Agenda and minutes

It was noted that apologies had been received from Richard Parker (Doncaster and Bassetlaw Teaching Hospitals), Kathryn Singh (RDaSH) and Riana Nelson (Doncaster Council).

The Chair welcomed Dr Nabeel Alsindi, GP and Place Medical Director (Doncaster) to the meeting.

It was moved and seconded that Anthony Fitzgerald, Executive Place Director for NHS South Yorkshire, be appointed as Vice Chair of the Health and Well Being Board for the 2022/23 Municipal Year.

RESOLVED that Anthony Fitzgerald be appointed as Vice Chair of the Health and Wellbeing Board for 2022/23.

The Chair announced that Doncaster Health and Wellbeing Board had been asked to nominate 5 members of the new South Yorkshire Integrated Care Board.  As a consequence, she confirmed that the nominations were:

Damian Allen - Chief Executive, Doncaster Council,

Cllr Rachael Blake - Chair HWB

Rupert Suckling – Director of Public Health, Doncaster Council,

Cllr Nigel Ball - Cabinet Member for Public Health, Leisure, Culture and Planning,

Dolly Agoro - Co-chair Inclusion and Fairness Forum

It was noted that following the Board’s endorsement, these nominations would need to be formally ratified by Mayor Ros Jones as Executive appointments to an outside body and the ICS would be notified accordingly.

(A period not exceeding 15 minutes for questions from members of the public.)

Mr Tim Brown put the following statement and questions to the Board:

“Thank you for the opportunity to speak in front of so many distinguished leaders and officers. 

I am grateful to Reni Eddo-Lodge and her inspirational book, “Why I am no longer talking to white people about race” to help me understand structural racism and micro aggressions.

I attend these meetings in good faith to offer a race equality lens and support to enable the board to address ethnic minority health inequalities in the context of access, experience and outcomes. 

From reading Reni Eddo Lodge book:-

‘I do now feel that entering into conversation with defiant white people is a frankly dangerous task for me.  As the heckles rise and the defiance grows, I have to tread incredibly carefully, because if I express frustration, anger or exasperation at their refusal to understand, they will tap into their pre-subscribed racist tropes about angry black people who are a threat to them and their safety.’

It is very likely that the Team Doncaster leaders and their white friends will conspire and rally around, ignore, disbelieve, rewrite history and make lies the truth. I will be subjected to further punishment for having the temerity to champion an anti racist and aspirational Doncaster!

Trying to engage with the Council and navigate the structural racism that was independently verified by Professor Gus John is why black citizens are increasingly tired of fighting for our basic rights. 

With little or none of Professor Gus John report recommendations ever being implemented, it comes as no great surprise that in 2022 social work practitioners are still failing to properly record the ethnicity of children and young people reference the recent Ofsted report in Doncaster children services 

Once again and year after year the race equality fundamentals are overlooked and there appears to be no accountability for failing to meet the cultural needs of black children and young people? 

It is in this context that I respectfully ask what exactly does good race equality progress look like in 12 month, 3 and 5 years and whether an assurance can be given that a review of recording the ethnicity of service users will be seen as a priority across the health and wellbeing board?”

In reply, the Chair, Councillor Rachael Blake stated that with regard to Mr Brown’s comments, this Board had never been defensive or defiant and had always welcomed the views expressed by Mr Brown, however offensive these might be to people in terms of calling them racists as he had done in previous meetings.  She explained that there had been much reflection in Doncaster over the last few years on where we are in terms of the governance arrangements, in terms of recognising our failures and in terms of recognising instances of systemic racism, not just in Doncaster, but everywhere and how that manifests itself.  And she confirmed that new governance arrangements had been put in place.  The Chair confirmed that she had also read the  ...  view the full minutes text for item 19.

There were no declarations of interest made at the meeting.

RESOLVED that the minutes of the meeting of the Health and Well Being Board held on 9^th  June, 2022, be approved as a correct record and signed by the Chair.

Dr Victor Joseph gave a presentation to the Board which provided an update on health protection work, focusing on COVID-19, and preparation for winter in relation to vaccination for COVID and Flu.

