150  Election of Chairman

RESOLVED:

That Councillor Simon Jones be elected as Chair of the Health and Wellbeing Board.

The following apologies were noted:

David Crosby – Chief Officer, Shropshire Partners in Care

Angie Wallace - SATH

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 meeting prior to the commencement of the debate.

Jackie Jeffrey declared that the VSCA received funding from the Better Care Fund.

To confirm as a correct record the minutes of the meeting held on 8 July 2021 and 9 September 2021 (attached).

Contact: Michelle Dulson Tel 01743 257719

9 September 2021 - Paragraph 140 - Integrated Care Systems Update

It was confirmed that the third paragraph on page 3 should read as follows:

‘The Director of Public Health was keen to link the Shrewsbury Health and Wellbeing Hub into the JSNAs and taken to the Health and Social Care Overview and Scrutiny committee.  It was confirmed that an equality impact assessment was being done which would go through the Project Board and would be linked into the JSNA. The Director of Public Health requested a full integrated impact assessment be undertaken’.

      RESOLVED:

      That the Minutes of the meetings held on 8 July and 9 September 2021 be approved and signed by the Chairman as a correct record, subject to the above amendment.

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 9 November 2021.

No public questions were received.

Integrated Care Systems (ICS) update (10.00am)

Report attached.

Contact: Nicky O’Connor, Shropshire, Telford & Wrekin CCG

Joint Commissioning Board (10.10am)

Report attached.

Contact: Laura Tyler, Assistant Director, Joint Commissioning

Integrated Care System (ICS) update

The Programme Director for Shropshire, Telford & Wrekin Integrated Care System introduced and amplified the ICS update and presentation (copy of slides attached to the signed Minutes) which covered the following areas:

·         The Integrated Care System Development

·         Urgent Care and Ambulance Pressures

·         Covid-19 Vaccination Programme

·         Hospital Transformation Programme

·         Community Diagnostic Hubs

·         Elective Waiting Times

·         SaTH CQC Inspection

The Programme Director updated the Board, she recapped the reasons for ICS’s being set up and explained that the Bill was still going through Parliament.  She explained what the new structure would look like from April next year with a view that the structure would be much more fit for purpose. From 1 April 2022 there would be an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP) and that those two bodies together would make up the Integrated Care System (ICS).  The ICB would probably look different to the current ICS Board, in that it would be smaller but would have the same chair, there would be non-executive Directors on that Board who would be new to the system so could not currently be in a non-executive role on any of the current organisations.  There would also be some new Executive Directors,  indeed there were four mandated executive roles in the legislation, and they were the Chief Executive, a Director of Nursing, a Medical Director and a Chief Finance Officer.  In addition to this, there would also be partner members who would be the two Local Authorities, a representative section of provider organisations and GP members.  Decisions would be made across those three sections.  In order to retain the history and knowledge within the organisations they were asking the chairs of the current provider organisations to chair some of the subcommittees of the ICB so that they also became involved in the workings of the Board.

The ICP was a much less mandated grouping of people and would be chaired by the two Local Authority Leaders and would probably meet two to three times a year and it would have representatives from the ICB, representatives from the Local Authorities, representatives from Healthwatch and whoever else it was wished to have on that Board, for example, Police, Fire Service etc.  The primary function of the ICP was to set the Integrated Care Strategy for the system.  Sitting elsewhere in the system would be the two place-based arrangements which would link closely to the Health and Wellbeing Board and were largely focussed on the population of those particular places on and around arranging provision of health care and care for the people in those populations.  There would also be a provider collaborative which was where the providers could get together and decide what might be the best way of providing care beyond the boundaries of organisations themselves and linking up care, so it was more streamlined for patients.  Still in development within the system was the neighbourhood arrangements which were centred around the 8 Primary Care Networks and that  ...  view the full minutes text for item 155.

Health Inequalities plan update (10.20am)

Report attached.

Contact: Berni Lee, Consultant in Public Health, Shropshire Council

Food Insecurity findings report (10.30am)

Report attached.

Contact: Sophie Padgett, Shropshire Food Poverty Alliance

Energy redress project (10.40am)

A presentation will be given.

