To receive apologies for absence and any substitutions notified to the clerk before the meeting.

The following apologies were reported to the meeting by the Chair:

Dr Julian Povey – Clinical Chair, Shropshire CCG (Co-Chairman)

Karen Bradshaw – Director of Children’s Services

Jackie Jeffrey – VSCA

Ros Preen – Shropshire Community Health Trust

Gail Fortes-Mayer

Mark Brandreth – CEO, RJAH

Sarah Bloomfield – Interim Director of Nursing / Deputy CEO, RJAH

Anne-Marie Speke - Healthy Child Programme Co-ordinator

Councillor Rob Gittins

The following substitutions were also notified:

Nicola Daniels (was Nicola McPherson) will be substituting for Jackie Jeffrey, VCSA.

Members are reminded that they must not participate in the discussion or voting on any matter in which they have a Disclosable Pecuniary Interest and should leave the room prior to the commencement of the debate.

Members were reminded that they must not participate in the discussion or voting on any matter in which they had a Disclosable Pecuniary Interest and should leave the room prior to the commencement of the debate.

To confirm as a correct record the minutes of the meeting held on 23 May 2019, to follow.

Contact: Michelle Dulson Tel 01743 257719.

RESOLVED:

That the Minutes of the meeting held on 23 May 2019, be deferred to the next meeting.

To receive any questions, statements or petitions from the public, notice of which has been given in accordance with Procedure Rule 14.

A public question was received from Mr John Bickerton, local resident in relation to West Midlands Ambulance Service response times (copy attached to the signed Minutes).  The following response was provided by the Joint Chairmen of the Health and Wellbeing Board, Councillor Lee Chapman and Dr Julian Povey:

West Midlands Ambulance Service provide performance updates for both the Health and Adult Care Scrutiny Committee, and the Health and Wellbeing Board once a year (more frequently if requested).  West Midlands Ambulance Service presented their update report at the Health and Adult Care Scrutiny Committee meeting on the 20th May 2019.  They were asked to respond to specific questions, and these responses formed the report.  If you wish to view the list of questions, they can be found here:

http://shropshire.gov.uk/committee-services/mgChooseDocPack.aspx?ID=3945

The same report has been tabled for the Health and Wellbeing Board on the 4th July 2019, and will be accompanied with a presentation.

We would just like to clarify that the Committee and Board have different functions.  Scrutiny Committees do as their title says.  They request specific information from services and ask for this to be presented back to their meetings for discussion.  The role of the Health and Wellbeing Board is different.  It has a strategic function, and works in partnership across the health and wellbeing system to help improve outcomes for Shropshire people, rather than holding specific services to account.  I can assure you challenges are still made by the Board however, and services are frequently asked to report back further when necessary.

Report attached.

Contact: Mark Docherty, Director of Clinical Commissioning and Service Development \ Executive Nurse

Pippa Wall, West Midlands Ambulance Service gave a presentation (copy attached to the signed Minutes) which covered the following areas:

·         Firmographics

·         Trust Overview – Progress

·         CQC Rating

·         Vision, Values, Strategic Objectives and Priorities

·         Operating Plan – Key Messages

·         Quality Account 2019/20

·         Activity, Demand and Performance

·         Comparison of Activity with Contract

·         Shropshire Performance

·         Rural Performance Comparison

In response to a query about how performance in the North of the County compared to the South, Ms Wall explained that she would have to take that away and find out in order to provide an accurate response.  The Chairman queried the reasons behind the relatively low ambulance usage per 1,000 of the population per year.  In response, Ms Wall explained that there had been an 8% increase, over contract in usage and that for 2018/19 activity had again increased and she agreed to find out whether there had been any update to those figures.  She reported that the older population only called the service when they really need it as they did not want to bother the service or did not wish to travel from their home.

Dr Julie Davies, Director of Performance and Delivery, Shropshire CCG explained that there appeared to be no underlying cause for the increase in demand for ambulances and that a trial was being undertaken to see how best to increase public knowledge of alternatives to using the ambulance service.  It was suggested that this be looked at in a future meeting.

Turning to Performance by Post Code, the Chair drew attention to the fact that the West Midlands Ambulance Service had only achieved its performance target for two post codes in Shropshire which was abysmal.  Ms Wall responded that the Trust level data was the best in the Country.  Mr David Stout, the Accountable Officer, Shropshire CCG felt that the Trust average did not show much and that Staffordshire and Herefordshire did better for a similar size contract and that indeed Shropshire was the worst in the West Midlands.

Ms Wall explained that the Service only had so many resources available to it and if an ambulance was out of the area it would take longer to respond to an incident in another area.  Response times obviously varied depending on when and where the activity was.  The Service responded as well as it could within the available resources.

In response to a query, it was confirmed that ambulance crews were trained in childbirth however they could undertake further training or get experience on the ward in their own time, if they wished.  Ms Wall explained that staff were being trained to provide improved services in pre-hospital environments and that opportunities for shadowing were provided.  She reported that a Senior Midwife had been appointed. 

In response to a query about whether the Service had any issues around being called inappropriately, Ms Wall explained that there would always be an element of this however it seemed to be less of a problem in Shropshire.  It was usually identified during  ...  view the full minutes text for item 18.

