Apologies were received from:

Paul Boyce from Wirral Council

Angela Johnson from Liverpool City Region.

Councillor Tom Usher, Wirral Council

From Wirral CCG Governing Body:

Dr Lax Ariaraj

Simon Delaney

Helen Downs

Paul Edwards,

Nesta Hawker,

Graham Hodkinson

Lorna Quigley

Karen Prior

Nominations were requested for the Co-Chairs of the Board from Clinical Commissioning Group (CCG) and Wirral Council.

Anita Leech nominated Chris Jones for Wirral Council. There were no other nominations.

Sue Wells was confirmed as the Co-Chair from the CCG and would be the Chair of this meeting.

RESOLVED: that

(1)  Councillor Chris Jones be elected as a Co-Chair (Cabinet Committee of Wirral Borough Council) of the Joint Strategic Commissioning Board for the remainder of the Municipal Year; and

(2)   Sue Wells be confirmed as Co-Chair from the Clinical Commissioning Group.

There were no declarations of interests.

To approve the minutes of the meeting of the Joint Strategic Commissioning Board held on 2 April 2019.

RESOLVED - That the minutes of the meeting of the Joint Strategic Commissioning Board held on 2 April 2019 be agreed as a correct record and signed by the Chairman.

The Board received a report from the Chief Officer, Wirral Health and Care commissioning Service and NHS Wirral Clinical Commissioning Group, which set out key areas of work from 9 April 2019 to 28 May.

There had been a meeting on 10 May with regulatory bodies and other CCG Chief Officers around the planning and contracting agreement and the commissioning of maternity care. There was a reminder that from April 2020 there was to be an obligation to offer patients, after 18 weeks on a waiting list, a choice of alternative provider for surgery at 26 weeks. It was noted that the meetings were to move to more of a blended model for the meetings, with meetings of Clinical Commissioning Groups (CCGs) and NHS England (NHSE) and NHS Intelligence (NHSI) and a parallel meeting of providers one month, the second month all of the providers and commissioners across Cheshire and Merseyside were to come together and in the third month would be a northwest footprint meeting with the Regional Director. It was noted that the team from NHSE and NHSI will be more thinly spread as they were covering a larger area.

In the near future work would focus on accident and emergency provision. It had been a challenging Winter and Spring and where systems were challenged there would be more intense support from regulatory bodies.

It was reiterated that the NHS long-term plan was about: boosting ‘out of hospital’ care; removing the divide between primary and community services; reducing pressure on emergency services by introducing same day emergency care as an approach and ensuring that there was adequate flow; giving people more control over their health with more personalised care; increased digitalisation; and increased focus on population health and local partnerships.

There had also been meetings with the Board of Cheshire and Wirral Partnership, who were the mental health provider, to discuss plans about improving their service and discussion about their communication concerning mental health care, their communication with neighbourhoods and how they improve communication with GPS about individual patients.

There was a meeting with NHS England on 10 May to provide assurance to the Secretary of State for Health about the CCGs. The financial year was expected to be challenging.

RESOLVED: That the report be noted.

The Joint Strategic Commissioning Board (JSCB), which was a Committee in Common of Wirral Council and NHS Wirral Clinical Commissioning Group (CCG), had met for just over a year, supported by Wirral Health and Care Commissioning (WHCC), which was a strategic partnership between the Council and the CCG. The strategic themes adopted in 2018 needed to be updated to reflect changes in the strategic and operating environment.  Work had been undertaken within WHCC to develop a shared purpose, mission, vision and aims. These had been aligned to the Healthy Wirral system transformation programme and the Wirral 2020 pledges.

RESOLVED: That further work be undertaken with Board members in a workshop and a report be brought back to the Joint Strategic Commissioning Board following the workshop.

Members considered the report regarding the Healthy Wirral Operating Plan for 2019-2020. NHS England (NHSE) had published the NHS Long Term Plan on 7 January 2019.  This had been accompanied by guidance for 2019/20, setting out “must do” deliverables and financial allocations.  The guidance set out an expectation that one-year operational plans for 2019/20 needed to be submitted to NHSE and NHS Improvement by 4 April 2019.  The Healthy Wirral System Operating Plan 2019/20 was attached to the report.

Through the Healthy Wirral programme, all the partners agreed to work together and submit one plan to the regulatory bodies. There was focus on financial recovery, creating a sustainable health and care economy. The long-term plan was about reshaping services based on the neighbourhood approach and get back to financial balance through sustainable collaboration. The next step was wider engagement of the public.

