Agenda and minutes

            The Minutes of the meeting held on 27 June 2023 having been circulated were signed as a correct record.

            The following public question had been received:

“In 2016 (pre pandemic) HBC made the decision to reduce Carers breaks by 50%, this decision has not been reviewed, but has resulted in large underspends in carers break funding year on year, which has meant hundreds of thousands of pounds of carers funding has then been redirected to fill gaps in Adult Social Care.  Is this bad management or a deliberate policy? Not to spend carers funding is inexcusable, to do so year on year is not defensible.  The 6,000 registered carers in Halton deserve a response.”

The following response was provided:

Halton Borough Council did not reduce the Carers respite funding in 2016. Expenditure in 2015/16 was £445,206. Expenditure in 2016/17 was £394,583.

The allocated budgets across these 2 years remained the same, a reduction in expenditure was seen in relation to Direct Payments, £41,000 and in voluntary sector grant application of £6,000.  As can be seen within the Carers Respite Finance report, the allocated budget for Carers Respite in 2022/23 was circa. £428k and represents a 9% increase in budget from 2019/20.

Spend against these allocated budgets does fluctuate dependent on activity / demand, but is not as a result of a deliberate policy by Halton Borough Council.

The minutes from the Health and Wellbeing Board’s meeting held on 22 March 2023 were submitted to the Board for information.

 The Board welcomed Tom Knight, Head of Primary Care: NHS Cheshire and Merseyside, who provided an update on the commissioning of Primary Care Dental Services.

NHS Cheshire and Merseyside had the delegated responsibility for the commissioning of dental services, including primary, community and secondary care.  It was reported that access to dental services was a local, regional and national issue impacting negatively on patients.

Post pandemic, the restoration and recovery of primary care dental provision was part of the NHS Operational Plan for 2023/24, with the expectation being that activity would return to pre pandemic levels. Practices continued to recover, supported by commissioners alongside a small number of national contract changes allowing some flexibilities focussed on improving access and increasing activity.

The report provided details of dental provision in Halton currently, through 13 practices.  It also advised of the development of the Dental Improvement Plan, which signalled NHS Cheshire and Merseyside’s commitment and ambition to ensure that access was improved for routine, urgent and dental care for the most vulnerable populations and communities impacted by the Covid-19 pandemic.  The Plan was submitted to the ICB System Primary Care Board on 22 June 2023 for approval and identified the key strategic aims; these were outlined in the report.  

Following presentation of the item, the following comments were made by Members and some additional information was provided in response:

·         The pandemic had made a huge impact on the oral health of the population nationally, including children.  There were now more patients than ever requiring more treatment, resulting in a backlog;

·         Staff retention – a workforce plan was being developed; it was important to understand what would encourage dentists to stay in the NHS and the offer required for this to be achieved;

·         It was felt that the current contracts were unworkable;

·         It was not just about the money – dentists had ambitions to achieve just like anyone else, these were restricted within the NHS which is why they turned to the private sector;

·         Commissioners were working hard with providers to get more dentists signed up;

·         It was confirmed that currently Halton’s practices were not taking any more new patients – the list of the 13 practices would be sent following the meeting;

·         The hard work of NHS dentists was recognised;

·         Care home providers were struggling to get dentists in for residents – the requirements for care home residents had changed in recent years due to them having better teeth.  Care home staff were being supported with encouraging better hygiene amongst residents – this aspect forms part of the Dental Improvement Plan;

·         Halton had the lowest number of children being seen by a dentist in Cheshire and Merseyside; and

·         Emergency telephone number for Halton – was discussed and requested to be an 0800 number like Manchester – Mr Knight would check if this was possible and report back.

Mr Knight was thanked for his presentation and the Chair invited him back to a future meeting when more data would be available on  ...  view the full minutes text for item 15.

The Board received a report from Lucy Gardner, the Director of Strategy and Partnerships, Warrington and Halton Teaching Hospitals NHSFT, which provided an update on Warrington and Halton Teaching Hospitals NHS Foundation Trust’s plan for the provision of a Community Diagnostic Centre (CDC) in Halton.

