To confirm as a correct record the minutes of the meeting of the Tower Hamlets Health and Wellbeing Board held on 26 July 2022.

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

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

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.

World Mental Health Day

The Board:

v  Noted that one in eight people worldwide are living with a mental-health issue, according to the World Health Organisation (WHO).  Therefore, this year’s world mental health day is on October 10^th has a focus on prioritising mental wellbeing; and

v  Agreed that it is important that the partners need to do as much as possible to prioritise reducing the factors known to pose a risk to people’s mental health, enhancing those known to protect it and creating the conditions needed for people to thrive.

The Board:

v  Expressed concern that more residents than ever are experiencing real hardship because of the cost-of-living crisis, and that the situation for many is set to worsen.

v  Agreed that further money should be channelled into supporting businesses, health initiatives, housing support, employment, and financial schemes to help with fuel bills, advice on reducing bills, information on benefits and what to do in a crisis.

v  Agreed to consider what help available for families, where to get mental health support and links to community organisations and charities that can help.

v  Agreed on the importance of the partners being commitment to work with others to find the best way to help residents through this crisis (e.g., a joined-up approach to help people through the coming months and beyond).

v  Commented that access to GPs is a longstanding public concern. GPs are usually the first port of call and gateway to being referred for specialist support. However, residents have reported barriers to access, poor communication from the practice, and a lack of choice (e.g., Residents with disabilities, those whose first language is not English, and those on lower incomes have all expressed concern about facing specific barriers to accessing GP services.

v  Agreed that the public should be able to choose the type of appointment that best meets their needs.

v  Agreed on the need to receive an update on the integrated care system and other issues (e.g., were air pollution; the wider health impacts of Covid; substance misuse; and mental health in younger people and health and well-being of older people).

v  Agreed that when any item is put before Board it needs to be presented within the framework of the Health and Wellbeing Strategy with a covering note on (i) how the approach is targeted for those in greatest need; (ii) it is helping people to get more connected; (iii) does it address equity discrimination; (iv) on how coproduction is built into the to any particular strategy or program: and (v) how it make best use of assets. This will allow the Board to be critically engaged.

v  Agreed that housing professionals who come into contact with adults with care and support needs, or who are experiencing or at risk of abuse or neglect, have a responsibility and duty of care to  tenants and service users e.g., Identifying their needs, raising concerns, and reporting them through the correct channels.

v  Recognised that safeguarding challenges have never been more complex, nor the legal requirements placed upon housing providers more stringent. The number and range of safeguarding concerns experienced by communities have grown exponentially to include issues such as anti-social behaviour, county lines, cuckooing and domestic violence. Therefore, those working in housing settings have an important responsibility to manage the scale of these challenges and this should be reflected in Boards forward plan.

The Board received a presentation that provided an update on the cost-of-living crisis, its impact on residents and the measures being taken at the local and national level to mitigate those impacts.  The main points of the discussion maybe summarised as follows:

The Board

v  Noted that due to a combination of factors, both internal and external to Tower Hamlets, the cost of standard household items like energy and food have increased significantly and continue to do so. Whilst the Government has announced a number of measures that will support households, these will not cover the additional costs households will incur in full. Therefore, the Council has to find ways to support its most vulnerable residents.

v  Noted that in April 2022 the energy price cap increased by 54%, which is £700 a year for an average household.  Whilst in October it is likely to increase by a further £800. This will mean that in the space of a year, the cost of energy bills has more than doubled.

v  Noted that food prices have increased by an average of 5.9%, the largest increase since 2011. However, there are items have exceeded this increase, such as pasta (10.1%), milk, cheese, and eggs (8.6%). Lamb (16.9%), beef (8.9% and oils and fats (18.1%). In other words, items which are household staples have seen the largest increases, meaning the largest proportional impact is on low-income households.

v  Noted that the British Retail Consortium expects this trend to continue across the year. With an increase in energy, processing costs rising even further than expected, driving further retail price increases.

v  Noted that residents can get help with essential costs from LBTH through the ‘the Household Support Fund’ that provides help for those struggling to afford things such as (i) energy and water bills; (ii) food; and (iii) other essential items.

v  Was informed that (i) this Fund is aimed at anyone who is vulnerable or cannot pay for essentials; (ii) they do not have to be getting benefits to get help from LBTH; and (iii) those already in receipt of benefits, will not be affected if they also get a payment from the Household Support Fund scheme.

v  Agreed that if LBTH did not provide any intervention other than those funded by the Household Support Fund. This will lead to many more vulnerable residents remaining in crisis, with an associated detrimental impact on their physical and mental health.

v  Recognised that it is likely that not supporting residents at an early stage would lead to increased costs for LBTH when residents make contact needing emergency support.

v  Commented that this situation is unfolding whilst benefits are at a 35 year low in real terms, and while coming out of a pandemic which has disproportionately impacted those on low incomes.

