Public Board papers 31.03.22

Board of Directors meeting Thursday 31 st March 2022 at 12.45 pm By virtual means Agenda Clinical presentation: Critical Care and Outreach Service - Vidiya Kasapandian, Consultant in Acute & Critical Care & Kerry Millington, Ward Manager, Acute & Critical Care

Public items

Page

10/22 Standard business a Apologies

Chair Chair Chair CEO CEO COO ECN EMD DoW DoW COO

b Declarations of interest

* *

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

2 7

11/22 Reports

* * * * * * *

a Chief executive’s report

10 21 58 72 75 86

b Integrated performance, quality & finance report c Six monthly compliance with NICE safe staffing guidelines d Responsible Officer Report: Appraisal and Revalidation 2021-22

e Workforce update f Staff survey 2021 results

g Digital update

103

12/22 Approvals

*

a Board governance

Chair

109

i Directors letters of representation ii Register of directors’ interests iii Fit & proper persons declaration iv Declaration of independence v General data protection requirement (GDPR) b Annual reporting cycle 2022/23

* *

CEO CEO

117 121

c Corporate objectives and board assurance framework 2022/23

13/22 Board assurance

a Board assurance framework 2021/22

* *

CEO

132 137 142 144

b Engagement activities c Audit Committee report

* Committee Chair *

d Quality Assurance Committee report

14/22 Any other business

Date and time of the next meeting Thursday 28 th April 2022 at 12:45pm

CEO COO ECN EMD(S) DoW

Chief Executive Officer Chief Operating Officer Executive Chief Nurse Executive Medical Director (Strategy) Director of Workforce

*

paper attached

v verbal p presentation

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Public meeting of the Board of Directors Thursday 27 th January 2022 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 Roger Spencer (RS), Chief Executive Bernie Delahoyde (BD), Chief Operating Officer Eve Lightfoot (EL), Director of Workforce Prof Chris Harrison (CJH), Medical Director and Deputy CEO Dr Neil Bayman (NB), Executive Medical Director Prof Janelle Yorke (JY), Executive Chief Nurse Sally Parkinson (SP), Interim Director of Finance Prof Fiona Blackhall (FB), Director of Research Prof Richard Fuller (RF), Director of Education Deborah Matier, Healthcare Solutions Manager, Amgen Elvira Pyrah Shira Baram, Project Manager, Tissue Biobank Liz Randall, Business Analyst Mike Norcross, Public Governor, Cheshire

In attendance: Jo D’Arcy, Assistant Company Secretary

Nada Khalil, Innovation Manager R&I Matt Bilney, Staff Governor, Nursing

Minutes:

Louise Westcott (LW), Company Secretary

CO noted that we are still in a level 4 incident and in line with the requirement to reduce the burden on staff we are having a shortened meeting. Item Action 01/22 Standard business a Apologies Apologies were received from Tarun Kapur (TK), Non-executive Director b Declarations of Interest No declarations of interest noted. c Minutes of the previous meeting – 25 th November 2021 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. 02/22 Key Reports a Chief executive’s situation report

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Colleagues have been kept up to date daily, and we have been playing our part in the system that’s been in full escalation. There has been a requirement to treat some patients with covid as well as to maintain delivery of care and treatment of oncology services to our patients. We have also carried out cancer surgery for other Trusts. There is a levelling off of the pressure at this time, and we are in a stable situation that should result in elective activity resuming in GM. Levels of omicron is high in the community and there are still large numbers of covid patients in general & acute (G&A) beds in GM as well as high numbers of patients who no longer need to be in hospital. At The Christie we currently have19 inpatients who have covid, and 101 staff absent from work due to Covid. The internal escalation has reduced, at the peak there were 250 staff off work with covid and we have been in full escalation. We have used redeployment of staff to maintain services. We are continuing to maintain and deliver all treatment services as well as running additional surgical activity. We increased a number of our biosecurity measures and these are still at full escalation despite national guidance to the general public. The Clinical Advisory Group is advising on this and considering these measures on a regular basis to protect our high risk patients. RS pointed out the Infection Prevention & Control assurance framework that shows appropriate measures are in place to keep patients safe. RS reported that the implementation of the mandatory vaccination guidance from NHSE is underway and a lot of work has been taking place to make sure we are up to speed with this ahead of the deadline for the first jab next week. The vast majority of staff have completed all vaccination requirements and the appropriate support is in place for those who haven’t. 92% are fully compliant, there are approximately 60 members of staff that are not vaccinated. There are some staff whose evidence of vaccination is in the process of being validated as well as some staff who are being assessed as to whether they need to be counted in those who require to be vaccinated. Unvaccinated staff present a potential risk to delivery of services and work is underway to assess this risk. We don’t anticipate a significant risk as it stands. Further validation continues. RA asked what the opportunities are to redeploy staff who are not vaccinated. RS noted that there are a number of steps to take prior to consideration of redeployment. The opportunities to redeploy from clinical facing to non-clinical facing are limited. CO noted that we continue to support Trusts with their cancer surgery and asked if there is an even spread of referrals from other Trusts for surgery. RS noted that this is complex and organisations are working through how they take advantage of mutual aid. We’re working with Trusts to improve this and focusing on some particular organisation. Mr Selvesakar has been doing incredible work with clinical colleagues in GM to facilitate complex arrangement for these patients to ensure they are not waiting. b NHS Regional Office’s conclusions following the Rapid Review of the Research and Innovation Division The board has had an opportunity to consider the paper in detail in a private session which is appropriate because the issues covered include matters relating to individuals and which are potentially commercially sensitive.

