Agenda and minutes

The Chair, Councillor Rachael Blake welcomed all to the meeting and thanked those attending the meeting who were there to comment and present their lived experiences regarding the items being discussed on today’s agenda.

Apologies for the meeting were received from Councillor Sarah Smith, Dr Rupert Suckling, Rachael Leslie and Lucy Robertshaw.

There were no announcements other than welcoming those from outside of the Board to the meeting.

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

Whilst there were no members of the Public in attendance, the Chair asked whether any Members in attendance had any questions/statements. The Board received and responded to questions/statements received as shown below:-

Councillor Cynthia Ransome expressed her concern regarding constituents not been able to access NHS Dentists and asked whether this was common throughout Doncaster. It was advised that this situation was not uncommon and was a South Yorkshire wide issue. She was assured that this was being looked at to bring the waiting lists for dentists down. It was also advised that the Board would receive a report focussing on dentistry at its November meeting.

It was AGREED that:-

1.        A report be submitted to the November Board meeting focussing on           the current issues being experienced in accessing dentist treatment         and what actions were been undertaken to make improvements; and

2.        Healthwatch supply data to help formulate the report and action plan.

Councillor Cynthia Ransome referred to the recent Lucy Letby case and asked whether further procedures had been put in place in Doncaster. It was advised that as the public enquiry evolves, it was envisaged that there be several actions to be looked at including how information is shared. It was acknowledged that Governance needed to be robust, and the Board were assured this would be kept under review.

Councillor Glynis Smith expressed concern regarding consultation on the NHS Joint Forward Plan. She felt that 1% did not reflect reasonable consultation and it appeared that many potential consultees had been excluded. It was acknowledged that consultation had not been good. However, this would be fed back to the ICB Board.

Further details were discussed regarding engagement with residents carried out by Healthwatch.

It was AGREED that:-

(1)      A copy of the engagement documentation and responses carried out by     Healthwatch be supplied to the Board; and

(2)      NHS South Yorkshire ICB work with Healthwatch to provide a            combined approach on how engagement can be improved, and an        update be submitted to the Board at its November meeting.

There were no declarations reported at the meeting.

RESOLVED that the minutes of the Health and Wellbeing Board held on 8th June, 2023 be approved as a correct record and signed by the Chair.

The Chair and Board agreed to change the order of business on the agenda to bring forward Agenda Item 12 “The Team Doncaster Dementia Strategy”, as Wendy and Phil were in attendance to tell the Board about their lived experiences.

The Board received a presentation by Mark Wakefield and Jo Forrestall who were accompanied by Wendy Sharps and Phil Bargh from the Doncaster Dementia Collaborative & Doncaster Dementia Strategy Group. Wendy and Phil presented to the Board their lived experiences in relation to dementia. The Board also received further information on the current commissioning arrangements regarding dementia services, together with an overview of the Dementia Strategy and development of an action plan.

Discussion took place regarding the tender process and officers stated that it was fair to say that the process had not gone smoothly. It was advised that with the action plan now in place it was envisaged that engagement and consultation will be wider, and improvements will be made. It was also noted that there would also be a 12-month review to assess progress.

The Board welcomed the presentation from Phil and Wendy and stated it was helpful to hear their experiences and it was acknowledged that the designed pathways will only work if there is access to them. It was noted that if communication was good then issues would not be left unresolved. The Board recognised the difficulties surrounding young onset dementia and felt that further training for staff was required to ensure the signs are recognised and it was important to advise and notify people appropriately when the operation of services was changing. Regarding patients receiving results from tests, it was advised that all tests have a specified turnaround time. If the results have not been communicated, then this should be followed up.

In terms of the difficulties that Wendy had experienced regarding direct payments, discussion would take place outside of the meeting to resolve this issue.

Further discussion took place regarding training. It was suggested that a collective approach be undertaken to dementia awareness training.

A number of actions were proposed as follows:-

·    NHS Colleagues to look at and promote patient power in terms of what they should expect when attending for tests and to ensure patients are aware that they are entitled to follow this up with the GPs if results have not been received;

·    reassurance be given to Wendy that the new service being provided will commence when stated;

·    a Joint approach be undertaken to ensure training on Dementia Awareness is carried out. To be a priority for the workforce lead/Doncaster Place Committee;

·    a system be devised to ensure poor behaviour experienced by users is logged and feedback is provided;

·    the direct payment issue experienced by Wendy be investigated outside of the meeting to explore a way forward; and

·    an update report be brought back to the Board in 6 months.

            RESOLVED that the Strategy and the priorities be endorsed

The Board received an update on progress from Pauline Dunn, Trustee, Secretary and Treasurer, Doncaster & District Deaf Society regarding the gaps, inequalities, and access to services for the British Sign Language User living in Doncaster at its meeting in March 2023.

