Public BoD papers 26.5.22

Board of Directors meeting Thursday 26 th May 2022 at 12.45 pm Room 6, Trust Administration Agenda Clinical presentation: Professor Adrian Bloor, CAR-T therapy service developments

Public items


19/22 Standard business a Apologies

Chair Chair Chair

b Declarations of interest

* *

c Minutes of previous meeting – 28 th April 2022 d Action plan rolling programme, action log & matters arising



20/22 Key Reports

* * * * *

a Chief executive’s report

CEO 11 COO 24

b Integrated performance, quality & finance report c Medical directors report – Education update


59 65

d Annual sustainability report e EPPR annual report

COO 79

21/22 Approvals a Update on CQC and regulatory activities

* *

ECN 83 CEO 89

b NHS Provider License conditions: self-certification declarations

22/22 Board assurance

a Board assurance framework 2022/23


CEO 94

23/22 Any other business


Date and time of the next meeting Thursday 30 th June 2022 at 12:45pm


Chief Executive Officer Chief Operating Officer Director of Education Executive Director of Finance Executive Chief Nurse

* paper attached v verbal p presentation


Public meeting of the Board of Directors Thursday 28 th April at 12.45 pm By virtual means

Present: Chair: Chris Outram (CO), Chairman

Kathryn Riddle (KR), Non-executive director Dr Jane Maher (JM), Non-executive Director Robert Ainsworth (RA), Non-executive Director Prof Kieran Walshe (KW), Non-executive Director Grenville Page (GP), Non-executive Director Alveena Malik (AM), Non-executive Director Tarun Kapur (TK), Non-executive Director Prof Chris Harrison (CJH), Medical Director and Deputy CEO Bernie Delahoyde (BD), Chief Operating Officer Eve Lightfoot (EL), Director of Workforce Prof Janelle Yorke (JY), Executive Chief Nurse Dr Neil Bayman (NB), Executive Medical Director Sally Parkinson (SP), Interim Director of Finance Prof Richard Fuller (RF), Director of Education Prof Fiona Blackhall (FB), Director of Research Sue Mahjoob, Freedom to Speak Up Guardian Ed Smith - Clinical Director, Proton Beam Therapy Thomas Edwards - Interim Clinical Services Manager, PBT John Archer - Radiotherapy Services Manager David Lines - Principal clinical scientist, PBT treatment planning Sally Corbett - PBT MDT/Referral Coordinator Lara Hoing - PA & Admin Team Leader Matthew Redfern – Superintendent radiographer Danielle Delaney – Senior Radiographer Gillian Walsh – Paediatric Nurse, PBT Day Unit

Minutes: Louise Westcott (LW), Company Secretary In attendance: Jo D’Arcy, Assistant Company Secretary Mohammed Qureshi, Public Governor

Clinical presentation: Proton Beam Therapy Service - John Archer (JA), Tom Edwards (TE) and Dr Ed Smith (ES) JA introduced his team. TE is covering the role of clinical services manager. ES introduced the service and noted that we take patients from across the country and that patients are referred through a national portal. About 50% are paediatric. Planning takes place after an initial visit then 6 or 7 weeks of treatment. Patients stay in Central Manchester at a facility called Stay City. ES explained how the rooms work and where the beam flows into the rooms. The 4 th room is a research room. The sister centre has now opened in London. 50-60% of total patients will be randomised clinical trials at full ramp up. This is very high. There is an active outcomes programme, and we continue to collect data on these patients following treatment. Many of the patients we treat with PBT are rare tumours. A video tour was shown TE introduced the staff on the call and explained their roles. KR asked how the shuttle bus from the accommodation works and whether the patients have to wait for transport. TE noted that the bus is scheduled around the appointments and a shared resource with MFT. There’s a comfortable waiting area in the PBT building to take them home.


