The Chair, Councilor Gulam Kibria Choudhury – 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).

No declarations were received at the meeting.

To confirm as a correct record the minutes of the meeting of the Tower Hamlets Health and Wellbeing Board held on 17^th January, 2023. Also to consider matters arising.

The Chair of the Board moved, and it was: - RESOLVED.

That the unrestricted minutes of the meeting held on 17^th January 2023 were confirmed as a correct record and the Chair of the Board was authorised to sign them accordingly.

To confirm as a correct record the minutes of the meeting of the Tower Hamlets Health and Wellbeing Board held on 20^th March, 2023. Also to consider matters arising.

The Chair of the Board moved, and it was: - RESOLVED.

That whilst formal approval of the unrestricted minutes of the meeting held on 20^th March 2023 be deferred until the next meeting. It was noted that the Board had considered a number of issues including a report:

1. That provided a high-level overview of the state of health and wellbeing in the borough and agreed that (i) as local people know what is needed to improve health and wellbeing in the Borough. The Council, the NHS and Community organisations in Tower Hamlets need to be listening and collaborating with people to make sure health and care services better address people’s needs; and (ii) co-production can form the foundation of safe, effective, inclusive, accessible, and efficient healthcare. It is the collaborative practice of clinicians, researchers, policymakers, health system managers and other professionals, working in a genuine partnership with patients and the public to improve health outcomes.
2. That considered the implications of the findings for priorities of the health and care systems and wider partnerships and agreed that concerted, systematic and sustained action is therefore needed to address the multiple and overlapping factors that drive health inequalities – from differences in experiences and quality of healthcare through to the wider determinants of health. This should include, but go beyond, the health and care system. It therefore will require working in partnership across services, sectors, and communities across the Borough.That reflected upon the Tower Hamlets Suicide Prevention Strategy 2023-2026 that had summarised the approach and plans for the refresh of Tower Hamlets’ multi-agency suicide prevention strategy and noted that there is a multi-agency steering group that comprises those organisations with an interest in suicide prevention collaborating with each other to make a difference to bring about the following outcomes: (i) talking about suicide and taking action to maintain good mental health, so that it is as normal as talking about and maintaining physical health; (ii) encouraging people who are experiencing emotional distress to seek help before they become suicidal; and (iii) ensure that when people in emotional distress seek help, they receive appropriate support from the people or organisations they approach and that they are offered appropriate options.

Nil items.

The Board received an update from Amy Gibbs Independent Chair of Tower Hamlets Together (THT) which can be abridged as set out below:

The Board:

v  Noted as the people of Tower Hamlets, understand what is needed to improve health and wellbeing in the borough. The Council, the NHS and Community organisations in Tower Hamlets need to be better at listening and collaborating with people to make sure health and care services better address people’s needs. Therefore, THT had organised three events to look at (1) how information is shared and how much power there for local people to change things; (2) the work with and for all the people of Tower Hamlets to create meaningful improvements in health, wellbeing, and equity. Through bringing together health partners, local authorities and the voluntary, community and social enterprise sector, with residents, patients, and service users to improve how we plan and deliver care and support services. The outcome of these discussions will form the basis of a report to the Health and Well-Being Board.

v  Noted that in regard to the Better Care Fund (BCF) that THT following discussions with residents and stakeholders had agreed that effective performance management of the BCF works best in a culture in which individuals and groups take responsibility for the continuous improvement of services and are prepared to be open with each other. In an open culture, it is also possible to learn from mistakes. It will also help in getting a vital understanding of other organisations’ performance drivers, risks and how they link in with local government. With the Health Well Being Board taking a lead in promoting and modelling this.

v  Noted that THT had considered the implications of the reduction in NEL ICB running costs and the implications for local clinical leadership roles. It is therefore important that options are identified for local funding to sustain the team of multi-disciplinary clinical leads that are in place to support transformation and deeper integration.

v  Noted that the THT has also considered the Better Care Fund in relation to 2023-25, which is a total pooled fund of £57m and the plan is due by 28 June. This is not new money and THT needs to deliver against 5 national metrics, including a new one on the number of falls in the community and existing ones on avoidable admissions into hospital, number of discharges to normal place of residence, proportion of over 65 still at home 91 days after leaving hospital and permanent admission to residential and nursing care homes. The BCF offers the opportunity for better joint oversight, joint delivery against joint metrics, financial benefits, and improvements in outcomes – Therefore it is important to review the overall logic and impact of the schemes. As well as ensuring that there are robust financial governance about how the BCF is being spent and monitored.

