GREATER MANCHESTER HEALTH AND SOCIAL CARE …...Commissioning Group and Donna Hall, Chief Executive...

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GREATER MANCHESTER

HEALTH AND SOCIAL CARE PARTNERSHIP

Strategic Partnership Board

Date: Friday 19 January 2018

Time: 10.00am – 12.00 noon

Venue: Council Chamber, Wigan Town Hall, Library Street,Wigan, WN1 1YN

Parking: Wigan Civic Centre - **please use SAT NAV PostcodeWN1 1AZ**

Wi-Fi: Please register and log on to public Wi-Fi

AGENDA

1. WELCOME AND APOLOGIES

2. CHAIR’S ANNOUNCEMENT AND URGENT BUSINESS

3. MINUTES

To consider the approval of the minutes of the meeting held on 13 October2017

4. CHIEF OFFICER’S REPORT

Report of Jon Rouse, Chief Officer, GMHSC Partnership

5. TRANSFORMATION FUND UPDATE

Report of Steve Wilson, Executive Lead, Finance & Investment, GMHSCPartnership

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6. GM HEALTH AND SOCIAL CARE PARTNERSHP GOVERNANCEREVIEW: PROPOSALS

Report of Jon Rouse, Chief Officer, GMHSC Partnership

7. GM HSC PARTNERSHIP BUSINESS PLAN 2017/18 - SIX MONTHSUMMARY

Report of Warren Heppolette, Executive Lead, Strategy & SystemDevelopment, GMHSC Partnership

8. WINTER PREPARDNESS UPDATE

Report of Steve Barnard, Head of Urgent and Emergency Care ServiceImprovement, GMHSC Partnership

9. BURY CCG MEDICINES STRATEGY – TO FOLLOW

Presentation of Stuart North, Chief Accountable Officer, Bury ClinicalCommissioning Group

10. WIGAN LOCALITY PRESENTATION – TO FOLLOW

Presentation of Trish Anderson, Chief Officer, NHS Wigan Borough ClinicalCommissioning Group and Donna Hall, Chief Executive Wigan MBC

11. GM COMMITMENT APPROACH TO CARERS: CARERS CHATER ANDCOMMITMENT TO CARERS – FOLLOWED BY SIGNING OF CHARTERAND PHOTOS

Report of Warren Heppolette, GMHSC Partnership

12. DATE OF FUTURE MEETING

Friday 16 March 2018 10:00am – 11:30am Council Chamber,Bury Town Hall

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GM HEALTH AND SOCIAL CARE STRATEGIC PARTNERSHIP BOARD

MINUTES OF THE MEETING HELD ON 13 OCTOBER 2017

Bridgewater Community Healthcare NHS Dorothy WhitakerTrust

Bolton CCG Su Long

Bolton Council Councillor Linda ThomasJohn Daly

Bury CCG Stuart North

Bury Council Steve Kenyon

Christie NHS FT Roger Spencer

GMCA Eamonn BoylanLindsay DunnJamie Fallon

GM ACCGs Rob Bellingham

GM Fire and Rescue Service Tony Hunter

GM H&SC Partnership Team Steve BarnardWarren HeppoletteClaire NormanNicky O’ConnorJon RouseSteve Wilson

Health Innovation Manchester (HiM) Rowena Burns

Healthwatch Jack Firth

Heywood, Middleton & Rochdale CCG Chris DuffySimon Wooton

Manchester CC Councillor Bev CraigGeoff Little

NW Boroughs Healthcare NHS FT John Heritage

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Oldham Council Councillor Eddie MooresCarolyn Wilkins

Primary Care Advisory Group (GP) Tracey Vell

Primary Care Advisory Group (Optometry) Dharmesh Patel

Primary Care Advisory Group (Pharmacy) Adam Irvine

Salford CC Councillor John MerryDavid Herne

Salford CCG Tom Tasker

Stockport CCG Ranjit Gill

Stockport MBC Councillor Wendy WildPam Smith

Stockport NHS Foundation Trust Adrian Belton

Tameside & Glossop CCG Paul Pallister

Tameside MBC Councillor Brenda WarringtonSteven Pleasant

Tameside NHS Foundation Trust Karen James

TfGM Bob Morris

Trafford CCG Matt ColledgeCameron Ward

Trafford Council Councillor John LambJill Colbert

Wigan Council Councillor Peter Smith (in the Chair)

Wigan, Wrightington & Leigh NHS FT Carole HudsonNeil Turner

SPB 85/17 WELCOME AND APOLOGIES

Apologies were received from;

Simon Barber, Ann Barnes, Councillor Jacqui Beswick, Wirin Bhatiani, Chris Brookes, AndyBurnham, Derek Cartwright, Paul Connellan, Bev Humphreys, Julie Connor, Mayor PaulDennett, Alan Dow, Councillor Richard Farnell, Anthony Hassall, Beverley Hughes, BevHumphreys, Majid Hussain, Pat Jones-Greenhalgh, Kevin Lee, Andrew Lightfoot, CouncillorCliff Morris, Silas Nicholls, Pete O’Reilly, Christine Outram, Dr Richard Preece, Steve

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Rumbelow, Colin Scales, Councillor Rishi Shori, Tom Thornber, Liz Treacy, Ian Williamson,Ian Wilkinson and Giles Wilmore.

SPB 86/17 CHAIR’S ANNOUNCEMENTS AND URGENT BUSINESS

The Chair thanked Oldham for the use of facilities for the revised arrangements of the GMHealth and Social Partnership Board meeting that previously met on the same day as theGreater Manchester Combined Authority. It was explained to members that as well as thefrequency and timings changing, the format would also alter in order to better engage with thetalents of those represented.

RESOLVED/-

To note the revised arrangements and format.

SPB 87/17 MINUTES OF THE MEETING HELD 28 JULY 2017

The minutes of the meeting held 28 July 2017 were agreed as a true record

RESOLVED/-

To approve the minutes of the meeting held on 28 July 2017.

SPB 88/17 CHIEF OFFICER’S UPDATE

Jon Rouse, Chief Officer, Greater Manchester Health and Social Care Partnership(GMHSCP), provided an update on key items of interest across the GMHSC Partnership.

The Board were asked to note and provide feedback on the content of the revised updatereport that included recommendations and decisions made at the GM Strategic PartnershipBoard Executive meetings.

The following items were highlighted;

In relation to the Workforce Strategy, GM has developed a system wide approach tonursing recruitment with some encouraging first results. Commendation was given tothe Directors of Nursing and the relevant Universities for their collaborative work in thisarea which has seen an 11% increase in student intake against a national reduction of6%. The Partnership is expecting to build on this collaborative model and extend tobenefit Social Care, General Practice and mental health where there are significantstaff shortages.

GM is investing £10m of capital in digital solutions across the health and care systemthis year. The funding will support the transformation of services to residents and is thestart of a digital improvement plan expected to invest up to £70m over the next 3-4years. Localities have had the opportunity to submit bids for the use of this fundingwhich relates to 2017/18. The recommendations from this process will be reported toSPBE for decision.

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The Care Quality Commission (CQC) will undertake place based reviews in both Cityof Manchester and Trafford over the forthcoming weeks with emphasis on theintegration of health and social care. The outcome of both reviews will be presented tothe Board in due course.

Urgent Care performance across GM is currently at 89.4% for the year to date with noindividual trust achieving the national standard of 95%. Bolton, Stockport and PennineAcute have particularly challenged performance.

Delayed Transfers of Care performance is at 3.7% for the month of July, showing apositive lower amount year on year. Variation still exists across the system, however,Stockport has reported significant improvements in this area.

Cancer performance is now a priority concern for GM. The Partnership team issupporting improvements to address, stabilise and correct the current position.

CQC have recently completed Primary care inspections. A tremendous achievementwas reported on the performance of Tameside and Glossop GPs practices, all of whichhave been found to be either ‘good’ or ‘outstanding’.

Although resources are much tighter this year, financial performance was summarisedas broadly to plan.

RESOLVED/-

To note the update report and provide feedback in relation to content or omissions for futureupdates.

SPB 89/17 HEALTH INNOVATION MANCHESTER – UPDATE ON PROGRESS

Rowena Burns, Executive Lead, Health Innovation Manchester introduced a report andprovided a presentation which outlined the work that has taken place since March 2017 torefocus Health Innovation Manchester (HInM) and create a sound platform for delivery. Italso outlined the further work scheduled for the months beyond October 2017.

It was reported that the operational merger of the Academic Health Science Network (AHSN)and Academic Health Science Centre (AHSC) organisations, including colocation of the staff,is complete. The HInM board has agreed a 3-year strategic business plan consisting of arevised set of three strategic objectives, which will be presented to this Board in due courseand published in November.

The HInM board, partners and staff have all been engaged in its creation. This plan will havea full suite of KPIs and a measurement framework to demonstrate contribution to GMHSCP’sgoals, and direct and indirect economic benefits.

The 3 key strategic objectives going forward for HInM were reported as:

To make GM an internationally renowned location for life science, med-tech and digitalhealthcare research and innovation.

To accelerate the discovery, development and deployment of innovations that improveour population’s health and well-being.

To contribute to national and international health and life science policy to strengthenthe competitiveness of the UK Life Sciences Industry, tackle health and social carechallenges and address the rising costs of ill health.

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The key next steps over the next six months were highlighted as:

Consolidation of the HInM delivery vehicle, governance arrangements and completeresourcing of the single HInM team.

The confirmation of the future funding model for HInM. The launch the 3-year strategic business plan to reflect the Key priorities for HInM

going forward. Extensive communication with partners and stakeholders, to improve understanding of

HInM’s work, and of the processes through which innovations will be evaluated andadopted.

Bringing forward quick win innovations in mental health, social care, and primary care,alongside implementation of the secondary care quick wins already identified.

On behalf of the Partnership, the Chair welcomed the update which demonstrated the use ofthe devolution agreement to ensure wider benefits for the region in terms of healthcare andpromoting GM as an attractive place for future innovative developments.

A member asked, if as a result, GM providers and commissioners would benefit fromobtaining drugs and medicines at a competitively reduced price. It was highlighted that thepricing of drugs is highly complex both in the degree in control at a national and local level. Itwas confirmed that at present, the focus of work alongside the pharmaceutical industry withregard to pricing, is on projects with payment linked to outcomes.

Jon Rouse confirmed that an adoption and diffusion framework is a critical developmentrequired for GM. This is currently being developed in order to drive perception into reality forthe potential opportunity to develop evidence based best practice. The adoption and diffusioncontext and structure will be presented to the Board in due course.

RESOLVED/-

1. To note the progress made in 2017 to establish HInM and provide a firm basis forimplementation of the priorities in the Business Plan;

2. To note and approve the next steps to be undertaken in 2017/18 to consolidate the neworganisation, launch the strategic objectives and new business plan and determine HInM’sfuture funding structure.

SPB 90/17 TRANSFORMATION FUND UPDATE

Steve Wilson, Executive Lead: Finance & Investment introduced a report providing an updateon recent developments with the Transformation Fund. Members were asked to acknowledgethe significant milestone in the investment of the fund as all ten localities have progressedthrough the locality bidding process for investment. It was noted that the Transformation Fundwill move into a different phase and focus on delivery of the plans and assurance thatinvestment will deliver the goal of clinically sustainable and financially affordable servicesacross GM.

This month had an expanded section on the findings and recommendations from theassessment team in their evaluation of the proposals from Bury, Rochdale and Trafford.

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The key headlines were:

Bury’s proposal supports the delivery of their locality plan to achieve a series of systemwide transformational ‘shifts’ in order to transform the health and wellbeing of thepopulation in Bury.

By 2021, Rochdale aims to have more people in control of their own health andwellbeing, managing their long term conditions well and being supported to achievegood health and wellbeing.

Trafford’s Transformation Fund Bid sought to secure a sustainable health and socialcare economy by 2021, in order to build a strong foundation for delivery of Trafford’svision for 2031.

TFOG recommended a substantive investment of £19.2m over four years for Bury,£23.5m over four years for Rochdale and £22m over three years for Trafford. Thesefunding recommendations were accompanied with material conditions for the funding.Funding for all Bury and Rochdale was approved by SPBE on 9 August 2017, and forTrafford on 28 September 2017.

RESOLVED/-

1. To note the progress update reported on the Transformation Fund;2. To note the Executive’s decision to:

To approve a substantive investment in Bury of £19.2m over four years, with phasing to beset out in the Investment Agreement and paid quarterly in advance:

2016/17: £1.0m 2017/18: £7.03m 2018/19: £6.31m 2019/20: £4.89m Noting that there are material conditions to funding, only to be released upon their

satisfactory completion. These are set out at 2.3.2.

To approve a substantive investment in Rochdale of £23.5m over four years, with phasingto be set out in the Investment Agreement and paid quarterly in advance:

2016/17: £0.46m 2017/18: £6.32m 2018/19: £14.95m 2019/20: £2.2m Noting that there are material conditions to funding, only to be released upon their


To approve a substantive investment in Trafford of £22m over three years, with phasing tobe set out in the Investment Agreement and paid quarterly in advance:

2017/18: £4.80m 2018/19: £13.42m 2019/20: £3.77m Noting that there are material conditions with funding only to be released upon their


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To note the BDO conclusion and revisions to the process to take into account theirrecommendations.

SPB 91/17 WINTER PREPAREDNESS

Steve Barnard, Head of Urgent and Emergency Care Service Improvement introduced areport which provided an overview of the work undertaken by the Partnership and localities tohelp mitigate the demands of winter. The report described how the GMHSC Partnership willprovide ongoing support for local systems to ensure they are able to respond effectively to thedemands of winter and continue to provide safe, high quality care to patients. It also set outthe current challenging position of the GM system and identified the ongoing risk in relation toservice delivery over winter.

The key headlines were:

GMHSC Partnership, in partnership with NHSI, has worked closely with each of thelocalities to support the development and ongoing review of plans to help mitigate theincreased demands of winter. There has been additional focus on (and support offeredto) three systems within GM (Bolton, Stockport and North East Sector), which areconsidered to be more fragile in the context of achieving the 4 hour performancestandard. The GMHSC Partnership has developed an overarching winter assurancedocument, which reflects local planning and nationally identified best practice. Thedocument also sets out the role of the partnership during winter in terms of operationalsupport, escalation, winter reporting and assurance.

From November, the GM UEC Operational Hub will be a key component of the GM-level of support, when urgent care pressures are experienced within the system. It willcollect, analyse and report key performance and flow information, to support decisionmaking as part of the escalation processes. It will also act as a single point of contactfor regional and national winter reporting – reducing the burden on local systems.

A GM winter summit took place earlier that day and was attended by Chief Officers andsenior system leaders from across health, social care and the voluntary sectorattended. The summit offered localities an opportunity to provide an update on theirplans and to discuss ongoing challenges. The GM and locality-level UEC DeliveryBoards continue to meet monthly and monitor progress and provide oversight of theplans.

The children’s programme for the flu vaccination was discussed and the Chair questionedwhether or not there was a possibility that some parent’s reluctance could be attributed toprevious concerns surrounding other immunizations. The reasons were thought to be difficultto understand, however it was believed that the current communication campaign has a goodchance of success and will feature along major gateways and on televised boards in areaswhere there is a high footfall.

RESOLVED/-

1. To note the content of the paper in relation to winter preparedness;2. To support the delivery against the identified priority areas.

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SPB 92/17 GREATER MANCHESTER MODEL FOR URGENT PRIMARY CARE

Dr Tracey Vell, Associate Lead for Primary and Community Care, GMHSC Partnershipintroduced a report that provided context regarding urgent and out of hours primary carereform in Greater Manchester. An overview of progress to date and the proposed futuremodel for an integrated 24/7 urgent primary care offer was detailed in the paper.

A model which articulates what a reformed, integrated 24/7 urgent primary care offer couldlook like with key components that will enable patients to receive the right care, in the rightplace in a timely manner while reducing the burden on highly pressurised A&E departmentswas described in the report. The new model of urgent and out of hours primary care willcontribute to a reduction in hospital utilisation by reducing avoidable A&E attendances andsubsequent admissions and at the same time assist in community resilience.

The rationale for a GM Model along with the risks, considerations and opportunities includingthe next steps, changes for this forthcoming winter and the future ambition were highlighted tothe Board.

Stuart North, Urgent Care Lead for the Association of Clinical Commissioning Groups(ACCGs) offered support for the approach and confirmed that there had been the appropriateclinical involvement throughout the process in the development of the model. The key nextsteps for health and social care partners in each locality is to implement the recommendedapproach and model. In support of this, a group chaired by the Urgent Care Lead for ACCGswill provide assistance to facilitate the development and mitigate risks identified in the report.

Members offered support for the proposals and requested that local elected members areprovided with a thorough briefing in order to positively explain and address concernsregarding access to appropriate treatment from members of the public. It was recognised thatthis maybe a complex process to understand, however the aim is to provide betterstandardisation across all localities. It was recommended that plain English is used inliterature to deliver communication on urgent primary care. A slide pack with a visualexplanation of the process has also been developed which will be considered to support thedevelopment of appropriate patient messages.

A Member brought it to the attention that Tameside and Glossop would be one of the areasthat would not meet the national specification highlighted in section 5.2.2 of the report. This isdue to the fact that the control total has not yet been signed off, and as a result, NHSI will notrelease funding for primary care streaming. Despite improvements locally to reduce directdemand on hospitals and the overwhelming contribution of health and social care staff,essential capital is required in order to continue to deliver improvements. Support wasrequested to continue to improve all services and resolve the release funding.

On behalf of the GM Partnership Jon Rouse explained that he was sympathetic to the factthat both Tameside and Stockport capital requirements to develop new models of care werelinked to control totals. This has been communicated previously and just recently expressedto the Prime Minister’s Health Advisor. This will now be followed up by a letter to theDepartment of Health (DoH), NHSI, NHSE and Treasury from Lord Peter Smith reiterating theconcerns regarding limiting the ability as a devolved system to make decisions and allocateresources.

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In offering support for the paper, Primary Care Advisory Group (PCAG) acknowledged theirrole in helping to develop and deliver the public message in the community. The involvementof local social care partners in planning at locality level was considered integral as appropriateavailability of social care support is essential to respond to and meet needs.

RESOLVED/-

1. To note the progress to date including development of future model of 24/7 urgentprimary care;

2. To support the proposed 24/7 urgent primary care model;3. To note the risks to delivery and considerations which will be picked up as part of the

work of the task and finish group;4. To agree the deliverables for 2017 and future ambition for GM;5. To provide effective communication to elected Members in order to provide support for

the model;6. To develop appropriate communication and engagement of the model for the public.

SPB 93/17 MANCHESTER ARENA INCIDENT RESPONSE

Nicky O’Connor, Chief Operating Officer, GMHSCP, provided a paper which highlighted thehealth and care input during the immediate response and recovery phases following on theManchester Arena incident on 22 May 2017. This included the delivery of actions within theHealth and Welfare plan focused on identifying and ensuring provision of appropriateimmediate and longer term psychological, physical, practical and social support for thoseaffected and their families.

Tribute was paid to all public sector and voluntary workers involved in the immediateemergency response and recovery phase which was described as exemplary.

The immediate health response saw 65 ambulances deployed to the scene of the incidentwithin 31 minutes. In total 59 individuals were taken to local hospitals depending on theirparticular injuries and which hospital was most suitable. The responsibility for the recoveryphased passed to Manchester City Council on 31 May 2017. The health and care response isproviding support to bereaved families, individuals injured as a result of the incident andpublic service staff involved in the response. This has been enhanced by the establishment ofthe GM Resilience Hub to provide support for people psychologically affected by the incident.Following the independent review lessons learnt will be used to inform responses to anypotential future incidents.

Geoff Little, Deputy Chief Executive, Manchester CC who has led the Health and WelfareGroup as part of the recovery phase, added to this that, this particular workstream willcontinue for as long as is required. Furthermore, where necessary, services will be improvedand support will continue for the survivors. The link between public services to deliverintegrated post discharge assistance for those that received the most severe physical injurieswill also remain in place. It was noted that the web site that has been created to sign postthose affected, will be further developed along with other support networks by the survivorswith expert guidance of Dr Anne Eyre.

The Chair added his appreciation to all those involved in the aftermath of the tragedy and onthe ongoing support for those in need.

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RESOLVED/-

1. To note the health response to the Manchester Arena incident during the immediateand recovery phases;

2. To note the actions delivered through the Welfare and Health plan in particular theestablishment of the GM Resilience Hub;

3. To note the involvement in the independent review and lessons learnt process whichwill influence responses to future incidents;

4. To note the gratitude to all those involved in the aftermath of the tragedy.

SPB 94/17 HEALTH AND HOMELESSNESS

Consideration was given to a report presented by Warren Heppolette, Executive Lead,Strategy and System Development, which set the background and emerging detail of thehomelessness and health work programme, which supported the wider Greater Manchesterpriority with a Mayoral commitment to end rough sleeping and homelessness by 2020.

The paper outlined some of the current challenges and activity in respect of homelessnessand rough sleeping in Greater Manchester and a proposed response from the Health andSocial Care system.

The involvement of the health and care system in delivering support to people experiencinghomelessness was acknowledged to be of critical importance. It was reported that the healthneeds of the client group can be acute and both a cause of homelessness and aconsequence of it.

The Strategic Partnership Board were informed of the intended contribution of the health andcare system to end homelessness and rough sleeping. It detailed the Greater Manchestercontext and the four principal commitments made by GMHSC Partnership at the meeting ofReform Board on 6 October 2017. Alongside this, based on evidence and understanding,some longer term action was proposed, which collectively will provide additional healthservice support to people experiencing homelessness. A task and finish group will beconvened over the forthcoming weeks to identify the necessary processes, stakeholders andmechanisms required to achieve delivery of the commitments.

Members offered support for the report and requested information on the numbers involved inorder to assess if there is likely to be any impact on the issues raised as a result of winterpressures. It was confirmed that the numbers are small and should not have an immenseconsequential impact on delayed transfer of care. It was noted that in some localities, housingis already embedded in the discharge process and integration with housing should bestandardised across GM.

It was noted that each Local Authority has a significant resource in the commissioning ofhousing which addresses and helps to provide housing solutions across the conurbation. Itwas suggested that these are included on the proposed task and finish group.

Members expressed concern with regard to the level of engagement and communicationrequired in order to respond to those individuals sleeping rough and homeless. Likewise the

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possibility of NHS processes being overly bureaucratic and in turn preventing the moralresponse referred to.

RESOLVED/-

1. To note and discuss the content of the report;2. To confirm support for delivery of the commitments made to Reform Board;3. To support collective engagement with the actions that will emerge from the identified

work areas, to ensure they are successfully implemented.

SPB 95/17 OLDHAM LOCALITY PRESENTATION

Dr Carolyn Wilkins, Oldham Chief Executive introduced a presentation that provided anoverview of the Oldham locality model of Public Sector Reform. The partnership vision andambition for improving Oldham’s population health by empowering people and communities,the case for change, next steps and journey to date were detailed in the presentation.

Thanks were placed on record for the contribution of Denis Gizzi, Chief Officer, Oldham CCGfor his involvement in the development of Oldham’s Local Care Organisation and the widerHealth and Social care system in GM. It was noted that it was his final day in the role and theChair extended his appreciation and wished him success in his new role.

Investment, innovation and Oldham’s achievements in establishing the primary care clustersystem and integrating services including a fully integrated hospital discharge team along withsuccessful local performance were highlighted to the Board.

RESOLVED/-

1. To note the progress provided and update on Oldham Locality Model;2. To acknowledge the role of Denis Gizzi in the GMHSC Partnership.

SPB 96/17 DATES OF FUTURE MEETINGS

Future meeting of the GM Health and Social Care Strategic Partnership Board are arrangedas follows:

Friday 10 November 2017 10.00am Stockport Town Hall

Friday 19 January 2018 10.00am Wigan Town Hall

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Greater Manchester Health and Social CareStrategic Partnership Board

Date: 19 January 2018

Subject: Chief Officer's Report

Report of: Jon Rouse, Chief Officer, GMHSC Partnership

SUMMARY OF REPORT:

This report provides Strategic Partnership Board with an update on activity relating to healthand 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 StrategicPartnership Board Executive.

PURPOSE OF REPORT:

The purpose of the report is to update the Strategic Partnership Board on key items ofinterest across the GMHSC Partnership.

RECOMMENDATIONS:

The Strategic Partnership Board is asked to note and comment on the content of the updatereport.

