GM HEALTH & SOCIAL CARE STRATEGIC PARTNERSHIP BOARD

GM HEALTH & SOCIAL CARE STRATEGIC PARTNERSHIP BOARD MINUTES OF THE MEETING HELD ON 16 DECEMBR 2016 3 Bridgewater Community Healthcare NHS Trust Bolton CCG Bolton Council Bury Council Bury CCG Central Manchester CCG Central Manchester FT Christie NHS FT GMCA GM H&SC Partnership Team GM Interim Mayor GMIST Manchester CC Dorothy Whitaker Wirin Bhatiani Councillor Cliff Morris Margaret Asquith Councillor Rishi Shori Mike Owen Margaret O Dwyer Ian Williamson Caroline Davidson Kathy Cowell Christine Outram Andrew Lightfoot Liz Treacy Rob Bellingham Tom Daines Warren Heppolette Geoff Little Claire Norman Nicky O Connor Steve Wilson Tony Lloyd Julie Connor Lindsay Dunn Emma Stonier Councillor Richard Leese Howard Bernstein 1

Carol Culley North Manchester CCG Oldham Council Oldham CCG Pennine Acute NHS Trust Pennine Care NHS Foundation Trust Primary Care Advisory Group (Dental) Primary Care Advisory Group (GP s) Chair LMC s Primary Care Advisory Group (Pharmacy) Martin Whiting Mike Greenwood Councillor Jean Stretton Carolyn Wilkins Denis Gizzi Sir David Dalton Jim Potter Michael McCourt Mohsan Ahmad Tracey Vell Adam Irvine Rochdale BC Councillor Richard Farnell Salford CC Salford CCG Salford Royal NHS FT Stockport CCG Stockport MBC Tameside MBC Tameside NHS Foundation Trust Mayor Paul Dennett Jim Taylor Anthony Hassall Chris Brookes Ranjit Gill Councillor Alexander Ganotis Councillor Wendy Wild Eamonn Boylan Councillor Kieran Quinn Steven Pleasant Paul Connellan Karen James 2

Tameside & Glossop CCG Trafford Council Trafford CCG UHSM Wigan CCG Wigan Council Paul Pallister Councillor Alex Williams Theresa Grant Matt Colledge Jane McCall Tim Dalton Trish Anderson Councillor Peter Smith (In the Chair) Donna Hall SPB 119/16 WELCOME AND APOLOGIES Apologies were received as follows; Cllr Sean Anstee, Simon Barber, Derek Cartwright, Barry Clare, Alan Dow, Chris Duffy, Nigel Guest, Ifti Khan, Jon Rouse, Steve Rumbelow, Colin Scales, John Scampion, Tom Tasker, Councillor Linda Thomas and Alex Whinnom. SPB 120/16 CHAIRS ANNOUNCEMENTS AND URGENT BUSINESS There were no Chair s announcements or urgent business. SPB 121/16 MINUTES OF THE MEETING HELD 25 NOVEMBER 2016 The minutes from the meeting held on 25 November 2016 were submitted for consideration. RESOLVED/- To approve the minutes of the meeting held on 25 November 2016 as a correct record. SPB 122/16 CHIEF OFFICER REPORT Nicky O Connor, Chief Operating Officer, provided an update on key items of interest within the GM Health and Social Care Partnership and partner organisations. The Board were informed that recruitment to the following key specialist posts; IMT, Estates and the Workforce Executive Lead for Theme 3; was underway. The Board were updated that two senior staff, Wendy Meredith (Director of Population Health) and Dr Raj Patel, would be leaving the Partnership over the next month and sincere 3

