To approve as a correct record the minutes of the meeting held on 10 January 2024.

Decisions

1.   To approve the minutes of the meeting held on 10 January 2024.

2. To receive the minutes of the Greater Manchester Mental Health NHS Foundation Trust: Improvement Plan Task and Finish Group meeting held on 23 January 2024.

The Committee considered the report of the Deputy Chief Executive and City Treasurer that set out the latest forecast revenue budget position, and the next steps. Following the Provisional Finance Settlement announced 18 December 2023 the Council was forecasting an estimated budget shortfall of £38m in 2024/25, £79m in 2025/26, and £90m by 2026/27. After the application of approved and planned savings, and the use of c.£17m smoothing reserves in each of the three years, the budget was balanced for 2024/25 and the remaining gap reduced to £29m in 2025/26 and £41m by 2026/27. This position assumed that savings of £21.4m were delivered next year.  

This report provided a high-level overview of the updated budget position. Each scrutiny committee was invited to consider the current proposed changes which were within its remit and to make recommendations to the Executive before it agreed the final budget proposals on 14 February 2024.

The Executive Member for Finance and Resources stated that the Government’s approach to the Local Government Settlement had been chaotic and only announced just before Christmas. He said the final announcement when announced had resulted in a cut of 84% in the Services Grant and this equated to a £6.1m cut for Manchester. He stated that this had resulted in an outcry from Local Authorities and MPs from all political parties. He stated that this situation needed to be understood in the context of fourteen years of austerity and Government funding cuts and unfunded pressures such as inflation and population growth.  

The Executive Member for Finance and Resources added that the Government then swiftly announced an additional £500m for Social Care, however Local Authorities were still facing a £4bn budget gap nationally, resulting in a number of Local Authorities serving a Section 144 notice and it was anticipated that more would follow.

The Executive Member for Finance and Resources commented that, despite this, Manchester had set a balanced budget and this had been achieved through diligent planning and management that had witnessed the strategic investment in preventative initiatives; using financial reserves prudently and investment in activities that were important for Manchester residents, such as libraries; leisure centres; parks and green spaces and the Climate Change Action Plan.

The Executive Member for Finance and Resources stated that although Manchester had been able to deliver a balanced budget this year, the Council’s financial position was expected to become even more challenging. The projected budget gap, even after using reserves for 25/26, was £29m in 2025/26 and rising to £41m by 2026/27, adding that since 2010 the Council has had to make £443m of savings.

The Executive Member for Finance and Resources concluded by stating that the Government had continually failed to listen to Local Authorities.

The Executive Member for Healthy Manchester and Adult Social Care made reference to the complexity of the budget arrangements, adding that a significant amount of funding were grants and one off funding arrangements which was totally impractical when attempting to plan and deliver important services. He  ...  view the full minutes text for item 8.

Report of the Deputy Place Based Lead and the Executive Director Adult Social Services

In September 2023, the Manchester Health Scrutiny Committee and the Council Executive was presented with a forward view of the plans for this winter. The following paper describes the current progress in implementation of winter plans, and summary of pressures within the urgent care system.

The Committee considered the report of the Deputy Place Based Lead and the Executive Director Adult Social Services that described the current progress in implementation of winter plans, and summary of pressures within the urgent care system.

Key points and themes in the report included:

·         Delivery of operational resilience across the NHS this winter, noting the four key areas of focus to help local systems prepare for winter;

·         An update on the Urgent and Emergency Care Recovery Funds;

·         Discussion of industrial action;

·         Urgent Care Pressures and Urgent Care Performance;

·         Information on the Greater Manchester System Control Centre (GM SCC);

·         Organisational winter deliverables, by organisation, noting that the plans considered lessons learned from last winter, aligning with the system’s urgent care recovery goals and with the core principle of working together as partners to keep people well at home; and

·         Summary.

Some of the key points that arose from the Committee’s discussions were:

·         Recognising and welcoming the partnership approach described;

·         Welcoming that North Manchester General Hospital had recorded the best ambulance turnaround times in the country during November;

·         Noting the important role that Community Pharmacies played to support residents especially with regard to flu vaccinations;

·         Noting the reported low Covid-19 vaccination rates; and

·         Requesting further information on Hospital at Home.

The Deputy Place Based Lead for Health and Social Care Integration, NHS Greater Manchester Integrated Care highlighted the whole system approach that was evidenced by the range of partners who were referenced throughout the report and present at the meeting. He stated that planning for this activity was ongoing and all opportunities for reflection and learning were utilised and shared.

