To receive the report of the Task and Finish Group

Councillor Heather Kidd, Chair of the Rural Proofing in Health and Care Task and Finish Group, gave a presentation on their findings over the past six months. Members were advised that the members of the task and finish group had been clear from their first meeting about the topic, that addressing any inequalities of service provision between rural and urban areas required a system wide understanding of the opportunities and challenges. Having this would help to identify the most suitable and effective options that need to be explored and implemented to effectively ‘rural proof’ the amendment or introduction of strategies, plans, policies and service design and provision in health and care in Shropshire.

The Group made 14 recommendations which they believe will contribute to addressing inequalities of service provision between rural and urban areas including recommendations:

· to Shropshire Council 

· to the Integrated Care Board

· promoting a system working approach across all Integrated Care System stakeholders

· promoting a consistency of approach with local and regional partner Councils

These were as follows:

1.     Recommendation: That an end-to-end evaluation of the travel and transport infrastructure which supports the Shropshire health and care system should be completed by the Integrated Care System to understand how effective the current provision is and to identify current and future demand. The evaluation should include:

·       Patient Travel Support

·       Public Transport

·        Concessionary Travel

·       Community Transport

·       A review of how health and care transport is co-ordinated at a system level

·       A mapping exercise to identify community capacity available to deliver voluntary community transport schemes, and whether there are sufficient services available and how best to provide an equitable service closing the gaps overall and in specific locations.

2.     Recommendation: The group recommends that rurality and the accessibility factors that are associated with it becomes a key consideration for Shropshire’s health and care system (including Shropshire Council) when adapting or introducing a new service or policy and recommend the use of the Rural Proofing for Health Toolkit to achieve this.

3.     Recommendation: That an evaluation be undertaken by Shropshire Council to understand the impact of digitalisation on protected and vulnerable demographics (including those living rurally.) Understanding more about the current and future needs in different communities and investigating alternative delivery models to provide the infrastructure, access to equipment and support to enable all communities to benefit from the advantages which digital services can provide. The evaluation should include: o Mapping mobile coverage and broadband access and use across Shropshire. o Developing/strengthening partnerships with broadband providers to help identify and support people experiencing digital exclusion? o Working with telecoms providers to ensure that vulnerable people are not left without the means to seek help in an emergency through line outages o Identifying the impact to vulnerable users of the plans to remove all analogue copper phone services nationally by 2025 o Working with other council departments, NHS partners, voluntary and/or faith organisations and district councils, to build on the model of an integrated services hub to enable people to access a number of services in one locality?

4.     Recommendation: That an evaluation be undertaken by Shropshire Council in their role as commissioner and Place co-ordinator to understand how the council’s intelligence and data gathering function can contribute to discussions and research on how to identify small pockets of deprivation in rural communities. Testing how ambitious the strategic plans are about strengthening the power of community, leading the way by using robust data to identify the challenges facing different areas, building local capacity, embracing coproduction and community delivery, and devolving power and resources to neighbourhoods.

5.     Recommendation: The Groups research has shown that local support from the voluntary sector does, and will continue to play, a vital role in supporting residents by providing access to health and care services in rural locations. However, as resources are required to do this; sufficient understanding of the needs of the voluntary organisations and planning time needs to be built into the system. The Group recommends that the Rural Proofing for Health Toolkit be completed alongside the impact assessment process, as in each section it includes prompts to consider the ask being made of the voluntary sector.

6.     Recommendation: The Group were very pleased to learn that the Rural proofing for Health Toolkit had been recommended for use within the Integrated Care System (ICS) by Simon Whitehouse (Chief Executive Officer for Shrewsbury Telford and Wrekin Integrated Care Board) and Cllr Cecelia Motley (in her role as Co-Chair of the Health and Wellbeing Board.) The Group recommends that the Toolkit be fully adopted into the Integrated Impact Assessment process of the ICS and all organisations whom it commissions and be accepted as a mandatory document to be completed when making changes to or introducing a new strategy or plan making process, so it can inform thinking from the outset.

7.     Recommendation: That the Shropshire Health and People Overview and Scrutiny Committees adopt the Rural proofing for Health Toolkit as a part of their own overview and scrutiny processes to support them in maintaining a robust view on the needs of their local rural populations when they review strategies, initiatives and service delivery plans.

8.     Recommendation: Whilst this Group have focussed on rural proofing specifically in the health and care system their findings have shown that its impact is much wider ranging and relevant to all areas of the Council and the support provided to rural communities. The Group therefore recommends that the Shropshire Council 2020 Community and Rural Strategy be updated and implemented.

9.     Recommendation: That the Rural Proofing for Health Toolkit be recommended for use to its partner local authorities of Telford and Wrekin to support the work of the Joint Health and Overview Scrutiny Committee. To the Shropshire Association of Local Councils for use in their work as Parish Council’s, creating a consistency of approach to rural proofing. Then this be expanded to Herefordshire, Monmouthshire and Powys as with evidenced cross border working through shared interests and the new Marches Forward Partnership, the Group recommends that the adoption of this Toolkit forms part of the Memorandum of Understanding by all the authorities which will contribute towards a shared understanding of the opportunities and challenges of delivering health and care services to rural communities.

10.Recommendation: That communication between Council officers, system partners and councillors be reviewed to ensure that the best use of councillor’s knowledge of their communities and where there may be previously unidentified health needs. It is recommended that regular briefing updates are provided to councillors from Council officers and system partners so that Members are aware of developments in service delivery and can feed in their local knowledge to the work being developed, sharing new developments and service offers with their communities especially supporting with facilitating communication with historically hard to reach groups.

11.Recommendation: That an agreed system approach to ‘local’ be defined to assist with having comparable data at a local rather than regional level. With Shropshire Council using its role as a public health authority and leader of the Health and Wellbeing Board to ensure that rural communities’ travel time to services is an integral factor in the planning of services in the health and care sector.

12.Recommendation: That the process and legal obligations for Equality, Social Inclusion and Health Impact Assessment (ESHIA) in terms of responding to impacts identified through the ESHIA be clarified for Officers and Members and until then that this matter be logged on the Shropshire Council strategic risk register.

13.Recommendation: That a deep dive be carried out into recruitment and retention policies and practices in the Shropshire health system by the Joint Health Overview and Scrutiny Committee including a review of best practice nationally encompassing the approaches recommended by the Rural Services Network to see if they would work in Shropshire.

14.Recommendation: That a permanent Mental health Commissioner role be appointed for Shropshire Council to provide system oversight and strategic leadership

Members were thanked for their hard work in preparing such a detailed report and it was stated that this piece of work had demonstrated what could be achieved by the scrutiny process. Thanks were also given to the Rural Support Network for their support and to Sophie Foster, Overview and Scrutiny Officer.

It was felt that a future report from the newly appointed Mental Health Commissioner would be beneficial.

Members queried whether the local plan had been discussed as part of the group’s work. Members were advised that although it did not feature in the report, it had been noted that the Local Plan process was too far along to influence, however it was hoped that the Rural Proofing for Health Toolkit would be used for any supplementary planning documents.

In response to a query regarding the pharmacy access scheme and targeted enhanced recruitment scheme, the Executive Director for Health confirmed that this would be taken to the ICS for them to respond as to how these have been viewed through a rural proofing lens.

Members noted that the Toolkit will be forwarded to the Marches Partnership and it was agreed that the report would be forwarded to full council.

The importance of monitoring was expressed to ensure accountability of the council and partners.

It was confirmed that a report would be brought back to committee regarding training on digital exclusion in rural areas.

RECOMMENDED:

That members endorsed the report and adopted it in its entirety.