WORKING FOR A HEALTHIER MANCHESTER STAKEHOLDER BULLETIN EIGHT February 2018 1
CONTENTS Foreword Page 3 The future of health and social care: the next five years Page 4 Healthy Neighbourhoods Page 5 Community-based care Page 7 Hospital Services Page 11 Making it work: strategies that support the locality plan Page 13 Greater Manchester Health and Social Care Partnership Page 15 Budget update from Manchester City Council Page 16 Update on NHS funding - Page19 2
FOREWORD Dear Readers Welcome to issue 8 of the Healthier Manchester stakeholder bulletin. This issue sees us all preparing for a new era in how we bolster health and care services in the community and out of a hospital setting wherever possible. The forthcoming Local Care Organisation will be fundamental to citywide work to transform how services are delivered near people s homes and within their own neighbourhoods. However, this move is more than just about system transformation. It s a large-scale change in approach: recognising that wellbeing means there should be no longer be any divide between mental and physical health. It s also about recognising the strength of support that already exists in our communities - through social networks, groups and clubs that can work alongside health and care provision. But, even more importantly, it s about us as Mancunians. Our ideas matter: and we know our communities better than anyone else. And I firmly believe that many of our health and wellbeing issues can be helped from within our own neighbourhoods and that s what s so exciting about this time. And that s what we call the Our Manchester approach. Sir Richard Leese, Chair of Manchester's Health and Wellbeing Board 3
The future of health and social care: the next five years Context: Manchester s Locality Plan: The vision that describes the future of health and social care in the city over the next five years is the Manchester Locality Plan called Our Healthier Manchester. This plan gives details of the city s approach to improving health outcomes in Manchester, while also moving towards long-term financial and clinical sustainability. In essence, it is the plan for joining up or integrating health and social care services in Manchester. It contains three key parts which will drive the transformation of these services, needed to keep our city healthy. These foundations, which are interlinked, are a Single Commissioning Function (now called Manchester Health and Care Commissioning); a Single Local Care Organisation; and a Single Manchester Hospital service (Manchester University NHS Foundation Trust). Both the Single Hospital Service and the Manchester LCO will deliver models of care which span both community and hospital settings to treat people as close to home as possible. 4
Healthy Neighbourhoods Council update on homelessness and rough sleeping approach As rough sleeping is increasing on the streets of our city, it s been clear that as a council we needed a new approach to communicating with the public, partners and professionals about the work that we re doing to help people who need it. All our communications have been developed in conjunction with the Manchester Homelessness Partnership, showing true partnership working. We're focusing on supporting those that need it, working hard on preventing those at risk of becoming homeless as well as supporting those who find themselves homeless. We re doing this alongside a broad range of partners and charities in the city, such as Street Support and Coffee4Craig and through a range of shared practices. Working with our partners, we have developed a communications approach that has increased visibility of the work we do and how that support can change somebody s life. We are actively promoting alternative giving instead of street giving heavily through Big Change. Our aim is to change the perception of homelessness and rough sleeping in the city. Our activity peaked in November - there was a social media takeover week where we shared key themes and messages across the Council s social media accounts featuring extensive council and partner video content highlighting the huge range of work going on to address homelessness. Overall it reached more than 591k people. The public comments were mainly positive and focused on the work of the voluntary 5
organisations. We re talking to our partners to understand what impact the week had and whether it led to further enquiries, offers of support or donations. This has been supplemented with weekly activity on four key themes - the Longford Centre in Chorlton, our newly opened homelessness centre; what the council and its partners are doing to help; the complexities of dealing with entrenched rough sleepers; and alternative giving. The official charity of the Christmas markets was Big Change - collection tins were placed on all the bars in the markets, and volunteers were coordinated to man bucket collections on Albert Square. More than 4,315 was raised, with the secondary aim of raising awareness of alternative giving and ensuring visibility of the Big Change campaign. This has been supplemented by visible on-street digital advertising of the Big Change, in prominent positions across the city centre. You can find out more about what Manchester City Council is doing to tackle homelessness by visiting: www.manchester.gov.uk/homelessness 6
Community-based care Manchester s work for a Local Care Organisation Manchester s plans to transform out of hospital care and improve health are set to go live with the launch of the city s Local Care Organisation this April. The LCO is not only a vital part of the city s plans for health and social care (its locality plan), but is also fundamental to the Our Manchester Strategy to create a healthy, thriving city. The LCO will provide proactive and co-ordinated care across twelve neighbourhoods in the city. This will 7
