The must-read stories and debate in health policy and leadership.
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Too big or too small
NHS providers must negotiate more than one current in healthcare practice and policy. While there’s a drive to integrate general services locally (bringing mental health into general practice and liaison with emergency care for example); specialisation is another reality – backed by NHS Improvement being very keen to meld and merge trusts horizontally.
The mental health sector in some respects moves quicker than others, so it’s particularly interesting to see how trusts respond to this environment.
This week a prominent mental health chief has brought the debate into the open, stating there are too many small mental health and community providers.
In an exclusive interview with HSJ, Joe Rafferty, of Mersey Care – a large mental health foundation trust also providing physical community health – indicated that small trusts risked being swept aside in system integration plans.
While the CEO’s comments are unlikely to be popular with all, they raise the important issue of whether MH services are likely to have more sway and influence if they are part of a bigger MH organisation.
Fewer chiefs could certainly mean less argument and quicker decisions. Whether mental health and community trusts which have merged are better off in is yet to be properly evidenced.
However, readers may find it interesting to note that two of the five smallest mental health and community trusts in England have recently agreed to merge – the Black Country Partnership Foundation Trust and Dudley and Walsall Mental Health Trust.
A third, North Staffordshire Combined Trust, occupies a sustainability and transformation partnership with one of the largest mental health and community providers in the country.
Unfit and proper
The Care Quality Commission has come in for a drubbing from a seemingly emboldened rival watchdog, the Parliamentary and Health Ombudsman.
Its report said the CQC’s mistakes in the case of Paula Vasco-Knight were so “fundamental” that it raised the possibility of wider failings and “questions the ability of the CQC to provide robust and appropriate” application of the FPPR rules.
Ms Vasco-Knight was in 2014 heavily criticised by an employment tribunal for the dismissal of two whistleblowers who complained about her helping to appoint her daughter’s boyfriend to a role at Torbay and South Devon Healthcare Trust, which she led.
Despite the criticism, Ms Vasco-Knight was appointed in 2015 as interim chief operating officer at St George’s University Hospitals FT in London, and then briefly as its chief executive before being dismissed when separate allegations of fraud were made to police.
CQC chief Ian Trenholm pointed out that the FPPR system was already in line for reform, but questioned elements of the PHO’s judgement: “We do have concerns about the approach adopted by the PHSO which led to some of the findings of maladministration. There was a considerable amount of contradictory evidence for the trust to assess.
“This included an employment tribunal decision, which was not consistent with other pieces of evidence. Under existing FPPR regulation our role is to consider whether the trust acted reasonably in coming to their conclusions about the weight that should be attached to various pieces of evidence, rather than whether we would have reached the same conclusions.
“We judged the trust had performed its obligations reasonably when faced with this difficult situation. We are disappointed that the PHSO came to a different conclusion. We have made these concerns clear in our response to the report.”