North by North West: Leading ICS sits bottom of activity rankings

The omicron wave put a huge dent in elective activity over winter across the NHS, with the vast majority of systems delivering under 90 per cent of their pre-covid levels.

The most recent system-level data also reveals an interesting subplot for the North West: Greater Manchester, one of the original and supposedly more advanced ICSs, appears to be a particular outlier, however, reporting the lowest activity levels in England for four consecutive months to the start of March.

Activity for elective procedures sank to 62 per cent of pre-pandemic levels in January, when a system-wide decision was taken to mass cancel non-urgent work, as omicron peaked.

Without fully understanding all the local circumstances, it’s difficult to judge how necessary these cancellations were, but the GM percentages do appear very low compared to the rest of the North West region, which faced similar pressures (see table).

For example, the proportion of beds occupied by covid-positive patients in GM over the four months was 11 per cent, versus 10 per cent in the rest of the region. Sickness absence rates were roughly the same.

It also doesn’t appear to be a case of GM focusing harder on long waiters, at the expense of overall activity, as its proportion of two-year waiters on the waiting list increased by more than the rest of the region.

Where GM does appear to have struggled more was on discharge problems, as it had higher proportion of beds occupied by patients who were medically fit for discharge, at 17 per cent, versus 14 per cent in the rest of the region (data was only available for the three months to the start of March).

This may reflect greater covid-related pressures in social care and community services, but could also indicate deeper underlying problems in those sectors.

There will be other factors, too.

Lancashire and South Cumbria’s success in securing additional funding for elective care, as part of the accelerator programme, as well as the new Nightingale facility at Royal Preston, will explain some of its relatively strong performance.

Meanwhile, in Cheshire in Mersey, I’ve heard suggestions that Liverpool’s multiple specialist trusts will have been able to preserve their elective lists, as acute leaders could not demand their routine activity be scaled back. GM only has one specialist trust, with most specialised services run by the big acute providers.

When approached by NxNW, system leaders in GM did not flag any other potential factors, and said pausing non-urgent surgery during omicron had been a difficult decision.

They said new surgical hubs are being developed, along with a new approach for children’s surgery, and some good progress had been made on two-year waiters during March.

Anxiety over new hospitals

There is growing anxiety in the North West around the government’s New Hospitals Programme, for which new timescales were published last week.

The rebuild of North Manchester General Hospital is in a priority group of eight genuinely new hospital projects, for which the original timescale was given as 2020 to 2025. This has been badly delayed by covid, however, as well as the government’s demand that Manchester University Foundation Trust and other trusts in this group resubmit their plans as part of a process to standardise designs.

The schedule published last week simply says “planned start dates TBC”. There has been frustration at MUFT at how slowly things are moving, as well as concern around the eventual funding pot that will be made available, amid rapidly escalating prices in the construction sector.

Meanwhile, arguably the most urgent hospital rebuild in the North West is not even mentioned in the document.

It emerged just before the pandemic that Leighton Hospital, along with several others around the country, has tens of thousands of concrete planks which are deemed structurally unsafe, and there could be some pretty catastrophic consequences were they to suddenly fail.

Around £20m per year is having to be spent to slowly work through the site and replace the unsafe planks, in order of risk, but this would take up to 15 years to complete. Therefore, the trust is simultaneously working with providers in the same position to seek funding for a complete rebuild, which is likely to be more cost effective in the long run.

It has submitted a bid for more than £600m, to the Department of Health and Social Care, to fund the rebuild. But it faces competition from 127 other bids nationally, and the DHSC says just eight of these will be selected later this year.

The third big project in the region, to replace/refurbish the hospitals in Lancaster and Preston, also faces funding difficulties, as the stated allocation of £1.1bn is well short of what’s likely to be needed.

Unsustainable but good

The departure of John Wilbraham from East Cheshire Trust was confirmed last week, following a 19-year stint as chief executive.

Since around 2015, the trust has been carrying a large financial deficit and has acknowledged its clinical configuration is unsustainable. Yet it has still managed to maintain a “good” rating from the Care Quality Commission, which Mr Wilbraham deserves much credit for.

However, as discussed here previously, his departure could now open the way for some form of shared leadership or provider group model with the hospitals in Stockport and Tameside.