BOARD MEMBERS PRESENT:

Carol Johnson-Eyre  Voluntary, Community, Faith and Social Enterprise Sector, (Chair)

Simon Banks  Place Director (Wirral), NHS Cheshire and Merseyside

Dave Bradburn  Director of Public Health, Wirral Council

Ian Cubbin  Primary Care Providers (Optometry)

Elizabeth Hartley  Director of Children, Family and Education, Wirral Council

Sayyed Osman  Director of Director of Adult Social  Care and Health, Wirral Council

Cllr Julie McManus  Wirral Council

Cllr Simon Mountney  Wirral Council

Cllr Kieran Murphy  Wirral Council

Paul Satoor  Chief Executive, Wirral Council

Paula Simpson  Wirral Community Health and Care NHS Trust

Terri-Ann Henshaw  Transforming Care Team

ALSO PRESENT:

Martin McDowell  NHS Cheshire and Merseyside

Gareth Prytherch  Voluntary, Community, Faith and Social Enterprise

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

Natalie Kevitt  Wirral Improvement Team

Pauline McGrath  Programme Director

  Cheshire and Mersey Transforming Care 

Vicki Shaw  Head of Legal Service, Wirral Council

Christine Morley  Secretary

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

·  Tim Welch, Cheshire and Wirral Partnership NHS Foundation Trust;

·  Mark Greatrex, Interim CEO, Wirral Community Health and Care was substituted by Paula Simpson, Chief Nurse, WCHC;

·  Dr David Jones, Primary Care;

·  Janelle Holmes, CEO, Wirral University Teaching Hospital.

·  Karen Prior, CEO, Health Watch.

The Chair noted that Gareth Prytherch, Wirral CVS CEO was the interim VCSFE representative.

The Chair thanked Justine Molyneux who had left the board for all her work on behalf of the community and voluntary sector.

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 asked for members to declare any interests in any items on the agenda. No interests were declared.

To approve the accuracy on the minutes of the meeting held on 25 July 2024.

Apologies were received from Cllr Julie McManus who was substituted by Cllr Tony Murphy.

Resolved – That the minutes of the meeting held on Thursday, 25 July 2024 be agreed, subject to the above amendment.

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The Associate Director of Finance, NHS Cheshire and Merseyside(Wirral) introduced this report, which updated the Board on the financial position for the Wirral Place health and care system partners, as at the end of August 2024, Month 4 in the financial year 2024/25.

The report noted that the system had an actual reported deficit of £23.2m compared with a planned year to-date deficit of £15.7m, which represented an adverse variance of £7.5m. The reported forecast out-turn position for NHS Health remained in line with the planned deficit of £29.0m although all partners acknowledged significant financial risks to the delivery of this position and progressing with stringent mitigation and action plans. The Wirral Metropolitan Borough Council (MBC) financial position at Quarter 1 for Adult Health and Care has been reported to the Council’s Policy and Resources Committee in its July meeting and reported an adverse variance due to increased activity and costs in social care services to be mitigated. It was acknowledged that there was a lot of risk in the system particularly round packages of care and there was an overspend in prescribing and there were still some inflationary risks and the industrial action in the first part of the year. It was noted that the reported forecast of the Pooled Fund was off plan for this stage in the year.

Members asked about the actual and budgeted pay awards and it was explained that guidance had just been received around the NHS pay awards of 5.5percent.  This would equate to an additionality of around 3percent and following analysis, any gap or additional pressures would be reported back to the Board.

It was clarified to Members that the allocation of income to Place was designed to take into account the needs of the population and Place was not set up to generate income. 

It was noted that Wirral had the largest Pooled Fund of any of the other areas in Cheshire and Merseyside.  The Pooled Fund increased from 2023-2024 to 2024-2025.  It was reported that as at month 4 there is a forecast variance of break even. We will have to revert to the overspend and those plans are challenged.

Members discussed the challenging financial position and the Associate Director of Finance would bring something back around where the drivers were in the system and how they could be addressed.

Members discussed the need for the board to take a strategic overview of the financial constraints and consider the consequences of any actions to mitigate them and to put Wirral first in that. It was reported that the Integrated Care Board had set up a recovery meeting to address that which met every two weeks and some of that information could be brought to the Board to provide assurance on progress. This was also running through the Policy and Resources Committee of the Council. A report was to be brought to the Wirral Place Based Partnership Board in November 2024 regarding the implication of the financial challenges on the  ...  view the full minutes text for item 26.

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The Associate Director of Quality and Safety Improvement, NHS Cheshire and Merseyside presented the report which provided oversight of the Quality and Performance across Wirral Place since the last reporting period. The report focussed on some key areas of improvement including Healthcare Associated Infections (HCAI) and Special Educational Needs and Disabilities (SEND). It was highlighted that in planned care, patients waiting more than 6 weeks for a diagnostic test had decreased so less people were waiting and both the local and national trajectory had been met. There had been a shift in metrics around access to mental health which had been changed to look at reliable recovery and reliable improvement. There was a national standard that 75 percent of people with a severe mental health problem receive a health check and this would be shown in the report from November 2024. It was highlighted that the dementia diagnosis rate had increased for June.

