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 on 0207 6089058, or send a direct message on Twitter.

In this week’s North by North West:

  • Manchester’s mega-trust will be swimming in cash, but has problems within
  • Contract trouble for the Manchester’s flagship transformation project
  • Union unrest for Stockport’s vanguard
  • Aintree set for CQC downgrade

Going public

In terms of financial success and delivering organisational change, there are very few NHS trusts that can claim to have had a better couple of years than Central Manchester University Hospitals Foundation Trust.

A £56m surplus in 2016-17 was followed by the long desired merger with University Hospital of South Manchester FT to create the largest provider in England last October.

The merger sets the stage for a major reconfiguration of services. To help with that, officials at the increasingly tight fisted Department of Health and Social Care have agreed to loan the new trust £125m.

But while it is winning endorsement from national bodies, the trust (now called Manchester University FT) has been struggling to win support from some people within.

Clinicians at Royal Manchester Children’s Hospital have gone public with concerns about patient safety, with the contents of an internal comments box in the critical care unit finding its way into the Manchester Evening News this month.

Among the more alarming messages were those warning of “dangerous” understaffing and claims of a lack of support when issues are raised with management.

This follows issues being raised publicly by surgeons last year, after a toddler died while waiting for emergency surgery. The surgeons warned of a shortage of emergency operating theatres and intensive care beds, and claimed that the management made it difficult to cancel elective procedures to ensure emergency cases could be treated.

A year earlier, a Care Quality Commission inspection report referenced concerns about the “culture” within the hospital’s surgical team, though there was little explanation of what exactly was meant by this.

In its response to the latest comments, the trust disputes the validity of the concerns, saying it achieves the required staffing ratios for critical care, while pointing to other indicators suggestive of an open and responsive culture.

However, workshops have been arranged with critical care staff to “build on the actions that were already in place and to involve them in identifying solutions to any ongoing concerns”.

Hopefully the hospital’s recently appointed “chief executive”, Dena Marshall, can start building bridges across the “cultural divide” between management and clinicians, and convince medics that the workshops are more than just a tick box exercise.

Contract trouble

Commissioners in Manchester have confirmed the ambitious new £6bn contract for out of hospital care in the city of Manchester will not be awarded by April.

It was clear before Christmas that the contract launch had run into difficulties, and committee meeting minutes leaked to HSJ reveal concerns from senior figures that “unrealistic” deadlines had been set.

Instead, services will be provided through existing contracts from April while the various providers concentrate on integrating staff within a nominal “local care organisation”.

Given the scale of the contract and the changes entailed, it’s not clear why there was such a rush to go live this year. It now looks likely that April 2019 will be targeted as the launch date.

Union trouble

More problems have emerged for the Stockport Together vanguard, which is facing the threat of industrial action from staff affected by the new care model.

Until now, the various vanguard schemes in England have gone about their work without too much controversy, but an indicative ballot by Unison members in Stockport has shown 98 per cent in favour of industrial action over the changes.

The union has now entered talks with the project leaders, convened through ACAS.

The union concerns aren’t helped by some of the projected activity reductions made in the vanguard’s business case, which I initially assumed I must have misunderstood.

A&E diagnosis

A chief nurse’s email that outlined plans to “influence” the CQC rating of Aintree University Hospital FT grabbed the headlines last week, but of greater concern for the trust and its patients will be some of the detailed findings about urgent and emergency services.

Problems were always likely to be highlighted in this area after the trust’s poor performance on the four hour target over the last year, and an “evidence appendix” seen by HSJ suggests staffing shortages are leaving the department stretched.

The document, now being scrutinised by the trust for factual accuracy, referred to one example of a nurse looking after up to 10 patients in the corridor while waiting for a bed in the department, against the recommended ratio of 1:4.

Meanwhile, while many hospitals have managed to reduce or at least stem the use of agency nurses, agency use in Aintree’s accident and emergency apparently increased threefold in the year to October 2017, to 27 per cent, while use of the trust’s bank staff dropped from 25 to 13 per cent.

The inspectors said agency staff were unable to complete all tasks such as administering medicines and accessing the electronic prescribing system, which sounds like a probable source of inefficiency and delays.

Overall, the trust has been given a provisional rating of requires improvement, after being rated good by the CQC in 2014.

North by North West takes an indepth look at one of the NHS’s most challenged and innovative regions every fortnight. There will be a particular focus on the devolution experiment in Greater Manchester, but my scope also includes Merseyside, Lancashire and Cheshire.

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