Healthier Together consultation response from The Pennine Acute Hospitals NHS Trust

Transcription

1 Healthier Together consultation response from The Pennine Acute Hospitals NHS Trust 30 th September

2 1. Why healthcare in Greater Manchester needs to change Do you agree or disagree that change is needed? The Pennine Acute Hospitals NHS Trust strongly agrees that change is needed. Our Trust shares the belief of the Healthier Together consultation that health and care services should be provided to a reliable, high standard every time for all patients. The Trust agrees that health services in Greater Manchester need to change to help make the Healthier Together goal a reality. The Trust recognises that the drivers for change are wide-ranging, and include: improving patient outcomes and service quality; providing care closer to home; responding to changing demographics and patterns of disease; reducing cost and ensuring optimal efficiency in the use of all resources; the wider public sector reform goals of reducing demand for public services; and emphasising the benefits of prevention, early intervention and selfcare. The Trust believes that the Trust s vision to be: A leading provider of joined-up healthcare that will support every person who needs our services, whether in or out of hospital, to achieve their fullest health potential, supports the general aim of Healthier Together. What do you think best care for you and your family looks like? The Trust agrees that the following principles are amongst the right ones to underpin the changes that are needed in health and social care services. These principles help form the picture of best care for all: Primary care services which are more easily accessible by patients, and which will offer a wider range of urgent and planned care services; Ensuring that there are no unwarranted variations in the quality of care across Greater Manchester, and that all services offer patients the highest quality of care; Ensuring that the NHS with its social care partners, helps people prevent or reduce the impact of long-term conditions by detecting them sooner, and improving the quality of care that they receive; 2

3 Ensuring that healthcare services in primary, community and acute services, are responsive to patients needs and are easy to access, helping England achieve health outcomes on a par with the best in the world; Integrating primary care services with community health and social care services, with the aim of enabling community services to play a stronger role in healthcare provision and prevention; Concentration of specialised expertise in a small number of centres, especially for complex emergency surgery; and Ready access to urgent care services for medical emergencies wherever patients live. The Trust has demonstrated its commitment to these principles in a wide variety of ways including through its new vision, which is to be: A leading provider of joined-up healthcare that will support every person who needs our services, whether in or out of hospital, to achieve their fullest health potential. Examples of the Trust s commitment to these principles include: We have implemented the most significant recent service reconfiguration in Greater Manchester over the period to create a single service model across the North East Sector of Greater Manchester by delivering services across 4 hospital sites within a single Trust service and governance model. We have undertaken a major programme of concentrating our own expertise in specific clinical areas, e.g., acute stroke care and cardiac at Fairfield General Hospital (FGH), breast services at North Manchester General Hospital (NMGH), vascular surgery and haematology at The Royal Oldham Hospital, with single teams providing services across our sites and the North East Sector. We have also centralised elective Gynaecology services on a single site as a centre of clinical excellence. We have invested 11m in expanding and modernising our three A&E departments and one Urgent Care Centre across our four hospitals. This has involved redesigning and implementing reformed urgent care services across our footprint, using a model of care closely in keeping with much of what is proposed by Healthier Together, e.g., the urgent care centre and clinical assessment unit at Rochdale Infirmary, the walk-in centre at North Manchester General Hospital and the inclusion of GPs in Accident and Emergency Departments. The success of this model in effect, as we shall seek to demonstrate, a single service across a multi-site Trust with a single catchment area is one which we believe has implications for Healthier Together s proposals as a whole, implications, which this response explores further in section 4. 3

