Agenda and minutes

The Chair welcomed those present to the meeting and noted apologies.

The Chair advised that the quoracy had been satisfied.

The Strategic Commissioning Board: Noted the information.

The Deputy Chief Executive, Bury Council presented the report which detailed the initial progress against the implementation plan and key activity over the last quarter, including recruitment, a review of the Equality Analysis process, celebrating International Women’s Day and developing an Action Plan for Race alongside broader community engagement plans across all protected characteristics.

Progress had been very positive thanks to the work of the Inclusion Working Group. It was noted that a best practice guide to inclusion in digital working had been produced, and a detailed plan will be developed to tackle race inequality over the next 12 months.

The Strategic Commissioning Board:

·         Noted this update.

·         Endorsed the best practice guide for inclusion in digital working.

The Chair reported that the CCG and Council both have statutory responsibilities in relation to the declarations of interest as part of their respective governance arrangements.

It was reported that the CCG had a statutory requirement to keep, maintain and make publicly available a register of declarations of interest under Section 14O of the National Health Service Act 2006 (as inserted by Section 25 of the Health and Social Care Act 2012). The Local Authority has statutory responsibilities detailed as part of Sections 29 to 31 of the Localism Act 2011 and the Relevant Authorities (Disclosable Pecuniary Interests) Regulations 2012.

The Chair reminded the CCG and Council members of their obligation to declare any interest they may have on any issues arising from agenda items which might conflict with the business of the Strategic Commissioning Board. 

Declarations made by members of the Strategic Commissioning Board are listed in the CCG’s Register of Interests which is presented under this agenda and is also available from the CCG’s Corporate Office or via the CCG website.

•      Declarations of interest from today’s meeting

There were no declarations of interest raised.

•      Declarations of Interest from the previous meeting

There were no declarations of interest from the previous meeting raised.

The Strategic Commissioning Board: Noted the published register of interests.

•      Minutes

The minutes of the Strategic Commissioning Board meeting held on 1 March 2021 were agreed as an accurate record.

•      Action Log

The following updates were provided in respects of the Action Log:

•       A/11/02 – The mental health paper was on the agenda for this meeting.

•       A/02/03 – Geoff Little advised the affordability of a Learning Disability Lead was being looked at as part of wider partnership arrangements and an update would be given at the first meeting of the municipal year.

•       A/02/04 – The financial trajectory and outcomes were included on the agenda for this meeting.

The Strategic Commissioning Board: Approved the minutes of the meeting held on the 1 March 2021

There were no public questions raised.

The Strategic Commissioning Board: Noted the information.

b) Covid-19 emergency response

c) Hospital Discharge arrangements

The Chief Executive, Bury Council / Accountable Officer, NHS Bury CCG provided an update on the latest CCG and Council developments.  It was reported that: -

·         The rate of transmission per 100,000 had been decreasing over the past 10 days. It was still above national levels but was now below 50.

·         Successful vaccine rollout in the borough was ongoing, with all priority groups having received their first dose. The second dose was underway and advanced planning was in place for younger cohorts when the national supply was in place.

·         Bury was meeting the national target around hospital admissions, but capacity pressure remained from efforts to reduce waiting lists.

·         No variants had been observed in Bury so far, but this was being closely monitored.

·         Bury was focused on safely lifting restrictions, helping businesses to restart and residents cope with hardship. The community hubs were still operating but were now supporting those with financial hardship or those with positive test results, as the requirement for people to shield had ended.

The following comments / observations were made by Strategic Commissioning Board members: -

·         With regards to national fatality rates in the Jewish community it was noted that although data on religious groups wasn’t available, locality data was held and was informing work in those communities to address concerns.

·         It was noted that supply of the vaccine was sufficient to deliver second doses. There were occasions where this might be outside the 12 weeks between doses but this was rare. For residents unsure of their status and whether they should receive a vaccine, they were advised to speak to their GP.

With regards to Hospital Discharge arrangements, Geoff Little advised that funding for community discharges from hospitals was due to cease in February but, after feedback from Bury and other Greater Manchester authorities, operational guidance had been issued advising funding was being continued and could be tapered out in a controlled way.

The Strategic Commissioning Board: Noted the update.

a) The GM ICS discussion - Partnership Executive Board paper

b) Update on the developing arrangements.

c) An update on the work of Carnall Farrar on the North East Sector footprint.

