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Much is written about integration, how vital it is, how difficult it is – but the honest detail of the latter rarely comes to light.
A case from Surrey gives some insight on the kind of issues that can bedevil an integration project.
An acute trust, three GP federations and a social enterprise providing community services won a joint contract from Surrey Downs Clinical Commissioning Group – with the acute as lead provider in the alliance. A few months later, the social enterprise brings legal action aginst the CCG saying it had been marginalised and as such the alliance had “materially changed” and the contract was therefore invalid.
It is easy to feel sympathy with the CCG that has let a contract to a consortium only to find the component parts fall out.
The causes of the dispute between Central Surrey Health, Epsom and St Helier University Hospitals Trust and the other members of the alliance are more illuminating.
The social enterprise thought it should retain the CQC registration for the service, and resisted a move to transfer this to the hospital trust.
Chief executive Steve Flanagan told HSJ another issue was maintaining clinical control and leadership of the workforce. This sounds like a more fundamental disagreement over who was actually in charge – something you would hope would be cleared before contracts were signed.
Mr Flanagan told the HSJ none of the blame for what happened rested with CSH but that he wanted to keep talking to the other members of the alliance.
The dispute shows what can happen when statutory bodies create less robust arrangements and just hope everyone gets along.
It is difficult to see how the situation will resolve without someone making significant concessions.
Five years later
The judicial review, brought by Swanage resident Anna Hinsull, argued Dorset Clinical Commissioning Group had not run a proper consultation over the changes, which will see a major emergency hospital in Bournemouth and a major elective centre in Poole.
But High Court judge Sir Steven Silber rejected the review’s claims, leaving the CCG and trusts free to continue with their plans.
Part of the planned changes will see the Royal Bournemouth and Christchurch Hospitals Foundation Trust and Poole Foundation Trust complete a long awaited merger.
Speaking to HSJ a day after the verdict RBCH chief executive Tony Spotswood revealed the trusts are asking the centre for permission to appoint a single interim chair and chief executive of the two organisations later this year.
It is thought this “clear leadership model” will make it easier to deliver the “complex change programme”, Mr Spotswood said.
A timeline for when the merger, if approved, can be carried out has not yet been confirmed. The clinical service reconfiguration is expected to be completed by or during 2023.