summary annual report & business plan · population – 46,500 fewer than two years ago – and...

ANNUAL REPORT& BUSINESS PLAN

2018 - 2019

SUMMARY

2 | SUMMARY ANNUAL REPORT AND BUSINESS PLAN | 2018-2019

WHAT’S CHANGED IN 2018-19? 4

WHO’S BEHIND THE WORK? 6

CHANGE ON YOUR DOORSTEP 7

A BETTER START IN LIFE 8

HELPING EVERYONE LIVE WELL 8

AGE WELL 9

OUR HOSPITALS 10

MATERNITY 10

TACKLING CANCER 11

SOCIAL CARE 11

MENTAL HEALTH 12

TACKLING COMMON CONDITIONS 12

DEMENTIA 13

THE ROAD AHEAD 14

• Start well 15

• Live well 15

• Age well 15

• Social care 16

• Mental health 16

• Dementia 17

• Urgent care and hospital stays 17

• Our environment 18

• Our workforce and infrastructure 18

CONTENTS

SUMMARY ANNUAL REPORT AND BUSINESS PLAN | 2018-2019 | 3

A lot happened in our third year. After all the planning, preparation and testing we’ve done since devolution in 2016, things really began to change, both across Greater Manchester and in people’s own neighbourhoods.

Now we’ve got a strong base to build on, and are starting to see the true potential of what devolution is enabling us to do, we can think long-term. This summary looks at the broader ambitions of our business plan for 2019-20, including a fresh focus on sustainable development and reducing inequalities that affect both the people who live in Greater Manchester and those who work for public services.

But we can’t look back or forward without considering the financial implications. Overall, the good news is that last year we expected to end up with a £35m

deficit – but instead finished 2018-19 with a £92m surplus. Some of the money will help the NHS nationally, but the rest we can keep to invest in our own services and infrastructure.

This goes to show how when we all work together, the way devolution allows us to do, we can meet the financial challenges and pressures facing health and care in every part of the country. But we must keep trying to be as efficient and productive as possible.

In fact, so much work went on – especially locally – that we can only give a taste of it in this summary of our 2018-19 annual report.

Photo: Marketing Manchester


The biggest shift has been that our 10 local care organisations (LCOs) are up and running, with each taking shape in its own way in response to its residents’ needs. As well as developing services, the LCOs have created networks and systems that mean they’ll keep sharing learning, ideas and information – and acting together when that’s the best approach – to constantly improve. We ran masterclasses on some common areas of interest to LCO leaders, like how best to involve voluntary, community and social enterprise (VCSE) groups.

During the year we had to consider the impact on what we’re doing of some major national and regional strategies, including the NHS long-term plan and the Greater Manchester model of unified public services. These will affect our future

approach – set out in our new prospectus – but they also show we’re on the right track to put care at the heart of communities, connect everything that is linked to our population’s health, and enable hospitals to focus on what they do best.

WHAT’S CHANGED IN 2018-19?


In 2018-19 we hit some big milestones:

The Christie’s £120m proton beam therapy centre began treating cancer patients in December 2018 – the first time this technology has been used in the UK.

Everyone in Greater Manchester can now access primary care through their GP practice seven days a week.

The number of smokers in Greater Manchester dropped to 16% of the population – 46,500 fewer than two years ago – and more than the national average are trying to quit.

Our care homes and homecare agencies are getting better all the time, and more quickly than many other parts of the country and North West. Only five out of 558 homes and one out of 375 agencies were not given a ‘good’ or ‘outstanding’ rating by the Care Quality Commission.

Stroke care in our hospitals is still top-rated, and we now have evidence that improvements have saved 69 lives a year.

We’re diagnosing more cases of dementia and cutting prescriptions of antipsychotic medicine faster than the national average.

Nearly all Greater Manchester health and care organisations now use a single WiFi system (Govroam) so it’s easy for staff to connect with each other. And patients can access NHS Digital’s standard public WiFi in all primary and secondary care settings.


