Greater Manchester Health and Care Board

Transcription

1 Greater Manchester Health and Care Board 4 Date: 16 March 2018 Subject: Report of: Chief Officer's Report Jon Rouse, Chief Officer, GMHSC Partnership SUMMARY OF REPORT: This report provides GM Health and Care Board with an update on activity relating to health and care across the Partnership. It includes key highlights relating to performance, transformation, quality, finance and risk. The report also provides a summary of the key discussions and decisions at the Partnership Board Executive. PURPOSE OF REPORT: The purpose of the report is to update the GM Health and Care Board on key items of interest across the GMHSC Partnership. RECOMMENDATIONS: The GM Health and Care Board is asked to note and comment on the content of the update report. CONTACT OFFICERS: Vicky Sharrock Deputy Director Strategic Operations, GMHSC Partnership Vicky.sharrock@nhs.net 1

2 1.0 KEY UPDATES AND ISSUES 1.1 People 1.2 Retirement of Bev Humphries 1.3 After twelve years as Chief Executive, Chief Executive Bev Humphrey is retiring from Greater Manchester Mental Health NHS Foundation Trust (GMMH). She leaves the Trust in a very strong positon, following the acquisition of Manchester Mental Health and Social Care NHS Trust, an ambitious three-year programme of transformation, and a recent Good rating in the CQC inspection (see below). 1.4 Kiran Patel stepping down 1.5 Dr Kiran Patel will be standing down as Chair of NHS Bury CCG, on 31st March He will also be stepping down as Chair of the GM Association of Clinical Commissioning Groups. Kiran has led the CCG over the last 5 years and has achieved a great deal working with member practices, staff at the CCG and wider partners and colleagues. He has ensured that Bury is well represented at the Greater Manchester level. He has also been an exemplary chair of AGG and has made a massive personal contribution to the first period of our devolution story. We are pleased that Kiran will now be providing primary care leadership for the Bury Local Care Organisation. 1.6 Ann Gibbs moving on and interim appointment of Linda Buckley 1.7 Earlier this month Ann Gibbs left NHS Improvement to join the South Yorkshire and Bassetlaw Accountable Care System as Director of Strategy. In the interim period Linda Buckley will be acting up to cover the joint post of Director of Delivery and Improvement for GM HSC and NHS I to give time for the new CEO of NHS I (Ian Dalton) to consider the structure of the organisation for the long term. 1.8 Cameron Ward moving on from Trafford CCG 1.9 Cameron Ward, the Interim Accountable Officer at Trafford CCG is now approaching the end of his contract at Trafford CCG where he has done an excellent job in both developing the CCG and in preparing for the move to an integrated management structure with the Local Authority 1.10 Health and Care Awards Nominations are now open for the first ever Greater Manchester Health and Care Champion Awards. The awards will see Greater Manchester s health and care champions; from doctors, nurses, physiotherapists and pharmacists, to care workers, unpaid carers, apprentices and volunteers, receive the recognition they deserve for really making a difference in our communities The Greater Manchester Health and Care Champion Awards 2018 are the first in the city-region to recognise members of our paid and unpaid health and care 2

3 workforce who regularly go above and beyond to improve the health and wellbeing of the people of Greater Manchester Award categories include Outstanding Carer, Apprentice of the Year, Dedication to volunteering and the People s Champion. The awards are open to all individuals or teams, paid or unpaid, who work in the health or care sector in Greater Manchester in either a paid or unpaid roles. Nominations can be completed by members of the public who wish to see an individual or team s hard work recognised Nominations can be completed online by visiting (tbc) and must be returned before the deadline of 13 April The awards are organised by Greater Manchester Health and Social Care Partnership, the body overseeing devolution of the area s health and social care budget, with support from the Mayor of Greater Manchester, Andy Burnham The winners will be announced at a sponsored event in July Greater Manchester Practice Nursing Awards 1.18 The very first NHS awards to celebrate the dedication and achievements of nurses working in general practice were held on Thursday 15 th February. This prestigious event honoured individuals and teams from across Greater Manchester that have worked to ensure the very best care for patients. The awards followed a call for nominations in the autumn with peers, public, and patients all invited to shine a spotlight on practice nurses who have gone above and beyond The awards helped to support the aims of the national 10 point action plan for general practice nursing by celebrating and raising the profile of this vital primary care role, promoting general practice nursing as a first destination NHS career. General Practice Developing Confidence, Capability, and Capacity sets out how a national investment of 15 million will help to develop and upskill the primary care nursing workforce Devolution has seen practice nurses leading on the development of social prescribing, which allows patients to be referred to a range of locally based, nonclinical sources of support such as walking groups or befriending activities. Stockport s Alvanley Practice in particular has spearheaded this work, winning the award for Practice Nursing Team of the Year. Greater Manchester practice nurses were also among the first in the country to trial new group consultations for patients with long term conditions, allowing more time to discuss their concerns as well as offering peer to peer support Key system developments 1.22 Devolution difference campaign 1.23 This week we have launched a devolution difference communications and engagement campaign that aims to demonstrate to staff, stakeholders and the 3

