Agenda and draft minutes

To receive any apologies for absence.

Apologies were received from Cllr Dean Ruddell, Cllr Ros Wyke (virtual attendance), Sarah James, Michael Lennox, Judith Goodchild, Jon Worsley, Emma Rawlings, and Peter Lewis.

To receive and note any declarations of interests in respect of any matters included on the agenda for consideration at this meeting.

(The other registrable interests of Councillors of Somerset Council, arising from membership of City, Town or Parish Councils and other Local Authorities will automatically be recorded in the minutes: City, Town & Parish Twin Hatters - Somerset Councillors 2023 )

There were no new declarations of interest.

The Chair to advise the Committee of any items on which members of the public have requested to speak and advise those members of the public present of the details of the Council’s public participation scheme.

For those members of the public who have submitted any questions or statements, please note, a three minute time limit applies to each speaker and you will be asked to speak before Councillors debate the issue.

We are now live webcasting most of our committee meetings and you are welcome to view and listen to the discussion. The link to each webcast will be available on the meeting webpage, please see details under ‘click here to join online meeting’.

There were no questions from the public.

Professor Trudi Grant and Lou Woolway gave a presentation on the purpose of the Board, including the statutory duties of the Integrated Care Partnership and the Health and Wellbeing Board, and the proposed approach for workshops for Board Members.

During the discussion, the following points were made:

• There are a number of areas that the Health and Wellbeing Board Chair needs to have oversight of. This includes the Adult Safeguarding annual report and the Children and Young People’s Plan. It was agreed that the adult safeguarding report will be a written update to Board members and a relationship would be established with the Children and Families Board as the experts for both SEND and the Children and Young People’s Plan where issues can be escalated to the Somerset Board as required with written reports also covering those areas.  Somerset Board members can request further information either to be presented at the formal Board meetings or through the workshops.  The Better Care Fund oversight will also be delegated to the Joint Commissioning Steering Group who is leading the work.
• There is a need to be mindful of NHS timelines as the NHS Joint Forward Plan takes place in the first quarter of the year.
• The importance of the “egg diagram” which describes the health and wellbeing system in the County was discussed demonstrating the yolk as the health and social care elements and the white as the wider social, environmental, and economic determinants of health. The aspiration is to “scramble the egg” across the local system to maximise the opportunities to improve the health and wellbeing of the local population.
• There was recognition of the financial situation of the Council and the NHS and the need to focus on the longer-term strategy and comparing it with other authorities under the similar stressors.

Cllr Bill Revans (chair) concluded the discussion by highlighting the opportunity the Board had for creating a long-term strategy based on the demographic challenge and other issues pertinent to Somerset.

Professor Trudi Grant and Jonathon Higman gave a presentation on the Improving Lives and Health and Care Strategies. Professor Grant detailed the four Strategic Priorities developed in 2019, and the need for a refresh on the outcomes and metrics post-Covid.

The four priorities are:

1)     A county infrastructure that drives productivity, supports economic prosperity and sustainable public services.

2)    Safe, vibrant and well-balanced communities able to enjoy and benefit from the natural environment.

3)    Fairer life chances and opportunity for all.

4)    Improved health and wellbeing and more people living healthy and independent lives for longer.

The Health and Care Strategy is linked to priority four.

There was discussion around the following areas:

• Recognition of the importance of communication and education of the public in relation to messages around prevention and health and wellbeing. Making sure the public are engaged in the work of the Somerset Board is essential and the importance of localities and communities was recognised. Agreeing the neighbourhood and locality approach which is proposed in the priority section will ensure the Board maximises this. The role of Local Community Networks and the VCFSE was acknowledged as important.
• Recognition of the inequalities that exist in the county in terms of healthy life expectancy was discussed in detail, as was recognising the importance of trying to delay the age at which the local population are diagnosed with a long-term condition.
• Recognition that starting at an early age is important for the preventative work.
• The pandemic highlighted the inequalities in access to health and that is something that needs to be centred in both strategies.

• There was a question about what a well-balanced community means. One example is looking at the aging demographic and the areas of the county where over 50% of the population is over 65, and do we want to actively try to reverse that demographic change?
• The importance of shared data and intelligence was discussed and the recognition that we need to overlay the many layers of information we have to focus on specific cohorts and communities that need extra support.

Lou Woolway presented on five priority areas that were agreed in previous Board member workshops: Housing, Care – all age, Educational attainment, Prevention and population health, and Climate. There are also two priority enablers: taking a system intelligence approach, and a Neighbourhood and locality approach.

During the discussion, the following points were made:

• These can work in parallel, and the enablers can be looked at using the lenses from the five priority areas. For example, looking at the neighbourhood and locality approach through the lens of prevention and population health.
• The work here isn’t starting from scratch, there are already work from the NHS and Adult Social Care on a locality level, but there isn’t a joint strategic direction for that work, and ensuring the strategic decisions made here are taken into practice.
• Is communication going to be a priority for us? We do need to think about wider communication and the wider stakeholders and public that need to be part of that work.
• It was recognised there are two elements to the neighbourhood and localities work: how do we build resilient communities, and how do we organise ourselves and the way we deliver care in communities from an NHS perspective?
• The public may not see the whole system as a system, so showing how the system works together in a holistic way and getting some stories out there may help.
• The importance of everyone involved having a shared purpose and a common cause.

The recommendations for the overarching and enabling priorities of the Board were approved.

Alice Munro, Consultant in Public Health, and Mark Leeman, Housing Strategy Lead Officer for Somerset Council, gave a presentation on the Housing and Health Work Programme. This was a priority area of work agreed under the previous committee in common.  The three priority themes around Housing and Health were Homelessness and Rough Sleeping, Independent Living, and Health Impact Assessments. The presentation also gave a background on Housing and its impact on Health and the pressures on Housing. The question asked of the Board was what aspects of Health and Housing would they like to be a priority?

During the discussion, the following points were made:

• The importance of influencing Local Plans in order to enable people to live more healthily in their own homes and communities.
• How do we ensure relevant data is fed the Joint Strategic Needs Assessment
• The input of health and housing are critical, and the right resources and people need to be in the discussions to ensure future work maximises the system work on health and housing. 

Cllr Bill Revans thanked the housing team for the work they are doing around housing and health.

There were no questions on Circulated Reports

An item was raised on behalf of the Acting Chair of the Adults and Health Scrutiny Committee to request a delay in the plan for changing Stroke Services in Somerset. The request was noted and there will be a formal response to the letter. The decision timeline is working towards a business case at the end of January.