Agenda and minutes

To receive any apologies for absence.

Apologies were received from Councillors Elaine Giles, Councillor Nicky Hinchliff, Councillor Laura Rollins, Rashpal Bishop (Director of Adult Social Care) and Reverend David Gould (Chair of Public Health Faith Sector Working Group).

Members to declare any interests in matters to be discussed at the meeting.

No declarations of Interest were received.

To confirm the minutes of the meeting held on 13 September 2023 as a correct record.

Resolved that the minutes of the meeting held on the 13 September 2023 are approved as a correct record.

To determine whether there are any additional items of business to be considered as a matter of urgency.

There were no urgent additional items of business.

To consider and note the Area Special Educational Needs and Disabilities (ASEND) Inspection Outcome and Next Steps.

The Board received an update from the Director of Children’s Services and Education following the inspection of the Special Educational Needs and Disabilities (SEND) local area partnership for Sandwell.

The inspection had been conducted by Ofsted and the Care Quality Commission (CQC) against a new Ofsted/CQC inspection framework which was launched in January 2023, for a period of three weeks in June and July 2023.  The revised framework ‘evaluated’ the effectiveness and impact of local area partners and the extent to which children and young people with SEND, including those who attend Alternative Provision (AP) settings, were receiving consistently good experiences leading to consistently good outcomes.

The inspection team had found that children and young people with SEND, including those who attended alternative provision settings, were receiving inconsistent experiences resulting in them achieving inconsistent outcomes.  This was commonly referred to as a ‘Category Two’ outcome for the local area partnership.

Recommendations made by the Department of Education (DfE) following the inspection included:-

·      Strengthening of multi- agency working across the partnership between education, health and social care.

·      Development of improvement strategies via co- production with children and young people with SEND.

·      Increasing and expanding short- break opportunities.

Following inspection, all local areas were required to publish a Local Area Inclusion Plan by 2024.  The Plan constituted an action plan in response to the recommendations made and would operate over a three- year period, supported by Ofsted, the CQC and the DfE with the next inspection due to take place in Summer 2026.  The Council would be publishing its Plan ahead of the deadline set by the DfE.

The inspectors had been highly complementary about the vision across the local area partnership and the launch of the SEND Eco- System Transformation Programme in June 2023.  This had given the inspectors a very clear understanding that the local area partners, through the self-evaluation, were accurate in their judgements and the actions they were taking to improve the experiences and outcomes of children and young people with SEND.

Members of the Board welcomed the outcomes of the inspection and noted the improvements that had been made.

The next steps of the SEND improvement journey included the expansion of SEND services and alternative provision settings within Sandwell, and the embedding of the recommendations of the report into daily practice.

To consider and comment upon the draft Health and Wellbeing Board constitution.

The Board received a draft revised constitution for consideration

Following changes to NHS structures in 2022, the Board’s membership had previously been reviewed.  The constitution, which had been written in 2013, had now undergone revision to reflect those changes.

To consider and note upon the Older Adult Therapeutic Service in Sandwell.

The Board received an overview of the Older Adult Therapeutic Service (OATS) for patients with Dementia in Sandwell.  The Black Country Healthcare NHS Foundation Trust (BCHNHSFT) service had been launched in May 2022.

There were four referral pathways into the service:

·      Organic referral route (Primary pathway)

·      Functional referral route (Secondary pathway)

·      Psychology input (START/ Co- facilitated psychology group)

·      Peer support (Referred via OATS staff only following initial assessment)

The organic referral pathway for service users had been curated so that service users opting to receive support post-diagnosis, would first attend the Dementia Information Group for an initial assessment, to identify which service would best support their needs.  Following the initial assessment service users would receive one of four services that was most appropriate for their needs:

·      Seeing Past Dementia

·      Cognitive Stimulation Therapy

·      Memory Management Group (This programme was in pilot stage in Dudley)

·      Football Cognitive Stimulation Therapy

The functional pathway received referrals from the Enhanced Community Mental Health Team for Older Adults (ECMHTOA).   There were currently four services providing support in Sandwell and these were:

·      Wellness Information Group

·      Living with Anxiety

·      Discovery through Activity

·      Managing Difficult Emotions (Pilot stage only)

All support groups were provided in community settings and the service was currently exploring venues in Oldbury and Smethwick, due to the high levels of need for residents within the Borough. 

Following the comments and questions from members, the following responses were provided:

·      To support Sandwell’s journey to becoming a Dementia friendly borough, it was important to raise public awareness and make it known that wasn’t possible to tell if someone had Dementia just by looking at them.  The process from diagnosis to post-diagnosis support needed to be more streamlined to remove repeated questions.

·      The service had been designed to be as simple as possible for the patient.

·      Staff had received extensive training with the key messaging centred around the understanding that dementia can impact ‘anyone, anywhere’.

·      Partner agencies such as West Midlands Police could not directly refer individuals via the functional pathway at present, however appropriate referral routes were possible.

·      Referrals had steadily increased since the launch of the service in May 2022, and now ranged between 15 and 40 a month.

·      The Community Mental Health Team was undergoing a transformation and BCHNHSFT was involved in those discussions to ensure that the OAT service was promoted. 

·      The service was currently at capacity and was working on a business case to increase staff and additional venues were being sought.

·      The service operated in a way that sought to avoid creating waiting lists.

·      Service users were not limited to the services within their own local authority and could choose to attend any site to receive support within the Black Country.

·      The service had been designed to be service- user centred, and clinicians were in regular contact with patients.

To consider and note the findings of the Child Death Overview Panel 2021/ 22.

The Interim Director of Public Health outlined the findings of the Child Death Overview Panel Report 2021/22.  This was the third report produced by the Panel, which was a statutory interagency body, accountable to both Sandwell Council and the Black Country Integrated Care Board.

