Live streaming of NHS Shropshire, Telford and Wrekin ICB Board meeting on 31st January 2024 at 2:00pm.
You’re welcome Julian Nick can we make the start that Finance exch over that the reg West Dave Andy can we can we make a start please by the West office because we as two have all done the we’re really not sure about hurry Patricia can
Please and the chief ex we it we think that somebody in our colletive West keep listening to our convers but not me thank you you’re relocated yeah fine and and that email that you nodded yes not too much no no and asking for that good afternoon everyone good afternoon welcome to this
Meeting of our integrated care board um as usual we have a full agenda um so I’d like to I’d like to start and and begin to move through it now remarks um can I make an introduction first though um I’d like to intr roduce Trevor per where is
Trevor hi Trevor Trevor is a long-standing non-executive director of sath but has recently been appointed Vice chair um you’re very welcome Trevor good to see you and um we look forward to working with you in your new capacity good to see you we’ve got quite a few apologies
Neil Carr um we’ve got Kathy Riley deputizing for him I Chan Leslie pikon sha Davis nitty Paul Rachel Robinson and I’ve got a note here to say that Lin Coley hopes to join via teams but may be late so um those are there um just a couple of um introductory remarks if I
May please first of all um although Simon will make some comments about this in his report I just wanted to make a personal um thanks really um gratitude to you all and your organizations and your staff for the really impressive responses to managing urgent and Emergency Care over the Christmas and
New Year period um I I don’t underestimate the challenges that you faced having been in a more Frontline post myself for many years in different guises I I get it and I know how much work um went into that it wasn’t all plain sailing but it was remarkably um
Remarkably well organized and smoothly um operated very smoothly really um there were one or two um aspects of that which exacerbated the position of course industrial election by um doctors meant that some of you and your organizations were not only managing for winter but you were making sure that rosters were
Available to provide safe cover and you were also scheduling and rescheduling hundreds of patients whose care uh was being dislocated as as a result of that so thank you for that um as well um some good news I’m pleased to um draw attention I think maybe Kath Riley or
Paulie would you like to tell us about mpfts recent CQC visit and the outcome of that so our older people’s Wards were visited and they assessed us on um safe caring and we good on both of those I was really pleased that of the um earlier
Work that have been done in our adults of working age W have translated well into the older adult W and have served as well in that inspection so that were things around fire training and also our restricted items policies which obviously are really important on mental healths so well done
Congratulations um I also wanted just to uh draw attention to a very valuable uh piece of work publication I think by help Health watch Shropshire but it’s about GP appointments for Shropshire tord and Ron um it contains a a stack of data which has been taken from that which is available locally regionally
And nationally and is an important addition to our understanding about the pressures faced by at general Practice in terms of appointments and and Gareth where is Gareth I think your your task with doing some followup work on the GP recovery program and appointments Etc you might like to make sure that the
Health watch report is taken into account as part of that yeah of course simar that we’re playing in in the same way as well Simon’s just Whispering something you Simon you’re going to tell me it was primarily led by tord and Ricky I looked at your web I if I may clarify um
Healthwatch shopshire have published a report on their own talking about t Reon as well as fra we are not part to that report so have you published a report not yet no no I’m I’m confused I’m confused because the shupure website for health watch talks about GP appointments
For shupure tord and Ricon I looked at your website and couldn’t see any reference to it there thereby my confusion yes we haven’t published ours yet we will be doing waed through all the 9,600 responses um which is going to take some analysis obviously but we’re not party to the other report that’s
Been published well thank you for clarifying that I thought our Arrangements were a bit complicated at time but but again it’ll be a valuable contribution to the debate and you’ll make sure Gareth that that’s taken into account as well we did a a useful accidental joint presentation at T and
And health and wellbeing board um join me was it two weeks ago now three weeks ago on that agenda okay that’s great thank you very much indeed and thanks for that clarification assment the last thing I just wanted to mention is the the ICB officers um are in the process of moving
There are packing crates Galore I understand in halesfield and the new office in Wellington is well starts to be open from next week and I’m told reliably the bulk of the services currently provided from halesfield will be operational from there in mid February um so please don’t Meander towards halesfield expecting to see
Executives and other people because from from the end of this week they won’t be there they won’t be there so moving on uh Declaration of interests um I don’t have any suggested changes to the register are you happy with that uh the minutes of the previous meeting have been circulated are you
Happy with their accuracy Katrina Sor just one question with regards to the winter plan did we approve it or did we refer it to the Urgent and Emergency Care board for further work that’s my recollection is that that’s what we did and I thought that’s what the minutes
Said no the minutes say the board approved um the board approved the 2324 winter plan including I think we noted the progress and the work that was underway and I think we remitted it to the urg Urgent and Emergency Care board yeah okay thank you thank you for that thank you so we
Correct the minutes on that point chair y we’ll certainly do that thank you very much indeed um moving forward if I may if you’re happy with the accuracy and there are two or three matters arising and the action list that I wanted just to draw to attention um according to the action
List um Nick white were meant to be having an overview um on the uh digital strategy at this meeting that was scheduled at last meeting for the March board meeting right so this action list is is incorrect and March that’s that’s helpful thank you um and I just wanted
To ask a question we we had a we’ve had a brief discussion about the rural racism report and we said we’d add it to the forward plan I just wondered is there a guardian of the forward plan in our midst do we have any ideas about when that might appear for discussion
There was a suggestion that it would be brought to the next board development session in February for a much wider discussion so is that still the intention as far as we know I know that it is subject to The Clash of meetings chair yeah I know that there a number of
The chairs won’t be there because there’s a there is a Richard medings chair of NHS England meeting of all chairs in London that day my inclination is if the chairs will forgive me that we proceed with the development session in February as planned um but but but if there’s strong
Strong views contrary to that then please let me know okay um so Gareth we were promise promise the action list says we’re going to have an update on Primary Care access ESS at a future board meeting and then it says January yeah so you’ll recall that this was presented at the last
Board meeting I think it was the it was 9 to 12 months down the line that we would come back with the report on where we’ve got to with progress against the metrics rather than an immediate update because the work is still being implemented so when do you think we can
Have a a further discussion and review about that uh so I think within within six months we’ll have the indications of the impact of those I think your full full annual cycle will be helpful given the interest in this given the two Health watch reports and all of the
Other work that taking place in this area the Improvement plan Etc um would would you and the chief executive just like to think about whether there’s opportunities to give us an update before that comes through quality and performance committee as well but we can definitely do yeah indeed that’s really
Helpful thank you um and the final thing I wanted to you I’m sorry it’s fine I just wanted to say I think because of the air conditioning and uh uh and probably my poor hearing uh it’s not always easy to hear people’s contributions so if we could all speak
Up a it yeah maybe make sure we use the microphones myself included and well if that doesn’t work Meredith let us know um I might be partially to blame about the air conditioning because I was freezing earlier and I if the heating could be turned on so apologies for that
Um the other issue that’s on the action list relates to msk but we’re picking that up in a couple of places later on the agenda is there anything else from the action list that anybody wants to raise okay um questions from members of the public um we’ve had about 30
Requests for um information questions that have been raised by one um correspondent um and in the time oned fashion we’ll respond to those within the three weeks and report will report to a subsequent board the next available board the questions and the responses they’re too detail to go into um um in
Right now they’re all very pertinent and so that’s how I propose we should handle that a people happy with that that’s in line with our existing policy thank you very much so um the next item Vanessa patient story would you like to introduce this and we’ve got
Sean Brooks yeah we have hi Sean welcome would you like to introduce yourself should I want me to just introduce the piece so know what they’re expecting so thank you chair um so I’d like to introduce um Shan Brooks Shan was the neonatal lead nurse at um Hope
House hospice um at the time of the patient story and worked very closely with this family was part of the team there um she since moved on still working for the hospice but as pathway manager um and she’s accompanied by Allison Massie who um works with the ICB Allison’s transformation system
Commissioning partner and has the lead for paled and end of life care so um The Story You’re about to hear um really um shows um a positive piece of work in a very sad scenario but with um with taking Health inequalities into um into consideration and so shows um how
Um how we can we can you know in a real life scenario um enact that responsibility but also um the really valuable work of the independent sector and the hospice and how lucky we are really to have um a children’s hospice um on our patch because not everybody
Does so um uh pal land of Life carees generally um have been on an improvement Journey over the last two years and done really well to move from a a system report that had some criticism to to a much better uh place and there’s an adult strategy in place and a children’s
One that’s in development and with that I’ll hand over to Sean Sean the floor is yours microphone need a microphone you you probably need a microphone actually yeah hold it will it come out I can bring a check oh is that better yes yes okay so um this is a case study
Where um I was obviously involved uh with this particular family and we were able to meet the family’s needs and despite the obstacles and challenges that we faced we were able to ensure that they we offer them an equitable access to Hope House children’s hospices services so to give you a bit of
Background um this was a premature baby be born at 28 weeks gestation the little one was born at their local um maternity hospital and transferred out to the tertiary Center for ongoing care the little one then moved between um the Women’s Hospital in this particular City and the children’s hospital for ongoing
Treatment and Care in the first few weeks of life before being transferred back to their local Neal unit for ongoing care the baby was actually referred to us from the local neonatal unit at 6 weeks of age um there was an antinal diagnosis of these complex conditions so
The baby and family could have been referred antenatally but they weren’t um but the reason we got the referral from the local unit um is that we have been building really good links with local nearn natal units spending a lot of time going in and out of the units raising
The profile of the hospice um so that people are aware of what services we can offer for families um so it it was a really good opportunity to show how much groundwork had paid off that the hospital knew what we did um and and then contacted us and said please would
We go over and meet with this family and see how we could support them working together with the neonatal unit because this baby was going to be in hospital for some time so I attended the neonatal unit um and for this family it was apparent very quickly that this was going to be
Incredibly challenging Not only was their baby possibly not going to survive um but they didn’t speak a word of English the whole situation was terrifying in for them there was not a lot of trust um in professionals from this family so when I arrived and first met with Mom we accessed the
Interpreting service used by the hospital um which was over the telephone um which didn’t feel very comfortable it’s much easier face to face but that’s the system they had in place for um ad hoc interpreting um Services I spent about two and a half hours with this mom
Um with this interpreter service over the phone and it took a long long long time to gain her trust for her to believe what we were saying she didn’t want to be referred to the hospice because she felt if she signed on the dotted line would’ then remove her baby from her and
She’d never see her baby again and would have no say in the care that this baby received so there was a lot of gentle conversations um reassurance what the hospice was offering and how we might be able to work alongside them and the neonatal unit that the baby was in um
During this time this this period of time was over many weeks that we um visited this Hospital on a weekly basis to visit uh the family mom was predominantly there on her own um as dad was looking after their other children or working um we accessed sometimes face-to-face interpreters which was much
Much easier for this family and during one of those sessions I noted how much better the communication was with one particular interpreter and this family how much more effective it was and how much more relaxed the communication was so I took the opportunity to talk to that interpreter and explore for you
Know how how they were managing so much better than other interpreters we’d met and this lady was able to give me some background on this family that they were a Roma family they probably were not um able to within their home country access the same education as others so their
Understanding of the comp complexities was probably uh much more challenging for them also um dialect that actually one language isn’t exactly the same um depending on where you’re from uh so she was able she’d worked with a lot of families and she was able to communicate so effectively with this family just by
Using her previous experience um so where possible we did use that same interpreter time and time again unfortunately um because of the complexities of his condition there was nothing that could be offered in the long term and and he was requiring uh respiratory support and that was something that wouldn’t be sustainable
Um and he would never be able to leave Hospital uh without that so over lots of uh time and conversations it was decided to reorientate his care and remove uh the breathing support we weren’t sure how long he would live for following that um and conversations were around
Whether he would come to the hospice or whether he would stay nearer to home there were an hour and a an hour and a quarter probably from their home to the hospice so it’s decided he would stay locally um because then their siblings um and and Dad could stay at home and
And you know to and fro so he actually died in the near Nal in their local hospital a few days after withdrawing that respiratory support um and at that point I felt that perhaps we had reached the end of the road with this particular family because um their baby had died
Communication was you know really challenging and really difficult but our normal service is to offer breev support for any families that are um accessing the hospice at any level um so you know we we approached the hospital while the family were still in there having uh
Lost their little baby and said is is that something they would like would they like breev support and the answer was yes at which point I was like I don’t know how I’m going to actually do this how am I going to offer a service to these this family um that’s Equitable
That that looks like the service we offer to all our other families who are english- speaking um and at this point it would have been easy to just assume that they wouldn’t want brevance support because they wouldn’t get so much from it but it was important that we made that
Offer so so how we were going to make that meaningful and effective we weren’t really sure but they’ said yes so we arranged to go and meet the family at home um we set up an interpreting service account with the hospice so that we could access we used the same one
That I was familiar with from the hospital um so we knew how that would work so from there we started doing home visits for this family um now often bereavement support is is very not necessarily always a lot of talking there can be a lot of listening but it
Was really really challenging with using the interpreting service um it was all over the phone sometimes the the line wasn’t great communication again depending on which interpreter we had sometimes the parents weren’t being understood they weren’t understanding The Interpreter so it was clunky it wasn’t easy but we were there and we
Were offering support to this family um on the very first visit the family were incredibly distressed when we were there because seeing us reminded them of their time in hospital and their baby and they were actually so distressed I didn’t think that they would want us to come
Back again um but at the end of our visit we offered a return visit if it was something that they would like um and they it was an absolutely resounding yes please they wanted us back there and they wanted us as often as we would go so we arranged um monthly visits and
Over time the visits became more and more relaxed um the families were less distressed when we visited and they were able to share lots of photographs and memories and it started to turn into a slightly more positive recollection for them of the time they did have with
Their baby and an important point that they made to us is that we were the only people that knew their baby in life that they then had contact with because the hospital obviously their time had ended um with the team they had around them in hospital they didn’t have any family in
This country uh they were quite isolated within their Community because their language barrier prevented them from you know the normal socializations and accessing support groups that that others might um so you know they viewed our visits as incredibly helpful um and supportive so they continued monthly face-to-face
Visits during that time we accessed the social work teams um and sibling support teams to give a a holistic package of of whatever they needed support with um and they they accessed those and and really did um use them quite a lot the next significant event in the calendar for
This family was the remembrance service that the hospice holds every year and that’s a service where any bereaved family that’s known to the hospice is invited back to the hospice um to attend a remembrance service I was particularly Keen that this family would be offered the opportunity to attend this service but
Again didn’t really quite know how we were going to make this happen and be meaningful for them um so we looked at what support we’d need to put in place to enable this to happen um we planned our home visits so that they were we were able to give them small amounts of
Information rather than over loading them and to then go back and recheck that they had understood what we were inviting them to what it consisted of what it would look like and what their choices might be um we send letters to All Families explaining but we actually
Were able to to go through that with The Interpreter and confirm that the family understood our offer they needed transport they live an hour and a quarter away from the hospice they couldn’t access public transport because they couldn’t communicate they couldn’t make themselves understood if they
Needed to change a train or where to get so we realized the only way way to help this family would be to go and collect them so the hospice arranged um some of their team members to go and collect mom dad and the three siblings to bring them over for the remembrance
Event one of the really important factors for me in this was The Interpreter that we would need to enable them to actually understand what was being said at the service and for them to get the most out of this event um and also if they were distressed we wouldn’t
Be able to communicate with them so it was essential we had an interpreter and at that point to me it was clear that we needed The Interpreter that had been really successful for this family in the hospital so I contacted the interpreting um service and asked for this lady by
Name but there was hundreds of people with the same first name and that’s the only information we had so I went back to the um referring hospital and and asked them if they wouldn’t mind trolling through their emails and bookings to see if they could get any more information which they very kindly
Did so we were able to identify The Interpreter um and then I was able to actually communicate and chat with her ahead of the event because it’s not something that everyone would feel comfortable um attending or presenting at she was very she was absolutely delighted that we had approached her um
Because she felt that she was able to work well with this family and was very happy to attend the service so we she arrived ahead of the family we were able to go do a run through of what the day was going to look like so that by the
Time the family arrived she was able to support them throughout the whole of that day nobody’s tell me I haven’t been moving on with this once I get on a roll that’s it so the impact um of of this was absolutely huge and I think um the words that the
