North by North West: A clear view on Greater Manchester

A sharper view in Greater Manchester

Looking through wide angle lens, the slowly emerging landscape of NHS structures still looks fuzzy.

But focus in on Greater Manchester and the image becomes much clearer.

In another significant development, Tameside Council’s chief executive has taken over the leadership of Tameside and Glossop Clinical Commissioning Group, with a view to this being a permanent joint role.

Steven Pleasant told HSJ his appointment was “symbolic” of the changes taking place in the region, and builds on the development of a single commissioning board between adult social care and the CCG, including a joint management team.

The changes in Tameside have received significant support from the Greater Manchester devolution team, including NHS England’s chief officer for the project, Jon Rouse, and it mirrors changes taking place in the city of Manchester – where, as one senior source described it, the three CCGs are effectively now acting like a department within the council.

The idea is to integrate the commissioning of health and social care as far as the current legislation allows, which essentially means bringing council and CCG staff under joint management teams and acting like single organisations. Formal mergers will have to wait for now, but are surely the endgame.

On the provider side, the makeover of Tameside Hospital Foundation Trust into an integrated care organisation will be an early litmus test for whether devolution is going to work.

The former basket case trust has already made good progress in addressing its quality concerns, but safely closing a deficit of £23m (a massive 14 per cent of turnover) will be a greater challenge.

A key question that has lingered over the summer is whether Theresa May and Philip Hammond will share the same enthusiasm for the devo Manc as shown by George Osborne. Any dilution of support or slowing down of the project would be a huge mistake, because the progress made represents the best representation of the Five Year Forward View to date.

Three days, three CQC reports

In case you missed it last month, the Care Quality Commission gave its verdict on three trusts in Greater Manchester within the space of three days, with the reports getting gradually worse each time.

Bolton Foundation Trust achieved a good rating, cementing its unofficial title as NHS Improvement’s favourite trust, before Stockport FT was rated requires improvement, largely due to concerns over emergency services.

Pennine Acute Hospitals Trust was last up, with the CQC confirming its inadequate rating, which had more or less been an open secret for months.

The trust’s problems featured heavily and frequently in the Manchester Evening News during August, and the new leadership has a major job on their hands to reassure and raise staff morale.

Difficult decisions may also need to be made in the face of severe staffing shortages, with changes around paediatric care at Fairfield Hospital just the start.