Patricia Davies, SCHT

Sara Ellis, RJAH

Members are reminded that they must declare their disclosable pecuniary interests and other registrable or non-registrable interests in any matter being considered at the meeting as set out in Appendix B of the Members’ Code of Conduct and consider if they should leave the room prior to the item being considered. Further advice can be sought from the Monitoring Officer in advance of the meeting.”

None received.

To confirm as a correct record the minutes of the meeting held on 19 January 2023 (attached).

Contact: Michelle Dulson Tel 01743 257719

The Chair Summarised the follow up action and notes of highlight in the Minutes which included the following:

•    The Executive Director for People had requested a report on the Oswestry Test and Learn site, which would set out the plan to roll this out across the County - this report was on the agenda for this meeting.

•    A recommendation from the JCG/BCF paper that a further paper regarding risk around funding gaps for hospital discharge and social care placements be brought to a future Board meeting - this had been noted on the forward agenda plan.

•    A recommendation from the Air Quality report that further reports would be presented to the Board as the project progressed - an update was scheduled to come to the June Board meeting.

•    A recommendation from the Shropshire Drug and Alcohol Strategy to receive a further report on progress - this had been scheduled for the September meeting.

•    Healthwatch Shropshire’s Forward Plan for 2023/24 and aligning it with the priorities of the system - the Chief Officer requested that if anyone had any thoughts around some focussed work that they could undertake, to speak to her and she would take it to the Healthwatch Board to agree.

•    Vaping and Children and Young People and the concerns of the Board - work was progressing well, with a Task and Finish group taking this work forward led by Public Health. A Briefing paper for schools and those who work with young people had been completed and would be circulated following final sign off. An update on this work would be provided at the June meeting.

It was noted that Lynn Cawley was in attendance in person at the previous meeting.

RESOLVED: 

that the Minutes of the previous meeting held on 19 January 2023 be agreed 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.  The deadline for this meeting is 5pm on Friday 14 April 2023.

No public questions had been received by the deadline.

A public question had been received out of time for the previous meeting from David Sandbach.

The full question and the response provided by the Chairman was available from the web page for the meeting.

Val Cross, Health and Wellbeing Strategic Manager, Shropshire Council  

The Board received the report of the Health and Wellbeing Strategic Manager – copy attached to the signed Minutes – which described what Adverse Childhood Experiences and trauma were and the potential damaging effects on learning, behaviour and health throughout a person’s life and explained, as a system, what could be done about it.

The Health and Wellbeing Strategic Manager introduced and amplified the report.  She also gave a presentation – copy of slides attached to the signed Minutes – which touched on the kinds of experiences that were adverse, the physical effect on people’s bodies including higher healthcare use and the effects on Mental Health etc, examples of national practice, trauma informed connection to local plans, trauma informed approach, what was already happening in Scotland / Wales / Shropshire, Telford & Wrekin. 

The Health and Wellbeing Strategic Manager drew attention to the film ‘Resilience - the Biology of Stress and the Science of Hope’ and the facilitated workshops that had been held along with the feedback received from staff.  She went on to highlight the next steps which had been agreed by the Trauma Informed Steering Group.

The Portfolio Holder for Children and Education, who chaired the Multi-Agency Trauma Informed Steering Group, informed the meeting that, as a veteran herself, she was shocked that the brain activity of a child that had experienced this trauma was the same as a soldier that had experienced severe PTSD.  She thanked the Health and Wellbeing Strategic Manager for her driving force and commitment in getting to this stage so that in every area of work people were aware of, and understood, how trauma could affect children.  She was excited by the level of training and the offer which would benefit residents and families of Shropshire. The Board echoed these sentiments.

In response to a query, the Health and Wellbeing Strategic Manager explained the next steps in terms of staff training for 2023/24.  She reported that the film and workshops would continue to be shown as an introduction to Adverse Childhood experience.  It was hoped to have a training offer in place once this had been costed out, to include an in-house online resource to be used as part of induction training and/or as part of annual training.  She explained that more work was required to ensure commitment throughout the system from senior management.

A brief discussion ensued and the Head of Service – Joint Partnerships stressed the importance of having a trauma package specifically for staff who see a lot of trauma, to enable them to be supported, as well as knowing how to support other people in this way.  However, the system was not quite there with this.

