Consultation Feedback Themes Report - Consultation ... · Healthier Together Consultation Feedback Themes Report - Consultation Feedback and how we responded Author Greater Manchester

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Consultation Feedback Themes Report -

Consultation Feedback and how we responded

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Title Healthier Together Consultation Feedback Themes Report - Consultation

Feedback and how we responded

Author Greater Manchester Service Transformation

Target Audience Healthier Together Committees In Common (HT CIC)

Version 0.18

HTP Reference

Created – date 10/11/2014

Date of Issue 10/06/2015

Document Status Final

File name and path S:\Transformation\SERVTRAN\HealthierTogether\KeyDocs\DMBC\4. Engagement and consultation\Appendices

Document History:

Date Version Author Details

10/11/14 – 13/03/15

0.1 – 0.8 GM Service Transformation

Initial drafting.

27/03/15 – 07/04/15

0.9 – 0.10 GM Service

Transformation Further amendments and reformatting of document following collation of responses and review of data queries

08/04/15 0.11 GM Service

Transformation Interim review by Committees in Common of Data Queries

09/04/15 – 01/05/15

0.12 GM Service

Transformation Further amendments and responses included ahead of interim review by NHS England.

20/05/15 – 26/05/15

0.13 – 0.14 GM Service

Transformation Further amendments including completion of Future Model of Care queries.

27/05/15 0.15 – 0.16 GM Service

Transformation Further amendments and responses included ahead of interim review by Healthwatch.

28/05/15 – 10/06/15

0.17 GM Service Transformation

Finalised version ahead of consideration by the Committees in Common

29/06/15 0.18 GM Service Transformation

Final version for publication

Approved by:

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Governance route:

Group Date Version Purpose

HT CIC 15/04/15 0.11* * Edited version presenting an interim review of Data Queries and responses only

NHS England 01/05/15 0.12 Interim review/assurance

Healthwatch 27/05/15 0.15 Interim review/assurance

HT CIC 17/06/15 0.17 For consideration by Committees in Common

Purpose

This document contains the Healthier Together Public consultation feedback queries and responses on how they have been considered and taken into account post consultation as part of the decision making process.

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1. Introduction

1.1 The Consultation Process

The formal consultation for Healthier Together ran from 8th July 2014 until 30th September

2014, although questionnaire responses were accepted up to 24th October. During the

consultation there were:

A total of 22,541, consultation questionnaires received;

658, responses to the residents survey from randomly selected residents;

95, written submissions from individuals;

130, MP-organised questionnaires;

894, pledges of support;

2,792 attendees of centrally organised public meetings;

4 petitions, with a total of 5,751 signatures.

1.2 Feedback received during consultation

Opinion Research Services (ORS), a spin-out company from Swansea University was

commissioned by the Healthier Together programme to facilitate aspects of the

consultation process and to provide an independent report of the formal consultation

programme. Following the Healthier Together public consultation ORS prepared a full

report of the consultation responses entitled “Presenting the Evidence: Final Report of the

Consultation Outcomes” which includes all the feedback from the consultation with

exception of the hospital options selection questions which are to be held back until an

appropriate point in the decision making process

1.3 Summary of Feedback – Key Themes

The feedback received during consultation was broadly aligned to different topics covered

within the consultation document as well to how the different options would be assessed.

Therefore, for the purpose of analysis the feedback received been categorised in to 8 key

themes:

1. Case for Change and Vision 2. Primary Care 3. Joined-up Care 4. In-Hospital Proposals – Future Model of Care 5. Transition/Implementation 6. Decision Making Process – including:

a. Potential New / Alternative Options b. Decision Making Criteria c. Fixed Points

7. Data Queries – including: a. Quality and Safety Data

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b. Travel and Access Data c. Transition Data d. Activity Data e. Affordability and Value for Money Data

8. Consultation Process

1.4 How has the feedback been reviewed?

The feedback received during the consultation was reviewed by the relevant group(s) within

the Healthier Together governance architecture (shown below) to ensure that the feedback

was responded to, but ultimately that it was taken into consideration as part of the decision

making process.

Figure 1: Healthier Together Decision Making phase governance architecture

For example, data modelling concerns and queries have been managed by the Data

Modelling Advisory Group and the workforce concerns have been managed by the HR and

Workforce Group; depending on the nature of the query some have been considered by

more than one group and on more than one occasion, for instance where the query has led

to additional work to be undertaken (such as updating/amending the data set used). These

groups have considered the feedback and their responses to the queries have been

captured in the report below. . Following review, all responses have been either categorised

as “Closed” meaning that the query has been reviewed by the relevant group and the

appropriate response agreed, or “Complete – further work during implementation planning”

meaning that the response has been appropriately responded to for the purpose of the

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decision making stage, although further work is required during implementation of the

chosen option.

1.5 Our responses to feedback

This section describes the feedback by theme and also how we responded to this feedback

post-consultation. For ease of reference, the feedback by key theme is listed within the

index as follows:

Feedback Index:

Section Theme Page

1.5.1 Theme 1: Case for Change and Vision 7

1.5.2 Theme 2: Primary Care 9

1.5.3 Theme 3: Joined Up Care 15

1.5.4 Theme 4: In-Hospital Proposals - Future Model of Care 22

1.5.5 Theme 5: Transition/Implementation 33

1.5.6 Theme 6: Decision Making Process – (a) Potential New / Alternative Options 40

1.5.6 Theme 6: Decision Making Process – (b) Decision Making Criteria 42

1.5.7 Theme 6: Decision Making Process – (c) Fixed Points 46

1.5.8 Theme 7: Data Queries – (a) Quality & Safety Data 52

1.5.9 Theme 7: Data Queries – (b) Travel & Access Data 53

1.5.10 Theme 7: Data Queries – (c) Transition Data (I) Workforce Data 63

1.5.11 Theme 7: Data Queries – (d) Activity Data 64

1.5.12 Theme 7: Data Queries – (e) Affordability and Value for Money Data 69

1.5.13 Theme 7: Data Queries – (e) Affordability and Value for Money Data (I) Estates & Capital

Data 71

1.5.8 Theme 8: Consultation Process 74

1.6 Appendix 1: Full Table of Queries 83

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1.5.1 Theme 1: Case for Change and Vision

Ref. Theme: Case for Change and Vision

Feedback Query Detailed description and relevant examples of feedback

Stakeholders who raised the feedback

Feedback reviewed by (date)

Our response following consideration of the feedback

Status

C1 Is the primary motivation for change cost cutting, rather than quality improvement as advertised?

There are some concerns that Healthier Together is motivated by saving money rather than improving clinical care. - “Healthier Together” is an

attempt to reduce costs rather than improving clinical care.

Individual letters

Questionnaire responses

Public events - Trafford 15/07, South Manchester 09/09, Wigan 16/09, Stockport 25/09

Committees in Common (21/01/15)

Healthier Together is a clinically led programme that aims to reduce the current variation in standards and outcomes that exist across Greater Manchester in Accident and Emergency, Acute Medicine(rushed into hospital with a serious medical condition) and General Surgery (planned surgical procedure). Under the Healthier Together proposals hospitals will be grouped into shared ‘Single Services’ One of the hospitals within each of the single services will specialise in providing emergency general and high risk general surgery for patients with life threatening conditions. This means care will be provided by a team of medical staff who will work together across the hospital sites within the single service. All hospitals that are part of the single

services will be improved to ensure

they meet the quality and safety

standards. All hospitals will continue

to provide care to their local

population as they do now.

Strong public support for the case for

Closed

C2 Is hospital change necessary?

Some stakeholders queried whether the described changes were needed? - Collaborative working between

hospitals is already happening in Greater Manchester. Surely you can build on this without this restructuring?

- Do you have an alternative; can we stay as we are?

- The option we all want is not on screen – all singing, all dancing General Hospitals.

Questionnaire responses

Staff events -Wrightington Hospital 23/07, Central Manchester Foundation Trust 08/07, Stockport Foundation Trust 11/08


Closed

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change was recorded during the consultation with 82% of 658 people surveyed in the representative household survey agreeing with the statement ‘To what extent do you agree or disagree that hospital services need to change to meet Quality and Safety Standards and provide the best care for you and your family?’ The issue of quality and safety means more lives will be saved through the changes. This is estimated at 1,500 lives over 5 years. The future model of care also means speedier attention for patients by a consultant who can make a decision on treatment. This means less waiting and more urgent attention for life threatening issues. The hours that consultants will be available under the future model of care also increases to either 16 hours or 24 hours per day or at the end of a phone on call to attend hospital. In light of the strong public support for the case for change and the impact on quality and safety, on the 21/01/15 the Committees in Common confirmed support for the case for change.

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1.5.2 Theme 2: Primary Care

Ref. Theme: Primary Care





Status

P1 Is primary care change necessary?

Some stakeholders believe that change to primary care is not necessary either because their GP service is already good enough or because GPs are overstretched and can’t do more. - I can already be seen the same

day at my GP. They have a telephone triage service and can arrange an appointment for you if they think you need it. They also open late in the evening.

Stakeholder meetings - Stroke Association group 18/09, Sure Start group 26/09

Primary Care Transformation Team

Whilst we acknowledge and appreciate the positive experiences in the majority of general practice, there is no doubt that collectively, as many as 1 in 5 patients have experienced challenges in accessing GP services; National GP survey (September 2014). A large proportion of the Greater Manchester population have stated their preference for increased access to general practice in the Healthier Together Consultation. We will be working with all CCGs/localities to ensure this increased access builds on current good practice and is delivered safely to the public and our workforce.

Closed

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Status

P2 Are the proposed primary care standards feasible and achievable

- The Trust tends to agree with the primary care standards, but is concerned that they are unachievable and unaffordable without significant change to Greater Manchester’s primary care services. The Trust therefore desires more confidence that these challenges are being addressed comprehensively.

- (The Trust) is, though, reluctant to provide unreserved support for “a movement of patient care away from hospitals into local primary and community care services” without clearer evidence of the feasibility and cost effectiveness of such a move.

Pennine Acute Hospital Trust (PAHT)

Pennine Care

Wigan, Wrightington and Leigh (WWL) Foundation Trust

WWL Council of Governors

Stockport Foundation Trust

Royal Bolton Foundation Trust

North West Ambulance Service


Greater Manchester has the lowest levels of primary care investment in the country and there is no doubt that the standards contained within the consultation cannot be delivered without significant additional investment. There has already been new investment of £8m in primary care over the past year (Prime Ministers Challenge Fund for 5 CCGs) and in 2015/16, this will rise by a further £7m in order to deliver 7 day access to primary care (NHS England funding for the remaining 7 CCGs). Increased access will ensure primary care is accessible 7 days a week and therefore we can start to examine how new models of care can be introduced for the benefit of our population. This will be considered carefully, will build on evidence already available and services will only move from secondary to primary care when it is safe, feasible and cost effective to do so.

Closed

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Status

P3 The primary care changes should be in place before the secondary care changes

- The primary care proposals within HT are not scheduled to happen quickly enough or to the degree necessary to facilitate the scale or speed of change proposed for secondary care

- I am concerned that proposals for further reconfiguration of hospital care services in advance of appropriate community alternatives being in place risks leaving more people without the care they need.

Public meetings - Tameside 12/08, South Manchester 09/09

Kate Green MP


Greater Manchester is leading the way in redesigning primary care to ensure it is accessible 7 days a week by undertaking to deliver this by the end of 2015. 7 day access is already available to over 1 million of our population and plans are well advanced to ensure this is achieved across the whole conurbation by the end of 2015. Access is only the initial step in the wider transformation programme of health and social care services but as stated above, no services will be withdrawn or reduced in secondary care until community and primary care services have the ability to manage these new services in a safe and cost effective way.

Closed

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Status

P4 Is there sufficient funding and workforce to achieve the primary care proposals?

Some stakeholders and the public are concerned about effective funding and of staffing. - No financial information is

provided as to what extra resources are needed in Primary Care or whether this money is available or not

- No financial details of primary care budgets have been provided.

Staff events - Manchester Mental Health 05/09, Royal Bolton Foundation Trust 21/07, Salford Royal Foundation Trust 06/08, Wrightington Hospital 24/07, Tameside Hospital 19/08, PAHT 01/09, 03/09, NWAS 30/09

Stakeholder events Stroke Association 16/09

Public events - Manchester P30/09)

Written responses - Stockport Labour Group

Individual response from a member of the public

Lisa Nandy MP.


There has already been £15 million additional investment into primary care for 2014/15 – 2015/16. In order to ensure that increased access is sutainable it is believed to cost in the region of £12million per annum across Greater Manchester. Throughout 2015/16, the new and improved access arrangements will be tested and evaluated to ensure this investment is proving value for money. NHS England is working with all 12 CCGs across GM to agree the levels of increased investment for subsequent years.

Closed

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Status

P5 Are GPs bought in to the proposals?

A small number of concerns were expressed about gaining GP agreement and momentum.