Our partnership includes all Greater Manchester’s NHS organisations and councils, plus voluntary and community groups, NHS England, Healthwatch, the police, fire service and GP practices.

They’ve all played a part, but we’re constantly developing new relationships and networks – locally, regionally, nationally and globally – that have contributed (or will do in future) to our population’s health. For instance, we joined the international HIV Fast-Track Cities network as part of our efforts to end all new cases of HIV within a generation.

Health Innovation Manchester now has a wide range of industry and academic partners that are doing research and development here, and we can support them to get new products available through the NHS as soon as possible. We’re already seeing results from the 50 projects that began in 2018-19. We received 174 enquiries from pharmaceutical companies keen to work in Greater Manchester, leading to 16 projects on important health topics like identifying women at greater risk of breast cancer, eliminating hepatitis C and managing lung problems better.

Our residents played an increasingly important part in the improvements we made in 2018-19. Volunteers from our 10 localities have joined the new Greater Manchester Citizen Network. The alliance responsible for our cancer plan includes patients as well as health professionals and voluntary groups. So does work to improve specialist hospital services. People with a learning disability and/or autism and their families co-produced our new strategies on these in 2018-19.

We hope to get real insight into what it’s like to live with dementia, or care for someone who does, through expert reference groups set up with Alzheimer’s Society and the Together in Dementia Everyday (TIDE) network. Women who’ve given birth in Greater Manchester are among those looking at how we can improve our maternity system.

WHO’S BEHIND THE WORK?

Obviously our workforce is vital to what we do, and during the year we’ve tried to attract more staff and develop and keep those we’ve got. We ran campaigns to recruit nurses and people from overseas, and events to encourage school pupils and students to begin careers in primary care. We showed our appreciation of existing staff through our first regional awards and changes to enable them to move easily between local health and care jobs.


Now LCOs and distinct neighbourhoods are a reality, we’re seeing more change at local level in primary care and other community services. And we’re perfectly placed to incorporate the primary care networks (PCNs) being introduced nationally into our neighbourhood teams.

Increasingly our LCOs have specialist technology to help them develop business intelligence to run their organisation and give every patient an integrated digital care record. An online platform is making it easier for LCOs to know what staff they need.

Funding through our GP Excellence programme saw 100 practice managers do primary care diploma courses and over 500 practice team staff get leadership and other training to improve services.

Practice teams now include 125 clinical pharmacists to support GPs across Greater Manchester. Meanwhile community pharmacies saw 10,000 local residents as part of national health promotion campaigns on topics like bowel cancer screening and dementia awareness.

We value all Greater Manchester’s unpaid carers, and have developed a resource to help LCOs design the best possible local carer support services.

A priority in every area has been programmes that focus on the individual and the community. We’ve created a digital template for holistic care and support plans based on conversations to draw out a person’s goals and motivations.

All but two localities now offer social prescribing, enabling 8,000 people to benefit from nearby non-clinical resources, like befriending, arts activities, healthy eating advice, volunteering and sports. The other two plan to introduce social prescribing in 2019-20.

CHANGE ON YOUR DOORSTEP


We’ve launched a health and wellbeing framework so local agencies work together to give all Greater Manchester children and young people the best chance to fulfil their potential, right from birth.

Our priorities are: better mental health; more support if children have conditions like asthma, epilepsy and diabetes, so they can avoid going to hospital; and getting them ready for school. In 2018-19 we saw an additional 200 under-fives leave early years ready to learn, but there are still too many who don’t.

Physical activity can help children concentrate in class, so we’ve encouraged 394 primary schools

to sign up to the ‘Daily Mile’ – it means 110,000 pupils will run or jog for 15 minutes each day.

We keep trying to improve their oral health. We ran supervised toothbrushing sessions for 31,400 children. Health visitors offered advice and free brushes and fluoride paste. Many local dental practices are part of programmes to target babies under the age of one with advice for parents on feeding, oral hygiene and visits to the dentist.