The Chair reported that this item had been presented to the ICB meeting and it had generated a significant amount of conversation and he felt that a piece on residents’ stories should be presented at the start of every ICB meeting and he committed to doing so.

In response to a query, the Health  ...  view the full minutes text for item 65.

Darrell Jackson, Senior Commissioning Manager, NHS England

Kate Taylor-Weetman Consultant in Dental Public Health, NHS England

The Board received the report of the Senior Commissioning Manager, NHS England - Midlands and the Consultant in Dental Public Health, NHS England – Midlands – copy attached to the signed Minutes – which provided an overview and scope of existing NHS Primary Care dental services in Shropshire.

The Senior Commissioning Manager and the Consultant in Dental Public Health introduced and amplified the report.  The Senior Commissioning Manager highlighted the challenges due to covid and what had been done to mitigate this and to get better access for patients.  The report set out the dental services that were available in Shropshire both primary care and secondary care provision and also set out examples of treatment for each treatment band and how many UDA’s (Unit of Dental Activity) that equated to, with a full-time experienced dentist expected to deliver around 7,000 per annum.

The Senior Commissioning Manager explained that during Covid there was a period where all dentistry was suspended due to infection control issues and social distancing, which led to the set up of urgent Dental Centres so that strategically urgent dental treatment could be delivered for patients.  He went on to explain how incrementally they had increased the delivery that dental practices should be providing (20% from 8 June 2020 to 31 December 2020 back up to 100% on 1 July 2022).  This had however led to a backlog which was why patients were now struggling to get access to a dental practice.

Prior to the pandemic, approximately 55.7% of the population of Shropshire, Telford & Wrekin accessed NHS dentistry and although now on the increase, had fallen to 48.3%.  The report set out how services were getting back into recovery and highlighted several initiatives that had been implemented to help restore dental access to pre-pandemic levels and the Senior Commissioning Manager drew attention, in particular, to the dental advice line and the new NHS practice in Oswestry.  Finally, he highlighted the current challenges which were around the workforce and in particular recruitment and retention.

The Consultant in Dental Public Health reported that although the population of Shropshire in general had good oral health, this was not the case in the more deprived communities and the Oral Health Network were focussing interventions on those communities to reduce inequalities.

A brief discussion ensued and the Senior Commissioning Manager and the Consultant in Dental Public Health answered a number of queries from members of the Board.  Lynn Cawley, Healthwatch Shropshire informed the Board that she had shared the Healthwatch report published in September 2021 with the Senior Commissioning Manager which had identified the limits of access to NHS Dentistry, particularly in Oswestry and Market Drayton and that Healthwatch had been pleased to assist in the re-procurement of the new practice in Oswestry. She highlighted issues around the accuracy of the NHS England website. 

The Senior Commissioning Manager shared the frustrations around the ‘Find a Dentist’ service on the NHS Website especially as services started to struggle to deliver services due to  ...  view the full minutes text for item 66.

Melanie France, CYP Integration Lead, Shropshire Council

The Board received the report of the CYP Integration Lead, Shropshire Council – copy attached to the signed Minutes – which provided an update on early Intervention and Prevention across Shropshire and described the integration test and learn site at Oswestry, one of several projects in development alongside the draft All-Age Early Intervention and Prevention Strategy.

The CYP Integration Lead introduced and amplified her report.  She gave some strategic background before going on to discuss the Test and Learn site in Oswestry. The Test and Learn site had focussed mainly on children, young people and their families with the aim of building the community-led offer and to identify and encourage children and families to tackle issues early on to prevent them from reaching a crisis point.

Oswestry was chosen as the first site using Population Health data which recognised that there were areas of deprivation in Oswestry and the work had been in two parts, first creating a multi-disciplinary team and secondly the development of a community led offer.  It was noted that many of the practitioners included in the multi-disciplinary team did not know each other despite working with the same families, so one of the aims was to do joint visits which made a huge difference to the families.  All practitioners were being trained to use the same system (liquid logic) which allowed them to see that holistic whole view of the family.

The CYP Integration Lead drew attention to the Community Collaborative which supported practitioners by filling in gaps that were being identified within the community and gave the example of OsNosh which was an initiative around food waste and was on a pay-what-you-can basis.  So when practitioners meet families who were known to be in particularly difficult circumstances they would meet them at OsNosh and would eat with them whilst they had their meeting which has had a very positive impact for those families. Although not a new approach, best practice was being followed and built upon.