BD noted that the cyclotron can be temperamental and that there is time each month for servicing to the cyclotron. Patients are managed to ensure they are not impacted by any downtime. The gantries are staffed up until 9pm where needed. KW asked about the limited number of indications that were commissioned for PBT and if this has changed in the 3 years since opening. ES noted that it has not changed, and that we are limited to radical treatments for paediatrics or for dose escalation for adults where radical treatment couldn’t be done with x-ray radiotherapy. ES noted that referrers are more aware of who can be referred as well as unwell patients now being able to use a service on UK soil. Numbers have increased year on year. The evidence base is building all the time to look to increase the patients that can be treated. The focus on research is very important and these developments will provide much more evidence base for other types of cancer. CO noted the constraints from NHSEI. ES noted that there is a process for discussing difficult cases so there is some flexibility. JA noted that growing the indication list is in our interest and we are looking at evaluative commissioning and growing our research studies as a priority. CH noted the MDT working is the core element of cancer care and this service exemplifies this. Referral pathways must connect across the country. Sally Corbett explained that referrals are sent to the national portal, the imaging is then requested as well as upload of all other information. The referral is then sent to a specific panel and the decision is made to treat or not. Most referrals are accepted and allocated. This then comes to us and is listed for an MDT where the information is discussed, and the decisions are made. It’s a complex system that works well and the process is quicker and works much better after 3 years. Everyone knows what is needed and the turnaround is quick from referral to acceptance of the patient. NB noted the responsibility to educate and train our future workforce in PBT and there’s an ambitious programme to do this. ES noted that there is a proton school to train staff nationally and internationally. We learned from others and are now supporting others through our School of Oncology. Observations and Fellowships are also in place and the ongoing relationships are helpful through this. Diagnostic and therapeutic radiographer hybrid working has been taking place that we have won an award for. We’ve used radiographers from the other Christie centres and given them opportunities to work in PBT. RF noted that regarding the PBT education programme, some of the work for undergraduates around coached/mentored activity is highly original and draws on contemporary education theory. Alison and team have been hugely successful and are working through evaluation and dissemination. This has fostered stronger links with Liverpool based colleagues too. prestigious-healthcare-award

CO thanked the team for coming along and talking about their service. CO noted that we are hoping to move to face-to-face meetings soon. Item 15/22 Standard business a Apologies Apologies were received from Roger Spencer (RS), Chief Executive b Declarations of Interest No declarations of interest noted. c Minutes of the previous meeting – 31 st March 2022 The minutes were accepted as a correct record.



d Action plan rolling programme, action log & matters arising All items from the rolling programme are noted on the agenda. 16/22 Key Reports a Chief executive’s report

CH noted the decrease in the number of patients and staff with Covid. Covid is still having an impact; we are monitoring this and continue to look at national policy and biosecurity measures through Clinical Advisory Group advice. There are ongoing infection control issues and changing guidance aimed at continuing to provide cancer care. The planning activities for 2022/23 continue and we continue to be part of the discussions. The Ockenden Report is mentioned in the report, we are looking at the recommendations from this report to ensure that any general issues are picked up and addressed. This will come back to Board. The Modern Slavery Act declaration is in the report and needs approval by the Board. This will be published on the website. CH noted that a Clinical Nurse Specialist (CNS) Day took place in March, this shows the changing nature of the workforce. CO invited questions and noted the positive awards referenced in the report and extended congratulations. Board approved the Modern Slavery declaration. b Integrated performance, quality & finance report BD outlined the key points from the report for month 12. Safe: 0 SI incident, 0 Never Event, 1 Major. 3 Corporate risk 15+, 2 risks at 20, 1 risk at 15 Effective: 0 cases MRSA bacteraemia, 2 cases of C.diff with no lapses in care, no cases of E-Coli post 48 hours and 20 Covid nosocomial infections. Responsive: 14 new complaints received in month and 67 PALS contacts. 6 Inquest request and 8 moderate incidents. Average length of stay is 5.87 days and there were 2 cancelled operations in month. In terms of waiting time targets for 18 weeks was at 98.6%, 62 day performance is 80.6%, 24 day performance 81.9% and 31 day performance was at 96.6%. There are 23 ‘104 day’ waiters and our referrals are within the predicted range. HR metrics show higher sickness associated with Covid. Due to higher rates of absences, we have seen no improvement in PDR’s or essential training. The Divisional Service and Operational Reviews have been re established and will look at addressing this going forward. We continue to track our vacancies alongside the sickness rates. Lots of work is ongoing to understand our workforce plans and how that aligns to our predicted activity. Workforce turnover is at around 16%. Finance: Surplus £87K (£989K deficit in month) against an agreed control total, EBITDA surplus £43.252m, I&E surplus £30.984m and cash balance £152,205k. Debtor days of 12, Capital expenditure at 107.7% against the NHSI plan and at

110.6% against the reduced £2.5m NHSI plan. The key escalations going into 2022/23 are;


