Agenda and minutes

(a)   To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health & Wellbeing Board held on 2 December 2020; and

(b)   To note the outstanding actions.

RESOLVED

That the Committee agreed the minutes of the previous meeting held on 2 December 2021.

Apologies for absence were received from Councillor Lucy Richardson, Glendine Shepherd, Inspector Mark Kent and Janet Cree.

To confirm attendance, the Chair will perform a roll call. Members will also have the opportunity to declare any interests.

If a Member of the Board, or any other member present in the meeting has a disclosable pecuniary interest in a particular item, whether or not it is entered in the Authority’s register of interests, or any other significant interest which they consider should be declared in the public interest, they should declare the existence and, unless it is a sensitive interest as defined in the Member Code of Conduct, the nature of the interest at the commencement of the consideration of that item or as soon as it becomes apparent.

At meetings where members of the public are allowed to be in attendance and speak, any Member with a disclosable pecuniary interest or other significant interest may also make representations, give evidence or answer questions about the matter.  The Member must then withdraw immediately from the meeting before the matter is discussed and any vote taken.

Where members of the public are not allowed to be in attendance and speak, then the Member with a disclosable pecuniary interest should withdraw from the meeting whilst the matter is under consideration. Members who have declared other significant interests should also withdraw from the meeting if they consider their continued participation in the matter would not be reasonable in the circumstances and may give rise to a perception of a conflict of interest.

Members are not obliged to withdraw from the meeting where a dispensation to that effect has been obtained from the Audit, Pensions and Standards Committee. 

The Chair noted the attendance of members of the Board, officers, speakers and observers. There no declarations of interest reported.

The Better Care Fund provides financial support for councils and NHS organisations to plan and deliver local services jointly. The Board is being asked formally to approve the borough’s BCF agreement for 2020-21.

The Chair introduced a report on the Better Care Fund which sets out details of financial support provided to the council to plan and help deliver local health services.  The Board was asked to review and formally approve the agreement.  Lisa Redfern presented the report which would help deliver services through a partnership arrangement within a framework of joint priorities agreed with H&F Clinical Commissioning Group (CCG).  A proposed budget of £49 million comprised of approximately £31.1 million contributed by the CCG and a H&F contribution of £17.8 million.  Councillor Coleman welcomed the agreement which offered a positive example of partnership working. The Board looked forward to receiving an end of year report outlining the expected outcomes of the schemes and the impact of these in terms of improving the quality of life experienced by residents.

RESOLVED

1.    That the Chair on behalf of the Health & Wellbeing Board agreed the planned total expenditure and the proposed schemes for 2020-21; and

2.    That the Board received an end of year report that outlined the outcomes of each scheme and the difference it made for residents of H&F.

The NHS is responsible for vaccination. The Board will discuss the Clinical Commissioning Group’s activity and plans for Covid and flu vaccination in the borough and consider what further support the health partners can provide.

Councillor Coleman briefly provided context to the discussion highlighting challenges around increasing flu vaccination take up which had been prevalent for the past 5 years, what activity had been undertaken by the CCG address this and how the council could provide support.  Sue Roostan referenced the local plan which had been jointly agreed between H&F CCG and the council and submitted to the North West London (NWL) Collaborative of CCGs. This was a “live” document which would incorporate improvement around vaccine take up. Presenting data on improved local uptake Sue Roostan offered assurance that ongoing work was having an impact. The new vaccination site at the Novotel had by 24 March administered vaccinations 6370. It was recognised that there was significant ongoing work being undertaken jointly between the CCG and local authority to support groups that were reluctant or had refused the vaccine and that this contributed to a much broader piece of work across NWL.

Locally the use of pharmacy sites was also being considered (subject to review) as was the deployment of pop-up clinics and how these could be strategically placed around the borough.   As the vaccination programme developed there would be a shift in focus to second dose vaccinations and the delivery, availability and supply of vaccines had been planned to mid-April.

Linda Jackson added that it was important to recognise that this was an on-going journey and that process had been continually refined.  There had been challenges in identifying H&F residents that had refused an offer of the vaccine and the reasons for that choice. Joint engagement work with the GP Federation within the borough included follow-up phone calls with residents and the provision of support where needed ranging from transport to home visits.  It was anticipated that this was potentially a model that could be successfully replicated for other vaccination programmes such as flu and childhood immunisations.  Long term, the work would also help inform the Vaccine Equity Plan and continued joint working.

The Board was informed about the significant work being undertaken with the borough’s Faith Forum, community and voluntary groups speaking with community leaders to help communicate information about vaccination which had been very successful and would inform the Vaccine Equity Plan. Linda Jackson reported that the mass vaccination site had been a very successful piece of work and thanked all partners for their commitment and hard work. 

Councillor Coleman commented that the borough had been unfairly criticised for having lower vaccination rates compared to neighbouring boroughs.  Sue Roostan responded that in the previous three months H&F CCG had proactively engaged with hugely diverse communities and that open and continued dialogue was essential. The range of screening work undertaken within the NHS invited public engagement which helped with prevention and earlier diagnosis.  Lower H&F vaccination rates could be attributed to several factors including target setting within a fixed time frame, particularly in the 80+ group  or people waiting to see how others would be impacted but there had been  ...  view the full minutes text for item 5.

Covid has highlighted long-standing health inequalities. The Board will discuss current and future work by health and other key partners to address this in the borough.