The Chief Executive, Bury Council / Accountable Officer, NHS Bury CCG and the Chief Officer, Bury Local Care Organisation presented three joint reports on the developing arrangements for the Integrated Care System (ICS)

The Board received a report presented to the GM Health and Care Partnership Executive Board and the GM Health and Care Board which sought to reset a number of GM wider discussions on the future form and shape of the Greater Manchester Integrated Care System (GM ICS). Members discussed the report, making the following points:

·         Workshops would be held over the next month with two representatives for each Borough, including key providers, professionals and clinical leaders to represent a cross section of sectors, organisations and localities in GM.

·         It was noted that the task wasn’t necessarily how to comply with the requirements of white paper, but instead to work out what was best for Bury and ensure the legislation was permissive of that. Although the White paper proposed two boards, it was hoped Bury could continue with a single operating model.

·         The timetable for establishment was clear, with proposals being submitted in spring 2021, shadow arrangements in place for late summer/early autumn, and legislation in spring 2022.

·         With regards to how residents would be involved it was noted that Bury’s representatives at the workshops would bring their understanding based on local views, and that community and voluntary sector representatives were included in the workshops. Moving forwards, neighbourhood focus would be built into design with a grass roots system supported by the ICS.

·         Members discussed the bigger ask on communities and noted that more support and appropriate infrastructure was needed for volunteers to take on these responsibilities. Concerns were raised over the unknowns around governance and finance, and it was noted that key historical knowledge could be lost with staff changes.

The Board received a report which provided an update on progress establishing the previously agreed framework for the system, providing early consideration of the objectives and membership of the Bury Locality System Board and the Bury Integrated Delivery Collaborative Board, and describes the developing work of on building the capacity and capability of integrated neighbourhood teams in health and care. Members discussed the report, making the following points:

·         Innovation was needed to engage with residents in a different and meaningful way, making locality groups fit them and empowering them to tell us what they want. 

·         It was agreed that the aim was to improve health over the course of a generation, not just seeking to deliver services but to address health through a holistic approach.

·         Concerns were raised over the current scattered and hierarchical clinical voice. A representative senate and a ‘golden thread’ was needed throughout governance to facilitate the right conversations at System Board.

·         It was noted that intelligence was needed to enable decision making at neighbourhood level, devolving power and budgets to resource communities effectively.

·         The Board were advised that much of that detail was still to be worked through as well as the governance  ...  view the full minutes text for item 27.

The Chief Executive, Bury Council / Accountable Officer, NHS Bury CCG presented a report on the regeneration of Radcliffe coordinated through the Radcliffe Strategic Regeneration Framework and its ambition to improve population health and well-being and reduce inequalities.

The following comments / observations were made by Strategic Commissioning Board members:

·         It was agreed that this would be a challenging project but was about far more than buildings, taking a holistic view of peoples’ lives including housing, jobs, communities, and access to services. This view needed to suit not just those moving into Radcliffe, but to those already living there.

·         A need to do things differently was discussed, including the language used. The right infrastructure was needed to empower people to talk about aspirations for the area, through community champions with local understanding and existing contacts.

·         It was noted that the right metrics of success needed to be identified to enable meaningful monitoring and learning, which could inform future developments.

In terms of a model, it was noted that initial thoughts and proposals would be brought to the Board’s next meeting.

The Strategic Commissioning Board: Noted the report and agreed that a paper on initial thoughts and proposals for the Radcliffe model would be brought to the Board’s next meeting.

The Director of Community Commissioning, Bury Council presented the report which sought approval in principle for the Pennine Care Foundation Trust (PCFT) Urgent and Emergency Care by Appointment Mental Health pre-ED streaming service to continue at Fairfield General Hospital.

Members discussed the evaluation report which demonstrated the rate of deflection away from A&E and the positive impact of this for both patients and services. It was noted that despite the system-wide benefits, savings made in one area didn’t always feed back into the area responsible for that saving. The Board noted that this decision was in principle at this point, as it would be subject to the wider development of mental health 24/7 crisis offer in Bury and front-end Urgent Care redesign at Fairfield hospital.

The Strategic Commissioning Board:

·         Noted the content of the report and attached evaluation report.

·         Approved in principle the 12-month funding of £271,233 for the continuation of the UEC by Appointment service. This would be subject to the wider development of mental health 24/7 crisis offer in Bury and front end Urgent Care redesign at Fairfield hospital.

The Interim Chief Finance Officer, NHS Bury CCG presented the report which provided an update on the Integrated Commissioning Fund (ICF) budget for 2020/21, forecast outturn for 20/21 at quarter 4, and incorporated a review of ICF achievements.

