General Surgery UPDATE NOVEMBER 2019 Background

In 2012, health and care leaders across Greater Manchester (GM) identified the need to address the variation in care and outcomes for patients across GM. A formal programme of change, Healthier Together, resulted in the 12 GM clinical commission groups (CCGs) support by the GM Combined Authority (GMCA) proposing changes to some hospital services; urgent and emergency care, acute medicine and general surgery (abdomen and bowel). The Bolton, Salford and Wigan partnership (BSWP) was established in the north- west sector of Greater Manchester following the Healthier Together review and is tasked with supporting NHS organisations to work in partnership to make sure that hospital services are the best they can be, so that patients receive the same high quality, safe and accessible care.

Bolton, Salford and Wigan Partnership Working Together

The Bolton, Salford and Wigan Partnership aims to ensure that residents have access to the best health and care in the country. This will be achieved by increasing quality and safety standards and working together to develop ‘single services’. Already in Greater Manchester, major trauma and stroke services have been changed to work in this way and the evidence shows that consolidating services onto fewer hospital sites has saved lives and improved patient care.

Bolton, Salford and Wigan Partnership Benefits of working together for patients

Bolton, Salford and Wigan Partnership Benefits of working together for staff

Bolton, Salford and Wigan Partnership General Surgery

The biggest transformation will take place in general surgery where the Partnership will lead on the creation of a single service. This means that care will be provided by a single team of surgical staff working together across Bolton, Salford and Wigan to provide emergency and elective general surgery. Salford Royal has been designated as a specialist ‘hub site’ where a consultant surgeon will be on duty 24/7 to provide timely care to high-risk patients. Low-risk surgery, ambulatory care and outpatient services will continue to be provided at Bolton, Salford and Wigan hospitals.

Design plans have been signed off for a new build Acute Receiving Centre (ARC). The building is expected to open at Salford Royal in February, dependent upon timing of the release of funds from HM Treasury.

Bolton, Salford and Wigan Partnership Healthier Together is part-funding this development, which will result in the following additional facilities at SRFT:

 5 emergency theatres  32 Critical Care beds . 6 of these are to accommodate general surgery activity from Bolton and Wigan.  48 in-patient beds

Bolton, Salford and Wigan Partnership Colorectal cancer care

The largest group of high risk patients undergoing planned surgery at the hub site will be those diagnosed with colorectal cancer. Working as a single team will ensure all these patients have their operation carried out by an experienced colorectal surgeon and get consistent access to pre and post-operative care, specialist nurses and clinical trials where appropriate. A multi-disciplinary team (MDT) will meet to agree the best treatment plan for patients diagnosed with cancer, and will review how well treatment is working. These meetings are known as cancer MDTs. Our MDT will bring together surgeons, radiologists, pathologists, nurses and other specialists from across the Partnership area to improve care through combined knowledge and experience. Clinical staff from across the partnership are already meeting fortnightly to discuss the treatment of patients with rectal cancer. By the time high risk planned surgery moves to the surgical hub site clinicians from Bolton, Salford and Wigan will be working together to deliver better care for every patient diagnosed with colorectal cancer.

Bolton, Salford and Wigan Partnership Ambulatory Care

Surgical ambulatory care units (SACU) will be a central part of the new sector wide single service for general surgery. Ambulatory care is provided by all three trusts and is a service offering same day emergency care to patients without the need to be admitted into a hospital bed overnight (wherever possible). This means that patients are assessed, diagnosed, start treatment and are able to go home the same day. The majority of patients accessing general surgery will be treated in a SACU.

Bolton, Salford and Wigan Partnership How many people will be affected?

To understand the volume of patients affected by the transformation, the Partnership has carried out service modelling work based on 2017/18. In total 17, 050 patients accessed general surgery services in the north-west sector. Under the new model: 1524 (approximately 9%) would be transferred to the hub site at Salford Royal.

15526 (approximately 91%) are cases where the risk is lower that would be treated locally in hospital wards, outpatients and surgical ambulatory care units.

Bolton, Salford and Wigan Partnership How many people will be affected?

Bolton, Salford and Wigan Partnership Successfully working together

Royal Bolton Hospital hosts the sector pacing suite utilising state of the art technologies to treat cardiology patients from across Bolton, Salford and Wigan. Pathology at Wigan and Salford (PAWS) provides pathology services across Salford and Wigan. This impressive service has been recognised for the value it provides to patients and tax payers alike coming first in the “Value in Healthcare Awards” in 2015. Trauma – Salford Royal Foundation Trust is the principle receiving site for all major trauma patients across the sector increasing the chances of successful recovery for anyone unfortunate enough to be involved in an unexpected emergency situation.

Bolton, Salford and Wigan Partnership Events

On the 18th July the Equalities and Experience Reference Group (EERG) was held at the Friends Meeting house in Bolton. Thanks to everyone who attended and contributed to a lively discussion around Patient Choice. We are now looking for members of the public to work alongside staff in all the work streams of the programme. This was the final EERG of 2018-19. If you have attended any of the EERG meetings over the last year then please accept our grateful thanks for you contribution.

Bolton, Salford and Wigan Partnership Have your say

If you have any questions, suggestions or comments please get in touch with the BSWP Programme Team [email protected] Follow @BSWPartnership on Twitter We’ll be using Twitter to talk about transformation work we are involved in and to highlight how partners are working together to improve safety, patient experience and to ensure services are of the same high quality whichever hospital patients attend. If you’re on Twitter please join the conversation using the hashtag #BSWPartnership

Bolton, Salford and Wigan Partnership