bring primary, community and mental health together, with social care at local level. As mentioned in previous bulletins, Manchester Health and Care Commissioning has been leading the work to establish a publicly-funded LCO, bringing together public services, which can integrate existing health and social care teams. The Manchester Provider Board (MPB), was the single qualifying bidder in this procurement process. MPB includes the city s GP federations, the city council, the city s hospital trusts and community services, Greater Manchester Mental Health Trust and the voluntary sector. Now, as planned, the LCO will go live in a matter of weeks, with the clear goal of improving health outcomes for the people of this city. Due to extremely complex VAT and other external issues, which will take some additional time to resolve, existing contracts and a new partnering agreement will underpin the LCO for the first year. All providers are in agreement that the focus, services and action and momentum must continue to make this city as healthy as possible for the people who live here. There have been lots of key achievements to date including the launch of new services where colleagues from different organisations are working together to reduce duplication and best meet the needs of the people they care for. One example of this work is High Impact Primary Care (HIPC). This involves multidisciplinary teams led by general practice who will proactively support those people who are frail or living with long-term conditions to reduce hospital admissions and delays in transfers in care. The LCO has also now got a formal name Manchester Local Care Organisation. And, Michael McCourt (previously interim Chief Executive, Manchester Provider Board) has been appointed as its chief executive. 8
Three new teams pioneer High Impact Primary Care Three new teams of NHS healthcare staff and council social workers are pioneering an innovative way of helping people who have the most complex health and care needs. The pilot High Impact Primary Care teams are intended to help find ways of transforming the way people use NHS and care services. Emma Gilbey, programme manager, explained: The team builds a relationship of trust and then we support them to manage their health in a different way. They will have other issues than their health maybe debt, housing problems, or family difficulties. We will identify what is important to them and what will make the difference. It is not about fixing illness, it is about long-term interventions. The service is targeted at the two per cent of people who are estimated to be the highest users of NHS and care services. They are identified by GPs in the neighbourhood and referred to the team. Emma said: The people we are working with are those for whom the existing primary and community services don t work. They are heavy users of hospital services, turning up at A&E for example. It is very early days for the teams, but they are loving the new way of working and the trust they develop. It s the way primary care should be. High Impact Primary Care teams have been set up in three neighbourhoods: Cheetham Hill and Crumpsall, Gorton and Levenshulme, and Wythenshawe and Baguley. The team in the north of the city has been supporting people since November from its base at Cheetham Hill Health Centre, while the teams in the central and south areas have begun their work during February. The service is commissioned by Manchester Health and Care Commissioning (MHCC) through the city s GP federations. The federations employ the GP, nurse and a service manager who helps to ensure the programme meets its objectives. The team also includes a pharmacist, who is employed by MHCC, a council-employed social worker and a health coach, who works for Greater Manchester Mental Health Trust. 9
New North Manchester community neuro rehabilitation team A NEW community neuro rehabilitation team launched recently to deliver a service to North Manchester residents. The service started in September 2017 and is based at Charlestown Health Centre. The team will work alongside the community stroke team to form the community stroke and neuro rehabilitation service. As a single point of contact for all stroke and neurological referrals, the team provides a comprehensive community-based assessment and neuro-rehabilitation service which comprises occupational therapists, physiotherapists, speech and language therapists, specialist nurses, neuropsychology, rehabilitation practitioners, a consultant presence and administration support. Around 300 patients per year are expected to use the service which is provided six days a week from Monday to Saturday. Credit for CASS THE Community Assessment and Support Service (CASS), in north Manchester, has just won an accolade for its innovative work. The award was from inetwork an organisation that facilitates work within the public sector. CASS, which was launched in 2015, comprises both health and social care professionals who can give highly specialised help in the community to stop people having to be admitted to hospital, or, alternatively to reduce the amount of time they need to be admitted for. It is a new integrated service delivery model in the community that was developed in partnership with NHS hospital and community service providers, Manchester City Council and the city s commissioners. 10
Hospital Services New Trust delivers early patient benefits Since the creation of Manchester s new, city-wide hospital NHS Trust on October 1st 2017, Manchester University NHS Foundation Trust (MFT), a number of positive developments have taken place. For example a new Council of Governors has been appointed to represent the interests and views of Foundation Trust members and the public and seek assurance from the Board of Directors. Staff and public members also attended a Special Members Meeting in December to meet the new Governors. Leadership arrangements have been developed for the hospitals within MFT and leadership teams appointed for the hospital sites: Manchester Royal Eye Hospital and University Dental Hospital of Manchester; Saint Mary s Hospital; Manchester Royal Infirmary (MRI), Royal Manchester Children s Hospital; and Wythenshawe, Trafford, Withington and 11
