Healthier Together is a transformation programme that is changing the way that general surgery is delivered across Greater Manchester. It is part of the wider transformation programme being led by Greater Manchester Health and Social Care Partnership, the body responsible for overseeing health and social care devolution
As part of health and social care reform in the city region, the NHS Transformation Unit (TU) has secured a commission to support the standardisation of acute and specialised care.
Key to its on-going success is engagement with patients. Patient engagement is at the heart of the implementation of single service teams in each of the region’s four sectors established in the Healthier Together process.
Four sectors have been created within Greater Manchester:
- Manchester and Trafford (Central Manchester Foundation Trust (CMFT), University Hospital of South Manchester (UHSM), and Trafford);
- South East (Stockport’s Stepping Hill, and Tameside General);
- North East (Royal Oldham, North Manchester General, Fairfield Hospital, Bury, and Rochdale Infirmary); and
- North West (Salford Royal, Royal Bolton and Wigan’s Royal Albert Infirmary).
Every hospital will benefit from staff working across sites and sharing resources as part of a single service.
To ensure the implementation of single services is patient centred and co-designed in line with NHS statutory duties, the Healthier Together team has been working in partnership with Healthwatch and Clinical Commissioning Groups (CCGs) to establish a framework for Patient Participation Groups (PPGs), encouraging the involvement of the community before, throughout and after the implementation phase.
PPGs enhance each sector’s engagement with patients and form part of each sector’s governance structure, with PPG members identifying any potential issues for the programme and assisting in mitigating these issues.. The PPG provides an opportunity for both patients and staff to offer their views on the different components of the medical pathway being transformed by Healthier Together. PPG members offer their views in both an advisory and champion capacity to ensure that local voices are heard throughout the entire transformation process.
The establishment of PPGs in each sector allows commissioners, providers and members of the pubic to work together for the benefit of the local area and form part of a local resource to enable co-design and co-production in other areas of health. The PPGs intend to:
- Inform implementation planning by integrating a patient perspective;
- Own the equalities implementation action plan for each sector , ensuring equalities conditions are implemented at each hospital site;
- Scrutinise and provide advice on decisions about service change, to ensure that they are based on fairness and inclusion;
- Appraise information that will be made widely available to patients and public;
- Enable and promote communication with the wider local population;
- Determine priorities for wider local patient engagement;
- Act as a local resource for patient engagement and participation; and
- Improve and monitor quality of care and patient satisfaction.
The NHS Transformation Unit’s chief executive, Leila Williams, explains: “The TU has a strong record of achievement in developing new models of care and programme managing whole system transformation projects.
“The Healthier Together programme was a starting point for the transformation of acute services in Greater Manchester. For us, the key principle of successful transformation is finding solutions that deliver the best outcomes for patients across our region.
“Success for the TU means transformation becoming a reality, services being improved for patients with demonstrable positive impacts of change. It’s great that this is well underway for the Healthier Together programme in the Manchester and Trafford sector.”
Hayley Michell is the project manager for the Manchester and Trafford sector (MaTS) and has lead on the establishment and organisation of the sector’s PPG.
Hayley says: “It is important that patients, carers and their families continue to have the opportunity to offer perspectives on the implementation of Healthier Together. Therefore, all sectors are required to set up PPGs across Greater Manchester. Manchester and Trafford is the first sector to hold an official meeting.”
In the lead up to implementation, it remains a priority for patients to continue to have the opportunity to co-design and offer perspectives on the model of care in partnership with single service teams in Greater Manchester.
Hayley adds: “MaTS has established a PPG whose membership comprises of patients from a number of existing patient forums, representatives from a number of equality organisations, for example Age UK, the LGBT Foundation, the BME Network and sector CCG and provider communications and/or engagement leads. The PPG is co-chaired by Trafford and Manchester Healthwatch.”
The group has now met several times, with more meetings planned at regular intervals. The outcomes of the meetings have contributed to the development of the MaTS model of care. Discussions have taken place to evaluate proposed patient pathways using process mapping to work through hypothetical patient scenarios in order to understand the impact the new model of care may have on different patient groups. For example, patient groups such as older people, disabled people, BAME (Black, Asian and Minority Ethnic) groups and those living in deprived communities.
How it works
Meetings are attended by 10 patients and patient advocacy group members, and 21 clinical and non-clinical colleagues from CMFT and UHSM.
Hayley says: “At a recent meeting attendees were split into three groups who were given different hypothetical patient scenarios, designed to represent different minority groups. Each scenario involved a patient presenting themselves at UHSM, who could be identified as either a low or high risk patient. The emergency pathway proposes that if a patient goes to UHSM A&E, he or she will be assessed through Triage and identified as a high or low risk patient. This will determine the care pathway. If low risk, the patient will follow an ambulatory care route prior to discharge. High risk patients will be assessed by a speciality doctor and transferred to CMFT for emergency surgery.
“Group attendees were asked to consider each stage of the pathway and comment upon the likely impact for the patient described in their scenario. This worked particularly well because it encouraged the group to think about their own experience and apply it to a context that they wouldn’t usually consider. Problem areas were identified allowing clinicians to offer a resolution. This is an excellent example of patients and professionals working in partnership to resolve real issues.”
To facilitate this, the proposed emergency pathway was presented on big pieces of wallpaper and attendees were asked to discuss and physically pin point potential problem areas with sticky notes.
The identified risks and issues (along with suggestions for improvement) were added tothe sector’s Equality Impact Assessment to be escalated to and resolved by the appropriate sector work stream.
Hayley adds: “The process behind our PPG is continually evolving to meet the needs of patients and to communicate proposed changes in a clear and concise way. There are several scenarios that could be discussed and applied to patient pathways to ensure that as many patients groups are considered as possible. After each group session, we ask members of the public to cascade the information throughout their own groups, where it can be refined further and discussed in more detail at the next PPG meeting.”