Health and Wellbeing Board - Thursday 3 September 2026, 2:00pm

Health and Wellbeing Board
Thursday, 3rd September 2026 at 2:00pm

Speaking:

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Cllr Isobel Darby

1 Welcome

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Cllr Isobel Darby

2 Apologies

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Sanila Hussain - Partnership Support Officer
Cllr Isobel Darby

3 Announcements from the Chairman

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Raghuv Bhasin - Chief Operating Officer, BHT
David Munday - Director of Public Health
Craig McArdle - Corporate Director for Adult Social Care
Dr George Gavriel - Director, Bucks GPPA
Alison Holloway
Zoe McIntosh - Healthwatch Bucks
Andrea Young
Kate Walker
Bobby Pozzoni-Child
Cllr Steve Bowles
Daniel Leveson
Sanila Hussain - Partnership Support Officer
Cllr Isobel Darby

4 Declarations of Interest

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5 Minutes of the previous meeting

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Health and Wellbeing Board Meeting minutes - 14.05.26

6 Public Questions

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Sanila Hussain - Partnership Support Officer
Bobby Pozzoni-Child

7 Health & Wellbeing Strategy Focus - Principles/ ways of working including Neighbourhood Health Planning

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HWB Report Principles Update September 2026 (002)

Cllr Isobel Darby
Bobby Pozzoni-Child
Cllr Isobel Darby
Bobby Pozzoni-Child
Cllr Isobel Darby
Daniel Leveson
Cllr Isobel Darby
David Munday - Director of Public Health
Cllr Isobel Darby
Bobby Pozzoni-Child
Cllr Isobel Darby
Dr George Gavriel - Director, Bucks GPPA
Cllr Isobel Darby
Craig McArdle - Corporate Director for Adult Social Care
Cllr Isobel Darby
Zoe McIntosh - Healthwatch Bucks
Zoe McIntosh - Chief Executive, Healthwatch Bucks
Cllr Isobel Darby
Kate Walker
Kate Walker - CEO, Community Impact Bucks
Cllr Isobel Darby
Kate Walker - CEO, Community Impact Bucks
Cllr Isobel Darby
Andrea Young
Bobby Pozzoni-Child
Cllr Isobel Darby
David Munday - Director of Public Health
Cllr Isobel Darby

8 Director of Public Health Annual Report 2026

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David Munday - Director of Public Health
Cllr Isobel Darby
Raghuv Bhasin - Chief Executive Officer, BHT
Cllr Isobel Darby
Daniel Leveson
Cllr Isobel Darby
Andrea Young
Andrea Young - Chair of Oxford Health NHS Foundation Trust
David Munday - Director of Public Health
Cllr Isobel Darby

9 Buckinghamshire Executive Partnership

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BEP HWBupdateJuly26

6 Public Questions

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Raghuv Bhasin - Chief Executive Officer, BHT
Cllr Isobel Darby
Raghuv Bhasin - Chief Executive Officer, BHT
Cllr Isobel Darby
Daniel Leveson
Cllr Isobel Darby

10 Heathwatch Update

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Healthwatch Bucks update report H&WB 110826

Zoe McIntosh - Chief Executive, Healthwatch Bucks
Alison Holloway - Healthwatch Bucks
Cllr Isobel Darby
Dr George Gavriel - Director, Bucks GPPA
Cllr Isobel Darby
David Munday - Director of Public Health
Cllr Isobel Darby
Alison Holloway - Healthwatch Bucks
Cllr Isobel Darby
Kate Walker - CEO, Community Impact Bucks
Cllr Isobel Darby
Alison Holloway - Healthwatch Bucks
Cllr Isobel Darby
David Munday - Director of Public Health
Cllr Isobel Darby
Daniel Leveson - Director for Places and Communities
Cllr Isobel Darby
Zoe McIntosh - Chief Executive, Healthwatch Bucks
Cllr Isobel Darby

11 Integrated Care Board Update

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TVICBHWB Report August

Daniel Leveson - Director for Places and Communities
Cllr Isobel Darby
David Munday - Director of Public Health
Daniel Leveson - Director for Places and Communities
Cllr Isobel Darby
Craig McArdle - Corporate Director for Adult Social Care
Daniel Leveson - Director for Places and Communities
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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Disclaimer: This transcript was automatically generated, so it may contain errors. Please view the webcast to confirm whether the content is accurate.

1 Welcome

Cllr Isobel Darby - 0:00:00

Thank you very much.

Cllr Isobel Darby - 0:00:12

Well, welcome everybody to this meeting of the Buckinghamshire Health and Wellbeing Board

on the 3rd of September.

Everybody back from holidays now and time for some hard work to look after the health

and wellbeing of the people of Buckinghamshire.

I would need to remind you that the meeting is being webcast and in the

unlikely event that there is a technical issue with the webcast, Sunila will wave

at me and tell me that we've got to pause the meeting until that has been

resolved but hopefully we won't need that. And I'm also welcoming Councillor

Carl Jackson who is joining us online because he can't be with us today so

So, Carl, I'm sure you'll waive it as we'll do something if you wish to participate.

And I will move swiftly on to ask Tanila to confirm apologies and substitutes, please.

2 Apologies

Thank you, Chairman.

Sanila Hussain - Partnership Support Officer - 0:01:04

So, we have received apologies from Errol Albert and apologies from Gemma Thomas, but

we've got Bobby here representing Gemma.

Lovely.

Thank you very much.

3 Announcements from the Chairman

Cllr Isobel Darby - 0:01:14

So, as I say, we've got Bobby who's going to be presenting on Item 7 on behalf of Gemma.

And we've also got Alison Holloway, who is, hello.

You're going to be speaking on item 10,

so you're here with Zoe from Health Watch.

And I'd also just like to take this opportunity to thank Nicola Newstone

for her ongoing support and valued contribution to Health and Wellbeing Board.

Nicola's recently taken up a new role,

and we wish her every success in her future endeavours.

and looking ahead Sam Burrows will become the board's lead representative

from the Thames Valley ICB.

And board members, sorry, I've missed one already, I can't even read my own notes.

Daniel, welcome Daniel Levison and your attending on behalf of the ICB

and presenting item 11.

Apologies for that.

So we've got Sam Burrows will be coming in the future we believe

And then board members are also asked to note that updates

from the central east ICB will no longer be a standing

agenda item.

Instead, we'll have updates brought

to the board as and when needed.

So what I'd like to do now is just go around the room

so that everybody can introduce yourselves.

And I've realised rookie error, back from the holidays,

totally forgot, my name is Isabel Darby.

And I'm cabinet member for health and well -being

at Buckinghamshire Council, and I am chair of the Health

and Wellbeing Board.

Raghuv Bhasin - Chief Operating Officer, BHT - 0:02:49

Hi everyone, Raghavasthi, Chief Sec of Buckinghamshire Health

Care, NHS Charles Park has my old job, a long time ago,

and I'm the vice chair of the committee.

Hi, David Munday, I'm the Director of Public Health

David Munday - Director of Public Health - 0:02:59

for Buckinghamshire.

Hello, Craig McCardell, corporate director for Adilson

Craig McArdle - Corporate Director for Adult Social Care - 0:03:04

Health, Buckinghamshire Council.

Afternoon, everyone.

Tiffany Adonis -French, I'm service director

for operations at Buckinghamshire Council. I'm George Gathera, I'm the director for Buckinghamshire Primary Care.

Dr George Gavriel - Director, Bucks GPPA - 0:03:18

Hi I'm Alison Holloway, I'm a project manager with Healthwatch Bucks.

Alison Holloway - 0:03:22

Zoe McIntosh - Healthwatch Bucks - 0:03:26

Hello I'm Zoe McIntosh, I'm chief executive of Healthwatch Bucks.

Andrea Young - 0:03:30

Kate Walker - 0:03:34

Andrea Young, Oxford Health. Hi I'm Kate Walker, I'm the chief exec at Community Impact Bucks and

and also representing Thames Valley VCC Alliance and the Bucks VCC partnership.

Bobby Pozzoni-Child - 0:03:44

Bobby Potts, the only child here as director for integrated care for Bucks Place -Based Partnership.

Cllr Steve Bowles - 0:03:51

I'm Steve Bowles, I'm the cabinet member at Buckinghamshire Council for Communities.

Daniel Leveson - 0:03:57

I'm Dan Levison, director for Places and Communities, part of Thames Valley ICP.

Sunila Hussain, partnership support officer.

Sanila Hussain - Partnership Support Officer - 0:04:04

And Carl, would you like to introduce yourself?

Cllr Isobel Darby - 0:04:07

Yes, thank you Chairman, Carl Jackson, Buckinghamshire Council's cabinet member for education and

children's services.

And my thanks to you Chairman for allowing me to join by teams.

Fantastic.

Right.

Do we have any declarations of interest from anybody?

4 Declarations of Interest

Okay, that's lovely.

That's that one finished with.

5 Minutes of the previous meeting

Then we come on to the minutes of the previous meeting held on Thursday 14th May 2026.

Is everybody happy first that I signed those as a correct record?

All agreed? Fantastic, thank you very much. I'll sign those in just a moment.

And then we will move on. So there's no actions I think from these minutes, others, Nila,

so we don't need to go any further than obviously we've read them, digested them.

and now they can be filed.

We've public questions.

6 Public Questions

We have received questions in relation

to the health and wellbeing strategy focus,

principles, ways of working,

including neighbourhood health plan.

So, Sunil, can I pass to you to take that item forward?

Sanila Hussain - Partnership Support Officer - 0:05:13

Thank you, Chairman.

So we have received a few questions

from a member of public in relation

to the health and wellbeing strategy focus principles,

ways of work, including neighbourhood health plan.

There have been some background information

that was also shared, which has been shared with colleagues.

I just wanted to highlight that the guidance states that we are able to accept one question

from the member of public per meeting, but in this case, because the question is kind

of related to one another, we have accepted it as a whole.

So now I will just move forward and I would like to invite Robi to share the response.

Thank you.

Bobby Pozzoni-Child - 0:05:53

And we've drafted a response on behalf of collaboration

with a number of members around the table.

And so Buckinghamshire has a strong track record of working

with residents, patients, voluntary

and community organisations and local partners

to shape health and care services.

We welcome the NHS England guidance on working

in partnership with people and communities.

And the principles set out within it align closely

with our existing approach and the ambitions

of the Buckinghamshire health and well -being strategy.

As we develop neighbourhood health plans

across Buckinghamshire, we are committed to ensuring

that the voices of local people

and communities are central to that work.

The plans will be developed

through our neighbourhood arrangements informed

by engagement with residents, community groups, Health Watch,

patient participation groups and wider partners.

And this engagement will help shape priorities, services

and outcomes with completed plans being brought

to the health and well -being board

for consideration and approval.

Public engagement will also be an important part

of the development of neighbourhood health centres.

