Agenda and draft minutes

Members are asked to declare any disclosable pecuniary or affected interests in respect of any matter to be considered at this meeting.

Any Member with a Disclosable Pecuniary Interest in a matter should withdraw from the meeting when the matter is under consideration and should notify the Democratic Services Officer in attendance that they are withdrawing as they have such an interest. If the Disclosable Pecuniary Interest is not entered on the register of Members interests the Monitoring Officer must be notified of the interest within 28 days.

Any Member with an affected Interest in a matter must disclose the interest to the meeting.  There is no requirement to withdraw from the meeting when the interest is only an affected interest, but the Monitoring Officer should be notified of the interest, if not previously notified of it, within 28 days of the meeting.

There were no declarations of interest.

Election of Vice Chairman:

·       Resolved that Nicola Airey be elected for the rest of the municipal year.

To approve as a correct record the minutes of the meeting of the Board held on 7 June 2022.

The minutes of the meeting held on 7 June 2022 were approved as a correct record.

There were no matters arising.

QUESTIONS: If you would like to ask a question you must arrive 15 minutes before the start of the meeting to provide the clerk with your name, address and the question you would like to ask. Alternatively, you can provide this information by email to the clerk at committee@bracknell-forest.gov.uk at least two hours ahead of a meeting. The subject matter of questions must relate to an item on the Board’s agenda for that particular meeting. The clerk can provide advice on this where requested.

PETITIONS: A petition must be submitted a minimum of seven working days before a Board meeting and must be given to the clerk by this deadline. There must be a minimum of ten signatures for a petition to be submitted to the Board. The subject matter of a petition must be about something that is within the Board’s responsibilities. This includes matters of interest to the Board as a key stakeholder in improving the health and wellbeing of communities.

There were no items submitted for public participation.

To receive an update on the Frimley ICS and ICB.

It was noted that the ICS (Integrated Care System) Strategy was in the process of being refreshed. 

The Integrated Care System included health partners, local authorities, and others.  ICB was the Integrated Care Board. 

It was noted that the strategy was first published in 2019.  It was stated that despite the refresh, the strategy was not expected to be changed fundamentally as it was likely that there would be the same outcomes such as improving healthy life and reducing inequalities which would mean that the strategic ambitions would stay the same.  It was noted that the strategy would need to be refreshed by December 2022.

It was highlighted for consideration whether there would be any further opportunities for more Section 75 arrangements which would improve relationships. 

It was understood that one of the focus points for the strategy over the next few months would be research into the work completed along with the strategic ambitions and questions regarding how they could be enhanced. 

It was noted one of the big roles of the ICP was the development of the ICS strategy.  It was also mentioned that the ICP would not meet regularly but they would hold meetings when necessary.  It was noted that there was an additional requirement for the ICS to share its capital resource plan. 

A roadmap of key dates for the ICP was also produced and would be shared.  It was noted as of 6 September 2022, the ICP itself had met twice and all the directors of the ICS had been appointed which essentially meant that the leadership team would be in place as of the next week. 

In response to questions, the following point had been noted:

·       One of the challenges for the board was to ensure that those organisations that were not represented on the board would still be engaged and that information would still flow through to them.  It was suggested that two different routes may be used; the first route would be through the borough representative feeding information through the borough get-togethers and the second route would be through Nicola Airey getting briefed from the point of view of an NHS executive.

To seek feedback on the approach, content and format of the delivery plan for priorities 2, 3 and 4 of the Health & Wellbeing Strategy.

It was noted that the update was regarding the delivery of the outcomes from the Health and Wellbeing Strategy.

Appendix one showed the number of outcomes provided from the Health and Wellbeing Strategy across the 6 priorities and their collaboration in terms of funding.  It was noted that there had been a total of 37 outcomes. 

It was noted that the research into how the improvements and outcomes could be delivered had been coproduced by all partners.

It was noted that as seen in many of the outcomes, the first year had focused on establishing the targeted milestones which would help achieve the outcome measures. 

