The Wirral Place Based Partnership Board will receive updates on a number of topics relating to the performance of health and care provision across Wirral. The meeting will include detailed reports on the Place Delivery Assurance Framework, the financial position of the Place and updates on the delivery of programmes associated with the Wirral Health and Care Plan 2024-25. The Board will also receive detailed updates on progress in relation to Special Educational Needs and Disability (SEND) improvement.

It is important to note that the report pack for this meeting only shows what is scheduled to be discussed, and does not mean that any decisions have yet been made.

SEND Improvement

The Board will receive a report on SEND improvement which includes the Written Statement of Action Impact Group Tracker. The report summarises progress on the areas for improvement identified in the Improvement Notice served on the Council by the Department for Education in May 2024.

The report says that since April 2024, there have been 29 opportunities to assess progress against improvement targets. 83% of these targets have been met or exceeded, and in 8 of the 10 areas for improvement all targets have been met. The two areas where improvement is not on track are the 20-week timescale for the completion of Education, Health and Care Plans and the embedding of the graduated response in schools and settings. An in-year investment of £1.1m has been agreed to enable the restructure of the SEND Service which will double caseworker capacity and introduce new locality management.

The report also describes the new SEND Quality Assurance Framework which was implemented in October 2024.

The report is critical of the Local Authority's complaints process and says that for some parents, it is not adequately addressing their complaints. The report says, Whilst parent carers are provided with an apology and explanation, there are still a number of cases in which the issue being raised is not resolved in a timely or satisfactory manner. This leads to further frustration and repeated complaints.

The report also notes that Parental satisfaction with the local area provision is inconsistent and can fluctuate considerably with long waiting times for health provision a particular cause of dissatisfaction, despite the services themselves receiving generally positive feedback.

Place Delivery Assurance Framework

The Place Delivery Assurance Framework (PDAF) will be discussed by the Board. The PDAF is used by NHS Cheshire and Merseyside to manage strategic risks to the delivery of health and care in each of its nine Places. The PDAF for Wirral identifies seven areas of strategic risk: service delivery, children and young people, collaboration, workforce, finance, community wealth building and unscheduled care.

The PDAF was last reviewed in November 2024 and the report describes the work undertaken to review the PDAF and sets out the outcomes.

The current PDAF states that there are significant workforce challenges including recruitment, retention and sickness absence in Wirral, and identifies workforce capacity, capability and availability as a key area of strategic risk. The PDAF also says that the implementation of the Wirral Review outcomes should mitigate the risk of ineffective collaboration between leaders and organisations in the Wirral health and care system.

Place Finance Report incorporating Pooled Fund Update

The Board will receive a report that updates them on the financial position for the Wirral Place health and care system. The report says that the Wirral System has a reported deficit of £31.4m compared with a planned year-to-date deficit of £16.9m, which represents an adverse variance of £14.4m.

The report describes the risks to the financial position and the shared risk arrangements in place with Wirral Metropolitan Borough Council. The budget for the Better Care Fund, which is jointly funded by Wirral Council and the NHS, is expected to break even and therefore no shared risk arrangements will be required. However, the report notes substantial financial risks emerging in the first part of the year due to an overspend on All Age Continuing Healthcare Packages of Care.

The report says that adult social care budgets in Wirral are reporting an adverse variance due to increased activity and costs, and are predicted to be £6.5m overspent unless further mitigating actions can be identified.

Unscheduled Care Improvement Programme

The Board will receive an update on the work of the Unscheduled Care Improvement Programme for Wirral, which seeks to improve urgent and emergency care services. It is noted that good progress has been made in the delivery of the key programme milestones and a test of change for a 'call before convey' initiative is due to go-live on 9 December 2024. This is expected to reduce the number of ambulances taking patients to Wirral University Teaching Hospital.

The report details progress on each of the four workstreams of the programme: pre-hospital, hospital, post-hospital and mental health. The hospital workstream includes an appraisal for additional Same Day Emergency Care capacity at the hospital. The report also says that a bed modelling exercise has been completed, and will be used to review bed configuration at the hospital.

Quality and Place Performance Report

The Board will receive an update on the Quality and Place Performance across Wirral. The report focuses on key area[s] of improvement including Healthcare Associated Infections (HCAIs).

