Region ordered to improve its emergency units
TWO years after Greater Manchester signed its groundbreaking health devolution deal the region has been ordered to improve its A&Es by government.
Latest figures show all but one of our hospital trusts are missing emergency targets laid down by Whitehall under 2016’s deal.
Several local hospitals are also facing massive deficits while Greater Manchester councils have raided £66m in reserves this year to fund social care.
It is a situation that has raised significant questions over whether ministers gave our region enough money to pay for the new system in the first place.
One hospital trust has described ‘extreme’ and ‘immense strain’ on its A&E because of rising numbers of frail, elderly patients with complex conditions requiring a lot of medical attention and a longer stay in hospital.
In some areas exhausted staff, completely committed to their communities, are struggling to cope.
Greater Manchester’s devolved health system took effect on April 1, 2016, with its terms stating that 85pc of patients must be seen at A&E within four hours.
Below that level, govern- ment has the option to ‘step in’ and take the reins.
Despite a range of other improvements since devolution – including in cancer and stroke care – in February the region’s figure stood at 83pc.
Two local trusts, Stockport and Wigan, ranked in the bottom 10 per cent of performers nationally.
Jon Rouse, the region’s chief health officer, confirmed that, theoretically, national health bosses could ultimately choose to intervene as a result.
He said: “There are trigger points within the system which if we fall below – depending how far we fall below – NHS England can either request an improvement plan or, in extremis, they could decide to intervene and step in to the situation.”
Greater Manchester had been in breach of its fourhour target ‘for some time’, he said, adding that while its performance was not unusual in terms of the national picture, its devolution deal makes it unique.
“Only Greater Manchester is under a devolution agreement with this type of accountability standard and I think NHS England have made a judgement that it’s reasonable to ask us for an improvement plan,” Mr Rouse said.
“Given that we’re not behaving very differently from the rest of the country, I don’t think they’re in a position where they’re considering ‘step-in’, but they want to know what we’re doing to try to improve the situation. And from my perspective that’s fair enough.”
The ‘principal driver’ of the situation had been high numbers of medically sick patients needing urgent hospital care, he said, adding: “The issue is the number of people with high acuity coming in the front door over the winter period.”
However, he pointed to three underlying challenges faced by the region in improving emergency waiting times.
Many of Greater Manchester’s A&E units are ageing and physically too cramped, he said, and while some ‘little bits of capital funding here and there’ have been provided by government, a new bid for money is now being drawn up so the departments can handle ‘a totally different number of people’.
“Some of the A&E departments are just too small for the number of attendances and the patients with high acuity coming through them and that is a real problem,” he said. At the same time, in common with other parts of the country, Greater Manchester had struggled to recruit frontline staff, he said, adding: “The third issue is our overall financial situation.”
Four trusts – Stockport, Tameside and Glossop, Pennine Acute and the mental health provider Pennine Care – are facing particularly major financial challenges, he said. Tameside reported a £22m deficit at its last board meeting, while Pennine Acute’s North Manchester General was looking at a £13m shortfall.
Mental health provider Pennine Care has not published its papers for March.
Board papers for Stockport NHS Foundation Trust, which runs Stepping Hill hospital and has consistently struggled with A&E targets in recent years, show it projecting a £36m deficit next year, which will see it rely on emergency financial funding via NHS Improvement. They also show the scale of the pressure faced by its A&E department.
“The trust has continued to experience extreme challenges to operational performance with significantly high levels of attendance in the emergency department in recent weeks,” reads an update to the board from its chair last week.
“This has resulted in exceptional strain on services which led to the medical director to take the reluctant, but necessary, decision to cancel a number of clinics and temporarily suspend training in order to maximize the clinical resource available to manage patient flow. The consequence of these challenges on our performance against the A&E four-hour standard is starkly reported elsewhere in the board papers.”
A spokesman for Stockport NHS Foundation Trust said its hospital has been ‘under immense strain for some time now’.
“A&E numbers are up by 8pc and many of our patients are frail and elderly, with complex conditions that require a lot of medical attention and a longer stay in hospital,” she added. We have become better and faster at coping with the surge in demand and opened extra beds, but there is no easy solution.
“We are sorry that despite the huge efforts of our hard working staff, only 65.3pc of A&E patients were admitted to a bed within four hours last month. It is important to point out however that everyone is receiving safe care.”
The trust is also making ‘continuous’ savings and trying to treat more people at home, she added.
Ever since the devolution deal was signed, many senior political figures have feared it could be undermined by lack of cash, particularly in the face of the ongoing squeeze in councilfunded social care.
Barbara Keeley, Labour’s shadow minister for social care, said: “Tory ministers often hold up Greater Manchester as an example of progress in integrating health and social care.
“However, Greater Manchester started out with a black hole in finances for both the NHS and social care. If the Tory government wants to make a success of devolution in Greater Manchester, they must also find adequate funding to tackle some of the challenges we face.”
Bury-born shadow health secretary Jonathan Ashworth said: “Eight years of financial squeeze, eight years of severe cuts to local authority social care budgets and eight years of failing to recruit frontline clinicians we need are all coming together now into a perfect storm - and it’s patients who are suffering the consequences.”
Despite the pressures in A&E, Jon Rouse said two years of health devolution had brought significant benefits. While some trusts are facing severe cash difficulties, the system as a whole is set to record a small surplus for 2017, he said, as it has the powers to move money around in a ‘mature’ way thanks to devolved powers.
Cancer treatment targets had been met most months since the devolution deal, an achievement ‘which isn’t the case in most parts of the country’, he pointed out, and one that had taken ‘a huge amount of work’.
“On stroke care I think there’s a very good story to tell,” added Mr Rouse. “We’re now the highest rated acute services in the country - all of them are ‘a’ rated. So if you have a stroke in GM you can be confident that whichever of our stroke services you go to, you’ll get incredibly high quality care, which is something we are very proud of that’s been achieved.”
Health leaders are now drawing up a strategy to get 90pc of patients seen within four hours at A&E by the end of June as part of the improvement plan for NHS England.
A spokesperson for NHS England North said: “It’s our role to monitor performance to ensure patients are receiving the safe, high quality care they deserve.
“Many systems have faced challenges this winter and where this has been the case, we have worked with local organisations to resolve issues through appropriate mechanisms.”
The then Chancellor George Osborne, right, and Secretary of State for Health Jeremy Hunt on a tour of NHS facilities following the groundbreaking £6bn Greater Manchester budget deal