Health and Wellbeing Board - Thursday 27 November 2025, 2:00pm

Health and Wellbeing Board
Thursday, 27th November 2025 at 2:00pm

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Speaking:

Start of webcast

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Cllr Isobel Darby

1 Welcome

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2 Confirmation of the Vice-Chairman

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3 Apologies

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Cllr Isobel Darby

4 Announcements from the Chairman

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Raghuv Bhasin - Chief Operating Officer
David Munday
Cllr Isobel Darby
Cllr Isobel Darby
Cllr Isobel Darby
Cllr Isobel Darby
Cllr Isobel Darby
Cllr Isobel Darby
Harry Thomas
Cllr Isobel Darby
Cllr Isobel Darby

5 Declarations of Interest

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6 Minutes of the Previous Meeting

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Minutes of Previous Meeting

Cllr Isobel Darby
Sanila Hussain - Partnership Support Officer
Cllr Isobel Darby

7 Public Questions

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8 Health and Wellbeing Strategy Focus- Start Well

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Michelle East
Michelle East
Cllr Isobel Darby
Michelle East
Cllr Isobel Darby
Sarah Ashmead
Cllr Isobel Darby
David Munday
Cllr Isobel Darby
Raghuv Bhasin - Chief Operating Officer
Michelle East
Cllr Isobel Darby
Sarah Ashmead
Michelle East
Cllr Isobel Darby
GTeorge Gavriel
George Gavriel
Michelle East
David Munday
Cllr Isobel Darby
Raghuv Bhasin - Chief Operating Officer
Cllr Isobel Darby
Craig McArdle
David Munday
Cllr Isobel Darby
Cara Atkinson
Cllr Isobel Darby
Cara Atkinson
Cllr Isobel Darby
David Munday
Cara Atkinson
Cllr Isobel Darby

9 Director of Public Health Annual Report

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David Munday
David Munday - Director of Public Health
Cllr Isobel Darby
David Munday - Director of Public Health
Cllr Isobel Darby
George Gavriel
Dr George Gavriel
Dr George Gavriel - Director, Bucks GPPA
Cllr Isobel Darby
Raghuv Bhasin - Chief Operating Officer
David Munday - Director of Public Health
Craig McArdle
Craig McArdle - Corporate Director, Adults and Health
Cllr Isobel Darby
Kate Walker - CEO, Community Impact Bucks
Cllr Isobel Darby
Michelle East
David Munday - Director of Public Health
Cllr Isobel Darby
David Munday - Director of Public Health
Cllr Isobel Darby

11 Integrated Care Board Update

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Nicola Newstone - Assistant Director for Partnership Development
Cllr Isobel Darby
David Munday - Director of Public Health
Cllr Isobel Darby

12 Forward Plan

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David Munday - Director of Public Health
Cllr Isobel Darby

13 Date of Next Meeting

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Webcast Finished

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Disclaimer: This transcript was automatically generated, so it may contain errors. Please view the webcast to confirm whether the content is accurate.

Cllr Isobel Darby - 0:00:00

Okay. Good afternoon, everyone, and welcome to this meeting of the Buckinghamshire Health

and Wellbeing Board on Thursday, the 27th of November. Apologies for the slightly late

1 Welcome

start, which is all down to me. So I would need to remind you all that this meeting is

also being webcast, and in the unlikely event that there is a technical issue with the webcast,

the meeting will be paused until that issue has been resolved.

So I would like to first of all confirm our new vice chair.

2 Confirmation of the Vice-Chairman

So Raghu, Basin, thank you.

I'm terrible with people's names.

I do apologise.

You've been nominated to be vice chairman by the ICP in accordance with the terms of reference.

I'm happy to formally propose it.

Is everyone happy to second it?

and are there any objections? No? If not, then Raghuf will be the Vice Chairman, so

3 Apologies

congratulations. Thank you. So, apologies from absence please, Harry. Yes, we've got

apologies from Carl Jackson and Steve Bowles. Ashley Waite is attending as a

substitute for him today and also from John Meech. From, sorry, John? Meech.

Cllr Isobel Darby - 0:01:21

Okay, lovely. Thank you very much and I think it might be helpful if we go

around the table and also to our people online just so that we know who we've got in the

meeting. That would be helpful. I'm going to ask my officer colleagues if they can keep

an eye on the screen because I seem to be hopeless because I see people putting their

hands up in the room and then I don't see people putting their hands up. Is that you

up there David?

You get two of me.

Oh my word.

It's only because I need to share my screen.

Oh great. Okay.

kind of in the meeting.

Okay.

First of all, shall we go to the people on screen first?

So, and I don't, I can see a gentleman in the corner

from NHS Oxford, so it's David.

Right, that gentleman is David Walker.

Thank you.

I'm chair of Oxford Health,

and I'm sorry I happened with you in person,

but I'm glad to be here.

Not a problem, and thank you so much for joining.

And I can see we've got Dan.

Hello, yes, never accused of being a gentleman. Dan Flagno, Consultant of Public Health.

Thank you. And is it?

Cara.

Cara at the bottom.

Hi, I'm Cara Atkinson. I'm the Assistant Director of Children's Services for the nowadays in

Buckinghamshire.

Fantastic. And can I just confirm that those four are the only people we've got, well,

the three plus David are the only people we've got joining online. I'm not missing anybody.

Fantastic. So going round, I'm Isabel Darby, I am cabinet member for health and

4 Announcements from the Chairman

well -being at Buckinghamshire Council and for my sins I chair this meeting.

Raghuv Bhasin - Chief Operating Officer - 0:03:04

Raghavasthi N, interim chief executive at Buckinghamshire

David Munday - 0:03:09

Healthcare Trust. David Munday, director of public health for

Cllr Isobel Darby - 0:03:13

Cllr Isobel Darby - 0:03:21

I am the director of the Bux GP provider alliance.

Cllr Isobel Darby - 0:03:31

I am Michelle East, director of midwifery at Bux Healthcare and HS Trust.

Hi I'm Sarah Ashmead, I'm Director of Children's Services at Bucks Council.

Apologies I have to leave just before three for meeting with inspectors. Thank

you. So is there anything that you would particularly like us to cover before you

leave? So I'm hoping that the start well item which is the main one for me is

it's going to be well covered by then. Okay.

Cllr Isobel Darby - 0:04:04

Hello Kate Walker for Chief Exec at Community Impact Facts. Thank you.

Straight in.

Ashley Wade, Deputy Cabinet Member for Communities.

Cllr Isobel Darby - 0:04:12

Thank you.

Cllr Isobel Darby - 0:04:13

Harry Thomas from Democratic Services.

Harry Thomas - 0:04:15

Cllr Isobel Darby - 0:04:16

Sunila Hussain, Partnership Support Officer.

Cllr Isobel Darby - 0:04:20

Thank you very much. Right, so we've welcomed everyone to the meeting and we've talked about

Apologies, so announcements from myself.

Excuse me.

Daniel Flecknow, Consultant in Public Health,

will provide a short update

on some wider Start Well partnership work

for Item 8 after Michelle East.

This update will cover both Healthy School

Neighbourhood Project

and the new Women's Community Health Worker Service,

Buck's Joyful Mamas,

who I had the pleasure to meet at the libraries

on Baby Week.

I would also like to welcome Carla Atkinson,

and head of service for Bucks Joyful Mamas

who will then give us an update on the implementation

of this innovative new service.

So declarations of interest is the next item.

5 Declarations of Interest

Nobody with any interest to declare, fantastic.

Now we need to review the minutes and actions

from the previous meeting.

6 Minutes of the Previous Meeting

So are we happy, has everybody seen the minutes?

And are we happy to agree the minutes

Cllr Isobel Darby - 0:05:30

as a correct record. Everyone agreed? So I will sign them offline in a moment if

that's okay. Fantastic. And then I'm going to pass over to Sunila who will review

the previous actions and provide an update. So we had one action from the

previous meeting on the health and wellbeing strategy focus principle and

ways of working where it had been agreed that a mapping engagement exercise to be completed

to develop a single framework for community engagement and it should be referred to the

Sanila Hussain - Partnership Support Officer - 0:06:05

executive partnership for further work and feedback to be provided at future meetings.

Nicola Newston kindly provided me with an update on that. So the action had been taken

forward within the principles action plan of the joint health and wellbeing strategy.

engagement roles within each neighbourhood are being mapped. There is a

community engagement maturity matrix under development as part of the SE NHSE

community of practise focused on community engagement development. This

should be finalised imminently and will be used as a framework to review and

inform our progress in Buckinghamshire. Thank you very much. Has anybody got any

Cllr Isobel Darby - 0:06:40

comments on that at all? Are everybody happy with that? Excellent. So we will move on to

7 Public Questions

public questions. Item seven. We haven't received any public questions so I'm assuming that

8 Health and Wellbeing Strategy Focus- Start Well

there are none. Fantastic. Thank you. So we now go to our first meeting item on the agenda

which is looking at one of our strands

of health and well -being in Buckinghamshire,

which is Start Well.

So, it's looking at everything to do with Start Well.

So, we've got lots of lovely people here today

who commit their lives to ensuring

that every child has the best start in life

from lots of different aspects.

So, am I going to start off with yourself, Michelle,

and then we'll take it from there.

So, I will hand over to you. Thank you.

Thank you. So I'm presenting today the Q1 and Q2 reports for this year for the StartWell

programme. The StartWell programme is designed to ensure that children get the best start

in life, acknowledging that the first 1000 days from conception through to the age of

Michelle East - 0:07:52

two are the most important, but with a particular focus on health promotion and reducing health

inequalities. So I believe that the metrics that we are looking at specifically through

this year's Start Well programme have already been to the Health and Wellbeing Board, so

I'll just provide an update on those today. So starting with child development and early

years, so we've maintained fairly stable performance around children meeting the expected child

development outcomes by the age of two. We have had a slight dip in performance around

and the timeliness of those two to two and a half year

reviews in this first half of the year.

That is a resource issue that has subsequently been

addressed and we're hopeful that when we see the Q3 data

there will be an improvement in the timeliness

of those reviews.