The biggest concern as a system was around health care acquired infection rates.  The C-difficile rate was higher than the target and C-difficile created harm and increased hospital stays which would lead to increased costs. The C-difficile strategy would be taken to the Health Protection Board for approval in September 2024. It was noted that the hospital acquired infection rates threshold had arrived late in the last two weeks and this would be looked at in the next report.

The All Age Continuing Care performance standards were included and there was a management of change progress going on across Cheshire and Merseyside and this would be included in future reports.

Members asked about learning disability health checks which are noted in quantity and the quality of the health checks was discussed. Members queried whether people with lived experience had been involved in the Eastway and Greenways quality visits led by NHS England and the ICB and a written response would be given.

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 around the robust improvement plans in place to manage specific areas for improvement be received.

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The Place Director (Wirral) presented this report which provided an update on the system management of key strategic risks as identified in the Place Delivery Assurance Framework. The finance risk had been moved from a 12 to a 16 based upon the deterioration of the deficit position for the Wirral system and this had put it back in the high risk area. It was reported that in late November there would probably be a change in a couple of the metrics as the risk management framework definitions were being revised.

Resolved – That

• The work to apply NHS Cheshire and Merseyside’s Risk Management Framework to the Wirral Place Partnership governance arrangements be noted.

• The updated Place Delivery Assurance Framework be approved.

• An updated PDAF will be presented at the Board meeting scheduled for 19th December 2024 be noted.

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The Programme Manager, Wirral Improvement Team presented the report which provided the performance dashboard for the programmes within the Wirral Place Health and Care Plan.  The report aimed to provide the Board with information and assurance on the progress of the Programmes associated with the Wirral Health and Care plan 2024-25. The overall delivery RAG rating for the Health and Care plan delivery in August was Green, with one programme in the portfolio reporting Red, two reporting Amber and the rest reporting Green.  There had been one change in the RAG ratings for use of resources and this was due to an increased level of risk for Wirral achieving the financial targets. The RAG for Children and Young People remained on red while Wirral were under an improvement notice.  It was highlighted that in the area of  Children and Young People work had continued in recruitment and processes and Branch, the new platform for the central point of access was undergoing a soft launch with identified stakeholders including GP’s, schools and social care.  A draft project structure and outcome measures had been completed for the Ageing Well workstream for delivery in the next 3-5years. In addition, a revised Project Initiation Document had been produced for the roll out of the Integrated Frailty Work.

It was reported that the phased discharge of patients with mental health had been piloted and Magenta had appointed a Neighbourhood Engagement Officer to support the transition for the new residents.

Under the Estates and Sustainability a Transformational workstream programme was in development and joint leadership between health and Wirral Council was being sought.

It had been agreed to prioritise the migration of the population health management system from the WIrral Care Record to CIPHA.

Within the Workforce programme four priorities had been identified which included future planning and how to attract and develop the workforce. The Wirral Care leavers project had secured 7 work placement s for individual care leavers across health, Local Authority and the private sector.

Members asked about the workshop in Section 1.13 of the report and a written response would be provided by the

the Programme Manager, Wirral Improvement Team.

Members asked about the shared learning workshop with Cheshire. The workshop has not happened yet and information would be fed back at the next meeting.

The Chief Executive, Wirral Council queried whether the Children’s narrative was correct. The SEND Partnership Board was up and running with robust governance and therefore the risk around governance could potentially be reduced to amber because of the progress that had been made and the work with the Department for Education. The issue with the SEND Partnership Board was around funding from the ICB in terms of neurodiversity. It was agreed that the description needed to be looked at with a bit more narrative around the health related work and updates on new models of care and updates on speech and language therapy. The Chair noted this as an action for The Programme Manager, Wirral Improvement Team  ...  view the full minutes text for item 29.

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The Programme Director for Transforming Care Merseyside assisted by the Senior Social Worker for Transforming Care Merseyside presented the slides.

As a result of high level investigation and subsequent closure of facilities the Transforming Care Programme came into being. The key target area from a national point of view was about reducing admission to hospital for people with a learning disability and discharging people who have been in hospital for a long time. Another key target was annual health checks and care and treatment reviews. The national driver was learning from deaths of people with learning disability and autism. The Down Syndrome act was waiting to go through parliament and there would be some work on the delivery of that.

