via Microsoft Teams
 
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Present:
Cllr Jim Beall (Chairman),Cllr Lisa Evans, Cllr Luke Frost, Cllr Lynn Hall, Cllr Mrs Ann McCoy, Martin Gray, Ann Workman, Fiona Adamson, Sarah Bowman - Abouna, Jon Carling, Alex Sinclair (Sub for David Gallagher), Dominic Gardner, Barbara Bright (Sub for Julie Gillon), Lisa Oldroyd, Anne Sykes
Officers:
Michael Henderson, Gareth Aungiers (SBC), Clare Abley (TEWV)
In Attendance:
Press
Apologies for absence:
Cllr Jacky Bright, David Gallagher, Julie Gillon, Sheila Lister
Item Description Decision
Public
HWB
17/20
DECLARATIONS OF INTEREST
 
HWB
18/20
MINUTES OF THE MEETING HELD ON 28 OCTOBER 2020
 
HWB
19/20
OUTBREAK MANAGEMENT UPDATE
RESOLVED that the update be noted.
HWB
20/20
CHILDREN AND YOUNG PEOPLE - MENTAL HEALTH AND EMOTIONAL WELLBEING - AN UPDATE AND NEXT STEPS
RESOLVED that:

1. the update report be noted, and a progress report be provided to the March 2021 Board meeting.

2. a report on Neurodevelopmental Pathway be provided to a future meeting of the Board.
HWB
21/20
SYSTEM ENABLERS
RESOLVED that:

1. the update and discussion be noted, and the areas highlighted as ‘What can the Board/System do’, in the report, be the basis of the development of an Action Plan that would be presented to the Board on a periodic basis.

2. Consideration be given to a report being presented to the Board on the impact of Covid on working age adults and older people.
HWB
22/20
WINTER PEAKS - FLU AND WINTER ILLNESS - TO FOLLOW
 
HWB
23/20
MEMBERS' UPDATES
 
HWB
24/20
FORWARD PLAN
 
2PM - 4PM

Preamble

ItemPreamble
HWB
17/20
Cllr Ann McCoy declared a personal, non-prejudicial interest in item 5 'Children and Young People - Mental Health and Emotional Wellbeing - An Update and next steps' as she was a member of the Council of Governors of Tees, Esk and Wear Valleys’ Mental Health Trust.
HWB
18/20
The minutes of the meeting held on 28 October 2020 were confirmed as a correct record.
HWB
19/20
Members received an Outbreak Management Update presentation, which included data for the 7 days ending 25 November 2020.

The Board noted some key information:

- There had been 590 cases, which was a significant decrease over the
previous 7 day, which had stood at 849.
- There had been 15 deaths.
- The seven-day infection rate was reducing, which was the broad pattern
across the north east, and nationally.
- the Borough had the 4th highest infection rate in the north east. At the
October meeting the Borough had had the highest rate.
- the Borough had the largest decrease in infection rate over last 4 weeks.
- 10 out the 11 LAs in the north east had seen a decrease in rates, compared to
4 weeks ago.
- The affects of restrictions took at least 15-20 days to show in data.

In terms of transmission:

- The Borough had widespread community transmission, with no hotspots.
- Households were the main areas where transmission took place.
- There were cases across all age groups.
- There were cases and outbreaks across key settings, including care homes, schools and hospitals.

Members noted that prevention and response activity continued in the community and across settings. Data was constantly reviewed, and activity/approaches refreshed.

Members noted that the key communication and engagement messages continued to be the basic ones - distance, face coverings, wash hands, test and isolate. Messages highlighted that Covid could impact on anyone.

Work was ongoing, with a network of community champions, as working closely with the community was key to addressing the outbreak. Part of this was recognising the hardship people were facing, particularly in areas where there was greater deprivation and providing support to those communities.

The Board noted the recent reducing rates of infection, the news regarding several vaccines, the roll out of rapid community testing and announcements relating to relaxations of restrictions during the Christmas period. It was agreed that, whilst these all represented positive progress, there may be a temptation for the public to relax, too much, and potentially loose some of the recent gains, achieved during national restrictions. It would be important to continue with communication and engagement, with even more focus, to encourage people to maintain good and safe behaviours, as much as possible.

Discussion:

-Noted that guidance, relating to Christmas relaxations of restrictions still urged caution, by those who were clinically extremely vulnerable.

-In terms of deaths and serious illness, caused by Covid, it was noted that such situations often occurred in people who had underlying illnesses, which were more prevalent in people living in areas of greater deprivation. The greatest risk factor, from Covid, presented for the older age groups. In the Borough, the over 60s age group was underrepresented, in terms of cases of infection in the population, and this was considered to be positive.

-It was highlighted that some predictions suggested that there may be a spike in cases after Christmas and it was explained that this was being taken account of, in terms of planning, by the Council, hospital trusts etc.

-There had been recent discussion, nationally, around Rapid Community Testing. The Borough was to be provided with rapid flow tests and work was being undertaken, regionally, and locally, to ensure that these tests were used in the best way possible. It was explained that any testing model needed to be sustainable, with the key aims being to reduce transmission, protect the most vulnerable and support business continuity, as much as possible. There would be close links with all partners, as plans were developed. Members noted the significant capacity and logistical issues associated with any rapid testing plans. Members of the Board were asked to consider where tests should be targeted and to let the Director of Public Health have any suggestions.

-The Board noted that there were currently 153 patients who had tested positive for Covid in the North Tees and Hartlepool Trust, with 9 in its Intensive Treatment Unit (ITU). It was explained that, learning from wave 1, had helped the Trust reduce the number of positive cases needing to move to ITU, during the current wave.

-It was explained that the Trust was still undertaking all of its usual work, during the outbreak and it was important to reassure members of the public that the hospital was a safe environment to attend.

