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Agenda Item 2.1.1

Positive – Collaborative – Fair 1

Manchester Health and Care Commissioning Board

Agenda Item: 2.1.1 Date: 28 March 2018

Report Title: Manchester Health and Care Commissioning (MHCC) Operational Plan 2018/19

Prepared by: Sarah Griffiths, Policy and Programme Manager Dr Leigh Latham, Head of Planning & Policy

Presented by: Ed Dyson, Executive Director Planning and Operations Dr Leigh Latham, Head of Planning & Policy

Summary of Report: This paper presents MHCC’s Operational Plan for 2018/19, for review and approval.

Strategic Objective:

MHCC’s Operational Plan sets out how MHCC will deliver against its strategic aims – and the underpinning priorities – during 2018/19:

To improve the health and wellbeing of people in Manchester

To strengthen the social determinants of health and promote healthy lifestyles

To ensure services are safe, equitable and of a high standard with less variation

To enable people and communities to be active partners in their health and wellbeing

To achieve a sustainable system

Board Assurance Framework Risk:

Outcome of Impact Assessments completed

(e.g. Quality IA or Equality IA):

An Equality Impact Assessment on the Operational Plan will be completed and results will be included in the Q1 18/19 report.

Outline public engagement – clinical, stakeholder and

public/patient:

There has been engagement relating to the priorities identified within the 18/19 Operational Plan. In addition there is ongoing engagement relating to the various work programmes contained within the Plan.

Recommendation:

The MHCC Board is asked to:

a) Note the contents of the paper

b) Approve MHCC’s 2018/19 Operational Plan

Agenda Item 2.1.1


1.0 Introduction

This paper MHCCs Operational Plan for 2018/19 and provides an overview of how the plan has been developed. The Operational Plan sets out how MHCC will deliver against constitutional, statutory and financial requirements, as well as the transformation of Manchester’s health and care system (i.e. MHCC’s contribution towards achieving Our Healthier Manchester). This is a refresh of the two year (2017-19) plan that was published in April 2017. It reflects the progress made by MHCC during 2017/18, and is presented in the context of MHCC’s priorities and objectives for the coming year. It also sets and how MHCC will deliver the requirements of the 2018/19 NHS Planning Guidance which was published in February 2018.

2.0 Developing MHCC’s Operational Plan for 2018/19

The Operational Plan is presented in two parts:

1. Operational Plan (slide deck). This sets out how MHCC will deliver against constitutional, statutory and financial requirements, as well as the transformation of Manchester’s health and care system (Appendix A)

2. Stocktake document. This sets out in detail how MHCC will meet the national ‘Must Dos’ contained in the 2018/19 NHS Planning Guidance, Refreshing NHS Plans for 2018/19, which was published in February 2018 (Appendix B)

Work to develop MHCC’s Operational Plan for 2018/19 began in the autumn of 2017, with the initial focus on identifying initiatives to support the development of MHCC’s 18/19 Financial Sustainability Plan (FSP), alongside the wider work plans for the year. Alongside this, the Executive Team led the development of the MHCC’s priorities for 2018/19, which are include the FSP and are underpinned by a series of objectives. These priorities and objectives provide the framework for the 18/19 Operational Plan. The priorities for 2018/19 are:

1. Deliver national and statutory requirements and drive the transformation of health and care in Manchester

2. Develop high quality, effective residential, nursing and home care

3. Deliver effective out of hospital care

4. Develop core primary care services

5. Tackle health inequalities

6. Deliver strategic programmes in line with Manchester’s priorities

7. Develop a transformed health and care system The Operational Plan brings together for each priority:

What the impact of delivery will be during the year

The key milestones for each quarter, drawn from across the underpinning work programmes across MHCC.

This will form the basis of reporting to MHCC Executive and MHCC Board during the 2018/19 year.

Agenda Item 2.1.1


In addition, the Planning and Policy Team has worked with managers to produce a stocktake which sets out in detail how MHCC will meet the national ‘Must Dos’ contained in the 2018/19 NHS Planning Guidance, Refreshing NHS Plans for 2018/19. This accompanies a stocktake against the original 2017/18-2018/19 NHS planning guidance, which is being updated on the basis of local progress made during the 2017/18 year.

3.0 Monitoring and reporting arrangements

From April 2018, MHCC is operating a single planning, delivery and assurance process. Taking on feedback regarding the need for more summarised, focused reports, it is proposed that reporting against the Operational Plan will be based on progress against the key milestones identified for each the priorities. The monitoring and reporting arrangements are summarised as follows:

Reporting to MHCC’s Executive will continue to take place monthly and will focus on progress against delivery of the quarterly milestones for each of the 7 priorities

Reporting will include progress against the Financial Sustainability Plan. The Financial Sustainability Plan will be monitored through more detailed implementation plans and progress will also be reported to Finance Committee on a monthly basis

Existing monthly monitoring will continue at the work programme level, however the focus will be on milestones rather than the work programme’s progress as a whole. The new way of working will improve the robustness of monitoring but will rely on having clear milestones and associated timescales for achievement. There should be no duplication of monitoring against work programmes within the Operational Plan

Each of the 7 priorities has a responsible Executive Lead. The Planning and Policy Team will work with the respective Lead to understand progress, any issues arising, and agree a ‘RAG’ (red / amber / green) rating each month. Each Executive Lead will talk through their priority report at the Executive Committee

Progress against delivery of the priorities will be reported to MHCC Board on a bi-monthly basis

4.0 Recommendations

MHCC Board is asked to:

a) Note the contents of the paper

b) Approve MHCC’s 2018/19 Operational Plan

Manchester Health and Care Commissioning (MHCC)

Operational Plan 2018/19

1

Appendix A

CONTENTS MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

2

INTRODUCTION

ACHIEVEMENTS IN 2017/18

Slide 3

OUR MISSION, VALUES AND STRATEGIC AIMS Slides 4 - 6

Slide 7

OPERATIONAL PLAN 2018/19: CONTEXT Slide 9

OUR PRIORITIES FOR 2018/19 Slides 10 - 27

NATIONAL REQUIREMENTS Slides 28 - 30

FINANCIAL SUSTAINABILITY PLAN Slides 31 - 33

GOVERNANCE, MONITORING AND ASSURANCE Slide 34

REFERENCES Slide 35

INTRODUCTION MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

Established in April 2017, Manchester Health and Care Commissioning (MHCC) is responsible

for the commissioning of health, public health and adult social care services in the city of

Manchester. This annual plan is a refresh of the 2017-2019 plan that was published in March

2017, and therefore reflects progress made within MHCC, across the wider health and care

system in Manchester, Greater Manchester and requirements of the 2018/19 national planning

guidance.

This plan will outline the organisational priorities for 2018/19 to ensure that MHCC will deliver

against all national requirements, which include the Must Dos, the national clinical priorities and

the constitutional standards, and deliver the transformational change across the health and

social care system i.e. MHCC’s contribution toward the delivery of Our Healthier Manchester.

3

OUR MISSION MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

4

OUR VALUES MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

5

OUR STRATEGIC AIMS MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

6

Improve the health and wellbeing of people of Manchester

Enable people and communities to be active partners in their health and wellbeing

Ensure services are safe, equitable and of a high standard with less variation

Strengthen the social determinants of health and promote healthy lifestyles

Achieve a sustainable system

• Proactively support people’s health by starting well, living well, ageing well and at the end of life.

• Improve both mental and physical health.

• Provide services fairly, to reduce local variation in healthy lives.

• Enable healthy lifestyle choices and prevent ill health.

• Support improvements in housing, jobs, education, the economy and people’s social connections.

• Coordinate health and care, ensuring safety, quality, value for money and high standards for all.

• Transform the health and care system, shifting care from hospital to the community.

• Build on the strengths of communities, voluntary groups and social networks.

• Invest in individuals and carers, supporting them to manage their own health.

• Individuals take greater responsibility for their own health and wellbeing.

• Reinvest the savings we make into better care.

• Balance our finances now and in future years.

• Develop our workforce so we have committed, healthy, skilled, people where and when they are needed.

ACHIEVEMENTS IN 2017/18 (1/2) MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

Key achievements in 2017/18 included:

• Emergency admission for children’s asthma have reduced by 19.5% in in 2017/18 compared

to 2015/16.

• Continued delivery of the primary care standards across Manchester; when compared to

16/17 2000 more patients with asthma, 1000 more patients with diabetes, and 500 more

patients with COPD, having received a ‘Gold Star’ review, and therefore better able to

manage their long term condition.

• Delivery of the 7 day GP access across Manchester

• Achieving the top quartile (CCGIAF rating) for the number of referrals booked electronically

and the recording of a dementia diagnosis

• ‘A rated’ stroke services as determined by the Sentinel Stroke National Audit Programme

(SSNAP).

• Zero 12 hr trolley waits, or mixed sex breaches at MFT

• Consistent delivery of cancer waiting time and diagnostic standards at USHM site

• 35 VCS organisations receiving greats through the Mental Health Grants programme, which

have engaged to date over 800 new service users through the programme.

• The expansion of Manchester’s Lung Health Check pilot to benefit thousands more people

at high risk in the north of the city. The pilot quadrupled lung cancer early diagnosis rates.

The pilot was recognised nationally and is a trail blazer for other areas within the UK.

7

ACHIEVEMENTS IN 2017/18 (2/2) MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

Key achievements in 2017/18 included:

• Opening of Crumpsall Vale, a 24 bed intermediate care unit in North Manchester

• The launch of Extra Care housing at Village 135 in October 2017

• MHCC’s support of the roll out of the National Diabetes Prevention Programme. This

supports people at risk of developing Diabetes to make lifestyle changes to reduce their risk

• The development of a community Diabetes Specialist Nursing team in Central Manchester

so that coverage is now in place across the City

• In collaboration with Parkinson’s UK Manchester now has a Parkinson’s Disease community

nursing team

• The development of a Neuro-rehabilitation service in North Manchester

• MHCC’s involvement in the city’s work regarding homelessness

• Significant investment into health and care services in the city, to support developments in

primary care; mental health services for children, adolescents and adults; social care

services; and new models of care which aim to support people outside of hospital

• The delivery of the first phase of Manchester’s single hospital service, through the

establishment of Manchester University NHS Foundation Trust (MFT); and the initiation of

the process for North Manchester General Hospital (NMGH) to transfer to MFT as the

second part of the single hospital service programme

• The development of a Local Care Organisation (LCO) for Manchester, which has set up in

shadow form in readiness to become operational from April 2018

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OPERATIONAL PLAN 2018/19: CONTEXT MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

MHCC’s Operational Plan has been developed in the context of and responds to local, regional and national drivers

and plans. These include the following. Links to further information are contained in slide 34:

Our Manchester1 – describes the vision for the city up to 2025. It was based on consultation with residents,

businesses, staff and partners.

Our Healthier Manchester2 – Manchester’s locality plan sets out the plans for the transformation of health and social

care services in Manchester. Refreshed in 2017, the locality plan focuses on delivering improvements for Our

Services, Our People and Our Outcomes. It sets out five strategic aims for Manchester’s health and care system,

which all partners – including MHCC – are working towards.

What we know about our communities3 – from information such as the Joint Strategic Needs Assessment, our

neighbourhood profiles and our ongoing programme of engagement activity.

Greater Manchester Strategic Plan4 – sets out the collective ambition for the city region. It describes how aligning

health and social care reform is a fundamental change in the way people and communities take charge of and

responsibility for managing their own health and wellbeing. In addition, GM devolution allows Greater Manchester to

be innovative in using public sector finances to best effect. This includes, for example, the use of Greater Manchester

Transformation Funding to support the delivery of new models of care.