CONTACT OFFICERS:

Karishma Chandaria, Executive Officer, GMHSC Partnership

[email protected]

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1.0 KEY UPDATES AND ISSUES

1.1 People

1.1.1 I wish to start the report by recognising the sad loss of Cllr Kieran Quinn, Leader ofTameside Council, over the Christmas period. Kieran’s legacy is wide and deep butwe wish to recognise his contribution to promoting the health and wellbeing of thepeople of Tameside and Greater Manchester, and in particular, his boldness indriving the integration of health and care services in Tameside, working tirelessly tobuild partnership and put the needs of his residents first.

1.1.2 At the end of December Ann Barnes retired from her position as CEO at StockportNHS FT and as Chair of the Provider Federation Board. We had the opportunity togive Ann, the send-off; she deserved after so many years of wonderful service andwould want to place on record at this Board meeting her substantial contribution tothe delivery of Taking Charge Together. She is succeeded by Sir Mike Deegan aschair of the Provider Federation Board and by Helen Thomson on an interim basis asCEO at Stockport NHS FT.

1.1.3 We want to welcome Tony Oakman as new CEO of Bolton Council. Tony joins fromDudley which is one of the most integrated health and care systems in the country,so I am sure we will have much to learn from him.

1.1.4 Ian Wilkinson is stepping down as Accountable Officer for the CCG in Oldham.Again, we would recognise his significant contribution. Oldham are putting in interimarrangements pending the planned move to a single commissioning function acrossthe local authority and NHS.

1.2 Specialised Commissioning of Mental Health Services

1.2.1 Given the significant work being undertaken in GM around the implementation ofthe mental health strategy, GM is extremely pleased with the decision of the NHSEngland National Commissioning Committee that we have now been given theability to make key decisions around specialised mental health services. This willaid GM in ensuring pathway cohesiveness and also enable creative solutions toservice design to be pursued – in keeping with the national direction for specialisedmental health services.

1.2.2 In this context, GM has agreed a delegated specialised commissioning portfoliowhich has been developed in collaboration with the NHS England North Westspecialised commissioning team and national colleagues. The proposals will seethe value of GM’s delegated portfolio increasing by c. £40 million per annum. Thefollowing are included in the portfolio:

CAMHS Tier 4 General Adolescent

CAMHS Tier 4 Eating Disorders

Adult Inpatient Eating Disorders

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Specialised Perinatal Mental Health – Mother and Baby Unit

Low Secure Mental Health

Low Secure and Forensic Support Team Services - Learning Disabilities

1.2.3 The commissioning arrangements for these six services will mirror those in place forexisting delegated services to GM. We will immediately look to initiate work todevelop clear commissioning objectives for the new areas of responsibility. Thoseobjectives will be framed to align with the implementation of the GM Mental HealthStrategy, the implementation of the Commissioning Review and the establishmentand early work of them Commissioning Hub.

1.3 Transforming children and young people’s mental health provision: a greenpaper

1.3.1 The Government has published its Green Paper on Children and Young People’sMental Health. It has three main proposals.

Ambition by 2022/23 that every school and FE college is to have a named leadfor mental health

Pilot in 2019 new CYP MH teams working with schools/colleges to deliverevidence based interventions for mild to moderate needs – known asMHENCO’s. This may not be provided by the NHS but would be supervised bythe NHS

Pilot shorter waiting list in some areas that aim for 4 weeks from referral totreatment by 2022/23. This seeks to build towards improved waiting times andunderstand the resources and funding required to make this happen.

1.3.2 These 3 elements are to be piloted in trail blazing areas and by willing providersand STPs/areas – these are not determined at this stage. The ambition is after2022/23, 60% of the country could be covered. It is hoped that by not having todeliver all elements of the pathway, the NHS CAMHS specialist services will befreed up to focus on delivering better waiting times, seeing children and youngpeople more timely. The Green Paper does not affect the Five Year Forward Viewfor Mental Health commitments, which remain a priority.

1.3.3 This a clear signal of a fundamental shift in mental health support, with over £300million funding available to deliver what is laid out in the green paper, with themajority (over 2/3) going to create new Mental Health Support Teams which willimprove join-up between schools/colleges and the NHS.

1.3.4 GM will respond to the consultation by the deadline of 6 March. We will also seek toreconcile our own plans for CYP MH, including working with schools, with theproposals in the Green Paper. The Government’s proposals will not roll out until2019 so we are likely to be well ahead of the pack, which should put us in a goodplace for becoming a trailblazer if we want to.

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1.4 Mayoral priorities - homelessness

1.4.1 Work continues to contribute to the delivery of the key Mayoral public service reformpriorities. With respect to homelessness we have had a significant drive to registerpeople with no fixed abode with a GP and now have almost 500 people registered.We are developing a standard protocol across GM to ensure no one is dischargedfrom hospital straight on to the street. And we have put together some earlyproposals to support families who are homeless and in temporary accommodation.

1.5 Children and Young People’s Health Board

1.5.1 The latest meeting of the Board was in December at Altrincham Grammar Schoolfor Girls where we undertook a deep dive workshop on how best to support schoolsto promote health and resilience, with a focus on physical activity and mentalhealth. We had contributions from young people from primary and secondaryschools, and from some Manchester University medical students. Our key findingwas that the support structure is already quite well developed for physical activitybut very patchy for mental health and resilience. We are now drawing up a plan toensure every school can be supported in line with the objectives of the Green Paperset out above.

1.5.2 The overarching Children’s Health and Wellbeing Strategy is nearing completionand will be brought for final consideration to SPB in May.

1.6 Sport England Local delivery pilot award

1.6.1 In November GM was confirmed as one of Sport England’s Local Delivery Pilotareas and will therefore attract significant investment to address physical inactivityin our city region. The audience focus for this pilot will be:

C&YP in out of school settings

People out of work or in work but at risk of becoming workless due to ill-health

People aged 40 – 60 with or at risk of LTCs

Initial monies will be drawn down to support the development of a fully costedprogramme which will be co-produced over the next 3 – 4 months with SportEngland and the GM system. This work is being seen as a key strand of the GMMoving Strategy and as such will be overseen by the GM Moving Executive Groupchaired by Steve Pleasant, which reports into the H&SC Partnership and GMCAgovernance structures.

1.7 Visit to Accountable Care System in Sheffield and Bassetlaw

1.7.1 Members of the Senior Management Team recently visited South Yorkshire andBassetlaw Accountable Care System. The purpose of the visit was to get someinsight into the journey of an ACS with a similar demographic to our somewhatdifferent devolution programme, and to share to experiences and areas of best

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practice, understand the opportunities and challenges that they have faced andcreate a peer to peer learning relationship. The visit was very successful and weare now planning a reciprocal visit for their senior team to come to GreaterManchester in March.

1.7.2 We also received a visit from the London Borough of Croydon on 12 January

1.8 Future of the Pennine Acute Hospitals NHS Trust Services

1.8.1 The Pennine Acute Hospitals NHS Trust (PAHT) currently runs four hospitals andassociated community services in North Manchester, Oldham, Bury and Rochdaleboroughs. An effective arrangement for the long term management and ownership ofPennine Acute's services is essential to support the future clinical and financialsustainability of acute hospital and community services across Greater Manchester.

1.8.2 NHS Improvement (NHSI), the sector regulator for health services in England and thestatutory vendor of Pennine Acute Trust (as a non-Foundation Trust Hospital), hasnow outlined its proposal for the North Manchester General Hospital site to beacquired by Manchester University NHS Foundation Trust (MFT), and Salford RoyalNHS Foundation Trust (SRFT) to acquire the Oldham, Bury and Rochdale hospitalsites to join its group of healthcare services, called the Northern Care Alliance NHSGroup. This decision follows discussions and views taken from Pennine Acute Trust'scommissioners and the legal process is now beginning.

1.9 Plans in Development

1.9.1 While many of our strategies are now approved and in delivery we still have some indevelopment, this includes the palliative care and end of life strategy, the electivecare demand management plan, the maternity plan, the medicines strategy, thelearning disabilities strategy and of course, the acute services strategy. These will bebrought through for consideration and decision over the next year.

2.0 SYSTEM PERFORMANCE

2.1.1 There are a number of performance measures that the GM Health and Social CarePartnership are monitored against. Current performance against these is outlined inappendix A. The key performance measures within this set are outlined in more detailbelow:

Urgent care 4 hour standard (National standard is 95% with higher being betterperformance) – Due to the recent challenging environment with increasingly highlevels of demand and higher acuity patients we are off target for this particularindicator with our latest figures showing 81.5%. Spikes in admission rates haveresulted in increased bed occupancy rates and the proportion of patients staying 7days or more. We have now received confirmation of the additional funding from thenational winter funds. This will be used to increase bed capacity and recruitment of

6

additional staff. In addition we are also investing in primary care to maximise primarycare provision, supporting home visiting and responding to lower acuity patients.

Delayed Transfers of Care (National standard is 3.5% with lower performancebeing better) – provisional data from NHS England for November 2017 shows a GMposition of 4.0%. This is 0.1% lower than the overall North Regional position andsignificantly lower than the national position of 4.7% (as at October). Analysisidentified the main reasons for performance are delays in arranging domiciliary carepackages, patient and/or family choice and delays in arranging nursing homeplacement. We remain focused on reducing delayed transfers of care through regularmulti agency discharge events; these alongside the Home for Christmas campaignare showing initial indications of a positive impact.

Referral to Treatment (national standard is 92% of patients should wait lessthan 18 weeks for treatment) – The most up to date data for November shows GMhas missed this target by a fraction with performance at 91.9% against a target of92%. It is anticipated that due to urgent care pressures and the current nationalguidance to defer non-urgent care until February we will see a reduction inperformance against this measure during the early part of 2018.

4.0%

Delayed Transfers of Care

Better Is Lower

7

Diagnostic test waiting times (National standard is for no more than 1% ofpeople waiting 6 weeks or more) – current GM performance is at 1.6% which fallsbelow the national standard of 1%. There are a number of activities in GM that areanticipated to have a positive effect on this measure including the new endoscopysuite at Manchester Foundation Trust and the investment in gastro services withinPennine Acute. Both of these will be monitored and the impact noted on the overallGM diagnostic position.

Cancer 62 day wait (National standard is 85% with higher being betterperformance) – The most up to date performance as at October is at 86.7% andtherefore above the national target. There are areas we are looking at improving, inparticular around patients seen within 2 weeks of referral for breast symptoms wherecancer is not suspected (currently 85.9% against a target of 93%) and treatmentwithin 62 days of national screening (currently at 80% against a standard of 90%).

Improving Access to Psychological Therapies recovery rate (IAPT) (Nationalstandard is 50% with higher being better performance) – IAPT recovery standardis marginally off the national target with the most recent data showing 49.21%(August 2017) against the standard of 50%.

91.9%

Referral To Treatment - 18wks

Better Is Higher

Diagnostic Tests Wait

1.6%Better Is Lower

86.7%

Cancer - 62 Day Wait

Better Is Higher

8

Early Intervention in Psychosis (EIP) (National standard 50% people startingtreatment within 2 weeks) – Current performance is at 72.8% which is a significantimprovement on last month and well above the national target. We have stayedabove the national target all year despite workforce pressures.

2.2 GP Services

2.2.1 Current performance information shows improvement in three key indicators relatingto GP services:

GP extended access is at 58.7%, an increase on previous performance of1.9%

Patient experience of GP services is reported as 85.7% and Patient satisfaction with GP opening times is 77.6%

2.3 Quarter 2 Assurance

2.3.1 All quarterly local assurance meeting have now been completed and actions agreed.Many examples of good practice have been identified such as Wigan’s ‘outstanding’rating for their diabetes services, Bury’s excellent work on medicines management(presented at this SPB meeting) and Tameside’s work on digital services for carehomes. Common themes in terms of challenge included urgent care, mental healthrecovery rates and workforce planning. These were the first set of meetings wherewe had considered public health issues against the new national public healthdashboard and while the measures remain quite crude they stimulated productiveconversations on drug and alcohol services, sexual health, smoking cessation andother topics.

49.2%

IAPT Recovery Rate

Better Is Higher

EIP - Treated Within 2 Weeks

72.8%Better Is Higher

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2.3.2 Based on concerns about different areas of performance, it is planned to havediscretionary Q3 meetings with Stockport, Wigan, Trafford and Oldham.

3.0 QUALITY

3.1 Performance as at October 2017 against our key quality indicators shows:

There were 2 reported MRSA infections in October. GM is 10.3% above plan for C Difficile in the year to date to October 2017.

The GM Nursing Team, alongside colleagues from NHSI meet quarterly withInfection Prevention Control leads from trusts to discuss management ofinfection control.

Data for October shows 187 cases of E.coli in GM. This is an increase of 2 onthe September figures. To improve this each CCG has identified an ExecutiveLead and developed an Improvement Plan.

3.2 SEND Inspections

3.2.1 The Children and Families Act 2014 is a statutory framework for the integration andpersonalisation of services for children and young people that requires healthservices in England to work closely alongside education and social care services toprovide the right support for children and young people and their families. A five yearprogramme of joint inspections by Ofsted and the Care Quality Commission (CQC) iscurrently underway to assess the way the local area (education, local authority &health) carries out its statutory duties in relation to children and young people withSEND. There have been four inspections to date in Greater Manchester, of whichRochdale, Bury and Oldham have been required to produce a formal WrittenStatement of Action (WSOA). There is work to do in GM to strengthen jointarrangements between Local Authorities and CCGs. The new statutory frameworkrequires CCGs and local authorities to agree joint arrangements, focused on theassessment and planning of an individual Education, Health and Care plan for eachchild with special educational needs.

3.2.2 The Children’s Health and Wellbeing Board considered this matter at theirSeptember meeting and are drawing up an action plan to improve the contribution ofthe health system to meeting children’s neds, including those identified and capturedin their Education, Care and Health Plans.

3.3 Safeguarding

3.3.1 In Quarter 2 (July 17 – September 17) the Nursing Team liaised with each CCGSafeguarding team to discuss local concerns, challenges and achievements. Fromthe 1st of October 2017 the Safeguarding Collaborative was disbanded. Assurancewill be provided by the CCG Executive Nurses/Directors of Quality and the threeSafeguarding networks (Adult, Children & Looked After Children). Each Network has

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agreed to review their terms of reference and develop an updated work plan; this willbe reported back to the GMHSCP Quality Board.

3.3.2 The Safeguarding Assurance Framework is updated by each CCG on a quarterlybasis and for Quarter 2 it confirmed that in GM, we do not have any area of non-compliance (rag rated red). Quarter 2 has seen a significant reduction in the riskareas from Quarter 1 and assurance has been provided to GMHSCP that highlightsthe risks and demonstrates that robust action plans are in place.

3.4 Child Protection Information System

3.4.1 The Child Protection Information Sharing project (CP-IS) is a nationwide system thatenables child protection information to be shared securely between local authoritiesand NHS trusts across England. Data is uploaded by local authorities for children andyoung people subject to a child protection plan or looked after child plan.

3.4.2 GM has made good progress in the implementation of CP-IS with NHS Digital andexpected to achieve timescales for further roll out.

3.5 Quality in Care Homes

3.5.1 Across Greater Manchester (GM) there are 571 care homes with a total of 19,431beds.

3.5.2 The CQC data as of 3rd November 2017 shows that there are still too many peoplebeing cared for in homes across GM that either require improvement or areinadequate:

3.5.3 A Care Sector Lead was appointed into the Nursing Team to lead work stream 2 ofthe GM Nursing and Residential Care Home Delivery group, ‘Best practice in carehomes, quality improvement’. The purpose of this work stream is to improve clinicalpractice and support care homes with a focus on reducing the level of avoidable

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none elective attendance and admission to acute hospitals, a reduction in delayedtransfers of care to the care home environment, reduction in avoidable harm andimprovements in the quality of care delivered within the care home sector.

4.0 FINANCE

4.1 The financial performance of GM Health & Social care at end September 2017(Month 6) shows a current forecast gap of £13.2m against the agreed plan for2017/18. Although work is ongoing to identify mitigations in closing the gap thisremains a significant risk to the Partnership. The detail at a sector level is shown inthe table below. A more detailed picture of the current finical position is included asappendix 2

4.2 Key points to note in relation to the current financial position include:

Excluding specialist commissioning, GMHSCP central budgets are reporting anew year to date underspend of £1.1m. Within this is an overspend on directcommissioning budgets of £60k which is offset by an underspend in NHSEcorporate budgets.

Specialist commissioning is forecasting acute contract over performance of£20.1m, particularly relating to activity at CMFT, Christie FT and UHSM. Workis underway to understand the clinical reasons or changes in patient pathwayswhich would have increased activity at these trusts causing this overperformance.

GM has received a capital allocation for Primary Care of £18.3m. Spendagainst this allocation is forecast to be fully committed in 2017/18.

At the end of month 6, CCGs forecast a surplus of £3m in line with plan. With the exception of Pennine Care FT, all Trusts are forecasting to deliver

their planned financial position. This means that at the end of month 6provider Trusts are reporting a year to date deficit of £59m against a plannedyear to date deficit of £53.4m.

Whilst the year end position for Local Authorities is projected to deliver a£0.5m surplus, this relies on Local Authority reserves of £50.6m which is inaddition to savings targets of £53.9m already embedded in budgets.

It is important to note the lack of comparability with last year’s figures becauseof the treatment of CCG surpluses.

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4.3 Transformation Fund Update

4.3.1 The allocation of transformation funds from the £450m is nearing completion. All tenlocalities have now been successful in securing funding. The focus therefore will beon assuring implementation and measuring impact.

4.3.2 The table below summarises the funding awarded from the Transformation Fundthis financial year.

Proposal Locality /Programme

Fundingawarded

SPBE approvaldate

Single Hospital Service Manchester £56.3 12/04/2017Dementia United Theme 2 £2.3m 12/04/2017Local Care organisation andSingle CommissioningFunction

Manchester £38.9m 12/05/2017

Healthier Together Theme 3 £11.7m 12/07/2017Mental Health Cross Cutting 12/07/2017Locality Plan Oldham £21.3m 09/08/2017Locality Plan Bury £18.2m 09/08/2017Locality Plan Rochdale £23.5m 28/09/2017Locality Plan Trafford £22m 28/09/2017

4.4 Digital Transformation Fund update

4.4.1 Some £8.6m of the initial £10m of the Digital Transformation Fund has now beenallocated. The allocations have been made using the same criteria and approach forthe wider GM Transformation Fund. The table below shows these allocations:

Locality /Programme

Funding Proposal

Bolton £700,000 Mobile working/capability for community users andsupport for EPR programme

Bury £716,000 Roll out Vision Community for community users

Manchester £1,020,113 Implement EMIS Community product across theManchester locality ensuring all community users areusing a shared electronic record

Rochdale £328,333 Mobile working/capability for locality

Salford £510,300 Extend Graphnet integration and radiology requestingfor the wider LCO

Stockport £908,011* Multiple projects including, WIFI in care homes,integration with DataWell, electronic prescribing,

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mobile working/remote consultations and extension ofEMIS Community

Wigan £962,500 Multiple projects including virtual desktop, integrationwith DataWell, mobile working, data analytics

GM - NWAS £182,400 Tablet devices for use in ambulances at point of care

GM -DataWell

£2,000,000 Rolling out of a core Health Information Exchangecapability across GM

GM – securemessaging

£150,000 Run a pilot proof of concept on the ability and capabilityof solutions to securely message individuals or teams incontext of patient care

PennineCare

£804,306 Accelerate the usage and roll out of PARIS functionalityacross all mental health services and roll out mobiledevices

GreaterManchesterMentalHealth

£377,644 Development of infrastructure to align clinical systemsand deploy mobile devices

Total £8,659,607

4.4.2 The Digital collaborative is currently looking at potential schemes for the unallocatedamount for 2017/18.

4.4.3 This £10m is part of a bigger potential allocation of £70m over the next three years.In anticipation of the future years funding we are now looking at starting the processfor 2018/19 bids. This will support a range of projects across localities and GMaligned to the GM Digital Strategy.

5.0 TRANSFORMATION PORTFOLIO

5.1 We are starting to gear up for 2018/19 by assessing the current implementationstatus of all projects / programmes and reviewing the assumptions made aroundbenefits realisation for each. As part of this work we will consider those things whichare already agreed for 2018/19 and national must do’s, identifying any programmeswhich need to be accelerated to meet those must do’s.

5.2 This approach will enable us to prioritise our projects and programmes, ensuring allhave a clear route to implementation and delivery. The outcome of this work will bereported to a future Board meeting.

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

14

registers. Each of these are based on the agreed GM Risk and Issues ManagementFramework (RIMF), which supports the development a risk management process forthe GM HSCP.

6.2 The most significant current risks to the GM HSC Partnership and how they are beingmitigated can be summarised as:

Return on investment of Transformation Funding across GM – as part ofthe transformation portfolio approach 90 day plans for each programmehaving received transformation funding have been developed. In addition thelocality assurance process will ensure implementation of locality plans andmonitor the financial returns being achieved.

Performance against national standards in particular accident andemergency & urgent care demand – GM wide and locality plans are inplace and performance is being regularly monitored. Our approach also hasclear escalation processes. The UEC Hub will also support the delivery ofthese national standards.

Failure to achieve financial sustainability – this is being mitigated throughregular monitoring and escalation processes including the quarterlyassurance process. The GM Finance Executive Group and close workingrelationship with NHSI will play a significant role in mitigating this risk.

Delivering the workforce strategy ensuring a full complement of highlyskilled staff – The GM Workforce Collaborative is working with localities andnational bodies to coordinate investments in workforce to maximise impactand benefits.

7. SPBE DECISIONS

7.1 The Strategic Partnership Board is asked to note the recommendations supported bythe Strategic Partnership Board Executive recommendations at the meetings on 25th

of October and 29th November. These are outlined in more detail in the decision log(Appendix 3).

Financial impact of Transforming Care – recognising the longer term financialimplications of the Transforming Care Programme when it comes to an end inMarch 2019

GMHSC Partnership Risk Register and Board Assurance Framework - anew approach to risk and issues management including the development of aBoard Assurance Framework

GMHSC Partnership Governance Proposals - drawing together proposals fora new approach to governance recognising the Partnership has now moved moredeeply into implementation

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IM&T GM Architecture Interoperability and innovation – proposal for thecomponents necessary for sharing information across organisational and localityboundaries

IM&T DataWell – Proposals for the next stages of the DataWell programme andlinkages to the emerging GM IMT architecture

Financial Assurance for Single Commissioning Functions – implications ofthe emerging locality commissioning structures on the duties of CCG CFOs andthe assurance requirements of NHS England

Incentivising Delivery Through Payment Reform – outlining the local andnational work that has been undertaken to look at opportunities to reform thecurrent payment system and incentivise different behaviours for commissionersand providers

GM Medicines Strategy – update on the direction and ambition of the MedicinesStrategy

8.0 RECOMMENDATIONS

8.1 The Strategic Partnership Board is asked to note and comment on the contents of theupdate.

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Appendix 1: GM System Performance Dashboard

17

Appendix 2 – GM HSC Partnership Finance Dashboard

18

Appendix 3 – GMHSC Partnership Decision Log

Appendix 3 – GMHSC Partnership Decision Log SPBE 11th November 2017

Report summary Recommendations Decision

Financial Impact of Transforming Care -

NHS England has developed a tool for Transforming CarePartnerships (TCP) which collates historical and plannedfinancial details from CCGs, Local Authority and SpecialisedCommissioning related to Transforming Care. This includesthe increased number of community packages, reducednumber of beds and new community services. The toolcalculates the overall recurrent financial impact of theTransforming Care Programme once it comes to an end inMarch 2019. The tool was developed in response to theincreasing number of reports from TCPs that TransformingCare was not a cost neutral programme as previously statedby NHS England and that there was an ongoing negativefinancial impact.

SPBE was asked to note the reportand consider the next steps fornegotiating with NHS EnglandFinance Team.

Resolved

The comments of theExecutive were notedwith regard to costimplications andnegotiations withNHSE Finance Team.

GMHSC Partnership Risk Register and Board Assurance Consider the risks highlighted in theRisk Register and discuss any

Approved

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Framework

Following the mandate from SPBE in June 2017, the GMHSCPartnership Team have over the last few months beendeveloping a new approach to risk and issues management,including the development of a Board Assurance Framework(BAF) .The report provided:

The GMHSC Partnership Risk Register for information,as part of the agreement to share the Risk Register on aquarterly basis with SPBE.