Staff event - Wrightington Hospital 24/07


All 12 CCGs have extensively engaged with their members regarding the proposed standards as outlined in the Healthier Together consultation. At the Association Governing Groups meeting on 3rd June, the CCGs agreed their intention to provide 7 day access to primary care by the end of 2015.

Closed

P6 Will patients still be able to see their own GP?

A proportion of the public were concerned that this might mean that they would not see their own GP. This was particularly relevant for some vulnerable and protected groups. For example, a stroke survivor and individual with moderate to severe mental health issues described communication issues and the need for their GP to know and understand their complex histories, making GP consistency important to them.

Stakeholder events - Stroke Association 16/09, Stroke Association 16/09, Sure Start 18/09 and OPAL 25/09


General Practice is built on the principle of continuity and this will not change. Patients will continue to be registered with their preferred GP and will always have the ability to book an appointment to see their GP either during their GPs routine hours or, should their GP offer some additional extended access sessions, then within these times. These proposals for increasing access will not change in the importance or need for continuity for many patients. The aim is to hopefully, over time, actually enhance continuity for those who value this above necessity or convenience. If however, a patient wishes to see a GP urgently or has a medical need which makes this appropriate, the patient will be able to access a GP any day of the week who although it may not be their own GP, will be one within their locality and who will have access to the patients records.

Closed

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Status

P7 Should the primary care programme scope be broader?

Some stakeholders felt that the scope of the primary care programme should be wider than GPs for example:

- The Trust is concerned that the proposals focus on GPs, and feels that they should also consider the form and structure of primary care to include a broader range of clinicians working to a nationally-agreed set of standards and competencies.

Pennine care

Written responses from Kate Green MP 5 and Boroughs Partnership NHS Foundation Trust


The Healthier Together standards for Primary Care are just the start of the transformation programme for health and social care services. However, there is general recognition of the vital importance of a well -funded, high quality, safe and technologically advanced primary care sector as the lynch pin of improving outcomes for the population. A successful integrated care system is the aim and transforming primary care is one significant step in achieving this. Many models for developing primary care are being explored by localities and they will determine the most appropriate to deliver improved outcomes for their local populations.

Closed

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1.5.3 Theme 3: Joined Up Care

Ref. Theme: Joined Up Care

Feedback Query

Detailed description and relevant examples of feedback




Status

J1 What is the evidence for the feasibility and cost effectiveness of the proposals to join up care?

Some stakeholders questioned the feasibility (particularly cost, funding and staffing implications), planning and overall achievability of such complex change. - (The Trust) is reluctant to provide

unreserved support for “a movement of patient care away from hospitals into local primary and community care services” without clearer evidence of the feasibility and cost effectiveness of such a move.

- The Governors …have grave reservations around the Healthier Together vision of being able to treat patients with long-term, complex or multiple conditions in the community or their own homes. It is said that the competition between the Greater Manchester districts to recruit staff is already fierce due to the fact that not enough qualified staff are available- and also that, as most complex needs occur in elderly people, fewer of whom now have access to regular help from relatives, it is inevitable that in the majority of cases they will not be


Wigan, Wrightington and Leigh (WWL) Foundation Trust

WWL Council of Governors

Stockport Foundation Trust

Pennine Care

North West Ambulance Service

Public meetings - Tameside 12/08, South Manchester 09/09, Manchester 30/09, Stockport 25/09

Staff meetings – Manchester Mental Health 05/09, Royal Bolton Foundation Trust 21/07, Salford Royal Foundation

Integrated Care programme

Better joined up care that is able to be provided in or closer to people’s homes is an important objective in its own right. With an ageing population and an increasing prevalence of chronic disease, ever more people require care and support services from organisations that cross the boundaries of health, social care, housing and voluntary organisations. Community based, integrated services providing more personalised and proactive care for larger and larger groups of the population is our core strategy to avoid exacerbations of illness and crises for individuals.

A wealth of studies report that people with chronic complex health problems – particularly older people – are often confused by the array of services they are faced with, receive duplicate interventions and find it hard to understand where to turn with specific problems. They value initiatives to coordinate care and simplify their journey through the health and social care systems. Equally, with pressure to deliver elective care in community settings

Closed

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Feedback Query





Status

able to be treated or managed successfully in their own homes.

- Clearer evidence of the feasibility and cost effectiveness of moving patient care away from hospitals into local primary and community care services is required – though where the evidence exists there is strong support for a reallocation of care and resources.

Trust 06/08 and 06/08, Wrightington Hospital 24/07 and 24/07, Tameside Foundation Trust 19/08, PAHT 01/09 and 03/09, NWAS 30/09, CMFT 30/07

Stakeholder meetings - Stroke Association 16/09

Individual responses from members of the public.

Written responses - Graham Stringer MP, Lisa Nandy MP and Kate Green MP

Stockport Labour Group

and prevent avoidable ill health, integration and collaboration between generalists and specialists – GPs, consultants, specialist nurses and other clinicians – is increasingly important.

However, we must make significant developments in the capacity of community based services to ensure the scale of targeted early help and support is available to those at increasing risk of hospitalisation.

The Business Case will make clear the progress made on establishing and operating integrated neighbourhood teams across health and social care; the levels of general practice involvement in those teams, and the extent to which those teams are providing proactive care for people with long term conditions.

J2 Should the scope be wider and include more emphasis on mental health?

Some stakeholders commented on the need for increased focus on integrated mental healthcare (and, to a lesser extent Public Health and the Third Sector).

Pennine Care

Staff meetings – Manchester Mental Health 05/09 and 17/09,


We recognise the need for an increased focus on mental health alongside a radical upgrade in public health and prevention.

Closed

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Feedback Query





Status

- There needs to be greater appreciation and understanding of the shape, size, role, function and capacity of community services. A discussion is needed at a regional level to ensure that community care, including physical and mental health, has parity of esteem and is properly resourced, funded and structured to support the acute reconfiguration.

- For the full benefits of integrated care to be realised, a broader vision than that presented in the consultation document is required. It needs the primary and community, secondary (general hospital) and tertiary (more specialised) health services and the social care services to be working so closely together that the patient/client receives seamless care.

University Hospital South Manchester 13/08

Public meetings - Stockport 12/08 and 25/09, Heywood Middleton and Rochdale 17/09, Bury 28/08,

Stakeholder meetings - Salford Mental Health Forum 24/09

Written responses - Andrew Stunnell, MP and Kate Green MP

Healthwatch Oldham, Tameside and Wigan

Individual responses

Improvements in mental health, and our ability to support mental and physical health together would have dramatic impacts on life expectancy and the health of the population overall. It will make immediate improvements in the life chances, potential and wellbeing of individuals. A Greater Manchester strategy for mental wellbeing and health, a person-centred strategic framework will be developed as an immediate priority. This will seek to support mental health needs across the whole population in three domains: A. People with impaired mental

wellbeing, or with early signs of mental illness, often regarded by the NHS as sub-clinical. These issues can lead to community problems, crime and disorder issues, reductions in productivity and much more. In addition to those individuals not enjoying the full degree of wellbeing, they have a significant impact on Greater Manchester society and economy.

B. People with mental health as well as physical and social care needs, who often only have one

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Feedback Query





Status

of these needs identified or addressed. Focusing on either their mental health conditions or the physical health conditions, for lack of parity of esteem, can mean that they are not provided with a holistic range of support. As a result they may use the health and social care system and public services in an erratic way.

C. People with severe mental health needs. How they are cared for and how they access services.

Each of these domains has a set of characteristics and needs. While there is overlap between them, the distinct characteristics and needs of each require a clear strategic response. It is proposed that the Greater Manchester mental wellbeing and health strategy is built around them.

J3 Is there a data loss risk? Some stakeholders were concerned about the shared risk of data loss. - Ensuring safe and effective

communication between Trusts and primary/community care should be a major priority, with the aim of setting up a single IT platform (or at least an inter-operable system) that will carry messages and clinical

Public meetings - Trafford 15/07 , North Manchester 15/08

Stakeholder meetings - Stroke Association 16/09

Healthwatch


Supporting local health and care economies to establish an infrastructure that enables the flow of high quality, comprehensive and up to date information between healthcare professionals, to and from patients remains an urgent priority. Having access to the right information at the right time enables excellence

Closed

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Feedback Query





Status

information in real time. Bolton

Provider submissions

Stockport Council

Bridgewater Community Healthcare NHS Trust

and patient safety. It helps professionals document handovers accurately and makes it easier to share information quickly across multi-disciplinary teams and with other providers. In progressing such a development safeguards must be made against unwanted third party access. Data protection and enabling secure access will be paramount when implementing any such system.

J4 Would access to services delivered in the community be inferior to access in hospitals?

Healthwatch Oldham and Tameside were concerned about comparable ease of access if services are moved into the community.

Healthwatch Oldham and Tameside


Standards of care and measurable indicators of clinical quality and positive experience will apply in all care settings whether hospital, general practice, pharmacy or in the patient’s home. That is why the development of standards of hospital care and standards for community based care have been developed together. To ensure consistency and reduce variation we have developed a full suite of Community Based Indicators, representing primary/community/social care services (out of hospital) including, for example:

People will have access to professional health and social care

Closed

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Feedback Query





Status

advice and triage (assessment) provided 24 hours a day, seven days a week and be directed to the most appropriate service to meet their health or social care needs

Everyone with an urgent social care need will have access to social care within 2 hours, and those with a less urgent need will be contacted on the same day

All people with a long term condition will have access to their own care record and shared care plan, including a crisis plan where appropriate

All people with a long term condition will have a named professional who has the lead responsibility for coordinating their care

Health and social care teams will have input from GPs, primary care, community care, social care, mental health and other specialists to support care as appropriate.

J5 Success requires a great deal of cultural change; has this been planned for?

Cultural change is important and a change programme should be designed. - Cultural change is as important as

Healthwatch Bolton

Stockport Council


The programme will challenge us in relation to working both within and across organisations. The consultation response is correct in highlighting that

Closed

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Feedback Query





Status

organisational change. - Barriers between different

professionals need to be broken down into a genuine approach which focusses on individuals and not simply applying eligibility criteria.

- We are concerned that the Healthier Together Plan does not elaborate a theory of change and does not describe a change management programme that will address the requirement for cultural and bureaucratic change within the key institutions involved in delivering the programme.

such cultural change needs to be specifically planned for and supported. Relevant programmes of organisational and team development are taking place across Greater Manchester. Their aim is to develop the culture of collaboration across Greater Manchester to ensure successful delivery of the reform objectives that underpin these service changes. They will include the support necessary to establish new relationships at both Greater Manchester and local levels in accordance with the governance developments.

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1.5.4 Theme 4: In-Hospital Proposals - Future Model of Care

Ref. Theme: Future Model of Care

Feedback Query





Status

F1 Might a ‘network’, ‘partnership’ or ‘collaborative’ model be a viable alternative model of care?

Some stakeholders have responded to the consultation by describing the designation of hospitals as “general” (as opposed to specialist) as a “downgrading” and expressing a preference for a more collaborative approach such as partnerships, clusters or networks. Do these represent alternative models? - We do not want a hospital that

has been effectively down-graded and heading for cottage hospital status


Staff meetings - Wrightington 24/07, University Hospital South Manchester 27/08, The Christie 04/09, Central Manchester Foundation Trust 30/07, Stockport Foundation Trust 11/08

Clinical Advisory Group (04/12/15) Clinical and Patient Safety Group (08/01/15)

This feedback was reviewed by the Clinical Advisory Group. The idea of the single service is one of collaboration – teams working together across hospital sites within a single service to care for high risk and emergency General Surgery patients. However, where different language has been used to describe the single service model of care, this does not, in itself, represent an alternative model. A suggestion would only be identified as a possible alternative if the principles were different to those of the Future Model of care.

Closed

F2 Would rotation of specialist staff between sites (rather than moving patients) be a viable alternative model of care?

An alternative model would be to “move specialist teams around rather than moving patients” - Using the specialist care teams to

travel to various hospitals could help people who cannot travel to specialist hospitals out of their area

Staff meetings – Royal Bolton Foundation Trust 11/07

Clinical Advisory Group CAG (04/12/15) Clinical and Patient Safety Group (08/01/15)

This feedback was reviewed at the Clinical Advisory Group and the Clinical and Patient Safety Group. This potential alternative model is not viable because: 1. The ambulance service need

consistency in the services offered at each site to be able to effectively and safely stream patients.

2. Any specialist kit may not be easily transferred between

Closed

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Feedback Query





Status

sites. 3. Patients requiring specialist

care need pre and post-operative care from the team on-site and quality could be compromised if the team moved between sites.

F3 Three “Sector” responses have been provided by the Hospital Trusts; do these represent a viable alternative model of care?

Three “Sector” responses have been provided by the Hospital Trusts (North West Sector, the Southern Sector Partnership and a joint response from PAHT and CMFT); do these represent a viable alternative model of care?

Provider responses


The Clinical Advisory Group assessed the sector responses for consistency with the future model of care and confirmed that the proposals provided are consistent with the principles of the Healthier Together model of care (i.e. they are not alternative models of care).