• Cancer Waiting Time performance – reports through QAC, key to strive to achieve these post Covid. • Capacity and Demand / efficient use of resources • Workforce and recruitment plans • Patient flow – playing our part on the GM system, maintaining shortened LOS and running the ambulatory service so we don’t send patients elsewhere. • PDR’s/Essential training • 5% efficiency programme BD invited questions. RA asked about the yearend financial result. Were there any surprises in the final month. SP noted that there were no surprises. RA asked about making recurrent CIP’s. SP responded that we did this through vacancies last year, we are working differently post covid and this will support CIP’s. BD noted that divisions are finalising plans for CIP now and this will be transacted from month 2. We will be sharing these plans with Board going forward. GP asked about the essential training targets. BD noted that there are plans to address training across the Trust and to tackle harder to reach departments with face to face as well as online options. KR asked about diagnostics and any impact on delays with covid. BD noted that PET-CT has been impacted and scans were cancelled but replanned within a day. This is managed daily and there’s been nothing significant. EL noted that reporting and compliance with essential training is managed through the Workforce Team and any risks are escalated through the risk management system. JY noted that nurse training is closely managed, and actions are being taken to manage this with each area. Report noted. c Medical directors report - Research update FB noted the report. The last 6 months have been challenging, staff have been working from home and trial activity is recovering. Grants were noted that are positive and support research teams in the delivery of trails. FB noted that the observational study numbers were significantly higher during covid. Set up times look slow as we decided to continue to set up slowly during the pandemic so that as soon as we got going again, we were ready to recruit and start. FB noted that work is ongoing to address the recommendations following the NHSEI review, conversations are continuing and there is a continuing focus on staff engagement. CO noted the importance of feeding back to staff and FB noted that we are doing this in a continuous way to ensure staff are kept informed. FB noted that fixed term contracts for staff who have been on fixed term funding are being made permanent where possible. After 4 years staff are entitled to all the benefits of NHS employment and we then take these staff on as permanent staff. FB noted that very few staff are funded through one funding stream, most are funded through many funding streams. Staff work across several trials usually in one cancer type or are in a more generic role.


FB noted the terms of contracts need to be made clear when staff are recruited. KW congratulated the Trust on the use of permanent contracts and noted they are setting the example to the University on this. CH echoed this. CO thanked FB and noted that it is very good to know about the feedback to staff and ongoing conversations. FB noted that there is a strong steer to highbred working and staff working from home hasn’t shown any reduction in productivity. It’s a very positive way forward for our staff. GP asked about the assurance process around grants. FB noted that it’s working well and a step forward. Report noted. d Freedom to Speak Up 6 monthly report SM was welcomed to the meeting. SM noted her role as FTSUG. She shared details of the contacts by quarter that are at an expected level. Of the contacts received, 50% were about attitudes and behaviours, 21% about policies, procedures and processes. In the staff survey, 9.5% reported bullying and harassment from managers, 16.2% from colleagues. The specialist trust average was 10.5% and 18.1%. One staff member reported detriment and we are deciding how to proceed following the outcome of a HR process and other review. Key objectives going forward; • Use of recorded stories • Guidance – sources of support • Listen to Learn events – staff networks • Supporting Respect campaign and positive behaviours • Training – launch of “Follow Up” • I would feel secure raising concerns about unsafe clinical practice • I am confident that my organisation would address my concern • I feel safe to speak up about anything that concerns me in this organisation • If I spoke up about something that concerned me, I am confident my organisation would address my concern We are above the average for all acute specialist trusts on these aspects of the survey. An additional question was asked; Reasons why staff would not speak up • Don’t want to upset colleagues (40%) • Worry about being treated badly by colleagues or managers as a result (39%) • No point as nothing will be done about it (36%) • Belief that they would not be able to raise their concern in confidence scored high at 25%. For all the Speak up questions, staff with protected characteristics report they feel less secure to raise concerns; and were less confident that their concerns would be addressed. These results are being shared with the staff network • FTSU champions National staff survey;


groups to see what we can do to address this. AM thanked SM for the presentation. She asked about the issue of confidentially and the understanding of the parameters around this. SM noted that there is guidance but it needs to be supported to get individuals to understand what they can do. KW asked about the breakdown of the data. SM noted this will be broken down by staff group and division to find areas with problems. We will break down the data based on the fields we have. GP thanked SM for the report and her work and observed that the reasons for not speaking up were worrying. SM responded that there’s plenty of work to do even though we compare well. CO noted that KR is the Board FTSU Champion. KR noted the clear report and the difficulties around confidentiality. RF noted the FTSU work that drives into our future workforce and behaviours and commented that it is excellent and unusual to see this so overtly linked into undergraduate student placements in the Christie. Report noted. 17/22 Board Assurance a Board assurance framework 2021/22 CH noted the closing position of the BAF 2021/22 to note. This has been reviewed by the patient safety team as part of a full review following the Ockenden report. b Board effectiveness review A questionnaire will be circulated for completion and return to JD. c Register of matters approved by the board CH noted the annual summary of the matters approved by Board. d Audit Committee report GP noted the items discussed at the last meeting, the focus on the final reports of the year 2021/22 and the forward look to the work in 2022/23. The committee agreed for an extension to the internal audit contract for a further year but will then go through a procurement process to test the market. 18/22 Any other business No items raised.

