Agenda and minutes

Minutes of the meeting held on 8 October 2020, attached.

RESOLVED that the minutes of the meeting held on 8 October 2020 be signed as a correct record.

Items which in the opinion of the Chair should be considered at the meeting as matters of urgency.

There were no items requiring urgent attention.

An update from the Director of Public Health.

The Director of Public Health outlined there were still high rates of infections in many areas in the country, and whilst some had seen a levelling off, the South West was still rising, as well as Devon.

The key messaging of staying at home was crucial and not leaving home unless absolutely essential. 

The presentation from the Public Health consultant presented the UK summary which now included those vaccinated with their 1st doses, the number being almost 4,973,248. 

The national data showed that growth had slowed slightly but caution was still required with the data as rates had fluctuated since the Christmas break.

The number of deaths within 28 days and patients admitted to hospital (nationally) was still rising.

The Devon statistics showed 1456 cases in latest week equating to approximately 181.5 per 100k population (whilst below the England average, it was one of the highest rates seen).

Other data shown was the trend when compared to neighbouring Local Authorities which again showed a continued increase, but signs this was slowing. 

The age profile was also shown, which highlighted the large increase in the aged 80 plus cohort, mainly attributable to outbreaks in care homes and the interactive map showed cases and data at neighbourhood level, demonstrating outbreaks and higher cases in areas such as Newton Abbot, Honiton and Cullompton.

The number of workplace cases had also been rising, as well as rises in primary age children.  This could be due to pandemic fatigue, and it was therefore important to reiterate the key public health messages of Hands, Face and Space.   

The data shown during the presentation was available at:

DCC Covid-19 Dashboard: Coronavirus dashboard and data in Devon - Coronavirus (COVID-19)

National Coronavirus Tracker: Daily summary | Coronavirus in the UK (data.gov.uk) National Coronavirus Interactive Map: Interactive Map | Coronavirus in the UK (data.gov.uk)

Members discussion points included:

·       In terms of seeing a positive outcome of the vaccination on the statistics, the Director of Public Health advised that the vaccination programme was about reducing serious health issues experienced by the most vulnerable, and it was unlikely that we would see the positive effects of the vaccine just yet.  Research was still being conducted into the effects of the vaccine, and whether those who had been vaccinated could still transmit the virus if they didn’t maintain social distancing measures.  It was anticipated a reduction should be seen in the next few weeks and months in the seriousness of health problems in the most vulnerable and a reduction in the number of deaths and hospital admissions.

·       The vaccination programme was not about getting all the community vaccinated and reducing social distancing measures but focussed on reducing deaths and the number of seriously ill patients in order to reduce the impact on the NHS – therefore it targeted the most vulnerable.

·       The rollout of community testing programmes had begun, which focussed specifically around asymptomatic testing and picking up those 1 in 3 people who had the virus but no symptoms. This  ...  view the full minutes text for item 189.

Report of the Director of Public Health, which reviews progress against the overarching priorities identified in the Joint Health and Wellbeing Strategy for Devon 2020-2025.

The appendix is available at https://www.devonhealthandwellbeing.org.uk/strategies/

The Board considered a Report from the Director of Public Health, on the performance for the Board, which monitored the priorities identified in the Joint Health and Wellbeing Strategy for Devon 2020-25.

The indicator list and performance summary within the full report set out the priorities, indicators and indicator types, and included a trend line, highlighting change over time.

The full Health and Wellbeing Outcomes Report for January 2021, along with this paper, was available on the Devon Health and Wellbeing website: www.devonhealthandwellbeing.org.uk/jsna/health-andwellbeing-outcomesreport . The Report monitored the four Joint Health and Wellbeing Strategy 2020-25 priorities, and included breakdowns by local authority, district and trends over time. These priorities areas included: 

• Create opportunities for all
• Healthy safe, strong and sustainable communities
• Focus on mental health
• Maintain good health for all

The indicators below had all been updated since the last report to the Board;

