To agree as a correct record the minutes of the last public meeting o fteh board held on 29 February 2024

Decision

To approve the minutes of the meeting held on 29 February 2024

Report of the Deputy Place Based Lead attached

The Deputy Place Base Lead provided an update on key developments within the national and GM systems, and their impact on the Manchester system.

He advised that since the Partnership Board last met, there had been a number of developments in national policy. Professor Lord Darzi had published a review into the NHS in England. This outlined the issues the health service faced across the country, stemming from a deterioration in the overall health of the population and exacerbated by a worsening in the social determinants of health and an ongoing lack of capital investment, stifling productivity. The report suggested key areas of focus for the upcoming NHS Long-Term Plan.

The Chancellor would deliver her first Budget on 30 October 2024. Indications from the Government were that one theme of the Budget would be NHS reform underpinned by ‘three big shifts’ in healthcare:-

·            a shift from hospital to community;

·            a shift from analogue to digital and

·            a shift from sickness to prevention.

Ministers had repeatedly emphasised the tight fiscal landscape, and so it was anticipated that any additional funding made available would be highly targeted and contingent on delivering reform that contributes to the three big shifts.  The Budget would be followed by the 10 Year Plan for the NHS, with publication expected in spring 2025. This would draw out a more detailed proposal for achieving the three big shifts. The Plan would be informed by a ‘national conversation’, in which the public, clinicians and experts would be invited to submit ideas and shape the future of the NHS.  It was noted that Manchester was well-placed to assume a leading position as these reforms were brought forward, given its existing focus on community and prevention.   In addition, further information from Government on the development of North Manchester General Hospital was soon expected. A review of the New Hospitals Programme, of which this formed part, was announced over the summer.  It was expected that the Budget would include further details of the Government’s capital spending plans over the coming years.

In terms of GM, the focus had been on developing the Sustainability Plan for the Integrated Care System.  In addition, each locality had been asked to develop a ‘local sustainability plan’ by December. This would consider how the five pillars of the GM Sustainability Plan could be applied in each place, with a particular focus on reducing prevalence and prevention.

Specifically within Manchester,  Mental Health continued to be an area of focus. The numbers of Manchester residents in Out of Area Placements (OAPs) remained high, with 51 people in OAPs as of 9am Monday 21 October. This had reduced slightly from a high of 58 in late August, and it was expected to reduce further over the coming weeks. The locality team had been working closely with colleagues in GMMH, central commissioning colleagues in NHS GM and colleagues in the City Council (particularly in adult social care) to identify the principal factors behind this increase and to address them as quickly  ...  view the full minutes text for item 49.

Report of the Greater Manchester Integrated Care Partnership attached

The Associate Director of Planning, NHS GM presented a report that set out the Greater Manchester (GM) Integrated Care Partnership Sustainability Plan

It was reported that as a system, GM had sought to improve population health through working with partners whilst at the same time improving the NHS financial position and health service performance. Working with partners, the GMICP had developed a Sustainability Plan which had been approved at the GM Integrated Care Board on 18 September 2024.

The Sustainability Plan was based on the recognition that system sustainability rested on addressing the challenges face across finance, performance and quality and population health - and the relationship between these.  The Plan showed how the system both returned to financial balance through addressing the underlying deficit and secured a sustainable future through addressing future demand growth and implementing new models of care year on year.

In developing the Plan, the financial and performance position of NHS providers had been considered, along with plans to transform and optimise care provision, in order to address the underlying financial deficit by the end of the 2026/7 financial year.  A population-based approach to developing the plan had set out the current and future pattern of demand and associated costs attributable to Non-Demographic Growth (NDG), quantified the opportunities to improve population health, and set out the immediate priorities to inform phasing and sequencing of these opportunities over time.

The Plan set out how the current deficit may be compounded by approximately £600m of additional demand but could be addressed over time through a combination of population health measures, system collaboration and provider efficiencies.

It was recongised that there was a need to act both on reducing the prevalence of poor health through prevention activities and provide early intervention and proactive care to stem further deterioration.  The Sustainability Plan was clear that the projected non-demographic growth in demand and costs could only be addressed through radical changes in both care models and in tackling the social determinants of health. All partners in each locality, including GM-level functions, would need to create the right conditions for the Sustainability Plan to be delivered. The Locality Board (Place-Based Partnership Committee) was the focal point for this, and the following steps were proposed;-

·            Develop a place-based representation of Sustainability Plan delivery;

·            Connect the Sustainability Plan to the position of the local authority;

·            Ensure use of population health management approaches;

·            Establish a much broader set of locality metrics;

·            Design an Investment Plan; and

·            Confirm relationship of GM-level programmes to place-delivery.

