Confronted by a series of strategic challenges, a Greater Manchester trust's leadership team opted for a new way of agreeing its vision to engage with staff and other stakeholders.

Trafford Healthcare trust is a small district general hospital based across three sites in Greater Manchester. It is the birthplace of the NHS - it was opened by Aneurin Bevan on the day the service was born in 1948 - and has a rich clinical history. But like many local hospitals, it has encountered difficulties during the last decade. Small changes in service provision or training guidelines can affect the flow of patients using a local hospital, and therefore place clinical sustainability and business viability at risk. Trafford was no exception when Edna Robinson took over as the trust's chief executive last May, and observed: 

'We had ambitions to be a relevant, effective and viable health provider, but we didn't know what the future meant for a small local hospital surrounded by large university teaching hospitals. Increasing our anxiety was a complex financial position and the prospect of more services leaving our portfolio.'

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