In particular, the presentation highlighted the following key points:

• Progress in the last quarter, including a review of the local health protection approach and learning from COVID.

• The latest position in relation to COVID-19 rates in Doncaster, including hospital admissions.

• Details of the Winter Plan for the delivery of the autumn COVID-19 booster and flu vaccine programme were outlined.

During subsequent discussion, Dr Rupert Suckling stated that it was pleasing to note that the national COVID alert level had now been reduced to level 2, which was an indication that although the virus was still circulating, it was not causing particular pressures on the health and care service, as before.

Anthony Fitzgerald confirmed that he was confident that the NHS would have the capacity to deliver the flu and COVID vaccination programme over the autumn period.  He stated, however, that there were risks, such as ‘vaccine apathy’ amongst the population and that all partner organisations had a responsibility for promoting the vaccination programme and engaging with communities to encourage take up of the vaccines.  Anthony added that it was important that vulnerable people were given priority to receive the vaccines, and he stressed the need to get the workforce vaccinated at the earliest opportunity, as there were currently gaps in the workforce and this presented an additional risk in terms of delivering services over the winter.

After other Board members had commented on the importance of raising awareness of the vaccinations to combat the risk of apathy, it was

RESOLVED to note the update on health protection for the people of Doncaster.

The Board received a presentation by Anthony Fitzgerald which provided a detailed update on the development of the South Yorkshire Integrated Care System and Doncaster place.  This included information on the establishment of the SY Integrated Care Board and its Governance structure, including Committees, Partnerships and Delivery Groups.  Information was also provided on the Place Based Health and Care Partnerships and how these would operate.

During subsequent discussion, Board members made a range of comments/observations, including the following:-

• Dr Rupert Suckling referred to the ICB’s stated Purpose, which included ‘eliminating health inequalities’ and felt that while it was great to see ambition, this would be a challenging target to achieve unless radical new approaches were adopted.  Dr Suckling also spoke of the need to ensure that staff were empowered to make the best decisions for patients and that momentum in the system was maintained, without the governance structures slowing things down.  In reply, Anthony Fitzgerald confirmed that local decision making by staff would be encouraged, and he acknowledged that more could be done in supporting staff to work in a more integrated way, now that everyone was working together under a single budget.

• In reply to a query, Anthony explained that within the key priorities across the ICB, there were elements of commonality and the intention was to charge the alliances and federations of either Acute Trusts, Mental Health Trusts and Children’s Trusts to come together and identify the areas of commonality which would then inform future commissioning.

• Steve Shore spoke of the importance of remembering to see things from the perspective of patients and considering whether the average citizen would understand the changes being implemented and how these might impact on their lives, as in reality, residents were only interested in how long they would have to wait for GP and hospital appointments, or how long they would have to wait to be seen in A&E departments.  In response, Anthony Fitzgerald stated that he fully understood the need for effective and meaningful communications with the public with regard to health service delivery, particularly at a time when the offer for the public had changed since the COVID pandemic, in terms of expectations of face to face appointments with GPs for example, and conversations were needed about what the new reality was and how services would be delivered in future.

• Arising from a comment by Councillor Glynis Smith, the Board discussed the need for all partners across the South Yorkshire ICB to work closely together in identifying instances of best practice and eliminating poor working practices.

RESOLVED to note the presentation and update from NHS South Yorkshire.

The Board received a presentation by Laurie Mott, Senior Strategy and Performance Manager and Allan Wiltshire, Head of Policy Performance and Intelligence, which gave an update on the work carried out to date on the 2022 JSNA, the Work Plan and the enabling infrastructure.

In summarising the results of the first tranche of data from the 2021 Census, Laurie Mott explained that the Census was incredibly important to the Health and Wellbeing Board, as it provided a rich data set on the health, social and economic environment in Doncaster.  It was noted that a substantial amount of data was still to come and this would not be available until the end of the year or early next year, so a more detailed insight into the findings of the Census would be provided at a future meeting of the Board when the data was released.

