The Walsall Together Partnership Board meet on a monthly basis.
The meeting is held in private and a highlight report goes to the Walsall Healthcare NHS Trust Board each month for asurance.
A copy of the highlight reports can be found below.
Board was briefed on the highlights in February’s operational data. There has been an easing of pressures and a reduction in demand for out of hospital pathways. Referrals for complex discharge support had increased, but despite this, the numbers of people at the Manor who were medically stable for discharge reduced by around 20% from January 2023. The Board was alerted to discussions within the Partnership around funding for out of hospital acute and discharge pathways in 2023/24.
Board was assured that CPLG has full oversight of the development of an outcomes framework for the partnership and were informed that there has been significant progress made with the diabetes and end of life priority areas. The Partnership with Commissioners are making the first steps of transition to an outcomes-based contract for Walsall Healthcare NHS Trust (WHT) community services. A Service Development Improvement Plan (SDIP) is being drafted as part of the 2023/24 Community Contract where this transition will take place with a commitment to embed in the contract agreement for 2024/25.
The final report of the 2022/23 programme was presented along with confirmation of those projects that would either transfer to the 2023/24 programme or be closed down during quarter 1 of 2023/24. The Board approved a recommendation from the CPLG for the 2023/24 programme and took assurance that adequate resource was available within the central programme office to support delivery.
Board approved the paper for circulation across the partnership.
A series of workshops have been held by the Integrated Care Board (ICB) to confirm the operating model, governance arrangements and finance and contracting frameworks for the 2023/24 financial year and the recommendations from those workshops will be taken to the Integrated Care Board at the end of March. The position is intended to be interim for 2023/24 and partnerships across the Black Country system will be part of further developmental work in early 2023/24 to continue to shape this work. A joint letter has been drafted and sent to the ICB on behalf of the 4 places with the Black Country. The letter indicates that without additional ongoing investment the good progress can no longer continue. Discussions are expected to continue with the ICB into quarter 1 2023/24.
Board Development Equality, Diversity and Inclusion (EDI)
Board members received an overview of work happening within the Council’s Walsall for All programme, demonstrating the links between EDI, health inequalities and community cohesion. There will be a series of further discussions in coming months, supported by EDI leads at WHT, to agree a partnership commitment to EDI. This will: build on the commitments already in place across statutory partner organisations to the race code charter; support smaller organisations to identify elements of the race code that can be adopted within their capacity; maximise opportunities to build capacity and cohesion across our wider communities.
A staff story was presented to board members from the lead EDI (Equality, Diversity and Inclusion) midwife. The presenter shared some of the work done to engage with communities to try and release barriers to accessing services and increase the uptake in essential antenatal services. Board members were impressed with the work achieved by a single person and offers was made from multiple partners to collaborate on some communications, potentially extending the scope of the model and assisting with evaluating and monitoring outcomes. Formal connections will be made and the board agreed to have a dedicated session looking at EDI within all aspects of the partnership.
Board was briefed on the last few weeks and the sustained pressures on operational services, increased due to the strep A concerns in children and the increase of covid and flu cases in adults. Board was informed of the mitigations implemented to help deal with the additional pressures as well as the ongoing active conversations to try and secure funding for those implementations to help manage demands. Board took assurance that the appropriate actions are in place to mitigate the issues.
The board received assurance that the transformation programme is making progress. Due to the timing of reporting therefore not included in the transformation exception report, temporary funding has now been secured for the mental health workers within the Family Safeguarding Model. February’s paper will see that project deescalated back to on track.
The communications brief was presented to board members and key items were highlighted. A formal announcement was made to board detailing the appointment of the new Group Executive Director for Place.
Place based governance
Board was presented the latest update on the place-based governance arrangements. Formal confirmation of the operating model is still outstanding and there is no additional update on the proposed areas of delegation on the 1st April. Good progress is being made within each of the workstreams and the board approved for the Partnership Management Committee to transition into the Joint Planning Group. The ICB has approved for funded protected learning time for general practice on a quarterly basis. Board took assurance that the partnership would be able to accept the additional responsibilities from April if required.
Due to the amended date of the partnership board the report provided included operational data from October. Board was briefed on immediate operational pressures in the system including an increased number of acutely unwell patients requiring hospital interventions and enhanced packages of care on discharge also impacting on available finances. Additional pressures are presenting in children with the strep A concerns and mitigations are being investigated with the Walsall Together tactical command meetings reviewing regularly. Board took assurance that the appropriate measures are in place to minimise operational strains.
The board received assurance that the transformation programme is making progress and that there are no new risks to report.
The monthly communication brief was approved for circulation subject to the addition of the news that whg has been shortlisted for a Health Service Journal award for the collaborative work with Walsall Together and the Integrated Care Board (ICB). It is nominated in the category: best not-for-profit working with in partnership with the NHS.
Place based governance
Board was presented with an update on the place-based government arrangements. Approval was requested for a list of ICB services to be considered by the Joint Commissioning Committee and ICB for delegation on 1st April to the previously approved place-based governance arrangements. Delegation would be made to the Walsall Place Integrated Commissioning Committee (PICC), via the ICB appointed Managing Director for Walsall. Partners discussed the papers and expressed concerns in relation to resourcing the additional responsibilities associated with delegation. Board was informed that resource requirements are included in discussions with the ICB yet noted the risk was not fully mitigated at this stage. Board approved the list in principle subject to additional conversations with partners absent and noted that there would be a lot of work required in order to gain approval and ensure the relevant supporting structures are in place before 1st April. The Board agreed that, irrespective of whether formal delegation is received, the partnership will look to establish the necessary governance arrangements to operate in shadow form from 1st April.
There was no board meeting held in November 2022.
The board received assurance that the transformation programme continues to make progress with no significant risks to report.
