Meeting documents

To receive the report, presentation and recommendations.

The Somerset Health and Wellbeing Board approved the following recommendations:

1. Notes the progress made with delivering Improving Health and Care Through the Home in Somerset (MoU);
2. Reconfirms the integration of health, care and housing systems/services as a HWBB priority, recognising that progress in this area is an important driver of prevention-focused service delivery, and confirms that all HWBB partners are committed to supporting this work via relevant partnership arrangements;
3. Supports a programme of work (suggestions on Pages 11/12) that will enable us to make significant progress within the realm of health, care and housing integration, recognising that this will require both robust leadership and resources (staff/funding), and commits to this programme of work to coming back to the Board for ratification and monitoring;
4. Supports collaboration with external support programmes (e.g. Leading for System Change/others) who can bring additional leadership capacity, ideas and general support towards this priority area of activity.

The Chair invited Mark Leeman, Strategy Specialist for Housing, Health and Wellbeing from Somerset West and Taunton District Council, to present the report, which had undergone several consultations, was quite wide-ranging, and focused on closer working.  He advised that Debbie Sorkin of the NHS Leadership Centre, Ian Burden of the NHS, Dave Baxter and Sarah Stillwell of Sedgemoor District Council, and Jai Vick of Mendip District Council were also on hand virtually to answer any potential questions. 

The Board was advised that a person’s health is determined by many factors, and housing was the second most important.  Unhealthy, unsuitable, and/or precarious housing can seriously affect one’s health, while one’s health can conversely affect a person’s ability to maintain a home.  There are many factors involved in homelessness, including both individual and wider forces that affect one’s ability to access and maintain housing.  A range of services and support are provided for the elderly to remain independent in their homes, as well as for helping families and communities to thrive.  People are at the heart of care services, as per the Adult Social Care Reform white paper which discusses the need to integrate service delivery. 

Mark revisited several previous decisions by the Health and Wellbeing Board regarding this issue and noted the progress made or lack thereof; matters dealt with included:

·       Homelessness and rough sleeping, including the establishment of the Homeless Reduction Board (HRB) with a highlight being no deaths due to Covid amongst rough sleepers, countrywide expansion of nursing support (RSPH award nomination in 2022), and progression of Better Futures for Vulnerable People in Somerset

·       Independent Living, for which BCF funding continues to drive a range of prevention-related activity and they have obtained a housing provider perspective from Homes in Sedgemoor

·       Climate change

·       Gypsy/Roma/Travellers

·       Health Impact Assessments, where more progress is needed

Strengths have included systems leadership (HWBB/MoU/HRB) and Somerset now being part of the national MEAM network and receiving praise for their efforts; weaknesses were identified regarding culture and commissioning.  Opportunities are available with respect to the ICS/ICP, LGR, and programmes such as Family Connections; threats include LGR’s impact on capacity, workforce in the health and care sectors, refugees, and the cost of living.  There have been many offers of help to address these challenges, including Leading for System Change from the NHS, the Better Futures programme, and Adult Social Care workshops. Potential areas of focus in the future which enable outcomes and are prevention-based include support from the HWBB/ICP, the HRB, the BCF, person-centred commissioning, changes in the workforce, creative solutions, specialist accommodation, etc.

The Board discussed several issues which are summarised below:

Somerset Strategic Planning Conference - Cllr Ros Wyke asserted that the most important thing SCC needs to look at seriously is the Somerset Strategic Planning Conference, on which there has not been much movement; Mark Leeman replied that the Board agreed a couple of years ago to look at the relationship between housing, health, care, and the town planning system with the desire to develop a county-wide approach to health impact assessments.  This would regard both local development plans and major planning applications for large housing sites.  There is much government advice coming out on this from Public Health regarding helping town planning systems to design neighbourhoods and dwellings that are good for people’s health, along with access to sport, leisure and recreation.  However, it has not been possible to progress this conversation as it was disrupted by Covid, and town planners say it is very difficult to effect these objectives due to the many pressures on developers (such as required contributions to education, local centres, open space, and affordable housing).  In some areas such as Torquay they have made progress by having an officer that liaises between the two systems of health and town planning, in order to help planners develop the guidance.  Cllr Wyke responded that a dividend from the upcoming unitary council must be the support of this initiative and the determination to get it right.  She was very disappointed that they have not got on top of the issue of housing and health, and she suggested that the Health and Wellbeing Board work programme have this as a focus.  She is happy that we are currently exchanging on land being sold for a development that will include protective housing as well as affordable housing. 