Contact: Simon Ross, Director, Marches Energy Agency (MEA) 

Trauma informed approach and Resilience workshop update (10.50am)

Report attached

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

Health Inequalities plan update

The Consultant in Public Health introduced her report (copy attached to the signed Minutes) and gave a presentation (copy of slides attached to signed Minutes) which covered the following areas:

·         Development of Shropshire Health Inequalities Plan

·         Background

·         Population Health Board and ICS Priorities.

·         NHS Priorities with impact on Health Inequalities.

·         Shropshire Priorities and Principles

·         Next steps

The Consultant in Public Health explained that Shropshire’s Health Inequalities Plan was intended to draw together in a single document a range of plans and priority work programmes that were already under way.  The provisional intention was to document at a high level, a summary of information in relation to those existing plans and pull them into the Shropshire Health Inequalities plan.  In looking at relevant data and information, gaps in activity may be identified, in which case there may be a need to start additional or enhanced work programmes.  The plan would include priorities for tackling health inequalities that were relevant to the Integrated Care System, that were Health and Wellbeing Priorities or those relating to the wider Council.  Each of the work programmes to be included in the plan would be aligned under one of the four domains within the population health model.

In terms of the key programmes that were identified for more detailed performance management in terms of delivery, they would be mindful of the evidence both in terms of the factors which predispose individuals and population groups to health inequalities as well as the evidence provided through the national Marmot reviews.  These reviews set out the key areas where the evidence suggests attention should be focussed in order to reduce health inequalities whilst recognising the importance of promoting a healthy standard of living including the role of central government.

The Consultant in Public Health drew attention to the various priorities that were to be included.  She explained that the Population Health Board was a group sitting under the Integrated Care System Board and which oversaw the development of the system-wide approach to health inequalities, which included NHS England’s health inequality priorities for integrated care systems.  There was an overarching framework for the system, system-wide prevention and equalities programmes and sitting alongside were the priorities local to Shropshire.

The Consultant in Public Health then gave more detail around the NHS preventions and transformation programmes that would be delivered to Shropshire residents and that could have a significant impact on the population if they accessed the services as intended.  Looking at the principles which would underpin the approach to health inequalities, these included the need to adopt a whole-system approach to the issue, recognising the complexities that sit behind problems and the vital importance of understanding problems from the perspective of those with lived experience.  She confirmed a successful bid to the LGA/Health Foundation in securing monies that would include an opportunity for a local learning programme in relation to adopting a whole-system approach.  The need for co-production has also been discussed as an additional principle.

In  ...  view the full minutes text for item 156.

Report attached

Contact: Vivek Khashu, Strategy and Engagement Director, WMAS

Mr Vivek Khashu, the Strategy and Engagement Director, West Midlands Ambulance Service (WMAS) introduced and amplified the WMAS Annual Report (copy attached to the signed Minutes).  He gave a presentation which looked back at the previous year but where relevant he drew out where things had changed and moved on.

The presentation covered the following areas:

·         Refresh of 5-year Strategy including the vision, strategic objectives and values.  The previous vision had been reaffirmed and an additional value, environmental sustainability, had been added.

·         ICS priorities – the WMAS worked with six ICS across its region.

·         Service lines – demonstrated all the constituent parts of the organisation.

·         National CQC ratings and single oversight framework segmentation.  There were now at segmentation level 2.

·         Surge management of covid-19 related calls.

·         Actions taken to manage the initial surge of Covid-19.

·         BAME risk assessments.

·         Summary of achievements through the challenges of covid-19.

·         Flu and Covid-19 vaccinations - 91% of staff have been vaccinated.

·         Call answering.  EOC performance >2 minute 999 call answer delays.  Performance much better than peers.

·         Remain the only Ambulance Service to achieve all E&U targets (response time standards).  However that would not be the case next year as the response times had deteriorated over the course of the year.

·         Conveyance rates - had progressed relatively well.

·         Hear and treat for Category 3 or 4 whereby a clinician speaks to the caller to ascertain their needs - much closer to 20% now and as a result take fewer patients to hospital.

