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The right leadership

Liverpool’s acute providers face years of difficult transformation and reconfiguration work, while somehow recovering performance at the same time.

Getting the leadership right for the big acute trust being formed by the Aintree/Royal Liverpool merger is therefore going to be a huge decision.

But there has already been confusion around the recruitment process, which has had to be reset after a false start.

With the Royal’s chairman Bill Griffiths stepping down at the start of the year, Aintree’s Neil Goodwin looked favourite to chair the new trust.

But according to minutes of a governors’ meeting last month, NHS Improvement wasn’t keen on this due to Aintree’s “requires improvement” Care Quality Commission rating.

Yet their view seems to have softened after joint regional leadership was established with NHS England, because Mr Goodwin did end up applying and being interviewed.

In fact, Mr Goodwin, a former chief executive of Greater Manchester SHA, was the only person interviewed after another candidate pulled out (Aintree said the role was advertised nationally).

But the interview panel then decided not to recommend his appointment to the council of governors, so the recruitment process is back to square one with the role being re-advertised.

This may also have delayed interviews for the chief executive role, which had been due to take place earlier this month, as normally you would want the chair to be determined first.

Whether this could also delay the merger is unclear.

The trusts still insist it is being planned for October 2019, with both boards being asked to approve a full business case later this month.

But that timeline is looking increasingly ambitious with the transaction still to go through the NHSI and Competition and Markets Authority approval processes.

Short-term necessity

Pressure from national regulators seems to have finally sparked some action in Lancashire to reduce the time mental health patients are spending in accident and emergency departments.

The county has been a glaring outlier for 12-hour breaches in recent years, with mental health patients accounting for the vast majority of cases.

A recent risk summit called by regional directors made it clear the situation could not continue, and that extraordinary measures were needed.

The result has been a review of procedures under which the acute hospitals – particularly the Royal Blackburn and Blackpool Victoria – determine whether a mental health patient can be admitted to a general acute ward.

A more risk-based approach should lead to more patients being admitted to acute wards, rather than waiting in A&E for a mental health admission.

I’m told the arrival of Caroline Donovan, the new chief executive of Lancashire Care Foundation Trust, has helped smooth this out, and acute leaders have so far been kept on side.

It’s clearly not an ideal situation and will prompt lots of nervousness among acute staff. But, for now, there is acknowledgement that the long-standing lack of mental health inpatient capacity in the county makes it a short-term necessity.

However, the concern will be that a short-term fix turns into a long-term solution.

A system review has been commissioned from Northumberland, Tyne and Wear Foundation Trust to come up with recommendations, but there’s not going to be a quick fix.

A senior manager at NTW told me recently that it took the best part of a decade to get their system right.

Bloody setbacks

There have been various setbacks for Lancashire’s pathology collaboration and the project is now looking increasingly uncertain.

The strategic outline case had already been revised to remove any mention of Lancaster University as the preferred location for a centralised hub for “cold” testing, and now NHSI has asked for more technical detail.

This is likely to mean a revised SOC will have to be approved again by all four trust boards.

So even if everything now goes to plan, the hub is unlikely to be built before 2024.

Meanwhile, a number of senior clinicians have raised concerns about the project internally and demanded more involvement in the service design.

More fundamentally, East Lancashire Hospitals Trust has never agreed to the Lancaster option and will keep pushing for a wider range of options to be properly examined.

With ELHT’s chief executive Kevin McGee also now in charge of Blackpool Teaching Hospitals FT for at least the next six months, support for exploring a longer list of solutions has just got stronger.