The Chair Councillor Rachel Blake (Deputy Mayor and Cabinet Member for Adults, Health and Wellbeing) welcomed everybody to the meeting. 

To note any declarations of interest made by members of the Board. (See attached note of Monitoring Officer).

There were no declarations of disclosable pecuniary interest were received at the meeting.

To confirm as a correct record the minutes of the last meeting of the Tower Hamlets Health and Wellbeing Board. Also to consider matters arising.

The Chair Moved and it was: -

RESOLVED

The unrestricted minutes of the last meeting were confirmed as a correct record and the Chair was authorised to sign them accordingly.

The Board noted that:

1. Due to the current pandemic they had been unable to discuss several key items at the 9^th June 2020 board meeting and because of timeframes the SEND strategy had been circulated to Board Members offline on 24^th July 2020 with a deadline for comment by 7^th August 2020.
2. Over the past year the context has changed rapidly and since the Special Educational Needs & Disabilities (SEND) strategy was first developed in late 2018 there has been two external reviews; A SEN review conducted by a former Ofsted inspector and a review of health and the Tower Hamlets Clinical Commissioning Group (THCCG) by the Council for Disabled Children (CDC). Feedback and recommendations from both have helped better understand the strengths and weaknesses in the local area and the steps needed to improve. Therefore, one year on, the SEND strategy has been reviewed & refreshed to ensure a sharper strategic direction.
3. Comments from the Board and other stakeholders have been taken into consideration and the strategy can be recorded as signed off by the Board.

The presentation will be shared at the meeting via Teams.

Ruth Roberts (Bromley by Bow Centre) and Allison Talbot a service user provided an update on how Bromley by Bow Centre has adapted services during the Pandemic. The main points of the discussion maybe be summarised as follows:

The Board:

• Were particularly concerned about how people with learning disabilities are managing and how particular their carers are managing to support them.
• Noted that many people with learning disabilities have multiple health conditions and it is important for people to keep up to date to see their GPs to feel safe to go out.
• Noted that since October 2016, the GP Care Group has run the Tower Hamlets Social Prescribing service with funding from the local Clinical Commissioning Group (CCG).
• Noted details of the Social Prescribing for GPs, nurses, and other healthcare professionals to help improve patients’ health and wellbeing, specifically those who do not need a medical intervention, by referring them to access non-clinical services and support.
• Noted that in the more deprived wards in Tower Hamlets, patients visit their GP for reasons other than clinical problems, as they might not know where to access support for wider social issues such as debt advice or housing problems. These determinants can have a significant impact on people’s health and wellbeing. The Social Prescribing service offers direct support to access ‘social prescription’ helping to improve residents’ overall health and wellbeing.
• Noted that the Coronavirus has presented an unprecedented challenge to the local Food Banks as they have become more important than ever for the most vulnerable members of the community.
• Noted that the purpose of establishing Food Hubs is to principally provide logistical support to those Food Banks that provide essential food to people classed as extremely vulnerable and at the highest risk of severe illness from Coronavirus and to help others at-risk residents who might have difficulty getting food. These include the very elderly who may be self-isolating or unwell with symptoms of coronavirus and without a support network of family or friends.
• Was advised that the Council and its partners also provide an intensive, individualized care management process for residents with serious or complex needs. This wraparound care typically includes formal services and interventions, together with community services and interpersonal support and assistance provided people drawn from social networks.

In conclusion the Board

1. Noted that the reflections of organisation and service users would remain as a standing item on all Board agendas; and
2. Encourage Members; Partner Agencies and Services Users to submit suggestions for updates on examples of how various schemes have adapted during the Pandemic.

The presentation will be shared at the meeting via Teams

Somen Banerjee, Director of Public Health provide an update on current situation and challenges to date related to outbreak control.  A summary of the discussions on the presentation is set out below:

The Board

• Noted that despite a fall over the summer, the number of cases of Covid-19 have risen and it is accepted that the situation is once again worsening. Tower Hamlets now has one of the highest levels of Covid-19 in London. Therefore, as a second rise in infections hits the Borough, all steps necessary must be taken to limit the spread of the virus and protect those most at risk.
• Noted that whilst confirmed cases are going down the GPs are seeing people coming into their practices with suspected cases continues to rise and the other thing that continues to rise is the calls to NHS 111 online coronavirus service which gives an indication that of an increase.  Although there is not a great deal of change in terms of hospital admissions and therefore not having an impacting on bed occupancy and those indicators
• Noted that Tower Hamlets has been in the top third in London in terms of incidents rates
• Noted that Public Health England provide data where there is a high risk of an outbreaks such as care homes; schools workplaces; hospitals and faith.
• Noted that whilst in Tower Hamlets there have been no significant outbreaks to date, there is evidence to show an increasing number of these situations in these settings.
• Noted that in Tower Hamlets the testing rates are low relative to the rest of London.  Therefore, it is a priority for the Borough and last week a local testing site was opened in Watney Market which is an appointment only and whilst it has only been only been open a few days 500 people have been tested.
• Noted that the National Programme of Test and Trace has been progressing and they are (i) seeing 80 percent of cases who have been identified as positive; (ii) 20 percent of people that they cannot contact.
• Noted in response to this Tower Hamlets is very close to implementing a local Test and Trace programme in which we get passed on the names of the 20 percent of cases that the national system was unable to identify and we have people locally who will contact those people and then pass the contacts back to the national system.
• Noted that we need to strengthen the Test and Trace System that residents have access to.
• Noted regarding those cases known to Tower Hamlets they are being track on a day-to-day basis.
• Noted the Borough gets very good data from the National Biosecurity Centre and good local data.
• Noted when the Second Wave started it was mainly in the younger age group but as it has progressed there have been more cases in older and more vulnerable groups. It was initially in the more affluent groups but now it is very clearly higher in the most deprived groups. It  ...  view the full minutes text for item 3.2