Closed

F4 Could any other services be impacted by altering the in-scope services? Also, if certain sites offer co-dependent services, does this affect whether they should be designated as a provider of emergency General Surgery?

Could delivery of any other services and specialisms be affected, in particular (but not limited to): 1. Children’s General Surgery,

children’s A&E, maternity and neonatal

2. Critical care 3. Diagnostics 4. Major Trauma 5. Specialisms (e.g. burns) 6. Future commissioning plans at

UHSM 7. Cancer patients 8. Pathology 9. Cystic Fibrosis 10. Upper GI bleed


University Hospital South Manchester

Children’s Strategic Clinical Network (SCN)

Public Meetings - Stockport 12/08 and 25/09, Trafford 15/07, New Mills 22/07,

Clinical Advisory Group (24/04/15) Clinical & Patient Safety Group (04/06/15)

Work was completed prior to consultation on which out of scope services might be affected by the changes (e.g. anaesthetics). This was described in the Future Model of Care Appendix of the Pre Consultation Business Case. The Clinical Advisory Group reviewed that work (called service “co-dependency” work) in November and December 2014 and confirmed that there were no issues for other services that meant that the future model of care was not viable. To supplement this, a comprehensive review of national specifications

Closed

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Feedback Query





Status

South Manchester 09/09, Wigan 16/09, East Cheshire 23/09, Trafford 24/09, Central Manchester 10/09, Stockport 25/09, Bury 28/08,

Staff meetings – Royal Bolton Foundation Trust 11/07, Stockport Foundation Trust 17/07, 25/07 and 11/09, Wrightington Hospital 23/07, University Hospital South Manchester 27/08 and Central Manchester Foundation Trust 30/07

and co-dependencies frameworks was undertaken to assess the inter-dependencies between the in-scope services and those named (left). An independent literature review has now been completed. An independent panel of clinical experts, convened with the support of NHS England will assure all of this work and the findings. If there are any issues identified that need to be taken into account during decision making these will be highlighted to the Committees in Common prior to decision making, however most of the co-dependency issues will be managed through design work. The Decision Making Business Case will include a full report on this topic.

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Feedback Query





Status

F5 Does the model affect Greater Manchester resilience (i.e. the emergency response in light of a major emergency?)

Is Greater Manchester resilience affected by the changes (e.g. if there was an emergency at the airport would the Greater Manchester response be impacted?). If so, could this inform which site is selected to deliver emergency General Surgery?

EPPR (NHSE emergency planners)

Public meetings - South Manchester meeting


NHS England Emergency Planners worked jointly with the Clinical Advisory Group and Clinical & Patient Safety Group to confirm that there are no resilience issues that would prevent implementation of the model of care. However, some implementation planning will be required; for example, resilience plans will need to be updated.

Complete – further work during implementation planning

F6 Patient Pathway queries Specific questions have been raised about patient pathways including: 1. What happens if you’re at your

General hospital and you need to

have an emergency procedure as

a consequence of a complication

during the operation?

2. Transfer of frail patients (what

would happen if a frail patient

presented at a local general

hospital and needed transfer to

another hospital in the single

service?).

3. Repatriation of patients and on-going treatment (can non-emergency care be provided at the local general hospital following specialist treatment?).

Wigan Council

Wigan Wrightington and Leigh Foundation Trust

Staff Meetings - Wrightington Hospital 24/07

1 and 2: Clinical Advisory Group 30/1/15 Clinical and Patient Safety Group (5/3/15) 3: Clinical Advisory Group (27/3/15) (further implementation planning required during the next phase)

1. Complications: All patients will have a risk assessment undertaken prior to surgery to ensure that their elective surgery is delivered at the site in the single service suitable for that patient. Higher risk patients will have their surgery at the high risk General Surgery site and lower risk patients at the low risk elective site. Sometimes, even after low risk elective surgery, complications can occur that require patients to return to theatre for an additional emergency procedure. When these patients are already at a high risk General Surgery site, the

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resident consultant surgeon will be available to assess the patient and if required take straight for immediate surgery. In cases where the patient is an inpatient at the low risk General Surgery site, they may require either to be transferred to the high risk site for assessment and subsequent treatment or alternatively, the on-call surgeon for that site will attend. The decision as to whether to transfer or call the on-call surgeon will be made on a case by case basis with assessment from the surgical team and input from the resident surgeon at the site that provides high risk General Surgery. This is consistent with the approach used for complications by trauma services. Suitable pathways for patients who experience a surgical complication will need to be defined between providers within in each of the single services and will be assured as part of the Healthier Together implementation framework.

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2. Frail patients: There will be

occasions when a frail patient at the non-acute surgical site will require a surgical opinion from within the single service. In most cases, patients who require an urgent surgical opinion/admission will be transferred to the site within the single service providing acute surgical care. For frail patients this decision to transfer should be assessed on a case by case basis between the clinician at the general hospital and the surgeon at the specialist site to ensure that the most appropriate course of action is taken for that patient.

3. Repatriation of patients: One of the philosophies of the model of care is “local where possible”. If a patient requires care at a high risk General Surgery site that is not the patient’s closest site, there may be opportunities for continuing care to be provided at their local site, for example attending clinics following an operation.

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These detailed pathways will be designed during implementation planning.

F7 Is Patient Choice negatively affected?

Some stakeholders were concerned that patient choice (between hospitals and over whether to be treated in hospital or the community) would be reduced? - From a patient point of view will I

still have the choice of where I’m cared for or will it be determined by the algorithms?

- ...concerned on how patient choice may be impacted by these changes as there was no language around choice in the consultation material.

- Whatever happened to Patient Choice? Under these proposals the medical profession (hospital based consultants) are deciding which hospital the patient should go to… they also restrict choice by cutting down the alternative hospitals.

Meetings (e.g. Tameside P12/08, Oldham P14/08, South Manchester S27/08, Christie S04/09, PAHT S18/08, South Manchester P09/09)



The Clinical & Patient Safety Group formally recognised that reducing the number of sites offering in-scope services reduces patient choice in relation to high risk and emergency General Surgery. These changes were endorsed by the Clinical & Patient Safety Group and form one of the inputs to decision making; the benefit to quality and safety, ultimately saving lives, outweighs the reduction to patient choice.

Closed

F8 Might four sites achieve better clinical outcomes than five?

Some stakeholders contested that four sites may achieve better outcomes than 5 due to the higher concentration of in-scope patients and opportunities for experience. - Establishing four (rather than five)

emergency and high risk elective surgery sites across Greater Manchester is more likely to allow

Salford Royal Foundation Trust

Clinical and Patient Safety Group (26/03/15)

Workforce considerations formed one of the criteria for decision making. However there was no clear evidence of any other material clinical difference between four and five sites. Some qualitative points were taken into account during decision making as follows:

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the standards for surgery to be implemented. This would also further facilitate the delivery of subspecialist surgery, surgical training, surgical research and surgical innovation, and the adoption of new technology.

Greater Manchester will be centralising in-scope services because there is evidence (set out in the case for change) that this will achieve quality and safety benefits. Whilst there are studies showing that small numbers of interventions can be linked to poorer outcomes, there is unlikely to be a specific study identifying, for the specific in-scope services, a “tipping point” for four and five sites.

Four sites may be more clinically beneficial than five because this produces a larger pool of Consultants at each site and more sub-specialties to draw from at any point in time.

Conversely, five sites may be more clinically beneficial than four because travel time, and therefore internal transfer time, may be lower.

Closed

F9 Does specialisation alone drive up standards?

Specialisation or concentration is not the only mechanism to drive up standards; there are other levers such as such as penalties and incentives.

Pennine Acute Hospital Trust


The Healthier Together changes represent a significant change to ways of working for the affected clinicians. It is likely some clinicians will be expected to work different shifts and to work at different sites. Furthermore, to achieve the


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stated benefits of Healthier Together will require cultural and behavioural changes to current practice. Building strong single service teams with aligned objectives and incentives will be key to success. In addition, managing the changes to individuals sensitively and in the right way will be vital to build buy-in to the model of care and standards and to ‘bring people with the change’. Healthier Together will improve quality through a number of “levers”, such as application and monitoring of standards (for example minimum Consultant working hours). It is recognised that there may be other opportunities to improve standards, such as altering incentives. Further work will take place during the implementation design phase to refine local improvements.

F10 How will patient discharge be affected by the in-hospital proposals?

Discharge may be affected by networking of hospitals; both discharge processes and pathways across organisational boundaries need careful design.

Bridgewater Community Healthcare NHS Trust

This has been considered as part of the implementation planning

As part of the implementation of changes, there will need to be detailed design work to confirm patient pathways. Local discharge processes and processes across

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- The Trust is strongly of the view that care planning, admissions and discharges should be done in co-operation (with explicit pathways of care that follow best practice guidelines)... In the past, it was put under significant pressure when patients were discharged to follow-up at home without recognition of the resources required to meet their needs (because the tariff was being paid to the prime provider).

organisations will form part of this detailed design work.

F11 How will the Single Service work?

More definition of the single service way of working (e.g. governance) would be beneficial, and clarity is required around how joint “performance management” might be delivered

Hospital Trusts and most meetings

Clinical Advisory Group (09/01/15) (further work to be completed as part of implementation planning)

The future model of care Pre-Consultation Business Case appendix describes the standards that will be applied across A&E, Acute Medicine and General Surgery (for example consultant cover), as well as the principles of the model of care (i.e. how the single service will work). These were assured by the National Clinical Advisory Team and NHS England prior to public consultation in 2014. Further detail, such as how staff will rotate between sites, local governance structures etc. will be designed locally with patient and staff during the implementation design phase. During this phase there will


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continue to be Greater Manchester oversight and assurance to ensure consistency of design (where necessary/beneficial) and that the benefits are achieved.

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1.5.5 Theme 5: Transition/Implementation

Ref. Theme: Transition/Implementation

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T1 How much of the design can be locally adapted vs. designed at a Greater Manchester level?

PAHT requested clarity on how much of the design will be consistent vs. locally determined. - Some aspects of the proposals

within the consultation document are not clear. Indeed, PAHT argues that some concepts within Healthier Together are open to broad interpretation and would like to know if this 'permissive' approach is encouraged by Healthier Together or whether beneath each concept is a more detailed, standardised design.

PAHT Implementation will be led at a Single Service level, wherever possible. However, some elements of implementation or design will only need to be done once for Greater Manchester and tested locally. Other elements of the implementation will require oversight and management at a Greater Manchester level.

Oversight and assurance will be critical to implementation. The following aspects of design will be overseen at a Greater Manchester level: • Programme planning and

governance • Sequencing of implementation

across Greater Manchester • Management of clinical risk • Management of Greater

Manchester wide functions such as: - Liaison with NWAS North West

Ambulance Service) regarding implementation of Pathfinder (a triage system)

- Management of recruitment and training to ensure appropriate sequencing of resource availability

- Staff side liaison

Assurance of single service Outline

Closed

T2 Will design be overseen at a Greater Manchester level?

PAHT suggested that Greater Manchester oversight is required. - It is also important that a Greater

Manchester overview is not lost if financial challenges are to be met and truly integrated services implemented.

PAHT

Closed

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Business Case/ Full Business Case • Assurance of go live readiness • Development of Greater

Manchester wide benefits realisation plans

• Completion of assurance processes (Office for Government Commerce, Independent Review Panel, NHS England)

• Programme communications with media / MPs / public

• Greater Manchester liaison with Monitor / Trust Development Authority / NHS England

• Post implementation review

T3 Does successful implementation of the hospital model of care depend on implementation of the primary and integrated care solutions?

Primary care implementation and take-up by the public will ease pressure on hospitals and could be a pre-condition for Healthier Together in-hospital changes.

North West Sector Response, Wrightington, Wigan and Leigh Foundation Trust, East Cheshire Trust, Wigan Health and Wellbeing Board

Organisational written responses (e.g. Manchester City Council,

The implementation of the hospital, primary care and integrated care solutions are complimentary, and are all part of a whole system change to shift care closer to home where possible, and ensure that specialist care, when needed is delivered to the right standard. This is why the standards for hospital care, primary care and integrated care have been developed together. However, changes such as those needed in hospital care (the creation of single services to treat emergency and high risk General Surgery patients) and community-based care (for example improving access to GPs and health

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Shevington Parish Council and Bolton Council)

Individual written responses

Meetings (e.g. meeting references Wrightington S24/07(1), Wrightington S24/07(2), CMFT S08/07, Tameside S19/08, PAHT S01/09, MMH S05/09, CMFT S30/07(2) and Greater Manchester G29/08)

and social care advice) affect different groups of patients. Those patients presenting at A&E who may need emergency or high risk general surgery are a very small and specific group – around 160 patients per day across Greater Manchester – for whom, we can make changes to improve their standard of care, without being tied directly to the implementation of changes in community-based care. However, to achieve the desired shift in the whole system, every step taken in this direction will help to ease the considerable pressure on the hospital and emergency care system. And unless all of these solutions are implemented in a coherent and timely way, the full benefits we want to deliver for patients will be far more difficult to achieve.

T4 Have the workforce risks and considerations been taken into account?