The draft Board Assurance Framework and supportingassessment material.

omissions or concerns.

Consider the first draft of the BoardAssurance Framework (BAF), using theagreed risk categories.

Month 6 Finance Update

The report provided an overview of the Month 6 year to datefinancial position and forecast outturn position for 2017/18 forthe individual organisations and sectors within GreaterManchester (GM). The monthly reports will highlight any keyissues that are impacting on financial performance on a GMwide basis.

Note that GM has set a deficit plan of£17.6m for 17/18

Note that the year to date (Month 6) deficitof £60.9m represents an adversemovement of £7.5m against M6 plan.(Table2 refers)

Note that the forecast position currently

Noted

20



shows a £13.2m adverse variance againstplan by reporting a forecast outturn of£30.9m deficit.

Note the risks to the delivery of the GMfinancial plan for 2017/18

GMHSC Partnership Governance Review Proposals

The report set out a number of proposals for refreshedgovernance for the GMHSC Partnership. When the initialPartnership Governance was established it was recognised itwould need to be regularly reviewed as the Partnership itselfdeveloped and moved more deeply into implementation ofprogrammes.

In drawing together the proposals in this report, providers, CCGsand Local Authorities have all been consulted. In addition therecommendations from a recent NHS England Internal Audit ofgovernance have been incorporated.

Note the issues and concerns with thecurrent governance approach

Note the high level findings from thegovernance audit

Discuss and comment on the proposals putforward in this paper, with the intention thatthey be further refined and then submittedfor final approval to Strategic PartnershipBoard in January.

Noted

Proposal to bepresented to the SPBin January.

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IM&T: GM Architecture – Interoperability and InnovationHubs

The report described the expected components of a platform(interoperability hub) necessary for effective sharing ofinformation across organisational and regional boundaries fordirect care, the relationship of this platform with existingarchitecture and with a GM innovation hub.

Note the proposed components of thearchitecture.

Note the relationship between theinteroperability and innovation hub.

Noted

IM&T Datawell

The report described the Datawell programme was conceived bythe Academic Health Science Network in 2014 as a means ofintegrating health and care data across Greater Manchester.During 2015/16 the shadow Strategic Health and CarePartnership Board embraced the potential of Datawell as part ofits overall planning for devolved control. In June 2016 a paperwas brought to SPBE on the emerging IMT strategy thatincluded a description of Datawell and its potential future role. Itdescribed the pilot phase of the programme and committed thePartnership to carry our further work on whether Datawell was agood investment proposition in terms of full roll-out.

As an interim measure, in March 2017, the SPBE agreed to

To note the background to the Datawellprogramme and the progress made to date;

To support work to review implementing theGraphnet product in the remaining 4localities across GM as an integrated digitalcare record and harmonising licencingcapabilities across GM;

To support the approach agreed at theHInM board of slowing down the Datawellprogramme while it is re-focused onto asmall number of key accelerators, includingpathology, both to remove duplication withGraphnet and to support increased value

Approved

22



provide development funding for Datawell of £793,107 to allowthe programme to continue to make progress, subject torepayment from national digital funding.

for money;

To delegate to the Chief Officer thedecision to allocate funds to the Graphnetand Datawell programmes from the digitalfund 17/18 subject to the actions andcriteria set out in this paper.

To support the evolving GM architecture,including the integrated interoperability huband innovation hub and note the importantrole DataWell could play within theinteroperability hub.

To note that a key objective of therelationship between interoperability andinnovation hubs is to provide the capabilityfor anonymised, longitudinal, linked healthand social care data, covering the whole ofthe GM population, to be used for non-direct care purposes.

To support the view that a concerted effortwill need to be made to acceleratinginformation governance, data sharing,support for GP GDPR compliance and

23



information sharing gateway adoptionacross GM for direct care.

To support the view that a singlegovernance structure needs to be createdto oversee the development of theinteroperability and innovation hubs, andthe relationship between them. Also, thatthis governance needs to define roles andresponsibilities for development andadoption of the GM interoperability hub.

To note that the HInM board’s view is thatthere should be joint ownership goingforward between the Partnership executive(focusing on interoperability hub for directcare) and HInM (focusing on innovationhub).

To note that a joint executive group hasbeen set up following the HInM Boardmeeting to take the next steps, includingestablishing the right governance.

To note the main risks that have been

24



identified.

To agree that a further report on progress ismade to SPBE in January 2018.

Financial Assurance for Single Commissioning Functions

The report describes the work due to be commenced across GMto consider the implications of emerging locality commissioningstructures on the professional duties of the CCG CFOs and theassurance requirements of NHS England which are deliveredthrough the GMHSCP Executive lead for finance andinvestment.

The reports asks for the active participation of CCG and LocalAuthority Leadership teams to support the production of a paperfor approval at SPBE in January/February.

To note the work to be undertaken

Ensure active participation in the proposedprogramme of work within localities

Approved

Incentivising Delivery Through Payment Reform

The report describes the local and national work that has beenundertaken thus far to explore the opportunities offered by

Note the work undertaken Approved

25



reform of the current payment system to incentivise differentbehaviour from commissioners and providers of health andsocial care services. The report proposes next steps to progresspayment reform within GM and draws out the crucialinterdependencies between this work and both theimplementation of the GM commissioning review and thedevelopment of the local care organisations in localities.

Support the proposed way forward, bothlocally and nationally

GM Medicines Strategy

The reported provided an update to members of SPBE on thedeveloping Medicines Strategy and to gain feedback on theoverall direction and ambition outlined within it.

The draft Medicines Strategy has been developed following wideinput from across the Greater Manchester system including:

The strategy is intended to support the delivery of thetransformation themes within Taking Charge and drive themedicines agenda forward. .

The draft strategy has been shared with the system andreceived positive feedback in relation to overall direction andambition with specific comments around.

Comment on the content of the paper andthe strategic direction it sets

Agree to the next step as being:

Final version of the strategy to bedeveloped following feedback from SPBE,including costed implementation plan tobdeveloped in conjunction with localities.

Report noted;

To note that the DraftGM MedicineStrategy will bepresented at themeeting of theExecutive on 14December 2017alongside a costedimplementation plan.

1



Subject: Transformation Fund Update

Report of: Steve Wilson, Executive Lead, Finance & Investment, GMHSC Partnership

SUMMARY OF REPORT:

The report contains an update on recent developments with the Transformation Fund. Thismonth has an expanded section on the findings and recommendations from the assessmentteam in their evaluation of the proposals in relation to Mental Health and proposals from theSalford and Wigan localities.

KEY MESSAGES

The report provides a general update on the latest developments in relation to the £450mGM Transformation Fund and contains, in detail, the findings of the Transformation FundOversight Group (TFOG) on 23 November, 5 December and 13 December 2017, and thedecisions of the Strategic Partnership Board Executive on 14 December, where the MentalHealth, Salford and Wigan submissions were considered.

The mental health proposals allocate funding to two key elements of the GM Mental HealthStrategy supporting both the development of the Children and Young Peoples Crisis CarePathway and the Liaison Mental Health Services within GM Acute Hospitals.

The Salford proposals supports a plan to deliver a radical upgrade in population healththrough stratification and needs identification, engagement and prevention. It will supportpeople to live healthy independent lives, managing their own conditions through acommunity asset based approach.

Wigan’s proposals build on their phase 1 transformation fund allocation and look to deliver anew approach to out of hospital unplanned care, a reformed housing with care offer, a placebased approach to specialist mental health services and a further acceleration of the Heartof Wigan programme.

TFOG recommended a substantive investment of £27.68m in mental health services (this isout of the total transformation fund allocation of £42m agreed by SPBE in July 2017) £3.44minvestment in Salford and £15.43m for Wigan. These funding recommendations were

5

2

accompanied with material conditions for the funding. Funding for all proposals wasapproved by SPBE subject to those conditions.

PURPOSE OF REPORT:

The purpose of the report is to update the Strategic Partnership Board on investmentdecisions made by the Strategic Partnership Board Executive in December in relation to theMental Health, Salford and Wigan proposals.

RECOMMENDATIONS:

The Strategic Partnership Board is asked to:

Note the Strategic Partnership Board Executive’s decision to:

Approve a substantive investment in the Mental Health business case for theChildren and Young People’s Crisis Care Pathway of £13.44m over four years, withphasing to be set out in the Investment Agreement and paid quarterly in advance:

o 2017/18: £0.56m

o 2018/19: £3.89m

o 2019/20: £4.51m

o 2020/21: £4.48m

o Noting that there are material conditions with funding only to be releasedupon their satisfactory completion. These are set out at 2.4.3.

Approve a substantive investment in the Mental Health business case for the LiaisonMental Health Services in Acute Hospitals of £14.24m over four years, with phasingto be set out in the Investment Agreement and paid quarterly in advance:

o 2017/18: £0.37m

o 2018/19: £2.96m

o 2019/20: £4.73m

o 2020/21: £6.18m


Approve a substantive investment in Salford of £3.44m over four years, with phasingto be set out in the Investment Agreement and paid quarterly in advance:

o 2017/18: £0.28m

3

o 2018/19: £1.51m

o 2019/20: £1.37m

o 2020/21: £0.28m


Approve a substantive investment in Wigan of £15.43m with phasing still to bedetermined, set out in the Investment Agreement and paid quarterly in advance:


CONTACT OFFICERS:

Rick Thompstone, Transformation Fund Strategic Lead, GMHSC [email protected]

Thomas Daines, Transformation Fund Project Manager, GMHSC [email protected]

4

1.0 INTRODUCTION

1.1. The GM Transformation Fund (TF) became operational in April 2016 following thesuccessful delegation of transformation responsibilities to the GM Health & SocialCare Partnership.

1.2. This paper is written to provide the Strategic Partnership Board (SPB) with anupdate on recent developments and asks the board to note key decisions on theTransformation Fund.

2.0 THEME UPDATE: MENTAL HEALTH

2.1. Background and Context

2.1.1. The funding envelope for Mental Health was approved by the Strategic PartnershipBoard Executive (SPBE) in July 2017. The funding provided for the strategic outlinecase for investment in Mental Health was an agreed substantive investmentenvelope of £56.2m over 4 years to 2021.

2.1.2. In line with the proposed amendments to the application process as agreed at July2017 SPBE, the internal assessment team will review individual projects over £5mcontained within a programme with TFOG making recommendations to SPBE forapproval.

2.1.3. The submission seeks funding of £13.44m for the Children and Young People’sCrisis Care Pathway over four years and looks to achieve the following:

Children and young people with mental health needs have access toappropriate services that support their psychosocial wellbeing and allow themto thrive into adulthood.

Children, young people and those who care for them are able to accessassessment, intervention and support at the right time, at the right level, and inthe right location.

Children, young people and those who care for them are supported within afully integrated, recovery focused pathway.

2.1.4. The submission also seeks funding of £14.24m for the Liaison Mental HealthServices in Acute Hospitals over four years. The investment will look to achieve thefollowing:

By 2020/21, no acute hospital should be without all-age mental health liaisonservices in A&E departments and in-patient wards, and at least 50 per cent ofacute hospitals with a type 1 A&E should meet the core-24 service standard asa minimum.

In GM there is a more ambitious target, which is to attain a core-24 standardliaison mental health service in all 10 GM acute hospitals with a type 1 A&E

5

and a modified version in the 2 acute hospitals with an urgent care centre by2020/21.

The NHS England & NICE guidance on Urgent and Emergency Mental HealthLiaison in Acute Hospitals (2016) describes the staffing levels that are neededto achieve a core-24 compliant service.

The recommendations made in the GM SCN liaison mental health clinicaladvice document go beyond this and suggest that we should aim to scale upcore-24 staffing levels to reflect the actual number of beds and acuity of eachhospital and that there should be an enhanced-24 service (which is a moreadvanced and expensive model than core-24) in all specialist acute hospitalswith the remaining hospitals working towards achieving this model.

This request is for the funding needed to attain the staffing levels for a 500 bedacute hospital in all 10 GM acute hospitals with a type 1 A&E and modifiedlevels in the 2 acute hospitals with an urgent care centre.

2.2. Findings from the Assessment Team – Children and Young People’s CrisisCare Pathway

2.2.1. The overall view from the assessment team is summarised as follows:

The narrative for transforming the Mental Health provision for GM is compellingand comprehensive, and the proposal strongly aligns to the GM Strategy andeach of its five themes.

The project provides the platform for investment and delivery of Mental HealthServices across GM which is needed for transformation.

There are robust governance arrangements in place which reflect cooperationand commitment across all organisations to deliver the transformation.

The proposal includes a clear breakdown of the cost of the programme andcomprehensive workings are provided in the CBA. The CBA indicates cashablesavings from reduced demand for acute services that will be reinvested incommunity-based / preventative provision. Recurrent funding of the service willbe funded from the expected increase in GM funding from 21/22.

The proposal addresses the Five Year Forward View, the Greater ManchesterMental Health Strategy and historic underfunding of the services

The programme will be monitored over the period to ensure this redistributionof funds is delivered.

2.2.2. The key points from the discussion at TFOG were as follows:

There was a question about the future of the programme post-TransformationFund. Whilst there is no formal agreement from a financial perspective,

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recurrent funding supported by the Transformation Fund is being done at asustainable level that could continue to be funded post Transformation Fund. Itwas agreed that it needed to be made explicit what was recurrent and whatwas non-recurrent funding.

It was suggested that there was a lack of clarity over how this service wouldplug into existing services elsewhere but as localities were asked not to focuson mental health in their submissions, this is to an extent understandable

It was noted that there is a need to be realistic over whether the workforcewould be available to deliver the programme. It was further noted that similarworkforce needs had been fulfilled in recent years, however.

2.3. Findings from the Assessment Team – Liaison Mental Health Services inAcute Hospitals


The narrative for transforming the Mental Health provision for GM is compellingand comprehensive, and the proposal strongly aligns to the GM Strategy andeach of its five themes.

The project provides the platform for investment and delivery of Mental HealthServices across GM which is needed for transformation.

There are robust governance arrangements in place which reflect cooperationand commitment across all organisations to deliver the transformation.

The proposal includes a clear breakdown of the cost of the programme andcomprehensive workings are provided in the CBA, the model is based on theBirmingham model and existing schemes across GM. The CBA indicatescashable savings from reduced demand for acute services that will bereinvested in community-based / preventative provision. Recurrent funding ofthe service will be funded from the expected increase in GM funding from21/22.

The proposal addresses the 5YFV MH Strategy and historic underfunding.

Further development of the spend breakdown for PCFT is required in line withthat which was provided by GMMH.

The programme will be monitored over the period to ensure this redistributionof funds is delivered

Further detail is required on how services will be decommissioned as thesavings are predominantly from reduced LOS for inpatient admissions, relatedto faster discharge from hospital.


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There was some scepticism at the size of the benefits case for this programme.

There was discussion as to whether the benefits are already accounted for inlocality plans. It was clarified that savings should be being counted in thelocality plans based on assumptions on GM work streams, rather than insubmissions from the themes and cross-cutting programmes.

It was highlighted that such a service is already in place in some GM hospitals,so a more robust, local benefits case should be able to be drawn up. It wasagreed that there needed to be a material condition of a new, more realisticbenefits case.

It was commented upon that the governance structure appeared to lackprimary care provider involvement, who would likely be highly involved withsuch a group of potential patients, and that this should be addressed via amaterial condition.

It was also agreed that there should be a material condition of a slippage ofsetup costs to be protected for these programmes, but for recurrent costs thatare not being spent, they will either be clawed back or rephrased.

2.4. TFOG Recommendation

2.4.1. Approve a substantive investment in the Mental Health business case for theChildren and Young People’s Crisis Care Pathway of £13.44m over four years, withphasing to be set out in the Investment Agreement and paid quarterly in advance:

2017/18: £0.56m

2018/19: £3.89m

2019/20: £4.51m

2020/21: £4.48m

Noting that there are material conditions with funding only to be released upontheir satisfactory completion. These are set out at 2.4.3.

2.4.2. Approve a substantive investment in the Mental Health business case for theLiaison Mental Health Services in Acute Hospitals of £14.24m over four years, withphasing to be set out in the Investment Agreement and paid quarterly in advance:

2017/18: £0.37m

2018/19: £2.96m

2019/20: £4.73m

2020/21: £6.18m

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2.4.3. There are a number of material conditions attached to the above recommendations:

The mental health team shall provide a detailed breakdown of the impact of theexpected reductions in activity on the acute sector for both the Crisis Care andLiaison Mental Health Service.

It shall be ensured that any slippage of setup costs is to be protected for boththe Crisis Care and Liaison Mental Health Service, but any recurrent costs thatare not being spent, will be returned to the Partnership.

The mental health team shall produce a detailed breakdown of the benefitsrealisation by March 2018 to fully understand the financial position andexpected finance flows for both the Crisis Care and Liaison Mental HealthService.

The mental health team shall gain commitment from relevant parties to ongoingmonitoring and reporting of benefits realisation in practice, to evidence the shiftin spend from acute to community sectors for both the Crisis Care and LiaisonMental Health Service.

The mental health team shall produce a new, more realistic benefits case thatincorporate learning from similar services in other GM hospitals for the LiaisonMental Health Service.

The mental health team shall ensure the involvement of primary care providerrepresentation for the governance of the Liaison Mental Health Service, due totheir likely ongoing involvement with potential patients.

The mental health team shall evidence agreement/sign up to the Mental Healthplan, and the intent to reinvest savings realised in mental health services andfund the model recurrently from 2021/22 allocations

3.0 LOCALITY UPDATE: SALFORD (POPULATION HEALTH)


3.1.1. In line with the revised assessment approach as agreed at September 2016 SPBE,Salford’s Population Health proposal was assessed by a team from the GMHSCPartnership between October and November 2017.

3.1.2. Salford were one of the first localities to previously to submit to the TransformationFund and were given an investment of £18.16m. When submitted, there was arecognition and agreement both within the locality and at the Partnership thatpopulation health and prevention, aligning with Theme 1 of Taking Charge, were outof scope and would be subject to a further submission to the Fund.

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3.1.3. Salford’s Population Health submission seeks to secure £3.44 million “deliver aradical upgrade in population health through stratification and needs identification,engagement, prevention and activation of its plans. It will support people in Salfordto live healthy independent lives, managing their own conditions through acommunity asset based approach, tackling factors that influence the decline inhealth, function and wellbeing.” The investment would be made into sixprogrammes of work:

Start Well – Early Intervention and Prevention; Start Well – Vulnerability and Safeguarding; Start Well – Parenting; Start Well – Children are Thriving; Live Well – Obesity and Cancer Prevention; and Person and Community Centred Approaches.

3.2. Findings from the Assessment Team

3.2.1. The estimated gross fiscal benefits total £19.0m over the 25 year period (beforediscounting), and are driven by improvements in the following outcomes:

reduced mental health disorders: £5.0m (26% of total gross fiscal benefits);

increased employment (when children leave school): £4.4m (23%);

reduced incidence of asthma: £4.0m (21%); and

increased school readiness: £2.8m (15%).


There is a strong sense of ethos throughout the submission. The programmeswithin the scope of the submission form part of a larger portfolio of work that iscommunity and VCSE focussed.

The proposal strongly aligns to the GM Strategy and the locality has taken careto ensure that their Population Health work dovetails with what the Partnershipare proposing to lead on across GM. There is no duplication with GM-ledworkstreams in Population Health, PCCA or mental health.

As much of the investment would be enhancing existing work, delivery wouldbe accelerated through utilising existing teams with less dependency onenablers such as workforce or estates.

There are existing robust governance arrangements in place, which reflectcooperation and commitment across all organisations in the Locality to deliverthe transformation, and which will be revised to incorporate a board dedicatedto Population Health work.

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Clearly articulated financials are underpinned by coherent assumptions, anddetailed cost-benefit analysis modelling undertaken at a programme levelshows a strong ROI over the long term, although this is dependent on trustingmodels with an emerging evidence base.

Whilst there appeared to be a good level of wide-ranging engagement, widerprimary care (pharmacy, optometry, dentistry) should be further consulted onrelevant programmes of work to ensure that they are fully contributing to thewhole system and resilient communities approach.

Should funding for this submission be agreed, the locality will need to work thePartnership to revise their investment agreement to allow effective monitoringof the proposed transformation.

More detailed and granular planning for programmes would have beenwelcomed to provide further assurance on timescales and deliverability.

Although there is clear intent to evaluate progress, learn from and sharelessons, further detail and assurance is required as to how this will be done.Plans for evaluation, for instance, are not yet developed.


There was some concern whether there were strong enough social careaspects to the work in Salford’s Population Health submission, but it was notedthat the projects in Salford’s submission need to be seen as part of their widerprogramme.

The Group called for learning to be shared from the PCCA work, as it is amodel of work that most localities will be commencing on and learningtherefore needs to be shared across GM.

It was agreed that Salford have made good progress with their initialinvestment and it would be sensible therefore to allow them to make themfurther innovative transformation.

The Group was explicit in wanting to see the learning from this investment andSalford’s other Population Health work spread across other localities.


3.3.1. Approve a substantive investment in Salford of £3.44m over four years, withphasing to be set out in the Investment Agreement and paid quarterly in advance:

2017/18: £0.28m

2018/19: £1.51m

2019/20: £1.37m

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2020/21: 0.28m

Noting that there are material conditions to funding, only to be released upontheir satisfactory completion. These are set out at 3.3.2.

3.3.2. This further investment would total £21.60m when totalled with the already awardedinvestment from the locality’s initial submission.

3.3.3. There are a number of material conditions attached to the recommendation:

The locality shall work with the GMHSC Partnership to revise their investmentagreement to take account of the new investment, ensuring that metrics andmilestones are documented to allow monitoring of transformation.

The locality shall commit to engaging with wider primary care on relevantprogrammes of work to ensure their inclusion and participation into theirproposed programmes.

The locality shall commit to sharing learning from innovative strands of workthat could potentially be replicated across GM.

4.0 LOCALITY UPDATE: WIGAN (PHASE 2)


4.1.1. In line with the revised assessment approach as agreed at September 2016 SPBE,Wigan’s Phase 2 proposal was assessed by a team from the GMHSC Partnershipbetween September and November 2017.

4.1.2. Wigan previously submitted their Phase 1 submission to the Transformation Fundand were given an investment of £15.59m over two years after a recommendationby TFOG in November 2016. While Wigan originally planned to submit threePhrases to the Transformation Fund, this second Phase is now to be the finalsubmission.

4.1.3. Wigan’s Phase 2 Transformation Fund Bid seeks to secure £15.88m to completethe delivery of the Wigan Locality Plan, securing improved outcomes for residentsand helping to close the projected financial gap of £87.5m.

4.1.4. Wigan’s submission stated that “the scale of the reform required would not besolved just by accelerating the delivery of component parts of the Healthier WiganPartnership, but also by addressing some of the complex and structural challengesof the system, “ and requested funding for a mixture of service deliverytransformation programmes and enabling programme capacity:

a hospital with a reduced cost base as a consequence of reduced anddisplaced activity,

a reformed housing with care offer,

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a different and places based approach to the delivery of specialised mentalhealth services,

more rapid implementation of transformation programmes across the lifecourse predicated on a scaled implementation of the unique asset basedapproach,

the further acceleration of the Heart of Wigan programme, and strengthening enabling capacity to support the service reform across the

borough.

4.2. Findings from the Assessment Team


Wigan’s narrative for transforming the health and wellbeing of its population iscompelling and comprehensive, assuring of a strong basis on which to deliverthe Locality Plan.

The proposal strongly aligns to the GM Strategy and each of its five themes.Additionally, the Phase 2 proposal clearly dovetails and builds upon theprogrammes of work contained within the Phase 1 submission.

There are robust governance arrangements in place which reflect cooperationand commitment across all organisations in the Locality to deliver thetransformation, and good evidence of co-design between the CCG, localauthority and providers, with engagement and involvement of the voluntarysector.

Clearly articulated financials are underpinned by coherent assumptions, anddetailed cost-benefit analysis modelling undertaken at a programme leveldemonstrates a strong ROI.

Each programme has a clearly defined set of milestones, outcomes andfinancial/activity impact which are aligned to a comprehensive overarchingoutcomes framework

For the work related to Out of Hospital – Unplanned Care, Wigan are fundingmuch of the new models of care and the bulk of the Transformation funds theexisting provision in the meantime until this is established. This is the other wayround to most bids which are assuming that the existing provision continues tobe funded as normal and the Transformation Fund funds the establishment ofthe new models of care.