Regular update reports to the Health and Wellbeing Board are attached:

Shropshire Care Closer to Home

Report attached.

Contact: Barrie Reis-Seymour, Shropshire CCG / Lisa Wicks

The Sustainability and Transformation Plan for Shropshire, Telford & Wrekin

A verbal update will be given.

Contact: Martin Harris, Telford and Wrekin CCG

Better Care Fund, Performance

A verbal update will be given.

Contact: Penny Bason, Shropshire Council / Shropshire STP/Tanya Miles

Healthy Lives Update

Report attached.

Contact: Val Cross, Health and Wellbeing Officer

i.        Shropshire Care Closer to Home

Lisa Wicks, the Head of Out of Hospital Commissioning and Redesign introduced and amplified the Shropshire Care Closer to Home update (copy attached to the signed Minutes).

She confirmed that all eight demonstrator sites were now up and running.  The Case Management roll out was currently being developed and work had been taking place on a risk assessment tool that had identified 383 patients who would benefit from a case management approach.

The Head of Out of Hospital Commissioning and Redesign informed the meeting that a workshop had taken place around developing a shared Care Plan, potential solutions for which had been shared with the IT Sub Group. 

Turning to the draft models for Phase 3, these had been shared with the Programme Board who had requested a three-month impact assessment from across providers to ensure that the new models dove-tail with current processes.

In response to a query, the Head of Out of Hospital Commissioning and Redesign reported that the Frailty Intervention Team were full time for five days a week in the Royal Shrewsbury Hospital and that the service was being provided via a phased implementation at the Princess Royal Hospital.  Dr Julie Davies updated that the service had now gone up to 5 days a week at the PRH and that the challenge now was how to turn this into 7 days.

ii.       The Sustainability and Transformation Plan for Shropshire, Telford & Wrekin

Martin Harris, STP Director gave a verbal update on the STP Programme.  Copies of the STP Governance Structures were circulated (copy attached to the signed Minutes). 

The STP Director explained that the schematics showed how the governance structure would operate and provided a formal link between the System Leadership Group and the CCG Governing Bodies who made the strategic decisions.  He reported that a Shropshire, Telford and Wrekin Chairs Group was being set up.  Going forward, it must be ensured that the system was evidence driven, as well as financially and clinically robust.

The STP Director informed the meeting that an audit of engagement was being undertaken to understand what routine engagement had been taking place across the system.  This information would be used in a system wide approach to back better decision making going forward by understanding the requirements/expectations of the public.

The Board were pleased that work was progressing.  Nicola Daniels of the VCSA wished to ensure that the right place was found for the VCSA within the governance structure in order to ensure it was used to the best of its ability/use.

The Accountable Officer, Shropshire CCG informed the Board that there was a requirement for a local Five Year Plan to be developed by November, which would come back to this Board.

In relation to future STP update reports, the Chairman requested a rethink about the way these updates were presented to the Board.  An update on progress would be helpful but for those areas that were not so straightforward, perhaps reference to where  ...  view the full minutes text for item 19.

Report attached.

Contact: Lynn Cawley

Lynn Cawley, Healthwatch Shropshire introduced and amplified her report (copy attached to the signed Minutes) which set out the findings from the work undertaken by Healthwatch Shropshire on behalf of the Healthy Lives Programme.  The brief was to engage with people in Shropshire about Social Prescribing, in order to get a better understanding of the needs of local people and the challenges facing social prescribing within the county.

The Chairman congratulated Healthwatch Shropshire for their valuable report which would make a significant contribution to social prescribing within Shropshire.

The Head of Adult Services wished to ensure that work was now undertaken to address the findings to the greatest effect to progress and build upon this service.  The Director of Public Health stated that the report would be taken away and looked at before the next meeting when an update would be provided.

It was felt that mental health problems within the farming community needed to be talked about more and given a higher profile.

In conclusion, it was reported that Healthwatch Shropshire would be publishing its report in relation to the STP Long-Term plan the following week.

ACTION:  to hold a joint meeting to discuss social prescribing with partners from the CCG, Voluntary and Community Sector and Shropshire Council, to be arranged for late September.

Report attached.

Contact: Stewart Smith

Stewart Smith introduced and amplified his report (copy attached to the signed Minutes) which updated the Board on the 2019 Shropshire Partnership Summit which focused on co-production, what it meant for Adult Social Care and Children’s Services and how they could work together differently.  He informed the Board that the event showed a good appetite for working together and had highlighted some good examples of co-production that had already taken place and ideas for the future.  Positive feedback had been received from attendees.

The Head of Adult Services felt that more decision makers from Health should be invited to the next Summit.  In response to a comment that Shropshire Council did not have a policy for co-production, it was agreed for the Head of Adult Services along with the Portfolio Holder to look at developing a co-production policy.

Report attached.

Contact: Gordon Kochane

RESOLVED:

That this item be deferred to the next meeting.

Correspondence – action for noting.

In relation to the application to open a new pharmacy in Baschurch, discussed at previous Health and Wellbeing Board meetings, it was reported that the pharmaceutical company had submitted an appeal against the decision to refuse the application.  The Chairman proposed that an undertaking be given by the Board reaffirming its previous view that Baschurch remain a controlled locality, which was supported.