June 2014

Delivering solutions to the current challenges

facing hospitals

Manchester Academic Health Science Centre is a partnership between The University of Manchester, our Trust, Manchester Mental Health and Social Care Trust, Salford CCG, Salford Royal, The Christie and University Hospital of South Manchester.

• Inconsistent adherence to existing clinical/patient standards and pathways of care

• Significant variation in clinical outcomes and the growing transparency in publication

• Move towards 24/7 and consultant delivered care

• Lack of workforce availability in key specialties and areas

• The overall financial settlement

• Increasing concentration of specialised services into fewer providers

• Integrated models of health and social care in localities shifting elements of acute care into different settings

Context: Drivers for change…

• The traditional DGH model has been a cornerstone of the NHS for over half a century but now needs to transform

• New definitions of how hospitals can be shaped must be forged locally and must align providers, commissioners, patients/communities and regulators

• No “one size fits all”

• A range of potential ways of transforming the leadership, organisation and delivery of hospital services

What does this mean for hospitals?

Achieving sustainable hospital services in Trafford

Central Manchester FT

The Christie

• Trafford Hospital – a small DGH and birthplace of the NHS declared itself non-viable as a stand-alone Trust

• £19m underlying deficit

• Acquired by CMFT 1 April 2012 following restricted procurement process

• Organisational integration delivered by October 2012 (incl. back-office merger)

• New service model consulted on and agreed by Jan 2013

• Service changes approved by SoS in July 2013

• Assurance process completed and full authorisation for service change given by end October 2013

• Implementation from late November 2013

Local context and timeline

Day case surgery, day case

medicine and endoscopy

Intermediate Care

Out Patients

Elective Orthopaedic CentreDaycase Unit

Inpatient and daycase

elective orthopaedic

surgery

Emergency Access Centre

Adult Medical Assessment

OP clinics and direct access

radiology and tests

Clinical Model – Care Quadrants

Common infrastructure HDU

Crash team Radiology Pathology

• Urgent Care Centre

– Consultant-led service provided by experienced medical and nursing staff with ALS/APLS training and access to resuscitation facilities

– Job plans and training arrangements rotate staff through Trafford UCC and MRI A&E

– Safe management of acutely ill patients that present at Trafford General Hospital

– Jobs that allow high quality candidates to be attracted and retained

Clinical model – single services

• Acute Medicine

– Acutely ill medical patient presenting at Trafford UCC can be admitted to:

• MAU/general medical wards at Trafford General (eg non-specific conditions, frail elderly), or

• specialist medical wards at MRI (eg Cardiology, Resp Medicine)

– Admission to MRI ward no different to Trafford General ward – ie patient does not go through MRI A&E/MAU

– Ward staff/local consultants managed within Trafford Division; medical staff managed from specialty Directorate at MRI (eg Gastroenterology, Cardiology)

– Service model and job planning facilitates: • sustainable acute take at Trafford

• development of Consultant sub-specialist interests

Clinical model – single services

• Orthopaedics

– One integrated consultant team

– 95% of elective patients treated at Manchester Elective Orthopaedic Centre on Trafford site (high-risk patients retained at MRI)

– All trauma patients admitted at MRI

– Outpatient clinics, pre-op assessment, rehab, etc maintained on both sites

– Huge potential to be hub of multi trust orthopaedic JV, with strong academic underpinning

Clinical model – single services

• Critical Care

– Service managed by MRI Critical Care service

– Small high dependency unit maintained at Trafford General (2 beds)

– Additional intensive care capacity opened at MRI

– Patients have the same priority and process for admission to ICU, regardless of site

– Medical and nursing staff groups managed as integrated teams

Clinical model – single services

• Comprehensive clinical diagnostic review undertaken immediately upon acquisition

• Risks around small-scale services addressed (eg Intensive Care, acute surgery)

• Ward staffing improved

• Safety culture improved (eg incident reporting)

• Trafford HSMR down from 128 (pre-acquisition) to 101 (current rolling quarter)

• Single (unified) services provide safe, effective treatment of patients and attractive jobs for staff

Key messages

• £24.2m deficit eliminated over 18 months (historic debt plus annual CRES)

• Contributions to savings include:

– Back office – £5.5m

– Estates/FM – £4.9m

– Clinical support services – £1.9m

– Surgical specialties – £4.0m

– Medical specialties – £3.4m

– Other – £4.5m

• Support from Commissioners tapered as savings delivered

Key messages

• Acquisition model worked well in Trafford context

• Strong commissioning and regulatory support

• Critical service changes only delivered through creation of single service with primary hospital site

• Trafford Hospital now busier, proud and vibrant as a local hospital not a DGH

• Standalone specialist focus based on cold orthopaedics

• Significantly reduced costs, significantly improved outcomes, better staffing base and improved patient satisfaction

Conclusions - 1

• Transferable? Definitely, in the right circumstances

• Providers need to work hard to create a strong voice to shape innovative models with policy makers, commissioners and regulators

• We need to create a new language and presentation that underlines the major ongoing contribution of local hospitals to the shifting NHS landscape

Conclusions - 2