Agenda and minutes

Apologies for absence were received from Councillor Roger Lawrence, Councillor Sandra Samuels OBE, Brendan Clifford, Chief Superintendent Jayne Meir, David Watts, Dr Alexandra Hopkins and Tim Johnson.

Bhawna Solanki attended on behalf of Dr Alexandra Hopkins.

There were no declarations of interest made.

[To approve the minutes of the previous meeting as a correct record]

Resolved:

That the minutes of the meeting held on 18 October 2017 be confirmed as a correct record and signed by the Chair.

[To consider any matters arising from the minutes of the previous meeting]

There were no matters arising from the minutes of the previous meeting.

[To consider and comment on the items listed on the Forward Plan]

Helen Tambini, Democratic Services Officer presented the report and highlighted key points.

John Denley, Director for Public Health confirmed that the Public Health Annual Report 2016-2017 would include a vision for public health and business going forward.

Linda Sanders, Independent Chair of Adults and Children’s Safeguarding Board advised that the Adults and Children’s Safeguarding Annual Reports would be available in the Autumn for the Board to receive.

In answer to a question regarding the rate of progress nationally for Placed Based Commissioning, Steven Marshall, Wolverhampton Clinical Commissioning Group (CCG) and Mike Sharon, Royal Wolverhampton Hospital NHS Trust (RWT) advised that there were no fixed models to follow and it was expected that each area would shape its own development and Wolverhampton wanted to be ahead with progress.  National policy was changing and it was hoped that in the next six months some progress would be made.

Madeleine Freewood, Development Manager – City Health referred to item 10 on the agenda which proposed a five-step action plan for strengthen governance and system leadership within the Board.  As part of that action plan, it was recommended that several issues would be added to the Forward Plan and that could be considered at the next Agenda Group meeting.

Resolved:

1. That the Board approve the current Forward Plan.

That the Adults Safeguarding Board Annual Report and the Children’s Safeguarding Board Annual Report be added to the Forward Plan for consideration in Autumn 2018.

[Dr Helen Hibbs, Wolverhampton Clinical Commissioning Group to update the Board]

Steven Marshall, Wolverhampton CCG stated that the Wolverhampton CCG Operational Plan was a standing agenda item.  The NHS had amended the annual cycle and it had now become a two-year plan.  As the Operational Plan was still live, it was considered appropriate to give an overview of the key priorities and main activities of the last year.

Steven Marshall gave the following Operating Plan update:

Local Place Based Models of Care/Primary Care:

·       Primary care groupings established, joint working underway with hub working together to deliver increased access in primary care on weekends and bank holidays. Discussions underway to identify services that could be delivered at scale across primary care, for example wound care and joint injections.

·       Development of Local Quality and Outcomes Framework (QOF) scheme underway.

·       Performance dashboards developed for each care model to help determine patient outcomes, demand and variation.

·       Working with key stakeholders across the health economy to develop an Accountable Care Alliance model, aiming towards shadow form by         1 April 2018.

·       Implemented risk stratification, social prescribing and enhanced rapid response service provision which will help strengthen partnership/multidisciplinary (MDT) working with Health and Social Care as well as delivering admission avoidance and care closer to home.

·       Two-way text messaging currently being piloted with a view to being rolled out to all practices by the end of the financial year.

·       First phase of Care Navigation being rolled out in primary care (Minor Eye Conditions, Minor Ailments Scheme, etc.)

·       Primary Workforce Strategy drafted and in the process of being finalised.

·       Clinical Pharmacists working in practice groups.

·       Practices undertaken Practice Resilience training. 

Urgent and Emergency Care/Improving Flow and Admission Avoidance:

·       Discharge to Assess Pathways implemented across all wards, regional recognition for D2A work and Direct Transfers of Care (DTOCs) reduced on track to hit NHS England trajectory.

·       Frail elderly pathways being developed and falls service being redesigned in partnership with trust to have a much greater focus on prevention.

·       Step up beds commissioned.

·       Developed Integrated Emergency Care Passport jointly with Social Care, West Midlands Ambulance Service and RWT.

·       Rapid response service provision has been enhanced to include seven days a week provision (over six months 3,375 patients were seen, 3,155 were successfully treated in the community, representing an 85% admission avoidance rate).

·       Enhanced risk stratification and MDT approach with primary and community and social care services.

·       Launch of red bag scheme.

·       A&E Delivery Board is continuing to support schemes that will help improve patient flow and reduce impact on A&E during the winter period.

Elective Care:

·      Musculosketal (MSK) service is embedded, community eye care services have been recently re-procured and work is ongoing with the Trust to redesign ophthalmology pathways and shift services into the community closer to home where possible.

·      Currently scoping out opportunities to implement clinical assessment services in other specialities.

·      The CCG is also currently in the process of reviewing and redesigning other pathways such as wound care pathway, End of Life, neuro rehab and heart failure.

·      Continuing to support practices with offering choice to patients  ...  view the full minutes text for item 7.