Engagement will focus on understanding the services

that local communities want and need

and how those services should be designed and delivered.

Where there are realistic options available regarding

locations, public views will be considered

as part of that process.

However, in most cases, the use of existing estates

and available funding may mean

that there are limited viable location options,

in which case engagement will focus on services provided

and the benefits for local people.

A communication and engagement approach has already been

established to keep communities informed

as this work progresses.

And this will be shaped through learning

from health watch reports, patient

and public engagement activities,

community organisations and with local partners.

And the approach will continue to evolve

as further feedback is received,

helping us to improve the information we provide

and the ways in which we engage with residents.

Population health management information is an important tool

that helps partners understand the health needs

of local communities and identify opportunities

to improve care.

However, the neighbourhood level analysis containing information

that could potentially lead to the identification

of individuals in population, in small population groups,

and therefore we cannot publish those in their entirety.

We will continue to share insights and findings

from this work where appropriate, and will,

while ensuring that information governance

and confidentiality requirements are maintained.

Overall, we're committed

to developing neighbourhood health plans in partnership

with our communities in line with the NHS England requirements

and the Buckinghamshire health and wellbeing strategy.

And we look forward to bringing a full neighbourhood health plan

to the board in due course.

Thanks very much, Bobbie.

Thank you.

So now, moving swiftly on to item seven, which is your baby.

7 Health & Wellbeing Strategy Focus - Principles/ ways of working including Neighbourhood Health Planning

So I will hand straight back to you.

Cllr Isobel Darby - 0:08:36

This is the health and wellbeing strategy focus principles,

ways of working, including neighbourhood health planning.

It's on page 13 of the pack.

And Bobby is going to take us through that.

We need to discuss it and hopefully feel that we are,

as a group, able to endorse it.

Brilliant. Thank you.

So just to provide a bit of a brief update then

Bobby Pozzoni-Child - 0:08:54

on the 12 months of the development

of our neighbourhood programme across the last 12 months

and setting out the ways of working

in the local health and wellbeing strategy.

I'm assuming, I'll take it, that you've all read the report.

So just a sort of high -level introduction or summary of that.

There's four items really or four areas that we're keen to highlight link to those principles

But the overall message is that Buckinghamshire has moved from designing neighbourhood models to now and putting that infrastructure into practise

And we're now seeing some really encouraging early outcomes set out in that report

And so first of all working with our communities as we've already

Referenced we are strengthened the way that community insights feeding into the neighbourhood health and priorities

We've linked with health watch bucks who have produced several reports including

issues such as rural access to healthcare and travel costs, healthcare travel costs,

and those findings are being shared and informed into the teams.

Our integration leads have also been building links with community boards and working with

colleagues through those, and bringing those into the neighbourhood steering groups, which

is helping us to move towards much more sort of local priority and coproduction through

those sort of agenda setting and priority setting.

Secondly, around integrated neighbourhood working, so the infrastructure and governance

oversight that we've set up is now fairly well established.

We have a neighbourhood programme group, which several members of the board are part of.

We have steering groups in each of the six Buckinghamshire neighbourhoods, and we also

have integration leads and neighbourhood clinical leads in place.

And we also have VCSE neighbourhood leads in two of those geographies, so Aylesbury

and Wickham linked to our Opportunity Bucks programme.

As you all know, we've developed population health management

packs, working with our public health colleagues,

and those have been used through those neighbourhoods to kind

of design and develop the priority areas.

And social care and community teams are shifting alignment

to kind of match those neighbourhood footprints as well.

So everyone moving into that same space.

And through that, we've been able to kind of develop

and design some multi -agency approaches that really start

to bring together better healthcare, the voluntary sector

and other partners to try and start to address some

of those people with more complex needs.

And I know, for example, Jenna spoke with you

about the proactive frailty work

that's already started in BUCKS

and we're seeing an expansion of that as one example.

Important just to reiterate that the programme

is not about creating another layer

or another set of services,

but it is about bringing together existing teams,

existing services, working in a more coterminous way

around patients and really sort of effectively driving

that emphasis towards prevention and early intervention

where we possibly can.

The third area is focusing

around being much more evidence led.

I've mentioned the population health management packs,

but also the rollout and utilisation of segmentation

as a tool for decision making in Buckinghamshire and ways

that we identify people that need support

and influence local decision making.

And segmentation is already in use in most GP practises

and is now available in the emergency department

at the HT as well.

And we're working through the clinical interface group to look

embedding that into routine ways of working.

And another real highlight from this year is the significant

and substantial increase in the utilisation

of the shared care record, which enables care professionals

to see information about a patient

and make better informed decisions

with that patient in the moment.

And we've increased to more

than 26 ,000 patients having shared care records accessed

across Buckinghamshire, which is 16 ,000 increase on last year,

which is really significant on the same month in last year,

which is really significant.

And then finally that sort of focus on equity.

So a number of new programmes

have sort of come online this year.

So you will have heard frequently

about community health and wellbeing workers

which are now functioning in two of our most deprived LSOAs

in one in Wycombe and one in Aylesbury

and engaging with those communities.

And we're already seeing some really fantastic results

through that sitting alongside other OPCS programmes

such as the healthy school neighbourhoods

and kind of bringing that together.

And we're also seeing really encouraging results from sort

of proactive and personalised care through social prescribing.

So, using the JOI tool, we've been able

to evidence significant reductions in GP contacts

and in A &E attendances and in fit notes being issued

to patients who have been supported by social prescribers.

And the proactive frailty work is really showing some value

of that early intervention with all patients now responding

through the patient reported outcome measures

and that they're feeling better able to manage their own care.

So really positive outputs from patients through that.

And we're now looking to ramp that

up to covering 4 ,000 patients this year through support

from the TVIF funding with the ICV.

Looking ahead, context has changed slightly

and you have already been briefed at the last meeting

on the NHS England neighbourhood health framework

which was published in March.

And that gives us a really clear direction now

around this baseline minimum that we need to deliver.

Positively for Buckinghamshire,

a lot of those foundations were already in place.

And there's a lot of green already on that sort of checklist

around that framework.

And so for us now, it's around really kind of ramping up,

moving forward and making sure that that delivery is spread

and scaled across our whole county

where it is appropriate to do so.

Finally, priorities for 26 -27, focusing as I've mentioned

on expanding that proactive care, focusing further

on community health and well -being work as service

and ensuring that's effectively embedded.

Really driving an increase in uptake

of healthy lifestyle support, healthy lives support.

And then strengthening the support for people

with complex needs and multiple long -term conditions.

And finally, real focus on moving outpatient care

into the community.

And one of the successes or soon to be successes is the work

that's gone on with BHT around gynaecology

and fed bucks with that new service being live from the 1st

of October with a real shift in sort of demand

from the hospital now into the community.

So alongside that, we obviously need to continue work

on segmentation, we need to continue work on that sort

of community insights and communication and sort

of care coordination.

But overall, I'm sure I'm not speaking out of term

when I say the direction of travel is very positive.

We're really pleased and proud with the content of that report

and the work that has gone on.

We have that neighbourhood infrastructure

and we are seeing promising early outcomes.

And now we've got that opportunity to kind of build

on the foundations of that as we move forward and develop

that full neighbourhood health plan.

So I think there's an ask of you all today to endorse

or recognise the progress, endorse those 26, 27 priorities

and then to help us to support the development

of that full neighbourhood health plan.

Cllr Isobel Darby - 0:15:47

Well, thank you very much, Bobby.

I mean that is huge to the battle fruit, but you know it's really really positive stuff and

It's what what everybody wants. It's what?

individuals want in terms of their care or will benefit from

Once they realise that they don't need if you like to go to the doctor in the first place because they're lonely and that kind

Of thing and it's just it's just the whole thing and I'm just taking that as one example

I think my question is to you, and I'll use my prerogative as chair to ask the first question,

is that obviously this is quite a big change which we're being asked to manage,

and do you feel that you have adequate resource to deliver that change?

I think we've got huge ambitions and we've got a long way that we want to go.

Bobby Pozzoni-Child - 0:16:50

And so I think the reality is there will never be enough resource to do all of the things

that we all want to do today.

And so it's about making sure that we are utilising the capacity that we have and making

sure that we can drive as fast as we can.

And I think probably being challenging with each other

in terms of what we do need and drawing down.

I think what's really heartening across the last six months

of time, particularly I would say in the last six months,

but longer than that, is that there's a real feeling

across partners that this is a shared agenda.

And I, you know, certainly in my role and working with Gemma

and looking around the room, you know,

the kind of teams coming together to drive this,

I think is probably where the opportunity is.

It's not about creating a whole new team sitting somewhere

in the middle, but actually drawing the resource together

from the existing teams and organisations.

Lovely. So doing things differently.

Cllr Isobel Darby - 0:17:41

And it's really, it is really encouraging to hear.

And I think, you know, certainly there is certainly ambition

from this board that we work as we work together

to make things better.

Daniel.

Yeah, it's probably just worth adding to what Bobby said.

So as part of our planning for this financial year,

we use some of the growth.

So we have the innovation fund,

Daniel Leveson - 0:18:02

which I think we've been updated about.

And we've held some of the innovation fund back

to support partnerships over the course of the next six

to 12 months to accelerate some of that as well.

So as far as additional capacity,

and I'll talk about it a little bit later on,

we've appointed a strategic development partner

to work directly with partners

to accelerate some of this stuff,

recognising that different partnerships

are at different stages of development in the system.

Thank you very much.

We've got David.

Cllr Isobel Darby - 0:18:31

Thanks, Bobby.

Really good update.

David Munday - Director of Public Health - 0:18:37

And it's three really quick kind of reflections or thoughts

from my point of view.

On the priorities of 26, 27, it's really good that we've got

that healthy lives kind of ambition.

So I think earlier in the report it described some

of the outcomes we're already seeing in terms

of smoking cessation kind of numbers people supported.

And I think that really speaks to the point you were making

about how strong the partnership is when you asked

about the capacity thing because it feels

like doing that's a team sport.

It's not simply about commissioning a service

or it's not simply about identifying patients.

It's about having that kind of rounded approach.

So kind of really welcome that.

That's kind of first reflection.

And then the other two just read the action plan.

I had a look back at what's

on the Joint Strategic Needs Assessment kind of work plan

for the next few months just before the meeting.

And I wonder if when we do an update on the evidence

and data part to the action plan, we can capture some

of that work a bit more clearly.

Because the data that, and we'll talk about it in a bit

on the Director of Public Health and your report,

we're putting into the JSNA

so that that wider determinants data is available.

There's a chapter that's updating on inequalities.

There's one on demographic shift and modelling for the future.

There's another on mental health.

There's one on HIV.

There's a lot of really important stuff.

And I'm not sure we always kind of publicise it or share that

well enough, which is, I think, probably a fault of mine.

And we could probably do a bit more on that.

But I wonder if there's an opportunity

to just capture that a bit more in the action plan going

forward.