Board was assured that work to implement the objectives of the place development programme continued in line with the agreed plan. Following approval of the high-level governance model for Walsall place, discussions remained in progress to seek formal approval from the Integrated Care Board and Cabinet.
It was agreed that there would be a Board away day on 9 December to review place-based arrangements and confirm priorities for 2023/24.
GP engagement event (held in November 2022)
An event was held for GPs and practice staff to brief them on the role of Walsall Together and provide them with examples of current and future partnership working. The event was jointly chaired by Dr Anand Richie and Patrick Vernon and was attended by over 100 people.
The session provided an opportunity to consider the collaboration agreement between primary care and Walsall Together. Practices had the opportunity to articulate what they sought from working with the partnership and how their needs could best be addressed. The Walsall Together Partnership Board will consider the outputs from this session at the away day in December.
August has seen an increased delay in discharges for out of areas patients. The issue is being addressed and connections have been made with neighbouring Trusts to address the issue. The funding of virtual wards is another area to highlight within the report.
Cost of living
A comprehensive report was shared with board members on the cost-of-living crisis drafted by the Resilient Communities Steering Group. The paper detailed areas and schemes that the partnership can link into for little or no funding and additional schemes where funding was requested. The paper highlighted the high levels of deprivation within the borough and how to date government interventions will have little impact for the residents and communities.
The paper included priorities and principles with support and dignity at the heart of the suggestions. A recommendation to board was made to approve the following schemes, Food clubs, Growing healthy in Walsall, Library of things and warm hubs. The board had an in-depth conversation on the proposal, and it was agreed to provide residents with coordinated communications of where and what support is available, to explore the flexibility of local funding across partners to support the schemes and therefore the paper was approved by the board.
The Board were presented with a user story from a couple from Darlaston who between them have established two support groups for the community. Those groups are an amputee support group and a diabetes group. The couple shared their personal experiences of dealing with amputation, diabetes and the lack of support available from statutory services. The group works with amputees and their families providing practical and emotional support and have an ambition of extending their reach with the help of the partnership. A request was made to help with sharing and promoting their groups within GP surgeries, help upgrading their website, and potentially help creating a signposting directory. The board agreed to help where possible and agreed that an agenda item to explore diabetes is required.
The board received assurance that the transformation programme is making progress and that there are no new risks to report and of the two outstanding programmes in exception there will be a detailed update on the Shared Care Record.
Shared care record update
Board was given an update on the delays to the implementation of the Shared Care Record. Colleagues from the ICB were in attendance to explain the delays. Several components are required to ensure the legal implications are addressed and successful execution of the plan. Walsall are ahead of neighbouring localities and have completed all their sign up and members requested a revised timeline of implementation. The board were reassured that implementation is very close and updates will be given as soon as available.
The monthly communication brief was approved for circulation subject to the addition of including an update on the cost-of-living crisis.
Place based governance
Board was presented with an update on the place-based government arrangements. After discussions with board members recommendations was finalised and the final draft was presented for approval of the board. The board approve for the model to be taken to the Integrated Care Board (ICB)board for their approval.
Items for escalation
The Board discussed the delays to several areas of non-recurrent funding from the ICB and the potential impact on developing robust plans for Winter. It was agreed that a new risk would be added to the partnership risk register and discussed at the Walsall Healthcare Risk Management Executive in October.
There was no formal board meeting of the partnership in August 2022.
The Board were presented with a story from an individual who had been supported through the whg social prescribing team. The presentation outlined the interventions that had been delivered and how they had increased the person’s self-esteem and skills. The individual involved was assisted to take part in whg’s stay safe befriending campaign that was established during the pandemic, and this proved to be a gateway to securing employment as a Community Connector.
The presentation outlined innovative ways of making links within hard-to-reach communities and with people who often decline educational resources. The discussion highlighted the support offered by Walsall College and outlined different social prescribing models within the borough and how they could provide support to more people.
In June the high level of demand on services provided within the Partnership was sustained. There had been a visit to Walsall from the National Discharge team looking at good practice and they had highlighted the willingness of teams across partners to work together for the benefit of the patient / citizen. There was discussion about the process and level of detail required to gain funds form the Black Country system to support initiatives at place.
The Board took assurance that there were no new or significant risks to delivery of the transformation programme. There are currently two live projects that are facing obstacles but all of them have robust actions to address the issues.
Place based development
The board received assurance that the agreed workstreams within the place development programme are being mobilised. A Senior Responsible Officer for the two remaining workstreams have now been identified. Details of the expenditure of the ICS funds for 2021/22 and 2022/23 were shared with the group. It was agreed that the governance for the spending plan will sit with the Walsall Together Senior Management Team. There was a discussion regarding proposals around governance and scope of services for the place-based partnership. It was agreed that August board meeting slot will be used for a workshop to consider these in more detail.
Cost of living crisis
There was a discussion about the impact of the cost-of-living crisis. This included findings from all areas and organisations within the partnership and the effects it is having on staff as well as residents. The board has tasked the Resilient Communities steering group to map out current services and infrastructure within Walsall to address some of the impacts.
Items for escalation
There were three formal items for escalation to the Trust Board.
- The sustained demand within the system and the pressures faced by teams to ensure effective service delivery
- Resource allocation from system to place and the rigidity of funding application processes
- To raise awareness of discussions around the ongoing cost of living crisis.
Lived experience of somebody with Sickle Cell Disease (SCD). The Board were presented with a story from a local Walsall resident who has Sickle Cell Disease and who wished to share some experiences of living with the condition and accessing services. She sits on several boards, steering groups and forums and acts as a navigator for other people with this condition.
