Agenda and draft minutes

Councillor K Middleton was stepping down as Chair and nominations were, therefore, invited for a new Chair.

RESOLVED – that Councillor A McClements be appointed as Chair of the Health & Wellbeing Board.

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None

To confirm the minutes of the meeting of the Health & Wellbeing Board held on Thursday, 09 December 2021

RESOLVED – that the minutes of the meeting held 09 December 2021 be confirmed.

None

The Associate Director: Policy & Governance informed the Board that the Terms of Reference had been updated to take account of Cabinet Member changes. There had also been further clarification around public speaking. It was noted that it was a requirement at the start of each municipal year to review the Terms of Reference meaning there was to be a further review at the next meeting.

RESOLVED –That the terms of reference be approved.

To receive Healthwatch Telford & Wrekin’s presentation on the Urgent Care Survey and Children’s Mental Health Survey

MentalHealth CrisisServices forChildren &Young PeopleSurvey Report

The Board heard that Children's mental health had been a concern for a number of years but had been highlighted by the findings of the CQC report of the Shrewsbury and Telford Hospital NHS Trust (SaTH) in February 2021. Healthwatch’s key findings were broken down by those identified by children and the adults surveyed. Amongst the five children and young people surveyed, the main issueshighlighted were access andwaiting times, changesto staffand relationships with professionals. Adults surveyed additionally identified issues with assessment and diagnosis, discharge and on-going support and communication and value placed on the parent/carer's views. It was also notedthat healthcareprofessionals hadhighlighted complexneed asa further area of concern.

The Boardheard thatthe evidencein thereport indicatedthat awhole system response was required and that it was hoped that the Integrated Care Board made this a priority.

Members thanked Healthwatch for their report and noted that it was great to see attention paid to the voices of children and parents using these services andoffered theirfull support.They agreedthat awhole systemapproach was requiredas itseffect waswide reaching. Membershighlighted thatthe lackof tier 4 beds resulted in patients spending more time in A&E, causing further strain there.

During the debate, Members raised the need for a focus on early intervention andsupport tobe provided.It wasagreed thatthe reportbe addedto boththe Children & Young People Scrutiny Committee and the Health Scrutiny Committee work programmes for further review.

Urgent CareSurvey Report

The Board heard that the Urgent Care Survey report was a joint report prepared in conjunction with Shropshire Healthwatch. This was the second time they had undertaken the survey at the request of the CCG due to the concerns raised surrounding access to urgent care. Of the 181 responses received, 80 of those were residents of Telford & Wrekin. The resultsindicated thata higherthan averageproportion ofpeople underthe TelDoc PCN contacted their GP as afirst point of contact, whereas around 60% of people from the Wrekin and Newport areas contacted 111 first. A number of concerns raised through the Survey related to the first pointof contact suggestinghow importantit wasto getit right.Members heard that the evidence regarding outcomes indicated that NHS 111 did work better in Telford & Wrekin than in Shropshire, yet the majority of those whoanswered the survey responded that the 111 service was ‘very poor’. Of those who indicated that the service was ‘very poor’, a large number cited long wait times as the reason. It was found that, when issues were not addressed in a timely manner, respondents were then calling 999 or attending A&E. It was also noted that a number of respondents were not aware that same day appointments could be booked through 111, greater public awareness of this  ...  view the full minutes text for item HWB43

To receive a verbal update from the Director of Urgent Care and Planning, NHS Shropshire, Telford & Wrekin Clinical Commissioning Group on the key system pressures experienced since the last Board update in Deember

The Interim Accountable Officer(Shropshire, Telford &Wrekin CCG)provided an overview of thecurrent key pressures experiencedacross the system. The Boardheard thatCovid patient numberswere onceagain risingas thebooster impact waned, with 101 patients with Covid across Princess Royal and Royal Shrewsbury Hospitals as at the day of the meeting. This was in addition to a further 24 patients in community hospitals. It was noted that this was among the highest rates of admission since the pandemic began and providing the necessary beds had resulted in strains on other services. The Interim AccountableOfficer statedthat carehomes hadbeen particularly affected,but wanted to highlight the fantastic job they had done in managing that. The Board heard that, across Princess Royal and Royal Shrewsbury Hospitals, the current level of staff absence was over 10%. This was considerably higher than the NHS average of 4% pre-Covid. This affected their ability to respond as a system.

