BOARD MEMBERS:

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

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

Councillor Simon Mountney   Wirral Council

Councillor Kieran Murphy   Wirral Council

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

Dave Bradburn   Director of Public Health, Wirral Council

Karen Livesey   Voluntary, Community, Faith and Social Enterprise Sector representative

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

Karen Prior   Chief Executive, Healthwatch Wirral 

Dr Jo Chwalko   Wirral Community Health and Care Trust

Dr Abel Adegoke   Primary Care

Dr David Jones   Primary Care

Dr Stephen Wright   Primary Care

ALSO PRESENT:

James Barclay   Wirral Improvement Team.

Louise Morris   Head of Finance (Wirral), NHS Cheshire and Merseyside.

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

Julian Eyre   Programme Director, Wirral Improvement Team

Vicki Shaw   Head of Legal Services, Wirral Council.

Christine Morley   Secretary

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

Apologies for absence were received from:

Janelle Holmes, Chief Executive, Wirral University Teaching Hospital NHS Foundation Trust was represented by Dr Jo Chwalko

Councillor Julie McManus, Wirral Council

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

Paul Satoor, Chief Executive, Wirral Council

The Chair welcomed Karen Livesey from One Wirral who was the new VCSFE rep on the Board.

It was reported that the NHS Operational Planning Guidance 2025-2026 report had been delayed as the Planning Guidance had not been published. The initial draft of the refreshed Wirral Place Governance Manual was deferred to February with ratification due in March 2025.

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 19 December 2024.

Resolved – That the minutes of the meeting held on 19 December 2024 be agreed.

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 the report, the purpose of which was to provide oversight of the Quality and Performance across Wirral Place since the last reporting period.  The report focussed on the key areas of improvement including Healthcare Associated Infections (HCAI). It was reported that December 2024 data for HCAI had now been published and Wirral remained an outlier. A briefing note would be prepared for members with the most up to date data which would also include data around the time taken to handover patients at the acute trust. It was highlighted that seven new metrics had been added to the mental health section of the report.

The risks around ambulance hand over delays, corridor care and length of stay in unscheduled care and the mitigations in place were discussed.

Members asked about the movement of people into social care beds and this was discussed. The first issue was having sufficient capacity both in terms of review and assessment to be able to support the discharge process. It was reported that Wirral had invested significantly in the system through Homefirst which allowed people to go home with some domiciliary care. Clatterbridge had beds for people who needed to recuperate and needed more therapy. It was reported that in agreement with the ICB and Arrowe Park additional capacity could be purchased to allow people to be discharged. The challenge was to recognise the exponential increase in demand since 2022. 

Members asked about talking therapies and those who were not reliably recovered and also about the numbers of people with learning disabilities and/or autism being referred for talking therapies and this was discussed.

Members asked about the number of beds required to eliminate corridor care and the issues around this were discussed including virtual wards and only conveying people to hospital in an emergency. The Chair noted that this was a whole system issue not just specifically around hospital beds.

In response to a member question about the numbers of those with No Criteria to Reside it was reported that there was a cohort of patients with more complex needs around mental health and wellbeing and disabilities that needed bespoke wrap around care. The challenge was to provide a system response to meet these needs and this included community care which was discussed.

The Associate Director of Quality and Safety Improvement, NHS Cheshire and Merseyside would meet with the Voluntary, Community, Faith and Social Enterprise Sector representative to provide quality and performance group metrics which may be helpful to measure outcomes in relation to the WIRRAL Core 20+5.

The Programme Manager of the Wirral Improvement Team highlighted the ambition around corridor care to get back to zero in March 2025. An update on capacity and demand would be brought to the next meeting. Call before convey enabled an ambulance to call in before conveying a patient to hospital to look at what other alternatives were available and the actions around this would  ...  view the full minutes text for item 95.

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, NHS Cheshire and Merseyside, introduced this report

which provided an update on the financial position for the Wirral Place health and care system partners as at the end of November 2024, Month 8 in the financial year 2024/25.

In terms of the Wirral System and System Partners for Month 8 there was a year to date variance from plan of £20.7million and a forecast variance from plan of £6.5million relating to the Quarter 2 position of the Wirral Local Authority. It was noted that there were significant risks to the delivery of the forecast and mitigation plans were ongoing to try and secure the position for all partners.

The Pooled Fund on the Wirral of £304million had an adverse forecast of £2.34million and that related mainly to Wirral Local Authority schemes that held the financial risk

The Discharge Fund of £7.8million was on plan to be spent in full and there were currently no financial risks reported to delivery.

It was reported that the Better Care Fund had a pooled fund of £62million all of which was on plan to be spent. It was acknowledged that there were a couple of financial risks, namely the Wirral Integrated Service and the Disabilities Facilities Grant, however there were mitigations in place to bring the plan in on forecast. In summary, the final quarter of 2024-2025 would be challenging.

It was clarified to members that the £2.19million variance in terms of Adult Health and Care in the pooled fund would need to be met by the Local Authority element of Adult Care and Health. Given the budget constraints on Adult Social Care, members asked how the shortfall would be met and this was discussed. It was acknowledged that the two areas of financial pressure within the Local Authority were learning disability and mental health.