5 Year Forward View5 – sets out the strategic vision for the NHS by 2020/21. It details a shared view on how services

need to change and the models of care that will be required in the future.

National requirements6 – as set out in documentation including NHS planning guidance and NHS constitutional

standards. In addition, there are several relevant frameworks for MHCC’s services, including the Adult Social Care

Outcomes Framework, Public Health Outcomes Framework and CCG Improvement and Assessment Framework.

9

OUR PRIORITIES FOR 2018/19 MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

10

Deliver national and statutory requirements and drive the transformation of health and care in Manchester

Develop high quality, effective residential, nursing and home care

Deliver effective out of hospital care

Develop core primary care services Tackle health inequalities

Deliver strategic programmes in line with Manchester’s priorities

Develop a transformed health and care system

11

MHCC PRIORITIES 2018/19

12

Priority 1: Deliver national and statutory requirements and drive the transformation

of health and care in Manchester

Rationale: The service areas in this priority will drive the delivery of a transformed health and social care system for the

benefit of people in Manchester. They are fundamental to ensuring that MHCC meets its statutory obligations and is able to

secure high quality, sustainable services which meet the needs of our population now and into the future.

• Achieve CQC rating ‘good’ or above for all

commissioned services

• Delivery of CQUIN improvement programmes

• Improve performance against national (including

constitutional standards and CCGIAF), GM and local

targets, including delivery of agreed planning

trajectories

• Deliver improvements in quality by implementing

lessons learnt from serious incident investigations

• Achieve Financial Sustainability and statutory financial

requirements

• All practices to drive up quality by delivering against

MHCC’s primary care standards

• GP Practices able to provide fully accessible online

consultations and support demand management

• MHCC are compliant with all regulatory/statutory

requirements

• Improved staff retention and career development for

under-represented groups

• Become a more efficient and effective workforce

• SHS delivery of benefits realisation measures

• Increase in user adoption and satisfaction levels for

the Manchester Care Record

Impact measures include:

MHCC Leadership: Joanne Newton

13

This priority includes the following areas of expertise: Our Manchester, Safeguarding, Finance, Performance and Quality, Business and Health Intelligence, Workforce and

Organisational Development, Planning and Policy, Communication, Engagement and Governance, Information Technology,

Estates, Nursing and Infection Control.

Q1 milestones (Apr-Jun) • Development and agreement of the MHCC approach to

‘Our Manchester’

• Submission of the Annual Assurance Statement for the

Adult and Children’s Safeguarding Boards

• Submission of the Section 11 Safeguarding Audit

(Providers)

• Develop the Inclusion and Social Value Strategy

• Implementation of the Electronic Staff Record Manager

module across MHCC

• 2019/20 Business planning cycle agreed

• Agreement of the MHCC Nursing work plan

• Agreement of the MHCC Infection Control framework

• All 2018/19 contracts signed by the end of Q1

• Agreement of the Performance, Quality and Improvement

strategy and framework for all commissioned services and

corporate performance

• Deliver Q1 Trajectories agreed as part of planning round

Q2 milestones (Jul-Sep) • Implementation of agreed new processes regarding

improving outcomes for Looked After Children (LAC)

• Rollout of Inclusion & Social Value Strategy

• Maternity Voices Network established in Manchester

• Launch of the new VCSE grants scheme

• Manchester Care Record to be used by NW Ambulance

Service to support 111 and triage

• Agreement of Service Level Agreement regarding

finance/contracting for LCO

• Integration of CCG and MCC financial reporting

• Make available executive and operational performance and

quality dashboards via the Tableau system


• Achieve 100% utilisation of NHS E-referrals

Q3 milestones (Oct-Dec) • Submission of the Section 11 Safeguarding Audit (MHCC)

• Development of the evidence base, in line with local Research

and Development opportunities, to inform the business

planning cycle in the light of priority setting.

• Rollout of Online Consultations with GPs to commence

• MHCC to move to a single headquarters


Q4 milestones (Jan-Mar) • Review of the MHCC approach to ‘Our Manchester’

• Results of the bids for Voluntary Community & Social

Enterprise grants announced and delivery commences

• Review the impact of the Inclusion and Social Value Strategy

• GM wide access to Manchester Care Record in place

• Review of the MHCC Nursing work plan

• Review of the Infection Control framework

• Conclude negotiations and alignment of 2019/20 contracts

and submission of initial plans, as per national timetable.

• All adult social care commissioned services to be on one

common framework


14

Enabling Priority Delivery

• Establish activity datasets to support

development of New Models of Care

• Establish monitoring systems for

priority programmes such as LCO,

Manchester Agreement

• Locality Plan public engagement to

take place

• Rollout of Online Consultations with

GPs to commence

• Supporting financial, contractual,

investment and savings delivery to

progress the key priorities

• Develop and review robust financial

arrangements regarding the LCO

• MHCC to move to a single

headquarters

• Development of pooled budget

arrangements and monitoring

processes

• Development and implementation of

desk top access to Performance and

Quality Dashboards via Tableau • Pay gap analysis to take place

• Undertake development work with

NMGH to align performance, quality

standards and assurance

arrangements in preparation for the

proposed transaction process

Service Improvement

• Inclusion and Social Value Strategy

developed

• Create a culture that drives

continuous improvement in

inclusion and social value

• Core set of commissioning

intelligence available to all MHCC

staff

• GM wide access to Manchester

Care Record to be in place

• Implement the performance and

quality framework across all sectors

of provision – mental health, adult

social care, acute, primary care,

community and corporate

performance responsibilities (e.g.

CCGIAF)

• Implement the quality walk round

programme and identified

improvements

• Implement specific service

improvement programmes in

relation to – RTT, diagnostic waiting

times, A&E standards, cancer

standards, stroke services and

acting on diagnostic test results.

• Improved initiation of treatment

process for people with suspected

Sepsis (supported through the

national CQUIN)

Statutory Delivery

• Submission of the Annual

Assurance Statement for the Adult

and Children’s Safeguarding

Boards

• Embed learning from all Child and

Adult statutory reviews

commissioned in Manchester and

external reviews as required

• Fulfil statutory financial

requirements

• Deliver, monitor and provide

assurances to Boards and

Committee in relation to

Constitutional standards, statutory

targets, CQUINS, CCGIAF and

other priorities agreed on a

national, GM and local basis

• Provide assurance of delivery

against the Operational Plan

This provides an overview of key activities that are intended to be

completed by the end of 2018/19. These are linked to the key

actions taking place within Priorities 2 to 7

PERFORMANCE TRAJECTORIES FOR 2018/19 MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

Trajectories to achieve performance against the following metrics are being developed with providers for the

2018/19 year. Trajectories will be finalised by the end of April 2018.

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Description

Standard

Description

Standard

A & E 4 hour standard 90% (Sept 18)

95% (Mar 19)

Diagnostics - % of patients waiting for a diagnostic

test in excess of 6 weeks

<1%

RTT- total number of patients waiting over 52 weeks

RTT – % of people waiting less than 18 weeks

Halve by Mar 19

>= Mar 18 (Mar 19)

Extended GP access 100% practices

Cancer waiting times – 31 days

1. 1st treatment

2. Subsequent treatment of surgery

3. Subsequent anti-cancer drug regimens

4. Subsequent radiotherapy

1. >= 96%

2. >= 94%

3. >= 98%

4. >= 94%

Cancer waiting times – 62 days

1. 1st treatment for cancer – GP referral

2. 1st definitive treatment – NHs screening

3. 1st definitive treatment for cancer – consultant

upgrade

1. >= 85%

2. >= 90%

3. Monitored

Estimated diagnosis rate for people with dementia 67% IAPT Access for people with common mental health

conditions

19%

IAPT recovery rate >= 50% IAPT Access 6 / 18 week performance 75% / 95%

1. Reliance on in patient care for people with LD or

Autism

2. Annual health checks delivered by GPs to people

with LD

1. Max 10-15

patients in CCG

beds

2. 64% increase

People with suspected 1st psychosis starting

package of care in 2 weeks

53%

Children's wheelchair provision 100% % of children with a diagnosable MH condition

receiving treatment by NHS funded community

services

Increase of 7%

or 32% in

2018/19

1. CYP eating disorder waiting times

2. CYP starting treatment in 4 weeks / 1 week from

routine / urgent referral

1. 95%

2. 95%

Deliver one third reduction in out of area

placements

E-referral utilisation – outpatient referrals via e-RS 100% Q2 2018/19 Personal Health Budgets 40-55 per 100k

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Priority 2: Develop high quality effective, residential, nursing and home care

Rationale: “People who lived in residential or nursing homes were less likely to experience care that was safe,

compassionate and caring as a high number of services were rated as requires improvement or inadequate. People living in

residential or nursing homes were also more likely to be admitted to hospital with preventable illnesses.” (CQC, 2017)

The priority is to radically improve the provision of residential, nursing and home care services through re-design,

recommissioning and delivery of enhanced primary care care home service.

• Achieve £0.25m savings by 31/3/19

• Improvement in quality of nursing and

residential home provision (CQC ratings)

• Increase in the number of dementia-friendly

residential and nursing home environments

• Reduction in out of area nursing and residential

home placements

• More people receive the right care at the right

time

• Care homes across the city benefit from an

enhanced primary care intervention service

• Increased self-reliance among service users,

leading to improvements in physical and mental

health


MHCC Leadership: Carolyn Kus

17

1. Stabilise current provision of residential, nursing and home care

2. Develop and test new models of residential, nursing and home care

3. Implement new primary care care home service

4: 5: 6:

Q1 milestones (Apr-Jun)

• 5 identified homes signed up and completed their

first quality framework

• Approved Homecare specification

• Approval of fee re-negotiation and implementation

of revised rates

• Enhanced primary care intervention service to

cover all care homes, (excluding mental health)

offering an additional service for patients who need

additional care and support from GPs and

pharmacy

Q2 milestones (Jul-Sep)

• 40 care homes to be signed up and submitted their

first quality assessment framework

• Redesign of residential care Insight document

completed

Q3 milestones (Oct-Dec)

• Achieve £188k (YTD) of financial savings

• Homecare contract awarded

• Outcome based commissioning mobilised

• Co produced nursing home Continuing Healthcare

service specification priorities

Q4 milestones (Jan-Mar)

• Achieve £0.25m (Total) of financial savings

• Continuing Healthcare nursing home specification

produced to reduce variation in provision

• Homecare contract mobilised

Objectives:

18

Priority 3: Deliver Effective Out of Hospital Care

Rationale: 30% of the population have a long term condition but utilise 70% of health service spending.

The focus is on a 'neighbourhood model', with emphasis upon: local population health and prevention of ill

health; providing targeted care and support which builds on people's strengths and self-management skills.

