Agenda and minutes

None.

To confirm the minutes of the previous meeting.

RESOLVED – that the minutes from the meeting on the 10 June 2020 be approved by the Chair.

None.

To receive a presentation from David Evans, Accountable Officer for Telford and Wrekin CCG.

The Health and Wellbeing Board received a presentation from David Evans, Accountable Officer for Telford and Wrekin Clinical Commissioning Group on the moving from restoration to system recovery and the new normal following the COVID-19 global pandemic. Mr. Evans provided a verbal executive summary on the following topics which were referenced in the presentation received by the board:

·         Framework for planning & managing the stages of the pandemic.

·         The 8 tests that Shropshire, Telford and Wrekin must meet.

·         The Shropshire, Telford and Wrekin Integrated Care System principles and expectations.

·         Capturing innovation.

·         Learning captured through triple lens.

·         Methods of information gathering to inform learning about impact of changes.

·         Timescales for assimilating learning.

·         Recovery & new normal governance structure.

·         System strengths in response to COVID-19.

Members noted that there had been a reduction in the number of people attending A&E during the COVID-19 lockdown period, resulting in less unnecessary trips but also the avoidance of legitimate medical emergencies.  Members questioned how to get the balance right moving forward. Mr Evans responded by agreeing that A&E had seen at least a 50% reduction in attendance at certain points, and that moving forward the NHS needed to ensure the correct messages were put out so that some behaviour exhibited in the lockdown was retained. He stressed that the public also needed to know that the NHS had been open for business as usual for the last three or four and to still attend if you had a medical emergency.

Members asked about the work that had been done with the care sector in relation to a potential second wave, and provided anecdotal evidence of other good practices that had been taken up by care homes in other areas of the West Midlands. Mr. Evans responded by saying that all patients are tested for COVID-19 before discharge and are told to self-isolate for 14 days. Some challenges were presented for patients receiving continued care in care homes. Some care homes have set up separate wings so that they can take patients returning from hospital can reside there. Mr Evans continued by saying that a particular area of challenge for care homes surrounded the patients returning to care homes who suffered from Dementia and may had unknowingly walked out of that wing and cross infected other patients. Mr Evans concluded by saying he believed that there would be recurrence in the prevalence rate at some point within the next five or six months.

Members were keen to understand why the borough of Telford and Wrekin had seen a lower percentage in deaths in care homes due to COVID-19 compared to other local authorities. Mr. Evans was unsure on the answer for this and indicated that Liz Noakes, Director for Public Health at Telford and Wrekin Council may be better equipped to answer the questions. Ms. Noakes picked up on this question and said that the Telford and Wrekin average was just below the West Midlands average in terms of deaths in care homes due to COVID-19  ...  view the full minutes text for item HWB4

To receive the report of Jonathan Rowe, Executive Director: Adults Social Care, Health Integration & Wellbeing, Telford and Wrekin Council.

The Health and Wellbeing Board received a report from the Jonathan Rowe,Executive Director: Adults Social Care and Health & Wellbeing, Telford and Wrekin Council on the Care Act Easements 2020 and was presented by Sarah Dillion, Director: Adult Social Care, Telford and Wrekin Council. The report had been published to support the decision making within Adult Social Care in Telford and Wrekin Council in relation to the implementation of the Coronavirus Act 2020 which allowed for some flexibilities of the duties in the Care Act 2014. Ms Dillion reported that Telford and Wrekin Council had rated itself a level two based on the guidance set out in the Coronavirus Act 2020. The main flexibilities were:

·         Adjustments to the method of undertaking Care Act Assessments in line with social distancing and non-essential visits.

·         Three month suspension of client contribution for all care and support delivered in the community.

·         Scheduled reviews of care and support plans undertaken remotely where possible.

Ms. Dillion concluded by summarising that the main impact that had been undertaken by Adult Social Care in response to the coronavirus was the suspension of day services for individuals with learning difficulties but have continued to maintain contact and provided some services virtually as well as temporarily suspended respite care at Lakewood Court residential home but have continued to provide some care with individuals where required and a delay on minor works on equipment and occupational therapy.