We were able to protect many local people from flu – especially those at risk like pregnant women, babies and over-65s – and piloted schemes to offer flu jabs to homeless people, users of drug and alcohol services, pupils at special schools and hospital patients. We also responded quickly to increased demand for the MMR vaccine after a major measles outbreak in Greater Manchester in spring 2019.

In its first six months since being launched as a pilot in October 2018, the CURE programme at Wythenshawe Hospital helped 589 smokers quit. It quickly identifies smokers admitted to hospital (for any reason) and offers advice, practical help like nicotine replacement therapy (NRT), and a specialist assessment.

We started testing our Working Well early help programme to support people who may lose their job – or already have – because of health issues. Local employers can use our toolkit to identify and support carers in their workforce, and we’re also helping older carers into jobs.

Twice the number of people – 2,200 – now use personal health budgets to design their own support for complex or round-the-clock needs.

A research project provided 237 patients with extra support to take prescribed medicines when their treatment or care changed, to reduce the risk of unexpected adverse effects.

We’re developing services to adapt and improve vulnerable people’s homes so they can stay independent. We’re working to ensure homeless people get the healthcare they need, including after a hospital stay.

A BETTER START IN LIFE

HELPING EVERYONE LIVE WELL


As our population ages a growing priority for us is how we support clinically frail people in an environment that’s right for them. Our new resilience and independent living framework is linked to other work that can help us address their psychological, social and physical needs, like GM Moving’s efforts to encourage everyone to stay active.

We’re tackling dehydration and poor nutrition in older people. In 2018-19, we assessed 3,800 over-65s, identified 300 at risk, and helped them improve their diet – 75% gained weight as a result.

Hydration and nutrition are also part of a new model we’re testing to check people can live well at home, which covers things like financial and technical support too.

We’ve made a firm commitment to the quality of sensitive, individual and skilful care anyone in Greater Manchester approaching, or in, their last year of life can expect. That includes considering all the needs of the people close to them.

AGE WELL


During 2018-19 we carried on our efforts to divert people from emergency care they don’t really need to more appropriate services closer to home. We’ve held workshops to encourage more GPs to ‘stream’ patients and offer primary care in A&E departments. We piloted a way to better manage 6,000 people who’d called 999 but didn’t require such intensive care.

A new mobile phone app for ambulance crews is helping them recognise stroke symptoms and take affected patients to the most suitable hospital straightaway. We’re now able to treat potential strokes through a surgical procedure to remove blood clots, making this as easily available across Greater Manchester as we can.

When people have to go into hospital, we try to get them home again as quickly as possible. A review by localities found that there’s been a 30%

drop in hospital stays of over 21 days, and a 15% reduction in stays of more than seven days.

We’ve particularly focused on identifying frail patients admitted for urgent and emergency care so not only do they get the most appropriate treatment, we can help them stay independent by returning them to their communities sooner.

We’ve started to introduce the national Better Births programme locally to offer women kinder, more personalised services, and genuine choice.

And we want to make childbirth safer for both mother and baby. Our hospitals have adopted the national Saving Babies’ Lives advice on actions to reduce the risk of death and brain injury, including monitoring a baby’s growth in the womb. Midwife ‘champions’ are leading these changes in their own maternity units.

The Rainbow Clinic at St Mary’s Hospital is a new antenatal service especially for those who’ve previously experienced a stillbirth. In its first year it cared for over 700 families, reducing the stillbirth rate by 34%.

Another new project encouraged pregnant women to take more magnesium sulphate to reduce the risk of their baby developing cerebral palsy by nearly a third.

We want to end cases of foetal alcohol spectrum disorder in Greater Manchester, so in 2018 began a programme to reduce women’s drinking during pregnancy.

