Agenda item

Report is attached.

Katy Calvin Thomas, Director of Strategy and Mike Ryan Pennine Acute NHS Trust attended the meeting to provide members with an update in respect of the progress of the implementation of Healthier Together (HT). The Presentation contained the following information:

Royal Oldham Hospital will become a high acuity site for general surgery for the North East Sector (Bury, Rochdale, Oldham and North Manchester).

No implementation date has been agreed.  

Under HT the following procedures will move from non-hub sites to specialist hospitals;

·         All high risk elective General Surgery (GS).  GS being defined as activity codes 100-General surgery (minus breast and vascular), 104 colorectal and 106 upper GI surgery. High risk being defined as a high risk procedure on any patient or a low risk procedure on a high risk patient

·         All emergency GS

Since the Decision Making Business case was agreed, HT have decided that the difficulty in identifying relevant patients for ambulance crews means that no urgent, emergency or acute medicine (UEAM) will transfer under HT however UEAM still have a number of HT standards they will be expected to meet.

Under HT the Royal Oldham Hospital becomes a specialist hospital. Modelling work indicates the following activity numbers will move;

·         High Risk elective General Surgery 254 cases will move from the NMGH to the ROH

·         Emergency General Surgery 1974 cases will move from the NMGH to the ROH

Modelling undertaken by HT and NES (using actual patient spell data) indicates that to accommodate the GS activity moving from NMGH the following additional resource will be required at ROH;

·         43 beds

·         4 Critical Care Beds

·         2 theatres

·         Additional diagnostic and endoscopy resource requirement for GS is still being calculated

·         Supporting infrastructure

Members of the committee discussed the main issues and risks identified by the Trust in respect of the proposals.  The risks include:

·           It is still unclear as to where additional resources noted for both revenue and capital in the original HT work are going to be secured from.

·           There remains a risk that required workforce may not be available or be able to be put in place, particularly around critical care, radiology and the requirement to deliver consultant led care 16 hours a day minimum at the specialist Emergency Department  and 12 hours a day minimum at the non-hub Emergency Department

·           Moving high risk activity to ROH will put additional strain on critical care which is currently being managed as a fragile service within the Pennine Acute Improvement Plan.

·           There remains a view from Surgery is that moving high risk elective GS and emergency GS separately will present a number of issues around continuity of care for patients and the best approach will be to move both elements at the same time. As the emergency GS activity will require capital build to accommodate this will lead to a longer anticipated timeline for implementation

·         There are a number of interdependencies between GS and other services which mean that moving GS will increase risk in other specialities. These are  still to be worked through and include;

·         GS surgeons are often required to assist with fractured neck of femur patients on an emergency basis

·         The same cohort of junior staff the rotas for both GS and urology at NMGH. Moving the juniors to ROH with GS with destabilise the urology service.

It was agreed:

The Pennine Acute NHS Trust will provide Members of the Joint Committee with regular updates in respect of the implementation of Healthier Together.