4 We continue to progress an active programme of modernisation and change for our clinical services, for example our urgent care services at North Manchester General Hospital which are now closely integrated with social care services and with community services in the North Manchester Clinical Commissioning Group (CCG) locality. We have worked closely with key partners across our four site footprint to implement integrated care arrangements. Of particular significance is our work in North Manchester where we have worked with partners including Manchester City Council and North Manchester CCG to design and implement the Living Longer, Living Better integrated care programme. This has generated clear evidence of reduced hospital admissions and better community services for local people as well as improved experiences and outcomes for patients who require hospital inpatient stays. We are also working closely with North Manchester CCG and Manchester City Council as we shall note later on plans for a health campus at North Manchester General Hospital and have just agreed plans for a new intermediate care facility on the site, the first phase of which is a 5m investment in this current year. We believe all of these plans are aligned to Healthier Together. We have demonstrated a flexible approach to hospital design and use, based on a clinical model, making best use of skilled clinicians and physical resources, and optimising patient access to care including specialist care. In so doing, we have created many services of which local commissioners and local people are proud, for example, the state-of-the-art day surgery service, urgent care centre and clinical assessment unit and the Oasis Dementia Unit at Rochdale Infirmary. Our refurbishment and expansion of the Accident and Emergency Department at The Royal Oldham site prepares us well for the Healthier Together proposals. Within our existing 4 hospital footprint we have, therefore, already achieved single services across sites under a single governance arrangement and have developed a model which we believe Healthier Together is trying to replicate in other sectors. Under current arrangements we have achieved an urgent care centre model on one site at Rochdale; general hospital services in North Manchester; are moving to a more acute hospital model in Oldham which has been designated a specialist site under Healthier Together; and at our Fairfield site we no longer do emergency surgery (and are moving to more elective services) with enhanced specialist medical services. We have invested 20m in establishing a modern centralised pathology facility at The Royal Oldham Hospital and have invested 44m to enable successful implementation of the Making It Better reconfiguration for Women & Children s services at The Royal Oldham and 34m at North Manchester General Hospital. We are also developing our integrated care offering as part of the Trust s Clinical Service Transformation Programme. 4

5 A summary of our performance against a number of the key Healthier Together targets we believe demonstrates that operating a single service model, such as the Trust does, is aligned to Healthier Together. In fully implementing the changes that are required to Greater Manchester s health and social care services, the Trust s experience and expertise will be invaluable. Healthier Together in the North East sector can build on the significant, successful, transformation which the Trust has already undertaken; our Trust is, therefore, particularly keen to be engaged actively in the design and delivery of the healthcare services which will emerge following the Healthier Together consultation. In your opinion, how can we move from where we are now to the best care? The Trust believes that, in moving from where we are now to the best care a number of important steps must be taken. First, effectively functioning integrated health services need to be in place ideally prior to, and certainly no later than, the implementation of major change to hospital services. Our experience shows that good relationships between organisations and individuals, good planning and design led by clinicians including nurses and allied health professionals, together with appropriate contractual and underpinning financial arrangements are the bedrock on which successful system change occurs. Where these characteristics are present, as in North Manchester, significant change to health and social care utilisation can occur and patient outcomes can be improved. We believe that the model of community services within specific localities is of real importance in calibrating the impact of integrated care arrangements. It is our view that the integration of community health services within acute trusts such as in North Manchester is an efficient and effective model which enables streamlined patient pathways. We are very supportive of models in which primary, community and secondary care are integrated along care pathways. Second, primary care services need to be remodelled at the same time as integrated care and hospital changes are made. Our experience suggests that the historic model of general practice does not lend itself to the changes that are required for the future. GPs, we believe, need to be able to see more patients, sooner, and to be able to offer them a wider range of high quality services, if major hospital change is to be successful. We recognise that GPs are already considering the opportunities to develop new organisational forms within the North East sector, and we believe that this work is encouraging and should be supported. We recognise that the creation of new forms such as GP federations may be important to underpin the achievement of new primary care standards, whilst at the same time we also recognise that the NHS as a whole will need to review the facilities and buildings available to GPs. We acknowledge that, although there are many visionary GP leaders and examples of forward thinking practice across our 5

