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Stakeholder briefing – October 2013 Note from Dr Chris Brookes, As we move into an era of technological advancement, groundbreaking scientific research Medical Director As I enter my second month as Medical Director for Healthier Together I have witnessed a high level of passion and commitment from immediate and wider colleagues. This is exemplified by the many clear demonstrations of leadership focused on building the will for the necessary change, to improve clinical outcomes for patients across the conurbation. Everyone should get the right treatment, in the right place, at the right time.

Poor health, housing and lifestyle choices, unhealthy diets, social deprivation, alcohol dependency, physical inactivity and variations in life expectancy across Greater Manchester boroughs have become synonymous with our history and culture.

and improvements in medicine all of which have and will continue to contribute to prolonging life, we need to be resolute in challenging why any one of our hospitals is not meeting the clinically led specification of the Greater Manchester ‘Quality and Safety’ Standards. That said, we cannot look to the past, only forwards, while recognising the achievements of 65 years of the NHS. There must be celebration around achievements thus far (for example, the reduction in deaths from coronary heart disease) but more importantly, an acknowledgement of how much further we still have to travel. Currently, we are on a journey towards taking a major step in health and social care reform aligning the trinity of primary care, with secondary care partners and integrated community care. Continued on page 2

Main Headlines This briefing sets out updates to the Healthier Together programme for October 2013. Key areas of development include: New Medical Director sets out Healthier Together vision Dr Chris Brookes shares his passionate views about the NHS and our journey towards taking a major step in health and social care reform. [Click for more] Primary Care Summit unites over 250 professionals Over 250 primary care professionals united for the second Greater Manchester Summit to discuss the proposed Primary Care Commissioning Strategy for 2014 – 18. [Click for more] Future Model of Care bespoke briefing sessions underway Bespoke briefing sessions this month to inform and engage clinical staff from the in scope workstreams including, consultants, middle grades, nurses, healthcare professional and allied health professional representatives. [Click for more]

Chris Brookes’ Note continued… A reconfiguration of this scale has never been approached before and in seeking this system redesign we must be united and resolute in the approach being the only feasible way to raise our standards of care and improve patient outcomes. After 30 years of clinical practice, it is profoundly disappointing that a man in Greater Manchester can live 14 years longer than his neighbour who lives just a few miles away. This is both unacceptable and highly unfair. To tackle this, we have to work together and provide better and more reliable in-hospital care delivered to an agreed standard specification thereby eliminating variation in patient outcomes. Underpinning this, is the visionary concept of a ‘single service’ working seamlessly across boundaries and between organisations providing an opportunity for specialists to share their skills and experience across more than one hospital.

This approach where the ‘offering’ to patients is standardised care across a service, is addressing what patients want and where their care is both more reliable and also delivers better clinical outcomes. In addition, the alignment of health and social care will result in care being, quite rightly, closer to home for patients and also giving patients the right support to ensure they can manage their own care, while retaining some independence and dignity. To achieve this fundamental change, we need more people to vocalise their aspirations and concerns thereby shaping, refining and improving the model of care. In addition, we want patients and staff to challenge the care that is available to them if it is of a ‘low’ standard. Conversely, if something works well, we want them to speak up about it. Being vocal is important to us as we design a health and social care system that is seamless and clear, which minimises variation in clinical outcomes as well as unnecessary deaths and limits the number of patients accessing the wrong service for their needs.

Summary of activity in October

Out of Hospital – Integrated care What has been happening? As a continuation of the development of the programme, the 10 Greater Manchester localities have submitted their Integrated Care Plans focusing on providing joined up health and social care for individual needs. The plans have been discussed at the AGMA Executive and the Association of Greater Manchester CCGs meetings and much progress has been made to understand each local care plan.

What is planned? On Friday 11th October Dr Martin McShane, Director for Enhancing the Quality of Life for People with Long Term Conditions, NHS England, met Integrated Care leads from each locality to tie-in work being undertaken across Greater Manchester, offering advice from a national perspective. Discussions centred around trying to identify solutions to challenging issues as raised by locality areas.

Out of Hospital standards A set of Out of Hospital Standards are in the process of being developed with partners and members of the public from across Greater Manchester. These will bring together the common themes emerging from the 10 locally developed integrated care plans and the primary care commissioning strategy to describe a coherent offer for out of hospital care.

Integrated Care Practice Sharing Event – the third instalment is taking place on 9th December 2013. Further details to follow. This follows an initial meeting which took place in June, focussing upon sharing progress with the development of local integration plans and a second event in September which focused upon sharing progress with identified problems and challenges.