And then finally, and I think it's

and I know everyone in the board knows

we had the Chris Whitty visit in July,

so since our last meeting of the board.

But we got a chance to show Chris the Healthy School

Neighbourhood work, which sits under that equity lens

work that you were describing.

We got to show him the proactive frailty work as well.

And I just wonder if we, and he was really impressed by that,

like genuinely impressed by that.

And I wonder if we shout enough about the things

that we're up to here.

Because I think there's some work that's

really positive that isn't happening everywhere.

And I wonder if we're kind of flying off like enough kind

of regionally and nationally.

Who am I going to?

George or Bobby?

Cllr Isobel Darby - 0:20:51

I think I'll just pick up on that last point.

Bobby Pozzoni-Child - 0:20:54

I think that's something we've possibly all recognised,

is that particularly from the Claire Fuller visit with the ICB,

which David, you were at as well,

the feedback after that was incredibly positive

around the Buckinghamshire foundations

and the programme that we have to date.

I think we see that.

So, for example, there's a nomination for a HSJ award

for the proactive frailty work,

and we're starting to be invited to share more widely

out of our area, out of our place actually,

around the work that's going on.

But I think we're probably not championing ourselves

internally and externally well enough.

And to that end, we've got a communication and engagement,

very experienced, comes an engagement lady joining the team

to support us in some of that as well,

which I think will be really positive.

And I just wanted to pick up your point

around the sort of strength of partnership.

And I think we've all sat here and agreed

that actually we have a really positive partnership

and working relationships.

One of the other things that was in the report

that we were particularly proud of was the response,

the staff responses where we put out a kind

of a net promoter score around staff activation

and engagement with the neighbourhood programme

and it's the third time that we've done that.

And we've seen an increase in responses

but actually we'd also seen 83 % of people were saying

that they've made additional connexions outside

of their team across services and with other providers

and for us that was a huge win because that was one

of the sort of key drivers.

it shouldn't just be about leaders sitting around and knowing each other, but actually on the ground,

does this start to make a difference? And that was something we were incredibly proud of that's

Cllr Isobel Darby - 0:22:29

reflected in that report as well. Thank you. George? Yeah, I think just maybe a bit of a comment

Dr George Gavriel - Director, Bucks GPPA - 0:22:33

and an expansion on David's point. I think we've been doing this for a while now, whether we've

called it neighbourhoods or not. And I think all of us who've been involved for many years,

I think we've always done it because we think it's the right thing to do and it's what our community tell us,

what our representatives tell us and it's just the right thing to do.

And I think that comes back to your resource question in terms of actually this hasn't been resourced up till now.

We're starting to see that come through with TVIF and things like that but the reason that we've been able to do this

is because people have resourced it themselves,

you know, whether that be Buckinghamshire Council

or primary care in Bucks or BHT or other providers.

So I think that's the first part.

But I think where we've got to now is,

I almost feel like NHS England is catching up with us.

And actually, I think a big part of what I think

we should be doing better,

I think there's a bit of a duty to do it,

is I think we're all at national forums

and we're all influencing ourselves,

you know, places like, you know, NHS Alliance and other forums.

I think we maybe need to think more about going out together

and actually saying, do you know what, this is us all together,

you know, not just me in a primary care forum or, you know,

Zener or Craig, a local authority forum,

but actually saying that this is neighbourhood work,

this is what it should look like, this is best practise.

And it works because we're doing it together,

we've designed it together with our providers and community,

with the ICB support and I think that might be something I'd maybe like to, I think,

push a bit more because I think we're still promoting it in a siloed way even if we're

not working in a siloed way anymore.

Thanks very much George.

Craig?

Cllr Isobel Darby - 0:24:19

Yeah, it really helps.

Do you want to?

No, it's not.

Craig McArdle - Corporate Director for Adult Social Care - 0:24:22

Really helpful to report, Bobby, thank you for that as well.

I was really heartened to see the progress as well.

I think sometimes we have to challenge ourselves on some of the areas we're not quite so good at.

And I think one of those areas for development is working with our communities.

And it was really good to see referenced in there as well that you're doing some work on that.

So you've answered a lot of questions, Bobby. So this is more for Kate and Zoe.

The Community Insights Workshop, et cetera. Just wondered how that went, what the outputs were.

And what we could learn going forward from that approach would be really useful.

Cllr Isobel Darby - 0:25:03

Zoe McIntosh - Healthwatch Bucks - 0:25:08

So the community insights workshop we held a couple of months ago, it was really well

attended and there is a clear kind of appetite from all our kind of VCSE colleagues and everyone

who attended and local authority colleagues who attended to think more about how we capture

Zoe McIntosh - Chief Executive, Healthwatch Bucks - 0:25:29

community insight and feed it in to some of this work. We were also mindful of the

fact that the that the ICB had been doing some work on a wider

insights bank so we were kind of mindful of that and how we feed in that place

insight and how we get you know ring -fence that place insight for place

as well. So I think we saw it as the start really of that work.

Cllr Isobel Darby - 0:25:58

Kate Walker - 0:26:02

I think it's a really great report and I think there's been a lot that's happened over the

last year, probably longer, but I've only obviously been involved in the last year and

I think Craig you're right, I think it is from a voluntary sector perspective, I think

we've started and it's really great that we've got pilots in Aylesbury and Wickham, but one

of my reflections was it would be great to see maybe one of the actions on there

to look at doing more to engage or involve the voluntary sector in

communities using that as an example or using best practise from elsewhere as

well over the next year as part of those priorities and I know we talked lots

about it and so I know it's in the agenda and there's lots of reference to

the voluntary sector being key to neighbourhood health so I think there's

more we can do. And yes, that insight session was just, I guess, a starting point. And if

I'm honest, it's a beast. And I think I'm not sure anyone has cracked anywhere how you

capture community insights, unless there's somewhere that we don't know that has captured

it, please do share. And we know that the ICB are doing some work on insights as well.

So I think how we feed that in is definitely something that we need to continue to crack,

Kate Walker - CEO, Community Impact Bucks - 0:27:22

but we haven't nailed it.

But there's a huge amount of appetite.

There's a huge amount of knowledge as well.

Like we all hold insight and information through like commissioning reports,

through you know, from all sorts of angles,

but we're not great at pulling it together or sharing it.

So it's not that we have to go and start afresh.

The information's there, but it's just how do we bring it together.

Yes, thank you very much Kate.

Cllr Isobel Darby - 0:27:45

And I think that's the thing, especially with voluntary organisations,

we're all coming from our own organisations where we, if you like, know the rules and know the structure.

And then there's all these amazing voluntary organisations who each have their individual rules and structures and whatever.

And they could be different in different areas.

And it's how you get everybody to work together.

and I don't know the answer, but I think certainly people are absolutely willing to do it

because let's face it, every volunteer is there for the right reasons.

It's certainly not to get paid because they don't get paid a lot of them.

And it's, you know, there's so much there and it's actually how we draw on that.

But remember to appreciate them at the same time because without volunteers we'd be lost.

Kate, do you want to come back on that? And then I will go to Andrea.

It's a slightly different point, Chair.

Kate Walker - CEO, Community Impact Bucks - 0:28:39

But I think the other thing, I think just in relation to the action about signposting around healthy life services and healthy life support,

which quite a lot of that will sit within the voluntary community sector, not everything, but quite a lot of that will sit within that sector.

We just need to be mindful and probably keep a cheque and challenge on ourselves around what the impact of that is and whether or not that then,

whether there's any investment that needs to follow within that.

So we are hearing that there's an increase on demand

in some of these areas and in some of these services.

So it's just something for us to, I guess, be mindful of

and ensure that we are, as a partnership,

checking and challenging ourselves on that,

so that we're not reducing demand in one space

and overloading it in another,

and I guess hiding the impact of that cost elsewhere.

So it would be really good to continue that

over the period of the programme.

Thank you. Andrea.

Cllr Isobel Darby - 0:29:32

Yeah, thank you.

I echo all the comments about how much progress has been made.

It's really quite phenomenal.

Andrea Young - 0:29:40

So I agree with the promoting and publicising progress.

I've got two sort of small operationally type points,

which I could take offline,

but I'm really interested in the frailty work

and what sort of multidisciplinary team is involved

in trying to support those people,

either during the assessment or afterwards.

And I'm just obviously thinking with an Oxford Health hat on,

what does that look like?

Then secondly, when you're going to complex needs for next year,

just wanting to cheque in that mental health is,

you know, you're getting what you need from us.

And then coming up a bit of a level to where David came in.

I admire and respect the fact

that you stayed with a few key priorities because it's so easy

to suddenly overload a new collaboration

and suddenly say let's do this, let's do children,

let's you know go everywhere.

But I guess that also then leads me to ask the question

if we do these initiatives what's the impact

or the outcome we expect to see shift and change which I hope

or guess is wider than non -elective admissions,

although that's clearly, you know,

a big cost releasing opportunity cost.

Do you have that in mind?

These are the outcomes or these are the indicators

or JNSA metrics that we'd expect to shift over time.

And I don't know if that's in your thinking,

but not yet explicit.

So sorry, that's a bit of a rag bag.

On the first bit, maybe with the operational detail,

I can furnish you with some more information,

but it is a multidisciplinary,

multi -organisational approach in both of those.

Bobby Pozzoni-Child - 0:31:28

And we, Oxford Health colleagues, are very much part

of the kind of design and the thinking as well.

So to reassure you, but we can give you loads of information

around this operational detail.

I think that the second one is much more challenging to sort

of articulate, and I think something

that we've all been saying all along is that actually we need

to hold our nerve with a lot of this because evidence, yes,

OK, great, reduction of GP contacts

and A &E attendances, et cetera.

Wonderful.

But actually, the sort of longer term healthy years

that we want people to be living in,

that is much, much more difficult to kind

of measure and forecast.

And what we're starting to see is a lot of different things

are having impact in different ways.

So I think what I would like us to be focused on

is we start to sort of plan the next year

is better articulating what we're aspiring

to with some of those outcomes.

and also sort of trying to draw the threads together to sort

of try and understand better what has impacted

or what has delivered some of the outcomes

that we're starting to see.

Because it's, I think, probably impossible really

to attribute anything to one single intervention or action.

But I think it would be nice to start sort of drawing some lines

so that we can, I suppose to Kate's point,

start to see the consequence of a reduction in A &E admissions

or the consequence of people, less people smoking

and start to understand that as we go.

David.

Cllr Isobel Darby - 0:32:55

And thanks for the question and the challenge.

And just to quickly add to what Bobby has said,

David Munday - Director of Public Health - 0:32:58

I think that so on, for example, the referrals for healthy lives services,

but there's targets around that.

So it's not simply a let's just try and do a bit better.

Like we've clearly worked through like where are we now,

where do we want to get to, to try and quantify.

but that isn't an outcome, that's just,

that's a bit of a process bit, but trying to be focused.

