To note the appointment of the new Independent Chair of the Board

Councillor D. Ali, Vice-Chair and Portfolio Holder for Health opened the meeting and asked Board Members and Officers to note the appointment of Mrs. Chris Mayer CBE as the new Independent Chair of Heywood, Middleton and Rochdale Locality Board.

Resolved that the appointment of Mrs. Chirs Mayer CBE as the new Independent Chair of Heywood, Middleton and Rochdale Locality Board be noted.

The Independent Chair welcome the Northern Care Alliance Chair who attended today’s meeting.

The Place Based Lead informed the Chair that Mrs. Samantha Lawton had joined the Board as the newly appointed Monitoring Officer for Rochdale Borough Council.

To receive any apologies for absence.

Apologies for absence were received from the following Board Members:

Councillors Wardle and Massey, Sally McIvor, Kate Jones.

The following Supporting Officers submitted their apologies:

Martin Lawton and Jonathan Evans.

Members are required to declare any disclosable pecuniary, personal or personal and prejudicial interests they may have and the nature of those interests relating to items on this agenda and/or indicate if S106 of the Local Government Finance Act 1992 applies to them.  

The Independent Chair declared an interest with reference to item 13a on the agenda by virtue of her role as Northern Care Alliance Maternity Ward Champion. The item in question was for information only. 

To determine any items on the agenda, if any, where the public are to be excluded from the meeting.

The Board noted that the following items were for exclusion of press and public:

-Item13a - Quality, Safety and Safeguarding Assurance Report

-Item 14a - Best Interest Assessment (BIA) and medical professional /doctors (S.12) assessments for deprivation of liberty Safeguarding authorisations (DoLS) Retendering

-Item 14b – Supported Employment Contract and Retendering

Members are requested to approve the minutes of the meeting held on 29^th August 2023

Resolved that the minutes of the meeting held on 29^th August 2023 be approved as a correct record.

To determine whether there are any additional items of business which, by reason of special circumstances, the Chair decides should be considered at the meeting as a matter of urgency.

There were no items of urgent business received.

To consider public questions received since last meeting of the Board

The Board noted that the public question concerning “Tourette’s Syndrome and out of area referrals”had been addressed and theresponse has been sent to the questioner and shared with all Board Members.

To receive a verbal update from the NHS GM Integrated Care Representative and the Place Based Lead – Item for Information

The Board received a verbal update from the NHS GM Integrated Care Representative on some of the work streams being progressed by the Integrated Care System in Greater Manchester.

The Senior Officer informed of three main areas of development:

1) The final staff structure for GM Integrated Care would go live on 1^st October 2023;

2) Formal work was ongoing on financial recovery across GM through a significant in year review of current financial forecast to support recovery for 2023/24 and improvements in 2024/25. This work strand would include engagement across GM and Rochdale to participate and support this exercise;

3) The establishment of a shared intelligence hub and business intelligence asset and work with the ten localities across GM to achieve good reliable performance information and route to “single truth” and to support delivery planning.

With regards to the shared intelligence hub, the Board noted that Rochdale had provided its business intelligence resources to GM to help to set up the hub. However, it was noted that it was important to have those resources back from October 2023 in order to support the work of the locality.

The Board also queried whether, in light of shared intelligence, contracts with health and social care providers needed to be reviewed.

Resolved:

1.    That the update be noted;

2.    That the NHS GM Integrated Care Representative look at reintegrating business intelligence analysts to Rochdale locality from October 2023;

3.    That consideration be given to whether contracts with health and social care providers need to be reviewed in light of the new GM intelligence hub.

To consider a report of the Associate Director of Integrated Systems, NHS GM Integrated Care HMR   – Item for decision

The Board considered a report of the Associate Director of Integrated Systems which sought to inform of the revised terms of reference of the Board.

The Senior Officer informed that, as part of the formal establishment, NHS GM Integrated Care Board had requested that the terms of reference be reviewed in September 2023 to include a review date and reference to NHS GM Risk Management Framework.