Some really positive things to report around health

prevention is that breastfeeding rates at six to eight weeks

remain very stable and performing well compared to national

averages and smoking at time of delivery is just 3 % this quarter which is as the

lowest it has been for us as a county and is significantly below the 6 %

national target that we have been set and that stability has now enabled us to

expand that service out further to looking at the number of smoke -free

households so we know that 80 % of households for women that are about to

to their pregnancy are smoke -free, but it shows that there's room for improvement.

We've signed up to an incentive scheme, which initially was encouraging women to prevent

smoking at the time of birth, and that's now being extended to the wider family, so we

hope to see some traction on that data soon.

We launched a healthy pregnancy service this year, so this service is designed to target

women that are most likely to not reduce or gain weight during their pregnancy.

pregnancy. We started with a pilot for those at most risk of developing gestational diabetes

and have subsequently extended that to all women with a raised body mass index that are

booking their pregnancy with us. The hope is that we develop healthy lifestyle behaviours

during the pregnancy that will then continue on into the postnatal period and have a positive

impact on the baby's life as well. This includes activities such as food demonstrations,

walking groups and other online resources to enable people to be more active. Half of

Michelle East - 0:10:25

those that have participated have actually demonstrated positive lifestyle changes as

a result of that. The uptake of early funded school places remains stable. The engagement

is slightly higher amongst three to four year old children than it is with two year olds,

so some outreach programmes are underway to try and encourage more access to those free

school places and the ELIM, the early language identification measure is being

piloted by a health visiting team at the moment. The aim of that is to identify

early language speech and language needs prior to the child entering school. We

have added perinatal mental health into the Start Well programme this year as

acknowledging the impact that poor perinatal mental health has on the

received the first two quarters worth of data. Women should be screened at

booking using a validated tool and our performance around that has not been as

we had expected. So referral rates are higher than those that appear to be

being screened so we know that there is an opportunity for us to ensure that the

validated tool is being used more robustly. But all of that service

enables us to identify that women are getting the most appropriate care and we

partner with Oxford Health around those services for both the perinatal mental

health service and the maternal mental health service.

So in summary, I think the key steps for us for going into this next quarter is to restore

the timely development of those reviews by maximising clinic capacity.

We will continue to offer the same level of intensity of support for smoking cessation,

specifically around our more deprived areas where we know it's more difficult to get traction.

We will continue to expand the healthy pregnancy service, ensuring that we have the right eligibility

criteria set for that. And the outreach programme for school places, funded school places, will

continue. The plan is to roll out the early language identification measure more widely

across all of our children over the next six to 12 months. And we will be addressing the

on mental health risk assessments through both the local activity that's

underway but also the release of the national tool that is being shared

amongst all maternity units. I'm happy to take any questions.

Cllr Isobel Darby - 0:12:53

I'll learn in the end. That's amazing, thank you very much. I've just

got one question just to start the ball rolling. You're talking about your

in performance on the two and a half year reviews.

What is, how critical is it that these are done at that age?

Because I believe there's a bit of a window

that you can do these reviews,

but if you miss that window completely,

you will presumably still pick up some issues,

but would some issues be masked

because you'd gone past that sort of age of development?

I'm probably not the most qualified to answer that. I would leave my health visiting colleagues,

or perhaps Sarah you might have some insight into that, but the timeliness of those means

that we have enough of a time lag prior to the child starting full -time education to get them

Michelle East - 0:13:49

to the best level of development that they can be so that when they start school they're more

likely to excel. So it is earlier the better but this is a review it's not a

sort of an intervention of some sort but obviously the intervention wouldn't happen if you

Cllr Isobel Darby - 0:14:04

haven't done the review. So did you want to add anything to that or not really?

Sarah Ashmead - 0:14:13

I think that sort of really targeting that particularly in our opportunity

box areas is really important because we know that the earlier that we can get

sort of children in settings, the earlier we are likely to pick up any needs that they've

got as well as sort of promote their development. So I know a lot of work is going into really

trying to promote that in those targeted areas in particular.

Thank you. David.

Cllr Isobel Darby - 0:14:39

David Munday - 0:14:41

And a comment that hopefully kind of builds on that, if that's okay, Cher. So nationally

we've also been set and Sarah and I have been working together on this with partners, a

target for the overall good level of development that children are at at the end of reception.

And that's kind of a national priority. And in Buckinghamshire we've been set an 80 % target

to be achieving and we're kind of working the trajectory to kind of get towards that.

So the two to two and a half year cheque is a really important kind of step to help achieve that good level of development so that children can thrive at school.

But building on what Sarah said in terms of the targeting and opportunity bucks, I think the E -LIM measure that Michelle has referenced,

that early language identification measure is something that we then take a targeted kind of approach with to try and ensure that we're picking up and providing that additional screening

and then support for those that need it most to help with achieving that 80 % good level

of development by reception. So it's really helpful to think of this as all kind of funnelling

towards that so that children are set up to thrive kind of in that school.

So it's all the building blocks to get there.

Okay, thank you. Sorry.

Cllr Isobel Darby - 0:15:57

Raghuv Bhasin - Chief Operating Officer - 0:16:01

Thanks, Michelle. A couple of questions. So the screening levels and perinatal mental

health, what should the number be and what steps do we need to get there?

Michelle East - 0:16:12

And then a second one on, so for those mothers who don't engage with stopping smoking, are

they sort of flagged as potentially more challenging families to engage with stroke might need

more support through to health visiting and beyond?

because that for me is a bit of a sign where either there's an additional

complexity or lack of engagement that we might need to provide

further support or focus on going forwards. Thank you. So in answer to your first

question there is no national benchmark for the number of women that should be

assessed at booking that will come with the new maternal death care bundle which

is being launched next year, where the ask of that is actually to ensure that there is

a consistent approach to assessing mental health needs during a pregnancy. Our actual

number of women that are caseloaded by the specialist team is 20 % of our population,

so the number of, the percentage of completion of the risk assessment is lower than the actual

number of people that are being assessed, so we know they're being assessed and they're

in the right care but they're not being assessed using the validated tool. So we do need to

get that as close to 100 % as possible, so quite a significant amount of work to do around

the recording of that but not so much around the actual risk assessment. And in answer

to your second question about smoking, so we know these are the families where there

is significant social complexity. They tell us that smoking cessation is just the one

extra thing that they cannot cope with during their pregnancy. They are often having additional

support from our vulnerable women's team already and they work very closely with health visiting

to ensure that there's a smooth transition for the family.

Thank you.

Thanks very much.

I see Sarah.

Cllr Isobel Darby - 0:18:15

Thank you. I just wanted to come back in on the ELIM measure

Sarah Ashmead - 0:18:19

because we're hearing some really exciting feedback about how effective that is going to be.

And I just wonder, it says about accelerating the rollout.

I wonder what that acceleration looks like and whether we can go even faster on that

because I'm hearing some really good feedback.

Michelle East - 0:18:40

So I believe the target that we've been set is 70 % of families are being assessed using

the E -Lin measure by the end of the three -year programme which is 2027. It is an internal

resource issue around the time that it takes for health visitors to undertake that assessment.

It's about 20 to 30 minutes on top of the original assessment that they're doing.

So that time will shorten as people become more proficient at the assessment. But we

do we are the CYP team at BUGS are in discussion with their leadership team

around the resource allocated to that so that we can accelerate that.

Cllr Isobel Darby - 0:19:24

Okay thank you. Any more questions? George. So I mean first of all just I think to

note actually the fantastic achievement on the smoking work and actually I think

it's amazing to be at that lower level and I'm sure it will take a lot of work

to stay at that level now. I guess my kind of question is it feels like it

will take a lot of work to make those changes in those three percent but it

does feel like perhaps there might be more opportunity in the smoke -free

GTeorge Gavriel - 0:19:55

homework. I guess it's just you know are there any plans to try and address that

because obviously it's not nationally measured so you know it's difficult to

benchmark and know where we stand but it feels like you know thinking about the

George Gavriel - 0:20:08

complexity of families, I just almost feel like the value for a reduction in those might

now be higher than what will be quite a large investment to get quite a small improvement

now in the pregnant ladies who are smoking.

Yeah, David?

Michelle East - 0:20:24

Yeah, Michelle, you might want to come in as well, but I think it's a really interesting

David Munday - 0:20:28

reflection, George, and I agree with you.

That point of it's a real achievement to get to where we are, and often when we think more

broadly about being smoke -free and being a smoke -free county and we know that

there's national ambition in terms of being a smoke -free country, we talk about

prevalence being below 5%, that's often what we mean by that. So you're

absolutely right, there's a point where you think okay so where's the best use

of our kind of time and resource in terms of helping reduce that tobacco

harm. One of the things we chose to do in in Bucks is whilst there was a national

initiative to support the smoke -free homes part, which was particularly looking at kind of partners

of pregnant women. It was a little bit too restrictive and there was some kind of rules

around it in terms of when someone had to beg a quit attempt or it could be one person in a

household and so forth. So we have chosen to just have a broader offer and we do now use our

incentive scheme to be able to provide some of that kind of offer to anyone in

the household who of the pregnant women to try and support that kind of

smoke -free environment. So I think we're fairly early on, I think it's fair to say

in terms of that work, but I think you're right that is an important area of focus

and might yield more benefit than trying to get to absolutely zero on women

Cllr Isobel Darby - 0:21:56

themselves. Thank you. Any more for any more? Everybody looks fairly happy. So I'm looking

at the screen. Nobody's putting their hand up on the screen. So we are firstly sort of

thank you and I think it is a really, really encouraging report and I would say we are

absolutely going in the right direction but I would always put that challenge is faster,

faster, you know, but we, you know, we have to be realistic about the resources that

are available and I certainly think that what the work that is being done appears

to be the best use of those resources and we are, I think everybody, all partners

are committed to ensuring that every child gets the best start in life and

yeah, there's some, some families are tricky and we have to accept that but we

have to do the very best we can for everybody because if we get that start

everything else should tickle on quite nicely.

