Greater Manchester Health and Care Board

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Greater Manchester Health and Care Board

Date: 16 March 2018

Subject: Chief Officer's Report

Report of: Jon Rouse, Chief Officer, GMHSC Partnership

SUMMARY OF REPORT:

This report provides GM Health and Care Board with an update on activity relating to health

and care across the Partnership. It includes key highlights relating to performance,

transformation, quality, finance and risk.

The report also provides a summary of the key discussions and decisions at the Partnership

Board Executive.

PURPOSE OF REPORT:

The purpose of the report is to update the GM Health and Care Board on key items of

interest across the GMHSC Partnership.

RECOMMENDATIONS:

The GM Health and Care Board is asked to note and comment on the content of the update

report.

CONTACT OFFICERS:

Vicky Sharrock

Deputy Director Strategic Operations, GMHSC Partnership

[email protected]

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mailto:[email protected]

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1.0 KEY UPDATES AND ISSUES

1.1 People

1.2 Retirement of Bev Humphries

1.3 After twelve years as Chief Executive, Chief Executive Bev Humphrey is retiring

from Greater Manchester Mental Health NHS Foundation Trust (GMMH). She

leaves the Trust in a very strong positon, following the acquisition of Manchester

Mental Health and Social Care NHS Trust, an ambitious three-year programme of

transformation , and a recent ‘Good’ rating in the CQC inspection (see below).

1.4 Kiran Patel stepping down

1.5 Dr Kiran Patel will be standing down as Chair of NHS Bury CCG, on 31st March

2018. He will also be stepping down as Chair of the GM Association of Clinical

Commissioning Groups. Kiran has led the CCG over the last 5 years and has

achieved a great deal working with member practices, staff at the CCG and wider

partners and colleagues. He has ensured that Bury is well represented at the

Greater Manchester level. He has also been an exemplary chair of AGG and has

made a massive personal contribution to the first period of our devolution story. We

are pleased that Kiran will now be providing primary care leadership for the Bury

Local Care Organisation.

1.6 Ann Gibbs moving on and interim appointment of Linda Buckley

1.7 Earlier this month Ann Gibbs left NHS Improvement to join the South Yorkshire and

Bassetlaw Accountable Care System as Director of Strategy. In the interim period

Linda Buckley will be acting up to cover the joint post of Director of Delivery and

Improvement for GM HSC and NHS I to give time for the new CEO of NHS I (Ian

Dalton) to consider the structure of the organisation for the long term.

1.8 Cameron Ward moving on from Trafford CCG

1.9 Cameron Ward, the Interim Accountable Officer at Trafford CCG is now

approaching the end of his contract at Trafford CCG where he has done an

excellent job in both developing the CCG and in preparing for the move to an

integrated management structure with the Local Authority

1.10 Health and Care Awards 2018

1.11 Nominations are now open for the first ever Greater Manchester Health and Care

Champion Awards. The awards will see Greater Manchester’s health and care

champions; from doctors, nurses, physiotherapists and pharmacists, to care

workers, unpaid carers, apprentices and volunteers, receive the recognition they

deserve for really making a difference in our communities.

1.12 The Greater Manchester Health and Care Champion Awards 2018 are the first in

the city-region to recognise members of our paid and unpaid health and care

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workforce who regularly go above and beyond to improve the health and wellbeing

of the people of Greater Manchester.

1.13 Award categories include ‘Outstanding Carer’, ‘Apprentice of the Year’, ‘Dedication

to volunteering’ and the ‘People’s Champion’. The awards are open to all individuals

or teams, paid or unpaid, who work in the health or care sector in Greater

Manchester – in either a paid or unpaid roles. Nominations can be completed by

members of the public who wish to see an individual or team’s hard work

recognised.

1.14 Nominations can be completed online by visiting www.gmchampions.co.uk (tbc)

and must be returned before the deadline of 13 April 2018.

1.15 The awards are organised by Greater Manchester Health and Social Care

Partnership, the body overseeing devolution of the area’s health and social care

budget, with support from the Mayor of Greater Manchester, Andy Burnham.

1.16 The winners will be announced at a sponsored event in July.

1.17 Greater Manchester Practice Nursing Awards

1.18 The very first NHS awards to celebrate the dedication and achievements of nurses

working in general practice were held on Thursday 15th February. This prestigious

event honoured individuals and teams from across Greater Manchester that have

worked to ensure the very best care for patients. The awards followed a call for

nominations in the autumn with peers, public, and patients all invited to shine a

spotlight on practice nurses who have gone above and beyond.

1.19 The awards helped to support the aims of the national 10 point action plan for

general practice nursing by celebrating and raising the profile of this vital primary

care role, promoting general practice nursing as a first destination NHS career.

‘General Practice – Developing Confidence, Capability, and Capacity’ sets out how

a national investment of £15 million will help to develop and upskill the primary care

nursing workforce.

