The must-read stories and debate in health policy and leadership.

Looking from the outside in

NHS Improvement has announced it will immediately disband a panel it had created to review the findings of the independent investigation into Shrewsbury and Telford Hospitals Trust’s alleged maternity failings.

This announcement followed HSJ approaching the regulator on Friday with further evidence of possible conflicts of interest. This was after HSJ learned the Care Quality Commission’s representative, Nigel Acheson, had led a CQC inspection of the trust in December 2016 which may come under scrutiny for being too uncritical.

Last week, HSJ reported families’ concerns about the panel, which also included representatives from the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists as well as NHSI officials.

Given the widespread concerns raised by families and the conflicts of interests, the panel being disbanded felt somewhat inevitable. While there is no suggestion anyone on the panel would have acted improperly, the perception alone could be enough to undermine an independent investigation. Not to mention an NHS-heavy review panel has never been put in place on other independent investigations ordered by the secretary of state.

It feels odd that at no point during the panel’s establishment did anybody at NHSI raise their hand to question how such a panel would appear to those on the outside. But, if such a concern was raised, it is even more curious why such warnings were not heeded. 

A problem shared

Pathology services are under pressure to reform as never before, with trusts in England told to work in 29 networks and expected to release significant savings following the Carter Review.

For many that means merging services, with smaller labs in many hospitals for urgent work, and less urgent and GP-ordered tests being carried out in hubs serving more than one hospital.

In Kent and Medway, the aim is to create a “single service” for pathology across the area’s four acute trusts. Debate continues on how that will play out in practice – how many hubs and whether a private sector partner is needed to provide investment, for example.

But there’s a salutary lesson in a much smaller merger in one part of the county. Since last June, a single lab in Dartford has handled non-urgent blood specimens for both Dartford and Gravesham Trust and Medway Foundation Trust. In that time, nearly 3,300 patients have had to be recalled for repeat testing, with samples going missing, being left too late to be tested, and reporting systems failing.

A harm review is now taking place with an independent review by the Royal College of Pathologists to follow. That should provide some pointers of what to avoid for any future Kent and Medway-wide reconfiguration of services.

But it may also make it harder for that to happen. Kent trusts have struggled to work together on pathology in the past (plans for Maidstone and Tunbridge Wells Trust and East Kent Hospitals University Foundation Trust to create a single service were abandoned after years of discussion and initial investment).

Any move now is likely to be subject to intense scrutiny by unions, councils, and campaigners.