We have got outcome, we've got an outcomes framework

attached to the health and well -being strategy.

We haven't got it in papers today

because those outcomes link to,

can start well, live well, age well,

and we're doing the principles action plan to update,

but usually we would have 10 -ish linked to each of them.

But what we haven't necessarily directly done is said,

okay, so with these neighbourhood health priorities,

which one of those outcome measures which we've agreed

as a board are our key things.

Are we thinking we're going to kind of be influencing?

And I think that is a good discipline to make sure

that we kind of bring it back to that

because those are the metrics we've said as a board we want

to be positively influencing.

Thank you.

Cllr Isobel Darby - 0:34:04

Is there any more, anybody else wishing to comment?

If not, I'll go to the recommendations we are being

asked to note the progress made against the four strategy principles on the

neighbourhood programme over the last 12 months and to endorse the 2026 -27

priorities set out in section 4 and to agree to review a full neighbourhood

health plan in the future once developed by BEC and in line with the NHSE

requirement. So are we happy with that everybody? Thank you very much. So now we

8 Director of Public Health Annual Report 2026

We have item eight, which is the Director of Public Health Annual Report.

I'll be handing over to David for that.

It seems only yesterday we were looking at last year's,

but doesn't time fly when you're enjoying yourself?

And David has yet again produced something

which is good reading and thought -provoking.

Definitely thought -provoking, David, and thank you.

But I will hand over to you to take us through.

Thank you, Chairman.

And thank you for referencing last year's report,

because that's actually where I wanted

to start with just three simple introductory comments

David Munday - Director of Public Health - 0:35:12

about this year's report, which I

assume people have kind of read from cover

to cover in detail.

And I occasionally get compliments

for the quality of our Harvard referencing.

But joking aside, this is very much a team effort.

So whilst it's got my name on it,

it's very much the team that work with me who have helped

produced the report.

So starting with last year, so last year's report

was entitled Tomorrow's World.

And most people kind of tried to tell me

that they were too young to remember the TV programme,

but I didn't believe them.

But that report was all about the future health

of our county and how we are a growing county,

we're an ageing county.

And despite affluence and overall good health,

when you compare against national kind of averages,

is that the health of our county is not

moving in the right direction.

The reason I start with that is to say that this report then

is telling us a bit more, OK, it's fine a year ago to argue

for let's have some long -term preventative approach

to health and well -being.

The idea of this report is to tell us, well,

how might we go about that?

What are some of those key areas we

should be focused on to help?

So I think that's the first thing to say.

The second thing is the reason I used

the building blocks kind of frame,

is I think that's the right frame

to be thinking about health in.

Because health, as much as we're involved with primary care

services and secondary care services

and really good public health preventative services,

the health of people in Buckinghamshire

doesn't start with those service points.

The health of people in Buckinghamshire

starts with their day -to -day lives

and starts with the day in, day out

of, whether it's the house that they live in,

whether it's the job that they've got and access

to money and resources, whether it's the food that they can

eat, whether it's the community they live in,

whether it's their surroundings, whether it's

their transport options, whether it's

their education and skills.

So the idea of the report was to do that framing to say,

yes, we're busy with a range of these different services

we're responsible for across the room here,

but that isn't actually where health starts,

and we need to pay attention to these key blocks.

And part of that metaphor is to say,

you can have a number of these blocks in place,

but if one is missing, then it can significantly negatively

impact on your health.

So to give an example of that, you

can live in a decent quality house

and have sufficient money to heat it,

and you can eat healthily.

You can exercise well.

You can choose to cycle or walk where

you want to access green space and so on,

have a good and stable job.

But if you live in a community that you feel unconnected to

and feels unsafe and you're lonely and isolated,

then it's equivalent approximately

to smoking 20 cigarettes a day.

So you can have all of these building blocks in place.

But if one of them, in that example, the community one,

is missing, that whole building is significantly weakened

and indeed can fall down.

And the purpose of the report then, and the third thing

I'll say is in those case studies that I brought together

at the end of them of Amir positively and then Lucy

negatively, was trying to show how we, of course,

need to think about these building blocks

that I've just listed as specific areas of focus,

but how they work together.

And done in the right way, you get that positive virtuous cycle and access to green space leads

to physical activity opportunities, leads to community connexions, leads to active

travel.

A stable job means the resources that you need means it's easier to engage and support

in your children's education and in their development and their life chances.

But equally, then, in the example of Lisa,

that negative spiral exists as well,

where if you feel threatened in your community

and you don't want to go out and socialise,

and you spend more time in your home, which is already crowded

or is already damp or is not suitable in other ways,

and you have unstable employment,

and you don't have those sufficient resources,

and the impact that has then on children and their education

kind of within the household, and so you see that negative

spiral.

So the reason again for using that kind of that building blocks frame was to show some of that

interconnectedness that we have between those between those building blocks, so

That's all I wanted to say in terms of the kind of in terms of the kind of content part

I think in terms of then the recommendations and I'm really open up for any kind of

Questions and kind of comment on it if that's okay

is that I think it's my conviction that if we can,

if it's possible to take positive action in this space

anywhere, it must be possible in Buckinghamshire.

And I think there's a couple of reasons for that.

One of them is, and we've touched on some of that strength

of partnership and ambition that I think we've got

among many organisations in this room.

I think that's one of the things.

I think also we start from a strong base in Buckinghamshire

where a lot of residents have a lot of this in place.

And we need to support that where that's helpful,

but also leave communities to be resilient,

and support communities to be resilient,

and provide some of those blocks,

and then provide that support where there are the gaps,

or where people do have it toughest,

and they need that help.

But that strong starting base we have in Buckinghamshire,

I think, is also really helpful and means

that we can take forward action.

So, the last thing I'll say then in terms of the kind

of recommendations and so forth, they're kind of laid

out within the report.

A few thoughts but welcome comments in the room.

I think this leads us to considering what more we can be

doing kind of as kind of anchor institutions within the county.

So, thinking about how we're,

what our procurement practises are,

what our social value approaches are,

our kind of employment policies, how we use our estate

as kind of key organisations kind of within the county,

although there's other organisations as well

as those represented in the room here.

I think it helps us thinking through how do we make those

kind of graduated kind of services and support for people

where there is a universal offer for residents in Bucks,

but then we have some specific focus

on where there are needs for those particular building

blocks that might be missing.

And then as we've got our local plan in development

and we are a growing county and thinking

about how we build well for an ageing and growing population

and have the right infrastructure in terms

including health infrastructure in place,

I think recommendations on that I think are important.

And on a slightly more kind of patient by patient kind of level,

I'd be interested in people's reflections, you know,

thinking in primary care, for example,

like how many consultations kind of that we,

kind of at the GP's door every day are being driven

by these building blocks and how are we best supporting,

while someone might present to a GP with a particular issue,

like how are we helping get under the skin

of that a little bit more and under the bonnet to address some

of the driving issues, how do we ensure we're supporting

homes to be warm?

And as we come to winter plannings,

I know it feels like we've only just got through heat waves.

Winter planning is very much happening.

How are we ensuring homes are warm to reduce

some of the throughput because of respiratory and CVD issues

in A &E and other forms of urgent care,

but also on the discharge home?

And then as we're doing the neighbourhood health planning,

thinking about, well, if these building blocks are

and these seven areas of focus, how are we co -locating services

and providing that kind of holistic support,

not simply thinking about primary and secondary care.

So there's a number of recommendations in the report,

but I think those are kind of areas which

I feel are most relevant for the health and well -being board

particularly.

So I'll stop there and really welcome any questions

or comments on the report and where

we think there might be opportunity to move forward

Cllr Isobel Darby - 0:44:05

with some of this. Thank you very much David. So I've got Raghu and then Daniel to start off with.

Raghuv Bhasin - Chief Executive Officer, BHT - 0:44:12

Yes, so huge fan of the report David and I think it is quite fundamental for how we work in

Buckinghamshire and thinking about this. So really support the wider view about health and well -being

or just health and care that focus on these building blocks and we need to do a lot more in

this space to rethink that. I mean, working with Zina, Chief of Executive Council, to think about how we might bring that together more widely across Buckinghamshire public sector and beyond.

So I think it also, for me, plays a slightly different role for the voluntary sector potentially in this space, because it's almost not filling gaps, but it's increasing community assets, increasing resilience.

So over the past few weeks, I spent some time with Linden Gate,

Wickham Homeless Connexion, One Can Trust, the three really important

charities that are part of our communities that are creating that resilience.

So how are we supporting those organisations?

Each of them are working hand to mouth, year and year

to be greater than the sum of their parts through, again,

us being key anchor institutions in Buckinghamshire.

So that's really important.

We've got the voluntary sector event on Monday,

where I think it's a really good opportunity

to have some of those conversations

and do things differently.

I also think one of the points that Dave has made,

but we need to do a bit more of,

is some of the sort of modelling behind this.

So is it more effective for an acute

and community hospital trust to put money

into nutrition in schools

than it is to build another ward.

I mean, crude, I think the answer is yes.

And because I don't think others can do it

unless we decide to do that.

But having that sort of, David and I were talking

about the importance of green spaces early on.

So having that slowly harder nosed,

we're making these resource allocation decisions

on this evidence, even if it's not,

it's never gonna be 100%.

But if we don't start now, we're not gonna be able

to sort out these building blocks right from the start of people's life.

So I think something for us as a board to think through is how we get

how we get in that sort of capability and understanding to then steer

how we use the collective Buckinghamshire pound in the most effective way.

Yeah, thanks very much.

I think that's the thing.

Cllr Isobel Darby - 0:46:38

It's I think that in a way, our relationships in Buckinghamshire

are relatively mature in comparison to possibly other areas where it's not, it's my budget,

it's your budget and I run a hospital and I run a council. It's actually saying these

are our people and this is how we can serve them best and this is how we can spend that

money in the best way. And I welcome, I've heard you say before, if I can see a benefit

in that it's going to reduce my front door, albeit you all of a sudden won't need a hospital

because there'd be no patients, but I think we're a long way from there.

But you're prepared to invest in that, because you can see the long -term benefit.

And I think all of us as organisations, being able to say that,

here's this population, and we can all have an input into making things better,

even if it's not, if you like, our day jobs, putting resources in that direction,

I think that is how we absolutely give our residents the best possible outcomes.

I'm going to hand it over to Daniel,

because I'm hoping he can wait for his question.

Yeah, thanks very much.

I've got one bill, David.

Daniel Leveson - 0:47:45

I've got a question, and then just an area of emphasis,

I suppose.

The build on that, as Raghub was saying,

is something I remember looking at when I was in books.

I'm not sure about nutrition in schools, but that bit about,

we know that people are being admitted

to hospital every year, every winter,

who live in damp, cold homes.

And I think the value proposition there is actually,

would it be better for us to pay their heating bills

because it's a better intervention?

Longer term, would it be better to insulate, replace boilers,

all that?