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The purpose of discussion at this meeting is therefore to make the report formally available publicly as directed by the Regional Office and to formally adopt the recommendations in the covering paper and listed in the report. NHSEI have confirmed they won’t take any further regulatory action and that there is no evidence of any wrongdoing relating to bribery & embezzlement by Christie staff. Now that board members have had an opportunity to read the report and discuss it, further questions were invited. RS noted that colleagues have had opportunity to discuss this, the cover paper has had input from executives and the wider organisation. He drew attention to the summary conclusion and appendix 1 of the paper that shows the actions that have taken place that correspond to the recommendations from the report. This allows the Board to have assurance on the activities that have taken place in response to the findings. Colleagues in the Management Board have also been briefed. Further actions to conclude the action plan will be reported at the Quality Assurance Committee at their next meeting. RS alerted the Board to the issues of accuracy raised by the Regional Office in respect of the correspondence. Amendments will be made to the Board papers to reflect those following the meeting. KW noted that the report and action plan illustrate that there has been constructive change in the R&I division. He asked FB to update on progress with developing the research strategy and how will this link with the wider strategy for the Trust. FB noted that there’s a need to tighten alignment with the main Trust strategy. Publication of the report and response allows reflection, the next step is to give wider staff access to the report and there will be continued dialogue in how the culture and work is modernised and taken forward in everyday practice and future direction. We can never have too much feedback, and this provides support in how we take this forward. The nature of a highly regulated area can mean change can be difficult and the team are striving to be the best. JM asked about what’s being done to bring about further improvements in Trial set up times and what the impact of COVID has been. FB noted that trial set up is complex and can be very different for different trials, this is being looked at so that the process can be supported and improved with sharing of good practice. Mapping work has been undertaken to understand the process and this intelligence will identify blocks and barriers to improve. Quick fix’s have ben undertaken and there are also some changes that can just be actioned straight away, a culture of empowerment is being encouraged. Breaking down hierarchical decision making is part of this as well as encouragement to listening to what the issues are and how they can be progressed. Dialogue is key to ensure staff know they can voice their issues without needing to use the freedom to speak up (FTSU) processes etc. KR noted that as the NED who oversees freedom to speak up, she would like to confirm that the sequence of events as set out in the covering paper is correct and that in this role she can confirm that the organisation has reviewed and updated our process in line with national guidance. This has been appropriately reported and it was also noted that the FTSU Guardian is liked, trusted and well respected. Discussions take place every 6 months with the Chair, NED lead, Director of Workforce and FTSUG. Focus must be on getting staff to genuinely feel that they can raise issues and that their confidentiality will be protected.

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RA asked about the development of the R&I strategy and would like to understand the next steps, what will be the process to get a consensus on this. FB noted its very difficult to satisfy all views, this is the aim and the process of wider discussion has commenced in groups and in 1 to 1’s. There are many researchers who have individual strategies, or alongside the University of Manchester or the Clinical Research Facility (CRF). There is a huge amount of information already amassed to progress and an understanding of unmet need for patients. Due time and diligence to progress the strategy has been appreciated and this will now look to consider a final draft in April/May with an implementation plan alongside. This will coincide with some significant research grants. CO confirmed the Board support to R&I. AM noted that as a board we are committed to the equalities agenda and asked EL about the RESPECT agenda. EL noted there is an equality diversity & inclusion (EDI) group and 3 network groups with executive sponsors. There is a plan with objectives. We held an EDI summit in December with a wide range of contributors. We now have fair recruitment champions across the organisation. We have undertaken a listen and learn exercise with the network groups and the FTSUG to encourage staff with protected characteristics to speak up. A programme Board has been established for some time. We launched the RESPECT campaign in 2019 alongside our staff side colleagues. Divisions have individual campaigns with tools and resources for all. There was a launch and a pledge event. We have also had a Grand Round to promote the campaign and the campaign has been further promoted throughout the pandemic and workshops have been undertaken remotely. As things stabilise there are plans to do more across the Trust. CO noted that she met with the chair of the Race Network Group and it was very positive. They were very grateful to BD for her support. EL noted that there are plans to get network leads to come and speak to Board. CO thanked FB for her input and thanked the EDs for their hard work in responding to this and for the NEDs in their constructive challenge around this. CO asked that the board approves the recommendations as set out in the paper and notes that the report has been made available on the Trust website today. Noted and agreed. 03/22 For approval a Risk Management strategy & policy 2021-24 JY presented the Trust updated strategy that will take us through the next 3 years. This is underpinned by the patient safety strategy. This aims to further enhance our risk management culture. We are also developing our own safety response strategy with a focus on what we do well as well as what goes wrong. Risk champions are being developed to help support the Quality & Standards team. CO thanked to NB and JY for their continued work on this. CO noted the link to a culture where people are happy to speak up. GP noted the comprehensive strategy and the effective management of risk. He asked about recognising risk appetite and that this will be different dependent on the risk. Also about the target score aligned to risk appetite to gauge the level of

