Agenda and minutes

Please refer to the explanatory notes below.

Mr Roy Worman asked public questions relating to the NHS White Paper in relation to (i) Whether it was a charter for increasing back room staff, providing no solution to the basic problem of recruiting Front line staff, (ii) how the accountability, transparency and engagement with the public, patients would be addressed, (iii) how the proposed committees ensure equal  partnerships for decision making, (iv) where and how the public would able to comment including redress of actions arising, (v) how it would be ensured that social care would not take a back seat when it comes to ICS Priorities, and (iv) whether Adult Social Care And Children’s Social Care should continue to be funded it its current form. The Chair and Officers responded at the meeting.

To receive the minutes of the meeting held on 9^th December 2020.

Resolved – That the minutes of the meeting held on 9^th December 2020, be confirmed and signed as a correct record.

Richard Smale, Director of Strategy and Transformations (Banes, Swindon and Wiltshire), made a presentation to the Board on the NHS White Paper “Integration and innovation; working together to improve health and social care for all” published on 11^th February 2021, and answered the Board’s questions in respect of:

·        The white paper which made recommendations to government on legislating for Integrated Care Systems and was based on four themes, Working together and supporting integration, Reducing bureaucracy, Ensuring accountability and enhancing public confidence and Social care, public health, safety and quality.

·        It was anticipated that there would be further detail and guidance available later in the year in respect of the contents of the white paper.

·        It was anticipated the draft bill would be introduced in the summer with an implementation of April 2022.

·        Media coverage of the proposals had been relatively positive focusing on the move away from competition toward greater collaboration and partnership working and away from cumbersome procurement processes, although the working process for this would need to be monitored. There was also an emphasis on greater integration, with primary care being a key player, to improve service delivery.

·        The timeline for the transformation and sustainability partnership and white paper.

·        The partnership working of Board member organisations during the Covid-19 pandemic.

·        Key elements of the integrated care system including, (a) improving population health and healthcare, (b) tackling unequal outcomes and access, (c) enhancing productivity and value for money, including prevention and wellbeing work, and (d) helping the National Health Service to support broader social and economic development.

·        How joint working could support neighbourhoods both from a Banes level to Local Authority level intervention and working and the duty to collaborate set out in the white paper and integrated care systems becoming statutory.

·        The proposed establishment of a Statutory Integrated Care System (ICS) NHS Body with a unitary Board (the Board will be directly accountable for NHS spend and performance within the system) and a Statutory Integrated Care System Health and Care Partnership (tasked with promoting partnership arrangements, and developing a plan to address the health, social care and public health needs of the system).

·        The responsibilities of the ICS NHS Body – Clinical Commissioning Groups (CCGs) will become part of ICSs and the ICS NHS Body in each area will take on the commissioning functions of the CCGs, and some of those of NHS England and will be responsible for the day to day running of the ICS.

·        They would have responsibility for (a) Developing a plan to meet the health needs of the population within their defined geography, (b) Developing a capital plan for NHS providers in the area, and (c) Securing the provision of health services to meet patients' needs.

·        ICS Health and Care Partnerships which would bring together system partners to support integration and to develop a plan to address the locally based health, public health, and social care needs.

·        Rules will enable NHS providers to form committees that sit alongside the ICS structures  ...  view the full minutes text for item 26.

Annette Perrington (Director of Inclusion and Achievement) and the Head of Statutory SEND Services presented a report setting out the Annual Report on Special Educational Needs and Disability Services and answered Members questions in relation to:

·        The local authority was responsible for co-ordinating across partners the Special Educational Needs and Disability (SEND) service.

·        The responsibilities of the Health and wellbeing Board and processes for partnership working and joint commissioning.

·        The outcomes of the SEND inspection in November 2018, with a further inspection expected in the near future.

·        The local context of SEND in Swindon with a significant increase (71& since 2015) in the number of children and young people diagnosed with SEND (4,723 or 13.3% OF 35,662 PUPILS IN Swindon schools). This increase was slightly higher than the national average.

·        Additional children had not met the threshold for SND but had been identified by schools as requiring additional support.

·        The increase in the number of children with Educational, Health and Care Plans (4.1% of school children in Swindon).

·        The specialist provision available in Swindon for children and young people diagnosed as SEND but that 47.6% with an Educational, Health and Care Plan were currently educated in a mainstream school setting. The number of children with SEND educated outside Swindon was well below national averages.

·        A comparison of local and national SEN population needs analysis over a range of needs and work to understand variances arising from this in order to improve SEN support in liaison with the Borough’s Early Help Services.

·        The Code of Practice (2015) setting out the legal duties of joint working and of the Health and Wellbeing Board in respect of individual and joint commissioning across education and health.

·        Improvements made in respect of statement system for Education, Health and Care Plans.

