Refreshed Urgent and Emergency Care Improvement Plan

Sam Tilley, Director of Urgent Care and Planning, NHS Shropshire, Telford & Wrekin Clinical Commissioning Group (STWCCG)

Shropshire Integrated Place Partnership (ShIPP) update

Penny Bason, Head of Joint Partnerships, Shropshire Council and Shropshire, Telford & Wrekin Clinical Commissioning Group (STWCCG)

Joint Commissioning Board/Better Care Fund (BCF)

Report to follow

Laura Tyler, Assistant Director, Joint Commissioning, Shropshire Council and STW CC / Penny Bason, Head of Joint Partnerships, Shropshire Council and Shropshire, Telford & Wrekin Clinical Commissioning Group (STWCCG)

Healthy Lives Update – paper for information

Val Cross, Health and Wellbeing Strategic Manager, Shropshire Council

Shropshire, Telford & Wrekin Urgent & Emergency Care (UEC) Improvement Plan

The report of the Director of Urgent Care & Planning, Shropshire, Telford & Wrekin CCG had been received by the Board (copy attached to the signed Minutes) which set out the context of the Urgent & Emergency Care Improvement Plan for the current financial year.  She gave a summary of the plan and took the Board through the headlines of the Plan.  She explained that following development of an initial improvement plan for UEC the previous year this plan built on that and set out a set of objectives and aims and deliverables for the coming financial year.

The Director of Urgent Care & Planning drew attention to the UEC Improvement Plan Review development process that had been utilised in the development of the plan and the development of its three priorities, as follows: Pre-Hospital; Hospital improvement and flow; and Discharge.  She explained that they had tried to be very clear about the set of parameters they wished to focus on in order to ensure they were going to be deliverable.  The crafting of the plan was very much aligned to tackling some of the most prominent issues that they had been challenged with and making some real improvements within the next financial year.

The Director of Urgent Care & Planning took the Board through the three priorities in more detail along with the range of linked programmes across the system that were being delivered that did not fall directly within the remit of UEC but were inevitably important in enabling them to deliver what was required.  She explained that there was a whole programme of work looking at the whole pathway but being very distinct about the things to be focused on and the things it was felt would provide the most benefit in the next 12 months.  This was a distinct part of a much longer-term journey that really focussed in on what could be achieved within that time frame.

The Director of Urgent Care & Planning explained that there was a process of this going through approvals, the Urgent and Emergency Care Board had approved it in principle as a set of priorities and a good discussion was had at the Urgent Care Delivery Group the previous day to work up the next level of detail around these plans and that would then go through the Urgent and Emergency Care Board at the end of May.  This would then be monitored throughout the year and supported with data flow and communications to ensure the best results were achieved.

The Executive Director of Health, Wellbeing and Prevention commented that the Board would be particularly interested in understanding the detail of the whole plan and requested that more detail be brought back to a future meeting. In response, the Director of Urgent Care & Planning agreed to bring back the next set of detail which would make it easier to see how this tracked through in terms of some of the improvement areas and how that was then monitored.  She explained that there had been a lot of discussion around the ambulance piece because it had been an area of particular concern and she stressed how interconnected all the elements were.  By doing the things set out in the plan it would absolutely improve performance where it was known it needed to be improved particularly around some of the issues with ambulance delays.

Members felt this work was heading in right direction.  However, some residents in rural divisions in the south of the county had great difficulty even seeing their GP just because of distance, so it was critical therefore thatthe client group understood how they should behave if they felt they were in need of careand how that should be conveyed to them fairly simply.  Although not at that stage just yet, it was felt to be a very important part of this because then there would be a good chance that the general confusion that so often surrounds hospital admittance, treatment and discharge would be cleared up and patients would understand the process. 

Lynn Cawley, Shropshire Healthwatch commented on the importance of all of this but also of importance was gathering the patient experience along the way as these things move forward.  She reported that Shropshire Healthwatch was planning a piece of work to try to gather the wider experience of ambulance services and while hearing in the press of difficulties across that service, they would also expect to hear some positive comments from people as well.  They hoped to understand the challenges, particularly across the rural parts of Shropshire and also ask people what they think could help while they were waiting because there did not seem to be a quick solution to those long waits.

