Agenda and draft minutes

Apologies were received from Caroline Green, substituted by Clare Keen, Cllr Chewe Munkonge, substituted by Cllr Louise Upton, Lisa Lyons and Karen Fuller.

Professor Sir Jonathan Montgomery had let it be known that he would arrive late and Olivia Clymer was substituing for him until he arrived.

There were none.

Members of the public who wish to speak at this meeting can attend the meeting in person or ‘virtually’ through an online connection.

To facilitate ‘hybrid’ meetings we are asking that requests to speak or present a petition are submitted by no later than 9am four working days before the meeting i.e., 9am on <<DATE>>.  Requests to speak should be sent to simon.wright@oxfordshire.gov.uk

If you are speaking ‘virtually’, you may submit a written statement of your presentation to ensure that your views are taken into account. A written copy of your statement can be provided no later than 9am 2 working days before the meeting. Written submissions should be no longer than 1 A4 sheet.

There were none.

To approve the Note of Decisions of the meeting held on 5 December 2024 and to receive information arising from them.

David Munday, Deputy Director of Public Health, updated the Board on a Housing Needs Assessment arising from the homelessness update given to the Board in December and further work on housing within Oxfordshire.

The Board agreed to the Note of Decisions of the meeting held on 5 December 2024 to be signed by the Chair as a correct record.

The Chair, with the agreement of the Board, moved item 7: Marmot Place Update ahead of item 6: Oxfordshire Health & Wellbeing Board – Update to Terms of Reference, to allow for Professor Sir Jonathan Montgomery to arrive and participate in the discussion.

The Board is to receive a verbal update.

David Munday gave an update on the Oxfordshire Marmot Place. Specific areas of work covered included health inequality, rural inequality and giving children the best start possible in life. There was also a brief update on the structure of the Marmot Place work, including on an Advisory Group. The Health & Wellbeing Board would be the primary body overseeing the work.

Cllr John Howson, Cabinet Member for Children, Education and Young People’s Services, asked if rural inequality was measured the same way as urban inequality as circumstances were different, using the availability of public transport as an example. He also raised representation from early years being included on the advisory board.

David Munday agreed on the points raised surrounding the measurement of rural inequality and committed to look at the membership of the advisory board regarding early years representation.

Ansaf Azhar, Director of Public Health and Communities, commented on the framework that shows the progress of work on becoming a Marmot Place and stated that the advisory board would evolve over time.

The Board noted the Marmot Place Update.

Report by Director of Law and Governance and Monitoring Officer, and Director of Public Health and Communities

The Oxfordshire Health and wellbeing board (HWB) is a formal statutory committee where political, clinical, professional and community leaders from across the health and care system come together to improve the health and wellbeing of their local population and reduce health inequalities

There have been changes to the operating model and staffing structure of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB) and therefore membership of the HWB and its Terms of Reference (ToR) need to be updated accordingly.

The Health and Wellbeing Board is RECOMMENDED to:

a)    Approve the update to the Terms of Reference of the Board (see Annex 1)

The Chair introduced the proposed changes to the Board’s Terms of Reference, owing to recent changes at the ICB.

The first change was that Dan Leveson would no longer be a member of the Board and would be replaced by Matthew Tait, ICB Chief Delivery Officer.

The second change was that the Vice Chair, Dr Sam Hart, would be leaving the Board, and that Professor Sir Jonathan Montgomery would be taking over as Vice Chair of the Board.

Cllr Nathan Ley, Cabinet Member for Public Health, Inequalities and Community Safety, raised the issue relating to a representative from NHS England, given recent government announcements. Ansaf Azhar stated that conversations would continue, and it would be kept under review.

It was noted that if the Board agreed to the changes of the Terms of Reference, it would be considered at Council in April.

RESOLVED to:

a)    Approve the update to the Terms of Reference of the Board (see Annex 1).

The purpose of this paper is to provide an update on our planning activities across BOB, this will specifically cover:

1. BOB ICB Operating Model – next steps
2. Working with local people and communities
3. 10-Year Health plan for the NHS
4. New provider for BOB non-emergency patient transport services
5. NHS Operational Planning for 2025/26 and associated national priorities:

- Priorities and operational planning guidance 2024/25

- Development of a medium-term plan for transformation and improvement

6. Joint Forward Plan refresh – timescales and engagement

The above activities are a key part of BOB ICBs responsibility to plan and arrange health and care services to meet the needs of our population, working to improve their health and lives.  This will require joint working with our partners to ensure we prioritise our resources effectively, based on evidence, to achieve the best outcomes for our residents and communities. 

