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

Neil Nisbet              Finance Director & Deputy CE SaTH NHS Trust
Ros Preen              Shropshire Community Health NHS Trust
Anne-Marie Speke Healthy Child Programme Coordinator, Shropshire Council

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 17 January 2019.

Contact: Michelle Dulson Tel 01743 257719.

Minute Item 58 – Healthwatch Shropshire Update

It was clarified that the two pieces of work referred to in the second paragraph were the STP Long Term Plan and Maternity Mental Health Services.

The final sentence of the third paragraph should read ‘The Clinical Chair, Shropshire CCG would welcome the work of Healthwatch Shropshire....’

RESOLVED:

That the Minutes of the meeting held on 17 January 2019, be approved and signed by the Chairman as a correct record, subject to the above.

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 George Rook, requesting that the Health and Wellbeing Board take positive action to ensure that a Joint Commissioning Lead for Dementia in Shropshire be appointed and that the Dementia Strategy for Shropshire be implemented.  A joint response from Shropshire CCG and Shropshire Council was circulated around the table at the meeting which reported that the Joint Commissioning Lead post had been advertised but had been unsuccessfully appointed to and that there were a number of proposals currently being explored (copy of question and response attached to the signed Minutes).

Report attached.

Contact: Ivan Powell/Sam Anderson

Ivan Powell, Independent Chair of the Shropshire Safeguarding Children Board (SSCB) introduced and amplified the Keeping Adults Safe in Shropshire (KASIS) Annual Report 2017/18 (copy attached to signed minutes) and gave a brief presentation, which covered the following areas:

·           The 4 Board Priorities;

·           Adult Safeguarding in Shropshire;

·           Training;

·           Safeguarding Adult Reviews;

·           Multi-Agency working;

·           Areas of focus moving forward

The Independent Chair reported that the personalisation agenda had led to a big shift in approach and that there was now a duty on local authorities under the Care Act to support people in the safeguarding process.

In response to a query, the Independent Chair explained that the Police Service had no bespoke policy on safeguarding and had a different definition of Vulnerable Adult.  He explained that the Mental Health service would provide a response rather than the police however some Police forces operated a triage system in order to respond more appropriately. 

RESOLVED: That the report be noted.

Report attached.

Contact: Ivan Powell/Sam Anderson

Ivan Powell, Independent Chair of the SSCB, introduced and amplified the Shropshire Safeguarding Children Board Annual Report 2017/18 (copy attached to signed minutes) and gave a brief presentation, which covered the following areas:

·           The 3 Board Priorities;

·           Child Death Overview Panel (CDOP);

·           Training and Multi Agency Audits;

·           Section 11 Audits;

·           Ofsted Inspection;

·           Working Together 2018;

·           Serious Case Reviews (SCRs);

·           Areas of focus moving forward

The Independent Chair reported that the Shropshire Safeguarding Children Board had received a ‘good’ from Ofsted with one action around the narrative and collection of multi-agency data, which was, in part, due to the introduction of a new IT system which had reduced the quality and timeliness of the data.

Turning to the Board’s 3 priorities, the Independent Chair informed the Board that this year 340 children had been exposed to domestic abuse, whilst 85 referrals had been considered by the CSE Panel, 15 of which were considered high risk and most were females.  He reported that the Regional Organised Crime Unit along with the Children’s Society had delivered a workshop to professionals across the West Mercia area to improve knowledge.

The Independent Chair explained that Compass looked at all missing incidents, some of which may include victims of CSE.  There had been a significant reduction in the number of missing episodes this year (630).  It was confirmed that two staff now conducted return home interviews for those missing children from Shropshire.

It was reported that by year end 2017 there had been a 6% reduction to 53% in children subject to a Child Protection Plan under the category of neglect however the current year workload has returned to 59%.  The Independent Chair explained that a focus was being kept on this area and that the Neglect Strategy was being revised.

