HSJ’s round-up of the must read stories from Wednesday


Royal Free empire expands

Would it be too cynical to suggest that the announcement of a senior director from the Royal Free as the new chief executive of West Hertfordshire Hospitals Trust might be related to the revelation that the same trust has begun to explore buddying with the Royal Free?

And that West Herts, put in special measures in September 2015, might go the same way as Barnet and Chase Farm, now fully acquired by the Hampstead-based trust?

A Royal Free director was given the interim chief executive role at Barnet and Chase Farm in November 2013, shortly before it was absorbed by its neighbour to the south.

The Royal Free, led by David Sloman, is one of England’s hospital chain vanguards and might say that it is early days for the form. But West Herts needs fairly significant action soon, having had a string of governance and care problems in recent years.

The news comes as North Middlesex University Hospital – to the east of the Royal Free, announced they would be applying to become a founder member of the Royal Free chain.

There has been disagreement as to whether chains would be a bag failing trusts were put into or a club that providers joined voluntarily.

In greater Manchester it looks as if they could be both, with Pennine Acute Hospitals Trust unofficially taken over by Salford Royal chief executive David Dalton while Bolton and Wrightington, Wigan and Leigh join voluntarily.

Might we see the same situation in outer north London, with in-difficulties West Herts asked politely to join the hospital group by their regulator and North Middlesex opting in of its own accord?

How will this work if chief executives within a chain disagree? We will see.

Kent commissioners in court

It’s always sad to see the playing-shop pseudo-market of the NHS leak real money outside of the system in lawyer’s fees.

That is what has happened in north Kent as a spurned incumbent provider took commissioners to court to overturn their decision.

Kent Community Health Foundation Trust last week lost part of its legal challenge to CCGs. The provider had won a suspension of a new contract, which had been awarded to Virgin Care, while its complaints about the process were considered.

Commissioners overturned this at the High Court on Friday and it is not clear whether Kent Community will continue to push their case for overturning the contract (essentially, that the CCGs didn’t give proper weighting to quality issues in giving the work to Virgin).

There are knotty issues around transferring staff, rights to use an IT system Kent Community developed and more in the patch.

The fact that it had to go to court suggests relationships are poor, but the system is set up to be winner-takes-all.

The purchaser-provider split was encouraged in the NHS to incentivise productivity in a time of plentiful resources. Its role in getting best value in a more constrained world is less easy to demonstrate.