The report notes that infection rates are deteriorating and highlights the governance arrangements that have been put in place to manage this. The report also says that a Clostridioides difficile webinar was held on 11 December 2024 with good representation from Wirral.

The report describes work to manage All Age Continuing Healthcare provision in Wirral and the performance of the service against national standards. It says that Work will be undertaken with Wirral Council colleagues to understand the drivers of the high eligibility rate and the future trend. The report also notes that there are 15 patients waiting more than 116 days for a Continuing Healthcare assessment and says, Of the 15 waiting 7 have yet to be booked in. Those not booked are due to arranging suitable times/dates for families to attend.

The report says that Wirral's performance on the new primary care metric of the percentage of appointments made with General Practice seen within 2 weeks is 89.9% which is above the national standard of 85%. The report also says that 90% of patients requesting an appointment with a GP are seen within two weeks.

Primary Care Group Report

The Board will receive a report from the Primary Care Group. This report summarises the meeting of the Group on 26 November 2024, at which the members were informed about a number of issues, including an opportunity for primary care to participate in “Complete Care Communities” via NHS England and “expectation that increased action will occur” in relation to GP Collective Action because of recent Budget announcements relating to increases to National Insurance contributions for employers.

The report says that two Acute Respiratory Hubs will operate in Wirral from 2 December 2024 until 28 February 2025. One will be located at the Birkenhead Medical Building and the other at the Sunlight Group Practice. The hubs will provide a 7-day service. The Group also received updates about local and regional work to improve services for patients with Attention Deficit Hyperactivity Disorder.

Finance & Investment Group Highlight Report

The Board will receive an update on the work of the Finance & Investment Group. This reports summarises the meeting of the Group on 27 November 2024 at which the members discussed the Group's proposed Terms of Reference and received a report on the Wirral system's financial position. The report says that all partner organisations in Wirral reported significant risks and challenges to delivering their financial and efficiency targets. It also says that substantial financial risks are emerging relating to care packages, prescribing costs, and the challenge of delivering cost efficiencies. The Group will oversee the 2025/26 planning process for Wirral and provide regular updates to the Board.

Strategy and Transformation Group Highlight Report

The Board will receive a report from the Strategy and Transformation Group. The report summarises the workshop held by the Group on 14 November 2024. The workshop sought to bring together programme leads in order to improve collaboration and co-ordination. The Group received presentations from the following programmes: Prevention, Mental Health, All Age Disability, Digital, Primary and Community, and Medicines Optimisation. Further presentations from programmes will be received at the Group's December 2024 and January 2025 meetings.

Wirral Health and Care Plan Programme Delivery Dashboard

The Board will receive a report that updates them on the performance of the programmes included in the Wirral Health and Care Plan. The report says that as of November 2024, three programmes were reporting 'red' status, four were 'amber' and six were 'green'. The programmes reporting 'red' were the Neighbourhoods Programme, the Use of Resources programme, and the Workforce programme. The Neighbourhoods Programme was subject to a pause and review process, the Use of Resources programme reported an overspend of £6m and the Workforce programme was delayed due to absence and personnel change.

The report highlights a number of areas of progress, including work to embed the Core20PLUS5 approach to tackling health inequalities, the rollout of integrated frailty teams in Wallasey, the formation of an All Age Disability Programme Board, and work by the Mental Health Programme to understand the causes of inpatient admissions.

The report also says that a meeting has been arranged between representatives from the Get It Right First Time programme and clinical staff at Wirral in order to identify opportunities to improve support for frail people in the community.

The report describes the progress made by the Digital Maturity Programme in migrating from the Cerner HealtheIntent population health management system to the Cheshire & Merseyside CIPHA platform. It also describes the achievements of the Florence project, which has achieved 100% go-live across all Wirral practices, and the BP@Home project which is supporting digitally excluded hypertensive patients and has already reached 500 patients.

The report notes that the Estates and Sustainability Programme is developing plans for its workstreams and is working to reconcile savings against the £5m target for collaborative working identified in the Wirral Review.

Wirral Place Based Partnership Board Work Programme

The Board will be asked to note and comment on the work programme for the remainder of the 2024/25 municipal year. The programme includes a report on dentistry in January 2025, a discussion and decision on a refresh of the Wirral Place Governance Manual in February 2025 and a Wirral Review update, also scheduled for February 2025.