In response to the Healthwatch Telford & Wrekin Report, the Interim Accountable Officer noted that, although the sample size of the survey was small,they did notdisagree with itsconclusions. Theyexplained that111 was commissioned regionally rather than locally and suggested that the Board invite them to speak on how that was funded and commissioned at a future meeting.They concurredthat thenumber ofpatients attendingA&E washigh. Staff had been working hard to accommodate this and they thanked the local authority for their ongoing support.

During the debate, the Board acknowledged the pressures that frontline staff facedand howresilient they hadbeen. Therewere concernsamong Members regarding the findings of the Healthwatch report relating to 111. It was noted that, since the last survey, there had been a significant reduction in the percentageof peoplewho werehappy withthe service.The Boardwelcomed the Interim Accountable Officer's offer to facilitate a review of how 111 was commissioned regionally but additionally sought a timeframe of improvements that addressed the concerns outlined in the Healthwatch report. The Chair called for the report to be referred to the ScrutinyWork Programme for further review.

To receive an update briefing on the Joint Strategic Needs Assessment Update and Pharmaceutical Needs Assessment from the Insight Manager, Policy & Development, Telford & Wrekin Council

The Insight Manager: Policy & Development (Telford & Wrekin Council) providedthe Boardwith anupdate onthe JointStrategic NeedsAssessment (JSNA) and the Pharmaceutical Needs Assessment (PNA). This was a statutory requirement of the Health & Wellbeing Board. Members heard that rather than providing the Board with an update every two years they were looking to enhance the content and provide it on a more regular basis. This wasto berelaunched inthe firstquarter ofthe nextfinancial year.In addition to the profiles and population health needs this was to include a more visual place-based analysis.

It was explained that the census data would start to be released in June 2022and providedan insightinto thepopulation thatwas onlyavailable once adecade. Thisinformation wouldfeed intothe profilesthey were developing.

TheInsight Manager:Policy &Development updatedthe Boardon thecurrent process to complete a cross-County PNA for both Telford & Wrekin and Shropshire Local Authorities. The resulting draft PNA was due to be open for a 60-day consultation during Summer 2022. The proposed PNA and all consultation responses relating to Telford & Wrekin services were to be presented to the HWBB in September 2022. Any changes and modifications would then be made to allow for publication in October 2022.

The Boardnoted thereport. Duringthe debate,members recognisedthat this was crucial to addressing health inequalities. They welcomed the real-time intelligence based approach that helped to steer the Board.

To receive a pesnetation on the Better Care Fund & Narrative Plan from the Service Delivery Manager, Prevention and Enablement, Telford & Wrekin Council

The ServiceDelivery Manager:Prevention andEnablement and theDeputy Director Partnerships,Shropshire, Telford& WrekinClinical Commissioning Group provided the Board with an update on the Better Care Fund and the approval process.

Members heard that this was a programme that supported local systems to successfully deliver the integration of health and social care in a way that supported place-based functions. The Service Delivery Manager: Prevention andEnablement highlightedthat theBetter CareFund Boardlinked tourgent care, TWIPP and wider NHS functions. They stated that in the last year the Better Care Fund had raised the profile around health inequalities. The Deputy Director Partnerships elaborated that the profile of the borough was changing and the population aging. This meant adapting the fund to reflect that. The metrics indicated that despite the impact of Covid, discharge pathwayswere operatingwell andthe re-enablementmeasure threemonths following discharge remained stable.

The Board heard that the level of funding allocated to the Better Care Fund was linked to NHSdeposits. Thesehad graduallyincreased overthe lastfive yearsthrough the national programme. However, there had been no formal confirmation on what that looked like moving forwards. The Service Delivery Manager: Prevention and Enablement explained that in order to maximise funding they had prioritised a range of programmes focused on integration and supporting people at home as a way of preventing admission.