The Director of Public Health referred to the discussion relating to flu and Covid vaccination rates by commenting that Covid vaccination rates had fallen, stating that this could be attributed to complacency and vaccination fatigue amongst the general population. He made reference to Manchester having strong vaccination coverage within its care home population. He stated that the key Public Health messaging around the importance of vaccinations was important, especially in regard to the issue of measles and referred to the national media coverage this had received following increased cases in the West Midlands.

The Group Chief Operating Officer, Manchester University NHS Foundation Trust reiterated and acknowledged the importance of system wide partnership working, adding that patient safety was everyone’s responsibility. She further made reference to the importance of vaccinations, noting that flu admissions at the hospital had doubled in the last week. She said that all levers of influence and channels of communication should be utilised to articulate this important message. 

The Chief Operating Officer, MLCO described that the Hospital at Home included virtual wards or other technology-enabled care at home, provided the care and treatment a person would expect in a hospital in the place they called home.

The service brought together nurses, doctors and other health professionals to deliver the hospital care a person needed. It combined the latest health technology with the specialist knowledge of doctors and nurses  ...  view the full minutes text for item 9.

Report of the Manchester Deputy Place Lead and Marie Curie Lead

This report provides critical research from the Better End of Life programme,  conducted in collaboration between Marie Curie, King's College London Cicely Saunders Institute, Hull York Medical School, the University of Hull and the University of Cambridge, in relation to experiences of palliative and end of life care, as well as identifying policies and resources that will help to make a positive difference to the lives of people affected by dying, death and bereavement. Marie Curie have asked all localities to respond to an audit questionnaire and the findings from this are discussed in the body of this report and will inform locality developments.

In order to give a rounded perspective of issues and challenges across Manchester as well as the GM Integrated Care Board, contributions have also been collected from the GM Quality Improvement Programme Manager, Palliative & End of Life Care, who describes the developments and ambitions of the GM Palliative and End of Life Care Programme, and the Manchester Locality Team, (Primary Care as well as Quality), where the issues and challenges in relation to transformation are discussed. 

The Committee considered the report of the Manchester Deputy Place Lead and Marie Curie Lead that provided critical research from the Better End of Life programme,  conducted in collaboration between Marie Curie, King's College London Cicely Saunders Institute, Hull York Medical School, the University of Hull and the University of Cambridge, in relation to experiences of palliative and end of life care, as well as identifying policies and resources that woulld help to make a positive difference to the lives of people affected by dying, death and bereavement.

Marie Curie had asked all localities to respond to an audit questionnaire and the findings from this were discussed in the body of this report and would inform locality developments.

In order to give a rounded perspective of issues and challenges across Manchester as well as the GM Integrated Care Board (ICB), contributions had also been collected from the GM Quality Improvement Programme Manager, Palliative & End of Life Care, who described the developments and ambitions of the GM Palliative and End of Life Care Programme, and the Manchester Locality Team, (Primary Care as well as Quality), where the issues and challenges in relation to transformation were discussed. 

Key points and themes in the report included:

·         Providing an introduction and background;

·         Discussion of Marie Curie’s ‘Better End of Life’ programme; that included consideration of poverty, inequality and inequity; support for Carers; and bereavement support;

·         Information regarding the UK Commission on Bereavement;

·         Greater Manchester developments with reference to the Greater Manchester Palliative and End of Life Care Programme that had been established in 2013;

·         Manchester developments, with reference to the Manchester Palliative and End of Life Care Partnership;

·         Summary and next steps.

Some of the key points that arose from the Committee’s discussions were:

·         Thanking the Chair of the Committee for bringing this important report to the Committee and having an opportunity to hear from partners;

·         Recognising the importance of this subject area in the context of Manchester becoming an ACE-aware and Trauma Informed City;

·         Discussing the cultural attitudes to death and dying and asking if there were examples of good practice that could be learnt from;

·         Noting the significant issue of poverty and the impact this had on individuals and their families;

·         Recognising the importance of carers and families;

·         Noting that across the UK, over 40% of adults who wanted formal bereavement support didn’t receive any and asking that any future update report include a breakdown of this figure by protected characteristic if available;

·         Did the Council as an employer provide any bereavement support for staff:

·         A network of Champions should be established to promote and support this work, including Council Directorate Champions with a single point of contact for residents to expedite any request for support;

·         Information was sought in relation to Compassionate Communities;

·         How was the voice and experience on citizens captured to inform this work;

·         Supporting the identified priority to improve earlier identification in Primary Care; and

·         What were the next steps.

The Local Public Affairs Officer, North West,  ...  view the full minutes text for item 10.

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.

The 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

The Committee notes the report and agrees the work programme.