Members were reminded of the actions agreed following the presentation at the last meeting and discussion took place on what progress had been made since the meeting in March.

Pauline advised the Board that good progress had been made and conversations had taken place. She advised that there was a national shortage of BSL interpreters and Doncaster had no trainee in place. She also stated that meetings with the NHS had been good, and work was continuing to establish an App for the hospital which was suitable for BSL users. Pauline suggested that colleagues look at using the ‘Sign Live’ App which most hospitals had installed.

Pauline also wanted the Board to be aware that the Citizens Advise Bureau didn’t have a BSL experienced community link worker. Work had been undertaken to team up with CAB. Once funding had been secured, advertising for a post would be established.

The Board were pleased at the progress made. Dr Alsindi stated that a session had been planned for 19th September with the focus group where he would pick up in more detail. He advised that discussion had taken place a few years ago, however nothing changed, and commitment needs to be forthcoming to ensure this didn’t happen again. He also advised that there was a need to correct the misconception around BSL and communication needs to be refreshed and targeted where required.

           RESOLVED that:-

(1)       the update on progress be noted; and

(2)       a further update report be brought back to the Board if there were any further concerns.

The Board received a presentation by Emma Price, Head of Strategy & Delivery, Children and Maternity, South Yorkshire Integrated Care Board, Martyn Owen, Head of Service Inclusion, Doncaster Council providing an update on the development of the Children and Young People’s Mental Health and Wellbeing Strategy.

Members were advised that based on the ambitions of young people, priorities had been refined for delivery in Year 2 of the strategy. The presentation set out the priorities and how these will be delivered.  A video message from the Young Advisors was also presented.

The Board welcomed the presentation and a number of comments and questions were raised and answers provided in regard to the following:-

·    BCF Schemes such as Vulnerable Adolescents, Care Leavers and Parenting Support Service may be willing groups to engage with.

·    Need to ensure all recommendations are visible and tracked in the actions.

·    How Looked After Children (LAC) were integrated into the Strategy.

·    Pleasing to see Special Educational Needs, outlined within the Strategy. However, certain pathways can be difficult, it would be beneficial to see how this can be integrated in a more positive way.

·    In terms of training for staff, was this followed up and did they feel confident after the training had been provided.

·    Pleasing to see the linkages within the strategy to healthy eating.

·    In terms of the voice of people, how diverse had this been.

·    How data had been used to inform about different characteristics.

·    Support for Deaf Children within schools in the form of offering sign language lessons to parents of deaf children.

·    It was important that people know exactly what they need to do and what route they need to take to access the support and guidance they require.

The Chair and Board proposed the following actions:-

• officers to engage with looked after children’s service and the “Hear me Out Group”.
• the Board asked to see data on waiting times and feedback from parents and young people at the next update.  
• a further update be provided to be Board in 6-9 months to assess the impact that the Strategy has had on reducing waiting lists and how schools are supported.

RESOLVED that the Board supported the priorities and activities described in the presentation.

The Board received a presentation from Callum Helman, Transformation Manager Children, Young People, & Families Directorate which provided an overview of the Family Hubs and Start for Life programme and explained how this contributes to a reduction in inequalities in health and education outcomes for babies, children, and families.

The programme’s objective was to join up and enhance services delivered through transformed family hubs in local authority areas, ensuring all parents and carers can access the support they need when they need it.

Members noted that the programme will:

·    provide support to parents and carers so they can nurture their babies and children, improving health and education outcomes for all

·    contribute to a reduction in inequalities in health and education outcomes for babies, children, and families across England by ensuring that support         provided is communicated to all parents and carers, including those who are hardest to reach and/or most in need of it

·    build the evidence base for what works when it comes to improving health and education outcomes for babies, children, and families in different delivery contexts.

The Board welcomed the presentation. Dr Alsindi commented it would be beneficial for GP Practices, RDASH etc to be aware of any events or activities scheduled to take place within the hubs to enable them to signpost patients, which in turn will hopefully drive uptake of attendance. The Board were advised that the next task for the team was to produce a communication plan with a key focus on GP Practices.

Further comments were made regarding the family hubs not being able to facilitate people from the BSL community.

The Board agreed that contact be made with Pauline Dunn (Doncaster & District Deaf Society) and Health Colleagues on how engagement and communication regarding Family Hubs and Start for Life Programme can be improved.

           RESOLVED that the contents of the presentation and Family            Hubs/Start for Life contribution to a reduction in inequalities in health        and education outcomes for babies, children and families be noted.

The Board received a presentation by Jon Gleek, Policy, Insight and Change, City of Doncaster Council providing a mid-way update on the work of the Fairness and Wellbeing Commission.  It detailed the methodology used by the Commission in its data gathering and outlined the emerging recommendations, together with the timeline leading up to the publication of the final report.

