To receive a report from Trafford CCG.

The Committee received a report which provided an update on the performance of acute trusts across Greater Manchester, the local system including performance for the year to date 2016/17, system resilience, ongoing risks to performance, governance and delivery of the Accident and Emergency (A&E) improvement plan and monitoring of progress, delayed transfers of care (DTOC’s), and intermediate care.  Dr Nigel Guest, Trafford Clinical Commissioning Group (CCG) introduced the report across its main themes.  He outlined the significant collaboration that was ongoing across Greater Manchester to improve system resilience and how the risks to this were being mitigated.  He stated that in respect of DTOC national figures had been released following publication of the report which indicated that UHSM had 105 DTOC and Trafford General Hospital had 43 adding that Manchester and Stockport experienced issues with DTOC also.  He added that there had been improvements in respect of intermediate care with increased collaborative working. 

Gina Lawrence, Trafford CCG, said that in respect of whole systems resilience the issues were not unique to Trafford.  She explained that officers were working to improve sustainability but that problems were experienced sustaining packages of care over holiday periods, in particular Christmas.  In response to a members query she said that many casual workers were attracted instead to short term opportunities in retail over this period.  She said that Trafford CCG were working with new providers to address this.  One solution was the introduction of block contracts across nursing homes to ensure that sufficient beds were available.  Gina Lawrence said that Ascot House was now fully operational running at full capacity and discussions were ongoing with Mary Burney and the Estates Team to employ more workers to provide intermediate care.  It was a recognised problem that a large group of patients were re-admitted as their care had broken down leading to a cycle of repetition.  A new Care Co-ordination Centre was planned which would deliver support services and care plans and take on 100 per week up to a 1000 maximum. 

She stressed the importance of proactively managing patients prior to their presenting at A&E.  She explained that since the primary care offer had been expended early intervention was required.  Systems changes had resulted in increased capacity.  She added that Trafford had an ageing population with complex needs and it was estimated that 130 beds would be required over the next 12 months in addition to those already commissioned. 

Members sought clarification on whether Ascot House could be used if it was not at capacity and whether the current block contracts for nursing care included the additional 130 beds required.  Gina Lawrence responded that an additional 130 beds were required to those already commissioned.  In response to a member’s query she advised that there was not a time limit on the nursing beds provided; patients admitted to Ascot House could stay there indefinitely should they choose to do so. 

A member acknowledged that funding for health and social care was under pressure but asked what was being done in Trafford in particular to address DTOC.  He added that further detail and a breakdown of the barriers faced by UHSM should be provided within a future report.  Gina Lawrence said that work was underway to understand those hospitals which did not experience as high rates of DTOC such as North Manchester and Wigan.   She explained it was difficult to translate this directly to Trafford as the demographics of residents differed, for example the average life expectancy of Trafford residents was ten years longer than in Wigan.  She said that information was being collated on outlier ward delays at Trafford.  She noted that although the number of DTOC had increased the time period that patients were delayed had reduced over the past twelve months.  She described developments which helped such as personalised care packages and personal care budgets being a key focus to help patients’ access care packages at home and which was working well but it was a slow process.  She was happy to provide further information when it was available. 

Members discussed the issues around recruiting healthcare staff.  Officers described the shift to skilling up nurses and freeing up Drs to focus on more complex tasks.  In response to a members query Stephen Gardener advised that work was ongoing by Greater Manchester Health and Social Care Devolution to look at the bigger picture, including the implications of the UK leaving the European Union (EU).  He stressed the importance of a whole system approach adding that Lord Peter Smith had chaired a group working on a Greater Manchester Workforce Strategy which would be in place by May 2017. 

The Chair reported that Councillor Harding had requested further detail on mental health performance and the results of the internal audit and requested this be provided to Trafford Health Scrutiny Committee.  Gina Lawrence explained that the reference to mental health was in respect of those entering the A&E and they had the right amount of beds to meet demand.  However, she acknowledged that Greater Manchester overall may experience high occupancy and that they were looking at different ways of commissioning these on a Greater Manchester footprint.  Rob Bellingham, NHS England explained that a Greater Manchester Mental Health Strategy had been submitted to the Partnership Board and new commissioning arrangements would be implemented from April 2018 onwards.

DECISIONS:

1.    To note the report with thanks.

2.    To agree on the continued need to monitor the implementation of the New Health Deal for Trafford, in particular the performance of the Urgent Care Centre at Trafford General Hospital.

3.    To re-iterate that the Committee does not at this point support the downgrading of the Trafford Urgent Care Centre to a Minor Injuries Unit.

4.    To request that should the NHS wish to make any further changes to the service provision at the Trafford Urgent Care Centre appropriate consultation is carried out with both the Joint Health Scrutiny Committee and Trafford Health Scrutiny Committee.

5.    To request further detail on Delayed Transfer of Care (DTOC)’s numbers and a breakdown of the reasons for this.

6.    To note that further information on mental health issues and the internal audit would be provided to Trafford Health Scrutiny Committee at an appropriate time.

7.    To request that Committee Support canvas members availability for a meeting    of the Committee in March 2017.  To delegate responsibility to the Chair and Vice Chair to confirm whether to proceed with a meeting at this time.