JUNE TO AUGUST: The TU supports the Greater Manchester Health & Social Care Partnership to deliver a multi-agency risk summit to assess the challenges faced by PAHT and agree a course of action. Salford Royal NHS Foundation Trust (SRFT) immediately takes on a formal leadership/stewardship role. The TU works with the Medical Directors of PAHT and SRFT to understand the challenges and options in A&E, Paediatrics and Maternity through staff engagement and data analysis. SEPTEMBER TO NOVEMBER: The TU sets up a system-wide Improvement Board, chaired by Jon Rouse (Chief Officer of the Greater Manchester Health & Social Care Partnership) and with input from NHS Improvement and the CQC, to hold the Trust to account as it begins its improvement journey. SRFT prepares a comprehensive improvement plan, ready as the CQC releases a formal “inadequate rating” for the Trust. The TU supports the Improvement Board to work with clinicians across Greater Manchester to present and shortlist a number of options for rapid improvements to A&E, Paediatrics, Maternity and Critical Care. As part of this work, the TU works with Greater Manchester Trusts to complete an A&E resourcing assessment in order to determine how best to deploy Greater Manchester A&E resource in support of PAHT, resulting in a number of Trusts providing short term consultant resource to PAHT. JANUARY TO MARCH: The TU supports the Improvement Board to monitor the improvement plan, ensuring that Board actions are commissioned and completed. The TU is asked to reconvene clinical working groups to assess the impact of actions taken and, for A&E, consider the impact on the Trust and wider system of taking further action. 5.5 WEST YORKSHIRE ASSOCIATION OF ACUTE TRUSTS The West Yorkshire Association of Acute Trusts (WYAAT) is an innovative collaborative which brings together NHS Trusts delivering acute hospital services from across West Yorkshire and Harrogate to drive forward the best possible care for their patients. WYAAT are embarking on a programme of clinical services transformation and will need to respond to a number of specialised service reviews being undertaken by NHS England (and supported by a Clinical Senate). The first is on the proposals for the future configuration of Vascular services across Yorkshire & Humber. The TU was engaged by WYAAT to support in clinical engagement and co-design for a new model of care. DECEMBER TO JANUARY: Advice on approach provided to the WYAAT leadership and engagement with NHS England Specialised Commissioning. FEBRUARY: One-to-one engagement with key stakeholders (Clinical Directors, Medical Directors and Chief Executives) within the WYAAT group. Feedback was used to prepare and design a ‘Clinical Summit’ to review the Senate’s key recommendations and what they mean for the future model of care and the clinical teams that deliver the service. MARCH: ‘Clinical Summit’ held with good representation and significant input from all key stakeholders. The approach was agreed for development of the Clinical Model, with supporting analysis and modelling work initiated. This activity is continuing into 2017/18. 5.6 THE NUFFIELD TRUST The TU is providing analytical support to The Nuffield Trust on a National Institute for Health Research funded research project. This project seeks to explore the strengths and weaknesses of different models of generalist medical care deployed in smaller acute hospitals. SEPTEMBER TO MARCH: The TU has been working on understanding the case mix of the generalist medical care workload, and specifically how to distinguish between ‘specialist’ and ‘generalist’ patients. There are two main objectives of this work. Firstly, to create a new case mix classification that identifies patients who may benefit from generalist care, then use this to describe and compare workload, resource utilisation and outcomes between hospitals and models of care. Secondly, to assess the degree of alignment between patient case mix and medical generalist skills mix in smaller hospitals. Good progress has been made in developing the initial clinical classifications, with further work on analysing and classifying the workload of smaller hospitals planned for the first half of 2017/18. 5.7 STAFFORDSHIRE SUSTAINABILITY AND TRANSFORMATION PARTNERSHIP (STP) Since September 2016, the TU has been supporting the clinical engagement and leadership element of the Staffordshire STP. This includes providing individual support to GPs, hospital doctors and the STP Medical Director. We continue to provide support to the Clinical Leadership Group which brings together senior clinicians from all components of the Staffordshire health and care system. 23