v  Noted that the Government has also confirmed that another tranche of Household Support Funding will be given to Local Authorities for use between October 2022- March 2023 which should particularly target those who  ...  view the full minutes text for item 4.1

The Board noted that the purpose of this agenda item is to provide an overview the Royal London and Mile-End Hospitals initial winter planning and the continued development of plans and also to briefly provide an overview of vaccination plans over Winter. The main points of the discussion may be summarised as follows:

The Board

v  Noted that as Autumn and Winter approach the Royal London wanted to share the planning already underway for this winter. There are a range of risks and uncertainties with increasing demands across health and social care. Issues such as cost of living increases and rising energy costs are placing pressures on households and individuals, impacting on their health and ability to cope. Seasonal infections are also on the increase such as respiratory viruses, flu and new covid variants which may place additional pressure on services, and the need to vaccinate for these as well as unexpected viruses such as monkeypox and polio are affecting vaccination capacity and resource.

v  Noted that the system is already under considerable strain due to the need to work through a backlog in elective care, as well as increased demand.

v  Noted that the Royal London is developing plans to manage these competing pressures as winter approaches alongside its health and social care partners. The work underway is underpinned by clear governance and decision making as well as effective communication and escalation channels across the partnership from place and providers and we want to ensure that as a system everyone is aware of the work underway and has an opportunity to shape it further.  The Royal London is also focused on regular and effective communications to local residents.

v  Commented that patients from ethnic minority backgrounds have faced inequality when accessing healthcare services due to language, culture, population diversity and institutional attitudes. New policies and processes should be created to tackle these issues, with ongoing research to further explore and monitor outcomes. With primary care being the front door to healthcare services, it must be geared to meet the needs of the whole population consistently and competently.

v  Stated that primary care services provide the initial point of contact in the healthcare system, acting as the front door for the NHS. These services should therefore notably be a point of equal access for all in the community (e.g., using Accident and Emergency or the immunization programmes for polio, measles, mumps, and rubella).

v  Agreed that it is imperative (i) to encourage understanding of those groups who experience difficulties in accessing primary care services and consider ways to help them overcome obstacles they may encounter; and (ii) to have adequate patient access and experience can only be improved if the need for resources to support the care of BAME populations within primary care is recognised.

In conclusion, the Chair thanked officers for their presentation and all attendees for their contributions to the discussions on the winter planning and the development of plans over the Winter.

The Board received a presentation is to provide an overview of the Better Care Fund (BCF) programme that supports local systems to successfully deliver the integration of health and social care in a way that supports person-centred care, sustainability and better outcomes for people and carers.

The BCF (i) is aimed at bringing together health and social care organisations to plan, fund and commission integrated services; and (ii) Policy Framework sets out four national conditions that all BCF plans must meet to be approved. These are:

The paper requested approval of the BCF Plan for 2022-23 as part of the NHS England Assurance process and in line with national condition. The main points of the discussion may be summarised as follows:

The Board:

v  Noted that the Better Care Fund is not additional funding instead it represents a continuation of existing funding to support the base budget spend on integrated services. NHS North East London is responsible for planning and buying health services across north east London and supports adult social care with BCF spend on services such as community equipment, reablement teams and hospital social work teams. A full list of services funded by the Better Care Fund is included in the Better Care Fund Plan attached to the report.

v  Noted that the Better Care Fund (BCF) is aimed at bringing together health and social care organisations to plan, fund and commission integrated services. The BCF was introduced in 2016-17 for implementation and has effectively been rolled over year on year while the outcome of a national review of the programme is await.

v  Noted that the national guidance this year has seen the introduction of three new health metrics around ‘avoidable admissions’, ‘length of stay’ and ‘discharge’. The length of stay metric will be the particular focus of the national assessors. Tower Hamlets has met all the national conditions as set out in the guidance.

v  Noted that the Tower Hamlets Together Executive Board (which reports into the Health and Wellbeing Board) provides strategic oversight of the schemes that sit within the BCF. Generally, as the Fund sits within Integrated Commissioning team there is visibility of the range of budgets across the system, and a recognition that these are the areas where resources need to combine in order to deliver the collective priorities for Tower Hamlets.

v  Noted that the BCF is focussed on integrating health and social care services to better support people with a diverse range of illnesses and conditions. These include people with mental health problems, people at risk  ...  view the full minutes text for item 4.3

The Chair of the Board then Moved, and it was:-

RESOLVED that:

The NHS partner agencies were formally asked to provide a nomination for the position of the Boards Vice-Chair.   

With no other business to discuss the Chair of the Board:

A.   Called this meeting to a close.

B.   Indicated that the next ordinary meeting of the Board is currently scheduled for Tuesday 6th December 2022; and

C.   Thanked everybody for their attendance and participation at this evening meeting.