Essential insight into NHS matters in the North West of England, with a particular focus on the devolution project in Greater Manchester. By Lawrence Dunhill

Wretched mistakes

Liverpool’s health economy will be keen to move on from 2017, which has been marred by wretched mistakes and public discord between some of its key organisations.

There will be more bad news to come as well, with Bill Kirkup’s review of care failings at Liverpool Community Health Trust likely to attract national headlines next month.

But two things happened last week that can hopefully provide a clean slate from which the city can move forward.

The first was the appointment of Jan Ledward as interim chief officer of Liverpool CCG, following the decimation of its governing body, including chief officer Katherine Sheerin, due to a highly embarrassing review into salaries.

It’s clearly a tough gig for Ms Ledward, who is a long serving commissioner from Lancashire, but the fact that she’s a (not too distant) outsider could work in her favour. She should be baggage free in the eyes of the key players, and provide a fresh pair of eyes through which to survey the damage and start to reconstruct.

She will also benefit from the second thing that happened last week, which was a decision by NHS Improvement to award the city’s community services contract to Mersey Care Foundation Trust after all.

This followed a calamitous procurement saga in which Bridgewater Community Healthcare FT was initially named as the preferred bidder, ahead of Mersey Care.

When Bridgewater was eliminated from the running (due to its CQC report), Alder Hey Children’s Hospital FT stepped in on an interim basis, and appeared favourite to take the contract on permanently.

Whatever the merits of Alder Hey’s bid, the decision to plump for Mersey Care will at least satisfy most of the city’s GPs and the vocal MP Rosie Cooper, whose interventions and campaigning had prompted the break up of Liverpool Community Health Trust in the first place.

It should also address the financial concerns, as Mersey Care has secured a recurrent funding envelope of £81.7m for the core services, though clearly this will place additional pressure on the CCG, which had wanted to withdraw £4.6m after the first two years in the expectation of savings being made.

Although both procurements were formally run by NHSI, the CCG seemed to be more heavily involved in the first. Without the CCG’s spectacular downfall over the pay issue, Mersey Care’s victory in the second procurement may have been less likely.

Power and influence

On the barometer of power and influence in Liverpool, Mersey Care has clearly moved up a notch or two, with the troubles experienced by the acute trusts further emphasising the ascendancy of the mental health (and now community) provider.

Royal Liverpool and Broadgreen Hospitals Trust continues to have financial problems. It missed its control total in 2016-17 and was almost £10m behind plan after the first quarter of this year.

Meanwhile, Aintree University Hospitals FT is reporting some of the worst A&E performance figures in the country, leaving its leadership vulnerable to the whim of the regulators and the Department of Health.

It’s not been a great time for Alder Hey either. The trust not only lost out on the community contract but also had its proposal to host Liverpool Women’s FT’s services on its site rejected by a clinical review (in favour of them moving to the new Royal Liverpool).

The review even suggested that the best long term solution would be to relocate Alder Hey itself to the new city centre hospital. Given the children’s specialist has just moved into a new PFI build, this isn’t going to happen any time soon, but does pose a bit of an awkward question.

CCG culling 

The overhaul of Greater Manchester’s commissioning landscape continues, with Oldham CCG looking like the next to be slotted/crowbarred into the new model set out in a recent Deloitte review.

Sources have told me managing director Denis Gizzi is off to fill the position vacated by Jan Ledward at Greater Preston and Chorley and South Ribble CCGs, which would leave his post available to be merged with the local authority.

This comes after Tameside council chief executive Steven Pleasant took over leadership of Tameside and Glossop CCG last year, and Gina Lawrence left Trafford CCG in April with no permanent replacement hired.

When I talk to senior people in Greater Manchester about the health and social care devolution project, they often caution about the level of continued support from the outer boroughs.

Make no mistake, the effective merger of CCGs and councils – and the means by which this is achieved – will not be to everyone’s liking. There will inevitably be fewer senior positions, and there is a risk of it feeling like a cull.

The recent Deloitte report was clear in identifying which CCGs were deemed to have made least progress in terms of integrating with their council, and this is perhaps an indicator of where tensions could arise. As well as Oldham and Trafford, that means Rochdale, Wigan and Bury.

Get me there

When I talk about transformation work with NHS leaders, they often stress the importance of not getting preoccupied with organisational structures and who does what. The important thing is what the patient experiences.

It should go without saying, but the fact people feel the need to repeat it so often shows just how hard it is to do.

The laughable, yet tragic, attempt to introduce an Oyster style payment system to Greater Manchester’s transport network shows what can happen when you fail to look at things from the users’ perspective. As the region’s NHS organisations draw up their integration plans for health and social care services, this story is worth a read.

Shotgun merger

Amazingly by NHS standards, the shotgun merger of Manchester’s two teaching trusts has been completed just six months later than originally planned.

Manchester University FT has been formed out of Central Manchester University Hospitals FT and University Hospital of South Manchester FT, with North Manchester General Hospital due to join within two years.

It will clearly take much longer for real integration between Wythenshawe and Oxford Road.

One headache to resolve will be the trust’s electronic patient record. The Allscripts EPR has recently been installed at Wythenshawe, while the Central Manchester hospitals use a system called Chameleon, which is a combination of internally built applications and purchased systems.

The Chameleon system was said to be under review last year but the trust always kept very quiet when asked about this.

When asked what the plan was post-merger, it didn’t sound like there had been much progress. The trusts said: “For day one, all existing systems will remain in use to ensure continuity of patient care.”

North by North West takes an in-depth fortnightly look at one of the NHS’s most challenged and innovative regions. There will be a particular focus on the devolution experiment in Greater Manchester, but my scope will also include Merseyside, Lancashire, Cheshire and Cumbria.

Please get in touch to let me know how I can improve it, and to tip me off about stories you think I should cover: lawrence.dunhill@wilmingtonhealthcare.com. If someone forwarded this to you, sign up to get your own copy here.