One Year Post-Merger Report November 2018 Contents Foreword 3 Executive Summary 4 Key Messages 5 1 Introduction to Manchester University NHS Foundation Trust 6 2 The Creation of Manchester University NHS Foundation Trust 10 3 First Priorities Post-Merger 13 4 Establishment of Leadership and Organisational Structure 15 5 Establishing Robust Governance and Assurance Arrangements 21 6 Developing MFT’s Service Strategy 25 7 Planning for Major Clinical Transformation 27 8 Delivering Benefits in Year One Post-merger 29 9 Lessons Learned 40 10 Conclusion 46 One Year Post-Merger Report 2018 2 Foreword Manchester University NHS Foundation Trust (MFT) organisational structure that is fit for purpose. This was launched on 1st October 2017. The new means we can press on to finalise the service strategy organisation brought together a group of nine which will support more fundamental transformation hospitals plus community services, providing a once over the coming years. This is exciting work which in a lifetime opportunity to deliver even better services will continue to involve staff from across our nine for the people of Manchester, Trafford and beyond. hospitals and community services, along with partner organisations. Our first priority was to keep services running safely and smoothly. On day one, patients saw little change All this work has taken place against a challenging apart from the new name and new lanyards for backdrop. Like other NHS Trusts, we face increasing staff. We wanted to minimise disruption to maintain demand on our services, workforce challenges and stability for staff and ensure patient safety. financial pressures. Despite this headwind our staff have continued to deliver outstanding care whilst We quickly started detailed planning to maximise the also developing single services and delivering early opportunities to improve services for patients and transformation. We would like to thank them for address the health inequalities that exist in the City their unrelenting efforts and support in establishing of Manchester, Trafford and the wider communities MFT, and for the steps they have taken to maintain we serve. We started to deliver changes steadily and and improve services for patients. we are pleased to see some major improvements for patients being delivered already. Behind the scenes We look forward to continuing the development of significant work has also taken place to consolidate MFT, and remain excited about the potential for us the systems, policies and processes that support the to reduce variation in care so that all patients can get day-to-day operation of a major organisation. the same standard of service no matter where they are in MFT. Together we can achieve an international Designing and embedding new governance and reputation and exceed all expectations across care leadership structures was a key component of provision, education and training, and research and our early work. It took a great deal of effort and innovation for the benefit of patients. support from staff and, as a result, we now have an Kathy Cowell OBE DL Sir Michael Deegan CBE Chairman Chief Executive One Year Post-Merger Report 2018 3 Executive Summary Manchester University NHS Foundation Trust was created through the merger of Central Manchester “The overriding reason for the merger was NHS Foundation (CMFT) and University Hospital of to create single hospital services for the South Manchester NHS Foundation Trust (UHSM) on people in Manchester and Trafford and, to 1st October 2017. make sure every person using our hospitals and community services receives the same This One Year Post-Merger Report provides an excellent experience and quality of care, no overview of the Trust’s establishment and first year of matter where they live or where they access operation. It outlines the new organisational structure care. During our first year we have seen including the scope and scale of services it provides many examples of staff working together to before setting out the vision and values that have improve standards of care for patients and been collaboratively developed with staff. It explains their families.” the initial priorities of the organisation, including Professor Cheryl Lenney, Chief Nurse the primary objectives of maintaining stability and continuing to deliver core activities safely. The Report explains that a new organisation structure The Report outlines that delivery of patient benefits has been established comprising both traditional has commenced with major improvements already hierarchies and new networks that run across the evidenced in services ranging from lithotripsy breadth of the organisation. It outlines how the and urgent gynaecology services to the better Trust’s formal governance arrangements have been management of patients suffering a fractured neck set up and how the Hospital, Managed Clinical of femur. Across the organisation staff have been Services and Clinical Standards Groups function and working to develop single services that build on the interact. It also confirms that despite the significant strengths of the predecessor