Re-designing services in North West

Published on Friday, 11 November 2011 10:53
Posted by Scott Buckler

Re-designing patient services in ‘birthplace of the NHS’ proving to be no simple matter, Nuffield Trust finds

An in-depth study of the efforts made by health and social care organisations in Trafford to deliver a more integrated service provides valuable insights in to the challenges and barriers local organisations encounter when reconfiguring services at a time of severe financial constraint

Towards integrated care in Trafford, published today by the Nuffield Trust – an independent health think tank which along with The King’s Fund is advising the Department of Health on the development of a national strategy for the promotion of integrated care – examines the work done by clinicians and managers in Trafford since 2008 to develop an integrated care system.

Trafford, a borough of 215,000 people in Greater Manchester, is well known for being the site of the first NHS hospital. However partly in response to a financial situation that has made it impossible to sustain health services along existing lines, there is now agreement that the local NHS should move to a situation where a wider range of community-based and specialist services are provided.

Their story underlines the point that there are no easy solutions or quick fixes – the proponents of integrated care in Trafford have had to jump over many hurdles over the last three years.

Important lessons from Trafford’s experience of steadily developing a more integrated system, despite significant setbacks, include:


  • Flexibility and compromise are often required – the Trafford story demonstrates that it is feasible to make progress on service re-design with clinicians leading this process, even while the structural and policy development issues are being worked through. Thinking beyond structural changes (e.g. organisational mergers) and towards ‘an integrated care system’ can be essential to making progress.


  • The importance of establishing a clearly articulated vision, endorsed by the groups and individuals whose support is necessary to making change – in Trafford the focus has been on encouraging these groups to lead change rather than being swept along by external events and there has been major investment in fostering collaboration across professional groups, including local authority social services. Patient experiences and the views of local people have also been central to service re-design.


  • Leaders face specific challenges in the context of developing integrated systems – prospective leaders often come to the integration process with different agendas and levels of understanding about what is meant by integration and how it should be achieved. In Trafford arrangements were made for the clinical leaders to be supported by an internationally known leadership support programme, tailored to fit their needs. This has proven effective at upskilling the workforce.

Anxieties about the financial viability of the main hospital provider in Trafford, the constraints of NHS policy, and concern as to what integration might mean for patient choice have led to the proposals being changed several times.

In doing so the focus has moved away from organisational merger in favour of greater collaboration between existing and new services. A number of multidisciplinary clinical panels - groups of doctors, nurses, patients and other health professionals - are now taking this forward with a view to eventually bringing online a fully integrated care system incorporating GPs and hospital consultants.

Despite having had to continually refine its plans Trafford is now beginning to demonstrate signs of progress. Systems are being put into place that will allow clinicians to feed back almost ‘real time’ data on the use and costs of care by patients, helping to improve coordination and decision making, and new arrangements have made it easier for social workers and district nurses to work together to identify and support high risk patients.

Dr Sara Shaw, Visiting Senior Fellow at the Nuffield Trust and report lead author, comments:

Trafford is an important case study. The experience of its local NHS organisations in grappling with how to deliver more personalised, less fragmented, more efficient care must certainly resonate with others who are trying to secure radical change in the context of serious financial challenges.’

‘Their story underlines the point that there are no easy solutions or quick fixes. The proponents of integrated care in Trafford have had to jump over many hurdles over the last three years. They have managed to withstand these by lining up the right people early on and building close relationships, founded on a clear, shared vision.’

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