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

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

          Ros Preen
          Karen Bradshaw, Director of Children’s Services
          Cathy Riley, MPFT
          Megan Nurse, Non-Executive Director, MPFT

          Mark Brandreth, Chief Executive, RJ&AH Hospital Trust

          Gail Fortes Mayer, Programmes Director NHS Shropshire and Telford & Wrekin CCGs

          Nicky Jacques, Chief Officer, Shropshire Partners in Care (SPIC)

          Lisa Wicks, NHS Shropshire Care CCG

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 16 January 2020.

Contact: Michelle Dulson Tel 01743 257719

RESOLVED:

That the Minutes of the meeting held on 16 January 2020 be approved and signed by the Chairman as a correct record.

To receive any questions, statements or petitions from the public, notice of which has been given in accordance with Procedure Rule 14.  The deadline for this meeting is 9.30am on Tuesday 3 March 2020.

A question submitted by Mr George Rook, in relation to Shropshire CCG’s Dementia Strategy had been circulated to Members.  The CCG had provided a response to this question.

Questions submitted by Mr David Sandbach, in relation to the Liquid Logic Task and Finish Group had been circulated to Members. Again, the CCG had provided a response to these questions.

A copy of the questions and responses provided are attached to the signed Minutes and available on this Committee’s pages on the Council’s web site.

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

STP Update

A verbal update will be given.

Contact: David Evans, Joint Accountable Officer, Shropshire CCG and Telford & Wrekin CCG

Shropshire Care Closer to Home

Report attached.

Contact: Lisa Wicks, Deputy Director of Performance & Delivery, Shropshire CCG

Healthy Lives Update

Report attached.

Contact: Val Cross, Health & Wellbeing Officer, Shropshire Council

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

          David Stout, the Interim Chief Executive, Shropshire Community Health Trust gave a presentation - copy of slides attached to the signed Minutes - which covered the following areas:

·         Integrated Care System Development

·         Shropshire, Telford & Wrekin STP’s Long Term Plan

·         Financial Sustainability and Productivity

·         System Clinical Priorities 2020/21

·         System Cluster Priorities: Prevention & Place Based Care

·         System Cluster Priorities: Acute Care

·         System Cluster Priorities: Mental Health

·         Next Steps

Mr Stout confirmed that the Long-Term Plan had still not been signed off and could not therefore be published.  He informed the Board that the delay was in relation to the system’s financial position, however they were continuing to take the Long-Term Plan forward and were currently in the process of updating the Governance Structure through the Integrated Care System Shadow Board which had held its first meeting the previous week.

Mr Stout updated the Board about actions being taken to operationalise the Long-Term Plan ensuring that care was delivered efficiently whilst providing the right services at the right time in the right place.  He then took Members through the System Clinical Priorities for 2020/21 and reported that a series of implementation plans would be developed for the three main service transformation clusters: Prevention and Place Based Care Cluster; Acute Care Cluster; and Mental Health Cluster.  The 14 priorities contained within these three clusters would be the focus for the next 12 months.

In response to a query around the timescales for publication of the Full Business Case for Hospital Reconfiguration, Mr Stout reported that the aim was to submit this by the end of the next financial year (January – April 2021), however, it was a ‘moveable beast’.

The Chairman requested an update from the STP Digital Enablement Group for the next meeting.  An update was also requested in relation to Adverse Childhood Experience.

RESOLVED:  That the update be noted.

ii.         Shropshire Care Closer to Home

Dr Julie Davies, Director of Performance, Shropshire CCG introduced and amplified the report of the Deputy Director of Performance and Delivery, Shropshire CCG – copy attached to the signed Minutes – which provided an update on the Shropshire Care Closer to Home programme.

Dr Davies reported that the early indicators of success from the pilot sites had led the Programme Board to recommend an accelerated expansion and rollout of case management across the County which had been endorsed by the CCG.  She drew attention to the two steps to be taken to accelerate the rollout, more detail of which would be provided to the next meeting of the Health and Wellbeing Board.  Dr Davies felt that the pilot sites had had a significant impact and it was hoped to build on the success of these initial eight sites.

