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Consultants fight plans to centralise emergency surgery in Manchester

More than 100 consultants at a major Manchester hospital have objected to plans to move emergency general surgery to another trust.

The Medical Staffing Committee at Wythenshawe Hospital, part of University Hospital of South Manchester (UHSM) NHS Foundation Trust, voted unanimously last night to pen a letter to the trust’s chief executive objecting to the plans, because of the detrimental effect they could have on other services.

The proposed changes are part of a deal between UHSM and Central Manchester University Hospitals NHS Foundation Trust (CMFT) to create a network of hospitals each specialising in a particular type of care.

They would see serious emergency surgery centralised at Manchester Royal Infirmary – part of CMFT. Some vascular services could also be moved from Wythenshawe, with the specialism divided between the two hospitals.

Both Wythenshawe and Manchester Royal would retain their A&E departments and Wythenshawe would still perform non-emergency general surgery. Emergency patients would instead be taken to Manchester Royal.

The proposals are in response to the Healthier Together consultation to redesign hospital services in Greater Manchester. The controversial scheme’s focus is on creating a ‘single shared service’ for general surgery, with high-risk emergency surgery only performed at centralised sites.

A similar plan has already been proposed for the north west of the conurbation, by Salford Royal and Wrightington, Wigan & Leigh NHS FT that will see emergency surgery centralised at Salford.

Trusts are keen to make their own arrangements before the results of Healthier Together are announced shortly and imposed on them.

A spokeswoman for UHSM and CMFT said: “As two of the major university teaching hospitals in Greater Manchester it makes sense to work together to improve services and clinical outcomes for our patients, and to also facilitate opportunities for our clinical workforce to innovate and create leading clinical models of care.

“One aspect of the partnership agreement has outlined a proposal for shared service models; one for general surgery and one for vascular surgery.

“The partnership has been welcomed by our local clinical commissioning groups, the University of Manchester and Manchester City Council.

“This partnership further strengthens the services UHSM and CMFT offers to patients and we are fully committed to ensuring our local population continue to receive safe and high quality care.”

The consultants at Wythenshawe say that the changes are not in patients’ best interests and they are urging the trust board to put the move on hold while discussions continue on a better way to collaborate.

The doctors are worried that the lack of a helipad at Manchester Royal will inhibit the ability of those needing emergency surgery to get there in time.

They have also expressed concerns that losing acute abdominal and vascular surgery could lead to a loss of surgeons and other general surgery capabilities. It could also affect other services in the hospital.

These were worries that were also expressed by the trust’s chief executive to NHE during the Healthier Together consultation last summer. Local MP Kate Green was also worried about the changes.

Green 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.

“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.”

Dr Attila Vegh, chief executive of UHSM, echoed these fears. At the time he told NHE that he 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 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.”

The Committees in Common, made up of representatives of Manchester’s CCGs who are driving the change, will meet on Wednesday to discuss plans and decide how many ‘single services’ there will be.

Next month, a second meeting will decide where the services will be located. The collaborations between UHSM and CMFT, and Salford and Wigan, will factor into this.

Ian Williamson, senior responsible officer for Healthier Together, said “A number of providers are currently having discussions about how they could possibly deliver a single service.

“As part of the Healthier Together process, we asked providers to look at how they could best deliver single services to improve quality and safety standards across hospitals.

“This discussion between UHSM and CMFT is encouraging as it demonstrates provider support for the single service model.

“Such discussions between providers are one of the inputs being considered however the decision lies with the Committees in Common and no decision about locations has yet been made.”

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