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

Barking fallout

The fallout from last year’s highest profile NHS financial collapse continued with the publication of a second review into the organisation’s governance failures.

A review by Deloitte, which was commissioned by NHS Improvement, was heavily critical of the abilities of chief executive Matthew Hopkins to lead a financial turnaround at Barking, Havering and Redbridge University Hospitals Trust – and gave further context to his departure at the end of last month.

There was also some difficult reading for the trust’s former interim finance director Steve Collins, non-executives, and even the trust’s medical director.

The Deloitte report followed a separate review by Grant Thornton, which was commissioned by the trust and published in April.

Grant Thornton had looked at problems emerging over a period of at least two years from 2015, which culminated in the trust almost running out of cash in October 2017.

For a reason yet to be explained by NHSI, Deloitte has only scrutinised the trust’s finances and governance from April 2017 onwards, with a particular focus on the final few months before the cash flow crisis fully emerged.

The Deloitte findings formed the basis of yet another review by NHSI’s deputy chair, Richard Douglas, who examined the roles played by his organisation’s finance director for London, Jeff Buggle.

Mr Buggle was the trust’s finance director from December 2014 to March 2017, and then acting chief executive for four months before moving to NHSI.

The Douglas review, which NHSI said will not be published, found “no evidence that Mr Buggle crossed a professional line” and he therefore retains the regulator’s “full confidence and support”.

Taking on the consultants

There are clearly significant issues to deal with among the trust’s clinical workforce as well, with Deloitte highlighting tensions between the medical director and consultant workforce.

The experience of Nadeem Moghal, the trust’s medical director, illustrates the difficulty of taking on difficult consultants within the NHS.

Deloitte said Dr Moghal had sought to tackle “inappropriate behaviours” among the trust’s medical consultants, including around their private patient activities, but that this had created tensions, which may now mean it is difficult for him to stay in his post.

Yet another review (by Deloitte again) has been looking at the wider issues around medical leadership and cultural issues underpinning the tensions.

Long stay

Clinical commissioning groups and NHS trusts have been given yet another performance target to focus on.

In a bid to cut waiting times, increase capacity ahead of winter, while also saving some pennies, NHS England and NHS Improvement have asked local areas to adopt funding schemes to reduce “excess bed days” within acute trusts.

An excess bed day is effectively a fee that a CCG must pay when a patient stays in hospital for longer than a pre-determined time. The length and rate are calculated differently for each speciality.

In a letter, the two national bodies told local leaders they should agree a baseline level of excess bed days, which CCGs would have to fund, and with this a target to reduce bed days below the baseline. No direction was given for who pays if excess bed days increase above the baseline.

Any money saved by CCGs through these schemes should be transferred to the local community provider – unless local systems agree otherwise, which is an interesting caveat.