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

Apologies for absence were received from:

Karen Prior, Healthwatch Wirral;

Dave Bradburn, Director of Public Health, Wirral Council

Janelle Holmes, Chief Executive, Wirral University Teaching Hospital NHS Foundation Trust

David McGovern, Director of Corporate Affairs, Wirral University Teaching Hospital NHS Foundation Trust

Paul Satoor, Chief Executive, Wirral Council

BOARD MEMBERS:

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

Dr David Jones Primary Care representative

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

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

Councillor Kieran Murphy Wirral Council

Councillor Simon Mountney Wirral Council

Sayyed Osman Director of Adults, Health and Strategic Commissioning, Wirral Council

Gareth Prytherch Voluntary, Community, Faith and Social Enterprise sector representative

Tim Welch Chief Executive, Cheshire and Wirral Partnership NHS Foundation Trust

Mark Greatrex, Chief Executive, Wirral Community Health and Care NHS Foundation Trust Finance officer

ALSO PRESENT:

Louise Morris (for Martin McDowell) >Finance (Wirral), NHS Cheshire and Merseyside

James Barclay, Wirral Improvement Team

Lorna Quigley Associate Director of Quality and Safety Improvement (Wirral), NHS Cheshire and Merseyside

Julian Eyre 

Vicki Shaw Head of Legal Services, Wirral Council

Mike Jones (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 asked for members to declare any interests in any items on the agenda. There were no declarations of interest.

To approve the accuracy on the minutes of the meeting held on 21 November 2024.

Resolved – That the minutes of the meeting held on 21^st November 2024 be agreed.

There were no items on the action log.

There were no items on the action log.

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

The Associate Director of Quality and Safety Improvement, NHS Cheshire and Merseyside, introduced this report, which was to provide oversight of the Quality and Performance across Wirral Place since the last reporting period. The report focussed on the key area of improvement including Healthcare Associated Infections (HCAI).

Members discussed the infection rates, methods of reducing them and barriers such as reduced uptake of vaccinations.

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.

The PDF file 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 representative of the Wirral Improvement Team presented this repot which provided information and assurance on the work of the Unscheduled Care Improvement Programme for Wirral.  It was noted that there had been good progress across all of the work streams, aiming at reducing the attendance at Emergency Departments by meeting medical needs in communities.

Members discussed aspects of the work including high intensity users and recruitment.

Resolved – That the report be noted.

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

The Head of Finance for Wirral Place, NHS Cheshire and Merseyside spoke to this report which provided an update on the financial position for the Wirral Place health and care system partners as at the end of October 2024, Month 7 in the financial year 2024/25. It was noted that the system had an actual reported deficit of £28.6m compared with a planned year-to-date deficit of £16.0m.

Members queried details in the report.

Resolved – That the report be noted and on the specific recommendations in relation to the Pooled Budget:

·  the forecast reported position for the System, Pool Fund and the Discharge Fund, as at Month 7 2024/25 be noted.

·  It be noted that the shared risk arrangements were limited to the Better Care Fund only, which was reporting a forecast breakeven position.

·  It be noted that the 2024/25 Section 75 agreement was signed and sealed.

The Place Director (Wirral), NHS Cheshire and Merseyside, introduced this report which provided an update on the system management of key strategic risks as identified in the Place Delivery Assurance Framework. The single change, which reflected progress, was noted.

Members queried the longer term risks such as recruitment and retention of staff.

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.

• it be noted that an updated PDAF will be presented at the Board meeting scheduled for 27 March 2025.

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

The Programme Director, Wirral Improvement Team, introduced this quarterly report, which presented the performance dashboard for the programmes within the Wirral Place Health and Care Plan. The report aimed to provide information and assurance on the progress of the Programmes associated with the Wirral Health and Care plan 2024-25. The overall position of the delivery of programmes was noted as amber in the RAG ratings. Key points were highlighted.

Members questioned some of the details in the report.

Resolved – That the report which provides assurance on the delivery and oversight of the Health and Care plan programme be noted.

The Head of Quality and Safety Improvement introduced this report which updated on outcomes of the meeting of the Quality and Performance Group held on 14^th November 2024. 

Resolved – That

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

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

Louise Morris, Head of Finance for NHS Cheshire and Merseyside introduced this report which provided an update on the work of the Finance and Investment Group (FIG). 

Resolved – That the work of the Finance and Investment Group be noted.

The Director of Placed (Wirral), MHS Cheshire and Merseyside introduced this report which provided an update on the work of the Primary Care Group (PCG).

Members queried training of Primary Care staff and notification of learning disabilities.

Resolved – That the work of the Primary Care Group be noted.

The Place Director introduced this report which provided an update on the work of the Strategy and Transformation Group (STG). 

