Agenda and minutes

To receive any apologies for absence

Apologies for absence were submitted from Graham Ebers, Councillor Graham Howe, Steve Moore and Susan Parsonage.

To confirm the Minutes of the Meeting held on 14 October 2021.

The Minutes of the meeting of the Board held on 14 October 2021 were confirmed as a correct record and signed by the Chairman.

To receive any declarations of interest

There were no declarations of interest.

To answer any public questions

A period of 30 minutes will be allowed for members of the public to ask questions submitted under notice.

The Council welcomes questions from members of the public about the work of this Board.

Subject to meeting certain timescales, questions can relate to general issues concerned with the work of the Board or an item which is on the Agenda for this meeting.  For full details of the procedure for submitting questions please contact the Democratic Services Section on the numbers given below or go to www.wokingham.gov.uk/publicquestions

There were no public questions.

To answer any member questions

There were no Member questions.

To receive an update on the Wellbeing Board Steering Group.

Ingrid Slade, Consultant in Public Health, provided an update on the Wellbeing Board Steering group.

During the discussion of this item, the following points were made:

·       Following the approval of the Wellbeing Strategy in Autumn 2021, the next step was the agreement of a governance structure around strategy into action.

·       The Board was reminded of the Strategy’s five overarching priorities and the underpinning Wokingham priorities beneath each of those. 

·       Action Groups and Partnership Boards would take the lead on specific priorities and would be reporting to the Wellbeing Board on what action they had taken. 

·       It was proposed that the health inequalities priorities become cross cutting in the Strategy.  The Health Inequalities Action Group was currently on hold and the Group had asked that the integrated and cross cutting nature of health inequalities across all Action Groups be considered, and that there be a focus on health inequality for each of those groups.

·       Ingrid Slade presented the intended structure.  It was proposed that a new Steering Group be set up between the Wellbeing Board and eight delivery groups. 

·       The Steering Group would provide operational oversight of progress against action plans and to identify any exception reporting that required escalation to the Wellbeing Board.

·       The Steering Group would meet bimonthly in place of the informal Wellbeing Boards.  At each meeting four of the Action or Partnership Groups would report against a defined action plan, allowing performance and/or delivery risks to be raised or areas of best practice highlighted.  This would enable the Steering Group to monitor performance, quality and progress made.  The Steering Group would ensure the operational delivery of the Wokingham Strategy into Action.

·       With regards to membership, it was proposed that it be the same as the Wellbeing Board membership or an appointed representative.  In addition, a Primary Care Network Director member, health provider representatives (Royal Berkshire/Berkshire Healthcare), other service providers e.g MIND/Cranstoun, and a secondary Headteacher representative, would be sought.

·       Katie Summers, Director of Place Partnerships, NHS Berkshire West CCG, questioned whether the Chairmen of the Action Groups would be members of the Steering Group and was advised that they would be reporting to the Steering Group but not members.  Consideration was being given to the creation of an operational group for these Chairmen.

·       With regards to the secondary Headteacher representative, Helen Watson, Interim Director Children’s Services, indicated that the Borough Education Partnership had now been established and would be meeting shortly.  She offered to seek a nomination from the Partnership for the Headteacher representative.

·       Katie Summers offered to help source appropriate representatives from the Royal Berkshire and Berkshire Healthcare NHS Foundation Trusts.

·       With regards to the Primary Care Network Director representative, Ingrid Slade indicated that the Wokingham Integrated Partnership would be approached about a PCN representative.

·       Councillor Margetts questioned when the Steering Group membership needed to be finalised and was informed that it was hoped that the Steering Group would meet for the first time in March.  Whilst it was hoped all representatives would be  ...  view the full minutes text for item 28.

To receive the Wokingham Integrated Partnership Better Care Fund Annual Plan 2021/22 presentation.

The Board received a presentation on the Wokingham Integrated Partnership (WIP) Better Care Fund Annual Plan 2021/22.

During the discussion of this item, the following points were made:

·       NHS England had released the submission template in September, and the final version had been agreed on 16th November, following the agreement of the Chair of the Wellbeing Board.  It was essentially a formalisation of the Plan and budget agreed earlier in the year.