Out of Hospital – Primary care Over 250 primary care professionals united for the second Greater Manchester Summit on Wednesday 25th September 2013 to discuss the proposed Primary Care Commissioning Strategy for 2014 – 18. The Summit was also used to promote the innovative practice as seen by the successful demonstrator communities. For example plans in HMR include the provision of 25 virtual care beds in the community supported by GPs and community staff allowing safer early hospital discharge were revealed. A joint venture between NHS England and Healthier Together, the Summit welcomed optometrists, dentists, general practitioners and pharmacists across the 10 Greater Manchester localities for afternoon and evening presentations, focused workshops, Q&A sessions and displays. It gave testament to the strength within primary care currently, and showed how important it is to share skills, knowledge and experience for the continuing benefit of partners.

Primary Care Summit

[Click for more]

Out of Hospitals – Primary care Healthier Together in the media Fuelled by Greater Manchester’s initiative to drive health and social care whole system change, GP access was the focus of the national media earlier this month.

GP and Associate Director, Dr Anne Talbot, and Dr Ivan Benett featured on Channel 4 News, Radio 5 Live and Key 103 and were heralded as great examples of our clinicians being ahead of the game.

Earlier this month Central Manchester CCG hosted PM David Cameron during a ministerial visit to primary care venues. This complemented the Prime Minister’s strong support of proposing increased access to general practices and recognising the work already underway in our local areas.

We have captured some of the news for you so please open the hyperlinks below – BBC, Guardian, Sky News, The Independent and ITV

Dr Mike Eeckelaers, Chair of Central Manchester CCG, Dr Ivan Benett, central Manchester GP and Healthier Together clinical champion, Colin Tate, Practice Director and Julie Lees, Practice Nurse, both from The Range Medical Practice were present during the tour. Pulse Today picked up on Jeremy Hunt’s claim that ‘Cutting-edge GP practices here in

Manchester are leading the way, and we want many more patients across the country to benefit.’ A link to the article where Dr Ivan Benett and Dr John Hughes are quoted can be found here Coverage is a major plus to instil the message that primary care is high on the agenda and that our boroughs, along with other areas across England are piloting extended access schemes.

Also this month the Healthier Together Primary Care team will continue visits to the Local Medical Committee, Healthwatch, Health & Wellbeing Board and the Overview & Scrutiny Committee until the end of October.

In Hospital Future Outline Model of care Bespoke communications events

Key messages

The Healthier Together Medical Director and In Hospital clinical champions organised bespoke briefing sessions across Greater Manchester on 14th and 18th October to inform and engage clinical staff from the in scope workstreams including; consultants, middle grades, nurses, healthcare professional and allied health professional representatives about the Future Outline Model of Care. Additionally, the sessions will:

Key messages have been devised for inhospital care to help eliminate any confusion surrounding the proposed model. These are summarised below.

• Inform representatives of the aims of Healthier Together, the case for change and the proposed models for In and Out of Hospital care; • Gain input from representatives on the model of care for their specialty or area of work (for example, acute medicine) including more detail on pathways and workforce; • Identify staff concerns about the impact of the proposed model of care, in particular the single service; • Develop ideas and proposals about how these impacts can be managed and minimised; and • Direct staff to sources of further information on Healthier Together.

The Case for Change Currently, most of our hospitals are delivering both secondary care, such as treatment for injuries and illness, and care for the most acutely ill patients such as emergency surgery and intensive care. This has a number of consequences: Only a small proportion of hospital patients require the highest acuity care. This means some of our hospitals only care for small numbers of the most acutely ill patients. The same is true of highest acuity care. Currently we have unacceptable variation in quality and outcomes for highest acuity care across Greater Manchester. We are duplicating the same services in every hospital. For example, there are only a few patients who need emergency general surgery every night across Greater Manchester and yet each hospital is staffing a full 24/7 emergency surgery rota. This is not a cost effective use of this highly skilled workforce.

Four invitation only events take place this month, each for a different staff group as follows: 14th October AM – Consultants 14th October PM – Middle grades 18th October AM – Nurse and midwives 18th October PM – Allied Healthcare Professionals and Healthcare Scientists 8th November AM – All invitees who cannot attend events 1 – 4 For more information contact

In Hospital Future Model of care The Outline Model of Care Every hospital will deliver all but the highest acuity of care. This means these hospitals can become more efficient, for example planned surgery will not be interrupted by emergency surgery. A number of hospitals will also deliver highest acuity care - these hospitals will specialise in delivering this care improving outcomes and quality for acutely ill patients. The majority of patients will access hospital services as they do now – if they need the highest acuity of care they will be taken to the closest highest acuity site by ambulance. Hospitals will collaborate in a single service to serve a larger population. This means local services will work together – a number of local services delivering secondary care will collaborate with hospitals delivering the highest acuity care.

