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

The isle of plight

Running England’s only fully integrated NHS trust is never going to be easy, and doing it on an island with no connecting bridge makes the task harder still.

But the scale of the problems facing the Isle of Wight Trust, which provides acute, community, mental health and ambulance services, has become worryingly large in the last couple of years.

The trust was placed in special measures in April last year – coinciding with a rapid decline in its financial health.

In the summer of 2017, the trust brought in two KPMG consultants to oversee a financial review, which uncovered a growing underlying deficit and poor control of pay and non-pay.

The consultants also raised concerns about the trust’s “significant lack of commercial expertise” and warned it did not have the “right critical success factors for a successful turnaround”.

The trust has accepted the findings, and new chief finance officer Darren Cattell launched a financial governance review in response to the findings. KPMG continues to provide support.

It all comes as the trust is attempting to reconfigure its acute services, some of which have been unsustainable due to the difficulty in getting staff to the island.

Perhaps fortunately for the trust, its CEO Maggie Oldham has experience of working at troubled providers in the past, having overseen the dissolution of Mid Staffordshire Foundation Trust in a past life.

Campaigners back in action

Just when they thought they’d won the war, NHS England is set to face yet another battle over its accountable care organisation contract – or integrated care provider contract, as it now calls it.

The Court of Appeal has granted the campaign group named “999 call for the NHS” permission to pursue an appeal over its loss of a judicial review over the contract. 

This was the first of two judicial reviews against NHS England earlier this year, both of which were ruled in the national commissioner’s favour.

Following judicial review outcomes, NHS England has found it to be safe to push ahead with a consultation on the introduction of what it no longer calls accountable care organisations (they are now ICPs) into the NHS.

Part of the original judgement said the campaigners’ argument – that introducing “whole population annual payments” into the NHS through the ACO contract was unlawful – was a political matter, rather than a breach of the law. The appeal judge said, however, that their argument was “clearly an arguable question of law”.

It seems unlikely that NHS England will pause or stop plans for its accountable care contract to wait for the appeal outcome. However, should the campaign group be successful, it would clearly be a huge spanner in the works.