Details were shared of the daily struggle people with sickle cell disease face, especially when facing episodes of crisis. It was reported that there remains limited knowledge and understanding of Sickle Cell Disease and the presenter has experienced delays in timely clinical interventions. She receives care from several hospitals and has found that there is limited communication between them resulting in duplication of tests. From own experience and that of others with SCD, it was reported that there is a real desire for management of the condition to be primarily at home or within a community setting. A holistic approach was preferred, and it was suggested that there would be benefit from a community hub or centre with ready access to experts such as nurses, psychiatrists, nutritionists, financial advisers.
Board members raised that this encapsulated the ambition of the partnership to work with people around their health and well-being and to provide services that helped citizens to maintain independence and control. The Board resolved to review local community-based services in the light of this lived experience to see how access to and provision of care could be improved.
During May the Partnership experienced sustained demand on the system and services. The board were reassured that capacity within the system is increasing with staff returning to work following the impact of Covid and with vacancies being filled. Out of Hospital activity remained strong with the Care Navigation Centre receiving over 1200 calls in the month and relieving pressure on the acute system by caring for over 1,100 of the calls in the community. Walsall has been recognised nationally as coping with those pressures very well and there have been visits from external bodies looking at the good work done in the borough.
The Board took assurance that there were no new or significant risks to delivery of the transformation programme. There are currently three live projects that are facing obstacles but all of them have robust actions to address the issues. Oversight remains with the Clinical and Professional Leadership Group.
The Board resolved to accept the transformation report.
Place Based Development
The board received assurance that the agreed workstreams within the place development programme are still being mobilised. The board were asked to identify senior responsible officers for two of the outstanding workstreams (Workforce and Citizen voice).
Partners agreed that the structure for the partnership meetings will be revised into strategic and operational items. There was also a formal request to allow members of the Walsall Together strategic group to be present at Board meetings where strategic items are raised to improve connectivity between the groups. Board members were informed that there had been a delay in tendering for consultancy support for the place-based programme and were assured this would be looked at as a priority.
The Board approved the request to invite strategic members to board meeting where necessary and a revised partnership board development timetable will be drafted including the expected expenditure of development funds
Partnership leadership update
A development programme for leadership within the broader partnership is at an early development stage. The Board were asked for thoughts and ideas to progress the work to shape future leaders of Walsall. A proposal for ongoing investigation and the creation of a clear framework to support the work was approved by the Board. A meeting to discuss the extent of involvement from the Board will be arranged and a detailed progress update will be shared later in the year.
Items for escalation
There were no formal items for escalation to the Trust Board. It was agreed to review escalation routes within partner organisations as part of the overview of Partnership governance.
- COVID-19 continues to circulate within the community and continues to impact on staff absences
- There are potential implications for Walsall Healthcare as a result of the establishment of Place Based Partnerships. This includes changes to the governance of the partnership and also the scope of services contracted and provided by Walsall Healthcare. Walsall Healthcare is represented across several workstreams and an Executive Group, which are currently mobilising
- Demand has subsided in some areas, allowing workforce to be redirected to relieve pressures in areas of continued high demand
- Partnership risk registered was reviewed and approved
- No significant risks or delays in the transformation programme
- Partners received an overview of the Partnership Risks for which the Partnership Board is the monitoring group. Key themes within the risks reflect the continued demand across the system due to COVID-19 and restoration efforts. The detail of the risks was reviewed and approved
- Clinical Professional Leadership Group will continue to develop the 2022/23 transformation programme
- Agree a schedule of Place Development Sessions for Board
- Further scoping of organizational development for integrated health and social care teams delegated jointly to Workforce and Organisational Development Steering Group and Resilient Communities Steering Group
- MindKind is an organisation that supports people living within deprived communities; they are a third-sector organisation that was successful in securing grant funding to support Walsall Together to reduce health inequalities. They have a varied workforce including social workers, mental health first aid trainers and healthcare assistants. Board members received an update on the broad work of Mindkind, which includes working with citizens to break down barriers to accessing services and building trust. The Board also heard about some of the challenges facing third-sector organisations in the context of a) securing investment from statutory organisations and b) sustaining valuable work in the context of non-recurrent funding.
- The presentation was very well received and celebrated by Board members, recognising the invaluable work of this organisation with some of our most vulnerable communities. The Board resolved to maintain contact with Mindkind and to explore how we can work collaboratively in future achieve positive outcomes for residents in a more sustainable way
- The Board approved the monthly Communications Brief, which has since been disseminated across all partner organisations.
- The board took assurance that there were no new or significant risks to delivery of the transformation programme. The planning round for the 2022/23 programme has been delayed due to operational pressures in early 2022 and remains in progress with oversight from the Clinical and Professional Leadership Group
- The board received assurance that the agreed workstreams within the place development programme are now mobilising, with an initial focus on Governance, and Finance and Contracting. An Executive Group is being established to ensure strong leadership from across the Walsall Together partnership and Walsall Healthcare, due to the implications on both stakeholders as a result of proposed contractual and governance changes. A project managment approach is being established and the Board will receive a more detailed update, including timeframes, to the June meeting
- Partners noted the complexity and scale of work to be delivered by this programme and whilst the partnership is well sighted on the proposed direction of travel, stakeholders across the wider Place and System required more intensive support to ensure they are fully informed and engaged in the decision-making required. Board members also agreed the need to retain focus on delivering services and transformation for the residents of Walsall
- The Board resolved to hold a series of development sessions over the course of 2022 to ensure sufficient oversight and understanding is achieved for all partners collectively
Organisational Development and Integrated Teams
- The Board considered an approach to developing our integrated locality teams using a coproduction approach grounded in connectivity with the communities we serve
- Alignment to the Wellbeing Framework, previously approved by the Partnership Board, was recognised and supported
- Partners wanted further assurance on the intended objectives and outcomes of the work, to ensure there was sufficient focus on developing improved integrated between health and social care, and to avoid duplication with existing work in Resilient Communities. The Board approved the proposal in principle with delegation to the Workforce and Organisational Development Steering Group and Resilient Communities Steering Group to undertake detailed project design
- The Board took assurance that all operational risks and issues are monitored regularly by the established partnership groups. Demand has subsided in some areas during April, allowing workforce to be redirected to relieve pressures in areas of continued high demand. COVID-19 continues to circulate within the community and continues to impact on staff absences
- The Board received an overview of plans to secure funding and further develop the virtual ward model. There was a discussion about the risks associated with supporting patients from deprived communities, who may not have the resources required to support themselves in a traditional virtual ward model. The specific needs of Walsall residents and the impact of deprivation will need to be considered carefully as part of detailed project planning. Key points were also raised around: the need to consider mental health input into the model; the need to embrace digital technology whilst also securing support for patients that have difficulty in accessing digital technology; the involvement of housing partners that can provide assisted technology.
