Agenda and minutes

Leeds Committee of the West Yorkshire Integrated Care Board

Helen Lewis - Director of Pathway Integration

Directors of Leeds City Council

Victoria Eaton – Director of Public Health

Caroline Baria – Director of Adults and Health

Farrah Khan – Chief Officer Family Help, Children and Families

Representative of NHS (England)

Anthony Kealy – Locality Director, NHS England North (Yorkshire & Humber)

Representative of Local Health Watch Organisation

Dr John Beal – Chair, Healthwatch Leeds

Hannah Davies – Chief Executive, Healthwatch Leeds

Representatives of NHS providers

Sara Munro - Leeds and York Partnership NHS Foundation Trust

Sam Prince - Leeds Community Healthcare NHS Trust

Representative of Leeds GP Confederation

Jim Barwick – Chief Executive of Leeds GP Confederation

Wider Determinants of Health – Partnership Working Representative

James Rogers - Director of Communities, Housing and Environment

Leeds Committee of the West Yorkshire Integrated Care Board

Rebecca Charlwood - Independent Chair

Clinicians Joint Representative

Jason Broch, Chief Clinical Information Officer

Representative of Communities of Interest

Pip Goff - Director, Volition

The Chair welcomed Councillor C Anderson who had been appointed to the Board by Annual Council in May 2023 and expressed thanks to Councillor N Harrington for her contribution to the Board. Councillor Venner also reported that Thea Stein would be leaving the Board in September 2023 to take up a new role and thanked her for her work with the Board and partners.

The Board paid their respects to the sad news of the passing of Heather Nelson, the Chief Executive of the Black Health Initiative in Leeds and was also a recent Member of the Health and Wellbeing Board. The Chair expressed condolences to her family and community and noted that Heather was a wonderful person who worked tirelessly to make a positive difference to peoples lives.

To consider any appeals in accordance with Procedure Rule 15.2 of the Access to Information Rules (in the event of an Appeal the press and public will be excluded)

(*In accordance with Procedure Rule 15.2, written notice of an appeal must be received by the Head of Governance Services at least 24 hours before the meeting)

There were no appeals against the refusal of inspection of documents.

1  To highlight reports or appendices which officers have identified as containing exempt information, and where officers consider that the public interest in maintaining the exemption outweighs the public interest in disclosing the information, for the reasons outlined in the report.

2   To consider whether or not to accept the officers recommendation in respect of the above information.

3   If so, to formally pass the following resolution:-

RESOLVED – That the press and public be excluded from the meeting during consideration of the following parts of the agenda designated as containing exempt information on the grounds that it is likely, in view of the nature of the business to be transacted or the nature of the proceedings, that if members of the press and public were present there would be disclosure to them of exempt information, as follows:-

There was no exempt information.

To identify items which have been admitted to the agenda by the Chair for consideration

(The special circumstances shall be specified in the minutes)

There were no formal late items noted, but supplementary information had been circulated to Board Members prior to the meeting, in relation to item 11b – Healthy Leeds Plan Refresh & Item 12 – In Our Shoes Director of Public Health Annual Report.

To disclose or draw attention to any interests in accordance with Leeds City Council’s ‘Councillor Code of Conduct’. 

No declarations of interest were made.

To receive any apologies for absence

Apologies for absence had been received from Councillor S Golton, Tim Ryley, Jenny Cooke, Dr Phil Wood, Corrina Lawrence, Helen Hart, Thea Stein, Julie Longworth, Paul Money and Superintendent Dan Wood.

Substitutes were in attendance - Sam Prince on behalf of Thea Stein, Farrah Khan on behalf of Julie Longworth and Helen Lewis (Director of Pathway Integration) on behalf of Tim Ryley and Jenny Cooke and representing the ICB.

