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HEALTHIER TOGETHER
were about bringing hospitals closer together and having them work in concert instead of in silos as they currently do.
Interdependent services
Another area of concern is the knock-on effect of losing emergency general surgery and how this might affect other services offered by the hospital. Kate Green (pictured below), Labour MP for Stretford and Urmston, said: “The specialisms and the availability of emergency surgery and all the acute provision are interdependent. If you go in for one particular condition it’s likely you might need to draw on different specialisms, there may be an unexpected turn of events that means there needs to be an emergency response.
services that we provide, and it is only major emergency services that are under review, the longer-term unintended consequences of not being recognised as a specialist hospital would inevitably mean that our ability to retain and enhance our specialist services could be compromised.
“This has not been fully understood – what sort of strategic implications it would have. Also, the retention and recruitment of the specialist staff needed to maintain and enhance these highly specialised services like cardiac, thoracic, transplant, breast, and burn and plastic services, for which we are a regional centre of excellence with a very strong tertiary presence, could be also compromised.”
Recruitment and retention
The issue of retaining and recruiting staff is one that worries many of the chief executives who face the possibility of becoming a ‘local’ as opposed to ‘specialist’ hospital.
Dr Jackie Bene, chief executive of Bolton NHS Foundation Trust, believes the branding of “specialist” and “local” will be detrimental to those who are local hospitals and make it tougher for them to recruit and retain consultant staff in particular.
Consultation concerns
“You can’t take out one element of what is available without considering what the impact might be on specialisms that ostensibly aren’t being touched, but in fact wouldn’t be viable without other things being on site. And I haven’t seen any holistic analysis of how Healthier Together could damage that, it doesn’t seem to have been considered.”
This worry was echoed by Dr Attila Vegh, chief executive of University Hospital of South Manchester NHS Foundation Trust, who believes that losing out on specialist status in the consultation could affect many of the other highly specialised services available at Wythenshawe.
He said: “While the Healthier Together consultation is not about the specialist
34 | national health executive Sep/Oct 14
In addition to its actual proposals, Healthier Together has been criticised for the way the consultation is being handled. It is currently running for a 12-week period from July until the end of September. Twelve weeks is the recommended minimum for a consultation, according to the Government Code of Practice on Consultation. However, if a consultation is particularly complex, as many argue Healthier Together is, or if it takes place at a time when consultees are less able to respond, such as Christmas or summer, the guidelines say a longer period of consultation should be considered.
In a Parliamentary debate on the subject, many Greater Manchester MPs spoke out against the consultation process, including Mike Kane, David Nuttall, Kate Green and Graham Stringer. They believe there is little democratic input, with most of the decisions already being made. Lisa Nandy, MP for Wigan, said to NHE:“The main worry is the lack of democracy; decisions which will shape the future of health services across our region are being made by unelected officials, with no transparency or accountability. Information is not easy to get hold of and the consultation document itself is hard to understand. If the idea is to get the
general public engaged with this process then there is an awful lot of work yet to do.”
The lack of public engagement is a point many of the MPs have made. When asked about it Alex Heritage, programme director for Healthier Together, said that the Committees in Common (made up of representatives from all 12 CCGs in the region, who are leading the review) received a mid-term report on the level of response and that more than 4,000 documents or online responses had so far come through. With an affected population of over 2.7 million, that means barely 0.1% of the population has responded.
Events are being held around Greater Manchester to engage the public on the proposals, but many have had been poorly attended. Kate Green, who has attended several of these events in her constituency, said: “I’m very concerned that the public seem to be very unsighted on this consultation process. I was at a meeting with members of the local Parkinson’s support group, people who obviously very heavily rely on NHS and social care services, many of the people there didn’t even know about the consultation or the Healthier Together proposals at all. The meeting that took place in Trafford was very, very thinly attended and I understand that’s been true in other parts of Greater Manchester.”
The lack of engagement leads many to believe that the decision regarding the proposals has already been made. When he thinks about Healthier Together, Andrew Foster is often reminded of a quote he saw on Twitter: “It said ‘The purpose of consultation in the NHS is to find support for a decision that’s already been made’. That’s very much the way this particular one looks.”
Healthier Together responds in more detail to concerns about the consultation and engagement on page 35.
FOR MORE INFORMATION
The consultation runs until the end of September at: W:
healthiertogethergm.nhs.uk
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