The Board reflected on the cost-of-living crisis and the significant impact on several citizens in Walsall, recognising the implications for health and wellbeing. Members agreed to include a strategic discussion item at the June meeting to explore how the partnership can best support residents without duplicating effort or resources already mobilised across Walsall and the wider Black Country system.
- The Board welcomed Mr Patrick Vernon, newly appointed Chair of the Partnership, in advance of his formal commencement in post in April. Mr Vernon joined the meeting for the first hour
- The board received an overview of a patient story from Mrs Kirsty Donaldson, Lead Nurse for the Integrated Assessment Hub (IAH). Partners commended the work of the team, particularly during the recent period of high system pressures. An opportunity was identified to work with Council colleagues to further support vulnerable individuals that come through the service. Assurances were provided that the service is operating according to levels of demand and appropriate services for interpretation and other support are aligned. The Board resolved to note the update and the positive impact the services is having on patients in Walsall.
- The Board received an overview of operational performance for the services in scope across all Tiers of the Walsall Together model. The Board noted the increase in COVID cases being seen nationally and took assurance that the Walsall Together model had demonstrated its effectiveness in responding to increased demand over recent months. Members reported continued pressure across all services and noted increased levels of staff exhaustion. Fuel prices are also impacting several staff groups. In primary care, it is becoming increasingly challenging to deliver both recovery and vaccination targets. The Board took assurance that there remains a good level of excellent work being delivered by teams across partnership services. Yet there remains a considerable amount of work to be undertaken to develop and support a resilient workforce that can deliver high quality services. Several statutory partners confirmed their organisations’ respective commitments to paying the real living wage. However, a partnership position on such issues, and the role of Anchor Institutions and Anchor Networks, is being explored by the Workforce & OD Steering Group, aligned to the wider work of the Black Country system.
- The board took assurance that there were no new or significant risks to delivery of the transformation programme. Whilst several areas have been impacted by system pressures, work has continued, and live projects will be taken forward into the 2022/23 transformation programme. The central resources will be fully utilised to support next year’s programme, with non-recurrent monies also being utilised to support resource across both transformation and place development, including the workforce and OD workstream. The Board resolved to accept the transformation report.
- The Board approved the monthly Communications Brief, which has since been disseminated across all partner organisations.
- The central budget for the partnership was reported to be forecasting a small surplus for the 2021/22 financial year. This is a result of having additional non-recurrent funding available as well as vacant posts and there are some cost pressures against the budget into 2022/23. Funding partners have resolved to retain the current contributions for 2022/23 on the basis that some additional non-recurrent money has been allocated from the ICS and on the basis that the place development programme includes a review of the future recurrent resourcing requirements for the partnership
- Partners received a summary of the outputs of the Partnership Board development session, held on 16th February. This reaffirmed commitment to the partnership and the strategic aims. A proposal was made to establish a Place Development Programme, which will support the work required to define the future governance and accountability frameworks, establish an outcomes-focussed environment, and ensure the citizen voice is embedded throughout the partnership. The Board resolved to approve the establishment of the programme and to seek to identify Board-level sponsors for each of the workstreams. In addition to the workstreams identified, the Board resolved to consider development requirements relating to system leadership. This will form part of the existing Workforce & OD workstream
- The Board received an overview of the role and purpose of a recently established Children and Young People Strategic Alliance. In January 2021 there was a review of strategic partnership working around the agenda of children, young people and families. This review was undertaken in collaboration with the CCG, Walsall Health Trust, the Safeguarding Partnership and the Safer Walsall Partnership and raised some critical issues around the effectiveness of the partnership as well as some drivers for change, opportunities and solutions. As a result, all partners collectively agreed to a series of externally facilitated strategic partnership workshops to explore more effective strategic collaboration and decision making across the partnership in relation to children, young people and family business. The work of the Alliance is continuing to form and has representation from Walsall Together partners
- The Board received a detailed discussion paper on the challenges faced across the partnership from a workforce and organisational development (OD) perspective. The paper presented some questions designed to encourage debate and to provide an overall steer to the future work of this workstream. The main areas of focus are a) supporting the care provider market with recruitment and retention, and b) providing structured development to the integrated health and social care teams. In line with the partnership’s priorities, a focus on reducing health inequalities is a golden thread within this work, ensuring we can support individuals from our most vulnerable and deprived communities into work. An outcomes framework for the workstream is in development and partners will start to see workforce data being reported through the operational report in coming months. Early thoughts on providing support to the partnership around systems leadership were introduced and supported in principle, with further detail to be explored in the coming months. Partners referenced the challenges with recruitment and retention across several partner organisations and services. Part of the work will be to create developmental support and pathways across organisational boundaries and support all staff to feel valued and engaged in the work they undertake. Further discussions took place in support of ensuring the work includes: the role of apprenticeships; and the importance of cultural competence in the OD strand.
