To approve as a correct record the minutes of the meeting held on 5 February 2019.

To approve the minutes of the meeting held on 5 February 2019 as a correct record.

Report of the Director of Population Health and Wellbeing

In January of this year NHS England announced plans to expand the Pre-Exposure Prophylaxis (PrEP) Impact Trial to 26,000 participants by 2020. This represents a doubling of the current number of people on the trial nationally. This report summarises the implications of the national trial expansion for Manchester.

The Committee considered the report of the Director of Population Health and Wellbeing that provided information on the implications for Manchester following the announcement by NHS England in January 2019 of the plans to expand the Pre-Exposure Prophylaxis (PrEP) Impact Trial to 26,000 participants by 2020. This represented a doubling of the current number of people on the trial nationally.

Dr Chris Ward, Consultant Physician Genitourinary Medicine, The Northern

Integrated Contraception, Sexual Health & HIV Service referred to the main points of the report which were: -

·                Providing a description of PrEP as a way for people who did not have HIV, but who were at substantial risk of HIV infection to reduce their risk of acquiring HIV;

·                Information on the eligibility criteria for the PrEP Impact Trial;

·                Information on the treatment pathway for trial participants;

·                Data on the current trials across Greater Manchester clinics, noting that this was overseen by the PrEP Programme Oversight Board that was jointly chaired by Public Health England (PHE) and NHS England;

·                At their meeting of 15 January 2019 the PrEP Oversight Board had supported in principle the recommendation to double the number of trial places so that it could address emerging questions from the trial and more robustly inform the design and rollout of a full national programme;

·                Noting that the Board had asked that a rapid engagement exercise with local authority commissioners and research sites be undertaken to assess their capacity to accept additional places; and

·                Information on the Manchester response to this announcement to expand the trial and a description of the next steps, including the consideration to be given to improving access and pre booking appointments.

Members of the Committee noted that whilst they fully supported the extension of the trial, even with a doubling of the size the demand and waiting lists remained significantly high. A Member further commented that in reality the number of people who would benefit from PrEP would be higher still. The Committee were unanimous in calling for the national roll out of PrEP, appropriately funded by the NHS.  

Dr Ward responded to comments from the Committee by stating that it was recognised that many people were registered on more than one waiting list to be accepted onto the trial. He said that to address this, work was ongoing to establish one waiting list across Greater Manchester that could be centrally administrated to remove any duplication. He said that whilst people remained on the waiting list they were encouraged to purchase PrEP online, noting that regrettably there were cases where people had contracted HIV whilst on the waiting list. He said that for those people who could not afford to purchase PrEP at approximately £19 per week, applications could be submitted to the Terrence Higgins Trust hardship fund, and if successful the individual would be provided with a code that they could use to purchase PrEP online.  Dr Ward further stated that consultants would support those smaller clinics to deliver any extended programme.  ...  view the full minutes text for item 12.

Report of the Director of Performance and Quality Improvement and the Director of Integrated Commissioning and Chair of the Manchester / Trafford Urgent and Emergency Care Board

This report provides an overview of urgent care winter pressures for 2018/19. It contains information on the joint system-wide planning taken across the Manchester urgent care system, the surge and escalation approach taken in order to manage periods of pressure and the resulting impact on the 4 hour performance target in A&E.

The Committee considered the report of the Director of Performance and Quality Improvement and the Integrated Commissioning and Chair of the Manchester / Trafford Urgent and Emergency Care Board that provided an overview of urgent care winter pressures for 2018/19.

Matthew Swanborough, Director of Corporate Resilience, MFT referred to the main points of the report which were: -

·                Information on the joint system-wide planning taken across the Manchester urgent care system;

·                The surge and escalation approach taken in order to manage periods of pressure; and

·                The resulting impact on the 4 hour performance target in Accident and Emergency Departments (A&E).

Members noted that the report did not contain any comparative data which made it very difficult to assess any improvements in performance. Paul Thomas, Urgent Care System Resilience Manager, MHCC stated that in line with national reporting the performance against targets was reducing. He further informed the Committee that a full analysis of the 10 key interventions that had been agreed across the health and social care system for winter would be undertaken.

Dr Rosemary Morton, Emergency Medical Consultant, MFT stated that there had been a 7% increase in the number of attendees at A&E, stating that those patients attending A&E had higher medical needs. She described that patients would be assessed and treatment provided was based on the patients clinical need, which made the 4 hour performance target to a certain extent meaningless.