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mitigations that are taken. He noted that the risk champions are a great idea, however, the danger is that when someone is labelled as a champion, others may defer to them and everybody must take the same approach. JY noted that we don’t want to be too prescriptive, and we would expect discussion and an evolving process for risk. She noted that this could be added to the training programme. JY noted that risk champions are there to support staff in conversations around risk management and help to identify and report and encourage conversations with staff around risk. JY reminded Board that we are a high reporting, low risk culture and this is very 04/22 For information a Infection Prevention & Control Board assurance framework CO noted that this is for information and this will be further discussed at the Quality Assurance Committee. Noted. RS congratulated Matt Bilney on his promotion to Associate Chief Nurse and lead for Infection Prevention and Control. b Integrated performance, quality & finance report Report noted. c Board Assurance Framework 2021/22 Framework noted for information. 05/22 Any other business No items raised. much our culture. We continue to encourage reporting. CO asked the Board to approve the policy. Approved.

Date and time of the next meeting Thursday 31 st March 2022 at 12:45pm

6

Agenda item 10/22d

Meeting of the Board of Directors - 31st March 2022 Action plan rolling programme after January 2022 meeting

Month

From Agenda No

Issue

Responsible Director Executive directors

Action

To Agenda no

Annual reporting cycle Corporate planning (corporate objectives / BAF 2022/23)

Approve next year's BAF / note delay in planning

12/22c

Annual reporting cycle Letter of representation & independence Annual reporting cycle Register of directors interests

Chair Chair COO Chair DoW IEMD

Directors to sign Report for approval

12/22a 12/22a 11/22b 12/22a 11/22g 11/22e 11/22d 12/22b 11/22c

Annual reporting cycle Integrated performance & quality report and finance report Annual reporting cycle Declaration of independence (non-executive directors only)

Monthly report

For completion by NEDs

March 2022

Digital Update Workforce update

EMD/Dep CEO Update

Quarterly review

Responsible Officer report

Medical Appraisal & Revalidation Annual report

Annual reporting cycle

Chair

Approve Review

Six monthly compliance with NICE safe staffing guidelines

CN&EDoQ

Annual reporting cycle Integrated performance & quality report and finance report

COO CEO DoR CEO CEO

Monthly report

Register of matters approved by the board

April 2020 to March 2021

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

Review

April 2022

Annual reporting cycle Annual Corporate Objectives

Review 2020/21 progress

Modern Slavery Act update Board effectiveness review

Approve

Chairman

Undertake survey Quarterly review Quarterly update

Workforce update

DoW

Freedom to speak up Guardian report

FTSUG

Annual reporting cycle Integrated performance & quality report and finance report

COO

Monthly report

Provider licence

Self certification declarations

EDoF&BD CN&EDoQ

To approve the declarations Declaration / approval

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

May 2022

DoSoO

Review Update

Annual sustainability report

EDoF&BD

Annual reporting cycle Annual reports from audit & quality assurance committees

Committee chairs

Assurance

7

Month

From Agenda No

Issue

Responsible Director

Action

To Agenda no

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

COO

For approval

Annual reporting cycle Integrated performance & quality report and finance report

COO DoW

Monthly report

Workforce update incl FTSU development session

Quarterly review / training

Digital update

CIO/CCIO/CCIO (nursing) Progress report

Jun-22

Trust Draft Sustainable Development Management Plan 2021 - 2024

DoC&E

Approve

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

EDoF&BD

Approve

Integrated performance & quality report and finance report

COO

Monthly report

By email

July 2022 - no meeting

Integrated performance & quality report and finance report

COO

Monthly report

By email

August 2022 - no meeting

COO

Monthly report Six month review

Annual reporting cycle Integrated performance & quality report and finance report