- The Partnership Board received a story that was presented jointly by Children’s Services and Brownhills Community Association, demonstrating the achievements of the Holiday Activity and Food programme. The presentation included examples of both challenges and success stories and gave a case study of the positive impact the programme had provided for one child with challenging behaviour. The programme is predicated on a partnership approach to delivery and encompasses the core principles of the Walsall Together Resilient Communities workstream. The Board recognised the partnership effort that has contributed to the positive outcomes in Walsall and noted how other Local Authority areas, which have not adopted this approach, have not seen the same level of uptake. The Board congratulated the team for providing a window for families to partake in activities they may not otherwise be able to access. The Board also noted that more work is required to increase uptake, which is currently around 20% of eligible residents, particularly in our most deprived and vulnerable communities. The report offered some insight into the potential barriers to uptake and the board resolved to delegate oversight of the planning for the Winter programme to the Resilient Communities Steering Group
- The Board considered the system pressures across Walsall, which is recorded at a level 16 on the partnership risk register. The significant level of demand is being felt across all areas of the partnership and is impacting on the experience of citizens, their health and wellbeing outcomes, and on the workforce who are required to deliver care. Nevertheless, the partnership System Pressures Plan is already having a positive impact on flow through emergency portals and the acute hospital. Additional hours of care are being provided to support discharges and there are extended opening hours within the Urgent Treatment Centre. The Board noted specifically the immense effort that had gone into delivering increased packages of care, despite significant challenges from demand and workforce pressures. The Board resolved to retain the current risk scoring in anticipation of continued increase in demand, particularly during January and February, and to undertake some more detailed demand modelling that could inform future planning
- Building on the discussions regarding the current system pressures, the Board discussed the longer-term prospects of the local population. Concerns were raised about the level of inflation and the potential further worsening of health inequalities. This is compounded by pressures across community and voluntary organisations. There was a consensus that financial hardship is something the partnership needs to consider as a future strategic item
- Following the establishment of a Workforce & Organisational Development (OD) Steering Group in October, the Board received and approved the Terms of Reference for the group and 2 high-level work specifications:
- Developing a partnership workforce plan
- Building on the success of the integrated teams
- A discussion centred around how the partnership can create the conditions that would make Walsall an attractive place to work. There needs to be effort made in both attracting professionals to the area and also in building capacity within our existing communities through improved opportunities for employment. The Board resolved to receive a strategic discussion paper on workforce and OD at the December meeting
- Plans are in progress to commence the recruitment of a new Chair for the Partnership. Members considered an outline job description and resolved to finalise the document in advance of the December meeting
- The partnership discussed the potential value in holding a development session that would look to reconfirm the commitment to the partnership and agree the strategic priorities for the next 12 months and beyond. The Board noted the potential implications of the proposed health and social care legislation and agreed that the partnership was already operating in accordance with the current proposals. The Board resolved to hold the development session in the New Year, allowing sufficient time to agree the session structure and content.
This report provides an overview of the key items discussed at the Walsall Together Partnership Board at its meeting on Wednesday 22nd September 2021. The key points for the attention of the Trust Board are:
- The Partnership Board received a story about the end of life care that somebody had received within Walsall. The presentation outlined positive and negative experiences regarding the care that was both provided and commissioned by health and social care partners within the borough. The Board resolved to work with the person presenting the story to highlight to partners the issues raised and to seek to address those aspects of care that were felt to require improvement
- The Partnership Board considered the systems pressures within Walsall which were affecting all partners. The work that had been done with partners around the availability of packages of care was highlighted as an example of where a joint approach gave benefit. The number of patients who were medically stable for discharge had risen to an average of 52 during September but had reduced to 40 in October (up to the date of the Partnership Board)
- A presentation was received about Primary Mental Health services and the expansion of the service locally. It was agreed to establish a group to look at integrated working within primary care to ensure that people with mental health needs were not subject to multiple referral pathways which carry the risk of duplicated referrals and poor patient experience
- The System Pressure Plan developed within the partnership was reviewed. It was noted that Primary Care were concerned that this would not address all the pressures they are encountering, particularly with regards to paediatric attendances. It was agreed that plans would be reviewed with a view to increasing support in this area
- An escalation was received by the Partnership Board regarding a slippage in the implementation of the Shared Care Record due to the need to harmonise with the plans of other health economies within the Black Country. It was agreed to escalate the concern of the Partnership Board to the ICS central digital team in order to emphasise the importance of maintaining the pace of implementation at local level
- The Alliance Agreement between partners was due to expire at the end of October 2021. It was agreed that it should continue in its present form for six months while discussions continued with partners about future arrangements
- The Board received the partnership risk register and noted that a detailed review was in progress, with senior expertise provided by Walsall Healthcare as Host Provider.