v  Noted that THT had considered the North East London (NEL - HCP) Health and Care Partnerships strategy that highlights six crosscutting  ...  view the full minutes text for item 5.1

The Board:

v  Noted that EHCPs are for those children (0-16) or young people (16-19) or adults (19-25) with special educational needs who require support beyond that which an educational setting can provide at SEN support. A child who has educational needs may also have additional health and social care needs and those can be included in the plan so long as they relate to education.

v  Noted that whilst there had been a sustained increase in demand post-Covid with concentration of need amongst younger children. Positive progress had been made in addressing Education Health and Care Plan (EHCP) timeliness and backlog with a tentative but promising improvement in quality of new EHCPs. Accordingly, LBTH is proud of the progress that has made so far but does recognise that the profound level of change needed to fully embed the revised processes.

v  Noted that difference the changes made so far are making for parents and young people with regard to: (1) co-production which has provided a “face” & humanised process as parents felt both “included” and “listened to”; and (2) the process being made noticeably clear e.g. One parent involved with Co-production of Family Hubs approach said that they felt incredibly happy and empowered to give their opinion as a parent of a young SEND child and that they were listened to and appreciated for their time.

v  Agreed that access to safe, affordable, good quality housing can have a positive impact on a person's health and well-being. Housing conditions can influence physical and mental health, and children living in crowded homes are more likely to experience stress, anxiety, and depression. A warm, dry, and secure home is associated with better health, and poor housing is associated with a wide range of health conditions such as respiratory diseases, cardiovascular diseases, injuries, mental health, and infectious diseases. Whereas inadequate living space, low and high indoor temperatures, injury hazards in the home, and accessibility of housing for people with functional impairments are major health risks associated with poor housing conditions. Therefore, it is important that Board Members should all be working together to make the best use of the available assets that support people’s health and wellbeing (e.g.. helping families in navigating through a process as many may not be aware of the available support and may therefore be suffering in silence).

v  Noted that the current figures in relation to the EHCP timeline have been affected by having to clear the existing backlog in referrals for statutory assessment and additional resource have therefore been provided to eliminate that backlog. Whilst at the same time taking a view on how much of that resource should be  ...  view the full minutes text for item 5.2

v  Noted that in Tower Hamlets partners have identified the following ambitions that reflects the health and wellbeing outcomes that matter to residents (1) everyone can access safe, social spaces near their home to live healthy lives; (2) children and families are healthy happy and confident; (3) young adults have the opportunities, connections, and local support to live healthy lives; (4) middle aged and older people are supported to live healthy lives and get support early if they need to it; and (5) anyone needing help knows where to get it and is supported to find the right help.

v  Noted that, Tower Hamlets partners have two local priorities through their Place based Partnership. These are (a) living well; and (b) promoting independence.

v  Commented that during this year’s annual process of refreshing the NEL JFP there would be benefit of moving as soon as practical to a dashboard format using charts and graphs to visualize data in a single view.

v  Agreed that understanding data in relation to the health trends across North East London is the key to making the best decisions and in the more traditional report format the amount of information had the potential at times be considered overwhelming .  Therefore, such important data needs to be in a format that is easy to understand especially to those  ...  view the full minutes text for item 5.3

The Board considered the main findings from the Spatial Planning and Health JSNA (2023) Air Quality JSNA (2023) and discussed the planning policy actions that should be taken to improve health and wellbeing in the Borough prior to the consultation Local Plan going live in the summer. The principal points of the debate are as follows:

The Board:

v  Was reminded that in January the Health and Wellbeing Board, members had been informed that the Borough’s Local Plan is in the process of being updated, with plans for it to be adopted by autumn 2025.

v  Noted that the new Local Plan will set out a vision, strategic priorities, and a planning policy framework to guide and manage development in the borough for the next 10 to 15 years, in line with the planning policy requirements set out by national and regional government.

v  Agreed that the physical environment has a significant impact on health and wellbeing. With the greatest opportunity to influence how the built environment impacts on health being through the Local Plan. Therefore, to inform the new Local Plan, Tower Hamlets Public Health has reviewed the evidence to understand how planning policy can positively impact on residents’ health. This review will form the basis of the public health evidence for the emerging Local Plan health policies.

v  Agreed that the benefit of a local plan that you can design a place in a way that can create homes for people and in a way that also supports health and well-being.

v  Agreed that (i) every resident should be able to access safe, social spaces near their home to live healthy lives; and (ii) residents have the opportunities, connections, and local support to live healthy lives (e.g., any resident needing help knows where to get it and is supported to find the right help).

