Agenda and minutes

This is where members who are attending as substitutes will say for whom they are attending.

Apologies were received from  Karen Jackson, Sean Rayner, Catherine Riley, Stacey Appleyard, Dr Nick Hardiker and Nicola Goodberry Kenneally.

To approve the minutes of the meeting of the Board held on 30 March 2023.

That the minutes of the meeting held on the 30 March 2023, be amended to reflect that Sean Rayner was in attendance.

Mary Wishart attended as sub for Karen Jackson, Izzy Worswick attended as sub for Sean Rayner, Vicky Pickles attended as sub for Catherine Riley and Vanessa Taylor attended as sub for Dr Nick Hardiker.

The Board Members will be asked to say if there are any items on the Agenda in which they have disclosable pecuniary interests, which would prevent them from participating in any discussion of the items or participating in any vote upon the items, or any other interest.

No interests were declared.

Most debates take place in public. This only changes when there is a need to consider certain issues, for instance, commercially sensitive information or details concerning an individual. You will be told at this point whether there are any items on the Agenda which are to be discussed in private.

All agenda items were considered in public session.

The Board will receive any petitions and/or deputations from members of the public. A deputation is where up to five people can attend the meeting and make a presentation on some particular issue of concern. A member of the public can also submit a petition at the meeting relating to a matter on which the body has powers and responsibilities.

In accordance with Council Procedure Rule 10, Members of the Public must submit a deputation at least three clear working days in advance of the meeting and shall subsequently be notified if the deputation shall be heard. A maximum of four deputations shall be heard at any one meeting.

No deputations or petitions were received.

To receive any public questions.

In accordance with Council Procedure Rule 11, the period for the asking and answering of public questions shall not exceed 15 minutes.

Any questions must be submitted at least three clear working days in advance of the meeting.

No public questions were asked.

This paper highlights to the Board, the Kirklees Director of Public Health (DPH) Annual Report 2022/23, entitled ‘Poverty Matters’.

Contact: Rachel Spencer-Henshall, Strategic Director, Corporate Strategy, Commissioning and Public Health, Lucy Wearmouth, Head of Improving Population Health and Owen Richardson, Data and Insight Enablement Lead for Public Health

Rachel Spencer-Henshall, Strategic Director Corporate Strategy, Commissioning and Public Health, informed the Board that it is the responsibility of the Director for  Public Health to produce an annual report, and the 2022/23 annual report, is entitled ‘Poverty Matters’.

The Board was informed that although there has been some reduction in for example, the price of fuel, things are not necessarily getting better for people in terms of food inflation, and the situation with regard to mortgages and rents is getting worse.

Citizens Advice reported an unprecedented request for support, particularly from those who had reached crisis point.  The findings suggests that even though people were going to Citizen Advice before this period, people are reaching crisis quicker and there are more people in crisis and the demand is becoming greater.

There have also been reports from Healthwatch, highlighting that people are avoiding NHS appointments due to the cost of travel, and in some cases even the cost of phone calls are proving challenging.  In addition, there are reports of a few people unable to take up prescriptions and potentially not visiting the dentist.

This creates many things that could have been mitigated in Primary Care through use of prescriptions or access to dentistry, and that might ultimately impact on the system in terms of more people presenting at A&E. 

There has been twice as many referrals into food banks through the Welfare and Exchequer Team, and that is only the ones known about within the system, and not what is happening outside of the system.  Demand is high for all of those things.

The Board was informed that lived experience has become a bit of a ‘buzz’ word in terms of how to describe getting the view of people. It is however, fundamentally having a conversation with people who are experiencing this and getting a sense of what it is like for them to be in poverty.

It is important to thank the 12 people who contributed to this annual report, who were as open as they could possibly be about what they were experiencing, and the report could not have been written without them.  They were brutally honest about how it was affecting them day-to day of a life being in poverty.  They came from a range of different backgrounds and were in many different situations across the whole Kirklees district.

Many of the individuals had received support via the Local Area Coordination Teams, which is a partnership agenda, run in the council alongside health colleagues and Social Prescribing Link Workers. 