Family were using to feedback such as exceptional grateful support heartwarming and the fact that they were viewing the hospice team as family to them because we were the nearest thing um that they had to family in this country um but I think also the impact for staff that actually it’s important
That we look at outside the box it’s important that you know anything can be possible it might not look like the service that we offer to somebody else or it might be done slightly differently but one size doesn’t fit all and it needs to be a bespoke service um to meet
Those individual unique families needs and I think um you know it was absolutely a great opportunity for us I think as a hospice as a team to see how well uh we can actually support families and it doesn’t have to look like the last family we supported and I think
This is loads of words so I am going to read it out I’m sorry there’s loads of words on there but I think it’s incredibly important um that I do read this to you this is feedback we had via the interpreter from the family um she spent hours with that family that day
And she wanted to share all of this with us so I’ll share it with you so The Interpreter said she’d like to thank uh you for having me there and giving me the opportunity to be part of such an amazing event as I’ve already mentioned it was a very well organized day from
Beginning to end your premises were presented beautifully and what you do for all those families is incredible the baby’s family was exceptionally pleased to be there throughout the day they shared with me several compliments and expressed their gratitudes towards the staff and the support that they’ve received from all
Of you they said that they’ve never been treated like this never been invited to any sort of event and never received any support like this and that was due to the family’s Gypsy Roma background they were often discriminated against targeted and turned down this is the very first time they’ve
Experienced such warm and loving support from professionals the dad kept talking about the beautiful scenery and how he could imagine if the baby would still be with us they would play outside in this beautiful location both of the parents shared that they were so happy to have such lovely
People around them they had an amazing time there they loved the service the children enjoyed themselves as they had plenty of activities food drink and snacks available for them they were also very impressed when the staff offered to wash and dry the door daughter’s clothes
As she was sick in the car on the way there both parents and baby siblings wrote lovely messages for him and they loved the spirituality of it the mom was grateful for all the heartwarming support from yourself and other staff when she became emotional the family are
Really looking forward to next year when the service happens again and I don’t think I’ve ever come across a family that said they’re looking forward to coming back to the service but it obviously meant so so much to them uh that they were included and invited and
Able to celebrate the short life of their baby um and I think it was only after this event that I realized the huge importance this was I hadn’t realized how discriminated the family had been previously so I was not aware of any of that but it makes in fact to
Go Goosebump you thinking about it the the impact on this family was just huge and and it’s you know we’re proud as a hospice that we were able to support this family in that thank you thank you very much indeed let me let me throw it open
Vanessa did you want to add anything um no I think just to say that um the children’s pal Le for Life Care strategy is actually being led by the chief executive of the hospice so really um grateful to Anie goldon for his time and and effort in bringing a group together
And also I know he spent he spent a long time on engagement and thinking about engagement and a co-production approach with with families in that development of that so um so I’d just like to you know thank Shan very much for presenting thank you very much indeed Pauline you
Wanted to commit thank you thank you Sean it’s an exceptional story of how we’re actually being inclusive I’m curious around what’s changed as a result of the learning from this situation yeah I think we’re much more um ready to use interpreting Services instead of perhaps trying to manage
We’ve got it set up now um and we really promote the use of of the interpreting service even for families that um do understand English but actually these are really challenging conversations and you know in a second language you can’t be certain that you’re getting that full understanding so we’re certainly
Accessing um the the interpreting service much much more um and I think because so many staff were involved in the remembrance service and I’ve seen you know what we were able to do for one family I would hope that it would encourage the members of the teams now
To actually not be scared away or not offer the same you know we can do it and we’ve done it and we’ve proven that so I would you know hope that all the teams are encouraged to to go that extra mile because we can we can meet these
Families needs thank you any other questions or comments that people wish to offer Vanessa just I was interested in your um your comment about the development of a a strategy a plan just tell us a little more about that when we might see it what what kind of Passage would you
Expected to have um um well the um the um system Quality Group and the quality and performance committee have kept a close eye on pal and end of life care and had regular regular updates now I’m going have to defer to Allison to tell me when we might expect um a
Strategy bit of because what we wanted to be able to do that engagement piece for a very long time to get to understand what the way engage with notes but children peopleware children work to gety together we want understand okay thank youy first by end okay thank you um I was just
Thinking looking towards our schedulers again if we can actually think about how and when we might have the opportunity to discuss both both of the strategies together uh and have a thorough debate about it and excuse me and our views about priorities and the way forward that’ be hugely helpful but that’s a
Great contribution and thank you very much indeed for all of the work that you and your colleagues do and for your presentation today fantastic thank you very much indeed thank you okay moving on um the next item is emergency planning resilience and response and I see your name’s against
It Simon but I also see Sam Tilly sitting in the audience as it were how do you want to play this so I’ll do a very brief intro and then hand across to Sam if that’s okay chair so take the paper as red just to reinforce the board
Colleagues uh the ICB as a board we’ve got two responsibilities uh we got the responsibility to look at at the icb’s respon uh ability to respond to uh emergency responses incidents uh as a type one category one responder but also has the responsibility to have the oversight of our provider responses as
Well in that space the paper sets this out uh demonstrates that we’re in a challenging position across uh the system against the core uh competencies in this space but also then proposes some steps to take that forward uh and would value the conversation in terms of getting into that uh that discussion
That debate in terms of steps but as s to put the detail around that and go through the paper in more detail thanks Sam I think as simons’s explained that the the paper I hope you’ll find is a a comprehensive I can’t can’t hear is my microphone not working is that better
Yeah yeah pleas okay let’s start again um so just building on what Simon has said um the the paper I hope you’ll find sets out a a comprehensive um description of the work that’s been undertaken um over the last period it follows the reporting requirements uh that we need to
Undertake so not only does it um set out the position in terms of our um annual core standards assessment by NHS England and the role that we play across the system in that but it also sets out our participation within the local Health resilience forum and the partners that
Are involved in that are training and exercising um across the period urren of incidents but also importantly the lessons learned from that um so that it takes through through that information to meet our reporting requirements so I hope what you’ll pick up from the paper is that there’s been uh an extensive
Amount of work that’s been undertaken um I think what it then goes on to look at in a little bit more detail is the annual assessment process and as Simon has described the role um that the ICB takes not only in discharging its own duties but also in
Uh Assurance um around the the system responsibilities uh for individual Partners so as you will have picked up from the paper we have experienced some challenges around this this year uh and I think the the uh outcome of the assessment for uh for all parties in the
System has not been what we would have have hoped so what the paper then tries to do is look um at the improvement work that we need to put in place um taking account of some of the particular challenges that that we’ve had uh in this period um and how we’re going to
Move forward from that um clearly um there is a lot of work that we can do jointly so we’re now looking at how we can work across agencies uh to use our um limited resource uh most effectively but also looking um at how we resource the uh the requirement so that we have
Um in place resilient uh arrangements to do that I think it’s also fair to say uh that that the agenda has grown significantly um since the ICB um came into being and uh took on category one responsibilities um if we just think about some of the topics that might be
Included in this agenda so looking at our cyber resilience looking at how we might deal with uh mass casualty events um looking at flooding which is a particular issue for us uh in the county and now is becoming a much more regular occurrence uh and is evolving as an
Issue uh these are no small matters um and the work that needs to go on in the background to support uh the systems and processes the training the practicing um how we might respond to these things um is really quite complex and extensive work so in moving into um new territory
Uh as an ICB relatively speaking around emergency planning uh now is a good time for us to look at how we might resource this in a more resilient way going forward and I think that that will really support the improvement work that that we need to do not only as an ICB
But also uh as a system um given that responding to these events is is rarely done in isolation as an organization so I’ll I’ll leave it there okay Simon thank you Sam um let let me let me throw it open i’ be interested in the views of um some of
Our non-exec and provider colleagues about about the scores um and um the issues that lie behind them um I’m going to be fairly fairly random here I suppose but um let me ask Roger dun first of all if I may if you’ve got any thoughts about this and what you think of
It thanks um yes we discussed this at the audit committee on the 17th of January and um we had a a good discussion with Sam about the reasoning behind the non-compliance status across the piece um and that we were given some indication that steps were hand to um Rectify some of the
Concerns and we asked for a I think it was a report in four weeks time just to give the audit committee an update as to what progress has been achieved so I think the audit committee is now taking on this responsibility to assess the progress um across the various provider
Organizations and Sam will report back to us as to where the major sticking points will occur thank you thank you and looking at it um my um my heart lifted when I looked at the um the first table in terms of core standards assessment outcome with South sitting at
86% fully compliant um but sank a little when I saw the next table and showed a reduction in compliance a significant reduction compliance Louise tell us about that and and the kind of reasons for it and the lessons to be learned from that thank you um yes I think the report
Points to some of the issues in 4.4 regarding the um process I know there was a number of actions in train but until completed um those wouldn’t be taken into into account so there is a set of work programs in place in order to strengthen this we cited on those and
Similarly we have reports going to our quality and safety committee and our audit committee on this um I think there was some differences if I’ve understood it correctly between expectations against each of those um but it’s still an extremely important area it’s right that we um aim to have improved
Compliance and there are plans in place to achieve that and I’m confident there are some is already in train to do that thank you very much indeed and the other um area my eyes are lighted was was the ICB itself with the 177% reduction in the compliance score um who who from the
ICB wants to comment on the reasons for that and remedial steps that we need to take so I’ll comment on that uh chair so so similar to the point that Louise has made in terms of uh timing process uh some of the work that’s Tak taken place
Some of the deadlines that have been missed in terms of that uh you’ll see in the paper that I’ve also set out that I’ve uh commissioned a uh a review from NHS England and that’s completed uh or certainly well underway uh that’s reporting directly to me uh that will
Give me a set of actions for implementation part to support the shaping of the future structure of the epr response in the ICB as we go through our management of change uh but also to make sure that we’ve got a really clear oversight of action plan uh that can be
Implemented uh across the organization uh in terms of improving our position going forward so already taken a number of actions uh to improve on that uh but equally that independent review uh will be really key from a chief exec’s perspective uh to give me the oversight
And the action plan to put in place that’s great thank you thank you for that Simon and well done shropcom and Robert Jones who seem to offer a pretty high level of compliance um any particular particular lessons Patricia you want to share with us about that um
We recently took on a an eppr um person called Brian McMillan who has been fantastic very skilled um but I think his approach and style has been to work with service managers lead managers and Lead clinicians um and this is no mean feat for us because we haven’t just got
One building we’ve got over 76 buildings not least all of the services that we provide within people’s homes kit Etc being able to AC county is s say in some challenging circumstances amidst flooding and plague and various other things that hit sh tord and Rin so I think there is having some skilled
People that can work with key Champions across our trust clinicians and Senior managers uh so that we can have in place good business continuity plans because thankfully we don’t often hit on major instance but uh often we things go wrong having strong business continuity plans that are tested regularly means that we
Can respond appropriately so having that expertise um and I think there’s more that we can do across the system in terms of sharing expertise but there’s no mean feat in terms of organizations uh that cut across such a geography of 1300 square miles of making sure that you have somebody that can
Coordinate those activities have clear Champions and embed that learning into that and keep it updated thank you very much indeed so if I come back to you Roger because clearly the the order committee has been asked to um keep an overview of this on behalf of the board any anything that you want
To respond to in terms of that which you’ve heard this afternoon no as I said earlier um we will get a report middle of Feb that’s four weeks since the last meeting of the audit committee and we will assess progress then and identify any major concerns to be escalated okay
And it sounds as if quite a bit of the progress would be about process as oppos to definitive and collaboration be key I think collaboration thank you Julian um I think that was my point I was going to say this is an era surely we should have
A a joint sort of pan provider sort of piece of collaboration everyone work together I mean I think looking at those two tables for me it’s sort of a microcosm of our system really overall we’re we’re pretty poor and then over the years change you’ve got Robert James
And shopd do who sort of sticking to themselves you know pling along doing their own thing not changing you’ve got sath crashing because it’s you know overwhelmed with the other activity that’s that it’s got to do and you’ve got the ICB slowly deteriorating and yet also outside this you’ve got primary
Care that’s not even mentioned in this where really the approach to primary care about business continuities there’s no support from the system we just get a a message saying I hope you’ve got a business continuity plan you should have you’re an individual provider so for me
It Flags an area that we should actually be doing this joint across the whole system it’s surely it’s one area that we need to say we have a combined function for epr to actually try and improve these outcomes and improve the position we’re in in preparation for these events
There is a you know each trust will have its own challenges obviously you know Patricia Community TR have done really well they’re slowly you know improving as things go on but that’s not miror in everyone else it’s about learning from everyone working together it’s it’s a
It’s a fair challenge Simon uh so I’ve start so agree uh Julian and started those sorry agree with the proposal in terms of uh uh the collaborative working don’t agree with the summary of how you categorized organizations under system but that’s a different thing uh just to
Be clear I think uh the uh the point around the collaboration piece if we focus on that as a proposal uh uh yes uh but again that requires all Partners to want to be in that space and to collaborate uh there and we can’t do
That uh if we end up with bits of because we’ll end up with an even greater fragment or we run the risk of further fragmentation in there uh but that principle of a really strong uh response as a system uh with our resource aligned uh focused on that and
Working together is something that absolutely for me as part of the nhse review and as part of the conversations that we’ve kicked off with system Partners okay and I I I presume um Sam till part of the icb’s responsibility is to overly coordinate U draw together the
Respective responses so that there is a system view of of of this important topic what I’m not sure about and I think it’s a really interesting point is the icb’s responsibility in terms of individual practices Etc which is the point that Julie made and I don’t know
Whether you’ve got any comments to make about that that strikes me as yes a potential Achilles heal for everybody not just for us yes absolutely I mean I think there’s a there’s a number of elements in relation to that um one is that that hasn’t necessarily formed a core part of our um
Responsibilities um in terms of how we’re recessed and and um and the the guidance there is a direction of travel um towards that but we’re not there yet in terms of NHS England structures however um that’s not to say that it’s not an extremely important part of what
Uh what we need to do I think what has played out here potentially is a lack of capacity to do everything that we need to do hence the the um the the the notion that that’s woven through the paper in terms of the resourcing requirements that we need and
Simon’s obviously alluded to the review which will help with that so in terms of going forward and I think I’ve mentioned in the paper not only primary care but there’s also specialized commissioning um there’s The Wider primary care so not just primary uh GP practices but also
Pharmacy Optometry uh Dental Etc we need to factor those into our plans going forward because although there’s no formal requirement at the moment there will be in the future and as you’ll see from the paper um the enormity of the agenda we’re struggling to Service as it is okay that’s that’s that’s very
Helpful so in summary we shouldn’t forget the icb’s overall responsibility for coordination but that shouldn’t dilute individual organizational responsibilities we take the point about um primary care and the wide sense specialist commissioning and and you need to keep us up to date and advised about what we need to do and how
You think we might go about that we’ll remit to the audit committee um under Rogers leadership and the involvement of others um about Assurance with this process we look forward to getting a progress report in a month or so perhaps as an as an adjunct to the next board
Papers just so we can see about the kind of things but if you come forward as part of your routine report so that’s uh that’s really helpful um thank you everybody Dave did you want to come in yeah just just a just a question in terms of resources in terms terms of
This taking up resources I find it difficult to square that with uh with the view of the workforce plan um that we’re all 3,000 over plan um and I’m just wondering whether how we set priorities um uh if we’re if we’re over recruiting significantly or having significant over
Over over plan in terms of resources how this fits into priorities Sam I mean I think we’re talking about resourcing in The Wider sense so you’ve heard um discussions about how we might collaborate better um how we um elicit skills and experience and expertise in this particular field
Because it is a specialist uh specialist skill um so we do have um a certain amount of of capability and capacity and experience within the system across Partners also we’re now looking at as I’ve explained in the paper how we work with other icbs So within our local resilience Forum footprint across
Herford and Wester so it’s it’s not necessarily about more people although that would undoubtedly be helpful it’s also about how we use a skills and expertise that we have access to amongst the partners that that within our footprint but also externally and NHS England as well uh to support that so
There’s there’s a there’s a um a a complex way of looking at it that’s not just about numbers of people if that helps no I mean yes the only thing is that with it you know with 3,000 something over plan I thought we’d have found space 3,000 over plan yeah
According to the numbers on the workforce plan that’re looking at later um we would have we would have found some space to actually have those resources but anyway that’s come back to that yeah the slight problem of course that we’ve had this year is that we’re
600 over plan uh and what goes alongside that is a huge bill that we can’t afford in terms of our deficit your point is very well made about the importance of this and giving it due priority um I like Sam’s response I mean I think it is
The right thing to do to look within our existing resources through means of collaboration first and foremost but if we get to a point where we just can’t fulfill our statutary responsibilities then we need to know um and and the assurance that we’ we’d seek through Roger and the audit committee and then