4 public how devolution is making a difference to the lives of the people of Greater Manchester We have updated our story in a devolution difference document, produced a new two minute animated film, a Taking Charge 2 years on leaflet and four case studies. We will be engaging people via a social media campaign including 10 days of devo on Facebook and Twitter, which will include posts and gifs taken from the animated video A Devolution Difference toolkit will be available to help staff and partners share our key messages and practical examples of successes Part of the Devolution Difference campaign will include, over summer and autumn, a community event in each area, building on events and activities already taking place. We will work together with NHS and council communications and engagement leads, along with Healthwatch and VCSE, to showcase the devo difference across the whole of Greater Manchester Further information is available at: Facebook.com/GMHSCPartnership #takingcharge #devodifference 1.28 Pennine Acute CQC Hospitals NHS Trust report 1.29 The recent report published by the Care Quality Commission (CQC) has found that significant improvements have been made across every hospital run by The Pennine Acute Hospitals NHS Trust since its last inspection in The overall position has seen Pennine Acute move form inadequate to requires improvement with 70% of the aspects of the services inspected now rated as either Good or Outstanding The Pennine Acute Trust (PAT), now part of the Northern Care Alliance NHS Group with Salford Royal, runs four hospitals and a range of community services serving the communities of Oldham, North Manchester, Bury and Rochdale borough Since the Trust s last CQC inspection report, published in August 2016, the Trust has benefitted from joint working and support from the leadership at the Salford Royal NHS Foundation Trust. A leadership structure has been put in place, with one Board of Directors now overseeing both Salford Royal and The Pennine Acute Hospitals NHS Trusts Greater Manchester Mental Health Trust 1.33 The Care Quality Commission has rated Greater Manchester Mental Health NHS Foundation Trust as Good following an inspection by the Care Quality Commission. 4

5 This inspection included child and adolescent mental health wards and wards for older people which had previously been rated as requiring improvement CQC also inspected acute wards for adults of working age and psychiatric intensive care units; long stay/rehabilitation mental health wards for working age adults and substance misuse services. CQC also looked specifically at management and leadership to answer the key question: Is the trust well led? 1.35 The service was rated as requires improvement for safety, good for caring, effectiveness and responsiveness and outstanding for well-led. As a result of this inspection, the trust s overall rating remains unchanged as good. This is a considerable achievement given that during this period, the Trust incorporated Manchester Mental Health Trust Make Smoking History 1.37 The Don t Be the 1 campaign launched 5 February, aiming to support attempts to quit by some of our most persistent smokers. Research conducted in December 2017 across GM with 693 smokers, found 9 out of every 10 smokers underestimated the risk of dying from a smoking related disease Our History Makers engagement conversation was launched on 12 February by GM Mayor Andy Burnham at our Making Smoking History event in Manchester attended by 173 stakeholders from across the GM system. 530 surveys were completed in the first 4 days. Our aim is at least 5000 weighted surveys across the 10 boroughs and 1.5m social engagements with the History Makers campaign. Roadshow activity is planned across all boroughs and History Makers engaged will be supported to build our revolution for a tobacco-free GM over the next 3 years Winter Update 1.40 The winter period continues to be challenging for systems, with sustained high levels of demand and reports of higher acuity patients. Performance for January 2018 shows Greater Manchester achieved 83.8% against the four hour A&E wait performance standard. This is an improvement of 2.3% on the December 2017 position. Our ability to achieve the four hour waiting standard has been affected by reduced capacity in care homes and social care as a result of flu and other seasonal illnesses such as respiratory conditions. As a result, there has been an increase in the number of patients staying in hospital over seven days, which has reduced patient flow and bed capacity in the system Greater Manchester received approximately 21 million of additional winter monies from the national allocations for acute, primary care and mental health services. This has enabled us to implement: An extra 94 acute hospital beds Additional assessment space in acute medical areas 5

