Agenda item

Roger Gough (Cabinet Member for Business Strategy, Performance and Health Reform, Kent County Council), Andrew Scott-Clark (Director of Health Improvement, Kent County Council), and Julie Van Ruyckevelt (Interim Head of Citizen Engagement for Health, Kent County Council) were in attendance for this item.

(1)       After being welcomed by the Chairman and invited to address the Committee, Mr Gough proceeded to explain that the Joint Health and Wellbeing Strategy (JHWS) was a core part of the work of the Health and Wellbeing Board and was mandated as such by the Health and Social Care Act 2012. The Joint Strategic Needs Assessment had existed for a few years, but the JHWS was a new kind of document. It was meant to inform the commissioning plans of the commissioners represented on the HWB. It was not an Operating Plan, and it was later explained that this is reason there were no financial costings in the JHWS. While it needed to be strategic, it could not be too high level to be essentially meaningless.

(2)       Members’ attention was drawn to the graphical representation of the structure of the JHWS on page 40 of the Agenda. Priorities for the JHWS came from a series of connected sets of information. Firstly, there was an examination of the areas of health where Kent performed worse than the national average. A closer look at the data would reveal the local priorities by showing where, for example, the areas of highest and lowest life expectancy would be found. These were given as King’s Hill and Margate respectively. Gaps in provision would also be considered. A lot of public health goals looked to the longer term, but quick wins could be achieved by looking at gaps in provision. All this contributed to identifying which services needed to be improved or transformed as a priority.

(3)       At the national level there were Outcomes Frameworks for the NHS, Public Health and Social Care with a possible one for children’s services in development. The JHWS was intended to form a single Outcomes Framework for Kent.

(4)       It was explained that the timeline set out in the papers had slipped slightly to enable the Strategy and associated engagement to be as robust as possible Phase 1 of the engagement process concentrated on key stakeholders but as some emerging CCGs were not fully able to comment at that time, there was a second opportunity. Mr Gough also made the offer that along with the current meeting he would welcome the opportunity to discuss the strategy further with any Member.

(5)       One specific example of an issue where comments and suggestions were welcomed arose in response to a comment from a Member that the JHWS lacked a certain ‘person centred’ feel. This thought was taken positively, but given that health and social care cover such a variety of patient and personal experiences it was a challenge to capture the diversity.

(6)       In response to a specific question it was explained that hard to reach groups such as gypsies and travellers were included in the health inequalities plan. It was also accepted that the wording on p.52 would be looked at again.

(7)       A particular criticism was made of the priority given to safeguarding issues in the JHWS as the wording on p.42 of the Agenda suggested it was not as high as it needed to be. This was explained to be a placeholder target until a better one could be developed and not an indication of its status as it was important to get it right.

(8)       Similarly, the priority given to mental health services was questioned and anecdotal evidence provided that mental health charities were facing cuts in funding. In response it was explained that mental health was very important and its place in the JHWS would act as a counter-weight to the considerable pressures on limited resources to be spent elsewhere.

(9)       A broader argument was presented that the JHWS could give too high a priority to resources being used on such public health activities as breastfeeding rather than cancer and heart disease, given as the kind of things which affect most people most of the time. In response it was explained that in terms of breastfeeding uptake Kent was an outlier and that breastfeeding was one of the most important factors in ensuring longer term health, including reducing obesity and thus reducing the risk of cancer. It was accepted that it was difficult to input resources further upstream but that there were benefits of so doing. One Member commented that the JHWS was full of good intentions, but doubts remained about how possible it was to change people’s lifestyles; however, as the attempt needed to be made, support needed to be given to the JHWS.

(10)     One of the positive aspects of the HWB bringing all the commissioners together was that it would allow whole systems solutions to be tried. The South Kent CCG was working with the local HWB on integrated care and this way of developing plans was a model for the future to introduce across Kent.

(11)     The place of providers was another issue to consider. Kent was similar to around ¾ of HWBs across England in not including providers on the HWB. However, there were existing ways of bringing commissioners and providers together which would be built on.

(12)     The Chairman proposed the following recommendation:

·        That this Committee thanks its guests for attending and welcomes the opportunity to feed into the development of the Joint Health and Wellbeing Strategy and looks forward to continuing in a constructive and productive relationship with the Health and Wellbeing Board.

(13)     RESOLVED that this Committee thanks its guests for attending and welcomes the opportunity to feed into the development of the Joint Health and Wellbeing Strategy and looks forward to continuing in a constructive and productive relationship with the Health and Wellbeing Board.