i)                To receive a presentation from ShropComm and the ICB on the Local Care Transformation Programme. (To Follow)

ii)               To commission the Local Care Transformation Programme task and finish group.

Simon Whitehouse, Chief Executive of NHS Shropshire Telford and Wrekin, gave a presentation which provided members with an overview of the Local Care Transformation Programme, which identified the problems being faced and why transformation is necessary.

Members noted that the evidence base is compelling and there was a need to keep people in hospital for as short time as possible to get the intervention they need to then be in a position to leave hospital. Outcomes for people improve significantly when they are in the right setting with the appropriate wrap around care compared to those with a longer hospital stay.

It was reiterated that in terms of the model of care, this was not pre-determined. There was a commitment to redesign the models of care with stakeholders; focussing on prevention and early intervention that supports people staying in their own homes. There would also be a focus on the support for those with long term conditions, as if this was not provided well, this would result in longer hospital admissions where it was harder to regain independence. This must be a joined up approach, with every partner playing their part.

Lisa Keslake, Programme Director, Local Care Transformation Programme, advised members of the 5 critical programmes of work that sit within the Local Care Programme which required joined up working across all partners across the system. These were designed to stem the demand for further acute services, support people to say well and healthy, maximise functionality and independence, receive care closer to and at home, and focus NHS resources more appropriately for the needs of local people. Programmes of work included community based services such as rapid response, an integrated discharging team, the opening of 250 ‘Virtual Ward’ beds, creating neighbourhood teams and reviewing community based services.

Members received an overview of ‘Virtual Wards’ and the three main pathways; frailty, respiratory and cardiology and were presented with data showing an increase in total step up vs step down referrals which were exceeding the target for total referrals.

Members raised queries and/or concerns including:

·       It was questioned as to whether studies been carried out in the south west where digital technology is a significant issue, as well as the recruitment of staff;

·       The number of patients in hospital who had no medical reason to be residing in hospital had not reduced over the past two years.

·       It was felt that there was inadequate urgent care and that this model did not take into account acute emergencies which require immediate access to urgent care.

·       The continuing problem of culture within health organisations and the latest results of the staff survey in which bullying and other unacceptable behaviour was highlighted and how the ICB would be addressing these issues.

·       What if any barriers are there to rolling the Transformation programme out and what are the plans to expand?

·       The long-term funding available to support virtual wards.

·       Plans to expand the service.

·       Support for young people

Members were advised that Virtual Wards were one area where recruitment had been successful, and it was confirmed that the figures of step up/downs from Virtual Wards in the south west of the county would be provided following the meeting. Members were reassured that this was not a ‘one size fits all’ approach and would be implemented in the best way to give the most appropriate support.

It was acknowledged that bringing elective care waiting lists down would take out some attendance at GPs and reduce some unintended urgent presentations. With regards to the Care Model, it was imperative that people are supported through the appropriate pathway in a timely way to expedite the discharge from hospital.

It was stated that to address the culture, this would need to be a collective approach as to how to look after the workforce in a challenging environment. Positive promotion of the NHS within the community and within further education was key, as was providing employees with roles that are exciting which motivates them to stay within the job.

With regards to barriers, workforce is one of the biggest challenges yet one of the biggest areas for opportunities to work in integrated teams, which is a medium to long term endeavour. Options for approaches will be fed into the co-production and design process for the Plan.

Members were advised that funding has been made available to get Virtual Wards off the ground and build on the evidence base. It had been agreed collectively that this is a priority and that we build on co-production and collaboration, looking at services and how they are linked together to better meet the needs of the population we are responsible for.

Members noted that they are currently in the pre-consultation phase over the next 6-8 months which goes through NHSE Assurance before going to full consultation, with an engagement process taking place after September. They will work with Shropshire Council to ensure they can deliver in line with what we want to do.

Members raised questions surrounding the closure of Bishops Castle Community Hospital and it was confirmed that a Q&A document would be circulated following the meeting.