At the discretion of the Chair, a period of up to 10 minutes may be allocated at each ordinary meeting for members of the public to make representations or to ask questions on matters within the terms of reference of the Health and Wellbeing Board.  No member of the public shall speak for more than three minutes in the Open Forum, except by permission of the Chair.

No matters were raised under the Open Forum.

To approve the minutes of the previous Health and Wellbeing Board meeting, held on the 9^th of February 2023, as a correct record.

RESOLVED – That the minutes of the meeting held on 9^th February be agreed as a correct record.

To consider the report of ‘Transforming Community Mental Health’ outlining partnership work of NHS organisations, Leeds City Council, the Voluntary, Community and Social Enterprise (VCSE) sector, and service users/people with lived experience coming together to transform how primary and community mental health services are currently organised and delivered for adults and older people with ongoing and complex mental health needs (commonly referred to as severe mental illness/SMI).

The Board considered a report which provided an update on the work to transform Community Mental Health in Leeds. The report outlined the collaborative approach to the work undertaken by NHS organisations, Leeds City Council, the Voluntary, Community and Social Enterprise (VCSE) sector, and service users/people with lived experience. Partners had come together to consider the transformation of how primary and community mental health services were currently organised and delivered for adults and older people with ongoing and complex mental health needs (commonly referred to as severe mental illness/SMI).

In attendance for this item were;

·  Liz Hindmarsh – Programme Manager, Leeds Community Mental Health

·  Annette Morris – Involvement Lead

·  Debbie Thrush – Clinical Lead for Working Age Adult Community Mental Health Teams

In introducing the report, the Programme Manager, Leeds Community Mental Health highlighted that approximately 8000 adults in Leeds were recorded on the SMI register, but it was thought that SMI was under-reported. Additionally, people with complex mental health/SMI experienced very different physical health outcomes and their life expectancy could be 15-20 years shorter than other people. Initial consultation on transforming services was undertaken with the Early Intervention Partnership which identified the Partnership would value focus on access to care and compassionate care.

The vision was to:

-  Create a joined-up service from the primary and community mental care providers.

-  To remove any barriers to access to services.

-  The ability for people to access services as early as possible.

-  For people to remain in their community.

The Board received a video presentation which included the ambition to create Integrated Community Mental Health Hubs, to be placed withing Local Care Partnerships (LCP’s). Service referrals will be made to the Hubs where personalised treatment will be delivered by Third Sector partners. A pilot of the Hubs will be trialled in three Leeds LCP’s with the intention to roll out the Hubs city-wide during 2024-25.

The delivery model had been informed through extensive consultation and workshops and would entail a culture change in service delivery, with time for reflection to ensure the roles and relationships were right. The new roles will include:

·  8 Community Wellbeing connector roles - to connect individuals to the right support in their community. The Connectors would be part of the Hub Multidisciplinary Team/VCSE partnership of providers.

·  Peer Support Worker roles – to focus on the emotional/relational element of support for an individual at their time of need. They would also focus on working towards cultural change in services and be part of the Hub Multidisciplinary Team/VCSE partnership of providers.

The Board also received details on the work undertaken and planned which included following:

·  Work was moving from the consultation/engagement phase to involvement and co-production of the service with Healthwatch, to put in place the systems needed to achieve the transformation.

·  Work was ongoing with diverse communities to eradicate the imbalances in the systems and to reduce health inequalities.

·  Work built on the representations made by people with lived experience.

·  Work was being done to  ...  view the full minutes text for item 9.

To consider the report of the Big Leeds Chat Working Group outlining an assessment of the progress of the 10 Big Asks identified by the public through the Big Leeds Chat (BLC) 2021. It shows that both plans and actions are in place for the majority of the Asks. There is understandable variability in the governance and public presentation of progress. It is also clear there are Asks which are either not met or only partially met.

The report of the Big Leeds Chat Working Group outlined an assessment of the progress of the 10 Big Asks identified by the public through the Big Leeds Chat (BLC) 2021. It showed that both plans and actions were in place for the majority of the Asks.

