In this edition, North by North West outlines some the key priorities for the region in 2020.

Greater Manchester

The region will undergo a year of renewal and purpose-seeking in 2020, following the departure of Jon Rouse and other senior figures.

Alongside Mr Rouse’s exit, many of the current functions of Greater Manchester Health and Care Partnership are set to transfer into the provider sector, while it seems unlikely that GM will again get preferential treatment when it comes to transformation funding allocations.

The region must therefore figure out what ‘devolution’ means once the partnership team has been hollowed out, and how to sustain the best elements of the project.

Meanwhile, the horribly complicated negotiations over the future management of North Manchester General Hospital need to be completed.

The facility, currently owned by Pennine Acute Hospitals Trust, is set to be taken over by Manchester University Foundation Trust, with the sister hospitals in Oldham, Bury and Rochdale due to transfer to Salford Royal FT. Both trusts will then face tricky negotiations over the financial support they can expect in return, especially MUFT, which is pushing for around £500m to rebuild NMGH.

Vigorous head-scratching will continue over the region’s poor performance against the accident and emergency target, which was still lagging behind the regional and national averages over December.

But there should be greater focus given to electives this year — with a move towards consolidation of orthopaedics, better demand management, and curbing the cost of outpatient services. If there’s time, attention will also start to turn to tackling the region’s main killers: cancer, cardiovascular disease, and respiratory illness.

Cheshire and Merseyside

The regional structures in Cheshire and Merseyside are also undergoing significant changes, but unlike Greater Manchester, there could be a sense of winding up, rather than down.

The region had a slow start in the collaboration game, and new chair Alan Yates, who will soon appoint a sustainability and transformation partnership executive leader, will be expected to foster better relationships and ensure some strategic decisions get made.

The new Royal Liverpool Hospital, which has suffered multiple delays, is now not expected to be completed until 2022, but this will be a crucial year for the project managers to ensure there are no further delays.

The region will also need to review its priorities and tactics for securing capital funding. The new Royal will swallow up a huge amount of national investment, while there’s an apparent lack of national support for relocating Liverpool Women’s Hospital, which has thus far been top of the wish list.

This could finally be the year that solid plans are finally put forward for the future configuration and ownership of Southport and Ormskirk Hospitals, while similar considerations still need to be given to Cheshire’s acute trusts.

Lancashire and south Cumbria

The regional structure in Lancashire and south Cumbria is relatively stable, although a new independent chair role for this integrated care system will be introduced early in the year.

One of the main challenges for the ICS will be persuading local GPs to vote for seven clinical commissioning groups to be scrapped, merging into one large single commissioner.

Running alongside this, the patch’s NHS providers will be expected to come up with serious proposals for greater collaboration and new decision-making processes that remove the power of single organisations to veto long overdue reconfiguration decisions.

In central Lancashire, leaders will be building up to a planned public consultation on service consolidations between Preston and Chorley in the latter half of the year, which is likely to be politically troublesome.

However, efforts to get agreement on a major estates strategy for the whole region could easily muddy those plans, as the question of whether Preston and Chorley should be replaced by a major newbuild hospital is still up for debate. Agreeing a strategy would allow the ICS to make stronger bids for national capital funding.

Performance-wise, Lancashire and south Cumbria has huge problems with A&E services. Expect concerted efforts to improve hospital back-door blockages by providing more intermediate care for elderly patients who don’t need to be in hospital, but aren’t ready to be fully discharged out of clinical care.

Services in the area also need to build on the progress made within the urgent and emergency mental health pathway, by bolstering crisis response teams and commissioning more inpatient beds.