Healthwatch were also keen to help people understand how to use the NHS in its current form as we move forward.  She felt there was a huge education piece to be done around those communities of people who were relatively new to this area or even new to the country about how the NHS works and how to access it.

SHiPP update

The Head of Joint Partnerships gave a presentation (copy of slides attached to signed Minutes) which updated the Board on the position since the last meeting.  She reminded the Board of the priorities and drew attention to the programmes and subgroups.

She reported that a number of presentations and discussions had taken place around inequalities and she assured the Board that work was ongoing in earnest with the development of a health and inequalities plan that was Shropshire focused and were working closely with NHS colleagues on a broader system health and inequalities plan.  She explained that the Shropshire Plan was focused on the wider determinants of health thinking about all the ways in which inequalities are understood in communities and what can be done about it across all services.

The Head of Joint Partnerships drew attention to projects underway for which they had received funding from NHS England to work in partnership with the voluntary sector to deliver.  She explained the Core 20 Plus 5 approach which was designed to focus care and look at inequalities for those people who were most deprived and those with particular health issues.

The Head of Joint Partnerships turned to the work being undertaken around Children and Young People, Local Care Transformation Plan and Personalisation / Personalised Care which were some of the key areas of focus. She also highlighted Involvement which was a cornerstone of all programme development and was linked to the ICS involvement work and strategy developments.

The Head of Joint Partnerships drew attention to the areas they wished to bring back to the Board, including the metrics for mental health and dementia, end of life and VCSE infrastructure and community capacity building.

Lynn Cawley, Shropshire Healthwatch informed the Board that Healthwatch ran its annual event the previous week which had a focus on end of life and they were able to launch the system end of life strategy which was really helpful.  They had a great panel of speakers so people heard about the work that was currently being done about advanced care planning including the work being done in care homes.

BCF update

The Board received the report of the Assistant Director, Joint Commissioning and Head of Joint Partnerships (copy attached to the signed Minutes) which highlighted developments and system risks that had arisen over the last few months and included the 2021/22 Better Care Fund End of Year Report at Appendix A of the report.

The Head of Joint Partnerships introduced and amplified the report.  The BCF End of Year report was due on 27 May 2022 and the Board were being asked to endorse it with the proviso that the admission avoidance metric be updated before it was finally signed off by the Executive Director of People as proxy. 

The Head of Joint Partnerships took the Board through the key elements of the Better Care Fund final report for the year.  She confirmed that all BCF metric targets had been met or exceeded except one, 14 days length of stay which had been missed by 0.4%.  The report also highlighted the year-end feedback and highlighted that the greatest challenge was the local context, which included financial, demographic and rural challenges which made it more difficult to deliver services and reduce inequalities.  She drew attention to the Joint Commissioning update and the additional areas they were developing.  She reported that the paper highlighted the reliance on grant funding to support system flow and that this remained a risk for the system.

The Director of Partnerships, Shropshire, Telford and Wrekin CCG thanked the Assistant Director, Joint Commissioning and the Head of Joint Partnerships for all their work around the BCF and joint commissioning work.  She highlighted work that could be done that was linked to the place-based work as it was developed over the next 12 months around what was in the BCF and how that supported the system to function and the place to deliver eg around how much non-recurrent funding ends up in the BCF and how to get some recurrent funding to really deliver some positive changes for the population of Shropshire, Telford & Wrekin.  Members were pleased to hear that the BCF had been approved nationally.

Healthy Lives

The Board received the report of the Health and Wellbeing Strategic Manager(copy attached to the signed Minutes) which provided an update on Healthy Lives, the multi-agency prevention programme of the Health and Wellbeing Board.

The Health and Wellbeing Strategic Manager informed the Board that the Healthy Lives Steering Group meetings had restarted in February 2022 and she gave an example of some of the topics that had been focussed on.  She drew attention to the Governance Structure.  The priorities for the group to collaborate on were discussed and would be reported to the HWBB.

      In response to a query, the Health and Wellbeing Strategic Manager explained how the outcomes and impact of the Healthy Lives programme would be measured.