- The Partnership Board received a story from a deaf patient who described how inequalities in access to services have worsened through COVID-19. It demonstrated the need to consider the impact of decisions regarding access on all communities and reinforced the focus on ensuring COVID-19 recovery plans do not exacerbate health inequalities. The Board resolved to explore opportunities to work with the individual to better understand the current provision of interpretation services across the partnership
- The Partnership Board discussed the current system pressures around high demand for packages of care, noting that the issue is recognised nationally and not just in Walsall. There is an established cross-partnership daily tactical command structure, which is implementing a range of options to mitigate the risk to hospital discharges and flow. A System Pressures Plan is in development and will include input from the acute sector as well as all partners
- Project initiation documentation was approved for the NHS Charities bid that was awarded earlier this year, and also for a Resilient Communities project, Hope4U, which supports new and expectant mothers to improve the household’s health and wellbeing through a potential uplift in income
- The partnership board raised concerns around the delayed implementation of the Integrated Shared Care Record and resolved to undertake a deep dive into the project at the September meeting. It is understood that delays are a result of needing to align with the wider Black Country system. The Partnership Board is seeking assurance that the proposed revisions to the project timeline will now be met
- A detailed overview of the evidence based for the Walsall Population Health and Inequalities Strategy was received and the Partnership Board approved an approach to finalising the strategy. A pragmatic implementation plan is expected to be presented for approval in October
- All place-based partnerships have received an allocation of funding to support the transition towards achieving Integrated Care Provider status. The Committee approved the allocation of the Walsall funding at its June meeting, with the exception of the funding for an Associate Medical Director. The Committee approved the funding for the role at the August meeting on the basis that the Role Description and recruitment process would be developed in partnership with the Walsall Primary Care Networks
- There are 3 risks currently rated at 16 (major) and another 3 risks rated at 20 (major). These relate to the size and scale of population health challenges; funding for ICS beds; COVID vaccination uptake in BAME communities; recurrent investment in Walsall Together Services; Primary care demand and capacity; Delayed discharges due to low availability of packages of care (POC)
- The Partnership Board requested that a review of the current workforce risk was undertaken to reflect the current system pressures and the number of new roles required across the partner organisations.
- The Partnership Board watched a video from the Institute of General Practice Management entitled ‘If I die it will be your fault’. If you would like to watch the video visit you tube. This demonstrated the verbal abuse staff in GP surgeries have been exposed to. It was recognised that this has been experienced by all partners, and that a partnership approach to communication to combat it should be coordinated by the partnership. The partnership response to the issues of access that may be driving the behaviour was also discussed and will be explored further, as will the support that can be offered to staff
- The Partnership Board approved an approach to the governance and oversight of its response to reducing health inequalities in Walsall. This includes a Population Health and Inequalities Steering Group to coordinate this work and ensure strategic alignment for the reduction of health inequalities with the Integrated Care System (ICS) and at place. It was widely agreed that the health inequalities work is driven at place, and discussions at the ICS should find commonality across the system to address these. Further work is ongoing to map the governance structures and relationship with the Health and Wellbeing Board
- The Walsall Together Outcomes Framework dashboard has matured to include broader the metrics on the wider determinants of health. The dashboard also enables benchmarking of Walsall against the other four Black Country and West Birmingham CCG places, and against regional and national level data
- As part of the ICS/Integrated Care Provider development across the Black Country, each of the place-based partnerships have been allocated £250,000. The Partnership Board approved allocation of these funds for organisational development support; finance and contracting; and integrated performance and outcomes. An additional allocation for the position of Associate Medical Director for Primary Care will be discussed further at the July meeting
- There are 3 risks currently rated at 16 (major) and another 2 risks rated at 20 (major). These relate to the size and scale of population health challenges; funding for ICS beds; COVID vaccination uptake in BAME communities; Walsall Healthcare recurrent investment in Community Services; and Primary care demand and capacity. Mitigations for these risks are in progress and have oversight from the integrated governance workstream and SMT respectively
- A further two risks were identified at the meeting and will be added to the risk register, including (a) the community nurses vacancies; and (b) the success of the interventions the partnership has and continues to put in place may place it in danger of not reaching the targets for Improving Access to Psychological Therapy (IAPT)
- A revised programme plan was approved with no issues of concern to escalate. A review of multi-disciplinary team (MDT) approach was approved, with the potential to introduce specialist MDT sessions as well as local MDTs. The project initiation document was approved to establish an integrated acute therapy service.
Given the extent of the membership of the Partnership Board and the pace of work underway, meetings will now be extended to 2.5 hours to allow partners more time for discussion.
The report provides the key messages from the Walsall Together Partnership Board (Partnership Board) meeting on 19th May 2021. Key points for the attention of the Trust Board are:
All partner organisations were represented and the meeting was quorate. The level of partnership and shared debate on key items was highlighted as positive, with all partners able to both contribute to the presentation of papers they had contributed to, and comment equally in the discussions and sharing of concerns and risks welcomed.
Patient/staff story presented by colleagues from Walsall Family Safeguarding regarding the support provided to a family where substance misuse risked the child and family resilience. We heard about how drug misuse colleagues from Walsall Beacon Project working with Children’s Social Care together with Mum to ensure a positive result and optimistic future for the family. Colleagues emphasised how working together across boundaries within the programme enables a strong base for provision and engagement increasing the potential for the family to thrive.
An increase in adult safeguarding continues and was highlighted. Reassurance was given by the Director of Adult Social Care that numbers were considered to be within tolerance levels with the anticipation that this was a temporary situation. The Walsall Together Board will continue to monitor through the Operational Report
Further detail was requested on the capacity and demand requirements for Multi-Disciplinary Teams (MDTs) where activity has reduced over recent months. Details of reasons for reduction and potential solutions must be reviewed.
Although there is currently reduced occupancy within Care Homes, assurance was given that provider viability was not at risk.
Primary Care Networks reiterated their wish to be more fully involved in discussions and to play an effective collaborative/ partnership role.
Board approved a reframing of the Transformational Plan for Horizon 1 projects, following COVID-19 which had been undertaken by the Senior Management Team with representatives of all Partners. The priority of the Family Safeguarding Programme sustainability was reiterated across partners.
