Essential insight into England’s biggest health economy, by Ben Clover

A long time ago, the Department of Health ordered the end of a weird anomaly in the purchaser-provider split: primary care trusts which were responsible for commissioning services for their populations but also ran the community services in their patch.

The divestiture programme was called Transforming Community Services and saw PCTs choose who they would bequeath these unglamorous but important services to.

This saw mental health trusts do surprisingly well, since they were supposed to have moved everyone out of their dilapidated former country house estates and into the community anyway.

The grandest hospital chief executives did surprisingly badly in taking over the services and afterwards claimed not to have been interested anyway.

London saw unusual flowers bloom: a community services social enterprise in Bromley, for example; and two standalone community services trusts (Central London Community Healthcare Trust – encompassing Westminster, Kensington and Chelsea and Hammersmith and Fulham – for one. Hounslow and Richmond Community Healthcare is the other).

The capital also approved something unique in England – a set of community services given to a specialist tertiary provider (in Sutton and Merton). By any measure, the Royal Marsden Foundation Trust was an unusual choice to take over the operation in the two suburban boroughs, with the only real connection being that the cancer specialist ran a site in Sutton.

The more obvious local choices – Epsom and St Helier University Hospitals Trust, St George’s or the local mental health trust – were all in a pretty bad way in 2011.

Earlier this month the Care Quality Commission published its inspection report on the combined trust and rated it good across the board apart from one outstanding in the caring category and requires improvement for the community services section.

Some of the problems in that service were common to all community providers, such as a shortage of experienced nurses, but others fall more squarely at the door of management.

The report said: “Arrangements for governance and quality performance did not always operate effectively”; “Not all risks and issues were known and those that were known were not always recorded”; and: “Operational organisational processes impacted on continuity of care. We were not assured systems and processes were in place to effectively identify risks to patient care.”

The problems had not gone unnoticed locally, with Merton Clinical Commissioning Group deciding to give their part of the service to another child of TCS, Central London Community Healthcare Trust.

Now CLCH is even less accurately named, running things in zone four Merton as well as zone five Barnet at the other extreme of the Northern line – plus its three core boroughs.

London Eye features a look at what’s going on in England’s biggest health economy. London has the best and worst regarded hospital trusts in the country. It has excellence and dysfunction in commissioning and primary care. I will cover all of this.

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