In attendance were;

·  Hannah Davies, Chief Executive of Healthwatch Leeds

·  Paul Bollom, Head of Health and Care Development

The Chief Executive of Healthwatch Leeds, introduced the item and outlined the ambition to have the voice of the people at the heart of all levels of health and care planning. The Board was also reminded of the work undertaken across the city as part of the Big Leeds Chat 2021 where 40 events were held city wide. The 10 ‘Asks’ reflected the recurring themes of the events and previously the Board had felt it important to identify a lead for each ‘Ask’. Events had been held in an open conversation format, distanced from formal survey models. Notable events that took place prior to the Covid-19 pandemic were a joint event at the Civic Hall and two public conversation events run by Healthwatch at Kirkgate Market. 

The Head of Health and Care Development outlined each of the ten ‘Asks’, noting that some reflected the impact of the pandemic and more recently the cost of living crisis. He added that, in summary, when you asked people about their health, invariably they bring up the wider determinants of health, such as access to transport and greenspace, as much as they focus on the delivery and access to health and care services. The 10 ‘Asks’ were:

1. Make Leeds a city where children and young people’s lives are filled with positive things to do.
2. Make Leeds a city where there are plentiful activities in every local area to support everyone’s wellbeing.
3. Make Leeds a city where people can connect with services face-to-face when they need to.
4. Make Leeds a city where people feel confident they will get help from their GP without barriers getting in the way.
5. Make Leeds a city where each individual community has the local facilities, services and amenities they need.
6. Make Leeds a city where fears about crime and antisocial behaviour are no barrier to enjoying everything the community has to offer.
7. Make Leeds a city where services acknowledge the impact of the pandemic on people’s mental health and where a varied range of service- and community-based mental health support is available.
8. Make Leeds a city where there are affordable activities that enable everyone to stay healthy.
9. Make Leeds a city where green spaces are kept tidy and welcoming, because services understand the vital role, they play in keeping people well.
10. Make Leeds a city where everyone can get around easily on public transport, no matter their location or mobility needs.

The Board had challenged each Ask area to consider 4 questions, detailed at page 54 of the report and a video was played for Members which provided feedback to the Board on  ...  view the full minutes text for item 10.

a.)  The Leeds Health and Wellbeing Strategy Refresh - a strategy to 2030 - To consider the report of the Chief Officer, Health Partnerships outlining The Health and Wellbeing Strategy refresh is an opportunity to further embed and build on the strong existing health and care and wider partnerships in the city which have effectively navigated us through an unprecedented period, and as the system continues to develop in a new phase of health and care integration. The Strategy is aligned closely to key strategic ambitions and plans including the Best City Ambition and the two other key city pillars of Inclusive Growth and Zero Carbon, as well as the refreshed West Yorkshire Partnership Strategy and Healthy Leeds Plan. The Strategy resets our continued relentless focus on improving the health of the poorest the fastest. It will be by a renewed commitment from a cross section of partners in health and care and beyond to tackle health inequalities and the impacts of poverty, which have been, and continue to be, exacerbated by the global pandemic and cost of living crisis.

b.)  Healthy Leeds Plan Refresh: Update - To consider the report of The Healthy Leeds Plan outlining the health and care contribution towards delivering the Leeds Health and Wellbeing Strategy ambition that Leeds will be a caring city for people of all ages, where people who are the poorest improve their health the fastest. 

The report of the Chief Officer, Health Partnerships outlined the Health and Wellbeing Strategy refresh as an opportunity to further embed and build on the strong existing health and care and wider partnerships in the city which had effectively navigated the city through an unprecedented period, and as the system continued to develop in a new phase of health and care integration. The Strategy was aligned closely to key strategic ambitions and plans including the Best City Ambition and the two other key city pillars of Inclusive Growth and Zero Carbon, as well as the refreshed West Yorkshire Partnership Strategy and Healthy Leeds Plan.