OUR HOSPITALS

MATERNITY


Women in Greater Manchester can now get tested locally for HPV – a virus that can indicate a risk of cervical cancer.

A new community service run by voluntary groups draws on their local knowledge to encourage residents to be screened for cervical, bowel and breast cancers.

We’ve started targeted screening for women who’ve previously had radiotherapy in the chest area, as this raises the risk of them developing breast cancer.

As many as 1,000 cancer patients a year will benefit from a new package of physical activity, nutrition and wellbeing support to help them prepare for, and recover from, treatment.

We want to improve life for people in residential care, including by sharing expertise and good practice through our 17 ‘teaching care homes’ and leadership development programmes for registered managers of both care homes and homecare agencies.

All care homes are now aligned to local GP practices that can do weekly ‘home rounds’ to deal with any health problems at an early stage.

We’re rolling out initiatives like the ‘red bag transfer scheme’, so people receiving care have everything they need if they go into hospital, like paperwork, medicines, personal items and clothes for when they’re discharged.

TACKLING CANCER

SOCIAL CARE


We’ve launched a training academy to speed up improvements to mental health services for children and young people.

We successfully ran, then extended, a six-month pilot in which specialist voluntary organisations work with staff, children and young people to encourage mental and emotional wellbeing in 64 schools and colleges.

We’ve done the groundwork – including service standards and training – to better meet the mental health needs of parents during pregnancy and their child’s first two years.

We’ve set up a bereavement liaison service to support anyone affected by deaths from suicide or suspected suicide.

We’ve put £1m funding into a digital toolkit to help 150,000 people in Greater Manchester manage their type 2 diabetes. Our Diabetes My Way project gives them online resources and apps to upload glucose monitoring data and have virtual consultations. Meanwhile hundreds of people have already signed up to Healthier You, a programme to reduce the risk of developing diabetes.

Patients are part of a new network to tackle respiratory disease. A trial at North Manchester General Hospital offered flu jabs to people with asthma or occupational lung disease when they came for outpatient appointments – over eight out of 10 were vaccinated as a result.

We’re developing training and toolkits to reduce variations in cardiovascular disease care. As part of a new research project through Health Innovation Manchester, readings from 500 devices distributed across localities identified 153 previously undiagnosed patients with the heart problem atrial fibrillation.

TACKLING COMMON CONDITIONS

MENTAL HEALTH


We’re making sure everyone who’s diagnosed with dementia, and their families, gets the same level of support straightaway. We produced a leaflet to help people understand a diagnosis of mild cognitive impairment, which can indicate a risk of dementia.

We’re contributing to plans to make Greater Manchester transport not just age-friendly but dementia-friendly. We’re creating a tool to measure the everyday experiences of people with dementia and what can improve their lives.

More staff who work with people with dementia now get specialist training to help them receive the care they want and need at the end of their lives.

DEMENTIA


We want to be an ‘anchor institution’ – one that does not just fulfil its main function but plays a significant role by making a strategic contribution to the local economy and adds social and environmental value.

We want to meet and go beyond the ambitions of the national NHS long-term plan and to put health at the heart of every Greater Manchester policy, including education, housing and employment. We now have evidence this is the only way to unlock our city-region’s economic potential and get the biggest possible health benefit for residents. We have already seen the potential of integrated neighbourhoods to connect people to what matters to their health and wellbeing.

We’ll keep reviewing and updating our plans to make the most of every opportunity to improve health outcomes and reduce inequalities, monitoring and measuring the impact of what we do.

We have great plans to create a world-leading precision health campus here in Greater Manchester, in partnership with local academic and industry organisations and a global diagnostics firm. We hope this will create 1,500 jobs and add £150m to our regional economy over the next 10 years, as well as giving residents faster access to new clinical tests and treatments. Already we’re supporting 130+ industry innovators to get new products into NHS services.