In response to questions, the following point had been noted:

·       When researching the Health and Wellbeing Strategy, there had been sponsors allocated to each of the priority groups.  It was noted that all priority groups had a core group which consisted of partners, who would then report to members of the board.

To receive Healthwatch’s review of access to GP Practices.

It was noted that Healthwatch was used to listen to and obtain the views of the residents to then report back on the findings.

It was noted that the Access to GP Practices Project merged during Covid-19.  The reason for this project was many residents found it difficult to access primary care.  Due to this, the Healthwatch managers had decided this was a sensitive issue and wanted to create a measured and balanced approach.

It was understood that the team had noticed there was a negative media sentiment and that the GPs were busy with the vaccine programme along with there being a backlog of treatments which was why it was important to recognise a collaboration was essential when understanding the bigger picture. 

The Regional Working Group provided support to establish the programme.  This included liaising with GPs, Practice Managers, CQC, Reception Staff and more across the Frimley footprint and other Healthwatch’s. 

It was noted that a practice staff survey had been circulated with 250 responses received.  The public facing survey had resulted in several thousand responses with 1,000 responses across East Berkshire and 347 responses from Bracknell Forest.

The main issues found were the following:

·       Long telephone queues as there had been a large amount of feedback received regarding the time it took to speak to the surgeries as well as the availability of consultations. 

·       There had also been mixed responses regarding telephone consultations as some members stated they preferred consultations over the phone because it was quick and efficient whereas others stated they preferred a face-to-face approach. 

·       Regarding the online services, some members preferred the convenience of accessing the services online.  However, others preferred the personal approach along with digital inclusion being a factor. 

·       It was noted there was an issue with triaging as many patients were not aware of the term triaging.

Regarding the frontline staff, there had been 112 staff members who had responded, and they stated that patients should be aware of the following:

·       GP practices were pressured and overwhelmed.

·       It would be easier to try alternative routes before contacting the surgeries such as contacting pharmacies and 111. 

·       Be prepared to give a clear description of symptoms over the phone.

·       How triage works which meant knowing that receptionists would ask questions.

·       Booking appointments online and over telephones and the time it could take.

·       Behaviour towards staff.

Based on information gathered, the patients’ recommendations were:

·       New phone systems or increase the number of call handlers to take the number of incoming calls.

·       Phones that would have access to a third person in the consultation. 

·       Dedicated phoneline for diabetic nurses in the surgeries.

·       Dedicated line for registered carers.

·       Continue to review pre-recorded messages.

·       Implement phone queue systems as not all surgeries had this.

·       Staggered lunch time breaks so staff members of the surgery would be always available. 

·       Research into the efficiency of call handling to prevent queues in the future.

·       Appointments in consultations – more specific timeslots such as an hour window instead of stating morning or  ...  view the full minutes text for item 71.

To approve the Year End Report for the Bracknell Forest Better Care Fund 2021/22.

It was noted the first paper was to bring to the attention of the board, the 2021/22 end of year report for the Better Care Fund. The recommendation was for the Health and Wellbeing Board to approve the report as it had already been signed off by the Executive Director: People.

It was noted that in 2021/22, there had been a requirement to report against five metrics and the first one was avoidable admissions at the time of reporting as there was no available data. However, it was understood that the target of 630 had been achieved with a measure of 583 avoidable admissions. For 2022/23, there were targets of 9.4% for 14 days and 4.5% length of stay for 21 days or more. This target had not been met for Bracknell along with many other regions. The figures achieved were 10.5% for 14 days and 5.6% for length of stays. It was understood that the reason was due to staff absence due to Covid-19 and additional complexity of cases.

It was noted that key successes that were attributed to driving the enablers for integration was the opening of the new Heathlands Intermediate Care Service which allowed for a step up, step down facility where the therapist from the Bracknell ICS would be able to support Heathlands and link in with wider teams to support smooth and timely discharge and flow and the effective partnership working across from the ICS Bracknell Forest Council and Frimley Health Care Foundation Trust to develop and mobilize the integrated care home for dementia, nursing and intermediate care.