Although there is clear intent to evaluate progress, learn from and sharelessons, further detail and assurance is required as to how this will be done.Plans for evaluation, for instance, are not yet developed.

The revised total proposed by the assessment team was for £15.43m, followingdeductions for removal of optimism bias, in line with other Transformation Fundassessments.

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4.2.2. The Wigan submission was considered across two sessions of TFOG due to theneed to provide additional information to support the discussions. The key pointsfrom both discussions at TFOG were as follows:

There was scepticism on the high ROI based solely on TransformationFunding, but this was clarified in the fact that other sources of funding arecontributing to a lot of the costs, which exaggerates this figure. The ROI whentaking into account all investment is more reasonable.

The Group had concerns over how Wigan were structuring the funding of theiracute services and found it difficult to assess the bid due to not being clear onwhat was double-running of services.

There was disappointment at how wider primary care was factored into thesubmission and the involvement of GPs in the governance of primary care wasnot considered sufficient.

It was agreed that greater assurance was required on Wigan’s funding for theirPhase 2 submission and how this expenditure and how it tied into thealternative financial structuring behind the acute transformation.

There was some discussion of Wigan’s current activity trends, where adiscrepancy was highlighted between Wigan’s activity continuing to increase,despite forward projections for it to decrease.

There was a question as to the robustness and benchmarking of CBAs, andwhether they were considered reliable. It was confirmed that the CBAscontained good detail, and reasonable assumption, and that they comparedwell to those of other localities.

A query was raised about the gain share aspects of the submission. Wheredoes reinvestment go if further savings are made? There was also a questionof what happens if savings are not realised, especially through the blockcontract.

Concerns were expressed about the financial phasing of Wigan’s Phase 2investment and how it is now even more difficult to see expenditure of their2017-18 investment given the timescales.

There was a view that Wigan’s Phase 2 submission seemed like an extensionof Phase 1, despite the expectation of something more Population Healthfocussed.


4.3.1. Approve a substantive investment in Wigan of £15.43m with phasing still to bedetermined, set out in the Investment Agreement and paid quarterly in advance:

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4.3.2. There are a number of material conditions attached to the recommendation:

The locality and the Partnership shall engage in a period of mediation to ensurecommon understanding of the next steps for Single Commissioning Functionand Local Care Organisation in the locality, and how this relates toTransformation Fund investment.

The locality shall work with the Partnership to reconsider the phasing of thePhase 2 funding, due to the level of concern with 17/18 funding and a need toreview the Phase 1 investment progress.

The locality shall participate in a review to ensure the Partnership has a fullunderstanding of Wigan’s financial position both in-year and next year and howthis relates to any Transformation Fund monies. No investment agreement willbe entered into until this has been completed in a satisfactory manner.

The locality shall provide the Partnership with analysis on why its hospital hassuch high levels of activity compared to plan.

The locality shall describe in detail how any possible gain share would functionand evidence what any potential reinvestment would look like and provideassurance on the reduction of the block contract in 2018/19.

The locality shall work with Transformation Fund team at the Partnership torevise their investment agreement to reflect the proposed funding and intendedoutcomes and benefits.

The locality shall describe its plans for how it proposes the remainder of its£2.7m financial gap shall be covered and detail its potential impact on theTransformation Fund.

The Partnership will review the Estates funding to ensure that the locality aredue to receive an appropriate level of funding once other estates fundingsources are taken into account, e.g. neighbourhood asset review.

5.0 RECOMMENDATIONS

5.1. The Strategic Partnership Board is asked to:

5.1.1. Approve a substantive investment in the Mental Health business case for theChildren and Young People’s Crisis Care Pathway of £13.44m over four years, withphasing to be set out in the Investment Agreement and paid quarterly in advance:

2017/18: £0.56m

2018/19: £3.89m

2019/20: £4.51m

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2020/21: £4.48m


5.1.2. Approve a substantive investment in the Mental Health business case for theLiaison Mental Health Services in Acute Hospitals of £14.24m over four years, withphasing to be set out in the Investment Agreement and paid quarterly in advance:

2017/18: £0.37m

2018/19: £2.96m

2019/20: £4.73m

2020/21: £6.18m


5.1.3. Approve a substantive investment in Salford of £3.44m over four years, withphasing to be set out in the Investment Agreement and paid quarterly in advance:

2017/18: £0.28m

2018/19: £1.51m

2019/20: £1.37m

2020/21: £0.28m


5.1.4. Approve a substantive investment in Wigan of £15.43m with phasing still to bedetermined, set out in the Investment Agreement and paid quarterly in advance::


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Subject: GM HSC Partnership Governance Review: Proposals

Report of: Jon Rouse, Chief Officer, GMHSC Partnership

SUMMARY OF REPORT:

This paper sets out the review of the current governance arrangements for the GM HSCPartnership and proposes a number of changes to recognise and support the Partnership’smove into its next phase of delivery of Taking Charge Together..

KEY MESSAGES:

In drawing together the proposals in this report, all key stakeholders have been consulted. Inaddition the recommendations from a recent NHS England Internal Audit of governancehave been incorporated.

The proposals were supported by SPBE at their meeting in November 2017 and have beenupdated to reflect that discussion.

PURPOSE OF REPORT:

The purpose of the report is to set out a proposed revised governance structure for the GMHSC Partnership that supports the principles agreed within the GM HSC Devolution MoU butthat recognises the move into what is now the deep implementation phase of Taking Charge.The proposals seek to create clarity around responsibilities, accountabilities and decisionmaking, support engagement across all parts of the system and reduce bureaucracy andduplication of effort.

RECOMMENDATIONS:


Note the issues with and limitations of the current governance approach

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Note the high level findings from the governance audit

Agree the proposed changes.

CONTACT OFFICERS:

Vicky Sharrock, Deputy Director Strategic Operations, GMHSC [email protected]

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1.0 EXECUTIVE SUMMARY

1.1 Background

1.2 The Greater Manchester (GM) Health and Social Care Devolution Memorandum ofUnderstanding, signed in February 2015 facilitated the establishment of agovernance approach that would be responsible for the delivery of the GM vision forHealth and Social Care. The MoU was aimed at supporting GM to assume fullresponsibility for NHS funding streams in Greater Manchester.

1.3 A principle of subsidiarity runs throughout the MoU, seeking to ensure no decisionsabout GM are made without GM and that all decisions are made at the mostappropriate level. The governance structures put in place through the MoU enable allparts of the HSC system in GM to have input into and influence over the overallvision for GM, creating a dispersed model of leadership. This has ensured collectiveownership of the vision and a collaborative approach to delivery, although still haveconsiderable potential to go further in this respect.

1.4 The GM MoU is cognisant of the existing accountability arrangements andresponsibilities held by local authorities, CCGs and NHS Providers. The MoU alsocontained a commitment to regularly review the governance as Greater ManchesterHealth and Social Care Partnership (The Partnership) developed, recognising thatalignment of the development of the Partnership with the most appropriategovernance arrangements would be an iterative process and therefore thosearrangements would need to change over time.

1.5 Since the establishment of the Partnership the governance arrangements haveindeed adapted to address new and changing needs. This is a natural consequenceof GM being the first locality in England to have a devolved arrangement for Healthand Social Care (HSC). The last review was in autumn of last year and resulted in asub-governance that blended system oversight and delivery of transformationprogrammes. As we now move more deeply into implementation of our programmesand also start to think about our future operating model post this transformationphase, it is right to take a fresh look. We also need to recognise the introduction ofthe Mayor and although his office carries no formal responsibilities with respect tohealth and care, our governance should recognise his ambitions, particularly withrespect to public service reform, and also his ability to use powers and influence tohelp us achieve our objectives in Taking Charge.

1.6 Opportunities through refreshed governance arrangements

1.7 Our objective for this review is that a refreshed governance framework for GM HSCPartnership will enable us to:

Clearly outline what we are trying to achieve through the GM Health and SocialCare governance and each of its constituent parts and how best to fulfil theseroles

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Ensure an approach that facilitates leadership and participation across thesystem

Clearly sets out the responsibilities and accountabilities at each level ofgovernance, giving clarity over how decisions are made, aligned to statutoryresponsibilities, enabling GM to transact business efficiently and effectively

Improve depth of engagement across the system, reaching further intoorganisations and in particular strengthening links to primary care and ElectedMembers, enabling all sub governance groups to input into the GM governanceas effectively as possible

Secure greater clarity over decision-making processes, including the role ofsectoral representatives

Ensure the whole system holds the whole system to account, including a placefor localities to hold GM to account for the delivery of GM and cross-cuttingprogrammes of work

Reduce the amount of bureaucracy and duplication

Clarifies and supports the role of the GM Health and Social Care PartnershipTeam as a facilitator of the governance

Establishes a clear approach for the ongoing monitoring of the use of the GMHSC Transformation Fund and other similar GM funds such as the GM DigitalFund

Ensure all elements of the system and all localities have input into governancegroups without requiring all organisations to be on all groups.

1.8 Although this refresh provides the opportunity to ensure the GM HSC governance isfit for purpose and will support the delivery of the GM vision set out in Taking Chargeit will be dependent on the whole system taking ownership and being accountable fortheir part. A key question for consideration will be the system readiness for changeand the maturity of relationships at both GM and locality levels.

1.9 Summary of key proposals

1.10 To support the principles of the GM MoU and achieve the opportunities outlinedabove, it is proposed that:

The current Strategic Partnership Board becomes a GM Health and CareBoard (GM HCB) which would be non-statutory, public facing and focused onimpacting the determinants of health by working across public services andbeyond, including the role of the VCSE. It would meet bi-monthly and will bemore public facing and develop a strong relationship with the local statutory

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Health and Wellbeing Boards in pursuing their local strategies and with theMayor on his big public service reform priorities. The Board would also receiveregular reports on progress against the Taking Charge plan and hold theExecutive to account for their work. The work of the Children’s Health andWellbeing Board will also feed directly into the new GM HCB.

The operationalisation of the GM Strategic Vision for Health and Social Carewill be more clearly delegated to the GM HSC Partnership Executive (GM HSCPE). These meetings will become more formal with clearer respect for thesectoral representation reflected in the agreed voting rights. As well asreceiving reports from the sub-governance the Executive will focus time on thedevelopment of the future target operating model for the GM Health and Caresystem beyond the current transformation phase.

We will work towards establishing the Joint Commissioning Board (JCB) as agenuine Joint Committee of CCGs and Local Authorities. The JointCommissioning Board will be serviced by the GM Commissioning Hub, as setout in the adopted Deloitte Commissioning Review, with key roles includingagreeing common standards, models of care, undertaking some providerengagement and taking responsibility for some commissioning responsibilitiesdirectly.

The role of the Provider Federation Board to be enhanced, with a moredeliberate strategy of asking the PFB to lead collectively on some keytransformation programmes, as well as developing a stronger model ofcollaboration and mutual aid.

The Workforce and Digital Collaboratives, the integrated estates team andHealth Innovation Manchester are each supported to become core parts of ourlegacy architecture.

The sub-governance below the Executive is simplified so that there willultimately be three committees undertaking system oversight – finance, qualityand performance & assurance.

The new governance structures will require us to work in a new way withcollective values and behaviours, as a result organisational developmentactivity will be essential to making this proposal work.

1.11 A diagram of the proposed governance structure is included as appendix A.

2.0 GM HSC GOVERNANCE JOURNEY

2.1 There are a number of key principles upon which the existing GM HSC Partnershipgovernance is based. These remain fundamental building blocks of the proposedgovernance structure:

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GM NHS will remain within the NHS and subject to the NHS Constitution andMandate

Clinical Commissioning Groups and Local Authorities will retain their statutoryfunctions and their existing accountabilities for funding flows, pending anyfuture changes to legislation that would allow us to create a true SingleCommissioning Function

Clear agreements will be in place between CCGs and local authorities tounderpin the governance arrangements

GM commissioners, providers, patients and public will shape the future of GMHealth and Social Care together

All decisions about GM Health and Social Care to be taken within GM and byGM

The partnership will reflect the contributions and competencies of all parties

2.2 The initial governance proposed in the MoU consisted of a Strategic PartnershipBoard, Joint Commissioning Board and Provider Federation. It was proposed aseries of innovation groups would take forward specific workstreams and the wholegovernance framework would be supported by a devolution programme office.

2.3 The GM Health and Social Care Partnership Team was established to support thedevelopment and delivery of the GM Plan: Taking Charge. From the outset the teamhas had a role in enabling the governance arrangements, ensuring it facilitatesparticipative leadership across the system.

2.4 These arrangements still form the core of the governance for the GM HSCPartnership but they have developed significantly over the last eighteen months inorder to provide structures for decision making and assurance such as theestablishment of the Transformation Fund Oversight Group (TFOG) to facilitate theHSC Transformation Fund allocation process.

2.5 Following the signing of the MoU and the establishment of the governance outlinedabove an accountability agreement set out the delegation of internal responsibility forthe operational management of the delivery of the NHS constitution and mandate inGreater Manchester to the Greater Manchester Chief Officer (GMCO) reporting toNHS England’s Chief Financial Officer. This agreement came into effect from 1 April2016 and enables GM to take responsibility for NHS England’s assurance andcommissioning functions as well as providing overall executive leadership to GM’sdevolution, integration and strategy implementation. Quarterly meetings with the NHSEngland Regional team focus on ensuring the commitments in the accountabilityagreement and set milestones are being met.

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2.6 As GM progressed on its devolution journey, additional groups to those initiallyoutlined in the MoU have been added to the overall GM HSC Governancearrangements including:

Performance and Delivery Board – providing oversight to constitutional andmandated requirements of the GM HSC Partnership and initiating directperformance taskforces to support improvement and recovery whereappropriate.

Transformation Portfolio Board – established to oversee delivery of theStrategic Plan; aligning activities across themes; developing a clear programmemanagement approach to implementation and generating links betweenlocalities and GM

Finance Executive Group (FEG) – connecting finance leadership across thesystem to support transformation and day-to-day financial management;working with the Programme and Delivery Board to co-ordinate planning roundactivity and budget setting

Transformation Fund Oversight Group – established to oversee the pipelineof Transformation Fund applications, ensuring proper process and independentevaluation

Quality Board – a statutory function of NHS England working collaboratively tobring together a system wide focus on driving quality improvement, developinga shared view of risks with an early warning system around safeguarding thequality of care in GM

2.7 Given the strength and wide variety of primary care providers in Greater Manchesterthe governance outlined above is now supplemented by an engagement frameworkestablished in November 2015 incorporating all aspects of primary care. Thisframework consists of:

Representatives from all four aspects of primary care (GP, Dentistry,Optometry and Pharmacy) on Strategic Partnership Board

Representation on Strategic Partnership Board Executive, taken from theprimary care representatives on Strategic Partnership Board

Primary Care Advisory Group – drawing membership from all four disciplines ofprimary care, this group ensures a strategic collective voice for primary care inwider GM HSC governance discussions and programmes of activity

Discipline specific advisory groups – facilitating specific conversations amongstthe four disciplines of primary care to inform the work of the Primary CareAdvisory Group

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2.8 The current governance arrangements were set out in a paper to StrategicPartnership Board on 30 September 2016. A diagram showing this governancestructure is included as appendix B. Since this point however there have been furtherchanges to the overall governance arrangements as outlined below.

2.9 In December 2016 GM established a LCO Network with a primary focus onsupporting the work of Theme 2: Transforming Community Based Care and Support.The network is focused on aligning the ten localities in GM, public service reform,primary care, adults and children’s social care, Transformation Theme 1: RadicalUpgrade in Population Health Prevention, Theme 3: Standardising Acute HospitalCare and the cross cutting themes of the overall GM Transformation Programme. Inaddition the network takes account of regulatory landscape and the nationalIntegrated Support and Assurance Process (ISAP), identifying common issues anddeveloping solutions.

2.10 In order to improve engagement and involvement of the community, voluntary andsocial enterprise sector in the delivery of the GM vision for health and social care, aMemorandum of Understanding was agreed and signed in January 2017. Thisprovided a framework for engagement across GM’s devolution agenda aimed atachieving a step change in understanding and involvement of people andcommunities to drive better services and support for the residents of GM. In additionthis framework would provide increased mutual learning and joint professionaldevelopment, improving our ability to leverage the talent, capacity and social value ofthe VCSE organisations.

3.0 WIDER SYSTEM CONSIDERATIONS

3.1 In reviewing and refreshing the current governance arrangements, considerationshould be given to wider system changes including:

Changes to the number of organisations within the Partnership arrangementdue to the mergers of the Manchester CCGs, the acquisition of ManchesterMental Health and Social Care by Greater Manchester West creating a neworganisation, Greater Manchester Mental Health, and most recently, the mergerof CMFT and UHSM to create Manchester University Foundation Trust. Ourgovernance should be adaptable to further changes

Establishment of new organisational forms at the locality level and links tolocality Heath and Well Being Boards including Single CommissioningFunctions and Local Care Organisations that will have implications for ourexisting governance arrangements such as Joint Commissioning Board andProvider Federation Board

The need to clarify assurance mechanisms for the use of the GMTransformation Fund within our governance arrangements (This is not within

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the original ToRs for SPB or SPBE and is a specific audit action identified forthe Partnership)

Implications of the recommendations within the GM Commissioning Review

Impact of the Greater Manchester Mayor and the portfolio holders within theCombined Authority and the linkages across to the wider governance structureswithin the GM Combined Authority

The Order currently completing its progress through the Houses of Parliamentto convey public health duties and powers on the Combined Authority.

3.2 In addition to these changes some of the thematic areas of our HSC Strategy havealready or are soon to progress to the point of decisions needing to be made by thesystem, which may require specific decision making mechanisms to be in place. Thishas already been the case within Theme 3: Hospital Based Services for examplewhere a proposal was approved by SPBE in May for a revised sub-governancestructure to enable the delivery of the strategy.

4.0 LOCALITY CONSIDERATIONS

4.1 There are a number of further locality considerations that should influence the shapeof future governance proposals:

A need to strengthen connections between locality and GM governanceproviding clarity for localities and their relationship with GM

Assurance of the GM Transformation Fund and delivery against localityinvestment agreements

Ensuring confidence at the local level of system performance for GMprogrammes, particularly where they influence localities ability to deliveragainst their locality plan commitments, for example Mental Health

That we learn from the locality approaches to integrated arrangements tosupport joint commissioning decisions currently being implemented and applyto the GM level to ensure approaches are complementary

Linking with locality Health and Wellbeing Boards as a statutory function oflocal authorities

5.0 STATUTORY CONSIDERATIONS

5.1 It is important to also note that whilst there have been changes since the initialestablishment of the GM HSC Partnership, there are a number of key factors thatremain unchanged and need to be considered in a refresh of governance:

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Accountability back to NHS England is set out in the GM AccountabilityAgreement which delegates responsibility to the role of the Chief Officer of theGM Health and Social Care Partnership

Accountability for Social Care remains with Elected Members at the localitylevel

CCGs remain accountable to NHS England but are assured locally through theGM HC Partnership

Foundation Trusts are responsible to their Board of Governors

GM HSC Partnership has no regulatory responsibilities which are dischargedthrough NHSI and CQC. It should however be noted the Director of Deliveryand Improvement is a joint appointment across NHSI and GM HSC Partnership

5.2 Health Scrutiny

The Health and Social Care Act 2001 saw the establishment of Locality HealthScrutiny Committees as a statutory role of local authorities. The regulations andresponsibilities of these committees have been updated since 2001 but the intentionthat they strengthen the voice of local people, ensuring their needs and experiencesand considered as an integral part of commissioning services remains.

5.3 Health Scrutiny also has a strategic role in understanding how well integration ofhealth, public health and social care is working. Locality Health and Social CareScrutiny Committees hold local organisations to account and will therefore have animportant role in ensuring the delivery of local HSC Transformation plans and the useof Transformation Funding at the locality level.

5.4 In addition the Greater Manchester Combined Authority has a Joint Health ScrutinyCommittee. This committee has a different role to that of the locality Health ScrutinyCommittees who each delegate powers to the GM Committee to undertake allnecessary functions of health scrutiny relating to health matters at the GM level. TheGM HSC Partnership Governance already provides regular updates across all areasof Taking Charge, which will continue under a refreshed governance structure.

5.5 Changes to the Public Health Functions

5.6 This refers to the Order amending the role of the GM Combined Authority to includethe Public Health Functions currently undertaken by Local Authorities. The Order isintended to ensure the Combined Authority can play a full part on the GM Health andSocial Care Partnership and support integrated, strategic commissioning decisionsfocused on improving health outcomes and reducing health inequalities.

5.7 The changes will enable the Combined Authority to enter into partnershiparrangements with NHS bodies under section 75 of the NHS Act 2006 in respect ofpublic health functions and will therefore empower the GMCA to:

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Support a Greater Manchester-wide strategic leadership approach to thedelivery of agreed public health functions and commissioning responsibilities—for example, public health intelligence, health needs assessment and healthprotection.

Enable a Greater Manchester-wide approach to tackling health inequalities,variation in quality and service improvement, fair and equitable access, and toachieve an upgrade in health outcomes for the population of the wider CityRegion.

Support strengthened collaborative decision-making for population healththrough the identification of city-wide commissioning priorities and intentions,underpinned by shared principles and common commissioning standards —forexample, commissioning for whole-system sexual health and substance misuseservices.

Enable population health to be embedded across the city’s health, social careand wider public services through the Greater Manchester Strategy and theGreater Manchester Population Health Plan.

5.8 The order progressed through the Department for Health and Legal processes andreceived clearance from the Joint Committee for Statutory Instruments. The finalApprovals Motion was passed on 28th November 2017 and the Order receivedministerial approval on 29th November 2017.

6.0 NHS ENGLAND INTERNAL AUDIT

6.1 Governance has also formed part of 2017/18 GM HSC Partnership Internal Auditprogramme set by NHS England. The key findings from this work have fed into thispaper along with the recommendations. This review had three key objectives:

Evaluate the operating effectiveness of NHS England's arrangements tooversee and support the GM Health and Social Care model.

Evaluate the design and operating effectiveness of the GM Health & SocialCare Partnership's governance arrangements.

Understand the implementation status of the agreed management actions fromthe Governance over Transition to Devolution Internal Audit Report undertakenin FY2015/16, where these remain applicable

6.2 The audit noted that significant progress had been made in developing an effectivegovernance framework and that this framework has allowed wide stakeholderengagement and secured consensus of a number of key strategic and policydecisions affecting GM. It also recognised the need to review the current governancearrangements to confirm they are fit for purpose and that new governance frameworkshould:

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Give clarity over how the functions delegated to the Chief Officer are beingdischarged

Ensure risks and issues are being managed at SPBE

Review the GM Accountability Agreement as set out in the agreement itself

Reconstitute the Joint Commissioning Board with the legal authority required tocommission GM-wide services

Define a documented approach to recording stakeholder input to and approvalof papers submitted to SPB and SPBE

Implement a process to control the formation of new governance groups orchanges to existing groups

7.0 PROPOSALS FOR FUTURE GOVERNANCE ARRANGEMENTS

7.1 The proposals below are split by governance group. In addition there are a number ofpractical proposals that will apply to all parts of the GM HSC Partnership governance.

7.2 GM Health and Social Care Partnership Board

7.2.1 The GM HSC Partnership Board is focused on providing the overall strategic visionand direction for health and social care in GM, through a clear, shared understandingof need. The Partnership Board galvanises partners across all parts of the GM HSCsystem behind a joint focus on action and change, promoting integration to improvehealth and wellbeing for residents and creating a greater sense of place.

7.2.2 It is suggested that the Partnership Board needs to become more public facing,providing opportunities for the voice of GM residents to influence the development ofstrategy. To support this, the meetings themselves will need to be more focused onthe implications of change for residents rather than the operational considerations ofhow strategy is implemented. The introduction of service user stories and casestudies could be used to demonstrate impact. To support this, agendas may alsoneed to be shortened, allowing for more discussion, debate and involvement from themembers of the board. We need to minimise duplication with the work of thePartnership Executive while ensuring that the Partnership Executive is publicly heldto account for progress.