The Health and Wellbeing Board is recommended to note the content of this report and provide views or feedback on the ongoing planning process and development of the medium-term strategy.

Matthew Tait provided an update on the ICB to the Board.

Firstly, he thanked both Dr Sam Hart and Dan Leveson for their contributions over their time on the Board.

The ICB’s priorities for 2025/26 were outlined and there was an acknowledgement of potential difficult decisions upcoming. Rob Bowen, Director of System Transformation and Development, gave an update on the strategic ambitions long-term of the ICB.

The four areas of opportunity outlined by the report were: prevention, different models of care, addressing health inequalities and the efficiency and productivity of care.

Cllr Louise Upton, Oxford City Council, highlighted the concerns with short-term savings causing long-term expenses and stressed the need to think about any reductions in prevention activity. Matthew Tait confirmed those very conversations were happening at the ICB at the moment, with savings being balanced against long-term strategic priorities.

Cllr Rob Pattenden, Cherwell District Council, raised the issue of care for disadvantaged communities and asked how much the ICB was planning to work with District Councils. Matthew Tait confirmed that the ICB works with District Councils closely and wanted to build on the work to-date.

Cllr Pattenden asked about section 106 funding of capital programmes for the ICB. Matthew Tait acknowledged work on this with local partners, noting the constraints relating to particular care models, for example.

Veronica Barry, Executive Director: Healthwatch Oxfordshire, enquired about the monitoring of non-emergency patient transport services. Matthew Tait noted the robust transition plan in place and that challenges had been worked through, and that it would be an improved service for residents.

Following on from the question regarding section 106 funding, Cllr Upton asked if the ICB had appointed a planning expert to unlock developer opportunities. Michelle Brennan, GP representative, confirmed that this position had been filled, and work was underway to address these issues, citing that closer cooperation on CIL funding would be welcomed.

The Board noted the ICB Update.

In March 2024, the draft Primary Care Strategy was presented to the Oxfordshire Health & Wellbeing Board as part of the ICB’s commitment to ensuring the contribution and engagement of system partners and the public in the development of its Primary Care Strategy.

The final Primary Care Strategy was signed off by the ICB in May 2024 and the changes made were significant because of the extensive engagement that was undertaken. Slide 2 of the pack summarises how this insight has been used to inform the final version of the Primary Care Strategy.

The Health & Wellbeing Board are recommended to:

a)    Note and discuss the progress made since BOB ICB initially engaged with system partners and the public on the Primary Care Strategy, including changes made to the document consequently, final themes and essentially implementation to date.

Louise Smith, Primary Care Director: ICB, presented the report on the implementation of the primary care strategy to the Board and raised the following points:

-       The importance of the sustainability of primary care and working in partnership with secondary care providers.

-       The national emphasis on the ‘leftward shift’ in the priorities of health, especially on prevention.

-       The need for co-production with citizens to drive forward services.

Cllr Howson highlighted the issues of children in care having dental appointments post-COVID and audiology services, given the demographic situation of Oxfordshire. Louise Smith confirmed the need to engage further with Councils to tackle dental issues for children. Cllr Howson stressed the need to engage with childminders before children go to school as they are more impressionable.

Cllr Nathan Ley and Veronica Barry both emphasised the need to move to a preventative culture, with the need to co-product models of care with neighbourhood teams to ensure their needs are being catered for.

Sir Jonathan Montgomery asked for an update on the progress in Oxfordshire relating to digital, citing success in West Berkshire. Michelle Brennan noted that the Trusts needed to put data in for the tool to become useful and that implementation is difficult and expensive.

Cllr Helen Pighills, Vale of White Horse District Council, raised the NHS app and highlighted that it was not user-friendly. Michelle Brennan acknowledged the concerns raised but noted that General Practices were limited by financial constraints.

RESOLVED to:

a)    Note and discuss the progress made since BOB ICB initially engaged with system partners and the public on the Primary Care Strategy, including changes made to the document consequently, final themes and essentially implementation to date.

