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

Bringing back the board

The major piece of NHS reorganisation in Greater Manchester involves splitting up Pennine Acute Hospitals Trust, with three of its sites being subsumed by Salford, and the fourth by Manchester.

This was all supposed to be done and dusted by April 2020, but some horribly complex negotiations over national funding support and future service configuration have delayed the project.

In the absence of legal agreements, the parties have come up with a temporary solution which allows the hospitals in Oldham, Bury, Rochdale and North Manchester to be run by the respective trusts, without being formally acquired.

PAHT’s board, which was taken over by directors from Salford Royal Foundation Trust in 2016, will be formally re-established as an independent board, but will not be involved in the day-to-day running of the trust.

Instead, North Manchester will be run by Manchester University FT under a management agreement, while Salford Royal FT continues to manage the other three.

The formal acquisitions will still be pursued, but the agreement is aimed at allowing each trust to conduct separate negotiations with national bodies.

Both are likely to push for significant revenue investment, as PAHT reported a deficit of £24m for the first six months of 2019-20. It also owes more than £150m to the Department of Health and Social Care, and has significant clinical negligence liabilities.

MUFT is also seeking around £500m of capital investment for North Manchester General Hospital, which has one of the worst estates in the country, while SRFT will seek to negotiate a smaller figure for the other sites.

Immediate action

Regulators are calling for “immediate action” from a scandal-hit private mental health provider to improve its leadership and care quality.

The Care Quality Commission has told Cygnet Health Care — which ran Whorlton Hall before it closed in the wake of a BBC investigation showing patients being mistreated — its leadership team “did not have oversight of significant risks”.

CQC inspectors also said there was a comparatively high number of restraints, seclusions, assaults and self-harm at Cygnet facilities, and there was “no clear line of accountability” across the provider’s locations.

They also said they found no evidence ‘fit and proper’ persons tests had been carried out on its directors and board members. Cygnet subsequently told HSJ it did not have the paperwork ready in time but this has since been checked by external lawyers.

A total of nine services run by Cygnet have been rated either inadequate or placed in special measures, but this includes two services — Whorlton Hall and Cygnet Chesterholme — which have now shut down.

It comes in the week that it has been revealed Cygnet’s boss Tony Romero has been given a £445,000 payrise despite the company’s recent track record.

And next week an independent review into how CQC dealt with concerns about Whorlton Hall is due to be published.

Cygnet says it will take on board the CQC’s recommendations.