1.20 Devolution has seen practice nurses leading on the development of social

prescribing, which allows patients to be referred to a range of locally based, non-

clinical sources of support such as walking groups or befriending activities.

Stockport’s Alvanley Practice in particular has spearheaded this work, winning the

award for Practice Nursing Team of the Year. Greater Manchester practice nurses

were also among the first in the country to trial new group consultations for patients

with long term conditions, allowing more time to discuss their concerns as well as

offering peer to peer support.

1.21 Key system developments

1.22 Devolution difference campaign

1.23 This week we have launched a ‘devolution difference’ communications and

engagement campaign that aims to demonstrate to staff, stakeholders and the

http://www.gmchampions.co.uk/

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public how devolution is making a difference to the lives of the people of Greater

Manchester.

1.24 We have updated our story in a ‘devolution difference’ document, produced a new

two minute animated film, a ‘Taking Charge – 2 years on’ leaflet and four case

studies. We will be engaging people via a social media campaign including ’10 days

of devo’ on Facebook and Twitter, which will include posts and gifs taken from the

animated video.

1.25 A Devolution Difference ‘toolkit’ will be available to help staff and partners share our

key messages and practical examples of successes.

1.26 Part of the Devolution Difference campaign will include, over summer and autumn,

a community event in each area, building on events and activities already taking

place. We will work together with NHS and council communications and

engagement leads, along with Healthwatch and VCSE, to showcase the devo

difference across the whole of Greater Manchester.

1.27 Further information is available at:

https://youtu.be/ywtls25mbFU

Facebook.com/GMHSCPartnership

#takingcharge #devodifference

1.28 Pennine Acute CQC Hospitals NHS Trust report

1.29 The recent report published by the Care Quality Commission (CQC) has found that

significant improvements have been made across every hospital run by The

Pennine Acute Hospitals NHS Trust since its last inspection in 2016. The overall

position has seen Pennine Acute move form ‘inadequate’ to ‘requires improvement’

with 70% of the aspects of the services inspected now rated as either ‘Good’ or

‘Outstanding’.

1.30 The Pennine Acute Trust (PAT), now part of the Northern Care Alliance NHS Group

with Salford Royal, runs four hospitals and a range of community services serving

the communities of Oldham, North Manchester, Bury and Rochdale borough.

1.31 Since the Trust’s last CQC inspection report, published in August 2016, the Trust

has benefitted from joint working and support from the leadership at the Salford

Royal NHS Foundation Trust. A leadership structure has been put in place, with one

Board of Directors now overseeing both Salford Royal and The Pennine Acute

Hospitals NHS Trusts.

1.32 Greater Manchester Mental Health Trust

1.33 The Care Quality Commission has rated Greater Manchester Mental Health NHS

Foundation Trust as Good following an inspection by the Care Quality Commission.

https://youtu.be/ywtls25mbFU

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This inspection included child and adolescent mental health wards and wards for

older people which had previously been rated as requiring improvement.

1.34 CQC also inspected acute wards for adults of working age and psychiatric intensive

care units; long stay/rehabilitation mental health wards for working age adults and

substance misuse services. CQC also looked specifically at management and

leadership to answer the key question: ‘Is the trust well led?’

1.35 The service was rated as requires improvement for safety, good for caring,

effectiveness and responsiveness and outstanding for well-led. As a result of this

inspection, the trust’s overall rating remains unchanged as good. This is a

considerable achievement given that during this period, the Trust incorporated

Manchester Mental Health Trust.

1.36 Make Smoking History

1.37 The ‘Don’t Be the 1’ campaign launched 5 February, aiming to support attempts to

quit by some of our most persistent smokers. Research conducted in December

2017 across GM with 693 smokers, found 9 out of every 10 smokers

underestimated the risk of dying from a smoking related disease.

1.38 Our History Makers engagement conversation was launched on 12 February by GM

Mayor Andy Burnham at our Making Smoking History event in Manchester attended

by 173 stakeholders from across the GM system. 530 surveys were completed in

the first 4 days. Our aim is at least 5000 weighted surveys across the 10 boroughs

and 1.5m social engagements with the History Makers campaign. Roadshow

activity is planned across all boroughs and History Makers engaged will be

supported to build our revolution for a tobacco-free GM over the next 3 years.

1.39 Winter Update

1.40 The winter period continues to be challenging for systems, with sustained high

levels of demand and reports of higher acuity patients. Performance for January

2018 shows Greater Manchester achieved 83.8% against the four hour A&E wait

performance standard. This is an improvement of 2.3% on the December 2017

position. Our ability to achieve the four hour waiting standard has been affected by

reduced capacity in care homes and social care as a result of flu and other

seasonal illnesses such as respiratory conditions. As a result, there has been an

increase in the number of patients staying in hospital over seven days, which has

reduced patient flow and bed capacity in the system.

1.41 Greater Manchester received approximately £21 million of additional winter monies

from the national allocations for acute, primary care and mental health services.