And we know that it's evident, but it's bringing our data

together.

And then that commitment to do it.

So heading into winter, there might be something

that we could do to identify those people

with multiple admissions over winter

and do something different there,

which would be quite exciting.

particularly as I tried to do it about five years ago

and failed.

My second one, David, was a question just around one

of the things that jumped out at me

was the alcohol -related admissions.

And I just wonder again, that is a stark statistic, isn't it?

And I wonder how granular we can get

other particular areas, particular demographics,

and then link that back to the healthy lifestyles

and the neighbourhood work and something that might be done.

But I don't know whether there are

that we know.

And then my final thing, just on the point to emphasise,

that every year that I do, and like everyone says,

and you've heard me say it for many years,

I do enjoy the annual reports.

I think they're a really important thing.

But one of the things that always jumps out at me

from JSNA's and from health and well -being strategies

and things like that is we know there's a couple of areas

where we are worse than national average consistently.

And one of them is the level of development

for kids eligible for school meals.

And it comes back to that.

And Andrea, I think you said about it's great

that we've got these priorities, but I think that emphasis

on doing stuff with those priority families

from maternity right through to health visiting

and all the work around family hubs,

I think is gonna be really important.

And we might not see the benefit immediately,

but that's the real upstream intervention.

And that's the stuff that we know from Marmot

going back 15, 20 years as well.

So I think it's probably something for us

to really grapple with.

And it's not just Buckinghamshire, is it?

I think that's Thames Valley's kind of issue as well.

And as I say, for a healthy, wealthy region,

it's always the one that jumps out at me.

Yes, thanks very much, Daniel.

Andrea.

Cllr Isobel Darby - 0:50:21

Yeah, really glad you raised alcohol

because I think alcohol is rising everywhere.

It certainly was my experience a few years ago,

Andrea Young - 0:50:33

really shocking through emergency departments

what you're starting to see, and the age is getting much,

much lower, 30-, 40 -year -olds already

with alcohol -related disease.

So, yeah, good, something to do.

David, your question was about role of anchor institutions,

and it's probably top of my mind

because we had an Ofsted review of our apprenticeship programme

just a couple of weeks ago.

500 young people currently in an apprenticeship programme with our organisation,

skilling them up from things like carpentry, cyber security,

I hope they are doing some carpentry on our wards,

but in estates and obviously lots of the jobs that we have in the NHS.

I just wondered to what extent we could aggregate that to see what that picture looks like,

because that is about skilling up the young people

who live in our areas.

And of course, once you've got a job, you've got a profession,

you know, there's lots of benefits that accrue from that.

And I really just genuinely don't know

what that looks like across Bakhimshah, for example.

Andrea Young - Chair of Oxford Health NHS Foundation Trust - 0:51:41

So I think that's an area.

I think, I mean, regressively, it's still the situation

that our own staff do not look very healthy in the NHS.

so I think there's a role we consistently have to play.

It's associated with the dreaded 12 hour shifts

that everybody loves,

but it's really hard to shift people out of them now.

But healthy lifestyles are something we really need

to take seriously in our own organisations,

and I think you should be holding us to account for that.

And yeah, and I think the point that you made

about connecting people up,

So I think the more opportunity people have to kind of see what young people.

So I'm thinking as well about needs because I think that's quite a big issue.

You don't mention it specifically but I know it'll be in your report young people who are

not in employment or education and their huge overwhelming predominance in our mental health

demand that is rising and how we get to the bottom, you know, how we start to tackle that.

So I think sort of getting people into skills, into jobs,

connecting them at their neighbourhood level to try

and find out what's available, supporting them in schools,

all of those things are really important because you talked

about the five -year -olds or the under fives,

but that cohort is very worrying as well,

who are coming through now.

So I don't know if you've got any comments

about any of those things.

So thank you.

And so just a few things to come back on then, if that's OK.

David Munday - Director of Public Health - 0:53:19

So I think the green space point,

is really kind of welcome.

And I completely agree.

I'm looking forward to the event on Monday.

And thinking about how are we ensuring

we're doing some of that, building community resilience

and so forth.

I think that's really important.

On the specific point on alcohol,

So, this is something that we've seen rising over the last five years, and the local data

from BHT shows that 65 % increase over five years of people admitted with an alcohol -related

kind of issue.

In terms of the granularity of that, what we see in alcohol is that whilst consumption

patterns are often maybe slightly simplistic to say, but consumption patterns don't necessarily

very wildly across the county or across different population

groups, the harms do.

And we see the harms significantly kind of higher

in areas of greater general kind of deprivation,

general kind of health inequality.

And there's a couple of things that we're doing,

but I feel like there's more that we kind of want to try

and push on this.

So one of the things is kind of Raghu and I are together kind

of funding and establishing an alcohol care team

within the trust so that people who are admitted in

have that kind of more holistic support.

And this isn't simply people that

admit to what might be in mind of kind of in -liver failure,

but it's people that are admitted where alcohols are

likely to have been a contributing factor to a range

of illnesses, actually, and how are we then

providing that support, how are we using the One Recovery Bucks

service that we've got in Berkshire that performs well

to support those individuals.

We're also, as a council, using some of that fairly granular data we've got now into, to

feed into our licencing committee so that we've, to the licencing committee, have got

an opportunity to review actually what are some of the kind of local harms that we see

due to alcohol to help that inform decisions about licencing, so repeat licencing applications

or new applications so that we're able to kind of have that kind of full view from that

kind of licencing perspective.

We also ran, and we did deliberately do it,

just as the World Cup was ending,

some kind of public awareness thing.

I think there's a bit of a sense that there isn't quite

the public awareness of some of the harm here.

And obviously, with alcohol, it's a bit more,

there's some challenge because, A, it's

legal compared to some other substances that people use.

And also, the kind of overall kind of health guidance

isn't to say, just don't do it in a way that it's just maybe

slightly easier.

Not that it's an easy message, but it's an easy message

with tobacco.

So there's some nuances to how you message in alcohol,

which I think we need to keep building on.

And I think it's a partnership, something we can work on.

And then absolutely to the kind of warm homes,

and the boilers, and the insulation, and so forth,

Dan, I think that's absolutely something we need to push

forward on.

And it feels like that data kind of bringing together

or data in order to identify those cohort of people

effectively and then look at what

we can do to intervene, feels like, within the art

of possible.

And then broadly thinking about the,

which then picks up the points about kind of neat

and probably anchor as well with the best start.

I think, and it's kind of within one

of the chapters of the report, you

can draw almost a straight line, I think,

between the outcomes at a 2 and 1 1 2 -year -old's health

visit to cheque when they have an ages and stages review

to see how they're developing, with then their school

readiness assessment, age four, and their readiness

to learn and thrive at school, with school attendance,

with school attainment, with then the risk of NEET,

and then the thing about lifelong learning,

and do you have a job, or do you have a job that actually turns

into a career and something which is meaningful and rewarding.

And it's essentially, you just draw that line through,

and we know the cohort from age two.

And you can, not to sound kind of pessimistic,

But you can predict then who is at risk of being neat

and then kind of longer term.

So there is something long term in the best start part.

And I think the best start in life family

hubs are really important.

But I completely agree with the point of virtue.

There's a cohort who are at risk of needs now.

And we see mental health challenges

that are a significant risk factor for kind of neat

and that need to intervene.

So I haven't got all the answers to that.

But I guess I'm kind of agreeing.

And then finally, on that anchor institution bit,

I think it would be really interesting to do

that mapping to understand.

So you've described some of the apprenticeship work

at Oxford Health.

But what are other organisations doing

to make the best, kind of provide those best

opportunities locally?

Because it's all about creating those chances to then people

to be able to flourish and people to be able to thrive.

And I think there's, I agree, there's

work we could do together on that.

Cllr Isobel Darby - 0:58:24

Thank you, David. Is there anyone else wishing to speak on this item at all, ask any questions?

So are we happy to note the report?

I know so much, that sounds almost not quite enough, isn't it?

Because so much work has gone into that report

and I think each organisation we're probably quite happy to.

It's made us all think and reminded us of a lot of the reasons that we're here

and make us all think and focus on what we can do in our individual organisations

to look at these building blocks.

So we're really happy to note the report.

Thank you very much.

Right, the next one is the Buckinghamshire Executive Partnership,

9 Buckinghamshire Executive Partnership

which is on page 125 of the pack.

And the lead officer is Raghu.

And I think you'll go through it for us, yes?

Yes. Thank you.

6 Public Questions

Yes. So, Buckinghamshire Executive Partnership is the executive group that sits under the health and wellbeing board that delivers the programme on behalf of the health and wellbeing board.

Raghuv Bhasin - Chief Executive Officer, BHT - 0:59:30

What we've got here is a short report which sets out some of the work we're doing and what we've been discussing.

As you'll see, we've talked in detail about building lots of health work.

We've talked about the neighbourhood programmes in detail

and we also looked at road map on prevention

and health and quality.

So, I think quite a lot of what we've done, talked about,

it's mirrored in the conversations here.

One thing I would flag is we're doing some work at the moment

to try and review the sort of resourcing and governance

for the programme more broadly to ensure

that we've got the right focus as we try

and deliver a bigger scale.

So I think we're, by the end of this year,

we will have touched thousands.

Next year, we should be touching tens of thousands.

So what's that mean?

And I think that we'll be able to bring that forward

to the next Health and Wellbeing Board.

But happy to take any questions.

Lovely, thanks very much.

Have we got anybody who wants to ask any questions

or pass any comments?

Cllr Isobel Darby - 1:00:34

Oh, okay.

So we are being asked here to,

Well, it's for information and discussion, so I guess almost to note again.

So is everybody happy?

I feel a bit mean that nobody wants to say anything to the group after all that hard

work.

I think we are all so aligned and having conversations.

Andrea's going to go.

I'm sorry, Andrea.

I do have a quick one.

To what do you attribute your success at Bucks Executive Partnership?

Because you have made a lot of things happen.

Well, it's all me, Andrea, isn't it?

Raghuv Bhasin - Chief Executive Officer, BHT - 1:01:08

So I would say there's a few things.

So I think there's been a real focus on relationships

for the past decade.

So starting with Neil and Rachel,

the previous chief execs of the council and trust.

They built strong relationships.

Andrew McLaren, who's the chief medical officer of the trust,

and his predecessor Tina Kenny with George

and their predecessors in GP land.

So we've actually had those relationships

where we've got over quite a lot of the,

can we be honest with one another, can we sort things out.

And then just, I think we have, as George said earlier,

we've just backed it.

So three years ago, we invested in primary care,

clinical assessment service, no other place did that,

because that was seen as trust money.

Two years ago, we put in place the Director

for Intra -Ved Care.

This year, we're putting more money into things

like loneliness, and we just kind of act ourselves to crack on with it.

I think it's yeah, I think it's relationships and mindset

as opposed to structures and processes.