There are some staff related risks : - Some staff might perceive the

change in services to be a “downgrading”, impacting on recruitment, retention and moral

- “It makes me feel that our services are inferior to Salford”

Communication and further transition

Individual response (ID 9357)

Staff and public meetings (e.g. East Cheshire P23/09, Trafford

HR & Workforce Group (09/04/15) Clinical and Patient Safety Group (07/05/15)

This feedback was reviewed at both the HR & Workforce and at the Clinical and Patient Safety Groups. It is recognised that staff will feel anxious during times of significant organisational change. The clinical model and single service will be key in developing appropriate HR strategies

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planning is also required to address staff concerns such as:

- The practical challenges in working across sites (such as cultural differences, travel, training requirements, car parking, IT systems and continuity of research/training)

- continuity of care and building consistent working relationships with community and mental health staff

- Misconceptions around reducing consultant cover outside of the 16 or 12 hour standard times set by the programme

P24/09, Stockport P25/09, Wigan P21/08, South Manchester P09/09, Tameside P12/08, Derbyshire P15/09, North Manchester P19 and Salford P19/08)

to support staff. Key staff concerns will be addressed within the Programme Implementation Plan and a HR Framework will be developed to outline how the changes may impact staff. The framework will also ensure understanding for all staff and confirm that they are managed in accordance with nationally agreed terms and conditions of employment. Additionally we will provide sufficient assurance regarding training and development needs, induction arrangements and a establishing a governance framework to support staff that are required to work across organisations. This will be coupled with staff briefings and communication sessions to make sure that staff are kept fully abreast of proposed changes, timescales, and the impacts on individuals are understood. There will be formal engagement with staff side/trade union organisations and professional bodies to ensure transparency and management commitment to supporting staff during the transitional and

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implementation phases.

T5 What are the recruitment considerations?

Some stakeholders have queried what the wider recruitment considerations are: - Nowhere in the document has

sufficient attention been given to the educational implications of the demands.

- These arrangements also need to underpin a strategy to make clinical posts in Greater Manchester attractive, and so ensure effective recruitment and retention.

- there will continue to be significant challenges in maintaining specialist services in smaller hospitals, and particularly in recruiting and retaining appropriately skilled staff

- CMFT and PAHT both have direct experience of attempting to maintain a comprehensive service offering at smaller hospital sites, prior to the introduction of single service models. From this experience we can state categorically that significant difficulties in recruiting and retaining staff with the right skills is not some vague risk that may or may not materialise in the future – it is the day-to-day experience of

Individual Response

CMFT

PAHT

S NHS FT

NWAS

HR & Workforce Group (09/04/15) Clinical Advisory Group (24/04/15) Clinical and Patient Safety Group (07/05/15) HR & Workforce Group (14/05/15) Clinical Advisory Group (22/05/15)

Workforce is one of the criteria that the Committees in Common will consider in their decision making. This has also formed a key part of discussions at the HR and Workforce Group, Clinical Advisory Group, and the Clinical and Patient Safety Group. Expert opinion has been sought from the Deanery, Royal Colleges, and Medical Directors and has been discussed at these groups. Strategies to recruit the required workforce deficit are currently being considered. For example, a review of doctors ready to complete their training and achieve consultant status has been undertaken; as has a review of non-training grades and other professional staff to determine existing competencies, the potential to up-skill staff, transfer skills and increase flexibility of working. We recognise that the strategy and planning work for recruiting to single services across Greater Manchester will be a crucial and significant part of the implementation of Healthier Together.

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trying to manage smaller hospital sites right now.

- The potentially detrimental effect on recruitment at ‘local’ sites, it is believed, will be felt well beyond the three ‘in-scope’ services, leading to further diminution in access for the local population.

- There needs to be recognition of the lead in times required for procurement of vehicles and recruitment of additional staff.

T6 What is the financial contingency for transition?

Not enough financial contingency in commissioners’ plans mean feasibility of Healthier Together called into question Workforce – “the business case does not highlight how these additional posts will be funded”. - “The Consultation specifically asks

the public to express a choice regarding the status of some hospitals. It does so without giving any indication of the financial or other consequences (recruitment etc.) Consequences will be inevitable and may be very significant”

Stockport NHS FT

WWL NHS FT

Finance and Investment Group, April 2015

The Finance and Investment Group have considered this feedback. Modelling for the Decision Making Business Case will retest all assumptions relating to transition costs to ensure that the estimates are reasonable. There is a recognition that transition costs will need to be managed in a number of ways and will involve Commissioners and Providers working together as part of a structured framework agreed by Chief Finance Officers.

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T7 What is the investment in ambulance provision?

“There will need to be significant investment in ambulance provision in order to both compensate for the additional travel time and the increase

NWAS Transport Advisory Group 04/02/2015 and 15/04/2015

The Transport Advisory Group considered feedback relating to the impact of changes on ambulance services and the potential need to

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in inter-hospital transfers…consideration should be given for the separate establishment and funding for a dedicated transfer tier of ambulance and personnel to undertake the inter-hospital transfers”

invest in future provision. It was recognised that prior to implementation a full understanding of the resource impact in terms of the number of ambulances should be developed and considered. To ensure that a shared understanding of the impact on ambulance resource of additional transfers and increased journey times is developed, the group has written to NWAS (North West Ambulance Service) to request information and modelling on the impact of changes. This modelling work will take place following the selection of a preferred option and will be reviewed as part of the transition and implementation costing work.

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1.5.6 Theme 6: Decision Making Process – (a) Potential New / Alternative Options

Ref. Theme: Alternative Options

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D1 Single service configurations - could 1 specialist work with 3 general hospitals?

Does 1 specialist working with 3 general hospitals present an alternative option? - There is no reason why a single service

run over one Specialist Hospital and three General Hospitals should require a bigger specialist workforce, and so these options should be no less feasible in workforce terms.

- Concerned that proposals limit patient pathways to only two generals working with one specialist. We feel this is too limiting for the development of services and for patients themselves.

PAHT

Pennine Acute Hospital Trust and CMFT (joint response)

Meetings (e.g. Salford S20/08, PAHT S03/09(2), UHSM S13/08 and PAHT)

Clinical Advisory Group (20/11/2014) HR & Workforce Group (12/01/2015) Clinical & Patient Safety Group (08/01/15) Committees in Common (26/03/14) Committees in Common (25/01/15)

The Clinical Advisory Group, HR and Workforce Group, and the Clinical and Patient Safety Group have considered the potential alternative options for single services. The advice provided to Committees in Common was that there were no new viable options to arise out of consultation. The Committees in Common considered this advice at the meeting on 21/01/15 and were asked to consider three proposed alternative scenarios; three specialist sites, six specialist sites, and one specialist working with three general hospitals. The decisions taken by the Committees in Common for each of these were: (1) Three specialist sites: the analysis clearly showed a significantly greater negative impact of three site options compared to four site options in terms of travel and access, and therefore is not a viable option. (2) Six or more specialist sites:

Closed

D2 Could three or less specialist sites (for in scope services) be an alternative option?

Further analysis is required to assess the viability of the 3 (“fewer”) specialist hospital model - “We are concerned that moving to 4

or 5 specialist hospitals across Greater Manchester may be insufficiently radical. However, should it not be possible to move to 3 at this time, we would support 4 specialist hospitals.

- Would there be potential to reduce to 3 sites or less in the future?

Pennine Acute Hospital Trust

D3 Would 6 or more specialist sites (for in scope services) in Greater Manchester be an alternative option?

Other models could be viable (e.g. 6 or more specialist hospitals) - The choice on offer is too limited, and

that there must have been options

Labour Group and Wigan Healthwatch

Small number of

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Ref. Theme: Alternative Options

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available other than either a 4 specialist or 5 specialist hospital model.

meetings (e.g. Salford P19/08)


this is not a viable option due to the increased consultant workforce required. (3 ) Single service configurations PAHT and CMFT suggest that a single service could be made up of one site offering emergency and high risk general surgery and three sites offering low risk general surgery (rather than the one and one or one two proposed by Healthier Together). In response to this scenarios with single services made up of one emergency general surgery site and one, two and three low risk general surgery sites have now been modelled. As part of decision making commissioners will review the analysis of all scenarios to determine the optimal single service configuration.

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1.5.6 Theme 6: Decision Making Process – (b) Decision Making Criteria

Ref. Theme: Decision Making Criteria

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D4 Should travel time be more important in determining the preferable option/ configuration?

Some stakeholders argued that transport is an (or the most) important criteria in assessing the best option and collaboration. - Requires that travel times are fully

considered in the final analysis and agreement of the location of specialised sites given the rural nature of the Easter Cheshire economy.

- Locations of the selected options for specialist provision are likely to have a profound effect upon the extent to which the 45 minute ambulance travel time to specialist care can be achieved.

CMFT

East Midlands Ambulance Service (EMAS)


Public meetings and staff meetings


During the pre-consultation phase, travel and access to services for both patients and visitors was highlighted as an important criterion for decision making and as such was included at this stage to help provide an assessment of the options. The Committees in Common considered consultation feedback relating to decision making criteria at the meeting held on the 18th February. Feedback received during consultation has continued to highlight the importance of this criteria in the decision making phase. As such, full consideration of the travel and access impacts on patients and visitors and compliance with travel standards both within Greater Manchester and the surrounding areas will be described to the Committee in Common to support decision making.

Closed

D5 Should hospital outcomes be included as a

One member of staff questioned whether the public need full access to outcome

Staff meeting (UHSM)

Finance and Investment Group

This was assessed by the Healthier Together Finance and

Closed

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new/additional decision making criteria?

data to be able to make an informed decision on which services are best. - To make decisions about hospitals the

public need full access to outcome data to be able to make an informed decision on which services are best. We should assess on the basis of this criteria when the Committees in Common are making the decision.

(06/02/15 HT Programme Board (11/02/15 Committees in Common (18/02/15)

Investment Group (06/02/15), and the Healthier Together Programme Board (11/02/15). Conclusions from this assessment were presented to and HT Committees in Common (18/2/15), as follows:

The aim of Healthier Together is to improve quality and safety at all sites

The new model of care describes how this can be achieved

Recommendation: current outcomes should not be used to select an option.

This recommendation was accepted by the Committees in Common on the 18/02/15. In preparing information for decision making, the Clinical and Patient Safety Group reviewed this feedback in March 2015 and concluded:

“Everyone in Greater Manchester is entitled to high quality healthcare. As set out in the Pre-Consultation Business Case, there will be investment at all sites and under all options (costed into the affordability

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analysis) to meet quality standards and therefore there is no quality distinction between the options.” C&PSG 26/03/15

D6 Should deprivation be included as a new/additional decision making criteria?

Some stakeholders have queried how will population health need/areas of deprivation/disparity of income be taken into account in the decision making process? - It is striking that population health

need is not quoted as an evaluation criteria.

Shevington Parish Council

Oldham Council, Trafford Council

Rosie Cooper MP, Cllr Charlie McIntyre, Cllr Shaukat Ali, Cllr Naeem Ul Hassan


Royal Bolton NHS Foundation Trust

Finance and Investment Group (06/02/15 HT Programme Board (11/02/15 Committees in Common (18/02/15)

The decision on whether to include additional decision making criteria such as deprivation was assessed by the Healthier Together Finance and Investment Group (06/02/15), and the Healthier Together Programme Board (11/02/15). Conclusions from this assessment were presented to and HT Committees in Common (18/2/15), as follows:

Impact Assessment found that deprived groups do have disproportionate need for in-scope services, and therefore need to be able to access specialist services

Impact Assessment also found that this group may be disproportionately affected by an increase in travel time due to lower car ownership

It was recommended that the impact would be described through the Travel & Access

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analysis and the Integrated Impact Assessment, and feed this into the decision making process, this recommendation was accepted by the Committees in Common on the 18/02/15.

D7 Should estate quality be included as a new/additional decision making criteria?

Some stakeholders suggest that the quality of existing estate should be considered as part of decision making criteria: - UHSM note that the quality of the

Wythenshawe estate is better than other hospitals

UHSM Finance and Investment Group (06/02/15 HT Programme Board (11/02/15 Committees in Common (18/02/15)

This was assessed by the Healthier Together Finance and Investment Group (06/02/15), and the Healthier Together Programme Board (11/02/15). Conclusions from this assessment were presented to and HT Committees in Common (18/2/15), as follows:

Initial assessment of estate already made by IBI Healthcare

This informs the Capital Investment assessment (Affordability & Value for Money)

As result, it was recommended that this information was provided to the Committees in Common to support the decision making process, this recommendation was accepted by the Committees in Common on the 18/02/15.

Closed

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1.5.7 Theme 6: Decision Making Process – (c) Fixed Points

Ref. Theme: Fixed Points

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D8 How were specialist fixed points selected, and why weren’t other hospitals selected?

Some stakeholders argued that certain sites had a case for being a fixed point because of the suite of services that they offer. - Concern that Salford had been

designated a specialist hospital in all the options. If the clinical interdependences between neurosciences and A&E at Salford means it is designated a specialist site in all options then the clinical interdependences between the specialist services offered at UHSM such as burns/plastics and A&E should also make UHSM a specialist hospital.