• Percentage with NVQ4+ (aged 16-64), 2019 – The percentage of people who had achieved qualifications at NVQ level 4 or above in Devon was 37.6% (down from 40.1% in 2018), statistically similar to the England average of 40%. Variation existed across the Districts, with South Hams (43.2%), Teignbridge (43.1%) and West Devon (48.4%) being significantly better than the England average.
• Percentage with no NVQ qualifications (aged 16-64), 2019 – The percentage of people who had no NVQ qualifications in Devon was 4.2% (down from 5.1% in 2018), significantly better than the England average of 7.5%. Variation was minimal across the Districts with all except Torridge (7.1%) being significantly better than the England average.
• Child Poverty, 2018/19 – The percentage of children under 16 in Devon who were in absolute low-income families was 12.2%, significantly better than the England average of 15.3%. Variation was minimal across Districts with all being significantly better than the England average bar Torridge (17.3%), who were significantly worse.
• Gross Value Added, 2018 – The increase in the value of economy due to the product of goods and services in Devon was £21,061 (up from £20,843 in 2016), significantly lower than the England average of £29,356. Variation was minimal with all but Exeter (£41,172) being lower than the England average.
• Suicide Rate, 2017-19 – The mortality rate from suicide and injuries of undetermined intent in Devon was 12 (up from 11.2 in 2016-18), significantly worse than the England average of 10.1. There was variation between Districts, with East Devon (7.5), North Devon (11.3), South Hams (7.5), Torridge (13.9) and West Devon (12) being statistically similar to the England average. Exeter (15.3), Mid Devon (15) and Teignbridge (15) were significantly worse than the England average.
• Mortality Rate from Preventable Causes, 2017-19 – The mortality rate in Devon from preventable causes was 119.3 (down from 159.9 in 2017-19), significantly better than the England average of 142.2. There was minimal variation across Districts, with most being significantly better than the England average, except Exeter (150.5) and Mid Devon (130.9), who were statistically similar. 

The outcomes Report was also available on the Devon Health and Wellbeing website  ...  view the full minutes text for item 190.

Joint Report of the Associate Director of Commissioning (Care and Health) Devon County Council and NHS Devon CCG on the Better Care Fund (BCF), Quarter Return, Performance Report and Performance Summary on the BCF.

The Board considered a joint Report from the Associate Director of Commissioning (Care and Health) and NHS Devon Clinical Commissioning Group (CCG) on the Better Care Fund (BCF), Quarter Return, Performance Report and Performance Summary. The BCF was the only mandatory policy to facilitate integration between Health and Social Care, providing a framework for joint planning and commissioning. It brought together ring-fenced budgets from Clinical Commissioning Group (CCG) allocations, the Disabled Facilities Grant and funding paid to Local Government for adult social care services. The Health and Wellbeing Board had oversight of the BCF and was accountable for its delivery.

Regular reports were provided on the progress of the Devon Better Care Fund Plan to enable monitoring by the Health and Wellbeing Board. Performance and progress was reviewed monthly by the Joint Coordinating Commissioning Group through the high level metrics reports and progress overview.

In December 2020 the Department of Health and Social Care and the Ministry of Housing, Communities and Local Government published the Better Care Fund Policy Statement 2020 to 2021, which had been delayed from March due to the pandemic. The statement set out the requirements for 2020/21 including no requirement to submit a BCF plan for this year. However, the following conditions must be met:

• Agree the use of mandatory minimum funding and place this in a pooled arrangement by an agreement under s.75 of the NHS Act 2006, with an appropriate governance structure which reported to the Health and Wellbeing Board.

• The contribution to social care from the CCG via the BCF was agreed and met or exceeded the minimum expectation 

• Spend on CCG commissioned out of hospital services met or exceeded the minimum ringfence.

• CCGs and local authorities confirm compliance with the above conditions to their Health and Wellbeing Boards.

The Report highlighted that national reporting of Delayed Transfers of Care (DToC) was suspended from the 19 March 2020 and instead, providers were expected to provide daily data through the Strategic Data Collection Service (SDS).  DToC performance was greatly affected by COVID-19.  Delayed transfers started to decrease in March due to the requirement to reduce bed occupancy levels to 50% as part of the pandemic response, dropping to a very low level in April and May. In the period May to September delays increased steadily as elective services recommenced.

In addition, the Report highlighted that fewer older people were placed in residential/nursing care relative to population than comparator and national averages. However, there was an upward trend in permanent admissions to the end of March 2020.  Also, the percentage of people still at home 91 days after hospital discharge into rehabilitation / reablement services had declined significantlyto 72.9% at the end of Quarter 2 (September 2020), due to the pandemic. This was as a result of:

• a reduction in the take up of the service offer, for example with people self-isolating,
• changes to the recording of hospital discharges due to the Discharge to Assess guidance,
• some staff self-isolating meaning the service had to  ...  view the full minutes text for item 191.

