Agenda and minutes

Cllr Hannigan assumed the Chair, and welcomed everyone to the meeting, inviting them to introduce themselves.

Victoria Lawrence substituted for Karen Pavey

There were no declarations of disclosable pecuniary interests and personal or personal and prejudicial interests.

Resolved - That the minutes of the meeting of the Health and Wellbeing Board, held on 30 January 2023, be approved as a correct record.

The Director: Governance and Communities confirmed that the Forward Plan was up to date, and that all forthcoming actions were timetabled.  Board members were asked to feed through any additional business for inclusion on the Forward Plan.

There were no questions from members of the public.

The NHS Director of Place: North Lincolnshire and the Director: Adults and Health submitted a joint report requesting that the Health and Wellbeing Board formally agree and sign off the North Lincolnshire Adult Social Care Discharge Fund Plan 2023/24prior to formal submission to the National Better Care Team.   

The Directors informed the Board that, in September 2022, the government announced its Plan for Patients. This plan committed £500 million for the remainder of 2022/23 with further funding in 2023/24 to support timely and safe discharge from hospital into the community by reducing the number of people delayed in hospital awaiting social care.

The focus for the additional funding was a ‘home first’ approach and discharge to assess (D2A). The addendum to the 2022 to 2023 Better Care Fund (BCF) policy framework and planning requirements set out further detail for how this fund would be distributed, as well as conditions governing its use. The aim of this funding was to prioritise those approaches that are most effective in freeing up the maximum number of hospital beds, and reducing the bed days lost within the funding available, to the most appropriate setting from hospital, including from mental health inpatient settings.  Further details on the Discharge Fund were contained within the report.

The Chairman led a discussion of the Plan, highlighting that the details contained within the report were a reflection of a “moment in time”, and that there was a wider discussion underway about what the local system should look like, and how to reach that point.  It was highlighted that there was a need for funding issues to be resolved, and that there needed to be a shift from intensive support and treatment towards a preventative model.   

Resolved – That that the Health and Wellbeing Board formally agree and sign off the Adult Social Care Discharge Fund Plan 2023/24 prior to formal submission to the National Better Care Team.

The Director: Children & Families submitted a report to update the Health and Wellbeing Board in relation to the Integrated Children’s Trust and progress relating to the delivery of the Children’s Commissioning Strategy 2022 Refresh.

The Director set out how the North Lincolnshire Health and Care Integration Plan set the strategic vision and principles for integrated working within North Lincolnshire.

Following the publication of the inaugural Children’s Commissioning Strategy 2020/24 in September 2020, a 2022 refresh had been endorsed through appropriate partnership and democratic governance arrangements, including the Health and Wellbeing Board.  The 2022 refresh aligned with the refreshed Place Partnership strategic intent and the new iteration of the Health and Care Integration Plan.     

The 2022 refresh rearticulated the One Family Approach and the local ambition for children to be in their families, in their schools and in their communities; and it reset our integration priorities and commissioning intent across education, health and care for our children and families.  The 2022 refresh also refines the ‘shine a light’ areas of focus, which were now focussed around: 

·       Emotional wellbeing and mental health

·       Best start in life

·       Adolescents and youth offer

·       Outcomes for children and young people with vulnerabilities

The Board discussed the report, highlighting the need to reflect on differences between traditional health and social care provision, and local efforts to support families, often including a wider range of partners, providers and commissioners.  It was agreed that this was also a discussion that should be had at the Integrated Care Board. The NHS Place Director confirmed that relevant discussions were underway at the Place Partnership to maintain a ‘line of sight.’ 

Resolved – That the Health and Wellbeing Board note the update in relation to the Integrated Children’s Trust and the Children’s Commissioning Strategy Refresh 2022.

The Director: Children & Families submitted a report updating the Health and Wellbeing Board on the publication of the Stable Homes, Built on Love Implementation Strategy and Consultation; and to consider the implications and the local response.

The Director stated that the Stable Homes, Built on Love Implementation Strategy and Consultation was published on 13 February 2022 and was the Government’s response and detailed plan to address the recommendations to reform Children’s Social Care, as set out in the independent review of children’s social care:  Final report; Child Protection in England; and the Children’s Social Care market study. 

The Government’s response was a once in a generation opportunity to reset children’s social care system to transform the lives of children and families.  It set the tone and purpose of children’s social care and was built around six key pillars, as follows:

1.     Family Help provides the right support at the right time so that children can thrive with their families

2.     A decisive multi agency child protection system

3.     Unlocking the potential of family networks

4.     Putting love, relationships and a stable home at the heart of being a child in care

5.     A valued, supported and highly skilled social worker for every child who needs one

6.     A system that continuously learns and improves, and makes better use of evidence and data

A summary of the key strands associated with each of the six key pillars was outlined in appendix 1 to the report. 

