APRIL TO MAY: The TU delivers a series of workshops that bring Greater Manchester Urology and Oesophago- gastric cancer clinicians, strategic directors and operational managers together to agree how a new best in class service should operate. A case for change and set of Greater Manchester standards are developed and the TU works with Greater Manchester governance processes to ensure these are rapidly signed off. SEPTEMBER TO NOVEMBER: Further workshops are held to develop a service access framework and model of care, which the TU successfully manages through complex Greater Manchester governance processes. OCTOBER: The TU draft a detailed commissioning specification, which is agreed with the Health & Social Care Partnership's Joint Commissioning Board. Trusts receive notice that the Oesophago- gastric cancer service will primarily be delivered at one specialist site, meeting the new standards set out by the clinical community. Communications advising that the Oesophago-gastric cancer service will be compliant with standards for the first time in over a decade are shared nationally and reported upon in the Health Service Journal. JANUARY TO MARCH: The TU works with the three Trusts that currently deliver the Oesophago-gastric cancer service to set up an Implementation Board. Trusts are supported to collaborate to understand the implications for all sites and to work together to a common implementation plan. 5.2 THE GREATER MANCHESTER HEALTHIER TOGETHER PROGRAMME The Healthier Together programme is a clinically led programme aiming to improve health and care in Greater Manchester. There are three strands to the Healthier Together Programme: • Primary Care transformation • Local models of Integrated Care •  Improvements in hospital care (A&E, Acute Medicine and General Surgery) The Healthier Together programme celebrated its fifth anniversary in February 2017. Following the successful defence of a Judicial Review in January 2016, the detailed clinical design has now been completed. This has culminated in the preparation of a Full Business Case, which will enable the Greater Manchester system to assess affordability and agree funding in preparation for implementation. 5.1 TRANSFORMATION OF SPECIALISED CANCER SERVICES In 2015, the TU, the NHS England Specialised Commissioning team and NHS Trafford CCG (acting as Lead CCG Commissioner for Cancer Services on behalf of the 12 Greater Manchester CCGs) selected two specialised services as pathfinders to test and refine our transformation process. These were: •  Oesophago-gastric cancer (cancer of the oesophagus and stomach) surgery •  Urology cancer (cancer of the prostate, kidney and bladder) surgery The provision of both Oesophago-gastric cancer and Urology cancer in Greater Manchester has been non-compliant with the national specification for over a decade and a number of transformation processes. Over the financial year, the transformation process has galvanised the clinical, provider and commissioner community to develop and agree five deliverables: 5 KEY DELIVERABLES IN MORE DETAIL •  A Greater Manchester clinical and patient “case for change”; •  Clinical and patient “Greater Manchester standards”; •  A “service access framework” that describes requirements for co-dependent clinical services; •  A “model of care"; and •  A detailed commissioning specification. The new model of care for Oesophago-gastric cancer, with services centralised from three sites that, together, were non-compliant to one centre of excellence, was cemented by the agreement of the award of a new contract by Greater Manchester in Autumn 2016. The TU is now overseeing implementation work on behalf of Greater Manchester. The approach that was adopted has been widely recognised as a successful approach to tackle complex, cross organisational transformation of services and has formed the backbone of the Greater Manchester Health & Social Care Partnership’s “Theme 3” work. 17