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Croydon’s latest claim to fame
Croydon has trams. And before too long, it will have another even more exciting claim to fame: a borough-spanning integrated health and care system formed by NHS and local authority providers and commissioners. Can you match that, north London?
The borough’s combined acute and community provider, Croydon Health Services Trust, is at the heart of this and a key step has been aligning the trust with its commissioner.
Its chief executive, Matthew Kershaw, is now Croydon’s “place-based leader”. This means he continues to run the trust while ostensibly also running the clinical commissioning group (which remains a separate statutory body, under accountable officer Sarah Blow, who fills that role across all six of south west London’s CCGs).
The commissioners are merging. After April 2020, when they have agglomerated, Ms Blow will be AO of the unified commissioner and Mr Kershaw will be the place-based leader for the Croydon health system, with “full delegation” ensuring “decisions about Croydon are made in Croydon,” the trust told HSJ.
All this should lead to less fragmented care and improved outcomes. Understandably, this work is occupying quite a lot of the trust leadership’s time. Unfortunately, according to the Care Quality Commission, this has been to the detriment of some services which have seen quality and safety deteriorate.
“It was anticipated that the strategic changes would bring long-term benefits for patients and staff,” according to the CQC. While the trust was “rightly focussed” on them, the CQC was concerned about capacity at the top of the organisation.
Croydon says it is addressing this capacity issue, but the trust has for years been struggling financially, against access targets, and with workforce challenges. Some might argue the leadership should focus on sorting out the trust’s own challenges before embarking on ambitious integration schemes.
But that would mean turning its back on an opportunity to completely overhaul care in the borough. With more capacity at the top, perhaps a clearer picture of how health and care in Croydon is functioning will come when the CQC does a full system review, not just a trust inspection.
The worrying case of Harry Richford — the baby who died after a chaotic delivery and resuscitation at East Kent Hospitals University Foundation Trust — was always going to need a hefty response from the trust.
So, ahead of its board meeting this Thursday, it has announced it is setting up a special subcommittee to look at its maternity services. The subcommittee will be chaired by Des Holden, a respected obstetrics and gynaecology consultant who is medical director of the Kent, Surrey and Sussex Academic Health Sciences Network.
Under Dr Holden, the subcommittee will review what the trust did in response to a critical Royal College of Obstetricians and Gynaecologists report in 2015-16, look at whether the trust complies with national safety standards and make sure it implements the coroner’s recommendations in Harry’s case.
The trust has apologised for the failings which led to Harry’s death and has promised change. But more cases where its maternity services seem to have fallen short keep appearing and HSJ understands both the Richford family and local MPs have been contacted by other concerned families.
At the end of last week, a staff member also went to the media about the treatment of an elderly patient within the trust — an incident which led to staff being suspended.
HSJ understands concerned governors sought reassurances from senior management last week that there is nothing else to come out. But such reassurances may be hard to give, with some of the cases being reported stretching back several years, a period during which there was a succession of both chairs and chief executives.