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

Swept up

Another day, another hospital chief executive departs. This time, it’s Jon Green, formerly the chief of Queen Elizabeth Hospital King’s Lynn Foundation Trust, which was recently rated ”inadequate” overall and put back in special measures. 

The trust executive team’s cards have admittedly looked marked since the Care Quality Commission specifically rated its leadership “inadequate” and the chair, who himself stood down in October, said the trust needed “a change in board leadership and significant cultural change”.

But will it make a jot of difference?

System leaders have long pondered how to make the small rural district general hospital, with its catchment area of just 200,000 and chronic lack of staff, financially or clinically viable.

The trust has seen a stream of different executives, jolly well-paid consultants, and improvement directors come and go in recent years, none of whom who have yet managed to shift the dial.

Mr Green is now taking up what the trust called a “secondment post” at Norfolk and Norwich University Hospitals FT, where he will work on an “integration project” to bring services together across the local providers.

Integration work between the acute providers has recently gone under the rather misleading title of Norfolk Hospital Group (it is not actually trying to form a group model).

The “group” has pursued a string of largely incremental changes based around expanding existing voluntary networking arrangements with an “evolution not revolution” philosophy.

This is all very laudable, but the Norfolk health economy is now acknowledged as a “major problem” by system leaders. It would appear a logical conclusion that simply doing the same but better will not be enough.

The message on mergers

Legislation doesn’t always have the effect its authors intend, but, in a political and centralised system like the NHS, it sends a strong signal of the direction of travel.

That will go even more so if – as seems likely – the government and national NHS leaders put forward ideas for a bill, but don’t get as far as turning them into legislative reality for quite some time.

HSJ revealed on Friday one of the most interesting proposals being batted about internally, but little discussed openly, for legal change.

That is to give NHS Improvement, as the provider regulator, the powers to direct trusts and FT’s to collaborate, including requiring them to merge.

Allied to this is the prospect of giving NHS Improvement powers over FT senior appointments – a key mechanism for the regulators to, for example, force sharing of chairs and chief executives, and recruit people who agree with them – and more control over how they spend their money. The latter may be the most controversial aspect for true FT believers – their autonomy to spend accumulated surpluses is a treasured one, but can play havoc with efforts to balance the departmental books.

It backs up the messages issued from NHSI chief Ian Dalton that FT’s now have responsibilities beyond their own organisation (this could be codified in law, too) – the new cadre of regional directors may be pushing this message hard.

Doubters will question whether bigger is normally better, whether England’s hospitals and providers are not too big already, and whether big beast FTs will be able to win the trust of primary care and communities which is needed for an integrated, population-focused modern healthcare.

Another question is whether, in an effort to make short-term efficiencies, the NHS risks throwing the baby out with the bathwater by totally undermining the core of autonomous FT’s.