Agenda and minutes

None

RESOLVED – that the minutes of the meeting held on Thursday, 24March 2022 be confirmed and signed by the Chair.

It was noted that the minutes of the meeting of the 24 March 2022 referred an inclusion of delegated authority for the Better Care Fund within the Terms of Reference. It was clarified that no delegations were included within the Terms of Reference and that a report would need to be brought to the Board specifically recommending delegation at a later meeting.

RESOLVED – that the minutes of the meeting held Thursday, 24 March 2022 be confirmed.

The Chair invited a member of the public to speak on the GP Access. They highlighted the lack of data in the paper provided for this item and requested that further information be provided.

The Chair advised that this will be addressed as part of the GP access item later in the meeting.

To receive the Annual Public Health Report from the Director: Health and Wellbeing (Statutory Director for Public Health) Telford & Wrekin Council

The Director, Health & Wellbeing informed the Board that the Annual Public Health report was a statutory requirement and was produced on annual basis. Each year the report focused on a particular theme, with this year’s report focusing on the widening of heath inequalities and what the council and its partners had done to address the root cause. It was noted that there had not been a report produced in the last 2 years due to the pandemic.

The Board heard that the inequalities plan that was previously presented to the Board in September 2021, was intelligence led in order to understand the needs of different communities. This approach was both partnership and place based and allowed for services to be provided proportionate to need. The Director for Health & Wellbeing highlighted that the inequalities plan was based upon the Mormont themes and would like to see Telford & Wrekin move towards becoming a Mormont Borough. The inequalities plan was also influenced by the Building Back Fairer Report, which considered the effect of the pandemic on health inequalities.

Members heard that the first theme explored in the report was best start in life, which focused on the first 1001 days in life. Intelligence and case studies had been used to highlight what was understood about inequalities and what is being done to bridge the gap. The Director: Health & Wellbeing informed the Board that childhood poverty was above average across the borough. To combat this a perinatal strategy was being developed by the Council and partners. The second theme explored was economic opportunities. The Board were informed that a healthy income was important for our health. It was noted that whilst Telford & Wrekin had seen a recovery in employment levels, they were still low when compared to the national average. It was also noted that the employment gap between men and women, young and old, and affluent and poor had continued to widen. The Director: Health & Wellbeing advised Members that programmes such as Job Box, Kick Start and the Work Local Programme had been implemented, which supported local employers to find local employees.

The Director: Health & Wellbeing highlighted that in areas of public health and prevention Telford & Wrekin were under preforming across a number of key indicators such as smoking, alcohol and weight. They noted that Princess Royal Hospital had recorded higher rates of alcohol related cases and lower levels of cancer diagnoses than the national average. Members heard that the Healthy Lifestyles Team had done a lot of work to narrow inequalities, with 60% of the support they provided taking place in deprived areas. The Director: Health & Wellbeing advised the Board that further work was underway to improve health literacy across the Borough, particular within the BAME communities. Additionally, the Council had been successful in their bid for additional funding from the NHS to develop screening programmes and to raise awareness of early signs.

The Board heard that the environment and circumstances that we live in makes a difference to our health. Community  ...  view the full minutes text for item HWB52

To receive the report from the Director of Partnerships, Shropshire, Telford & Wrekin Clinical Commissioning Group.

The Director for Partnerships informed the Board that the information presented was based upon Shropshire, Telford & Wrekin data as per NHS England's instructions, but advised that a specific breakdown of Telford & Wrekin could be provided to Members following the meeting.

Members heard that at a Primary Care level there needed to be a more joint up approach that allowed the sharing of lessons learnt and best practice which promoted improvement. It was noted that in comparison to both regional and national averages, Telford & Wrekin had a high percentage of face to face appointments. At the time of the meeting 66% of appointments were face to face. The Director for Partnerships explained that these figures included appointments that took place with nurse practitioners, physiotherapists and pharmacists among other clinical professionals. In order to facilitate this there had been an increase of a number of professionals working across the Primary Care Network. The Board were informed that although there had been a staffing increase overall, this did not include GPs. Across the system there had been a 12% reduction in GPs and a 27% reduction in GP partners.

The Director for Partnerships advised Members that there had been specific work carried out recently relating to telephone access and triage to manage the 100% increase in those accessing the telephone systems. This involved working with a number of practices, including TELDOC, to understand and improve each practices system. It was recognised that there needed to be better communication with the public around how best to access these services.

During the debate Members expressed that they had similar concerns to those raised during public speaking, so welcomed the commitment to provide additional data, particularly with reference to timescales for improvements. Members noted that if residents continue to be put off from accessing primary care services due to their inability to get through on the phone, health inequalities will only increase and would like to see this audited. The Director for Partnerships advised that auditing individual practices proved difficult as each served different demographics and numbers of patients. Additionally, GP practices were overseen by the Care Quality Commission (CQC), but commissioned privately. The role of the Clinical Care Group (CCG) was only to support with areas such as telephone systems. The Director for Partnerships highlighted that of the two Telford & Wrekin surgeries reviewed by the CQC in recent months, both had been rated 'Good' on access.

The Board welcomed promoting the use of other services such as pharmacists, but worried that people may not feel as comfortable to discuss additional issues. The Director for Partnerships noted that all Primary Care professionals were trained to be on the look-out for alternative diagnoses.

Members thanked the Director of Partnerships for their report and for their willingness to provide additional data to the Board. It was noted that this is an area of the biggest concern for residents so a detailed plan of action would be welcomed. 

