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Manchester proposes single trust for hospital services

Central Manchester’s three hospitals will be united in a single NHS trust, under new proposals being considered by the city council.

Papers submitted to the council’s health and wellbeing board ahead of a meeting on 8 June confirm that it has completed two stages of a review of the proposal to create a partnership between Pennine Acute NHS Trust, Central Manchester University Hospital NHS Foundation Trust and University Hospital of South Manchester NHS Foundation Trust.

The proposed benefits of the partnership include reducing healthcare inequalities and service gaps within the city, standardising care pathways, recruiting more specialist staff and improving use of estate and data.

Reform needed to address health inequalities

In a letter to Sir Richard Leese, chair of the health and wellbeing board, Sir Jonathan Michael, who led the review, warns that there is currently “an unacceptable level of variation” among Manchester’s health services.

“Patients who live within 10 miles of each other, and who have the same severity of the same condition, are less likely to survive, or more likely to stay in hospital for an unduly long time, depending on where they live and the part of the system that they first attend,” he says.

“The city’s health services are facing a number of significant challenges. Health outcomes for the population are generally poor and in many instances are the worst in the country. All hospitals in the city are facing staff recruitment difficulties, and existing financial pressures and future efficiency requirements are significant.

“Without action this situation is only likely to worsen. To maintain the status quo in the way hospitals work would result in a failure to deliver the Manchester Locality Plan, which clearly identifies that there needs to be a marked change to the way that health care is delivered within the city. I do not believe that you can expect the existing organisational arrangements to deliver this change.”

He added that the introduction of a single hospital service within the city will not only address the existing variation in services but will also help to tackle some of the other challenges that Manchester is facing.

“The model of separate trusts, delivering similar services in competition with each other, has demonstrably failed to deliver improved quality or efficiency,” said Sir Michael.

The second stage of the review recommends establishing a new NHS trust to bring the existing trusts together as the best solution.

However, Sir Michael warns that this “is no small undertaking” and will require significant management capacity and resources.

The partnership is one of three pillars of the Manchester Locality Plan and will be used to help deliver the council’s health and wellbeing strategy, which seeks to address issues such as mental health and older people’s health.

Trusts support proposals but raise need for review

The three trusts expressed support for the proposals. Central Manchester Trust said it was “fully committed to delivering a single hospital service in Manchester”, while Barry Clare, chair of University Hospital of South Manchester, said in his response: “We are convinced that major, system wide change is needed to establish the underpinning organisational arrangements that will enable us to realise, in an efficient and timely way, the benefits you described.”

However, Jim Potter and Sir David Dalton, the chair and chief executive of the Pennine Acute Trust, cautioned that a review was needed on the impact of the proposed single service on the populations of Rochdale, Bury and Oldham, which the trust also serves.

They also said that the new model should be implemented with care to avoid a negative impact on recruitment and retention.

At the start of April, Greater Manchester became the first region in the country to have its health and social care budgets devolved to the local authority.

However, another centralisation proposal, which would have seen emergency surgery moved from University Hospital of South Manchester to Central Manchester University Hospital, was rejected by surgeons at the hospital last year.

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