Date and time of the next meeting Thursday 26 th May 2022 at 12:45pm


Meeting of the Board of Directors - May 2022 Action plan rolling programme after April 2022 meeting

Agenda item 19/22d


From Agenda No


Responsible Director


To Agenda no

Annual reporting cycle Integrated performance & quality report and finance report


Monthly report

20/22b 21/22b 21/22a 20/22c 20/22d 20/22e

Provider licence

Self certification declarations


To approve the declarations Declaration / approval


Annual reporting cycle Annual compliance with the CQC requirements Annual reporting cycle Medical directors report - Education update

Review Update

May 2022

Annual sustainability report

Emergency Preparedness, Resilience and Response (EPRR) annual report 2021-22

For approval

Annual reporting cycle Annual reports from audit & quality assurance committees

Committee chairs


June (joint Audit & QA Committee 8.6.22)

Annual reporting cycle Integrated performance & quality report and finance report


Monthly report

Workforce update incl FTSU development session

Quarterly review / training

Digital update

Progress report

June 2022

Annual reporting cycle Annual report, financial statements and quality accounts (incl Annual governance statement / Statement on code of governance)



Integrated performance & quality report and finance report


Monthly report

By email

July 2022 - no meeting

Integrated performance & quality report and finance report


Monthly report

By email

August 2022 - no meeting


Monthly report

Annual reporting cycle Integrated performance & quality report and finance report


Trust Draft Sustainable Development Management Plan 2021 - 2024 Compliance with NICE Safe Staffing Guidelines Emergency Preparedness, Resilience and Response assurance process


Six month review



Annual reporting cycle


Approval of compliance status Provide update to Board

MIAA audit recommendation Anti-bribery briefing

Annual reporting cycle Corporate objectives & board assurance framework

Interim review Monthly report Six month review Progress report Quarterly review Annual report Monthly report Six month review

Integrated performance & quality report and finance report

Annual reporting cycle Executive medical directors report - Research review (key issues, progress against objectives and future plans)

October 2022

Digital update Workforce update

Freedom to speak up guardian


Annual reporting cycle Integrated performance & quality report and finance report Annual reporting cycle Executive medical directors report - Education review (key issues, progress against objectives and future plans)


November 2022


December 2022 - no meeting

Integrated performance & quality report and finance report


Monthly report

By email



From Agenda No


Responsible Director


To Agenda no

Annual reporting cycle Integrated performance report Annual reporting cycle Risk Management strategy 2021-24


Monthly report Annual Review

January 2023


Integrated performance & quality report and finance report


Monthly report

By email

February 2023 - no meeting

Annual reporting cycle Corporate planning (corporate objectives / BAF 2022/23) Annual reporting cycle Letter of representation & independence Annual reporting cycle Integrated performance & quality report and finance report Annual reporting cycle Declaration of independence (non-executive directors only) Annual reporting cycle Register of directors interests

Executive directors

Approve next year's BAF

Chair Chair COO Chair DoW IEMD

Directors to sign Report for approval

Monthly report

For completion by NEDs

March 2023

Digital Update Workforce update

EMD/Dep CEO Update

Quarterly review

Responsible Officer report

Medical Appraisal & Revalidation Annual report

Annual reporting cycle


Approve Review

Six monthly compliance with NICE safe staffing guidelines


Annual reporting cycle Integrated performance & quality report and finance report


Monthly report

Register of matters approved by the board

April 2022 to March 2023

Annual reporting cycle Medical directors report - Research update (key issues, progress against objectives and future plans)


April 2023

Annual reporting cycle Annual Corporate Objectives

Review 2022/23 progress

Modern Slavery Act update Board effectiveness review


Chairman FTSUG

Undertake survey Quarterly update

Freedom to speak up Guardian report


Agenda item: 19/22d

Action log following the Board of Directors meetings held on Thursday 28 th April 2022

No. Agenda


By who


Board review

No actions arising from the meeting


Agenda item 20/22a

Meeting of the Board of Directors Thursday 26 th May 2022

Subject / Title

Chief executives report


Chief executive

Presented by

Roger Spencer, CEO

Summary / purpose of paper

To keep the board of directors updated on key external developments & relationships The board is asked to note the contents of the paper


Background Papers


Risk Score


Link to: 

Achievement of corporate plan and objectives

Trust’s Strategic Direction

Corporate Objectives


NHS England / Improvement

You are reminded not to use acronyms or abbreviations wherever possible. However, if they appear in the attached paper, please list them in the adjacent box.


National Institute for Health & Care Research


Clinical Research Network Allied Health Professional Integrated care system


Integrated care board Cancer Research UK


Department for Health & Social Care


Agenda item 20/22a

Meeting of the Board of Directors Thursday 26 th May 2022 Chief executive’s report

