On Wednesday 29 November, the meeting of NHS Shropshire, Telford and Wrekin (STW) Integrated Care Board was opened by Chair, Sir Neil Mckay, who started the meeting by acknowledging the intense sadness in relation to the death of the four teenage boys who tragically died the week before in a road accident and offered his deepest sympathy to the families and friends involved on behalf of NHS STW.  

Sir Neil congratulated Simon Whitehouse for being appointed Chief Executive of the NHS STW, Jacqueline Small in her new position as chair of Midlands Partnership University NHS Foundation Trust and Vanessa Whatley, as the new Interim Chief Nursing Officer. Sir Neil also wanted to recognise the work of Alison Bussey who is retiring from her role as Chief Nursing Officer and wished her the very best for the future.  

Before delving into the details of the agenda and some of our key challenges, Sir Neil wanted to acknowledge how all organisations are working incredibly hard to develop and agree the winter plan, as well as change the course of our financial position and noted the huge amount of work that is happening behind the scenes. 

Patient’s Story: Armed Force Covenant 

Following the signing of the Armed Forces Covenant earlier in the day, Gareth Robinson presented a veteran focused resident story. Sarah Kerr, Shropshire Armed Forces Outreach Support Co-ordinator talked on the video about our STW veteran community, the barriers for people identifying themselves as a veteran and the benefits of more GP practices becoming veteran friendly. In STW there is a population of nearly 22,000 veterans, with three military bases which includes a large number of service personnel and their families. Later in the video Bob Adams, a 90-year-old Korean War veteran, and his wife Sue from Shifnal spoke about their experiences of accessing healthcare in STW. To listen to the video in full, please click here. 

ICB CEO Update Report  

Simon Whitehouse, CEO, presented his report highlighting Operation Lazurite (lead by Shropshire Council) which has meant the repatriation of c250 Afghanistan’s who worked with British forces to Britian from Pakistan. A temporary site has been identified at Nesscliffe Training camp for these citizens whilst we work to house and integrate them into the UK. Simon thanked everyone involved for the speed of mobilisation, the support and collaborative teamwork. 

Simon updated on the latest position of right-sizing NHS STW (a national mandate to reduce the running costs of the organisation by 30%) - the programme is well underway, and his intention is to present a more detail paper about the operating model at the January Board before we enter a formal management of change consultation.  

Simon expressed his delight at reaffirming our commitment and signing the Armed Forces Covenant earlier in the day. He recognised and celebrated the work for Allied Health Professional Day and Black History Month across the system, however, commented that he thought as a system we could work better collaboratively in this area to maximise our voice and reach. He updated on the important Provider Selection Regime guidance that moves NHS providers and commissioners away from significant competition in terms of procuring and tendering and moves us into a collaboration and integration space.  

Simon noted the recent recognition that the NHS STW Communications and Engagement team were awarded at the Public Relations and Communications Association (PRCA) Awards for the Public Sector Best Value for Money Award for the ‘Think which service’ campaign and being highly commended for the Public Sector in-house team of the year.  

Simon concludes by highlighting the governance review of the ICB and ICS governance meeting structure which is taking place by the Good Governance Institute (GGI). He hopes to bring a report back on the GGI review to the January Board. 

Hospital Transformation Programme (HTP) 

Louise Barnett, Chief Executive at Shrewsbury and Telford Hospital NHS Trust (SaTH), noted that HTP is a key programme for SaTH and the system as a whole before handing over to Matthew Neal, Director of HTP and Dr Ed Rysdale, Clinical Lead for HTP to provide an update on where we are in the process, latest developments and next steps. 

Matthew updated that the Outline Business Case (OBC) had been submitted to Government for approval in line with the HTP programme and that, the Full Business Case (FBC) is expected to be submitted this Winter in order to move into the process of implementation. There was a recent announcement in Parliament around the funding for the FBC and enabling works, and the start of the enabling work is imminent. Dr Ed Rysdale, then gave an overview of the clinically led changes at both hospital sites with Princess Royal Hospital, Telford being the site specialising in planned care and the Royal Shrewsbury Hospital, Shrewsbury being the site specialising in Emergency care. 

In terms of next steps, the Trust is currently looking to secure planning permission for building works at the Royal Shrewsbury Hospital site, and there is continued public engagement, particularly around travel and transport, as well as aligning the programme to the local care programme.  

Winter Planning  

Gareth Robinson, NHS STW Director of Delivery and Transformation presented the system winter plan and welcomed discussion from the Board. He noted that although this was a ‘Winter Plan’ many of the actions had been implemented throughout the year. A key area he wanted to highlight to the Board was the current bed deficit due to an increase in demand, the virtual ward delivering a lower impact on acute beds than anticipated, a slight delay to the sub-acute ward from December 23 to January 24 and an in-year deterioration of no criteria to reside patients. This has led to a short fall of 91 beds in November, which will reduce to 30 beds in March. His paper sets out a series of interventions that are planned by system partners which can improve the bed situation by +110 beds, however, some of these interventions we have already been working on through the summer with mixed success. Therefore, it’s important to highlight the interventions may only partially deliver some of the beds which will result in difficult choices about how to care for patients.  Section 4.4 in the Winter Plan sets out the implications of these options such as caring for patients in unconventional care areas, for example, fit-to-sit areas, where the evidence shows the clinical risk increasing if patients remain in these settings. The other additional option is to deploy the full hospital protocol which results in the cessation of elective activity. The Board went on to discuss the challenge.  