6 footprint, much ground needs to be covered by GP and primary care development in many areas if primary care services are to be in place where and when they are required, appropriately staffed by the relevant professionals. Third, local planning and service design needs to be undertaken effectively and properly, engaging all of the right stakeholders and a wide range of disciplines and professionals. We recognise in this context that the Healthier Together consultation is a step on a longer journey and not an end in itself. However, we are concerned that Healthier Together may not be sufficiently ambitious at this stage, for example in the configuration and number of specialist hospitals, and we would be supportive in principle of a more ambitious programme. Once the consultation has concluded and the CCGs of Greater Manchester have made their decisions on the outcome, local health and social care communities will have a major task of detailed design and implementation ahead of them. This will require significant clinical leadership and technical support, as well as the development or maintenance of effective and wellfunctioning relationships between key partners. Plans will need to command clinicians confidence, local people s belief, and of course will need to be financially affordable. Plans may well also need to be tested by extensive further local public and patient engagement, and consultation. We understand and support the principle that primary care and integrated care services should be planned at local level, rather than at Greater Manchester level. However, we are keen to ensure that this planning commences in earnest as soon as possible, as the effective strengthening of primary and integrated care services is essential to the success of the planned changes to hospital care envisaged by Healthier Together. In addition, it is important that a Greater Manchester overview is not lost if we are to meet the financial challenges of tomorrow and have truly integrated services. For our Trust, as we imagine is the case for many other providers, we are already building on our recent transformation and reconfiguration by working with our local CCGs through our NE sector transformation steering group to plan and model a future service portfolio that is clinically and financially sustainable. This pre-existing task needs to be closely linked to, and aligned with, the outcome of the Healthier Together consultation and, of course, the wider public sector reform programme. In short, therefore, the conclusion of the Healthier Together consultation will only bring about effective change if detailed planning and implementation is achieved at local level, if proposed changes take into account current work that is underway and if it builds on successful previous change and models currently in place. Change will take time, resources and commitment from all partners and will also be a complex process in a complex and changing environment. 6

7 2. How primary care is changing Do you agree or disagree with the primary care standards? The Trust tends to agree with the primary care standards, but is concerned that they are unachievable and unaffordable without significant, possibly radical, change to Greater Manchester s primary care services. If you disagree with the primary care standards, please tell us why. As we have noted in our response to section 1, the Trust recognises that primary care services and GPs in particular will play a major role in enabling the models set out in the Healthier Together consultation to be achieved. Same day access, 7 days a week, supported by diagnostics, will be essential, as will anticipatory care planning for people with long-term conditions. However, it is inescapable that the standards set out in the Healthier Together consultation document are very challenging indeed to achieve. Our Trust would therefore like to have more confidence that these challenges were not only being addressed comprehensively, but also that tangible progress was being made at the scale required to enable wider change within the healthcare and hospital systems in Greater Manchester. 3. How we are joining up care Do you agree or disagree with our proposals for a joined-up health and care systems, delivered in the community where clinically appropriate? The Trust strongly agrees with the proposals for integrated care. However, we are concerned that more progress needs to be made in integrated care arrangements and that some aspects of the proposals within the consultation document are not clear. The rationale for integrated care set out in the Healthier Together consultation, and the clear evidence of patient and professional dissatisfaction with arrangements which are not integrated, is fully supported by our Trust. We have demonstrated our commitment to integrated care across our footprint, in localities where we are the main provider of community health services, and in localities where we are not. We have clear evidence of the impact integrated care arrangements can make on clinical outcomes, and on resource utilisation. However, these benefits are achievable only through close co-operation amongst partners, careful clinical service design, and the investment of considerable resources. These conditions exist variably across Greater Manchester and it is essential to the achievement of Healthier Together that every locality is as good as the best in integrated care arrangements. 7