She highlighted the aims of the integration programme and explained that it was about reducing demand across the system of health, the Council and other partners.  The work being done was currently being independently evaluated to evidence the results however it was felt that it was having a positive impact and she agreed to bring the results back to a future meeting.  The next phase would be to roll out this approach across the County where it was hoped to have five integrated teams, the next site being North Shrewsbury followed by Ludlow and Market Drayton.  She confirmed that this work was feeding into the All-Age Early Intervention and Prevention Strategy and conversations were being held around a leadership structure and how it would be delivered.

The CYP Integration Lead answered a number of queries from Board members.  In response to a query about the creation of a prevention offer led by the VCSA, it was explained that they recognised the importance of the VCSA and the work they  ...  view the full minutes text for item 67.

Lynn Cawley, Chief Officer, Healthwatch Shropshire, Telford & Wrekin

The Board received the report of the Chief Officer, Shropshire Healthwatch – copy attached to the signed Minutes – which set out patient experiences when calling for an ambulance in an emergency.  The Chief Officer thanked the Board for the opportunity to bring this report before them and she also thanked all the people who shared their experiences.  She gave a presentation (copy of slides attached to the signed Minutes) which covered the following areas:

·         What we did and why

·         Who we heard from

·         Where they lived

·         Themes of experiences

·         Positive comments

·         Sample negative comments

·         Response from and Actions Taken by the ICS

·         Response from Healthwatch England

The Chief Officer informed the Board what they did and why, how it was promoted, and the number of responses received.  Of the 168 responses received, 103 of those experiences happened between October 2021 and September 2022.  She reported that there was a large degree of positive feedback, particularly around staffing and the paramedics along with some very strong and powerful negative experiences, particularly where the loss of a loved one had been as a result of some delay across the system, and she gave some examples.

She was aware of the amount of work being undertaken within the ICS to try to address these challenges and had heard from the Chief Medical Officer about the complexity of the situation and the impact it was having on primary, community, secondary and social care and how as a system everyone was working together to try to resolve those challenges.

Going forward, in relation to Shropshire Community Health Trust, the Chief Officer stated that they would like to be involved in any work around getting feedback on the virtual wards, work being done to support care homes and people with mental health challenges, and she described the three pillars of improvement work currently being focussed upon by the ICS.  Finally, she described the conversation that had since happened as a result of the report.

The Chair thanked the Chief Officer for the report and the work that had gone into it and recognised the work that was taking place to improve the issues.  It was felt that the information contained within the report was vital and a brief discussion ensued around the issues raised.

The Head of Service – Joint Partnerships expanded on the point made around the falls pathway and the direct action as a result of the report being presented to a ShIPP meeting which was really positive and when some funding was received to deal with falls the system was ready to go with it and also addressed prevention of falls.

It was agreed to invite the Fire Service to future meetings so that they could become a part of the conversation.

The Executive Director of Health, Wellbeing and Prevention highlighted the work being done by Members through both the Health Overview and Scrutiny Committee and the Joint Health Overview and Scrutiny Committee whereby a task and finish group had been set  ...  view the full minutes text for item 68.

Claire Parker, Director of Partnerships and Place, Shropshire, NHS Telford & Wrekin

The Board received the report of the Director of Partnerships, Shropshire, Telford and Wrekin ICB – copy attached to the signed Minutes – which updated the Board on progress with the Joint Forward Plan and engagement on the plan including next steps.

RESOLVED:

To note the contents of the report.

Penny Bason, Head of Joint Partnerships, Shropshire Council and NHS Shropshire, Telford and Wrekin & Laura Tyler, Assistant Director, Joint Commissioning, Shropshire Council and NHS Shropshire, Telford & Wrekin

The Board received the report of the Head of Joint Partnerships and the Assistant Director, Joint Commissioning – copy attached to the signed Minutes – which presented an overview of the ShIPP Board meetings held in February and March 2023 and included actions, for assurance purposes, along with details of the Better Care Fund planning process.

The Head of Joint Partnerships introduced the report and highlighted the salient points.  She explained that delegated authority was being sought for the Executive Director of People, Shropshire Council and the Director of Delivery and Transformation, ICB to sign off the 2022/23 End of Year return.

