To receive a presentation and supporting documents from the Interim Director of Public Health.

The Interim Director of Public Health had taken the information from the last meeting and turned it into a report which had been circulated as part of the agenda. From this work it had become clear that Members felt the Board was good at stating what the issues were within Trafford but it was not good at stating what was or could be done within Trafford to improve those outcomes. The inequality in healthy life expectancy across the borough was still a major issue. The UK had seen a drop in life expectancy in 2015 which was the greatest drop on record since 1840 and was being seen amongst the country’s oldest populations.

The Interim Director then showed the Board the Health and Wellbeing Board plan on a page which gave an overview of the aims of the Board and its structure going forward. The number of priorities for the Board had increased from 5 to 7 with the additional 2 representing a focus upon the wider determinants of Health. The Interim Director spoke of the need for the Board to have strategies laid out so they can identify outcomes and milestones along the way to achieving long term outcomes. The Interim Director asked the Board to consider changing the structure of the partnership morning in October so that the first hour would cover the Boards business followed by a meeting with the other Boards to discuss how they could get people moving.

Councillor Blackburn asked what was being done to address the issue of smoking within schools. The Interim Director responded that there was a large amount of information available at schools and it was covered within PSHE classes. The Board were assured that Trafford had a low level of teenage smokers. Councillor Blackburn expressed her concern about vaping amongst young people and asked whether the figures included those using vapes.  The Interim Director agreed that vaping among young people was a concern but it was more highly regulated in the UK than in US. The smaller devices were not being made available in the UK and the data showed that the majority of the people using vapes were ex-smokers. The Interim Corporate Director of Children’s Services added that unhealthy weight was a bigger issue among children in Trafford at the moment.

Councillor Slater expressed her support of the proposals, especially the suggestion to bring all of the Partnership Boards together for a session on how to tackle inactivity. The Trafford Integrated Network Director was surprised by the data which showed that things were getting worse in the area and they stated that it showed how there needed to be a change in the way that services were delivered. They also noted that one of the new priorities was named climate change and asked whether it should be changed to climate emergency. The Board Members agreed that the name of the priority should be changed to Climate Emergency in keeping with the Council’s declaration.

The Chair of the Trafford Safeguarding Board raised the importance of making a change in approach and moving towards prevention. The Interim Director added that Trafford needed to move to primary prevention through place based working and to look at how changing people’s environment could have a big impact on their behaviours. The Medical Director for Greater Manchester Mental Health Foundation Trust (GMMH) noted the impact that poverty was having upon the population in general, the difficulties that people were facing, and the effect it had upon their mental health. The Interim Director furthered this point by adding that it had been shown that peoples attitude towards their health dropped the greater poverty they were in.  The Director of All Age Commissioning had attended a session delivered by Marmot upon the wider determinants of health and felt that it would be good for the Board to have a session on this. She added that the structure of the Board and the way that it represented large public organisations from across the borough meant that if it could align with grass roots organisations and community groups it would have a great impact upon Trafford and its residents.

The Chair spoke about how the Board needed to hold people responsible at the Board by having an actions log to capture actions and make sure that they are being done.

The Chair of the Trafford Safeguarding Board spoke about how the board did not see the daily lived experience of the people who they were working to support. These people often did not see things in the same way professionals did and in order to help them professionals needed to think about what moves and drives people as individuals and not presume that they know how these people feel and what they need to know. The Medical Director for Trafford CCG spoke about the importance of working within neighbourhoods and the place based model of working. As each area had its own issues and the residents had their own concerns and priorities that had to be taken into account in order to deliver the right support in the right way.

Councillor Blackburn mentioned the wider impact that those suffering from mental health issues had on those who lived with, worked with, and supported them. The Interim Director stated that this was why the Board’s prioritise included decreasing the impacts of mental health rather than just decreasing mental health.

The Board were then shown a diagram of the place based approach in Trafford and the Interim director linked this into the Health and Social care Long Term Plan.  Board Members were advised that if Trafford kept going forward in the way that they had been then they would continue to get the same results of increased inequality and worse outcomes. Instead Trafford needed to look at strengthening the system so that people could access the support they needed when they needed it. To have successful service improvement required everyone to take on the responsibility to change how services were provided to make them fit for purpose for residents.

Councillor Brophy spoke about the importance of education and how the right education for people with type 2 diabetes would be good and quick win for Trafford. The Chair responded that the CCG had expanded the education programme in Trafford so short term and long term education programmes were in place.