Our LCOs and their neighbourhoods will keep developing and learning from each other through business intelligence data, partnerships and

networks. Greater leadership and governance will give them the flexibility and accountability to move away from the traditional public service model of crisis response to prevention and early intervention, and to adapt to shifts in demand in their own communities.

Overall we want to build a stronger safety culture, building on a systematic approach that can work in any health and care setting. It will involve looking carefully at what’s gone wrong before, including the physical and psychological harm done, and learning from it. We will assess the reliability of our systems and people’s behaviour at work. We aim to develop our capacity to monitor patient safety on an hourly or daily basis, and our ability to anticipate and prepare for problems. We especially want to focus on identifying patients who are deteriorating, reducing the risk of long-term conditions getting worse, and understanding how we can adopt and spread good practices.

THE ROAD AHEAD


START WELLWe plan to digitise assessments of children’s development under the age of five.

Parents will complete the tests online, the results will feed into the child’s health record, and we’ll identify any who need extra support. This will ease the burden on health visitors.

We’ll introduce a ‘preparation for parenthood’ scheme plus extra support for those who really need it because of complex needs or higher risks.

We want to give children with diabetes, epilepsy or asthma, and their families, more confidence to manage these. There’ll be community children’s hubs and other ways to support them piloted in Rochdale, Salford and Oldham.

We want to reduce the number of maternal deaths, stillbirths, neonatal deaths and brain injuries that occur during or soon after birth by 20% by 2020, and by half by 2030.

AGE WELLWe plan to develop and test new technologies to share critical information about frail patients and people with dementia between the individual, their carers and professionals.

This will help detect small changes in their condition, addressing them at home and avoiding hospital admissions.

LIVE WELL We’ll introduce more specialist alcohol care teams across Greater Manchester and extend the CURE programme to help smokers quit to another six sites.

We’ve got £10m Sport England funding to help us become a ‘walking city-region’ where adults do at least 30 minutes of moderate activity a week, and will start piloting ways to make this happen.

We’ll develop our public service workforce to spot and understand the effects of trauma, abuse and communication disorders in people they see.

A new website and apps will encourage residents to adopt healthy everyday habits and look after their own health better.

We want to create an integrated sexual and reproductive health system, using digital technology and providing both neighbourhood

support and consistent specialist services across localities.

We plan to set up at least one centre where people with serious but non-specific symptoms can get a cancer diagnosis quickly. We’ll roll out a programme to improve the quality of life of an initial 1,000 patients already living with or beyond cancer, and improve follow-up care (including self-management advice) for those who’ve finished breast, bowel and prostate cancer treatment.

We’ve got funding for an innovative project to digitally monitor 1,000 heart failure patients to ensure their care meets their needs.

A new medicines dashboard will monitor any variation in prescribing across the localities.


SOCIAL CAREDuring the coming year we’ll focus on removing barriers to the success of Living Well at Home – our programme to keep people well and independent in their own homes and communities.

We’ll need to work together (including independent care providers, and residents and their families), use what neighbourhoods have to offer, consider new approaches like wellbeing teams, and attract and develop the right workforce through apprenticeships, career progression, and education and training.

We will be testing initiatives to provide more personalised support, such as training for homecare providers, and to develop care staff to take on new neighbourhood-based ‘blended roles’ or become managers.

Payment reforms will further encourage people’s independence by offering more choice and flexibility in their care and support.

MENTAL HEALTHWe’re helping children and young people access mental health support, but could do better. Within the next year we aim to cut waiting times for psychological therapies in every locality and set up a crisis care assessment centre and four rapid response teams so A&E is not the first port of call for children and young people with mental health problems.

We’ll roll out our pilot scheme to at least 10% of Greater Manchester schools and colleges, and work with local universities to develop a mental health service specifically for higher education students.

We aim to treat a further 1,680 new mums with mental health problems every year. We plan to recruit more psychologists so we can offer support to 84,000 adults, including greater access to psychological therapies.