This will deliver sustainable, high quality, affordable provision for primary, community and social care


• 12 neighbourhood teams fully operational, with

services being delivered in neighbourhoods

• Mobilisation of new models of care

• Expanded local personalisation of services

• Increased levels of patient self management

• Improved access to and choice in end of life

care provision, leading to fewer adults dying in

hospital and fewer avoidable emergency

hospital admissions in the last 12 months of life

• Reduced variation in management of respiratory

patients

• More patients managed in primary and

community care

• Improved patient and carer knowledge to self-

manage diabetes

• Fewer elective and non-elective hospital

admissions

• Improved community support through extra care

• Improvement in provision of nursing home

places for people with dementia


MHCC Leadership: Carolyn Kus

19

1. 12 Neighbourhood teams established and operating

effectively

2. Implement New Models of Care

3. Deliver respiratory, cardiovascular and diabetes pathway

redesign

4. Develop an integrated care pathway for people with

dementia

5. Carers (deliver strategy and new care model)

Q1 milestones (Apr-Jun) • Achieve £2,827k of financial savings

• Redesign current neighbourhood services

• Monitor and evaluate High Impact Primary Care (HIPC) pilot

• Commence rollout of crisis response model for Central and South

Manchester

• IV therapy project / service improvement plans in place

• Review of all enhanced community support services / revisit

service specifications and impact assessments

• Integration of intermediate care pathway & reablement

• Write COPD virtual clinic options appraisal

• Mobilise national diabetes prevention programme (phase 3) and

community pilot with 1 central locality

• Complete investment review of supporting people to remain

independent at home

• Finalisation of the commissioning brief regarding provision of an

integrated 24/7 urgent care access, clinical advice and treatment

service

Q2 milestones (Jul-Sep) • Achieve £6,031k (YTD) of financial savings

• Redesign neighbourhood teams pathways

• Review HIPC to inform if pilot will be recommissioned for Year 2/3

• Extra Care Housing Contract procured

• Discharge to Assess pathways in operation across the city

• Community Assessment Support Service (CASS) implementation of

crisis team ramp up

• Develop citywide business case for IV therapy

• Rollout MyCOPD app pilot and recruit patients

• Implement respiratory paediatric pathways

• Cardiovascular Disease quality improvement scheme launched

• Phase 1 of year 2 of national diabetes programme starts

• Scope out existing provision of diabetes education and design new

service provision

• Complete investment reviews for: Housing Options for Older People,

Enhanced Home from Hospital and North Manchester Intermediate Care

Beds

• Agree service specification for Elderly Mentally Infirm nursing homes

Q3 milestones (Oct-Dec) • Achieve £9,837k (YTD) of financial savings

• Implement standard citywide bed based operating procedures for

community response

• Decision taken on whether continue funding for HIPC following GM

Transformation funds

• Crisis team to take the amber pathway referrals.

• Begin procurement for enhanced support services

• Complete implementation of Manchester integrated lung service

(respiratory)

• Review Integrated Neighbourhood Team self testing pilot

(Cardiovascular Disease)

• Mid year review of diabetes community pilot

• Develop new model of care for children’s Asthma service with LCO

Q4 milestones (Jan-Mar) • Achieve £13.6m (Total) of financial savings

• Evaluate neighbourhood model/whether specialist services are able

to be included

• Evaluation of Manchester Community Response (CASS) service

• Mobilisation and delivery of new enhanced community support

services (Home from Hospital)

• Mobilisation of frailty service

• Agree process for diagnosis of dementia in care homes

• Develop a personal assistant register with neighbourhood teams

• New contracting model regarding an integrated urgent care service to be

delivered by the LCO from April 2019

Objectives:

20

Priority 4: Develop core Primary Care services

Rationale: Primary Care in Manchester faces major challenges; including in relation to funding, the workforce, rising

demands and expectations. The main programmes will deliver improved quality, health improvement and prevention for the

whole population, based around integrated neighbourhood working. There will be sustainable improvements including the

development of the workforce, improved access and medicines optimisation.

• Achieve £4.2m financial savings as part of the

Medicines Optimisation work programmes

• All GP Practices to be CQC rated ‘Good’ or

‘Outstanding’

• Improved quality of primary care (fewer practice

outliers identified via the Early Warning System)

• Improved access to general practice including to

enhanced Primary Care

• Increased utilisation of the 7 Day Access service

• Improved uptake of screening linked to Primary

Care Standards

• Reduction in late diagnosis of cancer

• Increase in immunisation rates for eligible patients

(flu/pneumonia)

• Increased % of annual reviews (Asthma/COPD)

• Increased % of Diabetes patients receiving 8

processes of care

• Equitable investment in Primary Care

• Developing role diversity in Primary Care to

increase resilience

• Increased training and research capacity

• Increase in the number of shared care plans

• Reduced hospital demand including non-elective

admissions, readmissions, and A&E attendances

• Increased % of patients receiving anti-psychotics in

a Primary Care setting

• Improved management of High Cost Drugs to

ensure financial stability

• Reduction in wasted medicines by streamlining the

repeat prescribing ordering process


MHCC Leadership: Manisha Kumar

21

1. Develop the primary care strategy and 3 year investment plan

2. Reduce unwarranted variation in activity in primary care through a neighbourhood-based approach.

3. Primary Care Medicines Optimisation

Q1 milestones (Apr-Jun) • Achieve £1,061k financial savings related to the

Medicines Optimisation work programmes

• Reduction in wasted medicines by streamlining the repeat

prescribing ordering process with initial roll out to a

Central and a North neighbourhood

• Implementation of the Quality Assurance Framework and

Early Warning System for Practices

• Alternative Provider Medical Services (APMS) contracts

to be awarded May 2018

• Continued implementation of the full population model

with Manchester Primary Care Partnership

• Evaluation of the 2017/18 Innovation fund

• Review and finalise proposed neighbourhood boundary

changes

• Clear service specification shared regarding effective

multi-disciplinary team (MDT) working in Neighbourhoods

• Agree the proposed delivery model and implementation

plan for 7 day access to primary medical care

• Mobilise the Physician Associate pilot

• Pharmacists in Practice Investment Review

Q2 milestones (Jul-Sep) • Achieve £2,122k (YTD) financial savings related to the

Medicines Optimisation work programmes.

• Evaluation of the piloted programmes regarding reducing

repeat prescribing waste and continue to roll out across the city

• Implementation of the 2018/19 Primary care Standards scheme

• Implementation Primary Care quality self-assessment toolkit

• New providers to commence APMS Contracts – August 18

• Implementation of action plans regarding Personal Medical

Services review

• Homelessness and Vulnerable Migrants to transition into the

population coverage scheme

• Service offer regarding MDT neighbourhood working to be

embedded

• Establish performance management reporting against the

national specification for 7 day access

• Mobilise Medical Assistant/Workflow Optimisation Scheme

• Primary Care Standards Investment Review

• Practice Neighbourhood Engagement Investment Review

• Locally Commissioned Service population cover investment

review

Q3 milestones (Oct-Dec) • Achieve £3,183k (YTD) financial savings related to the

Medicines Optimisation work programmes.

• Quarterly evaluation of the Primary Care Standards scheme

begins including review of funding/investment

• Review and evaluation of the new Neighbourhood working

arrangements

• Mobile Care Navigator role developed with Neighbourhoods

Q4 milestones (Jan-Mar) • Achieve £4.2m (Total) financial savings related to the Medicines

Optimisation work programmes.

• Review of the Early Warning System for Practices approach

• Develop the innovation scheme for 2019/20 based on the new

neighbourhood footprints (subject to outcome of engagement)

• 12 Neighbourhood Workforce plans to be available

• Revision of Primary Care Workforce Strategy for 2018-21

Objectives:

22

Priority 5: Tackle health inequalities

Rationale: Manchester has some of the worst health and wellbeing outcomes in England in terms of

physical and mental health. The priority is to radically change health outcomes with a focus on preventing

illness, transforming care and unlocking potential health improvement opportunities in the community.


• Reduce the infant mortality rate

• Reduce the proportion of low birth weight

babies

• Increase rates of breastfeeding

• Increase the proportion of children who are

ready for school

• Reduce the rate of hospital admissions for

dental caries among children aged 0-4 years

• Increase the proportion of Manchester residents

employed by local health and care

organisations

• Increase the employment rate of people aged

50 and over

• Reduce the premature mortality rate from

preventable deaths from CVD, cancer,

respiratory diseases, suicide and drug misuse

• Increase the % of physically active adults

• Reduction in the proportion who currently

smoke (down to 15% by 2021)

• Increase successful completion rates people

receiving drug and alcohol treatment

• Increase % of people with knowledge and

confidence to manage their condition

• Increase % of service users who have adequate

control over their daily lives.

• Improve access to primary care and support for

excluded groups

• Implement accessible information standards


MHCC Leadership: David Regan

23

1. Improve outcomes in the first 1,000 days of a child’s life

2. Strengthen the positive impact of work on health

3. Take action on preventable early deaths (including

prevention care model)

4. Create an age-friendly city that promotes good health and

wellbeing for people in mid and later life

5. Support people, households and communities to be

socially connected and make changes that matter to them

6. Inclusion health

Q1 milestones (Apr-Jun) • Achieve £1,008k of financial savings

• New Early Help Health Visitor team in place

• “Be Well” service operational in North Manchester

• Commission Winning Hearts and Minds (WHM) inactivity

initiative

• Recruit health development coordinators in each

neighbourhood

• Launch smoke free Manchester strategy

• Commence Health and Homelessness initiatives including

GP sign up to homeless primary care standards and

expanded service at Urban Village

• Launch asylum seeker and refugee health practice level

locally commissioned service

• North Manchester Prevention programme Investment

Review

• Key deliverables of the ‘Our Manchester Disability Plan’ to

be developed further


• Launch infant mortality strategy

• Complete delivery of Newborn Behavioural Observation /

Assessment training

• Agree oral health strategy

• Develop MHCC inclusion, diversity and social value strategy

• Complete tender process for “Be Well” service for Central and

South Manchester

• Co-produce the WHM community-led model. Launch service

for health checks, lifestyle coaching

• Rollout of GP intelligence-led referral and registration form.

Q3 milestones (Oct-Dec) • Achieve £3,154k (YTD) of financial savings

• Mobilisation and go live for Central / South CLFH

• Commence delivery of WHM primary care initiatives

• Evaluate suicide prevention plan

• Implement Smoke Free Manchester action plan

• Begin flu vaccine implementation and monitoring

• Add age-friendly dimension to commissioning of

neighbourhood services (LCO locality model)

• Self-care practitioner forums set up across the city


• Evaluate infant feeding service

• Evaluate new strengthened Health Visiting model

• “Be Well” service operational in Central and South Manchester

• MCC/MHCC become age friendly employers

• Secure investment for 2019 scaled up WHM programme

• Oversee the safe transfer of sexual and reproductive health

services and falls services to the LCO for April 2019

• Evaluate asylum seeker and refugee health activity / prepare

business case for further funding

• Implementation of the ‘Our Manchester Disability Plan’

complete

Objectives:

24

Priority 6: Deliver strategic programmes in line with Manchester’s priorities

Rationale: Manchester has some of the worst health and wellbeing outcomes in England in terms of

physical and mental health. This priority focuses on the transformation of services and pathways in the key

population groups of children and people with learning disabilities as well as focusing on key areas for

improvement such as mental health, cancer and system resilience.


