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Rouse: We may have been over optimistic

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A review of A&E performance in Greater Manchester will consider whether the conurbations’ health and care leaders have been “over-optimistic” about their transformation plans, its chief officer has said.

LGC reported on Tuesday that the Greater Manchester Health & Social Care Partnership was subject to intervention by NHS England and NHS Improvement after performance against the four hour A&E target fell below 85% in December.

Speaking to LGC this morning, Jon Rouse, chief officer of the Greater Manchester Health and Social Partnership, said the regulators’ involvement had been “facilitative and partnership based” and was in line with the accountability agreement signed in 2016 when the region’s £6bn health and social care budget was devolved to the partnership.

Under the terms of the agreement A&E performance below 95% but above 85% is dealt with locally. However, if aggregate performance falls below that the area could face national intervention. This is in contrast to most other areas of the country where intervention would be at a trust and clinical commissioning group level. 

Mr Rouse, who is employed by NHS England, said: “[The partnership] is NHS England in Greater Manchester.”

He added: “We completely accept we have not met that threshold. We are basically saying, great, bring your knowledge of accident and emergency, bring us best practice particularly in keeping people in their own homes.”

He said as well as putting in place recovery plans for those organisations struggling the most, a major study of capacity in the system was being planned as part of the intervention.

He added: “This is less about bed base in hospital because we know that, but have we really got the capacity in the community? Have we been over optimistic in where our transformation plans are? Have we suffered some optimism bias?”

Just 83.5% of patients in Greater Manchester were seen and treated or discharged within four hours during December against a target of 95% and a national average of 84.8%.

Of the seven acute hospitals in Greater Manchester, eight performed below 85% in December with performance ranging from 92.2% at Tameside Hospital Foundation Trust to 71.7% at Stockport Foundation Trust.

Mr Rouse stressed the four hour A&E target was only one measure of performance and said some parts of Greater Manchester, including Tameside, Salford, Bolton and Rochdale, were having success in “bringing the demand curve down”. He cited the example of Salford reducing non-elective admissions by 2.5% despite a 4% increase in activity.

However, he said there was a need to look at whether the partnership had been “over optimistic about the extent to which and the pace at which” they could move to a preventative model where integrated care impacts on people going through the door at A&E.

He said overcoming the culture of self-referral to A&E was proving challenging in some places.

Asked whether he felt intervention at local level was fair given the scale of performance failure against the A&E target nationally, which could suggest a more fundamental problem, Mr Rouse said: “There are fundamental issues around workforce capacity and [hospital] estates. But we signed up to the accountability agreement; we agreed this threshold and my view is we’ve got to meet it.”

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