It was further noted that the place-based representation of delivery would need to be complemented by an equivalent exercise on the provider trust side – setting out, for example, how provider collaboration could support efficiency and productivity improvements.

Decision

The Board:-

(1)       Support the Sustainability Plan

(2)       Endorse the above steps to progress the work at pace

Report of the Place Based Lead Manchester and the Strategic Director of Population Health attached

The Strategic Director of Population Health and Work and Skills Lead (MCC) presented a report that provided an update on the creation and implementation of the Making Manchester Fairer (MMF) Employment Kickstarter.  The report set out how the Kickstarter inter-relates and would be developed into a funded service with the Greater Manchester (GM) WorkWell Vanguard programme of which Manchester is receiving £1.3m between 1 October 2024 and 31 March 2026. 

Manchester’s WorkWell model had been designed to MMF principles and was aligned to the action plan to reduce health inequalities.  It was proposed that Manchester’s overall WorkWell approach is the future Kickstarter.  WorkWell specifically delivered against the following MMF themes:

·            Cutting unemployment and creating good jobs

·            Lifting low-income households out of poverty and debt

·            Fighting systemic and structural discrimination and racism

·            Community power and social connections. 

Manchester’s approach had been to build on the assets and infrastructure iyt had to ensure it delivered the best services for Manchester residents and communities aligned with the MMF 5 year action plan, Manchester Partnership Board Priorities, Work and Skills Strategy and Anti Poverty Strategy.  The Manchester approach had been designed through learning, consultation and engagement with stakeholders including patient and public voice as part of that process. The approach aligned to the MCC refreshed equality objectives of

·            Inclusive employment

·            Promoting community involvement and engagement; and

·            Delivering inclusive and accessible services.

The MMF Employment Kickstarter had been developed in partnership by Manchester Foundation Trust (MFT), Manchester City Council (MCC) and the Growth Company to offer an integrated health and employment service to support Manchester residents receiving Musculo-Skeletal (MSK) services to stay in or move into work.  The Kickstarter was unfunded and relied on the use of co-ordinating existing resources which brought limitations but had also been an excellent example of collaboration to create a transformational approach. The project design and implementation phase enabled excellent engagement of MFT’s clinical team in MSK to ensure the Kickstarter would be robust and add value. Good engagement and service led design had been paramount in the development of the service alongside lived experience and resident feedback.   

The Kickstarter was focused in North Manchester. MFT patients with MSK conditions had been identified by clinicians as needing support and referred into an online portal (Kickstarter bespoke) developed by the Growth Company. Once referred the MSK patient was assessed by the Growth Company for employability support and was able to access one of several employability programmes. The Growth Company were contracted to deliver these programmes by Greater Manchester Combined Authority (GMCA). This had enabled the Kickstarter to be developed using existing resources at minimal cost, but with the limitation that some of the programmes were due to end by March 2025.

The GM WorkWell partnership (GMCA and NHS GM) had provided Manchester with £1.3m of funding to deliver a WorkWell service (to 1,620 participants/residents).  WorkWell wad a new GM designed integrated work and health service which built on previous integrated services delivered in the city since 2014.  WorkWell would prioritise early  ...  view the full minutes text for item 51.

Report attached

The Board received a presentation from the Associate Director of Finance, NHS GM which set out the final winter capacity funding proposals for 2024/25 and sought agreement to the proposed approach and the proposed proportion of Manchester’s 2025/26 UEC Capacity Funding in the UEC Transformation Programme

It was reported that in preparation for winter, locality systems were required to develop capacity expansion plans to avoid becoming overwhelmed at times of peak demand.  The quantum of funding (£5.6m) for this winter was broadly the same as last year and there was collective responsibility to ensure there were local plans in place for services to remain as resilient as possible and respond to operational pressures.

System-wide planning discussions have taken place throughout the Summer.  In order to inform the plan, the system had:-

·            Gathered and used insight and learning from the experiences of last

·            Winter; and

·            Agreed principles, key metrics for improvement, and urgent care

·            priorities it wishes to target

At the winter debrief session held on 17 May 2024, the system considered the two key urgent care principles:-

·            Increasing the productivity of acute and non-acute services across bedded and non-bedded capacity, improving flow and length of stay, and clinical outcomes; and

·            Continue to develop services that shift activity from acute hospital settings to settings outside an acute hospital for patients with unplanned urgent needs, supporting proactive care, admissions avoidance, and hospital discharge