7.2.3 The focus and scope of the GM Strategic Partnership Board is aligned to theambition in the 2012 Health and Social Care Act behind the establishment of localityHealth and Wellbeing Boards. The membership of the GM Board also replicates theintention for HWBs, bringing together partners and creating a greater sense of place.Because of this it is suggested the GM HSC Partnership Board becomes a non-statutory GM Health and Care Board (avoiding the use of ‘Wellbeing’ to preventconfusion with statutory bodies at the locality level) with links back to locality Health

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and Wellbeing Boards in each of the 10 GM localities to ensure service user and carevoices are heard.

7.2.4 To ensure the GM HCB takes a holistic approach its membership should remainwhole system with a greater locality focus, incorporating all GM CCGs, LocalAuthorities and providers as well as representation from NHS England, NHSImprovement, Public Health England. Primary Care will be represented through theGM Primary Care Advisory Group. The Combined Authority will be representedthrough the GM Mayor and Chief Executive. GMFRS and GMP will also haverepresentation on GM HCB.

7.2.5 It was agreed as part of the original governance arrangements for the Partnershipthat the four principal stakeholder groups (CCGs, Providers, NHSE and LocalAuthorities) party to the GM MoU would be voting members of the StrategicPartnership Board with a vote of 75% in favour required for any proposal to carry. Toreflect the significant proportion of contacts across the health and social care systembeing in primary care it was later agreed primary care would also receive a vote andthe level of support would need to reach 80%. It is proposed that the move to a non-statutory Health and Care Board would not change this arrangement.

7.2.6 To enable more detailed discussion and consideration of implications on residents itis suggested the GM HCB should meet every two months and consider a smallernumber of agenda items. In addition agenda items and papers focused on theoperational and transactional issues of making the partnership work effectivelyshould be the responsibility of the Strategic Partnership Board Executive (see below).This could include for example:

Performance across the whole GM HSC system

Delivery of strategy

Transformation fund allocation and assurance

Management of risk

7.2.7 As a GM HCB would not be a legal entity and would have no regulatory responsibilityrequiring partner organisations to implement the decisions it makes, it will thereforeneed to use other mechanisms for ensuring formal adoption of agreed policy andstrategy.

7.2.8 The new GM HCB will work closely with the Mayor and Combined Authority,including through the existing GM Reform Board, responsible for co-ordinating PublicService Reform in GM, ensuring the two agendas are aligned and complementaryand driving a greater collective ownership of the wider determinants of health.

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7.2.9 The GM HCB should continue to be chaired by the GM Combined Authority portfolioholder for health and social care, supported by the Chief Officer of the GM HSCPartnership Team.

7.2.10 Specific thematic groups including the Children and Young People Health andWellbeing Board will be directly accountable to the GM HCB as will Health InnovationManchester. Over time there may be additional areas of work and governancegroups that feed directly into the GM HCB.

7.2.11 Draft terms of reference for the GM Health and Care Board are attached at appendixC

7.3 GM Strategic Partnership Board Executive

7.3.1 It is suggested above that the operational and transactional issues related todelivering the GM HSC vision is the responsibility of the Strategic Partnership BoardExecutive. In this way SPBE will act as a true executive to the GM HCB and the“engine room” of the GM Partnership. It is suggested therefore that it is renamedPartnership Executive, it will meet on a monthly basis and will have specificresponsibility including:

Ensuring the delivery of the GM strategy: Taking Charge

Accountability and performance across the system. This includes GM holdinglocalities to account and localities being able to hold GM to account for thedelivery of cross-cutting and GM level programmes such as Mental Health

Allocation of the GM Transformation Fund and any subsequent, similar GMlevel funding streams such as the delegated Digital Fund

On-going monitoring of the use of GM funding allocations and sign off to furtherfunding being released in-line with agreed investment agreements

Management of the GM risk register and delivery of actions

Development of the future Target Operating Model

7.3.2 It is proposed SPBE provides a quarterly summary report to the GM HCB to updateon progress against the areas which are delegated to it. This will be planned inadvance on the forward plan for the GM HCB. A decision log will be taken to eachGM HCB to outline the decisions that have been made by the Partnership Executive

7.3.3 The membership of the Partnership Executive will need to reflect the whole GMhealth and social care system, without needing to have representation from allorganisations in the partnership itself. This will enable the executive to functioneffectively whilst making sure all parts of the system and all localities are able toinfluence the discussion and decisions at Partnership Executive.

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7.3.4 This approach would require members of the Partnership Executive to have dualroles and to be accountable back to both their sector and their locality. The initialmembership of the Partnership Executive was agreed as four representatives eachfrom CCGs, Local Authorities and Providers and one representative from NHSEngland (which is fulfilled through the Chief Officer of the GM HSC Partnership.) Toaccommodate the proposals below we propose that the three sectors above reducetheir representation to three members each.

7.3.5 To strengthen the representation from the primary care sector and to recognise theimportant role primary care plays in achieving the GM vision for HSC, it is suggestedthere also be three representatives from primary care, to be agreed by the PrimaryCare Advisory Group.

7.3.6 The voluntary, community and social enterprise (VCSE) sector is also a key partnerin delivering the GM vision at both the GM and locality levels. The GM VCSE MoUagreed in January 2017 set out a shared ambition to enable the sector to have astronger role in the delivery of the GM vision. Supporting VCSE leaders to representtheir peers at a wide range of strategic boards was a key principle of the MoU. Toenable this to be realised it is proposed the membership of the Partnership Executiveincludes the VCSE with the specific representatives being agree through GM VCSEReference Group.

7.3.7 The voting rights of the new Partnership Executive will remain the same as for theprevious Strategic Partnership Board Executive and reflect those of the GM Healthand Care Board. This gives voting rights to Providers, CCG, Local Authorities andPrimary Care representatives on Partnership Executive and require an 80%agreement. It is recognised that although the CVSE sector would play an importantrole in shaping the discussion and direction set at Partnership Executive they wouldnot have voting rights on the Partnership Executive itself. To do so would be toexpect the representatives of the CVSE sector on the Executive to represent thecollective views of the whole sector when making voting decisions.

7.3.8 Members of the Partnership Executive should be identified by each sector throughtheir respective governance groups, for example Provider Federation Board shouldidentify the Provider representatives on Partnership Executive. Every effort will bemade through this process to coordinate nominations across the various sectorspecific governance groups to ensure representation from all localities whilstrespecting the decision on nominations must sit with the sectoral groups themselves.

7.3.9 To support members of the Partnership Executive to fulfil their roles a role definitionwill be developed and agreed by the GM HCB.

7.3.10 To enable members to represent their sectors, sub governance groups will berequested to clarity their collective position on proposals / papers taken to them priorto decisions at Partnership Executive. For example, where proposals are discussedat AGG, PFB, WLT and PCAG prior to the Partnership Executive itself, each of those

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groups will be asked to respond to the proposals and recommendations. Theseresponses will then be included in the final papers taken to the PartnershipExecutive. To enable this process, papers will need to be available in a timelymanner and should highlight the key issues / areas for discussion and resolution.

7.3.11 As with the GM HCB and to provide consistency across the two governance groupsthe Partnership Executive will be chaired by the GM Combined Authority portfolioholder for Health and Social Care, supported by the Chief Officer of the GM HSCPartnership Team. The GM HSC Partnership Team will provide support to thePartnership Executive and its members in executing their responsibilities as outlinedabove.

7.3.12 Draft terms of reference for the new GM HSC Partnership Executive are attached asappendix D

7.4 Joint Commissioning Board

7.4.1 The initial principles for the governance of the GM HSC Partnership set out arequirement for local Authorities and CCGs to retain their statutory functions,accountabilities and funding plans. This will remain under new governancearrangements. The GM Commissioning Review agreed by Strategic PartnershipBoard in July 2017 however, set out a vision for how a revised approach tocommissioning could look across the health and social care landscape in GM. Thisincluded a number of recommendations as outlined in the diagram below, some ofwhich have implications for the current governance arrangements and how JCB willneed to be constituted.

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7.4.2 The preferred approach to delivering the joint aspects of this review is through a GMCommissioning Hub working to a Joint Commissioning Board that would dischargespecific functions on behalf of localities, supported by a team of commissioners. Inorder for this to work the Joint Commissioning Board needs to be constituted in away that enables JCB to make decisions on behalf of localities and for health andcare organisations within localities to be able to delegate those functions to JCB.

7.4.3 This could be done through the establishment of a Joint Committee. The current legalframework enables the collective CCGs to enter into a joint committee with the GMCombined Authority but not directly with local authorities. As the GM CombinedAuthority does not at this time have a health function, local authorities in GM cannotdelegate their health functions to it.

7.4.4 As described above (section 5.5) there are current proposals to change theresponsibilities of the GM Combined Authority to include Public Health Functions.This will enable the Combined Authority to enter into partnership arrangements withNHS bodies under section 75 of the NHS Act 2006 in respect of Public HealthFunctions. As a result the Combined Authority will be able to work with the JCB inmaking joint commissioning decisions aimed at improving health outcomes forresidents of Greater Manchester.

7.4.5 Alongside these legal changes, as we move towards joint management structuresacross CCGs and LAs, individual locality representatives on JCB will be able torepresent a locality view in decision making.

7.4.6 To ensure a truly collective approach to commissioning it is also suggested:

The JCB will have a chair who is independent of the individual ten localitieswithin GM

Membership of the JCB will have equal representation from both localauthorities and CCGs

Input from clinicians and practitioners form both health and social care will besought in all joint commissioning proposals

Commissioning decision will be made on the basis of the greatest benefit toGM as a collective. It is important to recognise this may mean some localitiesbenefit more than others from individual commissioning decisions but that thisis likely to balance out when considered across the whole range ofcommissioning decisions being taken at the GM level

Overall affordability and quality will be key determinants off all proposalsconsidered by the JBC

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Decisions will be binding on all members delegating responsibility to the JCBthis includes where joint decisions are to be made at the GM level and enactedlocally

7.4.7 Individual commissioning proposals will either require:

CCGs and Local Authorities to maintain the budget for services to be jointlycommissioned at the locality level through the use of section 75 agreements. Inthis instance the individual organisations are responsible for enacting thebinding decisions made by JCB

or

CCGs and Local Authorities (via the Combined Authority) delegate the budgetfor jointly commissioned services to the JCB for the JCB to directly commissionservices on behalf of the collective health and care organisations

7.4.8 Given the Joint Commissioning Board will be constituted with representatives from alllocalities this provides assurance to the whole GM system on delivery against theareas delegated to it. Regular update reports will also be provided to the PartnershipExecutive demonstrating delivery against the implementation of the JointCommissioning Review.

7.4.9 To be successful the Commissioning Hub will need to have strong links to reformingcommissioning at the locality level and the development of single commissioningfunctions. In addition delivering the ambition of the Commissioning Review willrequire some resource to be moved into the Commissioning Hub from localities anddeployed alongside resources from the Partnership Team. This may be on atemporary basis depending on current workstreams and to ensure best collective useof expertise across the system.

7.5 Provider Federation

7.5.1 The GM HSC Provider Federation was established in January 2016 to enableincreased collaboration on strategic issues and to fulfil three key objectives:

Providing a structured provider voice for Greater Manchester Health and SocialCare Devolution;

Providing a strategic approach to transformation;

Addressing provider quality and efficiency.

7.5.2 In addition to these original objectives Provider Federation Board may also take on aleadership role for the development of relevant policies, plans and programme onbehalf of the Partnership Executive.

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7.5.3 Provider Federation Board enables GM providers to collectively influence and informGM approaches at the developmental phase through a single conversation. This isparticularly important as GM localities develop their LCOs which will have apotentially significant impact on the overall provider landscape across GM. Ensuringa mechanism for providers to input into these approaches through PFB, is thereforebe essential.

7.5.4 In responding to this new landscape Provider Federation Board will provide:

A system of mutual aid and support, including peer benchmarking and review

A leadership environment for the development of relevant policies, plans andprogrammes on behalf of the Partnership Executive

A space for providers to hold each other to account for acting in accordancewith the objectives of the Taking Charge Plan

7.5.5 In addition to this the overarching Theme 3: Strategy for Hospital Based Services willrequire collective input from providers across GM. The Theme 3 Programme sets outa number of workstreams which will require input for the Provider Federation Boardcollectively. It was acknowledged in the proposal that the overall programmerepresents a large scale change that will affect GM Providers and as such theinvolvement and engagement of Trust Leadership and Boards is crucial to itssuccessful delivery.

7.5.6 A proposal on the governance of Theme 3 was agreed by SPBE in May 2017. Theserevised governance arrangements included provider representation on the Theme 3Executive and Delivery Boards. A commitment to also gain formal feedback onproposals being taken through the GM HSC governance by Provider FederationBoard is incorporated as a specific step to improving overall engagement andinvolvement.

7.5.7 To ensure the dialogue with providers is as effective as possible, PFB needs to beincorporated into the route map for decision making and signing off GM proposalsprior to discussions at Partnership Executive. This will be incorporated into thedeveloping forward plans.

8.0 OTHER PROPOSED AMENDMENTS TO SUB GOVERNANCE STRUCTURES

8.1 There are a number of additional changes that are proposed to other sub-elements ofthe current GM HSC governance as outlined below:

8.2 Performance and Delivery Board

Performance and Delivery Board will be the single point for reviewing performanceacross GM HSC including system delivery and transformation programmes. Thisapproach will enable a more streamlined assurance process at GM and locality level,

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aligning together key STP, transformation and CCG IAF indicators. It will also be theplace to ensure we are delivering the strategic objectives set out within TakingCharge, aligned to the broader devolution programme.

8.3 Transformation Portfolio Board

It is proposed Transformation Portfolio Board becomes a Programme Co-ordinationGroup and will manage the relationships between and alignment acrossprogrammes, facilitating locality input via the designated SRO’s into the developmentof GM level and cross-cutting programmes. This is the forum that will be used toprioritise transformational activities, and ensure programme objectives andtimescales are appropriately aligned to the delivery of the ambition within TakingCharge. Whilst the Performance and Delivery Board will undertake assurance ofdelivery, Programme Coordination Group will review programme and portfolio scope,to ensure the required transformational change is delivered. Given the nature of thegroup it is suggested it is time limited to March 2019 but that this is reviewed prior tothis date.

8.4 Finance Executive Group (FEG)

The Finance Executive Group was established to provide a system wide strategicfinancial advisory and assurance function. Membership of the group is drawn fromthe finance community in local authorities, CCGs and providers. It has had asignificant role in developing and challenging the financial elements of thetransformation plans agreed through the GM HSC governance. In addition FEG hashad a crucial role in the processes for agreeing and allocating the GM HSCTransformation Fund.

8.5 Finance Executive Group has recently revised its terms of reference and as a resultwill continue in its current form.

8.6 Transformation Fund Oversight Group (TFOG)

TFOG was initially established to oversee the pipeline of applications and to makerecommendations on the allocation of GM HSC Transformation Funding. Thisprocess will largely cease at the end of 2017. It is suggested therefore that TFOGceases to exist within no more than a few months. Ongoing monitoring of the use ofthe fund and recommendations on the release of further funding in line withinvestment agreements will be made by the Finance Executive Group.

8.7 Quality Board

Quality Board if a statutory function of NHS England. Its terms of reference forQuality Board were reviewed in December 2016. Its purpose is to bring together thesystem together to:

Create a shared view of risks to quality through sharing intelligence

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Develop an early warning mechanism for risk and poor quality

Create opportunities to coordinate actions and drive improvement across theGM system

8.8 The Quality Board is primarily concerned with NHS and local governmentcommissioned care from public, private, not for profit and third sector organisations. Itfocuses on primary, secondary and tertiary services, holding commissioners toaccount for the effectiveness of how quality is managed within the system

8.9 Quality Board is recognised as a key part of the GM governance and has the abilityto provide a quality and safeguarding perspective on proposals being taken throughthe wider GM governance. It is proposed Quality Board is increasingly used in thiscapacity, consulted with and recognised as part of the route map for strategydevelopment and sign off prior to discussion and agreement at PartnershipExecutive.

9. PRACTICAL PROPOSALS

9.1 These proposals apply to all governance groups and should be adopted as bestpractice:

Governance routes for papers should be mapped out to provide clarity to thesystem about how the decision making process works in GM, recognising thismay be different for different issues the GM HSC Partnership Team will provideadvice and guidance on this process

Papers should be focused with summaries upfront outlining the key points andrecommendations and highlighting key issues to be disused and resolved

Sectors will be expected to undertake work in advance of meetings to considertheir positions and be ready to input into discussions at their respective sectorled governance group. Papers will need to be available in enough time toenable sectors to undertake this work.

System responses to papers should be clear prior to proposals going to thePartnership Executive for agreement. This will enable members of governancegroups such as Partnership Executive to fulfil the requirements of their role andrepresent the views of the whole sector in discussions

Agenda items and corresponding papers should be themed for example updatereports on finance, performance and transformation should be brought togetherinto one overall assurance paper

Forward plans should be prepared for all key governance groups identified inthis paper, ensuring clarity on where items are being discussed and agreed

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Decision logs will be developed and kept up to date following each keygovernance group meeting and fed into the quarterly assurance meetings withNHS England

A gateway process will be used for requests out to the system from thePartnership Team, these should be through a nominated single point of contactwithin the locality, potentially the locality SRO.

9.2 Thematic Governance

As the work on delivering Taking Charge has progressed, there has been acorresponding increase in the thematic based governance arrangements put inplace. As a result there are numerous thematic and cross cutting governance groupsacross the whole HSC system in GM. In recognition of this it is suggested that eachthematic area undertakes a review of groups. This should aim to address theopportunities and principles for governance outlined in this paper. It is also suggestedany further changes or requests to establish new governance groups be submitted tothe Programme Coordination Group as part of the gateway process being put inplace for GM Programmes. This will prevent the number of governance groupscreeping back up to an unmanageable number and ensure clarity over the role eachexisting group has within the overall system.

10. MAKING IT HAPPEN – NEXT STEPS

10.1 The proposals set out in this paper highlight a different way of working and as aresult will require a number of additional pieces of work to be undertaken including:

Accountability Agreement – the current accountability agreement came intoeffect on 1 April 2016 and is now due to be reviewed. This process will enablethe Partnership to review and agree where accountability sits across thegovernance structure

Organisational Development - the proposals set out will require the membersof the governance structures and the partnership as a whole to work in adifferent way. As a result the GM HSC Partnership needs to develop clearvalues, behaviours and expectations owned by all its members.

Approaches to managing conflict – the Partnership will need to set out clearexpectations in terms of managing conflict between localities, organisationsand GM.

System leadership – members of the Partnership and its various governancegroups will need to take on the role of system leaders. This may cause conflictsof interest for individuals which the governance arrangements need torecognise and respond to. A role profile will need to be developed to enablemembers of governance groups to undertake this responsibility

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Review of detailed programme governance – numerous thematic andprogramme boards and groups that have been established to take forwardspecific pieces of work across the partnership. These will need to be reviewedin light of the proposals outlined above to ensure the overall governanceapproach is as efficient as possible. In doing this it is important to differentiatebetween transformation and service improvement and to understand theappropriate governance required in each case. As an outcome of this review itis suggested we develop a complete governance map across the GM HSCprogrammes and that this piece of work is led by a cross-sector group.

11.0 RECOMMENDATIONS

11.1 Strategic Partnership Board is asked to:

Note the issues with and limitations of the current governance approach

Note the high level findings from the governance audit

Agreed the proposed changes.

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Appendix A: Proposed governance for GM Health and Social Care Partnership

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Appendix B: Governance arrangements (as outlined in SPB paper September 2016)

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Appendix C: Draft terms of reference – GM Health and Care Board

Greater Manchester Health and Care Board

Terms of Reference (draft)

1. Background


1.2 A principle of subsidiarity runs throughout the MoU, seeking to ensure no decisionsabout GM are made without GM and that all decisions are made at the mostappropriate level. The governance structures put in place through the MoU enable allparts of the HSC system in GM to have input into and influence over the overallvision for GM, creating a dispersed style of leadership. This has ensured collectiveownership of the vision and a collaborative approach to delivery, although we couldand should go further in this respect.

1.3 The GM MoU is cognisant of the existing accountability arrangements andresponsibilities held by local authorities, CCGs and NHS Providers. The MoU alsocontained a commitment to regularly review the governance as Greater ManchesterHealth and Social Care Partnership (The Partnership) develops, recognising thegovernance arrangements would be an iterative process and would therefore need tochange over time.

1.4 As we move more deeply into implementation of our programmes and start to thinkabout our future operating model post transformation phase we are refreshing thegovernance arrangements for the Partnership. Proposals for a new governancestructure incorporate a non-statutory GM Health and Care Board focused onproviding the overall strategic vision and direction for health and social care inGreater Manchester.

2. Aims and objectives

The primary aim of the GM Health and Care Board is the provision of strategicdirection for health and social care in Greater Manchester. It will do this through aclear and shared understanding of need across GM.

3. Principles

The GM Health and Care Board will:

Be the public face of the GM Health and Social Care Partnership Ensure the voice of residents influences the development of strategy

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Focus on the implications of change on residents

4. Roles and responsibilities

The GM Health and Care board will be responsible for:

Oversight of the vision for health and social care in Greater Manchester asoutlined in the GM Strategy: Taking Charge

Ensuring a full understanding of the health and care needs of our populationand the assets and resources that exist to help meet those needs.

Galvanising support across all parts of the GM HSC system behind a jointfocus on action and change

Promoting integration across organisations and localities to improve healthand wellbeing for residents

Ensuring that citizens are properly engaged in the development all plans andprogrammes.

Creating a greater sense of place within GM health and social careorganisations ensuring this influences the development and implementationof strategy

Delegation of aspects of delivering the GM vision for health and social care tothe relevant governance groups and holding those groups to account

The use of GM health and care funding including the GM TransformationFund and any similar GM level funding allocations aligned to the GM HSCStrategy.

The GM Health and Care Board will delegate responsibility for the operationalisationof the GM Strategy: Taking Charge to the GM Health and Social Care PartnershipExecutive. This will include but is not limited to:

Performance across the GM HSC system Delivery of strategy Transformation fund allocation and assurance Management of risk

5. Membership

The membership of the GM Health and Care Board will represent the whole healthand social care system in GM incorporating representatives from:

Each of the Greater Manchester CCGs (Chair and Chief Officer) Each of the Greater Manchester Providers (Chair and Chief Executives) Each of the Greater Manchester Local Authorities (Leader and Chief

Executive) NHS England through the Chief Officer of the GM HSC Partnership NHS Improvement Public Health England Primary Care through the LMC The GM Combined Authority through the GM Mayor and Chief Executive GM Fire and Rescue Services GM Police Community, voluntary and social enterprise sector representatives

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Healthwatch representatives

The Board will be chaired by the GM Combined Authority portfolio holder for Healthand Social Care.

Members of the GM Health and Care Board will be expected to represent both theirorganisation and locality at the Board.

6. Voting

As outlined in the GM Health and Social Care Devolution MoU, the voting membersof the GM HSC Partnership are those sectors who were original signatories to thedevolution agreement with the addition of primary care representatives, in recognitionof the significant proportion of the health and care system they represent.

Where a vote is required to agree a particular proposal, 80% support is required forthe proposal to be carried.

7. Meeting frequency

GM Health and Care Board will meet every two months. The venue for the meetingwill move around the ten localities of GM ensuring a locality dimension to themeetings themselves and increasing public accessibility across GM.

8. Accountability and wider governance

The GM Health and Social Care Partnership Executive is directly accountable to theGM Health and Care Board. In addition the GM Children’s Health and WellbeingBoard, Health Innovation Manchester, the Digital Collaborative and the GMWorkforce Collaborative will also be report directly into the GM Health and CareBoard.

9. Declarations of interest and decision log

Declarations of interest will be requested and logged at the start of each meeting anda decision log will be completed following every meeting in line with the requirementsof the GM accountability agreement.

10. Support arrangements

The GM Health and Care Board will be supported by the GM Health and Social CarePartnership and the GMCA Governance and Scrutiny Team.

11. Date agreed and review date

These terms of reference were agreed on (include sign off date) and will be reviewedon an annual basis to ensure they reflect the changing requirements of the GMHealth and Social Care Partnership.

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Appendix D: Draft terms of reference – GM HSC Partnership Executive

Greater Manchester Health and Social Care Partnership

Partnership Executive

Terms of Reference (draft)

1. Background


1.2 A principle of subsidiarity runs throughout the MoU, seeking to ensure no decisionsabout GM are made without GM and that all decisions are made at the mostappropriate level. The governance structures put in place through the MoU enable allparts of the HSC system in GM to have input into and influence over the overallvision for GM, creating a dispersed style of leadership. This has ensured collectiveownership of the vision and a collaborative approach to delivery, although we couldand should go further in this respect.

