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Chairman's Bulletin December 2015

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In this month's Governor update, I'd like to share with you some of the key areas of work which are underway to progress the GM Devolution Agenda and its aim to improve the health of the population of Manchester and also to tackle some of the pressures facing our health & social care system.

Whilst the additional £3.8 billion of NHS funding for 2016/17 announced in the Chancellor's Autumn Statement is very welcome, an assessment earlier this year indicated that, for Greater Manchester alone, a £2 billion gap would develop over the next five years.  With this in mind, one of the main objectives of the GM Devolution partnership is to get the whole conurbation to work together to find ways to address this challenge and realise our vision which is "to deliver the fastest and greatest improvement in the health and wellbeing of the population of Greater Manchester".

devomancTowards the end of last week, the final draft GM Health and Social Care Strategic Plan was endorsed, and this sets out a vision for health and social care in the region which can be delivered in a sustainable and effective way (The final draft plan is now available to view on http://www.gmhealthandsocialcaredevo.org.uk/). This endorsement followed confirmation a few days earlier that Greater Manchester is to receive £450m transformation funding from NHS England to help towards creating a sustainable and successful health and social care system by 2021.

Within the context of the GM strategy, the four commissioning organisations in Manchester (the three Clinical Commissioning Groups and Manchester City Council) have also developed the 'Manchester Locality Plan' which captures three main themes:

  • The integration of health and social care commissioning with the four commissioning bodies acting as one
  • The integration of community and out-of-hospital services in a "One Team" approach, including the formation of a Manchester Local Care Organisation (LCO), and,
  • The development of a "single hospital service" for Manchester

Governors will recall receiving a separate briefing on the Manchester Single Hospital Service earlier this month which reported that the three Manchester acute Trusts (CMFT, University Hospital of South Manchester NHS FT, and The Pennine Acute NHS Trust) have established an independent review, led by Sir Jonathan Michael, to look at how hospital services in the city of Manchester could be delivered more effectively through closer collaborative working.

The review will be structured in to two discrete stages.  The first stage (December - March) will focus on identifying the sorts of benefits that could be achieved for patients and local residents by bringing hospital services in Manchester into closer alignment.  This will cover all aspects of the functioning of the three hospitals, but with the greatest emphasis on clinical services.  Significant engagement and dialogue with clinical teams will be critical, but we will also ensure that Governors are able to feed in their views.  Specifically, it is intended to use part of the existing Forward Planning session on 26th January 2016 to discuss all aspects of the Manchester Locality Plan (including the Single Hospital Service review and the Local Care Organisation proposal), and then to hold a separate session in the Spring to discuss and comment on emerging findings from the review.

The second stage (April - June) will focus on what sort of leadership and organisational arrangements we need to develop to realise the identified benefits quickly and effectively.  This will involve some consideration of governance functions across the city, so it will be particularly important to involve Governors in this debate. The arrangements for doing this will be agreed with Governors in the coming weeks and a further session will be arranged in due course to coincide with the timescales of this second phase.

The final outcome of the Single Hospital Service review will be reported to the Manchester Health and Wellbeing Board in summer 2016 and I am convinced that the review will identify significant potential benefits for our patients and for Manchester residents.

In summary, the CMFT Governor Sessions currently being organised are:

  • 26th January 2016 - A Governor Forward Planning Workshop which will also discuss all aspects of the Manchester Locality Plan
  • 2nd March 2016 - The Council of Governors will receive a detailed update on progress with the GM Devolution Agenda with particular focus on the 'Manchester Locality Plan'
  • Spring 2016 - A Governor Workshop to discuss and comment on emerging findings from the Manchester Single Hospital Service review.
  • May/June 2016 - A Governor Workshop to discuss and comment on the governance arrangements necessary to realise the identified benefits of a Manchester Single Hospital Service and Local Care Organisation quickly and effectively.

The Trust is also working as closely as possible with Trafford CCG and Council on the Locality Plan for Trafford.  The centre-piece of the Trafford approach is the development of a substantial "Care Coordination Centre" function, which is intended to coordinate and integrate the activities of the various service providers.  We will provide further briefing to Governors once the Locality Plan has been approved by Trafford Health and Wellbeing Board.

You will be already aware that pressure on our urgent care system has tangibly increased, which very much reflects the national picture.  I can assure Governors that CMFT is faring better than most other organisations - we are among the best performing Trusts in Greater Manchester and other comparable Trusts nationally.  However, it's disappointing to report that it's unlikely the A&E standard will be delivered in Quarter 3.

We have implemented a number of schemes to respond to urgent care pressures, from additional overnight staffing in the Emergency Department to social workers and intermediate care bed provision. Without these actions the position would be considerably worse, but resources are very tight and not all potential schemes could be approved.

A significant factor for CMFT is providing additional bed capacity, which has been affected by work on two wards to address environmental issues related to Carbapenemase-Producing Enterobacteriaceae (CPE). This work is expected to complete in early January, and Julia Bridgewater (Chief Operating Officer) is leading the planning around bringing this capacity into use in a sustained and effective way.

I'm pleased to tell you that the capacity issues on diagnostic endoscopy I mentioned last month are being overcome.  The backlog of patients waiting over six weeks is reducing and full compliance is expected by March 2016.  Similarly the measures to address the increased demand from GPs for urgent referrals for patients with suspected cancer are proving effective, with delivery of the standard in Q3 now expected.

The cancellation of elective procedures and patient appointments in anticipation of strike action by junior doctors also had an impact on our activity.  The strike action was postponed and national negotiations will continue after Christmas to resolve the dispute.

A welcome initiative involving GPs is also set to help reduce pressure on hospital services.  Manchester Access is an innovative new scheme to give patients better access to primary care services in the city of Manchester.  Supported by the Prime Minister's GP Access Fund, it enables almost 590,000 patients registered with 91 North, South or Central practices to see a GP outside normal surgery hours.  It operates from 12 Community Hubs and three GP-A&E locations, seven days a week between 8am and 8pm.

Primary care is a vital partner in meeting the healthcare needs of our communities, and I'm very pleased to welcome our new Non-Executive Director (NED), Dr Ivan Benett, whose appointment Governors approved at the Council of Governors' meeting in October.  Ivan has an outstanding track record in primary care, and he takes up the NED role on 4th January 2016 (see below for more information).

All of these developments will help to inform our forward planning process.  I am very grateful to all the Governors who attended our recent development sessions.  Your very positive contributions and suggestions will feed into the forward planning and quality reporting processes, which continues with the Governor Forward Planning Workshop on 26th January.  In the meantime, do please encourage members to complete our forward planning questionnaire and tell us their priorities via our new online survey.

Listening and learning is a key part of developing our services. Recent press coverage about Southern Health NHS Foundation Trust's failure to investigate the unexpected deaths of patients with mental health conditions or learning disabilities is a matter of serious concern for all healthcare organisations.  I'd like to reassure Governors that, as part of our commitment to providing safe, high quality care, CMFT investigates any unexpected deaths and ensures that any lessons are learned and fully acted upon.

I'd like to close by reflecting on my first 12 months as your Chairman.  It's been busy, challenging and immensely enjoyable, and I'm proud to be part of such a forward-looking organisation at the heart of a great city.  My thanks to you all for the contributions you've made as Governors, and the support you've given to me, our senior leadership team, staff and members.  Your commitment and involvement is very much valued and I'm looking forward to working with you to shape our future strategy and priorities in 2016.

My very best wishes to you and your families for the festive season and for a peaceful, happy New Year.