Image: Wikipedia. Royal Manchester Children's Hospital is part of the Central Manchester University Hospitals Foundation Trust.

All hospital services in the city of Manchester should be run by a new single city-wide Trust, an influential report has proposed. The review, penned by former trust chief executive Sir Jonathan Michael and commissioned by the chair of Manchester city council, recommends that the creation of a new NHS Trust to take over the running of services currently provided at Central Manchester University Hospitals Foundation Trust, University Hospitals of South Manchester FT and North Manchester General Hospital.

The merger would create the biggest NHS trust in England, with a turnover in the region of £1.6bn.

That would produce a big tick in the “economy of scale” box, but also significant risks.

One risk is that this sort of package could be a very easy picking for the private sector. We are told the move is an alternative to private-sector-friendly ‘hospital chains’ (the general direction of travel put forward by Sir David Dalton and Simon Stevens), but it’s unclear what the difference is in practice.

Another risk is that the reorganisation will be a distraction, taking the focus away from delivering care, and the organisation will become too big to manage. 

Over the past 20 years we’ve seen too many reorganisations take the NHS mandarins’ collective eye off the patient and on to schemes that aim to cut back on services, often with no money actually being saved even as patient services are reduced. We should remember that the reorganisation of children’s services in Manchester resulted in higher, not lower, costs, for example. 

It’s also likely that this organisational merger will hasten the trend towards centralisation of hospital provision. We already know that mergers often lead to one site losing activity and income while another gains.

This has significant concerns for increased workload with diminished resources for general practice too.

However, I do believe that Manchester has too many hospitals. There is inefficiency and waste due to duplication, variation in patient access to services, and all hospitals are experiencing difficulties recruiting clinical staff.

I have dedicated my working life to the NHS and can see that changes are needed to modernise our hospital services, and in this regard we cannot exclude merging of hospitals from the debate.

So it is worth giving some consideration to the argument behind this report – that this scheme, along with the other Manchester plans like including devolution, Simon Steven’s ‘vanguard’ plans and other local reorganisations, gives an opportunity to make health and social care in Manchester safest, the best and most vibrant one in the country.

We are told that the NHS has to be more efficient, financially as well as clinically. Simon Stevens, the NHS Chief Executive of the NHS says we need to find £22bn savings to cope with increasing costs of an ageing population. In Greater Manchester we will be £2bn in deficit by 2020. Hospitals utilise a significant proportion of the NHS budget and are thus an easy target. But what will be the likely impact on patient care? 
NHS Manchester proposes rationalising specialist services into fewer, larger hospitals. I accept that if high quality hospital care is to be delivered, there is a clear need to consolidate. However, at a time when we need better access to specialised care, is this the time to build centralised ‘ivory towers’ that in truth will be less accessible to patients, carers and their GPs? 
I have said before that the NHS in Manchester must be better organised to serve its population. Hospitals and community services have been forced into different and competing camps. We should be strengthening the idea of bringing hospital quality into the community so our local NHS is the same, regardless of our postcode.
But can we really transfer healthcare from hospitals into the community and expect the same specialised, quality care? Can those behind the proposals convince consultants, GPs and NHS managers that expertise and resources will migrate to local communities, and that these are not just cost-cutting plans?

Fewer hospitals would mean longer journeys for many. Fewer A&E departments means GPs will have to fill the gap, at a time when GPs are being drawn into administrative roles to commission NHS services.

The effect of such mergers must not be under-emphasised.

The A&E forms the gateway to admissions to psychiatric, medical and surgical wards, so what would a radical shift in such provision mean to these services?
A&E closures might lead to a ‘domino effect’ with some specialities being transferred to a hospital with an A&E. Unless this is factored in, some A&Es will become overcrowded and they will constantly breach the target of four hour waits.
As a supporter of positive change, I would expect these proposals will be subjected to public scrutiny.

Policy makers must publish a frank and detailed account of the benefits to patients of any proposed reorganisation, and demonstrate clearly how any proposed reorganisation will result in savings to the taxpayer without compromising quality and care. We have too many plans landing on us – there’s a parallel plan in NE Manchester being worked up by Mike Farrar. How do the plans relate?

We owe it to ourselves to get this issue properly debated, and ensure we do not lose sight of what the local population demand from NHS hospitals, with or without an A&E department.

I sincerely hope this review by Sir Jonathan Michael is not just a financially driven panic measure to close the deficit. If so, it will lack transparency and engagement and ultimately further the cause of the marketisation of health.