thanks was extended to both for their work at the Partnership. The Transformation Portfolio Board met for the first time in November and progress updates are intended to be provided to the Board and the Executive from January 2017. The Partnership are in discussions with NHS England (NHSE) about integrated personalised care budgets and investing capacity and expertise into the Partnership, to work with all GM localities, to drive forward progress in this area. The Executive will be updated on progress and it was intended to work closely with AGG and Local Authority leaders on this. The current contract for clinical provision of unscheduled dental care is delivered across GM in a number of different ways and is due to come to and end on 30 September 2017. The re-procurement will be completed within the next 6 months and a new service in place within the year; the Partnership intends to take this opportunity to ensure that consistent and equitable services are developed across GM. On 28 November, Jon Rouse, Chief Officer, provided evidence to the House of Commons CCG Select Committee on Social Care Funding; other senior team Partnership representatives had given evidence to the House of Lords Health Select Committee on the sustainability of NHS Finances. Carol Culley, City Treasurer, Manchester CC, provided an update on the Social Care funding announcement for 2017/18. The 2016/17 settlement showed an estimated Social Care Funding gap of 214m, the latest STP announcement showed an overall gap of 190m, with 176m attributable to Social Care. The key elements of the settlement for 2017/18 were the ability to bring forward the increase in the council tax precept for social care and the announcement nationally of 240m of additional grant funding for social care; this funding will be directly funded by a reduction in another stream of Local Authority funding; the New Homes Bonus funding. The additional grant funding for social care grant will use a needs based formula and will not take into account the differing abilities of areas of the country to raise council tax through the increase in the social care precept. The overall impact of this across GM will be a net benefit of 340k with some localities receiving more funding and some less. It was noted that this would not have a significant impact on the funding gap in GM. RESOLVED /- To note the content of the brief. SPB 123/16 WINTER PLANNING ROUND UP Nicky O Connor, Chief Operating Officer, introduced the roundup of updates on Winter Planning across GM. Overall it was highlighted that across GM sites were showing progress against their A&E improvement plans. Levels of attendance for type one admissions were as expected, although it was noted that feedback from 4

major providers had indicated demand for services felt higher. Emergency admissions had been higher than predicted at the Pennine Acute Sites and Wigan, medical outliers and patient flow remained key factors and admissions had remained higher than discharges leading to bed pressures. North West Ambulance Service (NWAS) turnaround times and ambulance waits continued to be an issue and reports of Norovirus had started earlier which had had some minor impacts. It was noted that since October there had been a decline in A&E 4 hour standard performance for most providers, although the figures for November and December were not yet fully validated, meaning there could be some changes to these. Wirin Bhatiani, Chair Bolton CCG, provided an update on the position in Bolton. The main areas highlighted were; 1. The significant demand faced by urgent care systems; 2. The work taking place in Bolton was to address 3 key areas; i. Reducing delayed transfer of care and improving flow; Bolton has commissioned 27 community discharge/assess beds to improve transfers of care, has introduced a fully integrated discharge team and has implemented a hospital to home service in partnership with Age UK. ii. Reducing demand in A&E; Bolton has implemented a 12 hour/7 days per week streaming model in primary care services in A&E which started on 15 December 2016 and has partially co-located OOH services at weekends and bank holidays for 12 hours per day; iii. Reducing unplanned admissions to hospital; the ambulatory care unit for medical and surgical patients has been extended to 7 days a week, work with care homes has been undertaken to prevent emergency admissions and readmissions in partnership with other healthcare colleagues, the admissions avoidance team has been enhanced, a 24/7 carer support line and 5 day per week rapid access clinics for children will also be introduced. 3. The pressures faced across the whole healthcare system, and not only in urgent care. Ian Williamson, Chief Officer Central Manchester CCG, provided an update on the position in Central Manchester, South Manchester and Trafford. The main areas highlighted were; 1. The hard work of staff, professionals and carers across the healthcare system and the importance of people using services other than A&E where appropriate; 2. The current pressures in Central and South Manchester; in Central 5

Manchester these were being caused by increased activity, and in South Manchester these were attributable to delayed transfers of care; 3. Looking forward they want to use their resources and skills to best effect to ensure that the Health and Social Care System is properly joined up and that the main focus is on managing services and delivering the best care for patients. Martin Whiting, North Manchester CCG, provided an update on the position in the North East Sector. The main areas highlighted were; 1. The system has been under significant pressure for 12 months; 2. The leadership of the Acute Trust has changed; the process has taken a while to deliver; and 3. Staffing issues were being felt across the conurbation and especially at North Manchester General Hospital; both in the recruitment of Doctors and Consultants in A&E and Urgent Care as well as suitably qualified nurses. Significant efforts have been made in this area. 4. Pressures were being felt across all sites; with North Manchester General Hospital in particular experiencing a deterioration in average performance; 5. Hospital flow remained the most significant issue; attendance has roughly been stable, winter has been benign and front end demand has been controlled; 6. Winter funding was in place with a total of 1.5m across the sector and an additional 400k of funding has been provided by North Manchester CCG. A third of the funding has been used for front end and deflection services with the remaining funding being used to facilitate community services and enable discharge. The majority of schemes implemented are up and running; 7. The trusted assessor programme between Manchester, Oldham and Rochdale has been put in place, work has been taking place in Bury but performance improvements had not yet been seen; 8. The reporting of Delayed Transfers of Care (DtOC) was highlighted as a concern. In North Manchester the average length of stay for beds varied dependent on which Local Authority a person resides. Anthony Hassall, Chief Officer, Salford CCG, provided an update on the position in Salford. The main areas highlighted were; 1. The pressures on the urgent care system, with roughly 300 patients being seen per day in A&E; the pressures on primary care were also highlighted with between 3.5-4k patients being seen per day; 2. Extended Primary Care opening times had been instigated across the locality and a GP had been situated in A&E to deflect patients where appropriate; 3. Flow within hospital was an issue and work was underway between community, primary care, social care, mental health services and hospital 6

