The Chair welcomed the members of the Board, officers and those watching the webcast to the meeting.

Apologies for absence were received from:

Dr Abel Adegoke, Primary Care Provider

Carol Johnson-Eyre, Voluntary, Community, Faith and Social Enterprise sector will be substituted by Justine Molyneux.

Janelle Holmes, WUTH who will be substituted by Mr David McGovern and Mr James Barclay.

Dr David H Jones, Primary Care Provider

PRESENT:

Simon Banks   Chair and Place Director, NHS Cheshire and Merseyside

James Barclay   Wirral Improvement Team

Dave Bradburn   Director of Public Health, Wirral Council

Julian Eyre   Wirral Improvement Team

Graham Hodkinson   Director of Adults, Health and Strategic Commissioning, Wirral Council

Karen Howell   CEO, Wirral Community Health and Care NHS Foundation Trust

Tom Knight  Head of Primary Care, NHS Cheshire and Merseyside

Paul Mason  Wirral University Teaching Hospital NHS Foundation Trust   

Martin McDowell   NHS Cheshire and Merseyside

David McGovern   Wirral University Teaching Hospital NHS Foundation Trust

Councillor Julie McManus Wirral Council

Justine Molyneux   Voluntary, Community, Faith and Social Enterprise sector

Councillor Simon Mountney Wirral Council

Councillor Kieran Murphy   Wirral Council

Karen Prior   CEO, Healthwatch Wirral

Councillor Simon Mountney Wirral Council

Lorna Quigley   Associate Director Quality and Safety Improvement, NHS Cheshire and Merseyside

Paul Satoor   CEO, Wirral Council

Vicki Shaw   Head of Legal Services, Wirral Council

Matthew Swanborough   Chief Strategy Officer, Wirral University Teaching Hospital

Tim Welch   Cheshire and Wirral Partnership NHS Foundation Trust

Simone White   Director of Children’s Services, Wirral Council

Dr Stephen Wright   Primary Care

Christine Morley   Secretary

Members are asked to consider whether they have any relevant interest in connection with any item(s) on this agenda and, if so, to declare them and state the nature of the interest.

The Chair invited members to declare any interests they had in any items on the agenda. No interests were declared.

To approve the accuracy of the minutes of the meeting held on 28 October 2023.

Resolved - That the minutes of the meeting held on 19 October 2023 be agreed.

This was the second meeting under the new agenda structure and there were no items on the Action Log.

The Associate Director of Quality and Safety presented this report which provided oversight of Key Performance metrics relating to Wirral Place. Two priorities were noted. Firstly, healthcare associated infection was still a priority within the Borough. The rates of C-Difficile and Gram Negative Blood Stream Infections remained high and focussed work was continuing around this to look at the improvement plans and improve the trajectory. It was noted that the Health Protection Team with the support of the Infection Prevention and Control Team won a Gold Award for their work which reduced urinary tract infections. and admissions to hospital.  Secondly, it was reported that work continued on a written statement of action for SEND with the majority of actions completed.  Focussed work was to continue around the priority area of the neurodevelopmental pathway and this work was to be expedited to put the pathway in place for Quarter 1 of next year.  The number one priority was to focus on people that transitioned between Childrens and Adults Social Care and improve those services by looking at planning and making appropriate provision in terms of housing and specialist services.

Resolved that –

· The work underway across the system to monitor quality and performance, identifying areas for improvement be noted.

· The further work underway to strengthen the governance around quality and safety across health and social care be noted and endorsed.

· Assurance be received around the robust improvement plans in place to manage specific areas for improvement and particularly C-Difficile and SEND.

· The implementation of a revised neurodevelopmental pathway for children and young people by Quarter 1 of 2024/2025 be supported.

The Associate Director of Finance, NHS Cheshire and Merseyside presented this report which provided a high level update of the Month 6 2023/24 financial position for the Wirral Health Care System and the second part of the report focussed on the Pooled Fund Budget arrangements between the ICB and Wirral Borough Council.

It was noted that the Council’s legal requirements meant that they would have to deliver a balanced plan overall and further work would be done around mitigating that. Members were informed that final NHS funding was announced early November and revisions to the plan were to be considered so the numbers may change by December and the risk in the latter part of the financial year will be demonstrated.

In terms of the risk share the Better Care Fund was at break even and members were assured that there were no implications around flowing money between the two partners at this point. It was noted that the sign-off of the Section 75 Agreement was to be delayed until January 2024 as it did not make the agenda of the last Finance Committee at the ICB.

The Chair noted that two areas were to be protected in the NHS with regard to savings which were Patient Safety to maintain the viability of the Healthcare system through winter and the second area was mental health investment standard.  The drivers of the costs in the NHS were industrial action and the pressures of inflation.

Resolved that –

·  The report and the specific recommendations in relation to the Pooled Budget  listed below be noted.

·  The forecast reported position for the Pool and the discharge fund as at Month 6 2023/24 be noted.

·  The shared risk arrangements are limited to the Better Care Fund only, which is reporting a forecast breakeven position be noted.