The updated terms of reference had been reviewed and approved by the Monitoring Officer in line with Rochdale Council’s Constitution Part 3 – Responsibility for Functions.

Resolved that the updated terms of reference be noted and approved.

To consider a report of the Associate Director of Integrated Systems Development – Item for discussion

The Board considered a report of the Associate Director of Integrated System which provided a draft six monthly update which was required to be submitted to NHS GM Integrated Care Board for presentation at the November meeting. The update also formed part of the reporting requirements following establishment of HMR Locality Board in April 2023.

The Senior Officer informed the Board that the six monthly update would be brought to the Board for approval in October. However, Board Members were asked to consider the draft document and to provide their comments.

The Board enquired about the template for the report as it appeared to be fragmented and it appeared not to offer the opportunity to state what the Board had achieved in the last six months.

Board Members agreed that additional content could be added to the report rather than through the template.

Resolved:

1.    That the report be noted;

2.    That additional content be provided in the final report about the achievements of the Board in the last six months.

To consider a presentation of the Director of Health & Care Integration (DASS & Deputy Place Lead) Integrated Commissioning –

Presentation will be delivered on the day of the meeting - Item for discussion

The Board received a joint presentation of the Associate Director of Integrated Systems Development and the Local Care Organisation (LCO) Chief Officer which sought to inform of the progress against the development of a health and care operating framework, coproduced across the system, to achieve the best outcomes for the residents of Heywood, Middleton and Rochdale (HMR).

The Chief Officer for the LCO started the presentation informing the Board that NHS England Lead Officer for Health and Care Equality had visited HMR locality and Middleton Hub and, via press release and social media, had commended on the work of the Heywood, Middleton and Rochdale locality, speaking about it as an example of what health and care systems across England should look like.

The Chief Officer continued outlining the key drivers of the HMR operating model such as a consistent strategic intent of integrated working and working in conjunction with the Greater Manchester (GM) Operating Model. HMR had strong foundations to build on such as a consistent outcome based approach to Health and Wellbeing priorities through the target operating model.

The Associate Director of Integrated System Development informed that HMR population was at the heart of the proposed operating model and this approach had made possible to have strategic shared priorities across the HMR system. Integrated ways of working had been developed because of the relationships established across health, care and voluntary sector partners and supported by a consistent leadership that brought forward the vision of integrated care.

The Senior Officer continued informing that there were some questions that needed to be addressed through the draft locality operating model, for example, integrated delivery and commissioning intentions and how these worked in the new system, and governance and delegation and how HMR locality linked with GM and what delegations needed to take place within the locality and the different parts of the systems.

The Senior Officer outlined the themes to discuss at a developing session with the Board Members planned for October in order to agree a draft HMR operating model. These were: Our Population, Social Operating Model, System Leadership, Governance and Delegations, Integrated Delivery and Connectivity within GM.

The Senior Officer noted that this was a complicated task but there was commitment in the system to work together and to coproduce this document. There were some areas to clarify, for example how to connect with the GM Operating Model. Language was important to ensure engagement with workforce and population.

Board Members discussed the importance of addressing this piece of work rapidly, with a mind-set of reciprocal relationship with GM and with a language which was most suitable for the users that the HMR locality intended to reach. 

Resolved that the information be noted.

To consider a joint report of the Associate Director of Transformation and Delivery NHS Greater Manchester Integrated Care HMR and of the Divisional Managing Director, Northern Care Alliance, NHS Foundation Trust – Item for discussion

The Board received a joint report and presentation of the Associate Director of Transformation and Delivery NHS GM IC HMR and the Divisional Managing Director, Northern Care Alliance NHS Foundation Trust which sought to inform of the winter plan for the health and care system in Heywood, Middleton and Rochdale (HMR).

The Associate Director of Transformation and Delivery, the Divisional Managing Director and the Director of Care and Projects were in attendance to present the information and to address the questions and comments of the Board.

