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North Yorkshire Health and Wellbeing Board
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This was a hybrid meeting. An * indicates those Members who attended remotely
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Board Members |
Constituent Organisation |
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Councillor Michael Harrison (Chair) |
Executive Member for Health and Adult Services |
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Councillor Alyson Baker |
Substitute for Councillor Simon Myers |
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Wendy Balmain |
Place Director for North Yorkshire, Humber and North Yorkshire Integrated Care System |
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Zoe Campbell*
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Managing Director, North Yorkshire, York and Selby, Tees, Esk and Wear Valleys NHS Foundation Trust |
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Stuart Carlton |
Corporate Director, Children and Young People’s Service |
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Councillor Caroline Dickinson |
Substitute for Councillor Janet Sanderson |
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Jonathan Dyson* |
Chief Fire Officer, North Yorkshire Fire and Rescue Service |
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Jonathan Coulter*
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Chief Executive, Harrogate and District NHS Foundation Trust |
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Ashley Green |
Chief Executive, Healthwatch North Yorkshire |
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Nic Harne* |
Corporate Director, Community Development, North Yorkshire Council |
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Nancy O’Neill, MBE* |
Chief Operating Officer, Bradford District and Craven Health and Care Partnership – part of West Yorkshire Integrated Care System |
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Louise Wallace |
Director of Public Health, North Yorkshire Council |
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Richard Webb |
Corporate Director of Health and Adult Services, North Yorkshire Council |
In Attendance:-
Patrick Duffy, Principal Democratic Services and Scrutiny Officer and Louise Hancock, Senior Democratic Services Officer
Copies of all documents considered are in the Minute Book
50. Welcome by Chair
The Chair welcomed everybody to the meeting. He stated that this was a hybrid meeting due to the fact that a formal decision would be required to approve the Better Care Fund Item. He had arranged for enough people to be present in person to enable the Board to be quorate and, thereby, to be able to take a decision, but he had not wanted to ask partner Members from across North Yorkshire to travel to and from Northallerton, for what is anticipated to be a relatively brief meeting.
51. Apologies for Absence
Apologies were received from:-
· Amanda Bloor, Chief Operating Officer, Humber and North Yorkshire Integrated Care System
· Councillor Simon Myers, Executive Member for Culture, Arts and Housing
· Mike Padgham, Chair, Independent Care Group (Care Providers Representative)
· Jill Quinn, Chief Executive, Dementia Forward (Voluntary and Community Sector Representative)
· Councillor Janet Sanderson, Executive Member for Children and Families
· Sally Tyrer, Chair, Yorkshire Local Medical Committee (Primary Care Representative)
52. Minutes of the meeting held on 29th November 2023
Resolved –
That the Minutes of the meeting held on 29th November 2023 be approved, subject to Bridget Lentell’s title being amended to General Manager.
53. Declarations of Interest
There were no declarations of interest.
54. Public Participation
Patrick Duffy, Principal Democratic Services Scrutiny Officer, confirmed that two public questions had been received from Mr. David McAsey and Mr. Roger Tuckett. They would be taken in the order that they had been received.
Mr. David McAsey
Mr. McAsey made the following statement:-
Mr Chairman and members of the Health and Wellbeing Board. Thank you for allowing me to speak.
If your adult child had a disability, imagine what it would be like if every time you tried to get help and support, organisations such as Social Services, the NHS, Housing, Employment Support etc. failed to provide the services that legislation says your adult child is entitled to receive. The hundreds of families in North Yorkshire who are caring for autistic adults don’t need to try and imagine it. What I have described is their lived experience of services.
In April 2014, I stood before this Board and congratulated them on producing their first Autism Strategy. I looked forward to that strategy being the start of meaningful improvements in support for autistic people and their families. But here we are 10 years later, consulting on the 3rd Autism Strategy that acknowledges the same old problems and says the same old things with no realistic prospect of it taking us any further forward.
My autistic daughter is 32. She lives at home with me and my wife. Just like 80% of autistic people she does not have a learning disability but is significantly disabled by her autism and by the failure of services to respond appropriately to her needs. Despite getting 8 good GCSEs she has, for the last 12 years, not been in education, employment or training because of an absence of appropriate services.
I want to share with you an extract from an email received just last week from my daughter’s social worker. She wrote: ‘I am bit stuck on what else she [my daughter] may benefit from as we unfortunately do not have Autism specific services in our area. I have asked more experienced members [of staff] that have worked with Learning disability and Autism and have a vast array of knowledge and I have been advised there isn’t anything’.
The absence of appropriate support means that my daughter’s life chances are being eroded and the burden of caring for my daughter increasingly falls to me and my wife. We are not alone. There are hundreds, if not thousands, of families like ours in North Yorkshire.
