Agenda item

(To receive a report from Derek Ward, Director of Public Health, Lincolnshire County Council (LCC) which invites the Committee to comment on the Joint Health and Wellbeing Strategy for Lincolnshire 2024 and the Better Lives Lincolnshire Integrated Care Partnership Strategy 2024, prior to their approval and publication in March 2024.  Michelle Andrews, Assistant Director Integrated Care System, Public Health LCC, Alison Christie, Programme Manager Strategy and Development LCC and Pete Burnett, Director of Strategic Planning, Integration and Partnerships, NHS Lincolnshire Integrated Care Board will also be in attendance for this item)

Consideration was given to a report from the Director of Public Health, which invited the Committee to consider and comment on the draft Joint Health and Wellbeing Strategy (JHWS) 2024 and the Better Lives Lincolnshire Integrated Care Partnership Strategy 2024 (ICP), prior to their approval and publication in March 2024.

The Chairman invited the Director of Public Health, Lincolnshire County Council (LCC) the Programme Manager Strategy and Development (LCC) and the Director of Strategic Planning, Integration and Partnerships, NHS Lincolnshire Integrated Care Board to present the item to the Committee.

The Committee noted that in Lincolnshire, the County Council shared the same geographical boundary as the Integrated Care Board (ICB), and that this area was the basis for the integrated care system, and as a result there was a requirement to have both a Health and Wellbeing Board (HWB) and an Integrated Care Partnership (ICP) with each being required to publish its own strategy.  It was highlighted that the local ambition had been to align the HWB and the ICP by connecting the JHWS and the ICP Strategy to avoid any duplication and gaps.  It was highlighted further that each strategy would keep its identity with the JHWS focusing on ‘the what’ for example, the population health and wellbeing priority areas, the evidence in the Joint Strategic Needs Assessment; and the ICP strategy would focus on ‘the how’: the key enablers that the health and care system would  focus integration efforts on, to support the delivery of the JHWS and its priorities, and the system’s overarching ambition and aims.

It was reported that the JHWS aimed to inform and influence decisions regarding the commissioning and delivery of health and care services in Lincolnshire as a system, by adopting a life course approach.

The five priorities of the Joint Health and Wellbeing Strategy were detailed on page 63 of the report pack.

It was reported that the Integrated Care Partnership Strategy brought together a system approach to ensure there was more connectivity between statutory bodies, voluntary organisations, social enterprise and the independent sector.

The five strategic enablers identified were shown on page 92 of the report pack.  Each of the five enablers were then presented in more detail throughout the strategy, identifying why each one was an enabler, and during delivery what each enabler was going to focus on.

It was highlighted the five strategic enablers would ensure that as a system all organisations could play their part in delivering the collective ambitions.  The Committee noted that each enabler had a Senior Responsible Officer and a delivery lead for the system who would support and challenge the system to embed the strategy.

The Committee was advised that the shared ambition was ‘For the people of Lincolnshire to have the best possible start in life, and be supported to live, age and die well’.

It was reported that as the two strategies were so linked, they would be published together along with a shared single introduction which was detailed in Appendix A to the report.  A copy of the Health and Wellbeing Strategy for Lincolnshire was detailed at Appendix B, and a copy of the Better Lives Lincolnshire – Integrated Care Partnership Strategy for Lincolnshire was shown at Appendic C to the report for the Committee to consider.

During consideration of the two strategies, the following comments were noted:

·       Some concern was raised regarding the varied role of carers within care homes and the work pressures they were experiencing.  One question asked was whether there was any guidance as to how care homes operated.  The Committee noted that the issues around care homes including staffing were known and were being discussed.  It was highlighted that the Public Health team had a strong relationship with the Lincolnshire Carers Association (LinCA), who were the umbrella organisation for care homes in Lincolnshire.  The Committee noted that from a public health perspective the public health team had a good relationship with care homes.  For instance, if there was an outbreak of an infectious disease in a care home, there was a named individual in every care home across Lincolnshire who was the key link person who could contact the public health team for help, and the public health team would then support the care home with a dedicated Health Protection Nurse who would advise on what they should do and provide any support required to minimise risks.  It was highlighted that there was guidance for care homes around how they should look after their clients.  It was also highlighted that care homes were Care Quality Commission (CQC) inspected and that through general practice and Primary Care Networks, there were linked GP Leads to each care home;