Yes, thank you.

And I think it is just that, you know, saying again,

Cllr Isobel Darby - 1:02:21

it's just that willingness of people to to sort of cut the barriers

and just get on with it and look at those people that we are trying to look after.

Daniel. Yes.

Daniel Leveson - 1:02:33

But I have the luxury of being able to look across this as a whole system, right?

And compare it.

And I think like Raghu says, I mean, the time that has been spent

and the effort and energy on building the relationships,

building the partnerships shouldn't be underestimated.

I think there is a couple of things that that that

do help the ingredients in Buckinghamshire.

And I think we've always recognised this are really fantastic.

Having a large integrated acute and community trust is a real benefit.

Having a federated, well -led, experienced primary care is a real benefit.

Having a single unitary authority is a real benefit.

These are things that, like I say, when I look across the rest of the system,

we don't necessarily have.

There are other differences in there, but I think we shouldn't underestimate

not only the time, effort, and energy, but the ingredients that we have in

Buckinghamshire for success.

And I think that was something that Claire Fuller also noted

as well as the type that it just feels like we're at that crest

of a wave.

And let's use that momentum to keep going and go further.

Yes, thank you.

Thank you very much, Daniel.

Cllr Isobel Darby - 1:03:46

And I think one of the things certainly

it was a little bit of a ripple with Neil and Rachel

both leaving their posts very close together.

And I think I would like to take this opportunity to pay tribute to both yourself, Raghu and to Zeena,

for hitting the road running and this seamless transition from two people who had a really good working relationship,

to be replaced by two more people who've got a really good working relationship.

And I think we are just so fortunate to have that, because in a new job you've got a lot of things you can invest time in,

And you have both chosen to invest time into this.

And I think that it is a really admirable thing.

And thank you both for seeing us watching,

which probably isn't because she's probably far too busy.

So is there anybody else who wants to make

any comments on this one?

So what we need to do here is information and discussion.

So we've discussed, I think we're fairly happy.

And all these things are coming to the same things,

aren't they?

It's the same bits that we're looking at.

And I think that's what you showed.

We're all on the same page.

So fantastic.

So our next item is item 10, which is the Health Watch

update, which is on page 129 of the pack.

10 Heathwatch Update

And we've got Zoe and Alison to talk about this.

Or is it Alison, are you doing a double act?

No, Alison's going to present the report summaries, I think.

But just picking up on what you just said, I think both reports,

there are kind of clear parallels between what we were talking about in terms of neighbourhoods,

Zoe McIntosh - Chief Executive, Healthwatch Bucks - 1:05:28

but also in terms of the building block reports as well.

Over to you, Alison.

Thank you.

So we have two reports.

I'll look at the rural community one first and then take any questions.

Alison Holloway - Healthwatch Bucks - 1:05:44

Both we collected feedback between January and the end of May this year.

So the rural communities, we hear a lot from the towns.

We go out into opportunity box wards.

So our urban population we hear from quite a lot.

So we went out to the rural communities

to see if they faced different challenges

in terms of their access and experience of healthcare.

We talked to 229 people.

We went out and talked to people in focus groups,

but also had an online survey.

We'd like to thank local magazines and the social media,

in the north in particular for getting the message out there.

So our reports, I will just pick up on a few highlights in terms

of our key findings and the recommendations we made.

So half of the respondents were currently concerned

with their physical health, and a third told us they were

concerned with their mental health.

Both groups, they saw that good health and well -being was

around being fit mentally and being active,

but also having a good quality of life.

Those who had a long -term condition, though,

put more emphasis on living without pain,

being socially involved, independent,

and knowing that the NHS was there when they needed it.

The positive feedback was three -quarters of respondents

felt that their overall health was good.

Many had undertaken the screening options

that they'd been offered and had thought

that the cholesterol and blood pressure information they got

was helpful.

However, half were looking for advice

about exercise diets and weight loss.

They were hoping that it would be more helpful

than they found it.

83 % of respondents had had their blood pressure checked last year

and 65 % were satisfied with using their local health

and social care services.

There were barriers though particular for those living

in rural locations compared to those living in towns.

So an example of this in digitisation

was that a quarter of people saying there were barriers

were saying they didn't have good enough

internet connectivity at home,

they couldn't afford to pay for it,

or they didn't have the knowledge or confidence

to use the IT that was required.

Where there were no other options offered,

this did result in some people

not seeking health and care services.

Not unexpectedly, transport is more difficult if you live in rural locations,

particularly in terms of secondary care.

Some people told us they travelled over two hours to attend appointments

because of the time required to find the parking spaces, wait for busses,

wait for connexions, not just the actual time to travel.

Access to services.

There were examples of people who struggled to get to services.

So, for example, carers can only get to an appointment

if they had someone else to look after the person they cared for.

Others could only get to appointments if the carer could actually accompany them.

This becomes more difficult if you have longer journeys

or the journeys require more public transport.

We made several recommendations to a range of organisations,

including Buckinghamshire Executive Partnership,

Buckinghamshire Healthcare Trust,

Buckinghamshire Council, and Thames Valley ICB.

Again, full details can be found in our report

and be read on our website.

Some examples included to ensure that the remain ways

for people who struggle to use digital tools

to get the care they need,

to continue to promote the work of social prescribers,

Age UK Bucks, the Joy App, and other services

which can reduce socialisation, provide support,

and help people locally.

to minimise distances travelled.

So that is looking particularly at secondary care appointments

and enable residents to have a choice of an appointment

at their nearest medical unit if that is suitable for them

and obviously for the care that they require.

And to continually publicise local community transport

and the healthcare travel cost scheme

to help those who may qualify.

Would anyone like to ask any questions before I move

on to the next report?

Cllr Isobel Darby - 1:09:54

Let's focus, George, your hands up.

Yeah, so I probably should declare conflict of interest

Dr George Gavriel - Director, Bucks GPPA - 1:10:01

as a rural GP in this.

First of all, I just think it's a really needed report,

so I'm really grateful.

And I know my patient registered with my surgery will be,

as will many in Bucks.

I think it ties in really well as well

with the Chris Whitty visit.

So obviously David's team facilitated a visit

from Chris Whitty where there was a large focus

on rural health care.

and a big part of his annual report is going to be focused on that.

I was very grateful that he asked me to comment on his initial draught as well.

So I hope that I've been able to give some Buckinghamshire context

on the aspects around rural general practise and primary care.

I think I just actually to highlight some of those if that's okay

because I think they're quite complementary to your report.

I think there was a big part of that around travel and transport links.

I think it's really important for us in our programme to be mindful of this.

There's a lot of directives from NHS England around neighbourhood work.

If you look at, you know, neighbourhood health centres, we're looking at a neighbourhood health

centre in every neighbourhood.

I, you know, was quite frank in my response that I don't think that will work in large

parts of the country.

I think if you look at some of our rural areas, particularly in the north, extremes north

and south of the counties, you're looking at well over an hour travel distances.

So to simply say we're going to have a rural hub in Buckingham, let's say, that doesn't really service Edlesboro.

So actually, I think that's an important thing that we need to remember in our local context.

And I think, again, when we're looking at planning services going out to the community,

we need to be mindful that having one building in a rural neighbourhood isn't going to suit our population.

We need to make local adaptations.

I think we also have issues around workforce.

I think we're really blessed to have Bucks Health Social Care Academy,

but recruitment for workforce in rural areas is really challenging.

And when you've already got access challenges in those areas,

the fact that it's hard to find qualified nurses, other healthcare

and non -healthcare professionals in those areas are really difficult.

And we rely on local communities.

So, you know, in a branch surgery, you're relying on people living

in that village to service that community in all aspects.

So really highlighting that.

And then the third part of that is we've got wonderful services

provided by community pharmacies.

And I think they're taking more and more of the slack

of supporting both the neighbourhood programme

and healthcare in general with things

like discharge medication reviews,

contraceptive services, hypertension,

and minor illness support.

But our rural communities often don't have access

to those services.

I made a comment that I think there needs to be consideration

about supporting that type of service delivery

from dispensing practises,

which in many rural communities take the place

of community pharmacy.

So I think, again, I kind of note

that this is really important report.

I'm really grateful for it.

And our residents I'm sure will be as well.

But actually, we need to be really mindful

about when we're designing our services to make sure

that we adapt for that, particularly

where I think an awful lot

of NHS England policy is quite London and urban centric

and definitely isn't necessarily appropriate

for our populations.

Thanks very much, George.

David.

Yeah, thank you.

Cllr Isobel Darby - 1:13:26

Two just quick things.

Firstly, it was positive to hear that people

David Munday - Director of Public Health - 1:13:31

were kind of connecting the dots regarding

some of those healthy lives kind of initiatives

and how they could be kind of improving their health.

But I think what I heard you say is that people

felt a bit underwhelmed by some of the advice

or support they got.

So if there's anything that me and my team,

and this may have come out in the recommendations,

can learn or feedback to our provider

to ensure we're giving people what they need,

not really ears are open to that.

And then the second point was on that,

more broadly on the rural part, one

of the things that's been stewing in my mind

since the Chris Whitty visit and doing the annual report

almost at the same time was that I didn't approach the report

thinking about what the rural frame was for each of those seven building blocks.

And I suspect there is some subtlety and difference on whether we're thinking about employment

opportunities, whether we're thinking about housing.

Obviously you're talking about transport.

And I wondered if you had any kind of almost more incidental insights.

It wasn't necessarily what you primarily were asking about that would help with some of

that understanding of, okay, so when we're thinking about building block A or B or C,

what is the rural lens or nuance that we need to be considering

in order to be effective because it is an important,

well, a key feature of Buckinghamshire.

Cllr Isobel Darby - 1:15:01

Yes, I mean, we asked a set of questions about particularly social care

Alison Holloway - Healthwatch Bucks - 1:15:04

that we didn't get any feedback from particularly and about health,

but they were very specific, they didn't necessarily link in directly to the other buildings blocks.

We've got lots of qualitative feedback that we can go back and look at the themes in terms of those.

And I'm sure like a simple thematic analysis might be just to kind of see if anything else did come through.

Great, thank you.

But one thing I would mention is that in terms of pharmacy first and using pharmacies more,

again there is an issue not only because there aren't as many pharmacies but a lot of the people we talk to

And I know there are young people that live in rural communities,

but the older population are usually the ones that have issues with public transport,

but obviously teenagers too.

But Pharmacy First has restrictions often on age and on people with complex needs.

So those who are older or who have complex needs and who live rurally

will also not necessarily benefit from Pharmacy First.

Cllr Isobel Darby - 1:16:09

Thank you very much Kate you wanted to contribute.

Kate Walker - CEO, Community Impact Bucks - 1:16:13

Yeah thank you and I just wanted to say echoing George's comments earlier really just really

welcome the report and thank you and Zoe you shared it with us at CIB.

So I think what we wanted to just reflect is that we see quite a lot of the same points that you've raised through our rural community council work and through some of our rural services.