The main theme that came out of the report was that people were struggling around household bills and general finances, which resulted in skipping meals, buying food that was out of date and as reduced as possible. Occasionally, this was on the basis of hoping that the produce was going to be all right, knowing there was probably a level of risk,  as in some cases it might have gone off.

There was a lot of hope,  ...  view the full minutes text for item 7.

The Board will receive an update on the Kirklees Health and Wellbeing Strategy (KHWS) approach, and an update on the following priorities:

-      Mental Wellbeing Update

-      Connected Care and Support

-      Healthy Places

Contact: Alex Chaplin Strategy & Policy Officer, Lucy Wearmouth Acting Head of Improving Population Health, Lisa Waldron Public Health Manager,  Rachel Millson Senior Strategic Planning and Development Manager Rebecca Elliott Public Health Manager and Paul Howatson Programme Manager – Mental Health and Learning Disabilities

Alex Chaplin gave a brief update on the Kirklees Health and Wellbeing Strategy (KHWS), advising that following feedback from the March Board meeting regarding the approach, the intention is to reaffirm the approach to the updates.

The Board was reminded that at the sign off for the KHWS in September 2022,  the Board asked for an in-depth update on one priority, and summary updates on the other two priorities at each meeting rotating.

At today’s meeting, the main priority update will be on Healthy Places, and a summary update with a RAG rating will cover Connected Care and Mental wellbeing.

The priority update will include:

-      A general overview of work under the priority and optional area(s) to highlight in detail, successes, challenges, and requests for support

The two summary updates will be brief, limited to one slide each and may include:

-      A general overview, an area to highlight, successes, challenges, and requests for support

The intention is to assess how the update is working, and if required, undertaken a review at the September 2023, board meeting.

Mental Health

Rebecca Elliot, Public Health Manager, gave a brief update on the Mental Health priority, advising that a further, more detailed update will be provided at the July board meeting.

The Board was reminded that the last mental health deep dive was in January 2023, where information was presented on the Primary Care mental health transformation piece of work, and the aim of today’s summary update is to share some of the successes. There is now a new serious mental illness and physical health and wellness team across Kirklees, which is inviting people who are on the serious mental illness register to attend for a physical health check with their GP.  In some Primary Care Networks, this is already having a significant impact, and this might be an area that the Board may want to hear more about in July.

In terms of suicide prevention, we are in the middle of a really insightful and successful suicide bereavement quilt roadshow, which is taking place across many  different communities in Kirklees, this will conclude on the 6th of July. It has proved fruitful and insightful to hear from  communities about having conversations around suicide in the district and tackling that stigma. That has been really positive.


One of the VCS organisations, Community Links, has a project called ‘Men's Talk,’ which is providing a mental health theatrical production around lived experience of mental health, which is now receiving national recognition.  It is important to  show that there are some new innovative ways of talking about mental health.
 

In terms of milestones coming up, a review of mental health community options contract is being undertaken, and just linking in with the DPH report on poverty, it is recognised that, poverty is both a cause and consequence of mental health.

With any commissioning that is about to be embarked upon,  it will be important to think about poverty and looking through the poverty lens  ...  view the full minutes text for item 8.

The Kirklees Health and Care Plan outlines the collective action the Kirklees Health and Care Partnership will take over the next five years. The plan supports delivery of the Kirklees Health and Wellbeing Strategy, with specific reference to the connected care and support priority.

Contact:  Rachel Millson, Senior Strategic Planning and Development Manager

Rachel Millson, Senior Strategic Planning and Development Manager provided an update on the Health and Care Plan, advising that the aim of the update is to pull out some key points around how the design was approached, as it has been done differently; and key points in terms of some of the development areas.

In summary, the Board was advised that the Health and Care Plan outlines how the Kirklees Health and Care Partnership, will collectively make changes over the next five years to deliver on the Connected Care and Support priority within the KHWS.

A different approach was taken in the development of the plan this year, as the aim was to make sure it was a systems plan that was representative of all of the partners within the health and Care Partnership.