So we are being asked to note the progress

outlined within the report,

endorse the ongoing direction of travel,

and continue to support integrated system delivery

of the Start Well programme.

Is everybody happy to do that?

Fantastic, thank you very much.

So now we are on, oh sorry,

no Daniel is to share a video clip, it says here, sorry.

Well there's a couple of slides

around videos that he will.

Ah, right, I beg your pardon, sorry, so I thought, is that, that's part of this, right, so I'm going to hand over to Daniel now.

Thank you very much, Councillor, apologies for my voice, I'm a little bit creepy.

Hopefully that will share, I just need to make sure I share with...

Right, so this is following on from Michelle's presentation there. This is relating to some

wider partnership projects which are feeding into the Start Well agenda. And as you said

at the beginning, this is going to cover the Healthy School Neighbourhoods project and

also our newly launched Women's Community Health Worker service. The one, the honourable mention

which isn't included here because it only completed a week ago was Buckinghamshire Baby Week

which I know several people attended and we had lots of support from our NHS colleagues and

the reason it's not included here is because we haven't formally evaluated it yet.

So I will move along with my slides.

So the Healthy School Neighbourhood programme,

for those who are not aware of it,

this is based on something that was done

in parts of London known as the school super zones project.

The idea being to focus on the approximately 400 metre

radius around schools, because this is the area,

especially with primary schools where families, parents and staff are passing through at least

twice a day on the way to and from school. The quality of the green spaces, the food and drink

environment, retail, public safety, all of these opportunities for active travel, all of these

things have a significant impact on the health and well -being of people in that school community.

So this is a two -year pilot which we are about one and a half years into now.

We're working with Oxford Brookes University to make sure that we have a rigorous evaluation in place

so that we can see what lessons can be learned and potentially things that can be scalable

or can be used in other school settings. But initially for the purposes of the pilot we've worked with

Elmhurst Primary School in Aylesbury and Cressex Community School in Highwicken which is a secondary

and we're working across five different domains including physical activity, including quality

of green spaces, community safety, retail environment, food and drink etc. Because there's

significant evidence that the environment around schools is a significant factor in contributing to

the prospects for a healthy and happy later life for pupils who experience it.

So there's a lot of activities going on. I'm going to move on to the video which

was recently produced and should summarise this project better than I can.

Hopefully the sound comes through.

So the Hatterschool Neighbourhood Project is a pilot project around two schools,

is Elmhurst School in Aylesbury and Cressy's Community School in Wycombe.

The aim of the project is to improve the environments in the neighbourhoods around the schools

to make it easier for children and families to be healthy.

But it is the broader factors which influence people's health and wellbeing.

The environment is incredibly important so we took schools

and we took the environment around it and looked at ways that we could improve that and make things better.

Rather than just focusing on one thing we've got five different domains.

So we've got active travel and air, food and drink, connected and safe communities,

physical activity and things to do and less harmful and risky behaviour.

And what we've found is that they all interact together.

Previously we've had issues with parking, now there's real visuals for parents,

especially as we have a lot of parents for whom English is an additional language.

Language barrier is quite important. I see a lot of parents, they can't even read or write.

We work with retailers to help them understand what is a healthier option,

but more importantly how a healthier option can be commercially viable and help them to grow profitable sales.

I think one of the key steps was to make sure that the park was a smoke and vape free zone

so that the children were benefitting from fresh clean air when they were going to play.

The most rewarding part of being a part of this project is just seeing the children and families

spending time using the equipment and enjoying themselves.

We have been increasing our patrols around Alfred Rose Park in particular.

It's been on it today hasn't it?

Yeah it has, yeah.

We do look to build stronger relationships within our community

and the purpose of neighbourhood policing is to give a voice to the community to target what they want.

Another supporting action has been to set up a youth club so that young people can go into there into a safe space

that can help address anti -social behaviour.

They can't put the summer effort in to come after school, free Wi -Fi, free snacks and have fun with their rates.

Well there's not much places we can go that we don't have to pay quite a substantial amount of money for.

It's like a free space, you can talk about whatever is on your mind, you can ask any questions.

I think the real hook of what the young people have really sort of enjoyed is being able to go to the workshop and work on our project car.

The hangout in Castlefield has proved a real success for our older students.

They like the fact they can go there weekly, do different things.

I feel how can we expect change sometimes when the young people might not have had the opportunity to see differently.

So we have another project going on which is the Underpass project, which will actually link young people from the hangouts to the Underpass project, which is a game, which is amazing.

So the impact that we're hoping to see from this project, and I think we're already witnessing, is the fact that we've got communities coming together,

different parts of communities with this one sort of goal of making this whole area around this school a healthier place to be.

So that was a very whistle stop tour.

The original video was over 20 minutes, and that's the short version that I thought I could sustain everyone's attention for.

Thanks very much Dan and yes does anybody want to watch the longer version because I'm sure he can put it on.

I came into this project fairly late in the day really because obviously I've only taken responsibility recently

and I was absolutely blown away with the sort of stuff that was going on and also I think the enthusiasm from some of the people like Hasib who's doing the car thing

I mean, he was just so into it and so keen on engaging these youngsters

and giving them something positive to do.

And it was just wonderful to see.

And also with the younger ones, and when they came to,

when we had the celebration event, some of the youngsters came.

And they were, I think the youngest was year two.

And they were talking to this room full of grown -ups.

And it was just lovely because to see the confidence of those youngsters,

and I went out and spoke to them afterwards and I said,

you know what, when I go into a room I get a bit scared,

when I've got to talk to lots of people and for you to do it,

I think that is absolutely amazing.

And it was just lovely to see.

And there's so much commitment and everybody really wants to make a difference.

And I think, you know, we just have to sort of keep that impetus going.

I hate to say it, but it all comes down to money at the end of the day.

But changing attitudes can sort of move on without too much money,

but if we want to roll that sort of thing out everywhere, it does cost.

But we need to be able to sort of evaluate properly and see, you know, was it worth it?

And certainly, just seeing the initial feedback at that sort of celebration,

it definitely seems to be so far.

But we need the proper evaluation to be able to see that.

So moving, sorry.

Raghuv Bhasin - Chief Operating Officer - 0:31:53

So Dan, I mean that's really exciting and excellent work.

I wonder, I think there's quite a lot of learning for the neighbourhood health side about that

community engagement, etc.

Just making sure that it's linked in in those two areas and how we could both learn how

to do some of this but also take an opportunity to link in around healthy

behaviours and and other things and this is exactly the sort of things we should

be doing more often so yeah just keen to make that link and if if it's going to

be successful how which I'm pretty sure it will be encouraging people to think

about the next schools and sort of so it we can start to build a rolling programme

based on the evaluation etc

Absolutely, yes, thank you. As I say, we're working with Oxford Brookes as our academic partner in this,

but I think one of the big successes has been the partnership working with the, as you saw in the video,

many different organisations have been involved and it's enabled a lot of cross -cutting work that, you know,

no one of those organisations could have achieved on their own, but the engagement of both school communities

been absolutely crucial. So yes, we'll be sure to disseminate the evaluation findings

as far as they can be used in other settings.

Cllr Isobel Darby - 0:33:19

Thanks very much Dan. David, you want to say, oh no Craig. Sorry, Craig and then.

David on the line.

Oh sorry. So who am I going to first?

Go to David first.

David on screen first.

Yeah, not a caveat, but just following up on what was said, you do need to watch, don't we?

We're having, as you know, this kind of great conversation in the NHS at the moment about neighbourhood.

And I suppose the scale question is important because we must make sure that our neighbourhoods do cohere with, you know, the micro -neighbourhood, for example, around the school.

I mean, you know, it's a major problem of public bureaucracy that people do different things in the same area

without necessarily talking to one another.

And I suppose here's a very good example of how we really do need to ensure that a micro -level, fantastic micro -level

initiative does mesh with, you know, our thinking about what scale of services, for example, around your GP paps

or whatever, is best. And I think it's just that it's a role into us to try and avoid duplication.

obviously goes to avoid unnecessary repetition of the neighbourhood initiative.

Absolutely, yeah. Who have I got now? Craig?

I would concur with some of David's points there. I think it's really important when

we talk about neighbourhoods, we recognise that neighbourhoods are actually on different

footprints as we're going forwards and sometimes we will operate on micro -neighbourhoods as

well in terms of that. I think Raghu's point is really important as well. I think there's

a lot of learning here for our integrated neighbourhood teams. I was struck there by

the range of partners there and if we got the right range of partners when we're talking

Craig McArdle - 0:34:59

about integrated neighbourhood teams etc, the police etc, that total place approach

is really, really important to health and wellbeing and we're seeing the benefits of

that. And then my, as David rightly says this is at a micro level but there is learning

here as well. David Munday now I'm going to ask the question too. Is this actually influencing

the emerging local plan, I wonder? Great. Thank you, Craig. And maybe I'll pick

David Munday - 0:35:27

that. I was going to say one other thing and I'll answer that bit as well if that's okay

because I think it connects. So on the point about the kind of scalability and kind of

what next on this, we're reviewing within the kind of public health management team

the kind of a proposal of what a phase two of this and what else where we could go next

with this in a few weeks time. And then from that also the evaluation will help. So I think

both the scalability of this, but the lessons learned, I think we're absolutely really kind

of keen on that. And then coming in a bit more to the kind of local plan bit, but also

the point about the cost of this. I think one of the bits which really struck me, and

And there was a couple of shots in the film from the NISA local convenience store.

And I know Councillor Darby, you were there as well.

Is the fact that working with that retailer, it's profitable for them.

And it's good business for them to be stocking healthy lines.

And there's work to do with them, but also with the wholesaler and also the supplier

that will support that.

And the organisation that we use to help us with that are very good at supporting that.

And actually, this is a win -win,

because we're not trying to get in the way of business at all.

What we're trying to do is to have that kind of partnership

work.

And the store owner there was really positive about the work.

So it feels to me like a win -win.

And then Craig, I think that is then part of the picture

in terms of the local plan.

What we're trying to do with the local plan

is to build a future for Buckinghamshire,

is to have that plan for building

a future for Buckinghamshire, which

is enabling and supporting health and well -being.