Compliance with NICE Safe Staffing Guidelines

CN&EDoQ

Emergency Preparedness, Resilience and Response assurance process

Sepember 2022

Annual reporting cycle

COO CEO

Approval of compliance status Provide update to Board

MIAA audit recommendation Anti-bribery briefing

Annual reporting cycle Corporate objectives & board assurance framework

CEO COO DoR CIO DoW

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

FTSUG

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)

COO

November 2022

DoSoO

December 2022 - no meeting

Integrated performance & quality report and finance report

COO

Monthly report

By email

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

COO

Monthly report Annual Review

January 2023

CN&EDoQ

Integrated performance & quality report and finance report

COO

Monthly report

By email

February 2023 - no meeting

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Agenda item: 10/22d

Action log following the Board of Directors meetings held on Thursday 27 th January 2022

No. Agenda

Action

By who

Progress

Board review

No actions were raised during the meeting.

1

9

Agenda item 11/22a

Meeting of the Board of Directors Thursday 31 st March 2022

Subject / Title

Chief executive’s report

Author(s)

Chief executive

Presented by

Roger Spencer

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

Recommendation(s)

Background Papers

n/a

Risk Score

n/a

Link to: 

Achievement of corporate plan and objectives

Trust’s Strategic Direction

Corporate Objectives



EDI - Equality, Diversity and Inclusion MRI – Magnetic Resonance Imaging

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.

10

Agenda item 11/22a

Meeting of the Board of Directors 31 st March 2022 Chief executive’s report

1. Situation Report Our Trust escalation remains at level 2 – service/divisional mitigations are in place. There has been a rise in patients with Covid and Staff absences due to Covid in line with the rising incidence in the community. We have continued to provide all cancer care and treatment for our patients, including those who have been affected by Covid. To ensure we maintain infection prevention and control measures we continue to maintain all our biosecurity measures in place, so that we can continue to provide treatment and care for our patients. In line with the changes nationally we are currently reviewing all our biosecurity measures via the clinical advisory group. We continue to implement plans for the sustained delivery of our services going forward as well as supporting the full recovery of cancer services together with other care providers in Greater Manchester. 2. 2022 local elections: considerations for NHS providers NHS Providers have issued a briefing relating to the pre-election or purdah period leading to the 2022 local government elections. This period starts on 28 th March and ends on 5 th May when elections take place. Practical considerations are laid out including the need for there to be no activity undertaken in this period which could be considered politically controversial or influential. We must not hold governor elections in this period or make arrangements for any political visits or engagement. Further information can be found here https://nhsproviders.org/media/693292/nhs- providers-pre-election-briefing-2022.pdf 3. NHS Operational Advice and Instructions on Improving Cyber Resilience The Ukraine conflict generated a heightened concern over a cyber-attack on UK infrastructure. This includes the NHS, as the NHS is considered part of ‘the national infrastructure’ covering government, defence, health etc. In response NHS England re-issued the regulatory cyber compliance ‘Data Security Protection Toolkits’ (DSPT) for all trusts, regardless of previous compliance. The re- issue set firmer cyber targets, with NIS intervention for non-compliance. There was a hard deadline for re-baselining the DSPT assessment of 4 th March 2022. In response to the urgency for action on cyber requirements, several staff were pulled off regular duties to focus as a task group. The group have successfully submitted our DSPT re-baseline and are now working towards compliance with the additional cyber requirements requested by NHSE for the deadline at the end of April 2022. 4. Equality, Diversity and Inclusion ( EDI) Accelerator The EDI Innovation Accelerator is a monthly programme of external speakers, networking opportunities and events to drive EDI innovation and sharing of best practice across the Trust. The programme began on International Women's Day with the official launch of the refreshed EDI strategy and guest speaker Dr Amy Bonsall on

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the labour of women's leadership. The next session is Friday, 8 th April 1:30 – 2:3pm "Working with Policy: Levelling Up and the NHS" by Dr Nicola Headlam. Chief Economist and Head of Public Sector Red Flag Alert. You can sign up here. https://www.eventbrite.co.uk/e/edi-innovation-accelerator- working-with-policy-levelling-up-and-the-nhs-tickets-302858687487 5. Greater Manchester Integrated care system - Preparations for the transfer to the Greater Manchester Integrated Care system from the 1 st of July continue. The appointment of Richard Leese as Chairman and Mark Fisher as Chief Executive will be followed by the appointment of Medical and Finance Directors to the Integrated Care Board. The national team have confirmed the commitment to the 1 st of July implementation date and provided extended the current CCG arrangements in place. GM Cancer - National guidance on the role of Cancer Alliances in Integrated Care Systems has been issued and supports the GM Cancer operating model. The Christie continues to support the Cancer Alliance in the transition to its new responsibilities on behalf of the system. Planning - The Christie have submitted the plans for 22/23 to GM health system. The Christie is the only trust in Greater Manchester planning to exceed the 104% of 19/20 activity. The continuing mutual aid to the system alongside demand increase have been incorporated into the infrastructure and workforce plans. The Greater Manchester system is submitting a plan that will meet the reduction in patients waiting over 62 days on the cancer pathway. The most recent Greater Manchester Health and Social Care Partnership Weekly Update is attached. 6. Estate Developments Paterson Redevelopment The project continues to makes good progress.

