Representatives from Trafford CCG, CMFT, NHS England and UHSM will be in attendance to provide an update to the Joint Committee on progress.

The Committee welcomed Jessica Williams and Rob Bellingham (NHS England); Dr Nigel Guest and Gina Lawrence (Trafford CCG), Stephen Gardner and Antony Middleton (Central Manchester Foundation Trust (CMFT)). Members were advised that Silas Nicholls from the University Hospital of South Manchester NHS Foundation Trust (UHSM) would also be in attendance. Gina Lawrence introduced the report provided by Trafford CCG and explained the quarterly performance targets. She said they had tried to show the impact of the New Health Deal for Trafford on performance and explained there had been some issues at UHSM with patient flows, particularly around discharges. Members noted that the information provided in the report was in a much more readable format than previously.

Members challenged the high conversion rates of attendances to admissions at UHSM and were told this was due to the complexity and nature of admissions. Gina Lawrence explained that audits had been carried out to investigate why the rates were higher at UHSM. She confirmed that all patients were appropriate to be admitted, however advised that junior staff were more likely to admit patients as they were more risk averse. She said as improvements were made to community care she expected the conversion rate would decrease. A member said this indicated the extent of the health problems experienced by Manchester residents. Officers could not confirm that any particular trends or health conditions had resulted in the conversions.

Members stressed that increased access to GPs could prevent or reduce unscheduled admissions to hospital. Dr Nigel Guest assured members that all Clinical Commissioning Groups (CCGs) in Manchester and Trafford were committed to 7 day GP access. He advised that the government had agreed to fund 5,000 more GPs nationwide to facilitate this and systems would be tailored to individual areas. He described different schemes that would help, including the use of medical students and delayed retirement. He confirmed that there was potential in Greater Manchester to provide additional access to GPs. Jessica Williams described the work of the Central Manchester Demonstrator which was one of six pilots funded by NHS England to test increased GP access. Members welcomed the progress though felt that some GPs were still reluctant and said that some practices still do not advertise how to get an appointment out of hours. Dr Guest advised that GPs were member organisations and changes to the healthcare system meant it was more important now to work together. He said that in Trafford 95% of GPs had agreed to a single operating system which would extend their core hours from 8am to 5.30pm and discontinue half day closing. He explained that they were not obliged to do this but it demonstrated that they wanted to make improvements. Rob Bellingham agreed there was a general recognition that more investment in GPs was required. However, he said there was lots that could be done in the interim to make Manchester a more attractive place to be a GP. Members asked about the Pharmacy Walk-in Pilot and were advised  ...  view the full minutes text for item 11

Representatives from the NHS will be in attendance to provide an update to the Joint Committee on progress with the implementation of the New Deal for Trafford programme and an update on issues raised at the last meeting.

The Committee welcomed Jessica Williams from NHS England and Silas Nicholls from the University Hospital of South Manchester NHS Foundation Trust (UHSM).  The Committee formally received the report.  The Chair noted that the report provided for the meeting contained lots of graphs and tables which were not always easy for a layperson to interpret.  He said that more detailed analysis would be helpful in future. 

Jessica Williams introduced herself, explaining that the role of NHS England was to hold the Clinical Commissioning Groups to account.  She said she could provide insight into the report, although she could not provide detailed analysis.  She explained that NHS England looked at this type of information on a weekly basis when the new Health Deal for Trafford was established in December 2013.  She said that Accident and Emergency (A&E) Attendances were higher than expected in year 2.  She noted that the performance figures for quarter 4 within the report were not comprehensive as the period ran from 1 January 2015 - 31 March 2015; however, UHSM was not expected to meet the 95% performance target in this quarter based on current data. 

Silas Nicholls introduced himself and explained the data provided for UHSM.  He said that in respect of A&E Attendances at UHSM in 2015, 85.3% of patients were seen within the four hour target in January, 91.4% in February, and 92.7% in March; which was a sustained improvement.  He said that it would have been difficult to achieve more due to the sheer volume of people attending over the winter months.  He said that there was a continued pressure of delayed transfer of care, in particular for patients from Trafford.  He said that over the previous week at UHSM approximately 20 patients no longer required hospital treatment but could not be discharged as they were waiting to be transferred elsewhere.  A member who was an ex board member of UHSM agreed there was a direct correlation between A&E performance and the volume of patients presenting at A&E.  Members agreed that improvements to community care were required to reduce the need for hospital admission.  The Chair stressed the importance of integrated care, noting that delayed discharge was a continued problem. 

