greater manchester health and care board · venue: council chamber, bury town hall, knowsley st,...

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GREATER MANCHESTERHEALTH AND CARE BOARD

Date: Friday 16 March 2018

Time: 10.00am – 12.00 noon

Venue: Council Chamber, Bury Town Hall, Knowsley St,Bury, BL9 0SW

AGENDA

1. WELCOME AND APOLOGIES

2. MINUTES

To consider the approval of the minutes of the meeting held on 19 January2018

3. CHAIR’S ANNOUNCEMENT AND URGENT BUSINESS

4. CHIEF OFFICER’S REPORT

Report of Jon Rouse

5. SCHOOL READINESS – THE HEALTH CONTRIBUTION TO EARLYYEARS

Report of Sarah Price

6. CHILDREN AND YOUNG PEOPLE MENTAL HEALTH PROGRAMMEUPDATE

Report of Warren Heppolette, presented by Simon Barber

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7. DEMENTIA UNITED

Report of Warren Heppolette

8. UPDATE ON CANCER WORK

Report of Richard Preece, presented by Richard Preece, David Shackley andClaire O’Rourke

9. HEALTHWATCH IN GREATER MANCHESTER – PROGRESS UPDATE

Report of Peter Denton

10. CARBON LITERATE HEALTH AND SOCIAL CARE – SALFORDLOCALITY PRESENTATION – TO FOLLOW

Presented by Cllr John Merry, Anthony Hassall and Phil Korbel

11. DATES OF FUTURE MEETINGS

11 May 2018 12 noon – 2pm TBC

13 July 2018 10am – 12 noon TBC

14 September 2018 10am – 12 noon TBC

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Greater Manchester Health and Care Board – 13 March 2018, Summary and Key Messages

Name of Board Report Summary of Report Key Messages

1. Welcome and Apologies N/A N/A

2. Minutes N/A N/A

3. Chair’s Announcement and Urgent Business

N/A N/A

4. Chief Officer’s Report

Report of Jon Rouse

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.

Please see report.

5. School Readiness – The Health Contribution to Early Years

Report of Sarah Price

This report outlines the health contribution to improving levels of school readiness in GM.

Every child deserves to be given the best start in life. Good health in the earliest years of a child’s life is vital to achieving our ambition of making the greatest and fastest improvement to the health, wealth and wellbeing of the 2.8 million people of Greater Manchester (GM). There is a firm commitment to transform the system from expensive and reactive to preventative and intervening early. At no

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stage is this more important than the 1001 critical days from conception to age two years.

6. Children and Young People Mental Health Programme Update

Report of Warren Heppolette, presented by Simon Barber Chief Executive, North West Boroughs Healthcare NHS Foundation Trust

The presentation describes the process by which the benefits of the Greater Manchester Mental Health investment into Children & Young People will be realised through the implementation of a number of key initiatives.

The presentation provides an overview of how the Greater Manchester Devolution agenda has had a positive impact on the Children Adolescent Mental Health Services (CAMHS) across Greater Manchester, including illustrating our ambitions and achievements on the Children & Young People’s Mental Health programme to date.

As part of the presentation we have interviewed a young person, a family member, the service clinical lead and BEAT (third sector partner). This will be presented as a video within the presentation exemplifying the co-development principles of the Greater Manchester Health & Social Care Partnership; which includes working closely with families within the system, the service provider and third sector partners.

The presentation also demonstrates the application of service transformation that the Greater Manchester Health & Social Care Partnership is applying to the Children & Young People’s Mental Health arena to ensure that we deliver on our ambitions and priorities.

7. Dementia United

Report of Warren Heppolette, presented by Anthony Hassall – Chief Accountable Officer Salford CCG and Senior Responsible Officer for Dementia United; Alan Mills – Person

The update will demonstrate that DU continues to be a priority for Greater Manchester by highlighting the need, opportunities and developing work plan to mobilise a strategy and system response for people living with dementia and those who care for them, aligned to the Greater

The developing DU work plan is based on the information gathered from the 2017 visits, engagement and knowledge developed since June 2015 to complement the agreed strategy (ratified January 2017) and is aligned to the Greater Manchester dementia standards (ratified September 2016). It considers work

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living with dementia; Nicky Timmis – Engagement and Participation Officer, Alzheimer’s Society; Jeff Schryer – GP and clinical lead Burry CCG and Greater Manchester & Eastern Cheshire Strategic Clinical Network; and Rachel Volland – Senior Implementation and Improvement Lead – Dementia United

Manchester dementia standards.

already underway in GM that DU can build on, Utilise and align to.

Accountability of the full programme of activity is the responsibility of the DU Strategic Board, with mobilisation overseen and driven by the DU Implementation Operations Group.

Both involve people living with dementia and are developing a meaningful involvement Strategy for carers.

The proposed work plan is being presented for information across Greater Manchester. The lead in paper explaining the development was presented to the Strategic Partnership Board Executive on the 28th February 2018. Updates/papers are also being presented at the following:

Directors of Adult Social Care Services

– 8th March 2018

Provider Federation Board – 9th

March 2018

The Dementia United Implementation

Operations Group - 13th March 2018

GM Health and Care Board – 16th

March 2018

Heads of Commissioning – 28th March

2018

Primary Care Advisory Group – 28th

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March 2018

Association of Governing Groups – 3rd

April 2018

Strategic Partnership Board Executive

– April/May 2018

Further engagement and agreement will be

made across Greater Manchester as work

develops. At a locality level we will continue to

support the development of local

implementation plans and share emerging

innovation and good practice.

8. Update on Cancer Work

Report of Richard Preece, presented by Richard Preece, David Shackley Medical Director of Greater Manchester Cancer; and Claire O’Rourke Lead Nurse of Greater Manchester Cancer

This report provides an update on cancer across our Greater Manchester network. The first part of the report gives an overview, some key data with associated commentary and outlines future priorities. The second part, as an appendix, is the 2017 Cancer Report of the Greater Manchester Cancer Board (published 9th Feb 2018) which outlines many of the signature programmes in more depth.

Good progress is being made against the targets described in the 4-year GM cancer plan of Feb 2017 and also the cancer related aspects of the NHS planning Guidance. The current highest priorities relate to delivering accelerated pathways in lung, colorectal, prostate and upper gastrointestinal cancer, alongside specific additional work in lung cancer, and delivery of the recovery package. A wide variety of programmes are currently in place.

9. Healthwatch in Greater Manchester – Progress Update

Report of Peter Denton

This report provides an update on the first year of the Greater Manchester Liaison function and signposts the joint work of the 10 GM Healthwatch organisations for the coming year.

The report highlights the statutory functions of local Healthwatch, particularly in terms of its role in assessing the quality of health and care services and in supporting community engagement (including people whose voices are ‘seldom heard’).

Local Healthwatch priorities have been mapped against GM Health and Social Care plans. It notes that Healthwatch priority

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activity with the Partnership is closely aligned with implementation of the Mental Health Strategy; Theme 3 Standardisation of Acute Hospital Services activity; and supporting effective engagement in the development and implementation of locality plans.

Healthwatch has secured representation in a range of the Partnership’s governance boards for both Mental Health and Theme 3 as well as at a strategic level. Healthwatch has also developed a process of aggregating patient, service user and carer feedback to inform its role on the GM Quality Board.

Development areas for Healthwatch the coming year have been identified as including:

Supporting our partners to build on

community based initiatives for the

ongoing transformation of the health

and care system and landscape.

Using our role within GM Health and

Social Care governance structures to

encourage and support the use of

‘soft intelligence’ and consideration of

social value and community benefit

alongside more traditional quantitative

data.

Working alongside all our partners to

promote, support and deliver

meaningful engagement with local

people, particularly those whose

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voices are seldom heard.

Reviewing how we work as individual

Healthwatch organisations with a view

to developing more consistent

practice across Greater Manchester.

10. Carbon Literate Health and Social Care – Salford Locality Presentation

Presented by Cllr John Merry, Anthony Hassall and Phil Korbel

N/A N/A

11. Dates of Future Meetings N/A N/A

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GM HEALTH AND SOCIAL CARE STRATEGIC PARTNERSHIP BOARD

MINUTES OF THE MEETING HELD ON 19 JANUARY 2018

Bolton CCG Wirin Bhatiani

Bolton Council Tony Oakman

Bury CCG Kiran Patel

Christie NHS FT Christine Outram

GM Mayor Andy Burnham

GMCA Eamonn BoylanLindsay DunnJamie Fallon

GM ACCGs Rob Bellingham

GM H&SC Partnership Team Warren HeppoletteNicky O’ConnorJon RouseSteve WilsonZoe O’NeillSarah PriceSarah Fletcher-HoggKarishma Chandaria

GMCVO Nathalie Long

Healthwatch Jack FirthMick Hodlin

Manchester Carers Forum David Williams

Manchester CC Councillor Bev CraigGeoff Little

Manchester Foundation Trust Kathy Cowell

Manchester Health and Care Commissioning Craig Harris

NW Boroughs Healthcare NHS FT John Heritage

Oldham Council Councillor Eddie Moores

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Oldham CCG Noreen Dowd

Primary Care Advisory Group (GP) Tracey Vell

Primary Care Advisory Group (Pharmacy) Adam IrvinePennine Acute NHS Trust Jim Potter

Rochdale MBC Steve RumbelowRoss Jeffrey

Salford CC Councillor Paula BoshellDavid Herne

Salford CCG Tom TaskerJim Potter

Salford Royal NHS Foundation Trust Chris Brookes

Stockport CCG Ranjit Gill

Stockport MBC Councillor Wendy WildPam Smith

Tameside MBC Councillor Brenda WarringtonGill Gibson

TfGM Bob Morris

The Gaddum Centre Lynne Stafford

Trafford CCG Matt Colledge

Wigan Council Councillor Peter Smith (in the Chair)Will BlandamerDonna Hall

Wigan, Wrightington & Leigh NHS FT Carole HudsonNeil Turner

Wigan CCG Tim DaltonTrish Anderson

SPB 01/18 WELCOME AND APOLOGIES

Apologies were received from;

Darren Banks, Simon Barber, Steve Barnard, Julie Connor, Paul Dennett, Alan Dow, ChrisDuffy, Councillor Alex Ganotis, Pat Jones-Greenhalgh, Anthony Hassall, Beverley Hughes,

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Bev Humphreys, Tony Hunter, Karen James, Kevin Lee, Claire Molloy, Steven Pleasant,Councillor Sara Rowbotham, Joanne Roney, Councillor Rishi Shori, Councillor AndreaSimpson, Mel Sirotkin, Jim Taylor, Liz Treacy, Alex Whinnom, Dorothy Whitaker, IanWilliamson, Carolyn Wilkins, Ian Wilkinson and Simon Wooton.

SPB 02/18 CHAIR’S ANNOUNCEMENTS AND URGENT BUSINESS

The Chair opened the meeting and wished members of the Board a Happy New Year. Hehighlighted that the NHS had received a considerable amount of publicity recently as itapproached 70 years of establishment along with the challenges for health and social caresystems nationally from winter pressures.

Tony Oakman, Chief Executive, Bolton Council was introduced and welcomed to the Board.Thanks were placed on record for the contribution of Anne Gibbs for her joint role as Directorof Delivery and Improvement, NHSI for GM and Lancashire and within the GMHSCP and waswished success in her new role.

SPB 03/18 MINUTES OF THE MEETING HELD 13 OCTOBER 2017

The minutes of the meeting held 13 October 2017 were agreed as a true record.

RESOLVED/-

To approve the minutes of the meeting held on 13 October 2017.

SPB 04/18 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;

NHS England (NHSE) National Commissioning Committee have given GM the abilityto make decisions around most specialised mental health services. In this context, GMhas agreed a delegated specilaised commissioning portfolio which has beendeveloped in collaboration with NHSE North West specialised commissioning team.Sarah Price, Sandy Bering, Tom Tasker and the team were thanked for the significantwork undertaken to develop and agree the delegated portfolio. It was highlighted thatthe first area of focus would be CAMHS Tier 4 provision in order to address thebarriers that existed between levels of intervention for children and young people.

There had been significant coverage of the whistleblower case and letter fromclinicians at Royal Manchester Children’s Hospital expressing concern with regard tostaffing levels in respect of critical care for children and young people. ManchesterFoundation Trust (MFT) have issued a clear statement in terms of the seriousness withwhich they had taken the concerns and the appropriate steps taken. The Board werereassured that in light of the Francis Report, all parties had taken the concerns

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seriously and were working to ensure that the provision of care in the unit was safe andof the highest quality possible;

It was expected that the national planning guidance for the NHS 2018/19 which set outhow extra resources announced in the November budget were to be allocated wouldbe published imminently. It was anticipated that there would be some newrequirements alongside the money which would need to be reflected in the devolutionaccountability agreement and may need some re adjustment to targets;

It was reported that in light of national guidance issued in relation to the potentialcancellation of elective procedures and outpatient appointments, GM had adopted aproportionate approach and had only cancelled procedures where necessary to ensurethe safe running of UEC departments. It was recognised that cancellations were ahuge inconvenience which could cause potential stress for patients. It was anticipatedthat just under 14% of procedures would be cancelled in January and partnership workhad ensured this had been minimised. Plans for recovery and rebooking would bescheduled as a priority over the coming months. It was also advised that if the positionwas to change due to winter pressures for example, then the partnership and publicwould be kept informed;

A succession of Ofsted and CQC SEND inspections has highlighted that there is workto do in GM to strengthen joint arrangements between Local Authorities and CCGs tofocus on the assessment and planning of an individual education, health and care planfor each child with special educational needs;

Salford locality were commended for their remarkable improvement in quality in carehomes performance. The percentage of care homes rated good or outstandingcompared to last year had seen a significant level of progress;

Steve Wilson, Executive Lead, Finance and Investment provided a six month financeposition update. It was advised that the financial position for 17/18 remainedchallenging especially for the provider sector. This was mainly due to Pennine Care FTnot expecting to meet the agreed financial plan for the year and other trusts notmeeting their UEC performance, thus not allowing for the maximum Sustainability andTransformation funding allocations from NHSI;

Dr Tracey Vell provided the Board with feedback from the delegation of representativesthat had visited 10 Downing Street earlier in the week to discuss support required toroll out primary care reform at scale. The meeting with representatives fromGovernment, Treasury and the Department of Health had provided an opportunity todemonstrate the progression made in the development reviews of the LCO’s as acollective part of the accountable care system. It also presented the opportunity tohighlight some of the difficulties experienced in general practice, with contracts andestates. The group had requested support and a positive narrative towards generalpractice, primary care and community work.

Members of the Board welcomed the update provided and asked for clarification on theprogress with government with regard to capital funding which had been held up due tocontrol totals not being agreed. It was confirmed that the Partnership continued to makerepresentations and the latest position was that resources could be released if GM couldmake a commitment across the system to meeting the aggregate of the individual controltotals. However, as previously highlighted in the finance update, there could be no guaranteeat this stage that such a position could be met due to the current deficit against plannedposition.

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Assurance that transformation fund allocations were being used to make the intendedimprovements to services along with the required checks and balances was requested by theBoard. It was recognised that there was a real and present risk with regard to funding and assuch built into investment agreements were clauses which ensured that the transformationfunding only be used for the purposes intended along with monitoring and tracking to provideassurance.

RESOLVED/-

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

SPB 05/18 TRANSFORMATION FUND UPDATE

Steve Wilson introduced a report providing an update on recent developments with theTransformation Fund.

This month had an expanded section on the findings and recommendations from theassessment team in their evaluation of the proposals from Salford and Wigan.

The key headlines were:

The report provided a general update on the latest developments in relation to the£450m GM Transformation Fund and contained, in detail, the findings of theTransformation Fund Oversight Group (TFOG) on 23 November, 5 December and 13December 2017, and the decisions of the Strategic Partnership Board Executive on 14December, where the Mental Health, Salford and Wigan submissions were considered.

The mental health proposals allocated funding to two key elements of the GM MentalHealth Strategy which supported both the development of the Children and YoungPeoples Crisis Care Pathway and the Liaison Mental Health Services within GM AcuteHospitals.

The Salford proposals supported a plan to deliver a radical upgrade in populationhealth through stratification and needs identification, engagement and prevention. Itwould support people to live healthy independent lives, managing their own conditionsthrough a community asset based approach.

Wigan’s proposals build on their phase 1 transformation fund allocation and looked todeliver a new approach to out of hospital unplanned care, a reformed housing withcare offer, a place based approach to specialist mental health services and a furtheracceleration of the Heart of Wigan programme.

TFOG recommended a substantive investment of £27.68m in mental health services(this is out of the total transformation fund allocation of £42m agreed by SPBE in July2017), £3.44m investment in Salford and £15.43m for Wigan. These fundingrecommendations were accompanied with material conditions for the funding. Fundingfor all proposals was approved by SPBE subject to those conditions.

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RESOLVED/-

1. 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: £0.56mo 2018/19: £3.89mo 2019/20: £4.51mo 2020/21: £4.48mo Noting that there are material conditions with funding only to be released

upon their satisfactory completion. These are set out at 2.4.3.

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:



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:



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:

o Noting that there are material conditions with funding only to be releasedupon their satisfactory completion. These are set out at 4.3.2.

SPB 06/18 GM HEALTH AND SOCIAL CARE PARTNERSHIP GOVERNANCE REVIEW:PROPOSALS

Jon Rouse introduced a report which set out the review of the current governancearrangements for the GM HSC Partnership and proposed a number of changes to recogniseand support the Partnership’s move into its next phase of delivery of Taking Charge Together.

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In drawing together the proposals in the report, all key stakeholders have been consulted. Inaddition the recommendations from a recent NHS England Internal Audit of governance havebeen incorporated. The proposals were supported by SPBE at their meeting in November2017 and have been updated to reflect that discussion.

It was highlighted that the review provided the opportunity to ensure that GM health andsocial care governance was fit for purpose and proposed that the current Board became morepublic facing and focused on impacting the determinant’s of health by working across publicservices and beyond, including the role of the VCSE. It would develop a strong relationshipwith local statutory Health and Wellbeing Boards in pursuing their local strategies along withthe Mayor on public service reform priorities.

The Mayor of Greater Manchester, Andy Burnham supported the direction set out in theproposals and thanked the Board for the work done so far to integrate and engage with thepublic service reform agenda. He highlighted the work done regarding homelessness and indoing so extended his gratitude for the implementation of the proposal to help those of nofixed abode register with a GP along with the commitment not to discharge those fromhospital onto the street and the ongoing efforts to address and improve mental healthoutreach. The broad GM person centred focus, which concentrated on place basedinterventions was welcomed and fully endorsed by the Mayor.

Members of the Board offered support for the report and discussed the importance ofengaging the public and by doing so recognising the need to ensure that reports are publicfacing providing a clear understanding of the vision and ambitions. It was recognised that itmay be challenging to implement citizen led agendas, however a balance would be requiredto become fully engaged with the public. Acknowledgment for the role of the VCSE in thereport and the opportunities to become more innovative were welcomed. The importance ofrecognising the public as people that may access a myriad of services rather than a patient injust a health setting was highlighted.

It was confirmed that there had been an oversight in the terms of reference for the Health andCare Board and that the broader Primary Care Advisory Group should be represented asopposed to primary care through the Local Medical Committee.

RESOLVED/-

1. To note the issues with and limitations of the current governance approach;2. To note the high level findings from the governance audit;3. To agree the proposed changes;4. To note the comments from the Board with regard to the broader public service reform

agenda, public engagement and a person focused place based approach;5. To amend the Terms of Reference for the Health and Care Board with regard to primary

care representation.

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SPB 07/18 GM HEALTH AND SOCIAL CARE PARTNERSHIP BUSINESS PLAN 2017/18– SIX MONTH SUMMARY

Warren Heppolette, Executive Lead Strategy and System Development, introduced a reportwhich summarised the Health & Social Care Partnership’s progress in delivering its aims forthe first six months of the financial year set out in the 2017/18 Business Plan.

It was advised that there had been a number of key achievements and relatively goodperformance against target, however there were inevitable challenges which would requireaddressing.

Key highlights included;

The proportion of children who start school ready has steadily increased. Goodprogress had been made in improving the oral health of children along with the co-ordination in reducing the numbers of pregnant women and their partners who smokein GM;

The Lung Health Check pilot introduced and focused on deprived areas has led to asignificant increase in early stage lung cancer being diagnosed;

£134m investment for mental health was one of the number of momentous steps todeliver on the commitment to improve mental health and well-being of the residents inGM;

The rate of progress with the mobilisation and progress to develop the Local CareOrganisations (LCO’s) was considered to be compellingly positive in helping to delivernew models of care and support in neighbourhoods;

The support and activity of the community learning disability teams across GM hadbeen recognised for the progress made in supporting people with learning disabilitiesto live in their communities;

In line with Mayoral priorities, an innovative housing and health programme includingthe commitment to tackle homelessness had been set up in GM;

Urgent and emergency care was one of the most challenging areas where there hadbeen significant steps to introduce stability and consistency including the introductionof urgent primary care on a 24/7 basis;

In order to improve hospital care, the first stage of the most significant hospital mergerin the country, the Single Hospital Service was completed. Progress had been made inthe development of the Northern Care Alliance along with secured national funding of£93m for capital investment for Healthier Together and the development to increasecapacity for major trauma services;

The work on genomics and cancer, being led by leading world experts and the GMCancer Board would aim to dramatically advance precision medicine in the treatmentof cancer;

£10m of funds has been assigned to a range of digital projects across localities; The Workforce Transformation Strategy was agreed to help address the key workforce

gaps and critical shortages;

The contribution of staff working seamlessly across the system to address the challenges andpressures faced by urgent and emergency care (UEC) systems to better support patients wasrecognised. A member welcomed that the rate of smoking had reduced in GreaterManchester but requested that consideration be given to a report which highlighted that

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younger people were taking recreational drugs as opposed to smoking which may have afuture impact on mental health.

