North by North West: Coming up with the wrong answer

Lancashire has got itself in a mess with the procurement of a shared electronic patient record across its hospitals.

The four acute trusts launched a procurement process last year for a joint EPR, but have now abandoned the process, saying they need to revise the specifications for the new system, as well as the process for evaluating bids.

The strong suspicion will be that the process was not coming up with the answer the trusts wanted.

Procuring a new EPR across four acute trusts is a huge undertaking, even if you have a clean slate.

And the Lancashire position was muddied by one of the trusts, East Lancs, having only recently implemented the Oracle Cerner EPR (last year, with much upheaval).

That means it would be incredibly helpful if the wider procurement somehow managed to select Oracle Cerner as the systemwide platform.

There are suggestions this was unlikely to happen, hence the decision to abandon and revise the process, although senior sources insisted it was more about the complexity of the project.

Nervecentre, Alcidion and Daedalus were thought to be among the other bidders for the contract, which was advertised through a procurement framework.

Gary Doherty, a Lancashire Teaching Hospitals director who’s leading the programme, said it became apparent the requirements described in the tender and draft contract “did not fully detail the scope of EPR functionality that we are looking to put in place”.

This meant the evaluation criteria did not enable “the most economically advantageous solution” to be selected, and the “right decision to be made for all four acute trusts” (my italics).

So, the process is due to be relaunched, probably later this year.

Uncoordinated

The East Lancs difficulty suggests a horrible lack of coordination. But that all dates back even further, to the mid-2010s, when East Lancs started its own EPR bid and picked Oracle Cerner as its preferred supplier in 2017.

This was before system working was fully in vogue, so a decision to go it alone at that point in time was more understandable. The expected capital funding then failed to materialise until 2021, when the deal was finally signed.

Had system working been more mature in Lancashire and South Cumbria by that point, the trust perhaps could have abandoned the deal altogether and waited for its neighbours (who were still tied to legacy contracts).

But given how long these things take, and the uncertainties around capital funding, it’s easy to see why they went ahead.

Best ambulance trust

Last week’s NHS staff survey included some standout results for the North West.

On the key questions – for the proportion of staff recommending the trust as a place to work and a place to receive treatment – North West Ambulance Service reported one of the biggest improvements in the country, and now ranks as the best ambulance trust for “recommending treatment”.

Liverpool University Hospitals also saw major improvement, albeit from a very low point. It was a similar story at Greater Manchester Mental Health, with its improvement at last offering something positive for the new leadership to build on.

Others seeing strong improvement included Warrington and Halton Hospitals, which is impressive given the recent strike action by HCAs, as well as Manchester University FT and Stockport FT. Meanwhile, Bridgewater and Wirral community trusts had the biggest improvements in their sector.

Only two of the region’s trusts worsened on both measures, against a national improvement trend. Those were Bolton FT, where there have been well-documented issues with whistleblowing concerns, and East Lancashire Hospitals, where the disruptive installation of its EPR may have impacted. The Christie’s scores also lagged well behind the national trend.

None of the region’s integrated care boards ranked well on “place to work”, with Greater Manchester around mid-table, Cheshire and Mersey slightly worse, and Lancashire one of the worst.

Back and forth

System leaders are locked in negotiations with NHS England about the financial deficit they will be allowed to plan for in 2024-25.

Greater Manchester and Cheshire and Mersey each submitted first draft plans of around £500m, which they will now be under pressure to reduce by at least 50 per cent.

GM must be careful about what it agrees to, given its large unplanned deficit this year.

Meanwhile, Lancashire and South Cumbria is looking to skip the inevitable back and forth, by submitting a number much closer to £100m. That sounds tough.

Total recall

The long-awaited investigation into how Salford Royal Hospital dealt with concerns over spinal surgeon John Williamson was finally published last week.

The 500-page report confirmed what hospital leaders should have established years ago – that the former head of the spinal division had harmed patients with poor surgical techniques, misled a coroner, and led the division in a way that made others afraid to speak up.

Anyone hoping for heavy criticism of senior managers will have been disappointed, however, as lawyer Carlo Breen blamed missed opportunities to identify problems on breakdowns in system governance and communication, on behalf of clinicians as well as managers.

Those failings were then compounded by a 2015 Royal College of Surgeons’ report that was assumed to be “gold plated”, but was in fact “strewn with errors” and gave false assurances to ex-leaders such as Sir David Dalton, Chris Brookes and Pete Turkington, Mr Breen said.

This may not be the end of the story. Patients and spinal consultants are pushing execs at the Northern Care Alliance, which now runs Salford, to issue a full recall of Mr Williamson’s patients. A previous review looked at cases between 2009 and 2014, but Mr Williamson began practising at the hospital in the early 1990s.

The trust said it is now considering this.

Concessions spreading

East Cheshire Trust is the latest to have reached an agreement in its backpay dispute with healthcare assistants, after signing off on a framework with Unison to determine eligibility.

This will determine how many HCAs will qualify for backpay to 2018 for performing clinical roles above their grade and puts the trust at the same stage as Mid Cheshire and Warrington and Halton Hospitals.

That still leaves Wirral University Teaching Hospitals, which has been hit by several weeks of strikes, holding out. 

Meanwhile, strike action has been spreading to other parts of the country, with the concessions won in the North West offering a template to Unison branches in the South.

Contrasting appointments

Mary Fleming was confirmed as permanent chief executive of Wrightington, Wigan and Leigh Teaching Hospitals last week, having served on the board since 2016 and been in the job on an interim basis.

That contrasted with the recent appointment at Blackpool Teaching Hospitals, where ICB executive Maggie Oldham has now taken over on an interim basis.

Blackpool had at least a few board members whose CVs suggest they could have stepped into the role while a permanent successor to Trish Armstrong-Child was found.