All hospitals will be required to adhere to the Greater Manchester Quality and Safety Standards, leading to greater equality and reliability of care for all patients, not just those receiving highest acuity care. The standards include the number of hours patients can expect care to be coordinated by an experienced consultant, seven days per week. This means an increase in the number of hours per week that consultants will coordinate care in most hospitals. In this model, hospitals will operate in a single services and all will comply with Greater Manchester Quality and Safety Standards, resulting in greater equality of care and health outcomes, providing the right treatment, in the right place, at the right time.

Watch this space: To ensure public understanding, new language to describe the hospital model of care is being tested with patients and the public. We have listened to feedback and the use of colours to describe hospital sites is no longer being used.

Transport Effective transport is essential to any successful reconfiguration. NHS commissioning groups, trusts, local authorities, transport bodies and providers, and organisations supporting people with access needs have been invited to an Integrated Care Transport meeting on 24th October to be facilitated by the Greater Manchester Centre for Voluntary Organisation (GMCVO). The day is designed for transport operators to explain their current services and share innovative ideas around how they can be enhanced. Delegates will be encouraged to join discussions around what community transport can offer health and social care need. In addition, the development of clinically defined transport standards is underway through joint working between North West Ambulance Service NHS Trust and the Future Model of Care Group.

Healthier Together Engagement Events Hearing the local voice has always been important to the Healthier Together programme and our most recent conversation with the public involved a cross section of Greater Manchester residents including patients, clinicians and political representatives coming together at the two Criteria Development Workshops. This was a fantastic opportunity for them to listen to and hear views on what criteria they felt should be used, in the future, to evaluate and compare options for delivering acute services when we get to consultation. Dr Chris Brookes walked delegates through the rationale behind the programme and the Future Model of Care narrative, highlighting the benefits of operating a single service, raising hospital standards, delivering better patient outcomes and reducing variation, and the impact on workforce.

Workshops focused on four themes; Quality & Safety, Sustainability, Transition and Accessibility which encouraged lively debate and raised many questions around various topics including staff training, patient pathways, patients being at the centre of care, transport, estates and data sharing. This is a key part of the programme as the options will form the basis of the public consultation. At a separate meeting earlier this month we briefed Rochdale Healthwatch about the Future Model of Care, enabling us to answer any questions raised by their local members and strengthened our connection to the group encouraging collaborative working.

Healthier Together in brief Healthier Together is a review of health and social care and is part of a wider public service reform, seeking to improve outcomes for all Greater Manchester residents. Why do we need change?

Greater Manchester, with a population of 2.8million, has suffered some of the poorest health in England and there is a major variation in health outcomes: up to 14 years life expectancy difference for men depending on where they live. Reasons for this include poor housing, problems with mental health and wellbeing, diet and alcohol dependency and fundamentally the quality of care they receive in their locality. What are the proposed changes?

Integrated care – local plans are in development for more joined up care that is overseen by local authorities and health and social care services.

News focus – media Last week The College of Emergency Medicine released a report following a survey to discuss the pressure on A&E which threatens patient safety. Over 1,000 consultants took part in the poll which found that 62% of emergency doctors reported their job is not sustainable in its current form.

In an interview with Key 103 Radio, Dr Darren Kilroy, A&E Consultant at Stockport NHS Foundation Trust commented “we need to keep safety at the crux of everything that we do. The fundamental premise of Healthier Together is that we get consistently safe care across the boroughs”. To read more about the story click here for BBC coverage.

Better quality primary care – standards are being set to make sure that wherever you live, your local general surgery will offer the best quality of care possible. Acute emergency care delivered in the right place, at the right time – plans are in development for changes to where you would receive the once-in-a-lifetime emergency surgery so that you will receive the best possible care when you need it most.

Get in touch There are many ways to contact us: 

When will this happen?


We are currently working with stakeholders and members of the public to develop the plans and create a health and social care system that is right for Greater Manchester.

We will consult the public on our plans in 2014 before making any final decisions.

Healthier together monthly stakeholder briefing october 2013  
Healthier together monthly stakeholder briefing october 2013