We need to have a discussion about how we’re going to deal with that yeah um Simon you wanted to come in um Louise and then Meredith Simon um would it be possible when you’ve actually looked at what the um uh piece of work that the
NHS has done for you in terms of looking at this what a predicted timeline might be in order to actually get to a point where we could have confidence that the system can meet its obligations I think the public is a right to know that or if
You’re not going to meet it that’s what you’ve just said about Workforce what then okay can I respond to that because I think there’s two bits of that that Simon so in terms of timelines and and next steps and actions linked to that absolutely that will be part of that
Process uh I think let’s let’s make sure that we understand an assessment against the core competencies versus the ability of a system to respond to incidents as they arise and the role they play uh and and often there is a gap between the two so in terms of the responses that both
Providers and the ICB have delivered against a number of incidents uh uh nobody’s saying that they’ve been failures uh or haven’t met the requirements of being a category one responder as ever there’s always things that you can do better and do differently uh the response in terms of
The core compliance as both Louise and myself have touched on uh set out in 4.4 uh there is a there’s a different there’s a different need and a different ask in terms of the the assessment of those core competencies now clearly we want to do better uh no arguments for me
In terms of that uh but it you can’t automatically just do a link from that to the provider or icb’s ability to respond to an incident and say one drives the other but we need to do better in both but a timeline yes but equally think of it from The
Public’s point of view and hence why this is hence why this is in public sment and why it’s talked about and why it’s shared on that basis I just wouldn’t want people to make the automatic assumption from an assessment on core competencies across to an organization’s response to an incident
That takes place during the year perhaps expand on that then next time yeah yeah that’s fair that’s fair yeah absolutely Fair Point um who was Louise I think yeah and then Meredith and then I need to move us on we welcome that as a provider and with other colleagues um in bringing our
Teams together they do meet um together now um there’s more we can do and we’re supportive of the work that Simon’s referenced um also I think in terms of this assessment it’s helpful in highlighting areas of focus within each report there will also be examples of
Good practice and I know that’s the case for us it will be the case for colleagues so we also have the benefit of being able to see tangible examples that have been independently identified that we can draw on to get the strength across the patch so I feel that the
Process we have will enable us to do that and um able to contribute to the um Assurance processes that you’ve described thank you Lise that’s very helpful Meredith thank you very much uh very very important piece of work and uh if we don’t do it right then it it could
Very easily blow up in our faces so uh I’m very supportive of of the work being done it strikes me that some probably uh some significant uh expertise in the room that we don’t tap into because as with many of our conversations it’s rather NHS focused so I just wanted a
Bit of reassurance that all of our EP are work is done in conjunction with our uh uh local Authority colleagues because they will be doing something similar but they might be doing it under a different Banner or to a different um time scale but uh if we’re not completely joined up
With local authorities during an emergency then then that is in itself one of our major risks I would say Nick yeah I can just pick up on that myi so as part of the working with local authorities there is a probably need to use your mind so is it working so um I
Co-chair with Rachel who’s the shopshire director of Public Health local Health resiliance Partnership which is how we Link in um with local authorities and also we are now moving to doing on a footprint jointly of Heron werer which is footprint for the police and crime commissioner and emergency services so that does
Exist okay an important discussion um and thank you Sam for drawing these issues to our attention um I described a bit of process earlier let’s let’s end the discussion there bearing in mind we’ve a lot to do um and we look forward to further discussion about this topic
In the near future and the board approves all the recommendations in the papers yeah um let me just double check that everybody’s comfortable with that section 11.13 recommendations in particular you’re comfortable with those you agree them yeah thank you um next item is uh the ce’s report Simon
Yeah so uh thanks chair we’ll take the paper as read uh we’ll pull out a couple of uh high points and uh areas of Challenge from it uh so paper goes through the usual areas and updates and covers a multitude of uh topics uh we still as we sit here today haven’t had
The planning the NHS planning guidance for 2425 however let’s be really clear that is not stopping the the process of uh planning uh and system conversations with providers with the ICB uh with local authorities in terms of working through what that looks like we’ve set out really clear uh timetable that’s
Been agreed uh and and then there’s a set of conversations confirm and challenge conversations that are happening clearly if the planning guidance is published and that changes things fundamentally then we’ll need to go back around that Loop but for now I think we’ve got a strong approach within
The system uh a clearly understood time timeline was discussed at Chief exex this morning I think the risk is really clear though in terms of balancing as we talked about uh our Workforce triangulation our performance and our financial position to make sure that uh we get the balance in place and and
Really clear in terms of what’s different in 2425 you’ve already touched on uh chair the uh ueec performance over the Christmas and New Year period and would Echo that in terms of thanks to colleagues for the work and effort that has gone in and that continues to go in
And I would add in the uh response in terms of the industrial action piece to that as well and the impact that’s had on staff across organizations look uh it it remains fragile though and whilst we are grateful and recognize that this year has been an improveed position from last
Year we’ve still got patients and residents uh in in areas where they’ve been cared for that’s far from ideal uh and would want to be managing that in an even better way going uh forwards and deliver even further improvements in terms of that so assistant partners are
Committed to uh continue to work through that and I’m grateful for Louise chairing the ueec board uh that’s driving that agenda and working through that in terms of the level of detail uh I reckon I highlight a number of areas where this year system Partners have responded and reacted and engaged uh
Differently in a more planned way uh that’s uh confidence in terms of the planning process it’s how do we keep building on that whilst we’ve still got that fragility in place across all all providers and across all areas so you know I’m not meaning to miss anyone out
There because it’s it’s as fragile in terms of some of the U in general practice uh in terms of urgent appointments as it is around other areas so we got to get that risk B balanced in the right way uh there’s an update then in terms of uh the progress being made
Around integrated neighborhood teams uh uh so we’ve talked about the local Care Program previously and we’ll have more formal updates on that uh uh but board previously had asked for an update in terms of the work that was progressing so that sets out uh uh some of the
Positive Works happening this area and you can see that’s across the area there’s a lot taking place in terms of Tel and rickin as well as in the rural areas around shopshire uh there’s some really joint planning in terms of how we’re developing buildings to have joint services in that’s building on that
Approach towards delivering the local care uh program uh and including Mental Health Services general practice voluntary Community sector in that uh have updated on uh the the shap the reshaping of the ICB uh just for clarity are the management of change in the formal process starts on Tuesday uh uh with uh
All staff being notified of then being in a formal process around that management of change uh which will deliver that reduction in running costs uh and so that you know the structures and the work that sits behind that uh is really important of recognizing the impact on individuals which touched on
It already but you know the key bit here will be the operating model for the system what do we mean by provider collaboration that we’re going to talk on later in the agenda what do we mean by place-based uh Partnerships uh uh the reframing of some of that work uh and
Making sure the ICB is able to discharge its statutory functions uh whilst understanding what you know what we spend in terms of running costs and and getting that back to within uh the budget that we propos that we get given is a really important part of this uh
But I note the impact on our staff as we go through a really challenging period uh in terms of the planning and setting up 2425 uh we’re going to talk later in terms of uh Health inequalities but the core plus core2 plus ambassadors is a
Real uh uh good news story in there in terms of the number of people that come forward but I’ll let Liz Tracy and others expand on that in more uh detail uh uh we’ve had quite a lot of uh girthed uh interventions across the system uh which has been uh relatively
Which has been positive in the main uh not reported in here but we’ve also then subsequently had an urg emergency care uh uh gir visit but that we’re still awaiting that feedback uh yet formally so not recorded in here and then I’ve updated on progress that’s been made uh
In the hospital transformation program and set that out as well uh happy to take any comments or questions chair on any of those bits or other areas of business thank you Simon as ever um your your report is packed with information and issues so let’s just spend a few
Minutes seeing what aspects of it people would like to quiz Tina thank thanks chair um I think it’s only when you see it detailed in your paper Simon that we realize the significant achievements that are happening at at neighborhood and a place um I was astounded actually
When I saw all the things that’s really good work that’s going on and I think we should celebrate that I don’t think we celebrate often enough some of the good things that are are happening and that’s happening through the local Care Program um my question is and probably not to be
Answered now but it would be interesting at a future date to know what impact those things are having so I if I may Che so a really important Point Tina and and that’s why we felt it was important to put as much detail in this report on this piece uh
Recognizing the developments uh session that we had on the local CARE program and linking to the inequalities conversation that we’re going to have uh I think it’s now how can we go further faster but make sure that the impact we’re tracking that and and it starts to feel differently because if it’s not
Feeling different both for our staff and for our residents then actually all of this really good work misses the point doesn’t it and then that needs to translate even more so into uh uh the the management of escalation and I mean that from a resident perspective so that
We look after people in their own homes as long as we possibly can and we really then get into that prevention piece uh the hospital transformation program local CARE program is predicated on that community- based work this sets out some of the structural things that are happening which are really important
That needs to then build that maturity and get into that bit so that people feel different in that space thank you any other question Meredith thank you just to reiterate Tina’s point I I think it looks brilliant actually all these developments and initiatives it’ be nice
To to see it in more detail but yeah absolutely completely agree in fact it’s the very list I was hoping we would see one day and it’s actually emerging so that that’s wonderful there’s just a an expression in here that made me slightly anxious and I’m sure you can help me
Simon 3.1 one of the bullets says that we’re unleashing the power of the community and the voluntary sector and I wondered unleashing power always sounds like something a politician might say um what does it mean and what does it look like and what have we done to
Unleash that power uh so I I I could look at politi City around the table and and ask if they feel Unleashed and what would that so so okay fair comment uh Meredith in terms of U highlighting that so we we know in some of these areas and I look
To my voluntary Community sector colleagues and we had some of this conversation at the ICP about 10 days ago uh last week uh there are some areas Meredith where we would say this is working genuinely differently than it has uh previously uh uh where we’ve got volunteering Community seor leading some
Of these areas and driving that forward and people want to come in and there’s some areas where we know there is more to do uh and and how it feels too governed by statutary responsibilities and statutory organizations rather than really engaging the communities in a in
A different way uh so I I I guess what we are saying there not I guess what we are saying there is where we’re able to get that right the difference that’s making to how we work in those communities is noticeable and marked a and there is a lot to learn from that
And we need to broaden that and widen that and keep working at it uh uh perhaps the language could have been uh slightly more toned down but actually where it’s working really well I would say that is exactly what is being delivered and is being achieved uh but
We’ve got more to go but I wonder if my colleagues from the volunteer community sector want to build on that just a little bit I’m not going to ask you the questions to whether you feel Unleashed or not but don’t unleash Jackie oh what would that mean um uh I
Think you’re right in to say that um where we get it right It’s Made A Difference my my push back would be we get it wrong no we don’t get it wrong I think the system gets it wrong more than it gets it right at the minute it feels
It works really well and at the IP meeting it was very much about the health and well-being boards and how at that local level working together we really do make a difference and those recommendations and it feels very very powerful it doesn’t feel like when we
Get up to this point that we understand that and there have been as far as the voluntary sector inup is concerned and maybe Louise might say something different in Telford is that unleashing the power I think we’ve got a lot more work to do on getting that
Right but when we do get it right wow interesting there was a there’s a comment made I can’t remember who made it at the integrated care partnership meeting last week about vcse feeling listened to by the health and well-being boards but being my word not the word that was used
Last week remote in terms of the ICB uh we didn’t pay sufficient attention to the kind of issues that you wanted to hear about and I think I mean that was said quite genuinely and i’ and I’ve been reflecting on that say I think we pinpoint sir Meredith’s Point whether
It’s about power being Unleashed or not for me Illustrated the point about us needing to do more work to make sure there’s a mutuality of purpose an understanding about what we want to do together and the contribution you want to be able to make there’s a there’s a
Missing link there and I was just reflecting on this um couple of days ago when we when we met on the 3D of October last year we talked a lot about these things we had that great event in this very room I think or In This Very
Building at least um and and I I’ve been in communication with Meredith just today in fact about about how we re-energize all of that because I think there’s something not quite firing as we would like it to um yeah so I’m in the middle of putting a response to that
Specifically about trying to get back to how are you going to embed the VCS into the system that we become you know a partner that matters and I think that was the comment we had at the health and well-being board we like coming there because we make a
Difference and it’s not about being listened to it’s not about being engaged with it’s about what we do making a difference um and working together so um I know um uh there’s something about um about going back and look using the navka um Quality development tool to
Rate where we are as a system in embedding the vcse and I think if we go back to that I think that’ll start some basic principles and how we do that so I have I have got a plan to come forward to do that as well as just yeah yeah and
And um yeah how we can get it right more times than we get it wrong well I think I think what what what would be hold as well and it’ be it’s about six it’ll be nearly six months since we met yes meet again uh think about the things we
Talked about look at the kind of ideas you’ve got reflect on the kind of comments we’ve heard around the table today and decide between us about how we’re going to take this important piece of our joint work forward TCH thank you yes okay um now got one or two of the I
Think who was next from from all quarters I think Julian was probably next then Paul and then Roger some of um what I may say may have come up at the ICP meeting I don’t know who was there for primary care but I wasn’t invited as the chair of the GP
Board I’m not sure whether what I’m going to suggest came up at the ICP meeting um but I think my question is about the planning and it feeds into some of this I mean for me obviously you know later on we’re going to hear about our financial position and we’re in a
Very dire financial position and so I presume most of the planning is really going to be just a continuation of what we’ve been doing with a gradual shrift in the in the direction towards more care in the left shift more care in the community supp my question is is how
It’s you know it’s too late in this process but surely as part of the planning there should be a bigger piece of work about how do we rep prioritize what we’re doing because we need to invest more money into the vcse more money into community-based care into
Prevention and how we can be doing our planning at this stage by inviting what our providers think without having done that piece of work to say actually where do we want to spend our money is a challenge I do hear I think and it’ be good at a later meeting talk more about
It a lot of um criticism about GP access whereas GPS are working you Primary Care is working at capacity it’s working on or under budget and you know it’s not Primary Care is not responsible for the majority of the or any of the overspend within the system directly we’re seeing
Primary Care being asked to do more and more yet we’re seeing sort of an unwillingness to commit more into primary care that’s above what’s required through the statutory sort of GMS PCA n based funding without an ability to increase the LCS local commission service funding and I noted
One of the comments in 1.3 is that um there’s going to be um you know discussions with providers about what their demands are or their asks are around activity and finance moving forward but I’m not sure there’s been I don’t know who’s championing primary care and saying well if you want more
Access in primary care you need to pay for more access in primary care and where is that challenge and that discussion coming so I feel like understand why we’re doing the planning and we haven’t got the the the the the NHS guidance for next year we haven’t
Got the new G there is a new GP contract starting on the 1 of April we have no idea what’s in that you know in theory the Press is saying it’s a a contract that’s really a holding position for a year before a new contract in 2025 but I
Think there is a need to invest in Primary Care in the vcse out of hospital and somehow we can only do that by moving some of the money around in the system and I can’t see how we’re can do that at the moment with the severe challenges that are being faced in our
In the acute providers and our other providers so it’s without having an open discussion about how we prioritize and how we transform our areas of spend I don’t see how we can transform our spend in a proper way yeah I think it’s a first of all in terms of the membership
Of the integrated care partnership um it’s it’s membership and the requirements of membership I must confess a bit of a mystery to but it doesn’t include providers um and therefore doesn’t include GPS either um and I think that probably I mean I’m not I can’t speak for the joint chairs because they’re not
Here um I think there might be some reluctance to open the the membership of that group um but but it’s certainly something that perhaps we need to just bear in mind your point about um prioritizing and making sure that we can direct funding into the area areas that
Will make a difference and set a different tone and style of how we deliver is is a discussion that um I and the Neds have been having with Simon and CLA on a regular basis and CLA might want to respond about how you think that might be taken forward in this very
Tight difficult financial position I mean let’s be clear the notion of just producing another plan that’s an incremental an incremental difference on this year and previous years years won’t cut the mustard we’re going to have to be seriously different seriously radical very focused on our priorities we’re
Going to have to think critically about some of the things we do that we might not believe we can continue to do I mean it’s it’s it’s a very difficult scenario and I I know that the executive team um and chief Executives agree with this I think we’ve got some really difficult
Challenging but actually exciting um opportunities if if we’re brave enough to take things forward in a different way now how that unfill from the 1 of April for the new Financial year is our moot point but the point we’ve got to bear in mind is um we’ve
Got to get away from this annualizing of planning because it doesn’t work it doesn’t work for anybody it certainly doesn’t work for a system like ours with the pressures we’re facing we’ve got to be thinking about the longer term the bank for books in terms of investment in
Primary Care prevention in terms of the trip and ship um integrated uh integrated care initiatives and neighborhood teams will come in years in years but we’ve got to lay down the foundations for that sooner rather than later I’m sorry for for the hobby horish can I just come back a
