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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
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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
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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.
5
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
15
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.
17
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
18
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
Report summary Recommendations Outcome
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.
The Partnership Executive was asked to:
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
Report summary Recommendations Outcome
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.
The Partnership Executive was asked to:
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
The Partnership Executive was asked to:
21
Report summary Recommendations Outcome
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.
The Partnership Executive was asked to:
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
22
Report summary Recommendations Outcome
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.
The Partnership Executive was asked to:
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
Report summary Recommendations Outcome
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.
The Partnership Executive was asked to:
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.
The Partnership Executive was asked to:
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
Report summary Recommendations Outcome
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.
The Partnership Executive was asked to:
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.
The Partnership Executive was asked to:
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
25
Report summary Recommendations Outcome
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.
The Partnership Executive was asked to:
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
26
Report summary Recommendations Outcome
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