Agenda and draft minutes

Dorset Council - Joint Public Health Board
Thursday, 5th November, 2020 10.00 am

Venue: MS Teams with Outside Broadcasting

Contact: David Northover 224175  Email: david.northover@dorsetcouncil.gov.uk

Items
No. Item

52.

Election of Chairman

To elect a Chairman from amongst the BCP Council representatives

Minutes:

Resolved

That Councillor Nicola Greene be elected Chairman for the meeting.

53.

Appointment of Vice-Chairman

To appoint a Vice-Chairman for the meeting from amongst the Dorset Council representatives.

Minutes:

Resolved

That Councillor Laura Miller be appointed Vice-Chairman for the meeting

 

54.

Apologies

To receive any apologies for absence.

 

Minutes:

An apology for absence was received from Councillor Graham Carr-Jones.

 

55.

Declarations of Interest

To receive any declarations of interest.

Minutes:

No declarations of disclosable pecuniary interests were made at the meeting.

 

56.

Minutes pdf icon PDF 139 KB

To confirm the minutes of the meeting held on 21 July 2020.

Minutes:

Resolved

The minutes of the meeting held on 21 July 2020 were confirmed and

would be signed at the earliest opportunity.

 

The Director of Public Health took the opportunity to inform the Board of what

had been done by Public Health Dorset (PHD) - in partnership with other

heath bodies GP’s; Dorset Clinical Commissioning Group; the NHS,

emergency services; and Dorset and BCP Councils - to address and manage

the Coronavirus pandemic within Dorset over recent months.

 

The Board was given a presentation outlining the local outbreak

management plans, how they were being applied and managed and what was

being done in practice, along with other associated information pertaining to

the pandemic, to put what PHD was doing – and had done - in some context. A copy of the presentation is incorporated in these minutes at minute ???

 

The Board expressed its appreciation for what the whole PHD team had done in addressing the Covid-19 pandemic and commented that this was a credit to the team.  They commented that this demonstrated the importance of public health and the Dorset and its residents were benefitting from the robust response.  They hoped this positive response could be maintained and looked forward to receiving a further update at the February meeting.

 

A DIP in Covid infection rates has been welcomed by Dorset’s director of public health, Sam Crowe.

He told a joint public health board meeting on Thursday that rural Dorset’s seven-day figures were now just under 100 cases per 100,000 and the Bournemouth, Christchurch and Poole area, just under 200.

Both figures had previously been higher.

He said: “We were concerned because the figures had stepped up considerably during the past two to three weeks. It’s great to see it coming down.”

“It suggests we might not continue to see those rapid rises of two to three weeks ago which were extremely concerning."

But he warned that there was still a chance that local hospitals might be treating more Covid patients by November 9 than they had been at the previous peak in April.

He warned that unless local people stuck to lockdown rules the figures could rise again.

“Unless everyone gets on message it will continue to rise,” he said.

Mr Crowe said there was evidence of people ignoring self-isolation requirements, despite knowing what they should be doing and a concern that problems with getting local tests had led to some people not bothering and carrying on with their lives even though they might be infected.

He said the local rise in infection rates had coincided with the period when there were local difficulties in getting tested as resources were switched to the north of the country.

The told the joint public health committee that many of the recent reported cases were among younger people (16-29) although there had been evidence of a spread to over 65s, the group more likely to need medical help in hospital.

Household transmission remained the most significant exposure setting, followed by visiting friends and  ...  view the full minutes text for item 56.

57.

Public Participation pdf icon PDF 49 KB

To receive questions or statements on the business of the committee from town and parish councils and members of the public.

Minutes:

No statements and questions from Town and Parish Councils or public

statements or questions were received at the meeting.

58.

Terms of Reference pdf icon PDF 52 KB

To note the Terms of Reference of the Board.

Minutes:

The Board’s Terms of Reference were noted.

59.

Forward Plan pdf icon PDF 167 KB

To receive and note the Board’s current Forward Plan.

Minutes:

The Board’s Forward Plan was noted and, what was due to be considered

over the coming months, accepted.

60.

Future of Public Health Dorset - Partnership Agreement pdf icon PDF 119 KB

To consider a report by the Director for Public Health.