So, some of the examples of what's happened within the Healthy School Neighbourhood

has informed the evidence study, which is part of what's been out to public consultation,

which is now being kind of reviewed kind of through the local plan process.

But I do think it's a real opportunity for us to kind of be thinking long term

and to be kind of building health and wellbeing into the way we're kind of building our county

for the future.

Cllr Isobel Darby - 0:37:32

Absolutely. And actually we're talking about the convenience store. What the owner said

was that he had, it wasn't just the kids that were being influenced, it was whole families

that were being influenced. Elderly people were walking in and asking, what's this labour

on the shelf for? And he was explaining, well, this is a healthier option. Oh, well, I might

try that. And so actually it's got that sort of unintended sort of knock on effect, which

is superb and it is a win -win, but absolutely this is,

these are pilots, they're in part of an opportunity

bucks area, they're a small part of an integrated

neighbourhood team area, it's this geography

and I think we do have to be really, really careful

that we try and explain to people where this fits

and what they can do as well over a larger footprint

because all the different, you know, if you just got a map,

you just have so many overlays on it,

you wouldn't know what was happening, quite frankly.

And it does get confusing, and it gets confusing

for the people who are trying to do a good job

in their field when they've got this footprint for this

and this footprint for that, and it's incredibly confusing.

So I think that's something that we all have to be aware of

in our own organisations when we are moving things forward.

Now, have I got anybody else who wants to speak on this?

Or I think we're now going to pass over to Cara.

Welcome Cara, who's going to talk

about community health workers.

Is that right?

Or is it Dan introducing it?

I'll just do a brief background if that's all right.

Yes, please.

Thank you.

Thank you, Angela.

So the next piece of partnership work

that I really wanted to highlight

has been in the making for quite a long time

since the beginning of the last Health and Wellbeing Board

strategy. It was, there was a lot of national data accumulated and evidence showing significant

disparities and inequalities in maternal and infant outcomes by deprivation and by ethnicity

significantly. So one of the key pieces came from the Embrace UK report which showed that

maternal mortality, that is women dying during or soon after pregnancy, maternal mortality

was about three times more common than average,

four women living in deprived areas, about twice as common

for women from Asian backgrounds,

and about four times as common for women

from black communities.

So these are really quite significant,

although fortunately in this country,

the numbers for maternal mortality are very small,

but there's still significant inequalities

that we wanted to be doing, something to address,

and conscious that maternal mortality is really

the tip of the iceberg.

There are lots of other less massive but still significant inequalities in outcomes.

So we did a large piece of engagement work.

We commissioned HealthWatchBox to do focus groups within the relevant communities.

So they did focus groups with women who'd had a baby in the last five years from black

Caribbean, African, British Indian, British Pakistani groups and also just in community

centres in deprived areas of Buckinghamshire to talk about their experience of pregnancy,

what they knew about preconception health, which is a really key area of focus now with

trying to make sure that health is optimised before pregnancy, where that's possible.

Obviously not all pregnancies are planned.

And the sum of this insight and engagement was brought together for a working group including

public health, voluntary sector colleagues, maternity colleagues, and members of the public

to put together a model of what sort of service in Buckinghamshire might help to address these

inequalities locally.

And we went with a community health worker model, which was commissioned towards the

end of last year.

And the contract was won by Benardos.

And very glad to have Kari here to speak a little bit about how the service has gone.

We've got the branding here for, I think it was felt that women's community health worker

didn't quite roll off the tongue.

And so, Benada's very kindly done some work with stakeholders, with the community,

regarding what would be a better branding, and you can see here the Bucks Joyful Mamas,

pre -pregnancy and beyond.

Obviously, a service like this has potentially incredibly long timescales in terms of the outcomes,

because as you said council Darmothy if we get children off to a good start in

life and that really sets them up to to get to have a healthy and happy

adulthood but in the short term we're looking at outcomes like engagement with

the attendee services making sure that we've got good uptake of our lifestyle

services for women who are pregnant or for women of childbearing age in the

deprived areas of Aylesbury and High Wycombe where the service is going to be based.

So we're looking at uptake of smoking cessation services of

healthy weight and exercise promotion services. In the intermediate, so this is a three -year pilot,

we will be looking at breastfeeding rates, uptake of health visitor cheques

on childhood development metrics. But obviously in the long term the overall goal is

reducing these disparities in maternal and infant inequalities.

Again, we have an evaluation partner, this time at Buckingham University, because we

want to make sure that we are comprehensively evaluating, making sure that we can show evidence

of the services working and how well it works to inform future commissioning.

And we had a very lovely service launch last month in Aylesbury.

If it is all right, I will now hand over to Cara,

who is head of this service for Bnardos,

to talk a little bit about how the early implementation has gone.

Lovely, thanks very much, Dan.

And over to you, Cara.

Hi, and apologies if anyone has heard this information before.

But let me just grab my presentation.

So...

Okay, so as Dan's already said, this is a three -year pilot and we're focused on delivering

to women before, during and after pregnancy in the High Impact and Opportunity Books wars

across the Alsbury and High Wycombe.

So in terms of the team, we've just got a small team of five women's community health

workers supported by our wonderful Children's Services Manager and Department Admin and

the team are from all sorts of walks of life from within the actual communities in which

we're working with. We have people that are highly experienced with working with children

and babies. We have people that have backgrounds in digital media. We have people with all

of different backgrounds.

And the one commonality between everyone

is that they are experienced in childbirth, themselves,

personally.

They've got children.

They've experienced maternity services here

within Buckinghamshire and elsewhere.

And they all want to make a difference to the journeys

of women moving forward.

So in addition to having an evaluation partner, we also have culturally relevant clinical

supervision within the team as well to support the learning and development and reflection

of everybody within the team.

And it's really important to us that we give space for learning because, like I said, everyone

comes from a different professional heritage and it's for us to continually support in

in terms of their learning and development.

So, interestingly, just the conversation earlier within the meeting

around two and two and a half year cheques and the importance of those,

that's also part of our intended outcomes is supporting the increase of those.

And we're already having conversations with the health care trust

around how we can support with those women who, for whatever reason,

have been able to take up with those reviews with their child and see how we as a service can support

through our approaches of targeted outreach. We're very much at the stage now where we've got

families already coming through and what we're finding is that a lot of women

at the moment are really struggling in terms of money, the impacts of poverty, being actually

able to move around outside in the community for lots of different reasons. And where there

is sort of support to get people to appointments, to support with getting provisions with OED,

all of that kind of basic stuff first before then we can have conversations about, you

early pregnancy health cheque -ins and preventive care uptake and all of that sort of stuff.

And trying to find sustainable ways for them to be able to make appointments.

And also just explaining what different people within the system do.

So, what is a health visitor? Why do they want to see my child?

Why do they want to see my child? What do they want from me?

And having those kinds of conversations with people right now as well.

So in terms of the variety of support that we can give, so I'll give you a couple of

examples of really practical things around, you know, preparations for baby, for anybody

that doesn't know, but nowadays also has a specific fund that supports the funding of

brand new things like, for example, white goods, beds, provisions for baby, food, electric

gas and that kind of thing that we can offer straight off. It's really an

amazing thing to offer because it helps in terms of building relationships to begin with.

Education, so all of our team have gone through a very rigorous training process.

As I said, they all come from lots of different backgrounds but it's about making sure that

everybody's saying something, the same thing, same messaging, utilising all of the

training that's available and they're able to give advice, very basic advice, you know,

the messages around, just an example, tooth brushing, whether that be around vaccination,

whatever it may be, very basic advice to support people being able to make really good evidence

and form decisions for themselves and their children, their babies, navigation.

That's a really, really key one.

Like I said, some women find systems quite difficult to navigate, quite complex.

Who do I go to for what?

Do I go to A &E for that or do I go to the GP?

Do I go to a pharmacist?

And we are there to help guide and support.

It could also be something as really, really, really practical as how do I get there.

So we'll support them with going on the bus and being on the bus with them to an appointment or whatever it is.

We're trying to find sustainable ways to support them in to make change.

And then intelligence.

And so part of what we're doing, not just through the evaluation, but just more generally anyway,

is collecting the storeys of women and their experiences of the systems and services that are here to support them,

in order to sort of help make sure that systems are designed with them in mind as well.

And underpinning all of this, everything that we do, is we do have a litmus test as to whether it feels culturally relevant

anti -racist and we believe that by adopting that, which is a very

Cara Atkinson - 0:50:34

individualistic approach to supporting people, is actually really beneficial to

everybody, not just people that are from racially minoritised backgrounds.

So yes, so in order to access we wanted to also make the service as easy as possible for

anybody to access. So if there's a health visitor, for example, that is on a visit with a mum

and they needed some additional support, they didn't have to sit down and go through

reams of forms with that mum, they could just give us a call and say,

so here with this mum, she needs help with ex -wives, could you help?

And we'd be like, yes! And so far that seems to be working really, really well.

because we're able to be really quite responsive right at the second we've already started.

And we'll accept phone calls, emails, just with basic details, we can pull it up if we need anything else.

Obviously we always need consent before we go out and see anyone or have that information shared with us.

But it seems to be working quite well.

Women can also contact us directly themselves.

We have social media pages, if their contact is on there, we'll follow up with them.

It's about having as many ways and as easy as possible for anybody to access us.

We use the ComD model in order to screen women,

so that's about understanding people's capability, their opportunity and their motivation to change.

and we've got a screening tool to support us in having those conversations with women

to see what their goals are, what is their physical capability in order to meet that.

So for example, the bus is the easy one, so how do I transport myself from A to B to get to places?

I'm struggling with that at the moment.

Well then we can look at how we can get that work done.

And from there we've also got, we'll be able to determine whether that person needs one -to -one support, group support,

which is going to be supported by volunteers as well from the community, by the community.

And signposting. Sorry, my cat has just jumped on my desk.

It's very, very off -putting.

And then overseeing all of the work of the service,

there's going to be a steering group made up of partners,

both statutory partners, voluntary sector partners,

and women to oversee the work and make sure we're doing what we should be doing

and making the difference we should be making.

