To receive any apologies for absence.

Apologies for absence were received from Steve Rumbelow, Warren Heppolette, Nichola Thompson, Sally McIvor, Steve Taylor, Nicky Clarke, Kate Jones and Dr Jiva.

Martin Lawton was present as substitute for Nichola Thomson for non-section 75 matters.

Sandra Croasdale was present as substitute for Nichola Thompson for Section 75 matters.

Mina Patel was present as substitute for Steve Taylor.

Margaret Parker was present as substitute for Kate Jones.

The following supporting officers submitted their apologies: Simon O’Hare, Sam Smith, Damian Mercer and Alison Kelly.

The Independent Chair shared with the Board some good news: Heywood, Middleton and Rochdale Local Care Organisation had won the prestigious Health Services Journal Awards in the category Integrated Care Service of the Year for putting communities at the heart of decision making.

The Independent Chair congratulated the Board for such an achievement and stated that this was a credit to entire team and a system’s effort.

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

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 Board discussed declarations of interest and agreed that all Board Members could stay in the meeting room during consideration of agenda items 13a, 14a and 14b. However, only Council’s Elected Members and NHS Greater Manchester Representatives could take part to the decision on these matters.

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 agenda items would be considered with the exclusion of press and public: Item 13a – Medicine Optimisation Finance Report, Item 14a – Public Health Commissioning Intentions 2024/25 and Item 14 b – NHS Contracts 2024/25

Members are requested to approve the minutes of the meeting held on 24^th October 2023

Resolved that the minutes of the meeting held on 24^th October 2023 be approved as a correct record.

To consider public questions received since last meeting of the Board

The Board noted that, in line with the Public Question Protocol for HMR Locality Board, the response to the public question on the “Health Equity North 2023 Report and locality response to recommendation 9” had been shared with the questioner and with Board Members.

To receive a verbal update from the NHS GM Integrated Care Representative and the Pace Based Lead - Item for information

In the absence of the NHS Greater Manchester Representative and of the Place Based Lead, no update was received.  

To receive an update on the progress against the development of HMR Locality Operating Model – Item for information and discussion

The Board considered a report jointly prepared by the Director of Health and Care Integration, the Local Care Organisation Chief Officer, the Director of Public Health and the Associate Director of Integrated Systems Development which sought to inform of the progress to date on the Locality Operating Model. This was the structure that enabled partner organisations to work with stakeholders across the Borough, Greater Manchester as well as with regional and national interested parties to achieve the best possible outcomes for the residents.

The Associate Director of Integrated Systems Development and the Head of Strategy Northern Care Alliance were in attendance to present the information and to respond to the questions and comments of the Board.

The Senior Officer delivered a presentation which summarised the work done so far to continue developing the Locality Operating Model and informed the Board of the three core enablers for the locality of Rochdale. Without these three elements, the rest of the model could not be developed; these were: 1) social operating model, 2) governance arrangements and 3) Connectivity with GM.

The Senior Officer continued informing that the social operating model was based on the principles of relationship, trust and culture, enabling leadership, innovation and learning, user voice, community assets and coproduction. In relation to these aspects, the Director of Public Health had led a workshop focusing on engagement from system partners and a report would be brought to this Board in January.

In reference to Governance arrangements and oversight of all population health and spend, gaps in governance arrangements had been identified as well as some duplications. The Senior Officer showed the Governance diagram with the yellow highlights representing new or newly established groups. These changes focused on enabling whole population health approach and strengthening management and oversight of performance, finance, quality, strategic planning and transformation.  

The Head of Strategy informed that also NHS GM had refreshed its operating model, focussing on where the population model was held and where responsibilities were, if at place level or at GM level. The Officer invited the Board to reflect on how the locality was connected to GM and how it could lead the way.

The Senior Officer asked the Board to support the direction of travel in developing the model so far. A final report would be presented to the Board in January 2024 for decision.

The Board asked to ensure that, in developing the locality operating model, the diverse communities and population of Rochdale remained central when producing new policies and strategies. The Board considered equally important that decision making stayed within the locality, with the ability to remain connected with GM and exercising the right level of influence.