This has enabled us to implement:

• An extra 94 acute hospital beds

• Additional assessment space in acute medical areas

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• Additional clinical workforce in emergency departments, acute assessment

areas and staff to support discharges

• Additional primary care access, 7 days a week 08:00 to 20:00

• An urgent care response in partnership with NWAS, to support primary care in

each locality

• Additional 24/7 mental health liaison and crisis support teams

• Additional mental health beds, including dementia care and intermediate care

(short-term support involving NHS and social care services to avoid

unnecessary hospital admissions, help individuals become as independent as

possible and aims to prevent a premature move into residential care)

1.42 The GMHSC Partnership is currently working with the North West Ambulance

Service, 111 and the localities to test direct booking into primary care. The testing

will be for direct booking into additional access in the first instance. There are four

test beds sites that are due to go live during late February - City of Manchester

(North, Central and South Manchester), Oldham, Tameside & Glossop and Wigan

Boroughs.

1.43 The GMHSCP are facilitating a winter de-brief session on the 9 March for all

localities, which will enable us to identify further improvements which we can put in

place for next year. Looking forward, localities are also being asked to ensure they

have plans in place for Easter. A ‘Home for Easter’ campaign will be adopted

across Greater Manchester during March.

1.44 Primary care reform programme

1.45 As part of the Greater Manchester Primary Care Reform Programme, around 60

pharmacists have been employed to work alongside GPs and nurses as part of the

general practice team. These clinical pharmacists will provide extra help to manage

long-term conditions, advice for people on more than one medicine and better

access to health checks.

1.46 Having clinical pharmacists in GP practices means GPs can focus their skills where

they are most needed, for example on diagnosing and treating patients with more

complex conditions. This helps GPs manage the demands on their time. It is

envisaged that an additional 30 pharmacists will be employed by the end of March

2018.

1.47 Greater Manchester is also in the process of a major international recruitment drive

to attract appropriately trained and qualified GPs from overseas. Following the

success of the Heywood, Middleton and Rochdale bid, the expanded programme

will now cover most of Greater Manchester.

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1.48 Review of looked after and adopted children’s health needs

1.49 Under the banner of the Children’s Health and Wellbeing Board we will be

commissioning an external review of health provision (physical and mental) for

looked after children and adopted children and young people at both local and GM

level. This will help us to identify shortcomings and gaps against both duties and

best practice, and to make recommendations for improvement that could feed in to

the wider GM Health and Social Care work.

1.50 Development of life sciences offer and visit from Lord O’ Shaughnessy

1.51 In February we took part in a high level visit from the Life Sciences Minister Lord

O’Shaughnessy to GM where we showcased the distinguishing aspects of our

GMHSCP system from a testing and adoption of innovation perspective and the

merits of optimising research investment in GM from different government

departments and arms’ length bodies. He was very interested to find out more

about the unique Greater Manchester offering which can support the Life Sciences

Strategy and future sector deals.

2.0 SYSTEM PERFORMANCE

2.1 There are a number of performance measures that the GM Health and Social Care

Partnership is monitored against. Current performance against these is outlined in

appendix A. Some of the key performance measures within this set are outlined in

more detail below, focusing on areas of exception:

• Urgent Care 4 hour standard (National standard is 95% with higher being

better performance) – GM’s performance in January 2018 is 83.8%, which is

an improvement on the December position of 81.5% and on January 2017

which was 82.9%. It is still though of course well below the national standard.

The numbers of attendances at Accident and Emergency departments are

relatively high. Systems have reported a larger number of high acuity patients,

which results in a high admission rate and also the proportion of stranded

patients to increase. There has also been reduced capacity in care homes and

social care as a result of flu and other seasonal illnesses such as respiratory

conditions. These have contributed to reduced patient flow and bed capacity in

systems.

Better Is Higher

83.8% p

Urgent Care 4 Hour Standard

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Delayed Transfer of Care (National Standard is 3.5% with lower

performance being better) - Published data from NHS England for December

2017 shows a position of 3.8% for all Greater Manchester Trusts. This is 0.2%

below the North Regional position but is an improvement of 0.2% on GM’s

November’s published data. Analysis of the data for December 2017 showed

that the top three reasons for delayed transfers of care were: delays in

arranging domiciliary care packages, patient and/or family choice and delays in

arranging nursing home placements.

Better Is Lower

q3.8%

Delayed Transfers of Care

Referral to Treatment (National Standard is 92% of patients should wait

less than 18 weeks for treatment with higher performance being better) -

The provisional data for January 2018 shows GM has narrowly missed the

92.0% standard with a performance of 90.8%. This is a slight deterioration of

0.3% on the December position. This drop in performance was expected due to

the decision to defer some non-urgent elective care, resulting in the

cancellation of scheduled operations. The impact of this is being monitored

carefully including plans for rebooking those patients who have been cancelled.

