Essential insight into England’s biggest health economy, by Ben Clover

Battle recommences

London Eye has written before of the struggle to control the North East London Treatment Centre – an elective treatment centre in the grand ISTC tradition.

There was an interesting fallout from the local clinical commissioning groups awarding the contract to the NHS, when Care UK referred the case to one of the competition regulators (Monitor’s little remembered competition directorate).

The CCGs’ judgement was overruled and the contract was returned to Care UK for a year. Now it is up for grabs again. Care UK and Barking, Havering and Redbridge University Hospitals Trust will once again go head to head.

What London Eye has been unable to establish is whether there are other bidders interested.

Since the last bidding process Havering CCG has been given legal directions by NHS England, but the trust has started to make headway on its elective work.

The trust is now reporting its waiting times data and might even come out of special measures in the next year.

The news comes as NHS Improvement’s report on the third quarter of 2016-17 put the provider sector’s outsourcing spend at a predicted £402m for the year (up from £241m last year).

A contract direct from CCGs wouldn’t fall into this category, of course, but the difference will seem obscure to the public.

Dusty in Edmonton

Talking of BHRUHT, there is a new chair at North Middlesex University Hospital Trust. Does the appointment of BHRUHT veteran non-executive director Dusty Amroliwala make a takeover of NMUH by the Royal Free more or less likely?

The having-a-very-difficult-time trust already has a new chief executive who was previously a director at the Royal Free, and there have been talks about closer working.

People have wondered if a full takeover is on the cards ever since the Royal Free joined other trusts in sending accident and emergency medics to cover at NMUH when it was having problems. (The same thought was raised when West Hertfordshire Hospitals Trust also got a former Royal Free director as chief executive).

Something indicating perhaps a full merger: Mr Amroliwala has been appointed for only one year – after NHS Improvement consulted with the Commissioner for Public Appointments. Maybe there won’t be a separate statutory body to chair after 12 months?

Something that doesn’t indicate a full merger: the Royal Free’s absorption of Barnet and Chase Farm hospitals is an increasing drag on the trust’s performance.

In the Q3 data, the Royal Free’s forecast financial outturn for the year has slipped from a £15.5m surplus to a £39.4m deficit – the biggest slide in London. NMUH’s position has also gone from black to red, by £23.1m – from a £14.1m surplus to a £9m deficit.

NMUH, like most trusts, has been set the impossible task of improving performance while controlling spending. Its success (or otherwise) on the latter can be seen by its ranking in the national table for agency spend over its NHS Improvement set cap – number one out of 237.

Back to St George’s

The Royal Free’s almost wasn’t the biggest deterioration in financial position in the Q3 papers. (although HSJ readers could have learned the same from my colleague Lawrence Dunhill last week).

St George’s in south London saw its predicted deficit worsen from £16.9m to £70m.

Those two trusts and King’s College Hospital Foundation Trust (£48.9m slide in position) were responsible for almost all of the capital’s worsening position. London had the second biggest deterioration in England.

King’s and the Royal Free have both taken on millstone trusts over the past five years.

St George’s didn’t, but its finances explode about once every five years anyway. After all, this is a trust that didn’t know how much it was spending with the private sector and tried to hide a critical report into its disastrous bid to become an FT.

The new chair (who isn’t Greg Dyke, as was rumoured) and their new chief executive (yet to be announced) have a lot to sort out. Not least IT, where the chief information officer, deputy chief information officer and the operations lead for IT have all left or are in the process of leaving.

Unlike North Middlesex, St George’s isn’t in the worst category for breaching their agency cap. The cap can seem like an abstract issue about money until the details of something like the Davis case, which we reported on last week, are made clear (in essence, a pay dispute over a locum shift led to a unit being understaffed, which contributed to a stillbirth).

Since London Eye wrote about the case, the trust has refused to confirm what the price differential between a senior registrar shift and a junior registrar shift is.

A trust spokesman said it would treat the request under the Freedom of Information Act, saying the amounts paid for the shifts might be commercially confidential or personally identifiable.

Other questions about this case remain unanswered by St George’s.