Staff engagement on the 5-year strategic plan
Responding to the staff survey
Thank you to the staff who fed back on the draft strategy to help inform it. We have ensured our 5-year plan reflects these views and have identified the main themes from this engagement exercise and how they have influenced the strategy below.
Detailed actions for each of the things described will be within our Joint Forward Plan which will be published in June 2023.
The strategy is referred to throughout the feedback; you may want to download the strategy so you can see the difference the feedback has made.
What staff told us and what we have done in response
There was significant feedback from staff about the language and terminology contained in the 5 year strategic plan.
In particular with reference to the following terms used within the strategy:
- The word ‘Mission’
- The term ‘Economic Inclusion’
- The term ‘Financial Sustainability’
Although the word ‘mission’ is still included in the strategy it has now been explained alongside as a series of actions, which gives practical examples of what we will do achieve the missions, see below:
“our priority actions in response to the current challenges” (p.7 – Executive summary)
“missions requiring action in each neighbourhood, in all ten localities and across the whole of Greater Manchester” (p.32)
Economic Inclusion is now not included as a term.
Within the section of the strategy describing the Model for Health (p24) there is a section about ‘An Inclusive Economy’ which includes an explanation off what this means.
“An inclusive economy – an approach to economic development where everyone can participate in local economic life; where local resources and wealth are redirected into the local economy and where local people have more control.” (p.24)
The wording Financial sustainability is still included but is now explained.
“Achieving financial sustainability for the health and care system can be described as ‘living within our means’ and ensuring that expenditure does not exceed income.” (p.40)
There was some challenge about the five year strategy not including enough evidence in relation to how we will we tackle things that are regularly in the media e.g. access in general, elective care, urgent and emergency care.
Following these comments from staff, and from many others across the Health and Care system, the recovery of core NHS and care services’ has been added (described on page 37-39 of the five year strategy): Recovering core NHS and care services.
Some of the actions in this section include:
- Improving ambulance response rates and A&E waiting times
- Reducing waits for hospital elective care and cancer backlogs
- Making it easier for people to access primary care, especially GPs
- Ensuring everyone gets access to the same level of mental health services across Greater Manchester
- Ensuring mental health is as important as physical health
NHS Greater Manchester and primary care providers will also engage on options to address the current issues surrounding access to NHS dental services and develop a dental access plan.
More details of the above are on pages 38 – 39 of the strategy.
Work has already started on the above but will be strengthened by the strategy and more actions will be in our Joint Forward Plan, which we will continue to engage on.
There was a lot of feeling and support for:
- Early diagnosis detection
- Workforce and members of our workforce who are carers (staff feeling undervalued, services being under resourced, the desire for better pay, terms and conditions and equality between health and care staff)
Both early diagnosis and equity for all of our workforce is already described in the strategy. The feedback we have received from staff has confirm their importance.
Actions for the above will be part of the Joint Forward Plan.
There was feedback from staff that suggested some elements were missing from the strategy.
Inclusion – The main feedback was for us to make it clear, that services need to be accessible for everyone, including children and young people, and promoted in a way that people can understand taking into account barriers they may have, especially around self-care, and where to access the right care.
Children and Young People are the focus of one of the shared commitments across both Health and Social Care (these commitments were not part of the staff engagement/survey process).
The commitments can be found on P12 of the five year strategy “Ensure our children and young people have a good start in life” (P.12)
The mental health of children and young people is included in the mission for recovery of core NHS and care services, as are other aspects of care for children e.g., waiting times.
The Model for Health also has a section focused on supporting children and young people (p.29)
“We will adopt a proactive approach to supporting children and young people to reduce the impact of mental health problems, and specifically to improve the pathway for eating disorders, and improve the interfaces of inpatient services with the whole system including alternatives to admission and discharge.” (p.39)
“For children and young people, we will reduce waiting times to within national standards through a Greater Manchester-wide approach to paediatric elective recovery with common clinical prioritisation, establishment of dedicated paediatric surgery hubs, sharing of best practice to maximise activity and transforming pathways.” (p.38)
There needs to be recognition that some communities face specific hardships and challenges that require specialist responses and care.
LGBTQ+ communities face disproportionate inequalities when it comes to health and social care, and this is made worse when our identities overlap with other forms of marginalisation (e.g. disabled LGBTQ+ people, LGBTQ+ people of colour etc.,) Staff strongly encouraged a specific point to be included in the five year strategy.
The strategy recognises that some groups face more challenges and inequalities than others. These are included in a section of the strategy and are described (P.15-21) and includes a response to such challenges (see below)
“We recognise that specific communities face greater challenges concerned with prevention, early detection and early treatment. These include people with severe mental illness, people with disabilities, communities facing disadvantage or discrimination as a result of ageism, communities where there are people who are racially disadvantaged and communities in poverty. We will, therefore, embed a comprehensive approach to reducing health inequalities to deliver improved equity, equality and sustainability across health and care.” (p.36)
Actions for the above will be part of the Joint Forward Plan, and we will continue to engage with staff on these plans.
Feedback from staff told us you thought health equity appears to be missing from the strategy.
Staff felt this needed to be included to make sure our services are equally accessible and usable, whatever a person’s capabilities, to ensure fair and just opportunities to attain good health.
As a result of the feedback health equity has now been included in the strategy and explained (see below):
“All of these missions are underpinned by the need to ensure equity, which means providing greater help for those with greater challenges to overcome in order to reduce health inequality” (P.32)
Feedback was received with regard to the rising number of people who are part of our aging population and as a result of this a rise in long term health conditions. The need to act now and plan ahead was highlighted.
