North by North West: Board nods through key decision with misleading data

Long-time readers may have wondered what happened to a landmark reconfiguration of surgical services in Greater Manchester, which was supposed to save 300 lives per year.

The Healthier Together changes had been planned for years, with millions spent on consultants and legal fees to see out a highly controversial consultation process.

The system even received significant capital funds relating to the planned changes, partly thanks to the claims made about its benefits. The funds have already been spent.

Despite the huge resources ploughed into the project, it became apparent a few years ago that the central part of the plan — to consolidate high-risk surgery at four hospitals — had quietly been dropped.

More modest changes, such as improved staffing, creating single rotas between some hospitals, and redirecting more complex cases, appeared to be reducing mortality rates without a big reconfiguration. So, leaders started to question the value of ploughing on with a consolidation that was still deeply unpopular among many clinicians.

Nothing formal was decided, however, and GM commissioners knew that at some point they would need to go through some formal motions to rubber stamp the decision.

A paper was finally brought to the integrated care board last month, containing an evaluation of how the services have changed, authored by Jane Eddleston and Jennie Gammack, of Manchester University Foundation Trust and the ICB respectively.

It suggested the Healthier Together process had brought additional focus to the services over the last decade, which helped drive various improvements at the existing sites. For example, most hospitals now have better coverage from interventional radiologists, increased coverage from GI specialists, and better access to same-day emergency care.

Trusts were also said to be working far more closely since covid, making it easier to share rotas and get mutual aid that helped the more fragile units.

As a result, the authors suggested, GM now performs better than the national average across four key quality measures, meaning full consolidation of services isn’t necessary anymore.

This all appeared sensible enough, and the ICB approved the decision without board members asking a single question. Chief commissioner Rob Bellingham even got a “well done” from chair Sir Richard Leese for getting through the agenda item without any fuss.

But NxNW wonders if board members had actually read the evaluation report, which suspiciously omitted some key mortality data that should have drawn more scrutiny.

It included a table of data from the national emergency laparotomy audit (of which previous iterations had driven the Healthier Together programme), showing GM performing better than average in the year to November 2020, with no units appearing to be major outliers.

The obvious problem, as you’ll notice, is that this is very old data. This is partly because of a long lag on the annual NELA reports, but also because the authors failed to include the latest data. The 2021 data was publicly available in early February, at least six weeks before the evaluation was completed and three months before the ICB meeting.

In the 2021 audit, GM’s overall rates still compare favourably. However, Tameside General Hospital, which was one of those supposed to be downgraded by Healthier Together, recorded an adjusted mortality rate of 18 per cent, which was the joint second highest in England and more than double the GM and national average.

The omission is all the more inexplicable when you see the evaluation included other metrics from the 2021 NELA report, which suggests the authors did access it.

Asked if the omission was an oversight or intentional for some reason, the ICB initially tried to cover all bases, saying the 2021 data was unavailable when the report was being produced, and that it would have been less reliable than the previous year anyway, as it coincided with the second wave of covid.

When NxNW pointed out that the prior year was also affected by covid, and that the evaluation authors clearly had access to the 2021 NELA data, the ICB made another attempt.

It replied: “We have committed to sharing through appropriate governance routes, a report on NELA performance and quality improvement work annually, which will include local trust review. When this review commenced, the [2021] data was not available. Future reports will follow the national release of the NELA data and as such it was always our intention for the [2021] data to be reviewed, with work now ongoing on this.”

It may be the case that scrapping Healthier Together is the right thing to do, but the complete absence of public scrutiny of this decision is troubling.

Years of management time, local revenue funding, and even national capital funds were spent fighting for and trying to implement the changes.

The very least we can expect is for leaders to give a decision like this some proper scrutiny.

Transfer rumours

The rumour mill has been quiet around the appointment process for NHS England’s regional director for the North West, possibly because the election has pushed everything back.

But Kevin McGee is one name I’ve heard mentioned a couple of times, which obviously raised an eyebrow after the former Lancashire Teaching Hospitals CEO decided last year to finish his frontline career in Gibraltar.

A restructure of the health authority in the British overseas territory looks like it may have substantially changed the organisation he joined. So who knows, maybe he’s looking for a way back?