• ’Hospital chain’ set to have two categories of members, with some relinquishing a greater degree of sovereignty
  • Salford Royal Foundation Trust and Pennine Acute Hospitals Trust could become ’full integrated members’, with Wigan and Bolton trusts as ’associates’
  • There have been ‘divergent views’ over how the chain should operate

The “hospital chain” being developed in Greater Manchester looks set to have two separate categories of members – with two major NHS trusts relinquishing a greater degree of sovereignty than others.

As part of the “vanguard” project in the north of the conurbation, it is likely to be proposed that Salford Royal Foundation Trust and Pennine Acute Hospitals Trust become “full integrated members” of the emerging chain, or group. 

The two trusts currently share the same chief executive, although Sir David Dalton’s appointment at Pennine Acute is an interim arrangement.

Full members of the group would be largely subject to a centralised executive body, while “associate members” such as Wigan, Wrightington and Leigh FT, and potentially Bolton FT, would retain a greater degree of control.

But Sir David, who developed the concept of the hospital chain in a review for the government, hopes that associate members would become full members over time, partly because this is considered potentially more attractive to NHS England. The aim is to launch the group in the autumn.

Associate members could benefit from the group’s shared operating systems, covering aspects such as back office functions, care pathways, and IT systems. But they would retain control in some key areas such as performance management, service configuration, and decisions over capital investment.

WWLFT has been developing the concept in partnership with Salford Royal, and the trust’s chief executive, Andrew Foster, told HSJ there have been “two sets of views about how the group should work”.

He added: “One view is of a highly centralised body that controls the operations of its subsidiaries…this would be the model used with Pennine Acute. You could have a command centre in each hospital and the group HQ could be anywhere.

“(But) I’ve spoken to chief executives at eight other trusts and said in principle would they be interested in joining, and the first answer is yes, providing I’m not a subsidiary organisation. They want the benefit of being equal partners in a collaboration.”

He said attracting members to join the group was crucial for its success, in order to achieve greater economies of scale and to attract investment from the private sector, in areas such as IT.

The proposals for Pennine Acute would relate to its hospitals in Oldham, Bury and Rochdale, as a separate review, which now seems unlikely to be challenged by the trust, has recommended that North Manchester General Hospital be merged into a new acute provider for the city of Manchester.

Sir David told HSJ: “The group concept is about enabling standardisation at scale - and quicker decision making, in the interest of a wider population base rather than the interest of individual organisation.

“There were some views that were divergent, but we’ve got to the point where we’ve agreed on two categories of membership.

“The group would consist of full integrated members, of which Salford would be one, and subject to due diligence and consent, Pennine Acute will probably be another.

“Then there would be associate or federated members who wouldn’t be committing themselves to the same extent and would retain a higher degree of sovereignty. Although I would hope (they) would want to work towards being full members, in order to maximise the benefits.

“Full membership is likely to be more attractive to NHS England, NHS Improvement and industry partners to invest in, because there would be a hardwired line of accountability.”

The separate review of services in Manchester rejected the idea of a hospital chain for the city area, in favour of a merger. Asked why this was not the preferred option for Salford Royal and Pennine Acute, Sir David said there was “no one-size-fits-all” and the group arrangement “can allow rapid change at scale”.

He added: “This contrasts with a merger whereby each merged organisation has to be dissolved and a new organisation is formed. This takes longer to do and is subject to greater regulatory oversight.”