6 Additional clinical workforce in emergency departments, acute assessment areas and staff to support discharges Additional primary care access, 7 days a week 08:00 to 20:00 An urgent care response in partnership with NWAS, to support primary care in each locality Additional 24/7 mental health liaison and crisis support teams Additional mental health beds, including dementia care and intermediate care (short-term support involving NHS and social care services to avoid unnecessary hospital admissions, help individuals become as independent as possible and aims to prevent a premature move into residential care) 1.42 The GMHSC Partnership is currently working with the North West Ambulance Service, 111 and the localities to test direct booking into primary care. The testing will be for direct booking into additional access in the first instance. There are four test beds sites that are due to go live during late February - City of Manchester (North, Central and South Manchester), Oldham, Tameside & Glossop and Wigan Boroughs The GMHSCP are facilitating a winter de-brief session on the 9 March for all localities, which will enable us to identify further improvements which we can put in place for next year. Looking forward, localities are also being asked to ensure they have plans in place for Easter. A Home for Easter campaign will be adopted across Greater Manchester during March Primary care reform programme 1.45 As part of the Greater Manchester Primary Care Reform Programme, around 60 pharmacists have been employed to work alongside GPs and nurses as part of the general practice team. These clinical pharmacists will provide extra help to manage long-term conditions, advice for people on more than one medicine and better access to health checks Having clinical pharmacists in GP practices means GPs can focus their skills where they are most needed, for example on diagnosing and treating patients with more complex conditions. This helps GPs manage the demands on their time. It is envisaged that an additional 30 pharmacists will be employed by the end of March Greater Manchester is also in the process of a major international recruitment drive to attract appropriately trained and qualified GPs from overseas. Following the success of the Heywood, Middleton and Rochdale bid, the expanded programme will now cover most of Greater Manchester. 6

7 1.48 Review of looked after and adopted children s health needs 1.49 Under the banner of the Children s Health and Wellbeing Board we will be commissioning an external review of health provision (physical and mental) for looked after children and adopted children and young people at both local and GM level. This will help us to identify shortcomings and gaps against both duties and best practice, and to make recommendations for improvement that could feed in to the wider GM Health and Social Care work Development of life sciences offer and visit from Lord O Shaughnessy 1.51 In February we took part in a high level visit from the Life Sciences Minister Lord O Shaughnessy to GM where we showcased the distinguishing aspects of our GMHSCP system from a testing and adoption of innovation perspective and the merits of optimising research investment in GM from different government departments and arms length bodies. He was very interested to find out more about the unique Greater Manchester offering which can support the Life Sciences Strategy and future sector deals. 2.0 SYSTEM PERFORMANCE 2.1 There are a number of performance measures that the GM Health and Social Care Partnership is monitored against. Current performance against these is outlined in appendix A. Some of the key performance measures within this set are outlined in more detail below, focusing on areas of exception: Urgent Care 4 hour standard (National standard is 95% with higher being better performance) GM s performance in January 2018 is 83.8%, which is an improvement on the December position of 81.5% and on January 2017 which was 82.9%. It is still though of course well below the national standard. The numbers of attendances at Accident and Emergency departments are relatively high. Systems have reported a larger number of high acuity patients, which results in a high admission rate and also the proportion of stranded patients to increase. There has also been reduced capacity in care homes and social care as a result of flu and other seasonal illnesses such as respiratory conditions. These have contributed to reduced patient flow and bed capacity in systems. Urgent Care 4 Hour Standard 83.8% p Better Is Higher 7

8 Delayed Transfer of Care (National Standard is 3.5% with lower performance being better) - Published data from NHS England for December 2017 shows a position of 3.8% for all Greater Manchester Trusts. This is 0.2% below the North Regional position but is an improvement of 0.2% on GM s November s published data. Analysis of the data for December 2017 showed that the top three reasons for delayed transfers of care were: delays in arranging domiciliary care packages, patient and/or family choice and delays in arranging nursing home placements. Delayed Transfers of Care 3.8% Better Is Lower q Referral to Treatment (National Standard is 92% of patients should wait less than 18 weeks for treatment with higher performance being better) - The provisional data for January 2018 shows GM has narrowly missed the 92.0% standard with a performance of 90.8%. This is a slight deterioration of 0.3% on the December position. This drop in performance was expected due to the decision to defer some non-urgent elective care, resulting in the cancellation of scheduled operations. The impact of this is being monitored carefully including plans for rebooking those patients who have been cancelled. Referral To Treatment - 18wks 90.8% q Better Is Higher Diagnostic Waiting Times (National standard is for no more than 1% of people waiting 6 weeks or more with lower performance being better) - The provisional data for January 2018 shows that GM s performance is 2.5%, which is a deterioration of 0.4% on the December 2017 position and falls below the national standard of 1%. Greater Manchester has been working to improve performance in this area by increasing diagnostic capacity through the opening of the new Endoscopy suite at Manchester Foundation Trust in January and the use of subcontracting arrangements to other health providers. 8