Altrincham Hospitals. These teams will play a key role in delivering integration plans to benefit patient care. Plans for Days 1-100 of the new Trust are all on track. Teams have been working together to gradually and safely start introducing some of the quick wins identified by clinicians in the pre-merger patient benefits case. Doctors, Nurses, Managers from across the hospital sites have set up an extra dedicated surgical list at Wythenshawe Hospital for women needing urgent gynaecological surgery, offering extra choice of location and waiting time. Patients from the MRI needing kidney stone removal have been offered treatment at Wythenshawe if this is quicker or closer. Wythenshawe Hospital has a specialist lithotripsy machine, which uses ultrasound to shatter kidney stones, avoiding the need for surgery. The MRI uses a visiting, mobile lithotripsy service. We have produced a short film including interviews with staff and patients talking about some of the early work. Plans for Year 1 are also progressing well. A number of workshops have been held with clinical and corporate teams to develop the vision for how we can best provide better, safer, more consistent care for patients using our services. A Trust wide service strategy that will underpin the delivery of longer-term improvements is also in development. A short film (https://mft.nhs.uk/working-together/) has been made with interviews with staff and patients talking about some of the early work. The second stage in the creation of a single city-wide Trust is to bring North Manchester General Hospital, currently part of The Pennine Acute Hospitals NHS Trust, into MFT. A Pennine Acute Transaction Board has been established to oversee the process, chaired by Jon Rouse, Greater Manchester Health and Social Care Partnership Chief Officer. A timeline for the process is being developed by the Transaction Board. 12
Making it work: strategies that support the locality plan Manchester s solid commitment to integrated working praised by watchdog after review of health and social care system Manchester s long-term goals to transform its health and social care system, along with its strong commitment to partnership working were recognised in a recently carried out review by the Care Quality Commission (CQC). Manchester was one of 20 sample areas chosen by the CQC for a Local System Review (LSR). The reviews were asked for by the Secretaries of State for Health and for Communities and Local Government back in July, to understand how people moved through the health and care system, with a focus on the connection between services. In particular, it had a focus on services to people aged 65 and over. Manchester s review took place in October and looked at the whole health and care system. It did not include mental health services or specialist commissioning, but it did look at cases of people living with dementia. The findings of the review have been welcomed by the city s health and care leads especially as they are very similar to internal, selfassessments of the system. In particular the report noted the strong partnership working, the benefits of devolution, and how collaboration has been able to drive the pace and major achievements on how services are commissioned and delivered; a single hospital trust and the vision for the local care organisation to bring more support into communities. It also recognised how all the major developments to date and for the future had been based on the needs of Manchester people, their views, and strong insight into the health issues facing our communities. 13
Just as positive feedback was welcome, so too have been the constructive comments about the need for more consistency in services across the city. Dr Carolyn Kus, Executive Director of Strategic Commissioning for Manchester Health and Care Commissioning (whose role also includes being director of adult social services), said: While we know there is a clear and compelling vision for the future, there is some inconsistency around current service integration and we need to be addressed. We also know that business as usual must be maintained. Ultimately, the planned changes we are all working for will help to take the pressure off the health and social care system to make it fit for the future. But until then, we are mindful of heavy caseloads within our social work teams for example which need to be addressed. Likewise, we need more resilience in our domiciliary and residential care sector for both the people it affects and its impact on the urgent care system. This review is an opportunity for Manchester to make improvements, while it continues to strive for excellence and to improve the health and care outcomes for our residents the best possible services for everyone who lives here. As part of that I d like to thank our dedicated staff, carers and the people of Manchester for their help to shape the quality and the delivery of services that we would all want for our own families and loved ones. The results of the LSR will also be fed back to the city s Health and Wellbeing Board in January and an ensuing report and action plan will be shared with partner organisations. 14
Greater Manchester Health and Social Care Partnership news Charter to support 280,000 carers in Greater Manchester Last month (Jan 19), Greater Manchester made a collective commitment to transform how carers are supported. The signing of a Greater Manchester Carers Charter and commitment to enhance and develop support and opportunities for carers has been led by Greater Manchester Health and Social Care Partnership the body overseeing devolution of the area s health and social care budget. One in ten people are known to be carers in Greater Manchester, but there are many more who have not been identified. Out of 280,000 carers that are known in Greater Manchester, 70,000 (nearly a quarter) spend 50 hours per week as carers, higher than the national average. 24,800 (c.9%) are young carers aged under 25 which is 2% more than the average in England. Similarly, more than 100,000 (c.38%, 107,391) are aged between 25 and 49, 4% more than the national average. The Charter and commitment have been designed by carers and is supported by voluntary, community and social enterprise groups, councils, NHS England and NHS organisations in Greater Manchester. It builds on the aims of the Care Act 2014 and agrees to acknowledge, respect and provide support and opportunities for carers. The priority over the next 12 months will be to understand what good support looks like. Carers will be at the heart of this transformation as experts by experience. They will be involved in reviewing, designing and checking support is fit for their needs. The Charter and commitment has been signed by Greater Manchester Health and Social Care Partnership organisations including voluntary, community and social enterprise groups. 15