Further to the NHS Long Term Plan, the Department of Health and Social Care announced that it was making significant funding available for the creation of Community Diagnostic Centres and invited applications for funding from NHS Trusts.  It was announced that the Trust was successful in its bid to secure an allocation of new capital and revenue funding to develop a CDC on the Halton site.

It was reported that the plan would be delivered in three phases:

·         Phase 1 – Fast Track Community Diagnostic Centre (this was already fully operational since June 2023;

·         Phase 2 – Community Diagnostic Centre in Halton Health Hub in Runcorn Shopping City – to be operational in November 2023; and

·         Phase 3 – New Build Community Diagnostic Centre at the Trust’s Halton site – to be fully operational in October 2024. 

Members were advised that the CDC scheme would support improvements in population health outcomes across Halton and Warrington, through the creation of increased diagnostic capacity to support earlier diagnosis of conditions such as cardiac and respiratory disease or cancer.   It would also significantly improve access to diagnostic services in one of the most deprived areas of Cheshire and Merseyside and will help address a number of stark health inequalities that were visible within the local population.  The additional benefits of the CDC were discussed and the fact that the creation of the CDC was on the Halton site was welcomed.

The additional information below provided clarification following Members questions:

·         The Community Diagnostic Centre in Runcorn Shopping City would include an outpatient Sleep Study Service, which patients would be referred to by their GP or other healthcare professional – it was noted that there were currently long waiting lists for the service;

·         The outpatients appointment telephone line had been addressed in relation to frustrations with patients being on hold; and an electronic booking system was being looked at so patients would be able to book online in the future; and

·         An observation was made by one Member in relation to a reduction in phlebotomy services being offered at some local GP surgeries – a response would follow after the meeting as Officers were not aware of this.

RESOLVED:  That the report be noted.

The Board considered a report from the Director of Public Health, which provided an update on the development of the One Halton and Health and Wellbeing Board Strategy.

It was noted that Halton’s previous Health and Wellbeing Board Strategy covered the period 2017 – 2022.  Developments within the NHS had led to the creation of One Halton, and as a partnership approach it was agreed that a shared Strategy be adopted. 

The report outlined the development of the Strategy, the consultation process, priorities identified and its four underlying themes – tackling the wider determinants of health; supporting communities in starting well; supporting communities in living well; and supporting communities in ageing well.  There were two year goals and five year goals for each of the themes; details of these were outlined in the accompanying presentation. 

The Strategy identified important system priorities and a strategic framework that would be used to develop a delivery plan.

The following additional information was provided in response to Members questions:

·         The two Family Hubs had now been established – one in Kingsway which was already open and one in Brookvale Community Centre, which was due to open in the Autumn 2023;

·         The inclusion of people with disabilities and special needs would form part of the Strategy which would support partnership work with other agencies.  The Strategy would challenge agencies to ensure that this cohort was supported with entering the jobs market for example;

·         An observation was made by one Member that this type of strategy had been done before without success – and that this was the same but under another name;

·         Observation made with regards to life expectancy and the disparity between Wards in Halton being a challenge; and

·         At the time of starting the Strategy the health statistics of the population were not known due to Covid and the impact it had on data collection, where data was simply not collected by clinicians during 2021-22 when services were closed.

RESOLVED:  That the report and presentation be received.

The Board received an update from the Director of Public Health, on the development of the Halton Public Health Annual Report (PHAR).

It was noted that since 1988 Directors of Public Health (DPH) had been tasked with preparing annual reports – an independent assessment of the health of local populations.  The annual report was the DPH’s professional statement on the health of local communities, based on sound epidemiological evidence and interpreted objectively.  It also allowed the DPH to identify key issues, flag problems, report progress and thereby, serve the local populations.  It was also a key resource to inform local inter-agency action and remained a key means by which the DPH was accountable to the population they served.

The Board was advised that the theme for the PHAR for 2022/23 had focused on health improvement and prevention work to support the Halton community with their health in the different stages of their lives, as well as coping with pressures such as the recent pandemic and rising cost of living.  To do this four key life stages were used as a guide to the issues – Start, Strong, Live and Well. 