Members of the Board noted the report and recognised that the Better Care Fundwas keyto thework undertakenacross Telford& Wrekin,particularly in referenceto theICS. It was noted that the Better Care Fund was subject to Health & Wellbeing Board approval.  Given this it was recommendedthat afurther reportwas broughtto the next Health & Wellbeing Board meeting with a recommendation for delegated responsibility for the Chair to approve.

To receive the report of the ICS Programme Director, Shropshire, Telford & Wrekin ICS

TheInterim AccountableOfficer, Shropshire,Telford &Wrekin CCGprovided an update on the ICS Development. The CCG would continue to operate as the statutory body until 23:59 on the 30th June 2022, after which the Integrated Care Board will replace it. Appointments were ongoing but conversations were already underway to ensure that the transfer was as seamless as possible. It was noted that the Chief Executive of Telford & Wrekin Council had been kept updated.

Members heard of the newly created Integrated Care Partnership which overlappedwith theHealth &Wellbeing Boardin someareas. Forthis reason, there needed to be greater definition about which areas were dealt with by which body. The Interim Accountable Officer recommended that Telford & Wrekin Council play an active role in those roles.

The Board thanked the Interim Accountable Officer for their report. Members agreed that ensuring the governance was correct before getting on with the work programme was key. They noted that further definitions were also required regarding the roles of scrutiny and the Telford & Wrekin Integrated Place Partnership. The Board highlighted the section of the report which referredto engagement,stating thataccountability andparticipation neededto be defined and unified across the system.

To receive the Health Protection Report 2021/022 from the Service Delivery Manager Health Protection, Telford & Wrekin Council

The Health Protection Update formed parted of the Health & Wellbeing Board's Strategy to protect the population of Telford & Wrekin from health threats.The oversightof HealthProtection arrangementsin Telford& Wrekin sat with theShropshire, Telford &Wrekin Health Protection Covid Board that met quarterly and had representatives from the Local Authority, UK Health Security Agency and the NHS. The Board was chaired by the Telford & Wrekin Director of Public Health and reported to the ICS Quality & Safety Committeeand eachLocal Authority’sHealth &Wellbeing Board.It wasnoted that the Health & Wellbeing Board received a report annually from the Health Protection Covid Board unless matters need to be escalated by exception.

The Service Delivery Manager: Public Protection outlined that the report only detailed the Covid and Local Authority Protection functions in this instance. Membersheard that,at thetime ofthe meeting,there were Covid55,000 cases,which equated to 30,000 per 100,000, slightly higher than the England average.

However, the Board was assured that deaths were slightly lower than the England average. The Health Protection Hub had been set up in response to the pandemic and had been involved in contact tracing, testing sites and lateral flow testing (LFT), carrying out around 20,000 tests. The Board was advisedthat alltesting siteswere tobe stooddown onthe 30thMarch and,at the time of the meeting, there had been no further details on how health and social care workers would continue to receive their free LFT's. The Board heard that the vaccination programme had gone well. The Health Protection Team had targeted areas with the lowest vaccine uptake, resulting in a 1.8% increase in uptake between December and January.

The Board heard that the Health Protection service had a range of statutory powers to prevent the spread of infectious diseases. The Food, Health and Safety team had responsibility for food and water sampling. However due to Covid, no sampling was undertaken in 2020; a sampling program had resumedin November2021. TheService DeliveryManager: PublicProtection noted thatthey werealready atthe targetset bythe FSAfor September2022. Members wereinformed thatwhilst Telford& Wrekindid notcurrently havean air quality management area they were working with a contractor on an air quality strategy in order to future proof against poor air quality.

The Service Delivery Manager: Public Protection requested that the Board approvedthe Termsof Referencefor theShropshire, Telford& WrekinHealth Protection Assurance Board.

TheBoard thankedthe ServiceDelivery Manager:Public Protectionfor their report and for the work that had been completed throughout the pandemic, particularly the success of the Hub. It was recognised that the Hub had been shortlisted for the LGC Award for their work with 'Betty the Bus', which was continuing to provide vaccination services in low uptake areas.

RESOLVED- That the Terms of Reference for the STW Health Protection Board be approved.