HSJ’s round up of the day’s must read stories and debate

A chair departs

The chair of embattled Wirral University Teaching Hospital Foundation Trust has resigned, following the exposure by HSJ of a series of governance and cultural problems at the organisation.

Michael Carr – whose departure has been welcomed by NHS Improvement – was the subject of serious allegations by trust executives alongside former chief executive David Allison. Remarkably, several executive board directors had felt it necessary to take their serious concerns about their own organisation to NHSI.

Earlier this month a non-executive director resigned, saying there had been a complete breakdown of relationships at board level.

Shaun Lintern, HSJ’s patient safety correspondent, wrote earlier this month on the subject: “It is time for Mr Carr to step down and allow the trust to move forward under new leadership.

“It is also time for NHSI to stop hesitating and act in the best interests of patients and staff who deserve better.”

Ian Dalton, chief executive of NHSI, said: “Michael Carr’s departure is the right thing for patients and the right thing for staff. This is a trust that has had a number of serious leadership, governance and cultural problems which need to be urgently addressed.”

Are big dowries for big acquisitions back?

HSJ reports on NHS Improvement discussions with the Treasury on securing funds to support the acquisition of troubled providers.

The paper, which has not been disclosed, was presented by Miranda Carter, NHS Improvement’s head of mergers and acquisitions, to a national committee.

There are a significant swathe of trusts which have huge underlying debts (more than £600m in the case of King’s College Hospital FT, more than £250m in the case of Barking, Havering and Redbridge University Hospitals Trust).

No chief exec in her or his right mind (nor their board or governors) would take on an organisation like that without strict limits on their liability.

As one knight of the realm hospital boss put it before an acquisition: “I’m not taking that place over before an accountant, that I have paid, tells me the money will work.”

There is some disgruntlement that acquisitions by Frimley Park, Royal Free and Central Manchester over recent years have taken the lion’s share of the cash available for these kind of guarantees.

There is still more chagrin that after months of wheedling from the centre, other trusts which have agreed to take on troubled organisations might not get the same treatment.

Would you expect Bristol to take over Weston, or Luton to take over Bedford, without it?

Meanwhile, another wave of acquisitions is not a happy sign for the sector. It reflects the trouble most trusts are having under the (increasingly tattered) purchaser-provider system and the ridiculous savings they are are being asked to make.

We should bear in mind how major trust acquisitions have gone in the past.

King’s is an unhappy example, Barts was another although it’s improving.

The phrase often deployed is that “two turkeys don’t make an eagle” when it comes to large scale mergers, especially shotgun ones.

Even some trust marriages which start well look a lot more strained once transaction support runs out. Witness York Teaching Hospitals FT and its takeover in 2012 of Scarborough.