Turning to Phase 3, Admissions Avoidance, Dr Davies reported that early indicators were positive and that the leadership from the Local Authority was very much appreciated.  She drew attention to the Task and Finish Group looking at Liquid Logic  ...  view the full minutes text for item 65.

Report attached.
Contact: Margarete Davies, Carer and Engagement Lead, Shropshire Council / Kate Garner, Service Manager, Shropshire Council

Kate Garner, Service Manager, Shropshire Council introduced and amplified her report – copy attached to the signed Minutes – which updated the Board on the activity and outcomes of a review of the services and support for unpaid adult carers in Shropshire and to share the recommendations and actions that have emerged from the review which will now be integrated into the existing Shropshire All-Age Carers Strategy Action Plan and taken forward by the Shropshire Family Carer Partnership Board.

A presentation was given which covered the following areas:

·         Family carers

·         Review

·         Carers Strategy Priority 1 Carers are listened to, valued and respected

·         Carers Strategy Priority 2 Carers are enabled to have time for themselves

·         Carers Strategy Priority 3 Carers can access timely, up to date information

·         Carers Strategy Priority 4 Carers are enabled to plan for the future

·         Carers Strategy Priority 5 Carers are able to fulfil their educational, training and employment potential

·         Next steps

The Service Manager reported that the offer for adult carers in Shropshire had not been very well understood so it was felt that a deep dive to find out what was available for the large number of unpaid adult carers in the county would be of benefit. The review began in June 2019 and was co-produced to sit alongside and be aligned with the All-Age Carers Strategy.

Margarete Davies, the Carer and Engagement Lead took Members through the five priorities that emerged from this work.  She explained the issues raised, ways in which these could be overcome and how services could be provided differently.  The All-Age Carers Strategy Action Plan had been updated and would now be taken forward and implemented by the Shropshire Family Carer Partnership Board and would inform recommissioning of carer support services going forward.

The Director of Performance, Shropshire CCG drew attention to cross-border/out of county links and agreed to discuss this with the Service Manager outside of the meeting to ensure they were taken into account when recommissioning services.

A brief discussion ensued in relation to carer friendly employers.  The Service Manager reported that carer friendly employers were inconsistent and dependant on particular line managers and the needs of the business.  The Director of Adult Services agreed that it was a complicated issue with no simple solution.

The Head of Social Care, Efficiency and Improvement wished to ensure that partners had up to date attendance at the Family Carer Partnership Board meetings.  The Chairman was requested to write to partners to ensure they had adequate representation.

RESOLVED:  That the contents of the report be noted and in particular the reference to the recommendations and actions that have emerged through the review work.

Report attached.

Contact: Rachel Robinson, Director of Public Health, Shropshire Council

The Director of Public Health introduced and amplified her report – copy attached to the signed Minutes – which provided a summary of the content of the Director of Public Health Annual Report. 

The Director of Public Health explained that the overall theme of the report was the County Motto ‘Floreat Salopia’ – may Shropshire Flourish, as although Shropshire had good health and wellbeing outcomes, there were some areas that could be improved.  The report also highlighted that public health and wellbeing were a shared responsibility.

The Director of Public Health gave a presentation – copy of slides attached to the signed Minutes – which covered the following areas:

·         Overview of Annual Report

·         Chapter 1 Patterns of Health and Wellbeing across Shropshire

·         Chapter 2 Areas of focus for 2020 and beyond

·         Chapter 3 Work that Public Health and partners are undertaking to address health concerns

·         Recommendations for Action

·         Health Inequality in England: The Marmot Review 10 years on

·         Case Studies

·         What next?

Referring to the lower level of public health funding per head of population allocated to Shropshire compared to the England figure (set out on page 5 of the Annual Report), the Portfolio Holder for Adult Social Care, Public Health and Climate Change felt that what had been achieved within the resources available was nothing short of miraculous.  He drew attention to the Quality and Outcome Framework snapshot of disease prevalence across Shropshire for 2017/18 (page 7 of the Annual Report).  He explained that some of the most rural parts of Shropshire struggled to make an impact and performed unfavourably due to reduced funding, which was the crux of the issue.  He reported that the Council lobbied the Government at every opportunity for an increase in funding based on the cost of delivering services in large rural counties.

