Agenda and minutes

The Chair reminded Members of the need to declare any known interests in any matters to be considered at the meeting.  No declarations were made.

Please refer to the explanatory notes below.

No public questions were received during the meeting.

To receive the minutes of the meeting held on 7^th October 2020.

Resolved – That the minutes of the meeting held on 7^th October 2020, be confirmed and signed as a correct record.

Sue Wald, Corporate Director of Adult Social Services, Health and Housing, David Freeman, Chief Operating Officer CCG, and Kevin McNamara, GWH Acute and Community, submitted a report updating the Health and Wellbeing Board about the latest developments in relation to the impact of Covid-19 in Swindon.

In introducing the report the Director of Public Health drew Members’ attention to and answered questions in respect of:

·        The first vaccination for Covid-19 carried out at the Great Western Hospital earlier in the day.

·        The local context and numbers of people affected within the Borough with 4,232 cases to date, 128 deaths and 117.5 cases per 100,000 of population.

·        An overview of the location of Covi-19 cases within the Borough.

·        The change in Covid-19 cases and the changes in seven day periods between 5^th November and 2^nd December 2020.

·        An update on testing figures within the Borough through RTS Wroughton (1,799), LTS Broadgreen (299), MTU Civic (866), and Postal kits (400) for the period 24^th to 30^th November 2020.

·        An overview of the Swindon Test and Trace Programme, follow-up to tests and checks for self-isolation payments.

·        Work to reduce the infection rate in Swindon including an update on the work of the Live Well Hub and its operations.

·        An update on situations and outbreaks within the Borough.

·        An update on the current restrictions for the Christmas Period covering 23-27 December.

·        Community engagement, communications and testing pre and post the Christmas period.

·        The process for arranging vaccinations.

·        Work to accommodate rough sleepers during the pandemic period.

·        On-going work to make care houses secure and to allow visitors.

·        The vaccination programme at the Great Western Hospital and the deployment of lateral flow testing for NHS staff.

·        The NHS preparations for the winter period and how these annual pressure would be affected on an operational basis by the Covid-19 pandemic.

·        The successful launch of the Covid Oximetry at Home Service which identifies and proactively monitors and manages patients in the community with suspected or confirmed Covid-19 and who are at high risk of deterioration.

·        The appointment of a new winter Director who would work across the whole of the Strategic Transformation Partnership.

·        That Swindon has led the development of primary care escalation triggers (“Swindon Primary Care OPEL1 Score”) agreed with Primary Care Networks. Currently piloting with Swindon practices to ensure real-time visibility of primary care pressures within the health system.

·        Mental Health and Learning Disability preparedness and support during the pandemic.

·        The maintenance, as far as possible, of the elective services and agreed mutual aid across the BSW CCG area.

Resolved – That the update be noted.

The Director of Public Health submitted a report setting out the Health and the findings of the Adults with Learning Disabilities Joint Strategic Needs Assessment and seeking the Board’s support for the recommendations set out within it.

Kate Yorke introduced the report and answered questions in relation to:

·        The current Adults with Learning Disabilities Joint Strategic Needs Assessment updated its 2012 predecessor in terms of operational and legislative changes (including the Care Act).

·        Future population projections for Swindon suggest that there will be a significant increase in the population of older adults with learning difficulties over the next 15 years from its current base of just over 4,000 (around 700 of whom were currently support by the Council’s Adult Social Care team). The largest increase was expected in the over 65 age group.

·        There were also likely to be a larger number of those with learning difficulties also having complex health needs and who may require additional support, even those currently with moderate learning difficulties, who were more at risk for health issues.

·        Admissions to Great Western Hospitals NHS Foundation Trust for adults with learning difficulties had been increasing over the last three years and this trend was likely to continue.

·        Additional support was also likely in the future as carers of those with learning disabilities grew older.

·        All adults with learning difficulties were entitled to an annual health check if they were on the GP learning disability register (currently around 1,000) and this was important for preventative treatment. Work was on-going to increase the number on the register and this was a national rather than a Swindon specific issue.

·        Around 40% of those on the GP learning disability register had received an annual health check and work was on-going to raise this to the 70% target.

·        Work was also on-going to make it simpler to join the GP learning disability register.

