Patient Benefits Submission to the Competition & Markets Authority Anticipated merger Central Manchester University Hospitals NHS Foundation Trust, and University Hospital of South Manchester NHS Foundation Trust Contents 1. Executive Summary ..................................................................................................................... 6 2. Introduction .................................................................................................................................. 12 3. Merger rationale and transaction process .............................................................................. 13 3.1 Events leading to the decision to create a single acute trust for Manchester ........... 13 3.2 Merger rationale ................................................................................................................. 14 3.2.1 Improving services: the Single Hospital Service review ....................................... 15 3.2.2 Organisational barriers to service improvement efforts ........................................ 17 3.3 Wider benefits expected from the merger ...................................................................... 20 3.4 Transaction governance and process ............................................................................. 21 4. Patient benefits overview .......................................................................................................... 22 4.1 Clinical engagement and the development of patient benefits ................................... 22 4.2 Common drivers for the patient benefits cases ............................................................. 23 4.3 Overview of patient benefits ............................................................................................. 26 5. Cardiology, vascular and stroke services ............................................................................... 28 5.1 Acute coronary syndrome ................................................................................................. 30 5.1.1 Background ................................................................................................................. 30 5.1.2 Current service arrangements .................................................................................. 31 5.1.3 Planned service arrangements and patient benefits ............................................. 34 5.1.4 Merger dependence ................................................................................................... 39 5.1.5 Implementation constraints and plans..................................................................... 40 5.2 Cardiac rhythm management ........................................................................................... 40 5.2.1 Background ................................................................................................................. 41 5.2.2 Current service arrangements .................................................................................. 42 5.2.3 Planned service arrangements and patient benefits ............................................. 45 5.2.4 Merger dependence ................................................................................................... 47 5.2.5 Implementation constraints and plans..................................................................... 47 5.3 Acute aortic surgery ........................................................................................................... 48 5.3.1 Background ................................................................................................................. 48 5.3.2 Current service arrangements .................................................................................. 49 5.3.3 Planned service arrangements and patient benefits ............................................. 50 5.3.4 Merger dependence ................................................................................................... 52 5.3.5 Implementation constraints and plans..................................................................... 52 5.4 Vascular surgery ................................................................................................................. 53 5.4.1 Background ................................................................................................................. 53 5.4.2 Current service arrangements .................................................................................. 53 5.4.3 Planned service arrangements and patient benefits ............................................. 55 5.4.4 Merger dependence ................................................................................................... 56 5.4.5 Implementation constraints and plans..................................................................... 57 5.5 Stroke ................................................................................................................................... 58 5.5.1 Background ................................................................................................................. 58 5.5.2 Current service arrangements .................................................................................. 59 5.5.3 Planned service arrangements and patient benefits ............................................. 60 5.5.4 Merger dependence ................................................................................................... 61 5.5.5 Implementation constraints and plans..................................................................... 62 6. Women’s Health ......................................................................................................................... 62 6.1 Urgent gynaecology surgery ............................................................................................. 64 6.1.1 Current service arrangements .................................................................................. 64 6.1.2 Planned service arrangements and patient benefits ............................................. 66 6.1.3 Merger dependence ................................................................................................... 69 6.1.4 Implementation constraints and plans..................................................................... 70 6.2 Community midwifery ........................................................................................................ 71 6.2.1 Current service arrangements .................................................................................. 71 6.2.2 Planned service arrangements and patient benefits ............................................. 74 6.2.3 Merger dependence ................................................................................................... 76 6.2.4 Implementation constraints and plans..................................................................... 77 7. Urology ......................................................................................................................................... 77 7.1 Patient access to core urology services ......................................................................... 78 7.1.1 Current service arrangements .................................................................................. 78 7.1.2 Planned service arrangements and patient benefits ............................................. 79 7.1.3 Merger dependence ................................................................................................... 80 7.1.4 Implementation constraints and plans..................................................................... 80 7.2 Urology cancer services .................................................................................................... 81 7.2.1 Current service arrangements .................................................................................. 81 7.2.2 Planned service arrangements and patient benefits ............................................. 81 7.2.3 Merger dependence ................................................................................................... 82 7.2.4 Implementation constraints and plans..................................................................... 83 7.3 Kidney stone removal ........................................................................................................ 83 7.3.1 Current service arrangements .................................................................................. 83 7.3.2 Planned service arrangements and patient benefits ............................................. 84 7.3.3 Merger dependence ................................................................................................... 85 7.3.4 Implementation constraints and plans..................................................................... 85 7.4 Seven day services ............................................................................................................ 85 7.4.1 Current service arrangements .................................................................................. 86 7.4.2 Planned service arrangements and patient benefits ............................................. 86 7.4.3 Merger dependence ................................................................................................... 87 7.4.4 Implementation constraints and plans..................................................................... 87 8. General Surgery ........................................................................................................................