Venue: County Hall, Matlock, DE4 3AG
Contact: Juliette Normington
RESOLVED that the non-exempt minutes of the meeting of the Cabinet Member for Health and Communities held on 4 February 2021 be confirmed as a correct record.
The Cabinet Member was given an update on the progress of the testing programme which commenced in Derbyshire on 21 December 2020, asked to note the change in approach due to new Government guidance and agree that Director of Public Health and the Director of Legal Services could negotiate terms of and enter into all documentation required to roll out the programme throughout Derbyshire.
Community testing in December focussed activity on defined geographies and populations where there was a higher case rate. The Government guidance at the time was for sites to operate for six weeks before transferring to other locations. Shortly after the January lockdown announcement, the Government re-focused the testing programme with a focus on individuals who could not work from home throughout the lockdown period. Derbyshire was asked to submit a revised proposal and realigned communications activity, messaging and planning to focus on promoting attendance at testing centres. A summary of the number of tests completed to date are summarised in Appendix 1.
The report detailed Derbyshire’s testing centres, providing a good spread of locations that people were able to access 7am-7pm, 7 days a week, plus mobile testing sites were provided to target more isolated communities, or workplaces experiencing an outbreak.
Government had agreed a scheme for businesses with 50 or more employees to sign up to take part in a testing programme and local authorities had been asked to support such businesses and was developing a training programme to support the delivery of this. The testing programme would be formally evaluated by Nottingham University and the Public Health team to look at the impact of the testing programme on communities in Derbyshire and ensure that any lessons learnt are identified as the programme develops. The programme was supported by funding of £14 per head for each test completed, a combination of in-kind support and cash allocated to the Council by the Government.
RESOLVED - that the Cabinet Member (1) note the change in approach due to new Government guidance; and
(2) agree that Director of Public Health and the Director of Legal Services can negotiate terms of and enter into all documentation required to roll out the programme throughout Derbyshire.
The Cabinet Member was given an update on organisations supported through the Public Health COVID-19 Emergency Fund.
The on-going response to the COVID-19 pandemic had seen many organisations across Derbyshire working to ensure the basic needs of the most vulnerable residents were met. It had become apparent that a number of community and voluntary sector organisations had insufficient resources to maintain their current level of response and supporting the clinically extremely vulnerable, social isolation and requirement for activities to comply with social distancing guidance had compelled many organisations to quickly adapt their service delivery model to operate within the guidance, often requiring additional resources.
Funding of up to a maximum value of £2,000 was available for constituted groups and £250 for non-constituted groups. As the Public Health COVID-19 Emergency Fund was funded from the Public Health Grant, all applications needed to be linked to the current Public Health work programme to allow the Emergency Fund to run concurrently with other corporate grant schemes, whilst retaining a clear focus on improving public health outcomes.
This was the third quarterly update covering organisations who have received funding from 22 December 2020 to 22 February 2021. Additional applications that had been reviewed and approved for funding, were detailed in the report. The overall value of the Emergency Fund was £0.200m and to date £98,973.52
had been awarded to Derbyshire organisations.
RESOLVED - that the Cabinet Member (1) note the allocation of the Public Health COVID-19 Emergency Fund to date;
(2) continue to delegate authority to the Director of Public Health to
approve awards of no more than £2,000 to individual organisations; and
(3) receive details of further recipient organisations on a quarterly basis.
The Cabinet Member was given an update on the Covid-19 Outbreak Management Fund funding allocations from 30 November 2020 to 20 February 2021 and approval was sought for the following use of the fund:
a. £0.150m paid to care home providers in Derbyshire on a per registered bed basis to fund wellbeing activities whilst visiting restrictions remain in place;
b. £210,218 to a range of voluntary sector organisations to deliver the Community Champions scheme, noting the full breakdown of allocations as outlined in the financial considerations section;
c. £26,000 to the University of Nottingham for the evaluation of the asymptomatic COVID-19 community testing programme in Derbyshire;
d. £0.279m to district and borough councils to fund Environmental Health teams to further support implementation of Derbyshire’s COVID Outbreak Management Plan; and
e. £8,617 to Derby City Council to recruit an Associate Director of Inequalities (COVID19) to work across Derby City and Derbyshire County. for itemised large payments from the fund.