In 2021/22 there were 40 cases of infant mortality (death aged under one year), which was the highest in the Black Country.  Child deaths in the Borough had been increasing since 2019/20, although they had decreased in Dudley, Walsall and Wolverhampton.

The primary factors for the increase were:

·      Smoking in pregnancy.

·      Fathers classified as high- risk.

·      Obesity.

·      Concealed pregnancies.

·      Post-delivery monitoring.

·      Awareness of risk factors

·      Adequate staffing for high-risk deliveries.

Key priorities detailed in the report included efforts to ensure that 85% of women who were expected to give birth at less than 27 weeks gestation delivered their child in a maternity unit; and to halve the rates of stillbirths, neonatal deaths, maternal deaths and serious intrapartum brain injuries by 2025.

Lessons learned included:-

·      Dads and partners were often missed when giving bereavement support and when receiving crucial information from the health visitor and midwife.

·      Co- sleeping advice needed to be consistent, repeated at every contact and include dads and partners.

·      Parents expectations needed to be carefully managed when babies were born with a poor prognosis or were given a diagnosis antenatally to support with the bereavement process.

·      Families should be assessed as a whole, looking at a cultural genogram to ensure the lived experience of the young person was assessed.

·      Where there were multiple agencies involved with a child and family, there should be a key worker who coordinated support.

·      Effective communication with parents during treatment was needed with a consistent management of expectations.

·      Parents should be aware of the benefits of a healthy body- mass- index (BMI).

A deep dive of the data was being carried out to understand why Sandwell’s child mortality rates were higher than neighbours.  Public Health was developing a heathy pregnancy service to address the primary factors identified and the lessons learned.

The Panel’s 2022/23 report would be submitted to the Board in early 2024, and would provide an update on progress with intervention programmes.

To consider and note the Healthwatch Sandwell Introduction.

The Board received an update from the Chair of Healthwatch Sandwell on its role and current work programme.

Local Healthwatch organisations were a statutory service required and commissioned by local authorities under the Health and Social Care Act 2012.  The aim of local Healthwatch was to give citizens and communities a stronger voice to influence and challenge how health and social care services were provided within their locality.  The legal power to Enter and View health and care services and see them in action offered a way for Healthwatch to meet some of its statutory functions and allowed it to identify what was working well with services and how they could be improved.

Healthwatch’s work programme had been informed by local intelligence data as well as public consultation.  Community Engagement exercises were used to understand how communities were supporting local people to stay healthy and to reach seldom- heard communities.  18,000 individuals had been reached using digital means in the previous year.  The priority theme for 2023/24’s was diabetes due to the high rates in Sandwell.

Healthwatch Sandwell had conducted public engagement for Sandwell Health and Care Partnership through exercises in all of Sandwell’s six towns - the Guided by You programme.  The programme had engaged with over 300 people to capture data relating to the health and wellbeing priorities of the borough’s population.  The final report was currently being prepared.

Following comments and questions from members, the following responses were provided:-

·      The subject residents contacted Healthwatch Sandwell about most was access to primary care.

·      Information resources had been developed regarding primary care access in the borough and had incorporated information about Urgent Treatment Care centres, the NHS 111 telephone service, and signposts to other services, to reduce the burden on GPs, as it was not always necessary to visit a GP.

·      Healthwatch Sandwell volunteers had engaged with young people and children via schools and the Black Country Integrated Care Board to determine whether healthcare provision was adequate for those with additional communication needs.

·      The faith sector was an important partner and assisted in accessing harder- to- reach demographics.

·      Healthwatch reviewed its engagement programme quarterly. 

(Councillor Syeda Khatun and Emma Taylor left the meeting during consideration of this item).

To consider and note the Healthwatch Sandwell Update upon Diabetes in Sandwell.

The Board received an overview from the Healthwatch Sandwell Projects and Partnerships Lead relating to its Diabetes in Sandwell project.

Sandwell had a diagnosis rate of 9.9% for diabetes compared to a national average of 7.1% and had been identified as a risk group of concern by Diabetes UK. 1,110 individuals had responded to the Healthwatch Sandwell diabetes survey and concerns regarding the management of diabetes related to:

·      Existing support network coverage across Sandwell.

·      Geographical coverage of local groups who supported those diagnosed with the condition.

·      The roll- out of preventative programmes related to diabetes across the Borough.

Feedback from older and elderly individuals had identified diabetes retinopathy eye screening tests, mobility implications and increased multiple health risks as focus areas.  Consultations with members of the African Caribbean community had raised topics relating to culturally appropriate information, eating habits and activities and community led education as key areas for further exploration.

The key recommendations arising from the project included:-

·      A focus on Diabetes prevention and risk reduction.

·      Development of a strategic relationship with Diabetes UK.

·      Investment in local communities and ‘grass roots’ support’.

·      Addressing health inequalities in minority ethnic groups.

·      Reviewing management of diabetes in the elderly population.

The recommendations had been shared with stakeholders.

Following comments and questions from members, the following responses were provided:

·      Public Health had developed a Health Aging app, which supported translations to multiple languages.  The Council was working with NHS partners Winter Booklet for 2023 would promote the app to newly patients upon diagnosis.

·      Sandwell Health Improvement Partnership was working to tackle cultural barriers.

·      Public Health had submitted a bid for funding to further support work on diabetes, as well as meatal heath and hypertension.

·      More work was needed to ensure that at-risk groups were targeted and to communicate basic knowledge about diet and hidden sugars.

·      Post- diagnosis support should be communicated effectively to patients.

·      Diabetes related communications could be cascaded to parents via schools to increase understanding of the condition.

Standing Item to note the Health and Wellbeing Board’s Work Programme 2023/ 24.

The Board noted its Work Programme for 2023/24.