9 Diagnostic Tests Wait 2.5% p Better Is Lower Cancer waiting times - all eight of the cancer standards were achieved in December January has been far more challenging; as a result we anticipate we are unlikely to quite meet the 62 day referral to treatment standard. Cancer - 62 Day Wait 86.4% p Better Is Higher Improving Access to Psychological Therapies recovery rate (IAPT) (National standard is 50% with higher being better performance) GM has missed the IAPT Recovery rate standard in the published November 2017 data with 47.5% rolling quarter figure against a standard of 50%. This is a deterioration of 1.1% on the October position. We are currently developing a recovery plan to improve performance in this area which will focus on sections of our population where we know there are particular issues with recovery such as black and ethnic minority groups. IAPT Recovery Rate 47.5% q Better Is Higher 9

10 3.0 QUALITY 3.1 Our Quality directorate work with the wider GM system to support improvement across our services. There are a number of key areas to note including: Safeguarding the Safeguarding Assurance Framework is updated be each CCG on a quarterly basis. For Quarter 3 this information confirmed that in GM we do not have any areas of non-compliance. Prevent - In April 2015 the Prevent Statutory Duty was introduced. The Health sector was one of those named statutory agencies required to demonstrate due regard to the need to prevent people from being drawn into terrorism. A clear delivery plan was approved by commissioners that would ensure that training compliance will be achieved by the 31st March NHS England agreed with regulators that as a minimum, 85% of staff should be compliant with training at any one time. Child protection information systems this is a nationwide system enabling child protection information to be shares securely between local authorities and unscheduled healthcare settings. Progress to roll this out in GM is continuing with many settings now reporting this system to be live in all areas or in relevant areas of service such as A&E, maternity and paediatrics. 3.2 Quality in care homes continues to be a key focus for the Partnership. The table below outlines the current performance across the 19,213 beds as at 20 Feb 2018: 3.3 A Quality Improvement and Best Practice group has been established to support our work across the care home sector. The group have agreed three key priority areas: Quality in Care To develop a portfolio of best practice that care home staff will receive training in. This is will include pressure damage prevention, nutrition and hydration, dementia, falls and end of life care. 10

11 Quality in Life To develop a portfolio of best practice that homes and other systems will offer to residents to ensure they have equal access to services, are able to navigate the care system, are not socially isolated and are able to make choices with regards to their health and wellbeing Partnership Working How commissioners, Acute providers, patients advocate groups, CQC and care home providers can work together to ensure residents receive the highest quality in care and are central to the delivery. 4.0 FINANCE 4.1 The financial performance of GM Health & Social Care at the end of December 2017 (Month 9) shows the current forecast is for GM to deliver a small surplus for 2017/18 of 1.3m. This represents an 18.9m improvement against agreed Plan. This improvement whilst welcome is largely driven by one off factors which will not be repeated in subsequent years. The underlying position for GM remains a deficit and presents a number of challenges. The position by sector is shown in the table below: Headline Position (at Mth 9) Plan Surpl/ Forecast Surpl / Better / (Worse) Sectors (Def) (Def) than Plan m m m Planned controls NHSE (excl Spec Comm) CCGs (0.1) Providers (20.7) (1.7) 19.0 Local Authorities Total Surplus / (Deficit) - GM Control (17.6) This forecast doesn t include 21m (0.5%) set aside by CCGs at the start of the year to support the national NHS financial position. It is likely that GM CCGs, in line with the rest of the country, will be required to release this to their bottom line at the end of the year, improving their financial positions by that amount. 4.3 The key points to note in relation to the financial position are: Excluding specialised commissioning, GMHSP central budgets are reporting a net year to date underspend of 1.7m and a break-even position at year end. CCGs are forecasting to deliver their plan of a 3m surplus. NHS Providers (Foundation Trusts and NHS Trusts) are now forecasting they will deliver an overall deficit position of 1.7m which is better than the planned deficit of 20.7m. This is largely due to the improvement in the forecast position at the Christie which is due to the accounting treatment of recent fire and associated insurance. Two trusts are forecasting they will not deliver their 11

