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.
The Partnership Board watched a video from the Institute of General Practice Management entitled ‘If I die it will be your fault’ ( https://youtu.be/hAM3fSDq9kA ). 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’s 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:
Programme Update (including a focus on Resilient Communities)
Integrated Care Provider (ICP) Update
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 2 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.