Transformation Unit

Oesophago-gastric (OG) surgical services in Greater Manchester

Developing and implementing a single clinical service

The Client
Greater Manchester Health and Social Care Partnership’s (GMHSCP) devolution plans aim to achieve the fastest improvements in health and wellbeing, experience and outcomes for the region. The NHS Transformation Unit (TU) were commissioned by the Greater Manchester Health & Social Care Partnership to support the establishment of a Single Clinical Service for Oesophago-gastric (OG) surgical services. We worked closely with colleagues at the GMHSCP and Salford Royal NHS Foundation Trust (SRFT), Part of the Northern Care Alliance NHS Group.

The Challenge
The Greater Manchester (GM) context was, and remains, exceptionally complex due to the many transformation programmes underway concurrently, as part of delivering health and social care devolution. There has also been a long history of attempts to successfully implement single service models for cancer services. To successfully deliver the programme we knew we would need to manage scepticism and weariness of change, alongside competing priorities and limited capacity within the system.

GM’s outcomes for OG cancer surgery were non-compliant against national standards and there was significant variation in patient outcomes across the surgical sites. There were also inefficient patient pathways due to various routes into diagnosis and treatment. GM had not been able to address these issues for many years.

The Outcome
We successfully coproduced and delivered the Greater Manchester (GM) Oesophago-Gastric (OG) commissioning specification and fully implemented the new surgical service hosted at SRFT in September 2018. This service has centralised all OG specialist cancer and benign surgery from across GM and is now one of the largest single OG services in Europe. The key benefits across the main areas are:

Improved patient & clinician experience. By bringing surgical expertise together and standardising clinical pathways and processes, the patient is afforded the best opportunity of surviving surgery with a good quality of life. This is due to the ready availability of specialist support at the surgical centre and removing clinical variation. As the service is now one of the largest in England it will attract interest nationally and internationally from high calibre clinicians who want to work in the service, and from research companies. In turn, this provides even better opportunities for good outcomes and greater access to patients for clinical trials which we need, to be at the cutting edge in the OG field.

Replicable and scalable. The OG programme was part of the Respect 21 Research programme – following GM and London transformation activity to evaluate change management in practice. The team, with Respect 21, shared the learning through a Lessons Learned sharing event for all GM colleagues involved in the other cancer programmes (which are at earlier stages of implementation). This provided an invaluable opportunity for honest and open conversations which in turn started to build trust, engagement and support for change going forward.

The implementation approach & lessons learned are already being applied in other specialities e.g. Urology (kidney, bladder & prostate) cancer; Gynaecological cancer; Vascular surgery; Neuro rehabilitation.

 “The NHS TU have enthusiastically engaged in ensuring that the ‘patient voice’ is captured and embedded in service transformation.  This has been like a ‘breath of fresh air’ and has helped to make the role of Patient Representative both fruitful and rewarding”. Patient representative.

“The single surgical site at Salford Royal is an important change which will help deliver improved clinical outcomes for people across Greater Manchester, provide around the clock specialist OG emergency surgical service for the whole city-region and unparalleled opportunities for clinical research, working in partnership with our colleagues at The Christie.” Jonathan Vickers, Consultant Surgeon at Salford Royal and Chairman of the GM Oesophago-gastric Cancer Pathway Board.