Resolved:

1.    That the content of the report be noted;

2.    That the Board support the progress so far in developing the Social Operating Model, the refreshed governance structure and the direction of travel to further develop connectivity with NHS GM;

3.    That the Board note that the final Locality Operating Model would be presented  ...  view the full minutes text for item 91a

To consider a joint report of the Director of Human Resources, Rochdale Care Organisation and the Assistant Director, Workforce and Organisational Development, Rochdale Borough Council – Item for decision

The Board considered a joint report of the Director of Human Resources Rochdale Care Organisation and of the Assistant Director Workforce and Organisational Development Rochdale Borough Council which sought approval of a phased approach to the adoption of the Good Employment Charter across Heywood, Middleton and Rochdale health and care sector.

The Assistant Director Workforce and Organisational Development Rochdale Borough Council was in attendance to present the report and to answer the questions of the Board.

The Senior Officer informed the Board that, since the submission of this report for today’s agenda, Rochdale Borough Council had become a member of the Greater Manchester Good Employer Charter.

The Senior Officer continued outlining the advantages of embedding the good employment ambition within Rochdale locality’s delivery plans as this would support positive recruitment and retention.

Board Members asked clarification on how all employers within Rochdale locality and GM would be able to gain the Good Employer status, considering current challenges with paying the Real Living Wage. The Senior Officer informed that this was the reason why a phased approach was recommended. Paying the Real Living Wage was one of the seven pathways to gain the status of good employer: emphasis on employees’ health and wellbeing or offering flexible working, were additional ways to make employment more accessible and to gain the benefit associated with promoting the charter.

The Independent Chair and all Board Members acknowledged the importance of this piece of work and its contribution towards improving the quality of life of residents through accessing good employment. 

Resolved:

1.    That the ambition for Heywood Middleton and Rochdale locality to become a health and care good employer borough and embed this as a key priority within local strategy be approved;

2.    That the inclusion of the membership of the Good Employment charter as a desirable criterion through the statement of intent in future commissioning intentions be approved;

3.    That a phased roll out of the good employment charter as described in the paper to align with the supportive resource be agreed.

Reason for decision:

To support improved employment standards across health and care providers within HMR to create health and care as a viable career of choice and to support recruitment.

Alternatives considered and rejected:

The alternative considered would be not to have this ambition and not to take a system wide approach to GM Good Employment Charter adoption. Individual organisation could adopt the charter (as some already have) but through taking a more strategic coordinated approach to this, organisations can learn from best practice and generate a culture of good employment in the locality across the sector.

To consider a report of the Interim Associate Director of Finance, HMR Integrated Care – Item for information  

The Board considered a report of the Interim Locality Finance Lead – Health which sought to update on the HMR Locality Health budgets for the period April – September (Q1 – Q2) 2023.

Resolved that it be noted that the year to date Q2 position of an underspend of £520k with a forecast outturn position of an overspend of £89k, with the expectation of achieving the required year end position of break even at 31^st March.

To consider a report of the Interim Associate Director of Finance, HMR Integrated Care – Item for information

The Board considered a report of the Interim Locality Finance Lead – Health which sought to inform of the financial position of the pooled budget for financial year 2023/24. The pooled budget excluded the Better Care Fund (BCF) which was being reported separately to the Locality Board in 2023/24.

It had been agreed that the risk share agreement for 2023/24 would remain in place so that both partners were responsible for their own pooled fund gap and in year underspend or overspend.

The opening position reported on the Health and Social Care Pool budget for 2023/24 was a break even position. The Local Authority (LA) had set a balanced position for the LA Pooled Budgets.

An overspend of £6.8m was being reported against LA pooled budgets (excluding Covid related pressures). This included pressures of £6.9m against Children’s budgets due to increased placements costs and Special Educational Needs and Disabilities (SEND) Transport pressures, £0.1m pressure against Adults due to placement demand and a £0.2m in year saving forecast against Public Health budgets due to in year savings on staffing costs caused by vacancies. It is anticipated that the overspend would be funded from increased LA contributions.

Health Locality budgets were forecasting a slight surplus of £0.1m.

The Director of Corporate Services / Chief Finance Officer informed the Board that the Council had started a recovery plan using reserves. The Children’s Services Q2, 2023/24 Revenue Monitoring report was being submitted to the meeting of Cabinet this evening and requested to share this report with the Locality Board at its meeting in December.