- Stepping Hill is well capable of becoming a Specialist Hospital – they are already specialists in bowel surgery; Stepping Hill has some of the best outcomes for surgery in Greater Manchester If we are to move surgery out of Stepping Hill it would be to hospitals with worse outcomes.

• Royal Bolton Foundation Trust

• University Hospital South Manchester Foundation Trust

• Staff meetings - University Hospital South Manchester 13/08 and 27/08

Committee in Common (18/12/13) Committee in Common (26/02/14)

The identification of specialist fixed points was subject to significant review and advice from the Provider Reference Group and Clinical Reference Group (CRG) in the pre-consultation phase. A robust process was used to assess potential services that could be fixed as high risk general surgical centres. This is explained in full in the Pre-Consultation Business Case. Using this process providers were asked to propose potential single site services that could be fixed and to provide comprehensive evidence to support this. The evidence was reviewed by the Clinical Reference Group and as a result of this, three sites were put forward as options for specialist fixed

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- UHSM is disappointed that Wythenshawe Hospital was not recognised as a “fixed point” in the first instance.

- Why was Oldham considered to be a fixed site as they do not have any specialist skills that we currently offer here at Wythenshawe?

- Commissioner justification for designating specialist sites i.e. paediatrics (for Manchester Royal Infirmary) and neurosciences (for Salford Royal) are as applicable to the Royal Bolton Hospital with our Obstetrics and Paediatric surgery services.

points for the purpose of the option appraisal process including RMCH (Tertiary Children’s Service), SRFT (Adult Neuroscience Service) and Adult Burns Service (UHSM). The Clinical Reference Group’s findings were considered by Committees in Common at their meeting on 18/12/13, the outcome of which was that further clarity was required by NHS England’s North West Specialised Commissioning Group regarding their future commissioning arrangements as the responsible commissioners for these services. Subsequently, work was undertaken to assess the implications of these services being a fixed as high risk general surgical centres. Submissions from the Trusts included a detailed description of clinical co-dependencies and operational infrastructure requirements. This allowed a full understanding of the impact of designating Tertiary Children’s and Adult

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Neurosciences on the Healthier Together in scope services. As result of this feedback it was proposed that specialist fixed points should be determined for Tertiary Children’s Services and Adult Neurosciences only due to the national review of burns services not yet enacted in the North West. This decision was endorsed at the Committees in Common meeting on 26/02/14, meaning that CMFT and SRFT would be designated specialist in all options. Commissioner groupings were used for the purpose of ensuring an equitable geographic spread of specialist sites across Greater Manchester. Three preferred groupings were used to generate a medium list of options to be considered and evaluated using “hurdle criteria” (pass/fail) in regards to Estate Capacity, Workforce Capacity and Transport and Access impacts. The potential shortlisted options were

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assessed against these standards; all options which did not include Royal Oldham as a specialist site did not meet the hurdle criteria for transport and access which requires no more than 10,000 of the population of any one CCG should have a greater than 75 minute journey by public transport to a specialist site. As result of this process the 3 fixed specialist sites used in the public consultation were confirmed as Salford, Central Manchester and Oldham.

D9 How were local fixed points selected, and why weren’t other hospitals selected?

Some stakeholders queried how local fixed points were selected? - No reason is given as to why the 3

hospitals NMGH, Bury and Tameside have been downgraded as local general hospitals.

- You have not consulted me or any other resident as to whether we want our local hospital NMGH to be downgraded to a local hospital.

Individual Responses

Committee in Common (26/02/14) Committee in Common (16/04/14)

The identification of Local Fixed points was determined by individual CCG’s local commissioning intentions. There are several reasons why commissioners may consider locations for local services including: - capital investment to deliver

the required services being high or prohibitive,

- services have been changed from sites in previous reconfigurations and previous consultations

- sites being involved in other

Closed

D10 Can fixed general hospitals be changed?

Some stakeholders queried whether made the case for their local hospital also being a fixed point. - Can fixed point general hospitals be

Joint letter from Cllr. Shaukat Ali and Cllr. Naeem UI Hassan

Closed

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changed?

Staff meetings - Tameside 22/08

formal planning processes and to include it as a specialist site would be inconsistent with local commissioning intentions and wider considerations.

As result three ‘local’ fixed points were selected: Fairfield General Hospital, Tameside General Hospital and North Manchester General Hospital. This decision was endorsed by Committees in Common at the meeting on 16th April 2014.

D11 Geography/ travel issues indicate that another hospital should have been allocated as a fixed point

Some stakeholders argued that certain sites had a case for being a fixed point because of geography/travel reasons: - ... if the Royal Oldham hospital was

chosen as a specialist site for its geographical location, then Wigan could be justified similarly. 1,000 new homes planned for Wigan, has that been accounted for?

- Wythenshawe should be a specialist hospital as it: has the transport links, proximity to the airport in case of major alert…why wasn’t it designated as one of the three (fixed)?

- It is inconsistent that the Royal Oldham Hospital should have been re-designated as a specialist site in all

• Public events - Wigan 21/08 and 16/09, New Mills 22/07, Glossop 18/08, Derbyshire 15/09, Stockport 25/09, South Manchester 09/09, East Cheshire 23/09

• Southport & Ormskirk Hospital Trust • Mike Kane MP

Travel and Access Group (09/06/15)

The Transport Advisory Group considered consultation feedback relating to the travel impact of accessing specific hospitals from different localities across the conurbation. During the pre-consultation phase analysis was undertaken to describe the impact in individual CCG areas on public transport travel to potential specialist hospitals. All options at this stage were assessed to see if more than 10,000 people within any one CCG could not

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options; on the grounds of excess travel times…it is felt that Stepping Hill is in exactly analogous situation in relation to the population of High Peak.

- Given the strategic location of Wythenshawe Hospital, and the other important specialisms which are based at the hospital I believe that it should have been recognised as one of the ‘fixed site’ Specialist Hospitals in the consultation.

meet the 75 minute public transport access standard. This analysis showed that options that did not include Oldham as a specialist had a large population from Heywood Middleton and Rochdale CCG that did not meet this criteria. Hence only options that included Oldham were taken forward at this stage. In the decision making phase public transport data has been updated to reflect the latest available networks and now includes the impacts of any increased journey times from non- Greater Manchester CCGs. This will provide a full assessment of the travel impact for those that use Greater Manchester hospitals and will be considered by the Committee in Common as part of the decision making process.

52

1.5.8 Theme 7: Data Queries – (a) Quality & Safety Data

Ref. Theme: Quality and Safety Data

Feedback Query





Status

Q1 Could Friends and Family Test data be updated?

Some stakeholders referenced the need to take into account more recent Friends and Family Test data: - Newer data on the Friends & Family Test

available since the PCBC e.g. UHSM achieved 98.4% for the 12 months to July 2014 (note no request for this to be updated in the analysis however)

UHSM NHS FT

WWL NHS FT


Work has been undertaken to refresh the Patient Experience baseline with the latest available Friends and Family Test data. Data has been collected over a longer timeframe using a full year to date for 2014-15. In addition, the two different data sets (inpatients and A&E) have been separated to provide greater clarity on scores. The Clinical and Patient Safety Group recommends that patient experience data (refreshed following this query) is an important consideration. Should there be outliers this information would be taken into account in differentiating between the proposed options. However, the assessment at the Clinical and Patient Safety Group of the updated data is that it doesn’t materially differentiate between the options. This will be considered by the Committees in Common in the decision making process.

Closed

53

1.5.9 Theme 7: Data Queries – (b) Travel & Access Data

Ref. Theme: Travel & Access Data

Feedback Query





Status

TA1 How will ambulances and transfers be affected and what implementation planning is required?

Ambulances will need to convey patients to different hospitals. Has work been undertaken to assess the resource and other requirements to achieve this? - EMAS notes that there would be a need

to make changes to the way that its ambulance clinicians assess, treat and convey patients

- The capacity of the ambulance service, response times, journey times, level of training and the specialist kit available are all critical to deciding whether lives will be saved or lost.

Also is there a risk that the ambulance service will identify more specialist hospital cases than anticipated, placing increased unplanned workload on the specialist hospital? - The front end “Pathfinder” tool may both

be sufficiently sophisticated enough to accurately address all of the clinical issues.

Meetings (e.g. Derbyshire P15/09, Stockport P25/09, Bury P28/08, Stockport S25/07, Christie S04/09, MMH S17/09, Trafford 24/09, Wigan P21/08, NWAS S08/09,MWASS08/09, NWAS S30/09, NWAS S30/09, Tameside S19/08 and NWAS S08/09)

North West Ambulance Service and East Midlands Ambulance Service (NWAS and EMAS)

SRFT

Cllr Charlie

Transport Advisory Group (04/02/15)

The Transport Advisory Group considered feedback relating to the impact of changes on ambulance services. It was recognised that prior to implementation a full understanding of the resource impact in terms of the number of ambulances that may be required and any impact on the responsiveness of ambulance services should be described. Real life testing of Pathfinder processes will also need to take place prior to implementation to ensure that patients are conveyed to the appropriate site when operationalised. To ensure that a shared understanding is developed, the group has written to NWAS (North West Ambulance Service) to request information and modelling on the impact of changes. This will ensure that all necessary considerations and the testing of Pathfinder can be fully described ahead of implementation. EMAS are also members of the Healthier Together Transport Advisory Group, and involved in this

Closed

54


Feedback Query





Status

Mcintyre

Individual questionnaire responses

Trusts (e.g. WWL, Stockport NHS FT)

Wigan Council

work, which will enable any similar impacts on their services to also be described and planned for ahead of implementation.

TA2 Will ambulance response times and travel times be affected?

Some stakeholders perceive that ambulance response and travel times may increase and are concerned about this. - Time taken to reach patients by EMAS

needs to be taken into account. - Review the impact of any extended

journey times on ambulance service resources and specifically any detrimental impact on EMAS to maintain current levels of response time performance in the affected area of North Derbyshire.

EMAS and NWAS

Most public and staff meetings



The Transport Advisory Group considered feedback relating to the impact of changes on ambulance services and increasing travel times. The maximum clinically acceptable travel time by car or ambulance to a specialist hospital was agreed by the Committees in Common following clinical advice from the Clinical Reference Group and published in the Pre-Consultation Business Case. All of the options put forward for public consultation were able to meet that maximum travel standard. In addition, work is underway to engage NWAS (North West Ambulance Service) in determining the impact on its services and the impact on its support and resource requirements. EMAS (East Midlands Ambulance Service) are represented

Closed

55


Feedback Query





Status

on the Healthier Together Transport Advisory Group to ensure that any similar impact on their services can also be understood.

TA3 How much additional travel will there be? This is a concern.

There is concern about additional travel in relation to practicality/cost and the perceived potential risk associated with additional travel time. - Local saves lives! .

Most meetings (e.g. Bolton P02/09, Derbyshire P15/09, Leigh P21/08, Oldham P03/09, Bury P04/08, Tameside P12/08, Oldham P14/08, Salford P19/08, East Lancs. P26/08, South Manchester P09/09, Derbyshire P15/09, HMR P17/09, East Cheshire P23/09, Trafford P24/09, Stockport P25/09, Bury P28/08, Wrightington S24/07(3), S. Manchester

Clinical Advisory Group (18/12/14) Transport Advisory Group (17/12/14)

The Pre-Consultation Business Case identified that travel times would increase for people travelling to sites that will offer high risk planned or emergency general surgery. The Clinical Advisory Group re-confirmed in December 2014 that all options meet the 45 minute car and ambulance travel standard and that this model does offer improved outcomes for patients. The Transport Advisory Group discussed points highlighted during the consultation relating to the additional travel impact on visitors and patients. The updated travel analysis will include increased detail on these impacts and will be presented to the Committees in Common as part of the options assessment in response to this query. Specific travel impacts on deprived communities and other protected groups will be described to the

Closed

56


Feedback Query





Status

S27/08, Salford S06/08/(1) and Wigan S15/08)


Committees in Common separately through the Integrated Impact Assessment.

TA4 Should areas outside of the Greater Manchester boundary, but using Greater Manchester services, be included in the analysis?

There are populations outside of the Greater Manchester boundary that are users of Greater Manchester hospitals (such as the High Peak). The impact on these patients should be taken into account. - There are significant implications for the

population out of the Greater Manchester conurbation that will be directly affected.”

- It is felt that the transport situation with High Peak residents is analogous to (if not worse than) the situation that led to Royal Oldham being agreed as a specialist site in proposals.

NWAS

EMAS

Public, staff and transport meetings

Stockport NHS FT and WWL NHS FT


The Transport Advisory Group considered this at the meeting held on 17th December 2014, following feedback from a number of sources through the consultation. The group agreed that the transport analysis will be refreshed for the decision making phase to include those areas outside of the Greater Manchester CCG boundary where the closest hospital is a Greater Manchester hospital. This will incorporate those patient groups that currently use Greater Manchester hospitals, and are affected by the proposals, into the transport analysis.