Members wanted some clarity as to when it could be expected that the emergency regulations would be suspended and the flexibilities reversed. Ms. Dillion responded by saying that biggest area of concern was the daytime support for individuals with disabilities while social distancing measures are in place. Work is being done to assess the types of support they can offer, but daytime support cannot be resumed until social distancing measures are relaxed.

Members asked what was the learning to take away from the alternatives types of support that has been offered and whether there was an invest to save strategy that could be implemented. Ms Dillion agreed that the learning was an important conversation to have as well as the conversation with individuals and their families about what a new offer of support could look like with the use of new technology.

Members also believed that it was important to be mindful that some people over the age of 50 didn’t need additional care from the Council. Ms Dillion responded to this by saying that calls to individuals led the direction of what was required, including that of minimal support. She added that Adult Social Care have worked closely with Wellbeing Independent Partnership to inform the individual about things in the community to support them if they wanted.

RESOLVED – that the contents of the report be noted.

To receive and agree the Health and Wellbeing Strategy from Helen Onions, Consultant in Public Health, Telford and Wrekin Council.

The Health and Wellbeing Board received a report from Liz Noakes, Director for Public Health. Telford & Wrekin Council detailing the Health and Wellbeing strategy refresh proposals for 2020/21-2022/23 in the context of the COVID-19 pandemic. The Board originally received and agreed the draft proposals in February 2020 however the full nature and scale of the COVID-19 pandemic could not have been imagined at the time. Therefore, within the recovery, reform and reset context for the council and partners, it provided a unique opportunity to re-imagine and re-invent the health and wellbeing agenda for the future. An additional health protection priority was added which focused on the prevention and reduction on infectious diseases in the community. Therefore the proposed priorities were:

• Continue to develop, evolve and deliver our Telford & Wrekin Integrated Place Partnership (TWIPP) Priority Programmes:

- Building community capacity and resilience.

- Prevention and healthy life styles.

- Early access to advice and information.

- Integrated care and support pathways

• Have a priority focus to drive progress on tackling health inequalities
• Set a priority call to action to improve emotional and mental wellbeing
• Ensure we protect people’s health as much as possible from infectious diseases and other threats.

One Member queried that the report did not make reference to the ageing population that Telford has and wondered if this has been addressed. Ms. Noakes responded by saying that the Health and Wellbeing refresh strategy was an all-ages strategy and referenced a later agenda item which surrounded the support for the elderly population of Telford and Wrekin.

RESOLVED – that the reset strategy proposals be approved.

To receive an update from Alison Smith, Director of Corporate Affairs, NHS Shropshire CCG and NHS Telford and Wrekin CCG.

The Health and Wellbeing Board received an update report on the Single Strategic Commissioner for Shropshire, Telford and Wrekin Clinical Commissioning Group from Alison Smith, Director for Corporate Affairs, NHS Shropshire CCG and NHS Telford and Wrekin CCG, and was presented by Dr. Jo Leahy, Chair of NHS Telford and Wrekin CCG. The purpose of the report was to provide an update on the application process for creating a Single Strategic Commissioner across Shropshire and Telford and Wrekin. The Health and Wellbeing Board was asked to note that the application for dissolution of the two existing CCGs and proposal to create a single CCG from April 2021 was made on 30th April 2020.

Members were concerned surrounding the number of sites that would be used by the CCG moving forward. Dr Jo Leahy responded by saying that the experience from the COVID-19 pandemic is that individuals can work effectively from home and that moving forward there will be more remote working so that the site will become less important.

Members expressed concern, that from a commissioning perspective, Telford & Wrekin and Shropshire had different needs, and didn’t want this to be overlooked. For example, the rural deprivation in Shropshire compared to the urban deprivation in Telford & Wrekin. Likewise, members also believed that more money should be directed to community based assets rather than primary care and hospitals. Dr. Leahy cited that the Telford and Wrekin Integrated Place Partnership group would push this area forward and assured the Board that the CCG would be engaged with this.