·       During the development of this annual return the Integration Team had liaised with colleagues from the CCG, BHFT, RBH and the other West of Berkshire Local Authorities.  Overviews were shared with all the WIP partners at delivery group (operational managers) as well as Leadership Board (Senior managers).

·       The return submitted to NHS England had been judged to be sound.

·       All the minimum financial contributions had been met as had all of the national conditions.

·       Some of the services currently funded by the Better Care Plan were highlighted.

·       Lewis Willing, Head of Health and Social Care Integration, informed the Board of targets identified.  The first, admission avoidance, was a change to the target around Non-Elective admissions.  A target around Length of Stay had replaced the target around Delayed Transfers of Care. 

·       The unplanned hospitalisation for chronic ambulatory care sensitive conditions aimed to get to the heart of the work of the Better Care Fund, and ensured that the partnership was supporting people in the community who would not necessarily require hospitalisation.

·       With regards to Length of Stay, the percentage of in-patients, resident in the area, who had been an inpatient in an acute hospital for: i) 14 days or more ii) 21 days or more as a percentage of all inpatient, was monitored.

·       The targets were very challenging but achievable.  NHS England were keen to keep levels of performance high, especially as during the pandemic, unplanned hospitalisations and length of stay were very low. As such, they had pressed to ensure that targets were challenging.

·       Other targets around discharge to normal place of residence, residential admissions and reablement, were highlighted.

·       Due to Covid, the performance was very good against the long-term placements piece.  Fewer placements than in a normal year were being made, and the Partnership had challenged itself to drop from 12 placements per month to 9.6 placements.

·       Each local authority was required to complete a narrative plan.

·       It was noted that Housing would become more involved in the discharge process.

·       Councillor Hare questioned how it was ensured that patients were being discharged at the right time.  Lewis Willing referred to the targets of keeping people in hospital no longer than 14 and 21 days so that they did not become ‘stranded’ or ‘super stranded’ in hospital, and the target that people were still at home 91 days after having been released from hospital.  The Reablement team helped people to stay independent in the community.

·       Councillor Hare noted that the 91 day target was the ‘Proportion of older people (65 and over) who were still at  ...  view the full minutes text for item 29.

To receive the Developing our Integrated Care System - Discussion with Wokingham Borough Wellbeing Board presentation

This item was considered as the final item on the agenda.  A 15-minute adjournment was held to enable presenters to be able to attend the meeting virtually.

The Board received a presentation on Developing our Integrated Care System (ICS) from Catherine Mountford, Director of Governance at Oxfordshire CCG and governance development lead for BOB ICS.

During the discussion of this item, the following points were made:

·       Conversations around the development of the ICS were still at early stages.  The input of all partners into the development was sought.

·       The change in structure was based on the Health and Social Care Bill which was progressing through parliament.  Amendments were being proposed at the various stages, so the final position was not yet fully known.

·       Statutory status had been put back from 1 April 2022 to 1 July 2022.  However, the System would take 12-18 months to evolve and to be fully functioning.

·       The forthcoming structure had been built on several years of discussion from the NHS Long Term Plan and the commitment to needing to work more in collaboration and with integrated services.

·       The four goals of the ICS were:

Ø  improve outcomes in population health and healthcare;

Ø  tackle inequalities in outcomes, experience, and access;

Ø  enhance productivity and value for money;

Ø  help the NHS support broader social and economic development

·       Catherine Mountford outlined some of the key terminology:

Ø  Integrated Care System (ICS) – the whole System across Berkshire West, Buckinghamshire and Oxfordshire, including local authorities, provider Trusts, Healthwatches, practices and the Primary Care Networks.

Ø  Integrated Care Partnership (ICP) – joint committee with local authority partners.

Ø  Integrated Care Board (ICB) – NHS statutory body within the System.

Ø  Place Based Partnerships – local working though partnerships based at a Place level.

·       From July 2022, the CCGs would no longer exist, and the CCG staff would TUPE across into the ICB.