-          A system planning group leads on the development of the Health and Care Plan, with a nominated lead from the different partner organisations that sit on the Health and Care Partnership

-          A principal was adopted early on to build on what was already in place rather than start with a blank sheet of paper

-          Work was undertaken with the program and transformational leads from across the system to understand what they were doing and what their next steps would be, and use that as the starting point for the development of the plan

-          An iterative approach was taken to the process, in terms of developing something and then checking back with people, and then developing it and refining it going along and continuing to work with those nominated leads and with the transformation leads, linking into the work that is been undertaken across West Yorkshire in terms of the development of their Integrated Care Strategy and the Joint Forward Plan

-          The principle taken, is that it is a live plan and although it has been signed off, the work does not stop, it continues, it is updated and refreshed annually

-          At the end of the process when it was signed off, there was a reflective session to understand if there were things that could have been improved and to make sure everybody was involved that needed to be

The Board was informed that a number of different groups and committees have had the opportunity to comment as it was being developed.  It was finally signed off by the Integrated Care Board (ICB) Committee on the 10th of May, and these are the priorities that are within it.

System wide strategic themes/programmes – starting well, living well, aging well

Priority actions – improving access to health care, holistic approach to out of hospital care, crisis response and workforce.

The Board was informed that within the plan, the first two years are very detailed in terms of the changes to be made and the last three years are more outcomes based and aspirational.  Another key point to note, is that the I statements have been integral to the development of the  ...  view the full minutes text for item 9.

The report provides an overview of the progress to date on the development of the West Yorkshire Joint Forward Plan.

Contact:  Rachel Millson, Senior Strategic Planning and Development Manager

Rachel Millson, provided an update on the West Yorkshire ICB Forward Plan. In summary, the Board was advised that the West Yorkshire Integrated Care Board, developed an integrated care strategy which was completed in January 2023.   It is a nationally mandated requirement for all Integrated Care Boards to develop a Joint Forward Plan by June 2023, that details how they will deliver upon that strategy.

The Health and Care Plan, supports delivery of the strategy alongside the Joint Forward Plan.  The timescale for the development of the Kirklees Health and Care Plan have been run alongside those for the Joint Forward Plan to ensure triangulation.

A Strategy Design Team was established at the start of last year,  and had representation from across all the five places within West Yorkshire, and also from all the programs of work that are led at West Yorkshire level.  There has been a public engagement and consultation process supported by Healthwatch, and that campaign was undertaken in early 2023, and that helped shape the narrative.  Kirklees has been an active member of those discussions, attending workshops and online events and contributing to the development of the narrative.

The Board was directed to the appended report which included the ICB covenant outlining the national requirements around the need to develop the plan, and what needs to be included in it, and also the process that they have undertaken.  There is also a draft of the plan included, correct as of May 2023.  For the West Yorkshire team, it is an ongoing refining process, and the aim is to sign off the final version of the plan on the 18^th May at their board, and then launch that alongside the Integrated Care Strategy on the 20th of July.

In terms of the ongoing process and keeping that document live, they are advocating that it will be alive document and will reflect changes as they happen.
There will be quarterly improvement events, from which anyone from place and programme can attend, with the first being in August 2023.

RESOLVED:

That Rachel Millson, be thanked for providing an update on the Joint Forward Plan.

The purpose of this item is to present a working draft of the West Yorkshire Climate Strategy. The strategy is accompanied by a proposed ‘menu of actions’ which set out a range of specific actions that can be taken over different time horizons.

Contact: Shannon Kennedy, Public Health Specialty Registrar, West Yorkshire, Health and Care Partnership

Shannon Kennedy, Public Health Specialty Registrar, provided the Board with an update on the Climate Change Strategy.  In summary, the Board was informed that the draft strategy went to the Partnership Board in March 2023, as a working draft where it was agreed that the next phase was to take this working draft to colleagues and Health and Wellbeing Boards for engagement and comment.

The strategy:

-        Sets out system ambition on climate change and sustainability

-        Highlights need for a risk management approach because climate change is everyone’s problem

-        Provides some high-level interventions across the ICP

It is looking at how the whole system can have an ambition on climate and sustainability. Climate change is already having an effect and is already a problem for people across West Yorkshire and across the world today, and this is going to accelerate. 