Externally, the roof coverings are nearing completion and progress continues with the cladding and glazing. Internally, work continues with the partitions and electrical and mechanical works and some rooms are ready for decoration. Whilst there remain a number of risks and challenges integrating the scientific equipment, the project currently remains on programme to complete late 2022. Tiered Car-Park The new facility remains on programme to be fully open by the end of March 2022. Works to improve the highway on Wilmslow Road will follow into the summer. The Trust plans to reintroduce the original parking tariff and permits from April 2022.

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Replacement of Energy Centre and Energy Efficiency The construction works relating to the new battery storage facility are in progress with the floor and frame of the facility in progress. Works on the new energy centre and chimney will continue into Q2 2022. Provision of New Outpatient Pharmacy Robot The Trust is currently developing plans for the provision of a new Outpatient Pharmacy. The new facility will include a new dedicated outpatient automated dispensing robot which will speed up the dispensing of medicines from the deposit of prescriptions. The facility will be located in the old MRI facility thus closer to the main patient pathway and will improve the patient experience with better patient waiting and staff facilities. Preparation works will commence in March with the facility opening later in 2022.

Provision of an Additional MRI Scanner in Existing Facility Works will commence soon on the installation of a fourth Magnetic Resonance Imaging machine within our existing MRI facility on the main hospital campus. When the original facility was constructed one room was left as a shell for future expansion. The 1.5T scanner was ordered in December 2021 and the original design and construction team have been appointed to continue the delivery of the scheme and works will commence in March 2022 with the facility opening late 2022 to provide valuable additional capacity.

More information about our new developments can be found at: http://christie.nhs.uk/about-us/our-future/our-developments/

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GREATER MANCHESTER HEALTH AND SOCIAL CARE PARTNERSHIP WEEKLY UPDATE FRIDAY 11 MARCH 2022

This briefing is intended to update stakeholders on how NHS and care services in Greater Manchester are managing an increase in demand. It is split into service areas and provides an update on the latest situation and actions being taken to address issues, as well as public advice and guidance on accessing services, and for specific issues. NHS England publishes a weekly online report showing verified data across provider organisations including all hospital trusts. You can access the latest reports here. Our weekly briefing gives an up-to-date overview of the situation across the whole of Greater Manchester system including primary care, urgent and emergency care, mental health and adult social care, as well as the Covid-19 situation. We are only able to share data that forms part of national data sets in line with NHS England publication dates. There is an exception for data that is unique to Greater Manchester and where the data controller is not NHS England. 1. Urgent and emergency care update and actions 2. Primary care update, data and actions 3. Adult social care and community services update, data and actions 4. Covid-19 update and data 5. Covid 19 vaccination update and data 6. Tackling the waiting list backlog and data 7. Statement from Greater Manchester Health and Care Partnership 8. Public advice and guidance: choosing the right service if you’re ill or injured, attending appointments and contact information for specific issues To note, this briefing will be the last in this format. To help consider how we update on system performance, we would welcome your views on how this content has been received. Please can you fill in this short survey, which will take approx. five minutes to complete. Take the survey 1. Urgent and emergency care This winter has seen significant pressure put on urgent and emergency care. Hospital occupancy in Greater Manchester is around 92%, with patients with a Covid positive diagnosis around 9%, and declining slowly. Rates of Covid-19 have gone up in all ten boroughs of Greater Manchester, likely attributed to increased mixing throughout the half term break. So far, this is not impacting significantly on hospital beds, and staff absences for Covid and Covid related illnesses has plateaued. The number of people in our hospitals with no reason to reside (people who no longer need hospital care) is still hovering around 900 patients per day, with significant work underway to try and reduce this to allow as much elective work to take place as possible; and support an improvement in patient flow through hospitals. There are site improvements plans in place to address this, though a key barrier is the available health and care workforce, which will take some time to address. Other barriers include complex needs within mental health and out of area placements.