Members questioned whether the strategy of savings helped providers as most of the money was spent on them and it would reduce their ability to balance their budgets. They noted that training on finances was expected in the next couple of months.

RESOLVED: That the Healthy Wirral System Operating Plan 2019/20 and the intention to engage further with the public and Elected Members in respect of the development of the Healthy Wirral 5 Year System Sustainability Strategy Plan be noted.

The Board considered a report providing a description of the arrangements that had been put in place to support effective integrated commissioning.  It setoutthekey issues in respectof the expenditure areas that were included in the 2018/19 shared (“pooled”) fund and the risk and gain share arrangements.

The pooled fund had a value of £131.9 million, with a forecast overspend of £200,000, split evenly between the CCG and the Council.

RESOLVED: That the financial position of the pooled fund, as at 28^th February 2019, be noted.

The Lead Commissioner for All Age Independence introduced the report and explained that Extra Care Housing includes care and support staff within the building 24/7 to support a person with both their planned, and unplanned needs. This provides opportunities for older people and people with learning disabilities to have greater choice and control to live as independently as possible, within the community in the full knowledge that support is on hand when they need it. This relieves social isolation, promotes independence and enables people to live in their own homes. Residences have affordable rents, with a possibility of shared ownership in some cases. Work has been done to establish the need for this type of accommodation, and Wirral is performing well towards meeting its target on the increased number of extra care housing units by 2021/22. The range of supported accommodation has increased and this is enabling more people to continue to live at home without the need to move into a care home setting.

RESOLVED: That the report be noted and the approach to Extra Care housing be endorsed.

The Chief Officer, Wirral Health and Care Commissioning Service and NHS Wirral Clinical Commissioning Group, introduced the report which outlined the business plan for Wirral Health and Care Commissioning (WHCC) for the financial year 2019-20. The outcomes/ targets related to the delivery of key areas of activity for WHCC and linked directly to the Healthy Wirral System Operating Plan 2019-20. 

Members attention was drawn to the strategic direction of the organisation about bringing together and jointly commissioning public health services in a manner which improved the health, wellbeing and outcomes for the people of Wirral, reducing health inequalities and delivering sustainable services. This was to be done with place-based care in identified neighbourhoods and ensuring that primary care networks aligned and supported that work.

The paper set out the challenge for the next year to increase cost benefits and reduce duplications to be leaner and more efficient. There was a need to reduce running costs by £800,000 by doing things once only, and this included redesigning of planned care on outpatients by reducing admissions and shortening hospital stays. In terms of women and children there was a programme for child health including obesity. There was also a plan for medicine optimisation which included reducing antibiotics and getting people to make best use of their own medications.

Significant progress had been made around mental health conditions, including improving access to psychological therapy service; work on dementia strategy and enhanced crisis care. There had been a focus on children and young people’s mental health such as improving emotional health and wellbeing; reducing alcohol admissions; supporting those with long term disabilities; and high blood pressure.

RESOLVED: That the Wirral Health and Care Business Plan for 2019-20 be approved.

The Assistant Director: Health & Outcomes presented the report which provided an update on the progress made in commissioning services for people with Learning Disabilities and/or autism, with a specific focus on the implementation of the Transforming Care Programme (TCP) priorities in Wirral. 

NHSE have highlighted TCP priorities for 2019/20 to Local Authorities and Clinical Commissioning Groups. The report listed areas of support to be developed which build on the existing work programme. Priority areas suggested are improving support to children with autism and their families, improving the offer of post diagnostic support to adults with autism and developing the intensive support service to help support people whose needs escalate and are otherwise at risk of hospital admission. A continuing priority is to ensure appropriate usage of hospital assessment and treatment units and it was noted that the reduced inpatient numbers has been sustained. Workforce is also a priority, with staff being skilled up to support people with complex needs to avoid crisis situations developing and to remain in their own homes. 85% of people with learning disabilities are supported to live in their own homes, and extra care housing schemes are being developed to give people more choice and independence.

RESOLVED: That the report be noted.

Tuesday, 9 July 2019 at 2.00pm in Birkenhead Town Hall.

The next scheduled meeting of the Board was on Tuesday 9 July 2019 at 2.00 pm in Birkenhead Town Hall.