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

The trust next door

When the management agreement between “outstanding” Western Sussex Hospitals Foundation trust and Brighton and Sussex University Hospital Trust was announced three years ago, cynics wondered what good would come of it.

BSUH was viewed as one of the most troubled trusts in the country, with an “inadequate” Care Quality Commission rating and a history of poor relations with black, Asian and minority ethnic staff. And it is a complex regional centre, not a minnow. Western Sussex’s chief executive, Dame Marianne Griffiths, was highly regarded but inevitably some were sceptical that she could repeat her success at the more challenging BSUH.

Today that cynicism seems misplaced. BSUH’s CQC rating has jumped to “good”, its deficit now seems under control, and the two trusts have just announced they will in future operate as a group with a shared leadership team.

It may stop short of a full merger but Dame Marianne will still head up the two organisations. It does, however, mean the organisations will still get separate CQC ratings – which may well be important to Western Sussex non-executives who are waiting to hear if it has retained its “outstanding” rating.

The pair have another neighbour, which should be watched with interest. Queen Victoria Hospital FT has a “good” CQC rating and is much loved for its famous services – but ran a deficit of 7 per cent of turnover last year, and is increasingly clinically dependent on Brighton.

It is working increasingly closely with BSUH: its inpatient adult burns service is likely to move to BSUH in the long-term, BSUH provides it with a number of support services and some consultant roles have job plans covering both trusts.

The QVH board, while supportive of increased joint working and networking with BSUH and other trusts, is likely to be fiercely protective of its independence. However, should it ever be persuaded of a different way forward, could it fit into a ready-made group structure?

The Care Quality Commission has dropped a prosecution against United Lincolnshire Hospitals Trust for duty of candour breaches due to a lack of evidence. 

The watchdog had been investigating the Lincolnshire trust, which is in special measures, over its failure to investigate the death of a patient Elaine Bradbrook, who died in April 2017. A coroner was also critical of the trust’s failure to carry out an investigation or contact the family after her death.

The CQC has been picking up pace with enforcing the duty of candour rules recently. In January, Bradford Teaching Hospitals FT became the first trust to be fined for breaching the rules and, earlier this month, it issued a £16,250 fine against the Royal Cornwall Hospitals Trust for 13 separate duty of candour breaches.

Such fines are a sign of the regulator’s increasing tendency to take legal action for breaches of the fundamental standards regulations brought in following the Mid Staffs care disaster.

United Lincolnshire has acknowledged it did not handle the case of Ms Bradbrook well nor were its processes around duty of candour up to scratch. It has said this situation has now improved.