Additional documents:

Minutes:

The Board considered a report by the Director on the future arrangements for the Partnership Agreement between Dorset Council and BCP Council in light of unitary status of the two councils arising from local government reorganisation in April 2019.

 

Since 2013, Public Health Dorset had provided a range of public health

services, advice and expertise to local councils, under a shared service

arrangement. During local government re-organisation, the Joint Public Health Board undertook a review of the shared service model, and agreed to continue the arrangements under the two new unitary councils. In the past year, the terms of reference had been updated and agreed by the Board, to ensure a clearer separation between the work of the Joint Public Health Board, and respective councils' health and wellbeing work.

 

The shared service agreement was also reviewed by both councils in January

2020. Although there was a delay in finalising a new agreement due to

COVID-19, both councils were now in a position to agree a new shared

service agreement to support delivery of public health.

 

The renewed shared services agreement and finance agreement was now being presented for agreement to the Board. Renewal of the agreement would enable the continued functioning of the shared service, as well as providing more certainty over use of the Public Health Grant, both within the shared service, and partner councils.

 

It was also bring recommended that a report summarising the performance of the shared services be taken to the Board each year, as part of the

continued assurance around provision of public health services within each

council.

 

The Board was in agreement with what was being proposed, and the reasons for this, and agreed that the provisions of the Partnership Agreement should be endorsed on the basis of the Director’s report.

 

Resolved

1)That the renewal of the shared service agreement governing the

public health service across both Councils be accepted and agreed.

2)That the development of a financial annex each year that sets the

service budget requirements, and respective contributions from partner

councils be supported and endorsed.

 

Reason for Decision

To enable the continuation of the shared service for public health in the two councils, and have a clearer view of the financial requirements of the service, to support effective use of the public health grant.

61.

Finance Report pdf icon PDF 219 KB

To consider a joint report by the Chief Financial Officer and the Director for Public Health

Minutes:

The Board received an update on the use of each Council’s grant for public

health, including the budget for the shared service, Public Health Dorset, and

the other elements of grant used within each Council outside of the public

health shared service. The report described how the funding was being

applied and to what services and in what proportion.

 

The Spending Round 2019 covered a single year planning round. It seemed

unlikely that in the midst of a COVID pandemic there would be reductions to

the Public Health Grant, so planning for next year was therefore built on an

assumption that the Public Heath Grant would be the same as 20/21.

 

In recognition of the difficult and uncertain financial circumstances that

both local authorities faced due to the COVID response, discussion

continued in regard to any potential change in retained elements or return

of any underspend to ensure local authorities could continue to provide and

transform their prevention and public health interventions.

 

Whilst it was acknowledged that the continued interventions needed to address the issues associated with Covid-19 were unprecedented and represented a unique challenge both in financial and practical terms, the Board recognised that the available funding was being used as efficiently as it could be and appropriately prioritised to continue to optimise outcomes.

 

Resolved

That the content of the Finance report, and what it was designed to achieve,

be noted and acknowledged.

 

Reasons for Decision

The public health grant is ring-fenced and all spend against it must comply with the necessary grant conditions and be signed off by both the Chief Executive or Section 151 Officer and the Director of Public Health for each local authority.

 

The public health shared service delivers public health services across Dorset

Council (DC) and BCP Council. The service works closely with both Councils and partners to deliver the mandatory public health functions and services, and arrange of health and wellbeing initiatives. Each council also provides a range of other services with public health impact and retains a portion of the grant to support this in different ways.

62.

Clinical Services Performance Monitoring pdf icon PDF 90 KB

To consider a report by the Director for Public Health.

Additional documents:

Minutes:

The Board considered a report on clinical services performance monitoring, providing a high-level summary of performance for drugs and

alcohol and sexual health services, with supporting data in appendices.

 

The Board considered that the performance was appropriate and

acceptable given the challenges of service delivery during the pandemic. The Board appreciated what the services had achieved so far and expressed their expectation that this would be maintained  and enhances where practicable.

 

Resolved

That the performance in relation to drugs and alcohol, and sexual health be noted, accepted and endorsed.

 

Reason for Decision

Close monitoring of performance will ensure that clinical treatment services deliver what is expected of them and that our budget is used to best effect.

 

63.