A key area of work for the Lead of Strategy involved undertaking reviews of people who have died who had a diagnosis of a learning disability or autism. Every person had to be reviewed to look at how and where the person was treated in the last 6 months of their life. It was not an investigation, it was a review of the care received and any lessons to be learned. The actions from the reviews were fed back to the governance board.  The community forensic service had been commissioned. It was reported that in Cheshire and Merseyside there were about 46 people in secure beds of which Wirral has about 5. These were high risk individuals and it was crucial for these people to be supported by a skilled team in the community when they were discharged.  There had been a reluctance to discharge high risk people as the framework was not there to support them but it was now.

The numbers waiting for assessment for autism was quite significant and investment had been made across Cheshire and Merseyside to put community services in place and to address the waiting lists.  People with autism had been admitted to mental health wards but the primary diagnosis was mental health and reasonable adjustment s were required on admission.

Capital bids had been made to access money through NHS England. Wirral had secured £1million for Lindhurst facility which is a children’s respite and shortbreak facility that should be ready early next year subject to CQC approval.

There was a Cheshire and Merseyside CTR Hub and there was a Band 7 Chair looking to support children and adults. There had been interest from lead provider collaboratives to undertake specialised CTRs and it had been advised that another Band 7 and Band3 administrative post to support the work would need to be recruited.

Investments into Wirral Place is shown – about improving community infrastructure which needs to be in place to keep people out of hospital.

The funding allocation for housing on Wirral was discussed and the community infrastructure that needed to be put in place. Care package costs ranged between £6000 to £10000 per week and some individuals required 1to1 or 2to1 care. Something more sustainable needed to be looked at such as  ...  view the full minutes text for item 30.

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The Chief Executive, Wirral University Teaching Hospital was unable to attend to present this report which provided the Board with information and assurance on the work of the Unscheduled Care Improvement Programme for Wirral.

Members asked about the impact of the Transfer of Care Hub on people who were digitally excluded. In terms of impact, the number of patients with No Criteria to Reside stood at 128 which had been considerably improved through collaborative work between health and care, the digitalisation of processes and the ability to move people on. The Transfer of Care Hub was for the professionals to use and the public did not access to it as it is not a public system.

Resolved – That this update be noted.

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The Director of Children, Families and Education presented the report which provided a copy of the SEND Improvement update report to the Health and Wellbeing Board on 19 September 2024. The Health and Wellbeing Board provided governance to the Local Area SEND Partnership Board. It was reported that the SEND Partnership Board was complying with the requirements of the SEND improvement notice and that progress had made against the written statement of action areas. It was noted that two of the ten areas for improvement had been moved into business as usual because sufficient progress had been made. Since the report was published further progress had been made against the metrics which included the completion of further work around co-production and the JSNA and both of these were now back on track.  There had been a request from the SEND Partnership Board to look at compliance with Educational Health and Care Plans to understand why the compliance rate is stuck at 17.

Other key developments included Liquid Logic EYES which was up and running which was a significant step in improving record keeping and being able to track and monitor the improvements. It was reported that preparation for the next SEND inspection was underway and that could happen at any time and a self evaluation would be published shortly to give stakeholders an overview of the progress being made.

In response to a member request for an update about Life School, the Chair asked for the update to be provided outside the meeting.

Resolved – That the SEND Improvement update report be noted.

The Associate Director of Quality and Safety Improvement, NHS Cheshire and Merseyside presented the report which provided an update on the discussion and outcomes of the meeting of the Quality and Performance Group held on 11 July 2024. It was highlighted that the focus was on all All Age Continuing Care looking at the transition from child into adulthood.

Members asked about the intervention to increase performance and increase number of people seen in A&E.

It was clarified to Members that the system had moved into Tier 1 intervention. There were sixteen hospitals nationally and five of those were in Cheshire and Merseyside. Arrowe Park Hospital was one of them and was focussed on 12 hour ambulance waits and ambulance turn around and there would be some direct system support to look at system processes and clinical pathways and this was discussed.

Members raised a concern that the Board and the Chair of Adult Social Care and Public Health were unaware of the problems that were backing up at Arrowe Park Hospital and requested to be made aware when there were problems in the future. A discussion would be had with the Arrowe Park Hospital as to how they alert members in times of pressure. It was agreed to bring a brief update on the Tier 1 situation in Arrowe Park Hospital in the next Unscheduled Care Programme Report.

Resolved – That

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

• Assurance around the robust plans in place to manage specific areas for improvement be received.

• The effective use of data to understand population health need and improve equality and access to services be noted.

The purpose of the report was to provide an update on the work of the Strategy and Transformation Group (STG).

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

There were no question from the public and no petitions or statements.

The Chair of the Wirral Place Based Partnership Board introduced this report which presented the future work programme of the Board.

It was agreed that the SEND Improvement report would be removed from October 2024 and move in line with the reports to Health and Wellbeing Board.

It was agreed that James Barclay would include Tier 1 in the next Unscheduled Care report and the system control network could be described.

Resolved – That subject to the changes noted above,

the proposed Wirral Place Based Partnership Board work programme for the remainder of the 2024/25 municipal year be noted.

There was no other business.

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