• Kevin McGee says chain model and shared leadership could enable crucial reconfiguration across four Lancashire trusts 
  • Currently leads East Lancashire Hospitals Trust and Blackpool Teaching Hospitals FT
  • Says “honest conversations” and “difficult decisions” are needed to address deficit of £133m

Creating a “chain” model and shared leadership between providers in Lancashire could enable crucial reconfiguration of clinical services to finally move forward, an acute trust chief executive has told HSJ.

Kevin McGee, who currently leads two of the four acute trusts in Lancashire and South Cumbria, said that urgent progress needs to be made to address the county’s financial problems and to create services which are clinically sustainable.

He said: “Take personalities out of it, just the ability to work together in a different way and take organisational barriers out of the way, I think, is very powerful. So it may lead in time to a different way of working across Lancashire. Linking the trusts together in a different way and sharing leadership is possibly one way forward.”

Mr McGee is substantive chief executive of East Lancashire Hospitals Trust and has also been in interim charge of Blackpool Teaching Hospitals Foundation Trust since May. He recently agreed to stay on at Blackpool for the “foreseeable future” as discussions continue about its future leadership options.

Asked if he wanted to lead both trusts permanently, he said: “If we can look at working in a different way across Lancashire then it would be a really good thing to do and I’d be really interested in doing that.”

As reported last month, former Salford Royal chief executive Sir David Dalton – who established a chain model, including a joint board, between Salford and Pennine Acute Hospitals Trust – has been brought in to help trusts in Lancashire look at options for closer collaboration.

The other two acute providers are Lancashire Teaching Hospitals FT and University Hospitals of Morecambe Bay FT.

Mr McGee stressed the huge financial challenge facing the Lancashire and South Cumbria Integrated Care System – which reported a combined deficit of £133m last year – and said “there needs to be some honest conversations now” around the way services can be provided.

Asked what had prevented more progress being made, he said: “It’s getting all the organisations into a place where they’re prepared to have those conversations and taking the competition out of the system. It needs to move on now.

“A chain model may make progress on this more likely. You would hope so anyway.”

Honest conversations needed

He said one example worth looking at could be “rationalising elective services and doing it on a couple of sites across Lancashire instead of all of the sites”.

Other services which have previously been cited for potential reconfiguration include: vascular; cancer; maternity; neonatology; paediatrics; critical care; and end of life care.

But Mr McGee said: “I still don’t think we are really clear about what’s the overall clinical model for the ICS.

“It’s clearly very complicated and wicked in terms of the issues and politics around the various sites… so it’s not an easy one to crack, but we really need to get some sense of the overall strategic direction from a clinical perspective and then we can start working through the detail.

“I think what we’ve done is we’ve dealt with individual bits of it because it’s been perhaps easier that way than to get an overall agreement.

“The trusts I think are working reasonably well together but when you’ve got separate organisations we’d be foolish to not accept there’s always going to be some tension between them. We are making significant progress on that, but it’s perhaps slower than you would hope.

“The finances in Lancashire are really difficult, the gap is so large that it’s not sustainable. Yes, we can do more in terms of efficiency, but ultimately we’ve got to have an honest conversation and make some difficult decisions.

“If we’re not careful the finance conversation is going to drive the clinical models and it should be the other way around.

“I don’t think we’ve done that big piece of work on the clinical strategy to figure out where the big wins are and the services that need to be consolidated.”

Disconnected leadership

As reported last week, Blackpool Teaching Hospitals FT was inspected by the Care Quality Commission in early June, and has received some critical feedback in a post-inspection letter.

Mr McGee said the regulator had identified a “disconnect through the organisation in terms of leadership”, but steps are now being taken to address that.

Medical director Mark O’Donnell recently became the trust’s third director to announce their retirement, following chief executive Wendy Swift and nursing director Marie Thompson.

Mr McGee said: “It was the right time for Mark and it was also the right time for the organisation. He’d been in the role a number of years. It felt right for him and it felt right for us because we needed different [and] new leadership in the organisation.”