The must read stories and debate in the NHS

Wirral rapped

The eagerly awaited independent report into governance failings at Wirral University Teaching Hospital Foundation Trust has been published and reveals what by now will be no surprise to HSJ readers.

Report author Carole Taylor-Brown exposes what she describes as “deep systemic cultural issues” at the organisation.

It follows a series of revelations by HSJ detailing the breakdown in relations between executives at the trust, the former chairman Michael Carr and chief executive David Allison who resigned in December.

Beneath the headlines of the report, Ms Taylor-Brown describes how the governance situation at Wirral deteriorated significantly – partly due to inappropriate behaviour and a culture that did not want to hear bad news.

It was unlikely the review was going to conclude anything else given the investigation was overtaken by events when non-executive director John Coakley resigned last month, after describing much that is in the report.

What was surprising was to see the lack of detail Ms Taylor-Brown set out in relation to NHS Improvement’s own handling of the affair. The section around its secondment offer to David Allison is vague and allows for interpretation instead of setting out a clear timetable and facts.

It remains unclear when NHSI offered the secondment to Mr Allison and why it did this even after executives at the trust had raised concerns with the regulator. It does not say who knew about the concerns, what the internal discussion was nor does it adequately explain the delays between the public revelations on hsj.co.uk before Christmas and the withdrawal of the secondment on 4 January.

Also concerning is the attempt by the investigation to identify the source of the leak to HSJ. The leak was in the public interest so such an attempt could be argued to be outside the spirit of the law on public interest disclosures.

The attempt was certain to fail as no whistleblower would use their NHS email account, though NHSI has now provided future whistleblowers with some confidence that using private emails is a safe bet.

HSJ will welcome their correspondence.

Money talks

High earning NHS employees including medical consultants and senior managers are choosing to leave the service because of government caps on the amount of tax relief that can be applied to pension schemes, the Department of Health and Social Care has admitted.

The DHSC said in its latest evidence to the Review Body on Doctors’ and Dentists’ Remuneration – published in January – that “there is evidence of high earning individuals opting out of the scheme” or “leaving NHS employment through early retirement”.

The report said this may be “due to the effect of the new lower lifetime and annual allowances tax limits”, which could “potentially affect some high earners”.

The allowances limit the amount which can be put into a pension with tax relief applied. Since 2010, there have been several pension reforms which have gradually reduced the “lifetime allowance” from £1.8m to £1m – meaning there is now no tax relief on payments once the pot tops £1m.

The story has attracted plenty of debate on Twitter and below the line on hsj.co.uk

One reader said: “Lift the cap. It is that simple. The retention of senior managers and doctors in the NHS will pay for itself many times over in experience and efficiency. The government truly is ‘cutting off its nose to spite its face’ over this issue.”

Another commented: “There seems to be a growing number of examples of unintended consequences - or could it be better called lack of proper or joined up thinking - that result in unnecessary damage to the NHS and other public services.”

While another reader warned: “If high earners opt out of the scheme it will potentially become unviable for all.”