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

Punishment by publicity

The small fine levied on Bradford Teaching Hospitals Foundation Trust for a breach of the “duty of candour” may be peanuts in terms of its overall budget – but it is a sign that the Care Quality Commission is prepared to tackle trusts on this issue.

As HSJ reported, this is the first time the CQC has taken enforcement action using its powers to treat breaches as a criminal rather than a civil action. The £1,250 fine is symbolic – and much of the punishment lies in the subsequent publicity.

Many HSJ readers were not impressed, however. Some questioned whether individuals should be targeted rather than institutions, as any fine effectively comes out of money which could be used for patient care.

The fine against Bradford may even seem slightly harsh, as the trust seems to have at least partially complied with the duty. Its main failing seemed to be not issuing a prompt written apology. However, it is a warning for other organisations and may be a prelude to more action against other trusts, including potential prosecutions. 

United Lincolnshire Hospitals Trust was criticised by a coroner for not complying with the duty of candour or carrying out an internal investigation in a case where a patient died after being transferred outside the trust without review by a doctor. The CQC is known to be investigating the trust in relation to this case but it is not yet clear whether action will follow.

Fat and rich

University hospitals are about more than just their NHS work, as their name implies. 

And these specialist facilities are – arguably – under even greater pressure than the rest of the acute sector. They are disproportionately hit by the effects of an un-ringfenced educational budget.

There is a sense that, since the Great Provider Tariff Revolt of 2015-16, the teaching hospital giants have become less powerful.

The only Shelford Group trust chief executive from that era still in place is Sir Mike Deegan in Manchester.

This week, the University Hospitals Association (formerly the Association of UK University Hospitals) warned that the triple mission of its members – education, research and service provision – was under increasing pressure as commissioners looked to reduce costs on the latter.

HSJ reported last year on the concerns of specialist children’s hospitals about the funding regime over the coming years.

Whether or not the centre actually regards university hospitals as “fat and rich”, as is alleged, their case is it doesn’t feel like it from where they are feasting. Sorry, sitting.