Daily Insight: The world on its shoulders

Great Ormond Street is a global brand and was in the 2012 Olympic opening ceremony, such is its clinical reputation.

So you would expect its consultants to have significant opportunities for private work. Doing that work at GOSH makes sense in some ways: why let a private company make the money from the same staff doing the same procedure in Harley Street?

On the other hand it’s a queasy balance to strike at a time when non-wealthy children face long waits for treatment.

It’s not clear whether more NHS patients get treated quicker than they would have done because GOSH do such large volumes of international and private work.

Certainly, it’s very important to the finances of a trust with a private turnover of more than £60m pre-pandemic.

GOSH aims to do a record £78m worth of private work this year.

This would be up more than 50 per cent on last year and in excess of its pre-covid peak.

It’s fair to hold GOSH firmly to its NHS responsibilities, considering NHS England covered it during the covid years, when private income dropped to £24m. But on the other hand, its waiting times performance is better than any of the other specialist children’s trusts in England.

The centrality of growing private work to its savings plans also reflects the wider strain on the system.

Some NHS leaders predict the wheels will come off NHS finances properly in September.

This would explain the NHSE pressure on trusts to sign-off less-than-entirely-realistic financial plans.

GOSH ended the last financial year with a deficit of £10m, about 2 per cent of turnover. This year’s outturn is going to turn heavily on the trust’s success in outcompeting other paediatric centres across the world.

That the stability of such an important organisation depends on the vagaries of the international market is worrying.

Outstanding but not perfect

It’s not easy running an “outstanding” hospital – there is sometimes an unrealistic expectation that everything will be perfect, with contented staff and few worries about patient care.

But, as a report by the then Health Education England has shown, things are not always universally rosy. A visit by HEE inspectors to Frimley Park Hospital brought forth tales of staffing problems, bullying and some patients not seeing a senior doctor for six days. Juniors’ concerns were wide-ranging – from the very practical such as different referral processes between departments to broader concerns about safety, with many doctors not recommending it as a place to work or to be treated.

Frimley Health Foundation Trust was swift to acknowledge that matching staffing and demand was challenging and said it had acted quickly when made aware of bullying and harassment issues.

But, as the General Medical Council issued a survey showing increasing burnout among junior doctors, these HEE – now NHS England – reports can be the canary in the coalmine for when things are starting to go wrong for an important group of staff. Experience during training will help doctors decide where they want to work – or not – in their later careers.