And also thinking about how we share those storeys,

what was talking about earlier around intelligence is sharing those storeys of women

and being able to think about how we can potentially do things differently as a system and as a group

to make their lives better.

And I think that's it.

Okay, so any questions?

Right, well thank you very much, Cara.

I'm looking around the table to see if I've got anybody wanting to ask a question.

I think my question is, obviously it's very early days for you at the moment,

Cllr Isobel Darby - 0:54:10

but have you got any sort of, you know, anecdotal success storeys

that you'd potentially like to share?

I mean, you know, obviously anonymised,

but I just thought that might be, you obviously can't say,

well, we've been doing this and our evaluation is whatever,

but, you know, I've met a couple of your joyful mummers at,

well, that's where I'm going to call them anyway,

at the library events, you know, and they're very keen, very enthusiastic.

and I think I love the name as well.

I think it is a really, really positive name

and it's not, you know, when you start talking about

you know, health visitors and health workers,

it all gets a little bit formal

and I think a lot of women are,

if they're not particularly confident,

are more at home with sort of somebody

who's more like a friend than a health professional

and that to me is good.

So, have you got any anecdotes at all yet?

One, I found out about this morning, so Mum had come through.

She is in temporary accommodation at the moment and is waiting for her move into different accommodation.

And she doesn't really get out at all.

Cara Atkinson - 0:55:32

And she happens to be Nigerian and we have a Nigerian member of staff and they're really connected and it's really beautiful.

And they got out this morning to a baby group together.

So it was the first time that she'd ever really gone and spoken to the parents and really started to integrate in that way.

But we've also supplied her with lots of beautiful baby things, brand new, which she didn't have before.

So baby was actually sleeping in a bottom drawer.

So now baby has their own bed, they have some safe sleeping, okay, so sleep safely.

and yeah, that's just really short piece of work so far.

That's only been a week, maybe two weeks of work

with that particular woman,

but I think we're making quite big strides with her already.

That is, excuse me, that's really fantastic news.

Cllr Isobel Darby - 0:56:27

And you know, that is one life or two lives,

should we say, that have been touched already.

And that's absolutely fantastic.

David.

Yeah, two just quick questions from Mikara, if that's okay.

David Munday - 0:56:39

do you have a feel yet for the number of,

the reach of the service, the number of women and babies

and families that you think will be able to reach

in this initial three -year period?

And then the second bit, I was struck by the,

on one of your slides with the four different elements

of the service, you have the, I think it said

culturally relevant and anti -racist in the middle.

Do you think there'll be any learning from this work

that could more broadly apply to how we're running

different services in Buckinghamshire to kind of overcome some of those cultural and kind of race barriers.

Cara Atkinson - 0:57:16

And in regards to your first question, no, I haven't really got an understanding of that just at this moment entirely.

Sorry, one second.

I haven't really got a real grasp of how big this can go just right now, but obviously we've got the flexibility of groups

and setting up as many groups will have a larger volunteer cohort as well.

So I think, you know, we can go quite loud.

In respect of the second question around a culturally competent and anti -racist approach,

we're actually, the framework that we utilise within this service is actually being utilised in,

so we've got a key work service in East Berkshire where that's being utilised.

but also trying it in a family pub in Essex to try and see if actually that approach can

be tailored to lots of different kinds of services, not just a maternity service.

So thinking about intersections with disability, thinking about intersections with other kinds

of services.

So yeah, I think there is a possibility to take that further.

And within Barnardo's, we've actually got a specific team called STEAM,

and they are focused entirely on disparities for African, Asian, Caribbean heritage children across the UK.

And that's where that sort of templating approach has come from.

And they're working with lots of different providers nationally

to see how we can start thinking about having anti -racist approaches to delivering lots

of different kinds of things. So schools are one and the police is another that we're working

with. So there's no reason why we couldn't try it in other spaces.

Cllr Isobel Darby - 0:59:19

Thanks very much. Are there any more questions for Cara at all? No? Well, I'd just like to

thank you so much for coming along today and also to wish you and your organisation the

very best of luck and we look forward to, you know, it's such an exciting project,

but we look forward to hearing from you again to see how it's going, you know, as the

three years progress. So thank you so much for that.

Thank you, everyone. So now we're on to item nine, which is director

9 Director of Public Health Annual Report

of public health annual reports. So I'm going to hand over to David.

it. Thank you, Chair. I'll just see if I can get

David Munday - 0:59:53

the slides to work for me. Just give me a moment, please. Here we go. The slides would

have been in the pack, but I thought helpful if we have them on the screen as well. Great,

there it gets worked. Good. So as the new Director of Public Health for

Buckinghamshire starting here in April.

I was keen that the first annual report that I did

was one that would really be relevant to the system.

So thinking about the council itself,

obviously where I'm employed,

but more broadly, kind of the partners

represented around this table and beyond.

And it felt to me that with the development

of the local plan, which we've touched on

in this meeting already that's happening in Buckinghamshire,

but also when I started in April,

we were kind of awaiting the 10 year plan for health,

kind of nationally, but also other changes that are happening structurally within local government as well as within the NHS.

It felt that having a forward look

on the health and well -being

for the future of Buckinghamshire was really relevant and the idea of this report is to

provide that kind of well -being, health and well -being forward look into that kind of context of change and of going forward planning

that's happening around us.

So, the aim of it is to be a tool and to help us in that space.

And as you'll see in the kind of recommendations, very much advocating that we kind of take

seriously the need for kind of additional preventative work to try and be improving

health and wellbeing.

The report itself and the full reports in the PAC, and so I'm sure people will enjoy

dipping into that in more detail if they haven't had the chance to already, is I

touch on demographics and overall health and then structure things

through the kind of life course approach and that's deliberate because I think it

helps kind of break things down a little but it also helps us just in terms of

having a new health and well -being strategy in Buckinghamshire which is

also structured around the life course so that we can use this report as I said

just earlier as a kind of a tool to help us thinking about how we best improve

health and wellbeing kind of at those points. So it's meant to kind of dovetail in that

way with the health and wellbeing strategy. And all I'll do, if it's okay, is just talk

through a slide on each of those kind of areas that I have kind of focused the report around.

David Munday - Director of Public Health - 1:02:27

So thinking first of all about demographics. So I think we know that we have an ageing population

in Buckinghamshire and if you're at my end of the room, it's slightly hard to see the

kind of the numbers on the axis, on the y -axis.

But the light blue on that graph is our kind of over 65s.

And we can see that they're the population group

that are growing the fastest in the county.

And I think that's probably not news to people in the room.

Our overall population in the county is also growing.

These are both trends that are happening nationally,

that are happening regionally,

but we are seeing both population growth and ageing

at a faster rate in Buckinghamshire than we see regionally and nationally.

And then that orange line shows actually a dip in terms of the percentage change for

children and young people.

The important thing to add into this then is that that kind of a population by 2045

of approximately three quarters of a million people living in Buckinghamshire is the best

estimate we can put on that at the moment.

We have to draw in both the population estimates and that shifting demographic, which is why

what I've shown you on the graph,

but also what will happen in terms of house building

in the county over that kind of 20 year period.

And we have to assume kind of migration into Buckinghamshire

as a result of the homes that are required nationally

to be built here by 2045.

What's most stark is a doubling of those aged over 90.

So obviously smaller in absolute number,

but kind of rapid in terms of kind of overall growth.

And then what we're also seeing is,

and one of the reasons I think it's important

to have heard from Cara and asking about

kind of culturally competent services is we are seeing,

and we will continue to see a change

in terms of the ethnic kind of makeup of the county,

particularly in younger cohorts, but not exclusively.

And obviously that in time shifts,

kind of shifts to the right.

and therefore understanding how we best work in an increasingly kind of multicultural way,

in a multicultural society, sorry, will be increasingly important for us in Bux.

In terms of overall health, so we know that life expectancy overall,

because nationally as well as in Buckinghamshire, has essentially stalled in recent years.

We spent many decades in this country and in this county gradually seeing improved life expectancy.

The graph on the right is showing you the difference.

It's girls on the left and boys on the right.

And then the two bars for each are split between the most deprived and the least deprived communities in Buckinghamshire.

And you can see the difference in terms of life expectancy.

But I think what is important to pull out as well,

and the bars are split between blue and orange,

is that that blue is then a healthy life expectancy.

So not just how long you live,

but actually the number of years you live in good health.

And a couple of things to pull out from that

are that we clearly see a difference

in terms of by deprivation on that measure,

but what we're increasingly seeing

is that people will be kind of under retirement age

at the point in which they're no longer experiencing

good health, and that has a significant impact for us in terms of economic productivity and

local economic growth.

Healthy life expectancy itself is actually getting worse, and it's quite hard to project

that going forward because of a range of risk factors that leads to it, but we are seeing

that moving in the wrong direction and is a significant challenge for us.

And this graph, again, it's a little small to see,

it's just highlighting change over the last 15 years or so,

so a look back as opposed to a look forward,

but just some of those risk factors,

and in fact all but smoking,

and I'll touch on smoking again at the end,

kind of getting worse.

So there is a real challenge in terms of addressing

that kind of worsening of healthy life expectancy.

So just a few things to pull out. There's plenty I could say, but I will obviously just

for the sake of time try and keep things brief across the life course. So two things, there's

more in the report itself, but two things to pull out in the start well space. One is

vaccination. So the graph on the right hand side is showing us the uptake of both of the

measles, mumps and rubella vaccines by the age of five. And there's just a comparison

on it by what's happening in Buckinghamshire compared to England and the South East.

So the good news in this is that we do better than average in Buckinghamshire.

The bad news is, whilst it's not dramatic, we're seeing a bit of a decline in uptake.

The interruption of how services were delivered for people during the pandemic hasn't helped

with that, but we're yet to see the bounce back from that in terms of vaccine uptake

rate.

There's some changes with childhood vaccination programme in terms of that second dose will

given earlier, including the vaccine for chickenpox, which we think will actually, we hope will help

in terms of redressing some of that. But there's more to be done thinking about how we best support

high uptake, because inevitably what happens as those vaccine rates have gradually been reducing

against a really potent disease like measles is we've seen more cases of measles. We see more

children in hospital because of measles. And we do see sometimes children dying as a result of

which is completely preventable.