National Minimum Space Standards - Cllr Gill Slocombe thanked those involved with the report for their work but noted that more needs to be done, such as having national minimum space standards for families, which will improve their health.  Developers who want to construct ‘shoeboxes’ and tower blocks should not be permitted to do so; there must be an agenda for considering impairments to health in housing and for establishing homes for life, keeping in mind the physical impairments of people especially as they become elderly.  Nothing can be achieved through town planning if these measures are not already in place. 

Memorandum of Understanding (MoU) - Cllr Janet Keen asked if the MoU could be amended to include measures preventing young adults from becoming rough sleepers; she noted that there had been providers in the past like Pathway to Independence, but now many programmes find that there is a better return by dealing with another sphere of housing with less complex needs.  Mark Leeman replied that the MoU can in fact be amended, but he gave reassurance that this issue has been picked up in sections on homelessness, rough sleeping, and independent living.  He said there were doing equalities impact assessments on it, and excellent work is going on though children’s services and particularly the P2I initiative, such as a pilot around commissioning.  As far as the independent living agenda, more of their grant money from DFGs and BCF is being used for housing and supporting children and families.  The MoU can be amended to highlight where that work is happening.  Lou Woolway noted that this is an issue that straddles the whole system and will be a topic for the HWBB/ICP; she proposes that this matter be set up as a priority workstream for the transition arrangements of the boards.  Mel Lock declared that the exciting part about housing is that it is now at the heart of adult social care reform, which gives us a tool, a way forward, and additional funding.  There was a meeting about it a few weeks ago where Adult Social Care and housing sat together for the first time in quite a while, and if it can move forward in the right way and make a difference for people, more funding will become available for it from both various areas. 

Rough Sleeping - Cllr Lucy Trimnell said it had been an excellent roundup of a huge piece of work; she was worried, however, that as we go into winter rough sleeping will be an acute problem, and the report seemed to indicate that partners have not engaged fully on this issue.  Mark Leeman replied that this situation has improved significantly in the past few months with more engagement from the Better Futures programme and the HRB.  Lou Woolway added that when these issues are reported back to the Board, they will need to be recognised as priorities and be dealt with. 

Social Housing Providers - Cllr Chris Booth asked whether social housing providers will be able to cope with helping their tenants during the cost of living crisis: Mark Leeman responded that this was an interesting point and noted that last Friday there had been a workshop with all major registered housing developers around early help and how to collaboratively support tenants and vulnerable individuals and families.  This is a big challenge, as different registered providers have different operating and finance models as well as different client groups.  These conversations are driven by the Better Futures programme, and there is a commitment to continuing conversations and working together collaboratively.  Also, the Council will have a conference with providers in about a fortnight to share data around prevention and early help.  Jonathan Higman stated that he supported the proposals in the report and that the ICP is a good place to start on this work.  Lou Woolway pondered if the wording in the recommendations could be tweaked to reflect that, but Cllr Ros Wyke said she supported having a working group rather than altering the recommendations, with their proposals needing to be realistic as well as ambitions.

The Somerset Health and Wellbeing Board approved the following recommendations:

1. Notes the progress made with delivering Improving Health and Care Through the Home in Somerset (MoU);
2. Reconfirms the integration of health, care and housing systems/services as a HWBB priority, recognising that progress in this area is an important driver of prevention-focused service delivery, and confirms that all HWBB partners are committed to supporting this work via relevant partnership arrangements;
3. Supports a programme of work (suggestions on Pages 11/12) that will enable us to make significant progress within the realm of health, care and housing integration, recognising that this will require both robust leadership and resources (staff/funding), and commits to this programme of work to coming back to the Board for ratification and monitoring;
4. Supports collaboration with external support programmes (e.g. Leading for System Change/others) who can bring additional leadership capacity, ideas and general support towards this priority area of activity.