Report by Director of Adult Social Care

Better Care Fund [BCF] Plans are owned and approved by the Health & Wellbeing Board on behalf of the Council and Buckinghamshire, Oxfordshire and Berkshire [BOB] Integrated Care Board [ICB] and other partners. As such, the Board approves the Plan each year.

This report sets out the background to the national and local BCF Plan development process for 2025-26 and the proposed route to signing off the plan for Oxfordshire. NHS England has brought forward the planning timetable for 2025-26. The final plan must be submitted by 1200pm 31 March 2025, and it will be necessary to achieve sign off for the Plan outside of a formal Health & Wellbeing Board meeting.

The Planning guidance for 2025/26 was issued on 30 January and makes changes to the investment and expenditure, funding structure and metrics that must be delivered by the Plan. Broadly, the changes support Oxfordshire’s existing ambitions as set out in the Oxfordshire Way and the Health and Wellbeing Strategy 2024-30. The policy guidance signals a shift from “sickness to prevention” and to support people living independently at home. These approaches are wholly consistent with Oxfordshire’s ambitions. 

The development of the 2025/26 Plan builds on the system approach to planning and engagement under the overview of the Oxfordshire Place Based Partnership established in 2023/24 and 2024/25.

The Health and Wellbeing Board is RECOMMENDED to:

a)    Note and approve the direction of travel set out in this report for the Oxfordshire Better Care Fund Plan for 2025/26 and the decision-making process set out at paragraph 13.

b)    Delegate approval of the Oxfordshire Better Care Fund Plan for 2025/26 and decision on the assurance statements set out at paragraph 16 to the Chair of the Board for submission by 31 March 2025.

Ian Bottomley, Head of Joint Commissioning (Age Well), presented the report to the Board and raised the following points:

-       A clear focus in guidance on moving to prevention.

-       Reducing admissions into hospital needs to match Oxfordshire’s success in discharging people from hospital.

It was confirmed that officers were seeking a delegation from the Board to the Chair of the Board, in order to sign off the Better Care Fund plan once all of the technical details and signoffs had been confirmed.

Stephen Chandler, Executive Director of People, noted words from the Secretary of State regarding ‘checkers’ of plans, which suggested less checks on how plans were put together would be needed in future.

Cllr Louise Upton referenced homelessness as a health issue and praised the cooperation with City & District Councils.

The Vice Chair asked if there was an opportunity to provide a revolutionary change in health outcomes through pursuing different models that blended the NHS & social care together.

Michelle Brennan noted that the system needed to get behind a culture shift of admission avoidance to increase the capacity of intermediary services in the community.

RESOLVED to:

a)    Note and approve the direction of travel set out in this report for the Oxfordshire Better Care Fund Plan for 2025/26 and the decision-making process set out at paragraph 13.

b)    Delegate approval of the Oxfordshire Better Care Fund Plan for 2025/26 and decision on the assurance statements set out at paragraph 16 to the Chair of the Board for submission by 31 March 2025.

Report by Director of Public Health and Communities

This paper presents three elements of the Community Insight Profiles programme of work, which includes:

(a)           Two further Community Insight Profiles within Phase four of the programme: Wood Farm (Oxford City) and a bespoke area of Witney (West Oxfordshire) referred to as Witney Central Community Insight Profile area. The report highlights the links to the Marmot Places programme.

(b)           A report on the first phase of evaluation of the Oxfordshire County Council funded Community Health Development Officer programme and the NHS ICB funded Well Together programme.

(c)           Enablers to address inequalities as a legacy of the Community Insight Profiles, including the first iteration of an interactive Community Insight Profile Dashboard to increase accessibility to the data and insight and a draft toolkit to support the development of partner led Community Insight Profiles in other areas.

Since 2021, Public Health have been working with partners to carry out a programme of work to develop Community Insight Profiles (CIP). The work was initiated after the publication of the Director of Public Health (DPH) Annual Report  for 2019/20 which highlighted ten wards in Oxfordshire which have small areas (Lower Super Output Areas) that were listed in the 20% most deprived in England in the Index of Multiple Deprivation (IMD) update (published November 2019) and are most likely to experience inequalities in health. The publication of Community Insight Profiles for all ten areas was completed in December 2023.

