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 here.

In this week’s North by North West:

  • Virgin Care and Lancaster University win again
  • Big victory for union staff in Bolton
  • Greater Manchester to make mental health leap
  • But inquest flags familiar problems in Rochdale
  • CQC verdicts on Lancashire Teaching Hospitals FT and The Christie FT

Same old, same old

The enforced re-runs of two contentious decision processes in Lancashire have both ended up with the original outcome.

Virgin Care has again been awarded the £104m contract for school nursing and health visiting, after Lancashire County Council was forced to repeat its evaluation of the two bids received.

The original decision had been successfully challenged by Lancashire Care Foundation Trust and Blackpool Teaching Hospitals FT, a joint bidder, which meant the evaluation process had to be conducted again.

The trusts will consider whether to launch another appeal, but will clearly be wary of creating further damage to local authority/NHS relations, and conscious that the process has already dragged on for more than a year.

Providing there is no appeal, Virgin would take over the contract in April 2019, with around 160 staff transferring to the company.

There’s the hub

Separately, a second evaluation process by Lancashire’s pathology collaboration has also resulted in the original outcome - with Lancaster University being named the preferred location for a consolidated “hub”.

The site, in the north of the county, had already been recommended in a previous assessment. But when East Lancashire Hospitals Trust was subsequently “put in” to the collaboration by NHS Improvement, it meant the evaluation process had to be carried out again with the ELHT numbers factored in.

A memo to staff announcing that Lancaster University had again been chosen after the second evaluation has led to inevitable suspicions from staff in the south (who have understandable concerns about the distances they would have to travel).

There are likely to be questions about the way the sites were partly scored on distance from the “geographical centre”, instead of a centre determined by the current spread of pathology activity and staff. They are both heavily weighted in the south.

I have asked the project leaders to share the full methodology and site scores.

Success of sorts

Lancashire Teaching Hospitals FT has faced several high profile problems since its Care Quality Commission report in 2016, so there will have been plenty of nerves around the regulator’s latest inspection in the summer.

The fact that its headline ratings have held at “requires improvement”, with some improvements beneath that, will feel like a success of sorts.

Power in a union

The debate around NHS subsidiary companies has taken plenty of twists and turns this year, including Wrightington, Wigan and Leigh FT deciding to drop its plans for a large scale transfer of non clinical staff.

By contrast, neighbouring Bolton FT have had an active subsidiary since 2016, when 300 staff were brought into the sub-co from a private contractor.

At the contractor, staff were paid significantly less than their NHS counterparts, and they went on strike earlier this month to demand their salaries be brought in line with Agenda for Change, requiring a 14 per cent uplift this year.

Union officials say the subsidiary iFM Bolton has now agreed to fund the increase, which represents a notable victory for their members.

This may mean fewer staff in the long run, however, as the trust said its sub-co would now need to work with staff and Unison to find efficiency savings to fund the pay deal.

Transparency

Published performance data for talking therapies has been one of the key reasons that greater attention and focus are now given to those services.

But this can also have a distorting effect, and most mental health leaders now recognise the need for greater transparency and performance monitoring in other areas as well.

It looks as though services for children and young adults will be first up, with NHS England preparing to announce a number of areas to pilot the publication of waiting times data. Devolution leaders in Greater Manchester have jumped the gun, though, by committing to publish by the end of the year.

Mind the gaps

Another area for improvement is the gaps between different mental health services and with other agencies.

A recent letter from a coroner to Pennine Care FT outlined the tragic consequences that can arise when patients are discharged from one service and incompetently handed over to further support.

An inquest found that Paul Robert Allan had killed himself after being being discharged by the community mental health team in Rochdale.

The coroner said he should have been transferred to a corresponding service near his new home in Stoke, and the trust should have engaged with drug and alcohol services over his care.

Blue end

At the blue end of the CQC scale, The Christie has maintained its “outstanding” rating after an inspection in the summer. The trust remained outstanding in four of the five key domains, and was “good” for safety. Inspectors said the “culture across all the services we inspected was extremely positive”.