The benefits of the Tameside integrated care digital health programme were highlighted to theBoard and it was suggested that a presentation to demonstrate the cost effectiveness of thismodel be provided to the Board.

RESOLVED/-

1. To note the six month summary update on the progress this year;2. To note the contribution of staff working across the system to address the challenges

and pressures faced by admissions to UEC;3. To receive a presentation from Tameside locality on the digital programme.

SPB 08/18 WINTER PREPAREDNESS

Jon Rouse introduced a report which provided an overview of the winter UEC performance todate and the work undertaken by the localities and the Partnership to continue to mitigate thedemands of winter and provide safe, high quality care to patients. It also set out the currentchallenging position of the GM system and identified the ongoing risk in relation to servicedelivery over the winter.

The effort, dedication and commitment of staff across health and social care was recognisedand the obligation to deliver a more sustainable framework at local and national level goingforward was acknowledged.

The key headlines were:

All local and national systems have reported a much greater number of higher acuitypatients, which had resulted in increased hospital admission rates. This had resulted inmuch higher bed occupancy rates of 95% plus. This was despite running a GM-wide‘Home for Christmas’ campaign and a significant effort by systems, leading up to thefestive period, to achieve 85% bed occupancy. The validated performance against the 4hour standard for Greater Manchester was 81.5% for December, down from 86.7% inNovember and 89.6% in October. Having sustained at or close to the recovery target levelof 90% over summer and through to end of October it is disappointing that we have beenunable to hold the position as winter has set in. On a more positive to note to date,partnership work across Greater Manchester has meant that OPEL4 major incidents havebeen avoided and delayed discharge numbers low.

The Greater Manchester Health and Social Care Partnership with NHSI, had continued towork very closely with localities through regular site visits, system conference calls andworkshops. Additional service improvement support has continued to be provided byNHSI, the Emergency Care Improvement Programme and Advancing Quality Alliance tothree systems within GM (Bolton, Stockport and North East Sector).

The Greater Manchester UEC Operational Hub had been operational for two months andhad been working with the systems to help reduce ambulance handover delays, maintain

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patient flow, support escalation processes and winter reporting to the regional and nationalwinter rooms.

GM had 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-urgentelective activity until the 31st January, the GMHSCP had asked each locality UEC deliveryBoard to consider their response to the guidance and submit a plan for January and theremainder of the financial year. Work was currently underway to understand theimplications of the guidance and any deferrals in the context of devolution and the formallyadopted accountability agreement, particularly around the requirement to achieveconstitutional standards such as Referral to Treatment.

The capacity of the estate and workforce were highlighted as constraints that would requireimmediate attention to manage the pressures and demand placed on the system.

Following his visits to the Emergency Care Hub, the Mayor reiterated the views of the ChiefOfficer and thanked all parts of the system for working in partnership and managing thesituation under increased and unprecedented levels of demand. The one system andpartnership approach to working, evident after the attack at the Arena had continued acrossthe health and care system and was commended for continually improving.

Following the guidance issued by Government on the cancellation of elective procedures, theMayor highlighted the proportionate and balanced approach adopted by GM which illustratedthe benefits of a devolved health and care system. This had resulted in fewer proceduresbeing unnecessarily cancelled which delivered a more favorable outcome for the residents ofGM.

The record number of people arriving at UEC and the ultimate admissions demonstrated thatthe care at home model was no longer acceptable. The increasing impact of that would havean inevitable effect on the demand placed on the system, therefore a new model of carewhich optimises the patient journey, like Care 2020 was considered essential.

The Chair replicated the views expressed with regard to the efforts of the workforce acrossGM.

RESOLVED/-

1. To note the content of the paper in relation to winter preparedness;2. To support the delivery against the identified priority areas;3. To note the positive comments from the Board with regard to the efforts of the workforce

across the system and;

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4. To note a national and local solution is required to manage the pressures of winter in asustainable framework.

SPB 09/18 BURY CCG MEDICINES STRATEGY

Dr Kiran Patel, NHS Bury CCG Clinical Chair, GMHSC Partnership introduced a presentationwhich provided an overview of the Medicines Optimisation project introduced ten years ago inBury. Two areas of focus for the project were diabetes prescribing and the national call toreduce psychotropic medicines for people with learning difficulties (LD).

The driver for the diabetes medicine optimisation project was due to the fact that Bury’sprescribing spend was 21% above the England average, higher than the North West averagespend and the worst 10% of English Primary Care Trusts for cost-effective statin prescribing.The programme recommended a combination of incentive payment and support, thedevelopment of a trustworthy relationship and a cost effective model along with qualityimprovements. The data was analysed to challenge well established views and a programmeof work was developed, the outcomes of which have reduced average practice spend onstatin prescribing along with good outcomes.

Collaborative work was undertaken between Bury CCG and Pennine Care NHS FT toimplement the call to action by reviewing all LD patients receiving antipsychotics. As a resultall people where prescribing was considered inappropriate have had reduction plans in place,and where agreed, appropriate support was provided.

Members offered support for the optimisation strategy and welcomed the balance of cost withquality and engagement across the system involving patients with treatment plans. The workof the Medicines Strategy Board to reduce wastage and the implementation of electronicpatient prescribing was highlighted as being a key area of focus.

The expansion of the primary care workforce to deliver front line medicine management carewas recognised as allowing GP’s more time to see and treat patients. It was suggested that inorder to roll out the important piece of work across localities, collaboration would be requiredthrough the GP excellence programme. The emphasis on quality as a focus to developinvolvement and understanding for patients would be paramount.

RESOLVED/-

1. To note the progress to date of Medicines Optimisation in Bury;2. To consider programme roll out across localities using the GP excellence programme.

SPB 10/18 WIGAN LOCALITY PRESENTATION

Will Blandamer, Programme Director of Health and Care Integration, Wigan Councilintroduced a presentation that provided an overview of the Wigan locality model which soughtto improve outcomes and secure sustainable cost reduction in public service provision

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through the large scale application of Wigan Deal principles across health and care and widerpublic services.

It was emphasised that large scale application of asset place based integrated place workingfor individuals and communities was core to the attainment of improving the population healthand wellbeing, managing demand and reducing the cost base. It was advised that the focus ofpublic services should be on the people who receive them and the communities in which theylive and not the organisations that provide them.

In line with the GM framework, staff from different public services and agencies in theHealthier Wigan Partnership, work closely together to support residents with a sharedcommon commitment and ambition.

Service delivery footprints built out of primary care clusters provided a focal point for newdelivery models and the foundation for public service reform. This was gaining significantmomentum and success as a single operating model for place based working has developed.

The best advocates to highlight the benefits already achieved of the single operating modeland develop further are the staff who have expressed enthusiasm and confidence.

Members offered their support for the co-ordinated work being carried out and described it asthe principle theme and aspect for the mobilisation of LCO development which was energisingpeople at neighbourhood level. The model of public service delivery which has people at thecentre was recognised as a tribute to reform. Will Blandamer was thanked for his contributionto the locality planning agenda and wished success in his new role.

RESOLVED/-

To note the progress provided and update on Wigan Locality Model.

SPB 11/18 GM COMMITMENT APPROACH TO CARERS: CARERS CHARTER ANDCOMMITMENT TO CARERS

Warren Heppolette, Executive Lead introduced a report which set out a commitment tocarers, agreed by organisations across Greater Manchester to support the implementation ofan integrated approach to the identification, assessment and meeting the health andwellbeing needs of unwaged carers; and the Carers Charter which has been developed bycarers for carers and which articulates what carers across GM could expect.

The report also provided 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 detailed the potential ‘ask’ of partner organisations going forward tosupport the many carers in GM.

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The background and emerging detail of the Support for Carers work programme, the keyprinciples for supporting carers formalised through a Carers Charter and Commitment toCarers and how the offer for carers as a whole could be improved were highlighted to theBoard.

Lynne Stafford, Chief Executive, The Gaddum Centre and the VCSE lead for carers providedan overview of the assistance provided by the voluntary and community sector to engage andconsult with carers to feedback and design the charter through the forums that were alreadyproviding support.

David Williams, Chief Officer, Manchester Carers Forum and working carer provided apersonal overview of the benefits of adopting the charter which he described as vital for thewellbeing of carers and maintenance of the essential workforce. He commended the Charterto the Board for endorsement which recognised the role of carers as partners in careprovided.

The Mayor offered his support for the Charter and recognised that the development reflectedthe ethos of work of the Combined Authority where individuals and support organisationswere involved in the development of policies. He suggested that ongoing core funding andfinancial support should be provided for carers organisations and the charter should beviewed as the start of the journey for carers. It was recognised that more could be done andthe potential to provide carers with one point of contact to offer accountability and assurancewas proposed.

The importance of the charter as new models of care are established and the potentialimplications and pressures on carers were highlighted. Reassurance was provided by theChief Officer that a commitment would be made to all carers and that localities would beaccountable for delivery of the charter and the commitment would be sought through theassurance framework. The challenge of funding for different cohorts was acknowledged.

RESOLVED/-

To approve and sign off the Commitment to Carers, the Carers Charter and delivery plan asappended within.

SPB 12/18 DATES OF FUTURE MEETINGS

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

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

14

Friday 11 May 2018 10:00am – 11:30am Council Chamber,Manchester Town Hall

Friday 13 July 2018 10:00am – 11:30am TBC

1

Greater Manchester Health and Care Board

Date: 16 March 2018

Subject: Chief Officer's Report

Report of: Jon Rouse, Chief Officer, GMHSC Partnership

SUMMARY OF REPORT:

This report provides GM Health and Care Board with an update on activity relating to health

and care across the Partnership. It includes key highlights relating to performance,

transformation, quality, finance and risk.

The report also provides a summary of the key discussions and decisions at the Partnership

Board Executive.

PURPOSE OF REPORT:

The purpose of the report is to update the GM Health and Care Board on key items of

interest across the GMHSC Partnership.

RECOMMENDATIONS:

The GM Health and Care Board is asked to note and comment on the content of the update

report.

CONTACT OFFICERS:

Vicky Sharrock

Deputy Director Strategic Operations, GMHSC Partnership

[email protected]

4

mailto:[email protected]

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

2018. He will also be stepping down as Chair of the GM Association of Clinical

Commissioning Groups. Kiran has led the CCG over the last 5 years and has

achieved a great deal working with member practices, staff at the CCG and wider

partners and colleagues. He has ensured that Bury is well represented at the

Greater Manchester level. He has also been an exemplary chair of AGG and has

made a massive personal contribution to the first period of our devolution story. We

are pleased that Kiran will now be providing primary care leadership for the Bury

Local Care Organisation.

1.6 Ann Gibbs moving on and interim appointment of Linda Buckley

1.7 Earlier this month Ann Gibbs left NHS Improvement to join the South Yorkshire and

Bassetlaw Accountable Care System as Director of Strategy. In the interim period

Linda Buckley will be acting up to cover the joint post of Director of Delivery and

Improvement for GM HSC and NHS I to give time for the new CEO of NHS I (Ian

Dalton) to consider the structure of the organisation for the long term.

1.8 Cameron Ward moving on from Trafford CCG

1.9 Cameron Ward, the Interim Accountable Officer at Trafford CCG is now

approaching the end of his contract at Trafford CCG where he has done an

excellent job in both developing the CCG and in preparing for the move to an

integrated management structure with the Local Authority

1.10 Health and Care Awards 2018

1.11 Nominations are now open for the first ever Greater Manchester Health and Care

Champion Awards. The awards will see Greater Manchester’s health and care

champions; from doctors, nurses, physiotherapists and pharmacists, to care

workers, unpaid carers, apprentices and volunteers, receive the recognition they

deserve for really making a difference in our communities.

1.12 The Greater Manchester Health and Care Champion Awards 2018 are the first in

the city-region to recognise members of our paid and unpaid health and care

3

workforce who regularly go above and beyond to improve the health and wellbeing

of the people of Greater Manchester.

1.13 Award categories include ‘Outstanding Carer’, ‘Apprentice of the Year’, ‘Dedication

to volunteering’ and the ‘People’s Champion’. The awards are open to all individuals

or teams, paid or unpaid, who work in the health or care sector in Greater

Manchester – in either a paid or unpaid roles. Nominations can be completed by

members of the public who wish to see an individual or team’s hard work

recognised.

1.14 Nominations can be completed online by visiting www.gmchampions.co.uk (tbc)

and must be returned before the deadline of 13 April 2018.

1.15 The awards are organised by Greater Manchester Health and Social Care

Partnership, the body overseeing devolution of the area’s health and social care

budget, with support from the Mayor of Greater Manchester, Andy Burnham.

1.16 The winners will be announced at a sponsored event in July.

1.17 Greater Manchester Practice Nursing Awards

1.18 The very first NHS awards to celebrate the dedication and achievements of nurses

working in general practice were held on Thursday 15th February. This prestigious

event honoured individuals and teams from across Greater Manchester that have

worked to ensure the very best care for patients. The awards followed a call for

nominations in the autumn with peers, public, and patients all invited to shine a

spotlight on practice nurses who have gone above and beyond.

1.19 The awards helped to support the aims of the national 10 point action plan for

general practice nursing by celebrating and raising the profile of this vital primary

care role, promoting general practice nursing as a first destination NHS career.

‘General Practice – Developing Confidence, Capability, and Capacity’ sets out how

a national investment of £15 million will help to develop and upskill the primary care

nursing workforce.

1.20 Devolution has seen practice nurses leading on the development of social

prescribing, which allows patients to be referred to a range of locally based, non-

clinical sources of support such as walking groups or befriending activities.

Stockport’s Alvanley Practice in particular has spearheaded this work, winning the

award for Practice Nursing Team of the Year. Greater Manchester practice nurses

were also among the first in the country to trial new group consultations for patients

with long term conditions, allowing more time to discuss their concerns as well as

offering peer to peer support.

1.21 Key system developments

1.22 Devolution difference campaign

1.23 This week we have launched a ‘devolution difference’ communications and

engagement campaign that aims to demonstrate to staff, stakeholders and the

http://www.gmchampions.co.uk/

4

public how devolution is making a difference to the lives of the people of Greater

Manchester.

1.24 We have updated our story in a ‘devolution difference’ document, produced a new

two minute animated film, a ‘Taking Charge – 2 years on’ leaflet and four case

studies. We will be engaging people via a social media campaign including ’10 days

of devo’ on Facebook and Twitter, which will include posts and gifs taken from the

animated video.

1.25 A Devolution Difference ‘toolkit’ will be available to help staff and partners share our

key messages and practical examples of successes.

1.26 Part of the Devolution Difference campaign will include, over summer and autumn,

a community event in each area, building on events and activities already taking

place. We will work together with NHS and council communications and

engagement leads, along with Healthwatch and VCSE, to showcase the devo

difference across the whole of Greater Manchester.

1.27 Further information is available at:

https://youtu.be/ywtls25mbFU

Facebook.com/GMHSCPartnership

#takingcharge #devodifference

1.28 Pennine Acute CQC Hospitals NHS Trust report

1.29 The recent report published by the Care Quality Commission (CQC) has found that

significant improvements have been made across every hospital run by The

Pennine Acute Hospitals NHS Trust since its last inspection in 2016. The overall

position has seen Pennine Acute move form ‘inadequate’ to ‘requires improvement’

with 70% of the aspects of the services inspected now rated as either ‘Good’ or

‘Outstanding’.

1.30 The Pennine Acute Trust (PAT), now part of the Northern Care Alliance NHS Group

with Salford Royal, runs four hospitals and a range of community services serving

the communities of Oldham, North Manchester, Bury and Rochdale borough.

1.31 Since the Trust’s last CQC inspection report, published in August 2016, the Trust

has benefitted from joint working and support from the leadership at the Salford

Royal NHS Foundation Trust. A leadership structure has been put in place, with one

Board of Directors now overseeing both Salford Royal and The Pennine Acute

Hospitals NHS Trusts.

1.32 Greater Manchester Mental Health Trust

1.33 The Care Quality Commission has rated Greater Manchester Mental Health NHS

Foundation Trust as Good following an inspection by the Care Quality Commission.

https://youtu.be/ywtls25mbFU

5

This inspection included child and adolescent mental health wards and wards for

older people which had previously been rated as requiring improvement.

1.34 CQC also inspected acute wards for adults of working age and psychiatric intensive

care units; long stay/rehabilitation mental health wards for working age adults and

substance misuse services. CQC also looked specifically at management and

leadership to answer the key question: ‘Is the trust well led?’

1.35 The service was rated as requires improvement for safety, good for caring,

effectiveness and responsiveness and outstanding for well-led. As a result of this

inspection, the trust’s overall rating remains unchanged as good. This is a

considerable achievement given that during this period, the Trust incorporated

Manchester Mental Health Trust.

1.36 Make Smoking History

1.37 The ‘Don’t Be the 1’ campaign launched 5 February, aiming to support attempts to

quit by some of our most persistent smokers. Research conducted in December

2017 across GM with 693 smokers, found 9 out of every 10 smokers

underestimated the risk of dying from a smoking related disease.

1.38 Our History Makers engagement conversation was launched on 12 February by GM

Mayor Andy Burnham at our Making Smoking History event in Manchester attended

by 173 stakeholders from across the GM system. 530 surveys were completed in

the first 4 days. Our aim is at least 5000 weighted surveys across the 10 boroughs

and 1.5m social engagements with the History Makers campaign. Roadshow

activity is planned across all boroughs and History Makers engaged will be

supported to build our revolution for a tobacco-free GM over the next 3 years.

1.39 Winter Update

1.40 The winter period continues to be challenging for systems, with sustained high

levels of demand and reports of higher acuity patients. Performance for January

2018 shows Greater Manchester achieved 83.8% against the four hour A&E wait

performance standard. This is an improvement of 2.3% on the December 2017

position. Our ability to achieve the four hour waiting standard has been affected by

reduced capacity in care homes and social care as a result of flu and other

seasonal illnesses such as respiratory conditions. As a result, there has been an

increase in the number of patients staying in hospital over seven days, which has

reduced patient flow and bed capacity in the system.

1.41 Greater Manchester received approximately £21 million of additional winter monies

from the national allocations for acute, primary care and mental health services.

This has enabled us to implement:

• An extra 94 acute hospital beds

• Additional assessment space in acute medical areas

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• Additional clinical workforce in emergency departments, acute assessment

areas and staff to support discharges

• Additional primary care access, 7 days a week 08:00 to 20:00

• An urgent care response in partnership with NWAS, to support primary care in

each locality

• Additional 24/7 mental health liaison and crisis support teams

• Additional mental health beds, including dementia care and intermediate care

(short-term support involving NHS and social care services to avoid

unnecessary hospital admissions, help individuals become as independent as

possible and aims to prevent a premature move into residential care)

1.42 The GMHSC Partnership is currently working with the North West Ambulance

Service, 111 and the localities to test direct booking into primary care. The testing

will be for direct booking into additional access in the first instance. There are four

test beds sites that are due to go live during late February - City of Manchester

(North, Central and South Manchester), Oldham, Tameside & Glossop and Wigan

Boroughs.

1.43 The GMHSCP are facilitating a winter de-brief session on the 9 March for all

localities, which will enable us to identify further improvements which we can put in

place for next year. Looking forward, localities are also being asked to ensure they

have plans in place for Easter. A ‘Home for Easter’ campaign will be adopted

across Greater Manchester during March.

1.44 Primary care reform programme

1.45 As part of the Greater Manchester Primary Care Reform Programme, around 60

pharmacists have been employed to work alongside GPs and nurses as part of the

general practice team. These clinical pharmacists will provide extra help to manage

long-term conditions, advice for people on more than one medicine and better

access to health checks.

1.46 Having clinical pharmacists in GP practices means GPs can focus their skills where

they are most needed, for example on diagnosing and treating patients with more

complex conditions. This helps GPs manage the demands on their time. It is

envisaged that an additional 30 pharmacists will be employed by the end of March

2018.

1.47 Greater Manchester is also in the process of a major international recruitment drive

to attract appropriately trained and qualified GPs from overseas. Following the

success of the Heywood, Middleton and Rochdale bid, the expanded programme

will now cover most of Greater Manchester.

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1.48 Review of looked after and adopted children’s health needs

1.49 Under the banner of the Children’s Health and Wellbeing Board we will be

commissioning an external review of health provision (physical and mental) for

looked after children and adopted children and young people at both local and GM

level. This will help us to identify shortcomings and gaps against both duties and

best practice, and to make recommendations for improvement that could feed in to

the wider GM Health and Social Care work.

1.50 Development of life sciences offer and visit from Lord O’ Shaughnessy

1.51 In February we took part in a high level visit from the Life Sciences Minister Lord

O’Shaughnessy to GM where we showcased the distinguishing aspects of our

GMHSCP system from a testing and adoption of innovation perspective and the

merits of optimising research investment in GM from different government

departments and arms’ length bodies. He was very interested to find out more

about the unique Greater Manchester offering which can support the Life Sciences

Strategy and future sector deals.

