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‘A total and complete breakdown’

HSJ has revealed the latest stage of the deepening crisis at Wirral University Teaching Hospital Foundation Trust, with respected former medical director John Coakley resigning as a non-executive director at the trust on Monday.

Dr Coakley, who only took up the post in July, told HSJ he was resigning because he believed the executive team, who are doing a “sterling job”, were not getting support from the rest of the board.

Other sources at the trust told HSJ there has been “a total and complete breakdown of relationships and governance”, after executive directors and non-executive board members disagreed during a private meeting last week over the future of trust chair Michael Carr.

Mr Carr intends to continue for the next five months at the trust until the end of his term – despite serious allegations of governance failings from his own directors – and a potential vote of no confidence by senior doctors.

In the background of all of this is NHS Improvement, which had to hastily withdraw a secondment offer to the trust’s former chief executive David Allison before announcing an independent investigation into the allegations last month.

As highlighted in our Risk Register expert briefing, the regulations say where NHSI is satisfied a trust licence is being breached or even at risk of being breached, it can impose conditions on a trust – including the removal of the chair or board members.

King-size deficit

Passing Cambridge and Imperial, King’s is now clearly the most beleaguered of the Shelford Group trusts.

HSJ readers will be aware of the money arguments the London trust had with NHS Improvement that saw the high profile departure of its chair and finance director late last year.

What has not been known, thanks to the trust’s unparalleled slowness in publishing financial data, is just how bad the financial picture was.

While the trust’s £92m forecast deficit for this year has been known about since November, it now appears clear that the overall deficit will be far worse.

The amount of revenue loan the trust anticipates needing is around £150m.

A sum of this size puts the trust even more fully in the “trusts with a deficit of more than 10 per cent” club – as well as among those that have had to reforecast significantly in year.

The problem is not especially new: HSJ first reported an indicated £100m deficit in 2016 and the trust is carrying underlying debts of more than £600m from previous years.

At December’s board meeting, chief executive Nick Moberly said the trust he had taken over in 2015 had an underlying deficit of £140m and he had brought that down to more like £100m.

If the position has worsened again it will be in spite of large savings programmes and strange property deals.

Large chunks of income are being disputed by NHS England and clinical commissioning groups, and when a deficit is of this overall size it does further damage to the idea of NHS finances as a quasi market system. A situation where hospitals negotiate with the Treasury (or its proxies) starts to look more like the 1980s.