Members raised concerns regarding the balance of the joint Governing Body as Telford and Wrekin had one GP and two Advanced Nurse Practitioners whereas Shropshire and three GP’s. Dr Leahy replied that these individuals were elected from GP practices in their respective areas and that there may have been some political undertones in the election. Dr. Leahy added that she believed that this was a great way of diversifying management at that level of seniority. Likewise, she believed that the individuals elected wouldn’t be out powered by GP Colleagues.

Members thanked Dr. Leahy for her work on the Health and Wellbeing Board, and wished her luck moving forward as she left the position of the Chair of the Telford and Wrekin CCG.

RESOLVED – that;

a)    The actions taken to date on creating a single strategic commissioner for Shropshire, Telford and Wrekin be noted.

b)   The feedback outlined in the Engagement report be noted.

To receive an update on the Telford and Wrekin Integrated Place Partnership’s work on the Health and Social Care Rapid Response Team from Tracey Jones Integrated Place Partnership Manager, Telford & Wrekin Clinical Commissioning Groupand Sarah Downes, Integrated Place Partnership Manager, Telford & Wrekin Council.

The Health and Wellbeing Board received a report on the integration of health and social care in Telford’s “place” approach and progress from Sarah Downes, Integrated Place Partnership Manager, Telford & Wrekin Council, Julie Smith, Integration Lead, Telford & Wrekin Council and Tracey Jones, Deputy Executive Integrated Care, Telford & Wrekin Clinical Commissioning Group. The report outlined the progress made by the Telford & Wrekin Integrated Place Partnership (TWIPP) over the last 6-9 months and the difference it had made to residents and the system as a whole. The report gave progress updates to the various projects there were being undertaken by TWIPP. These were:

1) Building Community Capacity and Resilience

• Grant Rounds to develop provisions of additional community groups
• Increased volunteering capacity with the community
• Development of the Personal Assistant (PA) role and support development of a PA+/Micro-provider role.

2) Prevention and Healthy Lifestyles

• British Heart Foundation community blood pressure testing programme
• Living with and Beyond Cancer Programme
• Development of social prescribing role in Primary Care Networks
• Implementation of Telford & Wrekin Smoke Free Plan
• Delivery of whole system approach to reduce obesity

3) Early Access to Advice and Information

• Ongoing development and promotion of Live Well Telford (Information Portal)
• Establishment of Independent Living Centres/Smart House

4) Integrated Care and Support Pathways (including out of hospital)

• Implement the Health and Social Care Rapid Response Team (HSCRRT)
• Rollout of Care Home Team & exploring early intervention team for care homes
• Hospital pathways development – including Pathway Zero
• Development of a telehealth option to deliver care for long term conditions
• Delivery of national service specification for PCN’s
• Consolidation and further development of domiciliary care zone model

5) One Estate

• Development of new integrated estates/extra facilities

6) Other TWIPP Deliverables

• Implementation of the Hertfordshire Family Safeguarding Model
• Mental Health – place based approach

The report also focused on the work of the pilot Health and Social Care Rapid Response Team which aimed to:

• Improve the person’s experience,
• Reduce avoidable unplanned admissions to hospital or care homes,
• Reduce the number of crisis referrals,
• Optimise follow up care to reduce re-admissions,
• Improve access to a range of community services,
• Happy and productive staff, and
• Provide data and information to support future decision making and service

Members expressed their support for the update they had heard regarding the Health and Social Care Rapid Response Team (HSCRRT) and how it was a good example of the partnerships that was needed in Telford and Wrekin.

Members wondered how the HSCRRT built into the longer term strategy of ensuring that individuals were able to stay in their home, rather than going to the hospital. Ms. Smith responded by saying that the HSCRRT was eleven months work on top of previous neighbourhood based work and that Telford and Wrekin was welded to the idea of place based working. Ms. Smith added that they understood that residents in different areas of Telford and Wrekin had a diverse set of needs, and this is what TWIPP as a place based partnership wanted to be welded to.