v  Noted that in conjunction with the Council, Healthwatch’s Healthy Neighbourhoods project collected feedback from residents in Tower Hamlets to find out what services are important to them, and how well these services in different areas of the borough currently support local people. The feedback will then be used to formulate a plan to support the development of local neighbourhoods to improve people’s health and well-being.

v  Noted that the feedback was collected through an online survey between October and December 2022. The survey was shared with local people through various community and voluntary organisations, Barts NHS Health Trust, and Tower Hamlets Council. In addition, the survey link was posted on Healthwatch Tower Hamlets’ social media channels and promoted at local events. In addition, the Healthwatch team had also conducted some street surveying in busy areas of the borough, such as the Whitechapel Market, and two focus groups that were hosted by Beyond Sight Loss – a community group of people with visual impairments – and the Tower Hamlets LGBT+ Forum.

v  Agreed that having public open spaces to facilitate social interaction is really important for local residents, particularly for children as through  ...  view the full minutes text for item 5.4

The Board was asked to consider the work on the integration, or pooling NHS and Local Authority budgets to create a seamless service for the general public. The Board considered (1) the BCF planning process for 2023/25 and the BCF Plan in advance of submission on the 23^rd of June 2023; (2) the need to have a retrospective sign off of the BCF Plan at the next meeting of the Board; (3) if any additional services areas could be included in the second year of the BCF Plan (2024/25). An abbreviated discussion of the prime topics discussed is as follows:

The Board:

v  Noted that the Better Care fund is now into its 8 year and the intent of the programme is to integrate, or pool existing NHS and Local Authority budgets to create a seamless service for the general public and providing the possibility of designing and delivering multi-agency services.

v  Noted that by enjoining services together the partners can create more seamless and better coordinated service experiences for residents (e.g., Producing multi professional teams that share expertise and resources and to create savings and efficiencies from sharing back-office functions).

v  Noted that the purpose of this report is to primarily develop a joint health, social care and housing services offer to help older people and those with complex needs and disabilities to live at home for longer.

v  Noted that a minimum of £7.2 billion nationally has already been committed to the BCF this year to enable people to stay well, safe, and independent at home and get the care they need, when they need it by funding things like adaptations to homes for disabled people and rehabilitating people back into their communities after a spell in hospital.

v  Noted that there is also the requirement to have joint monitoring, performance, and outcomes of anything which is funded through the Better Care Fund, which (i) provides a better statistical picture of local needs and any potential gaps in services; (ii) reduces the possibility of duplication of services between local NHS and local authority services.

v  Noted that to receive BCF funding, a local BCF Plan and programme needs to be agreed jointly by the council and the ICB, endorsed by the Health and Well-Being Board (HWBB) and finally approved by NHS England (NHSE). The jointly agreed programme then needs to be incorporated into a formal agreement under Section 75 of the NHS Act 2006. BCF plans set out the local joint vision for, and approach to, integration, including how the activity in the BCF plan will complement the direction set in the NHS Long Term Plan and are also expected to take into account the wider context, including the development of Integrated Care Systems; the requirements of the Care Act, 2014, and wider local government transformation in the area covered by the plan - for example, programmes, such as Integrated Personal Commissioning.

v  Noted that the Health and Wellbeing Board is required to approve Borough plans  ...  view the full minutes text for item 5.5

The Board received an update on the Covid -19 spring booster programme and evergreen offer. An abbreviated record of the prime topics discussed which may be outlined as follows:

The Board:

v  Noted that whilst Covid-19 levels are really low in terms of the key messages for residents, it is important that the Board continues to ensure the most vulnerable are protected through the targeted seasonal vaccination offer for those most at risk, which is why the Department of Health and Social Care are prompting the current on this year’s spring booster programme that will end in June, 2023. This will top up the protection of those considered at highest clinical risk. Spring booster vaccines will be offered to adults aged 75 years and over, residents in a care home for older adults and immunosuppressed individuals aged 5 years and over.

v  Noted that as the spring booster programme is due to end on 30 June and as we now live with the virus without past restrictions on our freedoms, anyone who has not yet taken up the offer of a first or second dose of vaccine is strongly encouraged to get vaccinated.

v  Noted that in the autumn there is likely to be a new program which is similar to that for the flu vaccine for Covid and that there is going to be the ongoing routine around Covid vaccination.

With no other business to discuss the Chair called this meeting to a close and thanked the Members and Officers of the Board for their contributions over the past year and the hard work undertaken by partner agencies to make a difference to the lives of local residents.