North by North West: Unpicking the headlines

Open goal

It’s been a turbulent few weeks for Warrington and Halton Hospitals, which can’t seem to stay out of the headlines.

Attentions began when social media flared up over its My Choice scheme, which was offering paid-for operations such as hip and knee surgery to patients who did not meet the threshold for NHS funding.

Self-pay services and private patient units are of course fairly common, particularly in the south east. Neighbouring Wrighthington, Wigan and Leigh makes £3m-odd-a-year from private patients.

Rising thresholds for NHS funded treatment have also been a familiar tale, with patients increasingly told their pain severity is not high enough, or their weight is not low enough, to be eligible.

What got WHH in trouble (and prompted Simon Stevens to call the scheme “misguided”) was the blatant linking of the two in their marketing, which described the scheme as an “affordable self-pay service to enable access for patients denied NHS procedures classified by commissioners to be low clinical priority”.

It also emphasised that the treatments were formerly available on the NHS, which all gave the impression that it disagreed with the commissioning decisions.

But taken in the round, it looked as though the NHS as a system was simultaneously blocking access to common procedures because it wanted to charge for them instead.

This represented an open goal for campaigners, Labour politicians, and the tabloids, whose reaction prompted the trust to “pause” a scheme which had been in place for several months without treating a patient.

Restarting it is perhaps more trouble than it’s worth, but ironically, all that attention may just have created some demand.

Integration

The trust then found itself on the other side of ‘privatisation’ fury after Halton CCG rejected its bid to run two urgent treatment centres, in favour of a mystery private bidder “rumoured to be” from the US (the company turned out to be a large primary care provider from Leeds).

WHH and its joint bidder St Helens and Knowsley Teaching Hospitals Trust lodged objections, and rather than press ahead with what it still felt was the right decision, the CCG instead abandoned the process, citing potential disruption and delays caused a legal challenge.

A key plank of the 2012 Lansley reforms was to give commissioners greater power to select different providers for services, whether public or private.

But the new world of service integration effectively removes that power, with the emphasis on system working meaning NHS providers must be kept happy at all costs.

There are plenty of upsides to integration, of course. But the downside is that patients could get stuck with an inferior service provided by a complacent and unmoveable NHS provider.

The Independent Healthcare Providers Network reckons the Halton case sets a “pretty worrying precedent”, and cited concerns raised in a recent health and social care committee report that “integrated care systems must not repeat mistakes of the past and become unresponsive monopolies or ‘airless rooms’ where non-statutory alternatives are shut out.”

STP role

Another point of contention here (as with the self-pay furore), is that the trust’s chief executive Mel Pickup is also system leader for Cheshire and Merseyside.

Sustainability and Transformation Partnerships remain informal entities without clear governance structures, and although there has been no suggestion of inappropriate interference in commissioning decisions, having a provider chief leading the ‘system’ can leave a suspicion that they wield too much influence.

It will be interesting to see if Bill McCarthy goes for another provider chief when choosing Ms Pickup’s replacement as STP leader later this year - she has successfully interviewed for the vacant post at Bradford Teaching Hospitals.

Besides the potential conflict of interest issue, the time they are able to spend on the job is clearly limited. With the role of CCGs quickly diminishing, might it be better to have a senior commissioner (someone like Jan Ledward of Liverpool CCG would be an obvious contender) doing the job?

Space cake

To top it all off for WHH, the trust ended up in the red tops again after a nurse ended up eating a cannabis-laden cake which an elderly patient had brought in to say thank you.

No competition

The Competition and Markets Authority has begun its statutory investigation into the union of the two acute trusts in Liverpool.

Although the deal has always been described as a merger, the papers say the Royal Liverpool and Broadgreen University Hospitals Trust is actually being acquired by Aintree University Hospital Foundation Trust. As I understand it, an acquisition is more straightforward.

In the old world, the regulator may well have blocked the deal, as it seeks to rationalise a series of acute services which are currently replicated (and supposedly competing)

But given the CMA’s new approach to the NHS, it would be a surprise if the deal wasn’t cleared at the earliest opportunity.