Development of a modern adult cystic fibrosis centre in Manchester

Abstract

In 1982, a small adult cystic fibrosis (CF) unit was initiated by a respiratory physician (AKW) and a paediatric CF-trained physiotherapist in the physiotherapy department at Monsall Hospital. Monsall Hospital was an old-style fever hospital based in the North District of Manchester. There was a need for a regional adult CF unit as about 30 CF adults were still under the care of the two specialist paediatric CF centres. The newly-forged adult CF unit prospered. The unit received large numbers of referrals from the paediatricians and GPs in the North West Region. The Regional Health Authority provided funding for expensive drugs and some crucial posts such as physiotherapists, social workers and dieticians. In 1986, the Cystic Fibrosis Trust provided funding for a clinical fellow to assist with clinical support and also to undertake clinical research. Patients and families began to raise funds for equipment and facilities to improve patients’ hospital stay. As the patient numbers outgrew the limited facilities, a ward with 10 cubicles was established in 1990. In 1990, the minister for health initiated the provider/purchaser interface whereby the NHS health authority covering the area in which a patient resided was cost accountable for services provided by hospitals to that patient, wherever that might be (this health authority responsibility has now been modified to be the primary care trust to which the patient’s GP ‘belongs’). A research grant provided by the Cystic Fibrosis Trust was used to undertake an accurate costing by an economist from York University of the regional adult CF service to the North West Region. CF adult patients were categorized by cost according to four bands of disease severity. At a later date, a fifth band for very costly patients on continuous intravenous antibiotics was added (Table 1). These bandings and attributable costs were accepted by the purchasers of the service. As a result, the adult CF unit, by bringing an income to the hospital immediately became an asset rather than a financial millstone. In 1992, through the Cystic Fibrosis Trust, a foreign benefactor provided a substantial sum to the Unit to build a dedicated CF building for adults with CF in the North West Region. It seemed reasonable for the dedicated building to be established in a hospital in South Manchester where the main regional respiratory services were established including lung transplantation. The move was opposed by the North Manchester District, probably because of the defined income which they received for care provided by the adult CF unit to the region rather than consideration of the medical benefit which the CF adults would receive by their care being relocated to South Manchester. A prolonged bitter conflict was only resolved by the CF adults saying they would go wherever the unit went. In 1993, the CF Unit went to South Manchester and was housed on a temporary ward until the new building was completed in 1994. DECLARATIONS