2.0 SYSTEM PERFORMANCE

2.1 There are a number of performance measures that the GM Health and Social Care

Partnership is monitored against. Current performance against these is outlined in

appendix A. Some of the key performance measures within this set are outlined in

more detail below, focusing on areas of exception:

• Urgent Care 4 hour standard (National standard is 95% with higher being

better performance) – GM’s performance in January 2018 is 83.8%, which is

an improvement on the December position of 81.5% and on January 2017

which was 82.9%. It is still though of course well below the national standard.

The numbers of attendances at Accident and Emergency departments are

relatively high. Systems have reported a larger number of high acuity patients,

which results in a high admission rate and also the proportion of stranded

patients to increase. There has also been reduced capacity in care homes and

social care as a result of flu and other seasonal illnesses such as respiratory

conditions. These have contributed to reduced patient flow and bed capacity in

systems.

Better Is Higher

83.8% p

Urgent Care 4 Hour Standard

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.

Better Is Lower

q3.8%

Delayed Transfers of Care

Referral to Treatment (National Standard is 92% of patients should wait

less than 18 weeks for treatment with higher performance being better) -

The provisional data for January 2018 shows GM has narrowly missed the

92.0% standard with a performance of 90.8%. This is a slight deterioration of

0.3% on the December position. This drop in performance was expected due to

the decision to defer some non-urgent elective care, resulting in the

cancellation of scheduled operations. The impact of this is being monitored

carefully including plans for rebooking those patients who have been cancelled.

Better Is Higher

90.8% q

Referral To Treatment - 18wks

Diagnostic Waiting Times (National standard is for no more than 1% of

people waiting 6 weeks or more with lower performance being better) -

The provisional data for January 2018 shows that GM’s performance is 2.5%,

which is a deterioration of 0.4% on the December 2017 position and falls below

the national standard of 1%. Greater Manchester has been working to improve

performance in this area by increasing diagnostic capacity through the opening

of the new Endoscopy suite at Manchester Foundation Trust in January and the

use of subcontracting arrangements to other health providers.

9

Better Is Lower

2.5% p

Diagnostic Tests Wait

Cancer waiting times - all eight of the cancer standards were achieved in

December 2017. January has been far more challenging; as a result we

anticipate we are unlikely to quite meet the 62 day referral to treatment

standard.

Better Is Higher

86.4% p

Cancer - 62 Day Wait

Improving Access to Psychological Therapies recovery rate (IAPT)

(National standard is 50% with higher being better performance) – GM has

missed the IAPT Recovery rate standard in the published November 2017 data

with 47.5% rolling quarter figure against a standard of 50%. This is a

deterioration of 1.1% on the October position. We are currently developing a

recovery plan to improve performance in this area which will focus on sections

of our population where we know there are particular issues with recovery such

as black and ethnic minority groups.

Better Is Higher

47.5% q

IAPT Recovery Rate

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3.0 QUALITY

3.1 Our Quality directorate work with the wider GM system to support improvement

across our services. There are a number of key areas to note including:

Safeguarding – the Safeguarding Assurance Framework is updated be each

CCG on a quarterly basis. For Quarter 3 this information confirmed that in GM

we do not have any areas of non-compliance.

Prevent - In April 2015 the Prevent Statutory Duty was introduced. The Health

sector was one of those named statutory agencies required to demonstrate

“due regard to the need to prevent people from being drawn into terrorism”. A

clear delivery plan was approved by commissioners that would ensure that

training compliance will be achieved by the 31st March 2018. NHS England

agreed with regulators that as a minimum, 85% of staff should be compliant

with training at any one time.

Child protection information systems – this is a nationwide system enabling

child protection information to be shares securely between local authorities and

unscheduled healthcare settings. Progress to roll this out in GM is continuing

with many settings now reporting this system to be live in all areas or in

relevant areas of service such as A&E, maternity and paediatrics.

3.2 Quality in care homes continues to be a key focus for the Partnership. The table

below outlines the current performance across the 19,213 beds as at 20 Feb 2018:

3.3 A Quality Improvement and Best Practice group has been established to support

our work across the care home sector. The group have agreed three key priority

areas:

Quality in Care – To develop a portfolio of best practice that care home staff

will receive training in. This is will include pressure damage prevention,

nutrition and hydration, dementia, falls and end of life care.

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Quality in Life – To develop a portfolio of best practice that homes and other

systems will offer to residents to ensure they have equal access to services,

are able to navigate the care system, are not socially isolated and are able to

make choices with regards to their health and wellbeing

Partnership Working – How commissioners, Acute providers, patients

advocate groups, CQC and care home providers can work together to ensure

residents receive the highest quality in care and are central to the delivery.

4.0 FINANCE

4.1 The financial performance of GM Health & Social Care at the end of December

2017 (Month 9) shows the current forecast is for GM to deliver a small surplus for

2017/18 of £1.3m. This represents an £18.9m improvement against agreed Plan.

This improvement whilst welcome is largely driven by one off factors which will not

be repeated in subsequent years. The underlying position for GM remains a deficit

and presents a number of challenges. The position by sector is shown in the table

below:

Plan Surpl/ Forecast Surpl / Better / (Worse)

Sectors (Def) (Def) than Plan

£m £m £m

Planned controls

NHSE (excl Spec Comm) 0.0 0.0 0.0

CCGs 3.1 3.0 (0.1)

Providers (20.7) (1.7) 19.0

Local Authorities 0.0 0.1 0.1

Total Surplus / (Deficit) - GM Control (17.6) 1.3 18.9

Headline Position (at Mth 9)

4.2 This forecast doesn’t include £21m (0.5%) set aside by CCGs at the start of the year

to support the national NHS financial position. It is likely that GM CCGs, in line with

the rest of the country, will be required to release this to their bottom line at the end

of the year, improving their financial positions by that amount.

4.3 The key points to note in relation to the financial position are:

Excluding specialised commissioning, GMHSP central budgets are reporting a

net year to date underspend of £1.7m and a break-even position at year end.

CCGs are forecasting to deliver their plan of a £3m surplus.

NHS Providers (Foundation Trusts and NHS Trusts) are now forecasting they

will deliver an overall deficit position of £1.7m which is better than the planned

deficit of £20.7m. This is largely due to the improvement in the forecast position

at the Christie which is due to the accounting treatment of recent fire and

associated insurance. Two trusts are forecasting they will not deliver their

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financial plans for the year, Pennine Care Foundation Trust and Pennine Acute

NHS Trust.

Whilst the year end position for Local Authorities is projected to deliver a £0.5m

surplus, this relies on Local Authority reserves of £66m which is in addition to

savings targets of £53.9m already embedded in budgets.

5.0 TRANSFORMATION PORTFOLIO

5.1 Over the past 3 months, a piece of work has been undertaken to understand the

alignment of the projects across the GM Health and Social Care Partnership. This

has enabled us to:

Ensure we are maximising opportunity to deliver the quickest improvements in

health and wellbeing for the benefit of the population of Manchester, whilst

ensuring clinical and financial sustainability of the Health and Social Care

system by 2021 as set out in our Strategic Plan: Taking Charge

Ensure there is clarity on the current position of all projects and programmes

within the Portfolio, to inform a review of the assumptions made around the

benefits they will deliver.

Inform the short-term business planning for 18/19, and to ensure

commissioners have built in funding and implementation resource for GM

programmes, aligned to locality programmes of delivery for 18/19

5.2 The exercise has categorised all of the projects in the portfolio as either:

Already embedded within implementation: Those projects which have been

approved through governance, which localities and GM programmes are

actively getting on with now, and are understood across the system, as a result

of the project maturity assessment process.

Being considered for acceleration: Those projects that have been identified

as a priority for delivery through the implementation of a GM standard where

affordable, to ensure a consistency across GM. With the exception of cancer

(where this exercise is ongoing already) and population health (which already

has funds aligned), we will be working through Programme Directors, CCG

Directors of Commissioning and LA Heads of Commissioning, to understand

the current position with regard to the funding and implementation of these

projects at a local level throughout March and April, to enable prioritisation and

sequencing to be determined.

For consideration in 19/20: Those are projects not yet fully designed and

costed therefore are unlikely to be ready for implementation before 19/20.

Given the current allocation of the Transformation Funding, these commitments

are also likely to require realignment of existing resources.

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5.3 As part of the next steps, work is underway to develop an appropriate set of

indicators that will enable us to monitor the delivery of Taking Charge. The approach

to developing and embedding these measures was discussed and agreed by

Partnership Executive in February.

5.4 The approach to be embedded to measure Transformation has been described within

a paper received by SPBE in February. An approach has been described to the

system to align operating plans, investment agreements and contracts, taking into

consideration the national planning guidance where appropriate.

6.0 RISK MANAGEMENT

6.1 The overarching GM HSCP risk register is built from the GM HSCP team risk register

(including all the GM transformation programme risks) and the 10 locality risk

registers. Each of these are based on the agreed GM Risk and Issues Management

Framework (RIMF), which supports the development a risk management process for

the GM HSCP.

6.2 Key partnership risks

6.3 Key risks for the portfolio and the actions being taken to mitigate those risks are

outlined below:

Locality plans do not deliver activity shifts and financial shifts as

intended: Operating plans have been received from localities to meet national

the 8th March national planning deadline. This has provided an initial indication

of variances proposed from already signed investment agreements, which will

be followed up by Exec to Exec locality meetings in March

GM programmes do not deliver quickly enough to release intended

benefits: Clear descriptions of projects already in implementation for 18/19

have been provided to the system. A dedicated focus will continue on

determining the possibility of implementation for those projects to be

considered for acceleration into 18/19, though it should be recognised that the

programmes being considered for acceleration will not deliver significant

financial savings. Cancer projects form a significant part of this cohort, along

with elective care and urgent and emergency care, which will support system

resilience.

GM and locality programmes do not connect effectively to deliver

collective benefits relating to quality, experience and outcomes: Alongside

the alignment of activity plans, work will be completed to describe the

contribution of GM and locality programmes to deliver constitutional and

outcome targets

How we rapidly progress programmes that have had a strategy agreed,

but do not have a fully funded route to implementation identified: The

prioritisation process for 19/20 projects will be designed with the system, to

ensure that the outcomes of this exercise are fully owned by the system, and

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there is agreement with regard to how GM programmes / standards will be

funded.

Ensuring robust measurement systems are in place to assure

transformation delivery. . Whilst the Portfolio definition piece is being

completed, work will also continue to strengthen methods of assurance to

measure delivery in line with Taking Charge ambitions.

6.4 Key actions for the next 2 months

Clear descriptions of key 18/19 ‘must do’s will have been provided for the

system. Work will be completed to align these to the broader constitutional and

outcome targets to be deliver at programme level. A dedicated focus will

continue on determining the possibility of implementation for those projects to

be considered for acceleration into 18/19. Cancer projects form a significant

part of this cohort along with elective care and urgent and emergency care.

The prioritisation process for 19/20 projects will be designed, to ensure that the

outcomes of this exercise are fully owned by the system.

Operating plans will be received from localities on the 5th March to meet

national the 8th March national deadline. This will provide an initial indication of

any variances proposed from already signed investment agreements, which will

be followed up by Exec to Exec locality meetings in March.

Whilst the Portfolio definition piece is being completed, work will also continue

to strengthen methods of assurance to measure delivery in line with Taking

Charge ambitions.

7.0 GOVERNANCE

7.1 SPBE Decisions

7.2 The Health and Care Board is asked to note the recommendations supported by the

Partnership Executive at the meeting on 31 January 2018. These are outlined in

more detail the decision log in Appendix 3.

Transformation Fund Stocktake - deployment of the GM Transformation

Fund, current and forecast expenditure from the fund and prioritisation of the

remaining fund

Winter update – plans to mitigate the demands of winter and provide safe,

high quality care to patients

Children’s Health and Wellbeing Strategy – process for the establishment of

a GM Children’s health and Wellbeing Strategy building on the outputs form the

boards and focused on 10 key objectives

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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.

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Appendix 1: GM System Performance Dashboard

17

Appendix 2 – GM HSC Partnership Finance Dashboard

Income Expenditure Variance

£m £m £m £m £m £m £m £m £m £'m £m % Plan % Plan

468.9 468.9 0.0 256.7 255.0 1.7 484.1 484.1 0.0 0.0 0.0 7% 4%

4,432.4 4,429.3 3.1 3,383.3 3,391.2 (7.8) 4,534.0 4,531.0 3.0 (0.1) (0.1) 95% 92%

4,742.1 4,762.8 (20.7) 3,628.1 3,686.2 (58.1) (1.7) 19.0 (19.9) 92% 95%

1,264.6 1,264.6 0.0 0.0 1,302.5 1,302.4 0.1 0.1 0.1 n/a 94%

(17.6) (64.2) 1.3 18.9 (19.9)

Spec. comm. (before reserves) 1,036.9 1,036.9 0.0 768.4 794.3 (25.9) 1,025.6 1,056.3 (30.7) (30.7) (29.0)

(17.6) (90.1) (29.4) (11.7) (48.9)

£'m £'m £'m £'m £'m

10.2 1.1 (1.0) 8.1 (2.1)

0.1 0.2 0.1 0.1 (0.0)

20.6 9.1 1.4 26.3 5.8

Oldham (11.3) (18.2) (3.3) (39.1) (27.9)

Rochdale 3.2 (4.6) (6.8) (4.8) (8.0)

Salford (1.4) (4.2) 1.4 1.1 2.4

Stockport (25.9) (20.4) 0.6 (25.1) 0.8

Tameside (24.3) (19.2) (0.0) (23.7) 0.6

Trafford 1.6 (13.3) (12.0) (4.5) (6.1)

Wigan (0.6) (2.5) (0.3) (1.2) (0.6)

Spec. Comm. (before reserves) 10.3 (18.1) (25.8) 33.6 23.3

0.0 0.0 0.0 0.0 0.0

(17.6) (90.1) (45.8) (29.4) (11.7)

Forecast outturn

P'ship exc spec comm

YTD

Manchester

Bolton

TOTAL

Total

Out of Area

Bury

Annual

Plan

surplusTrend - forecast variance

vs planActual

Variance

against

Plan

ActualVariance

against Plan

2. Financial position by locality

(appendix 2)

Year to Date surplus Forecast surplus

Year to

Date

GM H&SCP exc. Spec. comm

CCGs

Providers

Local Authorities

Variance

from planVariance

Greater Manchester Health & Social Care Partnership - Financial Performance Dashboard (Month 9) Appendix 1

1. Financial position by type of

organisation (appendices 3-7)

Plan Previous

Month

Forecast

Variance vs

plan

Trend - forecast

variance vs plan

QIPP/CIP Achievement

ForecastIncome Expenditure Variance Income Expenditure

(50)

(40)

(30)

(20)

(10)

0

10

20

30

M2 M3 M4 M5 M6 m7 m8 m9 m10 m11 m12

£'m

2017/18 f'cast surplus; variance vs plan by type of org'n

Spec comm (before reserves)

GMH&SCP exc s comm

CCG

Provider

LA

0

20

40

60

80

100

120

Transformation Fund 2017/18

Confirmed Commitments Allocated0

50

100

150

200

250

300

350

GM Primary Care capital Provider

£m

Capital Expenditure Capital budget

YTD Net Expenditure

Forecast Net Expenditure

Month 9 key headlines (revenue)

- Overall forecast M9 position is a £29.4m deficit, which is; -an improvement of £37.1m from last month.This is mainly due to an improvement of £38.9m across Providers.

- The Spec. comm. team has clarified that the position reported here is before the application of reserves. If these reserves (0.5% contingency and growth reserves) were factored in, the forecast deficit would reduce from £30.7m to £9.7m.

- Provider Trusts forecast outturn deficit is £1.7m which is an improvement £38.9m from plan across several trusts.

- CCGs' forecast position are unchanged from month 8. However, as mentioned last month, this hides a £6.1m adverse variance in Trafford CCG, offset by a £6m improvement in Manchester CCG

18

Appendix 3 – GMHSC Partnership Decision Log

Report summary Recommendations Outcome

Chief Officers Update

Jon Rouse, Chief Officer, GM Health and Social Care Partnership (GMHSCP), provided an update on key items of interest both within the GMHSC Partnership and also within its partner organisations.

Publication of joint NHS England (NHSE) and NHS Improvement (NHSI) updated

Guidance

Care 2020 model

Paul Baumann, Chief Finance Officer, NHSE

visit

The Partnership Executive was asked to

note the report.

The GMSPBE noted the updated

with the following actions agreed:

To circulate the Care 2020

model framework to the

Executive;

To provide an update and

progress report on the GM

Commissioning Hub.

Performance and Transformation Update

Nicky O’Connor, Chief Operating Officer, GMHSCP, provided a summary of current performance issues and progress points drawn from the work of the Transformation Portfolio Board and the Performance and Delivery Board.

The Partnership Executive was asked to:

Note the report.

Receive social care dashboard

performance at the next meeting

and further quarterly updates;

Receive mental health dashboard

performance once finalised and

available.

Noted

Agreed

Agreed

19


Transformation Fund Stocktake

Steve Wilson, Executive Lead, Finance & Investment,

GM Health and Social Care Partnership provided an

update on the expenditure from the GM Transformation

Fund to date and the proposed approach to allocating

the remaining available funds.

The report provided an update on the deployment of the

GM Transformation Fund and detailed expenditure from

the fund to date and forecast expenditure for the

duration of the transformation period to 2020/21.

The Board discussed the prioritisation of the remaining bids and it was advised that the Transformation Fund Oversight Group would continue to make recommendations to the Partnership Executive to approve investments from the fund. It was noted that there were a considerable number of investment programmes already approved along with further potential bids. It was therefore suggested that a strategic stock take across GM to be undertaken, focused on best use of available resources across work streams to deliver efficiencies and identify programmes that would require recurrent funding should be prioritised by the Executive.


Note the commitments against the

Transformation Fund to date and the

submitted bids for further investment;

Note the risks and mitigations to the

delivery of transformation within the

available funding;

Agree the approach to slippage within

recurrent investment elements of bids;

Approve the proposed process for

allocating remaining funds noting the

recommendation that the Executive

receives an update with regard to

prioritisation;

Support work to consider any future

approach to GM transformation

/Improvement.

Noted

Noted

Agreed

Approved

Agreed

20


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.


Note that GM has set a deficit plan of

£17.6m for 17/18;

Note that the year to date (Month 8)

deficit of £61.7m represents an adverse

movement of £26.7m against M8 plan;

Note that the forecast position currently

shows a £19.9m adverse variance

against plan by reporting a forecast

outturn of £37.5m deficit;

Note the risks to the delivery of the GM

financial plan for 2017/18;

Note the comments from the Executive

with regards to allocated funding

following the Manchester Arena attack

and future STF implications.

Noted

Noted

Noted

Noted

Noted

Winter Update

Jon Rouse provided an overview of winter UEC


21


performance to date and the work undertaken by the

localities and the GM Partnership to continue to

mitigate the demands of winter and provide safe, high

quality care to patients. It also set out the current

challenging position of the GM system and identified

the ongoing risk in relation to service delivery over the

winter.

Note the content of the paper in relation

to winter preparedness;

Support the delivery against the identified

priority areas.

Noted

Agreed

Children’s Health and Wellbeing Strategy

Jon Rouse introduced a report which described the

process of developing a GM Children’s Health and

Wellbeing Strategy building on the work to date of the

GM Children’s Health & Wellbeing Board.

The outputs from the children’s health and wellbeing board members and the children and young people were used to identify 10 objectives for the development of a GM Children’s Health and Wellbeing Strategy and to steer the work of the GM Children’s Health and Wellbeing Board. It was noted that safeguarding and vulnerability would be an objective to be included as an additional within the strategy.


Provide feedback and support the

inclusion of the 10 objectives currently

identified within the GM Children’s Health

and Wellbeing Strategy, noting that an

additional objective relating to

safeguarding and vulnerable children will

be included either fully or within an

existing objective area.

Note the feedback by the Executive with

regard to further objectives of Oral

Health; more explicit reference to the role

of the VCSE; references towards health

and justice, including domestic violence

and criminal justice liaison;

Resolved

Noted

22


Note the conditional offer received from

DfE to be considered by Leaders;

Support the proposed plan for socialising

the objectives and strategy across the

health and care system.

Noted

Resolved

Person and Community Centred Approaches Giles Wilmore, Associate Lead, People and Communities, GMHSCP provided an overview of the rationale, working model, evidence and benefits of a GM programme of work on person and community-centred approaches (PCCA). This included an overview of the support to all ten GM localities in progressing this agenda. The paper set out a coherent GM framework for person and community-centred approaches, underpinned by a clear programme to support capacity and capability building within localities, and in doing so deliver on the commitments set out in GM Population Health Plan, Primary Care Strategy, Taking Charge and the GM Strategy: Taking Charge.


Agree to supporting a shared GM

ambition for PCCA, which includes a core

GM offer;

Agree to a GM focus on the four key

characteristics of PCCA

Note the contents of this report,

particularly the PCCA model and benefits

to be derived from adopting PCCA within

emerging LCO’s;

Agree to the three component GM PCCA

support programme, noting the

challenges localities face in implementing

PCCA ;

Agreed

Agreed

Noted

Agreed

23


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.


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.


Note the content of the report and the progress on the Housing and Health Programme;

Note the request to include GMCA representation on the Housing and Health Programme Board.

Noted

Noted

24


Quality Update Dr Richard Preece, Executive Lead for Quality, GMHSCP introduced a report which highlighted recent progress with the Partnership's Quality Improvement Framework (QIF) agreed by stakeholders at the Strategic Partnership Board Executive in September 2017. The GM Quality Board was now leading the application of the QIF in a review of transformation programmes. The Quality Board continues meet regularly to monitor and review quality of care across all localities.