Little bit on one bit of bit not come back on it but it’s of elaborate the other flip side is perhaps where we need to spend the money is in sath and in qare and in our Orthopedic with our elderly frail population and in our care and there isn’t perhaps the ability to
Spend money on new things and if if we reach that point then we need a level of honesty with the public around where the money can be going yeah I was saying it wasn’t it was more an elaboration on yeah yeah no I could I couldn’t agree
With you more it’s got to be part of the debate um that we need to have and it and it won’t be just gosh that’s that’s lucky we’ve got a plan for next year it’s it’s got to continue it’s got to continue CLA did you want
To I’m not quite sure how we got into this bit territory but it’s an important bit of discussion so I’m happy for it to a little longer probably not a lot to add to what’s already been said I think um what we know we can’t do is fix the
Finance problem without reference to Quality patient safety and performance Improvement in in what we do and I think that’s that’s the difficulty we have so um as you say Neil um with the scale of our financial deficit this isn’t a one-year plan and certainly the conversation we were having with the
Chief execs this morning was about in order to have a credible plan for next year we have to set it in the context of that longer term recovery because at some point we’re going to have to invest uh in certain areas to unlock some of the challenges that we’ve got um but we
Don’t have uh money slushing around for us to be able to do that and it does take time to unlock it from one area and and and push it somewhere else in the system so um yeah we we’re definitely not heading into a plan round of salami slicing and incremental bits of
Efficiency we’ve had a conversation this morning about you know more fundamental consideration of the cost base itself and and the plans that we’re developing to look at things like demand management where we’re putting our Workforce are we getting the best outcomes from from what we’re doing um but yeah it’s um it’s no
Mean feet given the scale of the pressures that we’ve got um we need to come back to this whole issue um we can’t do it just as just now but thanks for raising it and are you saying more about this later Claire um I’ll be commenting on uh the INE position later
Which gives a sense of how we’re heading into next year that’s fine um I want to bring in the others who’ve had their hands sort of raised for a little while Paul take your question comment next thanks Ian it’s a positive reporting places and can I say the um the work of
Ship and TP is really is really really good I think and is the way forward and answering exactly what you’re saying Julie the only way we’re going to do that is by investing in those areas and making sure that that preventative work is affecting our uh the the cost of our
Acute services and it will do if we get it right and our partnership with the third sector is integral to that and must be at the Forefront of it um we we can already already see things that are happening in T and because of that partnership and it’s
It’s a really positive partnership and I think the Independent Living Center for example which is mean which means more people are staying at home is a good example of that and then can we move on to of course the hospital transformation program and you would expect me to
Mention that I’m yet again disappointed uh with this disappointed mainly because and I don’t see I don’t see it forgive me it’s in there the recommendations that the IRP has made to us is not is not um as a system to us as a system uh
Is not in the uh is not in the report but um and I also I’m a little concerned that the enabling Works to goe before the uh the the for business case has been made public um can I say public feedback is continuing and I can tell
You what the public feedback from t freakiness um and you know that and I don’t have to keep responding to it U people are really really really concerned about it that’s not me speaking as a politician I’m not I’m not raising a red flag I’m I am saying to
You when I knock on doors the first thing people say to me is what are we going to do listen Paul we we know the views of your Council we know the views and the concerns that local people have we are very confident that we have a
Plan that will provide the right kind of Healthcare in the right places for years to come uh but we have an awful lot of further explaining to do we have an awful lot of further work to do involving people with the with with the development of the detail of the plan
And Louise that’s something I know you and your team are working on did you want to can can I just let’s hear from Louise if we may yeah no I agree um we’re at a particular stage in the program um and absolutely committed to the ongoing engagement with communities
We want to make sure that the um changes and the services that we put in place are going to deliver the quality and experience that we all want for everybody that we serve across our entire catchment tfood um Rin U mid Wales um shopshire so um we want to work
With you um and we’ll continue to do that and I think the communication and engagement is absolutely at the heart of this across all the different groups um patient families um and the community so we want to ramp that up do that clearly and make sure that everyone understands
What’s going to happen and ensure that they’re able to access the services thank you and and I know there were one or two particular aspects of the irop recommendations and a ministerial response which you’re very keen to see made public and and embellished publicly if you like and we we we understand that
I think it will help Neil that’s I would say and actually we might we might have differences of opinions of a number of aspects of HTTP but on this particular point I think there’s probably a consensus it’s the differen is about how and when we can do it and we’re very
Keen to do it quickly so so my my commitment there chair with Paul with David uh with Louise and team is to continue to have the really active dialogue and conversation because I think Paul the point you’re saying there which is uh get this bit right at build
On what Louise is talking about in terms of that engagement and conversation at then we’ve got a collective responsibility to ensure that we we build public confidence in the services that we’re putting in place going forwards a and as a system that then becomes our Collective responsibility to
Build that public confidence uh in that but to do that we’ve got to get that dialogue right Paul David that you’re flagging Paul so I ABS so I give you my commitment to continue to work absolutely in that space in that open and transparent uh way
Okay we’ll um we’ll keep the lines open as they say Paul thank you for your your contributions Roger yeah thank you just going back to um 1.3 and Simon’s paper about the joint forward plan and the preparations for 2425 Financial year and I think from where I sit at the
Moment I don’t have much assurance that within two months we will actually have much of change in terms of our commissioning and Contracting objectives I think it’s all very late to try and achieve anything now so I’d welcome the views as to how we can begin to reshape our commissioning and Contracting for
2425 bearing in mind we’re only two months away from that that that uh start there’s also mention here of um National triangulation tool for activity Finance Workforce and productivity by provider um I think it be very interesting for us as an ICB to see that information as soon as possible
To see what lessons will will come from that thank you Roger sorry one final Point CH just um when we talk about integrated neighborhood teams and proactive care Etc all very laudable worthwhile exercises I think what we need to do is have some Assurance around
A how much this is costing and be what actual evidence there is of change in terms of making a difference how many members of our community are avoiding admission how having support just want to get some numbers around the quantification of who actually is being affected and having a benefit thank you
Thank you and of course it’s more than just about the interface with Hospital Services they lots of other yeah Services being provided by within the neighborhood teams but your point is well made and of course we we talked about this Patricia the development session I think we asked you for a a
Work plan and some some advice about benefits and so forth and presumably there there’s something on its way to us about about all of that moment I think we um uh certainly Lisa keslake and CLA Parker sort of driving the program of work are working with a key Partners across primary care
And uh and the local authorities on on this in terms of where what areas are we going to Target first so that we get maximum benefits and you’re right it’s not just about how many people have we avoided going into Hospital important that is an important factor for sure
It’s about um the reduction in cost across the system including mental health and others by having a lower level and earlier level of intervention one of the key kind of uh planks of that neighborhood work is also risk stratification because what we’re being very effective as as as a system uh this
Year but very costly is a reacting to the people on top of the pyramid coming in and through to uh the acute services on a fairly regular basis and there are further people down the pyramid that we need to be capturing identifying uh and intervening with further along the line
Which is why we’re seeing um costs type two diabetes flooding into type two diabetic clinics being put on which is ridiculous in the acutus that’s not where type two diabetes should be managed we’ve got higher rates of amputees we’ve got higher rates of renal dialysis because we’re not actually uh
Proactively intervening earlier on in terms of those clusters of patients so uh that’s going to be the kind of key Focus but not just on health across wider piece as well in terms of um social care intervention so that we’re not ending up overprescribing care both care and health care to patients that’s
More costly to them individuals as well as the system thank you and and the um ICP had a really good interesting presentation from Simon Collings about long-term conditions and variation and impact and and changes that could be wrought for the benefit of of citizens which is part and pass of this there’s a
Lot happening it just we just need to make sure it’s drawn together so um Patricia if you’re not able to say right now when you think we’ll get an update on this are you able to say right now can can you give us some help with that
And just let us know roughly when you imagine that can be made available I want to come back to the other very fundamental point that Roger raises um two months to draw together a plan that will pass muster so probably between myself and cl
If I make a start uh so uh the starting point isn’t today uh in terms of the planning process so the conversations have been happening already so uh it’s not then let’s start from today and hope that we can solve that in two months uh Chief exx uh received the update today
From the plan uh leads around this uh several key actions from that which was the you know individual organizations ICB included as a stru organization’s responsibility to go back and look at uh the asks and the investment that’s currently being uh proposed second element then was about making sure that
Uh we because currently that’s unaffordable in terms of 2425 uh the second ask then was the areas of collaboration the areas of joint working how does that demonstrate better value for money linked with better outcomes uh with the the workforce in the right place in the
Right way and the third element was a conversation that we’ve we started and touched on which was uh uh what would be the commissioning opportunities and uh how do we do that in a way that’s joined up to build and deliver integration rather than risk uh frag further
Fragmentation but the pace around that and the delivery of those elements now was increasingly important uh and how do we do that jointly together where that makes sense but equally recognize that the time uh uh for delivery against this needs to be our three-year medium-term financial plan that sets what will we
Deliver in 2425 what will deliver in 2526 and then what do we deliver in the subsequent year after that uh because we’re going to have to take some really bold steps in each of those three years and I think that’s where Chief exx and finance colleagues were at this morning
That won’t give Roger all the Assurance he’s looking for uh but that’s the conversation that we’re directly in uh there’s work immediately falling out the chief exx meeting there’s an update in two weeks time there’s an update in two weeks after that uh not to just say oh
We’re talking about it but actually in the nitty-gritty of what decisions are being taken now to to change the current uh uh uh spend profile so so CLA when when do you imagine that we as a board get the opportunity to spend some time to think
About this in detail as part of a process of signing it off um well certainly by the the end of February we’ll have something that has been through sufficient challenge internally within the management structures to be starting to bring headlines to board and particularly around some of those um difficult conversations we’re going
To have to have about what priorities we have um commissioning intentions there are so many good things that we want to do but we’re going to have to be um quite structured about how and when we do them because we won’t be able to do to do everything um at the moment we’re
Still work working on a planning timeline that would have um a position secured through March then but obviously that’s very heavily dependent on any final guidance coming out because we can only estimate some of the performance Ambitions and asks of us um and and I think you know we’re going to do some
Modeling some scenario analysis as well in terms of um how hard and fast we can go within the limits of the workforce finances um that that we’ve got and chair sorry there’s a I think there’s a genuine challenge of us as an integrated care board in this space and
It links to uh comments voluntary Community sector made local Authority colleagues have made so we’ve got an NHS statutory responsibility in terms of how we do that planning we know a number of these schemes and changes have to be done with volunteering Community sector with that local Authority Partners uh
But there’s a we don’t have another board that’s just an NHS conversation that you you would have had previously so there’s a risk the conversation feels really NHS dominated to deliver the statutary responsibilities that we’ve got in a way that disengages some Partners without the intention of it
Being how do we disengage Partners so I think we’ve got a bit of work to do through that because you know we the agenda today has got much more on health INE equality and and how we work in that space But we know as we get into the
Crunchy bit of the end of this year it will shift to our statutory NHS responsibilities that we’ve got and that risks disengaging Partners when we don’t want to disengage Partners but I’m not asking for a solution to that I’m just recogn recognition of our challenge it’s
A very re simple point and and I mean uh our financial position is just unsustainable I mean it’s it’s unex we all agree it’s unacceptable and it has to it has to improve um I think we have to be reasonable in terms of our expectations about that which would be possible in
One year next year but what we need to see as we’ve said already and CLA you’ve reiterated this is a a longer term plan about how we’re going to make the kind of improvements um that are expected of us and which we want to be able to do
And within that there needs to be reasonable assessments of Investments to bring about the changes in terms of transformation of care that we’ve talked about previously today so it’s it is tricky but I’m still I think outside of the meeting CL and what we need to do is
Give a bit of thought to the timelines and when the board can actually start looking at the detail of our emerging plan so we get give people the opportunity to influence it and and presumably Trevor from Finance committee’s point of view you are heavily involved in this
Already well in terms of being reported to I guess the in my worry and what you’ve just said Neil is that I think you sat in this room this time last year and said exactly the same thing I did yeah that we can’t change it in the year
And we need a medium plan in order to go to woods and yet we’ve got worse better and so I suppose the very direct question is do the chief xx and fds have an agreement on what number we’re aiming for is that still work in progress It’s
Still working progress um I think we have a broad working assumption at the moment that we do not want to be in a place where our deficit is worse than it is this year we have expectation from Regional Regional and National colleagues um which we call Flat cash
But it basically means that we shouldn’t be um having a a continued expenditure that grows beyond what it’s been in in Q4 um other than for for uh inflation which is recognized in in our allocation um we’ve got a lot of work to do to Define what that looks like and how far
We can we can get towards that and Beyond which is what we’ll be asked to do I’m sure Dave seised a little bit that we’re now in January and we’re not seeing what a first cut pass as a board a first cut pass of the uh of the outter for next
Year looks like because we know what the underlying underlying run rates are we know what the major assumptions are we can easily map out what that what the what the starting position and I think we talk about that being you know um you know something which is tremendously exciting for
NHS people and and perhaps less so for other people around the room but I think without that visibility it’s difficult to actually engage people in terms of thinking about other things that we can you know would want to do and how we actually change things and I think
Everybody’s got a real important role to play in how we change things but that has to be done I think um in the light of the realities of where we are and and and we’re not seeing the realities and I think this is the time when those realities need to be
Need to be exposed um uh and I’m personally disappointed that we’re now here at the end of January and we’re not we’ve not got that at this board because it’s being done elsewhere at this time Simon CLA response we do have so we do have that and that is through finance committee
And through Chief exx and finance directors so so d happy to brief Neds and take Neds through that providers are clear and thems of currently where they’re at in their positions uh what you’re not seeing is that being there’s so many moving parts of that it’s not being brought through the public papers
In terms of the board whilst that work is taking place uh currently with providers to do that sense check and that triangulation but happy to to use finance committee in terms of going through that in detail look um I’m not sure I expected us to get
Into this degree of detail today but I’m glad we have actually I think it’s been a extremely helpful discussion what we need to do outside of the meeting Simon CLA and and chief Executives is just draw together I’m sure you’ve got this already available um in some way shape
Or form some kind of a process where board members can see quite clearly when they can be engaged again and when they can expect the degree of detail that people are asking for and how and when they can get the opportunity to influence the outcome um I think that’s
That’s that’s basically what I hear people are asking for I think um Dave’s challenge about why haven’t we got a number yet um I I bet you there are lots of systems up and down the country who are no better nor worse than we are um actually um our position is exacerbated
Because of the um the extreme financial position within which we find ourselves um but but it is important you’re absolutely right that it’s shared with board members um in in total and and and we need to play into that the local Authority Financial view of the world forecast your own position looking at
Andy and uh and David so let’s let’s have some further advice about process timelines and opportunities for board members to really contribute further to this important discussion I’m really glad I included planning in the chief exact’s updates chair so am I exactly good discussion thank you very
Much indeed everybody um we’re asked to know we’re asked to note the contents of Simon’s report I guess we’re probably able to do that with knobs on really that’s great thank you very much indeed um now as often is the case um hopelessly behind time because Simon
Decided to put planning for 2425 into his report um so Nick specialist commissioning briefing report can we do this briefly before we break uh I think we can over to you you so first thank you ch um we’ve had discussions about this oh it’s really an update and sort
Of of where we are so take the papers read and I’ll just highlight the Salient points so as part of the legislation which brought icbs into being a number of services which were commissioned regionally and nationally are being delegated down to them um some of these are afraid of being delegated down such
As um Pharmacy Opthalmology and dental um specialized commissions service going to start being delegated down from the next financial year I just explain what we mean by specialized commissioning we often call it specom there’s a lot of work which goes on across the system which is complex and canical teams do
Work which is special but it’s a clear definition of certain service lines which are described as prescribed specialist services so there’s 178 in total um uh needs for a very clear service spec which which what the service involves and who can do it and who can’t do it and the funding streams
So um as as part of this piece of work um the services are going to be delegated down to us but not to individual icbs down to groups of icbs working together and for West Midlands is going to be uh effectively Committee in common of the six icbs in West
Midlands holding it jointly the reasons our specialist commission Services set up originally about 20 years ago was to help manage the risk because there’s a lot of risk in the complexity and nature of services also Financial Risk there other services which are coming our way um approximately the numbers are in the
Paper so the work we’re talking about is work carried out predominantly by um saf and as Roger so the SF Services mainly cancer and renal work and Rogers expect mainly specialist Orthopedics spinal and some bone cancer work so the service is coming down to us it’s about um