Dr Morton explained that the majority of problems experienced in hospitals could be attributed to patient flow throughout the whole hospital. She said that work was ongoing to address this, stating that a discharge lounge had been established to facilitate patient discharge in the mornings to free up bed space. She commented that improved patient flow improved the overall efficiency of a hospital.

Dr Morton addressed a question from a Member regarding the number of patients attending A&E for non emergency issues. She said that whilst this was always subjective, initial analysis of the available data indicated that many people attended A&E as they were unable to secure an appointment with their GP. She said more needed to be done to make people aware of other sources of non emergency health advice and care, such as pharmacies.  

Mark Edwards, Chief Operating Officer, Manchester Local Care Organisation (LCO) stated that the continued development and delivery of the LCO would significantly support the pressures experienced by A&E Departments, especially for frail and elderly patients who presented. He said that the emerging model of care, delivered in neighbourhoods would identify care needs and deliver support and care for people to help them remain in their own home and community, supported by a range of appropriate, multi-disciplinary health and social care teams. 

Marie Rowland, Associate Director of Performance stated that improvements had been made in regard to the treatment of patients presenting at A&E with mental health issues. She said that feedback from patients, families and carers had been very positive. She  ...  view the full minutes text for item 13.

Report of the Director of Adult Services, Children and Families Directorate

Our Manchester ambition is for all care homes to achieve good or outstanding Care Quality Commission (CQC) ratings within the next 2 years. Delivery will be supported by the MHCC performance and quality improvement team framework, providing effective tools and guidance for providers to achieve our aspirations.

This paper highlights the current CQC and MHCC quality compliance status of the nursing and residential care homes across Manchester and explains the efforts being made to support and improve the standard of care and quality for the residents in receipt of those services.

The Committee considered the report of the Director of Adult Services that highlighted the current Care Quality Commission (CQC) and Manchester Health and Care Commissioning (MHCC) quality compliance status of the nursing and residential care homes across Manchester and explained the efforts being made to support and improve the standard of care and quality for the residents in receipt of those services, noting that the Our Manchester ambition was for all care homes to achieve good or outstanding CQC ratings within the next 2 years.

The Director of Adult Services referred to the main points of the report which were: -

·                Providing information on the current CQC rating of the nursing and residential care homes across Manchester and explaining the efforts being made to support and improve the standard of care and quality for the residents in receipt of those services;

·                Describing the work undertaken by the performance and quality improvement (PQI) team with the inadequate care homes of Manchester since April 2017, had seen the reduction of the 7 providers we started with, to the current 1 that is in the City and was inspected in December 2018;

·                Providing information on the PQI framework for adult social care (ASC). Describing that the framework brought health and social care colleagues closer together, and focused efforts in areas that needed it the most, such as care homes that were rated as “inadequate” or “requires improvement” with the CQC;

·                All homes that had a “require improvement” rating from the CQC had been visited during 2018/19 in a prioritised order and were subject to a high level of scrutiny by the care home improvement group;

·                The ASC PQI team were currently working with the two main tools within the framework to assess and monitor quality across the sector with care homes being the first cohort of providers;

·                Information on the current CQC ratings for care homes in Manchester as of February 2019, noting that self-assessment used by the care homes rated as good and outstanding had also proven effective as services maintained their outcome following recent inspection;

·                Describing the work undertaken at a Greater Manchester level to develop good practice;

·                Describing the new models of care with future commissioning of care homes offering a more holistic approach to care placement and monitoring, in line with Our Manchester values; and

·                Future improvement initiative.

Members welcomed the improvements reported to date and supported the stated ambition for all care homes to achieve good or outstanding CQC ratings within the next 2 years, noting that this demonstrated an Our Manchester approach to delivering improvements. A Member commented that consideration also needed to be given as to where Care Homes / Residential Homes were located as this was very important to people in receipt of care and their families.

A Member commented that it was very important to recognise that Care Home systems could be very difficult for families of those receiving care to navigate and it was important to remember at all times that  ...  view the full minutes text for item 14.

Report of the Governance and Scrutiny Support Unit

The monthly report includes the recommendations monitor, relevant key decisions, the Committee’s work programme and items for information. The report also contains additional information including details of those organisations that have been inspected by the Care Quality Commission

(CQC) within Manchester since the Health Scrutiny Committee last met.

A report of the Governance and Scrutiny Support Unit which contained key decisions within the Committee’s remit and responses to previous recommendations was submitted for comment. Members were also invited to agree the Committee’s future work programme. 

Decision

To note the report and approve the work programme.