Better Is Higher

90.8% q

Referral To Treatment - 18wks

Diagnostic Waiting Times (National standard is for no more than 1% of

people waiting 6 weeks or more with lower performance being better) -

The provisional data for January 2018 shows that GM’s performance is 2.5%,

which is a deterioration of 0.4% on the December 2017 position and falls below

the national standard of 1%. Greater Manchester has been working to improve

performance in this area by increasing diagnostic capacity through the opening

of the new Endoscopy suite at Manchester Foundation Trust in January and the

use of subcontracting arrangements to other health providers.

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Better Is Lower

2.5% p

Diagnostic Tests Wait

Cancer waiting times - all eight of the cancer standards were achieved in

December 2017. January has been far more challenging; as a result we

anticipate we are unlikely to quite meet the 62 day referral to treatment

standard.

Better Is Higher

86.4% p

Cancer - 62 Day Wait

Improving Access to Psychological Therapies recovery rate (IAPT)

(National standard is 50% with higher being better performance) – GM has

missed the IAPT Recovery rate standard in the published November 2017 data

with 47.5% rolling quarter figure against a standard of 50%. This is a

deterioration of 1.1% on the October position. We are currently developing a

recovery plan to improve performance in this area which will focus on sections

of our population where we know there are particular issues with recovery such

as black and ethnic minority groups.

Better Is Higher

47.5% q

IAPT Recovery Rate

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3.0 QUALITY

3.1 Our Quality directorate work with the wider GM system to support improvement

across our services. There are a number of key areas to note including:

Safeguarding – the Safeguarding Assurance Framework is updated be each

CCG on a quarterly basis. For Quarter 3 this information confirmed that in GM

we do not have any areas of non-compliance.

Prevent - In April 2015 the Prevent Statutory Duty was introduced. The Health

sector was one of those named statutory agencies required to demonstrate

“due regard to the need to prevent people from being drawn into terrorism”. A

clear delivery plan was approved by commissioners that would ensure that

training compliance will be achieved by the 31st March 2018. NHS England

agreed with regulators that as a minimum, 85% of staff should be compliant

with training at any one time.

Child protection information systems – this is a nationwide system enabling

child protection information to be shares securely between local authorities and

unscheduled healthcare settings. Progress to roll this out in GM is continuing

with many settings now reporting this system to be live in all areas or in

relevant areas of service such as A&E, maternity and paediatrics.

3.2 Quality in care homes continues to be a key focus for the Partnership. The table

below outlines the current performance across the 19,213 beds as at 20 Feb 2018:

3.3 A Quality Improvement and Best Practice group has been established to support

our work across the care home sector. The group have agreed three key priority

areas:

Quality in Care – To develop a portfolio of best practice that care home staff

will receive training in. This is will include pressure damage prevention,

nutrition and hydration, dementia, falls and end of life care.

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Quality in Life – To develop a portfolio of best practice that homes and other

systems will offer to residents to ensure they have equal access to services,

are able to navigate the care system, are not socially isolated and are able to

make choices with regards to their health and wellbeing

Partnership Working – How commissioners, Acute providers, patients

advocate groups, CQC and care home providers can work together to ensure

residents receive the highest quality in care and are central to the delivery.

4.0 FINANCE

4.1 The financial performance of GM Health & Social Care at the end of December

2017 (Month 9) shows the current forecast is for GM to deliver a small surplus for

2017/18 of £1.3m. This represents an £18.9m improvement against agreed Plan.

This improvement whilst welcome is largely driven by one off factors which will not

be repeated in subsequent years. The underlying position for GM remains a deficit

and presents a number of challenges. The position by sector is shown in the table

below:

Plan Surpl/ Forecast Surpl / Better / (Worse)

Sectors (Def) (Def) than Plan

£m £m £m

Planned controls

NHSE (excl Spec Comm) 0.0 0.0 0.0

CCGs 3.1 3.0 (0.1)

Providers (20.7) (1.7) 19.0

Local Authorities 0.0 0.1 0.1

Total Surplus / (Deficit) - GM Control (17.6) 1.3 18.9

Headline Position (at Mth 9)

4.2 This forecast doesn’t include £21m (0.5%) set aside by CCGs at the start of the year

to support the national NHS financial position. It is likely that GM CCGs, in line with

the rest of the country, will be required to release this to their bottom line at the end

of the year, improving their financial positions by that amount.

4.3 The key points to note in relation to the financial position are:

Excluding specialised commissioning, GMHSP central budgets are reporting a

net year to date underspend of £1.7m and a break-even position at year end.

CCGs are forecasting to deliver their plan of a £3m surplus.

NHS Providers (Foundation Trusts and NHS Trusts) are now forecasting they

will deliver an overall deficit position of £1.7m which is better than the planned

deficit of £20.7m. This is largely due to the improvement in the forecast position

at the Christie which is due to the accounting treatment of recent fire and

associated insurance. Two trusts are forecasting they will not deliver their

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financial plans for the year, Pennine Care Foundation Trust and Pennine Acute

NHS Trust.

Whilst the year end position for Local Authorities is projected to deliver a £0.5m

surplus, this relies on Local Authority reserves of £66m which is in addition to

savings targets of £53.9m already embedded in budgets.

