Agenda and minutes
Venue: Shrewsbury Room, Shirehall, Abbey Foregate, Shrewsbury, Shropshire, SY2 6ND
Contact: Michelle Dulson Committee Officer
Apologies for Absence and Substitutions
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:
Steve Trenchard, Shropshire STP
Martin Harris, STP Programme Director
Bev Tabernacle, Director of Nursing, RJAH
Mark Brandreth, CEO, RJAH
Julie Davies, Director of Performance & Delivery, Shropshire
Disclosable Pecuniary Interests
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.
Jackie Jeffrey, declared that the VSCA
were funded via the prevention part of the Better Care
To confirm as a correct record the minutes of the meeting held on 14 November 2019.
Contact: Michelle Dulson Tel 01743 257719
It was confirmed that Dr Julian Povey (Clinical Chair, Shropshire CCG - Co-Chair) had indeed been in attendance at the meeting, as had David Stout (Transformation Director).
It was also confirmed that paragraph 38 of the Minutes should refer to Cathy Riley and not Megan Nurse.
That the Minutes of the meeting held on 14 November 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. The deadline for this meeting is 9.30am on Tuesday 14 January 2020.
A question submitted by Lisa Richards, Loss and Wellbeing Specialist, in relation to what the Council was doing to support their own employees in terms of their mental health and wellbeing had been circulated to Members. The Occupational Health, Safety & ICT Approvals Manager had provided a response to these questions.
A copy of the question and the response provided is 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:
Shropshire Care Closer to Home
Contact: Lisa Wicks, Deputy Director of Performance & Delivery, Shropshire CCG
A presentation will be given.
Contact: David Stout, Accountable Officer, Shropshire CCG
Better Care Fund, Update and Performance
Contact: Penny Bason, Shropshire Council / Shropshire STP/Tanya Miles, Shropshire Council
Healthy Lives Update
Contact: Val Cross, Health & Wellbeing Officer, Shropshire Council
i. Shropshire Care Closer to Home
Dr Julian Povey, Clinical Chair, Shropshire CCG (Co-Chair) 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.
He drew attention to the three phases, the enablers and the next steps. In relation to Phase 2, concern was raised about the level of consent from patients who wished to be case managed. The Clinical Chair, Shropshire CCG explained that the level of consent was different at each pilot site, but that the numbers were in line with what had been anticipated. In response to a query, the Clinical Chair, Shropshire CCG explained what was being done to reach those patients who had not responded. The Chairman requested that the Board be sighted on the percentage of patients who had agreed to be case managed whilst this phase was rolled out.
David Stout, the STP Programme Director, Shropshire CCG reported that those patients who were not in touch with Social Care/Health Care were being identified and that it was hoped that they would be picked up via the risk stratification tool. He assured the Board that the situation would be monitored to ensure the correct people were targeted. He went on to inform the meeting that it was planned to roll out case management across Shropshire and Telford & Wrekin as part of the Long-Term Plan. The Business Case was due to go through the CCG clinical commissioning committee the following week.
Jeanette Coin, Business Manager for Albrighton Medical Centre informed the Board that an information leaflet was currently being drafted and that this, along with other measures, were being utilised to actively address those patients who had not yet responded. Lynn Cawley, Shropshire Healthwatch offered some assistance with the drafting of the leaflet to ensure the information was clear.
RESOLVED: That the information and progress outlined in the report be noted.
ii. The Sustainability and Transformation Plan for Shropshire, Telford & Wrekin
David Stout, the STP Programme Director updated the Board in relation to the Long-Term Plan. He reported that publication of the Long-Term Plan had been delayed as it was still awaiting sign off by NHS England, which was the case nationally. He explained that it was expected that it would now be published in April 2020.
Work was continuing on the operational side of the plan along with work to develop implementation plans. The first meeting of the Shadow Integrated Care Board would take place in February following which a roadmap for the development of an Integrated Care System for the next year or so would be developed.
The Chairman requested an update on the role of technology across the system which was fundamental to the success of service transformation.
RESOLVED: That the update be noted.
iii. Better Care Fund, Performance
Penny Bason, the STP Programme Manager introduced and amplified her report – copy attached to the signed Minutes ... view the full minutes text for item 52.
Anne-Marie Speke, the Healthy Child Programme Co-ordinator introduced and amplified the report of the STP Programme Director for Mental Health – copy attached to the signed Minutes – which informed the Board of the progress made in the refreshed Children and Young People’s (CYP) Local Transformation Plan.
The Healthy Child Programme Co-ordinator gave an overview of the plan which had been submitted to NHS England / NHS Improvement in October 2019. Following feedback from NHS England / NHS Improvement amendments had been made and the most up to date iteration of the plan could be found on the CCG website. She then drew attention to the I-Thrive model which had been used to develop and map services. Further work was required to ensure Action Plans were updated and to that end a meeting had taken place the previous day to identify the lead officers to take this forward.
