Transformation Unit

Specialised Cancer Services

Equality Impact Assessment

The Client

The reconfiguration of specialised services, which includes major cancer surgery, is being undertaken by the Greater Manchester Health and Social Care Partnership, the body responsible for overseeing health and social care devolution in the city region.

It spans 12 Clinical Commissioning Groups (CCGs), 10 Local Authority areas and 8 acute hospital providers.

Our Challenge

National guidance set by the National Institute for Health and Care Excellence (NICE) provides standards relating to the minimum number of specialist operations that must be undertaken by clinicians. These standards are based on clinical evidence which clearly demonstrates that patient outcomes are improved by increasing individual operator and institutional volumes in sites carrying out specialised cancer surgery.

Sites across Greater Manchester do not meet these standards, with cancer survival rates in the Greater Manchester region being without exception below the average across England. As a result, a reconfiguration of the sites delivering specialised cancer services across Greater Manchester has been proposed to ensure these standards are met and ultimately the quality of care for patients.

As part of the team’s broader work on transforming these services across Greater Manchester we were asked to provide analyses of the current provision of urology and oesophageal-gastric (OG) specialised cancer surgery across Greater Manchester. This information was used to support the model of care and service specification for the proposed changes to these services.

Although yet to be delivered, the resulting reconfiguration proposals will inevitably have a negative impact on the ease of access for some service users. We were asked to analyse the key characteristics of service users who would be impacted under each service reconfiguration option (age, ethnicity, deprivation) and model the impact on travel and ease of access for these patients.

Our Approach

Utilising our in-depth knowledge of national datasets (specifically Hospital Episode Statistics) we were able to isolate and analyse accurate data regarding the current provision of services across Greater Manchester. This included a breakdown of the volume of procedures across sites and the complexity of the procedures conducted by each trust.

We provided data regarding the characteristics of patients that would be affected under each reconfiguration option. Specifically patient age, gender, ethnicity and deprivation were characterised, with a focus on identifying whether or not patients with protected characteristics would be disproportionally affected by any service changes.

We used mapping software to identify the geographical distribution of service users and provided an analysis of how changes in service would affect travel time and ease of access for patients across the conurbation.


Our team was able to play a key role in ensuring that due consideration of the effects of these changes to patients across Greater Manchester was taken into account. In particular providing evidence as to whether or not any reconfiguration model would disproportionately affect patients with protected characteristics and equality groups.

  • We Identify the positive and negative impacts for service users
  • Identify which equality groups would be more likely to be affected by the proposals, due to their propensity to require different types of health services, and what these impacts would be. This was critical in order to support the programme to meet its obligations under the 2010 Equality Act
  • We provided recommendations on ways in which positive impacts could be maximised for the population and ways in which to mitigate or minimise any adverse effects

Supported by our data analysis and our wider work engaging clinicians and patients, the model of care and service specification for proposed changes to the provision of urology and OG specialised surgery across Greater Manchester was signed off in summer 2016.

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