Good morning, everyone. My name’s Rob Forster. I’m the acting chief executive at Wrightington,
Wigan and Leigh. Our foundation trusts, Wrightington, Wigan and Leigh and Salford Royal, are two
high performing organisations based in adjacent geographical localities in Greater Manchester.
Together, our combined population for the 650,000 people and our combined workforce is over 11,000.
We share consistent values, with deep clinical staff and patient engagement which have received
national recognition. In the last two years we have strengthened our successful history
of partnerships working and we share the same world-class care record and health information system.
Our boards have now decided that should collaborate and work closer together and become the founding
members of a new operating group which is nationally replicable for which we are requesting Vanguard’s support.
I would like to invite Sir David Dalton to describe our proposed venture which we hope
secures your support.
Thank you very much, Rob. And forgive for me using a script, but please don’t mark
me on my powers of oration. So I’m going to be looking at this.
I pose the question, why do we tolerate the extensive variation in our service standards,
and patients’ outcomes and efficiency between our organisations across the country? If we
know the evidence of best practice, then surely we, you, should be capable of defining the
service standards and organising reliable delivery against those standards.
Now, we have NICE guidelines, and I know all trusts here today will be producing their
own trust policies and submitting those into their organisation. But I put to you that
I, and you, actually have no idea if the people in your organisation are actually adhering
to those standards. And the consequence is that patients suffer from sub-optimal treatment,
some will die, and we will continue to preside over inefficient and unproductive organisations.
Now, it’s our contention that reliability can be assured through standardisation, and
with an engaged and motivated workforce, we can use evidence based care pathways of our
electronic healthcare system to support clinicians’ decision making, to enable them to develop
standardised care pathways that will support them to determine and advise on the tests
and treatments required and the algorithms for prescribing.
This system can also ensure just-in-time ordering of consumables for the length of stay of our
patients. And, most importantly, it can determine, in real time, the skills and staffing needs
based upon the assessed dependency of every patient, every hour.
Now, we are delivering a coalition of global, globally leading industry support, organisations
who have invested a considerable amount of money in technical solutions which are already
being deployed in a number of places across the world but not yet in England. So we need
to deliver standardisation at scale. First, as a means of securing investment, we need
that scale. And, second, to spread benefits to patients by replication in multiple organisations.
Now, it’s my belief that having 240 organisations in our National Health Service or 15 organisations
in Greater Manchester is no longer an affordable or sensible way of delivering reliable care
at lower cost. If we want to, and if we’re really serious about reducing variation and
delivering better outcomes and improved efficiency, then we must use different approaches.
And the approach that we are interested in is developing an operating group, and it’s
designed to allow the benefits of standardisation to be achieved at scale. Now, Wigan, Wrightington
and Leigh Trust is the health service trust… Health Service Journal Trust of the year,
and Salford Royal is one of only that’s been rated outstanding by CQC.
So we represent two of the country’s most successful organisations. We already have
many cultural assets and we share similar cultural styles based upon our approach to
patients and carer engagement, based upon our values, leadership, with deep clinical
staff involvement and deference to their expertise.
So we want to start, the two of us, two organisations, the formation of an operating group to develop
a standardised operating system and to deploy this at scale.
Now, we envisage our group, starting with the two of us, to operate in the north-west
of England and have population coverage of up to two million, and, over time, we see
this group cluster likely to include between five and eight organisations.
Now, let me be clear. A group is not a traditional merger or acquisition. Foundation trusts would
continue to belong to a group, retaining their public membership, but ceding some sovereignty
to a group board, and that board determines the standard operating systems and assures
that they are reliably used.
We envisage the group co would also take responsibility for investment, asset management and strategic
service changes, supporting the development of care models, harmonising our policies both
vertically in a locality and horizontally across trusts in the group. Group co would
consolidate both back office functions and clinical support services and would organise
the delivery of all of the Carter Review recommendations.
Now, our proposal is to begin that group in Wigan and Salford through the creation of
two integrated care organisations using an accountable care organisation type of structure,
to include all hospital, community, social care and primary care within a single system
of governance and with responsibility for population health.
We want to work with NHS England to develop population health management systems and,
over time, see the transfer of responsibility of current commissioning arrangements to each
accountable care organisation.