8 In respect of the clarity of some of the proposals for integrated care set out in the consultation, we recognise that there are some goals which have been aspirations for health and social care services for several decades (e.g., eliminating duplication of assessment processes). However, some specific concepts within the Healthier Together consultation are in fact capable of broad interpretation and it would be useful to know if this permissive approach is encouraged by Healthier Together, or whether beneath each concept is a more detailed, standardised design. Two concepts where this applies in particular are the single point of contact, and the locally-based team. Individual localities, including within our own footprint, are in the process of establishing single points of contact and arrangements for integrated, locally-based teams. Each application of these concepts is different in one or more ways, and is intended to match local needs as well as possible. It would be useful for the Healthier Together programme to be clear, perhaps at the point of final decision-making, that this broad approach is the right one and that it is not, say, the intention of the programme to generate standardised models in the future. As we noted in section 1, we support the principle of local determination of primary and integrated care arrangements, and explicit support for this approach from Healthier Together would be valuable. For our Trust, as a provider of integrated care, we would want to draw attention to the progress made in improving health and social care services across our footprint, especially in North Manchester where we provide community services. We can evidence, that we have been able to make significant improvements to patient care and to the ways in which resources (people, buildings and money) are used in North Manchester to better effect than hitherto. We believe that these gains have been very valuable, and are recognised and supported by key partners. Following co-location of health and social care teams the excessive longer length of stay for NMGH has seen an impressive decrease. April 11 to September 13 has shown the following reductions: 56% reduction in patients with los > 15 days 52% reduction in patients with los > 30 days 61% reduction in patients with los > 60 days 83% reduction in patients with los > 100 days Following medical reconfiguration and the above reductions in length of stay the teams have also been able to demonstrate a reduction in readmission rate averages year on year from 13% in 2011/12 to 11% in 2013/14. 8

9 The integrated health and social care Crisis Response Team has prevented approximately 600 admissions in its first 6 months, against a predicted annual admission avoidance of approximately 800. As we shall note in more detail in section 4, we would be very concerned if this success was undermined or put at risk by future configurations of acute single services whereby North Manchester General Hospital became part of a single service centred outside of our Trust. Equally, we would not wish the current single service model across the four hospitals in the Trust, or the single governance arrangements underpinning these, undermined by any changes in configuration. It would seem odd to deconstruct across one footprint something that is already successful to only try and replicate it across another footprint with the consequent organisational change and disruption that this would incur. Finally, we would like to take the opportunity to draw attention to the importance of the transformation of the health and social care workforce across the whole of health and social care, especially in integrated care. We are keen to work in partnership with the wider health system to offer pathways for hospital staff to develop new skills and roles that best support community and integrated services. We would seek encouragement from Greater Manchester CCGs for providers to work together with Health Education North West to design flexible ways of developing and retaining, our highly skilled staff. Do you agree or disagree that children and young people should be cared for closer to home where appropriate? The Trust strongly agrees with the principle that children and young people should be cared for closer to home where appropriate. It is our view that integration between children s community services and hospital services is best done, as it is for adults, between community services and the acute provider. We would encourage children s commissioners to consider our experience in this field. We note that the development of future children s service models is likely to be a complex new planning workstream which is complementary to but separate from Healthier Together. We also note that similarly complex planning workstreams around mental health, as well as around matters directly considered by the Healthier Together consultation (i.e., integrated care and primary care) will need to be initiated at local, or conurbation level, dependent on the issue. We recognise that whilst change is essential and vital in all of these areas, the resulting strategy and planning challenges are very considerable and carry with them a range of risks, including system destabilisation and delay. 9

10 4. How hospital services could change Do you agree or disagree that: Hospital services need to change to meet the quality and safety standards and provide the best care for you and your family? The Trust strongly agrees that hospital services need to change to meet the quality and safety standards and provide the best care for you and your family. Providing specialist care at a smaller number of hospitals will raise standards of care to achieve the quality and safety standards? We agree that providing specialist care at a smaller number of hospitals will raise standards of care to achieve the quality and safety standards though other important factors are involved. Doctors and nurses should work in teams that provide care across specialist and local general hospitals as part of a single service? We strongly agree that doctors and nurses should work in teams that provide care across specialist and general hospitals as part of a single service. Do you think there is another way to provide hospital services to meet the quality and safety standards? We accept the analysis undertaken by the Healthier Together programme which shows that no hospital in Greater Manchester currently meets all of the quality and safety standards identified by the programme, and we therefore accept that change is required in order to ensure that the standards are met, everywhere. In general, as we noted in section 1 above, we support the principle that specialised care is best delivered in specific centres of expertise rather than distributed widely across a healthcare system. We do not feel however that the concentration of specialised services at a smaller number of hospitals in and of itself raises standards of care; rather, it is a condition in which standards of care can readily improve where other factors are in place. In other words, improvements in standards of care come from well-trained and well-motivated clinical teams who have patients at the centre of their practice, and who are supported and resourced by the organisations for which they work to practice the highest standards of clinical care. Undoubtedly, the concentration of expertise plays a vital role, e.g., in ensuring that clinical teams have appropriate levels of experience of assessing and treating 10