• Deliver mental health investment of £6.6m

• Deliver the A&E 4 hour standard, Ambulance

handover times and delayed transfers of care

targets

• Deliver more timely access to psychological

therapies, in line with national standards

• Provide timely access to first definitive treatment for

children and young people who have an eating

disorder, in line with national requirements

• Early diagnosis and treatment of lung cancer,

improving 1 year and 5 year survival rates for the

North Manchester population

• Reduction in length of stay for all people in inpatient

settings who have a learning disability

• Reduction in A&E admissions among people who

have a learning disability

• Reduction in out of area mental health placements

• Increase in the number of people on the mental

health register who receive physical health checks

• Reduce fragmentation between services for

children and young people and improve the access

to and experience of services

• Improve flu vaccination uptake within the at risk

population


MHCC Leadership: Craig Harris

25

1. Children’s Transformation Plan

2. Mental Health

3. Learning Disabilities

4. Cancer

5. System Resilience


• Achieve £755k of financial savings

• Develop mental health primary care standard

regarding screening and physical health interventions

• Implementation of actions from the learning disability

mortality review

• Deliver Q1 A&E, ambulance handover, delayed

transfer of care (DTOC) improvement trajectories

• Develop MHCC resilience priorities – using

dashboards, audits, evaluation and embedding

lessons learnt


• Develop a pooled budget arrangement between MCC/CCG in regards to

mental health commissioning portfolios

• Implement the action plan regarding improving the CAMHS to Adult

mental health services transition pathway

• Pathways regarding an integrated health and social care community

learning disability service to be redesigned

• Mobilisation of the learning disability crisis prevention/response service

• Autism strategy and action plan agreed

• Stabilise learning disability residential provision - secure 30 new beds

across 2 new build sites

• Implementation of cancer related community based lung health check

service within North Manchester

• Eating Disorders Investment Review

• Harpurhey Wellbeing Centre Investment Review

• North Manchester Lung Health Checks Investment Review

• Securing Effective End of Life in Primary Care Investment Review

• Deliver Q2 A&E, ambulance handover, DTOC improvement trajectories

• Annual refresh of national Operational Pressures Escalation Levels (OPEL)

framework and refresh and implementation of surge and escalation plans

• Develop MHCC resilience priorities (See Q1)


• Achieve £2,117k (YTD) of financial savings

• Children’s transformation plan – Implementation of

agreed specifications and new models of care by

MHCC and the LCO

• Agree the revised service specifications and KPIs for

the GMMH transformation programme and determine

the 2019/20 priority pathways

• Deliver Q3 A&E, ambulance handover , DTOC

improvement trajectories



• Review pooled budget arrangement in regards to Mental Health and

confirm the final agreement.

• Autism training rolled out to primary care professionals.

• Deliver Q4 A&E, ambulance handover, DTOC improvement trajectories


Objectives:

26

Priority 7: Develop a transformed health and care system

Rationale: The foundations of the transformed health and care system have been developed during 2017/18 and there

is a shift towards the new system realising benefits against the strategic aims. This will involve completion of the

organisational changes for the Local Care Organisation (LCO) and the single hospital service vision.

• Achievement of measures identified within the

LCO Outcomes framework

• Delivery of Healthier Together key process and

outcome measures

• Achievement of Manchester Agreement

measures

• Improved outcomes per pound spent for the

local population

• Reduction in duplication and increase in

employee productivity

• Robust business continuity in place

• Improved staff retention and reduction in staff

turnover

• Reduction in staff sickness rates and improved

attendance

• Greater collaboration between the MHCC

workforce and the Manchester community

• MHCC to be located in a single headquarters,

on time and to budget


MHCC Leadership: Ed Dyson

27

1. Procure an effective Local Care Organisation (LCO)

2. Deliver acute care reconfiguration, including clinical benefits and financial plan to ensure sustainability

of the sector

3. Deliver MHCC phase 2


• Phase 1 of the LCO successfully implemented

• MFT Year 1 – Implement benefits monitoring of

the GM Transformation Fund

• NMGH transaction timeline to be agreed

• MHCC Workforce and Succession strategy

developed

• MHCC Operating models completed

• Kings Fund Culture Diagnostic completed

• MHCC Volunteering policy launched

Q2 milestones (Jul-Sep)

• Award of contracts regarding the LCO for Phase 2

• MHCC Learning and Development plan in place and

aligned to the training needs analysis


• LCO – Commence Integrated Support and

Assurance Process (ISAP) checkpoint 2

• First Healthier Together activity shifts to take place

• MHCC Coaching and mentoring framework

developed

Q4 milestones (Jan-Mar)

• LCO – commence ISAP checkpoint 3

• LCO – prepare for mobilisation on 1st April 2019

• Healthier Together activity shifts completed

• Strategic Outline and acquisition case regarding

NMGH developed and signed off by NHS

Improvement

Objectives:

NATIONAL REQUIREMENTS MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

28

Alongside delivering

Manchester’s priorities, the

work programmes in the

Operational Plan are focused

on ensuring that we deliver a

range of national requirements.

These include delivery of the

NHS constitutional standards, a

set of Must Dos and achieving

improvements across a range

of frameworks including the

Adult Social Care Outcomes

Framework, CCG Improvement

and Assessment Framework

and the Public Health

Outcomes Framework.

NATIONAL REQUIREMENTS: CCG IMPROVEMENT AND

ASSESSMENT FRAMEWORK (IAF) MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

As part of delivering the national requirements we are assessed and rated against key indicators as per the

CCG IAF. The latest update regarding the CCG IAF was received in February 2018. It is expected that the

next data update will be received in June 2018. An update was provided for 31/44 indicators and shows

where Manchester is ranked nationally regarding performance via the top, inter and bottom quartiles.

It should be noted that due to data collection timescales these rankings may not be reflective of current

improvements taking place across Manchester.

29

Quartile No. of Indicators

Top 2

Inter 17

Bottom 12

The top quartile indicators include:

• Estimated diagnosis rate for people with Dementia (Priority 3)

• Utilisation of the NHS e-referral service to enable choice at first routine

elective referral (Priority 1)

The bottom quartile indicators include:

• % of children aged 10-11 classified as overweight or obese (Priority 5)

• Injuries from falls in people aged 65 and over (Priority 3)

• Inequality in unplanned hospitalisation for chronic ambulatory care sensitive

conditions and urgent care sensitive conditions (Priority 3)

• One-year survival from all cancers (Priority 1)

• IAPT recovery rate (Priority 6)

• Proportion of people with a learning disability on the GP register receiving an

annual health check (Priority 4)

• Dementia care planning and post diagnostic support (Priority 3)

• Emergency admissions for urgent care sensitive conditions (Priority 3) • % of patients admitted, transferred or discharged from A&E within 4 hours (Priority 6)

• Delayed Transfers of Care (Priority 6)

• Population use of hospital beds following emergency admission (Priority 3)

• Primary care workforce (Priority 4)

All indicators have a MHCC lead

who reports on the progress of

actions to improve performance.

The detail for each indicator can

be found at:

https://www.nhs.uk/service-

search/Performance/Search

https://www.nhs.uk/service-search/Performance/Search





NATIONAL REQUIREMENTS: ‘MUST DOS’ MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

This table summarises the ‘Must Dos’ set out in Refreshing NHS Plans for 2018/19. These build on the 2017-19 Planning

Guidance. Information on how we are meeting the Must Dos is set out in a stocktake document, which accompanies the

Operational Plan.

30

Must do Summary of requirements Stocktake

reference

Mental

Health

Progress against all deliverables in Implementing the Mental Health Forward View, including the

mental health investment standard; and access and quality standards across a range of services.

Section 1:

Page 1

Cancer Progress delivery of National Cancer Strategy. Achieve all 8 waiting time standards, progress

towards earlier diagnosis and prepare for implementation of 28 day faster diagnosis standard.

Implement new specification for radiotherapy. Progress towards stratified follow-up pathway for

breast cancer patients.

Section 2:

Page 6

Primary

Care

Progress against all commitments in General Practice Forward View. Support the resilience of

primary care and assurance of delivery of statutory functions. Support investment in transformation,

workforce, estates and information technology. Deliver evening and weekend access standards.

Section 3:

Page 9

Urgent and

Emergency

Care

Aggregate performance against the 4 hour A&E target to be 90% or above by September 2018 and

95% by March 2019. Deliver Integrated Urgent Care requirements. Reduce delayed transfers of

care and implement Improving Patient Flow guidance. Deliver ambulance response time standards

by September 2018. Progress against mental health and Continuing Healthcare developments.

Section 4:

Page 12

Learning

Disabilities

Reduce premature mortality through improved access to healthcare – especially community

provision – education and application of National Quality Board Guidance. Reduce inappropriate

hospitalisation.

Section 5:

Page 17

Maternity Improve safety of services, increase continuity of care, increase access to specialist perinatal

mental health services. Agree trajectories to improve safety, choice and personalisation by June ‘18.

Section 6:

Page 19

RTT Waiting lists in March 2019 to be no higher than in March 2018. Halve 52 week waits by March

2019.

Section 7:

Page 22

FINANCIAL SUSTAINABILITY PLAN MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

SUMMARY SAVINGS

31


CARE MODEL SAVINGS

32


OTHER SAVINGS

33

GOVERNANCE, MONITORING AND ASSURANCE MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

MHCC is operating a single planning, delivery and assurance process from April 2018. The

Operational Plan, as set out in these slides, sets out the means by which MHCC will achieve its

operational responsibilities for finance, service provision, quality and safety as well as

progressing towards its strategic aims. Delivery will be undertaken in the context of the Our

Manchester approach.

Having a single process will generate the following benefits:

• Joined up commissioning of health, social care and public health enabling more proactive

and joined up care

• More co-ordinated transformation; oversight of quality and performance and financial

management

• More effective and efficient spending

• Clear commissioning voice within and for the Manchester health and care system.

Governance arrangements for the delivery of the Operational Plan will sit within MHCC and be

led through MHCC’s Executive Committee, reporting to the MHCC Board. Reporting will be

provided to the CCG Governing Body, and the Manchester City Council through the Senior

Management team, and Executive members Group on a bi-monthly basis.

The Operational Plan will be monitored throughout the year with lead Directors and their teams

held accountable for delivery against the milestones.

34

REFERENCES MANCHESTER HEALTH AND CARE COMMISSIONING OPERATIONAL PLAN 2018/19

Further information on the key documents referenced in this slide deck can be found at:

35

Reference Web location

1. Our Manchester: The Manchester Strategy http://www.manchester.gov.uk/info/500313/the_manchester_strategy

2. Our Healthier Manchester https://healthiermanchester.org/

3a. Manchester Joint Strategic Needs

Assessment

http://www.manchester.gov.uk/jsna

3b. Manchester City Council Intelligence Hub http://www.manchester.gov.uk/info/200088/statistics_and_intelligence/7611/intelli

gence_hub/1

4. Greater Manchester Health and Social Care

Partnership

http://www.gmhsc.org.uk/

5. NHS Five Year Forward View https://www.england.nhs.uk/five-year-forward-view/

6a. Adult Social Care Outcomes Framework https://digital.nhs.uk/article/324/Adult-Social-Care-Outcomes-Framework-

ASCOF-

6b. CCG Improvement and Assessment

Framework

https://www.england.nhs.uk/commissioning/ccg-assess/

6c. NHS Planning Guidance https://www.england.nhs.uk/deliver-forward-view/

6d. Public Health Outcomes Framework https://www.gov.uk/government/collections/public-health-outcomes-framework

http://www.manchester.gov.uk/info/500313/the_manchester_strategy

https://healthiermanchester.org/

http://www.manchester.gov.uk/jsna

http://www.manchester.gov.uk/info/200088/statistics_and_intelligence/7611/intelligence_hub/1

http://www.manchester.gov.uk/info/200088/statistics_and_intelligence/7611/intelligence_hub/1

http://www.gmhsc.org.uk/

https://www.england.nhs.uk/five-year-forward-view/







https://digital.nhs.uk/article/324/Adult-Social-Care-Outcomes-Framework-ASCOF-















https://www.england.nhs.uk/deliver-forward-view/





https://www.gov.uk/government/collections/public-health-outcomes-framework







18/19 MHCC Stocktake Page 1

Appendix B

18/19 MHCC Stocktake – Must Do and Mandate Requirements

1 Mental Health

Description of MHCC plans in 18/19

1.1 Meet the Mental Health Investment Standard (MHIS) by which their 2018/19 investment in mental health rises at a faster rate than their overall programme funding.