Sexual Health - Mobilisation of new contract, integration progress and changes due to Covid-19 response pdf icon PDF 133 KB

To consider a report by the Director for Public Health.

 

Minutes:

The Board considered a report by the director on the Sexual Health Service and the mobilisation of the new contract, integration progress and changes due to Covid-19 response.

 

During 2020, Dorset Healthcare NHS Foundation Trust was successfully

awarded the contract to provide Sexual Health and HIV services, following

a collaborative joint procurement exercise undertaken between Public

Health Dorset and NHS England.

 

The new community-based pan Dorset service commenced on 1st October

2020. The new service had simplified fragmented delivery arrangements

and brought together a range of services to work together in an

integrated model. This new service model, developed over the past two

years, was more equitable, much more straightforward, efficient, effective and, over time had made the required cost savings in line with the national

savings made to the Public Health Grant.

 

This procurement presented an opportunity to improve service delivery,

providing the right level of service, by the most appropriate professional

(complex and routine care) at the right time and place. Designing a

responsive community-based clinical service, where people would be seen

efficiently for testing or treatment, but with an added focus on prevention,

education, self-care and innovative digital solutions to improve virtual

access and meet changing population need were critical in ensuring that need was met.

 

The new pan Dorset service had mobilised effectively and relatively

smoothly, and risks and challenges largely worked through, with additional

measures put in place because of COVID-19. In order to comply with

guidance, the service was working differently, including using digital service

offers, virtual clinics and community pick up points to keep essential

services running.

 

Services had stayed open for emergencies. As recovery began, the

service was working to risk assess and reopen the satellite clinics that closed

during lockdown. The recovery would be a phased approach due to capacity

and change in practice due to COVID-19.

 

The Board was pleased to see the progress being made and the success being seen with sexual health service improvements.  Officers affirmed that Public Health Dorset would remain committed to maintaining and developing these improvements going forward.

 

Resolved

1)That the successful joint procurement award to Dorset Healthcare NHS

Foundation Trust and subsequent service mobilisation progress be noted and endorsed.

2)That the additional COVID measures and phased recovery planning be noted and endorsed.

 

Reason for Decision

To update on progress and delivery of the Service during COVID-19.

64.

Update on the Children and Young People's Public Health Service (Year 1 implementation) pdf icon PDF 167 KB

To consider a report by the Director for Public Health.

 

Minutes:

The Board received a paper which provided a summary of year one progress, achievements and noted the local challenges faced by the Children and Young People’s Public Health Service (CYPPHS) during the COVID-19 pandemic.

 

Of note was the progress and achievements made in mobilisation prioritisation and restoration in the practical application of the service, what it entailed and the reasons for doing what was being done.

 

The stakeholder engagement process which helped to develop the service

specification and procurement process for this service, recognised the

important role this service would play within the local children and young

people’s partnership arrangements and specifically its contribution to

improving the outcomes for families, children and young people.

 

The specification outlined a number of ways in which the service would be

expected to demonstrate outcomes and an annual conversation was intended

to provide a regular partnership opportunity to review the evidence and

develop continuous improvement plans.

 

The Board was pleased to see what progress had been made, how this was being done and what achievements had been realised and considered this to be beneficial in meeting the needs of service users.

 

Resolved

1)That the progress and achievements in year 1 implementation of the

Children and Young People’s Service be noted and endorsed.

2)That the challenges and restrictions to elements of the service during the

COVID-19 pandemic and lessons learned to inform recovery planning be noted.

 

Reason for Decisions

To update on progress and delivery during the COVID-19 pandemic.

65.

Commissioning options for Drug and Alcohol services in BCP Council pdf icon PDF 172 KB

To consider a report by the Director for Public Health.

 

Minutes:

The Board considered a report on commissioning options for drug and alcohol services in BCP Council and the reasoning for why this was seen to be necessary. 

 

Since 2015, Public Health Dorset had commissioned most of the core

elements of service provision for BCP Council, other than the

Psychosocial and Young People/Families contracts for Bournemouth. This

included contracts with pharmacies for needle exchange and supervised

consumption.

 

There were several issues with the existing model of commissioning - outlined in the report - and the preferred model moving forward was for

all commissioning responsibility to move to a single set of commissioners.