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The support provided in recent weeks by army and navy staff has now ended in hospitals though North West Ambulance are still receiving specific support, which will end throughout March. Data: The weekly sit-rep from NHS England can be found here and includes staff absences. National data published monthly shows attendances to A&E, ambulance statistics and hospital admissions. Definitions of category types for calls / attendances can be found here: NHS England » Ambulance Response Programme. 2. Primary care Sustained pressures continue across general practice with both workload and workforce pressures reported. The number of practices registering a level nine has fallen to three practices across three localities, though some have registered at this level for a while, due to ongoing issues. Across Greater Manchester, 93% of GP practices have so far signed up to the national GP Community Pharmacy Consultation Service, which aims to improve public access to general practice by referring patients who can safely be seen by a pharmacist to them instead. The new scheme aims to get those with ‘minor illnesses’ seen quicker at their local pharmacy and will also help with any urgent requests for (previously prescribed) medication. Pharmacies have been at the heart of local communities during the pandemic and whilst the benefits of an enhanced pharmacy walk-in service are clear for patients, pharmacies too have been facing pressures not limited to staffing, managing multiple demands and managing expectations. Work is taking place with pharmacy and GP leads to improve ways of working to support patient expectations and engagement, consistency of messages and managing urgent requests. Due to the pandemic, the provision of dental services had to adapt to take on board the risks associated with the virus and the proximity between a dentist and a patient’s airway. While dental practices are and have been delivering a full range of services to support people’s oral health, our dental teams are still facing challenges due to reduced capacity as a result of continued infection prevention control requirements. In January, NHS England committed an extra £50 million nationally to dentistry, with Greater Manchester receiving £3.1m, until the end of this month, to provide additional urgent care. This money has funded additional sessions, including during evenings, and weekends, to support access to a dentist for people who have not seen one in over two years. The Greater Manchester dental team also set up the ‘Access Plus’ service. This operates as a referral service via the Greater Manchester Urgent Dental Care Service [information in public advice section]. Patients are either seen at the urgent care service or by an urgent dental centre, and if they require further treatment to stabilise their oral health, a referral is made to a dental practice on the scheme. The Covid-19 booster vaccination programme continues, and we really urge people to come forward, to protect themselves, others and our health and care services. Staff and volunteers will answer any questions; and there will be no judgement if you come forward now for your first vaccine. Data The majority of GP practices (64.87%, 277) have submitted a rating of six indicating that they are facing increased demand. The number of practices rated at seven or eight, showing a significant or very significant increase in demand is at 22.48%, 96). 3 (0.7%) practices have shared a rating of 9 or above representing extreme demand and are receiving extra support. 427 practices in Greater Manchester are now using the pulse check.

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3. Adult social care and community services The situation in social care in Greater Manchester is gradually improving and stabilising, though the picture is still challenging. Staff recruitment campaigns remain active across Greater Manchester, and where needed agency staff are recruited to support in the short- term. 4. Covid-19

Number of Covid-19 cases occupying hospital beds in Greater Manchester

09/03/2022

23/02/2022 02/03/2022

113

Weekly admissions to hospitals for Covid-19 106 Weekly in-patient diagnoses for Covid-19 Number of HOU/ITU beds with Covid-19 patients on specified date Number of beds (excluding HOU/ITU) withCovid-19 patients on specified date

112

259

194

195

17

23

17

481

531

455

• The hospital admission figures are of people who had a confirmed case of Covid-19 in the 14 days prior to admission. • The weekly inpatient diagnoses are patients who received a confirmed Covid-19 diagnosis after being admitted to hospital. • Figures only include data for NHS acute trusts. • The in-hospital data used is a subset of the data that is published monthly by the NHS here. It will not be made available at an organisational level. 5. Vaccinations Covid-19 • 2,137,150 first dose and 1,993,330 second dose vaccinations have been given to Greater Manchester residents as of 10/03/22. 1,454,393 booster vaccinations have also been given. • Uptake among 12–17-year-olds is c.54.1% across Greater Manchester. • Booster uptake (in the eligible population who had second dose at least 90 days ago) is 77%. Under 18s are also now eligible for the Booster dose. Following updated JCVI Guidance, the NHS is now offering boosters to all 16 and 17 year olds, and 12-15 year olds who are in a clinical risk group or who are severely immunosuppressed or who are a household contact of someone who is immunosuppressed. Sites can be found via the NHS online walk-in finder and appointments can still be booked via the National Booking Service. The NHS is offering coronavirus vaccines to children aged 5 to 11 years . Experts have advised that parents of all children aged 5 to 11 years should be offered the chance to have their child vaccinated. Vaccination is particularly important for children who have health conditions that put them at high risk from Covid-19 and those with a weakened immune system, as the benefits are greater. These children and those who live with someone who has a weakened immune system should already have been invited for vaccination. Parents will receive information offering them the chance to make an appointment for their child to be vaccinated. These appointments will be available from April over the Easter holidays and further slots will become available later. Find out more about the Covid-19 vaccine for children aged 5 to 11: A guide for parents of children aged 5 to 11 years - GOV.UK (www.gov.uk)