Additional funding from Central Government had been received to support the on-going response to the COVID-19 pandemic as part of the Contain Outbreak Management Fund, in addition to funding received by the Authority in early 2020. The NHS Test and Trace service ensured individuals who developed symptoms could access testing with high-risk contacts being identified and advised to self-isolate. Public Health Authorities were central to this programme and had evolved a function within the programme of work as a Local Tracing Partnership.
As part of the Contain Framework, had received a funding allocation equivalent to £8 per head to support proactive containment and intervention measures. Derbyshire’s initial allocation was £6.500m, with further allocations being received due to on-going lockdown and tier restrictions and allowed the development of new, and the extension of existing nonpharmaceutical interventions to manage and mitigate the impact of the pandemic across Derbyshire. This would include children and families, older people and individuals at higher risk due to their health status.
Delegated authority had been given to the Director of Public Health and Cabinet Member for Health and Communities to develop an implementation plan to coordinate the delivery of the different workstreams and, where appropriate, additional approvals would be sought. This was the first of these update reports which gave a thorough and detailed summary of the activity.
RESOLVED - that the Cabinet Member (1) note the update to the Cabinet Member for Health and Communities on the COVID-19 Outbreak Management Fund funding allocations from 30 November 2020 to 18 January 2021; and
(2) approve the following funding allocations: a. £0.150m paid to care home providers in Derbyshire on a per registered bed basis to fund wellbeing activities whilst visiting restrictions remain in place; b. £210,218 to a range of voluntary sector organisations to deliver the Community Champions scheme, noting the full break down of allocations as outlined in the financial considerations section; c. £26,000 to the University of Nottingham for the evaluation of the asymptomatic COVID-19 community testing programme in Derbyshire; d. £0.279 to district and borough ... view the full minutes text for item 16/21
Approval was sought from the Cabinet Member for the allocation of grant funding to Derbyshire Citizens Advice Services for delivery of advisory services in foodbanks, at a value of £33,600 for a one-year period.
Derbyshire Citizens Advice services had been working in partnership with Feeding Britain and Rural Action Derbyshire to deliver a project across Derbyshire to provide good quality, impartial, free and confidential advice and information to people accessing local foodbanks. The aim was to ensure that people in food crisis had immediate access to quality advice to tackle the issues that made them vulnerable to hunger and enable appropriate support to engender independence and mitigate continued risk of reliance on the foodbank.
Funding for the project had ended but the partnership recognised the value in the project and wished to continue the service until longer term sustainable funding was sourced. Investment in timely advisory services was more cost effective than allowing an individual’s financial, physical and mental health to decline to the point that they required more expensive services in the future. Sessions embedded in food bank settings supported those most in crisis and often experiencing emergency situations. Additionally, individuals would feel more able to cope with their situation and would have a greater awareness of where to find early help should it be needed in the future.
A 12-month extension was sought to continue the offer in a number of settings spread across Derbyshire. Citizen’s Advice would work in partnership with Feeding Derbyshire and Rural Action Derbyshire to identify areas of highest need, mobilising and moving resources accordingly. The grant would cover project costs and adviser salaries and would be monitored by the Public Health team. Regular monitoring reports would provide number of clients accessing the advice, number of issues, income gained and case stories demonstrating impact.
Work was on-going with Rural Action Derbyshire via the Feeding Derbyshire/Feeding Britain project to secure sustainable longer-term funding. It was anticipated that this would be achieved and enable the project to continue beyond the 12-month period. The report went on to give a breakdown of how the grant would be awarded between the four Citizens Advice organisations in Derbyshire.
RESOLVED - that the Cabinet Member approve the allocation of £33,600 grant funding to Derbyshire Citizens Advice, to enable delivery of an advisory service in foodbank project, over a one year period from date of approval.
Approval was sought from the Cabinet Member for the allocation of grant funding to Rural Action Derbyshire to manage and lead the work of the Feeding Derbyshire Alliance and the Financial Action and Advice Derbyshire Partnership and their associated work programmes to a value of £50,000 per annum for a two year period from April 2021 to March 2023.