The Healthy Child Programme Co-ordinator informed the meeting that recruitment to the new Mental Health Support Teams (MHSTs) was in progress with some practitioners starting in January and the rest of the team in March.
In response to a query, the Healthy Child Programme Co-ordinator explained that the data had been an issue however MPFT had introduced new systems so she was confident that the data was still reliable but that more up to date data should start coming through.
The Portfolio Holder for Children’s Services urged the Board not to underestimate the challenges faced by Children’s Services, particularly in relation to mental health and he requested that the barriers to support be looked at in more depth by the Board.
The Director of Adult Services felt that the outcomes in the Action Plan were very service orientated rather than focussed on outcomes for children and young people. In response, the Healthy Child Programme Co-ordinator reassured the Board that this had been looked at and that the Action Plans were being amended to reflect this.
Concern was raised that the majority of referrals came through GPs, however, the Healthy Child Programme Co-ordinator reported that other professionals including schools could refer into the service. Cathy Riley, MPFT also confirmed that this had shifted and that the majority of referrals were now from schools.
Lynn Cawley, Shropshire Healthwatch informed the meeting that Healthwatch had recently met with a cohort of young people/young adults (late teens/early 20s) who had great insight into mental health issues that were underlying in their own lives and who would welcome the opportunity to help shape these services.
A. That the contents of the update be noted and that the ongoing system leadership for effective joined up children’s services be supported.
B. That the refreshed Children and Young People’s Local Transformation Plan be approved, subject to the action plan being refreshed at a workshop on 15 January 2020.
Kerry Simmonds, the Deputy Head, Market Drayton Infants School introduced and amplified her report – copy attached to the signed Minutes – which provided an overview of the Wellbeing Award being completed at Market Drayton Infant and Nursery School. She also gave a presentation, which covered the following areas:
· Impact so far
· Everyone’s responsibility – how to make this happen
· The curriculum
· Parental involvement
· Resilience and prevention
· Staff wellbeing
· Collaboration beyond the school
The Deputy Head explained that wellbeing was key for children and families and that she worked with a lot of different people within the school including the school nurse, caretaker, cook, mental health lead, SENCO etc. She explained how wellbeing had been linked to the curriculum and that all schools within the Academy had wellbeing as a priority.
They were the only school in Shropshire that had undertaken the Optimus award but they felt that it was crucial to get wellbeing right at the earliest opportunity in order to achieve the best results and impact for their children. The Deputy Head reported that an interim assessment of their work towards the award was taking place the following day.
The Deputy Head drew attention to the impact so far which included changing the ethos in the school so that wellbeing became everyone’s responsibility. Parental engagement had also seen a big change with 95% of parents currently engaged.
The Portfolio Holder for Children’s Services praised the excellent work being done at Market Drayton Infant and Nursery School and wondered how best to get this into every school. In response, the Director of Public Health confirmed that this could be looked at to see how roll out could be supported. The STP Programme Director was very impressed with the enthusiasm shown but stressed the need to link what was being done with Ofsted. In response, the Deputy Head reported that wellbeing was important to Ofsted as it was recognised that by getting wellbeing right at an early age this would bring long term benefits as the children moved up to the Junior School.
The Chairman felt that the support being provided to parents was very important. He commented that he would be very interested to hear back on the sleep work that was currently being undertaken in order to more fully understand its impact on learning.
RESOLVED: To note the information and progress of the Wellbeing Award and the work being completed for children and young people in Shropshire.
Contact: Alison Smith, Telford & Wrekin CCG
David Stout, STP Programme Director introduced and amplified the report of the Accountable Officer, Shropshire CCG – copy attached to the signed Minutes – which provided a further update on the application process for creating a single strategic commissioner across Shropshire and Telford & Wrekin.
The STP Programme Director informed the meeting that they had applied and were turned down on their first application to create a single strategic commissioner for the reasons set out in paragraph 3.2 of the report. However, positive feedback had been provided (paragraph 3.4) and a new timetable for re-application agreed.
The Board were further informed that options were being explored by the two CCGs to align their governance structures in line with a move towards a single management team and to that end, a number of Director roles had been appointed to. The STP Programme Director reported that public engaement would take place during January and February 2020.
RESOLVED: That the contents of the report be noted.
Contact: Cathy Davies, Shropshire Clinical Commissioning Group
Linda Vaughan introduced and amplified the report of the Commissioning and Redesign Lead for Mental Health (interim), Shropshire CCG – copy attached to the signed Minutes - which provided the Board with an update on the current commissioning work in dementia, including key work areas for the programme for the coming year along with an update on hospital avoidance accreditation.
Ms Vaughan drew attention to the Key Objectives and Strategic Goals to be met in 2020, set out at paragraph 6 of the report. She then highlighted what had been achieved since publication of the Dementia Strategy in 2017 which included the funding of two dementia companions.
It was confirmed that Shropshire performed well in terms of diagnosis to prevalence rates (71% against the national target of 67%) however it was estimated that around 31% of people with dementia in Shropshire had yet to be diagnosed.