There is a commitment to invest in the mental health investment standard in line with allocation growth, national guidance and 5YFV. There are further decisions that need to be made on how the standard (formerly known as parity of esteem standard) will be delivered in 20/21.

1.2 Ensure that additional children and young people receive treatment from NHS-commissioned community services (32% above the 2014/15 baseline).

A staged trajectory has been set from the 16/17 position to 32% (or 7% increase per year) in Q4 2018/19. This has been communicated with the CMFT CAMHS Directorate lead and plans are established to operationalise, including implementation of new business processes to improve referral to treatment timelines and assurance regarding systematic reporting through the national minimum dataset. Mechanisms are in place to assure compliance through data flows from business intelligence to commissioning, quarterly performance reporting and Contract meetings. The service is looking to deliver its KPIs, which includes monitoring of contractual data, although there is a need for a more comprehensive CAMHS model. CAMHS transformation has been linked to the 5 Year Forward View. MFT is to remodel its services in order to dovetail with the GM plans and service specifications including the delivery of 24/7 crisis support.

1.3 Make progress towards delivering the 2020/21 waiting time standards for children and young people’s eating disorder services of 95% of patient receiving first definitive treatment within four weeks for routine cases and within one week for urgent cases.

MHCC have co-commissioned a new Children’s Eating Disorder Service with Salford which will comply with the access and waiting standards and will support a minimum of 50 children. This is now up and running. Further embedding is needed following on from this pilot and this will be reviewed as part of the wider CAMHS strategy. There is also a review of access and waiting times for CYP with diagnosable mental health conditions in line with the five year forward view taking place.


1.4 Deliver against regional implementation plans to ensure that by 2020/21, inpatient stays for children and young people will only take place where clinically appropriate, will have the minimum possible length of stay, and will be as close to home as possible to avoid inappropriate out of area placements

Monitoring and agreement of a trajectory to reduce out of area placements is a Quality Requirement within the 2018/19 NHS Standard Contract for Greater Manchester Mental Health Foundation Trust and is a key element of the SDIP for the Acute Crisis Care Pathway. The GM set trajectory will be in place for2018/19. There has recently been a sudden increase in the number of patients being sent Out of Area. In December 2017 there were 55 OAPs compared to 29 in September. Across the GMMH footprint there have been similar increases in Out of Area Placements. A paper has been produced by the senior leadership team at GMMH that looks at the reasons for increasing OAPs across the whole of the GMMH footprint. This paper has been shared with commissioners. There are many issues impacting on performance. One such issue is the high levels of bed occupancy that currently exist in Manchester which puts a higher risk on placing patients out of area. Patients are not being discharged from acute mental health wards as quickly, due to the limited access to appropriate accommodation. The is a lack of supported accommodation, social housing, lack of specialist placements for those homeless as well as limited availability of accommodation for those with learning disabilities on a mental health ward. There is also limited numbers of specialist rehabilitation placements, particularly for complex females. Further work is now being undertaken to understand the issues in more detail and an action plan is being developed to outline exactly what needs to be done to improve the situation. In the meantime, GMMH continues to do all it can to repatriate patients quickly

1.5 Continue to increase access to specialist perinatal mental health services, ensuring that an additional 9,000 women access specialist perinatal mental health services and boost bed numbers in the 19 units that will be open by the end of 2018/19 so that overall capacity is increased by 49%.

A business case has been approved for model of service based on the nationally documented evidenced based characteristics of high performing IAPT services and incorporates a specific perinatal service offer. The model of service developed for Greater Manchester proposes three distinct elements of care these are:

Specialised Perinatal Community Mental Health Team

Parent and infant mental health pathways

Perinatal IAPT


The perinatal IAPT offer involves the expansion of step 2 and 3+ services via the introduction of specialist perinatal IAPT practitioners. The staffing of the service will include perinatal specific senior PWP’S, perinatal CBT high intensity therapist and a perinatal psychologist. These posts will be supported by a senior clinical leadership role across the wider trust footprint. The aim of this service would be to ensure capability building within the core IAPT service as well as liaison with the more specialist GM perinatal services. Consequently, the offer of a consultation/liaison service will mean that the direct clinical activity of these posts will be significantly reduced relative to the normal IAPT practitioner outputs.

1.6 Improve access to psychology therapies (IAPT) services delivering an access rate of 19% for people with common mental health conditions, by supporting HEE’s commissioning of additional replacement practitioners and trainees to expand services. Approximately two-thirds of the increase to psychological therapies should be in new integrated services focused on people with co-morbid long term physical health conditions and/or medically unexplained symptoms, delivered in primary care.

In 18/19 the commissioners will continue to work with all providers to ensure that the commissioned access rate is maintained, recovery is improved and that MHCC is in a position to know how best to ensure delivery of 19% access as required by 2019. A business case has been developed to align with the GM Mental Health strategy. There is currently a 25% gap in the amount of recurrent resource needed to deliver the 19% target for access to IAPT. The 19% access target will also be required by IAPT providers that are in the 3rd sector. A group of 3rd sector providers have been identified who are delivering IAPT interventions and they will continue to be supported by Self Help in adhering to IAPT standards and submitting data to the IAPT MDS. The 3rd sector will support the delivery of the access standard through the pooling and restructuring of resources and delivery. Increased investment will be required to meet the 19% target. The GPFV is referenced in the Service Development Improvement Plan within the GMMH contract and ensures IAPT delivery is embedded within the LCO and will enable greater integration with primary care.

1.7 Continue to work towards the 2020/21 ambition of all acute hospitals having mental health crisis and liaison services that can meet the specific needs of people of all ages including children and young people and older adults; and deliver Core 24 mental health liaison standards for adults in 50% of acute hospitals subject to hospitals being able to successfully recruit.

Currently all three places of safety in the City’s A&E departments have fallen below Royal College of Physicians guidelines. A business case has been put forward in order to deliver a fit for purpose place of safety for S136 assessment suite in GM Mental Health and to improve the staffing response to people detained under S136, as well as potentially reducing waiting times. The key benefit being to have an improved physical environment for patients and staff that meets Department of Health standards in relation to places of safety. The service includes additional staffing to improve assessment response for those with mental health problems


1.8 Ensure that 53% of patients requiring early intervention for psychosis receive NICE concordant care within two weeks.

The standard will be extended to reach 53% of people experiencing first episode psychosis. However this extension does not need to be in place until 2019. A plan is in place to ensure that the provider of the mental health service works across all ages There is a gap in resource to be able to deliver against the target. There a high number of incidences across Manchester which is making it a struggle to deliver the targets. Providing access to meet the NICE guidelines is being delivered as part of Devolution Manchester, which includes a review of models of care. A business case has been submitted to GMHSCP which looks at fine tuning the delivery model and alignment of the mental health investment in the provider model to support the delivery of the NICE standards, increasing the referrals accessing the service within 2 weeks.

1.9 Support delivery of STP-level plans to reduce all inappropriate adult acute out of area placements by 2020/21, including increasing investment for Crisis Resolution Home Treatment Teams (CRHTTs) to meet the ambition of all areas providing CRHTTs resourced to operate in line with recognised best practice by 2020/21. Review all patients who are placed out of area to ensure that have appropriate packages of care.

Monitoring and agreement of a trajectory to reduce out of area placements is a Quality Requirement within the 2018/19 NHS Standard Contract for Greater Manchester Mental Health Foundation Trust and is a key element of the SDIP for the Acute Crisis Care Pathway. The GM set trajectory will be in place for2018/19.

1.10 Deliver annual physical health checks and interventions, in line with guidance, to people with a severe mental health illness.

As part of the primary care standards there will be proactive targeting of annual health checks in primary care to improve the health of people with learning disabilities. A comprehensive annual health check to identify needs, develop health action plans, initiate advanced care planning and identify an effective advocate to help navigate health care service is an will be an effective and important tool. In Year 1, each practice will nominate an LD champion from their clinical staff who has an interest in healthcare for people with disabilities to represent that practice within a neighbourhood focused network. Each practice will offer health checks with a nurse or doctor via scheduled double appointments.


In Year 2, best practice and shared learning from Year 1 will inform a more advanced programme in Year 2. The number of people health checks in 2016/17 across Manchester was 48% (based on health checks for patients aged 14 and over as per National Enhanced Service Specification). The trajectory from 2017/18 is for there to be 60% health checks for eligible people in place by July 2018.

1.11 Maintain the dementia diagnosis rate of two thirds (66.7%) of prevalence and improve post diagnostic care.

The service is currently meeting the overall dementia diagnosis target. We are continuing to monitor and work with practices when and where there is slippage in the rate.

1.12 Deliver their contribution to the mental health workforce expansion as set out in the HEE workforce plan, supported by STP-level plans, including an increase of mental health therapists in primary care in 2018/19 and an expansion in the capacity and capability of the children and young people’s workforce.

As part of our plans, a proposal has been submitted to the Transformation Fund to recruit and retain newly qualified GPs in Manchester. The initial proposal, through the South Manchester GP Federation, is for this to be piloted in South Manchester then up-scaled across Central and North Manchester

1.13 Deliver against multi-agency suicide prevention plans, working towards a national 10% reduction in suicide rate by 2020/21.

In line with PHE guidance, Public Health has led the development of a multi-agency suicide prevention action plan and a partnership group has been established to oversee its development over the 2 years (2017-19). This group will report to the Health and Wellbeing Board. MHCC will play a key role in the delivery of a number of the actions in the plan including:

A task group to explore issues about self-harm and how this can be addressed

Establishing pathways into appropriate community support for people receiving mental health services - particularly people being discharged

Strengthening and developing initiatives that support people in distress

Strengthening and promoting support available for people bereaved or affected by suicide

Ensuring key staff groups are equipped to provide appropriate compassionate support through the provision of training and awareness sessions.

In 2018/19 the aim is to secure funding in the first quarter to deliver the second phase of the Manchester suicide prevention plan with the aim being to reduce the age standardised mortality rate from suicide and injury of undetermined intent per 100,000 population. It is anticipated there will also be a Greater Manchester CQUIN on Suicide Prevention for 2018/19 NHS


Standard Contract (this will be adopted as the Local CQUIN). We are awaiting further information from the Strategic Lead Commissioner, Greater Manchester Association of CCGs.

1.14 Deliver liaison and diversion services to 83% of the population.

There is a requirement for liaison and diversion services to be in place within the criminal justice system. In Manchester services have been established within the criminal justice system as part of the commissioned Greater Manchester service that has been operational since April 2017

1.15 Ensure all commissioned activity is recorded and reported through the Mental Health Services Dataset.

This is being reported and recorded as part of the contract with GMMH.

2 Cancer


2.1 Ensure all eight waiting time standards for cancer are met, including the 62 day referral-to-treatment cancer standard. The ‘10 high impact actions’ for meeting the 62 day standard should be implemented in all trusts, with oversight and coordination by Cancer Alliances. The release of cancer transformation funding in 2018/19 will continue to be linked to delivery of the 62 day cancer standard.

Historically, Manchester has performed well against the cancer pathway access standards. However, performance has been challenging in terms of the 62 day standard within the central area.. Local improvement initiatives were mobilised in support of performance, aligned to national expectations regarding the ‘high impact’ actions required of providers in relation to access to cancer pathways. A number of local contract KPIs to support sustained achievement of the 62 day standard have been agreed. All providers are working towards achieving ‘first seen in seven days’. There is a particular challenge in achieving this for Upper and Lower GI pathways due to the limitations of endoscopy capacity. Across GM, more work is needed on ensuring adequate diagnostic capacity across all providers – in common with overall issues relating to diagnostic capacity and associated performance against diagnostic access standards. All providers have completed capacity and demand modelling for endoscopy, and performance has recovered over the last 12 months. There is an ongoing challenge to ensure sustainability of performance in the context of increasing demand and in the interim the providers continue to prioritise cancer diagnostics.