The Independent Chair informed the Board that the Child Death Overview Panel Annual Report was very robust, detailed, and provided reassurance of how agencies worked together.  National oversight of the COPD was moving from the Department of Education to the Department of Health with CCGs leading the work locally.

In relation to Serious Case Reviews, the Independent Chair confirmed that the SCR for Child C had been finalised and published whilst that for Child E had been completed and would be reported in next years’ Annual Report.

In response to a query, it was confirmed that all agencies were fully sighted in relation to CSE.  Concern was raised in relation to training for the teaching profession when dealing with safeguarding issues.  In response, the Independent Chair confirmed that anyone in contact with children had a responsibility for safeguarding and he referred to the threshold / level of need document which contained details of the referral process.  There was also a podcast and supporting information available on the website.

RESOLVED:   That the report be noted.

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

The Sustainability and Transformation Plan for Shropshire, Telford & Wrekin

Report attached.

Contact: Phil Evans, STP Director, Telford and Wrekin CCG

Future Fit – Next Steps

A presentation will be given.

Contact: Debbie Vogler

Shropshire Care Closer to Home

Report attached.

Contact: Lisa Wickes, Head of Out of Hospital Commissioning and Redesign, Shropshire CCG

Better Care Fund, Performance

Report to follow.

Contact: Penny Bason, Shropshire Council / Shropshire STP

Healthy Lives

A presentation will be given.

Contact: Val Cross, Health and Wellbeing Officer

i.        Future Fit

Debbie Vogler, Programme Director introduced the Future Fit update and gave a presentation (copy of slides attached to the signed Minutes), which covered the following areas:

·           Decision Making

·           Key Benefits of the new model

·           Recommendations agreed by the Joint Committee

·           Next steps

In response to comments from the Director of Public Health that the Council wished to see changes in clinical behaviour whereby patients do not have to attend hospital unnecessarily for eg repeat out patient appointments, the Programme Director confirmed that there was a separate pathway being looked at which considered alternative ways to follow up.

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

Phil Evans, STP Director introduced the STP Programme update (copy attached to the signed Minutes) which provided an update on the STP system response to developing a draft system narrative and the next steps.  The STP Director drew attention to the Commissioning Capability programme and the Integrated Care System Development Programme, for which providers had been agreed.

He reported that feedback from NHS England had been received on the first draft of the System Operational Plan submitted on 19 February 2019.  The deadline for the next submission was 11 April 2019 and this would be followed up by engagement and communications activities. 

The Director of Adult Services commented that although the NHS Long Term Plan had been published there was still no Green Paper for adult social care.  It was felt that the Green Paper would point in the direction of considering Adult Social Care in a broader sense and how other services impacted on wellbeing.  In response, the STP Director explained that the green paper may not materialise for a number of years so they were doing what they could anyway rather than wait for it.

A brief discussion ensued in relation to what the system priorities and ambitions should be whilst the Director of Public Health drew attention to the lack of assurances around rural proofing / disconnect prevention and the lack of investment.

The Chair felt that the Health and Wellbeing Board had struggled with a crisis of identity as to its obligations under the STP with no real acknowledgement of how to discharge its statutory duty and governance under which it was established.  Partners had been too focused on their own organisations instead of taking a system view.  Without commitment to a system approach, individual organisations would continue not to be able to take the best opportunities.  The HWBB needed to understand how to take the lead and how to progress as a system.  Stronger engagement was needed across both Local Authorities with clinical organisations being more open to accept the contribution that the LA’s can make.

Dr Povey agreed that there needed to be a system answer.  He explained that the long-term plan was merely a list of wishes, however, money was a huge problem and he urged the Board not to under estimate the challenges of the system. 

iii.      Shropshire Care Closer to Home  ...  view the full minutes text for item 67.

Report attached.