An update by the Chair of NHS Devon Clinical Commissioning Group, attached.

The Board received the Report of the Chair of the NHS Devon Clinical Commissioning Group which provided an update on CCG business, Devonwide and national developments within the NHS. It was intended to provide the Board with summary information to ensure Members were kept abreast of important developments affecting the NHS.   The Board noted the updates in relation to:

• Vaccination Programme - Thousands of people in Devon were being vaccinated against COVID-19 every day as the biggest vaccination programme in the NHS’s history gathered pace.  The NHS had a clear vaccine delivery plan and would contact local people when it was their turn to get the vaccine.
• How local people could play their part - There were four actions that people in Devon could do to help the NHS give the vaccine to as many local people as possible, as quickly as possible:  

i.    Choose the right service for needs as GPs were now managing extra pressures from the vaccine programme. Consider self-care for minor illnesses and injuries. Face-to-face appointments at your local practice could still happen if your GP felt this was appropriate. 

ii.   Attend all appointments, whether for a vaccine, to see a GP or at hospital. 

iii.  Don’t make things harder for the NHS by calling hospitals or GP practices about getting the vaccine – the NHS will contact people at the appropriate time. Blocking phonelines with queries stopped other people getting healthcare and diverts staff time, meaning the vaccine rollout would be slower. 

iv.Follow Government rules – the vaccines were a significant development, but the country was not out of the woods. Remember, ‘Stay at home, protect the NHS, save lives’ and ‘Hands Face

·     Vaccinations in care homes - Care home residents and staff had been set as the highest priority group by the independent Joint Committee on Vaccination and Immunisation. Unlike the Pfizer vaccine, the Oxford vaccine did not need to be stored at ultra-low temperatures and was much easier to move, making it easier to use in care homes.

·     Hospital hubs - Derriford Hospital in Plymouth, Torbay Hospital in Torquay, the Royal Devon and Exeter Hospital and North Devon District Hospital in Barnstaple were all giving vaccinations to priority groups. 

·     GP-led local vaccination centres - GP practices were working together to set up local vaccination centres across Devon, with 16 now established, serving 104 practices, with more to follow soon.

·                CCG Accountable Officer and Chief Executive of Devon’s Integrated Care System - The CCG had been recruiting for the joint post of Accountable Officer for both the CCG and the Chief Executive of Devon’s Integrated Care System. This was in line with national policy and mirrored the joint CCG and system arrangements put in place in some successful systems nearby.  Jane Milligan had been appointed to the role, had worked for the NHS for 33 years and had extensive strategic commissioning and operational experience.

·                Integrated Care Systems - NHS England considered a document outlining legislative recommendations that could make ICSs statutory corporate NHS  ...  view the full minutes text for item 192.

An update Report of the Director of Public Health on the work to develop an action plan that focussed on supporting the emotional health and wellbeing of the Devon population during and following the Covid-19 pandemic, attached.

The Board considered an update report from the Director of Public Health on the Prevention Concordat for Better Mental Health, developed by Public Health England as a mechanism for promoting good mental health and providing a focus for cross sector action to increase the adoption of public mental health approaches.  The Board received updates on the following areas:

Suicide Prevention - a number of STP–wide Suicide Prevention initiatives were now in place or about to start including:

-       NHSE 3rd Wave Transformation Monies – this funding would provide an additional £235,000 a year for 3 years to enable the Council to develop a system–wide suicide prevention programme, with a focus on community/ population initiatives;

-       NHSE Transformation Funding for Suicide Bereavement and Postvention Support - In 2019 Devon STP were awarded monies to expand the existing Suicide Bereavement and Support service, (Pete’s Dragons) across the Devon STP footprint.

-       NHSE Trailblazer Funding (Self Harm) - Supporting a ‘Family Intervention Pilot’ in Torbay, with the intention to share the learning across the Devon STP footprint;

-       Men’s Mental Health Project - working with The Lions Barbers Collective, to deliver training to barbers/ hairdressers, including via the Further Education Colleges

Devon Suicide Prevention Strategic Group - The Devon Suicide Prevention Action Plan was currently being updated and the Strategic Group had chosen to prioritise the following areas:

-       Preventing Suicide in Public Places;

-       Developing a Postvention Hub;

-       Supporting Victims of Crime; and, 

-       Preventing Suicide in Children and Young People. 