The Chair noted that information on re-admission rates was requested at the last meeting of the Joint Health Scrutiny Committee but had not yet been received.  Silas Nicholls advised that re-admission rates at UHSM were broadly in line with national averages.  He said variations occurred where hospitals became specialised.  At UHSM general medical re-admissions had increased, particularly amongst frail and older patients.  He said UHSM was working to address this by expanding the current geriatrics service based in A&E, creating a 12 bed specialist frailty unit, and working closely with GPs to provide appropriate care packages.  He offered to share the plan with members, to which the Committee agreed. 

As UHSM specialised in respiratory medicines, in particular Chronic Obstructive Pulmonary Disease (COPD) this had also affected re-admission rates.  Silas  ...  view the full minutes text for item 4

Representatives from Trafford CCG and UHSM will be in attendance to provide an update to the Joint Committee on progress. This will include

·         The impact of the New Health Deal for residents of Manchester and Trafford

·         Progress in dealing with winter pressures

·         Progress report from the Senior Management Team of UHSM on developments at the Trust

·         Progress report on the A & E capital investment

An update on the University Hospital of South Manchester NHS Foundation Trust is attached.

The Committee welcomed Attila Vegh, CEO, University Hospital of South Manchester (UHSM) NHS Foundation Trust; Silas Nicholls, Chief Operating Officer, UHSM NHS Foundation Trust; Dr Nigel Guest, Chief Clinical Officer, Trafford Clinical Commissioning Group (CCG); Gina Lawrence, Director of Commissioning and Operations, Trafford CCG and Jessica Williams, NHS England.

Mr Nicholls informed the Committee that UHSM narrowly missed the 95% Accident and Emergency (A&E) target in Quarter 3 of the 2014/2015 year, achieving 91.95%. He advised that the levels of patients from Trafford attending UHSM are in line with expectations, but admissions were higher than expected. At UHSM there has been a 20% increase in those attending in the higher illness category amongst over 75 year olds, and a 24% increase of those attending with respiratory problems. The Committee noted the information and asked if the figures are available regarding the number of readmissions. Mr Nicholls advised these figures are collated and they can be made available for members of the Committee.

Mr Nicholls further advised that the Trust had identified key areas to improve and manage patient flow; these include Internal Processes within the Trust, Increased Intermediate Care Support and increased Social Care Capacity. Mr Nicholls advised that to address the issue of Delayed Transfer of Care for those patients who are medically fit but require care packages to be in pace to allow them to safely return home, Trafford CCG and Social Services have addressed this by allocating a dedicated Social Worker in the Hospital and they have developed a more flexible approach to buying care packages.

In response to a question from a member regarding the increase in presentations of chronic respiratory problems amongst the over 75 year olds Mr Nicholls advised that work is ongoing to address this. He stated that proactive work is being undertaken with both nursing and residential care homes so that those residents who are identified as being at risk receive the correct care and management of their condition to prevent it from escalating. Ms Lawrence informed the Committee that this is one aspect of the work undertaken as part of the proactive Geriatric Outreach Service. This service had been designed so that nurses can monitor residents of both residential and care homes to identify issues and then liaise with GPs and Consultants where necessary to effectively manage their condition. Dr Guest stated that this co-ordinated approach of the Geriatric Outreach Service is very important and will include the co-operation of GP’s, Pharmacists and Physiotherapists.

Ms Lawrence advised the Committee that there is an issue regarding Nursing Homes in the Trafford area. She stated that whilst there are enough beds in Trafford they are significantly more expensive than neighbouring areas. To address this, the CCG are seeking to attract more quality providers into the area to help increase competition and offer a more competitive cost. She further advised that whilst Trafford had experienced an increase in demand for care packages, this has been compounded due to the lack of providers able  ...  view the full minutes text for item 2