So that's a really important area

that we need to have focus on.

And then you will have heard me before talk

about the challenge of childhood obesity

on that penultimate bullet point,

just pointing to the fact that the projections show

more than 40 % of year six children by 2040

being either overweight or obese.

And the challenge with that is that once children

at year six are overweight or obese,

more than half of them will carry that excess weight into adolescence.

Once people have excess weight into adolescence, about 80 % go on to have that into adulthood

and the data shows that then that lasts across the life course and it increases the risk

of a whole number of diseases.

The answer to that isn't singular and part one of the overall objectives of the healthy

school neighbourhood work that we saw about earlier is to try and take some of that whole

systems working and approach to address a more wicked issue like childhood obesity.

If we look at LiveWell, there's lots we could say about this.

Just drawing out a simple chart on the right -hand side, what we've done here is used data from

QAFS, the primary care data, to be able to show the current prevalence of different long -term

conditions.

the green dots are where we are now,

and then the kind of bluer bit to the right

is where we project to be in 2040.

And you see significant increases.

The depression one is obviously the one that stands out

kind of more than any other.

There will of course be some kind of factor

within that data in terms of,

I would suggest an increase kind of ability

to talk about mental wellbeing,

potential increase likelihood in that getting diagnosed, but we are seeing mental wellbeing

deteriorate. The answer to that isn't simply in the GP consulting room or in secondary

care services. We see an increase in a range, projected increase in a range of other kind

of long -term conditions. And one of the things to pull out here, or two things to pull out,

sorry, one is it's very expensive, the kind of things that we expect to see an increase

in, so we see that hypertension.

So whilst that kind of prevalence percentage might look like a few percentage points, when

you calculate the number of strokes that that results in and then the cost to the system,

not simply, before we even think about the individual themselves, of a stroke is significant,

but you could say the same in terms of the cost to the system of diabetes as well as

then of course the challenge to the individual of managing that.

We could talk about the expense of dealing with cancers. Now what we're

not saying here is that there's lots of different individual people, there will

of course be individual cases, but what the modelling suggests is that

multi -moderability picture increasing at working age. This isn't just people kind

of well into their kind of 70s, 80s and 90s, this is kind of happening then at

kind of at that working age, which comes back to that point about kind of work and health

that I made.

Some of the solutions to this sit within addressing some of the drivers of the increased prevalence.

So I pull out alcohol on this slide.

So every year for the last five years we've seen more people in this country in hospital

with alcohol -related disease.

So that's not simply alcoholic liver disease.

that's other diseases which are exacerbated or caused by harmful alcohol use.

And it's important to underline that the harm from alcohol is present long before there

is an addiction to alcohol, and there's sometimes a bit of a misconception kind of publicly

about that.

In Buckinghamshire, we've seen approximately a 65 % increase in the last few years in terms

of people in hospital, you know, in BHT beds with alcohol -related illness.

But I could pull out other drivers of some of these areas and some of these challenges.

So the last couple of things just to pull out then.

So within the age well part, I've tried to, within the report, focus on an optimistic

view of ageing.

So whilst it is inevitable that we all will grow old, it isn't inevitable that we will

grow frail.

And this infographic on the right is just highlighting the risk factors for dementia.

And when you add up, and all of them are small percentages, when you add up all of those

risk factors, it comes to 45 percent of the risk factors for dementia, as the best evidence

shows us from kind of a Lancet series publication, are risk factors that are preventable and

that you can intervene on.

So whilst I'm not suggesting we will be able to prevent every case of dementia, or maybe

not even all 45 % of all cases of dementia.

There is nothing inevitable,

kind of thinking at a population level,

about rising numbers of residents with dementia.

There are things we can do to reduce that.

Again, there's more information in the report

in terms of the challenge of falls.

With an ageing population, we would expect to see more falls,

and we know that emergency admission to hospital

with a fall is the strongest predictor

of residential care home placement, which again is a significant challenge for the individual

and is also kind of a significant cost into the system.

So just then the last kind of part of the report and then I'll sum up, Chair, is that

I also try to pull out some of the future health risks that we kind of see coming over

the horizon. I think we, whatever we want to be doing in terms of addressing climate

change, the change in the climate that we see does pose us risks in terms of both communicable

disease because of the vectors that hold disease that are more able to be prevalent in this

country and therefore more spread of infectious disease.

But also we know of the health impacts on flooding, but also challenges in terms of

kind of food stability potential challenges on air quality and so forth.

So there are, the climate change challenge spins into a few areas of health related kind of focus.

And then also we are seeing, and it's a national phenomenon, not simply a Buckinghamshire phenomenon,

as I'm sure people understand, challenges around problem gambling and some significant harm

that kind of comes from that.

And the prevalence of that and worryingly in under 18s is increasing.

So there's more we need to do to properly understand that for Buckinghamshire itself.

And of course, some of that will be online and not all simply happening kind of on our

high street, but an area that we need to kind of be able to understand better to inform

action.

So this final kind of conclusion slide just, I think, pulls out some of those points that

I've just been making as I've gone through.

I think probably I don't want to end on a negative point because it's possible to kind

hear all of that and look at the public health graphs and kind of feel a bit of

kind of worry and misery. If you think about, so the next steps in terms of,

in the report, sorry, describe where there is opportunity to enhance that

preventative effort. And to be optimistic, if we think back to 20 years ago, smoking

rates now have halved from what they were 20 years ago. Fewer men die of lung

cancer now than since records began.

We've seen an 80 % reduction in the last 20 years

of the number of teenage pregnancies.

So I'm looking at the 20 year forward look,

but if you look back 20 years, there's

some really good success storeys of what

we can achieve if you take kind of long term

consistent preventative effort.

So I think in a county like Buckinghamshire

where our baseline is better than average,

we've got a number of assets.

And we've got a good economy.

we've got a system that is really committed to working together.

If you can address some of the challenges and trends that I've pulled out in this report anywhere,

I think you can address it in somewhere like Buckinghamshire.

So I'm optimistic, but there is a nettle to be grasped in terms of some of that kind of

preventative work that we need to be doing. And that doesn't sit simply with me,

it doesn't sit simply with people in my team, or indeed simply with individuals in this room or

your teams, it really does sit kind of system wide, but as the kind of leaders of health

and social care for Buckinghamshire is obviously important for us to be considering how we

can be best taking things forward. So I know there's quite a lot there, but really interested

in any kind of immediate reflections of what stood out from the report and indeed where

people feel there's opportunity for action in their organisation or indeed in partnership.

Thank you. Yeah, thank you very much David and yes, you mr

Cllr Isobel Darby - 1:17:21

doom and gloom, but no actually, you know, we need to be realistic about this because you know

There is that there is a steam train coming down the line and we have

the collective power

Not to stop it

But to slow it down and I would say more than the power the duty to our residents

To do all that we can to do that just picking out a couple of things one

that really hit me was the depression projection.

That was so scary.

It was, you know, that really blew my mind,

in fact, you know, just because it was so,

such an outlier, if you like.

And I just wondered if you got any comments on that.

And the other one that I thought was interesting

was the osteoporosis.

And is that because we're not,

our bones aren't as strong

because we're not doing exercise,

or what's the reason for it?

So can I just throw those to you

and then I'll throw it out to everyone else,

having used Chairman's privilege.

Absolutely.

David Munday - Director of Public Health - 1:18:24

So I think the depression one is, I absolutely agree,

it's quite, it's really stark, isn't it?

And I think what we've seen is an increase

in the diagnosis of depression

and may be passed to kind of clinical colleagues

who may have some kind of other input

to kind of share on that.

I think what some of what is driving that is kind of is common to some of our other challenges.

So I think it's important that we hold the kind of mental well -being challenge in light of the work we need to be doing to ensure kind of stable housing and kind of good work.

And also some of the kind of health impacts that things like alcohol have and things like community cohesion and so forth.

So I would advocate a broad kind of view

of some of the determinants

and what we can be doing about it,

more than simply the kind of clinical,

that kind of clinical picture,

though clearly that is part of what is necessary

in terms of supporting people.

And you know, I think it would be fair to say

that the estimates that we've done

do have some margin for kind of error within them,

but clearly one that we need to kind of sit up

and kind of pay attention on.

I think the part in terms of osteoporosis is one which I think is primarily a function

of having an ageing population, but I think is something, I think like with a lot of musculoskeletal

conditions, they're unlikely to be the life threatening condition that put bluntly is

the thing that might kill someone.

But in terms of quality of life and in terms of the impact that it might have and the longevity

of some of that. I think broadly the musculoskeletal disease group is one that we need to be conscious

of in that sense and will be challenging in terms of people being able to be at work and

so forth where they're struggling. So a couple of initial reflections on those comments.

Does anybody want to comment on those two?

I don't border.

George?

Cllr Isobel Darby - 1:20:30

So actually I'm just going to talk about those and ask a bit.

George Gavriel - 1:20:38

I'll just start by saying I really appreciate a plain English pragmatic and optimistic report

which isn't...

Are you saying this is one?

This report.

I'll say both but genuinely I kind of sigh at long reports and I really enjoyed this

one.

So thank you.

And I really enjoyed the tone of it actually as well,

of the like, let's actually do something about this

because we can do something about these.

Cause you can talk about, you know, 10 times this,

but this is stuff we can do.

So just to kind of start with that.

I think on the prevalence, I found that really interesting.

I think, you know, if you look back 10 years,

there's been an increase in prevalence

driven by a number of things in a number of areas,

some of it ageing, but also some of it is kind of campaigns

with health professionals and the public.

So for example, we've seen increase in hypertension rates,

partly driven by ageing populations,

but I also think partly driven by public awareness

and healthcare practitioner awareness.

So actually, I think if you look at underlying prevalence rates,

true prevalence rates rather than say, co -op prevalence rates,

I think they're much higher than they are,

but I think they're closer to a true value now.

