With Devo Manc, Manchester has a great opportunity to be the region that puts clinicians at the heart of its vision for better care. By David Rose
It’s just over a month since Greater Manchester took control of its £6bn health and social care budget.
While there was little fanfare at the time, this may well be seen retrospectively as a defining moment for the NHS in England. By cutting the “apron strings”, Whitehall has given Manchester the chance to shape its health and care services according to local needs.
Of course, such large scale change doesn’t come without challenges. Indeed, the Greater Manchester Combined Authority (GMCA) – made up of the 10 councils, 12 clinical commissioning groups and 15 NHS providers in the region – has acknowledged in its strategic plan that, on current trends, it faces a health-and-care funding gap of £2bn by 2021.
But change is already afoot. The pre-existing Healthier Together partnership has been working for several years now to join up care more effectively. This has resulted in some controversial reconfigurations: in January this year, judges rejected a challenge brought by consultants at Wythenshawe Hospital against the removal of emergency abdominal surgery, following a decision last June to centralise the service at just four sites.
And it’s clear that this is just the start – as the recent review of a range of specialties at Manchester’s three main hospital sites, led by former trust chief executive Sir Jonathan Michael, shows.
As change proceeds, however, Greater Manchester’s health leadership would be well advised to keep some golden rules in mind:
1. Understand variations
Looking at data can tell us how Greater Manchester (GM) differs from the national picture. For example, providers in GM treat 14 per cent more patients with ambulatory care sensitive (ACS) conditions than the English average. This means more people in Manchester whose conditions should be managed in the community are ending up in hospital.
That will affect costs and suggests a lack of effective services in the community.
We see some interesting variations within GM in how COPD is being treated
It’s also important to understand GM’s burden of particular diagnoses. For instance, the North West has some of the highest rates of COPD (chronic obstructive pulmonary disease, including emphysema and chronic bronchitis) and Manchester city has the second highest rate of hospital admission for COPD in the whole of England.
This is related to historic work in heavy industry, as well as higher rates of smoking and deprivation.
But when we analyse the figures, we see some interesting variations within GM in how COPD is being treated. For instance, one provider with a very high number of admissions sees 20.7 per cent of COPD patients as zero-day stays, much higher than the GM average of 12 per cent. It also has the lowest rate of readmission within seven days in the region.
This suggests that it’s treating patients effectively without the need for them to be admitted to a ward overnight, potentially saving patients hassle and the system money. However, it could also be that many of these attendances could be avoided with better community provision. It certainly begs closer examination on the ground.
2. Focus on pathways
The GMCA’s strategic plan makes heavy mention of the need to standardise care pathways across the region.
We’re only at the very start of this process, but our work with both providers and commissioners suggests you can deliver real benefits for patients without spending more money – and potentially spending less through greater efficiency.
The GMCA’s strategic plan makes heavy mention of the need to standardise care pathways across the region
For instance, we recently worked with University Hospital of South Manchester on their pneumonia and stroke care pathways following a coding audit of 300 episodes. This revealed that over 50 per cent of pneumonia patients were being cared for by the general and geriatric medical teams on admission – not by a specialist respiratory consultant.
Since then, a new standardised pathway means any patient diagnosed with pneumonia is seen by a respiratory clinician or has their care reviewed and prescribed by a specialist, even if they are under the care of a generalist. This has resulted in practical changes for patients: it can mean, for example, that patients get earlier access to antibiotics or oxygen therapy depending on their symptoms.
3. Give power to those at the frontline
If change is going to happen, it has to be led by those at the frontline, particularly clinicians. This starts with good clinical engagement, something the King’s Fund has said is “critical” for innovation and improvement.
This starts with good clinical engagement
At Dr Foster, we’ve seen how significant this can be through working with surgeons, including those at Salford Royal, one of the country’s biggest neuroscience centres, to co-create a new online performance dashboard called My Practice.
This tool gives consultants essential information derived from their own theatre and administrative data about a number of process, outcome and casemix metrics tailored to the specifics of each individual’s practice.
Because the consultants have helped to develop the tool, they’re happy to use it. But crucially, it also provides information to the entire clinical team about volumes and performance that arms them with knowledge they need to lead service redesign where necessary.
“Devo Manc” is rightly being seen as a blueprint for other parts of England. Manchester has a great opportunity to be the region that puts clinicians at the heart of its vision for better health and care.
David Rose, director, Europe, Middle East & Africa, Dr Foster