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Devon disappointed

“We love a vision and a plan. When it gets to a difficult decision, we go back to developing a vision and a plan.”

“Conflict is not dealt with, people just get cross and withdraw.”

Daily Insight suspects many provider and commissioning chiefs can relate to the quotes above, which were uttered by senior NHS leaders in Devon, according to a report by PA Consulting.

The hitherto unpublished document, obtained by HSJ thanks to the Freedom of Information Act, makes disappointing reading for Devon’s NHS. The region has been trying to get out of the doldrums following the imposition of NHS England’s “success regime” four years ago.

Based on interviews with more than 40 senior leaders in the county, the report concluded Devon’s NHS had failed to build on progress made from NHS England’s intervention and leaders had “retrenched” back into their own organisations amid financial and performance pressures.

The health economy has not been helped by a significant turnover of leaders in the last three years, but the appointment of experienced NHS troubleshooter Philippa Slinger as the leader of the sustainability and transformation partnership presents a new opportunity.

She said the STP accepted, and has already begun addressing, the report’s findings.

The full extent of the increased pressure on a struggling city hospital after the downgrading of a neighbour’s emergency department was revealed by HSJ this week and raises significant questions for the whole system.

For the past three years, Peterborough City Hospital has had to cope with accident and emergency attendances from the “patch” covered by Grantham hospital, where the A&E has been closed overnight for three years as part of a controversial reconfiguration sparked by problems staffing the unit to safe levels. 

United Lincolnshire Hospitals Trust, which runs Grantham, agreed in March to hand over control of the hospital to Lincolnshire Community Health Services Trust, which will run it as an urgent care centre. 

The 2018-19 annual report for North West Anglia Foundation Trust revealed 1,381 additional patients from the Grantham area arrived at its Peterborough City Hospital last year. These patients accounted for 2.9 per cent of Peterborough A&E’s workload and represent a 13.4 per cent increase on the year before, when there were 1,217 additional attendances from Grantham.

The new arrivals have not happened at an ideal time either – Peterborough’s four-hour performance was just 65 per cent in February 2019 and 73 per cent in June 2019 against the 95 per cent target.

The Grantham downgrade’s impact on Peterborough is hugely significant to the whole NHS, given that NHS England’s long-term plan laid bare ambitions for hospital trusts to separate urgent and planned services onto “hot” and “cold” sites.  

This inevitably means more A&Es located on cold sites will be downgraded. Many, including Weston, Chorley, Telford and Margate, are already battling this fate.