And I think there's some really good examples of that,

dementia being one.

we still know that we have a massive underdiagnosis of dementia in our county,

but lots of work's being done, particularly as we develop more understanding of interventions that can help.

So with osteoporosis, we've had improvement of diagnosis because we have better interventions.

With dementia, when I qualified, there was no treatment, and now there is a treatment,

Dr George Gavriel - 1:22:22

so actually the importance of diagnosis has increased, so we're doing a better job of it.

So it'd be interesting how much of the data takes account of trends historically of under diagnosis,

which may go into the future.

But I do think actually what we need to look at is, you know, recognising that things like the depression,

what other things are causing the increase?

So the depression increase, I think, is partly an under diagnosis, particularly in, say, male populations

Dr George Gavriel - Director, Bucks GPPA - 1:22:52

and in elderly populations I think there's, you know, good amounts of

under diagnosis that we've worked hard on, but also, you know, understanding for

each individual on what is it driving that increase and is the number a true

reflection of the increase in underlying disease or is it an increase in good

work in diagnosing it, if that makes sense. So, but yeah, I think that's probably my

I think my take on that, I could comment on lots of things individually within those,

but I think you need to look at each one individually and there are different things driving the

increases for each specific disease that's in this graph.

Thank you very much.

Did you want to go to the next item?

Cllr Isobel Darby - 1:23:36

Yeah, so it's a really helpful report, David.

Raghuv Bhasin - Chief Operating Officer - 1:23:41

I think there's a ... If we think about for the health and wellbeing strategy implementation

and marrying this rapport.

So how does some of the analysis in here

guide future prioritisation decisions?

So the point you made about childhood obesity

was really stark.

So we know obesity is actually a driver

of a lot of the conditions laid down the line.

And if your big intervention is, effectively,

when children are before 11, then we

need to focus on that perhaps more than we currently are.

because we can treat the symptom and try to adjust the course.

So I wonder if there's something we could do with this report

to help guide us thinking about where is the biggest ROI,

where do we focus, and actually if we, where should we,

if we look at the way in which we're focusing our attention and resource,

almost using this as a bit of an independent judgement of actually,

because these are the things that always get squeezed out

because they're too far down the line, but as you say,

we've got opportunity to change things.

And so turning this into a bit of a tool, we judge our priorities again, so it's quite

useful.

Did you want to come back?

Maybe if I can make a few comments back.

Craig.

David Munday - Director of Public Health - 1:24:53

Yeah, I agree with what's being said.

Craig McArdle - 1:24:55

I think this is a great report, really challenging for us and the system, David.

So it's really great to have a 20 -year forward look as well.

We don't often get that as well.

So I think it's really important.

My reflections are when you read the report, we're doing lots in this space already,

which will make an impact against some of your findings there.

But I wonder if as a system, each year we needed to pull out a theme and really make

Craig McArdle - Corporate Director, Adults and Health - 1:25:24

a year of focus on one thing, whether it's vaccinations, et cetera.

We don't stop doing the other things.

But I just wondered if we collectively, you know, if you think of vaccinations, if collectively

we all put our mindset to that, our comms etc and focus on that for the year.

So I wondered if we need a year of focus on certain areas based on this report.

Cllr Isobel Darby - 1:25:47

How do people feel about that? Good idea? Sorry Kate.

Yeah I think I'm just going to echo what Raghu and Craig have said.

Kate Walker - CEO, Community Impact Bucks - 1:25:57

I think it's really really helpful and really useful to see some really stark figures in there.

and a similar kind of point that Raghu made.

I was just going to ask really how are you going to use it

to inform existing programmes as well.

So I think maybe that you're a focus.

So we've got neighbourhood health,

we've got opportunity bucks.

So how are we, one, how are you going to be sharing this

going forward to some of those things that are already happening

across the system and programmes that we've already got in train

and how is it going to influence some of those programmes

and things like how we're going to address the 10 -year plan

and what have you.

So I think it's really helpful to shape that.

And yeah, maybe the year in focus

might coalesce us around all of those programmes.

Excellent.

Sorry.

One last question.

Cllr Isobel Darby - 1:26:51

The incidence of depression, is there any breakdown

Michelle East - 1:26:54

into what age group that increase is likely to be seen in the greatest. The

reason I ask is because I think yes there's a lot we can do around childhood

obesity and I think the Start Well programme is trying to get as upstream as

possible with pregnancy, healthier pregnancies, but certainly what we see on

our acute site is an increased incidence of quite significant mental health

issues with children and young people and eating disorders or disordered

So, interesting if that huge spike in depression is happening in a younger age group or an

older age group.

David.

Got it.

Right.

Sorry.

Thank you.

So, maybe, yeah, so if you, I'll answer a couple of the questions and then some of those

David Munday - Director of Public Health - 1:27:39

reflections of the so what, if that's okay.

So, I would need to go back and cheque, actually.

I haven't got my fingertips in terms of the breakdown of depression, but certainly what

we picked up in the report was exactly what you described in terms of some of that trend

in children and young people, but we'll be able to pull that, I'm sure, so it's a bit

of homework for me and the data squad kind of back at the ranch.

And I think, George, to your point in terms of, I think absolutely we are picking up diagnosis

here and so some of what we're seeing is change in patterns of diagnosis and of course we

want that to be as close to underlying prevalence as possible.

And I think that if we superimposed in terms of hypertension on here, the amount of undiagnosed

hypertension as you know that would be kind of that would be significantly

significantly higher from what we've seen of the ICB's commissioning

intentions for 20 to 26 27 or you know their initial look in that space there

does seem to be a particular interest in focus on kind of diagnosing hypertension

which is a kind of a positive a positive thing to a positive thing to see. I am

really keen that we use this report however, you know, in whichever ways are kind of useful

in the system. And I think it can help us in that return on investment space and how

do we best kind of prioritise in making the case for, as you say, Raghu, kind of the things

that get squeezed out that we might otherwise kind of not kind of hold our nerve on. And

I think we absolutely need to be using it this way. We don't have yet, but I think it's

scenario that we want to be working on and working kind of potentially kind of across

the Thames Valley on is having that good kind of health economic kind of skill to be able

to really kind of plug in the pounds and pence and work out what that kind of return on investment

case is. And I think something we need to be able to do better. But I think this report

should be able to help us in that space. I like the idea of doing a year of focus and

choosing some specific bits to run after.

Our action plans for the health and well -being strategy

were designed, so whilst we've done a 10 -year strategy,

which has got those underlying principles

and those overall areas of focus,

we've said that those action plans

would need to be kind of renewed regularly.

So I think there's opportunity to be

kind of viewing and tweaking those,

and be therefore kind of using this

to help embed the strategy.

I think there are definitely opportunities because Craig, to your point, if it was vaccination,

for example, you think about the integrated neighbourhood teams, we think about the best

start in life hubs that are being developed and there's other opportunities as well.

We've heard about the joyful mummers work.

If you start throwing together all those pieces together, we really could do something kind

of impactful and kind of coalescing around the vaccination space as a starter might be

one that we could address.

So, and then to pick up Kate, your point, and this is how then do we go about kind of

actually kind of implementing some of the recommendations and points.

I'm doing various kind of conversations and presentations and discussions in different

settings really just to kind of show the report, understand from people where it fits with

kind of priorities and where they see the opportunities being.

We're developing a bit of a kind of what good looks like against the different recommendations

that are in the report to help us kind of have that picture of where we might want to

be, where we might want to be kind of going next.

So I'm very happy to kind of take that forward in settings that colleagues think would be

useful.

It feels like it will, like the strategy we've got and then the emerging kind of neighbourhood

health plan that we need to be developing for BUCKS seem to be two quite key areas where

we could really land this and kind of have those tangible kind of actions. So that would

be my, I think probably the places I'd suggest we look to embed the work. And then the last

thing I'd say is that the plan for the annual report next year will try to get a bit under

the bonnet of the building blocks of health and that kind of understanding of the various

drivers of health and wellbeing which should help us in that kind of being

smart in that kind of preventative space. So want to continue these reports being

things that are kind of tools and helpful for the system.

Cllr Isobel Darby - 1:32:12

Okay anybody else anybody on screen want to say anything? Any comments?

All right. So we are asked to note David's report, and I would like to add my thanks

because there's an awful lot of effort went into that, especially it's sort of you've

only been around sort of six months, haven't you? So it wasn't your annual report, it was

your six -monthly report almost. So, you know, and it is, it really, I think it's certainly

we studied it at cabinet and I certainly think

it's thought provoking and I think that's what it should be

and we all need that sort of, if you like,

the fresh pair of eyes that's come into Buckinghamshire

to say, have a look at this guys.

What does this mean?

And it is very, very powerful,

so I'd just like to thank you.

And then we need to consider how members of the board

or take forward action to support the recommendations.

So, is that something that we need to discuss now,

or is that something that, I don't know,

has every organisation had taken this to their board

or whatever, or board equivalent yet?

I think we're planning.

Yeah.

So, I think for the purpose of today,

I think some of the discussion we've had

is exactly kind of part of that, Councillor Derby,

and absolutely, we're kind of planning it

David Munday - Director of Public Health - 1:33:38

within kind of the structures of different organisations

to have that kind of more detailed look as well as then as I say I think informing what

we do with neighbourhood health planning here and also the kind of action plans for the

strategy. So it's kind of one in many ways it will be a bit of work in progress won't

Cllr Isobel Darby - 1:33:58

it in terms of that. So I shall just close this item by reading from your report. We

can build a better Buckinghamshire for all starting now and into tomorrow. All with that

thought. Thank you so much. So we're now moving on. Item 10 has been

11 Integrated Care Board Update

withdrawn so in moving on to item 11 which is the ICB updates and so first of

all we have the Parkhamshire, Oxfordshire, Berkshire West Integrated Care Board and

Nicola Newstone - Assistant Director for Partnership Development - 1:34:30

I shall hand over to Nicola. Thank You Nicola. Thank you. So there's one main

thing that's in the report that I'll just reference which came up before which is

the Thames Valley Commissioning Intentions

for 26 through to 2030.