Allan Wiltshire then presented the JSNA work plan for 2022-23 and highlighted the following key areas of work to be covered:-

• SEND (Special Educational Needs & Disabilities) – an investigation and equalities profile would be carried out in relation to children registered as SEND;
• ‘Core 20+5’ – this was an NHS framework looking at health inequalities for the most deprived communities nationally.  Joint analysis between the Council, ICB and NHS Health providers would look at the health inequalities and outcomes in 5 clinical areas;
• Adult Social Care Access and Inequalities – work would be undertaken in analysing data sets to look at inequalities in relation to Adult Social Care services;
• Census – further census data was due to be published later this year and this would inform a more detailed and up to date understanding of Doncaster’s population;
• Combatting Drugs Partnership – joint analysis would be carried out between the Council, local NHS bodies and South Yorkshire Police to inform the ‘Harm to Hope’ Strategy.  A local partnership board had been established to deliver this new national 10 year policy framework locally, and a needs assessment would be completed locally to inform a more detailed understanding of this area.

In noting that healthy life expectancy in women had fallen for the fourth year in a row to 56 years (down 5 years in 5 years), the Chair asked if this issue was included in the JSNA work plan as a priority area.  In reply, the officers explained that this could be added to the work plan, but that it would be ordinarily picked up in the outcomes framework.  The Board agreed that this decline needed to be examined in more detail as a priority in order to identify the reasons for this fall and possible measures to deal with it.  Dr Rupert Suckling added that the Health and Wellbeing Strategy did not currently have a specific gender focus and he felt that this was something to consider when the Strategy was refreshed.

Anthony Fitzgerald stated that there was a need to place healthy life expectancy at the forefront of our priorities and when refreshing plans and strategies,  ...  view the full minutes text for item 24.

The Board received a presentation by Allan Wiltshire which provided a progress update on the establishment of the Fairness and Wellbeing Commission.  It was noted that the Commission would be an independent body tasked by the Health and Wellbeing Board in Doncaster.  It would work to produce a report with some clear areas of focus that would improve well-being for residents.

Allan gave further details on the membership composition of the Commission, which included representation from Team Doncaster, local frontline organisations and the independent sector.  The presentation also outlined the planned work programme of the Commission, comprising a number of sessions on a wide range of topics, commencing in November 2022 and running through to May 2023, followed by the drafting of the Commission’s report in the summer of 2023.  Allan concluded by summarising the next steps, and confirmed that regular update reports would be brought to this Board on the Commission’s progress.

During subsequent discussion, Dr Rupert Suckling pointed out that the Commission’s programme did not currently include a session dealing specifically with Health and he felt that this was something that the Board may wish to keep under review with a view to possibly adding in a focus session on this topic at some point.

Dr Suckling also stressed that while the Commission would be reporting on the cost of living crisis as part of its work programme, Doncaster Council and Team Doncaster partners were taking action now in identifying ways of alleviating the situation for those affected.  It was agreed that a briefing on the cost of living crisis and actions being taken would be circulated to Board members outside of the meeting.

In reply to a query by Steve Shore as to whether Healthwatch Doncaster had been formally invited to sit on the Fairness and Wellbeing Commission, as the report stated that their representation was ‘to be confirmed’, Allan Wiltshire stated that he would pick this up with Steve outside of the meeting.

Councillor Nigel Ball referred to the Programme and the reference in the Commission’s first session to ‘some form of lunch/exercise to bring the Commission together’, and expressed the opinion that it would be inappropriate for the Commission to be seen to be enjoying a lunch at such a sensitive time when people were struggling with the cost of living crisis, and it was suggested that Commission members should instead be asked to bring their own lunch to the session if they wished.

RESOLVED to note the presentation and update on the Fairness and Wellbeing Commission.

The Board received and discussed a briefing paper by Dr Rupert Suckling, Director of Public Health which proposed a set of approaches, commitments and areas of focus for the Board to consider, aimed at improving engagement with local people.

It was proposed by the Chair that a Task and Finish Group of Board Members, including Steve Shore, Lucy Robertshaw, Cath Witherington and some of the Elected Members, plus any other interested Board members, should meet to discuss in more detail the suggested areas of focus for improving this Board’s engagement with local people.

