Agenda Item 19.0. These minutes were ratified on 4th June 2020

Lancaster District Health and Wellbeing Partnership

MINUTES

Wednesday 18th December 2019 13:00 – 16:00 Hours Large Lecture Theatre, Moor Lane Mills, Lancaster

Present: Andy Knox (Chair) AK Executive GP, MBCCG Craig Brown CB Lancashire County Council Helen Greatorex HG North Lancashire CAB Suzanne Lodge SL Lancaster City Council Claire Niebieski CN MBCCG Alison Scott AS UHMBT Cllr Alistair Sinclair ASc Lancaster City Council Gary Tunstall GT Lancashire Constabulary Mark Wight (Secretary) MW MBCCG Jared Williamson JdW Lancashire County Council

Apologies:

Paul Blythin PB Active Lancashire Ian Dewar ID UHMBT Chris Hardy CH Lancashire Constabulary Mark Hutton MH Lancashire Fire and Rescue Adrian Leather AL Active Lancashire Yak Patel YP CVS Debbie Thompson DT Lancashire County Council Julia Westaway JW MBCCG

No. Action

1.0 Welcome and Introductions The Chair welcomed the following new members: o Chris Hardy, the new Place Based Chief Inspector for Lancaster and Morecambe; o Gary Tunstall, Lancashire Constabulary; and o Vicky Jackson, Population Health Team, Morecambe Bay CCG.

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2.0 Minutes from meeting held 16th October 2019 The Minutes of the last meeting were agreed as an accurate record.

3.0 Action Log Members noted updates to the Action Log.

4.0 Matters Arising There were no matters arising.

5.0 Transformation Challenge Award Project update

 Food Poverty o West End Million was looking to work in partnership with organisations with matched funding to develop projects relating to housing. o This could involve taking over unused housing and renovating it using the skills of local people and tradesmen. There were parallels with projects in Blackpool and Toxteth in Liverpool. o However, a different model would need to be considered in Lancaster as the City Council owned no land and unused properties were dotted around the district. o The Housing Standards Team could helping to identify suitable properties for renovation.

 Social Prescribing o The £10K earmarked for social prescribing digital solutions would not be used. o It was proposed that £5K would be redirected to a project being run by Lancaster District Food Poverty Alliance to deliver food to socially isolated, elderly people in Morecambe. o The remaining £5K would be handed back to Lancashire County Council.

6.0 Health Foundation/ Local Government Association Grant Programme: Shaping Places for Healthier Lives The grant programme focussed on the wider determinants of health, on addressing health inequalities and on improving individuals’ health and wellbeing.

The grant must be submitted by a Public Health Grant holding local authority (i.e. Cumbria County Council, Lancashire County Council). This was not made clear in the initial documentation.

The deadline for submitted an Expression of interest is 17 January 2020.

A group of key stakeholders was convened and it was eventually decided that a Cumbria-wide bid would be submitted.

Lancaster City Council – together with Barrow Borough Council and South

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Lakeland District Council – saw the Bay footprint as its focus for both economic regeneration and population health.

7.0 Social Prescribing  Social Prescribing Digital Solutions o Compass and MARS are used as social prescribing digital solutions in South Cumbria. There is no comparable system in place in North Lancashire. o Discussions are taking place about aligning the social prescribing digital solution in North Lancashire with the system that already exists in South Cumbria. o This will be a cost neutral solution which will be relatively easy to implement. o Compass will also be a tool for the Social Prescriber Link Workers to support and refer patients to relevant services. o Yak Patel and Linda Vernon have both seen a demonstration of Compass and are impressed. o Any problems can be resolved during implementation and it can be aligned with any solution implemented by the Healthier Lancashire and South Cumbria. o Lancashire Voluntary Partnership may need to be involved to ensure alignment with the Our Lancashire product. o There should not be any further delay in implementing a social prescribing digital solution in North Lancashire.

 Morecambe Bay Event o It was planned to hold an event to facilitate conversations around social prescribing. o There was a high level of resource in the system across different organisations (e.g. district councils fire and rescue service, Integrated Care Communities (ICCs), police, Primary Care Networks (PCNs)). o It was important that all groups understood each other’s roles and took steps to avoid duplication and work effectively together in their neighbourhoods. o A planning meeting, involving key stakeholders, would be held on 25 February 2020. o It was suggested that the potential impact of the social prescribing agenda of the voluntary sector should be discussed.

8.0 Climate Change Citizens Jury There had – to date – been one meeting of the Climate Change Citizens Jury Oversight Panel. This Panel would oversee the work of the Climate Change Citizens Jury.

The Climate Change Citizens Jury would be selected from the population of Lancaster District. Letters had be sent out to 2000 people representing the diversity of the district inviting them to consider putting themselves forward to be a member of the Climate Change Citizens Jury.