64 million pounds of activity we commmission internally um some of the work is carried out predicted VAR which is the unal work and a somewhere cross border over half the specialist work which paid for by the iceb is actually carried at in neighboring tertiary centers which is effectively uhm in Stoke and wolver
Hampton and in Birmingham so there’s lots of flow across borders uh initially about of further the Work Commission nationally is going to be delegated down and that’s what we’re talking about there’s a lot of work on underway which is highlighting the paper around quality governance Financial governance and um
Just making sure that there’s fairness of access and ensuring that you know quality is available but you know having the opportunity to develop Services locally where possible and that that’s a balance we’ve got to remember so the time frame going forward is tight like a
Lot of the time frames NHS give us so the final draft um agreement in a paper say du to be out today on the 31st that’s been pushed back to the 9th of February that will come down the final draft version of what the documentation will look like it’ll be discussed by the
Committee common of the six ITB CEOs and it will come through to board final approval again a bit a tight deadline of our public board in March but we hope to get out all the information to all the key stakeholders in advance of that so that’s very well we’re very happy to
Take questions or some that is quite complex and urance so very happy to take take sort of email conversations with people around the table as well thank you um a number of years ago in a different life I used to chair the national specialist commissioning committee and it was very clear that the
Commissioning for these Services needed to be centralized because they were often um rare um they were high cost low volume and often risk to local Commissioners therefore they were centralized there was a there was a centralized view about developing strategies for some of these Services as
Well and it was a A system that seemed to work pretty well and I say that not because I shared it for two or three years it seemed to work pretty well so when I read these things Nick I think to myself why are we doing this what’s the
Purpose what’s the benefit other than nhse centrally um getting rid of some of its responsibilities and passing it on to local um services so should I so so help me understand understand this then I might get more interested do you mind if I answer that first and make go to space
Yeah I thought you were a bit Keen yeah so I think the paraphrasing your question is what’s the opportunity for the resident of shop R really how can we you know we’re here to improve heal politicians were further down well and also as some who’s also
Worked in Spec in a previous job and I’m still practicing cancer surgeon who does specially commissioned work I used to do what another term used to be called highly specialist work the opportunity to improve the health outcomes is around access and quality um it’s not about repatriation reversing what happened
Yeah there will be some Services perhaps we could grow but similar you know you don’t want to as a small system take on Services which are fragile I’m sure Louise can give you some examples of some for more specialized Services which are fragile and she worries about
Workforce and quality and you know some Financial issues around it it’s ensuring that we have a voice at the table so when we have those West MWI conversations about our our patients getting the right access to the services outside the the borders you know that’s an important question and lots of
Evidence around further away lifing specialist Services least access you’re going to have to it so it’s conversation saying people waiting for heart surgery you live in drop your we in all people in Birmingham next to the hospital that happens and also the quality conversations and saying you know are are the
Standards the services we’re commissioning of high enough level we’re fortunate in a way that we have effectively threee tertiary um providers on our borders we can always conversations with but there are some really good Services V shop in tord and Recon which not only you know should we
Be proud of but it can actually grow I mean one of the best services and there some fantastic Services is the Spinal Rehab unit in um Ru which is a national Exemplar you know and we’ve recently um put successful bid to expand and grer service hav we that takes patients from
Across not only nationally but I’d say um for home countries as well so so like a good politician you’re doing your very best to represent the corner of opportunity am I persuaded I’m not entirely sure yet but thank you anyway um let’s bring in um Stacy I
Agree I think we’re fortunate being a member of the Federation of specialy trusts we’ve had a lot of conversations with the national team around specialist commissioning and trying to understand I get some of what you’ve said and I agree for local people but when your services spam wider there’s concerns around
Funding flows I think which again wouldn’t be surprised I suppose just the pleas is the stakeholder engagement as this I understand the governance elements but I think we have really good relationships with our spe colleagues with our networks SP networks Etc it’ be Shine for that to to un just one final
Comat of financial flows which I might ask for some clarity about but there’s a line in the paper that since we’re in nor for we’ve got such a challenge financial situation um there’s are effectively a lock type of lock there any um deterioration of situation with
Specom um it would actually be held by the nationally rather us locally but similarly any excess Surplus will actually be held nationally so we sort of locked into that position to give us a certain degree of financial stability have I explained it appropriately so so that makes me even less inclusi Astic
About it it seems to be but anyway um what do I know so um it it sounds like this um this train has is has left is leaving the station and it sounds like there’s a natural policy direction that we need um to heed very carefully um what we got to
Do is make sure that we are absolutely clear about the opportunities and we’re very clear about how we’re going to mitigate the risks um and I think the paper gives us some reassurances about that but there is more to come but Simon there must be a lot of disqui about this
Around and about so so uh in terms of the West Midlands uh with the other ICB the same conversations are taking place in terms of uh the right time to take on the delegation to add value against the backdrop of everything else that we’ been asked to do and work in that space
And it doesn’t feel the time to uh destabilize uh some of some of the relationships and ways of working uh in this in this space at this point uh I think as a board we’ll have the opportunity to have that conversation and take a decision around where our
Board wants to get to but I think is worth and I will commit to do that work with my chief exec colleagues to understand where other boards are in this uh space with provider input as well we have a structure where we get provider input into those discussions
And uh conversations and and I want I’ll pick up as well to check that that provider lead is doing the Reach Out to make sure that what we’re hearing as icbt fex is coming from our providers collectively not just a single view of the world uh but I think in March we
Will have a robust conversation around the added value in this space and the risks that go with it um Tina thanks yeah not not now but I would be interested in the future to understand more about the quality aspects and how quality is going to be monitored and quality issues escalated if the
Signicant issues will I don’t know respons you see the great thing about the national specialist commissioning Arrangements was that Gathering data for rare conditions relatively rare conditions was relatively straightforward and you could monitor quality much more readily than I fear it might be possible to do once
It’s delegated but um um I think Roger wanted to come in and then Dave and I’m conscious that people are waiting for their we do this quickly break what this item yeah well I’m sorry you’ve got me well not alone uh Roger yeah just a quick question how reliable is the 148 million
Pound figure can we trust it say say that again what was the first part I heard how reliable is the 140 million for game uh my finance team are doing their due diligence at the moment and I’ve got a meeting with the uh director at NHS England Regional team on
Friday just to keepi the ties on it a little bit more okay thank you um who somebody else Dave Dave Dave thanks I’m not sure that it’s quite the same here but I I know I mean I’m on the board of um a large tery Center I I know our clinicians there are
Very worried about about this um because they believe that it creates incentives for other systems to create capability um uh and which won’t be delivered on a quality and scale basis that that can be delivered in a large T tery Center we already know that plans for example this is Southampton we know
That the plans are a foot in Bournemouth to look at capturing some of this commissioning money and developing Services they don’t currently do and our concern is a deterioration of quality thank you so there is um a sea of concern around this table which I know sign you represent in your
Discussion with your your colleagues it’s it looks as if this is coming so once we um um Grumble about it and make our points well known to Regional and National colleagues we better prepare for it which is really what I think this paper is saying and thank you for that
Nick and thank you um Simon’s looking at his watch he wants his cup of tea um so um let’s take a break it says 10 minutes I’m going to suggest five 5 minutes um and then we’ll restart okay thank you very much And let’s start again please but will be at an end will be not also you take your seats please the next item the next item on the agenda is the provider collaborative including msk update um fresh from Mount Kilimanjaro we have Nigel Lee um who is one of the
Co-presenters of this paper it says with Louise is it Louise or Patricia who’s co-presenting this or is it just that’s what I thought yeah so are you kicking off Nigel if that’s okay with colleagues so um thank you I think um just just to introduce briefly I think we’ve um we we
Heard with Simon’s introduction about uh the work happening in our two places uh and I think it’s important to just recognize that provider collaboration is another key part of how we continue to develop our system operating model um so this paper just gives a brief update on
The development uh in the last few months um the work that we’ve done in terms of establishing the Committees in common and obviously the shared purpose and the focus on those four initial uh priority work stream as well as obviously the next steps uh and as you
Say chair um uh you know illustrating with msk being one of those um obviously uh LED through the chief exec from Stacy just making sure that we’ve got mskk properly registered as a key work stream within that so happy to take questions Harry is our our lead chair for the
Committees in common Patricia is our our lead Chief exec for the Committees in common at this point thank you very much indeed um comments any any comments from um chairs yeah put aside if you like the sort of the the delivery of change Etc what I think has
Happened um is that you you’ve now got a very um robust team of providers committed to work together I think Sim described at one of the meetings I went to there there are no green shoots of collaboration so we just got to make sure we look after those green shoots
And deliver them but I think we’ve got something actually that is going to be capable of delivering change which I think is what we do want and okay um Dave yeah no it’s interesting the only thing I didn’t get from the paper as such was how how how it aligns with potentially
Any other broader strategy at that system level and and and if you look at the change how this how how this aligns to you know the ability the enabler the facilitator of actually making things happen I through funding so how does this then play back into funding if you
Wanted a fun particular change programs how does that how does that work I think I think it’s a great point and one of the is this you know this is an emerging um group and I think one of the issues that we we are conscious of is that
Actually it needs to be much bigger than four providers yeah and in particularly obviously commissioner needs to have engagement and then of course local authorities voluntary sector etc etc but it’s the start and I think we do recognize the point you make haven’t got the solution for it just yet and what we
Didn’t want to do was create some something that perhaps would be too big to manage and not deal with the here and now so Harry I mean I think has to be the right way to go because I mean change has to come from in this area has
To come from the bottom up you know I mean it has to be something that that you as the providers believe in and are going to deliver it’s I think it’s a question it’s a challenge back to the system as how we support you in being
Able to drive the programs you want to deliver I think that I think I think that will happen now yeah but in a collaborative way yeah any other other comments n I’m I’m just interested in getting comments from chairs and chief exec within the collaborative first Katrina I’m just
Reflecting on question and it’s certainly something I know I’ve spoken to you Neil about and some others and that is of course as the system is restructuring um the way that commissioning is going to be done will also change and so there’ll be elements of um tactical commissioning that could
As confidence grows grow come down into the um provider collaborative um so you know giving us the headlines as to what has to be achieved giving us the money to do it and then uh depending on the collaborative to actually Define The Innovation the pathways Etc by which those deliverables can be achieved
Within the envelope that’s offered um thus facilitating um strategic commissioning at the ICB level uh leaving the detail of delivery down to the collaborative level so I think that’s part of how I think I can see a shifting but let’s be clear the ask from system and from Midlands
Um NHS England Midlands in the first instance was to put the collaborative in place to deliver on the critical here and Nows um and shifting rapidly into the into that more that the situation I’ve just described as as quickly as possible but the big ask was can you
Sort out the ambulances can you sort out this can you sort out that but we can’t stay there we’ve got to shift rapidly as we transition okay thank you other comments um maybe back to you Nigel oh sorry Tina no I was just going to say I
Think the trick here is getting the balance between good governance um but not um overly burdening ourselves with bureaucracy and being able to deliver on some of these absolutely key things and it’s getting that balance right between governance and delivery thank you um that’s a really
Important point and I wanted I wanted to come to that and maybe we’ll just pick that up now um Meredith did you want to comment on that point about the balance between and if you like delivery and implementation do you mind if I just whilst we’re on that topic Roger terms
Of um this balance between governance and delivery have you any observations from the paper arising from the paper yes I mean my my thoughts about the provider collaborative having been through one in the West Midlands sorry wampton a few years ago is that you do need
Pace um and at the moment it’s quite difficult to see where the key milestones and timetable is in this process because you because these things are difficult and without that pace and that energy to deliver it it would just become a talking shop for one of a
Better word so it’s really what the provider collaborative is looking for in terms of tangible deliverables and when they will be achieved to give us the assurance that the benefits of the collaborative um will be that’s my my initial comment thank you it’s a really helpful point and I suppose that um
Sorry Nigel we’ll get you um question I have is sign off you the government’s arrangements and discussions are well under way well done that looks um promising um what given our position in terms of no what are the sign off Arrangements involving nhse and the collaborative what’s the part that
You envisage the ICB will play in that what’s what’s the sign off in terms of Roger’s point about outcomes um th those are things which don’t they don’t come across clearly in the paper and I know talking to you Harry there are things it it’s accepted need further work but
What’s the process to get to those what what we’re all Keen to do is as Roger said make sure that this works um and and doesn’t simply become um a talking shop but it’s through Pace it delivers real improvements help help us with that yeah so I think the I think what we’re
Focused on is the pace of change and we do recognize we’ve got to put in place some governance don’t think it needs to be overwhelming but some governance I think one of the things that we’ve seen so far for understandable reasons is an extraordinary level of interest in what
We’re doing from the region I think I think Patricia has written two or three papers what Patricia and I agreed this week or last week is that we’re going to meet with nhse to try and get to a degree a level of confidence where if you like they’ll leave us alone and get
Their Assurance through the ICB process so we can get on with it because frankly writing a report every month on what happened in a meeting isn’t good use of anyone’s time and then getting a letter back you know it’s just not good do you have to produce two within three weeks
Over Christmas or something yeah crazy yeah so we’re going to have that meeting to say if you like leave us alone um I think the sign off um I guess there a question of what they want I mean our view is it’s a matter for us actually it’s our collaborative it’s a
Matter for us if they’ve provid they’ve got assurance that we are focused on the right things delivering against them with the milestones at PACE we think that should be enough but we’re going to have that meeting with them and obviously we’ll engage with yourself s before we have that
Meeting but we need space to operate as well yeah I think I think yeah couldn’t disagree with that disagree with that point so thank you for the progress report unless there are other comments questions oh Julie and Lou and merid I think probably Meredith you were next
And I’m ignoring you again I apologize you go now Meredith thank you very much um just to say I think this is a fundamentally important piece of work and uh completely support it and Katrina’s point about the the Tactical commissioning is so critical because then that allows the
ICB to do its specific function properly because it’s not meddling in something that’s being done elsewhere and I think that’s that’s that’s great I just had one slight anxiety um I know this sounds like deja vu uh the there’s a line in the benefits you can probably uh
Set it out um it says to embed clinical and Community Voices in our work and I just wanted to make sure I understood what embedding Community Voices in your work meant and what that might look like I think I think through through all of the individual trusts we’ve got work
And you know and and please bear in mind this is uh Robert Jones structur Community sath as well as mpft so looking at both the physical and mental health side so with all of us we have got the trusts have got work about continuing Community engagement I saw
Something from south over the last few days or so which is looking at again as an open survey to continue that interaction so I think it’s through those and whilst it won’t be a specific priority work stream because they’re set out it will continue to both inform and
Ste of the way in which we uh we do our work just to add to that I think meridi is also the opportunity because I I don’t think the general public are really concerned about whether we”ve got forc of our boards that meet that’s ched by I think what they’re interested in is
How is this going to be different in terms of the delivery of care and I think what’s more important is having that Community voice uh in how we deliver on these priorities of care so urgent and Emergency Care the areas that we’re focusing on the uh children and
Young people agenda and so on and actually listening to that voice so that as we deliver care we’re delivering care with uh rather than just to people uh I think that’s going to be important so how we bring our engagement and Community Communications functions together to do that as joint providers
So actually listening to the whole rather than me going and talking about District nursing services or aspects of community care because they’re fundamentally joined up to the other bits so I think that’s where we want to get to in terms of that cons and engagement and again I think there’s
Something about us as a provider collaborative listening and incl people like yourself Meredith and and The Wider voluntary sector into how we do that so it’s not just a traditional health approach to here’s a set of services do you agree thank you thank you yeah that
That’s great I just I’m anxious When I See words like embed or indeed um unleashing they they they they sound a bit cliched and I’d like to see some kind of tangibles behind it all to help help me understand at least anyway but thank you that’s great I’m going to take
The other couple of contributions and I’m going to ask Nigel who’s had his hand raised for a long time to summarize for us what next but first of all was it Louise were you next or Julie L L you thank you um it was to an earlier Point actually which is recognizing overall
The strategy and plan of the system and then the contribution that this group of providers can make and ensuring transparency with the system work so for example in chairing the Urgent emergency um care board and working with um Gareth on that that we’re clear about the aspects which we are um dealing with
Through the provider collaborative which are contributing to that overall plan and we would expect to be transparent about those objectives and those measures and have that cross referencing so it was just to identify that we do recognize those interdependencies and increasingly those will then be set out
In those other Forum um so that that will hopefully work with other providers who can also influence through the different routes and ensure we’re doing the right focusing on the right things that’s yeah very good points L just just a thought occur to me will you be meeting in
Public no it’s not a board meeting it’s it’s not a board meeting but you don’t have to be a board meeting to meet in public do you so just occurred to me it might be anyway it’s it’s a matter for you to think about um juliia um thank