Note progress on implementation of the GM Quality Improvement Framework

Noted

Funding Proposition and General Progress report for Health Innovation Manchester Rowena Burns, introduced a report which set out the level of funding secured from commissioners and providers for 2018/19. The report confirmed the funding bid request for transitional funding from GM Health and Social Care Partnership, outlined the plans for future long-term funding and provided a general update on HInM progress to date.


Note the level of funding secured from commissioners and providers.

Confirm the approval of the funding from the GM Health and Social Care Transitional Bid of an additional £0.7m for 2018/19 in addition to £0.5m carried forward from 2017/18 along with the continued support for 6 months of 2019/20 (£0.6m).

Support the on-going discussions and

Noted

Approved

25


engage in the process to secure the longer-term financial model.

Note the progress to date of HInM activity.

Supported

Noted

Interoperability and Innovation Programme Update Consideration was given to a report which provided a progress update on the development of the Interoperability and Innovation Strategy and requested resolution on a series of important next steps. Members welcomed the report and offered their support for the proposal to develop a single business case for Local Health and Care Record exemplar and Digital Innovation Hub.


Note the background to the Interoperability and Innovation hub programme and the progress made to date;

Support Option 3 for DataWell to 20/21 including funding approach, committing £3.9m of digital funds for 17/18;

Support a single GM approach to the NHSE (Local Health and Care Record exemplar) and OLS (Digital Innovation Hub) bid processes together with external

bid writing support for the business case;

Support the escalation of the early need for confirmation of future digital fund

allocations from NHS England;

Delegate to the Chief Officer other remaining decisions with respect to

Noted

Agreed

Agreed

Agreed

Agreed

26


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

1


Date: 16 March 2018

Subject: School readiness – the health contribution to Early Years

Report of: Sarah Price: Executive lead population health and commissioning (GMHSCP)

SUMMARY OF REPORT:

This report outlines the health contribution to improving levels of school readiness in GM.

KEY MESSAGES:

Every child deserves to be given the best start in life. Good health in the earliest years of a

child’s life is vital to achieving our ambition of making the greatest and fastest improvement

to the health, wealth and wellbeing of the 2.8 million people of Greater Manchester (GM).

There is a firm commitment to transform the system from expensive and reactive to

preventative and intervening early. At no stage is this more important than the 1001 critical

days from conception to age two years.

PURPOSE OF REPORT:

This report identifies how health partners are working with wider partners across Greater

Manchester to develop a shared co-ordinated work programme to ensure that school

readiness is a key priority across Greater Manchester.

RECOMMENDATIONS:

The Greater Manchester Health and Social Care Board is asked to:

Note the content of the report and commit ongoing support to the ambition to

increase the number of children who are school ready in GM.

5

2

CONTACT OFFICERS:

Martin Ashton, Head of Public Health Operations (GMHSCP)

[email protected]

3

1.0 WHY IS SCHOOL READINESS IMPORTANT?

1.1. We have committed to making the greatest and fastest improvement to the health,

wealth and wellbeing of the 2.8 million people of Greater Manchester (GM). Good

health in the earliest years of a child’s life is vital to achieving this ambition. We

recognise that disadvantage starts before birth and accumulates throughout life,

meaning that our collective actions must start at conception and be followed

through the life of the child.

1.2. The foundations for virtually every aspect of development; physical, intellectual and

emotional, are laid in early childhood. From birth to age 18 months, connections in

the brain are created at a rate of one million per second. The earliest experiences

shape a baby’s brain development, and have a lifelong impact on mental and

emotional health. Evidence shows that when a baby’s development falls behind

during the first year of life, it is then much more likely to fall even further behind in

subsequent years, than to catch up with those who have had a better start.

Pregnancy and the birth of a child is a critical window of opportunity when parents

are especially receptive to advice, support and guidance.

1.3. We want every child in GM to have the best start in life. This means that every child

grows up in an environment that nurtures their development, derives safety and

security from their care givers, accesses high quality early years services and has a

belief in their goals and their ability to achieve them. Our ambition is that every

child in GM acquires the skills necessary to negotiate early childhood, primary and

secondary school and education and employment. Reform of Early Years services

is essential to increase the productivity and wellbeing of parents and their children

and therefore ultimately economic prosperity in GM.

2.0 WORKING TOGETHER IN GM

2.1. Work undertaken in GM around the Early Years is nationally recognised as an

example of good practice. The Early Years system represents a distinct challenge

due to the diversity of key stakeholders across both child and adult services,

recognising that the majority of children are part of a wider family group. Key

partners include NHS commissioners and providers, schools, early years settings,

community and voluntary sector partners, Local Authority children’s services and

public health teams. Whilst recognising the diverse range of partners, this briefing

will focus on the health contribution to school readiness.

2.2. System leadership of this agenda is rightly shared across the system with clear

commitment to improving School Readiness made in the GM Taking Charge

Strategy, GM Strategy, GM Population Health Plan, GM Start Well Strategy, GM

Mental Health Strategy and the GM children and young people health and wellbeing

strategy. Recently revised governance for this agenda has resulted in the

development of a GM School readiness Board co-chaired by Joanne Roney, Chief

Executive of Manchester City Council and Jon Rouse, Chief Officer GMHSCP.

4

3.0 WHAT IS SCHOOL READINESS?

3.1. School readiness is reported as the percentage of children who have a good level

of development (GLD) at age 5 (the end of the reception year in primary school).

This measure of school readiness at age five indicates that the gap between GM

and England still remains but has narrowed in recent years from 4.4% to 3.2% to

equal the North West average.

3.2. The development of school readiness begins very early in life when children acquire

the social and emotional skills, knowledge and attitudes necessary for success in

school and life. Children who are not school ready may struggle with social and

physical skills, reading, mathematics and speech and communication.

3.3. The percentage of GM children achieving a GLD was 67.5% in 2016-17; therefore

32.5% or 12,150 GM children are not school ready. Of the 12,150 children in GM

that are not school ready each year:

62% are boys.

The GLD rate for girls (75%) is 15 percentage points above the rate for boys

(60%). Across GM the size of the gap varies from 18 percentage points in

Rochdale to 12 in Stockport.

55% live in the 30% most deprived neighbourhoods.

As deprivation increases, the percentage of children achieving a good level of

development tends to decrease.

35% belong to a Black, Asian or minority ethnic group

28% do not have English as a first language.

Nationally, the GLD rate of those whose first language is not English is eight

percentage points less than the rate of those for whom English is a first

language. At 11 percentage points, the GM gap is significantly larger.

23% have Special Educational Needs.

78% (2300 children) of GM SEN pupils do not achieve a GLD. It is estimated

there are a further 450 Statement or EHC children in GM who did not achieve a

GLD, bringing the total to around 2,750.

3.4. Work to reduce the number of children who are not school ready will be based

around the four priority areas identified in the diagram below:

5

4.0 THE GM POPULATION HEALTH PLAN (GMPHP)

4.1. The GMPHP sets out our approach to delivering a radical upgrade in population

health which commits to earlier intervention and prevention to reduce the impact of

illness and disease in later life. At no stage is this more important than the 1001

critical days from conception to age two years. The Start Well programme within the

GMPHP commits to transform the system from expensive and reactive to

preventative and intervening early. The plan aims to support the delivery of

integrated early intervention and prevention services within the Early Years across

all localities in GM with the following specific objectives:

A: Fully implement the core elements of the GM Early Years delivery model

(EYDM).

B: Develop a sustainable, resilient and consistent set of GM interventions to

stopping smoking in pregnancy (investment committed).

C: Implement evidence informed interventions at scale in a targeted and

consistent manner across GM to improve oral health and reduce treatment

costs within 3-5 years (investment committed).

D: Develop IMT proposition to improve data processes to track progress and

allow earlier intervention (additional investment required).

4.1.1. A: GM EYDM:

4.1.1.1. Over recent years a range of partners across GM have worked to develop and

implement a GM Early Years Delivery Model which comprises of 4 key elements:

High Quality Universal Services

6

8-stage assessment pathway A range of multi-agency pathways A suite of evidence based assessment tools and targeted interventions

4.1.1.2. The foundation of the EYDM is high quality universal services offering support to all

families, with more support to those who need it most. When the EYDM is

implemented consistently it will ensure that all children irrespective of where they

live will be assessed for physical, social and emotional health utilising the basis of

the 8-stage assessment pathway. Early Years teams will deliver multi-agency

evidence-based interventions to provide early intervention or address an identified

need. The EYDM has been implemented to varying degrees across GM over the

last few years contributing to a modest improvement in school readiness.

4.1.1.3. Investment has been identified (pending award) via the GMPHP to facilitate the

implementation of the model within localities and support localities where they are

struggling to make progress, this includes supporting families with children least

likely to be school ready, workforce development and antenatal early intervention

and prevention.

4.1.1.4. The antenatal work recognises that becoming a parent is life-changing physically

and emotionally, these changes begin in pregnancy and progress into birth and

beyond. Preparation for parenthood is vital but challenging and difficult to achieve

alone. Antenatal early intervention and prevention work will incorporate evidence-

informed antenatal multi-agency preparation for parenthood (PfP) sessions which

will be co-designed with parents, service providers and commissioners. This work

will connect with the GM work programme which is responding to the national

maternity review ‘Better Births’.

4.1.1.5. Around 26% of babies in the UK are estimated to be living within complex family

situations, of heightened risk where there are problems such as substance misuse,

mental illness or domestic violence. Additional needs are identified for a wide

variety of reasons, for example there is a significant number unborn babies exposed

to high levels of alcohol during pregnancy. These children may experience

preventable life-long disadvantages which are entirely preventable. Work being

developed by the GMPHP and partners intends to ensure that all pregnant women

are asked about alcohol consumption during pregnancy and provided with

appropriate advice and guidance in line with the Tameside Multi-Agency Maternity

Algorithm (MAMA) Pathway.

4.1.1.6. GMHSCP is committed to working with partners to co-produce GM pathways / ways

of working to identify families with complex needs who require additional support

earlier (see appendix 2). Many current pathways are picking up need effectively, but

earlier identification would prevent many problems from escalating. For example

local evidence has shown improvements in identifying speech, language and

communication concerns and an increase in specialist referrals. These referrals

could have been prevented or the severity reduced via genuine prevention

messages in the antenatal phase or via earlier identification.

7

4.1.2. B: Smoke-free pregnancy

4.1.2.1. Smoking is still the biggest single cause of early death and ill health in GM.

Smoking in pregnancy can lead to a low birth weight, an outcome that the GM

Taking Charge strategy committed to reduce. Children born into households where

both adults smoke are four times more likely to take up smoking themselves (three

times more likely for one carer). Smoking in pregnancy is reported as contributing to

an annual loss of nearly 5000 viable pregnancies and the birth of 2200 premature

babies in the UK.

4.1.2.2. Smoking in pregnancy rates in GM are significantly higher than the national average

(13% versus 10.5%. So that every pregnant woman and their family receive

consistent support and advice regardless of where they give birth in GM, it was

agreed to develop a GM approach to stopping smoking in pregnancy. The smoke-

free pregnancy programme received £1.6m investment from the GMPHP and

implementation began December 2017. It will include a standardised smoke-free

pregnancy pathway with investment in workforce development, equipment, and a

targeted intervention aimed at our highest risk populations. Using this approach we

aim to reduce rates to <6% of women smoking at delivery in any locality by 2021

and ultimately for no woman to smoke during her pregnancy. This will be

implemented in all parts of GM during 2018.

4.1.2.3. The work programme covers two aspects:

Smoking cessation in pregnancy delivered via the babyClear model. This

evidence based model requires electronic testing of all pregnant women for

carbon monoxide exposure and referring those with a positive reading to

smoking cessation services. This is being rolled out in three clusters with

implementation in Rochdale, Bury, Oldham and North Manchester from April

2018 with all other areas by September 2018 or earlier.

A smoke-free pregnancy incentive scheme was launched in February 2018

which targets a defined group of vulnerable women living in communities where

smoking rates are highest, and who would find it hardest to maintain a quit

without additional support.

4.1.3. C: Oral health

4.1.3.1. Good oral health is a vital aspect of general health and wellbeing with poor oral

health impacting upon school readiness. In 2015/16 treatment of preventable tooth

decay in children cost GM approximately £20 million, (approximately 10% of the

total annual spend on dentistry). Extraction of decayed teeth under general

anaesthetic is the most common reason for a child aged 5-9 years of age to be

admitted to hospital in England. A child in GM is 60% more likely to undergo this

procedure than an average child in England. The average number of teeth

extracted is 5, but it can be as many as 20.

4.1.3.2. There are approximately 3500 dental general anaesthetics for children each year

due to dental decay; this results in approximately:

8

8777 school or college days lost across GM

3970 sleepless nights for children and families

3598 parent or carer work days lost.

4.1.3.3. A healthy mouth enables children to communicate, eat and enjoy a variety of foods,

socialise and attend school as well as contributing to their self-esteem, confidence

and readiness to learn. Child dental health in the majority of localities within GM

remains poor compared to the England average, both in terms of prevalence (% of

children affected by tooth decay by the age of 5), and severity (the number of teeth

affected). Nationally, thirteen Local Authority areas have been highlighted as

‘priority areas’ by NHS England due to the persistently high levels of dental decay at

5 years old; four of these areas are within GM (Bolton, Rochdale, Salford and

Oldham).

4.1.3.4. The GMPHP has committed over £1.5m to establish a consistent, evidence based

oral health improvement and prevention programme across the four localities of

highest need (Bolton, Rochdale, Salford and Oldham) to reduce the prevalence and

severity of dental decay using the following approaches:

4.1.3.5. Interventions delivered by the Early Years workforce:

From the start of the school year in September 2018 there will be daily

supervised tooth brushing programme in early years and reception school

settings. Support will include training, protocols, equipment and supplies,

including take-home toothbrush and paste packs for school holidays.

Health Visitors are delivering oral health and healthy infant feeding advice and

distributing 1,450ppm fluoride toothpaste and toothbrush packs at 9 month and

2 year reviews.

Interventions delivered by dental services (enhanced service to begin in April

2018):

Integrated oral health and healthy infant feeding advice, plus distribution of high

fluoride toothpaste and toothbrush packs at every child’s first dental visit.

Increase the implementation of twice-yearly application of fluoride varnish for

every child, in accordance with national guidance.

4.1.4. D: Early Years Digitisation Programme: capturing, sharing, storing and

analysing data

4.1.4.1. Why is investing in digital technology important for School Readiness? Put simply,

improved data processes and infrastructure will allow us to spend more time with

the people who really need our help. Good data systems will save time by allowing

us to identify the right people, work alongside them with all the information that we

need, refer them swiftly into appropriate services if they need more help, share

9

information between organisations, track their progress and ultimately make

investment decisions based on what we know really works.

4.1.4.2. The Ages and Stages Questionnaire (ASQ) is a series of age-appropriate parent-

led assessments utilised by Health Visitors and the wider GM EYs workforce to

screen the developmental of children in communication, fine and gross motor skills,

problem solving, and personal-social skills. All ASQ completed by professionals

across GM (and all of the UK) are paper-based due to requirements of the licence

held by the Department of Health.

4.1.4.3. With the support of the Department of Health, GM Connect working with Salford

City Council and Salford Royal NHS Foundation Trust piloted the replacement of a

paper ASQ assessment with a digitised two year old child assessment. This

demonstrated productivity gains of 18% - 30% per assessment. This capacity could

be used to support those families and children in most need of extra support.

Across GM it is estimated that this equates to approximately 250 Health Visiting /

Early Years staff or an equivalent annual investment resource of approximately £9

million.

4.1.4.4. Initial cost estimates indicate that this would require approximately £4.5 million

initial investment with a recurrent annual cost of approximately £400k. Funding was

provisionally agreed at the Reform Board on the 2nd February subject to a full

business case being developed. Significant investment has been allocated to

procure mobile devices for local care organisations from the Health and Social Care

Digital Fund. Of critical importance to this work is the need to be granted

permission from the Department of Health to purchase a UK digital license for ASQ.

4.1.4.5. A parallel initiative to turn historic paper records, which cannot be analysed for

useful information, into digital data which can be analysed is scheduled in Oldham.

This allows unknown information to inform commissioning and delivery. For

example a similar pilot in Bolton identified an unknown association between

mothers self-reported mental health concerns and / or Domestic Violence and

children not achieving development expectations for communication and language.

This GM Connect pilot will digitise 22,000 records to identify the scale of the

opportunity.

5.0 PARENT AND INFANT MENTAL HEALTH

5.1. Mental illnesses affect more than 1 in 10 women during pregnancy and the first year

after childbirth and can have a devastating impact on families. While the incidence

of many mental health disorders does not change in the perinatal period (pregnant

women and new mothers have the same level of risk as other adults), the effects of

these illnesses are likely to be more significant at this critical period in their lives.

However for certain serious mental illnesses – postpartum psychosis, severe

depressive illness, schizophrenia and bipolar illness – the risk of developing or

experiencing a recurrence of the illness does increase after childbirth. Additionally

10-21% of fathers can experience a common mental health disorder in the perinatal

period.

10

5.2. Babies and children need to feel safe, protected and nurtured by caregivers who

identify and respond appropriately to their needs. Unmet attachment needs may

lead to social, behavioural or emotional difficulties, which can affect the child’s

physical and emotional development and learning – and therefore their life chances.

5.3. The argument for intervening early and maximising the impact of change in the first

1001 days of a baby’s life is a compelling one in light of the significant impact

mental health needs have on parents, their children and the wider health and care

economy. Adopting a GM approach to this pathway allows for development of cost-

effective and high quality specialist provision underpinned by consistent and

equitable early intervention and prevention services shaped by and for local

communities.

5.4. The GM Joint Commissioning Board agreed the Perinatal Infant Mental Health

Business Case in November 2017. The importance of the critical days from

pregnancy to the age of two was recognised and £4.35m of GM MH Transformation

funding was committed to establish a GM-wide Specialist Perinatal Infant

Community Mental Health Team. In addition to this the Board requires CCGs to

invest an additional £7.8m recurrently in rolling out the Tameside and Glossop

Parent Infant Mental Health pathway - a whole system approach to identifying and

meeting the needs of parents in pregnancy and the first two years of life. This

requires localities to establish Parent Infant Mental Health Teams and Parent Infant

IAPT (psychological therapies).

5.5. The new integrated Perinatal Infant CMHT service will work collaboratively in GM,

across organisations with parent infant mental health and IAPT services (utilising

existing networks across primary care, maternity and social care) to improve access

for women and their families experiencing mental health issues in the perinatal

period across GM. Greater Manchester Mental Health Trust is progressing the plan

to roll out the service across all GM localities by 2020/21.

11

6.0 ACCESSING HIGH QUALITY SERVICES CLOSER TO HOME

6.1. Primary Care services are delivered in communities’ right across GM within General

Practice, pharmacies, opticians and dental surgeries. Primary Care is at the heart of

the development of neighbourhood hubs. The hubs will provide a range of

integrated health and social care services that previously operated separately on

behalf of local communities of 30,000-50,000 population.

6.2. Along with diverting unnecessary activity from General Practice there is also a

developing GM work programme focusing on reducing unplanned hospital

admissions (for 0-19 years). Within GM, unplanned hospital admission rates for

children with asthma, epilepsy and diabetes has been consistently higher than the

national average for several years. There is a significant relationship between

deprivation and child emergency hospital admissions for both asthma and epilepsy

across England which is also reflected in GM. This work programme includes

piloting the implementation and evaluation of community children’s hubs;

developing consistent pathways for paediatric asthma, epilepsy and diabetes and

developing a framework for preventing avoidable admissions including GP /

Case study: Tameside and Glossop Early Attachment Service (EAS) James was already struggling with anxiety and low mood and had sunk into a deeper depression on discovering his partner of 12 years was pregnant. He was adamant he hadn't wanted a baby and didn't feel ready to be a parent. His work was affected, and his relationship with his partner was strained. He had been referred for therapy to address his depression and anxiety but had begun to feel increasingly suicidal and presented as being at significant risk of harming himself which led to further assessment and risk monitoring by adult mental health services. The EAS took a whole family approach to addressing these issues encouraging him to bring his partner Alice to appointments. With James and Alice's agreement EAS linked up with the adult mental health practitioners and enhanced midwifery team to support them as they prepared for the baby's birth. Working with them as a couple allowed some of the difficult feelings between them to be safely talked about and managed and they were able to discuss plans for the birth and beyond which hadn't been possible previously. Jack was born and both parents were immediately delighted by him and continued to attend sessions together with Jack. Following the birth James and Alice came to understand how aspects of their own early life experiences influenced their feelings about bringing a child into the world and being parents. Extensive work was required to support the family unit, this included sessions with James alone, several antenatal sessions with James and Alice, multidisciplinary case work and contact during the period of time around the birth and finally sessions with James, Alice and Jack in the family home s following the birth. They are now discharged from both Healthy Minds and EAS and are doing well. (All names and identifying details have been changed to protect confidentiality)

12

Paediatrician advice line, observation and assessment units and Children’s

Community Nursing Teams.

6.3. Dental: More than one in every three children in GM has preventable dental decay

before the age of five years. Three key programmes are in place within dental

practices to ensure the proactive dental management of young children:

The Baby Teeth Do Matter Programme seeks to ensure all young children in

GM have access to proactive general dental care by increasing the proportion

of children <5 years who regularly attend a general dental practice, receive

appropriate dental advice and receive fluoride varnish.

