Essential insight into NHS matters in the North West of England, with a particular focus on the devolution project in Greater Manchester. This week by Rebecca Thomas, who covers Cheshire.

One of the most difficult sustainability questions to answer in the north west is what to do with East Cheshire Trust.

After years of reviews into its fragile acute services, including a botched attempt to downgrade the emergency department at Macclesfield Hospital, the trust remains unviable in its current form.

Yet another review has been carried out this year, which is yet to be published, but it’s unlikely to say anything radically different to what’s come before.

There has not been a miraculous turnaround in fortunes, and the stresses on services continue to be evident.

One telling example is the recent agreement with commissioners to no longer accept out of area referrals for certain specialities. Meanwhile, the emergency, maternity and paediatric services continue to struggle on with serious staffing pressures.

Eventually a decision will have to be made, and given the current winds of change in the NHS, perhaps the climate is now finally right for a decision to be backed?

Some reckon the trust would be better off merging with a neighbouring organisation, to pave the way for major reconfiguration. Mid Cheshire Foundation Trust is in the same STP, so might appear the obvious partner, but the transport links and patient flows point more clearly towards Greater Manchester, and Stockport in particular.

The problem with Stockport FT is that its finances and emergency services are in an awful state, and it’s in no position to start working on an ambitious merger or reconfiguration.

In fact, regional leaders in Greater Manchester will fear any kind of reconfiguration in Macclesfield, because it would most likely lead to more patients travelling up the A523 to Stockport, which is already overwhelmed.

A more leftfield option would be for Manchester University FT to acquire East Cheshire as part of its unofficial but very large hospital chain. It certainly has the financial security and expansionist outlook, but it would be a risky venture.

Positive vibes

The football manager-like turnover of NHS leadership is well-documented.

Being a trust chief is often a risky role. As the head of an organisation you are automatically placed at the centre of any scandal that may arise – whether you were culpable or not.

Tony Chambers, chief executive of the Countess of Chester Hospital FT, resigned from his post last month, amid an ongoing police investigation into a string of baby deaths at the trust.

It is unclear exactly why Mr Chambers has gone, but he said in a statement: “Recent times have been particularly challenging for the hospital not least of which is the ongoing police investigation into an increase in mortality rates in our neonatal unit. My thoughts will continue to be with the bereaved families as they await the outcome of the police investigation.”

What’s almost unique about this story is it prompted numerous expressions of support for Mr Chambers from HSJ readers. There wasn’t a single cynical comment on the article, which is a rarity indeed.

Andrew Foster, of Wrightington, Wigan and Leigh FT, best caught the mood with this remark: “It’s tragic when a really good person gets caught up in a tsunami not of his own making. Tony is behaving very honourably and deserves all of our support. He has been a great chief executive.”