·         Lost hours at hospital (>15 minutes pre-handover) – by October this had increased to 28,000 hours which was unprecedented.

·         Patient transport (PTS) – All KPIs achieved.

·         Achievement of Quality Account Priorities 2020-21.

·         Compliments and complaints.  There had been an increase of 1% and 9% respectively.

·         Integrated Emergency and Urgent care (integration of the services 111 and 999) achievements in 2020/21.

·         Integrated Urgent Care future model of delivery.

·         Health and wellbeing arrangements for staff.

·         Sickness 2020/21 - just below 5%.

·         Staff turnover - relatively stable, young workforce.

·         Awards and recognition.

·         Representation - how constituted as a Board and workforce.

·         Global digital exemplar site investment.

·         Digital developments e.g., roll out of ipads to all frontline staff.

·         Electric vehicles/fleet - no more than 5 years old, first to have electric vehicles.

·         Ockenden report – actions identified.

·         Looking forward to 2021/22.

The Chairman noted his disappointment that the report did not contain more detail on performance at a local level, the performance of the service specifically across Shropshire and the outcomes for Shropshire patients.  As noted in the report Shropshire and Telford and Wrekin CCG were one of the 20 commissioners for the service however data was not presented even at this level.  In addition, as noted in the report, the service is located in the heart of England, covering an area of over 5,000 square miles, of which 80% is rural landscape, it would therefore be expected that there would be variation across these areas, particularly rural areas such as Shropshire and transparency  ...  view the full minutes text for item 157.

Report attached.

Contact: Frances Sutherland, Shropshire and Telford & Wrekin CCG

Ms Francis Sutherland, Shropshire, Telford & Wrekin CCG, introduced and amplified the report of the Dementia vision and new model of care (copy attached to the signed Minutes) which provided details of the new revised Dementia model that had been co–produced and co-designed with people living with Dementia and their carers, in order to improve services.

Ms Sutherland and Mr George Rook, the Chairman of the Steering Group gave a presentation (copy of slides attached to signed Minutes) which covered the following areas:

·         Dementia Vision Statement

·         Key Elements of the model

·         General Practices are the keystone in this model and will be Dementia Friendly

·         Assessment to be completed within 4 weeks of a referral

·         Wish to rename the assessment service, to remove the implication that dementia is just about memory.

·         Dementia Navigator

·         Admiral Nurses

·         Peer support group

·         Annual Dementia Reviews in general practice.

·         Information and data sharing across the system.

·         Crisis Team - to keep people at home.

·         Provide better support in Care Homes.

·         Respite for unpaid carers and social care.

·         Carer support for every person providing unpaid care.

In conclusion, Ms Sutherland stated that for this to work the whole system had to work together and understand what their vision was and how it was going to be implemented and sought commitment from the HWBB to their vision and new model of care for dementia and the carers of people with dementia.

Mr Rook commented that when implemented this model would be the best provision in the UK.

RESOLVED:

To note the contents of the report and to receive six monthly updates from the Implementation Steering Group.

Report attached.

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

RESOLVED:

That this item be deferred to a future meeting of the Health and Wellbeing Board.

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

The Director of Public Health for Shropshire provided an update on Covid 19 within the county and made the following observations:

·         Case numbers remained high in Shropshire. 

·         In the previous week there had been 1232 cases.

·         The current rate stood at 378.6 per 100,000 which was above the figures for both the West Midlands and for England. 

·         The over 60’s rate had started to rise. 

·         There were 6 deaths in the latest week.

RESOLVED:

To note the contents of the Covid-19 update.

The Chairman updated the Board in relation to the following items:

·         Defibrillators - Correspondence from SALC asking for HWBB support work happening around provision of defibrillators in communities.

·         Pharmacy ownership notifications - correspondence from NHS England Primary Care Support England has been received.  The correspondence and report for full reasoning will be on the Council website on the Health and Wellbeing Board meetings page; and

·         The Drug and Alcohol Strategy consultation - Members wereencouraged to respond to the consultation, and an update would be provided at the January Board meeting.