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Vaccine as a Condition of Deployment On 31 January, the Department of Health and Social Care (DHSC) paused the rollout of mandatory Covid-19 vaccination for health and social care staff. Following a short consultation on the subject to get feedback, DHSC have now confirmed that health and social care staff will not need a Covid-19 vaccination in order to work with patients. The legislation that required mandatory vaccination will be repealed (cancelled) from 15 March 2022. The legislation requiring Covid-19 vaccines for care home staff and anyone who does any work in a care home will be repealed at the same time. As the requirement for care homes has already been rolled out, care homes are being advised to continue to require vaccination up to 15 March, so until this date, people may still be asked to prove their vaccination status. We will continue to offer information and advice to support decision making around the choice to have a covid vaccination as it continues to be the best way to protect yourself, family, A range of initiatives are being used across Greater Manchester to reduce the number of people on waiting lists, these include the use of specialist orthopaedic hubs, community diagnostic centres, and ‘a walk-in-walk-out’ model of surgery – meaning where appropriate patients can be treated without the need to stay in hospital. We are also working on developing some new roles to bolster the workforce, such as physician associates. Anyone waiting for treatment can find advice and support on the Greater Manchester While You Wait website (whileyouwait.org.uk). There they will find information and advice on how to manage their physical and mental wellbeing while waiting. We would urge anyone with health concerns to continue to come forward for help and treatment in the usual way, using their local emergency department only for serious illnesses or injuries. A reminder that NHS 111 can help if you have an urgent medical problem and aren’t sure what to do. You can call 111 or visit 111.nhs.uk. 7. GMHSC Partnership statement Sarah Price, interim chief officer of Greater Manchester Health and Social Care Partnership, said: “We continue to experience high levels of demand for care across Greater Manchester. Our health and care staff have shown exceptional resilience this winter and gone above and beyond to help people access the care they need. “We have faced considerable pressure this past two years and we have to be upfront and honest that it will take time to recover; and that we have to balance competing demands and pressures, making the best decisions we can. “Our priority is to bring down the overall waiting list, with particular emphasis on those who have waited the longest for treatment. A wide range of work is underway in Greater Manchester to reduce waiting times and provide support for patients who are waiting for operations, surgery, and hospital appointments. “If you are waiting for treatment, you can find advice and support on the While You Wait website. And remember, everyone can help us make sure those with the most urgent need get the treatment they require by thinking about how to access NHS services. If it’s not a life- threatening emergency please use NHS 111, either by phone on online - their trained advisors will be able to direct you to the best place to get the hep you need.” 17 colleagues and patients from the virus. 6. Tackling the waiting list backlog

Spokespeople available on request include but are not limited to: • Sarah Price, interim chief officer of Greater Manchester Health and Social Care Partnership • Dr Tom Tasker, GP and interim Greater Manchester Medical Executive chair • Dr Chris Brookes, A&E consultant, joint interim Greater Manchester Medical Executive lead for acute care and local medical director • Silas Nicholls, Greater Manchester Gold command chair and hospital chief executive Contacts for more information Please contact Jim Morrison, communications and engagement manager for Greater Manchester Health and Social care Partnership: james.morrison2@nhs.net 8. Public advice and guidance How to choose the right NHS service if you are unwell or injured Lots of illnesses can be managed safely at home, or with a trip to a local pharmacist . Your local pharmacist can give advice on lots of health issues and there’s no need for an appointment. Over 95% of community pharmacies now have a private consultation room from which they can offer advice to patients and a range of services. Almost 90% of the population has access to a community pharmacy within a 20-minute walk from their home. GP practices are open and have remained open throughout the Covid-19 pandemic. People often see their GP about minor short-term problems that have lasted longer than they expected or keep coming back; as well as support to manage long-term conditions. Many GPs are now working in a different way, asking patients to get in touch online initially (where possible) and operating a triage (order of treatment) system to ensure patients with more urgent concerns are prioritised, including for a face-to-face appointment. Online services don’t replace contacting your GP by phone rather they are another helpful, fast and convenient way to get in touch. Dental practices are open and providing services . Practices are working hard to see as many patients as possible while ensuring that services are safe for the public. They can be contacted by phone or online for advice, or to book an appointment if needed. The Greater Manchester dental helpline (0333 332 3800) is available from 8am to 10pm every day, including weekends and Bank Holidays for those who need help urgently when their practice is closed, or do not have a regular dentist. People can seek help in the community to avoid a visit to hospital for accident and emergencies related to eyes . A service has been set up so patients can access free urgent NHS care at some optometry practices locally. Some optometrists have equipment to take scans of the eye and others have had additional training to allow them to prescribe eye medications. Optometrists can share information with the Manchester Royal Eye Hospital to get an extra opinion when required. Sometimes patients may be sent onto the hospital if further care is needed. You can find more information here Find a Practice - Search for your nearest participating optical practice (primaryeyecare.co.uk) or if you live in Salford, call 0161 2590595. The emergency department (A&E) is for life-threatening emergencies including but not limited to severe chest pain, stroke, difficulty breathing, bleeding you can’t stop, possible broken bones, severe allergic reactions, severe burns, loss of consciousness and other major conditions. 7 trusts provide accident and emergency services across 10 sites. The NHS has a service finder on its website and a link is provided here. Anyone who has an urgent medical need and isn’t sure what to do can contact NHS 111 online ( https://111.nhs.uk/ ) or call for free . It’s available around the clock, seven days a week. Around half of those who call 111 speak to a clinician such as a GP, nurse, or 18