[David Loughton, Royal Wolverhampton Hospital NHS Trust to give update and presentation]

[TO FOLLOW]

David Loughton CBE, Royal Wolverhampton Hospital NHS Trust and Mike Sharon, Royal Wolverhampton Hospital NHS Trust gave a presentation on the Future of Acute Services in the Black Country and highlighted key points.

Councillor Sweet referred to the pressure on acute services and the excellent work undertaken by staff at the RWT to minimise the impact on the public.

David Loughton CBE referred to maternity services and confirmed that the Trust had not experienced any problems in filling vacancies and the ratio of midwives to births was currently at target.

In answer to a question regarding changes to patient geography, David Loughton CBE advised that the changes since 2013-2014 were based on volume of numbers and he confirmed that people were happy with the service at Cannock.

Resolved:

That the update be noted.

[Seeta Wakefield, Public Health Speciality Registrar, City of Wolverhampton Council to present report and give presentation]

Seeta Wakefield, Public Health Speciality Registrar presented the report and gave a presentation on the Wolverhampton Pharmaceutical Needs Assessment 2018-2021 and highlighted key points.

She advised that 256 members of the public had responded to the pharmacy survey.  The key findings of the survey related to opening times, accessibility and facilities.  She confirmed that in terms of opening times and accessibility there were now several pharmacies open from 7am weekdays, several on Saturdays and 10 were open on Sundays.  Those 10 were concentrated in more deprived areas where people could walk or there was good public transport; with people from more affluent areas more likely to be able to access those facilities by car.  Most pharmacies were within a 30-minute drive or walk, or could be accessed by public transport.  In respect of facilities, most had staff that could speak other languages; there was greater wheelchair access, more consultation rooms and home dispensing.

She confirmed that Lloyds Pharmacies would be releasing 190 pharmacies nationally (either through closure or by selling them to other pharmacies).  There were eight Lloyds pharmacies in Wolverhampton; however, as yet there was no notification of how many, if any, would be affected, and if they were, in what way.  Public Health would continue to monitor the situation on behalf of the Board.

The Chair referred to the important work undertaken by pharmacies in providing general health care advice.

John Denley, Director for Public Health referred to the importance of pharmacies in attracting people and other businesses to an area as they were very good businesses.

Jeremy Vanes, Royal Wolverhampton Hospital NHS Trust suggested that the Board would benefit from speaking with pharmacist to build a level of awareness regarding where and how to provide services.

Helen Child, Third Sector Partnership stated that it was often pharmacy staff who noticed problems at first hand, as they often saw people on a regular basis and during home visits and it was important that those skills were utilised appropriately.

John Denley advised that although facilities and building fabric were important, the most important thing was the build-up of relationships and being part of the community.

Seeta Wakefield confirmed that of the 64 customer facing pharmacies, 63 had closed rooms and the only outstanding pharmacy was looking to add a room.

Helen Child and Linda Sanders both referred to the terminology in correspondence and suggested that it would be helpful to simplify it.

Seeta Wakefield confirmed that this year timescales had been very tight; however, in future years issues including language, terminology and accessibility would be looked at more closely.  She also advised that the HWBB would be consulted at an earlier stage next time in the process.

Councillor Sweet stated that he was aware of one pharmacy that had a private consultation room; however, it was very small and at the back of the premises and had limited availability.

Seeta Wakefield acknowledged that the situation was not perfect; however, improvements continued to be made to make premises more accessible,  ...  view the full minutes text for item 9.

[Brendan Clifford, Service Director – City Health and Madeleine Freewood, Development Manager – City Health, City of Wolverhampton Council to present report]

Madeleine Freewood, Development Manager – City Health presented the report and highlighted key points and asked the Board to consider the five recommendations.

The Chair stated that it was a very opportune moment to undertake a review and the recommendations should be supported.

Linda Sanders, Independent Chair of the Adults and Children’s Safeguarding Board supported the recommendations and suggested that as part of the review, thought should be given to how the Board evidenced outcomes and impact.  She referred to the joint protocol document referred to in the report, which was in the process of being reviewed, a pre-meeting had been scheduled for February 2018 and a meeting would be held on 22 March 2018.  She referred to the development of a HWBB Communications Strategy and suggested the potential value of aligning that with other partnership board communication plans.  She referred to the Be Safe Junior Safeguarding Board and the important issues raised by members, including aspects around feeling safe, tackling drugs and alcohol abuse, domestic violence, guns, gangs and knife crime and the use of social media.  Members had requested more information about partnership boards, in particular quarterly updates and as the Chair already provided meeting updates, it would be possible to add the Be Safe Junior Safeguarding Board to the mailing list.

Resolved:

That the Health and Wellbeing Board agree the five-step Action Plan, including the five recommendations listed below, to strengthen the governance and system leadership of the Board:

1. 360-degree review.
2. Update the Joint Health and Wellbeing Strategy for Board approval in July 2018.
3. Development of a Health and Wellbeing Board Engagement and Communications Plan, including mapping community stakeholders.
4. Develop a Wolverhampton specific Health and Wellbeing Board identity, including branding and web presence.

Identify opportunities for learning from others.