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

In this week’s North by North West:

  • The conditions that led to Liverpool’s care scandal have not all gone away 
  • Failings at HMP Liverpool prompt national review of prison health commissioning
  • Awkward questions for NHS Improvement’s regional team
  • Why ministers will struggle to stop the “revolving door”

System failings

When Bill Kirkup’s wide ranging review exposed the full extent of bullying, denial and cover up at Liverpool Community Health Trust, most attention understandably focused on the individual executives who were primarily to blame.

The ministerial response (and briefings to friendly newspapers) helped narrow that focus and skirted over some of the underlying causes, which are still present across the NHS.

Although shameful and worthy of drumming home, let’s remember that the failings - and recycling of - the likes of Bernie Cuthel were revealed back in 2016, through a Capsticks report and in Parliament by MP Rosie Cooper.

If ministers really wanted to shove a wedge in the “revolving door”, why didn’t they take action on this two years ago?

What Dr Kirkup’s review has detailed for the first time are the shortcomings of the wider system around LCH, in creating the conditions for failure and then failing to spot problems when they emerged.

It told us that little care was taken to establish LCH on a strong footing when it was spun out of the former primary care trust in 2010.

A management team that was inexperienced and “inadequate from the outset” was appointed, and there wasn’t enough scrutiny because regulators and commissioners were focused on “higher profile” services.

There has been little change in attitudes towards community services over the last eight years. They still lack the glamour of the specialist sector, the target driven transparency of the acute hospitals, or the political attention of primary care.

Even mental health is now enjoying a long overdue time in the sun, with national leaders bending over backwards to demonstrate it is being equally funded.

Meanwhile, community services are still out in the cold conditions that helped crystallise the risks that led to the Liverpool scandal. And NHS England’s decision not to produce a dedicated “five year forward view” for them (as it did for mental health and primary care) suggests they could be in the cold for a while.

Prison health

If community services are the new Cinderella service, NHS prison services are the mice in the cellar.

The Kirkup review made it clear that the worst examples of care and governance in Liverpool were seen in prison health services, but it appears very little has changed.

As discussed in this newsletter previously, the prison contract was removed from LCH in 2015 and taken on by Lancashire Care Foundation Trust, which is now pulling out early amid concerns being raised by whistleblowers.

LCFT does not believe it can safely run the service with the funding available from NHS England, and has recently divested its other contracts in Lancashire.

LCH’s worst examples of care and governance came in relation to HMP Liverpool, and many of these problems will be replicated at other prisons in England.

Dr Kirkup called for NHS England to review its commissioning of these services – to make sure they are safe and effective – and we’ll have to see whether this will be taken seriously.

Ministers will struggle to stop the revolving door

In their response to the scandal, ministers said they will seek to “clarify” whether regulators facilitated new jobs for former board members at LCH, which will raise some tricky questions for NHS Improvement.

Letters seen by HSJ suggest the NHS Trust Development Authority (now part of NHSI) “arranged” for the trust’s former chief executive to go on secondment to a trust in Manchester, with the help of a reference from Lyn Simpson, one of its senior officers in the north.

Ms Simpson is now managing director of NHSI’s regional team in the north, which also featured in the demise of Wirral hospital chief David Allison in December.

Despite serious whistleblowing concerns being raised about his conduct and leadership, Mr Allison was offered a six month secondment at the regulator.

Whatever is said publicly, ministers and regulators surely know these secondments are likely to continue.

The alternative is to suspend people on full pay while allegations are investigated, which can take years. Meanwhile, the post cannot be filled substantively and significant management capacity is exhausted on the legal process.

Just look at what happened at Southport and Ormskirk Hospitals Trust, which successfully sacked its chief executive but only appointed a substantive replacement after more than two years.

It would be possible, perhaps, to introduce a new type of contract for very senior managers that is easier to terminate, but the additional risk would necessitate a far higher salary.

There is no easy solution.

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.

Please get in touch to let me know how I can improve it, and to tip me off about stories you think I should cover: If someone forwarded this to you, sign up to get your own copy here.