What is Healthier Together and who is leading on it?
Healthier Together is part of a much wider piece of work being carried out by the NHS, local authorities and other organisations to improve the health and social care system across Greater Manchester. We all believe the people who live in Bolton and throughout Greater Manchester deserve the best possible care. Healthier Together is the NHS-led part of this work.
The Healthier Together review is being carried out by a small NHS team on behalf of the 12 GP-led clinical commissioning groups (CCGs) in Greater Manchester. The CCGs make decisions on which health services to buy on behalf of local people.
All GP practices in Bolton belong to the Bolton CCG, and the board is made up of GPs, a nurse, a hospital doctor, managers and lay representatives who represent the wider community. Bolton CCG will be making sure it continues to act in the interests of the Bolton community, as well as looking at ways of working with colleagues throughout Greater Manchester to improve the lives of all residents.
Bolton NHS Foundation Trust is also a really important partner which is fully involved in these discussions, and we are also liaising closely with Bolton Council, and a wide range of other organisations, including patient groups.
Saving lives by providing care in the right place, at the right time
In so many ways Greater Manchester is a wonderful place to live, work and play and it is world famous for many things. But people here still suffer from worse health than in many other parts of the country. There are many very complicated reasons for this, such as high levels of deprivation, and a lot of hard work has taken place to improve things over the years.
However, we also know if we make some important changes to the way we do things across the NHS in Greater Manchester we can save and improve thousands more lives. Hundreds of these will be the lives of Bolton residents. This could mean ourselves or our families and friends — so this really is something we should care about.
The NHS was set up in 1948 and it’s a bit like a member of the family. Most people are proud of it, even though they sometimes criticise it. But the problem is so much has changed over the past 65 years, all our hospitals are under increasing pressure due to rising demand on services and increasing costs such as new technologies innovative treatments and rising utility bills. We need to act decisively to preserve, and in some cases improve, standards of quality and care.
For example, it’s been widely publicised that across the country people are more likely to die if admitted to hospital at the weekend than during the week. This is especially the case in an emergency situation. We are sure you agree everyone deserves the same care no matter what time of day or night it is, so in Greater Manchester we want to organise all our NHS services in a way that provides you all with the right care, in the right place, at the right time.
Hospital changes, not hospital closures
If we are to transform healthcare in the way we think we need to, the roles of hospitals are likely to change, with some taking on a wider role of “centres of excellence” for specialist care. Most of the waste that occurs within the NHS is because in the past we have tried to provide every service in every location.
For example, emergency general surgery is carried out in 10 acute hospitals in Greater Manchester, but not always with a consultant present or a guaranteed admission to a critical care bed — and yet we know this saves lives. So providing some specialist services in fewer places is actually a good thing for patients.
There are other recent positive examples. 200 lives have already been saved as a result of centralising stroke services across Greater Manchester, rather than having every single hospital provide these services. Rehabilitation of patients has also drastically improved with people making a better recovery from strokes because of the expertise of the people treating them.
Isn’t it safer to keep all services as local as possible?
Naturally people worry that in an emergency situation a longer journey to hospital reduces people’s chances of survival. This is not the case. Modern ambulances are like moving hospitals, and many lives are saved due to the care administered by paramedics. Local A&E services also do their best for patients, but they cannot always provide the right care.
The case of the former Bolton Wanderers footballer Fabrice Muamba is a topical example of why getting to a hospital as quickly as possible in an emergency situation is not always the answer. As Bolton people will know, Fabrice collapsed on the pitch due to an undiagnosed heart condition and his chances of survival looked bleak. However, his ambulance took him past the nearest hospitals in favour of the one that would give him the specialist care he needed, and he made an amazing recovery. Fabrice is a famous example, but we know that in general receiving specialist care can make a huge difference to survival rates — patients with heart conditions who are admitted to specialist cardiology wards have 20 per cent lower mortality rates than those treated elsewhere. We need to ask ourselves whether Fabrice would have survived if he had been taken to the nearest hospital. This is what we mean when we say it is the quality of the care that is received, not where it is received, that is the most important issue when it comes to saving lives.
We know where people truly believe that a facility is a centre of excellence as they do with the Christie Hospital, they are willing to travel longer distances to get what they perceive to be the best possible treatment. We believe that this would work well for a number of other serious conditions.
What does Healthier Together mean for Royal Bolton Hospital?
There has been a lot of publicity about the financial problems that Bolton NHS Foundation Trust is having. Only recently, consultants have been asked to take a pay cut, and the unions have been worried about job losses. Of course people in Bolton are concerned about this, and some people are frightened the hospital or the A&E department might close.
Royal Bolton is situated in a very central location, serves a wide community and provides a vital service — so talk of closures is unhelpful and misleading. But as I have said, some changes are needed at all our hospitals, including Bolton, to make sure services are safe and affordable.
Better care away from hospitals
Most of us want to live and die at home, but all too often frail elderly people end up going into residential care and dying in hospital due to inadequate provision for caring for them in their communities. Patients with long-term but non-urgent health conditions are also admitted to hospital for the same reasons. A key part of the Healthier Together programme will be to enable changes to take place to make sure that these patients can be well cared for in the community. This includes better use of IT and communications, including better advice on self-care so that people can manage their own health at home, with the right support to do this. This will allow them to remain independent and in control. This will also relieve the pressure on our hospitals, leaving them free to focus on treating those who really need to access the specialist care and treatment that only they can provide.
Most people want much greater access to their GP practices, some of which still open only during traditional working hours. This needs to change — we live in a 24/7 society and when people are ill they need to be able to access health care when and where they need it. This is an area I am interested in and involved with and am working with GPs across Greater Manchester to look at how we can achieve this. We also want to see far more emphasis on “prevention not cure” to help people take more responsibility for their own health so they don’t get ill in the first place.
No decisions about you without you
Healthier Together and Bolton CCG are talking about what the future NHS should look like in Bolton and we cannot make the changes we need without the input and involvement of a wide range of partners and the public. Any major changes to hospital services in Bolton or anywhere else in Greater Manchester would require a full public consultation, but we won’t be at this stage until the summer. What we have done and will continue to do is to make sure that people have the opportunity to help us shape our proposals before we get to that stage. Along with colleagues from Bolton, I will be discussing all of the issues around the programme and asking people what care they would like to see for themselves and their loved ones. To get involved in this or other events contact us at healthiertogethergm.nhs.uk I’d love to hear your views, so do get in touch.
- A public workshop is being held at Bolton Town Hall from 6pm until 8pm on Thursday, January 24.