Essential insight into NHS matters in the North West of England, with a particular focus on the devolution project in Greater Manchester. Contact me in confidence here.

The North West did well out of Boris Johnson’s initial spending pledges for the NHS, with five out of the 20 capital schemes announced.

Of the five projects in the north west, the largest amount, of £72m, has been allocated for a new mental health facility in north Manchester to replace the unsuitable Park House inpatient unit.

Park House is full of old-fashioned dormitory style wards that can often cause significant distress for patients who are already at their most vulnerable, so the new unit should have a hugely beneficial impact.

Meanwhile, Mersey Care’s warning to NHS England about patient safety risks around the ongoing uncertainty with Calderstones Hospital seems to have paid off, with the trust allocated £33m for a new low secure unit for patients in Maghull.

Now it just has to negotiate the Care Quality Commission’s registration process for new learning disability units, which may not prove straightforward.

The acute trusts in Stockport and Tameside were allocated £30m and £16m respectively, to provide new emergency and urgent care facilities.

This is particularly crucial for Stockport, which has struggled desperately on the four-hour target and needs the morale boost.

Wirral has been allocated £18m to build an urgent treatment centre at Arrowe Park Hospital, which should also enable much-needed improvement on the target that is still being reviewed yet remains the top priority.

Another day

Several bigger projects will have to wait until another day; such as the relocation of Liverpool Women’s Hospital; acute reconfigurations in central Lancashire and Southport and Ormskirk; and major rebuilding work at North Manchester and Royal Oldham.

It’s also worth noting that Boris’ money has only been “allocated”, and not yet received, by the trusts.

As reported last month, just 3 per cent of national capital funding allocated since 2017 has actually been released, due to the stringent requirements of the business case process (and the inadequacies of the capital budget).

A prime example is the reconfiguration of emergency services in Greater Manchester, which was first approved locally in 2015, but is still waiting for the Treasury to sign off up to £80m of funding that was allocated in 2017.

Those involved in the project have been repeatedly frustrated by multiple requests for more information, with government officials appearing uninterested in the 300 lives per year which are expected to be saved by the changes.

Paying for safety

Alder Hey Children’s Hospital is flush with “provider sustainability funding” after a bumper 2018-19, which means it no longer needs to draw down central cash to build a new neonatal intensive care unit.

But now the trust appears to be having problems getting the new service to be fully commissioned by NHS England, despite it being essential for meeting safety standards.

While Alder Hey performs neonatal surgery, it has to rely on NICU services at Liverpool Women’s Hospital in the city centre, which falls short of requirements for the two to be colocated.

In theory, non-compliance could lead to decommissioning, and when Alder Hey’s lobbying for LWH to be moved to its site failed, the trust knew it would have to get a NICU of its own.

Although NHSE has agreed to commission a 22-cot unit, the trust’s latest board papers said an “urgent meeting” had been called about the funding envelope being offered, as achieving the clinical standards would need a further £3m.

With building work supposed to start in 2020, this all sounds a bit worrying. The trust said the meeting is due to happen later this month.

The last commissioner

The commissioning sector has been hollowing out for the last few years, even before the requirement to cut 20 per cent from the staffing bill. The result is fewer CCGs being able to properly scrutinise and challenge their providers.

Liverpool CCG is still doing its best to keep ruffling feathers, however, strongly highlighting the performance problems at the Royal Liverpool Hospital a few months back, and more recently flagging issues at Mersey Care that may have contributed to five separate cases involving suicide attempts or killings.

A review into the incidents by the CCG found there were several common themes, including patients’ families complaining they were not listened to, shortcomings in staff training, skills, and supervision, and a disconnect with the acute trusts. Mersey Care says an improvement plan is in place.