Public Health’s involvement in finding sustainable solutions to alleviate food poverty in Derbyshire was centred around the work of the Feeding Derbyshire alliance. This had been operational since September 2015 and was one of the 12 official pilots of the Feeding Britain strategy. Rural Action Derbyshire were commissioned by Public Health to co-ordinate the Feeding Derbyshire programme and supported the work of foodbanks and community pantries, community cafes, community kitchens, school holiday clubs, and breakfast and after-school clubs across Derbyshire, as well as being responsible for working strategically to alleviate food poverty. Placement of the co-ordinating function of this work allowed additional funding to be accessed not available to the Council.
Feeding Derbyshire sought to help those struggling with low incomes, debt, poor access to affordable, nutritious food and reduced the negative impact of hunger by working to ensure projects were inclusive and reached the most vulnerable. This gave families and individuals the confidence and capacity to be self-reliant and be able to meet their own and their children’s needs. Rural Action Derbyshire co-ordinated a network of 34 foodbanks operating across 41 locations.
In response to Covid-19, Rural Action Derbyshire also set-up a batch cook-delivery scheme involving 12 projects providing ready meals. This scheme was providing a much-needed service to vulnerable people whilst they were shielding or self -isolating. By the end of October, the Batch-Cook Scheme Projects had produced and distributed over 55,000 meals. During the first two months of the Spring Lockdown, Derbyshire food projects doubled the amount of food provided to local people. The Feeding Derbyshire Network of Food Banks and Social Eating Projects were currently supporting more than 3,000 of the most vulnerable people in the county.
As part of their Feeding Derbyshire coordination role, Rural Action Derbyshire also lead liaison with Fareshare East Midlands to ensure that food supply met demand from community programmes in Derbyshire and saw the food weight they supply to Derbyshire projects increase from an average of 41,000kgs per month to over 81,000kgs in April and May 2020. Financial Action and Advice Derbyshire (FAAD) was a partnership of over 50 organisations from the Public, Voluntary and Community sectors and was established in 2013 and hosted by Rural Action Derbyshire, with funding provided by Derbyshire County Council.
There was significant crossover of two agenda areas, so funding one organisation to oversee both partnership agendas offered significant opportunity to align and link work and offered the best long-term opportunity to make a meaningful difference to alleviating food poverty across Derbyshire and improve the health and wellbeing of the local population.
RESOLVED - that the Cabinet Member approve the allocation of £50,000 per ... view the full minutes text for item 18/21
The Cabinet Member was given an update on the allocations of the Coronavirus (Covid-19): Local Authority Emergency Assistance Grant for Food and Essential Supplies. Approval was also sought to enable allocation of the final round of grant funding to external organisations and that further contingency identified as a result of underspend on projects was split equally between the projects outlined within the report.
Derbyshire County Council received £0.808m in the form of a Local Authority
Assistance Grant for Food and Essential Supplies, provided by the Department for Environment, Food and Rural Affairs (DEFRA) to support people who were struggling to afford essentials due to the impact of Covid-19. Local authorities had the discretion to identify and support those most in need and had been liaising with key partnership groups to develop ideas and seek assurance that the grant was meeting local needs.
Previous reports to the cabinet member set out the background in detail and allocated the bulk of the monies with the ‘risks’ section stating: “The impact of Covid-19 on our vulnerable communities is constantly changing, making it hard to predict future needs and pressure points. To mitigate against this, the report recommends that a level of contingency funding is set aside in the budget that can be allocated at a later date to meet any emerging needs that haven’t already been considered in the recommendations, or to strengthen ones that require more funding than anticipated’.
The report proposed expending the remaining contingency budget to meet the conditions of the grant by allocating the fourth and final round of money by 31 March 2021, which, due to Derbyshire Discretionary Fund and the ‘Back to Learning Grants’ drawing down less money than originally budgeted, the remaining contingency pot stood at £0.180m. The report outlined in further detail the extent of the work of a selection of projects previously approved and the approach set out in the original report of 4 September 2020 recommending contingency funding set aside be allocated at a later date to meet any emerging needs.