2.2 Support the implementation of the new radiotherapy service specification, ensuring that the latest technologies, including the new and upgraded machines being funded through the £130 million Radiotherapy Modernisation Fund, are available for all patients across the country.

Although MHCC is supportive of this overall process, local CCGs do not commission radiotherapy services in Greater Manchester as this is done through NHSE Specialist Commissioning.

2.3 Ensure implementation of the nationally agreed rapid assessment and diagnostic pathways for lung, prostate and colorectal cancers, ensuring that patients get timely access to the latest diagnosis and treatment. Accelerating the adoption of these innovations helps meet the 62 days standard ahead of the introduction of the 28 day Faster Diagnosis Standard in April 2020.

These pathways are being developed at GM level through the pathway boards. Once agreed these pathways will need to be costed and incorporated into revised service specifications. We await guidance from GM but local implementation will be overseen by MHCC.

2.4 Progress towards the 2020/21 ambition for 62% of cancer patients to be diagnosed at stage 1 or 2, and reduce the proportion of cancers diagnosed following an emergency admission.

The most effective way for patients to be diagnosed at an early stage is through the national cancer screening programmes for breast bowel & cervical cancer. Improvements in uptake to cancer screening programmes in included in the primary care standards. Primary care facilitators are now in post to support practices with low screening uptake. Serious Event Analysis (SEA) of patients diagnosed with cancer following an emergency presentation is also included in the primary care standards. A facilitator from CRUK is running workshops across the city to support practices undertaking SEA and how to act on the findings. The North Manchester Lung Health Checks will be implemented from Sep 2018. This will detect early stage lung cancers through low dose CT scans for people identified as being at increased risk of developing lung cancer.

2.5 Support the rollout of FIT in the bowel cancer screening programme during 2018/19 in line with the agreed national timescales following PHE’s procurement of new FIT kit, ensuring that at least 10% of all bowel cancers diagnosed through the screening programme are detected at an early

Local CCGs do not commission cancer screening programmes including those for bowel cancer. The communications & engagement team with MHCC will however link in with the GM bowel cancer screening improvement team to support any communication and engagement issues. It is accepted that screening is the most effective way for patients to be diagnosed at an early stage and therefore MHCC will look to ensure that this process is communicated effectively.


stage, increasing to 12% in 2019/20.

2.6 Participate in pilot programmes offering low dose CT scanning based on an assessment of lung cancer risk in CCGs with lowest lung cancer survival rates.

The North Manchester Lung Health Checks will be implemented from Sep 2018. This will detect early stage lung cancers through low dose CT scans for people identified as being at increased risk of developing lung cancer, with the aim of improved early diagnosis which should lead to improved survival rates.

2.7 Progress towards the 2020/21 ambition for all breast cancer patients to move to a stratified follow-up pathway after treatment. Around two-thirds of patients should be on a supported self-management pathway. All Cancer Alliances should have in place clinically agreed protocols for stratifying breast cancer patients and a system for remote monitoring by the end of 2018/19.

Stratified pathways are being developed by the GM Cancer Pathways Boards (Breast is complete). Once agreed these pathways will need to be costed and incorporated into revised service specifications. We await guidance from GM but local implementation will be overseen by MHCC. Stratified aftercare pathways and key elements of the recovery package, once in place, will allow patients to move to new supported self-management models of aftercare. This will reduce the need for long term routine hospital based follow up. Commissioning of the recovery package will be undertaken at a GM footprint and local implementation will be overseen by MHCC. MHCC will work with providers to ensure the National Cancer Survivorship Initiative NCSI Recovery Package is implemented in order to improve management of cancer as a long term condition and support new models of aftercare and stratified pathways. The recovery package will be targeted at all patients with breast cancer and patients with colorectal and prostate cancer.

2.8 Ensure implementation of the new cancer waiting times system in April 2018 and begin data collection in preparation for the introduction of the new 28 day Faster Diagnosis standard by 2020.

MHCC BI team (led by Graham Hayler) is in discussion with Greater Manchester Cancer team regarding the data requirements for CWT. Regular monitoring of data received will be conducted to ensure that targets are being achieved or that improvement actions are put in place should there be any slippage.


3 Primary Care


3.1 Provide extended access to GP services, including at evenings and weekends, for 100% of their population by 1 October 2018. This must include ensuring access is available during peak times of demand, including bank holidays and across the Easter, Christmas and New Year periods.

A population offer for 7 day GP access is in place across Manchester, delivered by the Manchester Primary Care Partnership (a tri-partnership of the three respective GP Federations in Manchester). The 7 day extended access service is delivered on a Neighbourhood Hub basis across the 12 Manchester Neighbourhoods. Access is provided 365 days a year although bank holidays have been commissioned separately through MPCP to date. The intention from 2018-19 is that bank holidays will be included within the agreed service delivery model. This will be monitored by the Contract Board. In addition to the 7 day extended access service, Manchester has 2 primary care walk-in centres that provide access 365 days year (8-8 Mon-Fri and weekend provision)

3.2 Delivering their contribution to the workforce commitment to have an extra 5,000 doctors and 5,000 other staff working in primary care nationally. CCGs will work with their local NHS England teams to agree their individual contribution and wider workforce planning targets for 2018/19.

MHCC has agreed plans to roll out a citywide practice based pharmacy model. This is based on a local rather than GM model. The service has commenced in North Manchester, and will be rolled out across the city during 2018-19. Through locally agreed MHCC Innovation funding, a number of neighbourhoods (in Central and South) have plans to roll out practice based pharmacists until the citywide model can be implemented. This has already commenced in one neighbourhood in Central Manchester with positive results. As part of the implementation of the Manchester workforce strategy and workforce development there will be greater knowledge to support the recruitment and retention of GP. Completion of workforce data analysis will lead to a better understanding of our current primary care workforce. Aligned to this are plans to increase the numbers of people moving into primary care with OD support being provided to support the workforce to make their career choices within Manchester. This includes sustaining the workforce through training and development, enabling career choices and development. There will also be the mobilisation of the 18/19 GP Education Recruitment Incentive Scheme.


In addition, investment has also been identified for 2018-19 and 2019-2020 to support role development (PA's, Mental health, paramedic, others). 2018-19 should also see investment in Nurse Preceptorship and Practice manager / admin development to aid recruitment and retention.

3.3 Invest the balance of the £3/head investment for general practice transformation support.

For 2018-19, Primary Care will continue to invest £5 per head into primary care standards. In addition, through our multi-year investment strategy, additional investments will be made into primary care through the following:

Funding for the 7 day access (primary medical care) service

Further investment into primary care standards through a population offer

Neighbourhood working

Health Improvement and Prevention

Quality Improvement

Inclusion Health (including Vulnerable migrants and homeless people)

High Risk / Complex patients (inc Multi-disciplinary team working)

Workforce development

Key enablers (IM&T, Estates)

3.4 Actively encourage every practice to be part of a local primary care network, so that there is complete geographically contiguous population coverage of primary care networks as far as possible by the end of 2018/19, serving populations of at least 30,000 to 50,000.

All practices are supported and facilitated to work in neighbourhoods – delivering neighbourhood based plans e.g. for COPD, the MHCC Innovation Fund, QIPP Plans and undertaking neighbourhood level peer review .

MHCC collates data at different levels of granularity; this includes neighbourhood level, to support neighbourhood working arrangements. This data is available to all practices through our GP wiki site.

Plans are in place for 18/19 to strengthen Neighbourhood plans – including population health and estates.

3.5 Investing in upgrading primary care facilities, ensuring completion of the pipeline of Estates and Technology Transformation schemes, and that the schemes are delivered within the timescales set out for each project.

MHCC with key stakeholders in the city has established a citywide Strategic Estates Group and have a citywide Estates Strategy. The citywide Estates Strategy is based upon the principle of integrated, community, place-based care delivered through the LCO at the level of the 12 neighbourhoods. MHCC is currently developing estates


plans for each neighbourhood which is likely to lead to the consolidation of practices, increased utilisation and improved integration with the other community based services. The priorities include:

an integrated health and social care hub for Gorton

a business case is to be developed (Sept 18) for additional estate costs for primary care services in Withington and Burnage.

3.6 Ensuring that 75% of 2018/19 sustainability and resilience funding allocated is spent by December 2018, with 100% of the allocation spent by March 2019.

We are working with all partners to shape a clearly articulated and robust resilience plan, utilising available resilience funding and appropriate contractual levers; and maximising opportunities arising from other strategic developments such as Urgent Care First Response and One Team

3.7 Ensuring every practice implements at least two of the high impact ‘time to care’ actions.

There are already a number of initiatives and plans underway that support the delivery of a range of the 10 High Impact Actions. These are expected to continue and evolve across the City throughout 18-19 and include: Active signposting Examples include:

Online Portal - Buzz Manchester has been commissioned who will be developing an app with active signposting functionality. Some local GP providers are already using systems such as Footfall and Click Your GP.

Reception Navigation - Manchester Citizens Advice Bureau has been commissioned to provide a telephone advice line providing receptionists with the tool to actively signpost. There are 10 pilot sites across the city. Some local GP providers have systems in place already where reception staff direct patients to the most appropriate service.

New Consultation Types Examples include:

Telephone - As part of primary care standards over the last few years, providers have been encouraged to optimise use of telephone consultations in order to improve both responsive and routine access. There are numerous examples of this across Manchester.

Text Message - The NHS.net system provided a free SMS service to users which ceased earlier this year. There is currently a bridge system at a lower rate for providers to use. Other practice


use systems linked to EMIS Web or their telephone systems.

E consultations - The primary care transformation proposal includes provision of online consultation platforms. There is currently use of Click Your GP, other providers include EMIS’s Econsult and AskMyGP. There are examples of Email consults already taking place across the city across the city. Skype consultations have been supported through the provision of webcams through IT.

Group Consultations – This has been championed by the MHCC Practice Nurse Lead and has been actively encouraged as part of the Primary Care Access Standard offer.

Reduce DNAs Examples include:

Easy Cancellation - IT solutions exist for self-managed cancellation via telephone/online.

Reminders - IT solutions exist for automation.

Patient recording - Smart phone technology exists.

Read back - Smart phone technology exists. Develop The Team Examples include:

Advanced Nurse Practitioners – as per the Workforce

Physician Associates –as per the workforce strategy

Practice based Pharmacists - Pilot service launched in North Manchester for citywide rollout in 2018-19

Paramedics – role development included within workforce plans for 2018-19 Productive work flows Examples include:

Matching capacity and demand - Provision of dashboard systems to inform pro-active capacity planning.

Efficient processes - Procurement of Docman for all the practices has improved information flow. Some local GP providers have digitalised their operational working.

Personal Productivity Examples include:


Personal resilience - We have previously commissioned emotional resilience training for practitioners.

Computer confidence - All information communicated to practices is via electronic methods with a move away from paper based systems. IT systems procured have facilitated sessions for practitioners.

Touch typing - Some local GP providers across the city have moved to voice transcription systems

Partnership working Examples include:

Productive federations - The city has three CCG locality based federations, covering the CCG footprint, who have come together to form a city wide federation – Manchester Primary Care Partnership (MPCP).

Community pharmacy - As part of our primary care transformation plans collaborative working between primary care disciplines has been core.

