The Wirral Place Based Partnership Board will be provided with a range of reports that relate to the provision of health and care in the borough. The meeting pack contains updates on NHS performance, financial positions, and the partnership’s approach to risk management.

SEND Improvement

The Board will be asked to note an update on SEND Improvement that will be provided to the Health and Wellbeing Board on the 12th of December 2024.

The report details progress made against a Written Statement of Action,¹ that the Local Area SEND Partnership Board are required to produce in response to the Department for Education’s Improvement Notice served in May 2024.

The update contains a tracker that is used to measure performance against the ten areas identified for improvement. The tracker contains 29 metrics, 24 (83%) of which have been met, representing an improvement on the 70% reported in July 2024.

In eight of the ten areas all the improvement targets have been met. The two areas that require further improvement are EHCPs² and the embedding of the graduated response across all education settings.

The tracker details performance against targets to reduce the number of EHCP requests and increase the number of children with EHCPs who are educated in mainstream settings. In October 2024 80 requests for EHC needs assessments were made, a reduction of 26 on April 2024. The percentage of children with an EHCP in a mainstream setting is currently 33%, against a target of 40%.

The report describes the positive impact of the Delivering Better Value in SEND programme on the embedding of the Graduated Approach in mainstream schools.

The report notes:

Inclusive Solutions Training is being rolled out across all settings and professionals. Graduates are identified and receiving support to deliver sector-led improvement. Educational Psychologists and the Council’s Inclusion Team are engaging with parents. SENCOs³ and School Governors are receiving specialist training sessions.

The report also notes that the graduated approach is being supplemented by the Emotionally Based School Avoidance (EBSA) project, and that early feedback from participants in the pilot scheme has been positive.

Place Quality and Performance

The Board will receive a report on Place Quality and Performance for the period since the previous meeting. The report contains information on Healthcare Associated Infections (HCAIs),⁴ the performance of urgent and emergency care, and the percentage of patients waiting more than six weeks for a diagnostic test.

The report notes that, despite being above both the Cheshire and Merseyside and national average, there had been an in-month reduction in access to Talking Therapies. The report describes how:

Targeted engagement work is being undertaken with identified groups e.g. those from an ethnic minority and people over 65 years of age.

The report also notes the continuing problem of finding appropriate accommodation for adults with learning difficulties and/or autism:

The NHS and Wirral Council are working with housing providers to seek creative solutions.

The report describes the ongoing focus on HCAIs in Wirral, detailing the strengthened governance arrangements of the Health Protection Board and the production of a C.Difficile plan to address a recent increase in cases. It notes that:

A C Difficile webinar was held on 11 December 2024 organised by the United Kingdom Health Security Agency (UKHSA) and NHS England. This had good representation from Wirral. Learning from this event is being brought into the Wirral system.

Place Finance

The Board will receive a report that provides an update on the Place finances, including the performance of the pooled fund and the discharge fund.

The report notes that, at Month 7 of the 2024/25 financial year, Wirral Place has reported a deficit of £31.4m, compared to the planned deficit of £16.9m. Wirral University Teaching Hospital NHS Foundation Trust is reporting a £7.2m overspend against a planned deficit of £5.8m.

The report describes the recent report made to Wirral Council’s Policy and Resources Committee which showed an overspend of £6.5m against the Adult Health and Care budget:

The Adult social care budgets are reporting an adverse variance due to increased activity and costs in social care services and are predicted to be £6.5m overspent unless further mitigating actions can be identified.

The report notes that the pooled fund budget for 2024/25 is £303.49m, and that the forecast outturn at Month 7 is an overspend of £2.05m.

The report details the agreed risk share arrangements between Wirral Council and the Integrated Care Board which means that:

host organisations retaining full financial risk on other areas pooled.

Unscheduled Care Improvement Programme

The Board will be asked to note an update on the work of the Unscheduled Care Improvement Programme.