Phil Holmes commented that all of the partner organisations represented on this Board had their own methods of engaging with people and he felt it would be useful if they could be asked to share this information with a view to identifying how this could then link in with this Board to find effective ways of connecting with residents.  In reply, the Chair agreed that such a conversation would be useful and suggested that this could be picked up once the Task and Finish Group had met and shared its findings with the wider Board membership.

RESOLVED that a Task and Finish Group meeting be convened to consider in more detail the options for improving the Board’s engagement with local people, as set out in the briefing paper.

The Board received a presentation by Mitchell Salter, Senior Policy and Insight Manager, on the development of a new Economic Strategy for Doncaster.  Mitchell gave an overview of the established strategic goals that would feed into the Strategy and outlined the factors that were influencing the Council’s thinking in the development of the new Strategy, including regenerative principles, circular economics and qualitative growth.  The presentation also summarised the key themes that had been emerging and the Board noted, in particular, that the Strategy would have an increased focus on health.

Discussion followed, during which Board members welcomed the fact that health was at the centre of the Strategy and that the strong connection between health and the economy was being recognised. 

Anthony Fitzgerald informed the Board that Chief Financial Officers and Finance Directors were currently undertaking a piece of work to identify what a financial health and care strategy would look like.  He spoke of the need to have a proper efficiency programme in place across all partner organisations, together with a targeted prioritisation and allocation approach to determine where money should be spent.

Dr Nabeel Alsindi highlighted the connections between people’s health and their work, which were often evident from his dealings with patients.  He stated that illnesses and poor health linked to people’s work impacted not only on the individuals concerned but also on businesses and the wider economy.  He also stressed the importance of workplaces being healthy environments for staff, as this was a major contributor to healthy life expectancy.

Phil Holmes requested that an explicit connection with family carers was made in the work on the Economic Strategy.  He advised that a Carers Strategy had recently been produced, along with an associated action plan, and that these were due to be considered by the Council’s Health and Adult Social Care Overview and Scrutiny Panel later this month.

Following discussion, the Chair encouraged partners in the meeting to contribute towards the Strategy and contact Mitchell with any comments/feedback on the contents.  It was noted that a consultation forum on the Strategy was due to be held in October which would have input from the health and care sector, and a further report with the finalised Strategy would come back to this Board in November 2022.

RESOLVED to note the contents of the presentation.

The Board received a presentation by Holly Campbell, Public Health Improvement Co-ordinator, summarising the findings from the consultation carried out to help inform the development of the compassionate approach to weight.  Holly began by explaining that today’s presentation would highlight the findings from the consultation questions that were considered to be most relevant to this Board, but that the full findings of the consultation would be made available to Board members for further reading outside of the meeting.

It was reported that the consultation had comprised 3 surveys, two of which were open to Doncaster residents, and the third aimed solely at health and wellbeing professionals.  Survey 1 (Doncaster residents) had asked questions about food, eating habits, physical activity and health behaviours. Survey 2 (Doncaster residents) had focused on experiences of weight management, weight stigma and attitudes to health.  Survey 3 (health and wellbeing professionals) had asked questions aimed at understanding perceptions around the relationship between weight and health and potential levels of weight stigma within the sector.

The presentation then summarised the key findings from the survey questions covering the following topics:-

·         What does good health mean to you?

·         What does good wellbeing mean to you?

·         Access and availability of food

·         Feeding children

·         What would your child have as a snack?

·         Food and advertising

·         Physical activity

·         Experiences of weight management

·         Weight stigma

·         Acceptability amongst professionals

It was reported that a training package was being developed to support health and wellbeing professionals in implementing the compassionate approach to weight, and any Board members and elected members interested in taking part in the pilot of this package were invited to contact Holly.  The Board noted that engagement with the public would be continuing, and that a public patient engagement group had been set up which would meet regularly to receive feedback from residents to help inform the development of the compassionate approach.  The findings would also be communicated to the public via the Doncaster Talks website, which would explain how the information gathered from the consultation would be used to inform current work streams.

Dr Rupert Suckling advised that, regarding the issue of junk food advertisements, the Council would be looking at the possible restriction of such advertising on Council-owned advertising spaces in the Borough.

RESOLVED to note the contents of the presentation.