Your essential update on health for the week

HSJ Catch Up

This weekly email gives HSJ subscribers a vital update on the biggest stories from the last week in health. If you have been out of the office or otherwise just too busy to keep up, HSJ Catch Up will ensure you are still in the know.

‘A total and complete breakdown’

HSJ has revealed the latest stage of the deepening crisis at Wirral University Teaching Hospital Foundation Trust, with respected former medical director John Coakley resigning as a non-executive director at the trust on Monday.

Dr Coakley, who only took up the post in July, told HSJ he was resigning because he believed the executive team, who he said were doing a “sterling job”, were not getting support from the rest of the board.

Other sources at the trust told HSJ there has been “a total and complete breakdown of relationships and governance”, after executive directors and non-executive board members disagreed during a private meeting last week over the future of trust chair Michael Carr.

Mr Carr intends to continue for the next five months at the trust until the end of his term – despite serious allegations of governance failings from his own directors – and a potential vote of no confidence by senior doctors.

In the background of all of this is NHS Improvement, which had to hastily withdraw a secondment offer to the trust’s former chief executive David Allison before announcing an independent inquiry into the allegations last month.

As highlighted in our Risk Register expert briefing, the regulations say where NHSI is satisfied a trust licence is being breached or even at risk of being breached, it can impose conditions on a trust – including the removal of the chair or board members.

King-size deficit

Passing Cambridge and Imperial, King’s is now clearly the most beleaguered of the Shelford Group trusts.

HSJ readers will be aware of the money arguments the London trust had with NHS Improvement that saw the high profile departure of its chair and finance director late last year.

What has not been known, thanks to the trust’s unparalleled slowness in publishing financial data, is just how bad the financial picture was.

While the trust’s £92m forecast deficit for this year has been known about since November, it now appears clear that the overall deficit will be far worse.

The amount of revenue loan the trust anticipates needing is around £150m.

A sum of this size puts the trust even more fully in the “trusts with a deficit of more than 10 per cent” club – as well as among those that have had to reforecast significantly in-year.

Thousands of staff could transfer to subsidiaries

The most sustained funding squeeze in NHS history has led to some desperate measures being taken to find never ending cost savings.

With the low hanging fruit plucked long ago, and the balance sheet well and truly shaken, many trust bosses are having to make more difficult decisions.

In the critics’ words, a “rash” of trusts are now looking to transfer non-clinical staff to wholly owned subsidiary companies, to take advantage of a VAT loophole and get new recruits on to less expensive, non-NHS contracts.

A handful of trusts have run small portions of their estate through a subsidiary for several years, or used them as a delivery vehicle for capital projects.

But over the last year more and more trusts have announced plans for large scale staff transfers to subsidiaries that effectively replace the traditional estates and facilities department.

Hospitals behind Carter targets

When Lord Carter published his review into efficiency at acute trusts two years ago, a light was shone on the complex world of NHS procurement.

For decades the sector received minimal attention from national leaders, but over the last 10 years there has been increasing focus on how the NHS spends its cash – the Carter review bringing the subject to the fore.

Among his recommendations, which were welcomed by the government, was that all acute non-specialist trusts should hit three targets that measure the efficiency of their purchasing process.

Lord Carter said these targets should be achieved by September 2017, but HSJ analysis has found only a handful have reached this level – and some are not hitting any.

It’s important to stress the targets do not measure how much value a trust gets for its product, but instead looks at how well a trust manages its non-pay spending process.

While the targets address only a portion of the overall NHS efficiency drive, our findings show there is still much work to be done before the NHS can say to Treasury: “We’re squeezing maximum value from every penny you give us.”

Older people waiting longer for hip ops

The time elderly people wait for urgent hip fracture surgery is on the increase – after nearly a decade of improvement.

The number of people receiving the surgery within the recommended 36 hours dropped by 2.6 percentage points between 2015 and 2016. It fell by 0.6 percentage points in 2015 compared to the year prior. These were the first drops since 2007.

It meant that in 2016, 28 per cent of over 60s needing the operation, normally in pain and immobile, waited longer than this. Experts say this likely undermined “compassion and dignity” in the care they were given.

New CCIO named

NHS bosses have appointed emergency medicine consultant Simon Eccles as the health service’s new chief clinical information officer.

The Guy’s and St Thomas’ FT consultant replaces Keith McNeil, who resigned last year to return to Australia, in a role shared across NHS England and NHS Improvement.

Dr Eccles is only the second person to hold the position which was established in 2016 in response to Professor Bob Wachter’s review of NHS IT. He will chair the national information board and report to NHS England national director for operations and information Matthew Swindells.