Essential insight into England’s biggest health economy, by Ben Clover

Taking the pressure off acutes

This week’s national-issue-affecting-trust-locally award, unfortunately, goes to Hounslow and Richmond Community Healthcare.

The two-borough community services provider was given a “requires improvement” rating by the Care Quality Commission, which found a shortage of community nurses, and problems at a community hospital it runs.

In common with many other areas struggling with increased rates of dementia, HRCH’s Teddington Memorial Hospital “was increasingly being asked to admit patients outside of its admission criteria because of pressures on the local acute trusts”

Rating care at the hospital “inadequate”, inspectors said that while most beds were for rehabilitation patients, an increasing number of these were occupied by patients living with dementia.

“This meant that staff spent a lot of time caring for patients with challenging behaviour [which] caused a great deal of distress and disruption to the rehabilitation patients. There were delays in transferring these patients to a more suitable setting due to their complex needs.”

HRCH already sits at an unfortunate locus of funding issues, serving prosperous Richmond and the more deprived Hounslow. Fears that further integration would see resources intended for Richmond transferred to needier Hounslow saw GPs in the former nix plans for further integration with the local authority.

The funding issues tied up with rehab beds and social care funding and local government are the kind of thing you’d hope the STP process would sort out.

London Eye wonders whether the political tensions across STPs (ie council tax implications – as politics is basically who gets what) will trump other concerns.


Staying with national events affecting south west London – the Competition and Markets Authority made a couple of decisions this week relevant to the leafiest corner of the capital.

Firstly, it cleared an American firm to buy the Priory - a private mental health provider most famous for its hospital in Roehampton. Priory Group are one of the biggest providers of private placements in the country – the kind NHS commissioners and providers are often forced to send patients miles and miles to because of a lack of beds locally.

The US company, Acadia, already owns Partnerships in Care – another large player in that business.

Out of area placements are a problem for most NHS mental health providers but especially West London Mental Health Trust, which outsources its child and adolescent services.

The CMA indicated it was likely to accept Acadia’s proposal to sell 19 of its hospitals so as not to have an over-mighty position in the market – one that often has the NHS over a barrel.

Perhaps some of those hospitals could be used for rehab beds?

Lack of beds was a particular problem for Camden and Islington Foundation Trust, when it reduced its bed-base from 300 to 180. An investigation into a cluster of patient deaths looked at whether they were connected to it but found no evidence to suggest they were. The foundation trust is looking to expand its in-house provision again.

The CMA also rowed back on its earlier plan to make the private HCA hospital group sell one or two of its central London hospitals this week.

The regulator had seen a serious fightback from private hospital groups after issuing initial findings to its long-running inquiry. They found fault with the methodology and said a forced sale would be disproportionate.

Why does it matter to a healthcare leader in the NHS? The location of private facilities can have a powerful effect on the medical workforce, and the CMA is now going to look in more closely at NHS-operated or joint venture private patient units. A proposed PPU at St George’s in Tooting recently stalled.

Patient transport

Talking of working with the private sector, a major NHS trust has taken a patient transport contract off an independent provider.

In late July the Royal Free London Foundation Trust announced it was stripping SRCL of the contract.

DHL will deliver the service until it is re-tendered.

The Royal Free’s board papers said an “increased level of resource” would be provided during the transition.

The report said the firm “could not provide the level of service the trust’s patients deserve”.

Non-emergency patient services are an unglamorous but important part of a health system. Why do they so often seem to go wrong?

London Eye is indebted to colleague Alison Moore, who has written at length about this and puts it down to:

  • A lack of data, often on basic details like journey numbers.
  • Being seen as a non-clinical service and thus easier to cut.
  • Firms with little experience with patients winning contracts.

You could also add that ambulance services used to provide more of these services and breaking this part of their operation off can cause resentment.

London Eye is not suggesting these were the factors at work in north London. If you know what happened there in any detail get in touch (anonymously is fine)

London Eye features a look at what’s going on in England’s biggest health economy. London has the best and worst regarded hospital trusts in the country. It has excellence and dysfunction in commissioning and primary care. I will cover all of this.

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