The Trafford Integrated Network Director stated that Trafford had been trying to link service strategies to the work on the ground. The switch of provider to Manchester Foundation Trust (MFT) from Pennine Foundation Trust represented an opportunity for Trafford, as did the development of GP networks by Trafford CCG. Trafford Council had broken down the area into four areas (the butterfly model) and another big change was going to be the implementation of the CCGs neighbourhood plans, which were based upon local data form each one of the newly defined neighbourhoods. This meant that each team would be focused upon the issues and needs of that population e.g. school readiness in the North of the Borough. This approach would also build upon the community asset work within each area by utilising those assets to deliver services. It was an evidence based approach where pieces of work were trialled on a small scale and then upscaled quickly if found to work.

The CCG were also changing their ways of working which represented an opportunity for the Board to be involved in the development of these new approaches, to embed new ways of working, and deliver real change. A number of staff events had been held by both the Council and the CCG and they had shown that staff members were keen to change and develop. Out of the five new GP networks only the South Network had not linked into this work but there were plans to engage with them soon.

Councillor Blackburn added that it was important that registered Social Landlords were involved in the work as they had a large impact upon the lives of people who lived in their properties, especially those who required adaptations in their home. The Director of all age commissioning responded that adaptations had been moved to operational social care and Commissioning had the responsibility around the Disabled Facilities Grants. The Council were looking at changing this responsibility so that social landlords could take on some of the work. Some of the resources had already been relocated to the one stop resource centre which had led to a reduction in waiting times. Another piece of work was being conducted to look at the accessibility of buildings and homes for older people in the area.

Councillor Brophy added that ward Councillors should have a role within the neighbourhood model as they knock on doors and represent the people within their community. The Trafford Integrated Network Director stated that they were looking at the neighbourhood engagement and have noted that ward councillors have a role to play. Consideration was also being taken as to how the voice of the child could be increased within the programme. Councillor Brophy reiterated that she felt that Councillors were not being engaged with enough. The Trafford Integrated Network Director replied that Ward Councillors were part of the programme and that they would be involved in ensuring that the language used by services was appropriate for the public. The Director of All Age Commissioning added that work was ongoing to get Ward Councillors and GPs to meet and network together as there was a lot that they could gain from each other.

Superintendent Hemingway also mentioned the work that Trafford was doing to create a Board in each area which would be chaired by a professional linked to the services in that area. The Interim Director emphasised the importance of linking all the pieces of work together to make sure that a consistent approach was taken and ensuring that the strides a person made within specialised services were not lost when the individual went back into the community.

The Board were told that the Council’s Corporate Plan included a dashboard which displayed public health information for Trafford and contained pages on the Joint Strategic Needs Assessment (JSNA). The data was displayed in a way which made it easy to digest and the plan was that this would developed further so that breakdowns would be available by neighbourhoods, GP Networks, and by start well, live well, and age well so that people would be able to access the areas of information that they were interested in.  The Interim Director then told the board about the work Public Health would be undertaking during the second half of 2019. The work included; running briefings on knife crime and utilising Tableau software to display data in new and more interesting/interactive ways.

The Chair of the Trafford Safeguarding Board noted that schools had been mentioned a number of times during the meeting which showed how everyone recognised the role they played in the lives of children and young people. However, she was unaware of how the Board and the work within Health and Social Care was being linked into schools and vice versa. The Interim Director responded that the start well Board had developed some networks with schools and that the Interim Director of Education Standards, Quality and Performance was doing some excellent work on building on those links.

The Interim Corporate Director of Children’s Services was encouraged that the Board was looking to work alongside schools and that they realised the importance of the role schools played. The Councils Ofsted Improvement Board had head teacher representation which was proving to be invaluable in Trafford’s efforts to improve services for Children and young people in the area. Councillor Blackburn added that Trafford should look to broaden their communications to reach out to governors in schools rather than just teachers and that the Council should see them as an additional resource.  The Chair of the Trafford Safeguarding Board stated that the Council and CCG should look at working with schools in the coproduction of services and take advantage of the insights that they had into children and young people’s lives. The Medical Director for Trafford CCG informed the Board that there had been a number of GPs who had developed links with their local schools and that this was something that the CCG would look to spread across the neighbourhood model.

RESOLVED:

1)    That the report be noted.

2)    That the Board support changing the structure of the Board meeting in October to have a partnership focus upon tackling inactivity in Trafford.

3)    That a session on Marmot’s wider determinants of Health be held for Board Members.

4)    That an action log be created for the Board.