The report of the Chair of Manchester Health and Care Commissioning (MHCC) is attached.

The Board received a report from Dr Bromley, Chair, Manchester Health and Care Commissioning (MHCC). Dr Bromley introduced the report that provided updates on the current recovery of health and social care services as part of the system’s response to the COVID-19 (Covid) pandemic, with a specific focus on Manchester University NHS Foundation Trust (MFT). The report also provided a description of the broader strategic recovery plans of the health and social care system. The Board noted that the MFT continues to experience operational pressures, as a result of the national pandemic that is impacting on delivery of NHS constitutional targets. Safety is being prioritised across emergency, urgent and elective pathways and system-wide improvement programmes are in place to support recovery. It is envisaged that progress will be made in reducing elective backlogs over the coming months, however this will be incremental and in the context of wider pressures. Demand for Mental Health, Community and Primary Care services has also significantly increased and out of hospital services are under equal levels of pressure. COVID-19 has had a much broader impact on the health and wellbeing on the people of Manchester. Some is evident now and some can be anticipated in the future and some may yet emerge. The development of a strategic recovery framework captures the breadth of the health and social care system’s response within the recovery phase. The framework covers four themes with associated outcomes metrics. (i. the resumption of services to bring services back to their pre-pandemic levels. ii. addressing the disproportionate impact that Covid has had on some population groups, as well as addressing the long-term health inequalities that would have widened, as a result of the pandemic. iii. meeting the new needs of our population because of Covid, including physical and mental health impacts. iv. the broader contribution the health and social care sector can make to the wider City recovery).

It is important to note that there is an ongoing, significant response, to Covid as well as high levels of demand for urgent care services. There is an interdependency between the level of demand within the system at a moment in time and implementation of recovery as it calls upon the same capacity and workforce.

The Board was addressed by officers from the agencies involved in the recovery process.

Sarah Perkins Director of Elective Recovery (MFT) addressed the Board on the work to re-engage with patients for a return to hospital services, post covid. Currently staff absence rates are between 9-10%, that presents resource issues to provide care across urgent care, paediatric care, mental health and elective services.  The process of engaging patients is under a period of change from non-face to face to in-person attendance. A process of grading patients is in place to deliver care to the most urgent patients and work is ongoing to engage with those patients in lower categories of need. The Board was informed of the process for engaging patients from across different ethnic communities.

Kate Proven, Quality Lead, MHCC addressed the Board on the work of the LCO which has seen higher levels of need. Work is ongoing on the delivery of the vaccination programme, although levels of covid related sickness has impacted on service delivery, plans are in place to help and support staff members. There is a comprehensive recovery and reform work programme with eight priority areas. Work is also ongoing in the integrated neighbourhood team hubs with other support services through various programmes of support and care.  

James Binks,Director Policy Performance and Reform addressed the Board on the Strategic Recovery Framework contained in Part 2 of the report. This is linked to four themes:

1.                 the resumption of services to bring services back to their pre-pandemic levels.

2.            addressing the disproportionate impact that Covid has had on some population groups, as well as addressing the long-term health inequalities that would have widened as a result of the pandemic.

3.            meeting the new needs of our population because of Covid, including physical and mental health impacts.

4.            the broader contribution the health and social care sector can make to the wider City recovery.

Julie Taylor, Director of Strategy (MHCC) reported that the framework is currently under development and the focus is to find a deeper understanding of covid and how it has affected the residents of the city.

The Chair invited questions and comments from Members of the Board.

Dr Murugesan Raja welcomed the report and thanked officers for the work being done and referred to the importance of recognising staff welfare in the delivery of services and the challenge in addressing the increases in public contact being made with care services.

The Chair asked officers what within the programme is there to deal with the longer-term effects of covid and the effects on mental health which may not materialise for some time such as young people who have lost a period of their developmental growth.

It was reported that there is a mental health services provision is available for university students. Details of other services would be provided in a later report.

Dr Bromley stated that as a GP in a high demand area of the city, there had been a shift over the past 18 months with mental health presentations taking up approximately 90% of work overall. This has included adolescents and younger children. GP’s have been able to provide help and referrals to secondary services.

Dr Wadhwa referred to staff wellbeing and the impact on staff health as a result of negative reporting within the media and an increase in levels of abuse towards staff members.

The Chair commented that demand management and preventative approaches is important as part of a whole system care approach to providing early preventative treatment. The Chair acknowledged the importance of data collection to improve the provision of services to address health inequalities within sectors such as the acute services. Reference was also made to the subject of work force and work-load and the responses received through the GM Community covering health services. It was noted that staff shortages in some areas of services were noticeable and others were struggling to meet high levels of demand. Other primary care services were not as visible and the point raised on abuse towards staff due potentially in part to the frustration of patients is not an acceptable reason. It was important to provide a clear picture of the level of pressure the whole health care system is currently operating within and the plans required to ensure that services work differently to get through the challenges of the winter period. In noting the level of challenge this presented the health service, the Chair offered the support of the Health and Wellbeing Board where possible.

Dr Jeffreys thanked the Chair for the support offered and suggested that the opportunity presented itself to blur boundaries between hospital and primary care/community services which appear to oppose to each other. The position has started to change, and it was important for each side to learn to trust the other. This could be developed further through the sharing of IT systems and closer working for hospitals to understand what community services can offer to patients to take care away from the hospital and into the community.

The Chair noted the comments and referred to the Manchester Partnership Board where work had taken place on the discharge of patients with respiratory diseases to receive care in the community. The joint working approach of the LCO during the peak period of the pandemic had proved to be invaluable in keeping hospitals functioning. The interdependency that was highlighted will provide a way forward for a better and more efficient form of working.

Decision

The report was noted.