Councillor Coleman referenced data analysis undertaken by the borough’s Business Intelligence Unit evidenced vaccine take up according to each ward and by ethnicity.  This had comprehensively depicted the reticence of some black and Asian minority ethnic communities in being vaccinated.  The underlying reasons for this varied significantly but clearly signalled the need to understand these in the context of race and health inequity. 

Dr Bob Klaber explained that following the good news of the vaccines being made available it was quickly recognised that there were also some disparities around the practical considerations that local authorities were having to work with in addressing health inequity. Working with Linda Jackson, Samira Ben Omar (Head of Engagement and Partnerships, NWL Integrated Care System (ICS)) and colleagues from within the wider ICS, and supported by Hannah Fontana (Strategy, Research & Innovation Programme Manager, Imperial College Healthcare NHS Trust) a 10-week series of co-production huddles was developed.  This was a weekly, hour long meeting which facilitated space for conversations between different people with the intention to co-produce concepts and share learning to comprehend the qualitive work underpinning the data.  Dr Klaber shared details of the huddles and encouraged Board members to access this through a link (shared in the Zoom chat) noting that many had already done so.

Sharing his reflections on the extent of reluctance to be vaccinated Dr Klaber accepted that there was a deeper issue around structural racism and a decades long, deep mistrust of medical research. He recognised that this was a pivotal opportunity for the NHS to evolve, moving from a model that not only treated illness but also progressively advocated for health and well-being.

Councillor Coleman commented that this was a conversation that exceeded a refusal to be vaccinated. The strength and prevalence of negative views about vaccination stemmed from the knowledge that black communities had routinely been unwitting test subjects or provided with lower standards of care to ensure more effective care for other ethnic groups.  It was abhorrent that 70 years after the establishment of the NHS, and, 65 years since Windrush such views were not unfounded. 

Jim Grealy commented on a Department for Education requirement that schools collect student ethnicity data. He advocated that there should be greater assurance offered about data collected by the NHS as it was apparent that minority ethnic people were more likely to have experienced cultural bias often when accessing health or education services. Councillor Quigley commented on the phrase “no blacks, no dogs, no Irish”, well known in 1960’s and 70’s Britain and that conversation and dialogue with black and Asian minority ethnic communities to tackle racism was critical.  Merril Hammer commented that the threat of removing local services galvanised many but there was significant mistrust of the wider NHS as an organisation and senior health managers.

Dr Cavanagh commented that greater data analysis had revealed unconscious bias within health services.  Working with the Royal College of Obstetricians and Gynaecologists in July 2020, he reported that data had shown that a  ...  view the full minutes text for item 6.

The Council co-chair the Integrated Care Partnership, which aims to coordinate a variety of health providers, the council and other health and wellbeing services around the whole needs of each person. The Board will discuss the ICP’s future draft priorities.

Councillor Coleman referenced the Chief Medical Officer for England, Chris Whitty’s recent comment on the amazing, collaborative social care and health work undertaken with local authorities which should not be lost and could be built upon.   Lisa Redfern indicated that the Integrated Care Partnership (ICP) reflected a similar ethos and explained that in her role as co-chair, together with Philippa Johnson, significant work had been undertaken to provide a foundation on which to develop five key areas for focus and as set out in the report. 

The relationships built during the past year in responding to the devasting impact of the pandemic could not have been achieved without a strong willingness to work together with a shared sense of purpose.  The purpose of a centrally placed ICP was to meaningfully drive forward a local agenda and this had been difficult to achieve to date.  The ICP board had recently been joined by Dr Nicola Lang who could not only offer empirical expertise on population health but as had been evident throughout the pandemic, was able to build strong relationships with colleagues an external partners.

 Philippa Johnson added that the key priorities had been informed by inclusive engagement workshops with primary care networks and residents.  At the same time, an evidenced based approach would be used to address health inequity.  Dr Lang commented that this aligned with well with a Public Health focus on wider health determinants (poor housing, access to education and employment) coupled with strong community engagement.

Commenting on the formation of relationships that had resulted from the response to the pandemic, Jim Grealy welcomed the establishment of the Integrated Care System (ICS) and felt that despite how remarkable this had been it was not sustainable without an institutionalised and formal framework offered by an ICP. The ICP and local decision making at a borough level would help inform the wider ICS and redress the balance of power.  Councillor Coleman agreed and referenced the fifth priority which was the development of an ICP with primary care networks located at the heart of local communities. An important part of this was to ensure that residents were engaged and listened to throughout.

Merril Hammer concurred that health inequalities needed to be a central priority but emphasised the importance of incorporating co-production within work of the ICP and more critically, the inclusion of the patient voice to directly inform and determine priorities.  On a final point she encouraged health colleagues to not talk about patients but “people” or “residents”. 

Toby Hyde reflected on his experiences of establishing ICPs across North West London and how they unfortunately did not always manage to succeed in capturing the excellent expertise and knowledge of board members and cautioned that there was much to be learned from this.  He reported that Imperial clinicians were keen to work with GPs and the local community to help improve health outcomes for H&F residents and that a way of managing this strategically should be considered. He welcomed the report  ...  view the full minutes text for item 7.

The Board is requested to consider the items within the proposed work programme and suggest any amendments or additional topics to be included in the future.

The Board noted that the current priority areas would continue to be informed by Covid-19 and the delivery of local health services through the reconfigured CCGs and establishment of new structures such as the ICS and the ICP.

The Board is asked to note that the dates of the meetings scheduled for the municipal year 2020/ 21 and 2021/22 are as follows:

Wednesday, 21 April 2021

Monday, 21 June 2021

Monday, 13 September 2021

Monday, 13 December 2021

To be confirmed.