In particular, I think the things that we're seeing and that are echoed in the report is

some of the comments around digital access, so accessing whether that's lack of funds

or just broadband access and general access to health services, which you kind of mentioned

already, George.

And through our community transport hub, we've seen a huge increase in the number of people

accessing that for health appointments.

So the majority of people using those services are majority for health,

for health, you know, primary or secondary care health appointments

because they just can't access them from where they live.

Or because of cost, so they can't, you know, access taxis or whatever

other kind of public transport isn't available in that locality.

And I think the other thing just reflect as well in terms of rural,

and it's not something that's in your report, but what we see is that

affordable living is a challenge as well in rural communities.

And quite often that impacts on things like workforce

or the communities that are in those areas, because it prices people out.

So young people end up having to move to towns

or outside of the communities that they've grown up and lived in,

because there's just not the affordable housing solutions there for them.

So, yeah, just thank you.

And we'll continue to work with you on some of the community transport bits.

Thanks very much.

Cllr Isobel Darby - 1:18:11

OK, so our other report was called My Health, My Responsibility.

So the primary kind of starting point for this was,

it's all about preventative medicine moving into the 10 -year plan,

but is anyone interested in this?

Alison Holloway - Healthwatch Bucks - 1:18:22

You'd be glad to know they were.

So again, the same sort of time period, we wanted to know whether they, you know,

to what extent Buckinghamshire residents felt it was their responsibility

to keep themselves well, as well as finding out what they did

to keep themselves fit and healthy.

We approached this slightly different because we were looking at the whole of the county.

We put an online survey on our website.

We had a short in -person survey, which we often called Just Five Questions,

which we take out into the streets, the markets.

We went to Eden, the park in Wickham.

We went into Aylesbury Market and to various other locations.

And then we also held some focus groups.

Just to note that the four focus groups, all the attendees were women.

69 % identified as Asian or Asian -British Pakistani and 58 % lived in the bottom 40 %

of post codes for levels of deprivation in England.

So 430 people gave us feedback and a few key points were,

most people told us they didn't smoke or vape.

Most try and eat healthily, try to reduce stress and drink less

than 14 units of alcohol a week.

Just because it's been mentioned before,

I will say these numbers are very small.

But less than half, mostly women of a variety of ages,

said they got between seven to nine hours sleep a night.

And of the 30 who told us they did drink more

than the recommended weekly amount of 14 units,

most identified as white British, over 45, as a woman,

and did not live in an opportunity box ward.

The numbers are very small.

Alison's desperate to do a project on this,

which is why she's mentioned it.

A lot of the things...

So, a lot of...

You have put in our report that a lot of things we look at,

and we look by age, by gender, whether people have

a long -term condition, where people live,

and by their ethnicity.

And a lot of the things we did not find differences.

So when we find differences, they're usually quite small.

But as people have mentioned it before,

I have just mentioned it then.

So a third of respondents said they did less than 20 to 40

minutes moderate exercise a day.

Some of this was because they found it difficult to look

after, they found they had caring responsibilities

and it was difficult to find someone to take care of children

or other loved ones.

A third of them considered themselves overweight and about

75 of these said they ate healthily.

But half of these were doing less than 20

to 40 minutes moderate exercise a day.

38 % of those who had a long -term condition thought they were

overweight, and the main barriers stopping people living

a healthy lifestyle were lack of time, the cost involved,

and not knowing enough about the places or groups that might

be able to help them.

Almost all respondents agreed their health

was their responsibility.

But to help them do more exercise or eat more healthily

or even manage their well -being better more generally,

60 % wanted more affordable and accessible leisure facilities,

And of the 31 people who said unhealthy food, sorry,

of the 31 people who said unhealthy food should be harder

to obtain, a third lived in the bottom 40 % of postcodes

for levels of deprivation.

So amongst the few recommendations we made

to the Bucks Exec Partnership and Buckinghamshire Council were

to continue to publicise risk factors

which can influence the chance

of a person getting high blood pressure, heart disease,

and diabetes that weren't all well known.

Keep spreading the message that anyone can do some sort

of exercise and not all types

of exercise require you to spend money.

There are lots of groups out there that cater

to either certain types of, you know, women's only,

people who help people with Parkinson's.

There's a lot of groups already doing things,

but people just don't know.

And in line with the latest government active travel paper,

make walking and cycling easier and safer,

so people can choose to bike or walk more often,

expanding Buckinghamshire's network of cycle paths.

Thank you very much, Alison.

Cllr Isobel Darby - 1:22:50

Anybody got any comments on this one?

David?

David Munday - Director of Public Health - 1:22:55

I think some really useful insights there,

and just picking up on just a couple of things that you said.

I think it was really interesting that physical activity

seemed to come out quite a few times in the report.

And of course, we, so the chief medical officer,

we seem to be talking about him a lot today,

kind of renewed his guidance on the 150 minutes a week,

at some point in the summer, wasn't it?

I think it was shortly after the visit to the visit to Bucks.

And I think it's really important

that we capture that point, which

I think you're articulating, that the people that

don't meet 150 minutes, actually, they're

the people who have got the most to benefit from doing

some physical activity.

And the 150 minutes isn't a golden kind of target,

but more any physical activity is

going to be positive for a whole range of physical and mental

well -being kind of point.

So there's something about how we get that message out

in a way that then it isn't simply,

it isn't then putting people off with 150 minutes feels too much

or, well, I don't like wearing Lycra and getting sweaty,

so it's not for me because there's so many things that you could do.

So I'd be, yeah, I'm interested in how we could be pushing more on that.

And certainly as a council, we've included the rate of physical inactivity as one of our key

metrics on our new corporate plan. You've obviously mentioned points about kind of

walking and cycling and so forth, because I think there's things that we can do, but it's not simply,

you know, I think it's a partnership challenge, not just a council one in terms of how we could

So it's probably just more you've kind of triggered some

kind of, you know, some interest and thoughts on that kind of

physical activity cycle.

I think it is really important.

Thank you.

Daniel?

Hey, yeah, thanks very much.

Cllr Isobel Darby - 1:24:44

And I love the reports.

Daniel Leveson - Director for Places and Communities - 1:24:47

Thanks very much for all the insight.

So one of the things around alcohol that, David,

I think you were saying was the consumption seems to,

the trend seems to be fairly consistent.

but the harm is more related to deprivation.

I think that's one of the things that the insight is great.

I'm just really a little bit cautious about my health,

my responsibility as a title generally,

partly because it feels like there are series of barriers

for certain parts of our population

that we have to recognise, prevent kind of stuff.

And some of it is within our control to influence

around policy, around a besogenic kind of environment,

around well lit streets and all of that kind of stuff.

So while this is really important,

I think there's an opportunity, David,

and I think what you're driving at is for us

to take a real proportional universal approach

to how we support people where the barriers

to healthy lifestyle are greatest,

because that's probably the population that we need

to support the most, as opposed to say, you know,

we can all take responsibility.

The fact that I can take responsibility

for my health is probably driven by the fact I have a good job,

I got a good education, and I live in a nice house

and a nice area and all of those kind of things.

Yes, thank you very much.

Sorry.

Cllr Isobel Darby - 1:26:14

So I think I hear that on the title, and I think

Zoe McIntosh - Chief Executive, Healthwatch Bucks - 1:26:18

on reflection we would have chosen a different title.

It does, we do try and make that point in the report though.

Thank you.

Any more comments?

No?

Cllr Isobel Darby - 1:26:28

So I'll be happy there for to note those reports and thank you so much for all the

work that's gone into them.

It brings things home when you see these things, doesn't it?

And it does focus your mind on the subject matter, like the people in rural communities.

And, you know, we all kind of know it,

but actually reiterating that information I think is always

very, very important.

And, yeah, we'll move on now.

So we're on to Thames Valley Integrated Care Board.

That's page 133, and I'll hand over to Daniel.

Yeah, thanks very much.

11 Integrated Care Board Update

Daniel Leveson - Director for Places and Communities - 1:27:05

I think it's a fairly self -explanatory report.

I'll try and just give a very brief update on two things.

One where we are with the kind

of operating model reorganisation,

and then something around the neighbourhoods

that I alluded to earlier.

So from the point of view of restructure,

we are still restructuring.

We're going through tier by tier with interviews

and appointments.

The end is closer.

It has been, I think we all acknowledge it's been a really

long, hard process.

We've tried now to accelerate some of it to get people

in post because it's really critical that we do.

So that's coming much closer.

And I think partly it's been complicated by, A,

the disaggregation of kind of our legacy

for Imli, part of our system, and then the consolidation

emerging into the Thames Valley organisation.

But we do have, we've got an all staff event planned

for the second half of October.

So by that point, most people should know their roles

and at least be in post by then.

So that's quite positive.

The other thing that we've been doing,

I think everyone's aware some of the guidance recommended

that we pass over some delegated funding, some,

apologies, some delegated responsibilities

to organisations that would take them.

So things like medicine optimization

and continuing healthcare.

Some of those devolved delegated functions have now passed

over to Frimley Healthcare.

So while the accountability remains with the ICB,

the responsibility for day -to -day running

of medicine's optimization will sit in Frimley.

It should be a seamless move,

but obviously we're gonna see how things progress

and develop over time,

but that's something that is also happening

at the same time.

So that's where we are with the reorganisation.

Then the second bit is the bit around neighbourhoods

and partnership development.

So, we use some of our innovation funding to go

out to the market to appoint an experienced strategic

development partner over the course of the next six

to 12 months.

Morehouse and National Association of Primary Care

was successful in that competition.

So, Morehouse is a consultant that's worked a lot

around nationally and internationally integrated

care and National Association of Primary Care is a well -known

organisation, hopefully, particularly for colleagues

in working in GPs and primary care more widely.

They're actually leading and working a lot with partners

here on the community health and well -being workers.

So they've been appointed.

The priority for that is to provide us

with a little bit of extra capacity and capability

to accelerate some of the neighbourhood planning.

So we're going to use the requirement,

as has been described earlier, to develop neighbourhood

So we as Thames Valley have to be part of

and lead the development of eight health and well -being plans

under the health and well -being boards,

which I think is really positive as far as the responsibility

to bring NHS and local authority together

and that democratic accountability.

So we're going to work with partners.

It's not a clean, it's not a fresh slate or a clean slate.

We're working with what's already planned and things

like that just to accelerate some of that.

we will look to provide a little,

a level of consistency across Thames Valley

so that we can see similarities,

particularly in some of the stuff

that's the national requirements set out

in the neighbourhood frame work,

and we'll consolidate into a Thames Valley plan.

So that will be the vehicle that we do most of this.

That should be done.

I think we're looking for March deadline

to have plans in place,

which should align with everything

that is planned locally.