-Members were assured that care homes, in terms of residents, visitors and staff were a priority for the Council and every assistance had and would continue to be given.

-It was confirmed that schools and colleges were being considered for the rapid flow community testing, in the context of protecting the vulnerable and supporting business continuity. Work was also being undertaken relating to school bubbles to ensure that only those pupils and staff members that needed to isolate, did so.

-It was also confirmed that consideration would be given to using the rapid flow tests in the Domestic Abuse refuge setting, as this was a particularly vulnerable group, at present.

-The Director of Public Health would keep the Board and all relevant partners updated on developments relating to the Community Rapid Testing.

-The Council Leader would be informing Council elected members of testing, specifically relating to care homes.
HWB
20/20
Members considered a presentation that provided an update on the current position, relating to mental health and emotional wellbeing services for children and young people and included updates on Covid-19 related modelling, enhanced offer, mental health support teams and whole pathway commissioning. The update also included details of the new models of working and proposals for wholesale transformation.

It was explained that update formed part of the work identified as part of the Board’s reset workshop sessions.

Key elements of the presentation included:


-What services were available.

-Impacts of the Covid pandemic across the whole mental health system, in terms of those people affected directly by Covid, the effects of lockdown, the expected recession.

-the forecasting model, which helped estimate increased prevalence of mental illnesses in Children and Young People.

-Details of what had caused the projected additional demand e.g. school and social network disruption.

-What the Covid offer had been, including CAMHS.

-Details around the core functions of the Mental Health Support Teams, which was a new way delivering support in and around schools and colleges. Currently only available as a Pilot, in Billingham, with the intention to roll out, across the Borough.

-Principles of whole pathway commissioning, which was about, looking at previous experience and lessons learned through the Covid response etc and to redesign the whole system, across all providers, working together, to create a service, at scale, that had children, young people, families and carers at the centre.

Discussions:

-With regard to the pilot scheme, in Billingham, members were informed that it was part of a national roll out of mental health support in schools. If it was successful it would be necessary to move some resources around the system to invest in and embed this kind of intervention. This would be part of the whole pathway commissioning approach.

-National guidance for the pilot was prescriptive and had to be, geographically, tightly defined, containing a certain number of schools with a certain number of children. However, work was moving towards universal provision in the Borough. Billingham had been chosen as there had been a history of those schools working together and it had provided the opportunity to include one of the sixth form colleges and the Pupil Referral Unit.

-Members were informed that the Footsteps service had been expanded to the whole of the Borough and was embedded in Primary Care. When GPs were seeing young people struggling with mental health issues, they were referring to Footsteps.

-It was explained that it was unclear when predicted prevalence of Covid related mental health issues would turn into demand, or, at which points, in the system, demand would present. Historically people were less likely to come forward with mental health issues, however, awareness campaigns in recent years were helping to change that.

-The Board was very supportive of the approach and applauded the partnership/ whole system working that the presentation had highlighted. It was clear that there was a willingness, by all partners, to move investment around the system in an effective way, and organisational siloes had been put to one side.

-It was suggested that a report be brought to the Board relating to the Neurodevelopmental Pathway, given the Board’s previous work around Autism Spectrum Disorder.
HWB
21/20
Members considered a report that provided an update on the work to develop the system enablers element of the strategy reset work. The update was based on feedback from partners and explored, in more detail, the actions taken, and actions proposed.

Members were reminded that a number of system enablers had been identified at the Board’s reset workshops and these had been confirmed at the Board’s meeting on 30 September 2020:

- Volunteering and community asset building
- Information, signposting and navigation
- Partnership working and communication
- Workforce
- Data sharing protocols

Discussions had been held between partners, and feedback had been collected, using a proforma, based on three main questions, to try and unpick the more general responses and reflections, previously collected for each of the enablers:

- What did we do? What did we learn?
- What can individual organisations do now?
- What can the HWB and the system do?

Members were provided with details of the feedback and proposals on how this would be taken forward.

The outcomes/proposals described in the paper had been identified collectively, to support a system wide discussion on some of the key learning from the pandemic response and had identified a number of areas of potential further collaboration, at a system level. The value in having a coordinated multi agency support hub; with networked and linked outreach offers; together with a consistent and energetic focus on the value of the VCSE in supporting and promoting community led activity, offered a potential model for the redesign of a number of key services.

Discussion:

-It was indicated that the pandemic had highlighted a new kind of volunteer with people who may have full time jobs and still wished to volunteer. The refreshed Volunteering Strategy would look to facilitate more of this and transform volunteering. The draft Strategy would be available for the Board’s consideration, early in the New Year.

-It was important to use data to identify individuals who had vulnerabilities and use volunteers who could support them in being referred to the correct services. A conversation between Catalyst and each partner would assist with this.

-The digital divide had to be considered, as not everyone could access services online and, in particular, the most vulnerable people.

-In terms of different ways of working, and similar to that described in the previous item, relating to Children and Young people’s Mental Health and Emotional Wellbeing, it was suggested that a presentation on the impact of Covid on working age adults and older people be provided to a future meeting.
HWB
22/20
It was explained that this item would be deferred to the Board’s next meeting. The Board was reassured that work was ongoing around flu and winter illness and partners were encouraged to get the message out on the importance of flu immunisation. A report would be issued to members before the next meeting.
HWB
23/20
Catalyst was experiencing increasing demand for food parcels and would be applying for funding, shortly, around social prescribing.

The digital divide was highlighted and that there were a significant number of people with no connection to the internet, who may be feeling isolated, at present and this had to be remembered.
HWB
24/20
The Forward Plan was noted, and members were encouraged to highlight any items they may wish to be considered for future agendas.

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