·        The role of parent and carer forums in the co-production of service delivery.

·        The statutory requirement for the statutory appointment of a Designated Medical and Clinical Officer, both of which were in post.

·        Local area duties under the SEND Reforms which included increasing the age range from school leavers to 25 year olds which could increase duties and financial responsibilities by up to seven years.

·        Governance and accountability structures across partnership working.

·        Key elements of the Written Statement of Action (eight priorities) and the SEND and Inclusion Strategy (six priorities) which were cross cutting and used qualitative and qualitative data to drive forward improvements and identify themes and trends.

·        An update on the Red, Amber, Green rating local content for the eight priorities of the Written Statement of Action eight priorities.

·        Written Statement of Action impacts or the eight priorities of the Written Statement of Action eight priorities.

·        Corporate support across Swindon Borough Council in the work of the SEND team in improving services.

·        Additional focus of the SEND Inspection team including (i) understanding the experience and needs of children and young people with SEND, and their families, during the pandemic, (ii) involving children and young people with SEND and their families in  ...  view the full minutes text for item 27.

Fiona Dickens (Public Health Programme Manager) introduced a report by the Director of Public Health setting out the Prevention of Chronic Diseases Joint Strategic Needs Assessment and its recommendations answering the Board’s questions in respect of:

·         The NHS Long Term Plan lays emphasis on prevention because of the increasing pressures on the health and social care system.

·         Chronic diseases (also known as Long Term Conditions) are common in the population of Swindon. In all, about 70,000 people in Swindon Unitary Authority had at least one chronic disease in 2015, (32.2.% of the population), while for people aged 65 years or more the corresponding figure was about 23,000 people (69.3% of the population aged 65 years or over.) By the age of 80 years, about 80% of local people have a chronic disease.

·         Many chronic illnesses had common causes and risk factors which allowed strategies and services to be formulated.

·         In terms of lifestyle Swindon presents a mixed picture, comparing well with England and similar towns on diet and exercise, but comparing poorly on smoking and overweight/obesity. Some psycho-social indicators (isolation in care, satisfaction, depression) are also comparatively unfavourable for Swindon’s population.

·         Tobacco use and high Body Mass Index (which is often linked with diet and low physical activity) were judged worthy of further scrutiny as preventive areas in our population, as ‘Smoking Cessation’ and ‘Diet-Activity-Weight’ respectively.

·         Swindon has a higher prevalence of smoking, (17.7% in adults), than England as a whole, but performs well in terms of the standards of the National Institute for Health and Care Excellence for smoking cessation services. Further work to evidence preventative intervention was needed and new formats (ie digital technology) was also required. In contrast, the complete range of recommended pharmaceutical methods to aid in smoking cessation is indeed deployed in Swindon.

·         In Swindon the majority of the adult population, 65.1%, is overweight or obese, similar to the level in England as a whole, but higher than comparable towns.

·         Health services in Swindon provide a full range of evidence-based preventive interventions for Diet-Activity-Weight.

·         However, Public Health England is advocating a ‘Whole Systems approach to Obesity’, in which the whole community works in concert to support healthy weight in its population. This aspirational approach will provide many challenges to Swindon as to all towns and cities.

·         Focus groups of local people experiencing Chronic Diseases report that the workplace, family relationships, psychological factors and social connections are important for optimising health.

·         The focus group participants felt that more could be done to promote health during the life course, but not all participants in the focus groups thought that they would necessarily have been receptive to health improvement messages in their youth and middle-age.

·         A summary of the recommendations set out in paragraphs 3.17 to 3.25 of the report.

·         The adverse effect of the pandemic on obesity within the Borough, and plans to fully reopen Council and NHS services with additional one year funding available for weight loss services.

·         The adverse effect obesity has on those  ...  view the full minutes text for item 28.

Resolved - That the minutes of the Joint Commissioning Group meeting held on 17^th November and 16^th December 2020 and 20^th January and 16^th February 2021 be noted.

It is anticipated that meetings of the Board will be held on:

Tuesday 25^th May, 2021 commencing at 2:00pm;

Tuesday 20^th July, 2021 commencing at 2:00pm;

Tuesday 19^th October, 2021 commencing at 2:00pm;

Tuesday 7^th December, 2021 commencing at 2:00pm; and

Tuesday 1^st March, 2022 commencing at 2:00pm; and

Resolved – (1) That meetings of the Board on the following dates be noted:

Tuesday 25^th May, 2021 commencing at 2:00pm;

Tuesday 20^th July, 2021 commencing at 2:00pm;

Tuesday 19^th October, 2021 commencing at 2:00pm; and

Tuesday 1^st March, 2022 commencing at 2:00pm; and

(2) That officers investigate the rescheduling of the scheduled meeting on Tuesday 7^th December, 2021 commencing at 2:00pm to January 2022.