Presentation Slides attached.

The Board received a presentation that provided a progress update on the work being undertaken to develop a new Health & Wellbeing Strategy for the Borough. Members were provided details of the engagement work that has been completed to date, and proposals for amending the approach to the next phase of strategy development considering the Covid-19 coronavirus. The discussions on this presentation maybe summarised as follows.

The Board

• Noted that prior to Covid-19 Tower Hamlets was on a pathway for developing a new Health and Wellbeing Strategy and the principles were around coproduction locality focus and delivery. 
• Noted that health data was considered, and strategies were reviewed
• Was informed that there had been several workshops with providers; and service users. Healthwatch also had conducted a resident conversation at local level to identify the issues that mattered to residents. It was intended that prior to the pandemic that there should have been a summit to bring all this together and think through priorities.
• However, Covid-19 has changed the landscape therefore it is recognising that that has been a lot of work that has done bit for which obviously we do not wish to lose.
• Recognised that we need to think slightly differently about our vision and especially around the inequalities that Covid-19 has highlighted in our society. This can be seen in several ways but the most obvious from doctor’s perspective is the disproportionate number of people affected in Black, Asian and Minority Ethnic (BAME) communities. E.g. in the medical community across the country 90 percent of the doctors who have died were from BAME communities. It is therefore very stark, and analysis has identified several reasons (i) poverty. (ii) overcrowded housing (iii) specific diseases like diabetes and obesity that clearly play a factor in all of this. Therefore, there is a whole raft of risk factors which fundamentally go to the core of preventative medicine and how we intervene at a much earlier stage both an illness but also to prevent the illness.  For example, if you take something like diabetes, we are in a very good position probably one of the best positions in the country because we have been running a project on preventative proactive work with patients with diabetes. Tower Hamlets has patients with diabetes who the best cholesterol and blood pressure control in the country.  You might say what has that got to diabetes the answers these things are all interrelated and the key to diabetes also to is not just the drugs prescribed that is a very small part of managing diabetes fundamentally the food one eats; the type of food the amount you eat; your weight; the amount of exercise you take are all critical and sometimes more important.
• Noted that this process has highlighted the inequalities that have been highlighted in this process. Therefore, fundamentally what we should do what will be the long-term legacy to Covid-19 as with the Second World War the biggest legacy was the foundation of the NHS. That came  ...  view the full minutes text for item 3.3

Presentation Slides attached.

The Board reflected the strategic direction; future priorities and start to shape the future forward work programme.  Discussions of the key points are summarised below:

The Board noted:

• Local strategy/policy development which will have an impact on Joint Health and Wellbeing Strategy (JHWS) and wider determinants of health in Tower Hamlets. 
• Using digital innovation, community engagement and social media
• Add value to arrangements between health and social care commissioners, including partnership arrangements such as pooled budgets, lead commissioning and integrated provision
• Improving quality and safety of maternity care.to ensure a better experience and improved clinical outcomes
• To prepare, educate and equip patients with end stage renal failure to enable them to choose their preferred form of renal replacement therapy and to commence this treatment in a planned manner through the delivery of a seamless and comprehensive out-patient service.
• As carers play a critical role in reducing the need for formal care. They are often the lynchpin between the person being cared for, social care, the GP, and other care workers and professionals.
• How use of tobacco and alcohol increases the severity of respiratory diseases.
• Recognition that some people may not feel safe at home and may experience some type of domestic abuse.
• engagement from the community and stakeholders
• Clear and defined roles and relationships with other partnership boards both within the local authority and across health and community partners.

CCG mergers

Noted that since the beginning of 2019, CCGs (clinical commissioning groups) in England have been encouraged to consider merging to cover larger areas the with the intention to (i) support system-wide working and (ii) more streamlined commissioning, with the single CCG directing commissioning across the entire system.

The merged CCG’s would also work directly with other partners across the system, including the ICS (integrated care system) or STP (sustainability and transformation partnership) leadership, PCNs (primary care networks), PCN clinical directors, NHS trusts, community and mental health care providers, local authorities and others. This is to reflect a longer-term trend of closer co-operation between CCGs.

The next meeting is scheduled for Tuesday 17^th November 2020, 5pm