The aim of the Climate Change Citizens Jury was to discuss ways of

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tackling the Climate emergency and working towards the development of a local Green New Deal.

A Project Officer had just been appointed on a 12 month fixed-term contract and would take up the post from early February 2020.

Lancaster City Council had also set up a Climate Emergency Advisory Group.

9.0 Population Health Programme Plan Workshop The Population Health Team has been allocated a budget in the 2020/21 to support the population health agenda and to tackle health inequalities across Morecambe Bay.

A workshop was held at Salt Ayre Leisure Centre in Lancaster on 26 November 2019. It was well attended by a range of stakeholders and a clear list of priorities for population health in the district was developed.

The output from this workshop would be considered at the next meeting of the Partnership in February 2020.

10.0 Health Checks Work was about to be started to manage the way that established, undiagnosed conditions and disease were identified in the population across Morecambe Bay.

A standard health check was available to all members of the eligible population (i.e. those aged between 40 and 74 years old who have no diagnosed underlying conditions). This is usually 30-35% of population. The health check includes, amongst other things, blood pressure, cholesterol, HbA1c, weight and a conversation about lifestyles. This is commissioned by Cumbria County Council and Lancashire County Council.

The uptake of health checks in Lancashire is good. However, in North Lancashire, although high numbers of the eligible population were invited for a health check, the uptake was lower than the rest of the county.

There is evidence that stretched and understaffed GP practices – especially small practices – may struggle to meet their targets in relation to health checks. A more sustainable solution was required.

There was also a risk that simply increasing the uptake of health checks could increase health inequalities as self-motivated patients who were already in generally good health would be more likely to respond to the invitation. However, this would only be the case the self-motivated patients were taking up spaces that would otherwise be offered to members of the population from more deprived communities. It was also noted that external commissions with pharmacies and workplace providers meant that health checks were available to a wider segment of the community.

The challenges included developing a universal offer whilst targeting

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elements of the population living in deprivation and providing support to primary care staff to deliver health checks. External commissions could help to provide that support.

Work was already being done to make health checks more accessible on various estates (e.g. Rylands, Marsh) and in the farming community.

More activated patients could be encouraged to upload information about their health via the MyGP application to reduce the burden on primary care staff. .

11.0 British Heart Foundation Blood Pressure Testing This project is designed to opportunistically measure people’s blood pressure and test for Atrial Fibulation (AF) in pharmacies, at football clubs and at Leisure Centres.

The uptake in North Lancashire - and Morecambe Bay generally - is extremely low compared to other areas in the Lancashire and South Cumbria Integrated Care System (ICS).

The large number of inflations required to test AF might contribute to the low uptake as people may not be prepared to wait. There is some evidence that take up has improved when only three inflations were used solely to measure blood pressure.

There was a need to clearly understand the reasons for the low uptake, to learn lessons around programme design, co-ordination and engagement and to agree what action is needed to increase the number of people being tested.

It was suggested that testing could be undertaken in a town centre locations (i.e. in a vacant shop), at community hubs (e.g. at livestock auctions) or at major employers (e.g. EDF).

12.0 Behaviour Change – mapping the system & optimising populations It was recognised that support needed to be given to improve the health of patients waiting for elective surgery in order to ensure that they underwent surgery in an optimal state and that adverse outcomes, morbidity and mortality were reduced.

A mapping exercise was currently being undertaken to identify services which could support this group of patients – and the wider population – to quit smoking, lose weight and reduce their intake of drugs and alcohol.

13.0 Aligned engagement strategy with our communities There was a need to align engagement activity across the Bay in order to ensure the most productive outcomes and to avoid public fatigue and disillusionment.

There was a need to understand what was important to the population and to use this information to develop a Morecambe Bay Deal.

There was a need for different organisations to work together and

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facilitate joined up conversations with the public.

Community organisers had a key role in bringing communities together and empowering individuals and groups to improve health and wellbeing.

Different organisations would have different questions, different viewpoints and would have to meet specific performance indicators.

It would be important to develop a clear set of aims for any individual engagement and to develop a broader combined strategy for public engagement around health and wellbeing.

Communities can become frustrated by duplication and/or apparent lack of progress. All conversations needed to be honest and constraints and difficulties should be shared with the public.

Additional effort was needed to reach out to individuals or groups who do not engage in such conversations (e.g. people with learning disabilities, the Gypsy Romany Traveller (GRT) community, refugees and asylum seekers).

It was suggested that the Digital Engagement Officer at Lancashire Constabulary have some useful input into ongoing discussions about community engagement.

14.0 Any Other Business ImaginationLancaster at Lancaster University is looking to fund projects with a research element from the Beyond Imagination grant.

The next meeting is scheduled to be held on Wednesday 15th April 2020 in the Large Lecture Theatre at Moor Lane Mills, Moor Lane, Lancaster.

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