1. Integrated Impact Assessment: Engagement Forum Healthier Together

2. Agenda for today Purpose of the impact assessment Objectives for the forum Overview of service proposals & questions Consideration of impacts Consideration of mitigations & opportunities Next steps

3. What is the purpose of the integrated impact assessment? to consider the positive and negative impacts across a range areas to inform decision-making and consider the consequences to suggest ways to maximise benefits and reduce any adverse factors

4. What doesn’t the impact assessment do? criticise, defend or justify the proposals make decisions or recommendations undertake a full public consultation exercise: engagement is much more targeted

5. Objectives for today Listening to your views on: Potential positive impacts Potential negative impacts Groups that might be affected more than others Opportunities and mitigations

7. Our Vision For Greater Manchester to have the best health and care in the country

8. What is Healthier Together? Improving how we join up Health and Social Care Improving GP Services Making sure the sickest patients receive best care in hospitals

9. All our hospitals are stretched You may not be getting best care 7 days a week No hospital meets all the Quality and Safety standards Why are we doing this?

10. For example Strong evidence suggests for the sickest patients needing emergency general surgery, the risk of dying may be twice as likely at some hospitals compared to others In Greater Manchester…

11. Which Hospital Services? A&E – Accident and Emergency. Acute Medicine – treats adults who arrive in an emergency and need immediate specialist care. General Surgery – Emergency and planned abdominal surgery. HOSPITAL V VV VV

12. There should be consultant doctors in Accident & Emergency during peak hours Patients undergoing emergency general surgery have access to an intensive care bed We know what the answer is…

13. Working together – Single Services

14. Deliver care locally for the majority of patients: All hospitals will have an A&E and acute medicine Planned general surgery operations for adults Testing and outpatients Upgraded to meet the standards. None of our hospitals meets these standards now General Hospitals GENERAL V VV VV

15. Provide General hospital care to the local population AND Care for the very small number of very sick patients across a wider area of Greater Manchester: Emergency and high risk general surgery operations Intensive care for complex patients Delivered in line with national standards Specialist Hospitals SPECIALIST & GENERAL V VV VV

16. Which hospitals are General and which are Specialist? We considered: Can the standards be met? How quickly people can access Specialist care? Is there a good spread across Greater Manchester? How much would it cost to implement and run the services? £?

17. How many Specialists? 5?4?

18. The 8 options – What is the same? Specialist and General General Hospitals not under review

19. The 8 options – What is the same? Specialist and General General Hospitals not under review

20. Specialist and General General Hospitals not under review The 8 options – What do we have to decide? ? ? ? ?

21. Options with 4 Specialist Sites Option 4.1 Option 4.2 Option 4.3 Option 4.4 Specialist sites: MRI, Salford Royal, Royal Oldham + Royal Bolton Royal Albert Edward, Wigan Wythenshawe Stepping Hill, Stockport or

22. Options with 5 Specialist Sites Option 5.1 Option 5.2 Option 5.3 Option 5.4 Specialist sites: MRI, Salford Royal, Royal Oldham + Royal Albert Edward, Wigan and Stepping Hill Royal Albert Edward, Wigan and Wythenshawe Royal Bolton and Wythenshawe Royal Bolton and Stepping Hill, Stockport or

23. How to get in touch