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

Ever the optimist

In September 2017, NHS Improvement asked trusts to agree on a partnership or outsourcing model by January 2018 for pathology services within new networks.

The target was missed, with HSJ reporting in late February 2018 that NHSI’s proposals had been agreed by less than half of trusts.

In September 2018, NHSI said it expected a third of the 29 proposed networks to be fully operational by April 2019.

That target has also been missed, with NHSI confirming to HSJ that five networks have been fully established so far.

Looking back at the last 18 months, it is clear that NHSI has been somewhat optimistic with its timescales – yet the regulator insists it is on track to deliver the £200m savings required by 2021.

Ultimately, it doesn’t matter if targets are missed en route as long as the pathology sector arrives at its final destination on time.

NHSI says it is “impressed” with the “pace and change” by trusts since the programme was launched. At first glance, this appears a little generous given the facts presented above.

But, when compared to previous attempts to improve pathology services, there does seem to be more energy and determination across the country this time, even if some areas are struggling to agree a clear direction.

Energy and determination on its own cannot deliver the savings, though, meaning trusts will have to increase their efforts if they are to hit the only target that matters.         

Credit where credit due

Medway Foundation Trust was a byword for underperformance for many years in the NHS.

Its problems are by no means over but considerable credit has to go to the organisation for coming out of special measures in 2017 and continuing to make progress.

The organisation recently appointed its former HR director James Devine as chief executive.  He replaces Lesley Dwyer, having filled in as acting chief executive since she stepped down to return to her native Australia

Ms Dwyer’s four-year tenure saw a lot of the ground made up between Medway and the rest of the acute sector. But she also went out of her way to mention the support the trust had received from Guy’s and St Thomas’ Foundation Trust when the trust was moved out of special measures.

GSTT is quietly more and more influential in Kent. It provides direct support to some of the region’s more troubled organisations, and is traditionally the tertiary centre to which a lot of the Garden of England’s patients are referred.

Its relationship with NHS England and NHS Improvement might also be expected to improve. The joint regional leadership which has since been rolled out in the rest of England was trialled in the south east and was understood to be difficult. It is thought to have improved somewhat now.

But finance remains a pressing issue for Medway. 

In an era where trusts running deficits of 10 per cent of their income is not unusual, £247m-turnover Medway’s deficit is around 17 per cent. How performance and morale do when (or if) this overspend is addressed will be the big challenge.