1.3 The GM MoU is cognisant of the existing accountability arrangements andresponsibilities held by local authorities, CCGs and NHS Providers. The MoU alsocontained a commitment to regularly review the governance as Greater ManchesterHealth and Social Care Partnership (The Partnership) develops, recognising thegovernance arrangements would be an iterative process and would therefore need tochange over time.

1.4 As we move more deeply into implementation of our programmes and start to thinkabout our future operating model post transformation phase we are refreshing thegovernance arrangements for the Partnership. Proposals for a new governancestructure incorporate a GM Health and Social Care Partnership Executive focused ondelivering the ambition set out in GM Strategy: Taking Charge.

2. Aims and objectives

The primary aim of the GM HSC Partnership Executive is the delivery of the ambitionwithin the Greater Manchester health and Social Care Strategy: Taking Charge. It isthe engine room of the GM Health and Social Care Partnership.

3. Roles and responsibilities

The GM HSC Partnership Executive will be responsible for:

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Ensuring the delivery of the GM strategy: Taking Charge Performance across the system. This includes GM holding localities to

account and localities being able to hold GM to account for the delivery ofcross-cutting and GM level programmes such as Mental Health

Allocation of the GM Transformation Fund and any subsequent, similar GMlevel funding streams such as the delegated Digital Fund

On-going monitoring of the use of GM funding allocations and sign off tofurther funding being released in-line with agreed investment agreements

Management of the GM risk register and delivery of actions Development of the future Target Operating Model

4. Membership

The membership of the GM HSC Partnership Executive will represent the wholehealth and social care system but will not have all organisations as members.Membership will therefore include:

3 representatives from Greater Manchester CCGs to be identified and agreedby the Association of CCGs

3 representatives from Greater Manchester Providers to be identified andagreed by the Provider Federation Board

3 representatives from the Greater Manchester Local Authorities to beidentified and agreed by the GM Wider Leadership Team

3 representatives from primary care to be identified and agreed by thePrimary Care Advisory Group

NHS England through the Chief Officer of the GM HSC Partnership 2 representatives from the community, voluntary and social enterprise sector

to be identified and agreed by the GM VCSE Reference Group

The Board will be chaired by the GM Combined Authority portfolio holder for Healthand Social Care.

Once representatives have been identified, a cross check will be undertaken toensure all localities are represented. Where this is not the case, alternativerepresentation will be sought in dialogue with the sectoral governance groups, theChair of the GM HSC Partnership Executive and the Chief Officer of the GM HSCPartnership Team to ensure the membership appropriately covers all organisationsand localities.

Members of the GM Health and Care Board will be expected to represent both theirorganisation and locality at the Board. To support this:

The Partnership Executive will develop a role profile for members, setting outtheir responsibilities as members of the Executive

Sectoral governance groups will be required to respond as a collective toproposals being taken through governance. These responses will beincluded with papers being taken to Partnership Executive.

5. Quorum and voting

The GM HSC Partnership Executive will be considered quorate if:

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At least 2 members from each sector (CCGs, Providers, Local Authorities andPrimary Care) are present and

The NHS England is represented at the meeting

The voting rights for the Partnership Executive will mirror those of the GM Health andCare Board which relate to the original signatories to the devolution agreement withthe addition of primary care representatives, in recognition of the significantproportion of the health and care system they represent.

Where a vote is requires to agree a particular proposal, 80% support is required forthe proposal to be carried.

6. Meeting frequency

GM HSC Partnership Executive will meet every month. A forward plan of agendaitems will be produced ensuring clarity on when items are to be discussed andagreed.

7. Accountability and wider governance

The GM HSC Partnership Executive is responsible to the GM Health and Care Boardand will produce a quarterly report to the Board outlining progress in relation to thedelivery of the GM Health and Social Care Strategy

The following groups will report into the GM HSC Partnership Executive:

Finance Executive Group Performance and Delivery Board Programme Coordination Group Quality Board

Each of these groups will also be required to provide regular updated to the GM HSCPartnership Executive on progress in the areas they are responsible.

8. Declarations of interest and decision log

Declarations of interest will be requested and logged at the start of each meeting anda decision log will be completed following every meeting in line with the requirementsof the GM accountability agreement. The decision log will form part of the quarterlyupdate to the GM Health and Care Board.

9. Support arrangements

The GM Health and Care Board will be supported by the GM Health and Social CarePartnership and the GMCA Governance and Scrutiny Team.

10. Date agreed and review date

These terms of reference were agreed on (include sign off date) and will be reviewedon an annual basis to ensure they reflect the changing requirements of the GMHealth and Social Care Partnership.

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Subject: GM HSCP Business Plan 2017/18 – Six Month Summary

Report of: Warren Heppolette, Executive Lead, Strategy & System Development,GMHSC Partnership

SUMMARY OF REPORT:

The enclosed document summarises the Health & Social Care Partnership’s progress indelivering our aims for the first six months of this financial year.

KEY MESSAGES:

We have a number of key achievements and have performed relatively well against ourtargets – but there are inevitably challenges that we need to address.

PURPOSE OF REPORT:

The report provides the Partnership Board with a summary of our progress in achieving theaims that we set in our Business Plan.

RECOMMENDATIONS:


Note the six month summary update on our progress this year.

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1.0 INTRODUCTION

1.1.1 In 2016 Greater Manchester became the first city region in the country to take controlof its combined health and social care budget – a sum of £6 billion. GreaterManchester Health and Social Care Partnership was formed to oversee this.

1.1.2 We are now in our second year of delivery, building on a first year in which weperformed strongly.

1.1.3 Our focus this year is on putting in place new models of care and support in GreaterManchester so that we can help people stay well in their homes and communities sothat our hospitals can focus on those who are most ill.

1.1.4 At the same time as we change the way that care is provided, we must also continueto improve our current performance. There are some areas where we are doing verywell, for example: satisfaction with GP services, how quickly people can have aplanned operation carried out and the quality of care for people who have had astroke. However, we know we need to improve in other areas, such as on urgent andemergency care and consistently meeting all of the national standards for cancercare.

1.1.5 We reached another important milestone for Greater Manchester in 2017 with theelection of a new Mayor. The Partnership has developed a strong relationship withthe Mayor’s office.

1.1.6 This document provides a summary of what we have done in the first half of 2017/18based on the aims that we set out in our Business Plan.

2.0 IMPROVING THE HEALTH OF RESIDENTS

Population Health

2.1.1. Greater Manchester may be a great place to live and work for many, but peoplehere die younger than in other parts of England. We want to change this.

2.1.2. We are seeing the proportion of children who start school ready to learn steadilyincrease in Greater Manchester – but we know we need to do more so that wereach the same levels as other parts of England. So this year we have:

Invested £1.5m in the priority areas of Oldham, Rochdale, Salford andBolton to improve the oral health of children between ages 0 and 5;

Contributed to the first school readiness summit in Greater Manchester,led by the Mayor and involving partners from across the city region;

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Worked with our ten areas to develop plans for a whole family earlyintervention approach at community level - including targeted support for0-5 year olds;

Developed an investment proposal for over £2m to support schoolreadiness in Greater Manchester.

2.1.3. By 2020, our aim is to meet or exceed the national average for the proportion ofchildren in Greater Manchester reaching a good level of development by the end ofreception.

2.1.4. Rates of smoking are also falling in our city region – but we know that we need tomove faster in this area. So we have:

Launched the GM Making Smoking History Strategy aiming to reducesmoking by a third by 2021, saving thousands of lives;

Agreed a plan to invest over £1.7m to introduce a consistent approachaimed at reducing the number of women and their partners who smoke inpregnancy.

Mental Health

2.1.5. This year, we have taken momentous steps to deliver on our commitment toimprove mental health and well-being in our city region:

In July we announced an investment of £134m for mental health. This isthe largest investment in mental health and well-being anywhere in thecountry;

The share of the investment (nearly £80m) dedicated to children, youngpeople and new mums reflects our commitment to increase the proportionof what we spend on mental health on young people.

2.1.6. Since devolution we have seen improvements in access, waiting times, andrecovery for people seeking talking therapies, such as counselling. We intend tobuild on these achievements and ensure that our investment in mental healthdelivers lasting improvements for our population by:

Supporting all schools in meeting the mental health and wellbeing needsof their students;

Helping new mums who experience significant mental health problems -we want to allow at least an additional 1,680 women each year to receiveevidence-based treatment;

Stopping people who need hospital care for a mental health problemhaving to go out of Greater Manchester when the service is availablehere;

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Making sure everyone in a mental health crisis is able to get immediatesupport - and that no one ends up in a police cell when they are in mentalhealth crisis;

Significantly improving access to talking therapies, such as counselling –an additional 33,500 people will benefit from access to talking therapies.

2.1.7. The Manchester Arena attack saw a unified Greater Manchester response onmental health and wellbeing. This includes the establishment of a GreaterManchester Resilience Hub that provides support to people affected by the attack.

Dementia

2.1.8. In Greater Manchester, we consistently achieve higher rates of dementia diagnosisthan the national average: our rates are at 77%; whilst the national average is 68%.

2.1.9. A dementia diagnosis can be difficult news but a formal diagnosis can help anindividual to get the care and treatment they need, as well as allowing them to planfor the future.

2.1.10. We are ambitious to do more, particularly as we know that dementia will be agrowing challenge as our population ages. So this year we have:

Invested over £2m in a programme we have called Dementia United – thisis a long term plan to improve dementia care and support in GreaterManchester;

Through Dementia United, and other steps we are taking, we have setourselves the ambition of making Greater Manchester the best place to livewith dementia in the UK;

By 2020/2021, significantly more people will get a named coordinator ofcare, a care plan and at least one annual review of that care plan; and olderpeople will receive diagnosis and referral within six weeks.

Cancer

2.1.11. Our vision is for people in Greater Manchester to have the best chance of avoidingor surviving cancer. Greater Manchester’s cancer networks have performed betteras a system than others in England over the last few years. In particular, we haveconsistently met the national target of 62 days’ wait from referral to treatment.

2.1.12. However, there are some of the national cancer standards where our performanceneeds to improve. So this year, we have:

Confirmed Greater Manchester as part of the NHS England CancerVanguard, leading the way in developing new ways of caring for patientswith cancer. Our involvement in this initiative has brought in an additional£2.3m in funding;

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Carried out a pilot lung heath check programme led by University HospitalSouth Manchester and Macmillan focused on deprived areas. Peoplereceived an invitation to a Lung Health Check, which was less likely tocause anxiety than ‘lung cancer screening’. The led to a significantincrease in early stage lung cancer being diagnosed. We want to deliverthis across Greater Manchester by 2020;

Signed up more than 5,000 Cancer Champions who will use theirexperience and knowledge to support those at risk of developing canceras well as those who have been recently diagnosed;

Participated in a national pilot in which we have developed a pathway forpatients with non-specific but concerning symptoms and we are testingmultidisciplinary diagnostic clinics on two sites - University Hospital SouthManchester and Royal Oldham Hospital. Our aim is to increase thenumber of patients diagnosed at an earlier stage and reduce the numbersof patients receiving a cancer diagnosis via a hospital admission.

3.0 TRANSFORMING CARE & SUPPORT

Local Care Organisations

3.1.1 The devolution of health and social care provides the opportunity to do thingsdifferently. This means developing new ways of providing care and support to helppeople stay healthy and well at home and in their communities.

3.1.2 We are doing this by developing Local Care Organisations (LCOs), which see theNHS, councils and other organisations, including the voluntary sector, workingtogether much more closely to address an individual’s mental, social and physicalhealth needs and tackle the causes of poor health.

3.1.3 In the first six months of this year, each of our 10 localities has made a lot ofprogress in their LCO development – all supported by investment from the GreaterManchester Transformation Fund (around £275m invested).

3.1.4 The LCOs are made up of a number of teams operating at neighbourhood level(covering populations of around 30,000 to 50,000). This year has seen manyexamples of innovation in these teams, including:

Employing community navigators to help people find the right support inthe voluntary sector – which can also reduce pressure on GPs;

Using technology to improve the way that care homes work with GPs andhospitals to avoid unnecessary admissions and GP call outs;

Much closer working with sectors such as housing, employment, leisureand the police to make sure that local public services are working togetherto address those factors that can lead to poor health.

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Transforming Primary Care

3.1.5 Many people have more contact with their GP practice, local pharmacy, dentist andoptometrist than any other health services.

3.1.6 Greater Manchester GP practices are currently performing better than the nationalaverage on measures of patient satisfaction. This includes opening times, extendedhours and overall experience. In November 2017, some 96% of GP practices inGreater Manchester were rated as outstanding or good by the Care QualityCommission – this is higher than the average for England.

3.1.7 This gives us a good foundation to build on – but we recognise that we need tocontinue to improve the quality of primary care, particularly since it will be at thecentre of the new local care models we are developing. So this year we have:

Invested an extra £41m in GP practices over the next four years toimprove access and quality;

Introduced Greater Manchester Primary Care Standards to improve theconsistency and quality of care across all our GP practices;

Developed an approach for providing urgent primary care services on a24/7 basis, including redirecting patients away from A&E to other servicesand setting up an urgent treatment centre in every local area.

Transforming Urgent and Emergency Care

3.1.8 When we first took charge of health and social care, we knew urgent and emergencycare would be one of the most difficult challenges we would face. Like other areas ofthe country, services in Greater Manchester are under increasing pressure with alimited workforce. We know, for example, that we need to improve our performanceon how long people wait in A&E.

3.1.9 To address these issues, we have:

Set up the Greater Manchester Urgent and Emergency Care OperationalHub to monitor activity across all hospitals across the region. The hubenables teams to predict and respond to any pressures building up inA&E departments and provide early warnings;

Confirmed our plans to reform Urgent and Emergency Care in GreaterManchester, including an agreed framework for all areas to work to. Thiswill drive the work across 2017-18 and ensure clear progress is achieved.It includes a new approach for urgent primary care (as noted above) andclinical streaming in every locality so that A&E departments are freed upto care for the sickest patients.

Undertaken a major campaign in preparation for winter – including drivingup the rates of influenza vaccination in our population, particularly in

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vulnerable groups, and encouraging people to go to their pharmacy forthe first signs of illness.

Hospital Care

3.1.10 NHS organisations across Greater Manchester are working together to transformhospital services so that they can provide safe, high quality patient care. A big part ofthis is improving consistency so that all Greater Manchester residents can access thesame high standards of care, regardless of where they live.

3.1.11 There are many areas where we already deliver a consistently high quality of care.For example, all stroke services in Greater Manchester have been rated as ‘A’ by theSentinel Stroke National Audit Programme – this is the best rating anywhere in thecountry.

3.1.12 We are also working on much closer collaboration between hospitals so that we areusing our skilled and experienced workforce as effectively as possible. So for,instance, we are focusing emergency and high-risk abdominal surgery in fourspecialist centres in Greater Manchester. This includes the new £20m medical andsurgical centre opened at Stepping Hill Hospital.

3.1.13 There is more that we need to do to improve hospital care, so this year we have:

In September 2017, completed the first stage of the most significanthospital merger in the country – the Single Hospital Service (SHS).Central Manchester University Hospitals NHS Foundation Trust andUniversity Hospital of South Manchester NHS Foundation Trust joinedtogether to form Manchester University Foundation Trust. NorthManchester General Hospital will join the new organisation in around 12-18 months.

Made more progress in the development of the Northern Care Alliancebetween Salford Royal Foundation Trust and Pennine Acute FoundationTrust.

Secured national funding, which was only available to areas with well-developed plans, for up to £63m capital investment for Healthier Togetherimplementation at Manchester Royal Infirmary, the Royal Oldham, SalfordRoyal and Stepping Hill. We also received up to £30m capital for the newdevelopment at Salford Royal to increase capacity for major traumaservices.

Adult Social Care

3.1.14 Social care faces some very difficult challenges including an ageing population andconstrained finances. We will only overcome these by much closer integrationbetween health and social care – which we see happening mainly through the LCOs.

3.1.15 We have more joined up working between health and social care that anywhere elsein the country. We are seeing results emerging from this. Each area in Greater

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Manchester now has a team working across health and social care to make sure thatdischarge arrangements from hospital work effectively. As a result, we are seeingimprovements in our figures for discharges across Greater Manchester.

3.1.16 However, we still need to make significant progress on social care, so we have thisyear:

Put in place a plan to improve employment opportunities for people with alearning disability;

Developed a new Carer’s Charter – members of the public and thevoluntary sector have worked with us to develop this;

Set up a work programme dedicated to improving the quality of carehomes;

Learning Disability

3.1.17 Like other parts of the country, we are working to reduce the number of people withlearning disabilities living in a hospital environment. The Transforming Care initiativeis all about improving health and care services so that more people can live in thecommunity.

3.1.18 We are performing well against NHS England targets with many people resettled innew homes, with the right support in place. For example, at the end of October, therewere 118 transforming care inpatients in Greater Manchester – significantly betterthan the national target of 130.

3.1.19 We know that we need to increase the pace at which we support people to resettle,so this year we have:

Introduced the Greater Manchester Resettlement Hub to support areas on thedischarge of patients who have been in a hospital for five years or more;

Put a Specialist Support Team in place, available 24/7, to work closely withCommunity Learning Disability Teams;

Secured over £1m investment to support Transforming Care in GreaterManchester to develop new autism services and early intervention servicesfor children and young people with complex support needs.

Housing and Health

3.1.20 We know the importance of the link between good quality housing and health. That’swhy we have set up an innovative housing and health programme in GM. Thisincludes our commitment to tackle homelessness – which we fully share with theMayor of Greater Manchester.

3.1.21 This year we have agreed with the Mayor that there are four priorities for how thePartnership can help with tackling homelessness. These are:

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To ensure all identified individuals of No Fixed Abode who wish to beregistered with their local GP practice are registered with a proper patientrecord;

Make sure that no patient is discharged from hospital onto the street,through coordinated discharge practices between hospitals and councilhousing teams;

To support the development of outreach teams in all localities offeringscreening, health advice and health support to those living in hostels,refuges and other temporary accommodation;

A joined up approach to targeted specialist support services such asmental health and substance misuse.

4.0 ENABLING BETTER CARE

4.1.1 We will only be able to achieve the radical changes we are seeking with the rightsupporting infrastructure in place. This includes research and innovation, digital, andmost importantly a skilled workforce.

Research and innovation

4.1.2 This year we have increased the pace of our work on some radical innovations thatwill not only change the lives of people in Greater Manchester, but across the globe.

4.1.3 The work on genomics and cancer, being led by leading world experts and the GMCancer Board, aims to dramatically advance precision medicine in the treatment ofcancer. This will mean that we can increasingly tailor health care to each person’sunique genetic make-up.

4.1.4 We have, through Health Innovation Manchester (HInM), developed a strong pipelineof proposals which can be rapidly evaluated, trialled, and implemented for the benefitof patients. This includes:

An innovative approach to managing Chronic Obstructive PulmonaryDisease (COPD) to avoid the need for hospital admission – pilotedwith 11 Manchester GP practices;

Healthy Hearts – working to make sure that those at high risk have theright statin dosage, targeted stroke prevention and blood pressuredetection control;

Hepatitis C elimination – working to the standard set out by the WorldHealth Orgainsation;

Rainbow Clinic – a service for women and their families following stillbirth or perinatal death.

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Digital progress

4.1.5 In the first six months of this year we reviewed and assigned £10m of funds to arange of digital projects across localities.

4.1.6 We also agreed a single Wi-Fi standard for health and social care across GMenabling connection from any location.

Workforce

4.1.7 We want to make Greater Manchester one of the best places in the world to work inhealth and social care, whether that’s in paid employment such as a doctor, nurse,clinician, social worker, manager or support staff or unpaid as a volunteer or carer.

4.1.8 This year we have taken some important steps, including:

Agreeing a Workforce Transformation Strategy – so that we are clear onour priorities, where we have workforce shortages and what we can do toattract people to come to and stay in Greater Manchester;

Commissioned a report on incentives for Nursing and Allied HealthProfessional careers to improve recruitment, retention and return topractice in Greater Manchester. We have a good platform to build on asGreater Manchester performed well this year on nursing recruitment – andthis included securing more than 240 nursing associate places;

One of the action areas identified in the Workforce Strategy is theestablishment of a GM international brand as a centre of excellence toraise the profile of Greater Manchester as top destination for health andsocial care professionals internationally.

As an example of this, the Wrightington, Wigan and Leigh NHSFoundation Trust (WWL) is hosting an international training fellowshipscheme to support more international doctors to work here as we knowwe have some areas of critical skill shortage.

Signing an agreement with Health Education England to give us morecontrol over what happens in Greater Manchester.

5.0 WHAT WE WILL DO NEXT

5.1.1 We have achieved a great deal in the first half of this year, but we do notunderestimate how challenging the months ahead will be.

5.1.2 We will need to continue to transform services so that they are ready for the futurebut also deliver and improve on our performance targets for all our residents –including on urgent and emergency care and cancer.

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5.1.3 However, we know that the direction we are heading in is the right one and our focuswill continue to be firmly on implementing our plans. We are moving forward withjoining up health and social care faster than anywhere else in the country.

5.1.4 We look forward to the upcoming months with confidence and will continue to buildon the strength of our partnerships – including with the Mayor. It will be these It willbe these partnerships that see us through the challenges ahead.

6.0 RECOMMENDATIONS

6.1.1. The Strategic Partnership Board is asked to:

Note the six month summary update on our progress this year.

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Subject: Winter Preparedness Update

Report of: Steve Barnard, Head of Urgent and Emergency Care Service Improvement,GMHSC Partnership

SUMMARY OF REPORT:

As predicted, the winter period has been particularly challenging for health and social caresystems across Greater Manchester and nationally. This report provides an overview ofperformance and the actions taken to manage surges in demand and to ensure patientsafety is maintained.

KEY MESSAGES:

All localities within Greater Manchester have worked extremely hard over the last fewmonths, preparing for winter and providing safe urgent and emergency care (UEC). Allsystems have reported a much greater number of higher acuity patients, which has resultedin increased hospital admission rates (also observed nationally). This has resulted in muchhigher bed occupancy rates of 95% plus. This was despite running a GM-wide ‘Home forChristmas’ campaign and a significant effort by systems, leading up to the festive period, toachieve 85% bed occupancy. The validated performance against the 4 hour standard forGreater Manchester was 81.5% for December, down from 86.7% in November and 89.6% inOctober. Having sustained at or close to the recovery target level of 90% over summer andthrough to end of October it is disappointing that we have been unable to hold the positionas winter has set in. On a more positive to note to date, partnership work across GreaterManchester has meant we have avoided OPEL4 major incidents and we have also we keptdelayed discharge numbers low.

The Greater Manchester Health and Social Care Partnership (GMHSC Partnership), inpartnership with NHSI, has continued to work very closely with the localities through regularsite visits, system conference calls and workshops. Additional service improvement supporthas continued to be provided by NHSI, the Emergency Care Improvement Programme andAdvancing Quality Alliance to three systems within GM (Bolton, Stockport and North EastSector).

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The Greater Manchester UEC Operational Hub has been operational for two months nowand is working with the systems to help reduce ambulance handover delays, maintainpatient flow, support escalation processes and winter reporting to the regional and nationalwinter rooms.

GM has received approximately £21 million of additional winter monies from the nationalallocations for acute, primary care and mental health services. The additional monies havebeen predominantly used to increase; bed capacity, clinical workforce, primary careadditional access and 24/7 mental health services.

Following the publication of NHSI and NHSE guidance on the deferral of non-urgent electiveactivity until the 31st January, the GMHSCP has asked each locality UEC delivery Board toconsider their response to the guidance and submit a plan for January and the remainder ofthe financial year. Work is currently underway to understand the implications of this guidanceand any deferrals in the context of devolution and the formally adopted accountabilityagreement – particularly around the requirement to achieve constitutional standards such asReferral to Treatment.

PURPOSE OF REPORT:

The purpose of this report is to provide the Board with an overview of winter UECperformance to date and the work undertaken by the localities and the Partnership tocontinue to mitigate the demands of winter and provide safe, high quality care to patients. Italso sets out the current challenging position of the GM system and identifies the ongoingrisk in relation to service delivery over the winter.