A summary was provided of the content of the PHAR relating to these issues and a weblink to the Report was provided, as follows:

HBC Director of Health annual public health reports (halton.gov.uk)

Members welcomed the PHAR and agreed it was informative and interesting to read.  The resources provided with regards to cost of living information and support was highlighted and it was suggested that perhaps future reports could also include DWP information on how to access work information for residents.   Thanks were given to the Health Improvement Team.

RESOLVED:  That the Board note the theme and recommendations within the Director of Public Health’s Annual Report.

The Board received a report from the Executive Director, Adults, which updated them on key issues with respect to safeguarding in Halton.

The Board was advised that in April 2023 Government announced that the implementation of the Liberty Protection Safeguards (LPS) would be delayed ‘beyond the life of this Parliament’ so whether the LPS were introduced now depends on what the incoming Government wants to do after the Election. It was the view that the LPS would offer a streamlined alternative to the current Deprivation of Liberty Safeguards (DoLS) system.

Halton received 894 DoLS applications last year; an increase of 6%.  To keep up with the increase in demand, independent Best Interests Assessors (BIAs) were used to ensure the backlog list was kept below 12 months.  Members were advised that work was ongoing with regional ADASS DoLs groups to explore different strategies in order to streamline the internal DoLS process and increase the DoLS assessments that were completed by Halton’s BIAs and therefore reduce the need for independent BIAs.

The report outlined some key safeguarding facts from 2022-23 (paragraph 3.3).  A typographical error was noted – second bullet point, 19% should read 9%.  The report also included information on the development of the Cheshire All Age Exploitation Strategy 2023-2025; provided details of a peer review of the Safeguarding Adults Board; and information relating to Halton’s 22 care homes, two of which were currently being supported by the Council. 

Members were also referred to the Safeguarding website:  www.halton.gov.uk/adultssafeguaring which had been updated and contained a range of resources and toolkits for use. 

Further to one Member’s question, it was confirmed that Halton’s inclusion with Cheshire East, Cheshire West and Chester and Warrington Safeguarding Adults Boards, as opposed to the Liverpool City Region’s (LCR) Board, was due to the fact that Halton fell within the jurisdiction of Cheshire Police, not Merseyside Police.  They did however, work together on many issues and shared information.  Regarding a query on the need for a modern slavery toolkit for Halton, it was commented that best practice was learned from other areas including the LCR, in order to give people the knowledge to be able to report modern slavery.

RESOLVED:  That the report and comments made be noted.

The Board considered a report which provided an update on the key aspects of the use of the funding available for respite services for carers in the Borough.

It was reported that the Adult Social Care Carers budget for 2022/23 was £428,070, which represented a 9% increase from the 2019/20 budget.

The Board was advised that the budget was available to spend on direct respite provision of services for carers of people who were in receipt of adult social care services as part of a carers assessment; carers who applied to Halton Carers Centre for finance to support their caring role; and as small grants to voluntary and independent sector organisations who applied.

The spend of the budget varied year on year; the report provided details of the allocated budgets and spend for the past 4 years.  It was noted that the decrease in spend in 2020/21 and 2021/22 was due to the pandemic. 

Further to Members questions, it was confirmed that the budget variance at the end of each year was not rolled over to the next and was not protected, as it formed part of a single budget within the Directorate.  Further, use of the carers respite budget was purely demand led and there was no deliberate policy on the Council’s part to underspend this.  Also, the carers allocated respite budget had increased year on year, as presented in the report.

It was commented that the Halton Carers Centre was located in Runcorn but did have an outreach facility in Widnes, at St Marie’s Church on Lugsdale Road.

RESOLVED:  That the report is noted.

The Board received the Performance Management Reports for quarter one of 2023/24.

Members were advised that the report introduced, through the submission of a structured thematic performance report, the progress of key performance indicators, milestones and targets relating to Health in quarter one of 2023-24.  This included a description of factors, which were affecting the service. 

The Board was requested to consider the progress and performance information; raise any questions or points for clarification; and highlight any areas of interest or concern for reporting at future meetings of the Board. 

No particular areas of concern were identified but one Member requested an update on the progress of the Big Conversation; this would be fed back.

RESOLVED: That the Performance Management reports for quarter one of 2023/24 be received.