Agenda and minutes

None.

To confirm the minutes from the previous meetings.

RESOLVED - that the minutes of the meeting held on 22 October 2020 be approved.

RESOLVED - that the minutes of the meeting held on 24 November 2020 be approved.

To receive an update on End of Life Care from Tracey Jones, Deputy Director Partnerships, Shropshire, Telford & Wrekin CCG.

Members received the update report of the Deputy Director: Partnerships, Shropshire, Telford & Wrekin CCG.

The Committee were informed that the report was an update on a previous report received by the Committee and that it covered the achievements of the review of end of life care to date and the next steps of the review.

The Deputy Director provided Members with an overview of the report. The first section of the report covered the background to the review. In the second section, the methodology of the review was laid out. The original idea had been to shortlist focus areas from data but there had been a decision to open up one of the focus areas to influence from the feedback received from those with lived experience. There was a desire to include symptom control as a focus. Section 3 of the report covered the four areas that formed the key areas of focus, while Section 4 set out the regional focus on palliative and end of life care. Section 5 focussed on next steps, in which working groups would seek to deliver change. Finally, Section 6 summarised where the review was.

Following the presentation, a discussion followed. Members asked a number of questions:

Who sat on the Community and Place Board?

Representatives from the main health providers, HealthWatch, and social care colleagues. The hospice was not involved but a representative was the Chair of the End of Life Group, so the hospice was involved.

Did the hospice contribute as an individual stakeholder?

It did.

Why had a generalist approach been favoured in the report to a specialist one?

Generalists needed support in end of life care as it was not something they usually dealt with. This would improve end of life care more broadly.

Could the term generalist be defined?

Generalists were staff that did not work in a specialist end of life care role.

Where was the CCG at with the Advanced Care Plan (ACP)?

This was outside of the area of expertise; however, the work was being led by the hospice in conjunction with oncologists from SATH. It was looking at producing an ACP.

Was the review of end of life care underpinned by a holistic approach?

The report was the result of engagement, holistic was not a term used in the report but the review was being approached holistically.

How close to fruition were information systems that shared data to avoid repetition of questioning patients?

Shared care records were not a part of the review, however, that work was progressing at pace.

For those who wished to die at home, there was an issue around support from GPs and district nurses. Was there anything in the report around supporting that choice?

In terms of the reviews, this was a routine end of life commissioning question. In those instances where individuals were unable to access the necessary equipment it was necessary to speak to service providers to find out why as equipment was commissioned. This  ...  view the full minutes text for item JHOSC3

To receive a report on the development of Shropshire, Telford & Wrekin Integrated Care System from Nicky O’Connor, STP Programme Director, Shropshire Telford & Wrekin STP.

The Committee received the presentation of the STP Programme Director from Shropshire, Telford & Wrekin STP.

It was expected that the legislation would begin the parliamentary process in May 2021 with integrated care systems (ICS) becoming statutory bodies from April 2022. The proposal would be that there would be two bodies forming the ICS – a statutory body made up of the existing NHS bodies and local authorities and another, broader, partnership bringing together partners from across the system. The second body would likely be focussed on population health.

There were four purposes of an integrated care system:

1.    Improving health outcomes in the general population

2.    Tackling inequalities in outcomes, experience, and access

3.    Enhancing productivity and value for money

4.    Helping the NHS to support broader social and economic development

System pledges had been drafted as an integrated care system on areas to improve. There was the potential to work together with the Committee to improve things. In terms of place based working, people had worked together locally to generate ideas on how to improve. A commitment had been made to tackle ill health and health inequalities as well as to improve mental health services.

Commitments had been made with local government on working together on climate change and to regenerate economies.

The sense was that the legislation intended for work to be undertaken locally as much as possible.  

Members posed a number of questions:

Concern was expressed at the creation of a two tier integrated care system in which democratic bodies, such as the Joint Health Overview & Scrutiny Committee, formed the lower tier.

The primary body would be the partnership board, the one including the democratically elected; it would then be for the statutory body to take the nucleus of what they asked for into action.

There was an engagement and accountability plan due in March 2021, where could that be found?

This had been delayed; it was expected in May 2021. However, the individual responsible would likely be interested in consulting with the Committee on how to pull that report together.

In terms of integrated care systems, would you agree that the system should be simple, local, and evolutionary?

Yes.

Does the workforce stream look at all workforce (including nursing staff, care staff) or just within the NHS?

This may be something to consider in a specific session, as a standalone item. Conversations on the issue were ongoing; workforce strategy covered all of the health and care workforce.

Given the challenges faced by the local health economy, are you confident that you can move forward in the way presented?

The pledges aimed to address these challenges; working together presented an opportunity to achieve goals.

Was there an agreed understanding of what health inequalities were within Shropshire, Telford & Wrekin?

In the next steps for place-based working, health inequalities were central. They were categorised in three ways, what could be done at a civic level? What intervention could be made in communities? And what could be done around services  ...  view the full minutes text for item JHOSC4

Councillor White thanked the Committee’s Co-Chair, Councillor Calder, for their work on the Committee.