Community services – As a city, Manchester has commissioned One Team – integrated health and social care teams which align with our twelve neighbourhood footprints.

Social Prescribing Examples include:

Practice based navigators as mentioned previously.

External services - We have commissioned BUZZ Manchester (mentioned previously)

Focused care pilot underway with several Manchester GP practices signed up Support self-care Examples include:

Acute episodes – Choose Well Manchester has been commissioned as well as Think Pharmacy, Minor eye conditions service. There is also a Dental Helpline commissioned through OOH provider.

Long Term conditions – An Expert Patient Programme has been commissioned. There are also structured patient education sessions commissioned.


Develop QI expertise Examples include:

Leadership of change - Developed clinical leads through development courses with NHS Leadership Academy

Process Improvement - Procurement of QI systems (e.g. RAIDR, Primary Care Dashboard, EWS) to inform proactive care in a timely manner and reduce unwarranted variation

Rapid cycle change - Manchester Primary Care Standards have been implemented through a phased approach. Elements of this pump prime innovation and new practice.

3.8 In all practices, delivering primary care provider development initiatives for which CCGs will receive delegated budgets, including online consultations.

MHCC has considered the options available and is progressing with a solution from EMIS as this offers the best integration options. The project commenced late in 2017. The aim is that during 2018/19 that all GP Practices should be able to provide fully accessible online consultations which should support demand management.

3.9 Where primary care commissioning has been delegated, providing assurance that statutory primary medical services functions are being discharged effectively.

The three Manchester CCGs previously discharged their delegated commissioning arrangements for primary medical services through the Manchester Primary Care Commissioning Committee. Since the merger of the three CCGs and the establishment of MHCC in April 2018, our delegated commissioning arrangements for primary care are discharged through the MHCC Board. This is supported by robust governance arrangements that enable our delegated commissioning arrangements to function effectively i.e. the Primary Care Contract and Improvement Group which has representation from, but not limited to, commissioners (MHCC and GMH&SCP), clinicians, lay representatives, population health, analytics and quality which reports to the MHCC Executive Committee or the Performance, Quality and Improvement Committee. These Committees consider and make recommendations, on behalf of primary care, to the MHCC Board.

3.10 Lead CCGs expected to commission, with support from NHS England Regional Independent Care Sector Programme Management Offices, medicines optimisation for care home residents

Improving care for residents living in nursing and residential homes in Manchester is an area which has been identified as a priority. All 3 CCGs have previously developed enhanced primary and community support to care homes in Manchester. Primary care has been working closely with care and nursing home teams, to ensure residents are receiving proactive, appropriate care in a setting they are comfortable with, which will result in reduced hospital admissions and improved outcomes for patients. These services are an example of early implementation of the One Team model and a shift of focus of care from organisation


to place. Integration and communication across a wide spectrum of specialities has facilitated high quality individualised care provision, which has reduced the number of inappropriate admissions to hospital, enable and facilitate patients to end their life in their preferred place of care and ultimately improve the quality outcomes for all individuals. This includes:

A number of Central Manchester practices, co-ordinated by Primary Care Manchester (GP Federation), providing the Promoting Access to Care Homes (PAtCH) service which uses a weekly MDT approach to support their own registered patients and support care home staff in their practice.

A procurement exercise in North Manchester with the aim of securing proactive primary care and medicines optimisation services in Care Homes. This is currently under review.

In the South of the City, there has been a focus on ensuring improved Nursing Home service outreach into care homes as the team have the skills that patients will benefit from.

4 Urgent and Emergency Care


4.1 Ensure that aggregate performance against the four-hour A&E standard is at or above 90% in September 2018, that the majority of providers are achieving the 95% standard for the month of March 2019.

The Urgent and Emergency Care Network operates across Greater Manchester, with leadership from the Greater Manchester Health and Social Care Partnership. It is responsible for developing GM programmes relating to urgent and emergency care. Current priorities include A&E performance and the reduction of delayed transfers of care.

4.2 Implementation of the NHS 111 Online service to 100% of the population by December 2018, with more than half of callers to NHS 111 receiving clinical input during their call.

Urgent Care First Response is Manchester’s principal urgent care transformation programme. It supports delivery of the National 2014 Urgent and Emergency Care Review. The programme aims to deliver a financially and clinically sustainable urgent care system for the city. The programme has four workstreams - 1) First Contact 2 ) Urgent Primary Care 3) Complex Community Response 4) Ambulatory Care. Work to develop the clinical hub offer to support 111 / 999 is taking place at a regional and city-regional level. In Manchester, an alternative to transfer (ATT) service is in place across the city, along with a local Acute Patient Assessment Service (APAS) in the out of hours period which forms part of the clinical hub (or Clinical Assessment Service) model.


Mental Health problems such as depression and anxiety are also commonly experienced alongside long-term physical health problems, such as diabetes, COPD, or neurological disorders. Integrated, collaborative treatment of both mental and physical health problems can produce much better outcomes. As part of the LCO development, community services for health, mental health and social care and some aspects of primary care will be delivered through a ‘One Team’ neighbourhood approach. Mental health commissioners are working through the scoping and phasing of integrating mental health services into the one Team structures, so that general community staff are able to manage mild to moderate depression and anxiety and their implications. Manchester’s health and social care system is undergoing significant structural change. Manchester’s urgent care transformation plans and the wider strategy for urgent care will be reviewed in this context to ensure that they are appropriately aligned. Population coverage will be an important consideration in this, particularly in relation to the urgent care offer for children and young people.

4.3 By March 2019, CCGs should ensure technology is enabled and then ensure that direct booking from IUC CAS into local GP systems is delivered wherever technology allows.

There is an IM&T strategy in place which will deliver the opportunity for direct booking of appointments from patients and NHS111 by March 2019. There are already a number of initiatives in place which allow technology to be used for bookings including the use of Click Your GP, other providers include EMIS’s Econsult and AskMyGP. There are examples of Email consults already taking place across the city across the city. Skype consultations have been supported through the provision of webcams through IT.

4.4 Designate remaining UTCs in 2018/19 to meet the new standards and operate as part of an integrated approach to urgent and primary care.

The First Contact work stream has two principal activities; maximising the effectiveness of the NHS111 non- emergency telephone number and implementation of the Clinical Assessment Service (CAS) (formerly known as the clinical hub). Urgent Primary Care details primary care streaming models, walk in centres and extended hours offering additional capacity for patients. The National Integrated Urgent Care Specification was published in August 2017 and it is clear that Manchester’s approach to First Contact is in line with the specification. GM’s position on implementation is still unclear; there is still currently no workstream around NHS111/clinical assessment in GM however governance is being reviewed. Some of the CCGs in GM, Manchester Provider Partnership, NWAS and GMH&SCP met in December to discuss the agreed concept of using NHS111 for direct booking into extended access at weekends to improve utilisation and reduce pressure on urgent care – Manchester is proposed to be early pilot and


we hope to be up and running by early February 2018.

4.5 Work with local Ambulance Trusts to ensure that the new ambulance response time standards that were introduced in 2017/18 are met by September 2018. Handovers between ambulances and hospital A&Es should not exceed 30 minutes.

The Performance and Quality Improvement (PQI) team at MHCC team continue to lead work with North West Ambulance Service (NWAS) and trusts across Manchester. The aim is to improve ambulance handover times and reduce handover breaches by sharing best practice. A monthly performance meeting led by PQI with stakeholders takes place and progress reported to the North, Central / Trafford and South Manchester A and E operational delivery groups (ODGs). Daily handover reports identify handover breaches across the city hospitals:

• There is live monitoring by each trust site, with a zero tolerance approach to holding ambulance crews longer than required

• Trusts will complete a root cause analysis (RCA) on each lengthy handover breach and share this with the PQI Manager, with trends shared with A and E ODGs

• Escalation triggers have been identified within the OPEL score cards to proactively manage surge in demand

• Monitoring of monthly handover performance takes place with stakeholders at PQI led meetings between trusts and NWAS

In January 2018, MRI and NMGH were ranked 2nd and 5th out of 10 Manchester hospitals for handover times. Work will begin with Wythenshawe site to share performance information and the offer of support continues.

4.6 Deliver a safe reduction in ambulance conveyance to emergency departments.

There will continue to be a focus on maximising deflection schemes and alternatives to conveyance across the city, and reducing inappropriate ambulance conveyances. (ATT, Hear and Treat, See and Treat). Key elements include:

Working towards the nationally mandated targets for see and treat, and hear and treat. Manchester currently performs better against the hear and treat targets than those for see and treat

Development of the clinical hub offer to support 111 / 999, which is taking place at a regional and city-regional level. In Manchester, an alternative to transfer (ATT) service is in place across the city, along with a local Acute Patient Assessment Service (APAS) in the out of hours period which forms part of the clinical hub (or Clinical Assessment Service) model


The roll out of the crisis response service to Central and South Manchester, to support urgent need in out of hospital settings where appropriate

Ongoing work with Manchester’s care homes to support residents and professionals and to reduce the risk of avoidable ambulance call outs and non-elective admissions to hospital

4.7 Continue to make progress on reducing delayed transfers of care (DTOC), during 2018/19, with the reduction to be split equally between health and social care.

The Manchester locality is working collaboratively to achieve the DTOC standards. There is a multi-agency action plan, incorporating national best practice and guidance to tackle the issues faced. There is daily monitoring and reporting of progress which appraises all stakeholders of performance against target. There is escalation support on acute sites with processes in place. There has been a considerable investment from MHCC in finance and infrastructure, with the aim of unblocking barriers identified and achieving sustainable performance. The overall performance is monitored at an executive level with commitment across all partners to deliver improvement against trajectory.

4.8 Continue to improve patient flow inside hospitals through implementing the “Improving Patient Flow” guidance6. Focus specifically on reducing inappropriate length of stay for admissions, including specific attention on ‘stranded’ and ‘super stranded’ patients who have been in hospital for over 7 days and over 21 days respectively.

The locality plan for Manchester is based on the ‘Our Healthier Manchester’ approach. This is to be delivered in part by the transformation investment provided by GMH&SCP. This investment is predicated on the achievement of key metrics. These include:

a. Reduction in A&E attendances b. Reduction in NEL – both length of stay and admissions c. Reduction in EL – both length of stay and admissions d. Reduction in outpatient attendances e. Reduction in ambulance journeys f. Reduction in prescribing g. Reduction in the cost of care packages h. Reduction in assessments

4.9 Continue to work towards the 2020/21 deliverable of all acute hospitals having mental health crisis and liaison services that can meet the specific needs of people of all ages including children and young people and older adults; and deliver Core 24 mental health liaison standards for adults in 50% of acute hospitals, subject to hospitals being able to successfully recruit.

The delivery of all of these service targets is a main focus of the Manchester Urgent Care Transformation & Delivery Board which has a dedicated citywide workstream for Mental Health. MHCC will also monitoring data to ensure that the standards are met. The Acute Crisis Care Pathway is identified as a priority area in the Service Development Improvement Plan for Greater Manchester Mental Health Foundation Trust and this should help to ensure that the standards are met.


4.10 Ensure that fewer than 15% of NHS continuing healthcare full assessments take place in an acute setting.

The number of CHC full assessments that take place within the acute environment has been falling in 2017/18. This is on track to meet the requirement by March 2018 and will continue to be monitored throughout the year.

4.11 Progress implementation of the Emergency Care Data Set in all A&Es (Type 1 and Type 2 by June 2018; and Type 3 by the end of 2018/19).