Ms Vaughan informed the meeting that a Sub-Group of key partners had been created in order to take an overview of the whole system. The Director of Public Health felt that the development work being undertaken in relation to prevention, dementia friends/communities, social prescribing etc was a great opportunity to bring in community level work.
Concern was raised in relation to how a diagnosis was communicated to the person and their family. In response, Dr Julian Povey, Clinical Chair, Shropshire CCG explained that there were pros and cons to having the diagnosis, which could be very impactful, however the evidence on balance was that having an early diagnosis was helpful in order to find out what was possible, what services were available etc. Obviously, some people would not be happy about having a diagnosis and he agreed that better communication was required.
The Chairman welcomed the report as he felt it had been a long time coming however he remained confident that it would be delivered and urged Ms Vaughan to take the opportunity of support offered within the meeting and the opportunity for joint working.
RESOLVED: To note the progress against the Dementia Strategy along with the updates in relation to national guidance set out in the report.
Report to follow.
Contact: Laura Fisher, Housing Services Manager, Shropshire Council
Laura Fisher, the Housing Services Manager introduced and amplified her report – copy attached to the signed Minutes – which updated the Board on a range of actions being undertaken to support and rehouse rough sleepers in the County.
The Housing Services Manager reported that the annual rough sleeper count had taken place on 14 November 2019 which consisted of both a count (in the main market towns) and an estimate of those known verified rough sleepers who were not seen. The final figures submitted were 16, which was a reduction from 21 the previous year.
She then drew attention to the cold weather provision, which was a non-statutory provision of accommodation, which had been activated on 30 November 2019, the earliest that this provision had ever been activated. Although the offer was made to all known and verified rough sleepers, not all would accept the offer and many would refuse initially. Severe Weather Emergency Provision was offered during times when the weather was severe eg if below freezing for three consecutive nights and was a statutory duty. This provision had been activated for three nights so far this year at 70 Castle Foregate.
The Housing Services Manager explained that the Outreach service operated all year round. She reported that funding had been secured to set up a rough sleeper team of 5 additional posts which would enable them to extend the service. The service would be based within 70 Castle Foregate and it was hoped to open the following week.
She then drew attention to the development of a new App for reporting rough sleepers (Appendix A) along with work with Shrewsbury BID to develop a streetlink website (Appendix B). She urged colleagues to circulate this information around their organisations.
The Portfolio Holder for Adult Social Care and Public Health congratulated the team for their hard work in reducing the number of rough sleepers in the County to 16, the lowest number yet, and for their work in relation to 70 Castle Foregate.
RESOLVED: That the contents of the report be noted.
Report to follow.
Contact: Rachel Robinson, Director of Public Health, Shropshire Council
Rachel Robinson, the Director of Public Health introduced and amplified her report – copy attached to the signed Minutes – which provided an overview and update on Shropshire’s position regarding screening and immunisation programmes. It also outlined areas of responsibility for partners locally and areas of concern.
The Director of Public Heath drew attention to the key findings which highlighted that whilst Shropshire continued to perform favourably in comparison to England as a whole, the uptake of the second dose of MMR and the shingles vaccinations remained a focus as did cervical screening uptake and the flu vaccine.
The Portfolio Holder for Adult Social Care and Public Health was reassured that the headlines were mostly positive, but there were variations within the data and take up rates were still below what was expected. Work with health colleagues to target specific groups more effectively, would be welcomed.
In relation to cervical screening, concern was raised that the waiting time for results appeared currently to be 3-4 months rather than the usual 2-4 weeks. The Director of Public Health had not been made aware of this delay but agreed to look into it.
To note the contents of the report and the data contained therein and to support and promote activities designed to improve uptake of vaccines and screening programmes raising awareness of these interventions.
To resolve that in accordance with the provisions of Schedule 12A of The Local Government Act 1972 and Paragraph 10.4  of the Council’s Access to Procedure Rules, the public and press be excluded from the meeting during the consideration of the following items
The Chairman updated the Board in relation to the following pharmacy updates:
· Pharmacy at 5 Cross Street, Ellesmere will be operated by Day-Night Pharmacy Ltd. A letter confirming the opening hours had been received.
· Notification of Closure: Day-Night Pharmacy Ltd, trading as Ellesmere Pharmacy, 18 Scotland Street, Ellesmere will cease to provide pharmaceutical services on 11 May 2020.
· Change of Ownership application by Lunts Healthcare Ltd granted for Lunts Pharmacy, Roushill, Shrewsbury.
· Combined Change of Ownership and no significant relocation application for Lunts Pharmacy from Roushill, Shrewsbury to the Ground Floor unit, Block C, The Tannery, Barker Street, Shrewsbury by Lunts Healthcare Ltd now open to written representations until 23 February 2020.
The Chairman informed the Board that it was intended to hold a joint Shropshire and Telford & Wrekin development session for members to increase their knowledge and understanding of mental health and what they can do to support communities. Each Health and Wellbeing Board would need to sign up to the Mental Health Concordat and develop work plans.
To approve exempt minutes