Following on from this, a further four Community Insight Profiles are being developed for areas across the county identified as falling within the 30-40% most deprived nationally according to the IMD (2019) and where local partners identified that there would be added benefit to developing a profile. Wood Farm and a bespoke area of Witney are included in these areas. A CIP for Berinsfield was published in September 2024 and a further CIP for Bicester West is in development and will be published in June 2025, which will bring the Public Health led programme of this work to a close.

The Health and Wellbeing Board is RECOMMENDED to:

a)    Use the findings and rich insight contained within the Community Insight Profiles for Wood Farm and Witney Community Insight Area (CIA) and their relevance to the Marmot Place programme of work to inform service delivery plans of partner organisations on the Board and support the promotion and sharing of the findings with partners and colleagues across the system.

b)    Support the promotion of the interactive Community Insight Profile (CIP) Dashboard and the Community Insight Profile (CIP) development toolkit that will serve as a legacy of the CIP programme of work.

c)    Support the promotion and sharing of the findings from the first phase of an evaluation of the Community Health Development Officer (CHDO) and Well Together programmes with partners and colleagues across the system.

David Munday, Tom McCulloch, Katherine Howell and Erica Charters presented the report.

Relating to the Witney Central Community Insight Report, Tom McCulloch reported that funding was an issue to continue these projects and gave a detailed insight into the number of residents spoke to, case studies and focus groups.

It was noted that community-based services are vital in Witney, and that more support was needed for parents & health visitors. Children & young people in particular did not feel involved in local decision-making.

Katherine Howell spoke to the Healthwatch Oxfordshire report into Wood Farm, Oxford. Community events were held and door-knocking in Wood Farm helped to receive opinions from local residents, as well as an art competition at the local primary school.

Strengths of Wood Farm were identified as having green spaces, play parks, nearby shops; but experiences of this were unequal. One issue that arose was the lack of availability to healthy, affordable food to those who didn’t have transport or were not able to be physically active. Some people who worked were found to be struggling in the cost-of-living crisis.

Dr Erica Charters (Oxford University) evaluated the approaches of the preventative work undertaken in Witney & Wood Farm, which had been ongoing since the inception of the project. Time was spent in the community to understand their regular days, patterns and commonly visited places through Community Health Development Officers (CHDO’s).

It was found that both programmes were effective; in terms of the grants being dispersed and through engagement with local communities. There were 196 health and wellbeing activities organised across the 10 most deprived wards.

One of the key concerns was the lack of consistent/secure funding, with new groups wanting to have new initiatives whilst the key for community groups was to focus on the sustainability of projects, rather than their novelty.

Key recommendations outlined by the University-led evaluation were:

-       ‘Rooted research’ instead of ‘parachute projects’.

-       Prioritising sustainability and reliability over novelty.

-       Interpersonal strengths of CHDO’s and CCBs (social relationships) to encourage expectations of improved health and wellbeing, breaking down community indifference and distrust

-       Supporting community trust and engagement with existing community resources.

Cllr John Howson noted this work was based in urban areas and stressed the importance of having a primary school in rural areas.

Cllr Louise Upton picked up on the ‘parachute projects’ being detrimental and Dr Charters noted the cynicism that was picked up around such projects in the communities, emphasising the need for stability.

Cllr Rob Pattenden noted the ongoing projects in Bicester and commented that it has to be long-term to see long-term benefits.

David Munday demonstrated the Community Insight Profile dashboard and toolkit with some short videos to the Board.

Cllr Nathan Ley asked about the Council’s plans to ensure that these toolkits and dashboards would be kept updated. David Munday confirmed there was a data warehouse that would be continually updated.

RESOLVED to:

a)    Use the findings and rich insight contained within the Community Insight Profiles for Wood Farm and  ...  view the full minutes text for item 114.

The Board is to receive a verbal update on the Director of Public Health Annual Report.

Ansaf Azhar and Jason Yun, Public Health Registrar, presented the Director of Public Health Annual Report 2024/25, based on children and young people’s mental health and wellbeing, raising the following points:

-       There had been a national rise in worklessness post-COVID in young people, driven particularly by mental health illnesses.

-       Healthy life expectancy in the UK was stalling, if not falling and people living with long term conditions is rising, whilst the growth of the workforce is increasing at a much lower rate.

-       These issues were evident in Oxfordshire, and work to tackle these issues currently was praised.

