New provider federation to dilute trusts’ veto over Manchester decisions

The federation would operate a “collective decision making” process, which would effectively limit the ability of individual trusts to veto a decision.

Leaders have already acknowledged that the financial challenge facing Greater Manchester will require “radical scaling up” of shared back office, diagnostic and clinical support functions.

The work involves 15 acute and mental health providers, and is being progressed as part of the region’s devolution plan.

The decision making process would feature a series of “locked gateways”, which once passed through could provide a solid basis for a majority vote in the final stages.

Darren Banks, director of strategy at Central Manchester Hospitals Foundation Trust, told HSJ: “If we as providers are trying to do things which run counter to the [Greater Manchester] strategic plan, then rightly it needs to be challenged.

“We want to get away from an organisation saying ‘no’ when they don’t like the outcome, when you’ve already agreed the need for change, the principles and processes that are to be followed, and the nature of the change.”

He warned that “it’s not going to be easy or straight forward, which is why nobody else has come up with this yet”. However, he added that the Healthier Together decision to reconfigure acute care in the region, which was agreed by every clinical commissioning group in Greater Manchester, has shown that collective decision making can work.

Two areas that could be considered by the federation are recruitment and induction processes, and research and development projects, as there are thought to be potential benefits of working at scale in these areas.

Mr Banks stressed the federation would not determine “where and who should provide a particular clinical service”, as this will remain the duty of commissioners.

Provider chief executives in Greater Manchester have held regular meetings for several years as part of a “nascent federation”, chaired by Stockport FT chief executive Ann Barnes. The new arrangement would formalise the group and enhance its terms of reference.

Mrs Barnes told HSJ there would be a “taper mechanism” for trusts adversely affected by changes, which could ease the financial impact of a decision.

Asked if the federation would be a prelude to a reduction in the number of providers in Greater Manchester, she said: “If that’s going to happen then this is not the first stage.”