They've been published a few weeks ago now,

but they obviously haven't been here yet.

So this is setting out the Thames Valley,

or what will be the Thames Valley ICB priorities

for that period.

They were developed through

population health management data, performance data,

and then it cites here a lot of insight work,

not specifically on this,

that have been gathered over the last few years.

And themes that come up around access,

a more focused on prevention, joined up care.

I mean, they're really familiar.

They're really similar things that came up in the insights

to our joint health and wellbeing strategy.

So that's sort of reassuring

that there's nothing totally different.

And then they're not listed in the summary,

but the kind of three strategic objectives

that have been referenced in the commissioning intentions.

and I just refer specifically to them which were commissioning for integrated

and proactive neighbourhood health and then also commissioning to prioritise

prevention and there are sort of three priority areas CBD, obesity and diabetes

and then children and young persons mental health so again we're seeing a lot of

similarity these are obviously headlines and there's a lot of work to do and I

think the note in here is that these have been published but they shouldn't

be static, there's going to be further engagement both with partners and with communities as

I guess these are taking forward and the Thames Valley ICU establishes itself from April.

And then just the other point that's referenced here is the positive start that's been made

to COVID and flu vaccinations, noting David's kind of headline in a meeting last week around

We know that flu this year though has been higher than expected.

So I guess it's just noting that alongside the positive news that's reported in here.

Okay, lovely. Thank you very much.

Cllr Isobel Darby - 1:36:36

Has anybody got any comments or questions for Nicola?

David?

Sorry, I'll be very brief.

David Munday - Director of Public Health - 1:36:44

But just wanted to pick up on that flu part, if that's okay.

So absolutely, so we see if you look at the,

well, I mean, I'm sure other people aren't as nerdy as me.

If you look at the curve in terms of positive flu cases or people in hospital with flu,

it's about four weeks earlier than usual in terms of when that started to increase.

So that may tell us that we're expecting a worse flu season.

It may tell us it's just happening a bit early.

We'll have to wait and see a bit on that.

There is a strain of flu that's circulating, which hasn't circulated for a number of years.

So the UK Health Security Agency have done an early season

analysis of this year's vaccine, which is showing it is highly

effective in protection against that H3N2 strain.

And therefore, whilst it's one that's not circulated

for a while, the fact that underlines

the importance of vaccination because it's less likely

that people have natural immunity to that strain of flu

and their vaccination is therefore really important

to give people that protection.

So the system works, I think, here really effectively

in terms of the offer in school, in primary care,

in pharmacy and so forth.

But incredibly important that we see good uptake rates locally

to protect our residents from what can be a really nasty illness

and we know leads to mortality.

I think the message, I believe,

Cllr Isobel Darby - 1:38:11

I think it was you that said it was either yourself or Dan at the library,

was if there was a year you were going to have a flu jab,

this year is the year.

And that really sort of resonated as well,

because we were talking to somebody who said,

I'm not having one of them.

I was really ill, I'm not having one of them.

But it is a very...

And that actual message stuck with me.

And maybe that is a message perhaps

that ought to go out on social media, quite frankly,

because it is important.

And yes, as you say, with the weather that we have these days,

I mean, you see plants, just bulbs coming out at the wrong time of year,

and I guess there's that kind of thing.

And also you've got diseases which happen at different times.

Is it just happening early, or is it just the start of something really bad?

And I guess we just don't know.

So, yeah. So any more comments at all? So that was an information item. Thank you very

much Nicola. Now we will welcome Michelle Evans -Riches, who is the programme manager from

Bedfordshire, Luton and Milton Keynes Integrated Care Board. And welcome and nice to see your

smiley face. And would you like to give us a little bit of insight into your area?

I am here for Maria who is recently been appointed as the neighbours health delivery director

for Bedfordshire, Leesville and Middleton Keynes. Since this report was written I wanted

to update the board on actions that have actually happened. I am reading back that this is based

on the board that happened on the 26th of September and the Health and Care Partnership

which happened on the 23rd and it actually seems like almost a year ago because so much

has happened. So you were saying in the report that we've had ministerial statements saying

that three of our integrated care boards which is both to the Milton Keynes, Temperature

and Peterborough and the Hertfordshire element of Hertfordshire and West Essex will be merged

on the 1st of April 2026 and so we're working very closely together the three organisations

to try and make that happen because it's a very short time scale. We've appointed a joint new

executive team across all three organisations and the chair Robin Porter is now the chair of all three

ICBs as well and is the chair designate for central east ICB as it will be called.

The governance structures have been aligned, we're having meetings in common or joint committees which

are quite problematic to serve but we're sort of getting there. We've just completed our first

round of cycle of meetings and we've got our full board tomorrow. How can I take any questions or

take questions back if I don't know the answers and come back to you?

Lovely, thank you very much. Has anybody got any questions at all?

No, it looks like you've got away lightly then.

So I'd just certainly just like to thank you for coming along.

And I think obviously the world that you're living in is a quite significant change.

And I think we probably sort of sympathise with the way that what you're having to deal

with because certainly in council world,

we did it a few years ago and it's,

yes, it's interesting, but it's nice when it's done.

So thank you very much.

So that then leads us on to item 12,

which is the forward plan and AOB.

12 Forward Plan

So do you want to talk about that at all?

We've got, we're looking at two items for,

we're looking at what we will be looking at,

what we will be considering on the 3rd of March,

all things being well.

Is there anything you want to, David?

David Munday - Director of Public Health - 1:42:43

Just one thing to, one or maybe two things just to add,

I don't know we can decide at this point,

but it's maybe something to consider

before the 3rd of March.

We're expecting the neighbourhood health guidance

to be published kind of nationally quite soon.

There will be a role for health and wellbeing boards

and I think we've said that in this forum before.

So, I think we may just need to create space for that,

but I think we have to wait and see,

just in terms of what comes through in the time.

Shall we sort of pencil it in as something that could well be there,

and then, or may not be,

but then we can perhaps move the agenda around

to give it the appropriate time.

And then we may, and I'll be led by ICB colleagues,

we may want to have some understanding of what's happening

in terms of the Thames Valley, kind of ICB, at that point.

but again, maybe one we just need to see where we are.

I think that some of this we're going to have to play by ear till near at the time when the agenda is set, aren't we?

But we keep those in mind. So I think, has anybody got any other business?

Cllr Isobel Darby - 1:43:44

No? Well, I think that's going to be it then folks. So can I just thank you all for your time today

13 Date of Next Meeting

and your contributions. It's been, I think, I feel it's been a really positive meeting even though

David decided to spread lots of doom and gloom,

but with a positive spin on it,

and I think that's the important thing,

and I think we're all here committed

to improving the health and well -being

of the people that we serve,

and I feel that we've done that justice today,

so well done, and thank you very much.

Cllr Isobel Darby

Conservative

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Health and Wellbeing Board - Thursday 27 November 2025, 2:00pm - Buckinghamshire Council Webcasting

Health and Wellbeing BoardThursday, 27th November 2025 at 2:00pm

Agenda

Slides

Transcript

Map

Resources

Twitter

Forums

Speakers

Feedback

Votes

Cllr Isobel Darby - 0:00:00

1 Welcome

2 Confirmation of the Vice-Chairman

3 Apologies

Cllr Isobel Darby - 0:01:21

4 Announcements from the Chairman

Raghuv Bhasin - Chief Operating Officer - 0:03:04

David Munday - 0:03:09

Cllr Isobel Darby - 0:03:13

Cllr Isobel Darby - 0:03:21

Cllr Isobel Darby - 0:03:31

Cllr Isobel Darby - 0:04:04

Cllr Isobel Darby - 0:04:12

Cllr Isobel Darby - 0:04:13

Harry Thomas - 0:04:15

Cllr Isobel Darby - 0:04:16

Cllr Isobel Darby - 0:04:20

5 Declarations of Interest

6 Minutes of the Previous Meeting

Cllr Isobel Darby - 0:05:30

Sanila Hussain - Partnership Support Officer - 0:06:05

Cllr Isobel Darby - 0:06:40

7 Public Questions

8 Health and Wellbeing Strategy Focus- Start Well

Michelle East - 0:07:52

Michelle East - 0:10:25

Cllr Isobel Darby - 0:12:53

Michelle East - 0:13:49

Cllr Isobel Darby - 0:14:04

Sarah Ashmead - 0:14:13

Cllr Isobel Darby - 0:14:39

David Munday - 0:14:41

Cllr Isobel Darby - 0:15:57

Raghuv Bhasin - Chief Operating Officer - 0:16:01

Michelle East - 0:16:12

Cllr Isobel Darby - 0:18:15

Sarah Ashmead - 0:18:19

Michelle East - 0:18:40

Cllr Isobel Darby - 0:19:24

GTeorge Gavriel - 0:19:55

George Gavriel - 0:20:08

Michelle East - 0:20:24

David Munday - 0:20:28

Cllr Isobel Darby - 0:21:56

Raghuv Bhasin - Chief Operating Officer - 0:31:53

Cllr Isobel Darby - 0:33:19

Craig McArdle - 0:34:59

David Munday - 0:35:27

Cllr Isobel Darby - 0:37:32

Cara Atkinson - 0:50:34

Cllr Isobel Darby - 0:54:10

Cara Atkinson - 0:55:32

Cllr Isobel Darby - 0:56:27

David Munday - 0:56:39

Cara Atkinson - 0:57:16

Cllr Isobel Darby - 0:59:19

9 Director of Public Health Annual Report

David Munday - 0:59:53

David Munday - Director of Public Health - 1:02:27

Cllr Isobel Darby - 1:17:21

David Munday - Director of Public Health - 1:18:24

Cllr Isobel Darby - 1:20:30

George Gavriel - 1:20:38

Dr George Gavriel - 1:22:22

Dr George Gavriel - Director, Bucks GPPA - 1:22:52

Cllr Isobel Darby - 1:23:36

Raghuv Bhasin - Chief Operating Officer - 1:23:41

David Munday - Director of Public Health - 1:24:53

Health and Wellbeing Board
Thursday, 27th November 2025 at 2:00pm