·       The System was made up of three Places (Buckinghamshire, Oxfordshire and Berkshire West).  Unlike some other South East ICS’ there was not a single point of focus.

·       The overall System would create strategy and delegation, whilst most care would continue to be managed and delivered at Place level.  Place would manage pooled budgets and deliver on Urgent and Emergency Care (UEC), Long Term Conditions (LTC) and integrated care.  Localities would deliver on inequalities.  Consideration would need to be given on how Provider collaboratives would deliver services beyond a specific Place.

·       The NHS wanted to work with partners to evolve the System and Place, and to discuss where it would add most value for integration and delivery to be at a local level and where it would best add value to work at a wider System level.

·       The Unified Executive in Berkshire West already brought together partners who were delivering on integrated care.  This would evolve in to the Place Based Partnership for the ICS, and could be a subcommittee of the ICB, meaning that authority and autonomy could be delegated to that committee, enabling it  ...  view the full minutes text for item 30.

To receive a report regarding the Refresh of the Berkshire West Local Transformation Plan, improving the response to Children and Young Peoples Emotional Wellbeing and Mental Health.

Nikki Cartwright, Interim Director of Joint Commissioning, NHS Berkshire West CCG, presented the refresh of the Berkshire West Local Transformation Plan, improving the response to Children and Young People’s Emotional Wellbeing and Mental Health.

During the discussion of this item, the following points were made:

·       The refresh had been published in September 2021.  The document built on the 2019 plan and provided an update on what had been achieved so far; local need, trends and the voice of children and young people and the parent/carer; the commitment to understand that further work was required; and resources required.

·       The goal overall was to reduce the number of children and young people and their families whose needs escalate and require specialist intervention, a crisis response, or an inpatient admission.

·       The Transformation Plan had been refreshed in line with the requirements of the NHS 10 year Long Term Plan.

·       Nikki Cartwright outlined what the successful delivery of the plan would look like, including that good emotional health and wellbeing would be promoted from the earliest age and that poor mental health was prevented wherever possible, and that children and young people were as emotionally resilient as possible.

·       The Board noted the refreshed transformational priorities, including building a formal delivery partnership arrangement, and tackling waiting lists in both specialist and core CAMHS.

·       During Covid an increase in eating disorders had been seen, which put pressure on services.

·       Two further Mental Health Support Teams were being mobilised.

·       The Board noted the project updates.

·       Councillor Margetts requested that the presentation slides be circulated to the Board.

·       Matt Pope, Director of Adult Services, commented that children and young people’s emotional health and wellbeing was one of the priorities within the Strategy into Action Wellbeing Plan and that there was an action plan and governance attached to this.  He questioned how the action plans and governances were working together or whether further discussion was required on the matter.

·       Helen Watson indicated that the Children and Young People’s Partnership would welcome the presentation.  She welcomed the breadth and depth of the work undertaken.  Helen Watson went on to question whether the Transformation Plan would have sufficient coverage to tackle the increased demand resulting from Covid.  Nikki Cartwright stated, along with the local authorities, increased capacity had been put in place around Kooth and eating disorders.  There was an eating disorders recovery plan in place which did address the impact of Covid.  She emphasised the need for continued monitoring and partnership working.

RESOLVED:  That the refresh of the Berkshire West Local Transformation Plan, improving the response to Children and Young People’s Emotional Wellbeing and Mental Health, be noted.

To consider the ICP Unified Executive report.

The Board received the ICP Unified Executive report.

During the discussion of this the following points were made:

·       The ICP Unified Executive had met that day.  However, the Chair’s report contained within the agenda had been carried over from December’s meeting.

·       Matt Pope highlighted the ICP priorities for 2022/23.  A lot of work had been undertaken to align those priorities across Berkshire West with priorities in the Strategy into Action Plan and the Wokingham Integrated Partnership.

RESOLVED:  That the ICP Unified Executive report be noted.

To consider the Board’s work programme for the remainder of the municipal year.

The Board considered the forward programme for the remainder of the municipal year.

RESOLVED:  That the forward programme for the remainder of the municipal year be noted.