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Despite special winter fund and rigorous planning, GM A&E still failing to cope

Despite investing an extra £5m in schemes to help local health and care systems to cope with winter pressures as part of its devolution arrangements, Greater Manchester (GM) fell substantially behind its A&E target over the colder months – with only 85.9% of visitors being seen within four hours against a 95% goal.

Figures from the end of Q3 showed that even with “rigorous planning, including reducing hospital occupancies in the run-up to Christmas… extra primary care provision, increasing staffing in hospitals and extra community beds”, GM – the country’s beacon of health devolution – nevertheless experienced a period of “intense pressure” on its urgent and emergency care systems over winter.

The region’s Q3 A&E performance figure for winter was even below the national average for December 2016, which according to NHS England figures stood at 86.2%. In the preceding month, 91% of patients had been seen within four hours nationally.

GM has long been hailed as the country’s frontrunner in terms of health and care devolution, with the region receiving £6bn in devolved funding last year. When speaking to NHE a few months ago, GM Health and Social Care Partnership (GMHSCP) boss Jon Rouse told us that there was a special focus on navigating winter, with the region having been able to scoop up a few areas of underspend in order to create an extra winter fund to support A&E departments.

But its latest performance figures, published in papers ahead of a GMSCHP board meeting set for this Friday, showed that its A&E has experienced challenges this winter much like the rest of the country.

Perhaps more positively, the board papers also revealed that GM is about to embark on a “fundamental reshape” of its urgent care system, details of which are still being finalised for sharing in the coming weeks.

The region has established an urgent and emergency care taskforce and is working with a “number of systems” to support its most challenged localities.

“The taskforce involves senior leadership from across Greater Manchester’s health and social care system and is supported by the work of the Urgent and Emergency Care Network and seven local A&E delivery boards,” the papers explained. “It has aligned with the national A&E improvement plan and aims to deliver the plan’s five key areas.”

These five key areas include introducing primary and ambulatory care screening in A&E; boosting the proportion of NHS 111 calls handled by clinicians; implementing the NHS England Ambulance Response Programme; rolling out ‘SAFER’, a tool to ensure safe staffing levels, and other measures to enhance hospital flow; and implementing best practice on hospital discharge to reduce delayed transfers of care.

With regards to the latter, it has been agreed by the GMHSCP that over the next six to eight weeks, a “reset was needed” in the most challenged areas, with improvements needing to echo what has already been achieved in the top-performing systems in terms of delayed transfers.

“The most challenged areas need to consider their trajectory of achievement over this next period and put in robust plans to significant improvements. It was agreed that the most significant factor in improving discharge was a truly authoritative integrated team with strong management,” said the papers.


Andrew Durkin   22/02/2017 at 11:27

Key to the success of hospital transfer of care is strong leadership demonstrated by a person who knows the whole system! This system knowledge must include all transfer of care at critical points across all areas. It has to have the right leadership in place that understands and can change manage patient/service user flow across acute, secondary and primary care, and how none of this can function without effective well managed and commissioned social care.

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