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

The creation of “freedom to speak up guardians”, which the FTSU office likes to tell us must NOT be referred to as whistleblowing guardians, despite that being rather less of a mouthful, were recommended by Sir Robert Francis in February 2015.

NHS England and Improvement, perhaps a tad behind the curve on this, put in place a programme to get their FTSU guardian programme looking ship shape in early 2020.

It is now getting more reports through and starting to look at them properly.

Considering their FTSU reports over the past 15 months at their recent meeting, the NHSE/I boards face a familiar dilemma in quality improvement. Are they getting more reports of problems to their guardians because they are now listening better, or because things are getting worse?

Those contributing, including two FTSU guardians from the shop floor, felt probably the former. Yet many who have worked in or with NHSE/I (and the two predecessors) will find some of the issues raised resonate with cultural concerns which have bounced around for quite a few years.

Those at the top of the pile include the “conduct” of senior leaders, and recruitment processes – with seemingly particular concerns about dubious internal promotions. Another one which will catch the eye of those who do business with the NHS is a conflict-of-interest concern in relation to appointment of management consultancy.

Some chunky stuff to be getting on top of. Board members, at their meeting, posit that there is now senior support for the agenda (although they were told that at least one senior person who has been challenged has been ‘resistant’) and that it’s going in the right direction.

For the sake of their staff – and those on the receiving end of its external behaviours – we hope they’re right.

Giving peace a chance

In the new world of integration, the big idea is that long-standing rivalries and competitive behaviours between local NHS trusts will start to dissipate.

The extent to which that really happens remains to be seen, but two of the best known local rivals are talking a good game, and pointing at some early progress.

Michael Luger, the chair of the Northern Care Alliance Foundation Trust, which has been formed through the merger of Salford Royal FT and Pennine Acute Hospitals Trust, says he has made efforts this year to improve relations with the large provider across the river Irwell, Manchester University FT.

He said: “In the past there’s been perceived to be some rivalry between [our trusts] and I think that’s really now receded… Since January the chief execs have been meeting weekly, I’m meeting regularly with Kathy and we’re arranging a board-to-board, and our medical directors are working well together.

“We recognise we’re only stronger together and there’s enough for us to work on at home that we can’t afford to have any kind of disagreements….

“We did some workshops, we worked on our language, we made a lot of effort to be visible in terms of reaching out and being compromising, and communicating well. I’m very pleased with the response since February/March.”

Professor Luger hails from the US, and also had some interesting thoughts on what the NHS can learn from some parts of the US health system.