The Buddy Practice Scheme aims to bring dentistry and oral health education

to children and their families by developing links between schools, early years

setting and local general dental practices.

The Dental Checks by One Programme is a national programme that aims to

get parents of babies to bring them to the dentist before their first birthday to

provide preventive dental advice, prevent dental problems early & establish a

longer term relationship with dental care.

6.4. Optometry: A multi-agency work programme “See More, Learn More, Go Further”

has been established to increase the uptake of sight tests. This includes working

with schools and their screening partners to develop and embed an awareness

programme to increase awareness of eye care and encourage referral of children

who may be suffering from vision difficulties for sight tests.

6.5. Pharmacy: 18 million GP appointments and 2.1 million visits to A&E are for self-

treatable conditions, at a cost of more than £850 million each year to the NHS. 95%

of people live within a 20 minute walk of a local community pharmacy and the NHS

‘Stay Well Pharmacy’ campaign is a new, national campaign commissioned by NHS

England launching February–March to raise awareness of and promote the use of

community pharmacy for clinical advice for minor health concerns. The principal

target audience is parents and carers of young children under the age of 5 years’

6.6. General practice: childhood vaccinations: Vaccination greatly reduces the burden

of infectious diseases, ill health, disability and death in young children; in fact only

access to clean water performs better in protecting the health of the population. The

childhood immunisation schedule is commissioned by the GMHSCP and delivered

within General Practice. Young children are classified as ‘super-spreaders’ of flu

meaning that uptake of the flu vaccine is essential to protect individual children and

wider family members. It is offered to all children aged two-four years old in General

Practice and four-eight years old in school. Uptake of flu and wider vaccinations is

good across GM as a whole; however improvement is required in some areas. To

protect vulnerable children and families it is essential that all General Practices

meet national targets for childhood routine vaccinations and pre-school flu

vaccinations.

13

7.0 CONCLUSION

7.1. The School readiness implementation plan is overseen by the recently reconstituted

GM School Readiness Board. The work within the plan, along with the GM

Population Health Plan work programmes commit to a two-year programme of

work. Stocktake and engagement work identified that as a GM Health and Social

Care Partnership we need to progress further faster in the following areas:

Identifying families whose children are least likely to be school ready and

delivering intervention and support early (including during the antenatal period).

Improving data capture, storage, sharing and analysis.

Understanding the role, contribution and training requirements of the following

partners:

o Maternity services

o Schools

o Voluntary and Community Sector

o Parents as partners.

7.2. Giving every child the best start in life has been recognised as a key priority of

several national and GM policy documents and the GM Mayor identified it as his

pre-eminent priority. The multi-agency commitment to partnership working across

health, education and social care has led to some positive progress however much

more is required to ensure that the ambition of the GM Strategy to ensure that by

2020, GM will meet or exceed the national average for the proportion of children

who are classed as ‘school ready’.

8.0 RECOMMENDATIONS

8.1. The Greater Manchester Health and Social Care Partnership Executive is asked to:

Note the content of the report and commit ongoing support to the ambition to

increase the number of children who are school ready in GM.

14

Appendix 1: Governance: Children’s Health and Wellbeing system:

15

Appendix 2 Multi-agency targeted pathways (in development )

16

Appendix 3: Measuring progress:

Progress will be measured using a range of indicators that recognises the contribution of a

range of key partners as identified below. Measuring progress is extremely difficult across

multiagency partnerships with progress dependent on digital solutions.

1


Date: 16 March 2018

Subject: Children and Young People Mental Health Progarmme Update

Report of: Warren Heppolette, Executive Lead Strategy and System Development,

GMHSC Partnership

SUMMARY OF REPORT:

The presentation describes the process by which the benefits of the Greater Manchester

Mental Health investment into Children & Young People will be realised through the

implementation of a number of key initiatives.

KEY MESSAGES:

The presentation provides an overview of how the Greater Manchester Devolution agenda

has had a positive impact on the Children Adolescent Mental Health Services (CAMHS)

across Greater Manchester, including illustrating our ambitions and achievements on the

Children & Young People’s Mental Health programme to date.

As part of the presentation we have interviewed a young person, a family member, the

service clinical lead and BEAT (third sector partner). This will be presented as a video within

the presentation exemplifying the co-development principles of the Greater Manchester

Health & Social Care Partnership; which includes working closely with families within the

system, the service provider and third sector partners.

The presentation also demonstrates the application of service transformation that the

Greater Manchester Health & Social Care Partnership is applying to the Children & Young

People’s Mental Health arena to ensure that we deliver on our ambitions and priorities.

PURPOSE OF REPORT:

The presentation provides an update on the Greater Manchester (GM) Children & Young

People’s Mental Health programme, including achievements to date, ambitions and ongoing

priorities.

6

2

RECOMMENDATIONS:

The Health and Care Board is asked to:

note the progress being made across the Greater Manchester Children and Young

People Mental Health programme.

CONTACT OFFICERS:

Warren Heppolette, Executive Lead Strategy and System Development, GMHSC

Partnership

[email protected]

Simon Barber, Chief Executive, North West Boroughs Healthcare NHS Foundation

Trust

[email protected]

0

Children & Young People Mental Health Programme

1

Children & Young People Mental Health Services Facts & Figures

1 in 10 young people have a diagnosable Mental Health condition

Equates to 3 in every classroom of 30 in Greater Manchester

75% of adult Mental illness begins before the age of 18 years

25% of these young people are accessing the right treatment and care

2

Greater Manchester Children & Young People

Mental Health Ambitions Improved access for

Children & Young People to

Specialist Mental Health

services; including priority

area of ADHD

3920 more children are able

to access Mental Health

services

Developing Needs led Mental

Health and Emotional

wellbeing services for

Children & Young People

New Crisis Care models for

Children & Young People &

care closer to home

Local Specialised Eating

Disorder Services from

prevention to community &

inpatient provision

Children & Young People in

need will receive timely

treatment based on need

Improved Mental Health

services for new mums

Women and their

families receive the

right level of help in a

timely manner

3

Children & Young People Mental Health Achievements in 2017-18

Community Eating Disorder Services

Greater Manchester has developed a core offer & standards across 3 GM clusters (West, Central & East)

leading to Improved Access & Waiting times: - All 3 clusters seeing 100% of urgent referrals within 1 week - Central & East clusters seeing 100% of routine referrals within

4 weeks - West cluster seeing 83% of routine referrals within 4 weeks

(all meeting national average )

Crisis Care Development of a ‘Reach-In’ model with multi-agency partners, including Health;

Social Care; Education; Voluntary Sector & Blue Light: Service that provides a needs

led response to crisis

4

Children & Young People Mental Health Achievements in 2017-18

ADHD Greater Manchester wide Care Model introduced to support

the needs of families with Children & Young People with

ADHD needs

Implementing Thrive New care model established to promote

system change - Thrive training hub for the whole Greater Manchester workforce

(including users and carers) to improve service delivery and outcomes across

Greater Manchester

5

Greater Manchester Mental Health Children & Young People Programme Structure – Single System Delivery

Children & Young People Mental Health Board

5 x Non-Transformation Fund programmes:

• Skilled workforce (CYP IAPT)

• ADHD • Eating Disorders

• Transitions (Children services reaching up to 25)

• Mental Health and Youth Justice

4 x Transformation Fund programmes:

• Community-based access and

crisis care programmes • Perinatal and Parent-infant

Mental Health programme (Mother & Baby)

• THRIVE – new models of care • Mental Health support in

School settings

Greater Manchester Mental Health Programme Board

6

Greater Manchester Children & Young People Transformational Programmes Priorities 2018-21

Children & Young People Crisis Care

• Implementation of the Crisis Care model: Community based (including Schools support) meeting the needs of the patient closer to home

• Implementation of 4 Rapid Response teams and 2 Safe Zones across Greater Manchester linked to the localities

• Early help to prevent difficulties from getting worse

iThrive

• Supporting the Children & Young People’s Mental Health & Emotional wellbeing workforce

• Learn to develop and deliver services together as a single system improving outcomes for Children & Young People

• Supporting the Greater Manchester ambition of 1700 more therapists and supervisors by 2020/21

Mentally Healthy Schools

• 6 month Rapid Pilot to deliver Mental Health & emotional wellbeing support to schools

• Raising awareness & improving the schools ability to support young people & their families

• Staff wellbeing & leadership training for teachers

Perinatal and Parent-Infant Mental Health

• Women and their families receive the right level of help

• Swift and easy access to support for new parents and infants – 1680 more women are able to access specialist Perinatal care

• Promoting awareness of parent infant MH to the wider public

7

Government’s Green Paper Transforming Children & Young Peoples Mental Health

Provision

Key Reforms:

1. Mental health leads in every school

2. New teams to support schools meeting children and young people wellbeing and mental health needs

3. Shorter waiting times to getting help

Greater Manchester Response:

Reforms 1&2:

Greater Manchester 6 month Rapid Pilot (Mentally Healthy Schools) is due to demonstrate these two reforms

Reform 3:

Our Greater Manchester plans are driving to deliver the 4 week waiting time standard; whereby we are providing timely support when and where children and those who care for them need it

8

Interviewing Service Providers & Users

Shining a spotlight on the new Greater Manchester Community

Eating Disorder Services for Young People

(video to be presented at the HCB)

9

Greater Manchester Mental Health Children & Young People

Core Values

1

Greater Manchester

Health and Care Board

Date: 16 March 2018

Subject: Dementia United (DU) Update

Report of: Anthony Hassall, Chief Operating Officer, Salford CCG and Warren

Heppolette, Executive Lead, Strategy & System Development GMHSCP

SUMMARY OF REPORT:

The update will demonstrate that DU continues to be a priority for Greater Manchester by

highlighting the need, opportunities and developing work plan to mobilise a strategy and

system response for people living with dementia and those who care for them, aligned to the

Greater Manchester dementia standards.

KEY MESSAGES:

The developing DU work plan is based on the information gathered from the 2017 visits,

engagement and knowledge developed since June 2015 to complement the agreed strategy

(ratified January 2017) and is aligned to the Greater Manchester dementia standards

(ratified September 2016). It considers work already underway in GM that DU can build on,

Utilise and align to.

Accountability of the full programme of activity is the responsibility of the DU Strategic

Board, with mobilisation overseen and driven by the DU Implementation Operations Group.

Both involve people living with dementia and are developing a meaningful involvement

Strategy for carers.

The proposed work plan is being presented for information across Greater Manchester. The

lead in paper explaining the development was presented to the Strategic Partnership Board

Executive on the 28th February 2018. Updates/papers are also being presented at the

following:

Directors of Adult Social Care Services – 8th March 2018

Provider Federation Board – 9th March 2018

The Dementia United Implementation Operations Group - 13th March 2018

7

2

GM Health and Care Board – 16th March 2018

Heads of Commissioning – 28th March 2018

Primary Care Advisory Group – 28th March 2018

Association of Governing Groups – 3rd April 2018

Strategic Partnership Board Executive – April/May 2018

Further engagement and agreement will be made across Greater Manchester as work

develops. At a locality level we will continue to support the development of local

implementation plans and share emerging innovation and good practice.

PURPOSE OF REPORT:

The update gives an outline of progress made, and future plans, for Dementia United (DU) in

developing the work plan covering the period April 2018 - March 2021. The work plan

reflects the findings of work since June 2015 and an intensive intelligence gathering phase

between October and December 2017.

RECOMMENDATIONS:

The Health and Care Board is asked to:

note the content of this report and proposed engagement with GM Governing Groups

and localities;

endorse the direction of travel.

CONTACT OFFICERS:

Rachel Volland – Senior Implementation and Improvement Lead – Dementia United

[email protected]

Geoff Holliday – Project Manager – Dementia United

[email protected]

0

Dementia United Anthony Hassall, Chief Officer, Salford

CCG

1

30,000 people in Greater Manchester are estimated

to have dementia

2

Time for Action

Aims to:

1. Improve the lived experience for

people with dementia and those who

care for them 2. Increase independence by reducing dependence

on health and social care

3. Decrease variation in access to and quality of

services for people with dementia and those

who care for them

3

The journey so far……………………

Description Timeframe

Programme Scoping & Stakeholder Engagement June 2015 – September 2016

Soft Launch November 2015

1st Greater Manchester dementia standards & locality profiles developed

September 2016

Locality programme modelling workshop September/October 2016

Dementia strategy (Dementia United) developed and reviewed through the GM Health and Social Care Partnership governance system

December 2016 – January 2017

Application submitted to the GM Transformation Fund March 2017

Implementation planning and engagement underway July 2017

Locality engagement visits October – December 2017

Work plan development January – March 2018

3

0

m

o

n

t

h

s

4

Why is it important?

5

Richness is already amongst us Greater Manchester already has a lot to celebrate for people affected by

dementia, to name a few……..

• Bolton – Dementia Friendly Communities & mystery shoppers

• Bury - Dementia Advisers and Age Concern offering advice on Power of Attorney

• HMR – Oasis Unit

• Manchester - Dementia Support Advisors link-up with Alzheimer’s Society

• Oldham – Dignity champions programmes working with care homes

• Salford – Delirium screening work

• Stockport - Services and Groups for Less Common Forms of Dementia

• Tameside - The Digital-Health support offer to Care Homes

• Trafford - Dementia in those with Learning Disabilities

• Wigan - Healthy Living Pharmacy Programme

https://www.youtube.com/watch?v=y2aXI9KVh-k&feature=youtu.be%3Chttp%3A%2F%2Fsrhtsophep1.srht.nhs.uk%3A32224%2F%3FdmVyPTEuMDAxJiY5MDZjNWYxMzk2NTY3MGNiYT01QTk4MzFCMV83Njg4Ml8zOTAzXzEmJjc4YzVmYTdiMjgzYTFmNT0xMjIyJiZ1cmw9aHR0cHMlM0ElMkYlMkZ3d3clMkV5b3V0dWJlJTJFY29tJTJGd2F0Y2glM0Z2JTNEeTJhWEk5S1ZoLWslMjZhbXAlM0JmZWF0dXJlJTNEeW91dHUlMkViZQ




6

But…there is much more to do

This is society’s challenge and everybody’s responsibility

We can and will make change to improve the lives of those affected

by dementia

Dementia United aims to support Greater Manchester to make the

changes it requires and desires

7

2018/2019

Lived Experience Barometer

Mild Cognitive Impairment

Black, Asian and Minority Ethnic support

End of Life Care

2019/2020

Dementia Navigators

Care Homes

Prevention

2020/2021

Dementia Friendly Transport system

Young onset dementia and rarer forms of

dementia

2021/2022

Transition to GM ownership of programmes

Work Plan Development

Community Support for people living with dementia and those who care for

them

Data and Information

Harnessing innovation

Programme Management, Shared Learning and Evaluation

Involvement of people living with dementia and carers

V4 21022018

8

Lived Experience Barometer Objective: Develop, test and implement the primary mechanism through which the GM system will establish its ‘big conversation’ with people living with dementia in GM to establish mechanisms to improve the lived experience. Delivery: GM level: Develop Barometer specification and tender for a delivery partner.

Mild Cognitive Impairment (MCI) Objective: Develop and agree a near cost neutral care pathway for diagnosis and support for those with MCI Delivery: GM Level: Sharing current best practice and implementing at a Locality level.

Black, Asian and Minority Ethnic (BAME) Communities Objective: Increase diagnosis and support for BAME communities who find our services hard to access. Delivery: Local Level: community and service delivery partnership.

End of Life Care (EOLC) Objective: Supporting People Living With Dementia (PLWD) at the end of life to ensure quality of life by relieving discomfort or distress Delivery: GM Level: Development of and adherence to Advanced Care Planning for PLWD.

Work Plan Development 2018/19

9

Dementia Navigators Objective: Supporting quality of life for PLWD through community and day to day activities; reducing the need for medical interventions where possible Delivery: Local Level: Locality based learning from experience to be shared across GM.

Care Homes Objective: Reduce variation in equity and quality of Care Homes for PLWD across GM Delivery: GM Level: Sharing current best practice and implementing at a Locality level.

Prevention Objective: Reduce preventable dementias across GM and increase health for PLWD and MCI Delivery: Local Level: Locality based learning from experience to be shared on across GM.


10

Dementia Friendly Transport System Objective: Enabling PLWD to remain engaged with their community Delivery: GM and Local Level: Engaging with PLWD to critique and design dementia friendly systems and implementing at a GM and locality level.

Young Onset and Rarer Forms of Dementia Objective: Develop and agree a care pathway for diagnosis and support for those with Young Onset and Rarer Forms of Dementia Delivery: GM Level: Sharing current best practice and implementing at a Locality level.


11

Questions? And

Thank you

@dementiaunited

1


Date: 16 March 2018

Subject: Update on Cancer Work

Report of: Richard Preece, Director of Quality, GMHSC Partnership

SUMMARY OF REPORT:

This report provides an update on cancer across our Greater Manchester network. The first

part of the report gives an overview, some key data with associated commentary and

outlines future priorities. The second part, as an appendix, is the 2017 Cancer Report of the

Greater Manchester Cancer Board (published 9th Feb 2018) which outlines many of the

signature programmes in more depth.

KEY MESSAGES:

Good progress is being made against the targets described in the 4-year GM cancer plan of

Feb 2017 and also the cancer related aspects of the NHS planning Guidance. The current

highest priorities relate to delivering accelerated pathways in lung, colorectal, prostate and

upper gastrointestinal cancer, alongside specific additional work in lung cancer, and delivery

of the recovery package. A wide variety of programmes are currently in place.

PURPOSE OF REPORT:

The report provides assurance to the Health and Care Board of the current progress.

RECOMMENDATIONS:

The Greater Manchester Health and Social Care Partnership Executive is asked to:

Note the progress made across the GM Cancer system

Endorse the current approach and priorities

8

2

CONTACT OFFICER:

David Shackley, Medical Director, Greater Manchester Cancer

[email protected]

Claire O’Rourke, Lead Nurse, Greater Manchester Cancer

[email protected]

3

1.0 OVERVIEW

1.1. In February 2017, the devolved health and care system agreed a comprehensive

plan for cancer across Greater Manchester (https://gmcancer.org.uk/the-plan/) –

the first such system-level cancer plan in the UK. This set out high level ambitions

and detailed programmes of work for the period 2017-2021.

1.2. Building on previous activities, this ambitious plan hopes to bring curative treatment

to an additional 1,300 people by 2021, and deliver huge benefits in other outcomes,

patient experience and the streamlining of care (key objectives set out in 1.9). To

achieve these objectives, Greater Manchester Cancer is overseeing a broad

range of projects covering the whole pathway from prevention through to palliative

and end-of-life care.

1.3. Greater Manchester Cancer was formed in late 2016 and represents a fully

integrated cancer system across Greater Manchester and Eastern Cheshire.

People affected by Cancer (many trained and mentored), NHS professionals,

locality leaders, academic researchers and the third sector come together within

this framework to create a single approach with this facilitating coordinated action.

The system is overseen by the Greater Manchester Cancer Board.

1.4. Greater Manchester has been recognised nationally and internationally as a system

leader for cancer. Along with our London partners, since 2016 we have come

together as the National Cancer Vanguard, designing and testing new models of

care for cancer patients before a broader rollout across England, bringing many

millions of pounds of extra investment into GM. The projects we have developed as

part of this programme have delivered some notable successes. For example,

Greater Manchester Clinicians have co-led work in describing the best practice

guidance for 4 common cancers in cancer diagnosis/ treatment, now embedded in

the latest planning guidance from NHS England.

1.5. In a further acknowledgement of the cutting edge nature to the Greater Manchester

approach, in late 2017 we received a delegation from the Netherlands wanting to

replicate some aspects of our system approach to cancer especially how we benefit

from our clinical networks of specialists, people affected by cancer and have a city-

wide coordinated cancer plan. Through national and international connections,

in cancer care and especially research, we are increasingly able to drive

improvements for patients.

1.6. To continue to deliver on the Greater Manchester Cancer Plan, additional resources

and energy are needed as the National Vanguard Funding draws to an end. A

preliminary sum of £10 million of transformation funding is being considered from

the GM Transformation Fund to facilitate the on-going delivery of the GM Cancer

Plan with a considerable amount of work now underway. Additional resources

(monetary and other) to support the programme continue to be made available from

locality, provider, third sector and other sources.

https://gmcancer.org.uk/the-plan/

4

1.7. Detailed programmes of work for the period 2018-2021 are being finalised,

subject to approval by the Greater Manchester Cancer Board with both a GM-wide

and locality based approach being used as appropriate.

1.8. It is recognised that a number of other GM HSCP work programmes will facilitate

improvement in patient outcomes for cancer notably the population health and

theme 3 and 4 work streams. On-going close liaison with such work will be pivotal in

preventing cancer, embedding new single services and adopting digital

transformation programmes.

1.9. The 6 headline ambitions set out in the GM Cancer Plan 2017-21 are:

We will reduce adult smoking rates to 13%

We will increase 1-year survival to 75%

We will prevent 1300 avoidable cancer deaths

We will offer class-leading patient experience consistently achieving over 9/10

in the National Cancer patient Experience Survey from 2018

We will consistently exceed the national target for starting treatment within 62

days of an urgent cancer referral

We will ensure the recovery package is available to all patients reaching

completion of treatment by 2019

The progress against these measures is outlined below.