The Assistant Director, Joint Commissioning reported that they were currently reviewing the last year’s plan and that the next two-year plan needed quite a lot of changes and that there may be some other schemes that would fit better within the plan and those conversations were yet to be had.

A brief discussion ensued and the Interim Director of Strategy and Partnerships, SaTH, felt that some of the work that had been done by SaTH could be combined with the work that was currently being done in this area and he agreed to share it with the Assistant Director, Joint Commissioning. 

The Chief Executive SCHT agreed that it was the right time to review the Better Care Fund to ensure it was aligned to the priorities and focused on prevention and supporting population health and keeping people well and out of hospital but it was important that the ‘where’ and the ‘how’ that work was going to be done was known so it was open and transparent and could be signed off in the full knowledge that everybody was supportive and had inputted into it.  She went on to recognise the importance for both health and social care of the core services that were supported in terms of the funding around that and therefore needed to understand the implications of any changes and how those core services were contributing to the overall benefit in the system to ensure that it met the objectives of the Board and the overall ICS priorities.

In conclusion, the Executive Director for People reassured the Board that there was a system-wide working group across the system for the last six months with representatives from SCHT, SaTH, the ICB and the Local Authority just thinking about what that review needed to look like so there was a great understanding of the current Better Care Fund and what it was delivering but also an idea about what they wanted the next two years to deliver.  She asked all system partners to ensure that those people understood the timeliness now of getting the submission in and to please commit to the meetings that would be scheduled in order to work at pace as the dates were not changeable.  The Chair added that it was important to ensure that the right people were in those conversations.

RESOLVED:

1.     to recognise the work underway to address the key  ...  view the full minutes text for item 70.

Margarete Davies – Shropshire Carers Manager & Carer Lead, Shropshire Council

The Board received the report of the Shropshire Carers Manager and Carer Lead – copy attached to the signed Minutes – which provided an update on the All-Age carer strategy.

RESOLVED:

To note the contents of the report and to support the All-Age Carer Strategy, recognising that carers were integral to any planning of services.

Rachel Robinson, Director of Public Health/Alex McLellan, Public Health Intelligence Manager

The Board received the report of the Director of Public Health and the Public Health Intelligence Manager – copy attached to the signed Minutes – which provided an update on the Joint Strategic Needs Assessment for Drugs and Alcohol.

RESOLVED:

To note the contents of the report and to approve the recommendations contained therein.

Susan Lloyd, Consultant in Public Health, Shropshire Council

The Board received the report of the Consultant in Public Health – copy attached to the signed Minutes – which provided an overview of the health protection status of the population of Shropshire along with the status of communicable, waterborne and foodborne diseases.

RESOLVED:

To note the contents of the report.

Sean McCarthy, Armed Forces Covenant Lead, Shropshire Council

The Board received the report of the Armed Forces Covenant Lead – copy attached to the signed Minutes – which provided an update on the Armed Forces Covenant in Shropshire.

RESOLVED:

To note the contents of the report and to acknowledge the hard work that was ongoing for the veterans and serving members of the armed forces within Shropshire.

          The Chair updated the Board as follows:

          Correspondence from NHS England

          Notifications had been received from NHS England about changes of pharmacy
           operator and ownership:

•   Hills Pharmacy in Church Stretton was now operated by Gill & Nagra Ltd

•   Lloyds Pharmacy in Ludlow, Shropshire was now owned by Gill & Nagra Ltd

And supplementary opening hours:

•   Murrays Healthcare, Market Drayton from 40 to 49.15 hours per week

•   Boots Pharmacy, Mytton Oak Road, supplementary opening hours from 40 to 44
     hours per week.

A summary would be placed on the Council website.

Director of Public Health's Annual Report

The Director of Public Health’s Annual Report was currently being drafted and would be brought to either the June or September Board meeting.

The Prevention Board will cease to be a separate Board, as its work was included under the Health and Wellbeing Board's Health Protection update.

Health and Wellbeing Board/ShIPP workshop

Members were reminded that this would be taking place on Monday 19 June from 10am-12noon in person.  A hold the date invite had been sent to all members.

          The Chairman informed the meeting that it was the Health and Wellbeing Strategic Manager’s last meeting and he thanked her on behalf of the Board for the energy that she brought to the HWBB and for all the work she did behind the scenes, and they wished her a long and happy retirement.