The report notes that the programme continues to make progress in the delivery of its key milestones. The report describes the programme's four workstreams and its robust partnership structure. The report explains the programme's use of a dashboard (Appendix 1) to monitor progress against sentinel measures, and provides a summary table to show the performance of those measures.

The report details the work being undertaken by the programme’s four workstreams:

• Pre-hospital – which aims to reduce hospital attendance and admissions. This workstream has recently completed benchmarking exercises and an audit of North West Ambulance Service conveyancing calls.
• Hospital – which is working to improve hospital flow and reduce length of stay. This workstream has recently launched a Virtual Ward Operational Group and is working to expand same day emergency care by completing an option appraisal for a new respiratory SDEC.⁵
• Post Hospital – which is focussed on improving discharge processes. This workstream has recently agreed KPIs, and a business case for bariatric beds at Elderhome.
• Mental Health – which aims to improve mental health services and reduce the number of mental health related attendances at the Emergency Department. This workstream has recently launched a mental health response vehicle, and is working to refine the operation of the NHS111 Mental Health service.

Place Delivery Assurance Framework

The Board will be asked to approve an updated Place Delivery Assurance Framework,⁶ and note that a further update will be presented at the meeting scheduled for 27th March 2025.

The report explains that the framework:

sets out the controls, the systems and processes, that are currently in place to prevent a risk from occurring, or to reduce the potential consequences and likelihood.

It describes the recent review undertaken by the Senior Responsible Officers for the delivery of the strategic risks identified in the framework and the governance leads from partner organisations.

The report details the key strategic risks identified in the Place Delivery Assurance Framework, which include:

• PDAF 1: Service Delivery – “Wirral system partners are unable to deliver the priority programmes within the Wirral Health and Care Plan which will result in poorer outcomes and greater inequalities for our population.” The report notes that the risk score for this risk has been reduced from 3(L)x4(I) to 2(L)x4(I) because of progress being made on programme reporting.
• PDAF 2: Children and Young People – “The Wirral health and care system is unable to meet the needs of children and young people with complex and/or additional needs leading to long term health issues, increased inequalities and demands on services.” The report notes that there has been no change to the risk score of 5(L)x4(I).
• PDAF 3: Collaboration – “Leaders and organisations in the Wirral health and care system may not work together effectively to improve population health and healthcare.” The report notes that there has been no change in the risk score of 4(L)x3(I).
• PDAF 4: Workforce – “The Wirral health and care system is unable to recruit, develop and retain staff to create a diverse health and care workforce with the skills and experience required to deliver the strategic objectives.” The report notes that there has been no change in the risk score of 4(L)x4(I).
• PDAF 5: Finance – “Financial pressures in the Wirral health and care system could impact in the quality of care and patient experience.” The report notes that there has been no change in the risk score of 4(L)x4(I).
• PDAF 6: Community Wealth Building – “The focus on responding to current service priorities and demands diverts resource and attention from delivery of longer-term initiatives in our strategies that support the broader social and economic development of the borough.” The report notes that there has been no change in the risk score of 4(L)x4(I).
• PDAF 7: Unscheduled Care – “There is a risk that a lack of Urgent and Emergency Care capacity and restricted flow across all sectors in Wirral (primary care, community, mental health, acute hospitals and social care) results in patient harm and poor patient experience.” The report notes that there has been no change in the risk score.

The report contains a detailed breakdown of each risk, (Appendix 4), explaining its potential impact, providing a rating for the strength of the current controls, detailing the lines of defence in place, and providing an assessment of the assurance rating.

Wirral Health and Care Plan Programme Delivery Dashboard

The Board will receive a report on the performance of the programmes of work contained within the Wirral Health and Care Plan.

The report notes that, at the time of reporting (November 2024), the overall performance rating was Amber, with 3 programmes rated Red, 4 rated Amber, and 6 rated Green.