-       The main objective was to reframe the conversation around mental health and how schools/employers can help in this area.

-       The reasons for worsening mental health in children and young people were explained, including the rise of social media, lifestyle factors and the impact of COVID-19.

-       Poor mental health leads to prohibitive factors of employment, which can then lead to deterioration in conditions due to financial stress.

The four recommendations outlined in the report were:

-       Strive to reduce mental health problems by addressing wider factors.

-       Prioritise opportunity, activity, independence and community.

-       Prioritising early and effective intervention.

-       Ensuring diverse career and training opportunities are available for all young people.

Cllr John Howson stressed the need to dive down within secondary schools versus primary schools, as well as via parliamentary constituencies in Oxfordshire.

It was confirmed that the full report would be published at the County Council meeting on 1 April.

Veronica Barry noted sessions on this topic were scheduled with young people soon.

Report by Director of Public Health and Communities

The Health and Wellbeing Board approved a new strategy in December 2023, with the priorities split between four thematic areas of Start Well, Live Well, Age Well and Building Blocks of Health. Delivery against the ambitions within the strategy is the responsibility of all organisations represented on the Board and is supported by an Outcomes Framework agreed by the Board in March 2024.

The Board has agreed to receive a rotating update on delivery of 1 of the 4 strategy themes at its quarterly meetings, meaning that over the course of a 12-month period an update on each theme would be presented once. This report is the first annual report of the thematic domain of Live Well covering: 

Priority 3 - Healthy People, Healthy Places

·       The length and quality of people’s lives in Oxfordshire should not be negatively impacted by exposure to tobacco, alcohol, or unhealthy weight.?

·       People in Oxfordshire should live in healthy environments where they can thrive free from these harms.? 

Priority 4 - Physical Activity and Active Travel

·       Residents of Oxfordshire should be able to be and stay physically active, for example by walking and cycling, especially in our most deprived areas. 

As agreed by the HWB, it is the Health Improvement Board that is the key partnership forum that drives forward implementation of the strategy under these two areas.

The implementation progress report in Annex 1 provides an update on key activities, challenges and plans for the year ahead against each theme and Annex 2 presents data for the Key Outcome and Supporting Indicators selected for these two priorities within the Board’s Outcomes Framework.

The Health and Wellbeing Board is RECOMMENDED to:

a)    Note the progress of the delivery of priorities 3 and 4 under the thematic domain of Live Well within the Health and Wellbeing Strategy along with key challenges.

Derys Pragnell, Consultant in Public Health, presented the report and raised the following points:

-       It was noted that whilst certain data points were green, that would not be the case for the entire county and thus, specific areas would need targeted provision to address this, and vice versa.

-       Physical inactivity in children was reported at 30% across Oxfordshire, but this ranges from 22% in Vale of the White Horse to 46% in West Oxfordshire.

Cllr Helen Pighills noted that the ‘You Move’ programme had been extended to cover early years, which is opening the programme up to families and continued work in the Districts was ongoing. It had also been identified that home-schooled children lacked PE taught as a subject.

Cllr Nathan Ley noted the concerns he has over physical inactivity and referenced the need to work with the highways department to deliver on schemes, such as the School Streets programme. The importance of e-bikes being rolled out across Oxfordshire was also highlighted.

Cllr Louise Upton noted the difficulties relating to fast-food takeaways near to schools due to the compact nature of Oxford.

RESOLVED to:

a)    Note the progress of the delivery of priorities 3 and 4 under the thematic domain of Live Well within the Health and Wellbeing Strategy along with key challenges.

Report by Director of Public Health and Communities

Every Health and Wellbeing Board (HWB) has a statutory duty to carry out a Pharmaceutical Needs Assessment (PNA) every three years. The last PNA for Oxfordshire was published in 2022 and has been kept up to date with supplementary statements reflecting changes in provision. The 2025 PNA is now due for publication in October 2025.

The Health and Wellbeing Board is RECOMMENDED to:

a)    To note that the process to produce a revised Pharmaceutical Needs Assessment (PNA) by 1st October 2025 has commenced.

b)    To receive an update on progress and the project plan timelines on the production of the 2025 Oxfordshire PNA.

c)    To agree the approach to the approval of the final PNA.