Closed

TA5 Is the public transport travel time standard reasonable?

Some stakeholders do not agree that the public travel standard of 75 minutes is reasonable.

- Your estimate of 1hr 15 mins as the maximum someone should have to travel by public transport is not acceptable given that relatives can be visiting twice a day.

Individual responses (e.g. Online ID 159)

Stroke Association meeting, staff meetings and public meetings

Transport Advisory Group (17/12/14 & 27/03/15) Transport Advisory Group

The Transport Advisory Group discussed this feedback at the meeting on the 27th March. The 75 minute standard has been subject to scrutiny having been used in previous reconfigurations of hospital services across Greater Manchester. The standard was

Closed

57


Feedback Query





Status

- It is grossly unrealistic to suggest that a travelling time of 1 hour and 15 minutes is acceptable for a patient to travel to hospital by public transport.

- It is highly unlikely that access standard 3 (75 minute public transport access to a specialist site) would be met for the North Derbyshire population under any of the eight options. The CCG’s travel analysis reflects worsening public transport access times if the specialist site was not at Stockport.

- The criteria that the programmes assessment of public transport access is based on is unrealistic.

- Have waiting times for buses, walking between busses, and a long journey at the end of the travel been considered.

North Derbyshire CCG

Wigan Healthwatch

(10/06/15) approved by the Committees in Common in the pre-consultation phase following testing with the public and stakeholders during criteria development workshops. Additional clarity in the definition of how travel time is calculated has been sought by the group for inclusion in the Decision Making Business Case. The public transport analysis has been updated to cover the current catchment area of all Greater Manchester hospitals; however this refreshed analysis shows little movement in overall compliance with the 75 minute access standard compared to the same analysis in the Pre Consultation Business Case. The Committees in Common will also consider this analysis alongside other travel factors, including looking at the overall longest travel times experienced by patients under each option.

TA6 Is transport data realistic and is there an opportunity to refine it?

Some stakeholders do not accept that the transport analysis is realistic (i.e. that transport standards can be met) or have requested that it is checked and refined. - Given the structure of the road and

Individual responses (e.g. Online ID 159) and MPs (e.g. Lisa Nandy)


The Transport Advisory Group reviewed this consultation feedback at the meeting on the 17th December 2014. The group agreed that the transport analysis should be

Closed

58


Feedback Query





Status

public transport network in the Greater Manchester area for many people this time limit is only good enough to get them to their local town hospital.

- Are you sure that the increase in travel time quoted for Southport and Formby DGH, rather than RAEI is correct?

- Alternative data for travel times from High Peak North Derbyshire suggest 37% of journeys would not meet the standard by car/ambulance, and 45% would not meet the standard by public transport.

- There is confusion and mis-judgement about public transport times to and from hospitals.

- TTHC’s checks of the Programme’s results found that journeys cannot be completed within the Programme’s parameters. Journeys cannot be completed for a variety of reasons, including too many bus service changes and excessive walking distances.

- Healthwatch Bolton members undertook the journeys and almost 80% of likely journeys to a Specialist Hospital (other than Wigan) would fail Healthier Together’s Transport Standard.

- Data provided for the transport implications of the proposals havebeen found to be woefully inaccurate. I am interested to know how the estimated

Provider responses

Local Authority responses

Healthwatch Stockport, Wigan and Bolton

Public meetings

extended to assess journeys at additional times of the day including peak times as well as interpeak/off peak, and evening public transport journeys. In addition, to provide a greater level of detail, the analysis will be updated at Postcode level rather than Lower Super Output Area to more closely reflect the journeys people actually make to Greater Manchester hospitals.

59


Feedback Query





Status

journey times included in the consultation document were calculated

TA7 Has the potential outflow of patients from Greater Manchester been taken into account?

A small number of patients may travel (by ambulance, car or public transport) outside of Greater Manchester for their nearest emergency general surgery/planned complex general surgery if there is a closer hospital outside of Greater Manchester offering that service than the nearest Specialist. Has this been considered? - Should stepping Hill Hospital Stockport

not be a specialist centre it may be necessary to direct patients requiring specialist care to alternative sites outside of Greater Manchester. Again this requires detailed modelling.

EMAS Transport Advisory Group (17/12/14) Transport Advisory Group (10/06/15)

The Transport Advisory Group considered the potential outflow of patients from Greater Manchester at the meeting held on 17th December 2014, following feedback from a number of sources through the consultation. The group agreed that the transport analysis will be updated for the decision making phase to include those areas outside of the Greater Manchester boundary where the closest hospital is a Greater Manchester hospital, to incorporate all patient groups that use Greater Manchester hospitals in the transport analysis. This analysis will identify areas where patient flows out of Greater Manchester could occur and will ensure that the Committees in Common are able to consider the potential impact on these populations before making a decision.

Closed

TA8 Have changes to the public transport system and road network since the transport analysis

Some stakeholders referenced new and upcoming changes in public transport provision since the PCBC was written, and requested that the travel time calculations should be updated before any decisions

Bolton NHS FT, UHSM, WWL NHS FT, UHSM NHS FT


The Transport Group reviewed this feedback at the meeting on the 17th December 2014. The group agreed that the analysis used to support the pre- consultation phase of the

Closed

60


Feedback Query





Status

was completed been taken into account?

are taken: - The planned improvements to road

access and public transport have not been considered by the consultation and we ask that this is considered in the next phase.

programme should now be updated for the decision making phase to take account of current road network and public transport systems. This updated analysis reflects the latest available public transport data (July 2014) and includes the Manchester Airport Metrolink line which has been recently added to the network.

TA9 Should transport data take better account of the Airport population?

UHSM argue that taking into account this extra population will lower the average travel times to UHSM – an average of 57,000 passengers travel through the Airport every day

UHSM NHS FT Transport Advisory Group (27/03/14, and 29/04/15)

The Transport Advisory Group considered this feedback at the meeting on the 27th March 2015 and 29th April 2015. The transport analysis uses census information to understand journeys from where people live to their nearest hospital. The provider activity data used in the options appraisal will indicate, for in-scope services, where there are existing flows of patients who use hospital services that may not be their nearest. The group also analysed historic data that described the number of patients taken annually to Wythenshawe hospital from the airport and found that there was not

Closed

61


Feedback Query





Status

a significant extra demand on services from this population. It was also noted that it would not be possible to realistically quantify and make adjustments in the travel model for the impact of varying populations in other specific areas and employment centres across GM. Analysis of projected patient activity information will take account of the impact of any flows of patients coming from large employment centres or the airport into GM hospitals, and this will allow a comparison to be made regarding the impact of travel time for these patient groups

TA10 Should single services reflect natural catchment area for Greater Manchester hospitals?

Some stakeholders have suggested that natural catchment areas (including outside of Greater Manchester boundaries) be considered: - “It is absolutely essential to recognise

the natural catchment areas of this grouping of southern sector hospital services which includes populations in Cheshire and North Derbyshire.”

- It is critical that access to specialist services and centres by patients outside of Greater Manchester are considered as part of this consultation.

Stockport NHS FT

David Rutley MP


The Transport Advisory Group considered this at the meeting held on 17th December 2014, following feedback from a number of sources through the consultation. The group agreed that the transport analysis will be refreshed for the decision making phase to include those areas outside of the Greater Manchester CCG boundary where the closest hospital is a Greater Manchester hospital in order to

Closed

62


Feedback Query





Status

- There has been little recognition that a population of 90,000 in High Peak is reliant upon hospital services in Greater Manchester

incorporate those patient groups that currently use Greater Manchester hospitals in the transport analysis. Information will be provided to the Committees in Common regarding populations that would potentially travel outside of Greater Manchester to their nearest hospital offering specialist care under Healthier Together proposals.

TA11 What is the impact of varying flows of patients to Specialist or Local Hospitals?

Thresholds for the Ambulance Service referring patients to Specialist or Local hospitals may vary which could cause negative / unintended impacts for capacity

Tameside Hospital NHS FT

Transport Advisory Group (04/02/15) Transport Advisory Group (10/06/15)

The Transport Advisory Group reviewed this feedback alongside other points raised regarding the impact of changes on ambulance services at the meeting held on 4th February 2015. Following this discussion the group have written to NWAS requesting that the process to test and implement Pathfinder is described and to ensure the impact of any variance in patient flows is considered and the impact on the number of patient transfers is fully understood.

Closed

63

1.5.10 Theme 7: Data Queries – (c) Transition Data (I) Workforce Data

Ref. Theme: Workforce Data

Feedback Query





Status

W1 Should the workforce baseline be updated and challenged?

Some stakeholders have queried whether the workforce baseline is up to date: - Workforce planning assumptions

require “further challenge” - WWL is investing in A&E and Paediatric

and Obstetric services to being consultant-led up to midnight

Individual Response

WWL NHS FT

Clinical and Patient Safety Group (26/03/15) Human Resources & Workforce Group (09/04/15) Clinical Advisory Group (24/04/14) Clinical and Patient Safety Group (07/05/15) Human Resources & Workforce Group (14/05/15)

The workforce model is fundamental to the achievement of the quality and safety standards outlined in the Future Model of Care. The Clinical Advisory Group and the Clinical and Patient Safety Group reviewed this feedback in March and April. Consequently, the workforce modelling exercise undertaken in 2014 has been repeated and updated in April 2015 with latest data available from each of the Trusts. This updated data has been reviewed by the Clinical Advisory Group and Clinical and Patient Safety group in both April and May 2015. This will be provided to the Committees in Common to inform decision making.

Closed

64

1.5.11 Theme 7: Data Queries – (d) Activity Data

Ref. Theme: Activity Data

Feedback Query





Status

A1 Can activity data be updated?

Activity has changed since the 2012/13 data analysis that will materially change the impact on hospitals of Healthier Together compared with proposals

Southport & Ormskirk Hospital NHS Trust

Data Modelling Advisory Group (25/02/15 and 25/03/15) Finance & Investment Group (06/03/15 and 10/04/15)

Comparative analysis of the 2013/14 HES Data with 2012/13 HES data was undertaken to confirm if there were any material differences. This comparative analysis concluded that :-

The overall Greater Manchester position had not changed materially.

By provider, however there are significant differences in total spell volumes ranging from reductions of 10.6% to increases of 8.2%.

Due to the differences at provider level, it was agreed by the Data Modelling Advisory Group (DMAG) on 25/02/15 that a full update to the baseline data would be undertaken to reflect 2013/14 activity. This recommendation was endorsed by the Finance and Investment Group (FIG) meeting on 06/03/15 subject to sensitivity analysis being undertaken to demonstrate whether the growth and deflection assumptions remain appropriate. This sensitivity analysis

Closed

65


Feedback Query





Status

along with the related recommendation was taken to the Finance and Investment Group meeting on 10/04/15. Sensitivity analysis has been done and base line year has been updated.

A2 Is the definition of General Surgery clear and how does this affect the data?

Some Provider Trusts questioned the definition of General Surgery used to prepare activity data. Changing this might affect the level of activity that might transfer from one site to another under the new model of care. - The Trust believes that the definition of

general surgery is still an issue, as yet unresolved.

- WWL code activity to the level of treatment function code, meaning that other activity (in scope) could sit in other treatment function codes such as Colorectal and upper GI Surgery. This could result in the level of in scope activity being significantly underestimated.

Bolton NHS FT, WWL NHS FT and North West Sector Response (verbal update to S. Hargreaves)

Data Modelling Advisory Group (08/04/15)

For the Healthier Together modelling specialty codes were used to define the activity modelled for each of the in scope areas. Whilst variations exist with regard to how general surgery activity is coded between hospitals, the majority of activity is captured under a general surgery consultant speciality code and is therefore included within the modelling. However, the activity modelling will specifically compare activity under this definition of General Surgery with activity defined by Treatment Function Code to ensure that no material elements of activity are missed. Breast and vascular surgery were removed and this point forms part of the local sector modelling discussion.

Closed

A3 Can we ensure productivity and deflection assumptions are not double counted?

One organisational response requested that the productivity and deflection assumptions should be reviewed for all services to ensure these are realistic and have not already been considered by organisations in delivering cost improvement programmes.

Organisation response

Data Modelling Advisory Group (08/04/15) Finance & Investment Group (10/04/15)

The Data Modelling Advisory Group and the Finance and Investment Group have reviewed this query. Within the activity model the deflections are applied with any balance deducted from the productivity deductions to avoid any double count.

Closed

66


Feedback Query





Status

A4 Will deflections be achieved and what will be the impact on the hospital proposals if not?

Cost-effectiveness and other benefits from primary care and community-based alternatives to hospital care will need to be continuously validated. - “We are concerned that very high

assumptions on the level of deflections (72.9% of the predicted growth) that will occur into primary care services and that little evidence exists to substantiate these plans.”

Stockport NHS FT

WWL NHS FT


The deflection assumptions that have been applied are those that were signed off by local commissioners and should therefore be reflected within local contractual discussions. Additional analysis has been completed to check that actual activity trends support these deflection forecasts. Joint updates are to be provided to the Committees In Common from Primary Care and Joined Up Care to provide scrutiny and assurance on these areas. This sensitivity analysis was undertaken ahead of the July Committees in Common meeting.