Resolved:

1.    That it be noted that the £6.7m overspend position being forecast in relation to pooled budgets and that this is to be funded from increased contributions from the Local Authority;

2.    That the Children’s Services Q2, 2023/24 Revenue Monitoring report be brought to the meeting of the Locality Board in December.

Reason for decision

As part of operating a pooled budget regular monitoring reports are required.

Alternatives considered and rejected

The operation of a formal pool in 2023/24 builds on the shadow pool that was operated by the NHS Greater Manchester predecessor organisation HMR CCG in 2017/18 and is in line with previous years reporting, there are no alternatives to consider.

To consider a report of the Interim Associate Director of Finance, HMR Integrated Care – Item for information

The Board considered a report of the Interim Locality Finance Lead – Health which sought to update on the Quarter 2 position for the Better Care Fund (BCF) for the financial year 2023/24.

The Board sought an received clarification with regards to the underspend for the Disabled Facilities Grant; officers informed that this year’s underspend figure was smaller than previous years; the demand for DFG spend in recent years had not been met due to Covid restrictions and difficulties in recruitment. The spend was now increasing again compared to 2022/23.

The Director of Corporate Services / Chief Finance Officer requested that the Council’s Revenue Budget Update 2024/25 to 2026/27 report, presented this evening to Cabinet, be brought to the next meeting of the Board for information.

Resolved:

1.    That Quarter 2 monitoring information at September 2023 period end be noted;

2.    That it be noted that there are contingencies being held for budgets not yet allocated in 2023/24 of £89k giving a total forecast revenue underspend of £89k.

3.    That the forecast underspend against capital budgets of £160k in relation to the Disabled Facilities Grant (DFG) and recommends under Council procedures the carry forward of any unspent capital budgets to 2024/25 be noted.

4.    That the increase in capital budget for DFG for the additional award of £206,680 in 2023/24 from the Department of Health and Social Care (DHSC).

5.    That the Council’s Revenue Budget Update 2024/25 to 2026/27 report be brought to the next meeting of the Board for information

Reason for recommendation

The Locality Board have responsibility for the BCF budget as mandated in the BCF Policy Framework and Planning Guidance. The NHS GM ICB and the Council have delegated responsibility for the BCF to the Locality Board. The revised 2023/24 budget for the BCF was agreed by the Locality Board in May 2023, this report provides an update on the forecast position against those budgets.

Alternatives considered a rejected

It is a requirement of the NHSE guidance to produce a budget for 2023/24 which the Locality Board approved at its May 2023 meeting. This report updates the monitoring against the 2023/24 budget, which is a requirement of the Section 75 agreement. Therefore there are no alternatives to consider.

To consider a report of the Director of Public Health, Rochdale Borough Council – Item for information

The Board considered a report of the Director of Public Health which sought to inform of the activities to date of the Engagement and Insight Sub-Group.

The Director of Public Health was in attendance to present the information and to answer the questions of the Board.

The Senior Officer informed of the cooperative engagement toolkit refresh that had taken place, with three training sessions being delivered with Senior Responsible Officers and Engagement and Insight Group Members. The tool would be utilised to share best practice and a more consistent approach to engagement.

The Board discussed risk associated with not having sufficient resources to fully engage stakeholders, including residents, to gather lived experience feedback and the implications of failing to be compliant with the requirements. 

Resolved that the report be noted.

To consider a report of the Associate Director of Integrated Systems Development, HMR Integrated Care – Item for information

The Board considered a progress report of the Associate Director of Integrated Systems Development which sought to inform of the Heywood, Middleton and Rochdale Locality Board Assurance Framework (BAF) Quarter 2 position, 2023/24.

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

The Senior Officer informed that, since the submission of this report for today’s agenda, Risk BAF 4 had reduced as some funding had been secured which would determine the ability to deliver the workforce strategy.

In reference to Risk BAF 5, the Senior Officer informed the Board that, over the last month, this risk had to be increased due to the ongoing recruitment freeze and impact on business intelligence, workforce capacity and lack of funding for new projects. However, NHS GM was aware of the risk as a report was being submitted on a quarterly basis. There were two operational risks, one concerning the voluntary sector and contracting requirements and another relating to Speech and Language Therapy waiting times.