The report details the programmes within the plan, which are structured according to the categories below:

• Guiding Programmes
• Delivery Programmes
• Enabling Programmes
• At Scale, Locally Supported Programmes

The report describes some of the key highlights of the November update which include:

• Guiding Programmes
  • The Core20PLUS5 programme – which recently held workshops to develop core principles, and is working to tackle cardiovascular disease and asthma.
  • The Neighbourhood programme – which is currently undergoing a pause and review.
  • The Use of Resources programme – which, at Month 5, is reporting a £16.4m overspend against a planned £10.1m.
• Delivery Programmes
  • The Primary and Community Care Programme – which is working to expand Integrated Frailty Teams, and develop a Falls Management and Prevention strategy.
  • The All Age Disability Programme Board – which is meeting monthly and has recently engaged with Mencap.
  • The Mental Health Programme – which is merging its First Response and Acute Projects, and working to develop a new framework for the programme.
• Enabling Programmes
  • The Wirral Estates & Sustainability Programme Group – which is working to develop an estate that can be taken to the Wirral Finance and Resources Group to show how savings can be made.
  • The Digital Maturity Programme – which is migrating its Population Health Management System from Cerner HealtheIntent to the CIPHA platform, and is working to expand its BP@Home project to engage with more hypertensive patients.

Strategy and Transformation Group

The Board will be provided with a highlight report that details the work being undertaken by the Strategy and Transformation Group.

The report notes that, at its meeting on the 14th November 2024, the Group held a workshop with all of the programme Senior Responsible Officers (SROs). The workshop aimed to understand the current programme of work, improve collaboration, and start to consider the programmes of work that will be needed in 2025/26.

The report lists the programmes that provided presentations, which include:

• Prevention
• Mental Health
• All Age Disability
• Digital
• Primary and Community Care
• Medicines Optimisation

The report notes that, at the next meeting, on the 12th of December 2024, presentations will be provided by:

• Children and Young People
• Neighbourhoods
• Workforce
• Estates
• Urgent and Emergency Care
• At Scale, Locally Delivery (e.g. maternity)

The report explains that the Group will be holding further workshops in December 2024 and January 2025:

This will be linked to the outcomes of the Wirral Review and planning guidance 2025/26.

Primary Care Group

The Board will be provided with an update on the work of the Primary Care Group.

The report details the discussions at the Group’s meeting on the 26th November 2024, which include:

• Primary Care Update – which included a discussion of the recent Budget announcement, which is expected to lead to an increase in GP collective action, and the Cheshire & Merseyside Primary Care Strategic Framework.
• Quality and Safety Update – which provided the Group with an update on performance in Q2 of 2024.
• ADHD Deep Dive – which was led by Dr Chris Pritchard, GP Lead for the LEAP service. Dr Pritchard provided a local and regional update on ADHD services, explaining that a new Cheshire & Merseyside wide specification for primary care ADHD services is being developed.
• Finance & Performance – the report notes that at Month 7, the Group is forecasting a year-end adverse variance to plan of £0.406m.

Finance and Investment Group

The Board will be provided with a highlight report that details the work being undertaken by the Finance and Investment Group.

The report details the discussions at the Group’s meeting on the 27th of November 2024. The Group discussed the proposed Terms of Reference, noting several issues for clarification, including:

confirming the definition for the Wirral system financial plan and links with other key groups / workstreams (e.g. population health management)

The Group also discussed the Wirral System Financial report, noting the overspend reported at Month 7. They also discussed feedback from the previous Wirral Place Based Partnership Board meeting, including the request that:

the FIG to oversee the 25/26 Planning process for the borough and to provide regular updates.

Wirral Place Based Partnership Board Work Programme

The Board will be asked to note and comment on a proposed Work Programme for the remainder of the 2024/25 municipal year.

The report details the proposed content of each of the Board’s meetings, (Appendix 1), noting that reports will be provided on Place Quality and Performance, Place Finance, the Place Delivery Assurance Framework, the Wirral Health and Care Plan, Dentistry, and SEND Improvement. It also proposes that additional agenda items be added to discuss the Wirral Place Governance Manual, and to provide an update on the Wirral Review.