Contact: Jo Robins, Consultant in Public Health

Jo Robins, Consultant in Public Health introduced and amplified her report (copy attached to the signed Minutes) which provided an update on progress. The Consultant in Public Health drew attention to the slides attached to the report at Appendix 1 which set out feedback following the Shropshire Social Prescribing External Evaluation conducted by Westminster University.

The Shropshire model mirrored the NHS England national guidance and had been identified as an exemplar site and had been invited to participate in regional events and national conferences.   

The Consultant in Public Health touched on the national picture following publication of the NHS Long Term Plan which gave a clear commitment to social prescribing and the creation of 1,000 social prescribing link workers nationally fully funded for 5 years and assigned to Primary Care Networks.

Jackie Jeffrey of the VCSA praised this great scheme and stressed that it had achieved a lot despite no funding or support for the voluntary sector so delivery was dependant on what the funding allowed.  Dr Julie Davies welcomed the opportunity to link in via Primary Care Networks.  Dr Povey appreciated that it was a challenge for the voluntary sector with restrictions on funding however he cautioned that there was a lot of unknowns in relation to PCNs including how they would be funded, but that no money would be forthcoming from the CCG. 

The Chairman welcomed the commitment to social prescribing and questioned whether agreement should be sought as to what social prescribing as a policy should look like.

RESOLVED:

1.    That endorsement be sought for a system wide approach for the creation of one joint model of social prescribing which builds on the Shropshire model, uses the learning from the evaluation findings and fulfils the guidance from NHS England linked to the Primary Care Networks (PCN).

2.    That support be sought to work with the CCG and PCN on a joint plan to achieve recommendation 4.

Report attached.

Contact: Steve Trenchard

Steve Trenchard the Programme Director for Mental Health introduced and amplified his report (copy attached to the signed Minutes) which informed the Board of progress made in relation to improvements to the service in line with an action plan agreed by system leaders in October 2018 following the visit of the NHS Intensive Support Team in June 2018. 

The Programme Director informed the Board that additional clinics for physical health screening had been delivered to 215 children and young people who had not previously been offered a health check because they were on medication.  No concerns were raised about any of those assessed to date. He confirmed that work was ongoing to identify those young people that had been discharged to Primary Care that may be on medication and where physical health checks were required.

The Programme Director drew attention to Programmes 4 (Targeted Prevention) and 9 (Crisis Resolution) set out at Paragraph 9 of the report which required immediate attention and he confirmed that a meeting date had been arranged to look at these.

The Programme Director reported that a meeting of the system leaders was taking place later that month for a reflective look back and would be reported to a future HWBB meeting.  The Chair was encouraged to see the level of progress and was keen to hear about the review and any lessons learnt.

The Chair expressed concern about the significant pressures around Looked After Children and how to access more early intervention.  He accepted that there were issues in relation to triage but leaving those least serious longer was an opportunity for them to get worse.  The Programme Director shared the Chair’s concerns but stated that the long term plan did prioritise young people’s services and investment for mental health especially within schools could see the school nurse workforce providing some of that intervention. 

RESOLVED: 

1.    To note the contents of the update and the assurance given that appropriate steps have been and continue to be taken, to continue to make the improvements identified. 

2.    To schedule a further update on the 0 – 25 Emotional Health and Wellbeing Service to a future meeting of the Health and Wellbeing Board.

Report attached.

Contact: Val Cross, Health and Wellbeing Officer

Val Cross, the Health and Wellbeing Officer introduced and amplified her report (copy attached to the signed Minutes) which provided a summary of activity and progress for the Health and Wellbeing Board Communication and Engagement Group during 2018-19.

It was confirmed that the 2019/20 Action Plan would be presented to the Board at its next meeting in May 2019.

The Chairman thanked the Health and Wellbeing Officer for the excellent work and requested that Board Members ensure their Communication leads attend this Group.

RESOLVED:   That the contents of the report be noted.

Report attached for information.

Contact: Phil Brenner

The Board received and noted a progress report (copy attached to the signed minutes) on the Pauls Moss Project in Whitchurch.