Simon recognised the pressures the system has been under and continues to be under and acknowledged the relentless hard work of all system partners to improve. He noted the lengthy discussions he had at system Chief Exec level and a number of actions that had arisen to help mitigate the risk and ensure we have considered every opportunity. It was agreed during the Board that the Urgent and Emergency Care (UEC) Board would have delegated responsibility to work at pace to reduce the bed gap and Simon asked the system to respond collectively to help find solutions. For speed, the UEC Board was asked to present their recommendations to the next Chief Exec Group for sign-off on behalf of the Integrated Care Board ensuring the Board is sighted on any risks. 

Local Care Programme and next steps in Place Development 

Patricia Davies, SRO for Local Care Transformation Programme gave an update on the programme and asked for the Board’s approval on the six recommendations outlined in the paper to support the strengthening of place with the system architecture which would help to create a local and sustainable delivery framework to deliver the local care programmes, providing clarity over appropriate responsibilities and accountabilities that sit with ‘place’ or system. It was also noted that the Provider Collaborative is a vehicle to support this work and that the local care programme needs to be adequately resourced for its successful delivery. It was acknowledged by the Board that there needs to be debate over what needs to be delivered and what doesn’t, the consequences and the benefits, what the financial implications of these potential operating models may be and then what work is prioritised moving forward.  Nick White, NHS STW Chief Medical Officer, commented on the need to focus on prevention and proactive care in STW. 

Sir Neil concluded that by the end of Q4 actions needed to be scoped out, prioritising the delivery with a clear timeline, looking at the support and resources required for the programme delivery, with a review of the strategic financial investment focusing away from remedial and acute services and more toward community-centred prevention models of care. 

System Board and Assurance Framework 

Alison Smith, Director of Corporate Affairs, presented the System Board and Assurance Framework and stated that it had been aligned with the new objectives outlined in the Joint Forward Plan. She gave assurance to the Board that the System Board and Assurance Framework and the Strategic Operational Risk Register have now been shared with the ICB committees so that assurance can be taken through the committees on behalf of the Board. 

Integrated Performance Report 

Claire Skidmore, Chief Finance Officer, presented the Integrated Performance Report highlighting two significant performance challenges as a system – urgent emergency care (UEC) and finance. 

Finance, at Month 7 the ICS has a deficit of £89m, which is £44.5m adverse to plan, a variation from in-month plan of £10.5m in Month 7. NHS England has given the ICS a target to reduce their deficit to £57million. A recent letter from NHSE asking all systems to review financial outturn (FOT) positions is currently being worked through at a system level, with a number of options being considered but no firm agreement yet. 

Claire wanted to highlight some good news, in particular the Community Diagnostic Centre which has now gone live; for cancer, there has been significant improvement in the Faster Diagnostic Standard and for the first time, the system is now ahead of our trajectory; FIT testing – STW is now one of the best in the region for performance standards; and there are slow and steady in improvements in Mental Health services. 

Claire noted the challenges in UEC and highlighted the good work in relation to elective waiting times and stressed the importance of protecting this activity not just for our patients but also because STW has a large amount of additional income tied to that activity which will help achieve the financial plan. Patients are waiting a long time on ambulances and in ED departments; there was some improvements in Q1 but there has been a deterioration in Q2 and Q3. The UEC improvement programmes are looking to focus on this, so there needs to be a focus on efficiency, productivity and building a sustainable workforce in order to help achieve targets.  

Roger Dunshea, Non-Executive Director of NHS STW commented that overspends were usually driven by one of three things – being underfunded, if unit costs are high, or if the system is outperforming. He noted as a Non-Exec Director perspective it is difficult to know why there is overspending. He asked at future Board meetings if this could be drilled down into so the board can look to see why there is overspending.  

Amendment to the Governance Handbook 

The Board approved the proposed amendments to the Terms of Reference and the scheme of Reservation and Delegation for the Audit Committee and the ICS People, Culture and Inclusion Committee.  

System Level Primary Care Access Improvement Plan 

Gareth Robinson presented this paper and highlighted that it has been through all the system Boards including SHIP and TWIPP, and it is also scheduled for Shropshire’s HOSC and JHOSC. The plan sets out the requirements for the recovery program within the national context but also the local ambition to improve access to General Practice, maintain and improve patient satisfaction, and work to streamline care and advice. The plan builds on 4 key pillars of work: 

1. Empowering our patients – roll out of the NHS App, increase self-referral and increase usage of community pharmacy
2. Implementing Modern General Practice – improving digital and online access
3. Building capacity – workforce and estates
4. Cutting bureaucracy – improve primary/secondary care interface. 

Julian Povey, Chair of the GP Board, noted the paper highlights the rising demand on primary care and the rising number of required appointments. Nigel Lee also noted the paper presented at the ICS strategy committee, ‘the GP Strategy’ which looks at doctors at all stages of their careers and how it needs to work alongside this plan.  

The Board accepted the Primary Care Access Improvement plan, but noted there is more to be done in terms of Primary Care staffing supply and demand and should ensure the GP strategy sits with it.  

Board Committee Reports 

No issues were raised from the Board Reports. There was an ask from Roger that now a Board Assurance Framework is in place that the audit committee of the ICB and all organisations look for evidence of it working.   

The next public NHS Shropshire, Telford and Wrekin Board will be on Wednesday, 31 January. 

To view the full agenda and papers from the Board meeting or to view the recording of the meeting, please click here.