 

Having considered the options in detail, the preferred option for BCP

Council was that they took the responsibility for commissioning drug and

alcohol services for BCP Council and BCP area with the aim of tendering

for new contract(s) for November 2021. Public Health colleagues would

continue to provide appropriate expertise to the commissioning cycle for

the BCP area.

 

The Board understood the reasoning for doing this and considered this to be a pragmatic and practical arrangement that would benefit the efficient and effective means of delivering this service.

 

There was a discussion about future reporting to the Joint Public Health Board and the Board asked for a further paper outlining a more detailed plan for governance of drug and alcohol services to be brought to the next meeting.    

 

Resolved

1)That the proposal for BCP Council commissioners to take on the core

responsibility for commissioning of drug and alcohol services for BCP

Council be noted and endorsed.

2)That the impact of this on future oversight of drug and alcohol service performance and commissioning decisions to the Board be noted and accepted.

 

Reason for Decisions

To resolve the current inherent challenges

with the drug and alcohol services commissioned for BCP Council and in

particular to achieve an equitable and sustainable service offer for all residents.

 

Action

Paper outlining a detailed proposal for future governance arrangements for drug and alcohol services to be brought to the next meeting.  

66.

Urgent items

To consider any items of business which the Chairman has had prior notification and considers to be urgent pursuant to section 100B (4) b) of the Local Government Act 1972. The reason for the urgency shall be recorded in the minutes.

 

Minutes:

The following items of business were considered by the Chairman as urgent pursuant to section 100B (4) b) of the Local Government Act 1972. The item was considered to be urgent.

67.

Public Health Dorset - Response to and action on Covid -19

Minutes:

 

 COVID-19 summary, BCP and Dorset Councils

 

As of 1st November – data taken from SW Alert tables

•BCP -197 cases per 100,000 population, testing positivity in pillar 2 is 7.4%

•Dorset –99.9cases per 100K pop -testing positivity in pillar 2 is 4.5% South West at 145 cases per 100k; England at 228 cases per 100K

•BCP Council 781cases in past 7 days (26 October to 1 November)

•Dorset Council 378 cases in past 7 days (26 October to 1 November)

•Age profile predominantly 16-29, but also infection rates have risen significantly in the over 65s in past week

•Household transmission is the single most important exposure setting, followed by visiting friends / family

•Also seeing outbreaks now in healthcare settings and workplaces –all being managed by joint work between public health, Council and NHS, but reflects increasing rates in community

•Currently 107 people in hospital with COVID in our local system –need to do all we can to prevent further infection rate rises, and admissions

•SW Region had fastest growing cases last week –reproduction rate R was 1.3 –1.6 

 

Public Health Dorset: summary of recent work

 

•Delivered local outbreak management plans x 2 in July

•Completed action cards and operating procedures for high risk settings

•Continue to build EpiCell–weekly reports to the system

•Health Protection Board meets weekly –longer term programme of work established under “Contain and Enable”

•Full out of hours rota established 24/7 with consultant cover all the time

•Incident mailbox supported by fully staffed duty desk for acute response

•Working with both Councils and ICS partners on our Contain strategy

 

*communications and engagement

*rapid testing capability

* localised contact tracing, including welfare calls to all positive cases

 

Testing

•Around 2,000 people are being tested per day in each Council through the different services, community, healthcare, and via the national portal (including care home testing)

•Roughly 7.5 per cent of people are testing positive in BCP Council –this is higher than 4 weeks ago, and higher than neighbouring Council areas like Dorset, where positivity is 4-5%

•Please use the national testing portal to book your test –this is only required if you have symptoms of coronavirus

•Additional testing capability for people unable to drive to Creekmoor at Lansdown and Talbot campuses

•New rapid tests that give a result in 15 minutes are likely to be rolled out soon to support local test and trace, with further details expected imminently

 

Outlook for the next month

•When BCP and DC Councils come out of lockdown, we are aiming to emerge under the Tier 1 restrictions –medium risk; cases have levelled off in the past week –need to do all we can to keep cases down so we can balance impact on businesses

•Hospital services remain open for people needing care for non-COVID conditions –and during lockdown we will endeavour to continue to provide services –support will continue particularly for the most vulnerable

•Local outbreak engagement board continues to meet regularly to review the position, and develop clear messaging  ...  view the full minutes text for item 67.