The presenters outlined the key information of the 2023/24 winter plan such as risks and challenges for the health and care system, provision already in place, the high-impact priority interventions drawn from the Urgent and Emergency Care (UEC) recovery plan and Better Care Fund and other strategies in place to support the delivery of the winter plan.

Officers informed that the funding allocation for the winter plan had been announced on 20^th September 2023 in the sum of £1.1M. The Virtual Ward had been paused and the review of the schemes supported by the funding was underway. 

Delegated authority to revise the local proposal had been granted to the Place Based Lead by this Board at its meeting of 27^th June 2023, when the UEC submission had been first agreed. Delegated authority had been requested to amend the schemes funded via the UEC in case of a difference between the submission and the funding allocation. Following communication of reduced funding allocation, the delegated authority would be exercised to submit the revised local proposal.

Board Members noted the update on UEC funding allocation and agreed that amendments to local proposal were urgent and asked Committee Services to action the delegation in line with statutory requirements.

Reason for decision:

To support the development and implementation of the system winter plan.

 Resolved:

1.    That the system challenges anticipated over the winter period across the health and care system in HMR be noted;

2.    That the plans in place and the proposed plans be noted;

3.    That the feedback on the plans be noted.

4.    That the update on UEC funding allocation be noted and Committee Services start the process to publish the delegated decision for the revised local proposal and treat it as an urgent decision.

Alternatives considered and rejected:

Not to have a winter plan. This is not possible as the requirement is to have a winter plan, the local system has developed a system wide plan to support this.

As part of the process, of the development of the plan the locality has conducted a self-assessment and interventions have been put in place to support an improvement in this position.

The report outlines the plans for winter for across the local health and care system.

To consider a report of the Director of Health & Care Integration (DASS & Deputy Place Lead) Integrated Commissioning – Item for information

The Board considered a report of the Director of Health and Care Integration (Director of Adult Social Services (DASS) and Deputy Place Lead) which updated on the introduction of a new Care Quality Commission’s assurance framework to assess how well local authorities meet their statutory duties to deliver high quality care.

The Senior Officer was in attendance to present the information and to answer the questions and comments of the Board.

The Senior Officer outlined the main changes to the inspection regime which would be likely to start from November 2023 onwards. Initially, 20 local authorities would be selected for the implementation of the new inspection regime and one of these would be likely to be a local authority in Greater Manchester. The first 20 sites would receive a 9 week notice. The CQC aspiration is to carry out 153 assessment in two years. There were several pilot sites identified and the inspection was underway or about to start in the coming weeks. These sites were Lincolnshire, Nottingham City, Birmingham City Council, North Lincolnshire and Suffolk.

The Senior Officer continued informing that the new process would continue evolving from the pilot sites. The key focus of the new process was on the lived experience with a deep dive following individual cases. Before the inspection, on line information, web-sites, returns and report would be reviewed.

The Senior Officer added that the system partners would be part of the new process.

Resolved that the information be noted.

To consider a presentation of the Chief Officer Rochdale Care Organisation – Item for information

The Board received a report and a presentation of the Discharge Integration Programme Director, Northern Care Alliance NHS Foundation Trust which sought to inform of the Discharge Frontrunner Integration Programme.

The report author was in attendance to present the information and to address the questions and comments of the Board.

The Local Care Organisation Chief Officer introduced the report noting that this was an innovative, long term solution and an opportunity for Heywood, Middleton and Rochdale locality to learn from the programme and, as system, to understand its benefits.

The report author outlined the key elements of the Discharge Integration Frontrunner Programme, one of six national pilot programmes jointly funded by NHS England and the Department of Health and Social care. Its main aim would be to implement a range of strategies to help discharge patients from hospital by testing new approaches, bringing together health and social care from across neighbouring localities, to find fully integrated solutions for the longer term.

Heywood, Middleton and Rochdale locality, together with Salford, Bury and Oldham localities, formed the Four Locality Partnership which was one of the selected test sites and it was specifically looking at Dementia and people over the age of 65.