1. Situation Report Our Trust escalation remains at level 2. As the incidence of Covid within the general population declines the impact on our staff and patients has also decreased over the past month. In line with the national guidance we have reviewed our biosecurity measures via the clinical advisory group and have further deescalated our biosecurity measures. Our focus continues to be to provide all cancer care and treatment for our patients, including those who have been affected by Covid. We continue to monitor plans including revised infection and prevention control measures to ensure sustained delivery of our services going forward as well as supporting the full recovery of cancer services together with other care providers. The national level 4 incident response from NHSE/I has been de-escalated to a level 3 regional incident response on 19 th May. Details are set out in appendix 1. 2. International Nurses Day 2022 – 12 th May 2022 International Nurses Day is an opportunity to showcase the incredible work that Nurses and their colleagues do, and the difference this makes to patients’ lives at The Christie. This year for International Nurses Day at The Christie we held our first ‘hybrid’ Chief Nurse Forum. Nurses have achieved a lot over the last year, so this event celebrated a range of achievements from across the Trust, including: • Susy Pramod – Tissue Viability developments • Rachel Rathbone – the development of ‘Bloods closer to home’ • Jude McLellan – Critical Care Outreach, winner of the QICA award • Nicola Myers – the launch of a new service on Withington Ward • Stephanie Meachin – the SAFER project • Eleanor Jones – the development of the Infection Prevention and Sepsis team There was also the opportunity for our patients and colleagues to leave a message about what Christie Nurses mean to them. They said:


3. Greater Manchester Research Celebration Week Greater Manchester Research Celebration Week 2022 took place week commencing 6 th May 2022. Research achievements made across Greater Manchester, East Cheshire and East Lancashire in 2021/22 were recognised during a weeklong celebration. Highlights from The Christie included: The past year has been accelerated recovery with 166 new studies set up – a 46% increase in activity from the previous year and a 19% increase from 2018/19 which was of course the last full Covid free year. Our current portfolio spans 913 phase I, II, III and IV studies in various stages of set up, open, closed to recruitment, follow up and analysis of clinical outcomes, with 35% of our currently open studies being early phase The Christie recently positioned 9 th out of the 189 trusts nationally for performance in terms of studies initiated in clinical research. Recruiting to time and target has been maintained at around 50% of studies, a rate higher than other cancer centres and in line with the mixed portfolio of clinical research and challenges of Covid-19


The aim of research and innovation at The Christie is to enable every patient the opportunity to take part in research, to learn from every patient and to apply this knowledge to improve the lives of people with cancer now and in the future. We currently have 178 studies with Christie chief investigators and are lucky to have the NIHR Manchester Clinical Research Facility here at The Christie. In total over 4,000 patients were consented to trials leading to approximately 1,800 being recruited onto CRN portfolio studies, which is consistent with our pre Covid activity and is a real success for The Christie. Link to film can be found at 4. Fellow of The Academy of Medical Sciences Professor Timothy Illidge, Professor of Targeted Therapy and Oncology has been elected as a Fellow of The Academy of Medical Sciences. The Academy of Medical Sciences is the independent body in the UK representing the diversity of medical science. Their elected Fellows are the UK’s leading medical scientists from hospitals, academia, industry and the public service, all with a mission to advance biomedical and health research and its translation into benefits for society. Tim Illidge, Professor of Targeted Therapy and Oncology and Senior NIHR Investigator, works as a clinician scientist and his laboratory programme has been supported by CRUK for over 20 years. His laboratory has made discoveries in mechanisms of action of anti-CD20 antibodies, adaptive resistance to radiotherapy and overcoming this resistance with immunotherapy. In the clinic his research has changed clinical practice in Hodgkin and improved outcomes in Non-Hodgkin lymphoma. Further information can be found at the-academy-of-medical-sciences/ 5. Senior Adult Oncology Unit As part of the Trust strategy, we committed to developing a dedicated ‘oncology of later life’ service to ensure our Trust meets the needs of an ageing population. We are delighted to announce that this goal will be achieved this summer, through the launch of our new multidisciplinary Senior Adult Oncology Unit led by Dr Fabio Gomes and supported during its implementation phase by the strategy department. This is a significant step forward, as despite being internationally recognised, only a small number of cancer centres around the world have a dedicated service to support this group of patients. The recruitment for this team (comprised of medics, nurses and AHPs) has been very successful so far and is due to be completed soon. This new outpatient-based service will support and benefit our growing population of older patients with frailty during anti-cancer treatments, promoting improvement in the care provided, as well as new opportunities for research and education. 6. Ramadan Celebrations Staff and patients at the Christie came together in April to celebrate the month of Ramadan. The Ethnic Diversity Group developed a number of initiatives aimed at providing staff and patients with support and to develop their understanding and awareness about the month of Ramadan. Many staff took part in a Nil by Mouth – Fasting Challenge, taking no food or water for over 16 hours. The fasting challenge invited staff from all faiths to experience fasting, spirituality and reflection for a day to show support for Muslim colleagues. Participants