·        Feedback from those with learning disabilities and their carer’s in respect of the priority of independent living and personalisation of care and support to facilitate this and to ensure individuals felt safe. 

·        Employment for adults (supported by Adult Social Care) with learning difficulties had improved from 3.5% in 2012/13 to 6.3% in 2018/19, but was still very low.

·        The need to ensure those adults living independently had a social life and weren’t isolated.

·        The impact of on-going work arising from the Covid-19 pandemic and work to support those with learning difficulties during this period and any transition to on-line activity.  

·        Learning disability representatives highlighted concerns relating to poor mental health due social isolation during the pandemic.

·        An overview of the recommendations set out within paragraph 3.11 of the report which will be taken forward by a Task and Finish group.

·        The issues facing the health service of the reduction of health related visits and appointments due to Covid-19 and actions plans to address this.

·        The appointment by the CCG of a specialist on health issues arising from learning difficulties.

·        Reasons for the increased risk of death due to  ...  view the full minutes text for item 18.

The Director of Public Health submitted a report setting out the infant feeding strategy for Bath and North East Somerset (BaNES), Swindon and Wiltshire (BSW) Sustainability and Transformation Partnership (STP) for 2020-2025.

The Director of Public Health introduced the report and answered questions in relation to:

·        The 2016-2020 Brest Feeding Strategy had expired and work across the BSW had been undertaken to create an Infant Feeding Strategy, including formula feeding, to support the physical and mental health of mothers and infants and to help develop a bond.

·        The strategy was a collaborative development across BSW with Children’s Services, Midwifery, Public Health, Health Visiting, General Practitioners, Primary Care representatives CCG Voluntary Groups and Service users (including the Paternity Services Partnership) participating in workshops and its creation.

·        Part of the strategy was to normalise breastfeeding in public places and to make mothers more comfortable doing this and to support families in their choice of feeding to provide their babies the best start in life.

·        There were a number of measures that the strategy wanted to achieve such as; increasing the rate of breastfeeding, to monitor and increase the number of mothers breastfeeding after the six to eight week period increasing exclusive breastfeeding (as opposed to mixed formula and breastfeeding),to reduce inequalities in breastfeeding, to encourage woman under 25 years of age to breastfeed and improve standards of care to support breastfeeding and parent infant relationships.

·        The accreditation of staff, currently at the Gold Standard, to help promote consistent messaging and ensuring policies and procedures are in place to provide advice on the best feeding options.

·        The auditing of staff knowledge and user feedback to gauge the level of services provided.

·        Action Plans to maintain the accreditation and in the delivery of the strategy and the creation of policies, this included improving data collection and dissemination.

·        In Swindon there were two specialist breastfeeding services one with the Health Service and within the Midwifery Service although across the BSW area the overall service was being evaluated to ensure it was as good as possible and consistent across the whole area.

·        The scoping of pilot projects such as the gap between the family nurse partnership support and women aged below 25 years of age and how the service might be adapted to meet this need.

·        Shared BSW campaigns and linking these with national campaigns and exploring the role of social media in promoting this.

·        Ensuring that there was Consistent and up-to-date information for women, families and professionals across BSW.

·        The evaluation of the previous breastfeeding strategy, the achievement of targets and lesson that might be learnt.

·        The role of the hospitality sector in encouraging women to breastfeed in a public environment and highlighting that it was legal to breastfeed in public environments.

·        The role of health visitors in promoting Baby Friendly Initiative and breastfeeding and work to undertake virtual training.

Resolved - That the Bath and North East Somerset (BaNES), Swindon and Wiltshire (BSW) Sustainability and Transformation Partnership (STP) for 2020-2025 be approved.  ...  view the full minutes text for item 19.

The Strategy and Development Manager: Adults and Children, Swindon Borough Council submitted a report on behalf of Swindon Safeguarding Partnership Executive Group (BSW Clinical Commissioning Group, the Council and Wiltshire Police) presented the first Swindon Safeguarding

Partnership Annual Report following the implementation of the new partnership arrangements in July 2019.

The Director of Adults Social Care introduced the report and answered questions in relation to:

·        The Annual Report which had been prepared on behalf of the three statutory partners who are responsible for co-ordinating, quality assuring and improving activity to safeguard children, young people and adults with care and support needs living in Swindon.

