The must read stories and analysis from Tuesday

Daunting challenge for teaching trust

Emergency pressures left hospitals across England creaking at the seams this winter, with some now showing cracks.

Many of the staff at Lancashire Teaching Hospitals Foundation Trust, which runs hospitals in Preston and Chorley, are now exhausted and have had enough.

Towards the end of last month, consultants at Preston accident and emergency wrote to trust leaders over unsafe staffing levels and dangerous levels of overcrowding in the department.

Then two weeks ago, the Lancashire Evening Post reported how nursing staff at Chorley A&E had also written to the board about having to work shifts of up to 17 hours due to the pressures, and were threatening to start leaving at the end of their shifts if the situation remains unresolved in a month.

This all sounds like enough for the trust board and operations team to have to deal with. But the sense of crisis intensified after the entire senior operations team handed in their resignations.

Operations director Suzanne Hargreaves announced her departure suddenly last week, citing the intolerable pressures she and other staff were having to endure. Meanwhile, three divisional directors have all accepted jobs elsewhere in the last fortnight, which the trust said was a coincidence.

With these senior departures and significant staff unrest, the difficulties facing the FT look daunting.

It is expected to report a £40m deficit for 2017-18, around £20m worse than planned, while performance against the four hour A&E target was around 80 per cent in the three months to March. Elective performance has been around 83 per cent (against the 91 per cent target), while the trust had one of the highest rates of cancelled operations over the winter and has consistently struggled on cancer waits.

Amid all this, the board is trying to progress with long overdue, highly controversial reconfiguration of its two hospitals, which even without the operational and performance problems would be enough to cause a major headache.

There can’t be many trusts facing challenges of this quantity and scale.