The Director explained that Stable Homes, Built on Love identified 19 consultation questions and build in additional consultation(s) in relation to Children’s Social Care National Framework and the Child and Family Social Worker Workforce.  The deadline for all consultation responses was May 2023.

The Board discussed the report, querying funding issues and whether North Lincolnshire would be likely to be asked to participate as a pilot, given recent successes.  It was confirmed that budgets were in place.

Resolved – (a) That the Health and Wellbeing Board note the publication of the Stable Homes, Built on Love Implementation Strategy and Consultation; support the ongoing local response to the consultations; and contribute to further discussion regarding local implications and implementation; and (b) that the Health and Wellbeing Board support North Lincolnshire acting as a national pilot area, if requested by government, in order to share local best practice with others.

The Chairman welcomed Helena Dent, Senior Commissioning Officer - North Lincolnshire Health and Care Partnership, Christina Harrison, Children Care Group Director – RdaSH, and Wendy Holmes, Head of Virtual School and Inclusion, to the meeting. 

A report was submitted, which provided an update to the Health and Wellbeing Board on progress and developments relating to children’s neurodiversity in North Lincolnshire. The paper explained current diagnostic demands and described the actions being taken to address this, whilst highlighting how the increase in children being diagnosed as neurodiverse required a whole-system response, to ensure children and families needs are met.

Helena and Christina explained that neurodiversity was a priority issue for the Integrated Children’s Trust and the Special Education Needs Disability (SEND) Standards Board due to the increased number of requests to assess North Lincolnshire children, over recent years.  Children who were neurodiverse receive support from a wide range of education, social, health and voluntary services, to meet their identified needs.

The models for children under 5 years of age, and children and young people aged over 5, were described and discussed, along with details of waiting times, assessments, and support given whilst waiting.

The Board discussed the issues in some depth, asking questions about waiting times, increases in demands, transition from children’s services to adult’s support, work with schools and colleges and primary care, and potential solutions to minimise inequalities.  It was confirmed that the model was based on ensuring that necessary support was in place, rather than receiving a formal diagnosis.  

Resolved – That the Health and Wellbeing Board note and accept the report.

The Director of Public Health presented a copy of their independent report on the state of people’s health in Greater Lincolnshire, with a particular focus on the communities of North Lincolnshire.

It was explained that Directors of Public Health in England have a statutory duty to produce an independent annual report on the state of health of the people they serve. Local authorities have a statutory duty to publish the report and the report should be as accessible as possible to the wider public.

As part of an innovative public health pilot, the DPH report covers three local authority areas being: Lincolnshire County Council (LCC), North Lincolnshire Council (NLC) and North East Lincolnshire Council (NELC) – collectively referred to as Greater Lincolnshire. To reflect this inter-authority partnership, a single DPH report was written which encompassed the diverse communities of all three local authorities.

The Director stated their intention that the report would provide a strong evidence base for identifying opportunities for health and wellbeing improvement, providing a focus to engage agencies and communities about identifying collaborative solutions.

The Board welcomed the report and discussed opportunities to improve the health and wellbeing of local people.

Resolved – (a) That the Health and Wellbeing Board welcome the report, and (b) that the Director note the feedback on its content.

The Director of Public Health submitted a short briefing report to provide insight into some of the core principles and objectives of population health management, as it features in the strategic integration intentions of the NHS and local partnerships.  The report described the priorities for population health management development in North Lincolnshire and outlines progress to date.

The Director confirmed that developing approaches to population health management was a key responsibility of Integrated Care Systems (ICSs) and there was a great deal of work underway to define and operationalise it.  There was therefore some leeway for the local ICS and its places to design and develop approaches which support local aspiration, within some clear parameters.

The Director stated that Population Health Management was an approach to using data insights to improve health and wellbeing now and in the future, and not a structure.  It was highlighted that the local intention was to move to models of neighbourhood working for primary and community services.  A step towards this would be the organising of communities into ‘neighbourhoods’, providing the defined populations required for this approach.  The report contained further detail.

The Board discussed the report, highlighting the need to go beyond the partners represented at the meeting in order to implement the approach effectively.

Resolved – (a) That the Health and Wellbeing Board note the briefing and the initial steps being taken in local strategic frameworks and partnerships to create the ambition and conditions for Public Health Management to be successful in improving health in North Lincolnshire; (b) that the Board endorse the recommendation to develop PHM capability in North Lincolnshire using the approach described at Option Three in the report; and (c) that a further update be provided to the Board in autumn 2023.

The Director: Governance and Communities confirmed that the date and times of future Board meetings would be circulated in due course.

There was no urgent or additional business.