After thorough consultation with a range of city partners the strategy was at a final draft endorsement phase. The Strategy maintained the ambition for Leeds whilst recognising the lived experiences of people, many of whom had experienced challenges before, during and after the pandemic specifically related to the cost of living and impact of poverty. It was noted that the Strategy lay with the remit of the Board to approve but it would also be presented to the Executive Board on the 26^th of July 2023 for endorsement.

In attendance for this item were:

·  Tony Cooke, Chief Officer Health Partnerships

·  Wasim Feroze, Strategy Partnership Development Manager

Introducing the report, the Chief Officer Health Partnerships and Strategy Partner Development Manager outlined the following information:

• A message of thanks was extended to many Council Departments, NHS and Third Sector partners for engagement and influence with the strategy.
• The contents of the strategy reflected the financial challenge being experienced by the city and its residents.
• Recent amendments had been implemented reflecting recent data and indicators, working closely with Marmot City and Inclusive Growth.
• Next steps included the development of action plans to underpin each of the 12 refreshed priorities. These will be developed with partners where relevant.
• Work will also be progressed to agree indicators to support the refreshed strategy with an aspiration to develop a single source of information e.g. data dashboard to track progress over time.
• An accessible, condensed version of the strategy was in development which was to be launched alongside the full version in October 2023.
• A public launch event was also planned for October 2023.

The Board discussed the following matters:

• Big Leeds Chat colleagues proposed to utilise the opportunity of the public launch to enhance public engagement and discussion of Big Leeds Chat principles.

RESOLVED –

a)  That the engagement and work that has been undertaken with partners as part of the development of the Health and Wellbeing Strategy refresh, be noted.

b)  That the final draft of the Health and Wellbeing Strategy refresh attached at Appendix 1 of this report, be approved.

c) That the proposed next steps in the development and delivery of the Health and Wellbeing refresh as outlined in this paper, including establishing a set of clear indicators of the Strategy, be approved.

d)  That the further development and graphic design work will be carried out with  ...  view the full minutes text for item 11.

The report of The Healthy Leeds Plan outlined the health and care contribution towards delivering the Leeds Health and Wellbeing Strategy ambition that Leeds will be a caring city for people of all ages, where people who are the poorest improve their health the fastest.

The following were in attendance:

• Catherine Sunter, Head of Population Health Planning, Leeds ICB

The Head of Population Health Planning ICB, presented the report and outlined the following information:

• The plan was ambitious to improve health goals in line with the system commitments to population needs, which was a different approach from traditional plans which had focused on primary care and point of access.
• It was noted that 26% of the Leeds population live in the 10% most deprived areas nationally. The plan will aim to achieve improved health outcomes for all.
• The link between the Health and Wellbeing Strategy and Healthy Leeds Plan with their collective commitments and shared goals will be demonstrated at the launch event in October 2023.
• The 9 exclusive segments of population and life stages that will be targeted by the plan were outlined as: children and young people, healthy adults, maternity, long term conditions, cancer, severe mental illness, learning disabilities and neurodiversity, frailty and end of life.
• Comments arising from consultation undertaken with the Adults Health and Active Lifestyles Scrutiny Board, ICBs and Health and Wellbeing Board were to be incorporated into the plan.
• Care Delivery Boards work alongside the plan with measures incorporated into the population outcome framework. Data led priorities had been established in consultation with Population and Care Delivery Boards and LCPs.
• It was noted that the 2023 plan will be comprised of 2 clear system goals - ‘reduce preventable, unplanned care utilisation across health settings’ and ‘increase early identification and intervention’ and owned by Leeds.
• The broader purpose and next steps of the plan were to contribute to the West Yorkshire Joint Forward Plan and influence local plans to meet regional and national goals. The plan will be unique for West Yorkshire and focus on its population demographics. The Joint Forward Plan will be subject to an annual review.
• The small scope of goals gave greater ability for tracking and agreeability and will be refreshed on an annual basis.
• The progress for goal 1 ‘reduce preventable, unplanned care utilisation across health settings’ will be robustly monitored with target reductions and compared with other systems and work, including the community mental health transformation programme.
• Goal 2 ‘increase early identification and intervention’ will be informed via goal 1 data.
• The communications plan proposed to create a clear easy read version for staff and the public once the plan had been agreed.
• Appropriate changes to the plan will be incorporated by the end of August 2023.