The purpose of this strategy was also to provide some interventions and actions at a high level across the health and care partnership, not just within the NHS bodies that make up the partnership, but for everyone, because climate change issue is not just for the NHS to tackle.

Referring to the presentation, the Board was shown examples of how climate change is affecting the West Yorkshire region, including flooding and wildfires.  The Board was informed of that unseasonable heat a few weeks ago, and during last summer’s heat wave, there were approximately 3000 deaths in people aged 65 and over and such issues are accelerating. Effects are also being seen in the health service and in well-being in general for people.

As part of this strategy, a menu of actions have been provided that could start to be taken at a systems level.  It is important to emphasise that these actions are not a mandate, but a starting point. If all of the actions were taken, the system would be in a substantially better place than it currently is, not just mitigating, but reducing  climate harms.  The living environment has many climate harming substances, such as climate harming fuels and gases,  medication and overprescribing and all these are hard on the climate.

There is much work that needs to be done in order to reach local targets on things like net zero, and national requirements under the Climate Change Act. 

The request to the Health and Wellbeing Board is:

-        Engage, support and be aware that this work is being undertaken

-        Consider the actions on the menu of options and think about how that might work in terms of taking ownership on climate and biodiversity at a place level

-        There is also an option to make a pledge and promote the ‘all hands in’ campaign that begun last year, and outlines ways for people to make simple personal pledges about how they might act on climate and biodiversity

The following question was posed to the Board:

“What do you need from the Climate Change Team to help you deliver the strategy and associated actions”?

RESOLVED:  ...  view the full minutes text for item 11.

The Board will receive a presentation on the Local Declaration on Tobacco Control.

Contact: Rebecca Gunn, Public Health Manager and Priti Gohil, Health Improvement Practitioner Advanced

Rebecca Gunn, Public Health Manager and Priti Gohil, Health Improvement Practitioner Advanced, provided an update on the Local Declaration on Tobacco Control.  The Board was informed that the update would focus on the local declaration on tobacco control, which the council had recently signed up to, what that means and what is being done locally.

The Board was shown information on the local picture of tobacco in Kirklees as follows: (prevalence data)

-   Higher smoking prevalence is associated with almost every indicator of deprivation or marginalisation and is more common among people with a mental health condition, people with lower incomes, people experiencing homelessness, people in contact with the criminal justice system, people who live in social housing, people without qualifications, lone parents, and LGBT people

-  Just over 12% of the adult population in Kirklees smoke (2020), however, that is higher in certain wards within the district which mirror areas of highest deprivation

-  Smoking costs Kirklees £121 million a year including NHS provision (ASH, ready reckoner). The impact is seen within primary care and within social care with smokers requiring more support from those services earlier

-  The average smoker in Kirklees spends £2000 per year on cigarettes

-  Smoking is the leading cause of preventable cancer, and there is the intergenerational impact, in terms of where children live in households with smokers, they are more likely to take up smoking later in life

-  Smoking is an addiction, and as much as it can be perceived as a lifestyle choice the majority of smokers do want to quit

The Board was informed that the Council has signed up to the Local Declaration on Tobacco Control.  It is a statement of commitment that the council is committed to taking comprehensive action to address the harms of smoking.

The declaration requires the Council to:

1.       Act at a local level to reduce smoking prevalence and health inequalities to raise the profile of the harm caused by smoking to our communities, and in so doing support delivery of the national smokefree 2030 ambition

2.       Develop plans with our partners and local communities to address the causes and impacts of tobacco use

3.       participate in local and regional networks for support

The Board was informed that over the last 12 to 18 months, work has been undertaken to commission a vaping device offer within the stop smoking services. 

The evidence is supportive of use of vaping devices, as part of a quit attempt for adults who smoke, and that is within recognised Nice guidance.  That is available within the Wellness Service and within Aunty Pams, and will be rolled out in other areas, for example Employee Healthcare.

Work is being carried out within schools, undertaking some insight work with young people, their parents, and teachers in North Kirklees regarding attitudes to smoking a vape.  The aim is to reduce it to 5% in line with the national target and around empowering people to create those safe and positive changes that  ...  view the full minutes text for item 12.