We want to develop, with NHS England and our regulators, appropriate arrangements for the
new legal framework and accountability arrangements.
An early priority for our two accountable care organisations will be to target a 20%
reduction in, sorry, 20% improvement in efficiency, and a 20% reduction of acute beds by developing
at home or close to home alternatives.
We believe it is possible to reduce acute beds by about 20%, which would take out about
1,000 beds across a group of six hospitals, and taking these assets off the group’s
balance sheet will be one of the speediest ways of liberating cash within the system.
Now, we want our Vanguard project to deliver value to the NHS and we’ve committed to
work with colleagues, foundation trusts, in both Northumbria and The Royal Free in London
to develop a knowledge management and solutions creation hub so that we can share learning
and organise its replication across our three localities in the country.
So, let me summarise. The project is radical. It is a new approach to reduce variation in
patients’ outcomes and to deliver reliability at scale through the standardisation of clinical
pathways, and coalition with industry partners.
We will pursue value based leadership across all elements of our group, and we will ensure
that benefit can be delivered at scale.
Both Rob and I hope that we secure your votes as a Vanguard, it’s to prototype a new organisational
approach with standardisation at scale, so that we can deliver better care and wellbeing
at lower cost and spread our learning across the country.
Thank you.
My name’s Brad McInnery. I volunteer in a voluntary community organisation in Gloucester
City working with quite vulnerable people, and am very proud and privileged to do that.
Could I just make a plea for all the presentations today, really, and that’s to expand the
acronyms. We talked about NICE; we talked about the CQC, etc., but, again, from Sam’s
presentation it was very clear that we’ve got people beyond the NHS in this room. So
that’s just a plea for all the presentations, please.
What didn’t come out very explicitly from the presentations is about how you’re going
to involve patients, carers, families, etc., in your work and how you’re going to ensure
those shared values are shared across to people in community groups beyond some of the organisations
you mention. It just didn’t come out explicitly enough.
Thank you very much, and forgive me, in seven minutes it’s hard to do that. So, to give
you an example of how we’re developing the accountable care organisation approach within
one of those localities, we have agreed to have our focus on neighbourhoods in our community,
where we will see an accountable officer, probably be a general practitioner, who will
be working with our voluntary organisations, our community assets, as well as the social
care services in that area and all primary care practitioners, to really understand how
we mobilise the community assets within that particular neighbourhood.
So, that’s the approach which is 12 months in being, and it’s already generating some
fabulous ideas because it’s the, you know, it’s the smaller organisations, not necessarily
part of the statutory ones who can take us to places that we can’t… we can’t get
to. So we’ve begun to have conversations with a number of charities about how to contact
some of our people who are usually hard to reach. And we’ve seen some great success
in the way that we’re organising now improvements for people who have difficulty with their
relationship with alcohol, for instance.
Okay. We’re moving over to this lady here.
Hi, Sarah Morgan from Guys and St Thomas’s. Thank you, David and Rob, for your compelling
presentation. There’s a lot of work in Manchester and Greater Manchester around evolution and
I just wondered how your proposal [unclear 00:11:50] to complement the devolution work.
So our proposal developed before the devolution arrangements but it’s entirely consistent
with it. To know the geography of our part of Greater Manchester, we are in the north-west
of the conurbation and it would be our intention that we can… we can look both to the east
into Greater Manchester and elsewhere to the west if there are partners who would wish
to join with us.
So far, all our conversations have been with organisations within Greater Manchester about
the development of a consolidated approach to the number of groups that may... may be
formed within Greater Manchester.
A question from the gentleman over here.
TW Tony Wigitski [?] from Croydon. I just wanted to ask that if you were going to all
this trouble to develop an ACO, why two and not one that can’t be integrated?
Because we strongly believe there is… there is benefit in maintaining a focus on a locality
having co-service arrangements with local government. So the approach will be to develop
accountable care organisations in a number of localities that would then have a single
governance wrapper across them.
So we’re not intending to have one accountable care organisation for the group. I think it’s
really important, back to the gentleman’s point earlier, that we have connectivity with
people through our neighbourhood approach.
Thank you very much. We’ve only got five minutes for questions. I promise I will get
to more people next time, but we now need to move on to next applicant.
The next applicant, thank you very much indeed, Salford and Wigan Foundation chair.
[Applause.]