organisations. This levels of change staff engagement to date has work has been underpinned by efforts to consolidate remained strong. systems, processes and policies in support services, such as IT, finance, HR and workforce. The Report confirms that the main driver for the creation of MFT was the opportunity to deliver The creation of MFT and subsequent work to fully significant patient benefits across the full range establish the organisation has been a significant of services offered. These span improvements in undertaking. The Trust has learnt useful lessons patient safety, clinical quality and outcomes, to during this process and these are set out in the improvements in the experience of patients, carers Report. This learning will go on to inform MFT’s and their families. It explains how the Trust is future work, including the proposed acquisition of developing its overarching service strategy, setting North Manchester General Hospital. It is hoped that out a long term vision that will shape how services other NHS organisations will also be able to benefit are provided in the future. This service strategy from this learning. work will inform the delivery of significant service transformation over the coming years. One Year Post-Merger Report 2018 4 Key Messages The value of having a credible, robust and The new organisational structure and adaptable Post-Transaction Integration governance arrangements were well Plan (PTIP) cannot be overstated. The PTIP planned pre-merger and established provided the Group Board of Directors and relatively quickly. Combining hierarchy external scrutineers with a framework to and certain reporting arrangements with assess progress and gain assurance about defined structures offered clear lines of the merger. More importantly it afforded accountability without stifling innovation, staff, clinical leaders, managers and agility and flexibility. Matrix working has, transformation teams a framework against and continues to be, encouraged. which to operate from day one of the merger. A key element of post-merger work Having a dedicated Single Hospital Service/ has been the consolidation of systems, Integration Team avoided the deployment processes and policies on a priority basis of external consultancy and enabled to ensure MFT operates as a single entity. delivery of the PTIP as a local product This work is complex and will continue to recognised and owned by staff. It also receive attention as part of the PTIP work provided a resource to coordinate post- stream. merger work including the transition from merger change processes to business as usual linked to portfolios of individual As planned, the development of the Trust’s Group Executive Directors and Hospital and long term service strategy is well underway Managed Clinical Services Chief Executives. with strong engagement from across the organisation and with relevant partners. Communicating and engaging with staff was crucial throughout the merger. Staff The focus for the first year was on ensuring were central to the planning and delivery as much stability for staff as possible as of the merger work and the subsequent well as protecting patient safety during a development of the Vision and Values time of significant change. In essence it was of the new Trust. Despite the significant a deliberate policy to maintain business level of change that has taken place staff continuity and avoid any unnecessary engagement remains strong. disruption to pre-merger working practices. The establishment of an Integration Steering Group with active involvement of During the establishment of MFT and in its Group Executive Directors has been critical first year of operation important lessons in driving change, tracking patient benefits have been learnt. These will be carefully and planning for Year Two of the merger. considered to optimise future work. “The creation of the new Trust was always going to be a fantastic opportunity to bring together the clinical strengths of our two predecessor organisations, and build on them to provide even better care to our patients. Both in the lead up to the merger and since, clinical engagement has been at the heart of the work to bring about benefits for patients; and I’m sure that’s a major factor in achieving the successes we’ve already delivered.” Miss Toli Onon, Joint Medical Director One Year Post-Merger Report 2018 5 1 Introduction to Manchester University NHS Foundation Trust MFT was created on the 1st October 2017 following the merger of CMFT and UHSM. It is one of the largest acute Trusts in England, employing over 20,000 staff. The Trust is responsible for running a group of nine hospitals across six distinct geographical locations and for hosting the Manchester Local Care Organisation: Manchester Saint Mary’s Royal Manchester Royal Infirmary Hospital Children’s Hospital Manchester Royal University Dental Hospital Wythenshawe Eye Hospital of Manchester Hospital Trafford Withington Altrincham General Hospital Community Hospital Hospital In Manchester City Centre Hospital and Withington Manchester. on the Oxford Road Campus care Community Hospital.