Closed

A5 What is the impact on patient flows, particularly the redirection of patients from Tameside to Stockport and to CMFT not Stepping Hill

Re-designation of Tameside General as a ‘Local’ site would mean an increased flow of emergency patients to Stockport – this may not have been factored in

UHSM cite the S. Sector Local Health Economy analysis as contradicting Healthier Together in that patients will go to CMFT rather than Stepping Hill in Option 4.4, 5.1 and 5.4

Stockport NHS FT

UHSM NHS FT


Activity flows for each possible single service configuration within each shortlisted option are being modelled. The activity modelling assumes that patients will present at the nearest hospital to them geographically based on travel time data from Transport for Greater Manchester. Although it is not possible to predict exactly how patients will behave in a future model (for example when self-presenting to A&E), analysis has been undertaken to compare current activity patterns with

Closed

67


Feedback Query





Status

the modelling assumptions used within the activity model.

A6 Is local modelling required to ensure case mix is reflected in requirements for beds, critical care beds and theatres

“The HT modelling has considered ward and critical care length of stay. It has also considered average theatre times for day case, low and high risk surgery. Local modelling needs to look at this in more detail to ensure the case mix is reflected in requirements for beds, critical care beds and theatres.”

Organisational response


This feedback has been reviewed by the Data Modelling Advisory Group. The update of the capital modelling will refresh the estate capacity and content required on each site to deliver the predicted case mix. This modelling will take into account the existing capacity on each site. The estates consultancy experts will agree their analysis and conclusions with individual Estates leads to confirm that the proposals remain robust, including the capital which remains on site. This work is now complete.

Closed

A7 Do capacity planning assumptions require further challenge?

Capacity planning assumptions require “further challenge” - It’s necessary to ensure any capacity

released from this work is not committed to other service developments.

WWL NHS FT and SRFT


This feedback has been reviewed by both the Data Modelling Advisory Group and the Finance and Investment Group. The refresh of the capital models will clarify whether any surplus estate/physical capacity can be disposed of or used elsewhere within the estate. The value of any disposal or alternative use will be recognised as a mitigation of the capital cost. The final mitigations agreed with providers will ensure that the updated position fully reflects provider estates strategy and plans. The methodology for this

Closed

68


Feedback Query





Status

approach has now been agreed by both Finance and Investment and Estates Groups.

A8 What are the financial Consequences to local hospitals?

One stakeholder has queried the likely impact on activity flows to local hospitals as result of deflections towards Specialist Hospitals: - Has a financial analysis been

undertaken to predict the financial consequences to local hospitals?

TH NHS FT

Data Modelling Advisory Group (11/03/15, 25/03/15 and 08/04/15) Finance & Investment Group (06/03/15 and 10/04/15)

This feedback has been reviewed by both the Data Modelling Advisory Group and the Finance and Investment Group. The activity and financial modelling undertaken includes analysis of all activity and financial flows for both Specialist and local hospitals in the future model for in scope specialties.

Closed

69

1.5.12 Theme 7: Data Queries – (e) Affordability and Value for Money Data

Ref. Theme: Affordability and Value for Money Data

Feedback Query





Status

V1 How do we avoid double counting provider efficiency savings?

Concern that achievement of the £489m provider efficiency savings (2.6%) is a double count with the £22m HT programme efficiencies. Concern that target reductions in bed days in ‘atypical’ spells cannot have efficiencies applied to them Concern that projected bed reductions are not shown at a provider level

WWL NHS FT Data Modelling Advisory Group (25/02/15, 08/04/15), Finance and Investment Group (10/04/15)

The Pre Consultation Business Case separately identified the £22 million savings which were attributable to benefits arising solely from the changes arising from the introduction of the Future Model of Care. The five year financial gap for the local health economy was explicitly reduced by £22 million to avoid double counting. Each work stream has been separated into two types – typical and atypical. For atypical spells, the approach has been to consider the number of bed days in excess of the standard trim point (typical length of stay) as compared to other provider sites within Greater Manchester. Projected bed days have not been shown at provider level in publically available information as this information is commercially sensitive for providers.

Closed

70

Ref. Theme: Affordability and Value for Money Data

Feedback Query





Status

V2 What is the cost effectiveness of 4 vs. 5 site options?

That 4 site options are more cost-effective than 5 site options. It is suggested that a detailed financial appraisal is required before conclusions can be drawn to take account of “currently unspecified service changes – without which five centres would almost certainly be more cost effective”

Bolton NHS FT Data Modelling Advisory Group (08/04/15) Finance and Investment Group (10/04/15)

This feedback has been considered by the Data Modelling Advisory Group and the Finance and Investment Group. The Commissioners will receive detailed financial and other analyses, including travel and access and workforce, to reflect the differences between four and five site options.

Closed

71

1.5.13 Theme 7: Data Queries – (e) Affordability and Value for Money Data (I) Estates & Capital Data

Ref. Theme: Estates and Capital Data

Feedback Query





Status

E1 Has hospital capacity been considered?

Some individuals (particularly staff) and MPs expressed concerns about how demand might increase in hospitals designated as providers of emergency General Surgery and whether sufficient planning is in place to manage this.

Meetings (e.g. Christie S04/09, Stockport S11/09, Stockport P12/08, Bolton S11/07(1), CMFT S30/07(3), Bolton S11/07(1), PAHT S03/09(2), Stockport S17/07, Wrightington S23/07(1), Christie S04/09, Salford S20/06, Tameside S22/08 and Wigan S15/08)

Individual responses – MPs

Data Modelling Advisory Group (08/04/15) Finance and Investment Group (10/04/15) Capital Group (10/04/15)

The activity modelling factors in all activity moves as a result of the service changes being proposed. This modelling includes the specific impact under each option of providers of emergency General Surgery. The estates work then considered the additional estate capacity and content required on each site to deliver these activity changes and how it would be made available. This work is being updated for 2013/14 activity levels following the decision to update this dataset. The results of this will be considered by the Committees in Common as part of the decision making process.

Closed

72


Feedback Query





Status

E2 What is the NPV calculation comparison?

Southern Sector Local Health Economy work found the two options with UHSM as their equivalent to a HT ‘Specialist Hospital’ had the highest NPV benefits – how does our analysis compare?

UHSM NHS FT Data Modelling Advisory Group (08/04/15) Finance and Investment Group (06/03/15 and 10/04/15)

Net Present Value will be considered by the Committees in Common as part of the Affordability and Value for Money criteria as part of the decision making process. They will also be aware of the capital and revenue implications on each provider for each of the options. This will enable a comparison to be made with the Southern Sector Local Health Economy work, however, it should be noted that the two may show difference results given that the Southern Sector work is based on a different model, with a different scope, and includes Macclesfield District General Hospital in the analysis.

Closed

73


Feedback Query





Status

E3 Can changes in Estate capacity be taken into account?

- Bolton NHS FT have a 5 year programme to make cost reductions equivalent to 250 beds – they already have spare capacity for high risk and emergency surgical patients

- Need to pick up changes in services beyond the scope of Healthier Together

- Stockport NHS FT have 6 unused but fully equipped critical care beds that could be brought into service; and plan to develop the A&E/Emergency receiving area; D Block development, and plans for an on-site multi-storey car park should also be taken into account

- WWL – framework agreement with major contractor that does not require further procurement should major work be required

- WWL – levels of capital investment required by site require “further challenge”

Bolton NHS FT, Stockport NHS FT and WWL NHS FT

Estates & Infrastructure Group and Finance and Investment Group (06/03/15) (Overview of methodology) Individual estates lead provider meetings – second meetings (08/04/15 and 09/04/15) Estates & Infrastructure Group and Finance and Investment Group (10/04/15) (Outputs of provider meetings) Estates & Infrastructure Group (30/04/15)

As part of the consultation process, the baseline position for bed numbers, theatre numbers/types and emergency department facilities were agreed with providers in May 2014. This data is being reviewed and updated to take account of the latest projections based on 2013/14 activity. The update, which is being done in conjunction with the Estates Lead for each provider, will identify any material changes to the additional estate capacity and content required on each site by each provider. All functional content and capital estimates will be supported by an overall summary to reflect the context for any estates reconfiguration and any dependency links to existing capital plans. In particular, this narrative will ensure that the capital proposals take into account any linkages to current capital proposals on site.

Closed

74

1.5.8 Theme 8: Consultation Process

Ref. Theme: Consultation Process

Feedback Query

Detailed description and relevant quotes to illustrate feedback




Status

P1 Concerns about some of the consultation questions and are ambiguous in nature

Some stakeholders have considered that the consultation questions used were leading and could only be answered in a positive manor: - the questionnaire is designed to lead

us to agree with what HT has determined should happen

- The questions at the end are leading and can only really be answered in the affirmative

- The questions are clearly designed for the rubber stamping of change

- The options given are too narrow, not comprehensive and do not leave scope for thorough comments and generally are limiting to certain desired outcomes

- The proposals consisted of two types of question, the first set being of such a nature that you were bound to get a positive response. … the second set were of a kind to which people had to respond by making a choice

- It does appear to be full of platitudinous statements which inevitably lead the respondent to an affirmative response

Also, in terms of the questions being ambiguous: - The wording for Q4 [specialist care]


Cllr Ali, Cllr Hassan

Graham Stringer MP

Stockport NHS FT

TH NHS FT

06/07/2015 by Communications and Engagement Group

The Healthier Together programme, as part of the development of the consultation, commissioned an independent research organisation, Opinion Research Services (ORS) to develop and verify the questions for the consultation. Opinion Research Services have worked on similar consultations across England and the consultation process was assured by NHS England. The consultation documentation was awarded the Crystal Mark accreditation by the Plain English campaign for its clarity and the use of “plain English”.

Closed

75


Feedback Query





Status

may be open to being interpreted as any specialist services

P2 The consultation meetings took place at inaccessible times/locations

Some stakeholders felt that the consultation meetings took place at inaccessible times and locations meaning that people could not attend:

- Meetings have been arranged at inappropriate times and places

- Consultation meetings have been arranged at inappropriate times

-


Graham Stringer MP


Healthier Together committed to a range of meetings across Greater Manchester to communicate the case for change and consultation process. The team also worked with our local Clinical Commissioning Group and Voluntary Sector partners to ensure that meetings were held in accessible venues. In total there were 341 public engagement events across Greater Manchester, these opportunities were split into the following categories:

1 press conference

19 public events

24 CCG led events

9 transport events

12 Question Time debates

54 staff listening events

6 staff drop in sessions

14 informal staff engagement events

1 “The Feeling” with young people

1 voluntary sector briefing

200 opportunities with community venues and groups

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Feedback Query





Status

Healthier Together ensured that the events took place at a range of times in order to enable participation from members of the public. All of the public question events took place in the evening and all of the transport events took place during the day. The other engagement meetings were evenly spread between morning, afternoon and evening sessions. In order to reach our deprived communities and communities who are considered to be seldom heard or hard to reach, we had a campaign bus with Key 103 to deliver outreach engagement in our communities across Greater Manchester.

P3 The consultation does not comply with Cabinet Office Guidance on Consultation Principles

A number of stakeholders suggested that the consultation did not meet Cabinet Office guidelines: - Timing of consultation to begin early in

policy development and to be proportionate and realistic.

- Making information useful and accessible so that the key issues are clarified and uses plain language

- Transparency and feedback to ensure that the purpose of the consultation is clear, it is available on different mediums and encourages active participation

- Practical Considerations: the consultation should not be launched during local or


Graham Stringer MP

06/07/2015 by Communications and Engagement group

The initial Healthier Together period of consultation was from 8th July 2014 until 30th September 2014, which is in line with the 12 week Cabinet Office consultation principles. As the consultation ran over the summer holiday period and in view of the complexity of the subject, the consultation period was extended beyond the usual 12 week period to 15 weeks. This extension allowed a comprehensive consultation and a full

Closed

77


Feedback Query





Status

national election period and it needs to be made clear how the consultation has been agreed to proceed

programme of events to be held, with ample time for the public to provide a response.

P4 The HT consultation should have extended to stakeholders beyond GM boundaries

Some stakeholders raised concerns that the impacts of the changes would extend beyond GM and that that these area should therefore be included within the consultation: - Health Bodies and patients adjacent

to GM have not been consulted - We cannot look at GM independently

when making changes to the NHS. Have health bodies adjacent to GM not been consulted?

- There has been no consultation with Health Bodies and patients adjacent to GM


Cllr McIntyre


Graham Stringer MP


Healthier Together ensured that bordering CCG’s were involved in strategic discussions at the Committee in Common meetings which are continuing to take place. Working in partnership with local CCG’s the programme advertised the consultation through local communication channels and held events in neighbouring areas to ensure that members of the population had an opportunity to input into the consultation. The consultation received 1740 responses from outside the Greater Manchester area, 1580 of these were from our neighbouring areas and 160 responses were from outside of the North West area. As the programme moves into making a decision and planning for implementation we are currently co-designing an engagement group for patients across Greater Manchester and working with our neighbouring

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Feedback Query





Status

CCG areas of North Derbyshire and Eastern Cheshire to ensure that their patient population have the opportunity to be involved in the next phase of the programme.