2.0 HEADLINE CANCER DATA, PERFORMANCE & COMMENTARY

2.1. Adult Smoking Rates

2.1.1. The GM HSCP through the population health domain have agreed and started

implementation of the tobacco control plan. Strong links exist between the lung

cancer clinical community and the population health group with joint working in

many areas.

2.1.2. Excellent progress was made in the last 12 months, with the smoking rate within

GM & EC falling from nearly 20 per cent of adults to the current rate of just over 18

per cent – this means more than 31,000 people in Greater Manchester have given

up smoking in the last year, much higher than the long-term quit rate of 10,000 per

annum.

2.2. Survival Data

2.2.1. In 2017, 150 more patients are estimated to be living with cancer for a year or

longer, compared with 2016. Greater Manchester cancer patients now have a much

higher chance of surviving cancer than previously: since the start of the millennium,

5

patients’ outcomes have improved such that over 2,000 more people are living a

year or longer after diagnosis.

2.2.2. In 2000, the number of patients surviving a year or more after a cancer diagnosis

was 57%. At that point Greater Manchester was 3% behind the national figure of

60%.

2.2.3. Since then, Greater Manchester has continued to close the gap and the latest

predictions suggest that for patients diagnosed in 2018, the survival for GM patients

will match the England average, before exceeding the national rate if current trends

continue. This success against a backdrop of Greater Manchester historically

scoring poorly on population-based measures of health shows that our cancer

treatments are very effective.

2.2.4. The latest 1 year cancer survival data is from patients diagnosed in 2015 followed

up to the end of 2016, with the figure for GM & EC being 71%. The trajectory and

additional programmes we will put in place mean that we are on target to reach one

of our main objectives of more than three-quarters of patients surviving at least a

year after cancer diagnosis by 2021.

2.2.5. The most effective ways to improve cancer survival are via earlier detection of the

disease, and more rapid treatment. Where targeted screening approaches can be

used, they are often highly effective as screening most often (in >80% of cases)

detects early stage, often ‘curable’, disease. GM are developing more sophisticated

cancer screening services, and working closely with our research community to

facilitate personalised approaches to screening for cancer.

2.2.1 The most effective ways for GM to reduce our rates of cancer are to focus on

prevention strategies as outlined in the GM population health plan. The lifestyle

factors which lead to diabetes, dementia, heart and respiratory disease are also

shared in cancer. Cancer Research UK has calculated that 42% of cancer cases can

be prevented by leading a healthier lifestyle. Smoking and excess bodyweight are the

2 biggest preventable causes of cancer in GM.

6

2.3. Stage at Diagnosis Data

2.3.1. One of NHSE’s national cancer objectives is to increase the percentage of cancer

patients diagnosed with early disease (so called stage 1 or 2) cancer to 62% by

2021. The reason for this is that the survival rates for patients diagnosed with earlier

disease are so much better. Over 90% of patients with early stage disease survive

1 year after diagnosis, and approaching 75% survive 5 years. In patients with

advanced disease (stage 3 or 4) the survival percentages are much lower at 50% (1

year) and 25% (5 years).

2.3.2. To significantly increase survival, it will therefore be necessary to diagnose patients

at an earlier stage – any positive movement in terms of more patients being

diagnosed at an earlier stage is therefore likely to indicate a step up in survival

figures in subsequent years.

2.3.3. We have made significant progress in this area over the last 3 years. In patients

diagnosed in 2014, early stage disease was diagnosed at presentation in 49%. The

latest data from 2016 patients was 55%. If this trajectory is maintained we will hit

the national target ahead of schedule. It is noteworthy that we were behind the

average England figures in data from patients diagnosed in 2014 data, and have

now moved over 2% ahead.

2.3.4. The picture is mixed however. The latest data from early 2017 looking at the

percentage of patients diagnosed as an emergency (a proxy for advanced stage) is

still higher than England (20% vs 19%). Good progress has however been made on

this measure with the GM & EC performance at 24% five years ago, further

evidence that GM is improving faster than other systems.

2.2.2 Estimation of additional lives saved: The Vanguard intelligence team have made

some calculations based on the assumption that treatments remain at the same level

of effectiveness as now. If the current trend in terms of earlier stage at diagnosis is

maintained and an 8% improvement is noted in stage 1 or 2 diagnoses by 2021, this

would equate to approximately 3000 more patients living at least 1 year following

diagnosis, and over 2500 patients living at least 3 years.

2.4. Patient Experience

2.4.1. The National Cancer Patient Experience Survey is published annually and gives the

most reliable benchmark measure of patient experience across England. This

survey has 50-70 questions and provides considerable detail. It has some

limitations as it does not include patients receiving out-patient cancer treatments for

example. The overall rating of care is the final question. Our ambition is to reliably

achieve over 9/10 as a system from the 2018 survey. The 2016 survey (data

published late 2017) showed we were just ahead of the England average at 8.8,

with progressive improvement being demonstrated across previous years.

7

2.5. Cancer Waiting Times

2.5.1. Patients travel into the GM Health and care system from surrounding Cheshire

areas especially East Cheshire and also to some extent Mid Cheshire. The GM

Providers look at the Cancer Waiting Time performance across this whole system

and the data represents the experience for patients being treated within Greater

Manchester rather than just living within Greater Manchester. The average (median)

time for a GM patient to be treated for their cancer from GP referral is now 44 days.

2.5.2. Greater Manchester Cancer continues to be the leading cancer alliance in England

in terms of achieving the national Cancer Waiting Times (CWT) targets. Over the

last three years, despite a growth in suspected cancer referrals of just under a third,

we have continued to treat patients in a timely manner despite a backdrop where

England as a whole has continued to fail the waiting time target

2.5.3. Continuing to meet the 8 CWT targets in an era of growing referrals and limited

resource does however remain an enduring challenge, even though GM are

undertaking all 10 of recommended national high impact interventions in this area.

Several of our localities do not, taken individually, currently meet the 62 day

performance target of 85%. Two processes (outlined below) have been put in place

to substantially improve times from referral to treatment.

2.5.4. In the last 6 months, a comprehensive clinically-led review of the Providers CWT

processes and performance has been undertaken and from this work, a series of 12

additional recommendations and system/ trust-level actions have been approved by

the system in January 2018 which should significantly reduce patient waiting times

for treatment. These include some new internal targets, a GM diagnostic

dashboard, greater clinical involvement including GM-level networking and more

coordination / communication between elements of the system.

2.5.5. National clinical agreement about the best practice timed pathways (or ‘accelerated

pathways’) has now been agreed (Feb 2018) in 4 common cancers where delays to

treatment are often seen (lung, bowel, upper gastrointestinal and prostate – these

representing 1/3rd of cancer referrals), work co-led by GM clinicians. These

accelerated pathways substantially cut cancer waiting times down by using same

day and often shared diagnostics between providers, same day ‘hot’ reporting of

8

tests, the use of ‘pathway navigators’ and streamlined MDT meetings. During the

implementation and embedding of these accelerated pathways locally, we will adopt

the models to improve the pathways in other cancers. The operational delivery of

these pathways is our highest priority as our patients say that delay in diagnosis

and treatment is their biggest concern.

2.6. Summary of Progress Against 2018/19 NHSE Planning Guidance

2.6.1. Published Feb 2018 (Cancer related aspects)

Achieve all 8 waiting time standards; all 10 high impact interventions

implemented – ACHIEVED to date

Support the implementation of a new radiotherapy service specification – still to

be formally announced – ON TRACK

Implement Nationally agreed accelerated pathways in lung, colorectal and

prostate cancer – FORMS PART OF HIGH PRIORITY WORKSTREAMS THIS

YEAR

Preparing for new 28d cancer diagnosis measure (patient told cancer yes or

no) – ON TRACK.

Progress towards the 2021 ambition of 62% of cancer patients being diagnosed

at stage 1 or 2 – ON TRACK (see 2.3)

Support roll out of new bowel screening tool (FIT) 2018/19– ON TRACK with

national programme

By 2021, all breast cancer patients will have stratified follow up pathway – ON

TRACK

Participate in offering low dose CT scanning based on an assessment of lung

cancer risk in CCG’s with the lowest lung cancer survival – ON TRACK;

national work based on GM pilot (see 2017 report in appendix for details)

3.0 CURRENT HIGHEST PRIORITIES

3.1. A number of cancer programmes have been developed from the GM cancer plan.

These have been developed through various sources including our clinical network

of specialists, the National Cancer Vanguard, and the relationships and cancer

ambitions of patients, 3rd sector partners, commissioners and providers. Many of

these programmes are in progress and a number need to be commenced in the

near future. These programmes need to be prioritised to ensure those with the most

impact are delivered first

3.2. Greater Manchester is on track against the latest NHSE planning guidance and

focus should be placed on programmes of work that impact most against our core

objectives (1.9)

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3.3. The further development and implementation of the 4 accelerated pathways

remains our highest priority in 2018/19. These are lung, colorectal, upper

gastrointestinal and prostate cancer. Preliminary analysis of the impact in LUNG

cancer suggests that moving from the 62 day referral to treatment pathway to a 28

day pathway could save 200 lives per year due to earlier diagnosis and quicker

treatment. On-going and improved delivery against the 62 day standard remains a

core priority

3.4. Lung cancer remains the biggest cause of premature death in Greater Manchester

(data showed for premature deaths in GM 2011-13).

3.5. A particular focus on lung cancer is pivotal to GM transforming its cancer outcomes.

3.6. In addition to the accelerated pathway (3.3), as 80-90% of lung cancer is caused by

smoking, it remains critically important that the tobacco plan is delivered. If the

secondary care CURE* pilot of 2018 is successful and mirrors the experience

from Canada where it was extensively evaluated, then this programme should be

rolled out to all NHS Providers in late 2018/ 2019. (* This project aims to have a

very active tobacco smoking quit programme offered to all patients admitted to

hospital and could lead to a 40% reduction in the risk of death at 2 years in this

cohort.)

3.7. Finally in lung cancer, further roll out, planning and evaluation of the lung health

check work (lung cancer screening) to North Manchester (in 2018) and in time to all

of GM (2018-20) which has the potential to save hundreds of lives from lung cancer.

3.8. From the moment they are diagnosed, patients benefit from a recovery package

(RP) receiving personal care and support. Developed alongside their care team, the

RP provides a comprehensive plan that not only outlines their physical needs but

also identifies other support they may require including help at home, psychological

and financial advice. In GM we aim to implement the 4-stage RP by 2019, a year

before the national target for full adoption. Implementation of the RP requires

considerable coordination across the system and is a current high priority. Once in

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place, it facilitates bespoke after care arrangements and other improvements to

care.

3.9. Other work-streams included in the GM Cancer plan, and outlined in the 2017

report (attached) will continue to be developed and implemented. The GM Cancer

users involvement programme ensures that patients play a pivotal role alongside

health professionals in shaping cancer services.

4.0 SUMMARY OF ACTIVITY IN 2017 – SEE APPENDIX

5.0 RECOMMENDATIONS

5.1. The Greater Manchester Health and Social Care Partnership Executive is asked to:

Note the progress made across the GM Cancer system

Endorse the current approach and priorities

1

Greater Manchester Cancer: Review of 2017Part of Greater Manchester Health and Social Care Partnership

Greater Manchester Cancer

Review of 2017

3

Greater Manchester Cancer: Review of 2017

page 2Foreword

page 4Prevention and screening

page 8Early diagnosis

page 10Improved and standardised care

page 16Living with and beyond cancer

page 18

Governance and accountability

page 19Patient experience and service user involvement

page 21Research

page 24Education

Contents

This review has been produced by Greater Manchester Cancer:

gmcancer.org

@GM_Cancer

[email protected]

0161 918 2087

32

Greater Manchester Cancer: Review of 2017Greater Manchester Cancer: Review of 2017

Foreword

In late 2016, a fully integrated cancer system across Greater Manchester and Eastern Cheshire came into being. Known as Greater Manchester Cancer, it brings together the knowledge and skills of cancer specialists and allows focused and coordinated improvement work to take shape.

Greater Manchester Cancer is part of the new devolved health and care system for Greater Manchester. Our vision is simple: we want to achieve world-class outcomes and experience for the people of Greater Manchester.

In January 2017, the devolved health and care system agreed a comprehensive plan for cancer across Greater Manchester. This plan gives a local focus to the framework provided by the national cancer strategy, Achieving world-class cancer outcomes. Building on previous activities, this ambitious plan hopes to bring curative treatment to an additional 1,300 people by 2021, and deliver huge benefits in other outcomes, patient experience and the streamlining of care. To achieve these objectives, Greater Manchester Cancer is overseeing a broad range of projects covering the whole pathway from prevention through to palliative and end-of-life care.

We work with many partners to achieve our goals, including, most importantly, a large number of people affected by cancer who are integrated into all our projects and boards, and who receive mentoring and training to help us design services around their needs. Our system ensures all voices are heard, including

all providers of cancer care (hospitals, primary care, community and social care), public health, councils, commissioners, the universities in Greater Manchester and the charitable or third sector.

Working as a system has enabled us to make more effective progress. In 2017, 150 more patients are estimated to be living with cancer for a year or longer, compared with 2016. Greater Manchester cancer patients now have a much higher chance of surviving cancer than previously: since the start of the millennium, patients’ outcomes have improved such that over 2,000 more people are living a year or longer after diagnosis.

We have also made great progress in terms of patients presenting earlier with their disease, and hence having a greater chance of cure. Over the last five years, for example, the proportion of patients presenting as an emergency (with more advanced cancer) has reduced from 24 per cent to less than 20 per cent.

In 2017, we were able to present very exciting work on developing lung cancer screening that showed a huge benefit by targeting patients more effectively. The pilot project illustrated that more than 750 lung cancer patients could be diagnosed much earlier at a curative stage and therefore fully treated if the screening were rolled out in full across Greater Manchester. This work has earned international recognition and plans are in place to expand the programme nationally.

Around 16,000 people in Greater Manchester are diagnosed with cancer every year. People in the area have a greater chance of getting cancer than the national average. Around 800 fewer people in Greater Manchester would have the disease if our incidence of cancer were the same as the England average. Despite this, our patient outcomes and system performance are in many areas among the very best.

The annual National Cancer Patient Experience Survey published in 2017 shows that we continue to have better feedback than comparable city regions, with an average rating of 8.8/10 for our cancer care, and we continue to improve year-on-year.

In prevention, we have seen a three-fold increase in people giving up smoking in the last year, with 31,000 fewer adults smoking tobacco. As lung cancer is the biggest killer in Greater Manchester, this is excellent news and will save many lives in future years.

Greater Manchester also continues to be the leading cancer alliance in England in terms of achieving the national Cancer Waiting Times. Over the last three years, despite a growth in suspected cancer referrals of just under a third, we have continued to treat patients in a timely manner despite a backdrop where England as a whole has continued to fail the waiting time target.

Greater Manchester has been recognised nationally and internationally as a system leader for cancer. Along with our London partners, we have come together as the national Cancer Vanguard, designing and testing new models of care for cancer patients before a broader rollout across England. The projects we have developed as part of this programme have delivered some notable successes. This year we also received a delegation from the Netherlands wanting to replicate some aspects of our system approach to cancer.

Despite these successes there remains huge ambition to transform cancer care across the whole of Greater Manchester. This review highlights the progress we have made in the last year, and looks forward to continuing improvements.

Richard Preece

Chair of the Greater Manchester Cancer Board

Dave Shackley

Medical Director of Greater Manchester Cancer

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Prevention and screening

Cancer ChampionsThe cornerstone of our prevention work is a movements to recruit 20,000 Cancer Champions across Greater Manchester. This is a unique and revolutionary initiative that aims to mobilise communities to take control of their own health and wellbeing. Cancer champions are individuals who share cancer prevention and early detection messages among their families, friends and colleagues, encouraging people to take an active role in their health and wellbeing.

Led by the third sector, the project has the potential to be a truly radical way of driving real change in our communities and has gained powerful insights into the priorities communities feel are important for improving

cancer prevention. Officially launched in January 2017, we now have more than 2,000 Greater Manchester cancer champions.

We have developed a digital platform which will support this movement by helping cancer champions broaden their knowledge, improve access to information and enrich their social networks. The platform – https://www.icangm.co.uk/ – will also support people who have already received a cancer diagnosis by providing a directory of organisations, services and resources for people living with and beyond cancer.

Research shows more than 40 per cent of cancer cases are preventable, which means that some 6,000 of the 16,000 cancers diagnosed in Greater Manchester and Eastern Cheshire each year could be avoided. This is why we have devoted significant resources to cancer prevention and early detection.

SmokingSmoking remains the largest single cause of cancer in Greater Manchester, representing half the preventable cases and we have launched an ambitious plan to reduce smoking at a pace and on a scale greater than any other major city region in the world. We plan to reduce adult smoking rates from the 20 per cent it was in 2015, to 13 per cent by 2021. By 2027 we aim to make smoking history altogether, delivering a tobacco-free generation and reducing adult prevalence to less than five per cent.

Excellent progress was made in the last 12 months, with the smoking rate falling from nearly 20 per cent of adults to the current rate of just over 18 per cent – this means more than 31,000 people in Greater Manchester quit smoking in the last year, much higher than the long-term quit rate of 10,000 per annum.

The success of Greater Manchester’s Making Smoking History strategy depends in part on gaining insights into the behaviour and attitudes of smokers. Our Vanguard Innovation programme over the last 18 months has funded various projects to give us a much clearer picture of the obstacles

to quitting among our smoking population. We used this understanding to amplify the national Stoptober campaign.

Our delivery is building pace in 2018, with an integrated multi-media smoking quits campaign, Don’t Be The 1, and the introduction of the CURE stop smoking programme, involving hospitals and the community. The CURE programme involves a series of evidence-based steps starting in hospitals, proven to support long-term quits, and builds on innovation just reported in Ottawa, Canada. This could save many hundreds of lives each year if the benefits seen in Canada are translated to Greater Manchester.

People across Greater Manchester are being invited to become history-makers and take part in a conversation and survey about our plans to deliver a tobacco-free future, breaking an inter-generational cycle of tobacco harm.

Cancer Research UK has also worked to urge all 10 local authorities in Greater Manchester to sign up to the Local Government Declaration on Tobacco Control – a statement of commitment made to prioritise tobacco in public health work, and to deliver comprehensive action on tobacco locally.

Cancer champion Gilbert Morgan, who was diagnosed with prostate cancer in 2014, helps raise awareness about the disease

One in every two smokers will die from a smoking related illness.

Don’t be the one.

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7


ScreeningScreening plays a vital part in the early detection of cancer, allowing the detection of disease at an earlier stage when it is most often curable.

In Greater Manchester more than 300,000 people access bowel, breast and cervical cancer screening annually: the number of people who have had a cancer detected by screening has almost doubled over the last 10 years. However, historically Greater Manchester has a lower uptake of cancer screening compared with other places in England. There are many reasons for this.

To try to improve screening uptake, we have used the latest theories about behaviour to

test and inform the content of the letters that invite people to cancer screening. We expect this work to improve uptake, especially among those people least likely to participate in screening.

We are working with those organisations that provide screening to better understand why some patients do not attend appointments. We want to ensure appointments include experiences that patients feel should always happen, improving the individual’s experience of screening. We also want to identify ‘teachable moments’, specific events or circumstances that could increase the likelihood of someone changing their behaviour and ultimately reduce their risk of preventable cancer. In addition, we always look to learn from best practice elsewhere to drive improvement.

Bowel cancer screening uptake continues to be below the national average in Greater Manchester, with large variations in uptake across different demographic groups and populations. We commissioned in-depth qualitative insight to better understand our population and address their barriers to engagement. We have developed a bespoke ‘Get-Talking Bowel Spoken Word Toolkit’ which enables individuals, cancer champions and healthcare professionals to influence those least likely to engage and motivate them to participate.

Lung Health Check PilotA lung health check project, offering smokers and ex-smokers free health checks and scans in supermarket car parks, is already saving lives in Manchester.

In a unique experiment in an inner-city area, the lung health check pilot scanned more than 2,500 people in several areas of Manchester where smoking levels are high, and discovered many cases of very early treatable disease. In lung cancer it is rare to find people with early disease and average survival rates are very low compared to other cancers.

The pilot screening project demonstrated that 80 per cent of the 42 cases of new lung cancer, diagnosed from 14 GP practice areas, were early-stage diagnoses and thus curable.

The results have drawn international interest, with NHS England wanting to support an expansion of this pilot across England in 2018 and beyond. We are exploring the feasibility of expanding the lung health check work across Greater Manchester. We aim to identify more cancers early enough to be treated.

The pilot was funded by Macmillan Cancer Support and Manchester Health and Social Care Commissioning (MHCC) through the Macmillan Cancer Improvement Partnership (MCIP). It was devised and implemented by Manchester University NHS Foundation Trust (MFT) and MCIP and underpins the importance of collaborative working across

the healthcare sector. A significant research study ran alongside this pilot - please see p25

Michael Brady (pictured), aged 64, was one of those diagnosed with lung cancer. He said:

‘They told me I had early-stage lung cancer but because they caught it early, my doctor said they could treat it and told me not to worry. This lung scan saved my life. I could have gone for two or three years without realising but thankfully they have caught it at the right time.’

Practice Cancer ChampionsA separate Cancer Research UK project is delivering an education and training programme called Practice Cancer Champions. This is for non-clinical staff in GP surgeries across Greater Manchester, equipping them with knowledge about cancer prevention, risk factors and the importance of screening.

