Issue - meetings

At the request of Board, this is a standing item on the agenda.

Members and officers presented are invited to update the Board on developments with the Stockport Together Programme.

The Chair invited partners present to update the Board on Stockport Together.

Andrew Webb emphasised the range of activity since the last meeting, including:-

·         the detailed draft Business Cases for the new models of care had been agreed in principal, with a range of caveats and would be subject to final adoption later in the year;

·         providers had now created an integrated leadership team, including the appointment of an interim Managing Director;

·         ‘Stockport Neighbourhood Care’ had been created as an embryonic Multi-Speciality Community Provider (MSCP);

·         a number of senior positions had been appointed to;

·         an implementation plan for the next 18 months had been developed, and this had identified the key inter-dependencies in the programme;

·         an alliance agreement between providers had been developed that would allow them to operate as if a single organisation, and was currently  proceeding through each organisations governance arrangements;

·         work continued to resolve commissioning and contracting challenges;

·         the provider procurement process had resumed, and Government guidance had now been published that would support that process;

·         detailed development work was underway for a Neighbourhood Led Accountable Care Trust;

·         partners were acting more effectively as if a single organisation in dealing with performance issues in the acute sector and, while challenges remained the situation was improving;

·         the resources used to address Emergency Department performance issues had impacted on the capacity to deliver the neighbourhood model which had progressed been slower than planned, although this was to be addressed;

·         subject to approval from the Council, the CCG and the Council as commissioners would begin stakeholder consultation on the Stockport Together programme.

Donna Sager provided the following additional update:-

·         Viaduct Health had now appointed an interim CEO;

·         as part of the shift in attention back to developing the neighbourhood approach there was work ongoing to explore how to improve GP clinical systems to reduce pressure and make it easier for patients to get appointments;

·         Neighbourhood Team recruitment was underway but was challenging;

·         ensuring sufficient physical space for locality based services was also proving challenging as many GP practices had limited capacity to host services.

Assurances were sought that following the efforts made by partners to address pressures on the local health and care economy that the programme was now ‘on track’. In response it was stated that from this point in the year the economy was now in a good position, including improved performance in ED. It was emphasised that while sustaining any further improvements would be challenging, the ‘system’ was now much improved and in a stronger position than it was a year earlier.

It was also commented that the Clinical Commissioning Group remained concerned about performance at the Hospital and that Winter was likely to be very challenging. An example was provided of senior clinicians at the hospital not being aware of services available outside of ED that would negate the need for admission. In response it was acknowledged that the Four Hour Admission Standard would not be achieved for this year overall, but that performance regularly exceeded this standard.

Clarification was sought on what effect the delays in moving toward delivery through Neighbourhood teams would have on the budget. In response it was stated that the current budget had built-in headroom for the double running of services, and further resources would be available through the iBCF. Current projections were that without corrective action the Pooled Budget would be £650k overspent at year end, but that action would be taken and this represented a small fraction of the total budget pool. It was further commented that the Transformation Fund resources used to support the implementation of the new models of care were released in tranches upon completion of particular actions, but the challenge was that the resources were often needed to achieve the actions to generate the savings needed to redistribute existing resources.

In relation to recruitment, it was commented that Stockport was looking to recruit from  ...  view the full minutes text for item 8

At the request of the Board, this is a standing item on the agenda.

Members and officers presented are invited to update the Board on developments with the Stockport Together programme.

The Corporate Director for People submitted a report (copies of which had been circulated) providing the Board with an update on the progress with the Stockport Together Programme.

The following issues were highlighted:-

·         There were Greater Manchester wide problems with Delayed Transfers of Care, which were most acute in Stockport and Trafford as these borough had the highest number, and fastest growing cohort of older people with complex needs; challenges with procuring appropriate packages of social care as there were insufficient staff to meet the demands. Stockport partners had worked with NHS agencies to address some of these challenges, but there remained a higher number of people being admitted into hospital. Despite work to stimulate providers in the market there remained a greater demand than available supply. A range of short term measures were used to easy problems at the hospital, including involvement of the Greater Manchester Health and Social Care Strategic Partnership.

·         Although many of the efforts in place over this Winter had been a ‘sticking plaster’ it was still hoped that the Stockport Together initiatives would lead to long term improvements.

·         Further work was needed to develop a fully integrated discharge team to provide more rapid and effective decisions. This type of initiative was the real aim of pooling budgets.

·         More analysis was needed to understand how Stockport benchmarked against other areas for spend on social care and other similar services.

·         Although Stockport Council spent a significant proportion of its budget on social care, this had not kept pace with the growing population demand.

·         Stockport NHS Foundation Trust was shortly to launch its ‘Better at Home’ initiative to highlight the benefits of being out of hospital and active at home.

RESOLVED – That the report be noted.

This item has been placed on the agenda at the request of the Chair.

A verbal update on progress with the Stockport Together Programme will be provided.

The Chair invited those present to provide an update on Stockport Together.

Andrew Webb, Corporate Director for People, Stockport Council and Senior Responsible Owner for Stockport Together provided the following update on progress in delivering the transformation programme:-

·         Neighbourhood leadership arrangements were complete in all 8 localities. Social workers had been aligned to GP populations, and nursing alignment was underway. Enhanced case management was now in place.

·         Three Neighbourhoods now had the enhanced primary care offer.

·         Intermediate Tier crisis response was now operating that would allow additional support to be deployed within 2 hours.

·         Mastercall were now providing triage of patients at Stepping Hill ED to stream patients to GP led care where appropriate, and coverage was to be expended in December. So far 300 patients had been deflected.

·         Work had recently been undertaken to identify the skills needs of the Multi-Speciality Community Provider, and steps were being planned to address challenges in recruiting Advanced Nurse Practioners and similar staff.

·         3 Mental Health Liaison workers were now in place.

Donna Sager, Deputy Director of Public Health provided the following update on the preventative workstream:

·         The Behaviour Change Services were now online.

·         Work was continuing with the voluntary sector to provide practical support for discharge.

·         A pilot had been launched to support and encourage volunteering in general practice.

·         The work undertaken on empowering local communities had been recognised nationally and partners had been invited to put forward a bid for Vanguard status in this area.

Ann Barnes, Chief Executive of Stockport NHS Foundation Trust emphasised that the theoretical aspirations of Stockport Together were now becoming reality, but that this created further challenges that required the approach to be reviewed and refreshed to ensure the programme objectives remained achievable.

Echoing the comments of others, the significance of the workforce development challenge was again emphasised, in particular the shortage of skills in some areas, but also the opportunity to ‘grow’ those skills locally.

Dr Ranjit Gill, Chief Clinical Officer, Stockport Clinical Commissioning Group stated that the reduction in Non-Election Admissions at the hospital was reflective of the work partners were already doing, and demonstrated that the investment in change was starting to yield results. He further emphasised the need to ensure that further investment was weighted to create a system capable of long term impact, not just resolve short term challenges, and that partners used their data and intelligence to predict and prevent problems in order to reduce Winter demand the following year.

Andrew Webb emphasised the significance and scale of the change underway and the progress that had been made so far. As work intensified, the Programme Communications Strategy would also change to reflect this.

RESOLVED – That the update be noted.