12 financial plans for the year, Pennine Care Foundation Trust and Pennine Acute NHS Trust. Whilst the year end position for Local Authorities is projected to deliver a 0.5m surplus, this relies on Local Authority reserves of 66m which is in addition to savings targets of 53.9m already embedded in budgets. 5.0 TRANSFORMATION PORTFOLIO 5.1 Over the past 3 months, a piece of work has been undertaken to understand the alignment of the projects across the GM Health and Social Care Partnership. This has enabled us to: Ensure we are maximising opportunity to deliver the quickest improvements in health and wellbeing for the benefit of the population of Manchester, whilst ensuring clinical and financial sustainability of the Health and Social Care system by 2021 as set out in our Strategic Plan: Taking Charge Ensure there is clarity on the current position of all projects and programmes within the Portfolio, to inform a review of the assumptions made around the benefits they will deliver. Inform the short-term business planning for 18/19, and to ensure commissioners have built in funding and implementation resource for GM programmes, aligned to locality programmes of delivery for 18/ The exercise has categorised all of the projects in the portfolio as either: Already embedded within implementation: Those projects which have been approved through governance, which localities and GM programmes are actively getting on with now, and are understood across the system, as a result of the project maturity assessment process. Being considered for acceleration: Those projects that have been identified as a priority for delivery through the implementation of a GM standard where affordable, to ensure a consistency across GM. With the exception of cancer (where this exercise is ongoing already) and population health (which already has funds aligned), we will be working through Programme Directors, CCG Directors of Commissioning and LA Heads of Commissioning, to understand the current position with regard to the funding and implementation of these projects at a local level throughout March and April, to enable prioritisation and sequencing to be determined. For consideration in 19/20: Those are projects not yet fully designed and costed therefore are unlikely to be ready for implementation before 19/20. Given the current allocation of the Transformation Funding, these commitments are also likely to require realignment of existing resources. 12

13 5.3 As part of the next steps, work is underway to develop an appropriate set of indicators that will enable us to monitor the delivery of Taking Charge. The approach to developing and embedding these measures was discussed and agreed by Partnership Executive in February. 5.4 The approach to be embedded to measure Transformation has been described within a paper received by SPBE in February. An approach has been described to the system to align operating plans, investment agreements and contracts, taking into consideration the national planning guidance where appropriate. 6.0 RISK MANAGEMENT 6.1 The overarching GM HSCP risk register is built from the GM HSCP team risk register (including all the GM transformation programme risks) and the 10 locality risk registers. Each of these are based on the agreed GM Risk and Issues Management Framework (RIMF), which supports the development a risk management process for the GM HSCP. 6.2 Key partnership risks 6.3 Key risks for the portfolio and the actions being taken to mitigate those risks are outlined below: Locality plans do not deliver activity shifts and financial shifts as intended: Operating plans have been received from localities to meet national the 8th March national planning deadline. This has provided an initial indication of variances proposed from already signed investment agreements, which will be followed up by Exec to Exec locality meetings in March GM programmes do not deliver quickly enough to release intended benefits: Clear descriptions of projects already in implementation for 18/19 have been provided to the system. A dedicated focus will continue on determining the possibility of implementation for those projects to be considered for acceleration into 18/19, though it should be recognised that the programmes being considered for acceleration will not deliver significant financial savings. Cancer projects form a significant part of this cohort, along with elective care and urgent and emergency care, which will support system resilience. GM and locality programmes do not connect effectively to deliver collective benefits relating to quality, experience and outcomes: Alongside the alignment of activity plans, work will be completed to describe the contribution of GM and locality programmes to deliver constitutional and outcome targets How we rapidly progress programmes that have had a strategy agreed, but do not have a fully funded route to implementation identified: The prioritisation process for 19/20 projects will be designed with the system, to ensure that the outcomes of this exercise are fully owned by the system, and 13

14 there is agreement with regard to how GM programmes / standards will be funded. Ensuring robust measurement systems are in place to assure transformation delivery.. Whilst the Portfolio definition piece is being completed, work will also continue to strengthen methods of assurance to measure delivery in line with Taking Charge ambitions. 6.4 Key actions for the next 2 months Clear descriptions of key 18/19 must do s will have been provided for the system. Work will be completed to align these to the broader constitutional and outcome targets to be deliver at programme level. A dedicated focus will continue on determining the possibility of implementation for those projects to be considered for acceleration into 18/19. Cancer projects form a significant part of this cohort along with elective care and urgent and emergency care. The prioritisation process for 19/20 projects will be designed, to ensure that the outcomes of this exercise are fully owned by the system. Operating plans will be received from localities on the 5th March to meet national the 8th March national deadline. This will provide an initial indication of any variances proposed from already signed investment agreements, which will be followed up by Exec to Exec locality meetings in March. Whilst the Portfolio definition piece is being completed, work will also continue to strengthen methods of assurance to measure delivery in line with Taking Charge ambitions. 7.0 GOVERNANCE 7.1 SPBE Decisions 7.2 The Health and Care Board is asked to note the recommendations supported by the Partnership Executive at the meeting on 31 January These are outlined in more detail the decision log in Appendix 3. Transformation Fund Stocktake - deployment of the GM Transformation Fund, current and forecast expenditure from the fund and prioritisation of the remaining fund Winter update plans to mitigate the demands of winter and provide safe, high quality care to patients Children s Health and Wellbeing Strategy process for the establishment of a GM Children s health and Wellbeing Strategy building on the outputs form the boards and focused on 10 key objectives 14