More than 110 practices now have a Practice Cancer Champion where they lead on delivering evidence-based interventions to improve the uptake of screening. Examples of the benefits include identifying and contacting people who have not responded to bowel screening opportunities, or helping patients understand how to complete the bowel screening kit. Further training sessions are planned in 2018 to develop more expertise in cancer within GP surgeries.

Faster diagnosisA successful scheme took place earlier this year to test a faster diagnosis clinic that aims to limit to seven days the time between a GP referral and a cancer diagnosis. The clinic – a multidisciplinary diagnostic centre – brings together under one roof a number of cancer specialists and offers patients a range of investigations to deliver a speedy diagnosis. A pilot project at Withington Community Hospital identified a number of cases of cancer more quickly than if the patients had followed a conventional pathway. On average, patients received their diagnosis more than two weeks sooner than normal. It also gave peace of mind to those individuals who did not have cancer.

Greater Manchester is one of five national pilot areas for an initiative known as ACE – Accelerate, Coordinate, Evaluate – that also aims to improve early diagnosis performance. The ACE project is being piloted at the Royal Oldham and Wythenshawe hospital sites and has been funded initially by NHS England, Cancer Research UK and Macmillan Cancer Support. It is aimed at patients with non-specific but concerning symptoms. The project involves GPs carrying out a series of tests before referring to a specific clinic where same-day investigations and results are available.

The first six months have been very encouraging: the average referral to diagnosis rate is 20 days, against the forthcoming

national 28-day standard (to be adopted by 2020). On the Oldham site, more cancers were diagnosed than would normally be seen on initial referral. The pilot is being nationally evaluated and an interim report is expected in March 2018.

We have also had considerable success with another project in Bolton. It focuses on three types of cancer – upper gastrointestinal (GI), lower GI and lung – and aims to give patients a confirmed diagnosis or exclusion of cancer within 28 days of a referral from a GP. This is achieved by fast-tracking patients with concerning symptoms straight to tests which confirm whether or not they do have cancer.

Patients diagnosed with cancer as an emergency have a much worse outcome than patients diagnosed via a managed pathway. Through our early detection and diagnosis plans, Greater Manchester Cancer and partners are seeking to reduce the number of people diagnosed by this route.

To help us make improvements, Cancer Research UK is working with CCGs, Macmillan GP leads and individual general practices to encourage doctors to reflect on the patient’s journey in such cases by completing a Significant Event Analysis (SEA). This work has helped identify areas to improve. Projects such as this have led to the marked reduction in patients being diagnosed with cancer after an emergency presentation.

Early diagnosis

While cancer survival is improving, England still lags behind other comparable countries, remaining about 10 per cent lower than the European average.

9

Greater Manchester Cancer Vanguard: Annual Report 2017

8


Laurence Smythe, from Hale, was treated at a multidisciplinary diagnostic centre after

complaining of stomach pains. He was given peace of mind after an infection was diagnosed, an outcome he described as ‘absolutely joyful’.

Early detection of cancer greatly increases the chances for successful treatment and is, therefore, key to improving our cancer survival rates. One of the principal reasons for the UK’s lower survival rate is that many cancers are not diagnosed early enough. As such, we have launched a series of initiatives to improve the numbers of cancers diagnosed at an earlier stage. These focus on encouraging people to visit their GP as soon as possible, ensuring the timely referral of suspected cancer, and rapid access to high-quality and responsive diagnostic and treatment services.

We are developing an innovative online system to allow individuals to refer themselves to a GP for further investigations for suspected cancer. This patient self-referral platform, which is being developed in conjunction with the University of Manchester, allows individuals, with appropriate supervision, to assess their symptoms and if necessary refer themselves to a family doctor.

Users of the system answer a series of questions and a computer formula then calculates the likelihood that they may have cancer and hence the need, or not, for a GP assessment. The system aims to help overcome some of the barriers that prevent people contacting their GP. For users who don’t have significant symptoms, the programme can also calculate the individual’s risk of developing cancer in future and offer realistic lifestyle advice. A pilot scheme to test the project is under way.

Progress in pathologyWe’ve embarked on a project to test out the latest technology in cancer pathology. The scheme explores the benefits of digital pathology, also known as virtual microscopy. This innovative technology is based on capturing digital images of tissue samples.

Currently, pathologists - doctors who make decisions on the type and nature of the cancer by reviewing biopsies - examine samples on glass slides under a microscope. If the specialist needs a second opinion, the slides typically have to be transported to another site.

The technology being trialled allows a digital image to be shared among specialists, regardless of their location, so they can reach a diagnosis more quickly. Broad adoption of this technology in future will put Greater Manchester in a position where it can benefit from computer-aided diagnosis, a likely development in the coming few years which will support the doctors in making accurate diagnoses more quickly.

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Improved and standardised care

Every year, GPs refer more patients with a suspicion of cancer for urgent assessment. There has been a 28 per cent growth in the number of such referrals in Greater Manchester in the last three years.

Where cancer is confirmed, patients should be treated definitively within 62 days in the vast majority of cases. The performance of Greater Manchester’s cancer network is rigorously assessed against this standard and compared to other areas of England.

We are glad to report that, in terms of our 62-day wait performance, we have continued over a number of years to be the

top performing cancer ‘alliance’ in England. Compared with comparable conurbations, we are seeing 50 per cent more patients within seven days of referral. Nevertheless, while we continue to meet the national minimum standard, we are committed to improve our performance and treat patients more quickly. As such, we have detailed plans to substantially improve our performance, many of which are outlined in this report.

For example, in Greater Manchester, with full adoption of the lung cancer proposal (refined for our system), we plan in the near future to treat everyone referred in with suspected cancer within 28 days, rather than the current 62 days. This requires hospitals to better coordinate care, including sharing scanners, reporting results more quickly and supporting patients to manage their own care.

Greater Manchester is co-leading a national conference to share the four pathways with partners from around the country in February 2018, and, alongside NHS England, published preliminary guidance for cancer alliances in autumn 2017. The ambition is for all alliances in England to fully adopt all the ‘vanguard-designed’ pathways by 2020.

Multi-disciplinary teamsAnother area of continuing reform is in the multi-disciplinary team cancer meetings (or MDTs). These are compulsory meetings where all suspected or proven cancer cases are discussed and care coordinated and agreed by doctors, nurses and other professionals. Because of the increasing numbers of patients, it is becoming more difficult to hold detailed discussions of the most complex cases. The reform and restructuring of MDTs in Greater Manchester is allowing us to minimise variations in care, offer more research opportunities and ensure the right

people are always present during complex discussions. Lung and colorectal cancer have been early priorities and in 2018 we will expand this work into other cancer areas.

In Greater Manchester, we benefit hugely from a series of coordinated, clinically-led pathway boards, where experts in certain cancer conditions come together from across the city region to agree and coordinate improvement work. Only London has a similar comprehensive clinical network with formally agreed improvement plans.

In the last year we have developed a new Psychological Support Board, a key priority for our patient group, and in early 2018 we will also set up a further two boards in primary care and in genomic medicine.

Our pathway boards have been working to develop system-wide guidelines, protocols and quality standards to improve and standardise the cancer care that the people of Greater Manchester receive. They have worked extensively with colleagues, commissioners and people affected by cancer to begin to change services to deliver these best practice standards.

In an exciting development, one of these boards – the Palliative and Supportive Care Board – is chaired by a patient, demonstrating our determination to ensure people affected by cancer are at the heart of the decision-making at our clinically-led pathway boards.

The graph shows the percentage of patients with suspected cancer

from Greater Manchester trusts, East Cheshire

NHS Trust and Mid Cheshire Foundation Trust who are treated definitively within 62

days, compared with the England average.

Multi-disciplinary team cancer meetings are being reformed.

Cancer VanguardAlong with our London partners at the Royal Marsden and University College London Hospitals, Greater Manchester is a partner in the national Cancer Vanguard, designing and testing new models of care for cancer patients before a broader rollout across England. Many of the projects are designed by NHS staff from Greater Manchester. The vanguard has had access to a £14million fund over the last 18 months to test new ideas, some of which have led to improved patient experience and outcomes and are being integrated into normal practice.

One of the main projects is testing and then providing guidance for the broader NHS on how best to investigate and treat cancer patients in the four ‘high priority’ areas (lung, bowel, oesophageal/stomach and prostate cancer) where the impact of slow diagnosis is most keenly felt.

The principle is to describe the ‘best practice timed pathways’ and associated support and guidance so that all patients across the country can benefit from advances in streamlined diagnosis and treatment seen in leading centres.

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we have developed a service specification for acute oncology aiming to enhance patient experience, clinical effectiveness and health outcomes, and maximize efficiency of our services for all patients.

Head and neck cancer

Human papilloma virus (HPV) vaccination is currently offered only to girls in England but there is a growing problem with HPV infections causing more cancers in our population. Greater Manchester clinicians are examining the case for extending vaccination to schoolboys, and there is a significant engagement programme with patients affected by cancer and local schools. This board is also testing, with CRUK, the use of an information bus with a pop-up clinic examination room in city centre locations, and will be providing public information sessions on the risks of head and neck cancer and signs and symptom advice.

Upper GI cancer2017 saw much preparatory work taking place prior to a major reconfiguration of services in 2018. This will allow all patients across Greater Manchester to access the same high-quality care, no matter where they live. It will mean more access to research opportunities and innovative treatments, and patients can expect better outcomes in oesophageal and stomach cancer as a result.

Blood and lymph node (haematological) cancerIn late 2017 we agreed a new model of testing and diagnosing this type of cancer so that we will be able to offer a streamlined, comprehensive service rather than sending up to 50 per cent of our samples to neighbouring cities for analysis. This will mean quicker results for our haematology patients and a more rapid diagnosis.

Hepato-pancreato-biliary (HPB) cancerA more rapid diagnosis of this group of cancers can be achieved by having a system-wide jaundice pathway and series of integrated jaundice clinics. In 2017, significant progress was made in this process and a fast-track referral process for surgery at the specialist centres has been refined, leading to better outcomes for this often aggressive group of cancers.

Lung cancer

Lung cancer remains the biggest single cause of premature death in Greater Manchester. Alongside work on tobacco use, the lung board has redesigned the pathway for patients to ensure faster diagnosis. This ‘optimal lung pathway’ will be in place in 2018, and our ambition is for patients to be seen within 14 days of suspicion of lung cancer. To achieve this, the pathway board has developed a new patient-centred surgical referral pathway and a complex early-stage lung cancer MDT clinic, as well as new treatment algorithms, or formulas, for chemotherapy and radiotherapy pathways. All of this will set the standards required to deliver an efficient, high-quality lung cancer service, and the work is being seen as a model for others to follow across England.

Urological cancer

Our specialists lead the national work on describing, testing and refining the most effective way of speedily diagnosing and treating prostate cancer. The new use of MR scanning and new biopsy techniques have meant a new approach had to be developed. The project will deliver faster diagnosis and reduce the need for prostate biopsies (which are often uncomfortable for patients and have significant associated risks). The national rollout of this work will be complete by 2020 with earlier implementation in Greater Manchester.

Gynaecological cancer

We aim to create a ‘single service’ for these cancers to ensure an equitable approach to treatments, robotic surgery and trials and new treatments. We also aim to develop one-stop clinics to fast-track diagnosis.

Colorectal cancer The pathway board will be rolling out the ‘straight-to-test’ pathway for almost 70 per cent of all GP referrals in 2018. Currently, patients have to see a specialist first before any tests: going straight to test will reduce the time to diagnosis and treatment by 7-10 days. Work will also complete in early 2018 on reforming the MDT process to further speed up treatment times.

Acute oncology In 2017 the acute oncology pathway group carried out a review which highlighted additional needs in the services we provide, plus a patient experience survey to understand patients’ needs when presenting with acute complications of their cancer. In response,

Key developments from our pathway boards in 2017 include:

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Greater Manchester recently secured a large grant from the Health Foundation to develop ERAS + (Enhanced Recovery After Surgery +). This will be developed further into a comprehensive programme for all patients across the city region within two years. ERAS+ is an innovative package of measures delivered to patients before and after major treatment for cancer. These will be delivered according to patient need, and care can be given in the community, GP practices or hospitals. The packages involve improved education for patients to facilitate better self-care and management. The emphasis will be on promoting long-term wellbeing and will involve digital support tools and other resources to support patients and their relatives.

The Christie Cancer Centre became only the seventh site in the world to host a pioneering MR-guided linear accelerator radiotherapy machine. This technology combines magnetic resonance imaging (MRI) scanning and tumour-busting radiotherapy treatment in one machine. Known as an MR-linac, it locates tumours very precisely, tailoring the shape of the x-ray beams to lock on to the tumour during treatment, even when tumour tissue is moving, for instance in the lung as a patient

breathes. Once fully operational in 2018, the machine will deliver some of the most precise radiotherapy available in the UK.

The Christie also opened the doors in 2017 to a new £7.6m day patient centre, the Integrated Procedures Unit (IPU), a state-of-the-art facility that brings together five services under one roof: plastic surgery, endoscopy, radiology, pain management and day case procedures. It aims to shorten waiting times and offers patients a more seamless experience of their care, while its longer opening hours mean it is more convenient for patients who have to fit appointments around work.

The first patients are due to be treated at the UK’s first high-energy proton beam therapy (PBT) centre at The Christie in August 2018. Proton beam therapy is a specialist form of radiotherapy that targets certain cancers very precisely, reducing side-effects and improving rates of success. The therapy is particularly appropriate for certain cancers in children who are at risk of lasting damage to organs that are still growing. The Department of Health and NHS England are funding the centre and a similar site at University College London Hospitals NHS Foundation Trust. Both sites will treat up to 750 patients a year.

Using medicines betterGreater Manchester has led the way in developing a new approach to the provision of cancer medicines. Our pharmacists have been at the forefront of a project to find innovative ways of working with the pharmaceutical industry that deliver better results for patients. As part of a project known as the Pharma Challenge, we asked commercial partners to work with us on the basis that they knew best how to get the most from their medicines. The collaboration resulted in six partnerships with the pharmaceutical industry, including a project to deliver a cancer treatment out

of hospital, and an education scheme to introduce hospital staff to a new generation of medicines known as biosimilars. The introduction of biosimilar medicines will support greater access to more cancer medicines, especially new treatments.

Meanwhile, Macmillan Cancer Support opened their latest information centre at Tameside Hospital, their eleventh such service in the Greater Manchester and Eastern Cheshire area. Work is also due to start on an extension to the information centre at Wythenshawe Hospital. Macmillan’s investment in services in Greater Manchester in 2017 reached more than £6m.

Artist’s impression of the PBT centre at The Christie

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Treating the individualA new broader plan to create ‘bespoke’ packages of care across all cancer types is well under way. This ‘recovery package’ will be available for all patients nearing the end of their treatment by 2019. The package, developed by Macmillan Cancer Support, will improve the quality of life and the general health and wellbeing of patients. It will also give them the confidence to manage their conditions themselves, as well as freeing resources to allow healthcare staff to focus on new patients and those with more complex needs. The recovery package includes a thorough assessment of a patient’s needs, and a plan that spells out how these will be addressed. It also includes a summary of the different stages of treatment that a patient has had, and an invitation to a health and wellbeing event. Our hospital trusts are working well together to make this ambition a reality.

We are also testing a web-based system that helps those cancer patients whose disease cannot be cured make crucial decisions about their treatment. This digital platform, known as Can-GUIDE (Cancer Goal Use in Decisions), features a series of films based on real experiences that help patients explore the implications of certain courses of treatment. Individuals can see how patients in similar situations to themselves arrived at decisions about what they wanted and expected from their care. This work is part of a programme of work that enables patients to formally record their goals and values, and give details of what they hope to achieve from their care.

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We are developing options for suitable patients to select ‘streamlined’ aftercare (sometimes called follow-up) in Greater Manchester that is better tailored to their needs. This is a more personalised approach, initially for those patients who were treated at early stages of breast, colorectal and prostate cancer. It will mean many more patients do not need to constantly travel back and forth to hospital for frequent follow-up when the risk of their cancer returning is low. A digitally enhanced clinical service will coordinate the surveillance tests in a more structured way. This service is up and running in some areas of Greater Manchester and will be extended over the next 12-18 months for all suitable patients.

Supporting our patientsPalliative care is an important part of cancer services and we are developing an approach for Greater Manchester that is standardised and fair to all patients. There is a plan to begin testing and evaluation of enhanced access models for seven-day face-to-face specialist palliative care advice and support in two early adopter localities in 2018. Our longer-term ambition is to provide access to specialist palliative care support seven days a week for patients whatever the setting, whether in hospital, in a hospice or in the community. Therefore the funding will include the development of a wider enhanced seven-day specialist palliative care implementation plan for other areas across Greater Manchester.

We are leading the way in developing services that are better designed to meet the needs of cancer patients. Enhanced supportive care (ESC) is designed to prevent and manage the adverse physical and psychological side effects of cancer and cancer treatment. The national clinical lead for the ESC programme is Manchester-based. ESC allows for the delivery of a package of care to patients very early in their cancer treatment. This has been shown in a research setting to produce better outcomes for patients and may even extend their lives. A number of principles underpin the care pioneered at The Christie, including teams working together more closely and harnessing technology to improve communications.

In 2018 we are reviewing our acute oncology services with plans to widen the same or next-day access to urgent oncology services with ‘drop-in’ clinics and a city-wide telephone advice service. This will allow patients to access specialists in a much more timely way and enable people to avoid being admitted to hospital, instead receiving better care in the community.

Living with and beyond cancer

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Governance and accountability

Greater Manchester aims to implement in full the key recommendations of the national cancer strategy by 2021. The creation of the Greater Manchester Cancer Board is a significant step in that direction. The separate cancer commissioning and provider boards have been dissolved, and the new board that replaces them brings together people affected by cancer, commissioners and providers of cancer services, and representatives from public health, primary care and cancer education and research.

The Greater Manchester Cancer Board is responsible for the implementation of the cancer plan for the area, Achieving World Class Cancer Outcomes: Taking Charge in Greater Manchester 2017-2012. It collectively holds the system to account for its performance across the whole cancer pathway and provides a mechanism for scrutiny and accountability across partner organisations.

It also actively manages and holds to account Greater Manchester’s cancer clinical network, Greater Manchester Cancer, along with Greater Manchester Cancer Vanguard Innovation, which is part of the national Cancer Vanguard.

A new team – Greater Manchester Cancer – provides clinical and managerial leadership and support to the whole cancer system in the area. It also monitors progress against the milestones of the Cancer Plan.

The Greater Manchester cancer pathway boards are the primary source of clinical opinion to Greater Manchester Cancer. These boards are made up of colleagues from across the region and across the professions involved in the pathway. The boards agree a programme of work that aims to deliver improvements in clinical care and patient experience.

Through the Vanguard Innovation work, we have been trialling a system to capture and analyse feedback from cancer patients in Greater Manchester and Eastern Cheshire. The system has been commissioned from iWantGreatCare (iWGC), the single largest source of patient feedback in the world and a company that operates in 23 countries. It provides real-time feedback from cancer patients at every stage in their treatment journey, and it aims to improve patient experience and ensure patients and their families play an equal role with clinicians in shaping cancer services. Alongside this, our service user representatives have continued to support the development and design of patient experience surveys being developed for different types of cancer.

Greater Manchester Cancer has continued work with Macmillan to further develop the User Involvement Programme which is supported by a dedicated team. It is a cornerstone of cancer services in Greater Manchester that People affected by Cancer (PABC) should continue to play a meaningful role and are effectively integrated into all stages of how we design and deliver our services.

This year, the programme has continued to build on the solid foundations established during its first two years. Our pathway boards oversee services for each different type of cancer, and there are now two Service User Representatives on every pathway board, ensuring the patient voice is embedded in everything we do. The programme has

Patient experience and user involvement

Patients in Greater Manchester generally rate their experience of cancer services very highly, and the latest figures from the 2016 National Cancer Patient Experience Survey are encouraging. When asked to rate their care on a scale of zero (very poor) to 10 (very good), patients gave an average rating of 8.8, which is a slight increase on the previous year.

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developed small communities for eight of the pathways: these bring together a broader range of PABC who get involved and bring their views to the work of the pathway boards. Two Service User Representatives also sit on the Greater Manchester Cancer Board, bringing the voice of PABC to the city region’s strategic work – and are valued members of the board.

A recent external evaluation of the programme showed a positive shift in culture: our Service User Representatives reported that

professionals treat them as equal partners in the work we do and value their contributions. Our professionals stressed the importance of having user involvement from the very beginning of service redesign and commented on how this has been extremely valuable in the development of our work.

The patient voice has never been more important and Greater Manchester Cancer can now call on a group of more than 100 PABC to use their insights and expertise in developing services.

Research

Our research focuses on prevention and early detection, developing personalised medicine approaches that target specific therapy to an individual’s cancer, through to living with and beyond cancer. We are investigating everything from understanding the molecular and cellular basis of cancer to the development and testing of novel treatments.

In April 2017, the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC) came into being. It provides more than £12m of funding for the discovery and translation of lab-based science into cutting-edge treatments. The three cancer themes – advanced radiotherapy, precision medicine and prevention and early detection – are making good progress and plans are already in place for the development of further themes, such as survivorship, in time for the next competition in 2022.

