On Wednesday 15th July, commissioners agreed new standards of care for emergency medicine and general surgery (surgery on the abdomen and bowels) in all hospitals across Greater Manchester. Under the Healthier Together proposals, ‘single services’ will be formed - networks of linked hospitals working in partnership. This means care will be provided by a team of medical staff who will work together across a number of hospital sites within the single service. All hospitals will improve to ensure they meet the quality and safety standards. The new standards will mean an additional 35 consultants recruited across A&E and general surgery, a minimum of 12 hours of consultant cover in A&E seven days a week, and a consultant surgeon and anaesthetist present for all high risk general surgical operations. All hospitals will keep their existing specialisms and will continue to provide care to their local populations as they do now.
There are three elements to the Healthier Together programme – Joined-up Care, Primary Care and Hospital Care. Clinically led, the programme aims to provide the best health and care for patients across Greater Manchester. Healthier Together is a key building block for a fully devolved health and social care system in Greater Manchester (GM), the decisions have been named as early priorities for the region’s ground-breaking devolution programme. Involving NHS England, the 12 Greater Manchester CCGs, the 10 local authorities and 15 NHS Trusts, the GM health and social care devolution programme aims to bring organisations together to work in partnership to deliver the biggest and fastest improvement to health and wellbeing for the people of Greater Manchester.
The changes to hospitals are being supported by improvements to primary care and joined up care. These improvements are already underway with, for example, pilot sites in Manchester, Bury, Heywood and Middleton now providing 500,000 people in Greater Manchester with same-day access to primary care services. This has led to a reduction of 3% in total A&E activity in the pilot site areas, compared to the rest of Greater Manchester. By the end of 2015 access will be expanded to everyone living in Greater Manchester with the aim of making care more easily accessible to patients and reducing the number of people going to A&E.
Greater Manchester has a long history of change; we have already changed the way we treat some specialist conditions such as major trauma and stroke. There is evidence that consolidating services onto a fewer hospital sites has already saved lives and improved patient care and we want to do more of this. We have used learning from the changes to major trauma and stroke services to design the single service model.
All hospitals specialise in providing certain types of care, for example some hospitals specialise in stroke care, others in cancer care. Similarly, one of the hospitals within each of the single services will specialise in emergency medicine and abdominal surgery, for patients with life threatening conditions affecting their stomach.
On Wednesday, clinical leaders decided unanimously that Stepping Hill hospital in Stockport will be the fourth hospital in Greater Manchester to provide emergency medicine and specialist abdominal surgery as part of a single service, under the Healthier Together proposals to drive up quality and standards.
Last month commissioners decided that there should be four single services introduced in Greater Manchester. Today the ‘Committees in Common’ (CiC), comprising of GPs from each Clinical Commissioning Group (CCG) in Greater Manchester, reviewed a range of evidence including: the feedback from the public consultation held last year and data relating to: travel and access, quality and safety, transition (how easy it will be to achieve the change) and affordability and value for money, and decided that the fourth hospital would be Stepping Hill.
The following hospitals will work in partnership to provide shared single services:
- Manchester Royal Infirmary, Wythenshawe Hospital and Trafford General Hospital
- Royal Oldham Hospital, North Manchester General Hospital, Fairfield General Hospital in Bury, and Rochdale Infirmary
- Salford Royal Hospital, Royal Bolton Hospital and Royal Albert Edward Infirmary in Wigan
- Stepping Hill Hospital in Stockport and Tameside General Hospital
Dr Ranjit Gill, Chief Clinical Officer for Stockport Clinical Commissioning Group and a member of the CiC, said:
“We have set clear pre-conditions to make sure that all the new centres for Single Services must be consistently providing the basic minimum national standards of care, before being finally approved to be a Healthier Together Single Service Centre. We also want to ensure that those people from North Derbyshire and Eastern Cheshire, who need emergency care in a Greater Manchester hospital, are able to receive care to not only the minimum standard but the best practice standards of Healthier Together.
“During the consultation, people outside of Greater Manchester asked us to specifically look at travel times as they said some options prevented them from accessing services easily. We listened to the public and that is what the data showed us. People in the North West region of Greater Manchester can get to Salford within the 45 minute emergency standard, therefore there wasn't a compelling reason to have another specialist centre in the North West of Greater Manchester.
“At the end of a robust and thorough three-year process, we have determined the best way to serve the whole of Greater Manchester and those who need our services from neighbouring areas. Supported by investment to make GP led care consistently excellent, a joined-up NHS and social care which is responsive and proactive - accelerated by the devolution process - we can now begin making the changes to deliver the best care for patients every time, everywhere in Greater Manchester."
Dr Chris Brookes, Medical Director for Healthier Together and A&E consultant said:
“This decision represents an unprecedented opportunity to start raising standards and saving lives by having hospitals working in partnership as part of shared ‘single services’, sharing their resources and expertise. Every site included in the review will improve their standards and quality of care. Additional consultants will be recruited across A&E and general surgery to make sure patients are seen more quickly by a senior doctor when they are seriously ill.
“Our aim is for all of hospitals to meet the recommended quality and safety standards, at the moment none of our hospitals in Greater Manchester do. It is estimated that by working in this way, we can save up to 300 lives a year. The first Patient Report of the National Emergency Laparotomy Audit, recently released, demonstrated that patients are dying unnecessarily following general surgery at hospitals across the country due to delays and variations in standards of care.
"In Greater Manchester we are blazing a trail to change, we intend to deliver the care patients deserve every time.”
Bob Williams, Chief Executive of North West Ambulance Service NHS Trust, said:
“The Trust supports Healthier Together as we are acutely aware that routinely taking all patients to any accident and emergency department is not always in the patient’s best interest and have always said we will work with whatever outcome the Healthier Together process decides.
“For some time now, cardiac, stroke and trauma patients from 999 calls have been taken directly by our ambulance crews to the nearest appropriate specialist centre to be treated. This isn’t always the closest hospital, but is the best option for the patient and is in accordance with the agreed pathway of care for their particular condition. So this process is nothing new for our ambulance crews.
“I am extremely confident in the clinical skills our staff have which mean patients can be safely taken directly to the hospital that can look after them the best. These skills are supported by robust pathways, along with additional clinical advice and supervision which are in place to assist the ambulance crews with their decision making.
"We are working closely with Commissioners and the Healthier Together project team to ensure that any impact on ambulance services is considered and what additional resources may be required to be able to accommodate the final decision.”
The single service model and way of working is entirely consistent with NHS England’s vision set out in the NHS five year forward view, to develop networks of linked hospitals to ensure patients with the most serious needs get to specialist emergency centres.
The process of introducing single services across hospitals is expected to take two to three years to complete. The programme will continue to work with providers during this phase to develop the single services as quickly as possible with the least disruption.
For more information, contact Edna Boampong on 0161 625 7120 / 07958 540 778 /firstname.lastname@example.org, Clarissa Langham on 0161 625 7119 / 07977 066108 /email@example.com or Paul Horrocks on 07768 615876 / firstname.lastname@example.org