To receive an update on the current work of the Health and Wellbeing Board and scrutinise the role, work undertaken and objectives of its Subgroups.  A report is attached. 

Contact:  Val Cross, Health and Wellbeing Officer, val.cross@shropshire.gov.uk

The Chair of the Health and Wellbeing Board introduced the paper before the Committee and outlined its membership, statutory duties, vision, objective and aims and mechanisms of delivery through sub groups.  The Board was not able to instruct services to make changes but could challenge, reflect and recommend activity for commissioning partners.  Success was dependent on positive engagement from all partner members.

In response to Committee comments and questions, particularly around the Joint Strategic Needs Assessment (JSNA), he reported that:

·         The Co-chair of the Board took an active role and the Council’s relationship with the CCG was good.

·         He regretted that the JSNA was not yet where it should be.  The Board would look to establish a narrative to set the context alongside the data available.  The new Director of Public Health’s background and ambition would help further identify health inequalities and need across Shropshire but the pandemic had put that work back considerably. 

·         The Board had last considered the JSNA at a time pre-pandemic, and had agreed the establishment of a working sub group across the system to consider how to progress it.  It was intended to sub-regionalise the data to integrate with economic data and base that around the Place Plans.  This would allow full understanding of the needs of communities in Shropshire, especially in relation to PCNs.

·         Governance around the Board might appear complex but was clearer than many other parts of the health economy.  The CCG Board and Council’s Cabinet were the only responsible executives capable of making decisions.   The Joint Commissioning Board worked to co-ordinate commissioning activities across the  health and social care economy.

·         Establishment of the STPs to attempt to bring together health care providers and commissioners to simplify and improve outcomes in local health and social care systems, had neglected to take into consideration existing Health and Wellbeing Boards.  The Board now had a reasonable working relationship with the STP and along with Telford and Wrekin Health and Wellbeing Board, was starting to align activities and responsibility across the wider footprint of STP.  Until primary legislation removed distinct Shropshire and Telford and Wrekin Health and Wellbeing Boards the disparate system would continue. 

·         There was now a considerable degree of co-ordinated work carrying on across STP and both Health and Wellbeing Boards.    Having just one CCG would mean that commissioning of health and social care services would be further streamlined and simplified.

·         The H&WB membership did not include a representative from the Area Pharmaceutical Committee.  The H&WB had observer status on the Local Primary Care Commissioning Committee at which the Medicines Management Lead for NHSE was present. 

·         With regard to a suggestion made about a larger pooled budget beyond the requirements of the Better Care Fund - this would require a release of sovereignty over funds which was not a short term prospect in a system where all partners were stressed financially.  However, jointly commissioned posts and jointly commissioned pieces of discrete work were possible. 

·         Co-ordination of drug and alcohol abuse services and clinical commissioning of mental health services was a source of challenge to the Health and Wellbeing Board.  Responding to comments that there was a core of people being excluded from mental health services due to drug and alcohol problems, he said he would look at this with a view to bringing the issue to the Board.  The Drug and alcohol strategy was currently being updated and a consultation document under development.  The importance of prevention, helping people early on and multi-agency working was recognised with strategies under development to engage local stakeholders. 

·         The Board continued to press for improvements in mental health service across Shropshire.  The Council’s Public Health Team had done some extremely good work in relation to mental health and suicide which had demonstrated the Council’s ability too co-ordinate an approach and bring together a good strategy and encourage commissioning in support of that.  It continued to request progress reports.  The failings around SEND had been highlighted at Board meetings and progress had been frustrating.  The Portfolio Holder for Children’s Services advised on how the Health and Wellbeing Board could contribute to improving outcomes in children’s services. 

·         The Scrutiny Officer reported that the SEND action plan was to be considered at the People Overview Committee shortly and the Chair said she would attend this meeting.

·         The role of the Board’s Commissioning sub-group besides commissioning of Better Care Fund activity was to look at opportunities and progress areas where there was shared ambition to commission services across the CCG.  For example, hospital discharge work and two carers in a car.  This work ensured the right vision and strategy and Social prescribing and preventative work had been considered by this group. 

·         The Chair of the Board reiterated that it could demonstrate best practice, evidence need, share and pull together a strategy for partners to buy into but ultimately individual organisations had sovereignty over funds and decision making.  

The Committee observed that the pandemic had shown the importance of working together.  The discussion had also underlined the importance of having a JSNA supplying evidence for more integrated commissioning.  The Chair of the Health and Wellbeing Board said he absolutely agreed with this and the Board’s commitment to progress the JSNA remained undiminished. 

The Committee thanked the Chair of the Health and Wellbeing Board and Director of Public Health for attending the meeting and providing candid answers to questions.

AGREED

That a clear resourced plan to create the Joint Strategic Needs Assessment for health services be presented to the 25 January 2020 meeting along with further information about the work of the Commissioning Sub-Group.