The NIHR Manchester Clinical Research Facility (CRF) at The Christie received renewal funding of £4.5m (as part of £12.5m awarded to a unified The NIHR Manchester CRF) for the continued development of specialised early-phase cancer experimental research infrastructure. A main aspiration over the next few years will be on increasing the quantity and quality of clinical research and to provide access to these trials for the more impoverished and ethnically diverse communities. In September 2017, a £3m investment expanded the unit to provide more experimental cancer medicine treatment facilities and an improved patient experience. The expansion will help Manchester build on its success as the leading experimental cancer medicine centre in the UK, to become one of the largest in Europe by 2020.

Our research partnersSalford Royal Foundation Trust and The University of Manchester were awarded £6.7m NIHR funding for the next five years to help Greater Manchester continue innovative research into patient safety in primary care and across transitional care settings on issues such as informatics, medication safety and safer care for marginalised groups.

Manchester Cancer Research Centre successfully renewed its status as a Cancer Research UK ‘major centre’, one of only two such centres in the UK, and attracted £39m funding over the next five years. Cancer Research UK itself invested £26m in research in Greater Manchester in 2016-2017.

Our research strength and capability continue to grow, delivering world-leading and life-changing research for the benefit of our population. At The Christie NHS Foundation Trust alone, one in seven patients were offered therapies through participation in research studies.

A patient’s perspectiveSaeed Shakibai, aged 67, was diagnosed with colorectal cancer in 2009. He is now an active Macmillan service user representative who helps to shape new ways of delivering cancer services.

“Whether you are diagnosed with cancer or know someone with cancer, you know it is hard to swallow. But accept it you must, and moving forward is the only option. You find yourself fighting the dark clouds daily and looking for a ray of sunshine. I found my ray of sunshine in the User Involvement Programme.

I realised Greater Manchester Cancer worked closely with Macmillan on many projects, and through the User Involvement Programme I could be involved too. I

realised people want service users like me to be involved, and value the inside knowledge we have, based on our close encounter with cancer.

In the last two years I have been involved in a number of projects, working very closely with clinical and non-clinical people who are giving their every waking hour to finding new ways to improve cancer services. I’ve seen at first hand how schemes such as Gateway-C, the online platform that helps GPs detect cancer symptoms, can make a major difference to the way we do things.

I am sure my colleagues would agree that I like to get to grips with a subject and challenge conventions. This isn’t because I like to create difficulties but because I genuinely care about the way services are developed. However well-intentioned the clinicians and other health professionals are, they can’t always see things from the patient’s perspective. That’s where I come in.

I can sense real urgency in the way we’re improving cancer care in the area. Things are changing for the better, in some cases very quickly. The people I work alongside have a strong sense of purpose.

I used to be angry about my cancer – now I’m passionate about being involved and making a difference, and it is because of my cancer that I’ve met so many wonderful people. How good is that?!”

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In August 2017, the research community in Greater Manchester received a significant boost when Professor Rob Bristow from Canada, one of the world’s leading prostate cancer experts, took up post as the Director of the MCRC. Professor Bristow is currently leading a refresh of the cancer research strategy across Greater Manchester. This will focus on partnership working to deliver world-leading research for the improvement of patient outcomes. We were able to recruit

many other scientists of international repute to Manchester in 2017 and our standing as an international cancer research centre continues to grow.

The year was our strongest to date for patient recruitment to cancer trials. This was reflected in the annual NIHR research activity league table which Greater Manchester topped in terms of patients recruited per 1,000 of population.

The Manchester surgical oncology group led a study which found that a number of people with rectal cancer will be able to avoid surgery, without their treatment being undermined. The work showed that, for about 15 per cent of patients, the cancer completely disappears after having just chemo/radiotherapy treatment without surgery.

The Christie pathology breast tumour team, with partners across Manchester, carried out the analytical work for a multi-centre clinical trial. The results showed that around a quarter of women, with a type of breast cancer known as HER2 positive, who were treated with a combination of targeted drugs before surgery and chemotherapy, saw their tumours shrink significantly or even disappear. This ground-breaking result offers the opportunity to tailor treatment to individual women.

Increasingly, the concept of personalised and precision medicine treatments, developed through research, will become more widespread – patients will benefit as treatments become more specific to the sub-type of cancer, meaning more effective treatment and fewer side effects.

The futureA clinical research study linked to a landmark community screening pilot is helping to revolutionise the detection of lung cancer. The feasibility study was set up to run alongside the pioneering Manchester Lung Screening Pilot, the UK’s first NHS community-based, CT lung cancer screening service (see page 09)

The pilot invites people at risk of lung disease to attend a lung health check at a special facility in a supermarket car park. More than 800 participants have been recruited to the study while attending their check-up.

The team behind the study is based at University Hospital of South Manchester NHS Foundation Trust in the Thoracic Oncology Research Hub (TORCH). With funding from Cancer Research UK Manchester Institute, TORCH has collaborated with a number of experts from across the field of lung disease and the team is excited by the study’s potential.

The Manchester Lung Screening Pilot has already delivered hard evidence that CT scanning of high-risk people helps identify lung cancers sufficiently early to cure them. Now the study could help identify a biomarker and provide definitive criteria to determine which people should be given the potentially life-saving CT scans.

Research innovationMany breakthrough studies changed the lives of our citizens in 2017. One case featured a Rochdale breast cancer patient who had already tried nine different treatments. She had been fighting secondary breast cancer since being told in 2004 that her cancer was treatable but not curable. She became the first patient in the world to be given an exciting new combination of immunotherapy drugs.

Researchers from The Christie and the University of Manchester are also set to lead a new precision medicine study for prostate cancer as part of a major new research programme launched by Prostate Cancer UK. The research drive will tailor treatments for men based on the genetic make-up of their cancer – a move which has the potential to extend the lives of 9,000 men every year in the UK. Prostate Cancer UK has awarded £1.4million to the nationwide study.

Greater Manchester scientists led a review showing that ovarian cancer survival rates in the UK could be improved by 45 per cent if patients were treated in specialised, regional centres rather than general hospitals. Their work proved that the survival rate improvement, from the average of two years to about three years, would not require new treatments but, rather, the optimal use of currently available surgical techniques and drugs.

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Education

We have created an online platform to help GPs and other primary care professionals detect the early signs of cancer which is currently being rolled out across Greater Manchester and Eastern Cheshire and the north of England. Gateway-C features interactive films, based on real-life consultations, and other resources to help family doctors make cancer referrals more efficiently. Almost one fifth of patients who are diagnosed with cancer in Greater Manchester are diagnosed in A&E departments. Very often, patients are diagnosed too late to benefit from effective treatment. Gateway-C helps our efforts to diagnose cancer earlier and its online content has been developed with the expert guidance of GPs themselves.

Gateway-C’s learning zones have been accredited by the Royal College of GPs and endorsed by Cancer Research UK. A pilot study to assess the scheme’s effectiveness showed that GPs rated the learning zone as excellent: more than 90 per cent said they referred back to their learning during consultations and almost 95 per cent said it had helped them with referrals. Nearly 400 of the city region’s 500 GP surgeries have so far signed up to Gateway-C’s learning zones.

Our strategyGreater Manchester now benefits from a cancer education strategy that sets out our ambitions for educating those health professionals who work in cancer services. By ensuring our workforce is well trained and educated we can deliver on our ambitions to provide world-class services for patients.

The vision is that everyone involved in cancer prevention and care will have access to world-class training, education and information. The strategic education plan aims to raise standards across Greater Manchester by providing this level of education and training.

A range of initiatives will contribute to our long-term goals right across the spectrum of cancer services, from cancer prevention to living with and beyond cancer. For example, we aim to train our health and social care workforce to become ambassadors who can help public health messages about lifestyle and screening reach a wide audience.

One of our main priorities is to ensure that the progress we make in the area of research is rapidly translated into practice, so that patients benefit from breakthroughs in research as soon as possible. We will also create a forum for our doctors, nurses and other professionals to share ideas and best practice, as well as support and promote best practice in any way we can.

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Date: 16 March 2018

Subject: Healthwatch in Greater Manchester – Progress Update

Report of: Peter Denton, Healthwatch Liaison Manager, Healthwatch in Greater

Manchester

SUMMARY OF REPORT:

This report provides an update on the first year of the Greater Manchester Liaison function

and signposts the joint work of the 10 GM Healthwatch organisations for the coming year.

KEY MESSAGES:

The report highlights the statutory functions of local Healthwatch, particularly in terms of its

role in assessing the quality of health and care services and in supporting community

engagement (including people whose voices are ‘seldom heard’).

Local Healthwatch priorities have been mapped against GM Health and Social Care plans. It

notes that Healthwatch priority activity with the Partnership is closely aligned with

implementation of the Mental Health Strategy; Theme 3 Standardisation of Acute Hospital

Services activity; and supporting effective engagement in the development and

implementation of locality plans.

Healthwatch has secured representation in a range of the Partnership’s governance boards

for both Mental Health and Theme 3 as well as at a strategic level. Healthwatch has also

developed a process of aggregating patient, service user and carer feedback to inform its

role on the GM Quality Board.

Development areas for Healthwatch the coming year have been identified as including:

Supporting our partners to build on community based initiatives for the ongoing

transformation of the health and care system and landscape.

Using our role within GM Health and Social Care governance structures to

encourage and support the use of ‘soft intelligence’ and consideration of social value

and community benefit alongside more traditional quantitative data.

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Working alongside all our partners to promote, support and deliver meaningful

engagement with local people, particularly those whose voices are seldom heard.

Reviewing how we work as individual Healthwatch organisations with a view to

developing more consistent practice across Greater Manchester.

PURPOSE OF REPORT:

For information.

RECOMMENDATIONS:

The Greater Manchester Health and Care Board is asked to:

Receive and note the contents of this report

Reaffirm support for all members of the Partnership to work collaboratively with

Healthwatch both at locality and Greater Manchester levels.

CONTACT OFFICERS:

Peter Denton, Healthwatch Liaison Manager, Healthwatch in Greater Manchester

[email protected]

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1.0 INTRODUCTION

1.1. There are 10 independent local Healthwatch organisations in Greater Manchester.

The GM Health and Social Care Partnership has provided funding to support a

Greater Manchester Healthwatch Liaison function. This function provides a clear

link between the 10 local Healthwatch organisations and other members of the

Partnership. It also enables the 10 organisations to work more effectively with each

other and maximise their collective resources.

1.2. This report provides an update on how Healthwatch organisations have worked with

each other and GM Health and Social Care Partners since April 2017.

2.0 ABOUT HEALTHWATCH

2.1. The Health and Care Act 2012 created a statutory duty for all top tier local

authorities to commission Healthwatch in their locality. Healthwatch has a number

of statutory functions and duties which it must deliver for people who live in the area

it serves and also for people who access services in the area. These statutory

functions include:

promoting and supporting the involvement of people in the commissioning,

provision and scrutiny of local care services;

enabling people to monitor for the purposes of their consideration of the

standard of provision of local care services; whether, and how, local care

services could be improved; whether, and how, local care services ought to be

improved - and to review for those purposes, the commissioning and provision

of local care services (this includes reaching views on these matters and

making those views known to the Healthwatch England committee of the Care

Quality Commission);

obtaining the views of people about their needs for, and their experiences of,

local care services;

providing advice and information about access to local care services and about

choices that may be made with respect to aspects of those services;

making recommendations to the Healthwatch England committee to advise the

Commission about special reviews or investigations to conduct (or, where the

circumstances justify doing so, making such recommendations direct to the

Commission);

giving the Healthwatch England committee such assistance as it may require to

enable it to carry out its functions effectively, efficiently and economically.

2.2. Commissioners and providers of health and care services have the following duties

relating to local Healthwatch:

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Permitting authorised representatives to Enter and View services (within a

clearly defined framework);

Responding within 20 days to requests for information;

Responding within 20 days to reports and recommendations made by

Healthwatch (and these responses must have due regard to the content of the

reports and recommendations).

2.3. In addition, local Healthwatch has the statutory power to refer matters to Overview

and Scrutiny Committees for their consideration. Healthwatch also has a seat on

their local Health and Wellbeing Board and a non-voting seat at local Primary Care

Commissioning Committees.

2.4. Regulation requires that local Healthwatch organisations must have the status of

‘independent social enterprise’. There is also a requirement that local people have a

role in setting Healthwatch priorities and that ‘seldom heard’ voices are amplified.

2.5. Some local Healthwatch organisations in Greater Manchester also provide the

independent NHS Complaints Advocacy service.

3.0 WORKING TOGETHER WITH THE GM HEALTH AND SOCIAL CARE

PARTNERSHIP

3.1. The Greater Manchester Healthwatch Liaison Function was established in March

2017 with funding for two years. Strong working relationships have been

established with staff in the GM Health and Social Care Partnership. This has

resulted in a range of activities to support the voice of local people in the

development and implementation of the GM transformation plans.

3.2. Building on work that is already being undertaken by Healthwatch in their local

areas, the following have been agreed as priorities for Healthwatch joint work at a

Greater Manchester level:

Engaging in the implementation of the Greater Manchester Mental Health

Strategy.

Supporting and promoting public engagement in acute hospital changes with a

particular focus on Theme 3 transformation work streams (local joint

Healthwatch activity is also considering Trust mergers, alliances and reviews

taking place on a smaller footprint than the whole of GM).

Sharing good practice between localities in terms of patient and public

engagement in the development and implementation of locality plans.

3.3. As a result of building these relationships and setting our priorities we have

Healthwatch established representation on the following boards, committees and

working groups:

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GM Health and Social Care Board

GM Quality Board

Heads of Comms and Engagement group

Mental Health Programme Board

Dementia United

Adult Mental Health Delivery Board

Children and Young People’s Mental Health Delivery Board

Population Health Board

Theme 3 Board

Theme 3 Clinical Reference Group

8 x Theme 3 work stream representatives

3.4. We are currently recruiting further representation to:

GM Children’s Health and Wellbeing Board

GM Primary Care Advisory Board

GM Medicines Strategy Board

3.5. Other GM level activities during the year have included:

Holding the first Healthwatch in Greater Manchester Conference. Supported by

the GM Health and Social Care Partnership and Healthwatch England, this two

day event brought together over 80 delegates from across Greater Manchester.

It provided an opportunity for operational staff and volunteers to come together

and share learning as well as for Healthwatch leaders to explore opportunities

for joint working, efficiencies through economy of scale and also working

together to support the GM partnership agenda. A programme of development

activity has been developed from this and is now being delivered.

Providing regular Healthwatch insight to the GM Health and Social Care Quality

Board. This includes developing the GM Healthwatch Quality Summit which

meets twice a year to identify key areas of concern that cross local Healthwatch

boundaries. This role has not been restricted to Healthwatch bringing topics to

the Board (e.g. patients detained under the Mental Health Act getting

appropriate assistance with toileting needs which in A&E, how effectively

providers with poor CQC ratings are engaging with Healthwatch and their local

populations). We have also been able to highlight how quality improvements

have impacted on patient experiences and where we feel it’s too early to

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consider a matter resolved (e.g. continuing to receive patient feedback which

suggests IT systems haven’t been fixed as thoroughly as the IT provider

suggests).

Delivering public engagement for the Diabetic Eye Screening service review.

Delivering public engagement for the Electronic Referral of Medicines between

Hospital and Community project.

Contributing to the GM Health and Social Care Partnership’s draft Consultation

and Engagement Framework.

Contributing to the draft Theme 3 Comms & Engagement strategy.

Commenting on a number of GM Health and Social Care strategy documents.

Compiling a library of GM Healthwatch reports which are available for GM HSC

Partnership staff to inform their work.

Promoting a number of public engagement opportunities provided by the GM

HSC Partnership.

4.0 IMPROVING LOCALITY WORKING

4.1. There are 10 local Healthwatch in Greater Manchester. Though our mission and

mandate is the same, and our contexts broadly similar, our organisations face

different operational constraints and have developed differently in response to

these. We are all small organisations and this presents challenges to our

operational capacity as well as heavy governance, management and external

relations demands.

4.2. The GM transformation plan extended our work load exponentially, we are all now

involved in ensuring that patients have a voice in individual locality plans in our

areas, but we also need to support patient involvement across our city region health

and social care institutions.

4.3. The HW in GM liaison Office has supported our efforts in this regard by;

Taking over the organisation of our monthly Network meetings (previously done

on rotation by individual Healthwatch), this has freed up time and improved the

Network’s productivity by ensuring a more consistent and forward moving

agenda.

Providing us with timely information about developments in the GM as a whole

and in other parts of the city and given us a ‘go to’ place for questions and

queries about GM activity. This helps us to direct and inform our conversations

with patients and respond to our residents concerns.

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Provided us with a structure through which to explore and agree practical

cooperation both in terms of activity and organisational development. For

example we now have a structure for responding to, bidding for and delivering

external commissions where GM wide engagement is required, we are able to

engage in cross-purchasing and joint purchasing. We are working on a number

of specific shared challenges (such as implementing the forthcoming GDPR

Regulation, workforce development, development of shared key documents).

Providing a clear mechanism for us to engage with the GM Health and Social

Care Partnership in a way that helps us to meet our objectives both locally and

co-operatively across the conurbation.

5.0 OUR FORWARD CHALLENGES

5.1. Healthwatch in Greater Manchester has identified some key challenges which they

seek to address, working with the GM Health and Social Care Partnership, during

2018/19:

5.2. How do we support true transformation?

5.2.1. Whilst much progress has been made in terms of developing new infrastructure and

governance and there are some individual examples of changes in the services and

support that people receive, Healthwatch has an informal sense that the thinking of

many people within these new structures is still based on traditional NHS and adult

social care processes. We are concerned that this may make it difficult for grass

roots ideas about changes to get sufficient traction in the system and that voluntary

and community organisations may not have the resources to make a sufficiently

strong case for change using the types of evidence base that are expected in the

NHS.

5.2.2. We are eager to work with local people and the voluntary, community and social

enterprise sector not just to support a greater use of community assets within

traditional pathways and structures but also to promote innovative, community

based thinking and solutions. This is about making sure that the “new relationship

between public services, residents, communities and businesses” has the space

and support not just to talk about change and make incremental changes but to be

bold and, over a period of time, transform into a system that looks significantly

different to the system that was in place when the Health and Social Care

Partnership was established.

5.3. How can we help grass roots transformation ideas to be heard?

5.3.1. Very often the evidence base for these is very different from clinical evidence

bases. Sometimes there may only be a very limited evidence base and an idea is

effectively the suggestion for an action research project that could be delivered at a

wider scale in the future. We are aware that this way of working can cause feelings

of unease in decision making processes that have been built on using particular

types of evidence bases to assess and manage risk.

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5.3.2. Through our locality and GM level activity we observe governance structures that

rightly focus on statutory responsibilities, risk, quality and cost. We recognise that

these are necessary and important in terms of keeping our population safe and

demonstrating wise use of public funds. We are pleased to have Healthwatch

representation on many of these governance boards and that the voluntary,

community and social enterprise sector is also increasing its representation here.

We are keen to use our role within these structures to help these governance

boards to consider how their work can also be informed by ‘soft intelligence’ in a

meaningful way (not all positive outcomes are easy to quantify) and how more

thorough considerations of social value and meaningful community benefit can help

in decision making and assurance processes.

5.4. How can we help the partnership to engage with local communities,

particularly people whose voices are seldom heard?

5.4.1. We feel that local Healthwatch can play a key role, through our well established

networking activity with local people and organisations, to support and promote

grass roots voices. We see it as one of the principal ways of delivering the GM HSC

Commissioning for Reform principle: “There is a new relationship between public

services and residents, communities and businesses that enables shared decision

making, democratic accountability and voice, genuine co-production and joint

delivery of services.”

5.4.2. We would welcome opportunities, either through our day to day insight collection or

through specifically commissioned work, to engage more with local people jointly

with the GM HSC Partnership. We anticipate that the new draft consultation and

engagement framework will provide a vehicle to promote and support this.

5.4.3. We also note that the work of the voluntary, community and social enterprise sector

is doing with the GM Health and Social Care Partnership around equality and

diversity will also play a significant role in ensuring that different community voices

are heard and able to engage with the Partnership.

5.5. How do we support consistency in Healthwatch activity across Greater

Manchester?

5.5.1. There is significant variation in the per capita funding for local Healthwatch across

the 10 localities. We have a strong history of working together – we are the longest

established network of multiple Healthwatch organisations in England. However we

are aware that there is variation in the range, depth and delivery of the work we do.

In part this reflects the diversity of our local communities but we recognise that

some differences are factors of history and could be improved to help us to provide

a more consistent Healthwatch offer to the population of the conurbation.

5.5.2. We are currently reviewing how we can make efficiencies operationally – an

example of this is that several GM Healthwatch organisations are working together

to procure the services of a Data Protection Officer who can support them

collectively as the General Data Protection Regulations come into effect in May and

on an ongoing basis thereafter.

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5.5.3. We are also looking to commission an independent review based on the national

Healthwatch Quality Statements to help us to identify what an effective and efficient

Healthwatch looks like in the context of a large conurbation with health and social

care services working in partnership. This is ground breaking work for Healthwatch

in Greater Manchester as similar reviews in the past have largely focused on

smaller populations and geographical areas.

5.5.4. When these reviews are complete we anticipate that recommendations will emerge

which will help to shape the future of Healthwatch within GM localities as well as at

the GM-wide level.

6.0 RECOMMENDATIONS

6.1. The Greater Manchester Health and Care Board is asked to:

Receive and note the contents of this report

Reaffirm support for all members of the Partnership to work collaboratively with

Healthwatch both at locality and Greater Manchester levels.

greater manchester health and care board · venue: council chamber, bury town hall, knowsley st,...

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