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GM must think ‘laterally & creatively’ about funding A&E upgrades

Greater Manchester (GM) organisations will have to think “laterally and creatively” about the best way to access sufficient capital to enable infrastructure upgrades in the region’s urgent and emergency care departments, the chief officer of GM Health and Social Care Partnership has said.

In an exclusive interview with NHE at the organisation’s headquarters, Jon Rouse argued that health bodies will have to be “absolutely amazing at utilisation” in order to consolidate services “into our best space”, so that they can both release land and enhance A&E operations.

Last week, the Health Select Committee said in a report on NHS winter pressures that the STP process must include an assessment of the infrastructure investment needed to ensure that major 24-hour consultant-led A&E departments are fit for purpose. The report argued that many emergency departments are outdated and were not designed to accommodate the growing numbers of patients that the NHS sees today.

Rouse said this exact evaluation was carried out last year as part of GM’s Healthier Together, an element of the region’s wider transformation programme which focuses on the efficiency and expertise of clinical services.

“One of the things we identified in Healthier Together for the high acuity centres is what expansion in their A&E would be required, and what changes. So, for example, Oldham needs a new critical care unit next to its A&E; Stepping Hill needs extra capacity for resuscitation; Manchester Royal Infirmary needs some expansion in their A&E as well, and so on,” he explained.

“We’ve already identified what capital works would be required and we’re actually doing the business case around that now. Clearly how we then access the capital is another matter, because that is probably the one big area where we have really very little delegated authority.

“I can approve capital up to a certain level, but in terms of how we access that capital resource, we’re going to have to think laterally and creatively about how we create the required headroom to allow that investment to proceed.”

Asked whether that wouldn’t fall under GM’s £6bn devo price tag, Rouse said this money accounted mostly for ‘business as usual’, such as meeting revenue payments that go against everyday capital. But it didn’t take any account of the major funds required to achieve transformation objectives.

“We’re going to have to do a whole load of things,” he continued. “We’re going to have to be absolutely amazing at utilisation in order to consolidate into our best space, because that will obviously reduce the cost of maintaining buildings that are past their sell-by date and also allows us to release land.

“We also have to make sure that the infrastructure in the communities is fit for purpose. We’ve said that we want integrated neighbourhood hubs at a 30-50,000 population level. We have some of those, some buildings we can use for that purpose, but not everywhere. That’s going to be a medium-term task to make sure we can access the capital to pay for those as well.”

In the long-term, Rouse said there are some acute hospitals that will require a “reworking” of their clinical services strategy, but that also have “really significant” estates requirements.

“I use North Manchester as an example because significant parts of that are Victorian and will need substantial replacement, and that is obviously a very significant capital project,” he added.

Long-term finance

In terms of how the region’s overall money for health and care integration is faring, Rouse said that, in the interest of full disclosure, the GM partnership will be publishing a six-month report – hopefully by the end of November – that explains how the region is doing in terms of its four pillars: performance, quality, finance and transformation.

“Our six-month figures are actually due to go to the board this month,” he added. “If you put everything together, which we do – commissioning, provider and social care – we are slightly off trajectory, but not dramatically. It’s really tough, isn’t it – even with the big slew of STF funding going in this year, some of our organisations are still struggling to meet their trajectories.

“But again, what is good in GM is that that reality is being managed across the partnership, along with NHS England and NHS Improvement (NHSI). We’re not having two finance conversations; my finance lead, Steve Wilson, and the NHSI finance lead, Stephen Downs, are in and out of each other’s offices – they are literally a floor apart.

“There is just one finance conversation and we’re looking across commissioners, providers and indeed social care.”


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Roger Steer   07/11/2016 at 13:52

One of the reasons A&E departments need to be expanded is because other A&E depts. are being closed. It may be cheaper to keep existing A&E depts. open and increase staffing to improve quality. But no one wants to hear that. Devomanc seems to be about expensive centralisation. We cannot tell because the plans are secret. Managing reality is the new name for it , it seems. Selling the family silver another.

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