·  The sign off and approval process and progress of the 2023/24 Section 75 agreement which is scheduled to complete in November 2023 be noted.

The Programme Director, Wirral Improvement Team introduced this report which presented the dashboard for the programmes within the Wirral Health and Care Plan. It was reported that the overall RAG rating was at green as three programmes in the portfolio were reporting ratings of amber and the rest were reporting green. Scoping meetings have taken place with two of the trailblazer Neighbourhoods. Further work took place around the population health programme and there were workshops around how earlier detection could be improved and better management of cardiovascular disease. There has been work around children and young people and SEND and for people with learning disabilities there were co-produced strategies around autism and supported employment which were on a trajectory to be delivered in March 2024. A data review in the Mental Health programme has been completed including a patient profile of acute beds.  The Dementia Strategy and Community Transformation Programme were well in progress although Work Force remained a significant challenge. Within the Primary and Community Programme work has progressed in the Cause Prevention and Ageing Well and this programme would be refreshed in early 2024.

It was reported that a lot of work around the CIPHER system has been completed and work would continue to connect up the population reports that stem from that to ensure an effective population reporting system. 

It was reported that in terms of Medicines Optimisation a single oversight group was due to meet for the first time at the beginning of December 2023.

The Work Force supporting programme September workshop outcomes were being integrated into the wider priorities and supporting the employment element of Health and Wellbeing Strategy.

Industrial action continued to be a risk to delivery of an elective recovery and in October WUTH achieved an overall performance of 95 percent against plan for outpatients.

Resolved – That this report which provides assurance on the delivery and oversight of the Health and Care Plan programmes be noted.

The Appendices to this report may not be suitable to view for people with disabilities, users of assistive technology or mobile phone devices.?Please contact james.barclay1@nhs.net if you would like this document in an accessible format.

The Programme Manager for Wirral Improvement Team introduced this report which provided information and assurance on the work of the Unscheduled Care Improvement Programme for Wirral and its component workstreams. It was highlighted that this was currently the largest Place Based Transformation Programme with partners which then reports to this Board. The sentinel measure for success was on No Criteria to Reside patients who required ongoing care but are in hospital waiting for a placement and there had been a statistically significant reduction in these patients from 117 in September 2023 to 111 in October 2023. Wirral was in second position in Cheshire and Merseyside out of seven areas where it had previously been an outlier at the start of the programme.

It was reported that Wirral had exceeded its 100 milestone target and reached 97 on the 6 November 2023. The continued improvement was directly related to the new Transfer of Care Hub and the Development of the Transfer of Care Hub Command Centre was continuing will provide live demand and capacity information with digital systems and improved reporting enabled patients to be tracked through their discharge journey.

Additionally, there was a focus on patient length of stay in hospital.

The Home First service supported 123 people home in October 2023 which is more than in any previous month and more than a ten percent increase on September 2023 at 110. This reflected increasing capacity and a focus on filling available spots. Success was credited to the close working between the hospital and community teams. 

An intermediate care review on Cheshire and Merseyside showed that Wirral had the highest percentage of patients going home from hospital with support and not needing long term care.

It was reported that Sir John Bolton OBE would work with the Wirral System to develop a medium term demand and capacity plan. Wirral Place Working Group has met twice to progress this work which was expected to be completed at the end of November 2023. In addition, the Winter Plan was being finalised and was to be brought to the WPBPB at the earliest opportunity.

Members commented that it was a credit to partnership working that Wirral has improved and moved from the bottom of the pack to the top and that the focus is on good outcomes for people that do not involve long term care as the only option. The risk of deconditioning was reduced when alternative care was available.

Resolved – That this update be noted.

This PDF may not be suitable to view for people with disabilities, users of assistive technology or mobile phone devices.?Please contact paul.mason19@nhs.net if you would like this document in an accessible format.

The Chief Strategy Officer for Wirral University Teaching Hospital and Executive Lead for Estates introduced the report. The Director of Estates, Facilities and Capital Planning for Wirral University Teaching Hospital, Chair of the Strategic Estates Group across Wirral and Chair of Cheshire and Merseyside Estates Group presented this report.

It was reported that the first thing the Strategic Estates Group wanted to do was to understand their assets in terms of what assets were owned and leased across the Wirral. The key priorities were information about assets and sustainability.

A high level piece of work with Wirral Council looked at opportunities around regeneration and considered how to create a pathway to control system wide thinking around the Wirral. This was to ensure that the right services were placed in the right location in the right assets around Wirral.

The Wirral Place Partnership Programme looked at the outcomes and key priorities to drive the way assets were used in the future.  One area to focus on in the next stage was to look at the condition of the assets. There were over 250 buildings in the Wirral and there was an opportunity to consider where buildings were needed in the future. There was quite a lot of void space that was not being used. There was an opportunity working collaboratively across the partners to develop a plan and a programme as to how to best utilise the assets to the utmost across voluntary sectors as well as across the other partners.