Budget update from Manchester City Council Updated plans for Manchester City Council s budget, including a reduced increase in Council Tax, have been published. Last year the Council set a three-year budget for the period 2017/18 to 2019/20 which followed a large-scale consultation with residents to understand their priorities. They told us that the things they valued most were care and support for vulnerable people, action on family poverty, tackling homelessness, supporting people into jobs and training, keeping our roads and neighbourhoods in good shape and parks and leisure to help keep people happy and active. The budget was framed to reflect this. Going into year two of the budget, 2018/19, those priorities remain the same and progress is being made towards goals such as bringing health and social care together, supporting people earlier so they do not need more costly support later on and changing waste collection arrangements to deliver increased recycling and savings. But slight changes in the Council s overall financial position, such as increased commercial income due to prudent investments, have increased the amount of resources available and provided the opportunity to boost priorities. More than half of the Council s service budget around 577m for 2018/19 goes on services to protect and care for vulnerable adults, including older people and adults with learning difficulties, and children. 16
Proposed budget increases this year include: - 3.4m extra funding for homelessness, to improve prevention work and offset the impact of government funding for temporary accommodation - A further 1m to support residents hit by the roll-out of Universal Credit with discretionary payments to help them not to lose their homes - 3.7m over 2018/19 and 2019/20 to keep streets clean, combat fly tipping and address other environmental issues this will be funded through savings made in waste collection and disposal arrangements and the use of other existing resources. The Executive also highlighted some of our notable achievements in the current financial year including the opening of the Longford Centre in Chorlton helping to support people vulnerable to homelessness; a new fund to make sure poorer children eat well at school; and the extra support we re giving young care leavers to settle into life after care, including delaying the requirement for care leavers to pay Council Tax until the age of 21. The Council is already committed to deliver major investments in 2017-20 including: - 100m investment to improve roads in every neighbourhood - 24m on building and refurbishing leisure centres including proposals to improve Moss Side Leisure Centre and Abraham Moss Leisure Centre. - 22.8m to help integrate health and community services in East Manchester - 6m improving housing with care and older people - 3m on supporting housing for adults with learning disabilities 17
Council Tax Manchester will still have one of the lowest Council Tax bills in the country. The Council s element of Council Tax bills will go up by less in 2018/19 than had originally been planned 3.49 per cent instead of the 4.99 per cent envisaged last year. This will be achieved by spreading a planned one-year increase to help fund adult social care across two years, enabled by a one-off rebate from the Greater Manchester Combined Authority for Mayoral functions that are currently being funded via the Mayoral precept, and increased business rate retention. This is in recognition that increases in precepts other parts of the overall bill which fund non-council services such as the police, fire brigade and GM Mayor - to maintain services will lead to increased bills, so the Council is doing what it can to reduce the increase without affecting services. The levels of planned investment in adult social care will be maintained. The draft budget was heard at the Council s Executive on Weds 7 February as well as being considered by various scrutiny committees. A special budget meeting of the full Council on 2 March will then set the final budget. 18
Update on NHS funding and planning guidance The NHS Planning Guidance published in early February announced some additional funding for 2018/19. It breaks down like this: The resources available to CCGs nationally will be increased by 1.4 billion, made available through: - Lifting the requirement for CCGs to underspend 0.5% of their allocations in 2018/19, releasing 370m to fund local pressures and transformation priorities. For Manchester this would be 3.9m. (The requirement to use a further 0.5% of CCGs allocation solely for non-recurrent purposes has also been lifted). - - 600m added nationally to CCGs allocations for 2018/19 (which otherwise remain unchanged). This is equal to a further 6.74m for Manchester. - A new 400m Commissioner Sustainability Fund to enable CCGs nationally to return to in-year balance while supporting them to deliver against their budgets. There are no direct implications for Manchester arising from this funding. The NHS Planning Guidance also includes an expectation that the funding is principally used for emergency activity, tackling waiting lists, adherence to the Mental Health Standard and transformation commitments for cancer services and primary care. Proposals are currently being developed for how the additional funding will be used for Manchester and the final joint financial plan for the pooled budget will be reported to the Manchester Health and Care Commissioning Board, the city s Health and Wellbeing Board and the March Executive meeting. 19
Thank you for your time If you have any further questions, please email: communicationsmanchester@nhs.net 20