Agenda and minutes

Members are reminded that they must not participate in the discussion or voting on any matters in which they have a disclosable pecuniary interest and should leave the room prior to the commencement of the debate.

None.

To confirm the minutes of the meeting held on the 6August 2020.

RESOLVED – that the minutes of the meeting held on 6 August 2020 be confirmed and signed by the Chair.

To receive a report on the System Winter Plan from Sam Tilley, Director of Planning, Shropshire, Telford & Wrekin Clinical Commissioning Groups and Nigel Lee, Chief Operating Officer, Shrewsbury and Telford Hospital NHS Trust.

Sam Tilley, Director of Planning, Shropshire and Telford and Wrekin Clinical Commissioning Groups, and Nigel Lee, Chief Operating Officer, Shrewsbury and Telford Hospital Trust, were in attendance to present the report before members and answer questions. The report explained that the usual winter planning arrangements were set within a wider Restoration and Recovery Programme for the NHS as a result of the covid19 pandemic. It also explained the requirements set out in the most recent “Phase 3 letter” (12 August 2020) including the acceleration of return to near normal levels of non-covid19 health services and preparation for winter demand pressures alongside vigilance for covid19 spikes locally.

The report explained the differences in planning arrangements for this year and how the benefits to be realised from Covid19 specific learning were being taken on board by the system into the next phase. Planning has been undertaken on the basis of five key themes: Discharge, Hospital Front Door, Community, Primary Care and Acute Services with the overall focus on demand management. Following a rigorous multi-agency process, 30 winter capacity schemes would be utilised in the winter plan across a range of system partners these would start coming on stream from November and there would be close oversight of implementation and impact through the Urgent and Emergency Care Delivery Group and Board and Gold Command. Examples of schemes related to attendance, admission avoidance and discharge to help preserve capacity in the acute trust over the winter months were provided.

The winter plan would be an iterative process and would be monitored and refined as real time data came through. It was also reiterated that the NHS was not closed and as much elective activity as possible was underway and this would be supported through the addition of an additional CT imaging unit and two mobile MRI scanners. Delivery of the vaccination programme would be a huge piece of work from December onwards.

Members asked a number of questions and received responses as follows:

What risk and challenges were there around staff resilience – in a system where this had already been an issue pre-Covid?

It was acknowledged that the challenges already in the system had been exacerbated by Covid 19. There was no easy answer, pressures were immense and staff were tired and stressed already. A System People Group was in place so that partners could manage the next few months and also the longer term. A Memorandum of Understanding had been agreed across key partners in order to redeploy staff to the areas of greatest need.

Support for care homes had been provided in relation to infection control and PPE training was available. As the first wave had arrived later in Shropshire than other parts of the country there had been the opportunity to utilise lessons learnt in relation to discharge into care homes and there was a very strict process of swabbing in place.

There had been an active bring back staff programme and although overseas recruitment had been held up due  ...  view the full minutes text for item JHOSC9

To receive an update on the End of Life Review from Tracey Jones, Deputy Director Integrated Care, NHS Telford Clinical Commissioning Group

Tracy Jones, Deputy Director Integrated Care, CCG and Alison Massey, Senior Project Manager End of Life Review were welcomed to the meeting.

Alison Massey took Members through a short presentation outlining the proposed scope and approach of the review – this would not be taking a traditional approach, rather one that involved using information already held - using a collaborative approach across organisational boundaries to design solutions. The expected timescale was six months and the purpose of the review was not to develop a strategy, rather to review how to make an impactful change on individual experiences.

Phase 1 of the review had just commenced and all stakeholders had been asked to review information they held and to identify themes and feedback to pose some questions and inform the work going forward.

Members asked a number of questions and received the following responses:

The report stated that a strategy was not the expected outcome but referred to ‘aspirations’ and appendix 1 was labelled as a strategy. What status did the document at appendix 1 have – who did it apply to, who had signed up to it and how was it co-ordinated throughout the system? What influence would this piece of work have across the whole system once completed?

Tracey Jones reported that the proposed methodology for the review had been shared with the groups across the system identified in section 1 of the report, and each had signed up to it. These included the organisations containing lead end of life clinicians.

The End of Life Review Group had been established as a sub section of the STP Community and Place Based Cluster which reported into the ICS Shadow Board. Phase 1 involved each organisation collating the information it held already to identify areas for action. Part 2 involved implementing that action through four key areas. Each area would have a system working group which would be made up of front line clinicians, managers and Healthwatch amongst others - key to developing solutions to the questions.

Some changes could be made by clinicians throughout the duration of the review to see if they could be made to work. This was an STP priority area and where any areas of difference or difficulty were identified, these would be escalated up to system leaders to identify how to remove barriers.

What quantity and kind of data has been collected - the Joint HOSC had experienced difficulties previously in seeking such data and information?

Each individual stakeholder had been asked to review information they already held to produce four questions. They had been asked to consider issues which were not to do with a single organisation but a pathway of care which was not connecting across the system.

Tracy Jones reported that the level of detail in PALS reports alone would be supplemented by individual one to one in depth interviews. If any JHOSC members knew of anyone willing to contribute to the review and share their experiences this would be welcome.

How  ...  view the full minutes text for item JHOSC10

An additional meeting of the Committee will be arranged in November focusing on children’s mental health.

The Chair encouraged any members of the Committee or members of the public to make contact if they had any observations, comments or questions related to the Committee’s work.