11 specific conditions, but those teams also need to be well-led, to be professionally committed to their work, and to be able to operate within a culture, organisational and governance infrastructure that gives them what they require to work at the highest standard. It is our clinically-informed view that alongside specialisation, the Healthier Together programme also needs to consider raising the bar of standards for clinicians, clinical teams and the care they provide, across Greater Manchester. This is especially the case, of course, where performance or clinical outcomes are less than patients should expect. We believe that demanding higher standards where there are shortfalls at present should be accompanied by a policy of rewarding success, and not failure. In other words, we would want to see the investment of any new resource, on services which have proved themselves to be successful and effective. We would like to see Healthier Together incentivising success, and making failure unrewarding. These observations underpin our earlier comments that the Healthier Together consultation is a step on a longer journey and not an end in itself. However, as we also noted, we are concerned that healthcare in Greater Manchester needs to make radical change. Agreeing how many hospitals will become specialised hospitals, and which ones they will be is only a step. The design, planning and execution of change management plans to turn these agreements into reality will be complex and multi-faceted. They may also mean that, for a period, there is elevated, rather than lowered, risk within Greater Manchester s clinical services. The changes will certainly require excellent clinical, workforce and financial planning but also close attention to organisational development, organisational culture and further consultation as appropriate. Single service In respect of the single service or single team proposals, we must first of all state that the concept as it is put forward in the consultation document lacks any great detail. We recognise that some quite significant further information is included in the pre-consultation business case (PCBC). We are concerned that the proposals and designs as described in the PCBC have not been explicitly put out for public consultation, as they have potentially very significant impacts on the provider landscape within Greater Manchester and which may have escaped public attention and scrutiny. We are concerned that the validity of any decisions about the single service, which relies on information contained only in the PCBC, may be at risk of successful challenge following the conclusion of the consultation process. We do understand, nevertheless, the challenges the Healthier Together team have faced in finding a balance between an accessible and understandable consultation documentation, and presenting the wide range of technical detail on which the consultation proposals rest. Turning to the content of the proposals, we understand the concept of a single service as set out in the consultation document and in the PCBC to be, in 11

12 effect, the combining of clinical teams across an agreed geographical area, covering emergency departments, general surgery, anaesthetics and critical care. The PCBC states that these clinical teams would have a single performance framework, governance and accountability framework, and training and education programme (PCBC, part 1, page 65). In the case of the Trust, we believe that we already operate a single service across our four hospital sites within our current footprint, and that in important respects the model of service which we have developed over several years underpins much of the Healthier Together clinical model. Our Trust is unique in Greater Manchester in operating a single service across four sites with a population in excess of 820,000 people; no other Trust or configuration of Trusts has achieved this in the Greater Manchester conurbation. The development of our single service has taken much hard work and effort on the part of a wide range of clinicians and staff, and it is an achievement of which we are very proud. Specific achievements of our single service include: Creation of a joined up model of single service hospital provision through two hot emergency sites supported by an emergency medical and elective surgery centre at Fairfield General Hospital and the integrated care hub and specialist day surgery centre at Rochdale Infirmary. A reduction in our Hospital Standardised Mortality Rate from 2003/04 to 2013/14 from to 82, i.e., 1,332 lives saved in 2013/14 alone. Creation of an urgent care centre and clinical assessment unit in the context of an integrated care hub in Rochdale. The development of a high-performing stroke and cardiovascular centre at Fairfield General Hospital. Implementation of a hot-and-cold model for orthopaedic surgery. Significant financial savings through transformation of the Rochdale Infirmary and Fairfield General Hospital sites. Centralised interventional and diagnostic cardiology on the Fairfield General Hospital site. One site for elective and non-elective gastroenterology. We believe that our single service, working across four hospital sites, and serving a population of 820,000 can readily and successfully flex to accommodate the changes proposed for our hospitals within the Healthier Together consultation. Under the Healthier Together proposals, the Trust will have one specialist hospital (The Royal Oldham) and two general hospitals (Fairfield General and 12

