Report of the Place Based Lead, Manchester Integrated Care Partnership

This report provides an update on Manchester’s connections with NHS GM in relation to governance, partnerships, financial arrangements and future plans within the Manchester Locality.

The committee considered a report of the Place Based Lead, Manchester Integrated Care Partnership which provided an update on the Council’s connections with NHS Greater Manchester (GM) in relation to governance, partnerships, financial arrangements and future plans within the locality.

Key points and themes within the report included:

• The background to Integrated Care Systems, which comprised of Integrated Care Boards (ICB) and Integrated Care Partnerships (ICP);
• Providing an introduction to NHS Greater Manchester;
• The key areas within NHS GM highlighted as requiring improvement in the agreed set of formal enforcement undertakings with NHS England, and the Single Improvement Plan developed in response;
• The role of localities within NHS GM;
• Priorities and governance, including the Manchester Partnership Board; and
• The financial picture for GM and Manchester’s ICPs.

Some of the key points and queries that arose from the committee’s discussion included:

·       The GM-wide deficit timeline suggested that the reduction strategy was off schedule, and querying the implications of this;

·       How estate savings could be achieved;

·       The relationship between the Council and the ICP following the departure of the Council’s Chief Executive;

·       Whether assessments were undertaken to ensure mental health spending was adequate to meet local needs;

·       How decisions were reviewed to ensure fairness for both the Council and the NHS;

·       Whether a year-to-date pressure of £15.4m for NHS providers was due to overspend; and

·       Requesting case studies of the achievements of the Manchester Joint Commissioning Board.

The Executive Member for Healthy Manchester and Adult Social Care introduced the report and explained that the Integrated Care System consisted of two bodies – the Integrated Care Partnership, which oversaw strategy, and the Integrated Care Board (ICB), which was responsible for delivery and implementation. He stated that he represented the Council on the Integrated Care Partnership, and the Place Based Lead was the Council’s representative on the ICB. He explained that progress was monitored through Locality Boards which scrutinised the system and escalated new methods of working with involvement from Primary Care Networks (PCN) and doctors.

The Place Based Lead stated that the NHS continued to recover from the pandemic which had caused significant financial and operational challenges for the national and regional systems. He highlighted that the National Audit Office estimated a £1.4bn deficit across the NHS in the previous financial year and inflationary pressures were affecting the health and social care sector, exacerbating other challenges and increasing the complexity of need and the deterioration of hospital estates. He stated that there was significant work ongoing to quantify, understand, manage and recover from this position and the ICP was in agreement with NHS England regarding key issues and the necessary steps within the next three years. He also acknowledged pressures within Population Health and the need to manage the immediate financial pressures whilst keeping Manchester residents healthy. 

In response to members’ queries, the Place Based Lead stated that monthly discussions took place between the Chair of the ICB Board and NHS England on progress with the Single Improvement Plan to ensure that local pressures were understood at national level. He also explained that significant work had been undertaken to identify priority areas of improvement across the capital estate and a senior group made up of hospital trust and Board executives had developed a multi-year capital maintenance pipeline. He acknowledged challenges with this but emphasised that the ICB remained focus on identifying areas of the estate with the greatest risk and deterioration levels.

With regards to the governance structure of the ICB, the Executive Member for Healthy Manchester and Adult Social Care stated that Manchester wanted to take a place-based approach to healthcare. He explained that the Deputy Place Based Lead was responsible for organisational arrangements and the relationship with the ICS and was supported by the Council’s Deputy Chief Executive. He also stated that the Council’s Interim Chief Executive had sat on the ICP and was familiar with its work. He stated that the only change following the departure of the Council’s Chief Executive was that Tom Hinchcliffe would represent the Council on the Manchester Partnership Board in his capacity as Place Based Lead.

In response to a query regarding mental health spending, the Place Based Lead stated that mental health services in Greater Manchester were in a challenging position and the Greater Manchester Mental Health NHS Foundation Trust (GMMH) had been placed under national intervention with recovery actions being implemented and an improvement board between GMMH and NHS England had been established. The Associate Director of Finance, NHS GM explained that the Mental Health Investment Standard guaranteed a minimum level of expenditure for NHS and private sector providers and specific funding was provided for this.

The Executive Member for Healthy Manchester and Adult Social Care concurred with a member’s expression of support for healthcare workers exercising their democratic right to strike. The Executive Member for Finance and Resources also highlighted that the new Labour government had negotiated a deal with doctors and healthcare staff.

The Executive Member for Healthy Manchester and Adult Social Care explained that the Manchester Partnership Board, which was chaired by the Leader of the Council, provided the checks and balances for decisions and included representatives of partners. He stated that this Board discussed difficult decisions and provided transparency in decision making. The Place Based Lead recognised the combined work of the ICP and the Council and reiterated the importance of resolving any potential tensions in a transparent way.

In response to a query regarding whether a year-to-date pressure of £15.4m for NHS providers was due to overspend, the Place Based Lead explained that providers forecasted exceeding their budget by this figure at the end of the year, however he stated that plans were in place to address this.

The Place Based Lead also agreed to provide some case studies of the achievements of the Manchester Joint Commissioning Board and provided an example that the range of branded prescribed drugs had been reviewed to ensure value for money.  

Decision:

1.     To note the report and

2.     To request a further update in 12 months, with more detail on the financial picture for Manchester.