The report author informed that the programme was not yet concluded and learning was still emerging. However, it was timely for the Board to be updated on progress, in order to provide the opportunity to shape future recommendations across the four locality partnerships.

The Independent Chair welcomed the presentation and requested an update in two/three months to assess the suitability of the programme.

Resolved:

1.    That the information be noted;

2.    That an update be brought to this Board in two/three months to review and assess the suitability of the programme.

To consider a report of the Locality Director of Strategic Performance – Health & Social Care) – Item for information

The Board considered a progress report of the Locality Director of Strategic Performance – Health and Social Care which updated on the financial position of the pooled budget for the financial year 2023/24. The pooled budget excluded the Better Care Fund (BCF) which would be reported separately to this Board in 2023/24.

The Director of Corporate Resources / Chief Finance Officer presented the information and outlined that an overspend of £6.7m was being reported against the Local Authority pooled budgets (Excluding Covid related pressures). This included pressures of £6.8m against Children’s budgets due to increased placement costs and SEND (Special Educational Needs) transport pressures, and a £0.1m in year saving forecast against Public Health budgets due to staffing costs because of vacancies. Cabinet had noted that the overspend was being reported and that a recovery plan was being developed, which would be reported alongside quarter two finance update report.

The Senior Officer also informed that the risk share agreement 2023/24 would remain the same as in previous two years, so that both partners were responsible for their own pooled fund gap and in year underspend or overspend.

Resolved that the £6.7m overspend position being forecast in relation to pooled budgets at Outturn, which would be either be recovered or funded from increased contribution from the Local Authority be noted.

Reason for decision:

This report updated the Board on the Health and Social Care pooled budgets for 2023/24 in line with National Health Service England (NHSE) guidelines and the Greater Manchester (GM) Health and Social Care Partnership requirements. As part of operating a pooled budget regular monitoring reports are required.

The Better Care Fund has been excluded from the pooled reporting and would be reported separately to the Board in line with NHSE requirements for reporting each quarter.

Alternatives considered and rejected:

The operation of a formal pool in 2023/24 builds on the shadow pool that was operated by the Integrated Care Board in 2017/18 and was in line with previous years reporting; therefore, there were no alternatives to consider.

To consider a report of the Strategic Estate Group Chair – Item for information

The Board received a progress report of the Locality Director of Strategic Performance Health and Social Care and Chair of this Sub-Group on the work to date of the Heywood, Middleton and Rochdale Strategic Estate Sub-Group. 

The report author was not present and the Board agreed to take the report as read and any questions would be sent to the Senior Officer for a response following today’s meeting.

Resolved that the information be noted.

To consider a report of the Chair of the Finance, Performance and Risk Sub-Group – Item for information

The Board received a progress report of the Locality Director of Strategic Performance Health and Social Care and Chair of this Sub-Group on Heywood, Middleton and Rochdale locality Financial Plan 2023/24 and on performance and risk for planned and urgent care, cancer, mental health and adult social care.

The report author was not present and the Board agreed to take the report as read and any questions would be sent to the Senior Officer for a response following today’s meeting.

The Independent Chair questioned the merit of having two separate reports: one for finance and one for performance. The Independent Chair would welcome the opportunity to see the connection between performance and Neighbourhoods and Strategic Plan for HMR locality.

Resolved:

1. That the information be noted;
2. That HMR Locality Board’s Development Session in October 2023 consider how to look at reporting on performance against the HMR locality’s operating model.

To consider a report of the Associate Director of Delivery and Transformation, NHS GM Integrated Care HMR – Item for information

The Board received a progress report of the Associate Director of Delivery and Transformation on the work of the System Clinical and Care Professional Leadership Sub-Group.

The report author was in attendance and informed that the Sub-Group had met in August to review its terms of reference, the System Winter Plan, the Treatment Advisory Group update and the Ockendon report – Impact on Inequalities / Maternity.

