The meeting scheduled discussions on a range of important local issues, including a strategic risk report, updates on performance, finance, and waiting times, and an update on the Children’s and Young People Delivery Plan. It also included a presentation on the proposed refresh of the Pennine Care Foundation Trust service strategy.

Finance

The scheduled discussion on the system finance update noted that:

The position of all partners continues to be very challenged in 2024/25 with NHS GM in undertakings with NHS England which brings additional scrutiny and rigour around finance, performance and quality.

The scheduled discussion on the locality healthcare budgets, noted that the locality was forecasting a deficit of £6.8m, which was less than the £7.1m deficit forecast the previous month. This was attributed to increases in the number and cost of complex case packages, prior year pressures, and changes to discharge pathways from acute hospitals, along with high performance in discharges of residents with learning disabilities or autism into the community.

The meeting also scheduled discussion of the operating cost budgets which noted that the locality had a budget of £3.4m and was forecasting to break even. The report pack notes that this is:

primarily due to £0.13m of non-recurrent funding and a significant number of vacancies that are not being recruited to.

This led to a scheduled discussion about the risk that:

there is a risk to delivering transformation projects and staff wellbeing.

Performance

The scheduled discussion of the integrated delivery collaborative (IDC) update noted progress on a number of fronts, including planning for 2025/26 and the development of a dementia hub. It also noted challenges, including:

severe pressure across Mental Health Services with the number mental health patients in ED, the number of patients who are clinically ready for discharge, and are managed under section 117 arrangements. All of these pressures are limiting required access for patients in community.

The report pack notes that there are local concerns with the prioritisation of out-of-area placements in the GM commissioning intentions and argues for a focus on community-based support for patients.

The scheduled discussion of the performance report noted continuing challenges in a number of areas, including A&E wait times, access to children's mental health services, length of stay for mental health patients, referrals for ADHD and Autism assessments, and primary care appointments. It also noted success in achieving zero out-of-area placements for mental health patients, good performance in dementia diagnosis rates and a high proportion of residents dying in their place of residence.

The scheduled discussion of the update on the Children’s and Young Peoples Delivery Plan included a presentation on progress against a range of targets, including:

• Embedding early years pathways through Family Hub infrastructure
• Full implementation of the Saving Babies’ Lives Care Bundle
• Reviewing and redesigning the GM neurodevelopmental pathway
• Rolling out the Balanced System® approach to Speech, Language & Communication
• Supporting children and young people to live healthier lives through the equitable, effective and efficient management of diagnosed health conditions, including Asthma, Epilepsy, Diabetes and Oral health
• Responding to the rise in the number of children & young people seeking support for mental ill health
• Understanding and responding to the specific health needs of children and young people who are vulnerable, at risk or have complex care needs, and those requiring palliative and end of life care, including Project Skyline.
• Working towards a shared vision of family help – supporting families to get help when they need it from the right places and people in their communities.

Waiting times

The scheduled discussion on elective waiting times noted that although the 4 hour A&E target was not currently being achieved, a range of actions was in place to improve performance. The scheduled discussion on the general practice services update considered the pressures and challenges faced by GPs, including difficulties with funding and contractual issues.

Strategic Risk

The scheduled discussion of the Bury ICP Strategic Risk Report covered a range of risks with a score of 15 or greater, including:

• A risk that the financial position of all partners challenges the model of partnership working in the Bury Integrated Care Partnership
• A risk that financial balance will not be achieved due to overspending in the locality healthcare budgets
• A risk that a recurrent financial balance will not be achieved due to overspending in the locality healthcare budgets
• A risk to delivering transformation projects and staff well-being due to understaffing
• A risk that data and insights are not adequately shared and used across partners due to the loss of locality analytics and data sharing solutions since the formation of the ICB
• A risk to the quality of care for patients due to limited flow out of the emergency department
• A risk that patients will have a poor experience of healthcare due to the condition of the Uplands practice estate
• A risk that children, young people, families, and carers do not get the right support due to the Bury system not delivering in-line with the SEND national framework expectations
• A risk that the local general practice strategy and GM PC Blueprint will not be delivered in full due to inequitable funding for primary care
• A risk that GP Collective action will negatively impact service delivery
• A risk of poor experience of care and financial pressure on the locality budget due to insufficient reduction in inappropriate out-of-area placements for mental health patients
• A risk of delayed discharge, inappropriate out-of-area placements, and 12-hour breaches in the emergency department due to lack of patient flow in mental health inpatient wards
• A risk of inequitable provision, cost pressures, and reputational damage due to inability to commission a provider of adult ASD and ADHD assessment and treatment
• A risk of inequitable provision and significant financial pressure due to continued increases in referrals for adult neurodevelopmental assessments via the “right to choose” pathways.
• A risk of continued delays in diagnosis and follow-up treatment and support, and of further poor Ofsted/CQC inspection outcomes, due to demand and waiting times for CYP neurodevelopmental assessments.

Other items

The meeting also scheduled discussion of updates on the Locality / Sustainability Plan, the Primary Care Commissioning Committee, and the Clinical and Professional Senate. Finally, it scheduled time for any other business.