Board noted the significant progress made by the Resilient Communities Workstream led by One Walsall and Walsall Housing Group. In particular the links to reducing health inequalities were noted with detail provided on a number of key schemes including:
- Kindness Counts project targeting loneliness and social isolation
- Mental Health first aid training in e.g. barber shops
- Alignment to the Council’s Holiday Food and Activity Programme
- Coproduction training for WT staff and community champions
- Expansion of the whg/WHT anchor institution employment scheme
- Social prescribing integrated reporting and identification of other opportunities for shared learning/alignment
- Pathway development/alignment with Family Safeguarding in line with the ambition set out in the Changing Futures bid
- Development of a partnership Engagement Model through the development of the Service User Group (membership and governance) and wider engagement on inequality
- Contribution to the Outcomes Framework through defining measures of resilience, social value, independence etc.
In terms of risks, the Board requested a deep dive on the funding risk associated with Intermediate Care Services.
Success was reported in receipt of funding via the STP (250k) for specified spend for the ICP development on financial due diligence, further development of integrated reporting across partners and organisational development.
The report provides the key messages from the Walsall Together Partnership Board (Partnership Board) meeting on 21st April 2021.
Key points for the attention of the Trust Board are:
- Primary Care Networks again reported increasing demand from non COVID-19 patients coming back to the practices, which will increase referrals to other partners over the coming months. The impact on partners of the increased demand is to be scoped so that a proactive approach can be developed
- The operational update is now reported according to the tiers, rather than by partners. The Committee agreed this will support partnership working, which will mature further in the coming months to reflect where partners are working closely across tiers and sharing risks. The Trust Board is reminded that the Walsall Together tiers are:
- Tier 0 – Resilient Communities
- Tier 1 – Integrated Primary, Long Term Conditions Management, Social and Community Services
- Tier 2 – Specialist Community Services
- Tier 3 – Intermediate Care, Unplanned Care and Crisis Services
- Tier 4 – Acute Hospital Services
- The Committee heard from two Walsall Housing Group Community Champions. The champions are key to the successful engagement of vulnerable customers to ensure they are involved and included in all aspects of service redesign and transformation and is linked to the Resilient Communities tier
- The Director of Public Health from Walsall Council provided an insightful presentation on health inequalities. This information will drive much of the direction of the partnership in the next 12 months
- The risk register was reviewed, with the addition of the risk of effectively reaching cohorts 10-12 (the under 50s) for vaccinations that will take place at mass vaccination centres rather than through all of the primary care networks
- Following the feedback from partners the final versions of the Model of Health, Care and Support, and the animation for the partnership were approval by the Board
- Revised terms of reference for the Clinical and Professional Leadership Group (CPLG) were approved
- The Care at Home Board Assurance Framework (BAF) is not discussed at the Partnership Board given that it is Walsall Healthcare Trust (WHT) specific. However the WHT Non-Executive Directors will now regularly meet with the Director of Integration and WHT team following the Partnership Board to review the BAF. The actions were reviewed and updated, and the risk rating agreed.
The agenda consisted of:
- Operational Update
- Programme Update (including a focus on Resilient Communities)
- Integrated Care Provider (ICP) Update
- Risk Register
- CPLG revised terms of reference
The meeting was quorate and well attended by all partners, fostering good debate and discussion.
Partners agreed that the operational update is maturing into a more integrated approach to reporting, noting that the next step is for it to move to a more balanced scorecard approach, making triangulation more effective.
The Partnership was not assured that funding for diabetes and care home support services was resolved and looked for a resolution with Commissioners.
An increase in safeguarding activity was noted by around 25% on last year, and it was agreed that it was important for the partnership to be clear that safeguarding takes a whole system approach to address inequalities in both children and adult safeguarding.
Primary Care Networks are looking at how they restart services on during Quarter 1 of 2021/22 to ensure priority groups are the focus and without increasing volumes to unmanageable levels, particularly given the degree of infection control measure still in place which increases appointment turnaround times. This was echoed by Healthwatch, and Black Country Mental Health Trust also looking at what business as usual looks like post COVID-19. The Primary Care Networks are seeing an increase in non COVID-19 patients coming back to the practices, which will increase referrals to other partners over the coming months.
Revised reporting was discussed for the programme update, which is amber overall. It was agreed that reporting would reflect not only progress, but outcomes and benefits also. Good and wide ranging debate was had on the Model of Care graphic for Walsall Together, which depicts the vision of how care will look for people and communities of Walsall. Adjustments will be made to reflect all areas of the partnership, particularly to reflect a person’s journey starting at the home, and reflecting a health, care and wellbeing approach in the partnership. The position (in the diagram) of schools and education as part of the good start to life philosophy was raised and a clearer link proposed. The Partnership Board will review the final iteration in April.
The refreshed proposals for Resilient Communities was considered and approved. Timeframes and outcomes would be formulated over coming months. Whilst the resilient communities’ workstream’s bid for funding from Changing Futures was not successful, the work that went into this bid will form the basis for action plans and outcomes to be formed. The Partnership Board will continue to review progress against this element of the programme.
The Integrated Care Provider (ICP) roadmap was discussed, and in particular the primary mental health and Improving Access to Psychological Therapies (IAPTS) services. It was reiterated that such services are in scope for the partnership and the rationale for that would be articulated to the Strategic Transformation Partnership (STP). Overall, good progress is being made in the ICP workstreams.
The risk register was reviewed, with the addition of the risk to the ICS Step Up Pathways and the impact on services and the community. The step-up pathway accepts approx. 20 patients per week, of which 1 or 2 are into beds. This pathway is at-risk in terms of packages of care and beds from additional pressures in the system. This will be discussed in more detail in April. The Partnership Board were encouraged to hear that partners are beginning to share their own organisational risk registers to see where the partnership can assist with mitigation and management.
The Clinical and Professional Leadership Group (CPLG) presented a revised terms of reference for initial Partnership Board discussion. The group is taking a ‘back to basics’ approach to the revision of their work, aligning with the development of the Health and Wellbeing Board over the coming months to ensure strong alignment. A clearer view of the connectivity with the Health and Wellbeing Board will be discussed by the Partnership Board in the coming months.