Staff felt forward planning for this particular cohort of people needed to be done alongside our local populations through engagement and co-production including staff working on the frontline, people with lived experience and those from our seldom heard communities including people who work alongside these communities
There is a focus on ageing included in the five year strategy through its inclusion as one element of the Model for Health (An age friendly Greater Manchester).
Much of the focus on living well, and strong communities (e.g., through the related mission) includes all ages.
There is a focus on supporting people to ‘live well’ at home described in the Model for Health as part of the ambition for adult social care.
“An age friendly Greater Manchester – responding to the opportunities and challenges of an ageing population in our city-region, focusing on reducing inequalities and ageing well. This requires a change in approach to health and social care to ensure more proactive care, healthy and active ageing and ensuring people get the right care when they need it.” (p.24)
“Our adult social care ambitions support people to ‘live well at home’, as independently as possible, making sure that the care and support they receive responds to their strengths and what matters most to them; valuing and respecting carers through recognition and support; supporting people with complex needs with enhanced care at home to prevent them going into hospital and to return home as quickly as possible; and working with social care providers to improve quality and ensure a resilient and diverse market for care.” (p.28)
The need to include education in the strategy was fed back by staff.
Specifically the need to promote the importance of self-care, especially to children and young people to explain they will need to have more responsibility for their own health in the future. How to do this, and where to access the care they need also needs to be from the right place which they feel comfortable with.
Children and Young People are the focus of one of the shared commitments across both Health and Social Care (these commitments were not part of the staff engagement/survey process)
The commitments can be found on P12 of the five year strategy “Ensure our children and young people have a good start in life” (P.12)
“Skills, education and good work – supporting early year’s development to enable more children to be school ready; ensuring successful educational experiences in schools and colleges which support positive mental health and securing more control of the post-19 skills system to lead to better employment opportunities across the city-region.” (p.24)
There were some overarching themes from the survey:
- How will we deliver the strategy?
- What will the practical actions be?
The full version of the five year strategy (rather than the headline version, which was used in the engagement process) describes focused actions again each of the missions
The missions and their focused actions are described on p.32-41
“We will develop and publish a Joint Forward Plan (JFP) by the end of June 2023 as a delivery plan for the ambitions in our Integrated Care Partnership Strategy and this plan will be updated annually. It will include progress measures for the elements of the plan which support the overall ambitions in this strategy.” (p.44)
All of these actions will be further detailed through the Joint Forward Plan, which we continue to engage on.
Communication of the ways of working both formally and through individuals was a strong theme.
Staff wanted ways of working to be promoted by individuals and encouraged by the health and care system. Colleagues said:
- “…make them part of interviews, objectives/PDRs etc., to ensure a collaborative working culture is nurtured and encouraged…”
- “Promote the ways of working so they are visible…”
- “Staff should believe they are workable and achievable not just a tick box exercise.”
The ways of working have been included in all presentations of the strategy and were praised by a member of the Greater Manchester ICP Board at its meeting 24 March 2023.
Resources and the development of leaders and the workforce were highlighted as a key feedback theme.
A colleague said, “Train and develop leaders to manage teams in the right way to develop the desired culture.”
The GM People and Culture strategy will support the commitments and missions related to workforce in the strategy, and leadership development and culture is a key element of this.
“We want a cultural shift to create a more compassionate and inclusive leadership culture, bolstering a culture of collaboration and a culture where wellbeing matters.” (p.39)
Staff felt that working together should be encouraged from the top, and could cut through bureaucracy and costs.
One of the four outcomes described in the strategy has been re-worded following feedback from a range of staff and key stakeholders and will now focus specifically on integration of health and care services.
“For the Greater Manchester Integrated Care Partnership this means we want to see a city region where … Health and care services are integrated and sustainable” (p.12).
Staff recognised working with communities is already happening and should continue to be encouraged and developed.
A colleague requested, “More joined up working between health care and services in communities.”
This feedback theme is included in the ways of working, but also in the Model for Health and the mission for strong communities.
“Transforming public services, integrating care to provide solutions which are more than medicine, and working with communities; not simply ‘doing to’, will fundamentally challenge our approaches to delivery and working together. The way that members of the Integrated Care Partnership work together, with each other and with our communities, will play an important part in achieving our vision.” (p.12)
More details of how we will do this will be included as actions in the Joint Forward Plan.
Staff recognise that adopting best practice takes time and will require supportive governance, including trial and error.
- “..it is important to quickly clarify the governance that all localities must work to in order to allow organisations to quickly take an and adopt best practice.”
- “There are great pockets of work being developed across GM but it doesn’t all appear to be aligned, there are too many inconsistencies across the system, we need to align our work and be more consistent.”
This now emphasised in the section describing the Model for Health and the ambition for joined up care to be universally realised across Greater Manchester.
“Our challenge is that this Model is not universally realised across Greater Manchester. Our aim through this strategy therefore is to confirm the actions and approaches necessary to achieve this and maximise the effectiveness of how we work together to improve our outcomes.” (p.22)
Staff felt that honesty was the key theme in terms of building trust, with the context of a supportive environment.
- “Open and honest communication with all stakeholders including a process that allows us to identify errors and address these without fear of repercussions at any level with the system.”
- “Keep an open, honest and supportive environment.”
Honesty is one of the elements included in our ways of working.
“Be open, honest, consistent and respectful in working with each other. Work on the boundaries and differences that we have in a constructive way, to support effective change.” (p.13)