·  Acknowledgement that the enormous challenge of ensuring we are living our values as set out in the plans and being able to demonstrate that the decisions made about short term cost saving measures do not undermine what the health and care  ...  view the full minutes text for item 12.

To consider the report of The Director of Public Health, who has a mandatory duty to publish a report annually describing the health of the population and make recommendations to improve health.  This year, the report is called “In Our Shoes” and focuses on the current state of children and young people’s health in Leeds. This includes exploring the impact of the COVID-19 pandemic on their lives. The report spans from when the first COVID-19 cases were identified in Leeds, to the ongoing impact as we learn to live with COVID-19 and respond to new threats and opportunities relating to children’s health.

The Board considered the Annual Report of the Director of Public Health entitled “In Our Shoes” which, described the health of the population and made recommendations to improve health. The report focused on the current state of children and young people’s health in Leeds, this included exploring the impact of the COVID-19 pandemic on their lives.

In attendance were:

·  Victoria Eaton, the Director of Public Health

·  Kathryn Ingold, the Chief Officer - Consultant/Public Health

The Director of Public Health and Chief Officer - Consultant/Public Health presented the report and outlined the following information:

• The report was nationally recognised for its high standard and child focused approach, providing an understanding of how much children and young people had missed out on during the Covid-19 pandemic.
• The report had involved input from a wide scope of Council departments.
• Headline findings and 10 recommendations had been developed as part of the study; these were detailed at page 194 of the report pack.
• It was the first annual report of the Director of Public Health since the Covid-19 pandemic, with the report’s theme relevant since the city emerged from the pandemic.
• An infographic document and child friendly summary version had also been developed.
• The broad scope of consultation and emotive conversations had produced a high-level narrative, using a combined approach with public evidence, real scrutiny of local data and huge engagement with over 260 health professionals to reflect the voices of children and young people.
• The Leeds report had been recognised nationally for best practice as 1 of 4 of the Annual Director of Public Health reports for its robust review of data and the only one to have put the voice of young people first.
• 11 key themes had been developed as; children’s mental health, parental mental health, children’s physical health, poverty, housing and where we live, children’s safety, play and screen use, child development, educational attainment, accessing services, childhood infections and positive impacts.
• The focus on inequality showed the difference between the Leeds average and the children living in areas which fall into the most deprived 10% nationally, constructing an awareness of these unequal outcomes.
• Indicators for self-reported mental health issues were worse when compared to previous data and demand for services had increased.
• Physical health indicators noted an increase in childhood obesity, an initial spike with emerging data after the pandemic having levelled off for reception age children but was still increasing for children in year 6.
• The negative effects of the pandemic had impacted less affluent children more which highlighted inequality, such as access to green space.
• Child vaccination rates had fallen over the pandemic which may put younger people at a greater risk of contracting measles or mumps.
• The next steps were covered by the 10 recommendations with 8 focused on conditions and prevention and 2 on health and care service improvements.

A video was played for Board Members displaying examples of anecdotal evidence and engagement with families and young people.

The Board discussed the following matters:

·  The report  ...  view the full minutes text for item 13.

To consider the report of the Leeds Health and Care System providing an overview on the ICB in Leeds and the LCC’s A&H Directorates requirement to complete and submit the Better Care Fund Plan for 2023-25 to NHS England by 28^th June 2023.  The plan has been completed to reflect key health and care priorities for the coming two years.