recorded their experiences on the Ramadan Reflections pad. Feedback has been overwhelmingly positive from staff and patients. We are proud of our colleagues that took part and would like to thank everyone for their participation. A great deal of understanding has been built through this initiative and it has also helped to facilitate more conversation about Ramadan and the Muslim faith. We look forward to running the challenge again next year and exploring how we can promote all faiths to continue to promote Equality, Diversity and Inclusion at the Christie. 7. Policy Exchange report We have participated in a consultation with Policy Exchange to inform a recently published report on specialised commissioning. The report highlights several issues including those surrounding the restrictions on capital expenditure at an ICS level. Two helpful recommendations have been included in the report: • ICBs must include a specific impact assessment on specialised services as part of their capital and estates plans. There should be sufficient flexibility in capital programmes to approve projects where the benefits will be derived beyond the given geographical footprint. • NHSE/I and DHSC should introduce a ringfenced capital spending pot for nationally significant specialised projects Both recommendations address the specific issues the Christie have been experiencing during the 2022/23 planning round of having sufficient cash balances to discharge the ambitious capital plans required to deliver the Trust strategy, but not being able to access sufficient approval to spend (‘capital envelope’) from the ICS. It also gives a helpful overview of the evolution of specialised commissioning and an analysis of the challenges and opportunities of the proposals for the future. 8. Greater Manchester Plans continue to be made for the transition in Greater Manchester to an integrated care system. The latest briefing on progress is at appendix ii. 9. Estate Developments The Paterson project continues with works remaining on budget and timescale. The team from CRUK met with members of The Christie and University of Manchester teams in Manchester on 18 th May and undertook a site visit to understand the progress of this significant programme. Work is underway on other major projects including the energy centre, installation of the MR scanner, pharmacy outpatient’s facility and replacement of the linear accelerators at the Oldham site.

More information about our new developments can be found at:


Classification: Official Publication approval reference: C1647 Appendix 1

To: • ICB chief executives (designate) • NHS trust and NHS foundation trust chief executives • CCG accountable officers cc. • NHS England and NHS Improvement regional directors

NHS England and NHS Improvement Skipton House 80 London Road London SE1 6LH 19 May 2022

Dear Colleagues, Next steps on transitioning from COVID-19 response to recovery Thank you to you and your teams for your continued hard work responding to the COVID-19 pandemic. We are writing to set out the next steps for the NHS over the coming months. On 13 December 2021, we declared a Level 4 (National) Incident to help prepare the NHS for the predicted surge in Omicron cases and to deliver the COVID-19 vaccine booster national mission. Since that point, the NHS has surpassed 730,000 patients with COVID-19 treated in hospitals and 123 million vaccine doses delivered, as well as delivering over 140,000 treatments through our new COVID medicine delivery units. With community cases and hospital inpatient numbers now seeing a sustained decline – thanks in part to the success of winter and now spring booster vaccines – and following advice from the National Incident Director, today I will report to the NHS England and NHS Improvement Board my decision to reclassify the incident from a Level 4 (National) to a Level 3 (Regional) Incident. The NHS needs to remain vigilant, and local systems need to ensure their resilience and capability to re-establish full incident responses in the event this is warranted. There will clearly also be a need to continue offering COVID-19 vaccines to those eligible, including running any further booster campaigns indicated by the JCVI and Government. However, the current trajectory with regards to COVID-positive inpatients affords us the opportunity to now ‘step across’ our resources from COVID-19 response to recovery of patient access, outcomes and experience, and to reform for the future, with integrated care systems (ICSs) taking a lead in building on the lessons of the pandemic to do things in a better way.


Recovery, and the quality of patient care As described above, the current level of direct impact from COVID-19 should allow much of the operational time and resource currently assigned to incident response to be refocused on recovering services further with a focus on those things which make the most significant difference for patient access, outcomes and experience. We are not setting any additional expectations or priorities on local systems beyond those already set out in the 2022/23 priorities and operational planning guidance, which sets out objectives across a range of services including primary care, community health, mental health, learning disabilities and autism, the Delivery plan for tackling the COVID- 19 backlog of elective care, and supporting guidance. We do, however, expect the immediate focus areas for ICSs, and their constituent organisations and partners, to be: • Delivering timely urgent and emergency care and discharge : Continuing to work as whole systems – including colleagues in local authorities, social care and the voluntary sector – to address the ongoing pressures across the urgent and emergency care (UEC) system and discharge pathways, with the aim of ensuring all patients receive timely and safe care in the right place for their needs. This includes improving discharge planning and processes for those patients who no longer require acute care, including ensuring that the levels of discharges on weekend days matches those on weekdays, while working with social care partners to identify and address wider system capacity challenges. Intensive work will continue nationally and regionally to support systems in this. We will also shortly be sharing operational best practice to support trusts in reviewing and improving the discharge related processes most within their control. • Providing more routine elective and cancer tests and treatments : Continuing the strong progress we have already seen towards ensuring those people who have been waiting the longest for elective care are offered treatment by July 2022, and people who are diagnosed with cancer are able to begin treatment within 62 days of first seeing their GP.

Again, intensive work will continue to support those systems with the greatest challenges to delivery.