based services to ensure hospital stays were as short as possible; and 4. Issues with delayed discharges, not only within Salford but to neighbouring boroughs and the importance of maintaining communication with these boroughs and social care colleagues. Dr Ranjit Gill, Chief Clinical Officer Stockport CCG, provided an update on the position in Stockport. The main areas highlighted were; 1. The Emergency Care Improvement team deployed by NHS England to assist with performance in A&E; 2. A 5/6 patient per day increase in visits to A&E had been seen and it was felt the real figures were higher; 3. A 2% reduction in emergency admissions in Stepping Hill, related to the Stockport Together Transformation work; 4. Influenza had broken out and it was noted that an increase in uptake of flu vaccinations needed to occur to contain this; 5. Flow within and out of the hospital and delayed transfer of care issues including to areas outside of Stockport; and 6. The implementation of front end streaming systems. Steven Pleasant, Tameside MBC, provided an update on the position in Tameside and Glossop. The main areas highlighted were; 1. Capacity within the system due to levels of demand on services and the financial challenge the system is facing; 2. The single system analysis in place which provided an understanding of short term challenges and the work taking place around system avoidance; 3. The focus on patient flow and bed occupancy; meetings are held on a daily basis to look at DtOC figures to reduce these; a discharge to assess model has been rolled out and a social worker has been put in place 7 days a week, community based interventions have been implemented which included the opening of new beds and an increased community bed capacity. Trish Anderson, Chief Officer Wigan CCG, provided an update on the position in Wigan. The main areas highlighted were; 1. The integrated discharge team which has been in place for several months has been very effective. Patients are reviewed on a daily basis and this has been enhanced over Winter to include Ward Managers, with impacts on patient flow beginning to be seen; 2. The integrated care service introduced in October 2016 and it was noted which was focusing solely on pulling out has now been extended to admissions avoidance; 3. An analysis undertaken had shown that daytime activity was mainly from self- 7

referring 18-44 year olds; to address this mental health inputs have been enhanced, alongside services such as aids and adaptations; 4. The slight increase of admissions from outside the borough which was thought to be linked to the recent closure of Chorley A&E. This was being monitored; 5. Primary care services had been enhanced which included increased out of hours services and additional GP appointments. To note the updates on Winter Planning and recognise that despite the discussed pressures staff are working extremely hard across the system and are committed to addressing the difficulties. SPB 124/16 TRANSFORMATION FUND UPDATE Steve Wilson, Executive Lead Finance and Investment GM H&SC Partnership, introduced a report that provided an update on recent developments with the Transformation Fund. Wigan s submission has been assessed and the Strategic Partnership Board Executive endorsed the recommendation of a substantive investment of 14.87m over two years in early December. A number of conditions have been attached to the recommendation which should be satisfied before the investment agreement is signed. Bolton and Manchester s bids are being assessed and a Transformation Fund Oversight Group has been convened for January 2017 to support the process. A bid from Oldham has been received and will be considered in the context of the developing North East Sector transformation framework. Tameside and Stockport s investment agreements have been agreed and are expected to be signed today. Bids have been received from a number of localities and themes for development transformation funding to support development of investment cases and to secure key early milestones. These are in the process of being assessed. Manchester, Wigan and Bury have made applications to the Prime Minister s Challenge Funding for primary care 7-day access and the SPBE supported the bid for 3.7m across these three pilot sites in early December. RESOLVED/- RESOLVED/- To note the progress update and the decisions made by the Executive. 8