By 2020-21 every A&E department and hospital ward in Greater Manchester will have a mental health liaison service to support people of any age. We’ll keep reducing the number of people in out-of-area placements so every Greater Manchester resident can get all the mental health hospital care they need right here. We’ll make sure anybody facing a mental health crisis gets immediate support in the right place rather than ending up in a police cell.

We want to address the reduced life expectancy of people with serious mental illness by providing at least 15,000 of our residents with better access to physical health checks.

By 2020 we’ll ensure 95% of local people who need eating disorder services are treated within four weeks, or a week if it’s urgent.

More training for frontline staff will increase their confidence and skills to have effective conversations with residents about mental health and wellbeing.


URGENT CARE AND HOSPITAL STAYSA single clinical assessment service, working with community-based multi-disciplinary teams, will offer a co-ordinated response to any resident who needs urgent care.

We’re now at a stage when we can look at which hospital sites might be most suited to providing a single specialist service – paediatric surgery, for instance – for the whole of Greater Manchester. In 2019-20 we’ll work with staff, patients, carers and residents to consider the options and decide what services should still be available locally. We’ll draw on all sorts of data, such as a travel analysis to ensure chosen sites are easy to reach.

We’ll keep tackling overcrowding in A&E in various ways, like our same-day emergency care model. Localities will help reduce the time their residents stay in hospital by ensuring they can get the right support to recover at home. We want to make everyone – both patients and professionals – aware exactly what health, social care and related services are available.

Our operational hub is invaluable in managing our urgent and emergency care system, but last winter, in spite of much planning and preparation, we still struggled to cope with the extra demand and see everyone who came into A&E within four hours (the national target). We can learn from this, and review demand and capacity to get ready for next winter and make sure we have the right staff and community support in place.

Outpatients will start to get faster access to diagnostic services, digital assessments and follow-up help through telemedicine and virtual clinics. We plan to do an in-depth analysis of how we use imaging and endoscopy equipment, outpatient services and operating theatres across Greater Manchester, so we can make them as productive as possible.

A single pharmacy hub will provide medicines direct to hospital wards so things run more smoothly. A single laboratory information management system will increase pathology and radiology efficiency, enabling clinicians to get hold of records and images easily.

DEMENTIAA new project will focus on rare forms of dementia and early onset dementia (which affects younger people) so we can find the best way to support anyone with these conditions.


OUR WORKFORCE AND INFRASTRUCTURELike every part of the country, we don’t have enough nurses, clinicians and other health and care professionals. We will develop new roles (especially in primary and integrated care) and encourage upskilling to attract more staff and keep our existing workforce.

In 2019-20 we’ll have an extra £8m for digital technology, including better connections between organisations (and individuals) and online services, and improved coordination and integration of care plans and records. This will generate data that we’ll keep safe but use to work more efficiently, including identifying areas to focus on and measuring the impact of what we do, from strategic level to GPs.

We face a backlog in maintenance work on existing buildings and bids for capital funding to transform our estate were unsuccessful. This is holding up some of our plans to improve services. But we’re looking more closely at all the

public sector assets within each locality and finding alternative financing for mental health provision. We’ve started to explore commercial options and external investment opportunities.

OUR ENVIRONMENTWe made a number of pledges at the mayor’s March 2019 Green Summit and have a five-year plan to deliver on them. We’re particularly focused on identifying and reducing our carbon footprint – nationally the NHS is responsible for 5% of carbon emissions.

Our aim is to cut air pollution from business travel by 20% by 2023-24 and for 90% of our NHS vehicles to use low-emission engines by 2028.

We’ll let staff know what they can do, including car sharing to and from work, and offer facilities (like bike racks) to encourage ‘green’ travel. We’ll work with both staff and patients to reduce our use of finite resources, such as single-use plastic products. And we’ll make the most of our daily contact with thousands of people to encourage them to make environmentally friendly health and care choices.

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summary annual report & business plan · population – 46,500 fewer than two years ago – and...

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