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The Healthier Together programme is a clinically-led programme to transform healthcare in Greater Manchester. The decision-making body is the Healthier Together Committees in Common (“CIC”), comprising one voting member from each of the 12 CCGs in Greater Manchester. 

 

The Healthier Together model of care proposes that ‘single services’ will be formed across Greater Manchester. Single services are networks of linked hospitals working in partnership. Hospitals will be designated as a ‘specialist’ or ‘local’ hospital. One hospital within each of the single services will be designated as a “specialist” hospital and specialise in general surgery for patients with life threatening conditions. 

 

Healthier together identified a short list of options for the configuration of single services through a pre-consultation options appraisal process. The process identified a number of ‘fixed points’ which were hospitals designated as ‘local’ or ‘specialist’ in all options.  The Clinical Reference Group recommended that the following sites should be recognised as specialist fixed points for the purpose of the option appraisal purpose:

 

  1. Royal Manchester Children’s Hospital – CMFT (Manchester Royal Infirmary)
  2. Adult Neuroscience Service – SRFT (Salford Royal Hospital)
  3. Adult Burns Service – UHSM (Wythenshawe Hospital)

 

 

On 26 February 2014, the CIC decided that both Manchester Royal Infirmary and Salford Royal Hospital sites would be designated specialist in all subsequent options. On the same day, the CIC decided that Fairfield General and Tameside General would be considered as local in all options. On 16 April 2014, CIC decided that North Manchester General Hospital would be designated as the third local hospital in all options. 

 

Hurdle criteria were introduced to identify the third specialist hospital. All options which did not include Royal Oldham Hospital as a specialist site did not meet the hurdle criteria for transport and access which required that no more than 10,000 of the population of any one CCG should have a greater than 75 minute (1hr 15min) journey by public transport to a specialist site. As a result of this process, the three fixed specialist sites used in the public consultation were confirmed as Salford Royal Hospital, Manchester Royal Infirmary and Royal Oldham Hospital. 

 

Between 8 July 2014 and 30 September 2014, Healthier Together conducted a public consultation although responses were received and accepted until 24 October 2014. In addition to the three fixed specialist sites already identified, the consultation put forward the following eight options for an additional specialist site(s) depending on whether there would be 4 or 5 single services in Greater Manchester:

 

  1. Option 4.1: Royal Bolton 
  2. Option 4.2: Royal Albert Edward Wigan
  3. Option 4.3: Wythenshawe 
  4. Option 4.4: Stepping Hill Stockport 
  5. Option 5.1: Royal Albert Edward Wigan and Stepping Hill Stockport
  6. Option 5.2: Royal Albert Edward Wigan and Wythenshawe
  7. Option 5.3: Royal Bolton and Wythenshawe 
  8. Option 5.4: Royal Bolton and Stepping Hill Stockport 

 

The consultation responses were collated and analysed by Opinion Research Services (ORS) – an independent organisation commissioned by Healthier Together to collate consultation responses and feedback. A majority of responses expressed support for five rather than four single services. 

 

On 19 November 2014, the CIC unanimously endorsed the Decision Making approach paper which outlined 6 decisions that needed to be taken in relation to the in-hospital programme during the decision-making phase: 

 

  1. Confirmation of the case for change 
  2. Is the model of care supported? 
  3. Are there any alternative options? 
  4. What criteria will be used? 
  5. How many single services should there be?
  6. Which option should be implemented? 

 

On 21 January 2015, the CIC voted on decisions 1-3. The CIC confirmed the case for change and the proposed model of care. 

 

On 18 February 2015, the CIC voted on the criteria to be used to select an option for implementation (decision 4). The agreed criteria were:

 

Quality & Safety 

  • Clinical Effectiveness and Outcomes 
  • Patient Experience 

 

Travel & Access

  • Distance and time to access services 
  • Patient Choice 

 

Transition 

  • Workforce 
  • Expected time to deliver
  • Greater Manchester Coherence 

 

Affordability and Value for Money 

  • Capital cost to the system 
  • Transition costs
  • Viable Trusts and Sites
  • Change in I&E versus 18/19 ‘base case’ position
  • Net Present Value

 

On 26 February 2014, the CIC decided that both Manchester Royal Infirmary and Salford Royal Hospital sites would be designated specialist in all subsequent options. On the same day, the CIC decided that Fairfield General and Tameside General would be considered as local in all options. On 16 April 2014, CIC decided that North Manchester General Hospital would be designated as the third local hospital in all options.

 

On 15 June 2015, the CIC voted in favour of four single services rather than five single services (decision 5). 

 

On 8 July 2015, Healthier Together published a Decision Making Management Report (“Management Report”) for the CIC. ORS presented its findings from the public consultation to the CIC in a report dated July 2015. The outcome of the household survey revealed that of the four hospitals, the preferred specialist hospital was as follows:

 

1.    Wythenshawe – 33%
2.    Bolton - 28%
3.    Stepping Hill Hospital – 26%
4.    Royal Albert Edward Wigan – 13% 

 

On 15 July 2015, the CIC voted unanimously to name Stepping Hill Hospital as the fourth specialist hospital (decision 6). This is the decision which is the subject of this challenge. 

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Healthcare in Greater Manchester needs change but change must be SAFE and quality should always be the priority in reconfiguration.

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