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Four years

Barts Health Trust can claim to be the largest in London and its heritage includes being the inheritor of the oldest hospital in Britain. But, in the eyes of NHS Improvement, it is no longer special. On matters of quality, at least.

The national regulator has accepted the recommendation from its fellow overseer, the Care Quality Commission, to take Barts out of quality special measures after four years under the regime.

That’s not to say the trust has been given a clean bill of health on all fronts. Its troubled Newham site has drawn fire for its “inadequate” maternity services, which sparked inspectors’ ire for not making progress on improving problems identified during its last inspection in 2017.

Some services across the trust’s multiple sites had improved their workplace culture. This cannot be said for the emergency department in Whipps Cross hospital where staff sought out inspectors to complain of “cliques, favouritism and passive bullying”. Some staff said having ideas accepted depended on “if your face fits” – and some staff were said to have left because of this behaviour, including senior midwives.

Beyond the quality of care, the trust remains in financial special measures. Saddled with private finance initiative payments and indebted to the Department of Health and Social Care, it is on course for a deficit of nearly £140m again this year.

Despite this, the NHS Improvement’s use of resources report on Barts struck a sanguine tone. It pointed to falling pay costs and the near halving of total agency spend. But again, it was not a time to break out the bunting as the NHSI pointed out there was “no defined estates strategy”. With empty spaces in the trust’s spralling estate, the inspectors said this was “a key opportunity for the trust to engage with”.

Trouble in Luton

One of the original eight integrated care systems is now preceding without the involvement of one its four local councils.

Bedfordshire, Luton and Milton Keynes ICS has had to agree new governance rules with Luton Council after the latter said it no longer wished to be a signatory to the ICS process.

The council pulled out of involvement over concerns that the process was “pre-determined” and “disempowered” local decisions.

The Labour council also said it was “politically opposed” to the ICS.

Interestingly, Luton Council and Luton Clinical Commissioning Group (one of the three CCGs in the patch) have a history of working well together and have gone much further with integrating their health budgets than most. This local relationship is expected to continue into the future.

Luton is also the second Labour council to pull out of an ICS process in less than three months – the first being Nottingham City Council, which suspended its involvement in its local system for six months.

It begs the question of how viable it is for councils to be involved in ICS at the top governance level, given that one is answerable to NHS England and DHSC while the other has to represent the interests of the people who voted it in, and associated political considerations.

Expect more of these type of issues to emerge as systems try to solve these competing and sometimes contradictory interests.

This article was updated at 9:20 on 15 February to correct the details of the use of resources report, which are produced by NHSI, not the CQC as originally stated.