RECOMMENDATIONS:


Note the content of the paper in relation to winter preparedness

Support the delivery against the identified priority areas

CONTACT OFFICERS:

Steve Barnard, Head of UEC Service Improvement, GMHSC [email protected]

Colin Kelsey, Head of UEC Transition and EPRR, GMHSC [email protected]

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1.0 CURRENT POSITION

1.1 The validated aggregate position for performance against the 4 hour standard inDecember was 81.5% for Greater Manchester, a decline from 86.7% in Novemberand 89.6% in October. Chart 1 below shows individual trust performance for October,November and December. Salford and Tameside are the only two trusts to haveachieved 90% or over during the last three months. There is no data available forManchester University NHS Trust, as a new single organisation, before December.

Chart 1

The GM system has experienced challenging performance against the 4 hourperformance standard during December and into early January. However, we arenow seeing some signs of recovery, with a continued rise in performance acrossmost systems. However, this should be treated with a degree of caution since we arecontinuing to see high numbers of admissions.

Unplanned admission rates have gradually increased over the last two months, to30% plus on a daily basis.

The proportion of stranded patients (patients with a length of stay of 7 days or over)remains high across GM at 40% plus. The optimum proportion of patients with alength of stay of 7 days or more is 20%. In addition, the stranded patient metric isoften inversely proportional to four hour performance (i.e. as the stranded patientmetric increases, four hour performance decreases and vice versa).

Chart 2 below shows the relationship between four hour performance, strandedpatients, admission rates and bed occupancy. The charts show an increase inadmission rates from as early as October, which has led to a gradual increase in theproportion of stranded patients and bed occupancy. This is reflective of a reported

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increase in the acuity of patients from all GM systems (and nationally). There hasbeen a gradual decline in the 4 hour performance during the same time period.

Chart 2

1.2 The published Delayed Transfer of Care (DToC) rate for November was 4%compared with a North region rate of 4.1% (the national rate has yet to be validated).While the data has yet to be validated, we anticipate there to be a further reduction inthe DTOC rate for December. Localities have worked incredibly hard over the lastmonths to achieve these improvements.

Chart 3

The top three reasons for delayed transfers of care in November were; delays inarranging domiciliary care packages (28.0%); due to patient and/or family choice(12.1%) - often due to a lack of available choice in the system for transfer placement;and delays in arranging nursing home placements, often due to a lack of availability(19.1%).

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There has been a system-wide ‘Home for Christmas’ campaign with localities runningMulti-agency Discharge Events (MADEs), Length of Stay Reviews and PerfectWeeks leading up to and after the festive period. These have helped to maintainDTOCs, reduce internal delays and the number of patients who are medicallyoptimised and no longer need to remain in an acute hospital bed.

2.0 ADDITIONNAL WINTER INVESTMENT

2.1. On 22 November 2017, the Chancellor announced £335 million additional fundingto help the NHS manage winter for 2017/18. The funding was allocated in twotranches. The first tranche was to reflect the cost of emergency and urgent reactivity across winter that is already in operational plans and is being incurred byproviders. The allocation was based on emergency services activity in trusts with aType 1 A&E.

2.2. The second tranche of funding was used to support new initiatives to improve A&Eperformance over winter. Trusts were asked to submit up to 3 bids each. Theregional NHSI and NHSE directors then agreed funding allocations.

2.3. In addition, there were funding allocations for primary care and mental healthservices.

2.4. Greater Manchester received approximately £21 million of additional winter moniesfrom the national allocations for acute, primary care and mental health services.The key areas that additional monies have been used to support the:

provision of an extra 94 acute hospital beds creation of additional assessment space in acute medical areas provision of additional clinical workforce in emergency departments, acute

assessment areas and staff to support discharges provision of additional primary care access, 7 days a week 08:00 to 20:00 development of an urgent care response in partnership with NWAS, to

support primary care in each locality provision of additional 24/7 mental health liaison and crisis support teams provision of additional mental health beds, including dementia care and

intermediate care

2.5. The GMHSCP continues to track progress against the agreed schemes, includingmonitoring of bed occupancy and impact on the four hour performance standard.

3.0 AMBULANCE ARRIVALS AND HANDOVERS

3.1. Ambulance activity has remained high during the last six weeks, with hospitalshaving to deal with high numbers of arrivals and frequent surges in demand.

3.2. Table 1 below shows the six week average (4th Dec 10th Jan) for ambulanceattendances across Greater Manchester. Stockport, and Salford have a significantlyhigher proportion (30%+) of arrivals by ambulance compared with other areas.

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No. of EmergencyDepartment attendances

No. of ambulancearrivals

% of arrivals byambulance

Stockport 263 94 35%

Salford 286 91 31%

Bolton 316 95 30%

Wigan 345 82 23.8%

Pennine 1066 235 22%

Tameside 411 81 19.7%

Manchester 1096 179 16.3%

Table 1

3.3. The standard for completing an ambulance handover at hospital is 30 minutes. Thisis a critical factor in ensuring that emergency ambulances are available to respondto 999 emergency calls. Chart 4 below shows the six week averages for ambulancehandover delays between 30 and 60 minutes and greater than 60 minutes. There iswork ongoing between GMHSCP, NWAS, commissioners and acute trusts toidentify improvements that can be made to reduce hospital attendances and delaysin the actual handover process. The work includes; developing out of hospitalservices to refer patients into and bypassing emergency departments to take morestable patients directly to ambulatory care, frailty units and acute assessment areas.

Chart4

4.0 ATTENDANCE AND ADMISSION AVOIDANCE

4.1. As part GP Access, patients in Greater Manchester can access pre-bookable andsame day appointments during evenings and weekends. This is delivered via

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additional access hubs in each locality. These hubs are embedded within the LocalCare Organisations (LCOs) and rooted within the neighbourhood delivery models,therefore more responsive to the needs of the population and better able to respondto the challenges we face in GM. Additional access has been funded from thewinter monies allocation on a capitated basis.

4.2. This additional capacity will also act as an enabler to proactively support andmanage more complex patients, both in hours and out of hours and provide themeans to:

Flex consultation and provision over longer consultations in core hours

Proactively case find and connecting with people with unmet needs e.g.carers, those in deprived communities, LGBT community etc.

Involve a wider multidisciplinary team and wider skill mix

Manage patient flow and demand across 7 days, for example, booking moreacute activity onto the 7 day access hubs to provide an alternative communityemergency service taking pressure from Emergency Departments

4.3. The GMHSCP are currently working with 111 and the localities to test directbooking via 111 into primary care. The testing will be for direct booking intoadditional access only in the first instance. There are four test beds sites that aredue to go live during January; City of Manchester (North, Central and SouthManchester), Oldham, Tameside & Glossop, Wigan Borough.

4.4. The GMHSCP are working with localities to rapidly develop and test, for fourmonths, an Urgent Care Practitioner response that is embedded within primarycare. The aims of the project are to:

Improve the management of urgent GP home visits

Enable primary care to respond directly to lower acuity 111 and 999 calls –reducing demand on 999 resources and improving timeliness of response

Reduce the number of conveyances to hospital through increased use of localprimary and community services

Increase capacity in primary care to undertake more proactive/preventativecare through activities such as; frailty screening, care planning and support tocare homes

4.5. The project is funded through the additional winter monies and is expected tooperational in some areas of Greater Manchester within the next four weeks.

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5.0 STREAMING

5.1. Primary care streaming is now fully operational within all emergency departments inGreater Manchester. However, an early review has highlighted significant variationin relation to the proportion of patients being streamed at each hospital site(between 1% and 15%).

5.2. Further work is underway with the localities to understand the reasons for suchvariation and to identify opportunities for improvement. GMHSCP is working closelywith NHSI to provide some specific support to hospital sites and is also in theprocess of arranging a GM-wide workshop on streaming.

6.0 DEFERRAL OF NON-URGENT ELECTIVE ACTIVITY

6.1. On the 2nd January, NHSI and NHSE published guidance on the deferral of non-urgent elective activity until the 31st January. The guidance was developed by theNational Emergency Pressures Panel. It asked trusts to consider deferral of all non-urgent inpatient elective care to free up capacity for the sickest patients. The letterhighlighted that cancer operations and time-critical procedures needed to preventrapid deterioration in a patient’s condition should go ahead as planned. Theguidance also asked trusts to consider the deferral or alternative management ofday-case procedures and routine follow-up and outpatient appointments to releaseclinical time for non-elective care. There were recommendations about re-deployingstaff to support emergency departments, acute medical areas and discharges.

6.2. The GMHSCP has written to each locality UEC delivery Board asking them toconsider their response to the guidance and to submit a plan for January and theremainder of the financial year. This will help us to better understand the GMposition. From a GM perspective, we are currently working with the national andregional leadership to understand the implications of this guidance in the context ofdevolution and the formally adopted accountability agreement – particularly aroundthe requirement to achieve constitutional standards such as RTT.

7.0 OPERATIONAL MANAGEMENT, RESILIENCE AND ESCALATION

7.1. The GM UEC Operational Hub has been operational since early November and hasbeen working with localities to develop an operating model and data sharingprocesses. Staff recruitment is still underway, with the hub almost fully established.There are now live data feeds in place from the all bar one of the acute trusts to thehub. These provide information that includes; the number of people in anemergency department, time to be seen, waits for beds, staffing, bed availabilityand OPEL pressure scores.

7.2. The hub is working closely with the acute trusts, local systems and NWAS tomanage patient flow, through the early identification of increasing pressures and byensuring hospital diverts are put in place quickly to avoid excessive ambulancehandover delays at hospital.

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7.3. The hub is also providing a critical role in relation to supporting the interfacebetween the regional and national NHSI/E winter reporting and escalationprocesses. The hub participates in daily calls and acts as a single point of contactfor all enquiries about systems in GM. This has helps reduce the burden on localorganisations, enabling them to focus more of their time and efforts on deliveringpatient care.

7.4. The quality of partnership work across Greater Manchester has meant that to datethis winter we have avoided any hospitals reaching major incident status due to theincreased pressure.

8.0 COMMUNICATIONS

8.1. The GM UEC Communications group produced a winter media pack that has beencirculated and used to good effect across the localities.

8.2. There has been a continued focus on flu and encouraging vaccination – particularlyfor younger children. The campaign has also focussed on promoting self-care andreducing demand on emergency departments by encouraging GP practice first asthe point of contact.

8.3. The GMHSCP communications team have been producing a weekly winter mediabriefing pack that goes to a wide range of local stakeholders. This provides anupdate on how the systems are coping with winter, emerging themes and issues.The briefing also provides guidance on further sources of information.

8.4. GMHSCP have also participated in a wide range of interviews with the mediaincluding regional and local TV and press to get key messages across.

8.5. The GMHSCP communications team is already starting to scope an evaluation ofthis year’s campaign to learn and inform the development of next year’s campaign.

8.6. Some of the key public messages that are being regularly communicated include:

Advising how busy emergency departments are and the long waits.

Local pharmacy can be the fastest route to care - visit them at the first sign ofillness.

Advising people that their GP practice should be their first port of call whenthey require urgent medical care (except for 999 emergencies). GPs aregiving extended hours access to care and working with other providers tomaximise care closer to home, reducing the need for hospital care

111 is also available out of hours

Advising a well-stocked medicine cabinet at home, and to take all medicinesthat are prescribed

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All those eligible should get their free flu jab. These are people in the ‘at risk’groups – people aged over 65, people with long-term health conditions likeasthma and diabetes, pregnant women, people with a body mass index (BMI)of over 40 and carers

Keeping warm this winter. Cold weather can be harmful. Heat your home to atleast 18°C.

People should also look out for their family, friends and neighbours who maybe vulnerable over winter

To visit nhs.uk/staywell for helpful tips and advice.

9.0 FLU UPDATE

9.1. Influenza vaccination remains the first-line intervention to prevent influenza and itscomplications. There has been a continued campaign to promote vaccination ofhealth care workers. Table 2 below provides an update on vaccination rates acrossthe GM health provider organisations for December 2017.

Organisation 2017/18 2016/17

Manchester University FT 54.5% N/AThe Christie FT 68.8% 57.6%Salford Royal FT 73.2% 76.3%Bolton FT 68.9% 65.9%Tameside and Glossop Integrated Care Organisation 65.1% 58.1%Wrightington, Wigan and Leigh FT 71.3% 61.1%Pennine Care FT 57.4% 27.6%Pennine Acute FT 74.3% 45.9%Stockport NHS FT 66.5% 62%NWAS 57.9% 38.2%Greater Manchester West Mental Health NHS FT 70.6% 66.4%Bridgewater FT 63.2% 45.7%Greater Manchester 65.9% 57.9%England N/A 55.6%

Table 2

Overall, the rates are higher than last year. The vaccination programme continuesto be monitored through the Greater Manchester Urgent and Emergency CareDelivery Board and locality delivery boards.

9.2. The prevalence of flu within the acute hospitals is now being monitored through theNHSI daily sit rep returns. As of the 10th January, there were 117 cases ofconfirmed influenza recorded in Greater Manchester hospitals. There aremonitoring tools in place that track the numbers of reported respiratory illnessesand flu-like cases in care homes and ambulance calls. The GMHSCP is workingclosely with localities to ensure there are sufficient plans in place to deal with anyreduced capacity in care homes as a result of outbreaks.

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9.3. The data in table 3 shows the uptake rates for the vaccine between 1st September2017 and week ending 7th January 2018. The data is extracted from the nationalImmForm system and is a representation of flu vaccine uptake in 97.2% of GPpractices for the main GP survey and 96.8% for the Childhood GP survey.

Eligible population % GMHSCPPracticesreporting

Flu vaccination uptake 1st Sept –31/12/2018 2016/17 %

uptake at samepoint in timeGMHSCP

% Uptake

England average %uptake

Those aged 65 yearsand over

97.2%

74.2% 71.3% 73%

Those age 6 months-under 65 years in aclinical at risk group

50.1% 46.9% 51.7%

Pregnant women 50.5% 45.5% 47.8%

All 2 year olds

96.8%

41.3% 40.8% 38.7%

All 3 year olds 42.9% 42% 41.2%

Table 3 *The data within this table is based on the national weekly unpublished reporting and is provisional andsubject to change following further validation.

9.4. Uptake of the flu vaccine in primary care is above the national average in GM in alltarget groups. The reported uptake of the flu vaccine in those aged 6 months tounder 65 years in a clinical at risk group, has declined when compared to the samereporting period last year. This reflects the national trend and the un-validated dataindicates that GMHSCP is the highest achieving area nationally within this cohort

9.5. The 2 and 3 year old uptake of the vaccine is now higher than the national averageand an improvement on 2016/2017. Data indicates that all GM localities haveachieved above 30% uptake in this cohort, which is the level that the nationalmodelling predicts will interrupt transmission of the flu virus.

9.6. Table 4 demonstrates uptake of the flu vaccine in the school programme from 1stSeptember to 30th November 2017. The provider has completed the vaccinationprogramme and is undertaking isolated mop up sessions on request from thecommissioner.

Table 4 Primary School Aged Delivery (monthly survey collection)

Reception Year one Year two Year three Year fourGM 61.2% 59.9% 59.5% 55.9% 54.7%

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9.7. The data is provisional at this point, subject to final validation checks, but indicateshigher coverage than the national average across GM as an average, and animprovement across all localities at this point, in comparison to 2016/2017.

9.8. There continues to be widespread media coverage about so called ‘Australian flu’due to the severe flu season seen there in 2016/17. This was flu strain A (H3N2)which we frequently see in the UK (it was the dominant strain in 2016/17 here) andtraditionally affects older age groups. This strain of flu is circulating currently, alongwith others and at this stage, no one strain is dominating.

9.9. The GMHSCP communications team have been facilitating media coverage topromote the uptake of the flu vaccine this week. PHE have also launched a ‘catch itkill it bin it’ campaign on the 11th January 2018.This included key interviews withthe Chief Medical Officer and NHSE. A joint letter to healthcare workers urgingthem to be vaccinated is being sent out from the Department of Health and NSHE.

10.0 RECOMMENDATIONS

10.1. The Strategic Partnership Board is asked to:

Note the content of the paper in relation to winter preparedness

Support the GM and local delivery against the identified priority areas

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Subject: Greater Manchester Approach to Carers: Carers Charter and Commitment toCarers

Report of: Steven Pleasant, Chief Executive Tameside MBC/Accountable OfficerTameside & Glossop CCG

SUMMARY OF REPORT:

In line with Taking Charge and the development of the Adult Social Care TransformationProgramme, in February 2017, the programme was charged with delivering fourtransformation priorities (alongside two enabling themes), one of which was to re-shape thecurrent offer and support available to unwaged carers across Greater Manchester.

KEY MESSAGES:

This report sets out the background and emerging detail of the Support for Carers workprogramme, the key principles for supporting carers formalised through a Carers Charterand Commitment to Carers and how we can improve the offer for carers as a whole, byensuring carers:

are identified as a carer as early as possible, informed, respected and included by healthand social care professionals;

have choice and control about their caring role, get the personalised support they needas a carer to meet their and their family’s needs;

are able to stay healthy and well themselves, and for their own needs and wishes as anindividual recognised and supported;

are socially connected and not isolated;

are supported to fulfil educational and employment potential, and where possible inmaintaining employment; and

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young carer or young adult carers are supported so they are able to thrive and developeducationally, personally and socially, and protected from excessive or inappropriatecaring roles.

PURPOSE OF REPORT:

The purpose of this report is to request that the Strategic Partnership Board (SPB) agree thecontents of the:

Commitment to Carers which sets out a commitment, agreed by organisations acrossGreater Manchester to support the implementation of an integrated approach to theidentification, assessment and meeting the health and wellbeing needs of unwagedcarers; and

the Carers Charter which has been developed by carers for carers and which articulateswhat carers across GM can expect.

The report also provides an overview of the programme of work and delivery plan beingprogressed to make real and embed the Commitment to Carers and Carers Charter intoeveryday support. It also details the potential ‘ask’ of partner organisations going forward tosupport carers in GM.

RECOMMENDATIONS:


approve and sign off the Commitment to Carers, the Carers Charter and delivery plan asappended within.

CONTACT OFFICERS:

Joanne Chilton, Interim Programme Director, Adult Social Care Transformation,Greater Manchester Health and Social Care [email protected]

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1.0 INTRODUCTION AND BACKGROUND

1.1. In December 2015, Greater Manchester (GM) published ‘Taking Charge’ and indoing, set out how the health and care economy will become clinically andfinancially sustainable by 2021 whilst addressing the significant health inequalitiesand poor outcomes that exist. There is a clear need to create public services thatare community based and which support people to live at home for as long aspossible. Currently, performance across GM is varied; there is significant variationin methodology, quality and effectiveness. A coordinated approach totransformation at GM level, supporting delivery through local care organisations isneeded to secure significant opportunities to improve system resilience and make atangible difference for people living in the region.

1.2. The Greater Manchester Health and Social Care Partnership (GMHSCP) has sinceestablished the Adult Social Care Transformation Programme which has seensystem leaders, providers and commissioners come together to confront the realityof the social care challenge, whilst seeking to design and implement innovativesolutions to radically improve outcomes for vulnerable people across thegeographical footprint. Supported by the Strategic Partnership Board and through astructured and inclusive process involving people who use these services, inFebruary 2017, the programme was charged with delivering four transformationpriorities (alongside two enabling themes), one of which was to re-shape the currentoffer and support available to unwaged carers across GM.

1.3. Building on the initial work led by the Strategic Advisory Group (now the StrategicCarers Group) the GMHSCP have been working with partners from the public,independent and voluntary community sector to develop a Commitment to Carersand rights based Carers Charter which, alongside a clear delivery plan, will definewhat we intend to do to improve the support for carers of all ages in GM.

2.0 COMMITMENT TO CARERS AND CARERS CHARTER

2.1. The Commitment to Carers (appendix one) was developed toencourage/drive/facilitate the commitment of organisations to improve theexperience of unwaged carers in GM.

2.2. Representatives of carers believe that GM should be a place where carers arerecognised, valued and supported, both in their caring role and as an individual. Anintegrated approach to identifying, assessing and supporting carers’ health andwellbeing needs rest on a number of supporting principles, taken from the NHSEngland Carer’s toolkit, and these subsequently underpin the Commitment toCarers.

2.3. Building on these principles, a Carers Charter (appendix two) has also beendeveloped to support GM in adopting a rights based approach for its carerpopulation and to articulate a universal offer of support to be made available. Toensure this is reflective of the views of carers in addition to those responsible for

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commissioning and service provision in the health and social care system,collaboration was sought with carers and carers support organisations across the10 localities. This engagement exercise was led by Lynne Stafford, Chief ExecutiveOfficer of the Gaddum Centre, who is also a member of the Carers Consortium,Manchester Carers Network, VCSE representative on the GM Strategic CarersGroup and a member of the GMCVO. The outputs determined the contents of theCharter in terms of what carers felt were the priority areas to focus on and this wassubsequently written in language that they wished to use. To ensure we aresupporting the key priorities as identified by carers themselves and in language theyunderstand, rightly so, we have had no input into the language used to articulate theexpectations – enabling this to continue to be a Charter developed by carers, forcarers.

2.4. The Carers Charter will be complemented by local easy read information that willdescribe the local models which ‘talk to’ the Charter and the Commitment to Carersand which will be accessible, clear, and readily available for carers locally in aformat that works best for local people - in effect bringing the Charter to life as towhat this means/is achieving in practice.

2.5. In order to ensure we deliver the commitments contained within the Charter thereare six critical priorities which are now brought to life within a detailed delivery plan,this includes developing models of support that will be co-produced, tested andagreed.

Early identification of carers;

Improving health and wellbeing;

Carers as real and expert partners;

Getting the right help at the right time;

Young carers and young adult carers;

Carers in and into employment.

3.0 PROGRAMME OF WORK

3.1. Work has been undertaken to ensure that the delivery and governance architectureof this programme is reflective of broader health and care economy, whilst ensuringthat the voice of carers remains pre-eminent. In pursuit of creating increasinglyintegrated and aligned services, engagement has taken place with a broader groupof organisations and representatives with connections developed across thesystem. This has been critical due to the multi-faceted nature of the challengesfacing carers and the multiple programmes and projects across GM which relate tocarers and has led to the development of a broader programme of work. Forexample, the primary care system reform programme has committed to pro-activelycontacting carers to assist with their health needs through primary care hubs.Further work is required to ensure their engagement with other GM programmes

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including the GM Children’s Services, Learning Disabilities, Mental Health andemployers.

3.2. To support development of the work programme, an initial stocktake was carried outas to what localities commission/provide to support carers. This looked at supportaimed at all carers – not necessarily those already known to adult social care, and anumber of the outcomes from this informed the programme of work going forward.Some key messages noted that there was significant variations in spend andsupport offers across localities with funding ranging from circa £100k to £500-600kper annum. A further particular area of concern was in relation to the provision ofsupport for young carers. Therefore, to ensure that the voice of young carers isembedded throughout the programme and the suite of offers being developed ismost effective, a co-production and consultation exercise specific to young carersand young adult carers is taking place throughout January - March 2018.Facilitated by young carers and VCSE representatives across GM, the outcome ofthis exercise will provide a detailed understanding of the needs of young carers andyoung adult carers including what support/services they feel are needed. Inaddition, we recognise the specific role, needs and context of parent carers andtherefore, working with our partners, in spring 2018 are ambition is to hold a GMwide co-production and consultation exercise so that we fully embed their needswithin the 6 priority workstreams.

3.3. The delivery plan is being progressed through the workstreams, a summary ofwhich is included at appendix three. Each workstream is led by an identified leadfrom within GM (public/VCSE) supported by project delivery groups comprising ofrepresentatives from Local Authorities, the NHS and Voluntary and Communitysector across GM to ensure a wide reach of influence and participation.Workstream plans have been confirmed and initial key deliverables identified whichwill support the Commitment to Carers and Carers Charter become a reality.

3.4. Through co-production, the wealth of knowledge of carers will be utilisedrecognising them as experts, in supporting decision making, and designingcommissioning principles. Carer support representatives have been identified andmatched to each group to ensure what we do is underpinned and influenced bycarers and families. In addition, this will be further supported through the re-designof the GM Carers Partnership (which has been an initial outcome of workstream 3‘carers as real and expert partners’). The Partnership, led by Lynne Stafford, CEOof The Gaddum Centre, meets monthly and consists of approximately 15 leadrepresentatives from the VCSE sector with all 10 localities within GM representedand this is further opened up every quarter involving wider participation from carersand affiliated carer support organisations. In addition, through the GM CarersPartnership and building on the initial stocktake, a short mapping exercise is beingundertaken, to identify what further support is available across GM including non-commissioned activity and specific support for carers from communities of interestor identity e.g. Mental Health, Learning Disabilities, BAME and LGBT in each area.