You got just a couple of points I think in terms of the paper’s title which is about ADV an update on the advancing the provide collaborative I think the paper doesn’t for me deliver on that it’s you know I think one of the issues I thinking Roger has raised it I think
Part of it I would have expected to see a you know a timeline with some milestones and to do that we probably need for the providers to have an agreed end point I don’t quite know what we’re aiming for what what does the end point of a provider collaborative look like in
Tropia tord and Rin and therefore then we need to develop the timelines and the Milestones towards achieving that the next bit I think is a little bit maybe letting out one of the secrets of general practice but quite often when the ICB ask us to do things general
Practice we look at what we’re already doing and say what can we put down in that list that we’re already doing that meets what we’re being asked to do and I think the you know the ueec work that’s already been in Train That’s not new it’s what’s been started the virtual War
Wards and Subacute beds and the idts the msk work is sort of being done so as I’m asking what are we going why this paper to me doesn’t tell me why that’s different what’s different about the processes we’ve now got in place that were different to when the ICB were
Leading on those pieces of work and now the provider collaborative is and I think the third point for about I think someone else said I think J said about making everything a bit more efficient so in terms of commissioning outcomes one of our outcomes is we want to see
That our Target in saving money or being able to have money freed up to be able to redirect it is achieved yet in the finance of the msk bit it doesn’t appear to me that it doesn’t really demonstrate that by having the provid for collaborative we’re achieving those aims
Any better than we were doing when we were doing it through the ICB leading it you know for 22 23 it was half the savings and I’m not even clear for 23 24 how much of the 1.3 million efficiency Target we’ve achieved or expect to
Achieve by the end of two months time so I think for me I would prefer to seen a paper which splits down what the final state is what the Milestones are what the timeline is but also dividing up the sections into what’s the structure is what the governance is and then really
Another bit I mean the msk bit is merely about what’s the output that that paper at the end that’s attached throughout the update msk is an output of what the provider collaborative will deliver as would be the sort of the the U element of it and I think they’re different bits
So I’m not sure the paper title fits in with what we’re being presented with thank you good points Roger did you want to build on that yeah I did thanks um I found the msk paper quite frustrating because there are some really good stuff in here about um reduce years living with disability
Optimizing expenditure and mskk services um managing more patients through conservative care such all very good stuff but when you get to the recommendations the recommendations and next steps are really quite procedural stuff still and it’s it’s trying to get into the next steps what are we going to
Do about those key gains for for the patients and the population because there’s no evidence I can see of how we’re going to deliver those key changes to the services it’s very much oh let’s explore and discuss and such like what we need is an action plan is how are we
Going to achieve that thank you if I can just come in on on that point Roger there is that plan I think then recommendations were additional to the current transformation plan that we’ve got that we agreed at the last um Committee in common I’m more than happy
To bring the in depth project plan the finances are still being worked through for next year off the back of the success of the msst and getting basine to be able to look to see how that’s done what potential savings that will be through that next year I don’t want to
Lose Julian’s really important points I’m going to ask Nigel to to comment on those in a moment or two if I may on msk um I I I shared some disappointment as well it’s great progress on a number of fronts but let’s not kid ourselves
The elephant in the room or one of the big elephants in the room is how are we going to provide elective Orthopedics and as far as I can see the paper silent on that within with with the paper we’ve got today is I think is silent on that I
May be wrong and yet we know from one of the appendices um I think it was Simon’s report gir is eulogizing the notion of centralizing elective Orthopedics and creating a center of excellence it talks about a center in is it London or the South Southeast somewhere sorry
Southwest is it right so and I I I thought to myself hang on a minute we’re looking for some steering on that particular point where is it so I’m I’m not looking for an answer on that particularly bit I’m a bit with Roger about sort of unfinished business on
That um and and I pick out msk because we had a big discussion about it in this very room as I remember in October um and I and I’m not sure I feel that we’ve made a great deal of progress but perhaps I’m not privy to all of the
The background information on that particular Point there’s progress lots of other things within msk acknowled that entir Lou yeah I was just going to make a general point and I know colleagues all disagree if they do in the collaborative but I think the aim is
Just to give a sense of where we’re at now so it’s been a relatively short time frame um we’ve all committed to this we’ve got some govern on the M sorry to interrupt but we we we set down some markers for that in October sorry sorry
Neil I meant because it’s terms no appre apprciate that I think in the paper in advancing the provider collaborative it was more about the collaborative itself within which there’s work streams I don’t think we’ve sought to present the plans and Ambitions of each work stream
In detail in this paper so I I just want to clarify that so I think really it’s more a sense of how the collaborative itself is maturing what stage we’re at we’ve definitely moved forward with governance we’ve got high levels of commitment we’re working through the crunchy bit on the work plans
Acknowledging the points you’ve got and where want to go next so that we can then be confident going forward that that is all in place and I think there have been some initial um uh actions that have been taken which we’ve demonstrated through winter uh which have been significant compared to
Previous years and more to go so I think it would be for us to then on specific issues be clear about what we then share and present we haven’t s to I can see what’s happened here we we asked for an update on the collaborative which we’ve
Got great we also said in October we wanted some decisions and solutions about msk including um the the the lockers of elective Orthopedics at some point in future and somebody’s attached an appendix to a paper which is an update and it doesn’t quite fulfill what
I thought we were going to get on msk and I think that’s partly Roger’s Point as well so how are we going to deal with the msk issue which I think is a really important test not just for the collaborative but for this board as well hurry help us so two three
Get to the point the first thing is um up until now the msk has almost been a Robert Jones project you know and Mike is the SRO and he’s Le it and that’s because we didn’t have a collaborative okay we now have a collaborative and Mike very made made a very important
Point that it should be the collaborative that owns that not Robert Jones so it’s a collaborative decision that I think that was agreed at the last meeting we’ve then got the experience of what has is happening over the winter which we need to learn from and look at we’ve also got the girthed
Recommendations so there’s a recommendation at the um collaborative that we take a look at the options to see what they are to the possible is and we clearly can use the winter experience the girth experience up until this point about future models we haven’t really talked to clinicians so I made the point
That we need to get a clinicians View and of course we’ve got a great way of doing that because we’ve got clinicians working collaborative at the moment so I don’t think there’s not work going on there is but we want to do this properly so that it’s clinically owned clinically
Driven and owned by the collaborative and that work is in train well okay I I think this is the first real asset test for the collaborative yeah agree to to resolve this and and quickly given I mean the issues have been in gestation about the future of elective Orthopedics for two or three
Years least and I thought we’d reach the view In This Very Room in October about the direction of travel based on we were told um a clinical consensus I suspect it’s more a majority view rather than a consensus but nonetheless strong support from clinicians who presented in this
Room but but I don’t think at that I think at that point we were talking about the msk pathways across the system we’re talking about reconfiguring the service now which I don’t believe we’ve engaged effectively on just yet maybe not you know okay but but let’s let’s
Get a fix picking up Louisa’s point this paper was never intended to deal with the msk issue in detail um we have an interest in that following the discussions we had last Autumn let’s get advice about that and and how long we think it will take before there’s a a
Clear recommendation and if it involves a reconfiguration obviously it’s a commissioning issue which we need well that was the point I was going to make finally there is a commissioning element to this which sort ofs back to the point I made earlier so just we’re going to
Come on to governance and how that works uh later I I wonder if there’s a reframe in some of this actually if we think about the planning piece uh because uh I think agree with what louisea talked about agreed in terms of Harry’s presentation and the challenge that’s
Coming I wonder if actually we could say the priority areas that people are saying we’re working at PACE and there’s more detail that sits behind actually if what we can start to articulate what the workforce change is going to look like what the activity profile is going to
Look like and then what the efficiency and finance savings is going to look like that takes in place good all the work that’s in place and that that plays through into the 2425 planning process and actually at a board level our responsibility is overall system not to
Do the all of the detail that sets under beath that because we want to empower providers to work in that space so I wonder if there’s a reframing of the ask around ueec and around msk to say that’s got to triangulate now Workforce activity and the you say Financial
Savings that will flow out of that into 2425 I think there’s a separate strand then which is around system architecture and governance uh which is about what does the future Pari collaboration look like what’s the end people you know Julian’s comment of what’s the end point and I think that’s still the development
Conversation of where we’re trying to get to there’s a risk we can flate and we’re try and pull all of that together actually whereas I think if we take the priority areas of which we know there’s been really good work already to get to this point but the papers in the board
Today don’t quite hit the mark in terms of answering slightly different questions than the first ask was and we play that into the planning for 2425 and we lock that in because then that gets us into the other bit which is uh so what are what collectively are we going
To agree is the commissioning intention the commissioning ask of what that looks like uh going into 25 26 and 26 27 uh uh now you know we could write that in sweet isolation couldn’t we but that doesn’t mean that’ll get delivered uh actually agreeing to do that collectively and jointly as a reframe
Building on the planning conversation locks that in I I think for me the discussion about msk needs to be taken outside of this meeting we need to find a way of resolving that quickly because um it’s been an issue that’s been on the on the table for two three years great progress but
The elephant in the room about elective Orthopedics and how that can be provided is still outstanding and we said ages ago uh we needed to have a resolution and we’ve had gir advice um about about what that solution might look like please help us with that please help us
With that um nidel what what next well I think obviously um colleagues have said that I think um if I may that were the three points I was just going to make but I’ll proceed that by I think you know Louise Louise mentioned Harry mentioned um th this was this was the
First time we’ve had an opportunity to just properly give an update on the provider collaborative to this board and it was important important to just make sure that we were clear about the Baseline of that so I was just saying now this is the first time we’ve had an
Opportunity to present an update on this so I think it’s really important um the fact that we’ve had some hearted discussion on a whole range of different elements I think is really important uh and and useful for that and we can take that away I think there’s there’s three
Elements I think I would would take and and and very kindly chairs and chief exec of the trusts you know I I I play a part and support uh that I think the first one is we absolutely want to continue to develop the collaborative I think um um Harry just pointed to that
There’s been some great work and we know that there’s areas of development that we want to do and that is about understanding what the work streams are how best we’re going to do those um and that in and that includes making sure that we develop together and I think
That’s the important bit that we want to to push on I think the second bit and Simon alluded to it is we want to make sure that this then the collaborative is an important function and component within the system you know the collaborative is not the the only thing
The only key component and we’ve talked earlier about the two places we’ve talked about other other different mechanisms so the this are really important as and again we’ll we’ll talk about it later on in the the good governance Institute we understand how the different components of the system
Operating model underpinned by both the Strategic and tactical commissioning allow us then to do things differently in a way that we want to move forward um and so that is a joint dialogue then between the the providers working with the ICB to make sure that we understand
How we’re going to do stuff and I think the final one and again colleagues have mentioned it is um we have indicated it and I think msk is a good example of where we’ve got clinicians of all all all varieties you know therapies um medical staff others um talking about
Different ways of working and how that’s happened and I think the The Joint work on the on the pathways linking from primary care for contact practitioners through therapies and that that involvement has genuinely involved a whole range of different parties which is is is important but I think in terms
Of signaling a different way that the trusts uh want to work together then that that is you know we know that communication is an area that we want to continue to work on and so I absolutely understand the points that colleagues have made but I think those are key key
Areas that you know we’ve absolutely talked about within the Committees in common and I know colleagues are really committed to okay thank you thank you and I mean for the avoidance of any doubt let’s all recognize um the good progress that you have made the fact that the government’s
Arrangements are um developing as far as they have done is to your credit the fact that you’ve got at least an initial view of your priorities um there’s some some further work that needs to be done picking up Julian’s point about are we all are we all content that they are the
Real priorities nhse you and the ICB and Views about outcomes and outputs for those in timel is something that we need some further um advice about um and then there’s the msk issue which we won’t go over again we’ve had a good thrash around that just on the
Priorities we were actually written to by NHS England laying out what the priorities were so they are the priorities although we don’t disagree because they are the priorities that are driving quality cost and efficiency so we’ we kind of agree and it was Simon and Rebecca the Jo
Yeah and I think as an initial statement of priorities they’re extremely helpful yeah um what what we can’t agree though is that they are the priorities until we’ve been through our planning process that might confirm or otherwise the priorities and that’s that’s my only Point that’s my only Point okay thank
You Nigel thank you all very much indeed it’s um good to see the progress um that’s being made in this area um late I apologize um Liz and Tracy you want to talk to us about um tackling inequalities in Access experience and an over to you can everybody hear me because I
Haven’t been able to hear much of the board no can’t hear you at the moment okay is that better oh that’s better sorry okay so uh thank you so core aim of the ICB is narrowing Health inequalities um firstly I’d say much of the work in terms of tackling inequalities um promoting healthier
Lifestyles and well-being is taking place within our health and well-being boards and with wider Partners I think um last week we had the ICB and there was I think a reflection in terms of the need for this board to be more cited on that work that is taking place within
The health and well-being boards um however this report that’s set out here today is the first for the ICB so that is that is good news that we’ve got inequalities on the agenda but it is about the delivery against Key Programs of work that is within the NHS operating
Guidance the long-term plan and the core2 uh program the core2 program is about addressing uh inequalities in Access to Health Care for targeted interventions focused on our most deprived areas we have 60,000 people living in those most deprived areas 5,000 in tord and Rin and 15,000 in t in
Shopshire so it’s really making sure we are narrowing those inequalities so we have set up a group a system group that has both directors of Public Health and um lead uh execs from each provider we’ve met uh a couple of two times and held a workshop so this
Report highlights the program the act the um progress against those NHS programs uh that are being monitored by that board I think for me my reflection would be the bigger wealth inequalities um we have started to develop a data tool but at the moment I
Would say we are we are kneed deep in uh we can’t see the wood for the trees so we do need to make sure that we use that data tool appropriately and we shed light on whether we are narrowing the inequalities at the population level and
I think there’s more work to be done in terms of that but we have started that piece of work and I think the the second question is are we integrating our approach and again I would say that we would reflect we’re in very much in early days in terms of that this report
Is highlighting the NHS programs we need to Now link with the local Authority programs and therefore we held a workshop Before Christmas where we highlighted a few Key Program few few key priorities in terms of trying to do that so we’ve talked about a waiting well initiative focus on the msk those
Waiting on the msk how can we sign post appropriately to their healthy lifestyle and wider self-care offer that is available in local communities how can we um promote providers in terms of becoming more anchor institutions in terms of thinking about their role as big employers big providers of services
B procurers in terms of helping to support the tackling The Wider determinance of ill health I think we need to do more work in terms of systematically ensuring we sign post to uh the prevention offer that is within the communities I was a bit disheartened to see from the big conversation survey
That only 19% of uh this those respondents felt they were signposted to self-care and healthy lifestyle so I think there’s more work to be done there and lastly to also more work to be done in terms of that that understanding of our needs and whether we are making a
Difference to those inequalities within our populations I’ll leave it there chair um thank you very much indeed Liz and and Tracy did you want to add anything no I think this covered that well um I’m here to speak to any elements of the NHS program answer any awkward
Questions thank you very much indeed I um I’ve said it on more than one occasion I was heartened by the discussion at last week’s ICP we’ve had some reflections of that today just to sense that um using ICP as a bridge between the health and well-being boards
And the local authorities and this board offers significant potential and we had a good discussion about some of these related issues there and here we here we are again with a with a paper and a very helpful update about the kind of progress we’re making I have a sense
That that things are starting to move um Liz am I being too dewe eyed about this possibly but I would say at least um I think we’re more aligned we’re having those conversations but it’s actually I think back to a theme of this board today outcomes and tangibles
And I think we’re not quite there yet and I think we’re probably trying to to um Feed the Beast to monitor the programs we’re supposed to do but are we making a difference and are we joining up hence why I asked those two big questions and I don’t think we’re there
Yet but at least at least we’re the conversation we’re having the conversations absolutely let me let me I mean this time last year I would like we weren’t yeah so there you there you go um Let me let me invite people to comment Vanessa what what’s your take on
This um well as you were talking I was just thinking about the role of um of um KPC actually and how we need more going into there around house inequalities and linking it with the other quality priorities um in the system so I think um we’re at that stage
Of the Year where we’ll be looking at our quality priorities and I think we really need to make sure that we play it in not that we you know duplicate but that we benefit and that there an integration of Health inequalities within the quality agenda so that’s what
I was Ring over as you were speaking um what about our provider colleagues what do you make of this agenda what do you make of the paper Patricia any thoughts initi our Ail on this very area I suppose what I’m interested in is um what’s our contri to this agenda as a
Provider and if we can really have that debate and discussion and get some Tang out of that that Workshop which was only a few of us in terms of that but in terms of thinking about what providers can offer as employers as buyers of services as using that lever as much as your