15 Person and Community Centred Approaches framework for a person and community centred approach and an overview of a proposed GM programme of activity across all ten localities for implementation. GM evaluation programme plan support for the outline approach to evaluating of Taking Charge with emphasis on locality evaluation Housing and health Programme GM approach to housing and health programme and governance Funding proposition for Health Innovation Manchester level of funding currently secured and confirmation of funding bid request for transitional funding form GM HSC Partnership Interoperability and Innovation Programme development of a GM Interoperability and Innovation Strategy, a single business case for local health and care record exemplar and Digital innovation Hub 8.0 RECOMMENDATIONS 8.1 Greater Manchester Health and Care Board is asked to: note and comment on the contents of the update. 15

16 Appendix 1: GM System Performance Dashboard 16

17 'm Appendix 2 GM HSC Partnership Finance Dashboard Greater Manchester Health & Social Care Partnership - Financial Performance Dashboard (Month 9) Appendix 1 Plan YTD Forecast outturn Previous QIPP/CIP Achievement 1. Financial position by type of organisation (appendices 3-7) Income Expenditure Variance Income Expenditure Variance Income Expenditure Variance Variance from plan Month Forecast Variance vs plan Trend - forecast variance vs plan Year to Date Forecast m m m m m m m m m 'm m % Plan % Plan GM H&SCP exc. Spec. comm CCGs Providers Local Authorities P'ship exc spec comm % 4% 4, , , ,391.2 (7.8) 4, , (0.1) (0.1) 95% 92% 4, ,762.8 (20.7) 3, ,686.2 (58.1) (1.7) 19.0 (19.9) 92% 95% 1, , , , n/a 94% (17.6) (64.2) (19.9) Spec. comm. (before reserves) 1, , (25.9) 1, ,056.3 (30.7) (30.7) (29.0) TOTAL (17.6) (90.1) (29.4) (11.7) (48.9) 2. Financial position by locality (appendix 2) Annual Plan surplus Year to Date surplus Variance Actual against Plan Forecast surplus Variance Actual against Plan Trend - forecast variance vs plan /18 f'cast surplus; variance vs plan by type of org'n 'm 'm 'm 'm 'm Bolton (1.0) 8.1 (2.1) 10 Bury (0.0) 0 Manchester M2 M3 M4 M5 M6 m7 m8 m9 m10 m11 m12 Oldham (11.3) (18.2) (3.3) (39.1) (27.9) (10) Rochdale 3.2 (4.6) (6.8) (4.8) (8.0) Salford (1.4) (4.2) Stockport (25.9) (20.4) 0.6 (25.1) 0.8 Tameside (24.3) (19.2) (0.0) (23.7) 0.6 Trafford 1.6 (13.3) (12.0) (4.5) (6.1) Wigan (0.6) (2.5) (0.3) (1.2) (0.6) Spec. Comm. (before reserves) 10.3 (18.1) (25.8) Out of Area (20) (30) (40) (50) Spec comm (before reserves) GMH&SCP exc s comm CCG Provider LA Total (17.6) (90.1) (45.8) (29.4) (11.7) Capital Expenditure Capital budget Transformation Fund 2017/18 Month 9 key headlines (revenue) m YTD Net Expenditure Forecast Net Expenditure Overall forecast M9 position is a 29.4m deficit, which is; -an improvement of 37.1m from last month. This is mainly due to an improvement of 38.9m across Providers. - The Spec. comm. team has clarified that the position reported here is before the application of reserves. If these reserves (0.5% contingency and growth reserves) were factored in, the forecast deficit would reduce from 30.7m to 9.7m GM Primary Care capital Provider 20 0 Confirmed Commitments Allocated - Provider Trusts forecast outturn deficit is 1.7m which is an improvement 38.9m from plan across several trusts. - CCGs' forecast position are unchanged from month 8. However, as mentioned last month, this hides a 6.1m adverse variance in Trafford CCG, offset by a 6m improvement in Manchester CCG 17