5.0 TRANSFORMATION PORTFOLIO

5.1 Over the past 3 months, a piece of work has been undertaken to understand the

alignment of the projects across the GM Health and Social Care Partnership. This

has enabled us to:

Ensure we are maximising opportunity to deliver the quickest improvements in

health and wellbeing for the benefit of the population of Manchester, whilst

ensuring clinical and financial sustainability of the Health and Social Care

system by 2021 as set out in our Strategic Plan: Taking Charge

Ensure there is clarity on the current position of all projects and programmes

within the Portfolio, to inform a review of the assumptions made around the

benefits they will deliver.

Inform the short-term business planning for 18/19, and to ensure

commissioners have built in funding and implementation resource for GM

programmes, aligned to locality programmes of delivery for 18/19

5.2 The exercise has categorised all of the projects in the portfolio as either:

Already embedded within implementation: Those projects which have been

approved through governance, which localities and GM programmes are

actively getting on with now, and are understood across the system, as a result

of the project maturity assessment process.

Being considered for acceleration: Those projects that have been identified

as a priority for delivery through the implementation of a GM standard where

affordable, to ensure a consistency across GM. With the exception of cancer

(where this exercise is ongoing already) and population health (which already

has funds aligned), we will be working through Programme Directors, CCG

Directors of Commissioning and LA Heads of Commissioning, to understand

the current position with regard to the funding and implementation of these

projects at a local level throughout March and April, to enable prioritisation and

sequencing to be determined.

For consideration in 19/20: Those are projects not yet fully designed and

costed therefore are unlikely to be ready for implementation before 19/20.

Given the current allocation of the Transformation Funding, these commitments

are also likely to require realignment of existing resources.

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5.3 As part of the next steps, work is underway to develop an appropriate set of

indicators that will enable us to monitor the delivery of Taking Charge. The approach

to developing and embedding these measures was discussed and agreed by

Partnership Executive in February.

5.4 The approach to be embedded to measure Transformation has been described within

a paper received by SPBE in February. An approach has been described to the

system to align operating plans, investment agreements and contracts, taking into

consideration the national planning guidance where appropriate.

6.0 RISK MANAGEMENT

6.1 The overarching GM HSCP risk register is built from the GM HSCP team risk register

(including all the GM transformation programme risks) and the 10 locality risk

registers. Each of these are based on the agreed GM Risk and Issues Management

Framework (RIMF), which supports the development a risk management process for

the GM HSCP.

6.2 Key partnership risks

6.3 Key risks for the portfolio and the actions being taken to mitigate those risks are

outlined below:

Locality plans do not deliver activity shifts and financial shifts as

intended: Operating plans have been received from localities to meet national

the 8th March national planning deadline. This has provided an initial indication

of variances proposed from already signed investment agreements, which will

be followed up by Exec to Exec locality meetings in March

GM programmes do not deliver quickly enough to release intended

benefits: Clear descriptions of projects already in implementation for 18/19

have been provided to the system. A dedicated focus will continue on

determining the possibility of implementation for those projects to be

considered for acceleration into 18/19, though it should be recognised that the

programmes being considered for acceleration will not deliver significant

financial savings. Cancer projects form a significant part of this cohort, along

with elective care and urgent and emergency care, which will support system

resilience.

GM and locality programmes do not connect effectively to deliver

collective benefits relating to quality, experience and outcomes: Alongside

the alignment of activity plans, work will be completed to describe the

contribution of GM and locality programmes to deliver constitutional and

outcome targets

How we rapidly progress programmes that have had a strategy agreed,

but do not have a fully funded route to implementation identified: The

prioritisation process for 19/20 projects will be designed with the system, to

ensure that the outcomes of this exercise are fully owned by the system, and

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there is agreement with regard to how GM programmes / standards will be

funded.

Ensuring robust measurement systems are in place to assure

transformation delivery. . Whilst the Portfolio definition piece is being

completed, work will also continue to strengthen methods of assurance to

measure delivery in line with Taking Charge ambitions.

6.4 Key actions for the next 2 months

Clear descriptions of key 18/19 ‘must do’s will have been provided for the

system. Work will be completed to align these to the broader constitutional and

outcome targets to be deliver at programme level. A dedicated focus will

continue on determining the possibility of implementation for those projects to

be considered for acceleration into 18/19. Cancer projects form a significant

part of this cohort along with elective care and urgent and emergency care.

The prioritisation process for 19/20 projects will be designed, to ensure that the

outcomes of this exercise are fully owned by the system.

Operating plans will be received from localities on the 5th March to meet

national the 8th March national deadline. This will provide an initial indication of

any variances proposed from already signed investment agreements, which will

be followed up by Exec to Exec locality meetings in March.

Whilst the Portfolio definition piece is being completed, work will also continue

to strengthen methods of assurance to measure delivery in line with Taking

Charge ambitions.

