Essential insight into NHS matters in the North West of England, with a particular focus on the devolution project in Greater Manchester. By Lawrence Dunhill

Competition is out

It is official. Competition is out; collaboration is in.

The Competition and Markets Authority’s decision to clear the merger of Manchester’s two big hospital trusts – Central Manchester University Hospitals Foundation Trust and University Hospital of South Manchester FT – cements a major shift in NHS policy, and will have been heartening news to many in the service.

Because not only did the regulator judge that the merger would deliver benefits for patients, it even expressed the widely held view that competition now plays a “limited role” as commissioners instead focus on cooperative working.

But there are critics, of course.

Many of the clinicians and supporters of Wythenshawe Hospital will fear a continuing dilution and destabilisation of services in the south of the city, and resent what they see as a giant carve up of Greater Manchester’s hospitals by the region’s two knighted chief executives – Sir Mike Deegan and Sir David Dalton.

If we take the plans at face value, however, Wythenshawe still has an important, albeit refocused, role to play. If managed well, there is no reason why this role cannot be fulfilled under the new structure.

Others question the whole concept of “at scale” economies, arguing that size is not the advantage it once was.

In 2017, people can easily self organise without needing to belong to a single organisation, thanks to advances in technology and communication, so value can still be extracted by organising and connecting people without expanding an organisation.

Meanwhile, bigger organisations are more likely to support the status quo, being less nimble or interested in investing in new or innovative markets. They may ignore the transformative developments they should be embracing, instead focusing on more straightforward growth and salami slicing.

This seems to be a powerful argument, but it may be possible to avoid some of the pitfalls with the right structure in place. The group model being created between Salford Royal FT and Pennine Acute Hospitals Trust (which is likely to turn into a merger if the right financial support is offered) is designed to offer devolution of decision making.

Each of the four main hospital sites now have their own dedicated management teams and work to defined financial plans, which was a long stretch from the centralised control that previously operated across the three Pennine Acute sites.

It’s not yet clear that Manchester will take this approach, or to the same degree, but it may be possible to register some benefits of organisational scale, while also benefiting from greater flexibility and decision making powers at local level.

And what of the claimed patient benefits? Some people wonder why a merger is necessary when the key services could simply be reconfigured between the two distinct organisations, to bring the benefits of larger departments and increased consultant cover.

I have sympathy with the trusts on this one. After 10 years of highly contested and largely failed attempts to centralise or merge services between the sites, I can understand why the transaction is deemed necessary.

Cash doesn’t lie

Financial bailout figures published by the Department of Health served as a reminder that despite the headline improvement to the NHS finances in 2016-17, many organisations are falling ever deeper into a financial black hole.

Some trusts – including several in the North West – are racking up eye watering (and interest bearing) debts for which there is no prospect of repayment.

It’s blindingly obvious that some form of planned support will need to be put in place for organisations such as North Cumbria University Hospitals Trust and University Hospitals of Morecambe Bay FT, but how long must they be made to wait?

Carter still bubbling

There has been a distinct lack of progress on many of Lord Carter’s recommendations around NHS efficiency, and many would say that momentum has dissipated.

But things still seem to be bubbling away in Lancashire, with Blackpool Teaching Hospitals FT, Lancashire Teaching Hospitals Trust and East Lancashire Hospitals Trust announcing the merger of their procurement departments.

This is expected to bring greater focus on product standardisation as well as enhanced “volume commitment” for the market (and therefore better prices).

The trusts will need to manage understandable nervousness among staff, both around their location of work and the number of roles that will be required in future.

Healthy lungs

Despite hosting some of the leading specialist services for lung cancer, Liverpool has one of the highest mortality rates in England for this condition.

But a pilot project in three parts of the city has found early detection rates can increase significantly through nurse led screening programmes, which would lead to better treatment outcomes.

Evaluation findings showed 75 per cent of those who received a lung cancer diagnosis through the programme received an early stage diagnosis, whereas typically 70 per cent of cases in Liverpool are not diagnosed until a late stage. This is quantifiable as a 30 per cent survival rate (for five years or more) where typically it would be 10 per cent or less.

North by North West takes an in-depth fortnightly look at one of the NHS’s most challenged and innovative regions. There will be a particular focus on the devolution experiment in Greater Manchester, but my scope will also include Merseyside, Lancashire, Cheshire and Cumbria.

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