The ICF is currently forecasting an underspend of £1.3m. it was noted that there was a £0.4m overspend on services held within the Section 75 Pooled Fund, £1.7m underspend on the Aligned Fund and breakeven position on in-view services. The key overspends are driven by COVID related expenditure, loss of income across Council services and delays in the achievement of savings. Underspends stemmed from unallocated COVID-19 grants.

The Board noted that a further report would be brought to the next meeting regarding discussions to find a longer-term solution for continuity of services. It was also noted that embedding the past year’s achievements in collaboration, new ways of working, and effective partnerships represented a major step forward to developing new care models and approaches and by enhancing effective neighbourhood and locality working.

The Strategic Commissioning Board:

·         Noted that all Quarter 4 figures are provisional as Month 12 has not yet closed.

·         Noted the increase in CCG allocations received since the Quarter 3 report to SCB and accept their allocation to the ICF.

·         Noted the ICF forecast underspend at Quarter 4 of £1.3m (provisional) and the assumptions on which it is based.

·         Noted the need for a longer-term solution to support the services funded from Transformation and other short term funding solutions and that a further report would be brought to the next SCB meeting.

·         Noted the financial risks to Bury.

The Interim Chief Finance Officer, NHS Bury CCG presented the report regarding the NHS 2021/22 Priorities and Operational Planning Guidance, which set out the priorities for the year ahead against the challenges of restoring services, meeting new care demands and reducing the back logs that are a direct consequence of the pandemic, whilst supporting staff recovery and taking further steps to address inequalities in access, experience and outcomes.

The Strategic Commissioning Board: Noted the NHS 2021/22 Priorities and Operational Planning Guidance.

The Interim Chief Finance Officer, NHS Bury CCG presented the report which provided an early working position for the ICF budget. Whilst Bury Council’s budget is approved, the CCG only recently received its notified allocation for the first half year to September 2021 (H1). This is based on the second half of 2020/21 and anticipates lower COVID reimbursements and some efficiency savings. Further guidance is expected later in the year regarding allocations for the CCG’s second half year to 31 March 2022 (H2).

It was noted that demand for mental health services and acute care exceeds the budget allocated to the CCG and discussions were underway to identify a system-based solution and manage the totality of resources to ensure the best value for Bury.

The Strategic Commissioning Board:

·         Approved the revisions to the proposed main purposes of the ICF.

·         Considered and approve the factors to consider and the key deliverables.

·         Noted the intended changes to the elements of the Pooled, Aligned and In-View Funds and agreed a 50/50 risk share, to be reviewed on a quarterly basis.

·         Noted the indicative opening ICF budgets that are based on Bury Council approved plans, the working position for CCG Mental Health and H1 allocations and H2 indicative plans.

·         Noted that a further update on CCG financial plans will be brought to the next Board meeting.

·         Noted that further updates will be brought to SCB once 12-month CCG allocations have been announced.

·         Noted the uncertain CCG financial regime beyond September 2021.

The Director of Community Commissioning, Bury Council presented the report which detailed the fee engagement process including timelines and proposed recommendations for the fee proposal to contracted providers of adult social care services for the period 2021/22. It was noted that the Council had undertaken a process of engagement and negotiation with contracted providers of adult social care services to define both the fee proposals for 2021/22 and determine the final fee recommendations.

The recommended Adult Social Care Provider Fee Uplifts were:

Care Homes

Care at Home

Supported Living

Direct Payments (Personal Assistants)

In response to Board member comments, assurance was given that officers are working with providers and supporting them, with discussions regarding not only fee proposals but also strategic direction, mutual support and innovative practices in order to not only support the sustainability of the provider market but support its growth. Members noted that further work was being carried out on the Real Living Wage, market management to ensure sufficiency of social care, and the impact of increased insurance costs for care homes.

The Strategic Commissioning Board: Approved the proposed Adult Social Care Provider Fee Uplifts.

The Chief Officer, Bury Local Care Organisation presented the report which updated on current discussions to address the financial risk of prioritising funding for the transformation fund. It was noted that discussions were ongoing, and no solution had been reached as yet.

The Strategic Commissioning Board: Noted the content of the report.

The Chief Officer, Bury Local Care Organisation presented the report which set out the current position against a number of the main CCG Performance Indicators along with an overview of the impact to these during the current response to the COVID-19 pandemic.

The Strategic Commissioning Board: Received the update and noted the areas of challenge and action being taken.

The Chair summarised the main discussion points from today’s meeting and thanked members for their contributions.

The Strategic Commissioning Board: Noted the information.