SPB 125/16 FUTURE HEALTH AND COMMISSIONING FRAMEWORK FOR GREATER MANCHESTER Rob Bellingham, GM Health and Social Care Partnership Team, introduced a paper which provided outlined proposals to conduct a detailed review and options appraisal of commissioning functions and future form across GM. Given its strategic importance, the review will be sponsored and overseen by the Executive. The scope of the review along with an expected timeline and product was provided. If approval is provided, it is anticipated that feedback will be presented in February/March 2017 along with an action plan setting out agreed actions and responsibility for delivery. Members offered their support for the proposal to conduct a review of commissioning functions across GM. The Board requested that work being undertaken with the voluntary and community sector in relation to joint commissioning and co-design of services was included in the scope of the review. RESOLVED/ 1. To approve and agree that the Strategic Partnership Board Executive will be the sponsoring body for the GM Commissioning Review; 2. To approve the proposed scope as described; and 3. To amend the scope to include a review of work between the health and voluntary and community sectors. SPB 126/16 NORTH EAST SECTOR FRAMEWORK Denis Gizzi, Oldham CCG, and Mike Owen, Bury Council, presented a report which described proposals to create a single commissioning arrangement for sector-wide services in the North East of Greater Manchester. The proposed new arrangements were intended to re-engineer the Single Commissioning Board already in place and to help address the significant challenges facing the sector. Discussions have taken place with the Pennine Acute Improvement Board regarding these challenges and how organisations can work together to address these and the wider integration of the health and social care system. It is proposed that a single commissioning system will be implemented which would; streamline existing commissioning arrangements; mobilise existing staff and create a single, integrated commissioning arrangement across Bury, Heywood, Middleton and 9

Rochdale and Oldham for the purpose of commissioning sector wide services once. Governance arrangements were being worked on and are intended to have three strands; leadership; doing and overview. It was noted that a clear role for elected members and CCG Chairs needed to be incorporated into the strategic leadership element of the proposals. It was updated that an independent review report into the current position of the sector had been commissioned, and that this report was in the process of being finalised. The outcomes of this report will inform the final governance proposal arrangements. The Board asked how the work underway in the North East Sector aligned with the GMHSC future commissioning review. The Board were informed that discussions would take place to ensure that the pieces of work were aligned and connected. The Board asked that and update be given at the Strategic Partnership Board Executive to provide clarity about how these two workstreams will be joined up. RESOLVED/- 1. To note the contents of the report; and 2. To receive a further update at the next meeting of the Strategic Partnership Board Executive. SPB 127/16 STOCKPORT TOGETHER TRANSFORMATION PRESENTATION Dr Colin Ross, Medical Director, Stepping Hill Hospital, and Dr Ranjit Gill, Chair, Stockport CCG, provided a presentation on the Stockport Together Transformation work. It was noted that within a financially constrained system working together can be challenging and the focus of Stockport Together was to get key providers working together collaboratively. The Board were informed that Stockport Together consisted of; NHS Stockport CCG Stockport NHS Foundation Trust Viaduct Health Stockport MBC Pennine Care The outlined goals of Stockport Together were; 1. To create a new care model, in which services are provided to patients by a single team; work so far included joint neighbourhood leadership teams led by GPs in place, community nursing and social care integrated teams in neighbourhoods, single integrated service model for intermediate tier service and a pilot for rapid telephone access for GPs to Consultants; 10

2. To create a new provider form; highlighted progress so far included; an agreement in principle between SMBC, Stockport Foundation Trust, Pennine Care and Viaduct Health to form a Care Trust, a full business case was being produced and interim leadership arrangements put in place for this, it had also been agreed in principle that the scope of the Multi-Speciality Community Providers (MCP)contract will include out of hospital services, A&E patients and short-stay medical capacity; and 3. To create a new contractual form; work so far included the pooling of 200m of budgets between SMBC and Stockport CCG covering the population of 65 and over; the establishment of a Health and Social Care Integrated Commissioning Board to progress work around supporting changes in pathways and commissioning processes, has started the procurement process for MCP; developing an Outcomes Framework which will move away from payment by results and will include social care outcomes alongside medical ones; and a Financial Modelling tool has been put in place to test out the financial impacts of changes. The presentation highlighted some of the impacts and challenges which have arose from the work undertaken so far. The impacts highlighted were; a 2.5% reduction in non-elective admissions; a 2.8% reduction in GP first outpatient activity (it was noted that this work was in its early stages and that these reductions demonstrated progress in the right direction); prescribing has been below plan; and Stockport are in the top 5 places for Cancer Outcomes nationally and top 10 for Dementia Care. The highlighted challenges were; the performance and challenges faced within the Urgent Care system; the progress related to integrating Mental Health Services; admission rates remained high and the financial challenges faced. Some challenges to progress were also highlighted and included; the management of transition from one system to another and how this is communicated; the management of historical cultural and legal differences between health and local authorities and keeping the public informed and communicated with about the changes taking place. RESOLVED/- To note the presentation. NEXT MEETING DATES Future meetings of the Strategic Partnership Board are arranged as follows: Friday 27 January 2017 Friday 24 February 2017 Friday 31 March 2017 11

Friday 28 April 2017 Friday 26 May 2017 Friday 30 June 2017 12