Better Mental Health For All

-       Workplace Wellbeing: Devon County Council were setting up a ‘Listening Ear’ Project aimed at the business community, delivered by Devon Communities Together.

-       The Communities Team were supporting another ‘Listening Ear’ Initiative being delivered by The City Community Trust and the District Council, which was being offered to people across Devon experiencing Loneliness and Social Isolation.

-       Prevention Concordat Action Plan - Public Health England had relaunched the Prevention Concordat meaning that Devon could officially sign up.  Work would commence on developing a Devon Action Plan with the ambition for it to provide the framework for DCC’s Recovery work.

Members noted the need to ensure continued good practice regarding mental health and wellbeing of staff within all workplaces in Devon during the pandemic.

RESOLVED that the Report be noted.

A presentation from the Head of Economy, Enterprise & Skills.

The Board received a presentation from the Head of Economy, Enterprise and Skills on the Economic assessment of Devon’s economy and impacts from COVID-19 which covered the following areas:

·       Pre- pandemic: Lower than national average productivity, near full levels of employment, lower than average wages.

·       Annual economic decline in 2020/21 would be deeper than originally expected, up to approximately 13-14%.

·       Picture for individual sectors remained mixed. Manufacturing and Construction seemed to be operating well, with purchasing indexes positive. Healthcare was performing strongly. Digital businesses rising to the challenge. Accommodation, Hospitality and parts of Retail sector were being badly affected. Business cashflow was an issue for many – half of hospitality, accommodation had been coping with less then 3 months cashflow.

·       DCC Oxford Economics modelling pointed to a protracted recovery in much of Devon, especially in Mid and West Devon – only Exeter and Plymouth were performing better (Health, education, public sector, naval and digital business concentrations helping).

·       Employment had a significant impact as a result of the pandemic.

·       Impact of furlough - Several areas remained more vulnerable. Northern Devon and Torbay / Teignbridge were more exposed to issues than other places.

·       April – the end of furlough may be a challenge for Devon should the third lockdown be extended through to later March. Remobilisation of visitor economy and other services was likely to take 2-3 months.

·       Economic Vulnerability Index – this looked at the pre-COVID economic situation, including health deprivation.

·       Emerging knowledge of the impacts on people: this looked at mental health, delayed education, career and relationship starts especially impacting on younger people, increased loneliness for some single people, increased foodbank usage, younger people’s jobs impacted most March to July – the rate of claimant increase was now slowing; there had been an increase in over 50s losing their jobs.  

The Board noted that Devon’s GDA had only increased by 2% compared to between 2016 – 2018, compared to the national average of 8%.  It was noted that Devon’s GDA was below national average, and the pandemic had resulted in a 14% drop in output. Growth was expected to return in 2021, however further lockdown restrictions would impact on the economy.

Nil

In order to prevent duplication, the Board will review the Council’s Scrutiny Committee’s Work Programmes. The latest round of Scrutiny Committees confirmed their work programmes and the plan can be accessed at; http://new.devon.gov.uk/democracy/committee-meetings/scrutiny-committees/scrutiny-work-programme/

The Board received a copy of Council’s Scrutiny Committee work programme in order that it could review the items being considered and avoid any potential duplications.

To review and agree the Boards Forward Plan.

The Board considered the contents of the Forward Plan, as outlined below (which included the additional items agreed at the meeting).

RESOLVED that the Forward Plan be approved, including the items approved at the meeting.

Members of the Board received regular email bulletins directing them to items of interest, including research reports, policy documents, details of national / regional meetings, events, consultations, campaigns and other correspondence. Details were available at; http://www.devonhealthandwellbeing.org.uk/

No items of correspondence had been received since the last meeting.

Please note that dates of future meetings and conferences will be included in the Devon County Council meetings calendar. All will take place virtually, unless otherwise stated.

Meetings

Thursday 8 Apr 2021 @ 2.15 pm

Thursday 15 Jul 2021 @ 2.15 pm

Thursday 28 Oct 2021 @ 2.15 pm

Thursday 13 Jan 2022 @ 2.15 pm

Thursday 7 Apr 2022 @ 2.15 pm

RESOLVED that future meetings and conferences of the Board will be held on:

Meetings

Thursday 8 Apr 2021 @ 2.15 pm

Thursday 15 Jul 2021 @ 2.15 pm

Thursday 28 Oct 2021 @ 2.15 pm

Thursday 13 Jan 2022 @ 2.15 pm

Thursday 7 Apr 2022 @ 2.15 pm