RESOLVED - that the Cabinet Member (1) note the information contained in this report relating to the Local Authority Emergency Assistance Grant for Food and Essential Supplies;
(2) approve the recommendations regarding the final allocation of grant
funding to external organisations as stated; and
(3) approve that any further contingency identified as a result of underspend
on projects is split equally between the projects outlined in this report.
Approval was sought from the Cabinet Member for the allocation of grant funding to Arts Derbyshire to employ an Arts, Health and Wellbeing Co-ordinator for a five-year period, at a value of £12,000 per annum, from April 2021 to March 2026.
The Arts and Health programme’s aim was to improve health and wellbeing through arts and creativity across the county and especially for those most in need. Arts Derbyshire had been established as a charitable organisation, to work with artists, service providers and the public to provide strategic direction for the arts in Derbyshire and enabling collaborative working for arts development. The Arts and Health Coordinator role had a well-established post-holder in place and had taken proactive steps to improve links between the Arts and Health programme and the Public Health Department and engaged with health service colleagues.
The Programme provided creative interventions through a range of activities, aimed at keeping people well and to support longer lives lived better, through alleviating loneliness, helping improve physical activity and mental health, with particular focus on reaching populations whose health outcomes may be affected
by long-term conditions, loneliness, mental health and ageing.
There was growing evidence on the effectiveness of arts programmes for improving health and wellbeing outcomes: the ‘Creative Health: The Arts for Health and Wellbeing’ report highlighted how the arts could contribute to significant challenges the health and social care services faced; the World Health Organisation European Regional Office published a Health Evidence network synthesis report that concluded there was evidence the arts contributed to the promotion of good health and the prevention of a range of mental and physical health conditions, as well as the treatment or management of acute and chronic conditions across the life course; and the UK Department for Digital, Culture, Media and Sport released a report on Arts and Health in April 2020 that corroborated these conclusions.
Locally, an independent evaluation of the ‘A Necklace of Stars’ arts project had shown that people were overwhelmingly pleased to take part and offered diversion and discipline; structured time; helped overcome blocks in thinking; took a participants mind off their problems and developed new skills, as well as improved participants’ sense of worth and self-esteem. The project has had a sustained and broad impact, with some individuals continuing writing or sewing and becoming involved in other groups after the end of the project.
RESOLVED - that the Cabinet Member approve the allocation of £12,000 per annum, for a five-year period, from April 2021 to March 2026, to Arts Derbyshire, to employ an Arts, Health and Wellbeing Co-ordinator.
Approval was sought from the Cabinet Member for the allocation of £0.100m funding to each of the eight Derbyshire Health and Wellbeing Partnerships, to enable delivery of an approach to support the emotional wellbeing of children and young people, over a two year period from 1 April 2021.
In December 2020, the Public Health Investment Panel supported an application for investment into the emotional wellbeing of children and young people through a locality approach, to help address the increasing rates of mental disorder in England. The proposed grants would support Health and Wellbeing Partnerships
across Derbyshire to co-ordinate a preventative approach that enabled the expansion of mental health awareness, promotion of protective factors, early identification, early intervention and support for the emotional wellbeing of children and young people through a community-based approach. It would also build on foundational work in localities that had developed over the last few years, including training, partnership engagement, pathway development and consultation.
The Public Health Localities and Place-based approach delivered a broad range of locally-developed projects and programmes which were monitored and reported annually and agreed through the Health and Wellbeing Partnerships. Each of the eight Health and Wellbeing Partnerships across Derbyshire, arranged on a district/borough footprint, worked to improve the health of local communities, through promoting health-related behaviours and addressing the wider determinants of health. Membership of each partnership reflected local variation, but core membership included elected members from County, District, Parish and Town councils, representatives from Adult Care and Children’s Services, district and borough council staff, NHS commissioners and providers, Police, Fire and Rescue, voluntary sector organisations and representatives from local communities.
It was proposed to build on local assets and intelligence with £0.100m being allocated to each of the Partnerships to support and drive work over a 24 month period to deliver against a Young Peoples Emotional Health and Wellbeing Framework, by developing bespoke action plans to address emotional wellbeing within communities. Each programme would be based on the Thrive model principles focussing on the delivery of prevention and promotion strategies in a whole-system partnership approach - work would be supported strategically by the Public Health Lead for Mental Health and evaluated internally.
