Transformation Unit

Healthier Together

Redesign of Specialist A&E Care and Emergency General Surgery

The Client

Healthier Together was established by the 12 Greater Manchester Clinical Commissioning Groups (CCGs), covering 10 Local Authority areas, 8 acute hospital providers and 10 in scope hospital sites.

The Healthier Together programme now falls under Theme 3, Standardising Acute and Specialised Care, of the Greater Manchester Health and Social Care Partnership Programme for Health and Social Care Reform.

The Challenge

Currently Greater Manchester has 10 hospitals providing both secondary care and the highest level of care for A&E, Acute Medicine and General Surgery. This means our specialist workforce (Consultant General Surgeons and Emergency Medicine Consultants) who are needed to deliver the highest levels of specialist care are spread thinly across all of our hospitals.

This means that our Greater Manchester hospitals are not always able to provide the best care every time. Commissioners wanted to remove the variations in the quality of care across the conurbation and ensure that services are high quality, safe and accessible, wherever you happen to live.

We were asked to design a robust case for change and an innovative future model of care for specialist A&E care and emergency general surgery (abdominal surgery) in order to deliver a step change in quality of care. The ultimate aim of Healthier Together, and subsequently the Greater Manchester Health & Social Care Partnership, is for Greater Manchester to have the best health and care in the country, to deliver better patient outcomes, better patient experience and make best use of its specialist workforce.

Our Approach

We worked in close partnership with clinicians from across the conurbation to develop a model that will provide the right care, at the right time, in the right place. We developed an option appraisal and decision making process for the programme in line with assurance requirements and statutory duties. This included:

  • Designing the programme approach and timelines;
  • Co-designing world class quality and safety standards for Greater Manchester hospitals in partnership with clinicians across Greater Manchester;
  • Designing and managing programme governance including 12 Boards and sub-groups;
  • Undertaking comprehensive leadership development with CCG decision makers;
  • Managing a complex stakeholder landscape with over 100 key stakeholders;
  • Undertaking clinical engagement across Greater Manchester;
  • Developing a comprehensive Pre-Consultation Business Case;
  • Designing and managing a large scale 15 week public consultation, to which over 29,000 responses were received;
  • Developing a Decision Making Management report and business case, alongside supporting the CCG Committees in Common through the decision-making phase;
  • Managing and successfully navigating assurance and legal processes including assurance by NHS England; and
  • Successful defence of a judicial review in the High Court.


In July 2015, the Healthier Together Committees in Common took a unanimous decision and named the four single hospital services that will be formed across Greater Manchester. This will mean that when the Healthier Together programme is implemented, standards in all 10 hospitals will be improved through consistent consultant presence in A&E and Acute Medical wards 12 hours a day, 7 days a week.

Healthier Together is now in its implementation stage with a plan for patients to begin to receive consistent higher standards of care in the four hub sites from 1st April 2017.

We anticipate that concentrating our specialist resources to treat those patients at highest risk will mean there could be up to 300 fewer deaths each year once the four single services have been implemented.

For more information about the Healthier Together Programme, visit:

High-res-NHS-in-GM - NHS-TU
GM CCGs plus neighbours - NHS-TU
Massive Health Shakeup Front Pagev2 - NHS-TU