In both December and January, COVID-19 created service pressures across the partnership around demand, staffing and care capacity. This was compounded by the significant amount of resource diverted to support the mass vaccination programme. The pressure on community services has significantly increased due to the rise in infection rates.
The Partnership Board recognised the significant efforts which the partners are making in very difficult circumstances. It also recognised the importance of partnership working and urged partners to continue to support each other rather than work in silos in times of extremis.
The Walsall Together Senior Management Team continues to meet daily to review any specific issues, either COVID-19 or usual operational, that require a partnership response or intervention. The Partnership Board emphasised the importance of this mechanism, and thanked the team for their flexibility and dedication.
The December meeting discussed the establishment of the Manor Hospital site as a COVID-19 vaccination hub on 11th December, and in January were informed that the hub was had been held up as a national example of best practice. As at 19th January, 20,246 vaccinations had been given, with an average of 1,000 per day. Live dashboards enable the partners to receive up to date information on progress.
The Primary Care Networks reported that vaccine compliance with the over 80s is 75% overall, with some sites reaching higher percentages. Some GPs have capacity to vaccinate more of the community, however supply of the vaccine has been an issue. Care home patients have been vaccinated and 54% of care home staff, however it was noted that they have a number of different avenues for vaccination therefore a review of how that data is being captured is required.
The partners agreed that communication and engagement needs to be strengthened to capture the most deprived and vulnerable in the community and ensure they are vaccinated. The rate of Black, Asian and Minority Ethic decline rates for the vaccine is significant and Stephen Gunther, Director of Public Health at Walsall Council, will lead on an engagement strategy to address this for the partnership.
Integrated Care Provider Roadmap
The Partnership Board reviewed the scope of each workstreams established to deliver ICP status, and the terms of reference of the core oversight team were approved in January. NHS England and Improvement has granted an extension to the end of January for the transaction guidance self-assessment, originally requested in early January, to take into account the significant attention currently being diverted towards delivery of mass vaccinations.
Focus is currently on defining the scope of services to be included in the contract from 1st April in shadow form, and also discussion and further due diligence during 2021/22.
At the December meeting representative from two of the Borough Community Associations provided the Partnership with background on their work and who they help, with partners being encouraged to use the service to signpost people who may need more support. The centres were providing services to 77,000 people and 16,100 referrals were made to the Making Connections (social prescribing) hub in October.
The partnership agreed that by working with the community association’s they will have a much further reach into the community than the partnership has currently, and that this will be framed within the resilient communities work going forward.
The overall status of the transformation programme is amber due to ongoing COVID-19 and mass vaccination pressures. However, the programme office is now fully staffed, and significant improvements in the progress made and visibility of all projects is seen. Several projects remain on hold and the process of recovering delayed milestones remains in progress. It is likely that the overall status will remain for this financial year and consideration will need to be given to any outstanding tasks within the forward-look programme for 2021/22. The Partnership Board recognised the progress on the programme despite the pressures the partners are currently under, and thanked the teams for that.
The partnership agreed to the Family Safeguarding Partnership Pledge in June 2020 and Sally Rowe and Helen Billings from Walsall Council presented progress in this area. The Partnership Board was reminded that family safeguarding provides an opportunity to address issues with adults to lead to better outcomes for children. The Senior Management Team are developing metrics in partnership with the family safeguarding team which will come back to the Partnership Board. The Partnership Board re-stated their support of the pledge and family safeguarding will form part of the regular programme updates.
In December the Partnership Board approved a project initiation document for the integrated assessment hub, which aims to reduce hospital admissions; turn people around at the front door; support more people at home; expedite discharges; and reduce readmissions. The hub opened as planned on 22nd December at the Manor Hospital, and the January meeting was provided with an update on progress with recruitment, education and training, early activity assumptions, and governance models. These will continue to be reported to enable the Partnership Board to assess the impact of this pilot, noting good early signs of progress.
New risks had not been added to the register since December. There are two risks currently rated at 16 (major) and a further risk rated at 20 (major), those being:
- Availability of funding to deliver the full transformation
- The size and complexity of the local population health challenges
Diabetes service provision (future funding)
With respect to the diabetes service provision, the risk is the ‘Inability to identify recurrent funding for several diabetes services may result in poor outcomes for the population and increased usage and expenditure of secondary care services’. The Partnership Board discussed this at length and it was agreed that a task and finish group would be formed urgently to look at potential investment/disinvestment priorities for the programme to link back to individual partner budgets and/or service provisions. The Walsall Healthcare NHS Trust Board Committees for finance and quality would also review the risk as it relates to their remit.
An additional risk was agreed to be added to the register related to community uptake of the vaccine.
The key themes across all of the identified risks are the ability to identify funding and resources to effectively and efficiently deliver the ambitious scale of transformation identified in the original business case, within a very challenged population. These risks are compounded by the current significant system pressures relating to COVID-19 and mass vaccination.
Risk Owners will attend dedicated risk review meetings to review individual risks and agree the principles of how each risk can be managed such that there is appropriate cross-reference to individual organisational risk registers. The partnership risk register will be transferred to the Walsall Healthcare Safeguard system to allow management and oversight of relevant risks directly in the system, with all partners receiving access. The Partnership Board continues to encourage all partners to add relevant risks to the Walsall Together risk register where there is potential for the partnership to assist with mitigation.
Changing Futures Expression of Interest
Partnership were updated on the integrated expression of interest proposal being developed for funds – Changing Futures; changing systems to support adults experiencing multiple disadvantage. A number of contributions had been received to support this significant proposal based on the existing successful Sector Work Academy Programme (SWAP) pilot and aimed at delivering training and employment for residents and address workforce shortfalls in organisations.