It was understood that there had been key challenges which were staff absences due to Covid-19 sickness as well as recruitment to vacant posts across the workforce. There had been difficulty in recruiting in reach Matron role as well as reablement support workers and therapists along with issues around complex discharge. It was noted there was an increase in complex cases such as delirium and confusion.

In response to questions, the following point had been noted:

• The length of stay would not be recorded. It was noted no rationale had been given behind the metrics. It was understood that it was advised to monitor the metrics but there was no requirement to officially report against those metrics as the metrics were discussed between NHS and ADAS.

It was noted that the report had been signed off and approved.

To consider the Better Care Fund Plan 2022/23.

It was noted that the plan was in draft form.  It was noted that there had been feedback provided from the regional quality assurance process.  Based on the feedback, most parts were reasonably comprehensive, and the strong partnership working had additional requirements which would need to be expanded, such as the impact the Better Care Fund had on protected characteristics and highlighting how the aging well forum and better care fund worked well together.  It was noted that the high impact change model self-assessment would be due on 30 September 2022 which would be brought into the narrative of the plan.

It was noted that the purpose of the paper was for the Board to note the development of the 2022/23 plan and to feedback any comments along with the board to give delegated authority to the Executive Director: People to sign the Bracknell Forest Plan, which would need to be submitted by the 26 September 2022.

To receive the Annual Public Health Report.

It was noted that the annual public health report was a report that the Directors of Public Health and their predecessors had provided on local areas, for 120 years or more.  It was understood that in the Victorian era, annual reports were often used to describe illnesses and symptoms along with issues and challenges that were faced at the time.  These would have been issues such as infectious diseases, tuberculosis, or cholera, for example. 

It was noted that with the advent of the joint strategic needs assessment, much of the data on various diseases of local areas had been provided through that route.  It was understood that this then enabled the annual public health reports of the Director of Public Health to focus on different areas.

It was understood that the overriding aim of the report was to provide an opportunity to highlight issues and if relevant to local communities, make recommendations to improve overall health and wellbeing.

The decision to focus on climate change was understood to be multifactorial.  It was noted that at the time the report was being developed, the climate crisis was in the news and still would be in terms of the cost of living crisis and the energy costs.  It was noted that this was also relevant to Bracknell Forest because of the Bracknell Forest Climate Strategy, which had been published earlier.

It was noted that the focus on food was where individuals and organisations could contribute to climate challenges, and so there was a collaboration across all of Berkshire which meant that there were three authorities in the east and three in the West to produce a joint report.  It was understood that the purpose of the title of the report, which was helping tackle climate change, one meal at a time was to emphasise the actions created at different levels to contribute to the area.  It was noted that there was also relevance to the time in which the report was produced to the recovery from Covid-19 and the ongoing challenge regarding overweight and obesity, particularly in childhood obesity.  It was understood that these points had been mentioned within the report.

It was understood that a key aim was to make the report engaging, accessible and relevant.  It was noted that this had completed through the use of case studies and videos on local projects.  The case studies provided examples of local initiatives being undertaken through various organisations.  There was also the stop and think logo which would direct to areas where there would be an increased focus along with prompting areas where individuals and organizations would want to take further action.  It was noted that many of the examples used in the report direct ways in which collective action could be undertaken whilst providing useful templates.

It was noted this was a scheme whereby food waste was minimised by ensuring food was donated by supermarkets to support people who may be in need.  It was also understood that composting food waste  ...  view the full minutes text for item 74.

It was noted that the pharmaceutical needs assessment (PNA), which was a statutory requirement for the Health and Wellbeing Board, came to the board as a draft. However, a copy had been finalised which would need to be signed off and one of the suggestions was to circulate the PNA to the members of this board. It was requested for all members to view the document, provide any feedback and if members were satisfied with the PNA, then to virtually sign the document.

It was agreed that the document should be circulated and virtually signed by the board members.