The Assistant Director for Integration and Health Children’s Services informed that to tackle the issue of the long Speech and Language Therapy waiting times, the service had started some innovative practice in the form of community support to deter issues from escalating to specialist intervention.

With regards to Risk BAF 1 high quality safety and safeguarding standards, the Independent Chair requested to revisit Adult Safeguarding at the meeting of the Board in February 2024.

Resolved:

1.    That the progress made in Q2 in respect of meeting the agreed HMR BAF risks be noted;

2.    That it be noted that the Locality Board is require to escalate strategic risks scored 15 or above to NHS GM quarterly, with the next report due on 28^th November 2023, following today’s meeting.

3.    That it be noted that the strategic risk scoring 15 and above to be escalated to NHS GM are included in section 5.6 of the report.

4.    That the Board review Adult Safeguarding at its meeting in February 2024.

To consider a joint report of the Independent Chair and of the Chief Officer, Local Care Organisation – Item for Information

The Board gave consideration to a progress report jointly written by the Local Care Organisation (LCO) Chief Officer and by the Independent Chair which updated on the LCO Business Plan which set out the key priorities for Heywood, Middleton and Rochdale LCO from April 2023 to March 2024.

The Assistant Director Integrated Systems Development NHS GM HMR and the LCO Director of Finance attended the meeting to present the report and to answer the questions of the Board.

The Senior Responsible Officers for the programmes that had impacted residents in quarter 2 were also in attendance and provided an overview of the completion of the actions associated with their programmes. In particular, the Board received a presentation concerning Adult Social Care – Preparing for Adulthood Workshop, Planned Care – HMR Community Heart Failure Service Development, Cardiovascular Disease – Blood Pressure Events, Population Health – Diabetes Awareness Events, Public Health – Tobacco Awareness Events.

Resolved that the progress made in Q2 with delivery of the LCO Business Plan and key achievements to date as defined in the impact slides be noted.

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 Part 1 of Schedule 12A to the Local Government Act 1972 and public interest would not be served in publishing the information.

Resolved that  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 Assistant Director Medicines Optimisation – Item for information

The Board considered a report of the Assistant Director Medicine Optimisation NHS Greater Manchester, which sought to inform of the financial position for the primary care, including community services for the period up until the end of August 2023.

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

Resolved:

1.    That the contents of the report and actions being undertaken be noted;

2.    That a progress report be presented to this Board in April 2024.

To consider a report of the Director of Public Health  - Item for decision

The Board discussed declarations of interest and agreed that all Board Members could stay in the meeting room during consideration of this agenda item. However, only Council’s Elected Members and NHS Greater Manchester Representatives took part to the decision on this matter.

The Board considered a report of the Director of Public Health which sought approval of Public Health Commissioning Intentions 2024/25.

The Head of Commissioning attended the meeting to present the information and answered the questions of the Board.

The Chair sought and received assurance that all the appropriate procurement processes had been followed and all contracts represented good value for money.

Resolved that the recommendations outlined at point 2 of the report be approved.

Alternatives considered and rejected:

Alternatives had been considered when developing all of the recommendations in this report. The recommendation for each element ensured that high quality services were delivered in the borough, best value was achieved and, where possible, stability for staff and service users was prioritised.

Reason for decision:

To ensure that the Council remained contractually compliant in relation to the services in scope.

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

The Board discussed declarations of interest and agreed that all Board Members could stay in the meeting room during consideration of this agenda item. However, only Council’s Elected Members and NHS Greater Manchester Representatives took part to the decision on this matter.

The Board considered a report of the Associate Director of Transformation and Delivery, NHS Greater Manchester (GM) Heywood, Middleton and Rochdale (HMR) which sought approval in principle of the proposed intentions for the NHS contracts which were due to expire in 2024/25. The list of contracts was outlined at appendix 2 of the report.

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

Resolved:

1.    That the locality contract intentions, as outlined in appendix 2 of the report, be approved in principle;

2.    That it be noted that these contract intentions are subject to approval from NHS Greater Manchester;

3.    That it be noted that the financial (STAR) process and any procurement or waiver applications require approval from NHS Greater Manchester team.

Alternatives considered and rejected:

As per paragraph 4 of the report.

Reason for decision:

To enable the contract approval process to progress with NHS Greater Manchester for the Integrated Care Board’s approval.