It was anticipated that the project would contribute towards several public health indicators including self-reported wellbeing, emergency hospital admissions for intentional self-harm and children reporting that they had a trusted adult. The report went on to outline total expenditure of £0.800m over a 2-year period from 1 April 2021, which would be met from the Public Health reserve budget and be awarded to Health and Wellbeing Partnerships in line with current locality arrangements
RESOLVED - that the Cabinet Member approve the allocation of £0.100m to each of the eight Derbyshire Health and Wellbeing Partnerships, to enable delivery of an approach to support the emotional wellbeing of children and young people, over a two year period from 1 April 2021.
Exclusion of the Public
To move, that under Regulation 4(2)(b) of the Local Authorities (Executive Arrangements) (Meetings and Access to Information) (England) Regulations 2012, the public be excluded from the meeting for the following items of business on the grounds that in view of the nature of the items of business, that if members of the public were present, exempt information as defined in Paragraph 3 of Part 1 of Schedule 12A to the Local Government Act 1972 would be disclosed to them.
RESOLVED that the public, including the press, be excluded from the meeting during consideration of the remaining item on the agenda to avoid the disclosure of the kind of exempt information detailed in the following summary of proceedings:
SUMMARY OF PROCEEDINGS CONDUCTED AFTER THE PUBLIC, INCLUDING THE PRESS, WERE EXCLUDED FROM THE MEETING
1. To consider the exempt report of the Director of Public Health on the Provision of Adult Integrated Substance Misuse Treatment Services: Additional Funding for Opiate Substitution Therapy (contains information relating to the financial or business affairs of any particular person (including the authority holding that information).
To consider the exempt report of the Director of Public Health on Substance Misuse Service Additional Payments
The Cabinet Member wasasked to approve the allocation of up to £0.499m Public Health reserves to Derbyshire Healthcare NHS Foundation Trust for Adult Integrated Substance Misuse Treatment Service for increased costs related to opiate substitution therapy for the financial year 2021/22- 2022/23.
The report provided information on the Service contract and available extensions to 31 March 2024. The Service was not mandated and was a requirement of the Public Health ring-fenced grant that this be provided. The baseline contract value was £5.1m per annum and provided treatment and recovery services to:
a) reduce the harm that alcohol and drugs cause to individuals, families and
b) improve the health, wellbeing and social functioning of service users;
c) provide recovery focused treatment; and
d) equip service users with the tools required to achieve sustained recovery
and community integration.
One of the services provided was opiate substitution therapy (OST) – a primary pharmacological approach to heroin dependence. Patients were prescribed a longer acting opioid which allowed them to reduce or cease heroin use and address underlying issues. The two most commonly used OST medications were methadone and buprenorphine with use largely informed by patient choice: buprenorphine was more suited to those patients able to refrain from concomitant heroin use.
In April 2018, the selling price of buprenorphine increased under the national drug tariff. A concessionary price was introduced to allow pharmacies to be reimbursed for the additional costs. In May 2019 the concessionary price increased substantially and in January 2019, buprenorphine was moved to category A of the drug tariff and remained at the increased cost. In addition, the price of methadone increased by over 14% between January 2020 and January 2021. As methadone made up the greater share of drug costs, the price increase and decrease in successful completions had a significant and unavoidable impact on the service.
The price increases had put a considerable cost pressure on the Trust, with the latest increase predicted an additional spend of approximately £246,364 for the financial year of 2020/21. This was likely to be a recurrent additional cost as prices were not expected to fluctuate far from current levels. The Director of Health Improvement at Public Health England had recommended that local authorities take into account the increased drug costs when setting substance misuse budgets. The increase in methadone prices had contributed to the predicted overspend and the Council had previously acknowledged the impact of this increase and supported the service by providing funding to cover the additional overspend.
RESOLVED - that the Cabinet Member approve the allocation of up to £0.499 million of Public Health reserves to Derbyshire Healthcare NHS Foundation Trust, for the Adult Integrated Substance Misuse Treatment Service for increased costs related to OST for the financial year of 2021/22 £246,364 and 2022/23 £252,636 totalling £0.499 over the 2 financial years of 2021/22 and 2022/23.
The meeting ended at 11:40 am.