The Director of Public Health agreed that funding was a challenge and they had to think very carefully how the collective investment could be best spent.  Concern was raised about the impact of mental health provision for young people on families and whether more could be done.  The Director of Adult Services felt that the importance of digital delivery going forward should not be overlooked.  Concern was also raised in relation to food poverty and lack of funding to support the ongoing work of the Shropshire Food Poverty Alliance.

Tanya Miles, the Head of Social Care, Efficiency and Improvement drew attention to the ‘Five Ways to Wellbeing’ set out on the back page of the Annual Report which was a good place to start when looking at good health and wellbeing.  The Chairman agreed and he congratulated the Director of Public Health on her Annual Report which was very accessible and easy to read and would be published as widely as possible.

RESOLVED: To support the recommendations set out on Page 4 of the Director of Public Health Annual Report, which require a joint effort if they were to be achieved to help improve the health and wellbeing of Shropshire people.  ...  view the full minutes text for item 67.

Report attached.

Contact: Sue Lloyd, Consultant in Public Health, Shropshire Council

Sue Lloyd, Consultant in Public Health introduced and amplified her report – copy attached to the signed Minutes – which considered the potential approach to the wider determinants contained within the Health and Wellbeing Strategy.

The Consultant in Public Health reported that the Health and Wellbeing Board (HWBB) workshops had defined the key priorities for the Board, set out in paragraph 2.0 of the report, and that the Board recognised the importance of including the wider determinants of health in all policies and strategies.  It was therefore being proposed that a chapter be included within the Health and Wellbeing Strategy addressing these wider determinants.

In response to a query about how to show/ensure that, when taking decisions, the wider determinants had been considered, the Consultant in Public Health explained that the approach would be to consider whether this area/topic would have an impact on health and wellbeing, and, if so, by demonstrating how any negative effects were being mitigating whilst maximising the positive effects.

The Consultant in Public Health explained that it would require a culture change across partners and the local authority to embed the process in all policies and strategies, eg Local Development Plan - how to embed health in land use.

RESOLVED:  That the HWBB endorse the integration of a chapter within the Health and Wellbeing Strategy (HWS) that specifically addresses wider determinants and work linked to the HWS priorities, by taking a ‘health in all’ approach.  This would include the impact of integrating health into work on air quality, housing, planning (land use), green infrastructure, culture, active travel, and climate change.

The Chairman updated the Board in relation to the following items

i. Coronavirus update

The Director of Public Health’s Statement on the preparedness for infectious disease outbreaks had been circulated at the meeting – copy attached to the signed Minutes – which provided the Health and Wellbeing Board with a summary of the local health economy and partner arrangements in terms of preparedness for outbreaks of communicable and infectious diseases, with a focus on the coronavirus emergency.

The Director of Public Health reassured the Board that there was a considerable degree of joined up work via the Local Health Resilience Partnership, membership of which had been extended and which was currently meeting twice weekly.  She reported that the situation was changing rapidly, however the Council were receiving regional and national updates on a daily basis.  The Director of Adult Services confirmed that the Council were therefore in a reasonable state of readiness to deal with the situation.

The Director of Public Health confirmed that as at 9am there were no cases in the West Midlands. 

The Chairman informed that Board that information posters could be provided to them upon request.

ii.  Response to the Care Quality Commission on behalf of the HWBB

The Chairman confirmed that this had been sent and thanked Lynne Cawley and Val Cross for their assistance.

iii. ACE/Trauma workshop update

The Chairman informed the Board that a facilitated half day ACE/Trauma workshop was to be offered to all Board Members in May 2020 which he asked Members to prioritise as it would give them a sound understanding and context of this priority and the next steps to move it forward.

The Chairman updated the Board in relation to the following pharmacy updates:

·         Combined Application for Change of Ownership by Lunts Healthcare Ltd granted for Lunts Pharmacy, Roushill, Shrewsbury and Relocation from Roushill, Shrewsbury to the Ground Floor unit, Block C, The Tannery, Barker Street, Shrewsbury.  Interested parties had the opportunity to make written representations by 9 April 2020.