3.5. Furthermore, it has been agreed to appoint an Independent Chair/CarersChampion, who will play a key role in ensuring carers issues are represented at thehighest level across GM. This role will also be a key influencer and develop and

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strengthen relationships across sector in order to maximise support andopportunities for carers.

3.6. It is important to note that although the work is currently housed in Adult SocialCare, the delivery of improvements will relate to the whole system includingresponsibility of such. The agreement of both the Adult Social Care TransformationProgramme and ‘Taking Charge’ and their subsequent implementation affords GMa significant opportunity to work collectively and in collaboration with health, socialcare, CCGs, the voluntary sector, carers groups and carers themselves to form anew more effective approach to meet needs of unwaged carers across GM.

3.7. The GM Carers Charter helps to provide a framework to support local responses inshaping their offer/local carers strategies and to support the delivery of the prioritiesand related desired outcomes which carers in GM feel should be of focus. Themodels/standards resulting from the GM programme will be provided to localitieswho will be asked to review their current position against these. This will supportthem to then determine their level of delivery against identified best practice, whichelements to take forward in their locality and the best way of introducing these overa time period based on their local position on the pathway to excellence.

3.8. To illustrate what this might mean for partner organisations we have detailed anumber of areas where it is anticipated each partner may need to develop/tailorcurrent practice, systems and/or support mechanisms in order to meet theCommitment to Carers and the Carers Charter locally, appendix four gives anoverview of the potential ‘asks’ going forward. This includes (but is not limited to):

asking GPs to commit to the delivery of GM Primary Care Standard 5; ensuring all organisations have employment practices which effectively

support working carers; involving carers as real and expert partners in the assessment and planning of

care and support for the person they care for (including the take up of personalbudgets) and also shared decision making around reviewingservices/designing commissioning principles;

committing to adopting best practice models.

3.9. It is important to note each workstream is in the process of developing bestpractice models/standards (from identifying what good looks like, reviewing arange of services and processes on offer and through co-production) which oncecomplete will be consulted on across the GM system. As these are underdevelopment and will focus heavily on co-production and consultation (whilst beingmindful not to undermine this work ongoing) the information in appendix fourprovides an outline of the current thinking of the workstreams as to some initialcommitments and best practice. The asks of the system and partners will bedeveloped further as the models are co-produced alongside clear communicationand engagement including through appropriate governance, to further securecommitment.

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4.0 Finally, we will continue to ensure that the roles and needs of Carers arerecognised by commissioners and planned for. This work will be co-ordinatedthrough each Authority’s Health and Wellbeing Board, the Better Care Fund Board,and underpinned by effective Joint Strategic Needs Assessments, which will includeidentification of the needs of all Carers, including Young Carers and Young AdultCarers. This identification will be crucial in planning services which reflect theprevention agenda that underpins the Care Act 2014. Therefore, whist the GreaterManchester programme has identified 6 specific workstream priorities, localtransformation improvement plans will, nevertheless, recognise the specific roles,needs and contexts of different members of the carers communities including:Young Carers and Young Adult Carers; Parent Carers; Carers of people with LongTerm Conditions (Dementia, Alzheimer’s, Health Failure, COPD, HIV, Mental Healthetc.); Working Carers; Carers within particular communities of interest (e.g. BAME,LGBT etc), and Carers within particular communities of place (e.g. urbancommunities, rural communities, deprivation, neighbourhoods) etc. This work will beundertaken with due regard to Equalities, Diversity and Human Rights strategies ofall our partners.

5.0 NEXT STEPS

5.1. It is proposed that a public launch of the Commitment to Carers and Carers Chartertakes place later on in the year.

5.2. The Public Launch event will focus on carers and any emerging outcomes from thedelivery plan. A detailed plan in relation to what the launch will look like will bedeveloped further alongside the VCSE representation, carers and the GM CarersPartnership.

5.3. As described above, work is also progressing to ensure that the programme beginsto articulate what the realisation of the Charter and Commitment to Carers will looklike, where each locality is in relation to the best models and what the gaps are bothin terms of activities and funding.

6.0 RECOMMENDATIONS

5.1 The Strategic Partnership Board is asked to:

approve and sign off the Commitment to Carers, the Carers Charter anddelivery plan as appended within.

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APPENDIX ONE – COMMITMENT TO CARERS

A Greater Manchester commitment to improvingsupport for informal carers

1. IntroductionThis document sets out a commitment, agreed by organisations across Greater Manchester, tosupport the implementation of an integrated approach to the identification, assessment and meetingof Carers’ health and wellbeing needs.

2. BackgroundThere are approximately 280,000 carers in Greater Manchester, who make up a crucial part of thehealth and social care system. Together, these individual carers make an invaluable significantcontribution to Greater Manchester, improving the wellbeing of the people they care for andreducing the demand on a range of Local Authority and NHS funded services. However, as well assupporting the people they care for, carers themselves have many needs of their own, not all ofwhich are currently being consistently met within Greater Manchester.

The Care Act 2014 was designed to improve support for carers, but the ‘State of Caring 2016’ reportby Carers UK and the Carers Trust report ‘Care Act: One Year on’ both show that carers are stillstruggling to get the support they need to care well, maintain their own health, balance work andcare and have a life of their own outside caring.

In recognition of the potential that the Greater Manchester Health and Social Care Partnership hasin ensuring that organisations work together to meet the needs of our carers, a Strategic AdvisoryGroup on Carers has been established. The group has worked together to identify how newarrangements could be put in place within Greater Manchester will improve the support offered toinformal carers across our city region.

This group has brought together representatives from the Greater Manchester Health and SocialCare Partnership team, CCG's, Local Authorities, Higher Education, NHS England, Carers Trustand local carer’s organisations.

This Commitment: Outlines a vision for carers in Greater Manchester; Seeks commitment from partners across the Health and Social Care Partnership and beyond to

work together to transform our approach to meeting the needs of carers ; Sets out how we plan to work together to meet carer needs and the principles which will

underpin this work; Details the key priority areas for action which will be delivered over the next year.

3. Our vision for CarersOur vision was developed and informed by the Greater Manchester Carers consortium. We believethat Greater Manchester should be a place where carers are recognised, valued and supported,both in their caring role and as an individual.

As a carer in Greater Manchester you should be able to expect the following:

To be identified as a carer as early as possible, be informed, be respected and included byhealth and social care professionals;

To have choice and control about your caring role, get the support you need as a carer to meetyou and your family’s needs;

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To be able to stay healthy and well yourself, and for your own needs and wishes as an individualto be recognised and supported;

To be socially connected and not isolated; To fulfil your aspirations in education and employment; If you are a young carer or young adult carer, you are able to thrive and develop educationally,

personally and socially, and you are protected from excessive or inappropriate caring roles.

4. Working together to support CarersBy signing this Commitment, organisations agree to work in partnership with each other to promotethe wellbeing of individual carers, and to adopt a whole family approach in their work to supportlocal carers of all ages, in order to:a) Support and encourage the independence and physical and mental health of carers and their

families;b) Empower and support carers to manage their caring roles and have a life outside of caring;c) Ensure that carers receive the right support, at the right time, in the right place;d) Respect carers’ decisions about how much care they will provide and respect Carers’

decision about not providing care at all

5. Key principlesThe integrated approach to identifying, assessing and supporting carers’ health and wellbeingneeds rests on a number of supporting principles that underpin this Commitment.

Principle 1 – We will support the identification, recognition and registration of carers in allorganisations including primary care.

Principle 2 - carers will have their support needs assessed and will receive an integratedpackage of support in order to maintain and/or improve their physical and mental health.

Principle 3 - carers will be empowered to make choices about their caring role and accessappropriate services and support for them and the person they look after.

Principle 4 – The staff of partners to this agreement will be aware of the needs of carers and oftheir value to our communities.

Principle 5 - carers will be supported by information sharing between health, social care, Carersupport organisations and other partners to this agreement.

Principle 6 - carers will be respected and listened to as expert care partners, and will be activelyinvolved in care planning, shared decision-making and reviewing services. Principle 7 - Thesupport needs of carers who are more vulnerable or at key transition points will be identifiedearly.

Principle 8 – the implementation of the Commitment (and Charter) will be consistent withintentions of Duty to Co-operate as determined in the 2014 Care Act.

6. Moving forwardsThis Commitment, its accompanying Charter and the principles which are set out above will bedelivered through a programme of change which forms part of the delivery of Taking Charge. It willbe expected that across Greater Manchester:

Carers are recognised as ‘experts by experience’, in monitoring and reviewing services, andwhen seeking to redesign, commission or procure Carer support services.

Programmes for learning and development are put in place to raise the awareness andunderstanding of the needs of Carers and their families, and of local Carer support services.

Training is designed to support those undertaking Carers needs assessments to have thenecessary knowledge and skills. This will include ensuring that practitioners in the local authorityand partner agencies are aware of the specific requirements concerning Carers of the Care Act2014 and amendments to the Children and Families Act 2014 and accompanying Guidance andRegulations.

We will develop a standard set of outcome measures that will, in future, be able to capture andreport on the outcomes we aspire to in this Commitment. This is part of making the changes

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real, although it is fully acknowledged that outcomes measurement will require carefuldevelopment so that it represents the real experience of carers in Greater Manchester.

7. Thinking care across the systemAcross Greater Manchester we recognise that by supporting carers we are also supporting theperson with care needs and we believe that no one should have to care alone.

Through the work that will be undertaken following the signing of this Commitment, it is expectedthat the following outcomes will be delivered:

Carers will receive the right support, at the right time, and in the right place and carers inGreater Manchester who indicate that they require additional support or that their capacity orwillingness to continue caring is diminished, will be able to access support from locally basedCarer support organisations to have their immediate needs addressed.

When a Carer indicates they have a health need during an interaction with the NHS, this healthneed will be addressed as soon as possible, after which it is expected that healthcarepractitioners initiate a discussion about the Carer’s wider support needs and refer to the localCarer support organisation.

Partnership working and co-operation will be enhanced in order to provide joined up, seamlessservices. This will include joint working in each locality between the local authority, the NHS,voluntary organisations, education, public health, housing and local communities to supportCarers.

Local data and information sharing processes between agencies will be developed so thatinformation follows the Carer across their own care and support pathway without themconstantly having to re-tell their story.

Employees in all organisations are able to understand who carers are, thereby ensuring they areable to identify and provide appropriate advice and support.

The needs of Carers will also be recognised by commissioners and planned for. This work willco-ordinated through each Authority’s Health and Wellbeing Board, the Better Care Fund Board,and underpinned by effective Joint Strategic Needs Assessments, which will includeidentification of the needs of Carers, including Young Carers and Young Adult Carers. Thisidentification will be crucial in planning services which reflect the prevention agenda thatunderpins the Care Act 2014.

o Through this work we will ensure that local transformation plans recognise the specificroles, needs and contexts of different members of the carers communities including:Young Carers and Young Adult Carers; Parent Carers; Carers of people with Long TermConditions (Dementia, Alzheimer’s, Health Failure, COPD, HIV, Mental Health etc.);Working Carers; Carers within particular communities of interest (e.g. BAME, LGBT etc),and Carers within particular communities of place (e.g. urban communities, ruralcommunities, deprivation, neighbourhoods etc). This work will be undertaken with dueregard to Equalities, Diversity and Human Rights strategies of all partners.

All locality plans will contain significant reference to carers and detail how the provision ofeffective advice and health and social care interventions will be key to delivering the ‘preventionagenda’ that underpins the Care Act 2014.

All local Health and Wellbeing Strategies will include shared strategies for meeting Careridentified needs, and setting out arrangements for working together and the actions that eachpartner will take individually and collectively.

8. SummaryIt is recognised that to deliver these outcomes, there will need to be a transformational change tothe way that organisations across Greater Manchester work, both on an individual basis andtogether to meet the needs of Carers. It is believed from the stock take undertaken to date, that thiscould impact significantly on many organisations and that transformation funding support will berequired to deliver the fundamental changes required.

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A detailed improvement action plan has been developed that supports putting the principles andaspirations contained in this Commitment into reality.

Through delivery of the action plan we will ensure that, by 2021, our vision and ambitions forimproved support and outcomes for carers will be achieved. This memorandum of understandingwill be subjected to an annual review.

Signatories:

Signatories on behalf of Greater Manchester Health and Social Care:

______________________________________

Lord Peter Smith, Chair of Greater Manchester Health and Social Care Partnership

_____________________________________

Jon Rouse, Chief Officer of Greater Manchester Health and Social Care Partnership

_____________________________________

Andy Burnham, Mayor of Greater Manchester

______________________________________

Lynne Stafford, Voluntary, Community and Social Enterprise representative Chair ofGreater Manchester Carers Partnership and

Chief Executive of Gaddum Centre

19 January 2018

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APPENDIX TWO – GM CARERS CHARTER

Carers Charter for Greater Manchester

In Greater Manchester we believe all carers have a right to be respected, valued and supported, equally intheir caring role, as experts for their cared for and as individuals in their own right.

The Greater Manchester Health and Social Care Partnership, Local Authorities and Voluntary & Communityorganisations are committed to working together in partnership to provide the best quality support for allcarers, through our Commitment to Carers and Action Plan.

As a carer you can expect –

To be identified as a carer as early as possible, be informed, be respected and included by health andsocial care professionals.

To have choice and control about your caring role, get the personalised support you need as a carer tomeet you and your family’s needs.

To be able to stay healthy and well yourself, and for your own needs and wishes as an individual to berecognised and supported.

To be socially connected and not isolated. To be supported to fulfil educational and employment potential, and where possible in maintaining

employment. If you are a young carer or young adult carer, to be supported so you are able to thrive and develop

educationally, personally and socially, and you are protected from excessive or inappropriate caringroles.

We commit to work together in partnership to –

Ensure the independence and physical and mental health of all Carers and their families Empower and support all Carers to manage their caring roles and have a life outside of caring Ensure that all Carers receive the right support, at the right time, in the right place, including when

caring comes to an end. Respect all Carers’ right to decide and choose in relation to how much care they will provide and

respect all Carers’ decision about not providing care at all Ensure all Carers will be respected and listened to as expert care partners, and will be actively involved

in care planning, shared decision-making and reviewing services.

Across Greater Manchester carers will be equal partners –

Valued, respected and recognised as ‘experts by experience’, in monitoring and reviewing services, andco-production to redesign, commission or procure Carer support services.

Supporting and developing training programmes to raise the awareness and understanding of theneeds of Carers and their families, and of local Carer support services for health and social staff andpartner organisations.

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APPENDIX THREE – PROGRAMME DELIVERY PLAN: SUMMARY

The programme will

This will result in:An increase in the number of carers identified as such by

GPs and other stakeholders at the earliest pointpossible, with carers finding it easier to find help, advice

and information

This will result in:An increase the number of carers support organisations

as affiliate members of the GM carers partnershipleading to a strong voice representing carers across GM.

An increase in involvement of carers, recognised asexpert carers

This will result in:increase the number of carers assessments undertaken;

numbers of carers in receipt of carer specific services;and take up of personal budgets to support in ensuring

carers get the right help is provided at the right time

This will result in:An extended and consistently available universal

support for all carers across GM; available to morepeople; leading to improved (measurable) well-being;

and reduction on acute and primary services via aneffective universal and statutory model

This will result in:increase the proportion of young carers and young adult

carers identified by key services (education/ health/social care) where they will be supported to exercise

choice and control over their lives and fulfil theirpotential going into adulthood

This will result in:

An increase in the number of carers identified as suchby GPs and other stakeholders at the earliest point

possible, with carers finding it easier to find help, adviceand information


An increase the number of carers support organisationsas affiliate members of the GM carers partnership

leading to a strong voice representing carers across GM.An increase in involvement of carers, recognised as

expert carers


increase the number of carers assessments undertaken;numbers of carers in receipt of carer specific services;

and take up of personal budgets to support in ensuringcarers get the right help is provided at the right time


increase the proportion of young carers and young adultcarers identified by key services (education/ health/social care) where they will be supported to exercise

choice and control over their lives and fulfil theirpotential going into adulthood


Support to more working carers to maximise theirability to remain and progress in the workplace, their

health and wellbeing needs will be met, enabling themto effectively balance working and caring. More carers

will be enabled to access new employment.

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APPENDIX FOUR – THE ‘ASK’ OF PARTNER ORGANISATIONS

The GM Carers Charter helps to provide a framework to support local responses in shaping their offer/local carers strategies and to support the delivery of the priorities and related desired outcomes which carers in GM feelshould be of focus. The models/standards resulting from the GM programme will be provided to localities who will be asked to review their current position against these models and standards. This will support localities todetermine their level of delivery against the exemplar, which elements to take forward in their locality and the best way of introducing these over a time period based on their local position on the pathway to excellence.

It is important to note that each workstream is in the process of developing best practice models/standards (from identifying what good looks like, reviewing a range of services and processes on offer and through co-production) which once complete will be consulted on across the GM system. As these are under development, the following information provides an outline of the current thinking of the workstreams.

Impact againstorganisations

18/19The ‘ask’

Impact =low = medium = highEarly

identify-cation ofcarers

Improvinghealth andwellbeing

Carers asreal andexpert

partners

Right helpat the

right time

Young carersand young

adult carers

Carers in andinto

employment

GPs(in line withprimary carestandard 5)

Commit to the delivery of GM Primary Care Standard 5, which includes:

identifying a carers lead within the practice; having a carers register which is maintained and updated; ensuring that all staff, including receptionists, are ‘carer aware’ and have a basic understanding of

support available; offering carers an annual health check (where eligible); offering annual flu vaccination (where

eligible); referring / signposting carers to relevant services and support; and

-- undertaking an assessment of mental wellbeing for carers.

Work to increase the identification of carers linked to the top 20% of individuals that are most at risk of hospital

admission and ensure these carers are offered support in line with primary care standard 5.

Work with the VCSE and health and social care commissioners on the development of social prescribing forcarers also linking to care navigation roles currently being developed within some locality neighbourhoodmodels.

Ensure the role of the carer is embedded within patient advisory/participatory groups to ensure thewealth of knowledge of carers as experts for the person they care for informs practice anddevelopments.

FoundationTrusts

(as employers, ascare providers)

As employers, develop and/or strengthen support for working carers linking into identified bestpractice guidance such as the ADASS ‘Top Tips for Supporting Working Carers’;

develop and agree actions that give working carers space and time to support each other in theworkplace;

encourage flexible working; support carers to access services and activities that help them to stay healthy; support each carer individually to access support to enable a good work-life balance; importantly, put working carers at the heart of the design and production of services and policies

that may impact on them as employees.

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18/19The ‘ask’





partners

Right helpat the

right time


adult carers

Carers in andinto

employment

FoundationTrusts

(as employers, ascare providers)

Cont…

Linking into identified best practice, develop and/or strengthen collaboration and partnership withcarers in the person supported and carer’s journey through mental health services.

For example, the ‘Triangle of Care’ approach developed by the Carers Trust and the National Mental HealthDevelopment Unit - described as a working collaboration or “therapeutic alliance” between the personsupported, professional and carer that promotes safety, supports recovery and sustains well-being. The sixprinciples of this are:

carers and the essential role they play are identified at first contact or as soon as possible thereafter; staff are ‘carer aware’ and trained in carer engagement strategies; policy and practice protocols regarding confidentiality and sharing information are in place; defined post(s) responsible for carers are in place; a carer introduction to the service and staff is available, with a relevant range of information across the

care pathway; and a range of carer support services is available.

Support to ensure a ‘think carer’ approach is embedded within care pathways, with a key focus on high impactLTC, as well as A&E, diagnosis and discharge. (‘think carer’ - identify carers, include them in careconversations, signpost to carers’ support).

Develop a carers lead/champion role on hospital sites to enable a continued focus on ward as well as strategiclevel, ensuring identified carers are provided with information, guidance and advice linked to their local carerssupport offer e.g VCS and primary care, carers centre and also any national offers.

Ensure the role of the carer is embedded within patient advisory/participatory groups to ensure thewealth of knowledge of carers, as experts for their cared for informs practice and developments.

Councils(as employers, as

social careleaders)

As employers, develop and/or strengthen support for working carers linking into identified bestpractice guidance such as the ‘ADASS Top Tips for Supporting Working Carers’;




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18/19The ‘ask’





partners

Right helpat the

right time


adult carers

Carers in andinto

employment

Councils(as employers, as

social careleaders)

Cont…

As standard practice, ensure carers are encouraged to be actively involved (to the level they wish) inthe care and support planned for the person they care for and also in shared decision making,reviewing services and designing commissioning principles.

Assess locally commissioned services against the best practice exemplar models for carers currentlybeing developed through the GM programme. Consideration could be given to leveraging the budget,optimising commissioning arrangements through facilitating service redesign, potential newcommissioning or joint commissioning as a few examples. Core elements of the offer will likelyinclude:

information, advice and guidance; access to peer-peer support; activities and short breaks; respite; benefits advice and support; advocacy support; care navigation.

Agree to adopt the best practice carers assessment (leading to an effective approach to the offeringand utilisation of personal budgets) currently being developed through the GM programme in order toimprove support offered to carers and reduce variation across localities. Ensure as many carers aspossible are identified and where required have their support needs assessed by trained individuals.Carers to be empowered to make choices about their caring role and have access to appropriateservices and personalised support that they need for themselves and for they person they care for.

Agree to adopt the practice standards being developed by the GM programme and make acommitment to ensure all staff complete the training which will be developed to enable a skilledworkforce GM wide which is engaged, aware and responsive to carers needs.

Work to increase the identification of carers linked to the top 20% of individuals that are most at risk of hospitaladmission and ensure these carers are provided with appropriate social/health care support.

Work with young carers and young adult carers to ensure the support commissioned delivers well against theChildren Society best practice standards, and engage with schools to unsure the right support is embeddedwithin education settings.

CCGs(as employers, as

health careleaders)

As employers, develop and/or strengthen support for working carers linking into identified bestpractice guidance such as the ‘ADASS Top Tips for Supporting Working Carers’




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18/19The ‘ask’





partners

Right helpat the

right time


adult carers

Carers in andinto

employment

CCGs(as employers, as

health careleaders)

Cont..

Assess locally commissioned services against the best practice exemplar models for carers currentlybeing developed by the GM programme Consideration could be given to leveraging the budget,optimising commissioning arrangements through facilitating service redesign, potential newcommissioning or joint commissioning as a few examples. Core elements will likely include:

information, advice and guidance; access to peer-peer support; activities and short breaks; respite; advocacy support; care / health navigation those to support primary care services in their commitment to carers in line with primary care

standard 5 e.g annual health checks, flu vaccinations, assessments of mental wellbeing forcarers (ref bullet point 3 below)

Commit to support and monitor the delivery of GM Primary Care Standard 5:

identifying a carers’ lead within the practice; having a carers' register which is maintained and updated; ensuring that all staff, including receptionists, are ‘carer aware’ and have a basic understanding

of support available; offering carers an annual health check (where eligible); offering annual flu vaccination (where

eligible); referring/signposting carers to relevant services and support; and-- undertaking an assessment of mental wellbeing for carers.

Support to ensure a ‘think carer’ approach is embedded within care pathways. (‘think carer’ - identify carers,include them in care conversations, signpost to carers support). Consider the role LCO’s can play and explorecontract lever opportunities with Primary Care and Foundation Trusts, looking at CQUIN, Quality Standards,SDIP for example.

Work to increase the identification of carers linked to the top 20% of individuals that are most at risk of hospitaladmission and ensure these carers are provided health and well-being support, considering the role LCO’s canplay and linked to the developing neighbourhood models

Work with young carers and young adult carers to ensure the support commissioned delivers well against theChildren Society best practice standards, focussing on school nursing services and ensuring this is linked intolocal carers support offers

GREATER MANCHESTER HEALTH AND SOCIAL CARE …...Commissioning Group and Donna Hall, Chief Executive...

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Transcript of GREATER MANCHESTER HEALTH AND SOCIAL CARE …...Commissioning Group and Donna Hall, Chief Executive...