The Board received the report of the Leeds Health and Care System which provided an overview of the Leeds Better Care Fund Submission for 2023 -23. The submission had been collaboratively produced by the ICB in Leeds and the LCC’s Adults & Health Directorate’s and met the requirement to complete and submit the Better Care Fund Plan for 2023-25 to NHS England by 28th June 2023.

The submission was an annual requirement and had been discussed in length at a recent Health and Wellbeing Workshop and had been brought to the Board meeting to be formally agreed.

Caroline Baria, the Interim Director of Adults and Health noted that the plan had been scrutinised, feedback had been incorporated into the final version and the formatting had been revised. The plan was compliant with the four national conditioned objectives.

The Board discussed the following:

• The collective review process alongside an independent sector review was queried. Reassurance was given that the partners from all sectors had ownership of the plan and delivery was integrated.
• The review had matured and been honest as to how money is best utilised, the document was transparent and coherently informed using relevant evidence.

RESOLVED – That the attached collaboratively authored and regionally reviewed Better Care Fund Submission 2023-25 plan for the Leeds City be noted.

To consider the report of Val the Chief Officer for Learning Inclusion, Children and Families Directorate and the Associate Director of Pathway Integration, West Yorkshire Integrated Care Board (Leeds Place) outlining the national SEND and Alternative Provision Improvement Plan published in 2023 sets out national plans for improvement in response to the 2022 green paper Right support, right place, right time. The Plan requires that all local areas have a multi-agency ‘local inclusion partnership’ which will co-produce and oversee local strategies to improve outcomes for children and young people with SEND aged 0-25. The Plan emphasises that ‘families will be part of Local Inclusion Partnerships and help to develop local inclusion plans’

The Board received the report of the Chief Officer for Learning Inclusion, Children and Families Directorate and the Associate Director of Pathway Integration, West Yorkshire Integrated Care Board (Leeds Place) on the national SEND and Alternative Provision Improvement Plan published in 2023 which set out national plans for the improvement in response to the 2022 green paper – “Right support, right place, right time”.

The Board noted that the changing needs of children and young people and the national changes had prompted a review of the governance arrangements and reporting mechanisms. OFSTED were scheduled to review SEND services focused on education and social care. Discussions at the SEND Board will provide feedback to the Health and Wellbeing Board to review issues.

Farrah Khan, the Chief Officer for Family Help, outlined the partnership arrangements for Leeds against national legislation and the changed terms of reference; the Health and Wellbeing Board will be updated on ongoing work from the Children’s and Young People’s Population Board.

RESOLVED –

a)  That the draft new Terms of Reference for the Leeds area SEND Partnership Board and proposed new reporting arrangements be noted.

b)  To note the proposal for the SEND Partnership Board to report regularly to the Health and Wellbeing Board.

Pip Goff, the Representative for Communities of Interest highlighted the difficult financial position of the Third Sector, noting the sector had absorbed cuts to Council and NHS organisations. It was outlined that over the period from 2020 to 2022 the Third Sector has lost 34% of its paid workforce and 25% of volunteers. The bi-monthly cost survey had noted approximately half of Third Sector organisations had been operating at a reduced service capacity level and the shortfall needed to be addressed.

Board Members acknowledged the pressures the sector was experiencing, and executive partnership work was ongoing. The Third Sector was noted to be comprised of a huge number of organisations and investigation will be needed to identify the populations and organisations experiencing the greatest challenge. A specific list of shared scheme proposals will need to be developed to provide an overview of the situation and support development of a management plan to alleviate impact.

The Chair agreed to write a letter to partners and recommend that the Board consider a formal item regarding sustainability plans for the Third Sector.

To note the date and time of the next meeting as Thursday, 9^th of November 2023 at 1:00pm.

RESOLVED – To note the date and time of the next Health and Wellbeing Board meeting Thursday, 9th of November 2023 at 1:00 pm.