The Chair of the Sub-Group and Associate Medical Director for HMR informed that once the membership of the Sub-Group was in place, the terms of reference would be brought to this Board for approval and the Sub-Group would start its work.

The Independent Chair asked to receive a timeframe of the work to fully develop this Sub-Group.

Resolved that the update be noted.

To consider a report of the Locality Associate Director Nursing, Safeguarding, Quality and Safety, NHS GM Integrated Care HMR

The Board considered a progress report of the Locality Associate Director Nursing, Safeguarding, Quality and Safety, NHS GM Integrated Care HMR which informed of the work and activities of the Sub-Group to date.

Part of the content of this report was reviewed by the Board during its closed session as it contained information deemed to be exempt from publication.

The Independent Chair declared an interest by virtue of her role as Northern Care Alliance Maternity Ward Champion.

 The report author informed that different agencies were represented in the membership of the Sub-Group and that assurance work had been undertaken for all the elements of the report.

Resolved:

1.    That the information be noted;

2.    That clinical involvement be requested when the topics were next reviewed;

3.    That the report author meet with the Chair to discuss the structure of the report.

To consider that the press and public be excluded from the remaining part of the meeting pursuant to Section 100(A)4 of the Local Government Act 1972 on the grounds that discussions may involve the likely disclosure of exempt information as defined in the provisions of Paragraph 1,2 and 3, Part 1 of Schedule 12A to the Local Government Act 1972 and public interest would not be served in publishing the information.

Resolved that, in accordance with the provisions under Section 100(A) (4) of the Local Government Act 1972, as amended, the press and public be excluded from the meeting during the consideration of the following items of business.

To consider a report of the Locality Associate Director Nursing, Safeguarding, Quality and Safety, NHS GM Integrated Care HMR – Item for information

The Board considered a progress report of the Locality Associate Director Nursing, Safeguarding, Quality and Safety, NHS GM Integrated Care HMR which informed of the work and activities of the Sub-Group to date.

This part of the report contained information deemed to be exempt from publication.

The Independent Chair declared an interest by virtue of her role as Northern Care Alliance Maternity Ward Champion.

 The report author informed that different agencies were represented in the membership of the Sub-Group and that assurance work had been undertaken for all the elements of the report.

Resolved:

1. That the information be noted;
2. That clinical involvement be requested when the topics were next reviewed;
3. That the report author meet with the Chair to discuss the structure of the report.

To consider a report of Director of Health & Care Integration (DASS & Deputy Place Lead) – Item for decision

The Board considered a report of the Director of Health and Care Integration (DASS and Deputy Place Lead) which sought permission to retender the Best Interest Assessor contract.

The Senior Officer was in attendance to present the report and to answer the questions and comments of the Board.

Resolved:

1. That a competitive tendering process for the Best Interest Assessor contract be undertaken;
2. That the Director of Health and Care Integration (DASS and Deputy Place Lead) in consultation with the Portfolio Holder for Adult Social Care and Wellbeing be given delegated authority to award the contract.

Reason for the decision:

There were no alternatives to retendering.

Alternative options considered and rejected:

Several options had been considered and discounted as outlined at point 4 of the report.

To consider a report of the Director of Health & Care Integration (DASS & Deputy Place Lead)– Item for decision

The Board considered a report of the Director of Health and Care Integration (DASS and Deputy Place Lead) which sought permission to retender the current Supported Employment Service contract which expired in March 2024.

The Senior Officer was in attendance to present the report and to answer the questions and comments of the Board.

Resolved:

1. That a competitive tendering process for the Supported Employment Service contract be undertaken;
2. That the Director of Health and Care Integration (DASS and Deputy Place Lead) in consultation with the Portfolio Holder for Adult Social Care and Wellbeing be given delegated authority to award the contract.

Reason for the decision:

The benefits of Supported Employment Service were outlined at point 3 of the report.   

Alternative options considered and rejected:

Two options had been considered and discounted as outlined at point 4 of the report.