Discussion took place regarding what was required from the Board. The Board welcomed the update and the approach taken had the right mix. However, felt that it needed to be pitched to tangible elements. It was suggested that a small working group be formed to look at this issue. However, the Board were keen not to lose the work what the Commission had already produced.

RESOLVED that:-

(1)       the update be noted;

           (2)      the Working Group that had already been established to look                        at the Health and Wellbeing Strategy/One Doncaster Plan                             be asked to look at the recommendations; and

            (3)     an Extraordinary Meeting of the Board be set to discuss the              recommendations in more detail.

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The Board received a report from Allan Wiltshire, Policy Insight and Change, City of Doncaster Council which provided a further update on proposals for developing the next Health and Wellbeing Strategy, following the discussion at the Board’s last meeting in June.  The briefing paper in the agenda pack gave a more detailed overview of the proposals, including context, approach, strategy development principles and process, progress, indicative timeline, and next steps.

Ailsa Leighton advised the Board that extensive resident engagement had been undertaken and officers were currently going back out to communities to ensure that they have it right in terms of what has been asked for and a further update would be presented to the Board in due course.

The Board thanked officers for the update.

            RESOLVED that:-

(1)       the proposals for the development of the HWB strategy and plan     be agreed; and

            (2)     the indicative timescales be agreed.

The Board received a presentation by Andy Collins, Public Health (CDC) and Vicki Beere, CEO of Project 6 providing a range of statistics in relation to liver disease and local alcohol profiles for England, together with figures for female adults in treatment in Doncaster.  The presentation focussed on the findings from research and on the work of Project 6 and how it is providing support to over 50s alcohol users.

The Board thanked Andy and Vicki for the presentation, stating that it was clear from the data and from past reporting that there is a major problem, and it had been known for some time the disparity in women which is unacceptable.  It was important that the officers along with the Board and its partners drill down on what can be done to tackle this issue.

Andy advised the Board that unfortunately there was no new monies available, and it was a case of how the team can use what is in the existing envelope more efficiently. Ailsa Leighton advised that discussions were ongoing on how the Council can provide a more team-based approach.

Dr Alsindi stated that he had had discussions regarding this issue and felt that there were 3 parts to the pathway as follow:-

·    Existing Intervention Services needed to be co-produced

·    Early harm – scans could be accessed from community hubs rather than waiting to see GPs (Nottingham Council Model); and

·    What the offer was for those patients who were further down the line and whether monies can be redistributed around the system to support the patients more effectively.

Further discussion in terms of how a co-produced Health and Social Care Strategy for women can be produced was undertaken, including primary intervention activity and supporting officers in terms of locality/community change.

            RESOLVED that:-

(1)      the Board look to co-produce a Health and Social Strategy                             for women; including methods on how to create funding to make               a changes to women’s relationships with alcohol; and

            (2)     Promotion of a wider Health Strategy for women to be                                     produced.

The Board received a brief presentation by Mike McBurney, Senior Policy Insight and Change Manager (Strategic Commissioning), City of Doncaster Council providing an overview of the BCF, including:-

·    BCF budget headings;

·    Expenditure against main funding themes;

·    BCF Performance Targets; and

·    Top priorities for 2023/24.

The Board were advised that the biggest cost centre was intermediate care and Falls was now a new targeted area. It was noted that there were 2 objectives to grant conditions. The first was to enable people to stay at home for longer, therefore reducing the pressure on acute services and secondly tackling the immediate pressures to enable discharges. Officers advised that the fund should be wisely invested to ensure it makes the best impact.

It was reported that whilst this does happen, there was further options available, funding was one lever. Workforce development and commitment to digital would create a more integrated way albeit challenging. It was noted that the ultimate challenge was for the Doncaster Plan was addressing health inequalities and commitment to engagement.

Richard Parker shared his views regarding 2 priority areas, the first being the navigating through the winter challenges and the second was managing spend over the year. All Board members commended spending wisely.

RESOLVED that:-

            (1)     The Board acknowledged sign-off of the BCF plan;

            (2)     The Board noted a Section 75 agreement between                                          South Yorkshire Integrated Care Board will be signed no later                       than 31st October, 2023, that will include details of the new                                national conditions and metrics; and

            (3)      The Board to review progress of Doncaster’s BCF plan for 23-                     25 and evaluation of BCF performance at future meetings.

The Board received and noted the minutes of the Health Protection Assurance Group meeting held on 19 July 2023.

Prior to the conclusion of the meeting, the Board received notification that a new Covid 19 variant had been identified. In response, it was advised that the vaccine programme for Flu and Covid 19 would be brought forward.