7.0 GOVERNANCE

7.1 SPBE Decisions

7.2 The Health and Care Board is asked to note the recommendations supported by the

Partnership Executive at the meeting on 31 January 2018. These are outlined in

more detail the decision log in Appendix 3.

Transformation Fund Stocktake - deployment of the GM Transformation

Fund, current and forecast expenditure from the fund and prioritisation of the

remaining fund

Winter update – plans to mitigate the demands of winter and provide safe,

high quality care to patients

Children’s Health and Wellbeing Strategy – process for the establishment of

a GM Children’s health and Wellbeing Strategy building on the outputs form the

boards and focused on 10 key objectives

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Person and Community Centred Approaches – framework for a person and

community centred approach and an overview of a proposed GM programme

of activity across all ten localities for implementation.

GM evaluation programme plan – support for the outline approach to

evaluating of Taking Charge with emphasis on locality evaluation

Housing and health Programme – GM approach to housing and health

programme and governance

Funding proposition for Health Innovation Manchester – level of funding

currently secured and confirmation of funding bid request for transitional

funding form GM HSC Partnership

Interoperability and Innovation Programme – development of a GM

Interoperability and Innovation Strategy, a single business case for local health

and care record exemplar and Digital innovation Hub

8.0 RECOMMENDATIONS

8.1 Greater Manchester Health and Care Board is asked to:

note and comment on the contents of the update.

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Appendix 1: GM System Performance Dashboard

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Appendix 2 – GM HSC Partnership Finance Dashboard

Income Expenditure Variance

£m £m £m £m £m £m £m £m £m £'m £m % Plan % Plan

468.9 468.9 0.0 256.7 255.0 1.7 484.1 484.1 0.0 0.0 0.0 7% 4%

4,432.4 4,429.3 3.1 3,383.3 3,391.2 (7.8) 4,534.0 4,531.0 3.0 (0.1) (0.1) 95% 92%

4,742.1 4,762.8 (20.7) 3,628.1 3,686.2 (58.1) (1.7) 19.0 (19.9) 92% 95%

1,264.6 1,264.6 0.0 0.0 1,302.5 1,302.4 0.1 0.1 0.1 n/a 94%

(17.6) (64.2) 1.3 18.9 (19.9)

Spec. comm. (before reserves) 1,036.9 1,036.9 0.0 768.4 794.3 (25.9) 1,025.6 1,056.3 (30.7) (30.7) (29.0)

(17.6) (90.1) (29.4) (11.7) (48.9)

£'m £'m £'m £'m £'m

10.2 1.1 (1.0) 8.1 (2.1)

0.1 0.2 0.1 0.1 (0.0)

20.6 9.1 1.4 26.3 5.8

Oldham (11.3) (18.2) (3.3) (39.1) (27.9)

Rochdale 3.2 (4.6) (6.8) (4.8) (8.0)

Salford (1.4) (4.2) 1.4 1.1 2.4

Stockport (25.9) (20.4) 0.6 (25.1) 0.8

Tameside (24.3) (19.2) (0.0) (23.7) 0.6

Trafford 1.6 (13.3) (12.0) (4.5) (6.1)

Wigan (0.6) (2.5) (0.3) (1.2) (0.6)

Spec. Comm. (before reserves) 10.3 (18.1) (25.8) 33.6 23.3

0.0 0.0 0.0 0.0 0.0

(17.6) (90.1) (45.8) (29.4) (11.7)

Forecast outturn

P'ship exc spec comm

YTD

Manchester

Bolton

TOTAL

Total

Out of Area

Bury

Annual

Plan

surplusTrend - forecast variance

vs planActual

Variance

against

Plan

ActualVariance

against Plan

2. Financial position by locality

(appendix 2)

Year to Date surplus Forecast surplus

Year to

Date

GM H&SCP exc. Spec. comm

CCGs

Providers

Local Authorities

Variance

from planVariance

Greater Manchester Health & Social Care Partnership - Financial Performance Dashboard (Month 9) Appendix 1

1. Financial position by type of

organisation (appendices 3-7)

Plan Previous

Month

Forecast

Variance vs

plan

Trend - forecast

variance vs plan

QIPP/CIP Achievement

ForecastIncome Expenditure Variance Income Expenditure

(50)

(40)

(30)

(20)

(10)

0

10

20

30

M2 M3 M4 M5 M6 m7 m8 m9 m10 m11 m12

£'m

2017/18 f'cast surplus; variance vs plan by type of org'n

Spec comm (before reserves)

GMH&SCP exc s comm

CCG

Provider

LA

0

20

40

60

80

100

120

Transformation Fund 2017/18

Confirmed Commitments Allocated0

50

100

150

200

250

300

350

GM Primary Care capital Provider

£m

Capital Expenditure Capital budget

YTD Net Expenditure

Forecast Net Expenditure

Month 9 key headlines (revenue)

- Overall forecast M9 position is a £29.4m deficit, which is; -an improvement of £37.1m from last month.This is mainly due to an improvement of £38.9m across Providers.

