1. June 2014
Delivering solutions to the
current challenges
facing hospitals
Manchester Academic Health Science Centre is a partnership between The University of Manchester, our
Trust, Manchester Mental Health and Social Care Trust, Salford CCG, Salford Royal, The Christie and
University Hospital of South Manchester.

2. • Inconsistent adherence to existing clinical/patient
standards and pathways of care
• Significant variation in clinical outcomes and the
growing transparency in publication
• Move towards 24/7 and consultant delivered care
• Lack of workforce availability in key specialties and areas
• The overall financial settlement
• Increasing concentration of specialised services into
fewer providers
• Integrated models of health and social care in localities
shifting elements of acute care into different settings
Context: Drivers for change…

3. • The traditional DGH model has been a cornerstone of
the NHS for over half a century but now needs to
transform
• New definitions of how hospitals can be shaped must be
forged locally and must align providers, commissioners,
patients/communities and regulators
• No “one size fits all”
• A range of potential ways of transforming the
leadership, organisation and delivery of hospital services
What does this mean for hospitals?

4. Achieving sustainable hospital
services in Trafford
Central Manchester FT
The Christie

5. • Trafford Hospital – a small DGH and birthplace of the NHS
declared itself non-viable as a stand-alone Trust
• £19m underlying deficit
• Acquired by CMFT 1 April 2012 following restricted
procurement process
• Organisational integration delivered by October 2012 (incl.
back-office merger)
• New service model consulted on and agreed by Jan 2013
• Service changes approved by SoS in July 2013
• Assurance process completed and full authorisation for
service change given by end October 2013
• Implementation from late November 2013
Local context and timeline

6. Day case surgery, day case
medicine and endoscopy
Intermediate Care
Out Patients
Elective Orthopaedic CentreDaycase Unit
Inpatient and daycase
elective orthopaedic
surgery
Emergency Access Centre
Adult Medical Assessment
OP clinics and direct access
radiology and tests
Clinical Model – Care Quadrants
Common infrastructure
HDU
Crash team
Radiology
Pathology

7. • Urgent Care Centre
– Consultant-led service provided by experienced
medical and nursing staff with ALS/APLS training
and access to resuscitation facilities
– Job plans and training arrangements rotate staff
through Trafford UCC and MRI A&E
– Safe management of acutely ill patients that
present at Trafford General Hospital
– Jobs that allow high quality candidates to be
attracted and retained
Clinical model – single services

8. • Acute Medicine
– Acutely ill medical patient presenting at Trafford UCC can
be admitted to:
• MAU/general medical wards at Trafford General (eg non-specific
conditions, frail elderly), or
• specialist medical wards at MRI (eg Cardiology, Resp Medicine)
– Admission to MRI ward no different to Trafford General
ward – ie patient does not go through MRI A&E/MAU
– Ward staff/local consultants managed within Trafford
Division; medical staff managed from specialty Directorate
at MRI (eg Gastroenterology, Cardiology)
– Service model and job planning facilitates:
• sustainable acute take at Trafford
• development of Consultant sub-specialist interests
Clinical model – single services

9. • Orthopaedics
– One integrated consultant team
– 95% of elective patients treated at Manchester
Elective Orthopaedic Centre on Trafford site (high-
risk patients retained at MRI)
– All trauma patients admitted at MRI
– Outpatient clinics, pre-op assessment, rehab, etc
maintained on both sites
– Huge potential to be hub of multi trust orthopaedic
JV, with strong academic underpinning
Clinical model – single services

10. • Critical Care
– Service managed by MRI Critical Care service
– Small high dependency unit maintained at
Trafford General (2 beds)
– Additional intensive care capacity opened at MRI
– Patients have the same priority and process for
admission to ICU, regardless of site
– Medical and nursing staff groups managed as
integrated teams
Clinical model – single services

11. • Comprehensive clinical diagnostic review undertaken
immediately upon acquisition
• Risks around small-scale services addressed (eg
Intensive Care, acute surgery)
• Ward staffing improved
• Safety culture improved (eg incident reporting)
• Trafford HSMR down from 128 (pre-acquisition) to
101 (current rolling quarter)
• Single (unified) services provide safe, effective
treatment of patients and attractive jobs for staff
Key messages

12. • £24.2m deficit eliminated over 18 months (historic
debt plus annual CRES)
• Contributions to savings include:
– Back office – £5.5m
– Estates/FM – £4.9m
– Clinical support services – £1.9m
– Surgical specialties – £4.0m
– Medical specialties – £3.4m
– Other – £4.5m
• Support from Commissioners tapered as savings
delivered
Key messages

13. • Acquisition model worked well in Trafford context
• Strong commissioning and regulatory support
• Critical service changes only delivered through creation
of single service with primary hospital site
• Trafford Hospital now busier, proud and vibrant as a
local hospital not a DGH
• Standalone specialist focus based on cold orthopaedics
• Significantly reduced costs, significantly improved
outcomes, better staffing base and improved patient
satisfaction
Conclusions - 1

14. • Transferable? Definitely, in the right circumstances
• Providers need to work hard to create a strong voice
to shape innovative models with policy makers,
commissioners and regulators
• We need to create a new language and presentation
that underlines the major ongoing contribution of
local hospitals to the shifting NHS landscape
Conclusions - 2