This situation arises because for the last 10 years there has been no proper understanding or appropriate response to meeting the needs of the estimated 15,000 autistic people who live in North Yorkshire. Within the organisations represented at this Board, there continues to be an absence of understanding, visible leadership and accountability, to drive forward the required changes, reasonable adjustments and prioritisation of services for autistic people.
The pace of change has been and continues to be far too slow! After 10 years that cannot be allowed to continue. Enough is enough!
In April 2014 I asked the Health and Wellbeing Board if North Yorkshire Council would appoint a Councillor to be an Autism Champion. The answer then was No.
In the last 10 years there has been no meaningful progress in meeting the needs of autistic people because of, amongst other things, a failure to provide visible leadership on autism. Therefore, will North Yorkshire Council designate a Councillor to be an Autism Champion so that autistic people and their families are properly understood and services are designed to meet their needs?
Richard Webb, Corporate Director for Health and Adult Services, responded. Among the points he made were:-
- The Directorate has had examples of where Direct Payments have worked well, but the challenge of putting in place the right service is acknowledged.
- We are seeing a significant number of people who have received a diagnosis.
- There is further work to be done on housing for people with autism of working age and the Directorate is looking at what other services it can commission, but there is no immediate solution to some of the issues raised.
- The internet is being used in Schools to provide support.
- We are very conscious of the issue and know that there is more work to do.
In response to the request from Mr. McAsey for the Council to designate a Councillor as an Autism Champion, the Chair advised that he did not agree with this. The Council has several Champions and he is not convinced of the benefit of having a Champion.
The Chair also responded to the comments by Mr. McAsey that there has been no meaningful progress and that there has been a failure to provide visible leadership. He stated that, with a lot of professionals represented on this Board, he could not let the comments go unchallenged and, whilst, he would not wish to downplay the challenge, there has not been a failure of leadership.
Mr. McAsey further commented that, overwhelmingly, the Local Authority and the NHS see autism as a learning disability issue. Richard Webb responded that raising awareness is key and that is why staff have undertaken accreditation training in autism. Initiatives are in place to support staff in this area, including the establishment of a Neuro-Diversity Network. The Directorate is striving to be more autism aware.
In response to the offer of a short supplementary question, Mr. McAsey asked if Members of the Board could indicate by a show of hands whether or not they had completed the Oliver McGowan Training in Learning Disability and Autism. Richard Webb stated that training for frontline staff had been prioritised but there will be a session on this for Members of the Board at a forthcoming meeting.
Wendy Balmain, Place Director for North Yorkshire, with the Humber and North Yorkshire Integrated Care Board, mentioned that she has personal experience of autism within her family and so understood the challenges. The afore-mentioned training is mandatory in the NHS. There are no easy answers, in response to the exponential growth in awareness. The Integrated Care Board is examining what it can do to support people and their families. There is a recognition that demand and capacity are not at the right level.
The Chair said that he would not be asking Board Members to answer the question as to whether or not they had undertaken the Oliver McGowan Training as it was not appropriate. The Chair intervened to bring the item to a close, pointing out that he had exercised considerable discretion in allowing a certain amount of subsequent discussion.
Mr. Roger Tuckett
Mr. Tuckett made the following statement:-
Relevant 2015 Statutory Guidance clearly states that Health and Wellbeing Boards (HWBs) have a crucial role in overseeing implementation of their Adult Autism Strategies. The current NY Partnerships website states that production of Joint Strategic Needs Assessments (JSNAs) is the responsibility of the NY HWB . The recent (Oct 2022) guidance on HWBs following legislation establishing the Integrated Care Boards confirms that these various obligations continue.
While there are more recent JSNAs in North Yorkshire for Autistic Children and Young People (2020/21), and generally for Learning Disabilities (2021), the only JSNA applicable to Autistic Adults without Learning Disabilities (at least 80% of which do not) is a very basic summary dating from 2013.
In her response to my question to the NYC Health Scrutiny Committee last week, a senior NYC public health official stated there were big gaps in available data but that no updated JSNA would be produced for Autistic Adults as matters were developing so quickly, and such a JNSA would be out of date before it was published. Instead a rudimentary Autism Data Pack has been produced to support the Autism Strategy although this has not been published, and it is excluded from the current consultation.
This Data Pack refers to diagnostic prevalence rates now being 2% or higher rather than roughly 1%; that over 5% of all cared-for adults are now Autistic; diagnosis waiting times of several years massively exceed NICE guidelines; there are major physical and mental health inequalities for Autistic adults, including greatly increased suicidality and significantly decreased life expectancy; that nearly 5% of PIP recipients have Autism recorded at their main condition with this proportion growing rapidly; that considerable underdiagnosis is still occurring and the number of people affected by Autism is likely far higher than is reflected in the data.