Bethan McDonald, Consultant in Public Health, presented the report and raised the following points:

-       The public engagement survey had run from 27^th January to w/c 3^rd March, with 454 responses which are currently being analysed.

-       If approved, the draft PNA will be available for public consultation.

-       Following the consultation, the final PNA will come to the Board in September for sign-off.

The approval for the draft pre-consultation and the final PNA was proposed by officers to be delegated to the Chair of the Oxfordshire Health & Wellbeing Board and the Director of Public Health & Communities. The Board agreed to this delegation.

RESOLVED to:

a)    To note that the process to produce a revised Pharmaceutical Needs Assessment (PNA) by 1st October 2025 has commenced.

b)    To receive an update on progress and the project plan timelines on the production of the 2025 Oxfordshire PNA.

c)    To agree the approach to the approval of the final PNA.

Report by Director of Public Health and Communities

The Joint Strategic Needs Assessment (JSNA) is a statutory annual report provided to the Health and Wellbeing Board and published in full on the Oxfordshire Data Hub.  It provides an evidence-base for the Health and Wellbeing Strategy and is an opportunity for an annual discussion about the key issues and trends from a review of a very wide range of health-related information about Oxfordshire. It should be used as a tool by all partners of the health and wellbeing board to ensure that services provided by their organisations are suitably tailored to the local needs in Oxfordshire identified by the JSNA.

Producing the JSNA is a collaborative project with contributions from many analysts and sector specialists from Oxfordshire’s Local Authorities, NHS, Thames Valley Police, Healthwatch Oxfordshire and Voluntary Sector organisations.

Following the proposal at the March 2024 Health and Wellbeing Board, this year’s JSNA will be available through a collection of interactive dashboards and accompanying narrative on Oxfordshire County Council’s new Data Hub website.

The JSNA is a contemporary assessment of the health and wellbeing needs of the population. However, information about services needed to address population needs is beyond the scope of the JSNA. In some cases, the data may not be recent enough to reflect changes in services.

The Health and Wellbeing Board is RECOMMENDED to

a)    Provide feedback on the proposed design of the 2025 Joint Strategic Needs Assessment (JSNA).

b)    Advise on the content of the 2025 JSNA and to highlight any additional topics/ themes of research and intelligence interest that they would like to see included.

c)    Via relevant officers in their organisations, contribute information and intelligence to the JSNA to further its development and participate in making information more accessible to everyone.

Bethan McDonald and Craig Miles-Clarke, Senior Research Officer, presented the report and gave a brief tour of the JNSA page on the Oxfordshire Data Hub. It was confirmed that the full JNSA would be brought back to the Board in September for approval.

Veronica Barry encouraged the continued use of easy-to-understand language and accessibility throughout the page.

RESOLVED to:

a)    Provide feedback on the proposed design of the 2025 Joint Strategic Needs Assessment (JSNA).

b)    Advise on the content of the 2025 JSNA and to highlight any additional topics/themes of research and intelligence interest that they would like to see included.

c)    Via relevant officers in their organisations, contribute information and intelligence to the JSNA to further its development and participate in making information more accessible to everyone.

To report on views of health care gathered by Healthwatch Oxfordshire.

Veronica Barry presented the report from Healthwatch Oxfordshire, and noted several publications from Healthwatch since this report was published.

Webinars around patient participation, following work with the ICB, had taken place to encourage sharing of good practice by different groups.

The Board noted the report from Healthwatch Oxfordshire.

To receive updates from Partnership Boards. Reports from –

·       Health Improvement Board (verbal); and

·       Children’s Trust Board (verbal); and

·       Place Base Partnership Board

The report from the Place Base Partnership was in the agenda packs.

Cllr Helen Pighills noted that the work of the Health Improvement Board had been covered under Item 11: Community Profiles – Latest Publications, Evaluation and Implementation Tools, but also referred to the focus on efforts to active lifestyles and how making people move was an investment to save in the future.

Cllr John Howson noted the focus of the Children’s Trust Board on the education attainment data, children’s inactivity in rural areas and the government’s Children’s Wellbeing and Schools Bill, which was making its way through parliament.

The Chair thanked all speakers for their updates on their respective Boards/partnerships.

The Chair thanked David Munday on behalf of the Board for his tremendous contribution to the Board and the County Council over the past few years.