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

The PDF file below may not be suitable to view for people with disabilities, users of assistive technology or mobile phone devices.?Please contact elizabethhartley@wirral.gov.uk if you would like this document in an accessible format. 

The Director for Children, Families and Education spoke to this report which provided a copy of the SEND Improvement update report to the Health and Wellbeing Board on 12 December 2024. 

Members questioned the SEND process and timescales.

Resolved - That the SEND improvement update report be noted.

Notice of question to be given in writing or by email by 12 noon, Monday 16 December 2024 to the Council’s Monitoring Officer (via the online form here: Public Question Form) and to be dealt with in accordance with Standing Order 10.

Please telephone the Committee Services Officer if you have not received an acknowledgement of your question by the deadline for submission.

One question had been received from Councillor Tony Murphy regarding drug effectiveness and what strategies were used to review the appropriateness of individual's medications.

The following response had been provided:

Polypharmacy work within Wirral Place – December 2024

Reducing inappropriate polypharmacy is a core workstream within Wirral Place medicines optimisation priorities. Our local priorities for 24/25 are as follows, these will be refreshed into 25/26:

•  Reduce emergency admissions (and re-admissions) related to falls associated with problematic polypharmacy.

•  Taking a joint approach to improve prescriber confidence to deprescribe when clinically appropriate for a number of high priority areas:

•  Opioids/drugs of dependence

•  End of life and palliative care

•  Frailty

•  Learning disability

•  Safe deprescribing of antidepressants, benzodiazepines, and z-drugs where clinically appropriate.

•  Prioritisation of patients who would benefit from a targeted medication review – using technology to support identification and prioritisation.

•  Taking opportunities in all settings to review medication burden for patients and consider deprescribing.

The examples described in the above query are exactly the priority areas we are trying to target so that patients do not end up on medication long term that they should not be on and to reduce admissions directly caused by medication. There is still significant work to do but this is some of the work already in place or underway:

• All patients on regular medication should have an annual medication review, or more frequent if there are significant risk factors e.g. elderly, reduced kidney function, high risk medicines. The GP clinical systems flag when the reviews are due and there are processes in place to ensure regular monitoring is undertaken for higher risk drugs and to complete reviews when they are due.
• Our Primary Care Network (PCN) pharmacy teams are targeting their reviews on patients with multiple medications e.g.10+ medicines, frail, at high risk of admission and/or on opioids or medicines of potential dependence.
• Risk stratification of patients who would benefit most from a structured medication review is still a challenge, we are linking in at ICB level re: this to utilise technology and AI to support a consistent approach.
• Post discharge medication reviews are being looked at by some PCN pharmacy teams as a good opportunity to ensure medicines started for a short-term issue e.g. post-surgical pain relief, are not inadvertently continued long term - we need to look at how this is developing and share best practice.
• We have linked the work into the Wirral falls prevention and management work programme so that MO is part of the local strategy and linked to the work at a patient level.
• All our clinicians are offered an opportunity to join the ICB Polypharmacy masterclasses and Community of Practice for education and shared learning but we do need to ensure invites get to wider audiences and encourage engagement from our Trusts. The next Community of practice is focussing on effective medication review to share best practice.
• We have presented to our GPs the data and the recommendations re: shared  ...  view the full minutes text for item 87.

Statements

Notice of representations to be given in writing or by email by 12 noon, Monday 16 December 2024 to the Council’s Monitoring Officer (committeeservices@wirral.gov.uk) and to be dealt with in accordance with Standing Order 11.1.

Petitions

Petitions may be presented to the Committee if provided to Democratic and Member Services no later than 3 working days before the meeting, at the discretion of the Chair. The person presenting the petition will be allowed to address the meeting briefly (not exceeding three minutes) to outline the aims of the petition. The Chair will refer the matter to another appropriate body of the Council within whose terms of reference it falls without discussion, unless a relevant item appears elsewhere on the Agenda. If a petition contains more than 5,000 signatures, it will be debated at a subsequent meeting of Council for up to 15 minutes, at the discretion of the Mayor.

Please telephone the Committee Services Officer if you have not received an acknowledgement of your statement/petition by the deadline for submission.

No statements or petitions had been received.

The Chair of the Wirral Place Based Partnership Board introduced this report, which detailed the annual work programme of items for consideration by the Wirral Place Based Partnership Board. 

It was noted that the All Age Continuing Care be a separate report rather than be incorporated into another report.

Resolved – That 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.

10am on 23 January 2025

10am on 20 February 2025

10am on 27 March 2025

The next three scheduled meetings were noted as:

10am on 23 January 2025.

10am on 20 February 2025.

10am on 27 March 2025.