13 North Manchester). As such, the Trust would meet the 1:2 ratio described in the PCBC (Part 2, p. 85) for specialist: general hospitals. We note in this context agreed between the Trust, its commissioners and the Healthier Together team that Rochdale Infirmary is outside of the Healthier Together consultation and does not count as a general hospital for single service purposes. SPECIALIST & GENERAL V V V V V Fig. 1. The single service across the hospitals within The Pennine Acute Hospitals NHS Trust To underpin the single service within our own footprint, we currently have in place, uniquely in Greater Manchester: A single accountability framework through our clinical, professional and managerial leadership structures, which report ultimately to our Board of Directors. A single governance framework for clinical and non-clinical components of our service, including a single Quality and Performance Committee and Audit Committee, each chaired by a non-executive director. A single performance framework, with integrated performance reporting from all sites and services. A single training and education programme across all services and sites, for each professional group at each stage of their training, working closely with the North West Deanery for the training of junior doctors, and in the context of our Trust-wide education and training strategy. A highly effective capacity management system which enables us to flex both medical and surgical capacity across our hospitals to meet both planned and unanticipated changes in patient demand. For example, we are able to transfer elective day-case surgical activity 13

14 from the Royal Oldham Hospital quickly and effectively to Rochdale Infirmary, where emergency surgery demands require it. We can build on our experience of doing this, and of minimising patient inconvenience, to support a wider corridor. A close relationship with the North West Ambulance Service NHS Trust to direct patient flows around our hospital emergency departments to spread demand and to optimise clinical appropriateness. These arrangements cover all Trust services including the hallmark services of emergency departments, general surgery, anaesthetics and critical care. We believe that the effectiveness of our arrangements is evidenced by our current performance against key NHS performance goals. We believe that the single service already operating within our Trust boundaries can be further enhanced under the changes proposed for our hospitals by the Healthier Together consultation. As part of our current clinical service transformation plans, we are keen to further develop our medical services within Fairfield General Hospital, building on our excellent stroke centre and extending and enhancing our Trust-wide cardiology service, to be based at Fairfield. We will ensure that appropriate critical care facilities are available at the site, and we intend to enhance rehabilitation and other post-acute medical services at Fairfield such that it continues its trajectory to become a regionally recognised centre of excellence. We note that these changes will be of particular benefit to patients of both the metropolitan boroughs of Bury and Rochdale, as broadly half of Fairfield s patients come from each borough. We are additionally developing the North Manchester General Hospital service as a local health campus, a development which is commencing with the commissioning of a 24-bed intermediate care unit on the North Manchester site. We anticipate the retention, following the Healthier Together consultation, of the wide-ranging suite of existing services on the site, except for emergency surgery which will transfer to The Royal Oldham Hospital. We expect to continue to develop the specialised services which are currently situated on the North Manchester site. Across all of our sites, we will welcome the opportunity to develop or host community services both from the NHS and social care. We recognise, that Healthier Together will contribute to significantly changed patient flows as hospitals across Greater Manchester change role and their service portfolios. We also recognise that change will arise from demographic and epidemiological factors, as well as from the exercise of patient choice. We recognise in particular that these factors are of relevance for patient flows from Tameside General Hospital to The Royal Oldham Hospital. We are in fact already seeing some evidence of changing patient flows driven not by planning and strategy, but by patient choice, e.g., patients from other areas choosing to come to our hospitals. 14