And fundamentally, what the other bits that we're going

to do, some of the stuff that we've, we are grappling

with is how we connect, and we've talked a little bit

about it today, how we connect residents, neighbourhoods,

partnerships, and the ICB, that governance and some of the stuff

that Claire Fuller picked up about how we make sure

that at each level of our system we are able to make decisions

at the appropriate level and safely and things like that.

So we'll work with partners to develop governance

and accountability decision making.

We're going to work with our data teams

to make sure we've got consistent outcomes framework.

Again, we've talked about that.

So aligning these five goals that are set

out in the national neighbourhood framework is really helpful.

It sets out things around urgent care, elective care,

GP access and things like that.

So to Andrea's point, these are the stuff that we know the NHS,

we will be required to deliver certain things set

out to us nationally, but then what we'll try

to do locally is align those then

with the local outcomes framework that David talked about,

so it's more meaningful for people.

The other thing that that should enable us to do

across Thames Valley then is to spread good practise.

So where we're getting better outcomes

or different access somewhere, we should be able to learn

from partnerships about what they're doing differently

and spread that.

So as opposed to a traditional red amber -green, reds are bad

and greens are great, we're going to take a much more learning approach to,

and an improvement approach to that.

So that's something that we will do consistently.

And then probably most, for the more developed partnerships, which,

which Buckinghamshire is, start to look at priorities for where we want

to commission differently and some of the stuff that we've talked about as far

as the new types of contracts that are coming out as far as outcomes based contracts,

lead provider contracts and things like that, where we can really aggregate

and then delegate some of the population budgets

out to organisations and contracts.

So we'll try to get some

of those early adopter sites moving quickly.

So there's about six key outputs that we want to work

with the development partner on.

And like I say, I can't stress enough that this isn't going

to feel like a traditional consultancy where they come in

and produce the for us.

They are going to parachute in and work

with our partnerships and our system to accelerate some of the work that's already underway.

And that's really as much as I wanted to say at this point.

There will be an opportunity to look in more detail and we'll do some formal, full communication

about that in the near future.

Thank you very much, Daniel.

Cllr Isobel Darby - 1:33:51

And my goodness, an awful lot has happened and an awful lot still to happen.

And it's a busy, busy time with a new organisation.

Is there anybody who wants to ask Daniel any questions

or make any comments?

So, David.

David Munday - Director of Public Health - 1:34:05

Yeah, just a quick one.

And it feels that with the pace and the kind of complexity

of organisational change and also some of the kind of asks

from NHS England, there I think just as Councillor Darby said,

there's a lot going on, isn't there?

One of my reflections on that is that the risk is

that the ICB kind of just tries to kind of manage that.

And we're really welcome that you

were starting towards the end of what you're saying, saying,

well, actually, this outcomes framework,

we want to then engage with health and well -being boards

on.

And clearly, there will be an ask on a population health

strategy that needs to be developed.

I know that there's an integrated needs assessment

that's being worked.

There's quite a lot happening.

And I think really important that there's

that connexion and engagement with kind of place

with colleagues kind of around the NHS system,

local government, and VCSC, and so forth.

and appreciate the challenge and the risk that it's kind of like with everything going on,

sometimes it's hard to have the time and the head space for that engagement and connexion across.

But yeah, would you agree that that's one important thing to ensure is there?

I think absolutely. And I think with the neighbourhood programme particularly,

that's reinforcing the need to do that.

Daniel Leveson - Director for Places and Communities - 1:35:16

I think there's no way that it can't happen in that way, David.

I think one of the things that I think will change how we do some

of this is, so one of the things that we need to start with,

and I know Bux has done a huge amount of this anyway,

is defining the populations and the geography.

So regardless of the organisational forms

that will change and are changing around us,

those populations and those neighbourhoods is probably

where it begins, David.

So I think that will help us as part of the neighbourhood plan.

But I mean, anyone that's read the guidance,

anyone that's looking through, I think

there's some level of certainty that we must continue

the integration journey.

We must find ways of working with partnerships.

I think the challenge for me and our organisation

generally or across the system is some of the stuff

we're working with a level of ambiguity and uncertainty

that's probably unprecedented and going to continue.

you know, and even some of the stuff that the definitional stuff around what is a place and what is a neighbourhood?

I think we don't we haven't really agreed

But I don't personally think we need to because I think everyone's definition is is valid and legitimate

I think there's a certain set of levels to this like I say so I did intentionally start with

Connecting from resident to neighbourhood into a partnership and then up into the the ICB which is our kind of basic elements of it

Cllr Isobel Darby - 1:36:47

Right, thank you very much and yes it is tricky when all the goalposts are moving.

I think the most important thing is that we do not forget the people.

Obviously from your perspective it's the whole of Thames Valley, from our perspective here it's Buckinghamshire.

It's just so important that we don't forget the reason why we're here which is our residents and the health and wellbeing of our residents.

So thank you so much Daniel for that.

Moving on, we're now on item, sorry, Craig,

you want to say something?

I beg your pardon.

Just to pick up on your report, Dan, which is really helpful.

Craig McArdle - Corporate Director for Adult Social Care - 1:37:18

The new Frimley Park Hospital programme consultation process,

I just wondered what the local engagement had been around that

in terms of Health Watch.

Have you been involved, for example,

have our local HAT been involved, et cetera?

I mean, the proposals feel positive in terms of that,

but I just wondered about the scope and local involvement.

Yeah, I'm not sure where that is, but I know,

Daniel Leveson - Director for Places and Communities - 1:37:45

so Sam Burrows is the, is the exec sponsor on the ICB side,

so I'll cheque in and make sure, particularly I suppose for south

of the county it's really important.

Yeah.

Thank you.

Any more comments at all?

Cllr Isobel Darby - 1:37:59

Going around the table.

So we will now move to item 12, which is the board plan,

which is just there for noting.

12 Forward Plan

And that's for things that could happen at our next meeting,

which is the 12th.

Oh, sorry, David.

I should say, at the last meeting, we had noted

that we'd want to bring through something

David Munday - Director of Public Health - 1:38:18

on the combating drugs and alcohol partnership.

And we've touched on alcohol a couple of times in this,

just in conversation in this meeting.

So if it's okay, I mean, I know we'll look

at formal agenda setting kind of in the round.

But I think that coming through in the November meeting,

in addition to what's already listed would be timely.

Yep, that's fine.

Everybody's in agreement with that.

Cllr Isobel Darby - 1:38:41

I think that sounds like a good, sensible suggestion.

So I think now we have come to the end of the meeting.

13 Date of next meeting

Thank you, everybody, for coming along this afternoon,

sort of back at school after the summer.

Thank you so much, everybody, for your contributions.

And thank you to anybody watching online for your interest.

and look forward to seeing everybody again on 12th November.

Cllr Steve Bowles

Conservative

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Cllr Isobel Darby

Conservative

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Interactive webcast player

Health and Wellbeing BoardThursday, 3rd September 2026 at 2:00pm

1 Welcome

Cllr Isobel Darby - 0:00:00

Cllr Isobel Darby - 0:00:12

2 Apologies

Sanila Hussain - Partnership Support Officer - 0:01:04

3 Announcements from the Chairman

Cllr Isobel Darby - 0:01:14

Raghuv Bhasin - Chief Operating Officer, BHT - 0:02:49

David Munday - Director of Public Health - 0:02:59

Craig McArdle - Corporate Director for Adult Social Care - 0:03:04

Dr George Gavriel - Director, Bucks GPPA - 0:03:18

Alison Holloway - 0:03:22

Zoe McIntosh - Healthwatch Bucks - 0:03:26

Andrea Young - 0:03:30

Kate Walker - 0:03:34

Bobby Pozzoni-Child - 0:03:44

Cllr Steve Bowles - 0:03:51

Daniel Leveson - 0:03:57

Sanila Hussain - Partnership Support Officer - 0:04:04

Cllr Isobel Darby - 0:04:07

4 Declarations of Interest

5 Minutes of the previous meeting

6 Public Questions

Sanila Hussain - Partnership Support Officer - 0:05:13

Bobby Pozzoni-Child - 0:05:53

7 Health & Wellbeing Strategy Focus - Principles/ ways of working including Neighbourhood Health Planning

Cllr Isobel Darby - 0:08:36

Bobby Pozzoni-Child - 0:08:54

Cllr Isobel Darby - 0:15:47

Bobby Pozzoni-Child - 0:16:50

Cllr Isobel Darby - 0:17:41

Daniel Leveson - 0:18:02

Cllr Isobel Darby - 0:18:31

David Munday - Director of Public Health - 0:18:37

Cllr Isobel Darby - 0:20:51

Bobby Pozzoni-Child - 0:20:54

Cllr Isobel Darby - 0:22:29

Dr George Gavriel - Director, Bucks GPPA - 0:22:33

Cllr Isobel Darby - 0:24:19

Craig McArdle - Corporate Director for Adult Social Care - 0:24:22

Cllr Isobel Darby - 0:25:03

Zoe McIntosh - Healthwatch Bucks - 0:25:08

Zoe McIntosh - Chief Executive, Healthwatch Bucks - 0:25:29

Cllr Isobel Darby - 0:25:58

Kate Walker - 0:26:02

Kate Walker - CEO, Community Impact Bucks - 0:27:22

Cllr Isobel Darby - 0:27:45

Kate Walker - CEO, Community Impact Bucks - 0:28:39

Cllr Isobel Darby - 0:29:32

Andrea Young - 0:29:40

Bobby Pozzoni-Child - 0:31:28

Cllr Isobel Darby - 0:32:55

David Munday - Director of Public Health - 0:32:58

Cllr Isobel Darby - 0:34:04

8 Director of Public Health Annual Report 2026

David Munday - Director of Public Health - 0:35:12

Cllr Isobel Darby - 0:44:05

Raghuv Bhasin - Chief Executive Officer, BHT - 0:44:12

Cllr Isobel Darby - 0:46:38

Daniel Leveson - 0:47:45

Cllr Isobel Darby - 0:50:21

Andrea Young - 0:50:33

Andrea Young - Chair of Oxford Health NHS Foundation Trust - 0:51:41

David Munday - Director of Public Health - 0:53:19

Cllr Isobel Darby - 0:58:24

9 Buckinghamshire Executive Partnership

6 Public Questions

Raghuv Bhasin - Chief Executive Officer, BHT - 0:59:30

Cllr Isobel Darby - 1:00:34

Raghuv Bhasin - Chief Executive Officer, BHT - 1:01:08

Cllr Isobel Darby - 1:02:21

Daniel Leveson - 1:02:33

Cllr Isobel Darby - 1:03:46

10 Heathwatch Update

Zoe McIntosh - Chief Executive, Healthwatch Bucks - 1:05:28

Alison Holloway - Healthwatch Bucks - 1:05:44

Cllr Isobel Darby - 1:09:54

Dr George Gavriel - Director, Bucks GPPA - 1:10:01

Health and Wellbeing Board
Thursday, 3rd September 2026 at 2:00pm