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

Who, what, where, when and why

Governance – boring word, but in the NHS it means who is in charge and who did what.

The level of transparency around governance when it comes to NHS Improvement and trusts whose finances have exploded is poor.

Gloucestershire Hospitals Foundation Trust had one of these incidents in 2016. Nearly the whole board was replaced when it was revealed three years of surpluses had in fact been underlying deficits.

The trust moved out of financial special measures last week but there is still a lack of clarity over what actually happened there.

Of the 30 page abridged version of the report commissioned from Deloitte, just two focus on what went wrong. The report essentially blamed the chief executive and finance director for deceiving the rest of the board, who did not know or did not ask enough about why suppliers were being paid late, low levels of cash and “significant swings in financial performance”.

We’ve seen that happen elsewhere, and we’ve seen similarly not-particularly-helpful summaries released 10 months or so after they were commissioned (take a bow, King’s College Hospital).

What these reports either don’t ask or don’t disclose is how the regulator Monitor (now rebranded as NHS Improvement) came to be so deceived. You’d think the people from Deloitte would look at what the trust was communicating to its relationship manager at the regulator – but not a word.

Considering how the former FD was thrown under the bus by the report, it is sad to see it say: “[Her] actions were a direct response to managing the underlying deficit position and, while we are of the opinion that they were taken by the former FD with the trust’s best interests in mind, decisions were taken in isolation and the board should have been more openly appraised regarding the cumulative extent of the problems and the excessive measures being taken to manage the financial situation.”

There’s yet to be a report on the pressure put on trust finance bosses further up the system and that can lead to cases such as Gloucestershire. Who would commission such a thing?

At least realistic deficits now seem to be tolerated. The organisation is looking at a more plausible deficit in 2018-19.

Courting Corbyn

Is Jeremy Corbyn partly to blame for a London trust quashing plans to partner with a private firm to manage its estate? 

That’s now something for the High Court to consider, as it mulls the reasons why Whittington Hospitals Trust pulled out of its planned contract with Ryhurst.

The builder is part of the Rydon Group, another part of which was involved in the refurbishment of Grenfell Tower. In court documents, Ryhurst claimed it has fallen victim to public and political pressure because of this Grenfell connection. Sources of this pressure included “a number of MPs, including Jeremy Corbyn”, the company said. 

Whittington denies this, saying that in the two years since it launched its tender, it managed to reach a position where it no longer needed outside help to find “commercial and income generating opportunities” in its estates plan. Its finances had improved as had its relationships with local government and the north central London sustainability and transformation partnership.