Pharmacies were dotted across Wirral and there was an opportunity to consider how best to utilise these assets. High costs were associated with Third Party Landlords and there could be opportunities to amalgamate services so that people were not tied to 25 year leases.

More analysis was required to understand the true picture of backlog maintenance and condition of assets. Population growth was considered in relation to where assets were needed and travel opportunities to get to Primary Care were looked at across the Wirral. It was reported that where assets were located in deprived areas there was an opportunity to work in collaboration with Wirral Council on regeneration.  Future opportunities for development at Clatterbridge were also highlighted.

Governance for the next steps in the optimisation of assets was to be worked on with the Strategic Transformation Group. The aim was to control and understand people’s demand of assets and requirements for space which provided an opportunity to combine services together and a phased approach was proposed.

Members commented that the work was a great starting point and was an excellent piece of work.

Resolved - That this report be noted.

This PDF file may not be suitable to view for people with disabilities, users of assistive technology or mobile phone devices.?Please contact Simon.Banks@cheshireandmerseyside.nhs.uk  if you would like this document in an accessible format.

The Chair presented this report which provided an update on the proposed approach to the planning round the 2023/24 contract year. This was to result in the refresh of the Wirral Health and Care Plan 2023/24 for 2024/25 to align the NHS, local authority and wider Place priorities.

Resolved - That the proposed approach for the 2024/25 planning round be noted and the production of the Wirral Health and Care Plan 2024/25 be supported.

This PDF file may not be suitable to view for people with disabilities, users of assistive technology or mobile phone devices.?Please contact tom.knight1@nhs.net if you would like this document in an accessible format.

The Head of Primary Care NHS Cheshire and Merseyside presented the report which provided an update on the commissioning of primary care dental services, described the national contract management process and the development of the NHS Cheshire and Merseyside Integrated Care Board (ICB) Dental Improvement Plan 2023-25. The Plan identified key strategic aims including recovering dental activity and improving delivery of units of dental activity (UDAs) towards pre-pandemic levels. Access for vulnerable and deprived populations was to be prioritised and the ambition was that no patient will wait longer than the nationally defined period for an urgent appointment. The plan to support greater workforce resilience was highlighted. There were challenges around recruitment and retention of dentists and a lack of national contract flexibility. Post pandemic the presentation of oral health of patients has changed significantly which impacts on the throughput capacity of practices.

In order to deliver these aims it was important to develop access sessions for new patients across 60 practices in the ICB. Commissioners were seeking to provide an additional 30,000 appointments across Cheshire and Merseyside and work with local authorities to identify organisations who work with vulnerable populations. Additionally, a number of Foundation Dentists were to commence work across Cheshire and Merseyside later this year to improve access.

The ICB Executive Team was developing a dashboard by place to provide detailed information for each of the nine places. This dashboard was to be finalised in the next couple of weeks. Overall activity was increasing across Cheshire and Merseyside but some patients were unable to find an NHS dentist. Overperforming practices were to be rewarded and encouraged to do more activity if possible.

Members discussed the difficulties of finding an NHS dentist as well as the difficulties of retention of NHS dentists. Dentistry had always had a fee but the challenge was that practices were flipping to offer private care as the NHS contract was not financially viable in terms of the increased costs of items used in dental treatment, X-ray  costs and laboratory treatment. The dental funding package had not increased since 2006. The Oral Health Improvement Plan included prevention activities such as teaching children to brush their teeth properly and highlighted the importance of healthy eating. A response to the ICB regarding dental primary care quality was being looked at. It was reported that the ringfence for NHS dental services was to be removed.

Resolved – That

1. the content of the report and the Dental Improvement Plan 2023-25 be noted.

the national contract management process be noted.

The Chair introduced this report which presented the key issues from the Finance, Investment and Resource Group which was one of the four key governance and assurance groups supported the Wirral Place Based Partnership Board.

Resolved – That the work of the Finance and Investment Group be noted and the Wirral Place Based Partnership Board continues to receive updates as a standing agenda item.

The Chair introduced the highlight report from the Primary Care Group which was one of the four key governance assurance groups supported the Wirral Place Based Partnership Board.

Resolved – That the work of the Primary Care Group be noted and that the Board continues to receive updates as a standing agenda item.

The Chair introduced the highlight report from the Strategy and Transformation Group which was one of the four key governance assurance groups supported the Wirral Place Based Partnership Board.

The 22 December 2023 meeting of the Strategy and Transformation Group had been stood down due to operational pressures.

Resolved – That the work of the Strategy and Transformation Group be noted.

There were no questions from the public or members and no petitions or statements.

The Head of Legal introduced this report which presented the future work programme of the Board.

Resolved – That the work programme for the Wirral Place Based Partnership Board for the remainder of the 2023/24 municipal year be noted.

There was no other business.

10am on 21 December 2023

10am on 25 January 2024

10am on 22 February 2024

10am on 21 March 2024

10am on 21 December 2023

10am on 25 January 2024

10am on 22 February 2024

10am on 21 March 2024