North by North West: Mega-merger will create largest trust in England

Manchester out in front

If delivering the Five Year Forward View was a race, Greater Manchester would be out in front and accelerating further away from the pack.

Significant developments in Salford were all set to top this week’s newsletter, but were trumped on Tuesday by substantive proposals for a mega-merger of Manchester’s hospitals.

An authoritative review, which is likely to be backed by commissioners and the trusts involved, has proposed that a single foundation trust be created for the city.

This would mean a merger of two big teaching trusts - Central Manchester University Hospitals Foundation Trust and University Hospital of South Manchester FT - with North Manchester General Hospital (currently run by Pennine Acute Hospitals Trust) also thrown into the mix.

While you might expect frosty statements from the various parties, there was very little protest, and even some enthusiasm, from the trusts involved.

As I have previously suggested, this probably has something to do with the changing of the guard at Pennine Acute and UHSM (both currently run by interims), as well as the growing influence of Manchester City Council.

The merger would create the biggest NHS trust in England, with a turnover in the region of £1.6bn – producing a big tick in the “economy of scale” box – but there will be significant risks.

Although there are trust merger success stories, such as the recent marriage between Frimley Park and Wexham Park, they are counterbalanced and often overshadowed by the apparent failures, such as the massively indebted and “inadequate” Barts Health Trust.

What’s also surprising about the Manchester review is the election for the “old” way of doing NHS transformation, as opposed to the “new” way of the hospital chain.

The new way is currently being developed by the acute trusts in Salford and Wigan, with the likely inclusion of Bolton and the remaining rump of Pennine Acute.

It’s horses for courses, perhaps, but it will be fascinating to compare how these models shape up, and how successful they are at driving real transformation.

What might help the project in Manchester, by making sure plans are aligned, is the parallel work to create a single “care organisation” to deliver out of hospital services in the city, as well as a single commissioning body.

Close to fruition

To balance my opening sentence, it is worth noting that very little of the radical change so far announced or agreed for Greater Manchester has actually been implemented – so there are still a fair few hurdles to jump in that race.

But one of those changes which is coming very close to fruition is Salford’s new integrated organisation.

In July, about 440 council staff will transfer to Salford Royal FT, which will be the “prime provider” of a host of health and social care services, with a budget of £213m.

This will be one of the first new care models supported by the national vanguard programme to be formally up and running.

A similar model is being worked up in Tameside, which is due to get up and running next year.

But it’s not all about Greater Manchester. Despite losing their vanguard funding, leaders on the Wirral have been quietly getting on with plans to transfer 240 council staff over to Wirral Community FT as part of their integration agenda.