15 Our Trust is clear that any arrangement which breaks down the existing single service and the governance and clinical model within which it operates may introduce significant risk for patients. This is because it could reverse considerable progress already made in implementing the very model Healthier Together is proposing, and would create disintegration and/or duplication. In addition, such an arrangement could create the following problems: More complicated patient flows and access. Duplication of governance systems and create governance issues where none currently exist (e.g., wards on the same site being subject to more than one Trust s governance arrangements) with resultant complexity and considerable extra cost. Compromise of the integrated information management and technology (IM&T) arrangements which we are successfully putting in place with partners in primary care and community services, and which significantly underpin the quality and safety of our services by offering key elements of a single patient record. The necessity of establishing a potential joint venture and the complexities that this involves. We are therefore concerned that any breakdown of our current single service model could lead to a greater degree of risk. As we have indicated, however, we do recognise that a number of factors including the outcome of the Healthier Together consultation will influence future patient flows across our boundaries, and we very much want to contribute to meeting the needs of these new patients in an effective and high quality manner. In particular we recognise that there is a growing relationship between our Trust and Tameside General Hospital. This is partly created by the exercise of patient choice, but also by the desire of both Trusts to develop common clinical pathways and to find means of achieving economies of scale. We are currently exploring a number of joint clinical appointments with Tameside Hospital NHS Foundation Trust. We have already made plans in principle to reconfigure our emergency surgery work, centralising all emergency surgery on The Royal Oldham Hospital. We have modelled likely emergency patient flows from Tameside and we are satisfied on the basis of our modelling that we can provide and maintain sufficient capacity to meet patients needs, achieve performance targets and, critically, provide high quality, safe care. Over time, driven by local commissioning expectations, it is possible that Tameside Hospital may become an integrated care organisation (ICO) with a service modelled on lines similar to Rochdale Infirmary. On this basis, we would be keen to explore further links with Tameside as appropriate. 15

16 In summary, the Trust: believes that we already operate a successful single service across our four-hospital-site footprint. This single service is based on a robust governance and operational model under the leadership of one Trust Board. We believe that this service can flex successfully to accommodate the changes proposed for our hospitals in the Healthier Together consultation. would be concerned that any reconfiguration which had the effect of destabilising our successful single service or introducing duplication is not in the best interests of local people. Please rate how important you think the following criteria are using a whole number between 0 and 10, where 10 means that the criteria is critically important and 0 means the criteria is of no importance Quality and safety Travel and access Affordability and value for money Transition i.e., how easy it will be to achieve the changes How would you prioritise between the following two options? Being treated in my local hospital Travelling further to receive <> the best specialist care Don t know Do you think that there should be FOUR or FIVE specialist hospitals? As we have commented previously, we are concerned that moving to 4 or 5 specialist hospitals across Greater Manchester may be insufficiently radical. However, should it not be possible to move to 3 at this time, we would support 4 specialist hospitals. Our rationale for this preference arises from the interests of patients flowing across services and from cost, quality, efficiency, and deliverability. Please indicate which option you prefer by writing 1 in the box alongside your first preference, and writing 2 and 3 alongside your second and third choices if appropriate Our strong preference is if there is to be a fourth specialist hospital, it should be located in the southern half of the city region, and we therefore prefer option 4.4 (first preference) or 4.3 (second preference). Please tell us why you prefer this option and provide any other comments that you would like to make. 16

17 In order to support cost, quality and patient flow, our preference is for the fourth specialist hospital to be designated in the southern sector of Greater Manchester. We do wish to acknowledge that we are delighted that The Royal Oldham Hospital is recognised as a specialist hospital and that the successful model that has been implemented, with partners, at Rochdale Infirmary, has been recognised. Overall conclusion The Trust welcomes the proposals within the Healthier Together consultation, whilst accepting that they are high level and in many cases the starting point for a journey, not its end. The Trust has a number of concerns, most particularly over the application of the concept of single services, and would in particular wish to ensure that any reconfiguration did not undermine or duplicate our current four-hospital-site model with its integrated governance framework, or risk its performance with consequential detriment to patient outcomes and quality. 5. Information about you What is your full postcode? M8 5RB If you are responding on behalf of an ORGANISATION, which organisation do you represent? The Pennine Acute Hospitals NHS Trust. We are the main acute healthcare service provider for the boroughs of Bury, Oldham and Rochdale, and for the northern locality of the city of Manchester. We are also the integrated acute and community care provider for the northern locality of the city of Manchester. This response has been prepared from the views of our senior clinicians and senior management team, and has been approved by our Board of Directors. 17