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You can’t please
plan for Greater Manchester – is not unique. We’ve heard many of the same concerns before when it comes to change in the NHS. Suspicion and distrust from some quarters; cries of ‘why not just invest more everywhere?’ from others; picking apart the process of the consultation from yet others, trying to find a loophole or technicality that invalidates the whole programme. Some don’t like the way the consultation is forcing providers to compete instead of collaborate.
everyone H
ealthier Together – the service
reconfiguration
impact. London went much further with its stroke reconfiguration, and now seems to have the mortality figures to prove that it was the right thing to do – a UCL-led study found that the eight hyper-acute stroke units in London save around 96 stroke patients every year who would likely have died under a non-centralised system, while also cutting average length of hospital stay.
In line with most modern consul- tations and NHS reconfigurations, those running Healthier Together try first to establish the ‘need for change’ as common ground, dis- cussing a lack of capacity, rising demand, workforce pressures, pa- tient safety concerns, new technol- ogy and changing models of care. Few of those NHE has spoken to, including the most ardent oppo- nents of the specific measures put forward (which, inevitably, include what amounts to the downgrad- ing of some hospitals and the loss of some services and specialties, even as others are bulked up), are attempting to argue that the status quo is rosy.
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Greater Manchester was also the site of a previous change programme, for acute stroke services. In that case, in 2010, local opposition to centralisation and specialisation plans helped blunt the potential
There were lower levels of “adherence” to the centralised model in Greater Manchester, which achieved reductions in length of stay, but not on mortality.
Both London and Manchester saw public and political opposition to stroke services centralisation from people worried about their local hospital’s status and perhaps unwilling to countenance the thought of literally being driven past it in an ambulance to a more distant but more specialist centre. Dr Stephanie Snow of the University of Manchester, who is researching stroke since the 1950s, says: “The Manchester model was less radical than the London model precisely because it attempted to assuage such concerns by allowing all hospitals to continue to play a role in stroke services.”
‘Safe and Sustainable’, the children’s heart surgery review, fell apart after opponents proved
that its process had been flawed, forcing NHS England to start again from scratch with a completely new approach (one which, for now, doesn’t mention the closure of specific units).
Anne Keatley-Clarke, chief execu- tive of the Children’s Heart Fed- eration, is among those demanding urgent action, saying the current unreformed system is not as safe as it could be and is thus risking lives. NHS England’s Specialised Commissioning Oversight Group says that “despite the clamour for a quick solution”, it is taking its time to ensure that this time, the process is done properly, without wasting four years and £6m like ‘Safe and Sustainable’.
As NHE was going to press, the Healthier Together consultation was about to close. Find out more about the programme, and the controversial ‘super-CCG’ model helping lead it, on pages 32-35.
Adam Hewitt Editor
18 Advancing Quality? Paying for performance in the NHS – the latest evidence.
20 Cover story
Making hospital and health system consolidations work.
37 Property rights Should CCGs let providers determine the local estate strategy?
49 Friends and Family Special feature on the extension of the FFT to new sectors.
national health executive Sep/Oct 14 | 1
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