Resolved – That

· The forecast reported position for the System, Pool Fund and the Discharge Fund as at Month 8 2024/25 be noted.

• The shared risk arrangements were limited to the Better Care Fund only, which was reporting a forecast breakeven position 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 Julian.eyre@nhs.net if you would like this document in an accessible format.

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 December was Amber,

with three programmes reporting Red, five reporting Amber and five reporting Green. There was one change around estates and sustainability which was reporting amber. It was reported that this change related to changes around governance.

The draft Falls Strategy Framework within the Primary and Community Care Programme had been completed and would be presented to the Programme Board for approval. The other key area involved the rolling out of integrated frailty teams and Wallasey and West Wirral would be the next areas to go live.

The work around the graduated approach in schools was highlighted and the BRANCH mental health platform was now live.

Within the All Age Disability Strategy there had been work around prescribing for people with learning disabilities and autism which had looked at the levels of prescribing, in particular around anxiety and sleeping.

The Mental Health programme had focussed on a rapid improvement process to support the escalating patient and reduce readmissions. It was reported that an enhanced discharge pathway had been developed.

Within the enabling programmes the demand tracker request form had been prepared for launch. Within the digital maturity programme the work migrating to the CIPHA platform was near to completion and programme closure was expected by the end of February 2025. It was reported that a new leadership model had been put into place around medicines optimisation.

Members asked why there was no improvement in neighbourhoods and use of resources and this was discussed. It was explained to Members that the original work around neighbourhoods had been paused while work took place around the way forward. It was explained that the resources risk was red as the financial balance overall was at risk.

Members asked what could be done to support the neighbourhood model and this was discussed. The VCFSE was keen to be involved in the design and delivery of the neighbourhood model moving forward and if there was an opportunity for a stakeholder forum they would support that.

Resolved – That this report which provides assurance on the delivery and oversight of the Health and Care plan programme 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 tom.knight@cheshireandmerseyside.nhs.uk if you would like this document in an accessible format.

The Chair deferred the Dentistry report to the next meeting as the Associate Director (Dental and Community  Pharmacy) was unable to attend.

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 Programme Manager – Wirral Improvement Team presented the report of the Chief Executive of Wirral University Teaching Hospital NHS Foundation Trust which provided information and assurance on the work of the Unscheduled Care Improvement Programme for Wirral. 

It was highlighted that a three day Multi Agency Discharge Event (MaDE Event) took place on Wirral between 17 and 19 December 2025 which brought together health system and Local Authority partners to support improved patient flow, to recognise and unblock delays and challenge and improve discharge processes. The event was deemed successful with a significant increase in Pathway 2 discharges from hospital. During the event key items were captured which would be owned and developed by the programme workstreams.

An emerging risk had been identified with the complexity of finding placements for end of life patients which was slowing down complex hospital discharges. Since writing the report an improvement in the position but it remained a risk and a report would be brought back to the Board.

It was highlighted that a Call Before Convey test of change 2 week pilot commenced on 9 December 2024 which was expected to reduce the number of ambulance conveyances to hospital. This involved paramedics calling the right care hub to speak to a clinician prior to conveying a patient to hospital to explore other community services, unless it was an obvious convey. There were 57 referrals and 40 patients were accepted and 17 people needed to go to hospital. The pilot kept people at home and arranged for the services to visit them at home It was reported that this was a significant improvement and this work had continued. From an audit of the 17 patients that did go to the Emergency Department, once diagnosed, it was found that if the community had more equipment such as bladder scanners, more patients could have been seen at home. A report in relation to patient feedback was being produced by Healthwatch Wirral.

Members asked about ambulance handovers and the significant drop in same day Primary Care appointments in September and August and the reasons for this would be looked at.

Members were assured that the occupancy of virtual beds was now maintained at over 80 percent. The urgent care pathway, including reasons for hospital visits, was discussed.

Resolved – That the report be noted.

The Place Director introduced this report which provided an update on the work of the Strategy and Transformation Group (STG). It was reported that the Primary and Community workstream and the Neighbourhoods workstream were likely to be merged, subject to further discussions. Members discussed the proposal that the main population and health reports would be aligned to the Health and Wellbeing Strategy which would be reported to the Health and Wellbeing Board. In the 10 year plan, there was going to be a focus on the NHS contribution to prevention and in particular a focus on secondary prevention and it was highlighted that this would need to be reported to the Wirral Place Based Partnership Board.

Resolved – That the report be noted.

Notice of question to be given in writing or by email by 12 noon, Monday 20 January 2025 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.

No Public Questions, 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 agreed that the Dentistry report would be moved to next meeting on 20 February 2025. 

Resolved – That, subject to the above amendment, the proposed Wirral Place Based Partnership Board work programme for the remainder of the 2024/25 municipal year be noted.

Members asked about the Health Care Recruitment Fair that had taken place and this was discussed.

20 February 2025

27 March 2025

19 June 2025

The Chair noted that Karen Livesey would chair the next meeting.

The next three scheduled meetings were noted as:

10am on 20 February 2025

10am on 27 March 2025

10am on 19 June 2025