P5 The consultation timescales were too short

- I believe the residents of GM have not

had adequate opportunities to find out the full details and potential consequences of the consultation.

- the timing and the length of the process, over the summer, may well account for the low response rate

- A period of less than 3 months including the peak holiday period is insufficient to digest many hundreds of pages of information. The last minute extension by 3 weeks tacitly concedes that the timing was wrong.

- Both the timing and duration of the consultation were not ideal

-


Lisa Nandy MP

Stockport NHS watch

Stockport Labour Group

Stockport NHS FT

06/07/2015 by Communications and Engagement

The initial Healthier Together period of consultation was from 8th July 2014 until on 30th September 2014, which is in line with the 12 week Cabinet Office consultation principles. As the consultation ran over the summer holiday period and in view of the complexity of the subject, the consultation period was extended beyond the usual 12 week period to 15 weeks. This extension allowed a comprehensive consultation and a full programme of events to be held, with ample time for the public to provide a response. Taking on board feedback in terms of the complexity of the information, we will be working with our stakeholders to ensure that future public facing documents are co-designed and robustly tested to enable full participation.

Closed

79


Feedback Query





Status

P6 The consultation document/ materials were unclear and difficult to understand

Some stakeholders felt that the consultation materials were difficult to understand and interpret: - There is insufficient information on the

website and in the booklet to make any kind of decision or useful comments.

- It is confusing and therefore I cannot give a decent reply to this consultation.

- The consultation document is vague and unclear about the nature and extent of restructuring that is envisaged

- The way in which the [information] is presented is extremely complicated and almost impossible for members of the public to interpret

- The consultation document itself was poorly written and difficult to understand

- Members of the public cannot be expected to wade through technical jargon

- The document is vague and confusing -

In addition, there were specific concern/comments in regards to the website:

The website is confusing and difficult to navigate


Lisa Nandy MP

Graham Stringer MP

Kate Green MP

Graham Brandy MP

Cystic Fibrosis Trust


The consultation documentation achieved the Crystal Mark and was translated into easy read and a number of languages as illustrated by the post consultation and reach report available via the following link: https://healthiertogethergm.nhs.uk/files/8114/1589/1359/Post_consultation_reach_and_engagement_report_-_final.pdf The programme has been developed by and involved a number of stakeholders, which has meant that some of the messages have been difficult to articulate and convey. The programme appreciates the feedback and will ensure that future materials are tested by members of the public and stakeholders to ensure clarity. The Healthier Together website will be re-developed in line with the next phase of the programme and will involve our stakeholders and patient groups, which are in development, to help us with this project.

Closed

https://healthiertogethergm.nhs.uk/files/8114/1589/1359/Post_consultation_reach_and_engagement_report_-_final.pdf




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Feedback Query





Status

P7 The availability of consultation documents was insufficient

Some stakeholders expressed concern over the lack of availability of the consultation documents: - The failure to provide sufficient copies of

the document was a cause of frustration - The city-wide mail drop has been

undertaken too late in the process; neither does it include all the catchment areas that are relevant to the services being consulted on.

Individual Response

Stockport NHS FT


Healthier Together recognised the importance of ensuring that everybody across Greater Manchester had the opportunity to respond which is why 1,250,000 leaflets were delivered to all Greater Manchester households. Over 200,000 consultation documents were distributed across Greater Manchester in the following places:

624 care homes

134 Children’s Centre

156 Libraries

100 places of worship

3 LGBT centres

264 pubs and Student Unions Consultation documents were also sent to bordering CCG organisations for distribution within their own areas.

Closed

P8 The consultation did not ask for feedback on all changes being proposed

Some stakeholders felt that the consultation did not cover all of the changes being proposed: - You have not consulted me or any

other resident as to whether we want our local hospital NMGH to be downgraded to a local hospital.

- The decision to award some specialist hospitals status had already been taken in advance of the consultation being launched and despite claims


Lisa Nandy MP


A robust process was used to assess potential services that could be fixed (See queries “Theme 6: Decision Making Process – (c) Fixed Points”). Providers were asked to propose potential single site services that could be fixed and to provide comprehensive evident to support this. The evidence was reviewed by the Clinical Reference Group and local commissioners who decided that

Closed

81


Feedback Query





Status

that pre-consultation engagement took place

- This scheme would make no changes to the provision of care at Rochdale Infirmary; Rochdale residents therefore would be unfairly disadvantaged in comparison of other areas who would have access to specialist & general care, and crucially A&E.

there should be at least three single services in Greater Manchester. Salford Royal, Central Manchester Hospitals and the Royal Oldham will each specialise in general surgery and emergency medicine due to the existing clinical services they currently provide and to ensure all areas in Greater Manchester have equitable access to specialised services.

P9 There has been too little public engagement

Some stakeholders expressed concerns that there was insufficient public engagement: - Public engagement has been poor,

despite a staggering amount of taxpayers’ money having been spent on marketing and other consultancy costs

- There has been very little public engagement with the consultation and a much less proactive approach from NHS managers to ensure the changes are widely communicated and discussed

Lisa Nandy MP

Kate Green MP


Prior to consultation, the Healthier Together programme undertook pre-engagement to discuss the need for change across Greater Manchester and to plan and co-design the best mechanisms to undertake consultation. The programme committed to a range of meetings and opportunities during the consultation period across Greater Manchester to communicate the case for change and consultation process. The team also worked with local CCG partners to ensure that meetings were held in accessible venues. In total there were 341 public engagement events across Greater Manchester. In order to reach our deprived communities and communities who

Closed

82


Feedback Query





Status

are considered to be seldom heard or hard to reach, we had a campaign bus with Key 103 to deliver outreach engagement in our communities. The reaching engagement post consultation report provides a breakdown of engagement mechanisms which can be found via the following link: https://healthiertogethergm.nhs.uk/files/8114/1589/1359/Post_consultation_reach_and_engagement_report_-_final.pdf

P10 The language and terminology used in the consultation was confusing

Some stakeholders raised concerns over the language used in the consultation: - The term “Special Hospital” implies

more than is indicated in these proposals

- A different title from “specialist hospital” for what is envisaged could have obviated some of the challenges this consultation has provoked.

- In the context of this consultation, the hospitals focussing on elective surgery could also legitimately call themselves “Specialist Hospitals” which would result in the terminology being meaningless.

Individual Responses 06/07/2015 by Communications and Engagement

The Healthier Together proposals are complicated to understand due to the nature of how healthcare works across Greater Manchester. The team recognised that NHS terms can be confusing and worked hard with stakeholders in order to ensure that the consultation documentation was crystal-marked. In response to feedback in relation to the programme’s public documentation, we will ensure that future publications and documentation will be vigorously tested prior to publication.

Closed





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1.6 Appendix 1: Full Table of Queries

Ref. Theme: Feedback Query

C1 Case for Change and Vision Is the primary motivation for change cost cutting, rather than quality improvement as advertised?

C2 Case for Change and Vision Is hospital change necessary? P1 Primary Care Is primary care change necessary? P2 Primary Care Are the proposed primary care standards feasible and achievable P3 Primary Care The primary care changes should be in place before the secondary care

changes P4 Primary Care Is there sufficient funding and workforce to achieve the primary care

proposals? P5 Primary Care Are GPs bought in to the proposals? P6 Primary Care Will patients still be able to see their own GP? P7 Primary Care Should the primary care programme scope be broader?

J1 Joined Up Care What is the evidence for the feasibility and cost effectiveness of the proposals to join up care?

J2 Joined Up Care Should the scope be wider and include more emphasis on mental health?

J3 Joined Up Care Is there a data loss risk?

J4 Joined Up Care Would access to services delivered in the community be inferior to access in hospitals?

J5 Joined Up Care Success requires a great deal of cultural change; has this been planned for?

F1 In-Hospital Proposals - Future Model of Care

Might a ‘network’, ‘partnership’ or ‘collaborative’ model be a viable alternative model of care?


Would rotation of specialist staff between sites (rather than moving patients) be a viable alternative model of care?


Three “Sector” responses have been provided by the Hospital Trusts; do these represent a viable alternative model of care?


Could any other services be impacted by altering the in-scope services? Also, if certain sites offer co-dependent services, does this affect whether they should be designated as a provider of emergency General Surgery?


Does the model affect Greater Manchester resilience?


Patient Pathway queries


Is Patient Choice negatively affected?


Might four sites achieve better clinical outcomes than five?


Does specialisation alone drive up standards?


How will patient discharge be affected by the in-hospital proposals?


How will the Single Service work?

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T1 Transition/Implementation How much of the design can be locally adapted vs. designed at a Greater Manchester level?

T2 Transition/Implementation Will design be overseen at a Greater Manchester level?

T3 Transition/Implementation Does successful implementation of the hospital model of care depends on implementation of the primary and integrated care solutions?

T4 Transition/Implementation Have the workforce risks and considerations been taken into account?

T5 Transition/Implementation What are the recruitment considerations?

T6 Transition/Implementation What is the financial contingency for transition

T7 Transition/Implementation What is the investment in ambulance provision?

D1 Decision Making Process Could 1 specialist work with 3 general hospitals?

D2 Decision Making Process Could three or less specialist sites (for in scope services) be an alternative option?

D3 Decision Making Process Would 6 or more specialist sites (for in scope services) in Greater Manchester be an alternative option?

D4 Decision Making Process Should travel time be more important in determining the preferable option/ configuration?

D5 Decision Making Process Should hospital outcomes be included as a new/additional decision making criteria?

D6 Decision Making Process Should deprivation be included as a new/additional decision making criteria?

D7 Decision Making Process Should estate quality be included as a new/additional decision making criteria?

D8 Decision Making Process How were specialist fixed points selected, and why weren’t other hospitals selected?

D9 Decision Making Process How were service interdependencies assessed when deciding on the fixed points?

D10 Decision Making Process How were local fixed points selected, and why weren’t other hospitals selected?

D11 Decision Making Process Can fixed general hospitals be changed?

Q1 Quality and Safety Data Could Friends and Family Test data be updated

TA1 Transport Data How will ambulances and transfers be affected and what implementation planning is required?

TA2 Transport Data Will ambulance response times and travel times be affected?

TA3 Transport Data How much additional travel will there be? This is a concern.

TA4 Transport Data Should areas outside of the Greater Manchester boundary, but using Greater Manchester services, be included in the analysis?

TA5 Transport Data Is the public transport travel time standard reasonable?

TA6 Transport Data Is transport data realistic and is there an opportunity to refine it?

TA7 Transport Data Has the potential outflow of patients from Greater Manchester been taken into account?

TA8 Transport Data Have changes to the public transport system and road network since the transport analysis was completed been taken into account?

TA9 Transport Data Should transport data take better account of the Airport population?

TA10 Transport Data Should single services reflect natural catchment area for Greater Manchester hospitals?

TA11 Transport Data What is the impact of varying flows of patients to Specialist or Local Hospitals may vary

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W1 Workforce Data Should the workforce baseline be updated and challenged?

A1 Activity Data Can activity data be updated?

A2 Activity Data Is the definition of General Surgery clear and how does this affect the data?

A3 Activity Data Can we ensure productivity and deflection assumptions are not double counted?

A4 Activity Data Will deflections be achieved and what will be the impact on the hospital proposals if not?

A5 Activity Data What is the impact on patient flows, particularly the redirection of patients from Tameside to Stockport and to CMFT not Stepping Hill

A6 Activity Data Is local modelling required to ensure case mix is reflected in requirements for beds, critical care beds and theatres?

A7 Activity Data Do capacity planning assumptions require further challenge?

A8 Activity Data What are the financial Consequences to local hospitals

V1 Activity & Value for Money Data

How do we avoid double counting provider efficiency savings?

V2 Activity & Value for Money Data

What is the cost effectiveness of 4 vs. 5 site options?

E1 Estates and Capital Data Has hospital capacity been considered?

E2 Estates and Capital Data What is the NPV calculation comparison?

E3 Estates and Capital Data Can changes in Estate capacity be taken into account?

P1 Consultation Process Concerns about some of the consultation questions and are ambiguous in nature

P2 Consultation Process The consultation meetings took place at inaccessible times/locations

P3 Consultation Process The consultation does not comply with Cabinet Office Guidance on Consultation Principles

P4 Consultation Process The HT consultation should have extended to stakeholders beyond GM boundaries

P5 Consultation Process The consultation timescales were too short

P6 Consultation Process The consultation document/ materials were unclear and difficult to understand

P7 Consultation Process The availability of consultation documents was insufficient

P8 Consultation Process The consultation did not ask for feedback on all changes being proposed

P9 Consultation Process There has been too little public engagement

P10 Consultation Process The language and terminology used in the consultation was confusing

Documents

Consultation Feedback Themes Report - Consultation ... · Healthier Together Consultation Feedback Themes Report - Consultation Feedback and how we responded Author Greater Manchester