- The Spec. comm. team has clarified that the position reported here is before the application of reserves. If these reserves (0.5% contingency and growth reserves) were factored in, the forecast deficit would reduce from £30.7m to £9.7m.

- Provider Trusts forecast outturn deficit is £1.7m which is an improvement £38.9m from plan across several trusts.

- CCGs' forecast position are unchanged from month 8. However, as mentioned last month, this hides a £6.1m adverse variance in Trafford CCG, offset by a £6m improvement in Manchester CCG

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Appendix 3 – GMHSC Partnership Decision Log

Report summary Recommendations Outcome

Chief Officers Update

Jon Rouse, Chief Officer, GM Health and Social Care Partnership (GMHSCP), provided an update on key items of interest both within the GMHSC Partnership and also within its partner organisations.

Publication of joint NHS England (NHSE) and NHS Improvement (NHSI) updated

Guidance

Care 2020 model

Paul Baumann, Chief Finance Officer, NHSE

visit

The Partnership Executive was asked to

note the report.

The GMSPBE noted the updated

with the following actions agreed:

To circulate the Care 2020

model framework to the

Executive;

To provide an update and

progress report on the GM

Commissioning Hub.

Performance and Transformation Update

Nicky O’Connor, Chief Operating Officer, GMHSCP, provided a summary of current performance issues and progress points drawn from the work of the Transformation Portfolio Board and the Performance and Delivery Board.

The Partnership Executive was asked to:

Note the report.

Receive social care dashboard

performance at the next meeting

and further quarterly updates;

Receive mental health dashboard

performance once finalised and

available.

Noted

Agreed

Agreed

19


Transformation Fund Stocktake

Steve Wilson, Executive Lead, Finance & Investment,

GM Health and Social Care Partnership provided an

update on the expenditure from the GM Transformation

Fund to date and the proposed approach to allocating

the remaining available funds.

The report provided an update on the deployment of the

GM Transformation Fund and detailed expenditure from

the fund to date and forecast expenditure for the

duration of the transformation period to 2020/21.

The Board discussed the prioritisation of the remaining bids and it was advised that the Transformation Fund Oversight Group would continue to make recommendations to the Partnership Executive to approve investments from the fund. It was noted that there were a considerable number of investment programmes already approved along with further potential bids. It was therefore suggested that a strategic stock take across GM to be undertaken, focused on best use of available resources across work streams to deliver efficiencies and identify programmes that would require recurrent funding should be prioritised by the Executive.


Note the commitments against the

Transformation Fund to date and the

submitted bids for further investment;

Note the risks and mitigations to the

delivery of transformation within the

available funding;

Agree the approach to slippage within

recurrent investment elements of bids;

Approve the proposed process for

allocating remaining funds noting the

recommendation that the Executive

receives an update with regard to

prioritisation;

Support work to consider any future

approach to GM transformation

/Improvement.

Noted

Noted

Agreed

Approved

Agreed

20


Month 8 Finance Locality Report

Steve Wilson provided an overview of the 2017/18

month 8 year to date financial position and forecast

outturn position for the individual organisations and

sectors within Greater Manchester. The monthly reports

highlighted key issues impacting on financial

performance on a GM wide basis.

It was reported that the Partnership was working with Cabinet Office and providers on the confirmed funding of £3.1m for the acute sector and £2.6m for mental health provision following the Manchester Arena attack. On behalf of the Provider Federation Board, thanks were reported for the work underway and it was highlighted that following the attack, elective activity had decreased across all the provider sector in GM which may have a subsequent impact on STF. It was suggested that this would considered and assessed across the conurbation in light of any future financial implications.


Note that GM has set a deficit plan of

£17.6m for 17/18;

Note that the year to date (Month 8)

deficit of £61.7m represents an adverse

movement of £26.7m against M8 plan;

Note that the forecast position currently

shows a £19.9m adverse variance

against plan by reporting a forecast

outturn of £37.5m deficit;

Note the risks to the delivery of the GM

financial plan for 2017/18;

Note the comments from the Executive

with regards to allocated funding

following the Manchester Arena attack

and future STF implications.

Noted

Noted

Noted

Noted

Noted

Winter Update

Jon Rouse provided an overview of winter UEC


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performance to date and the work undertaken by the

localities and the GM Partnership to continue to

mitigate the demands of winter and provide safe, high

quality care to patients. It also set out the current

challenging position of the GM system and identified

the ongoing risk in relation to service delivery over the

winter.

Note the content of the paper in relation

to winter preparedness;

Support the delivery against the identified

priority areas.

Noted

Agreed

Children’s Health and Wellbeing Strategy

Jon Rouse introduced a report which described the

process of developing a GM Children’s Health and

Wellbeing Strategy building on the work to date of the

GM Children’s Health & Wellbeing Board.