·        This was the first Annual Report, reflecting work across the multi-agency partnership, since the safeguarding of Children and Adults had been brought together (although a spate Adult Safeguarding Board and a Children’s Partnership Board had been retained).

·        The strengthening of the multi-agency quality assurance systems and frameworks.

·        The challenge, especially during the pandemic period, of obtaining the view of children and young people.

·        Sharing lessons learnt from any adult or children’s safeguarding reviews.

·        The achievements during the year, set out within the report, and the positive outcome of the Children’s Services OFSTED inspection.

·        Data, set out within the report, relating to Children’s Services and Protection as well as Adult Safeguarding Data.

·        Priorities identified and achievements against those priorities, in particular in relation to children and young people and vulnerable adults.

·        That the Swindon Safeguarding Partnership would continue to focus on an identified and specific set of priorities, set out in paragraph 3.7 of the report, during Municipal Year.

·        That both the Children’s and Adult’s Boards had an independent chair and the benefits arising from this independent challenge.

·        The format of the report which highlighted key areas, targets and achievement and differences being made in a clear and understandable format.

·        The creation of a stronger culture of collective responsibility for safeguarding across Swindon and collectively how this awareness might be promoted particularly through the sharing of information and issues identified during reviews.

·        The role of Members in challenging officers on a regular basis to create a culture of commitment in achieving action points.

·        The establishment of Learning and Development sessions for operational managers within the partnership to foster and embed the culture of shared responsibility.

·        The reasons for the fall in the number of Child Protection Plans which was now below the national and statistical neighbour averages following a systematic on-going evidence based review of cases.

Resolved – (1) That the progress made by Swindon Safeguarding Partnership during 2019/20 be noted.

(2) That the future work of the Partnership to continue Swindon’s safeguarding improvement journey be noted.

(3) That the Board’s support partner agencies to act on learning to continuously improve outcomes for children, young people and adults with care and support needs at risk be noted.

(4) That the Board’s support in assisting the creation of a stronger culture of collective responsibility for safeguarding across Swindon be noted.

Lucy Baker introduced a presentation showing the latest Section 136 activity and trends for the Bluebell and drew Members’ attention to and answered questions in respect of:

·        Work by BSW partners with their Bristol colleagues to reduce preventable Section 136 activity arising from Bristol in the Bluebell Unit and to ensure that there was capacity at this unit for local residents if required under Sections 135 and 136.

·        At its height this involved 17 individuals being housed from the Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (BSSG) and by October this had been reduced to 4 of 55 people being housed.

·        In November the number of detentions at the Bluebell Centre had further reduced to a total of 39 (3 from BSSG CCG) and only one occasion in November that there were capacity issues at Bluebell.

·        Work was on-going to reduce the number of people from outside the area using the facility to ensure there was sufficient capacity for local use, when required.

·        Multiagency work on early intervention and prevention and opportunities to interact with people experiencing concerns with their mental health to ensure they could access support in a timelier manner so that they don’t spiral into crisis.

·        A partnership review of ten complex Section 136 cases to understand what improvements to the process might be made at an earlier stage to keep people safe in their normal place of residence. This review would be completed in the new year.

·        Work to engage with carers and families to obtain feedback on their Section 136 experience. With the assistance of Healthwatch a survey was being launched to learn from people’s experiences and learn and understand what could have been done differently at an early stage.

·        That 47% of people detained at the Bluebell unit were discharged to their home residence so there was an opportunity to consider how support for these people might be best provided.

·        The multi-agency task and finish group was also considering was where there were pathway challenges and any changes that might be made to improve the system such as support for the police to enable more assessments in custody and to prevent individuals being moved around the system unnecessarily.

·        The number of high intensity users as opposed to one time users of the unit.

·        Work to produce care plans for those needing Section 135/136 intervention and to prevent those individuals reaching a crisis point and requiring multiple interventions and visits to the unit.

·        The role in Police street triage in reducing in reducing their time commitment for Section 136 work and reduce the need for ambulance conveyance.

Resolved – That the report be noted.

Resolved - That the minutes of the Joint Commissioning Group meeting held on 20^th October 2020 be noted.