RESOLVED  ...  view the full minutes text for item HWB8

To receive an update on the Telford and Wrekin Community Safety Partnership - Domestic Abuse Progress from Helen Onions, Consultant in Public Health, Telford and Wrekin Council.

The Health and Wellbeing Board received a report on the Telford & Wrekin Community Safety Partnership Domestic Abuse from Helen Onions, Consultant in Public Health, Telford & Wrekin Council and Stacey Norwood, Senior Public Health Commissioner, Telford & Wrekin Council.  The report focused on the work of the Domestic Abuse subgroup during the COVID-19 pandemic and then an update on the implementation of the Domestic Abuse Strategy 2019-2021.  The Board also received a presentation which summarised the key message of the report, which were:

• The Council and partners had a special focus as part of the COVID-19 response
• There had not be an increase in the number of domestic abuse crimes and incidents but this was expected to rise as lockdown was lifted.
• The Council had committed additional funding for victims through the West Mercia Women’s Aid Live Chat Service & the Shropshire Domestic abuse Service which supported people 1:1 and Helpline.
• ‘You are not alone’ campaign promotion: refreshed web pages, Shropshire Domestic Abuse Service video, social media call to action, supermarkets and NHS settings posters.

Members were wondered if the Council had the capacity in place to deal with the increased number of cases that was predicted to occur when the lockdown ended and worried that the numbers currently being reported didn’t reflect the usage due to not being able to report incidents of domestic abuse.  Ms. Onions responded by saying that the Council was ready to start commissioning arrangements around enhanced support and perpetrator programs as they already had a service model prepared. Ms Norwood added that the Council was ready to work with schools as they had a package prepared to provide support for individuals who suffered domestic abuse when the children returned to school.

RESOLVED – that the arrangements in place to assess the impact of domestic abuse locally in light of the pandemic, the additional support and awareness raising and the further progress made in implementing the Telford & Wrekin Domestic Abuse Strategy 2019-2021 be noted.

To receive an update and presentation from Steve Trenchard, Programme Director for Mental Health, Sustainability and Transformation Plan.

The Health and Wellbeing Board received a presentation on the Sustainability and Transformation Programme (STP) Trauma and & Adversity Work Stream on Mental Health and Inequalities from Steve Trenchard, Programme Director for Mental Health, Shropshire, Telford & Wrekin, Sustainability and Transformation Plan. The presentation focused on the following topics:

• Mental health and inequalities.
• What contributes to poor mental health.
• Long Term Plan ambition.
• System trauma informed approach.
• System approach to raise awareness of adverse childhood experiences.
• Support Offer.
• Health and Wellbeing: Psychological Support.
• Proactive response during COVID-19 outbreak.

One Member queried the use of community based assets for social prescribing before individuals were submitted to trauma informed therapy. Mr. Trenchard responded by saying that this was part of the step care model and that trauma based therapy was about normalising experiences and giving individuals the help and guidance they needed.

One member welcomed the report and the presentation that they had heard in the meeting, but wondered why that this piece of work wasn’t a part of the Telford & Wrekin Integrated Place Partnership (TWIPP)? Mr. Trenchard replied by saying that it was part of the TWIPP. Mr Trenchard added that just as he got to the point of signing off the plan for the initial submission, he begun the wider conversation on how to localise parts of the plan. Mr. Trenchard concluded by saying that he has been supportive of investment being allocated to front end services which concentrate on prevention, such as the Calm Café and out of office support, rather than just secondary specialist services.

One Member understood the importance of virtual therapy sessions for mental health support, but stressed the significance in retaining face-to-face sessions in the future. Mr. Trenchard responded by saying he believed that it should be a blended offer, depending on the needs and abilities of the patients.

RESOLVED – that the contents of the presentation be noted.