The outputs from the children’s health and wellbeing board members and the children and young people were used to identify 10 objectives for the development of a GM Children’s Health and Wellbeing Strategy and to steer the work of the GM Children’s Health and Wellbeing Board. It was noted that safeguarding and vulnerability would be an objective to be included as an additional within the strategy.


Provide feedback and support the

inclusion of the 10 objectives currently

identified within the GM Children’s Health

and Wellbeing Strategy, noting that an

additional objective relating to

safeguarding and vulnerable children will

be included either fully or within an

existing objective area.

Note the feedback by the Executive with

regard to further objectives of Oral

Health; more explicit reference to the role

of the VCSE; references towards health

and justice, including domestic violence

and criminal justice liaison;

Resolved

Noted

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Note the conditional offer received from

DfE to be considered by Leaders;

Support the proposed plan for socialising

the objectives and strategy across the

health and care system.

Noted

Resolved

Person and Community Centred Approaches Giles Wilmore, Associate Lead, People and Communities, GMHSCP provided an overview of the rationale, working model, evidence and benefits of a GM programme of work on person and community-centred approaches (PCCA). This included an overview of the support to all ten GM localities in progressing this agenda. The paper set out a coherent GM framework for person and community-centred approaches, underpinned by a clear programme to support capacity and capability building within localities, and in doing so deliver on the commitments set out in GM Population Health Plan, Primary Care Strategy, Taking Charge and the GM Strategy: Taking Charge.


Agree to supporting a shared GM

ambition for PCCA, which includes a core

GM offer;

Agree to a GM focus on the four key

characteristics of PCCA

Note the contents of this report,

particularly the PCCA model and benefits

to be derived from adopting PCCA within

emerging LCO’s;

Agree to the three component GM PCCA

support programme, noting the

challenges localities face in implementing

PCCA ;

Agreed

Agreed

Noted

Agreed

23


Support the approach being taken to

monitoring and evaluation;

Approve the programme funding request,

as part of the final Transformation Fund

allocation.

Supported

Approved

GM Evaluation Programme Plan

Paul Lynch, Deputy Director for Strategy and System

Development introduced a report which set out a

proposed approach to the evaluation of Taking Charge

with particular emphasis on the locality evaluations.


Support the approach outlined in this paper to allow the GM-led procurement of evaluation partners to commence.

Supported

Housing and Health Programme Update Paul Lynch provided an overview of the background and agreed priorities of the Housing and Health programme and gave an update on progress against the three initial areas of work. The report also detailed the proposed GMHSC Partnership led governance that would oversee the current work programme and take a joined up approach to agreeing future strategic priorities.


Note the content of the report and the progress on the Housing and Health Programme;

Note the request to include GMCA representation on the Housing and Health Programme Board.

Noted

Noted

24


Quality Update Dr Richard Preece, Executive Lead for Quality, GMHSCP introduced a report which highlighted recent progress with the Partnership's Quality Improvement Framework (QIF) agreed by stakeholders at the Strategic Partnership Board Executive in September 2017. The GM Quality Board was now leading the application of the QIF in a review of transformation programmes. The Quality Board continues meet regularly to monitor and review quality of care across all localities.


Note progress on implementation of the GM Quality Improvement Framework

Noted

Funding Proposition and General Progress report for Health Innovation Manchester Rowena Burns, introduced a report which set out the level of funding secured from commissioners and providers for 2018/19. The report confirmed the funding bid request for transitional funding from GM Health and Social Care Partnership, outlined the plans for future long-term funding and provided a general update on HInM progress to date.


Note the level of funding secured from commissioners and providers.

Confirm the approval of the funding from the GM Health and Social Care Transitional Bid of an additional £0.7m for 2018/19 in addition to £0.5m carried forward from 2017/18 along with the continued support for 6 months of 2019/20 (£0.6m).

Support the on-going discussions and

Noted

Approved

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engage in the process to secure the longer-term financial model.

Note the progress to date of HInM activity.

Supported

Noted

Interoperability and Innovation Programme Update Consideration was given to a report which provided a progress update on the development of the Interoperability and Innovation Strategy and requested resolution on a series of important next steps. Members welcomed the report and offered their support for the proposal to develop a single business case for Local Health and Care Record exemplar and Digital Innovation Hub.


Note the background to the Interoperability and Innovation hub programme and the progress made to date;

Support Option 3 for DataWell to 20/21 including funding approach, committing £3.9m of digital funds for 17/18;

Support a single GM approach to the NHSE (Local Health and Care Record exemplar) and OLS (Digital Innovation Hub) bid processes together with external

bid writing support for the business case;

Support the escalation of the early need for confirmation of future digital fund

allocations from NHS England;

Delegate to the Chief Officer other remaining decisions with respect to

Noted

Agreed

Agreed

Agreed

Agreed

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allocation of digital funding for 2017/18 with report back to SPBE;

Continue the development of the governance and functional organisation of the interoperability and innovation work strands, including full engagement with sectoral interests, and bring back to future meeting of SPBE.

Agreed

Documents

Greater Manchester Health and Care Board