• Improving patient experience: Providers should implement in full the recently updated UK Infection Prevention and Control (IPC) guidance given the significant benefits this can bring to increasing capacity and reducing waiting times. National principles on hospital visiting and maternity/neonatal services will remain in place for now as an absolute minimum standard. However, in practice, all healthcare settings should now begin transitioning back towards their own pre-pandemic (or better) policies on inpatient visiting and patients being accompanied in outpatient and UEC services, with the default position of no patient having to be alone unless through their choice. Where we are able to remove additional reporting, guidance and other burdens implemented as part of the pandemic response, without impacting on our ability to rapidly stand back up a national incident in the event of need, we will do so. Further detail on the exact changes to ways of working will be cascaded via the National Operations Centre shortly, and where guidance is withdrawn in the future this will be The NHS has faced incredible pressure over the 840 days since we first declared a national incident in response to COVID-19. In facing that pressure, thanks to the ingenuity, passion and commitment of our staff and local and national partners, and to the efforts of other key workers and the public, we have also achieved incredible feats. While our immediate task now is to improve patient access and experience, the coming months and years cannot see a blanket return to how things were done before the pandemic. Instead, we need to draw on the spirit of empowerment, partnership and innovation that have typified the pandemic response, and build on the improvements made and lessons learned, to reform our services so they are fit for the future. The legal creation of integrated care boards and partnerships on 1 July is the next step of our reform agenda; it is vital that every system partner has – and takes – the opportunity to contribute to making the strategic ambitions of ICSs a reality. In particular, this means maximising the gains from collaboration, including deployment of capital to increase capacity and improve key pathways such as diagnostics, and the notified through relevant bulletins where necessary. Learning lessons and building for the future



application of data and technology to support patient access and choice, as well as the planning of services which improve population health and reduce health inequalities. From our recent conversations with system and trust leaders we are aware that there is already a great deal of energy, thought and work going into both addressing the challenges and grasping the opportunities outlined above. We are immensely grateful to staff at all levels for their unwavering commitment to our patients, and to you for your continued leadership. As we embark on this next phase of NHS recovery and reform, these factors will remain as important as ever in galvanising our efforts to ensure the NHS evolves and continues to meet the changing needs of the communities we serve.

Yours sincerely,

Amanda Pritchard NHS Chief Executive

Sir David Sloman Chief Operating Officer NHS England and NHS Improvement



Appendix 2

Developments in forming a Greater Manchester statutory integrated care system Stakeholder briefing note 16th May 2022 Introduction Welcome to the latest update regarding Greater Manchester’s ongoing transition to a statutory integrated care system from 1 July 2022. We have made vital progress since the last briefing note in April; details of which are included in this update. There are also a few words from the newly appointed chief executive officer designate of NHS Greater Manchester Integrated Care, Mark Fisher.

Welcome from Mark Fisher – designate chief executive It’s now just a few weeks until our new organisation – NHS Greater Manchester Integrated Care – will formally come into being. There’s a great deal of work going on behind the scenes to make sure everything’s ready for the 1st of July and this is alongside everyone’s usual workloads. This is an exciting new era for Greater Manchester and I’m proud to be a part of it. I’m currently recruiting my executive team, some of whom have featured in these updates, and I also look forward to working with our locality place-based leads who will soon be in post.

NHS Greater Manchester Integrated Care builds on a strong history of partnership working, most notably after the devolution of health and social care in 2015. Our priorities – to tackle health inequalities and deliver high quality NHS and care services – may sound familiar to many. Our new statutory organisation will bring together colleagues working at neighbourhood, locality, and city region level into closer collaboration than ever before. This will allow us to step up our efforts to improve health and wellbeing for the benefit of the people of Greater Manchester and I look forward to working more closely with our stakeholders to achieve this as I take up my post on July 1. Best wishes, Mark Health and Care Act 2022 - Royal Assent Integrated care systems and partnerships are being set up across the country to help organisations work better with the public to keep everyone healthier; plan and deliver health services more effectively; make sure everyone is treated equally and fairly; help the NHS become as efficient as possible, and also help it contribute to the wider economy. The Health and Care Act 2022, which includes plans to establish Integrated Care Systems (ICS) on a statutory footing as of 1 July 2022, has completed the parliamentary process and is now law after it received Royal Assent on 28 April.


This is a welcome and important step in the journey towards establishing 42 ICSs across the whole of England. Nationally, it will enable the statutory merger of NHS England with Monitor and the NHS Trust Development Authority (the two organisations that make up NHS Improvement). From 1 July 2022, it is expected that NHS England will become the sole employer and will be named NHS England thereafter. Regionally, it means that plans to form a new statutory organisation, NHS Greater Manchester Integrated Care, can continue to progress as expected with a launch date of 1 July 2022. All staff currently employed by the 10 Clinical Commissioning Groups (CCGs), Greater Manchester Health and Social Care Partnership (GMHSCP) and Greater Manchester Shared Services (GMSS) are in a TUPE consultation period that will end on 31 May 2022, with a view to transferring to NHS Greater Manchester Integrated Care on 1 July.