Healthc care lever and ensuring Equity of access uh and and and making sure you’re narrowing inequalities in terms of your focused approach with some communities Katrina I’ve always seen you as a proponent for this agenda this kind of work have you any observations thoughts about the paper and other things you’ve
Heard I’m I’m actually just reflecting on the fact that um we as a aboard at sou we identifi that um Health inequalities is really important and we know that our staff on a day-to-day basis actually do work very closely with the patients and the service users that come through to talk about opportunities
For improving Health uh what’s their hurdles what’s the issues that they face and timeliness of appointments uh especially around um delays for surgery Etc um but I was just reflecting that we’ve got a seminar actually coming up on when thinking about the role of the provider other than the conversations
That are had what is our role as an acute provider where we can genuinely make a difference and I agree with you the staff staff well-being considering uh the number of Staff we’ve got and if we think collectively in that there really important but there is a lot more
We can be thinking about um so I’m just reflecting on that as I’m I’m thinking about the paper um I I think I could comfortably see that it would be challenging for us to determine how specific Health inequalities are playing out with regards to um specific patient flows
That are coming through other than things like maternity where we’ve got a really strong focus on things like um no smoking at the point of delivery for example and that’s where it’s obvious because that’s where the data are collected we don’t necessar collect data about the impacts of inequalities on the
Impacts of outcomes um Etc so and we’ve also talked at board several times about um how how people from different communities different postcodes are impacted differently and rather than us do the analysis and getting into places like that again we’ve been talking about how do we reach into the system how do
We reach into the the experts so we can look at it as a collective rather than us do some number crunch ing behind the scenes than just following on that point which I think is really important could you speak you know not just looking at it from an organizational level and we have
Got our sort of board seminar looking at our your mic doesn’t seem to the point of access Etc is all very relevant but I think there’s something fundamental on that is how we going to commission services so that our services are aligned in the right area and that might
Require this board and the components within it politically and otherwise to agree that um one area might have a different configuration of resources to another in order to start to do that uh because the danger of us just looking at it at a an organizational level is we
Might end up driving up Health inequality so I think absolutely there’s something about what are we doing now in terms of access we’re all really aware of some of the health inequali our are the question now is how do we align services and how do we commission
Services which which might have to mean some Brave decisions uh so that we start to really turn the dial on on closing some of those key gos thank you very much indeed um I know Nigel you want to come in but I’m going to ask you wearing your
Planning cap to describe how we draw all of this together including within our planning round priori and so forth um but I think Paul you wanted to come in Trevor and then Meredith quickly on our on our children’s services Improvement Journey we we we talked always about the
Talit p and how we as partnership worked on on using that t pan to improve the outcomes of children and and I think that’s what we’re doing now that’s what is doing and C ship is doing and we should look at the shop sh and tell pound and make decisions we had the
Conversation earlier we have to make brave decisions sometimes it is invest to save and it is investor save at the acute end as well not just at the community end um and it is about how we can work differently with our communities it’s about population health
I think PCMS have a huge role to play in partnership with us in that in that approach and the way that we offer the services and hopefully help to solve some of the 8:00 Rush issues that you get for to see a doctor when you could
See somebody in a community center in a different way um that kind of that kind of effect will have an effect on those inequalities that are there for us in tord and to to hear that uh that figure is quite frightening really I know that there’s an age
Difference within my ward there’s an age difference in terms of death uh between streets and for me in know in in the 21st century that’s apping thank you um I’ve lost my bearing Meredith I know you wanted to come in yeah thanks very much just sorry Trevor
As well yeah so I’ll quickly get myself out the way um just very quickly um just picking up Vanessa’s point I think quality and performance committee can play a part in and and requiring a qu a focused question of all p papers uh which is uh and what’s the specific
Inequality message in this paper to actually kind of guide us Focus get get our lens in the right place I i’ stress that’s a really important part second thing is um we’ve got two really well-known experts who who are kind of charting uh what what what’s going on
And they say they there’s some movement and progress which is great but I’d really be interested in Liz and trace’s view about what would make the big biggest difference over the next year rather than us um sitting here uh um coming up with our views we’ve got experts in the
Room so so hang on to that question for now I’m going to take the other um questions and points that people want to make Trevor I’ve been ignoring you for too long it’s all right I’ve been quiet um for a change for me this is an area that actually
Really pushes the ICB IC to the full extent of what it should be doing in that Health inequalities are is only partially and probably very partially going to be solved by changing the provision of health services this is what the local authorities will be thinking in day and day out whether it
Be housing whether it be schooling you know whatever else it it might be um and even takes us into something that we rarely discussed around this table but there one of our four pillars which is around the economic effect of what we do and it really in fact so you know no
Answers so really just a broad statement as to how we use this to really address that broad ICB and why we’re here and what we can do with the group of people around this table that no other table can achieve really powerful Point thank you
Um so I’ve got Julian and then Roger I think mine’s a very quick question I mean I agree with everything that’s been said I mean the health inequalities is or correcting those Health inequalities or providing services to help sort those health and quaran is what we’re here for
Really and I think first of all we need to recognize the amount of work that’s already done in the councils and the public health department around that and the fact that we need to be building on that work um I think the Highlight report is an a really detailed and good
Piece of work that I think has got a lot of things in it I suppose there are some specific questions in there which I don’t necessarily need to ask but my question I suppose is whether we’re triangulating that highlight report I know is written by the ICB leads in
Those commissioning areas in terms of our planning for next year so for example on page 221 it talks about in Asma and it talks about the U we know there’s a challenge with Asma we’ve had these very two tragic deaths over the last couple of years one very recently
In t ran and we it points out there’s an eight month wait to see um respiratory pediatrician in South it then points out that we haven’t got a commissioning decision on the um the children’s nursing team around the asthma reviews for next year the next page down on page 222 is about
Diabetes and I think it it highlights there that there’s some of the challenges of um lack of clinical leadership from South and um trying to identify a diabetic leading South I know these are a bit out of date but as my question is are we using these detailed
Reports to drive that conversation we had earlier about how we pick what we’re going to spend our money on next year to try and reduce heal health and the quties and we actually using all the information and the work that’s been done in the council’s public health departments on our own teams to
Influence what we’re actually doing because it would be a shame that all this work is done in the background and then it’s not really acted on and I think the other bit is around you know I’m here as a a clinician Nick’s here as a clinician but
You know it needs clinical buying all our plans whatever they are whether the msk out of Hospital you know Health prevention it all needs clinical buying not just at Doctor level but at every single leverence how are we stimulating that clinical Buy in to work as a whole
System can I just on the the points you made I really want to hear Nigel’s views about how we draw all of this together in a moment or two Nigel in in terms of a cent plan and how do we make sure the great ideas that are percolating through
This report um lock into that discussion about priorities and what we’re going to stop doing and how we’re going to fund things because I think you again put your finger on some really important points if I may say so and Roger yeah I think um I’ve got three
Quick points first of all this is very much about what the NHS should be doing my question is why don’t we do the two together what’s happening within the local Authority area as well so to bring the two together I think that also then picks up
How does that then feed into our Comm missioning goals and that fixed up Julian’s point about particular at risk groups um and I think my final point is again it’s this um rag rating table here and My worry is that is there optimism by us here I’m never seen so
Many greens and I’m just wondering are they really green good point good point you want me to answer a few of those questions yeah I do please right so I I think I I agree there is probably optimism by but don’t forget this is about delivery of program
So if you’ve hit a milestone you’re green it might not be making the difference so I think we’ve got to be able to understand that and it just depend on how ambitious we are with the plan um I think uh in terms of priorities I was asked in terms of
Priorities so I’ll I’ll wear two hats then I’ll wear a hat that says absolutely you need to have datal le decision making within this board um back to the point in terms of being able to see the wood for the trees and being able to Target the key outcomes that are
Going to make a difference to to inequalities and populations within within shop tord Enrique I would also say you need to have Brave decision making that follows that data Le decision making so those about the enablers as a director of Public Health I would say three things to you I would
Say um best start in life in terms of narrowing Health inequalities nobody can argue with that and I think we’ve got evid idence that we are not giving the best start in life to many of our babies and children within and and the and back
To the point is within the gift of this room and I think that is within the gift of this room I think cvd and diabetes we have poor out outcomes cvd is what’s driving our life expectancy Gap in both shopa and in tord and Rin you have a primary prevention and secondary
Prevention interventions that within the gift of this room and I think last ly I would recommend thinking about yourselves as anchor institutions and what you’re doing in terms of their wider determinance I’ll leave it there brilliant thank you and Nigel how would you how would you like to um yeah having
Um having been invited by Simon to take on this portfolio um about three or four weeks ago um Orit um you know I I do lead on on this um you know through Katrina and Louise I I think I think there’s a couple of things and Liz and
Liz and Tracy did did mention this um I do feel um and so again I might be on my own jewy eyed but I do feel there’s been significant momentum over the past sort of six to 12 months on some of this um and I think that’s important not not
Just in terms of the way in which we’re talking about some of the programs of work but that we’re all talking about these programs of work and we’ just heard from you know Katrina from Patricia and uh and Tina you know there is there is active interest by all the
Boards for all the right reasons to make sure that we’re that we’re involved in it and we’ we’ve been talking shortly you know you know I know Kathy’s been asking that from a strategy committee perspective so I think that is really really important um and it goes to some
Of the the points that that Trevor and Roger have made about the role of this board and making sure we’re starting to talk about it this this is an important paper to come to the ICB to make sure that we’re talking about a key area
Which we know we want to focus on the second bit is I think from a planning perspective um certainly from the operational plan and and Liz alluded to it we have some pretty dictated areas of focus there um some of which come with some of which we
We crack on and do some of which come with non-recurrent funding which not necessarily is easy to confirm whether it’s continuing in others I know Asma is is one of those so there is ongoing dialogue between all of these different um different teams I think I was just
Going to respond to Eva slightly I know Julian was talking about the clinical engagement within within these programs let’s say maternity let’s say asthma let’s say others there is a there is a significant amount of on the ground clinical and I mean by that doctor therapy nurse you know other other
Different um trads um involved in this work and a huge amount of commitment I think the other the other bit if if I may and it does link to um The Joint forward plan it’s a it’s a significant priority within our joint for plan and
Long should it remain so I think the bit that uh Liz alluded to is one of the other pieces of work is yes we had the joint strategic needs assessment we had the the information and uh Paul talked about some of the some of the aspects
There we’ve got that but I think what we didn’t necessarily have was as agile a an an intelligence picture to start asking the so whats um and how best we focus our efforts and allow us to have that intelligence-led uh decision making the the world work that with Julie
Garide with others that and it was Illustrated here I know Simon you and I had a very brief um illustration of that a couple of weeks ago but my my recommendation is and and certainly I’m going to recommend it to to Katrina and Louise is that I think that is something
That boards need to be made aware that is there and there you know not necessarily go through it in the 4 hours but just an example of the utility of how that information is able to be used and then that will help us do that decision making in the way that I think
We need to so that that would be my thank thank you very much indeed I I just want to go back to the point about making sure that we’ve got a process that enables this this analysis this discussion to feed into um the planning work that’s taking place at the moment the planning
Prioritization Etc so um we we don’t lose it really yes really valuable did you want to come in on that point or yes please just leaning to the mic to see if it’s picking up my voice is can you hear me okay because I can’t get feedback
That I’m on the mic so in terms of the work that’s in appendix um 1A which is the Highlight report and all of those detailed plans they are fed in already into our commissioning intentions for 2425 um I’m also a member of the Planning Group and I lead on this piece
Of work so I’m taking the work that I’m cating as part of those highlight reports into the planning meetings so that there’s actually that um Handover between the two parts of our work and I think it’s a really important point that Health inequalities needs to be and I
Spoke about this when you when you spoke at the beginning have we improved I came nine months ago and and gave a report to this board which was very very very different to the report that you’re seeing today so yes we have absolutely moved we’ve moved in terms of
Leadership and that’s the leadership both around this board and in the individual provider boards and also the leadership of individuals so to the question are we being optimistic in terms of green well actually the individuals who are delivering on the ground these projects are very committed
To their work so those greens are greens and it’s a difference um in terms of those individuals who are really committed we heard the individual patient story of just how committed that me one member of staff was to ensure that she delivered on health inequalities so we need to make sure
That we are linking and not seeing Health inequalities as a separate thing that’s happening over here and isn’t part of part and parcel of our planning work and our priorities and the way that we currently doing that is by ensuring that I’m leading not only on the health
NHS Health inequalities but also being a member of that planning committee and commissioning intentions so just to give Assurance we’ve got a process by which I’m feeding back through the work that I’m cating and leading over into the planning processes that’s very helpful thank you very much indeed I’m I’m sorry
I’m going to have to I’m going to have to move the conversation on um rich though the debate is um um we we’ll be returning to this time and time again this is what an ICB should be about frankly and thank you for reminding us of that thank you for drawing uh issues
To our attention as you have done today um Liz this might be your last ICB board meeting I guess potentially aren’t you retiring at the end of March I shouldn’t look so happy should I no no you face we we we will miss your contribution let
Me just say on behalf of the board in case we don’t get a chance to do so again thank you for your contribution not just on this issue but on so many issues that we’ve had contact with you about over the years ccg days maybe even
PCT I don’t know how long you’ve been around ccg ccg um so we wish you a thank you and a very long and happy retire thank you very [Applause] much so if I ask for a round of applause about my timee keeping in the agenda I don’t suppose I’d get
One um I’m going to I’m going to ask for your forbearance and beg another half an hour of your time if I can please because we really do need to get through some of these other issues if you need to go you need to go I fully understand
But let’s see if we can get through the rest of the agenda or most of it within the next half hour moving on to the U integrated performance report Claire thanks Neil and uh yes there’s a challenge to try and get through this as quickly as possible there are some
Really significant challenges we’ve we’ve touched on a lot of the things that are in this paper uh already and uh a lot of the key messages that are contained in here will not be new messages for member of this board so um it’s no surprise that the two uh particular pressures that are
Highlighted are Urgent emergency care and finance um I will come back to finance uh as I walk through the headlines that I wanted to make sure board members were recited on because there has been a significant change uh in the position since the last time we
Met due to the uh reforecast that we’ve done but but more about that in a moment um I’m going to Rattle through some headlines it’s going to feel very much like I’m reading a list for for Pace um but actually there’s some really important highlights that I wanted to
Just make from from the very comprehensive content uh in the report and first of all for Primary Care just to note that we have an what an acronym PE carp measures Primary Care access recovery plan these are some really important measures that we will start to
Be pulling through in more detail uh for our committees to look at and for board to consider so uh it’s a watch this space for that but actually a really important development in terms of the reporting that that we’re able to bring here I then wanted to touch on some of
Our uh significant areas of focus particularly around performance and some of these uh board members will be very close to uh particularly around the reforecast conversations that we’ve been having um we are seeing significant positive variation across our elective and cancer targets I’m really pleased to
Flag that we are now achieving uh our faster diagnosis standards and our fit fit testing targets so Testament to the the work of the teams there equally our long Waits are coming down we are are confident in delivering 78 weeks at the end of March so there’ll be zero
Patients waiting more than 78 weeks Robert Jones I know uh have particular mention here because you’ve mitigated the risk Stacy uh of the four particular cases that you’d got um and we are on track to deliver a reforecast target for greater than 65 week weights as well
Which again is great news for for those people on those waiting lists we’re slightly behind plan overall on diagnostics but just worth a mention is Radiology which is delivering more uh than the target percentage uh for for six weeks uh well reducing over six weeks weights um moving to mental health uh
Children and young people mental health as well we can see improvements across all areas but I do still need to flag talking therapist which is quite a challenging area for us at the moment however I know that quality and performance committee received a report
On that last week uh and had a look at some of the recovery trajectories that have being put into place urgent emergency care I can’t avoid with it um we are not seeing uh significant signs of improvement there particularly around our over 1H hour ambulance weights the 4our A&E Target
And 12 hours in Department however um we have seen uh uh some improvements in our time to initial assessment and we are better than the regional average for the first time um so I think that’s worth a note there in terms of that Improvement um there was also a deep
Dive uh on urgent and Emergency Care again that went to our quality and performance committee um and we are seeing uh year-on-year improvements in quite a significant number of our metrics it’s just that we’ve still got a long way to go I did want to just mention Workforce
As well um in positive news our sickness and turnover rates are the lowest that they’ve been all year so we can see some of the actions that the teams are taking actually manifesting now and we just hope that we’re able to hold those and improve further where we can but that’s
Significant progress for us um and Dave you’ve already mentioned earlier the the uh htime equivalent numbers being over plan that’s one of the areas that we’re looking at as part of our 2425 planning and seeing if we can better refine really our estimates around those areas