pharmacist. The NHS 111 service can provide self-care advice, signpost to an appropriate local service, or book people in to be seen at their local pharmacy, GP practice or emergency department. NHS 111 can book you an appointment at your local A&E or emergency department. This means you will have an allocated time to attend hospital and be treated, so you don’t have to wait a long time to be seen and can also help services avoid becoming overcrowded. Attending appointments • In healthcare settings, we need to do all we can to help protect our staff and patients and reduce the risk of infection for those working in our services and those who need our care - therefore we are reminding people that staff, patients, and visitors will all be expected to continue to follow social distancing rules when visiting any care setting as well as using face coverings, mask and other personal protection equipment. • NHS visitor guidance remains in place across all health services including hospitals, GP practices, dental practices, optometrists, and pharmacies to ensure patients and staff are protected. Advice for specific issues RSV / bronchiolitis advice for parents/carers: Respiratory Syncytial Virus is a common seasonal winter virus which causes coughs and colds and is the most common cause of bronchiolitis in children aged under 2 years. Most case of bronchiolitis are not serious, but you should contact your GP or call NHS 111 if: • Your child has taken less than two or three feeds, or they have had a dry nappy for 12 hours or more • Your child had a persistent high temperature of 38 °C or above • Your child seems very tired or irritable A public awareness campaign, Little Lungs Need Big Protection, informs parents and carers about the symptoms of bronchiolitis, and learn when and how to seek help. Childhood immunisations: • You'll usually be contacted by your GP surgery when your child is due for a routine vaccination. This could be a letter, text, phone call or email. • Vaccines are given at eight weeks, 12 weeks, 16 weeks and 1 year then less frequently after this. Call your GP practice to make sure your child has any vaccinations they've missed, whatever the reason. • Please make sure your child has had both doses of the MMR vaccine, so they are protected against measles, mumps and rubella. • More information here. How to book a Covid-19 vaccination: • Appointments can be booked online here or by calling 119 between 7am and 11pm • More information can be found here: Book or manage your coronavirus (COVID-19) vaccination - NHS (www.nhs.uk) • Details of walk-in vaccination sites in Greater Manchester can be found here. • Useful information on the NHS Covid pass can be found here. How to register with a GP: • Anyone in England can register with a GP surgery. It's free to register • You do not need proof of address or immigration status, ID or an NHS number • How to register with a GP Mental Health • Mental Health support can be found at: https://hub.gmhsc.org.uk/mental-health/covid- 19-resources/. 19 • You’re worried about your child

• Greater Manchester crisis phone helplines provide support 24 hours a day, seven days a week to people of all ages, including children, who need urgent mental health support. Our crisis lines aim to help people who need urgent mental health support because they are experiencing emotional distress and are struggling to cope. • The crisis helplines also take calls from family members, carers or anyone who is concerned that someone they know is experiencing a mental health crisis. • The crisis helpline phone numbers are as follows: o Bolton, Manchester, Salford, and Trafford: 0800 953 0285 (freephone) o Bury, Heywood, Middleton & Rochdale, Oldham, Stockport, and Tameside & Glossop: 0800 014 9995 (freephone) o Wigan: 0800 051 3253 (freephone) Healthwatch • Healthwatch information and signposting services can support you to make choices about the health and care services you may need. This service will help you to find out what information is available and how to access the support you need to live well within your local area. • Healthwatch can provide help over the phone, by email and in some circumstances face to face. • Healthwatch also listens to feedback about patient experience so that they can help providers of health and social care improve services. • You can find useful guides and contact details about your Local Healthwatch here.

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Integrated Performance Quality & Finance Report

Feb-22

Responsive

Caring

Safe

Effective

Well Led

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