The must read stories and talking points in the health service

The new Bruce Keogh

NHS England named their new medical director on Thursday morning – Professor Stephen Powis of the Royal Free Foundation Trust.

As is often the case with these things, he had not been widely tipped for the role in advance but his appointment made plenty of sense when it was revealed.

Professor Powis, a renal specialist, has a number of national roles with various medical bodies and sits on Merton CCG’s governing body – so has a better view than most acute medical directors of life on the commissioning side.

He has been medical director at the Royal Free for over a decade, during which time it has emerged as a major player in acute care – and, crucially, one with a reputation for innovation.

In recent years the Royal Free has done two big things that have attracted national attention. It has begun running a hospital group, which in practical terms means taking best practice clinical pathways and running them across multiple sites and demonstrates a willingness to lead from the front. And it has entered into a partnership with DeepMind to develop an app to track real time patient data and alert clinicians within seconds when a test reveals signs of serious illness.

Hence Simon Stevens’ welcome statement lauding Professor Powis’ “practical track record of driving major innovation and service improvement”.

The Royal Free/DeepMind tie-up is known to have attracted interest from other trusts – despite there having been some legal difficulties around the sharing of patient data. Watch this space.

South of the river

This week has seen south east London become one of the more troubled STP areas in England.

Where previously it had been relatively stable financially, this week has seen news of dramatic downward forecasts in year-end positions at two large providers.

King’s College Hospital has publicly admitted that its deficit this year could almost hit £100m.

Neighbouring Lewisham and Greenwich Trust has seen its estimate worsen from £22m to £66m.

King’s chief executive Nick Moberly told a board meeting this week, when he arrived in August 2015, the underlying deficit was £140m and the team, including the recently departed finance director, had brought this down to around £100m.

L&G has also been unfortunate in having its board blasted in an NHS Improvement ordered report for accepting a too optimistic control total. Presumably they were under some pressure to accept an overly optimistic control total.

Hiring VSM interims on more than £750 a day without going through the proper processes is more difficult to justify though.

It’s maybe not a coincidence that these two trusts each absorbed a third of South London Healthcare Trust, whose yearly deficits at the time of its dissolution was £65m.

The subsequent trust special administrator process has not been kind to Lewisham and Greenwich. The £28m it was promised to make some changes to Queen Elizabeth Hospital in Greenwich has not materialised. The true cost at that early PFI hospital could be considerably higher.

With King’s and L&G added to the list that includes Barking, Havering and Redbridge, Basildon and Thurrock, and Gloucestershire, it might time to start asking if the system is putting boards in impossible positions.