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

Not of its own making or within its power to change

One of the most troubled trusts in the country, Worcestershire Acute Hospitals Trust, finally looks set to shed the “special measures” label it’s worn for nearly four years, following its ratings upgrade from the Care Quality Commission.

The trust – which has moved from “inadequate” to “requires improvement” – needs to secure a yet-to-be-agreed funding package from NHS England/Improvement to move out of special measures, the CQC said.

The news is a credit to staff generally and new chief executive Matthew Hopkins specifically.

Mr Hopkins was brought in after a spell at another of England’s problem trusts – Barking, Havering and Redbridge University Hospitals.

The latest report from the CQC, while noting the ongoing challenges, exposes the uncomfortable fact that most of WAHT’s problems are not of its own making or within its power to change.

And those problems are significant.

The trust has reported some of the worst accident and emergency four-hour waiting times in the country, with one patient waiting 44 hours for an appropriate bed earlier this year.

Treatment on corridor trolleys has become a matter of course for the overcrowded emergency department at Worcestershire Royal. In 2017, two deaths saw the hospital’s inappropriate use of trolleys make national headlines.

Patients are still regularly treated in corridors, but subsequent inspections have shown some improvements. Although 16,000 patients were cared for in corridors between October 2018 and May 2019, the numbers are declining. On average, patients spent 3.8 hours on the corridor during this period.

The ball is now in NHSE/I’s court to decide how much support the trust will receive, both on finance and in making further difficult decisions.

Which way next?

Commissioners in Staffordshire have been left in a bit of a pickle after the GP members of five out of the county’s six clinical commissioning groups voted against proposals to merge.

The proposals have been long running and put forward as a solution to the county’s commissioning problems. Prior to the vote, the six CCGs have already merged four of their executive director roles. Some may argue the CCGs were perhaps a little overconfident that the merger would go ahead. 

As readers will know, NHS England is pushing hard for CCGs to consolidate across sustainability and transformation partnerships and integrated care systems. GP leaders in North Staffordshire, where members voted overwhelmingly against the merger, argued the national NHSE team was the driving force behind the local plans.

However, try as they might, the national and local commissioners will not be able to force through a merger without the GP membership on board – this being a condition of the CCGs’ constitution – so are left in a bit of a conundrum. The CCGs have said they will continue to meet in common but will no longer be submitting a merger application to NHSE.