RECONFIGURATION: Cardiac services in Manchester should be consolidated on one hospital site and several other specialities organised as “single services”, according to the initial findings of an independent review.

A review of the city’s three main hospital sites, led by former trust chief executive Sir Jonathan Michael, has estimated that recurrent savings of up to £29m can be made by reorganising eight service areas.



Source: Alamy

Radiology services currently operate independently on each site

It has suggested that obstetrics, critical care and paediatric care should be consolidated on fewer sites. The review was published by Manchester’s health and wellbeing board ahead of a meeting next week.

Groups of clinicians from Central Manchester University Hospitals Foundation Trust, University Hospital of South Manchester FT and North Manchester General Hospital – part of Pennine Acute Hospitals Trust – were asked to draft proposed service models in each specialty, with support from consultancy firm McKinsey.

Eight care models have been put forward for further discussion, though the locations of each service were not considered.

Proposed care reforms for Manchester

  • Cardiology – shared clinical staff, pathways and protocols, with a long term ambition to provide cardiac surgery from a single site. Services currently delivered across three sites, with UHSM and CMFT providing tertiary cardiac surgery. Estimated savings: £5m-£6m.
  • Secondary paediatrics – shared clinical staff, pathways and protocols, and potential for one inpatient unit and two assessment units. Services currently provided at three sites. Estimated savings: £4m.
  • Maternity – shared clinical staff, pathways and protocols, and potential centralising of “high risk” care. Obstetrics is currently provided on three sites. Estimated savings: £5m-£10m.
  • Critical care – shared clinical staff, pathways and protocols, and potential for services to be consolidated on two sites. All levels of critical care currently delivered on three sites. Estimated savings: £2m.
  • Inpatient infectious diseases care – new “hub and spoke” model including a single inpatient unit. Inpatient beds currently at North Manchester and UHSM. Estimated savings: £0.5m.
  • Radiology – shared clinical staff for on-call rotas and routine scanning, and differentiated sites for vascular and a hub model for complex reporting. Radiology services currently operate independently on each site. Estimated savings: £1m-£2m.
  • Respiratory – shared clinical pathways and protocols and a ‘hub and spoke’ model for complex care. Inpatient and outpatient services are currently provided at the three separate sites but some complex care centralised at UHSM. Estimated savings: £3m
  • Rheumatology – shared clinical staff, pathways and protocols. Services currently provided at three sites. Estimated savings: £1m.

HSJ has seen an internal document suggesting the chief executives of the three providers are set to publicly welcome the review’s findings.

The review had created a potential difficulty for Pennine Acute, which was progressing its own transformation plans involving North Manchester General Hospital. There appeared to be friction between trust chief executive Gillian Fairfield and council leaders over the plans last year.

However, it was announced suddenly in February that Dr Fairfield was going on secondment to Brighton and Sussex University Hospitals Trust. Sir David Dalton, chief executive of Salford Royal FT, has taken over on an interim basis.

Sir Jonathan was appointed after commissioners threatened to tender services if the trusts could not agree plans to remove duplication of services in the city.

He said in his introduction to the review: “However, much I respect the organisations and individuals providing care for patients from these hospitals, I do not believe that existing arrangement for hospital services in the city of Manchester serves the best interests of the population.

“The different hospitals have different mixes of specialist and general services, different priorities and different ways of working. This has led to duplication, indeed triplication in some services, variations in clinical outcomes, variation in patient experience and access to services. There is inefficiency and waste due to duplication and all hospitals are experiencing recruitment difficulties in shortage clinical staff groups.”

He has recommended that discussions continue on the eight specialties while plans are drawn up for other service lines, including surgical oncology. The review will move into a second stage looking at potential governance and organisational changes at the three trusts.

The providers are already implementing “single services” for emergency care, following a major consultation process that concluded last year.