How we will work at neighbourhood, locality and Greater Manchester levels

Naming conventions With any change to an existing way of working, system structure or introduction of a new organisation it can take time to understand the emerging naming conventions. Acronyms and abbreviations can be confusing to people working directly within the organisation, not least to wider partners and interested parties. As a result, we have agreed to use full names for the different elements of the system and only use shortened versions where necessary. The following names have been agreed: NHS Greater Manchester Integrated Care - this is the employing NHS organisation for the 12 organisations that will transition on 1 July 2022. When abbreviated, this should be NHS Greater Manchester or NHS GM

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NHS Greater Manchester Integrated Care Board – this will lead the NHS Greater Manchester Integrated Care statutory organisation. Greater Manchester Integrated Care Partnership – this is the name of our integrated care system; it replaces Greater Manchester Health and Social Care Partnership (GMHSCP) as the arrangement between all the different organisations which support people’s health and care. Greater Manchester Integrated Care Partnership Board – this is the body which will oversee the Partnership and is responsible for developing and overseeing the implementation of the integrated care strategy to meet health, public health and social care needs. Recruitment to key leadership roles As mentioned in Mark Fisher’s welcome, recruitment to key leadership roles will continue with approximately half of the executive team already established. The following additional executive posts are proposed as part of the NHS Greater Manchester Integrated Care executive structure: • Chief Officer for Strategy and Innovation • Chief Officer for Population Health and Inequalities • Chief Delivery Officer • Director of Organisation Transformation (transition role - 12 month temporary) Place-based leads In addition to the arrangements at a Greater Manchester level, there will be integrated care partnerships in each of our 10 districts or localities. Our system partnership will operate at three levels: neighbourhood, locality and Greater Manchester and will have a single vision and strategy. Hospitals, GPs, community services and other providers will come together to form collaboratives at all three levels. Each of the 10 localities in Greater Manchester will appoint a lead person responsible for the integration of health and care, called a place-based lead. Place-based leads will receive devolved responsibility and resources from NHS Greater Manchester Integrated Care. Announcements on each locality’s place-based lead will take place shortly. Governance arrangements Governance arrangements for NHS Greater Manchester Integrated Care are in progress and include the constitution, a scheme of reservation and delegation, a functions and decisions map and a financial scheme of delegation. Further development is now to take place to develop an NHS Greater Manchester Integrated Care governance handbook and terms of reference for the Greater Manchester Integrated Care Partnership Board.

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Build back fairer The significant inequalities in health outcomes experienced across GM communities and geographies are unwanted and unwarranted. This is not a new story. These are issues that have blighted GM for decades and for which action to date has not had the scale of impact that is required. However, poor health and inequalities are not inevitable. They are the direct and indirect consequence of the actions we take and the decisions we make as policymakers, politicians, organisations, and individuals. As the UK emerges from the COVID-19 pandemic, it is recognised that we need to do things differently to Build Back Fairer, tackle prejudice, inequality and discrimination and respond to climate change. ‘Build Back Fairer’ is a strategic framework which aims to bring sustainability, equity and inclusion into the heart of all decision making. It aims to reduce inequalities in access, uptake, experience and outcomes of care, as well as creating conditions for a greener, fairer and more prosperous GM. The framework is underpinned by a set of principles by which GM Integrated Care Partnership must conduct all of its business. These principles are being designed with people from health and councils, as well as voluntary, community, faith and social enterprises to ensure we work together to create places for our people to work and play which promote good health and are tailored to the needs and assets of our people and communities. This will be key to deliver against national guidance on health inequalities (for example CORE20PLUS5 ) A series of task and finish groups, with representation from across sectors, will draft the ICS Build Back Fairer Framework and an action plan by the end of the summer. Read our recent executive summary report on building back fairer in Greater Manchester and Independent Inequalities Commission report which includes recommendations for tackling inequalities across the city region.

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Integrated Performance Quality & Finance Report






Well Led



Safe •Incident Reporting •Serious Incidents & Never Events •Moderate Incidents •Learning from Incidents •Radiation Incidents

Caring •Patient Experience •Friends & Family

Responsive •Cancer Standards •Referral Analysis •Length of Stay •Activity •Complaints/PALS •Inquests •Claims

Effective •Healthcare Associated Infections •Covid Testing •Mortality Indicators & Survival Rates •Quality Improvement & Clinical Audit •NICE Guidance •HR Metrics – Sickness •HR Metrics – PDRs & Essential Training

Well-Led •Finance – Executive Summary •Finance – Income •Finance – Expenditure •Finance – Capital •Finance – COVID Revenue & Capital

•Harm Free Care •Pressure Ulcers •Inpatient Falls •Corporate Risks •Safe Staffing

•Workforce Metrics •Research Metrics


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