18 Appendix 3 GMHSC Partnership Decision Log Report summary Recommendations Outcome Chief Officers Update Jon Rouse, Chief Officer, GM Health and Social Care Partnership (GMHSCP), provided an update on key items of interest both within the GMHSC Partnership and also within its partner organisations. Publication of joint NHS England (NHSE) and NHS Improvement (NHSI) updated Guidance Care 2020 model Paul Baumann, Chief Finance Officer, NHSE visit The Partnership Executive was asked to note the report. The GMSPBE noted the updated with the following actions agreed: To circulate the Care 2020 model framework to the Executive; To provide an update and progress report on the GM Commissioning Hub. Performance and Transformation Update Nicky O Connor, Chief Operating Officer, GMHSCP, provided a summary of current performance issues and progress points drawn from the work of the Transformation Portfolio Board and the Performance and Delivery Board. The Partnership Executive was asked to: Note the report. Receive social care dashboard performance at the next meeting and further quarterly updates; Receive mental health dashboard performance once finalised and available. Agreed Agreed 18

19 Report summary Recommendations Outcome Transformation Fund Stocktake Steve Wilson, Executive Lead, Finance & Investment, GM Health and Social Care Partnership provided an update on the expenditure from the GM Transformation Fund to date and the proposed approach to allocating the remaining available funds. The Partnership Executive was asked to: Note the commitments against the Transformation Fund to date and the submitted bids for further investment; The report provided an update on the deployment of the GM Transformation Fund and detailed expenditure from the fund to date and forecast expenditure for the duration of the transformation period to 2020/21. The Board discussed the prioritisation of the remaining bids and it was advised that the Transformation Fund Oversight Group would continue to make recommendations to the Partnership Executive to approve investments from the fund. It was noted that there were a considerable number of investment programmes already approved along with further potential bids. It was therefore suggested that a strategic stock take across GM to be undertaken, focused on best use of available resources across work streams to deliver efficiencies and identify programmes that would require recurrent funding should be prioritised by the Executive. Note the risks and mitigations to the delivery of transformation within the available funding; Agree the approach to slippage within recurrent investment elements of bids; Approve the proposed process for allocating remaining funds noting the recommendation that the Executive receives an update with regard to prioritisation; Support work to consider any future approach to GM transformation /Improvement. Agreed Approved Agreed 19

20 Report summary Recommendations Outcome Month 8 Finance Locality Report Steve Wilson provided an overview of the 2017/18 month 8 year to date financial position and forecast outturn position for the individual organisations and sectors within Greater Manchester. The monthly reports highlighted key issues impacting on financial performance on a GM wide basis. It was reported that the Partnership was working with Cabinet Office and providers on the confirmed funding of 3.1m for the acute sector and 2.6m for mental health provision following the Manchester Arena attack. On behalf of the Provider Federation Board, thanks were reported for the work underway and it was highlighted that following the attack, elective activity had decreased across all the provider sector in GM which may have a subsequent impact on STF. It was suggested that this would considered and assessed across the conurbation in light of any future financial implications. The Partnership Executive was asked to: Note that GM has set a deficit plan of 17.6m for 17/18; Note that the year to date (Month 8) deficit of 61.7m represents an adverse movement of 26.7m against M8 plan; Note that the forecast position currently shows a 19.9m adverse variance against plan by reporting a forecast outturn of 37.5m deficit; Note the risks to the delivery of the GM financial plan for 2017/18; Note the comments from the Executive with regards to allocated funding following the Manchester Arena attack and future STF implications. Winter Update Jon Rouse provided an overview of winter UEC The Partnership Executive was asked to: 20

21 Report summary Recommendations Outcome performance to date and the work undertaken by the localities and the GM Partnership to continue to mitigate the demands of winter and provide safe, high quality care to patients. It also set out the current challenging position of the GM system and identified the ongoing risk in relation to service delivery over the winter. Note the content of the paper in relation to winter preparedness; Support the delivery against the identified priority areas. Agreed Children s Health and Wellbeing Strategy Jon Rouse introduced a report which described the process of developing a GM Children s Health and Wellbeing Strategy building on the work to date of the GM Children s Health & Wellbeing Board. The outputs from the children s health and wellbeing board members and the children and young people were used to identify 10 objectives for the development of a GM Children s Health and Wellbeing Strategy and to steer the work of the GM Children s Health and Wellbeing Board. It was noted that safeguarding and vulnerability would be an objective to be included as an additional within the strategy. The Partnership Executive was asked to: Provide feedback and support the inclusion of the 10 objectives currently identified within the GM Children s Health and Wellbeing Strategy, noting that an additional objective relating to safeguarding and vulnerable children will be included either fully or within an existing objective area. Note the feedback by the Executive with regard to further objectives of Oral Health; more explicit reference to the role of the VCSE; references towards health and justice, including domestic violence and criminal justice liaison; Resolved 21

