HEALTHIER TOGETHER
© Dave Thompson/PA Wire
who would have to make the system work.
He also argues that there is no evidence to sup- port the model that is being proposed.
He told NHE: “Not only is there no evidence for the benefits of centralising emergency surgery, but they make this claim that it can save 1,500 lives and there is no evidence behind that claim.
The North West Sector response: A Single Service Partnership
While Healthier Together has caused disagreement and division across the conurbation with its controversial proposals, one area has pulled together to come up with its own solutions focused on collaboration, not competition.
The North West Sector of Greater Manchester, comprising Wigan, Bolton and Salford, have put together a detailed plan addressing the challenges raised in Healthier Together.
Andrew Foster, chief executive of Wrightington, Wigan & Leigh NHS FT, said their proposals are different from Healthier Together in several key ways: “The first is in the detail of how this emergency service will be organised. Really, Healthier Together doesn’t talk about the detail of how an emergency surgical service will be operated. It simply says it will be centralised in one place.
“The second is that Healthier Together proposes this divisive set of titles of ‘specialist’ and ‘local’ hospitals. We’ve said the language we want to use is a partnership of three hospitals working together – not winners and losers.”
The third key plank of their alternative vision is work to address the clinical dependencies between the services – something missing from the Healthier Together proposals.
Under the main Healthier Together proposals, Salford Royal will become one of the ‘specialist’ hospitals, plus either Royal Albert Edward Infirmary in Wigan or the Royal Bolton. The North West alternative would create just one centralised site in Bolton, Salford or Wigan for emergency and high-risk general surgery. General surgery consultants would be combined from all three trusts to provide two rotas. One rota would provide round-the-clock surgery at the centralised site, while the other would provide 24-hour phone or on-site advice to the other hospitals. This second rota would be critical in addressing the clinical interdependencies with services the other sites provide. While most emergency surgery will be centralised, there will be rare instances where it is carried out at the other sites – in time-sensitive cases or when patients are too fragile to transfer.
This alternative plan allows each trust to retain their core services and specialties, the partners say, rather than having one or two ‘specialist’ hospitals.
The hospital trusts, CCGs and councils in all three areas are backing the alternative proposals, having signed a memorandum of understanding. A governance structure has been created to manage the partnership.
They plan to submit their proposals to Healthier Together at the end of September, after the consultation closes, so as not to confuse the public.
“When you look at it, what they’re simply saying is that if every hospital in Manchester achieved the same surgical mortality rate as the best hospitals in the whole of England then it would save 1,500 lives. So that’s like an arithmetical calculation, but it’s not a ‘how to do it’.”
The consultation lays out eight options for the organisation of specialist and general hospitals. Under all eight options, Royal Oldham Hospital, Salford Royal Hospital and Manchester Royal Infirmary are designated as specialist – because of geography and the unique services they provide. This leaves up to two specialist ‘slots’ up for grabs. The Royal Albert Edward Infirmary in Wigan is one of the hospitals being considered to be the specialist centre for the North West Sector; the other hospital in contention is the Royal Bolton. In the Southern Sector, Wythenshawe Hospital is being considered along with Stepping Hill Hospital in Stockport.
Forcing competition instead of collaboration
Healthier Together has faced specific criticism for the way it is forcing hospitals to compete with each other to become one of the specialist centres. Andrew Foster, whose Royal Albert Edward Infirmary is competing with Royal Bolton, said: “They’ve gone to this win/lose of specialist/local hospitals, so instead of having some sort of flexibility, every hospital is now forced into a beauty parade to decide who is going to be a winner and who is going to be a loser. What has been created is a very divisive process. In south Manchester you’ll see Stockport and Wythenshawe basically attacking each other, saying ‘we’re the ones that need to be the winning hospital’. And in the North West [Sector], Wigan and Bolton have been put into the same position. So rather than having the whole of the NHS working together to solve the problems it’s essentially pitched us into an unhelpful confrontation.”
Dr Brookes defended the plans, saying they Continued overleaf >
national health executive Sep/Oct 14 | 33
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