Uh I think there’s been a propensity in planning uh to be quite prudent about how many people we can attract and retain through that process but we’re going to unpack that a little bit um through the through the work that we’re doing um I think we’ve still got some
Concerns in that area phes have note we seem to be having reducing numbers of Pharmacists across the patch uh we’ seen increasing vacancies for Allied health professionals as well so there are a few areas that I know uh our HR and OD colleagues will be particularly focusing
On uh Finance to mention as I say slight difference in the numbers that are physically reported now we have had our reforecast position agreed and accepted so the significant risks that we’ve been channeling through our paper for some months are now crystallized into the position so you will see us reporting
132.5 million forecast outturn and that’s inclusive of around3 million pounds cost of the most recent industrial action as has already been mentioned that is disappointing and certainly I know that’s something uh a sentiment that’s shared by all of us um it means that we do need to regroup on
The planning and I’m not going to open up all that discussion again um but it definitely gives us um that inferus to to to make that Improvement what I can say at this point after we’ve looked at our month eight and month nine numbers we’re doing a lot of work on run rate
Are we stemming the flow are we uh is our expenditure coming in in line with that reforecast position we’ve got a few ups and downs which is not unexpected but all of them are explainable and there are plans in place to take us through to the forecast to the end of
The year so there’s nothing that I need to flag either through finance committee or to board here at the moment we we’re sticking to to the plan for that reforecast I know there are still risks in those numbers for all of us and but we all have that commitment through our
Individual boards to make sure that that we hit that forecast position apologies this is really Whistle Stop finally um just a point of note really and an Ask of the board Neil um we’ve had a a request um from the national team uh if we would be interested in being being
Put forward as an Exemplar for our integrated performance reporting not for the content not for the content but for the report um and we actually have a an offer from the national lead for the making data count program uh to come and do a session with the board about how we
Use data and how we interpret it I would strongly encourage that we take that up obviously we need all we can get so that’s I’m sure we could all agree here’s how you create a big number present we present it very well yeah we do we we present it very well so
Fabulous I will I will take that away and we’ll organize that happy to pick up any comments I imagine people have read the papers in advance of the meeting um are there any questions any comments I mean we’ve had a couple of extraordinary um uh part two meetings where we’ve been
Discussing the financial position the financial plan for the rest of the year so I don’t prop to go into all of that by any stretch of the imagination but any any any comments any questions I’ve got krina just just a point uh just to offer a point of reassurance and
Clarification um in the quality section um of the covered note it was saying that sath prevented from doing deep cleans just to be sure uh we are are able to do deep cleans what we’re prevented from doing is doing a total program of annualized deep cleaning as as most hospitals would
Do with redecoration the 5 day decant award put it somewhere else but every opportunity we have every time a patient moves from where they are then our cleaners go in and they actually clean so the wording unfor is unfortunate it’s not preventing uh we do do it it’s just
I wanted to reassure the the board that the cleaning is being done it’s it’s the um it’s the Deep Clean Program of the whole world was meant to be annualized deep cleaning program that we most definitely should be doing but without decant capability we can’t to
Smoke and and that’s what I assumed when I read it but then I was I was making a connection between that is there something in the paper about some of our infection numbers are higher than they ought to be is there a correlation between it’s in the same paragraph Yes
So is there a direct correlation so a key action to keep SE clust Diffy under control is to do a deep cleaning program yes every year to get around each board DeCamp in an Ideal World completely de have a spare Ward completely DEC clean the ward and move the patients back
Again um now that is an ideal world that all trusts can achieve that anyway always got an empty Ward but even most just managed to do it partially um I know the Community Trust Robert Jones I the cent of a chief that uh this year on
Their on on their WS it’s been a real challenge at sath because of um U pressures predominantly um but there was some good news that at Christmas where well November industrial action period going up to Christmas where there was slightly less pressure there was some opportunity taken wasn’t there in Bay by
B some work done take every opportunity at every point of time to do a DE thank you to thank you um the one question I wanted to ask is I assume that for the ICB and for the NHS providers there is a there is a plan that shows how we’re
Going to deliver each each of us is going to deliver our part of the year end position and I presume Trevor that will be that will be shared with your Committee in terms of assurance Etc is that right we’re we’re mapping the the Run rate as I described it through the finance
Committee so uh if any of the individual Partners deviates from their reforecast position for the month um we ask for an explanation of why that variation has occurred and what actions have been taken against it so that will continue over the next few months you happy with
That Tre yeah I mean I I always worry when I hear the phrase that the number is at risk um because because we hear that right from month one basically in the annual forecasts but yeah I think they everything’s been looked at um okay there’s a there’s a strong sense that
We’ve got to hit that number now well I mean the point is we we’ve pretty much been given credit for the number we asked for um and therefore not to deliver it would be very very difficult indeed to be able to defend and and therefore it’s incumbent upon the ICB
And the providers particular to be absolutely on top of this every living minute to make sure we deliver it and and next year and Beyond’s another matter which we’ve talked about already okay anything else thank you um can I just say I’m sorry jul just on the papers just on just make sure
That we can double check some with the tables I think particular on the appendix B on the quality Rings is a bit missing so it’s particularly issue around the near natal deaths and saying sath have brought in an ly but the bit which says when the finalized reports
Due isn’t is being cut off the table cut off the pace just really just to oh well can we can we can we remedy that I mean not now but no yeah just I think people will be looking at that and we’ll say that’s a really good
Point all of the areas for there to be an admission um if you can pick that up yeah we’ll take a look at that that’s really helpful thank you okay um chief medical officer Chief no nursing officer report we thought it was about time that
We had this kind of report on a monthly basis um if Nick and Vanessa will forgive me I’m going to ask um assuming that people have read it rather than you introduce it if you think people would raise any questions what I have asked is for Vanessa just to give us a quick
Update on measles um which would normally feature in this report um but if you want to do that Vanessa yeah I can do and Li Liz is going to correct me I feel like I’m still in lizz’s territory um so um measles has been all about preparedness until really recently
When we started to see um a well we it’s moved up the m6 and we’ we’ve had a first case now inrupt T and Rin um so the um so all of our preparedness has been very um done as a system it’s been a a a group meeting since beginning of
December um really regularly looking at um how we um what we’ll do in um how prepared we are from the public health perspective in schools and Communications to schools how we doing with GPS and vaccination and most of our GPS have got over 85% vaccination rate
Um but actually 95% is needed to and some have got that as well um to um get her immunity um and then um we’ve also looked at with the cute trust worked very closely with John and Haley to get a pathway for the postexposure prophylaxis that’s needed for severely
Imun compromised people and we’ve got that kind of outlined but until you actually test it out it’s extremely hard so we did have the opportunity to test it out last week um and there was good Lessons Learned and some of it worked really well and some of it needs improving as
You’d expect with the first case um we’re meeting again tomorrow we meet every Thursday um and uh there was a big um incident meeting after the first case to try and make sure that we contain measles as much as you possibly can it is highly infectious it is not something
That you can do a quick clean afterwards and and it goes away it is Airborne and it is uh also very infectious for four days before you even get symptoms so um so really challenging um area um the um the numbers in the Midlands it’s too early to say whether they’re coming down
They’re not as bad as they were but sometimes you get a peak before the big peak so um so it’s really hard to say um Health inequalities is really important the cases that have been in Birmingham and the West Midlands wide world black country and comry in warshire have been
Very focused on areas of deprivation where vaccination figures are much lower so um there’s been calls to our um seven lowest GP areas bearing in mind some of the rate 5% so it’s not as low as areas of Birmingham but um just a just a supportive conversation to say you know
Is there anything else you need anything we can do to to increase this and aware aware it’s another ask of General general practice um there are conversations now starting to happen with um you know it do we need to do anything else around vaccination so you’ll have seen probably on the news
That black country W Hampton did a popup shop in the middle of the city center um as they did with CO as well um to um to try and attract people to get get immunization but two vaccinations is a absolute priority and all the numbers are about children under five because
That’s what we collect but that’s that’s the key to the door um and so it’s vaccination all the way thanks Vanessa Liz do you want to add anything to just I mean Vanessa said it all but it’s the promoting the MMR yeah if you haven’t had four wond and in
A sense we’re talking about um a long period of time but um uptake has been lower than what we would want and therefore you’ve got susceptible people at work as well as as children young people I was heartened to hear only yesterday in terms of one of
The C to the practices with the lowest uptake our health protection Hub was able to put them in touch with our their local school and actually you know try and do something between the school and the practice which is just a sort of partnership working which is is good do
You need us to do anything around this table as it I think taking the message back to individual organizations to prom promote MMR in your staff because actually healthcare workers with two vaccinations have got measles and we think that’s what the national auor is that perhaps um the vaccinations waning
By the time you get into your 30s and 40s whereas with younger children it’s much more robust if it’s not spreading in children should spread in adults so that’s the theory um so take that message back back check your vaccination rates amongst your staff promote it um all the way and have sensible
Conversations with parents really and primary care to try and increase up as much as possible I wanted to bring in Julian jul in the advice there also some big impacts on Primary Care in terms of infection prevention control and also the the the extra work that comes into
Primary Care part of the advice is that anyone who you suspect could have meal so you know a young child with a fever and anyone with a fever and a rashu in the unimmunized or partially immunized States needs to be treated in a different way and in theory the
Practices need to assess them with the latest gun they need full PPE including face vises and ffp3 face masks which is something that practices didn’t have during covid and don’t have now and I think it’s about the fact that I know those guidelines may change and they may
Become more practical about how things are done but there is a big pressure there in primary care and potentially a cost pressure around providing adequate PPP for staff one of the issues I know has been addressed today through Vanessa sending an email about um testing of practice staff because one is about
Knowing whether practice staff have actually most practice staff W have had may not have had two measles immunizations or may not know whether they’ve had two measles immunizations are looking at my immunization records on the NHS app I’m not clear I’ve had the reell and the mons but I don’t think
I’ve had the meas so we need serology and it’s about putting in an occupational health system for that if you’re subsequently in contact with someone who has measles and you’re unimmunized you need to have think andless already knows it better need to be absent from work from day four to day
24 is it something like that yeah something around 21 days is what I yeah yeah so you be away from work for three weeks so if you’ve then potentially got you know one or two clinicians in a practice or pediatricians in the hospital you know even more so who were
Absent for work for 21 days so I think why from a public health point of view and the prevention point of view the most important is clearly the immunization rates and reinforcing that I think the practicalities of the guidelines and how we actually manage these children and suspected adult cases
In Primary Care is is a big challenge so so just a question for public health if you like and you Vanessa and Primary Care do we is there any kind of M engagement communication program that we ought to be offering within STW or is it covered in other
Ways I mean it’s it’s very much being led by uks say yeah so there’s a central the schools vaccination Service as a Loi we’ve been putting out coms a lot of coms in terms of schools early years we are doing that but I think it would be
Helpful for the STW comms team to be working alongside to reinforce so we we looked we can that’s that’s I suppose what I was looking for any Gap and they’ve got the can sent the information can you can you pick that up yeah Simon and Vanessa thank you very much indeed
Um and we’ll keep that under surveillance um and and and don’t wait for next meetings if there are things that you need us to consider please yeah can ask one of question about something else in the report which I think Al needs Al it’s the 2.6 which is the
Independent inquiring the he for child sexual exploitation some of the um in the report it says that the the NHS actions or the health actions are ready for completion but then it’s not clear that then it comment relates to the two that aren’t one which is the fun around Sexual Health Services for
Public health and one relates to the trauma informed approach I assume there are the ones that aren’t ready for recommendation that’s right there and it say the wording in the report doesn’t read like that okay it says there are three ready and then it’s going to Comm
And then it says the two so one it’s about hearing about that obviously that’s a very significant issue but also just to make sure the report thank you thank you very much indeed um the good governance Institute governance review um again I assume people have
Read it um there’s been quite a bit of discussion about it outside of the meeting with committee chairs Etc um Simon there’s a clear set of recommendations and if you’re comfortable about me asking people if they’re happy with them rather than asking you to the paper you all right
With that I I am other than I would want to thank Alice and and colleagues for the work that they’ve done in terms of getting it to this point uh and to recognize that because I know it’s really easy to capture the paper but the work behind the scenes to make sense of
Then the report and put it in place cannot be underestimated so I just would want to thank Allison on and Allison will be delighted to put this to bed because it stop me nting every other week about where’s this report where’s this report good stuff so so the recommendations mer
Um I could I saw the rationale for staff related issues to go through the executive group um but it seemed it felt like there was a risk there that things could be um well if I say hidden that that’s a pejorative expression but um there didn’t seem to be any report required
Reporting arrangement from the executive group through to anything uh and it just felt important to me that we needed a bit more transparency around that so I think the terms of reference say uh it may report to the ICB um but I would have thought we we
Should say will or or or must or indeed um struck me that the audit committee might be a good one as well but um I just wanted that to be considered Simon are you happy with the use of the word will I’m yes so yes and we will agree
Which committee that best reports through as well yeah thank you thank you very much indeed can I ask one more question really because it’s role today Dr P it’s just and sure I’ve been reading the papers um but 2.45 which says about the system executive group it
Talks about the lack of clarity on membership purpose and how the group fits into the rest of the performance into the governance structure I then couldn’t quite see any further mention later on in the report about what they’re recommending doing with the the system executive group I see what
They’re doing with the ICB executive group there’s a there’s a chart isn’t there and there’s a chart for the ICB committees but there doesn’t seem to be any further comment about what they recommend about the the system executive group as in the system transformation group or the ICB well
System executive group just just point me to a section 2.45 2.4.5 which is Page 253 of the pack and I assume that’s the way you meet with the other Chief execs and are you in the appendices in appendices yes so have you read all 390 pages of the
Appendices as well I know I have to ad I didn’t read all that garbage about the specialized commissioning Stu and there was hundreds of pages of that that is not even I’ve got time today read that I’m pleased I’ve met somebody who’s taking almost Simon do you want me to
Answer that because I think so go for it yeah so the the GGI described the system executive group that’s the group of Chief Executives that currently meet but they’re not part of any formal decision making process what the GGI propos which is what I’m suggesting we accept is that
Actually that is partially translated into part of the formal governance process as an interim measure um IDC Falls away the majority of what IDC is currently doing passes to the system transformation Group which is the chief Executives meeting as a formal part of the governance structure but that’s on
An interim basis because obviously there’s an assumption that provider collaboratives will move into that space and that there will be different excuse me governance processes to to f to to support that in the future yeah my worry was that was where a lot of
The not work at all where a lot of the sort of you know combining and collaboration is done is in that group currently to so to see that mentioned then to not see it mentioned again I thought well actually so the change in title and where it was picked up
Elsewhere it was that b jul that’s the pulling out un Harry chair of IDC yeah I mean I it makes perfect sense it’s sort of two stage approaches to get to where you want to get makes perfect sense and I think the point is about what goes there what goes there is the
Right stuff but the problem is it’s who goes there is the problem and by change to the system group you have the right people in the table Katrina um I I continue to have a concern that the people committee is is a strategic committee and not an insurance commit
Um I appreciate the uh the the rationale at the moment for some aspects of that but I’m just wondering if we’re missing an opportunity to actually think um about the people aspects of it um with a much uh more robust Assurance framework than I can than I can currently offer as
The chair of a provider been a lot of under a strategic framework so myself and Stacy met on Monday with HR colle and one of the actions from that Katrina was for the two of us to pick up a conversation with you to work through exactly that so that we could come back
With the updated more robust approach in terms of that space all right you can be assured then that I won’t fight the solution good you haven’t seen what I’m proposing but I’m pleased to I’m pleased to minute it at that point anyway I I think we are missing missing
A trick within today’s NHS regarding culture etc etc that it’s not seen as anur Comm that’s um that’s good stuff and thanks again Allison I’m I’m just riding over your final comments on that because it sounds like there’s a solution in the making and some dialogue which we’re in agree we’re in agreement
In terms of that Assurance because as well as a strategy okay thank you very much indeed now the committee reports I think I should have the last word the committee reports um as is my want I’m assuming you’ve read them all and unless the committee chairs who present that’s Trevor and Kathy and
Katrina and Harry more than I thought for a moment and un yeah unless there any particular points you want to draw to our attention given that we’ve covered a lot of the territory anyway during the course of the meeting um I propose that we note the contents of the
Various reports you happy with that Harry yeah Meredith happy with that Katrina y Trevor Excuse me yes and C yes brilliant thank you all very much indeed so um is there any other business the date and time the next meeting is currently um um publicized the 27th of March but there’s a
Potential issue with that which our office is ringing around about about that at the moment so we’ll confirm or otherwise that at the moment and um we finish on time I’m sorry for for that going on so long but actually we we discussed some really important issues and I thought we
Had some very good mature discussions about them so thank you all very much indeed for your contributions and I’m sorry if I’ve kept you away from your next appointments that includes you Mr Turner because you and I Simon have got I know we we we have another probably
Brief meeting that well maybe not brief okay thank you very much indeed everybody