22 Report summary Recommendations Outcome Note the conditional offer received from DfE to be considered by Leaders; Support the proposed plan for socialising the objectives and strategy across the health and care system. Resolved Person and Community Centred Approaches Giles Wilmore, Associate Lead, People and Communities, GMHSCP provided an overview of the rationale, working model, evidence and benefits of a GM programme of work on person and communitycentred approaches (PCCA). This included an overview of the support to all ten GM localities in progressing this agenda. The paper set out a coherent GM framework for person and community-centred approaches, underpinned by a clear programme to support capacity and capability building within localities, and in doing so deliver on the commitments set out in GM Population Health Plan, Primary Care Strategy, Taking Charge and the GM Strategy: Taking Charge. The Partnership Executive was asked to: Agree to supporting a shared GM ambition for PCCA, which includes a core GM offer; Agree to a GM focus on the four key characteristics of PCCA Note the contents of this report, particularly the PCCA model and benefits to be derived from adopting PCCA within emerging LCO s; Agreed Agreed Agree to the three component GM PCCA support programme, noting the challenges localities face in implementing PCCA ; Agreed 22

23 Report summary Recommendations Outcome Support the approach being taken to monitoring and evaluation; Approve the programme funding request, as part of the final Transformation Fund allocation. Supported Approved GM Evaluation Programme Plan Paul Lynch, Deputy Director for Strategy and System Development introduced a report which set out a proposed approach to the evaluation of Taking Charge with particular emphasis on the locality evaluations. The Partnership Executive was asked to: Support the approach outlined in this paper to allow the GM-led procurement of evaluation partners to commence. Supported Housing and Health Programme Update Paul Lynch provided an overview of the background and agreed priorities of the Housing and Health programme and gave an update on progress against the three initial areas of work. The report also detailed the proposed GMHSC Partnership led governance that would oversee the current work programme and take a joined up approach to agreeing future strategic priorities. The Partnership Executive was asked to: Note the content of the report and the progress on the Housing and Health Programme; Note the request to include GMCA representation on the Housing and Health Programme Board. 23

24 Report summary Recommendations Outcome Quality Update Dr Richard Preece, Executive Lead for Quality, GMHSCP introduced a report which highlighted recent progress with the Partnership's Quality Improvement Framework (QIF) agreed by stakeholders at the Strategic Partnership Board Executive in September The GM Quality Board was now leading the application of the QIF in a review of transformation programmes. The Quality Board continues meet regularly to monitor and review quality of care across all localities. The Partnership Executive was asked to: Note progress on implementation of the GM Quality Improvement Framework Funding Proposition and General Progress report for Health Innovation Manchester Rowena Burns, introduced a report which set out the level of funding secured from commissioners and providers for 2018/19. The report confirmed the funding bid request for transitional funding from GM Health and Social Care Partnership, outlined the plans for future long-term funding and provided a general update on HInM progress to date. The Partnership Executive was asked to: Note the level of funding secured from commissioners and providers. Confirm the approval of the funding from the GM Health and Social Care Transitional Bid of an additional 0.7m for 2018/19 in addition to 0.5m carried forward from 2017/18 along with the continued support for 6 months of 2019/20 ( 0.6m). Approved Support the on-going discussions and 24

25 Report summary Recommendations Outcome engage in the process to secure the longer-term financial model. Note the progress to date of HInM activity. Supported Interoperability and Innovation Programme Update Consideration was given to a report which provided a progress update on the development of the Interoperability and Innovation Strategy and requested resolution on a series of important next steps. Members welcomed the report and offered their support for the proposal to develop a single business case for Local Health and Care Record exemplar and Digital Innovation Hub. The Partnership Executive was asked to: Note the background to the Interoperability and Innovation hub programme and the progress made to date; Support Option 3 for DataWell to 20/21 including funding approach, committing 3.9m of digital funds for 17/18; Agreed Support a single GM approach to the NHSE (Local Health and Care Record exemplar) and OLS (Digital Innovation Hub) bid processes together with external bid writing support for the business case; Support the escalation of the early need for confirmation of future digital fund allocations from NHS England; Delegate to the Chief Officer other remaining decisions with respect to Agreed Agreed Agreed 25

26 Report summary Recommendations Outcome allocation of digital funding for 2017/18 with report back to SPBE; Continue the development of the governance and functional organisation of the interoperability and innovation work strands, including full engagement with sectoral interests, and bring back to future meeting of SPBE. Agreed 26