·       Some concern was expressed as to how changes in the health and care system would happen as fundamental problems were still present.  It was noted that none of the priorities in the HWBS were NHS priorities, they were about physical activity and how they cut across things like built environment, housing and transport.  All the priorities were geared to get the best clinical outcomes for patients.  Other things highlighted to gain capacity in the system included understanding population need better, by bringing together data and intelligence into one system, which had been mainly achieved.  It was however highlighted that it was hoped housing stock data, and prescribing data would be included in the future.  The Committee noted that the plan was already being delivered on and that everyone needed to support the plan for it to work going forward;

·       One member expressed some concern regarding the JHWS priority ‘Homes for Independence’, as it was felt that in certain circumstances some people could become and feel isolated in their own home. A suggestion was put forward that a more appropriate phrase could be appropriate homes, to ensure there was a more tailored solution around care to meet the care needs of the individual. The Committee noted that the title of the priority was a matter for discussion by the Health and Wellbeing Board. There was recognition that when people were independent there could still an issue of isolation, and that this needed to be balanced;

·       One member highlighted that the number of static caravans along the east coast was closer to 40,000, rather than the 25,000-figure quoted on page 71 of the report.  It was reported that over 6,000 individuals were registered as permanently living in caravans on the east coast. Of these it was estimated that around 30% of residents had long-standing illness, disability or infirmity and mobility issues which was creating pressure for NHS services and other services locally. Officers advised that the accuracy of the numbers would be verified;

·       That the ‘Healthy Weight’ programme was as the name suggested to encourage people to maintain a healthy weight.  It was also noted that someone who was obese could also be malnourished.  It was highlighted that public health focused on population changes the majority would benefit from and that could be gained by focusing on maintaining healthy weight and a healthy diet;

·       The need to listen more to make sure that more feedback was obtained as to the service customers were receiving and finding out what areas needed further improvements from a customer’s perspective.  The Committee was advised that the personalisation enabler would help the system collect comments from individuals, to help deliver more personalised care;

·       The Committee noted that each enabler would have a Senior Responsible Officer and a delivery lead enabler whose role it was to support and challenge the system to embed the life course approach, which would ensure delivery of the plan. The ICP would then monitor the delivery of the action plan for the enabler.  It was noted further that Senior Responsible Officers would report to the ICP on an annual basis;

·       One member from personal experience highlighted that some really good work was being carried out within communities already to help older people and more vulnerable people develop, keep active, healthy and be part of a community;

·       The Committee was advised that the integrated care system Personalisation enabler would move forward the person-centered approach, and that in moving forward that approach it would crosscut other areas i.e., mental wellbeing and physical wellbeing.  It was noted that the personalisation conversation would be around what mattered to the individual, at different stages in their life, as there would be different needs and requirements; 

·       The important role that charities and voluntary organisations played delivering the priorities was recognised. It was however highlighted that some voluntary organisations were struggling to survive and were now unable to provide services that were on offer before the pandemic. The Committee noted that there was some information available to support voluntary organisations on the Lincolnshire Connect to Support website;

·       Reassurance was provided that both the Joint Health and Wellbeing Strategy 2024 and the Better Lives Lincolnshire Integrated Care Partnership Strategy 2024 linked into the NHS Joint Forward Plan 2023-2028.  With regard to the Primary Care Access Plan, it was noted that this was a national strategy, which played a part in the Joint Forward Plan with regard to access to healthcare, and that how services were developed locally to meet the needs of local individuals and local communities was part of the purpose of local strategies; 

·       Confirmation was provided that it was not expected that there would be any immediate change in approach or new services, as a result of the Mental Health and Dementia priority, as this area was well established; and

·       There was recognition that for individuals to be confident with digital working there would have to be a cultural change.  This would involve working with individuals to find out how it worked for them on an individual level, and coming up with solutions, recognising that the system will not always get it right first time.

RESOLVED

1.      That unanimous support be given to the draft Joint Health and Wellbeing Strategy attached in Appendix B and the five priorities and their rationale for inclusion; and the Better Live Lincolnshire – Integrated Care Partnership Strategy attached in Appendix C and the five strategic ‘enablers’ and the themes supporting each enabler.

2.      That a summary of the Committee’s comments be submitted to the Health and Wellbeing Board and the Integrated Care Partnership on 12 March 2024.