The system agreed that all 2024/25 schemes should align to at least one of

these principles to be considered for capacity funding.  Additionally, within the national planning guidance, the following metrics would be utilised

to measure urgent care system performance:-

·            Improve A&E waiting times, compared to 2023/24, with a minimum of 78% of patients seen within 4 hours in March 2025;

·            Improve category 2 ambulance response times to an average of 30 minutes across 2024/25;

·            Improve mental health patient flow and work towards eliminating inappropriate out of area placements;

·            Improve access to virtual wards (Hospital at Home) by ensuring utilisation was consistently above 80% (focus on frailty, acute respiratory infection, heart failure and Children and Young People (CYP);

·            Reduce the proportion of waits over 12hr in A&E compared to 2023/24;

·            Reduce admitted and non-admitted time in emergency departments, and in particular arranging appropriate services for mental health patients requiring urgent care; and

·            Reduce ambulance handover delays.

In terms of 2024/25, the following funding proposals had been put forward:-

·            Additional £122k of the overall allocation top sliced at GM level (this included hospice bed capacity and an increased contribution towards discharge coordinator);

·            Maintaining the same £1.2m investment in primary care;

·            Maintain the same £0.5 investment in GMMH;

·            Inclusion of 2 additional uses of winter capacity funding aimed at diverting and deflecting acute hospital activity and delivering a left shift in healthcare.

·            Additional contributions/schemes funded through a gradual reduction (£0.4m / movement from 67.3% to 62.3% of discretionary spend total) of investment in acute bed capacity;

·            Funding for the existing 100 Hospital @ Home beds  (this was subject to  ...  view the full minutes text for item 52.

Report of the Associate Director of Finance, NHS GM (Manchester) attached

The Associate Director of Finance, NHS GM informed the Board of the most recent financial position for the locality, the 2024/25 forecast running costs and the existing financial risks and mitigations for NHS Greater Manchester.

It was reported that the ICBs plan was to deliver a balanced financial position in 2024, however this included several financial challenges:

·            Planning Risks c£220m - Targets at planning, primarily CIP and targeted reduction in allocations.

·            Emerging Risks c£60m - CHC, Mental Health and Prescribing materially over budgets set in June

All localities had been asked to submit a Financial Recovery Plan following Month 4 reporting to demonstrate actions to be taken to deliver a breakeven outturn position for 2024/25.  Manchester Locality had submitted a recovery plan at £2.4m deficit, which was a net £2.8m improvement on the Month 4 (which was a projected £5.2m forecast deficit).

The Locality had since resubmitted a revised Recovery Plan at £1.4m deficit which was a £1.0m favourable movement from Month 6 and related to:-

·            £1m reduction relating to recovery plan line – D2A services

·            £0.3m reduction relating to release of Cross Year Benefits

·            £0.4m Placements growth in CHC

·            £0.1m Placements reduction in MH

The locality was also reporting a net YTD underspend of £0.7m at Month 6 against a budget YTD of £84.3m relating to:-

·            £2.4m underspend for recovery plan actions (£1.9m Community, £0.2m MH & £0.3m Primary Care)

·            £0.2m underachievement of CIP against planned profile

·            £1.7m CHC placements pressure

·            £0.1m MH placements pressure

·            £0.3m net underspend across Community, Primary care & Other service

It was reported that as of Month 6, the system had delivered £4.75m CIP against a £13.65m full year target and the forecasted outturn assumed CIP delivery in full.

The Recovery Plan also included slippage lines against some baseline budgets, some cross year accrual benefits following review work and some re-classification of expenditure for existing services against alternative funding sources.  The Plan however, did not include service growth which remained a cost pressure risk in future months.

Decision

The Board note the report.

Report of the Deputy Place Base Lead attached

The Board received a report of the Deputy Place Based Lead, which set out the key achievements and progress to date of the Manchester Provider Collaborative Board delivery plan for 2024/25.

The update covered the following areas of the delivery plan:-

·            Children and Young People;

·            Long Term conditions;

·            Optimising the Neighbourhood approach;

·            Mental Health Transformation Programme;

·            Improving Access to Primary Care;

·            Manchester Cancer Delivery Group (MCDG); and

·            Urgent Care Recovery.

Decision

The Board note the key achievements and progress to date

To note that the date of the next public meeting of the MPB will be Tuesday 17 December 2024

Decision

The Board noted the date of the next public meeting was Tuesday 17 December 2024

Report attached

Decision

The Board note the report

Report attached

Decision

The Board note the report

Report attached

Decision

The Board note the report

Report attached

Decision

The Board note the report

Report attached

Decision

The Board note the report

Reprt attached

Decision

The Board note the report

Report attached

Decision

The Board note the report.