Manchester Foundation Trust is submitting ECDS for all of its A&E departments. PAHT is not yet submitting but a Task and Finish Group has been established with the aim of submitting by May 2018.

4.12 Increase the number of patients who have consented to share their additional information through the extended summary care record to 15% and improve the functionality of e-SCR by December 2018.

There is a work programme to roll out the next version of the Manchester Care Record which will be live by June 18 and will be delivered into NWAS to support 111 and triage by September 2018. As part of this process we are looking towards GM access to the care record and as part of the process user adoption and satisfaction levels will be monitored.

4.13 Implement a proprietary appointment booking system at particular GP practices, 50% of integrated urgent care services and 50% of UTCs by May 2018, supported by improved technology and clear appointment booking standards issued by December 2018.

There is an IM&T strategy in place which will deliver the opportunity for direct booking of appointments from patients and NHS111 by March 2019. There is currently use of Click Your GP, other providers include EMIS’s Econsult and AskMyGP. There are examples of Email consults already taking place across the city across the city. Skype consultations have been supported through the provision of webcams through IT.

4.14 Continue to rollout the seven-day services four priority clinical standards to five specialist services (major trauma, heart attack, paediatric intensive care, vascular and stroke)

Greater Manchester was picked as an early delivery site for Phase 1 of the national 7 Day Services Programme. With delivery of four of the ten nationally set clinical standards for 7 day services in full by March 2017:


and the seven-day services four priority clinical standards in hospitals to 50% of the population.

Standard 2 (time to first consultant review); Standard 5 (diagnostics); Standard 6 (intervention / key services); and Standard 8 (on-going review) The performance of this is being monitored by a survey completed by selected Trusts every 6 months and takes a snap shot over a week. MFT has senior clinical leadership for implementation of the 7 day service, with specific meetings with all divisions to give a Trust wide focus. A sample survey of data from March 2017 showed that 3 of the 4 standards (Standard 5, 6 and 8) had been met. For standard 2 the hospitals had shown improvement from previous survey results, with 87% of the sample having had a review within 14 hours in South Manchester and 69% in Central Manchester. Electronic patient records support improvement in this standard. The hospitals are offering a consistent level of performance 7 days a week.

5 Transforming Care for People with Learning Disabilities


5.1 Reduce inappropriate hospitalisation of people with a learning disability, autism or both, so that the number in hospital reduces at a national aggregate level by 35% to 50% from March 2015 by March 2019.

Three care co-ordinators are now in place to support the multi-disciplinary approach for those with complex conditions and implement a Care Programme Approach (CPA) across community learning disability service and related pathways which should help to reduce hospitalisation. A draft specification for an integrated health and social care community learning service, which reflects the national delivery model, and describes the integration between health and social care has been constructed and will inform the mobilisation plan towards an integrated service aligned with the timeline for the formal development of the LCO. The final specification will then inform discussions around the development of a silver or gold standard


service in terms of costs, capacity, cost benefits and financial implications as part of the mobilisation plan is currently with the LCO lead.

5.2 Improve access to healthcare for people with a learning disability, so that the number of people receiving an annual health check from their GP is 64% higher than in 2016/17. .

An LD specific Primary Care Standard has been agreed and is being implemented. This standard addresses quality issues related to GP practices including reasonable adjustments identifies the challenges for GPs and practice staff in working with people with learning disabilities to address them, and give consideration to a model of care. A work plan has been agreed and led by the LD GP Clinical Lead to mobilise the operational content of the new standards and ensure GP participation. A resource pack has been developed and will be circulated to all GPs, with regular communications regarding developments. A schedule of clinical workshops aimed at GP practice staff is in development and is awaiting funding approval. Primary care standards are designed to incentivise GPs in order to increase quality and productivity. The local LD standard is designed to increase both the registration of people with LD as well as the numbers of health screens conducted however more importantly, the standards will form the basis of the primary care work stream for people with learning disabilities so that people with learning disabilities have an improved experience of primary care.

5.3 Make further investment in community teams to avoid hospitalisation, including through use of the £10 million transformation fund.

Three care co-ordinators are now in place to support the multi-disciplinary approach for those with complex conditions and implement a CPA approach across community learning disability service and related pathways.

5.4 Ensure more children with a learning disability, autism or both get a community Care, Education and Treatment Review (CETR) to consider other options before they are admitted to hospital, such that 75% of under 18s admitted to hospital have either had a pre-admission CETR or a CETR immediately post admission.

A more robust community service offer with an enhanced response to prevent and mitigate crisis, care co-ordination for those with complex conditions and a redesigned community service and pathways will overall reduce the reliance on specialist inpatient care. A business case is being prepared for submission.

5.5 Work on tackling premature mortality by supporting the review of deaths of patients with learning disabilities, as outlined in the National Quality Board 2017 guidance.

MHCC is engaged in a critical transformation of services and pathways for people with learning disabilities so that more people can access services, have improved outcomes for complex & long term conditions, enjoy health and well-being and live longer. Key transformational programmes of work for 18/19 include:


Implementing an integrated health and social care community learning disability service specification as well as developing a Quality and Outcomes Framework included in contracts with all providers of learning disability services.

Commissioning a Crisis Prevention and Response Service.

Continuing to focus on Winterbourne requirements for safe and effective discharge of patients from inpatient facilities in line with NHSE targets.

Robust transition pathways for children and young people with LD and / or Austism including LAC

Development of a Quality and Outcomes Framework for Learning Disability services.

6 Maternity


6.1 Deliver improvements in safety towards the 2020 ambition to reduce stillbirths, neonatal deaths, maternal death and brain injuries by 20% and by 50% in 2025, including full implementation of the Saving Babies Lives Care Bundle by March 2019.

The Performance & Quality Team will establish a baseline for 18/19, ensuring a consistent data set is used in setting of baselines and targets. All maternity and neonatal services will participate in a three-year programme to support improvements in the quality and safety of maternity and neonatal units across England. This work will be supported by the Local Maternity Services (LMS), Operational Delivery Networks (ODN’s), NHS Improvement, GM Patient Safety Collaborative, access to the Life System and the establishment of a Community of Practice. The improvements will be monitored via:-

Still birth rate will be reduced.

Rates of early neonatal deaths and hypoxic brain injuries will reduce.

CQC inspections

Breast feeding rate at 6 weeks will increase.

Fewer babies born at or later than 37 weeks will have an APGAR score less than 7 at 5 minutes.

Reduction in the number of term babies separated from their mothers

Increase in the number of babies born in units with neonatal intensive care facilities who are


known to need these services.

Responses to National Maternity Survey environment questions are positive.

Network policy

MVP walk the walk visits

6.2 Increase the number of women receiving continuity of the person caring for them during pregnancy so that by March 2019, 20% of women booking receive continuity.

More low risk women in Greater Manchester and Eastern Cheshire will receive continuity of the person and team caring for them during pregnancy, birth and postnatally. Women and their families in Greater Manchester and Eastern Cheshire will define what continuity of carer looks like locally. Midwifery and obstetric teams will be aligned with a caseload of women. Midwives will work in small teams of up to 10 midwives with access to an identified obstetrician. Women and their families will have access to a named midwife who coordinates her care. For low risk women the named midwife will undertake the booking appointment, where possible, then plan and provide the majority of the women and baby’s care across antenatal, intrapartum and postnatal care, working from the community setting. The woman’s named midwife will liaise closely with obstetric, neonatal, anaesthetic and other services ensuring that she gets the care she needs and that it is joined up with the care she is receiving in the community. The named midwife will plan and provide post-natal care in the community, undertaking post-natal checks of mother and baby including routine examination of the new-born in partnership with support staff and GPs as necessary. When a woman enters labour the named midwife will normally be the first point of contact for an assessment by phone or in person. A small group of community midwives will support this process to ensure 24/7 cover. Women who need the input of an obstetrician will have continuity of a named obstetrician throughout their antenatal care. The named midwife will be with the women for labour and birth, whether at home or in a midwifery or obstetric unit. Where an operative birth is carried out this will be provided by the core hospital midwifery team. Women with the most complex vulnerabilities will have access to a specialist team. Midwives in these roles will continue to provide continuity of care and should have a reduced caseload in recognition of the complexity of women.


The care of the women and baby will normally be transferred to the health visitor from 10 days after birth depending on the family’s needs with the GP providing ongoing care throughout.

6.3 Continue to increase access to specialist perinatal mental health services, ensuring that additional women can access specialist perinatal mental health services and boost bed numbers in the 19 units that will be open by the end of 2018/19 so that overall capacity is increased by 49%.

Maternal Mental Health Care is one of the 17 Mental Health Improvement Programme’s Care areas. GM investment is being aligned with the GM specialist perinatal mental health community services. This includes CCGs delivering the IAPT perinatal pathway for 20/21 to support the achievement of the 19% access target.

6.4 By June 2018, agree trajectories to improve the safety, choice and personalisation of maternity.

All women will have genuine choice in relation to place of birth. These will include the choice of home birth, obstetric birth unit, alongside midwifery unit or free standing midwifery unit. A choice of 3 birth settings will be available to all low-risk women. Maternity services will also ensure that all women have access to midwifery care in all care settings. Women and their families will feel supported to make well informed decisions through a relationship of mutual trust and respect with health professionals, and their choices should be acted upon. Women will be provided with the unbiased information about the benefits and risks associated with each of the birth settings to help them make an informed choice of the place and style of care they wish to receive. Women with communication difficulties will have access to support to ensure they received the information they require in a format that is appropriate. Midwives, and where appropriate obstetricians, will discuss the place of birth from first contact and throughout pregnancy with the woman. The primary midwife will support the women in her decision-making as her pregnancy progresses and these conversations will be recorded in a shared plan.

All women will have a personalised care plan developed with the woman and midwife, which sets out her decisions about her care, reflecting her wider health needs and is kept up to date as her pregnancy progresses. This will be communicated to her relevant care providers.


7 Referral to Treatment Times


7.1 Waiting lists in March 2019 to be no higher than in March 2018. Halve 52 week waits by March 2019.

Through contract negotiations with providers, MHCC is commissioning activity levels to ensure there is no growth in the number of patients on waiting lists and deliver the current waiting time standard. In There is only one cohort of patients where MFT does not have the capacity to undertake the procedures within the waiting time standard of 52 weeks. Currently there are 25 patients waiting for deep inferior epigastric perforator (DIEP) procedures. This is being addressed with the expectation that they will be eradicated throughout 2018/19. Key actions include:

Manchester Health and Care Commissioning agreed a local tariff with the Trust

The Trust has since undertaken extensive demand and capacity modelling to better understand the infra-structure requirements moving forward to ensure women are seen and treated in this service within national waiting time standards

A business case is in the final stages of development that outlines the expansion requirements to meet current and likely future demands

All women who have waited in excess of 52 weeks are being clinical validated and choice discussions are taking place

7.2 Systems will be expected to demonstrate to regional teams that their RTT plans are robust and realistic, and that they make best and flexible use of available capacity across their STP footprint in order to optimise delivery against the objectives above.

MHCC will agree an activity and RTT delivery profile across 2018/19 that takes into account historical trends in throughput and winter pressures. There will be enhanced small provider monitoring and assurance for RTT. A robust process is being established to review monthly national data, identify services which are in breach and support services which are in breach to develop action plans to return to target.

7.3 Provider plans will need to consider the capacity required to deliver the growth in non-elective and elective activity and the impact on workforce, finance and productivity. Alongside these capacity considerations it remains essential that providers manage within their agency ceilings.

Providers are submitting activity plans as part of the annual planning submission. Baseline 18/19 performance will be established and support will be provided to providers to develop action plans to meet targets.

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