Question: Are the Board and its Members content that due process is being followed consistent with statutory and national guidance in the decision not to develop a new JSNA for such Autistic Adults prior to adopting NYC’s new updated All-Ages Autism Strategy, and will it be directly overseeing this.
Louise Wallace, Director of Public Health, advised Members that this matter had also been discussed at the recent meeting of the Scrutiny of Health Committee.
She added that there is a wealth of data available on the Council’s Website but it is clear that some of the data could be more robust. Through the consultation on the draft Autism Strategy, efforts are being made to simplify the process. Officers are keen to see the feedback from the consultation.
In response to Mr. Tuckett’s specific questions, the Chair stated that the Board is content that due process is being followed in the decision not to develop a new JSNA for Autistic Adults prior to adopting North Yorkshire Council’s new updated All-Ages Autism Strategy, and it will be directly overseeing this.
Mr. Tuckett commented that the response received was welcome and useful but, perhaps, a Joint Strategic Needs Assessment would be preferable to the collection of data being undertaken in an adhoc manner. He suggested that, with regard to follow up work, a Leadership Summit would be beneficial.
The Chair queried whose Summit it would be?
Richard Webb said that the suggestion would be noted as part of the consultation and this will be fed back into the Multi -Agency Group that oversees the consultation (which includes autistic people).
55. Approval of the Better Care Fund 2023/2025 and the Quarterly Returns for Quarters 2 and 3 2023/2024
Considered –
A report and presentation by Louise Wallace, Director of Public Health, which sought approval to:-
- the Better Care Fund Submission for 2023-2025; and
- the Quarterly Returns for the second and third quarters of 2023/2024
The report and presentation, are available to view here.
Louise Wallace stated that, as her presentation had been circulated with the Agenda for the meeting, she did not intend to go through it. The submission had been agreed with partners and fully costed. This was primarily a matter of process and she was seeking formal sign-off from the Board
Wendy Balmain stressed the importance of ensuring that the investment is correct and that it links into other priorities, including those of the Integrated Care Boards.
Ashley Green, Chief Executive Officer of Healthwatch North Yorkshire, said that he was pleased to see that the areas of priority and work outlined in the Better Care Fund proposal mirrored in many ways the priorities included in the current draft Joint Health and Wellbeing Strategy.
Ashley also asked if the Board had to report on progress against the work it had outlined in its Better Care Fund proposals. Louise Wallace confirmed this is the case, via quarterly reports.
He also felt it was important that this work and the funding included ‘public involvement’ to support this work. The Chair acknowledged that it would.
Resolved –
a) That the Better Care Fund Plan for 2023-2025 be approved; and
b) That the Quarterly Returns for Quarters 2 and Quarters 3, in respect of 2023/2024, be approved.
56 Rolling Work Programme – 2023/2024
Considered –
A report by Patrick Duffy, Principal Democratic Services Scrutiny Officer, which sought comments on - and approval to - the draft Work Programme for 2024/2025.
He advised that, as this was the draft Work Programme for the forthcoming year, he had taken the opportunity to outline the rationale for including Items in the draft, namely:-
a) Statutory documents that need to be considered
Examples include the Joint Local Health and Wellbeing Strategy and the Better Care Fund, which have to be signed off by the Board, according to its Terms of Reference.
b) Previous decisions of the Board
For example, last year the Board considered an update on Heath Protection and resolved that an update be provided every year.
c) Updates on Key documents likely to have an impact on the health and wellbeing of people in North Yorkshire
These could include the Carers Strategy and the Council’s Local Plan.
d) Convention
It has become the accepted practice that key Annual Reports are considered by the Board. For instance, those of the Director of Public Health and the Safeguarding Adults Board.
He also stressed that the document evolves, according to changed circumstances. The document is considered at each meeting but Members are welcome to propose Items for inclusion at any stage.
NOTED.
57. Any other business which, in the opinion of the Chair, should be considered as a matter of urgency
Membership
Nancy O’Neil, MBE, confirmed that she will replace Ali Jan Haider on this Health and Wellbeing Board, as the representative of Bradford Integrated Care Board.
The Chair advised Members that he and the Vice-Chair had written to the former Emergency Services representative, Lisa Winward, and the former NHS England representative, Shaun Jones, to thank them for their contribution.
Jonathan Dyson, Chief Fire Officer for the North Yorkshire Fire and Rescue Service, informed Members that he will liaise with the new Chief Constable and the Chief Ambulance Officer to agree who will represent the Emergency Services. He will advise who this is.
Patrick Duffy
The Chair advised that this would be the last meeting of the Board attended by Patrick Duffy before his retirement. The Chair thanked Patrick for the work he had done in relation to the Board and the support that he had provided to him.
58. Date of next meeting – Wednesday 22nd May 2024 at 1.00 p.m.
The meeting concluded at 11:10 p.m.
PD