The Director of Delivery & Transformation, Shropshire, Telford & Wrekin Integrated Care System provided the Board with an update on the creation of the Integrated Care System (ICS) and its statutory functions. The ICS sought to create a partnership of organisations in order to improve services and remove the barriers that people experience when accessing the National Health Service (NHS). The ICS is made up of 2 Boards. The Integrated Care Board (ICB) and the Integrated Care Partnership (ICP). The Board heard that the membership of each Board differed.  The ICB membership consisted of independent chair: non-executive directors; members selected from nominations made by NHS Trusts/foundation trusts, local authorities and general practice. Whereas, the ICP was made up of representatives from local authorities, ICB, Healthwatch and other partners.

The Director of Delivery & Transformation informed the Board that the ICP was at the heart of the system and worked in partnership with the Telford & Wrekin and the Shropshire Health & Wellbeing Boards. Member’s heard that there were still additional steps to be taken as to how the ICP, Telford & Wrekin Integrated Place Partnership (TWIPP) and the Health & Wellbeing Board (HWB) would work together in practice, but a steering committee had been appointed to cement that.  At an ICB level Board members had now been appointed formally, however the shadow board had been in operation since 1 April 2022, meaning the transition was expected to be smooth. The Board were informed that the Constitution was in place which formally embedded the involvement of the voluntary and community sector.

During the debate Members raised concerns regarding Telford standing and influence in comparison with Shropshire. It was noted that Telford’s make up and needs differed from Shropshire’s and assurances needed to be made to ensure that those needs would be met. The Director of Delivery & Transformation advised the Board that the TWIPP was key to ensuring this as it would be responsible for executing the delivery of everything expect for system level issues. The Board noted that it was important that there was transparency around changes made within the system, especially given current financial restraints. The Director of Delivery & Transformation agreed, stating that resources are finite but the ICS wanted to use them to maximise impact when working towards the inequalities agenda. The Board thanked them for their report.

To receive a verbal update from the Divisional director of Operations for Women’s & Children’s at the Shropshire, Telford & Wrekin Hospital Trust.

The Divisional director of Operations for Women’s & Children’s and the Director of Midwifery informed the Board that the Ockenden enquiry was intially launched in 2017, with the first findings being published in December 2022 and the final report was released in March 2022. The most recent report outlined 66 actions that must be completed, 50 of which required immediate and necessary actions.

The Board heard that the report highlighted significant failings and that its findings have had a continued effect on the service. The Divisional director of Operations for Women’s & Children’s recognised those failings and provided assurances that lessons had been learnt. Members were informed that significant work was underway to ensure that the best service was provided, in addition to implementing all 210 recommendations outlined in the reports. Of the 210, 65 actions had already been delivered and embedded.

The Divisional director of Operations for Women’s & Children’s advised that when the report was released it had been challenging but that they had continued to support the staff, local communities and the patients as a matter of priority. The Board heard that the learning from the first report had been reviewed by the senior team and used to develop a robust management approach. The Board heard that all actions were deemed essential and immediate but needed to be prioritised and amalgamated into a single plan. This plan also included other issues that had been identified outside of the report that required addressing. Members were informed that this was recently re-launched and there would be additional engagement carried out. In order to ensure transparent and effective governance they must provide evidence that a completed action had been embedded and three monthly audit cycle takes place to provide additionally assurances that staff are compliant.

The Divisional Director of Operations for Women's & Children's assured the Board that for those actions which couldn't be progressed without regional or national involvement, working groups had been created. It was highlighted that following the development of this approach other services had approached them for learning advice to develop their own.

The Board thanked the Divisional Director of Operations for Women's & Children's for their update. Members stressed the importance of ensuring that all actions are completed and embedded both locally and nationally.

During the debate Members noted that the staff culture was important to ensuring that actioned were fully embedded. The Divisional Director of Operations for Women's & Children's agreed and stated that staff morale had been a key concern. Members were advised that staff were supportive of the required changes and accepted the upcoming challenges that they faced. The Board heard that people and culture was a priority for the ICS not just in maternity services but across the whole system.

The Divisional Director of Operations for Women's & Children's recognised the scale of the challenge ahead and assured Board Members that details of the actions completed could be shared and future updates on progress provided at further meetings.

To receive a verbal update from the Chair of the Scrutiny Management Board regarding the Scrutiny Work Programme for 2022/2023.

The Chair of the Telford & Wrekin Council Scrutiny Management Board provided the Board with an overview of the upcoming 2022/2023 Scrutiny Work Programme. The Board heard that the Council had received over 70 suggestions from members of the public, Councillors and our Council partners that made up the Work Programme. Members heard that some of the key areas of upcoming scrutiny included mental health, primary & urgent care, the Hospital Transformation Programme and this rising cost of living.

The Board welcomed the work programme and noted that it was important that the Health & Wellbeing Board and the various Scrutiny Committees had a joined up approach in order to prevent repetition. Members noted that in order for scrutiny to be effective openness and honesty was required. The Director of Delivery & Transformation, Integrated Care System, noted that whilst there had been a decline in collaborative working with Councillors since the pandemic the Integrated Care Board welcomed more open conversations moving forward and would do what they can to provide assurances.

To approve the revised Health & Wellbeing Board Terms of Reference to include ICS Membership.

The Director: Policy & Governance informed the Board that the Terms of Reference had been revised to reflect the structural changes from the Clinical Commissioning Group (CCG) to the Integrated Care System (ICS), Integrated Care Board (ICB) and the Integrated Care Partnership (ICP).

RESOLVED – That the Terms of Reference be approved subject to the inclusion of reference to the Telford & Wrekin Integrated Place Partnership in the membership.