North by North West: Liverpool promises to change

If the configuration of hospital trusts and services in Liverpool was being designed from scratch, the blueprint would look very different from the current reality.

Uniquely, there are six separate acute and specialist trusts (one for every part of the body is only a slight exaggeration), with numerous interdependent specialties sitting in different parts of the city.

There’s a wide, though not universal, consensus that change is needed. But the example of Liverpool University Hospitals Foundation Trust – created through a 2019 merger – shows that changing anything in the NHS is incredibly difficult, even where there’s broad support.

This seems to have been realised by Cheshire and Mersey Integrated Care Board and their external consultants, Carnall Farrar, who have produced a report on how changes should be pursued.

They knew talk of “mergers” would risk jeopardising the level of support and cooperation of the organisations involved, so instead identify some immediate priorities for improving patient outcomes and saving money.

The authors were also at pains to acknowledge numerous workstreams are already in place, with their recommendations looking to build on those and pinpoint the areas requiring more emphasis. This seems a wise approach, given the common complaint that consultants often come in and imagine they’re starting with a clean slate.

Move the Women’s

On the patient care front, it strongly restates the case for relocating Liverpool Women’s Hospital onto the Royal Liverpool site, over which there has been previous agreement, replaced by uncertainty.

An ICB sub-committee, led by chief nurse Christine Douglas, will develop formal reconfiguration proposals that will lead to a formal business case and capital funding bid; several years back, the relocation was costed at around £100m, though inflation has likely pushed this up.

There is substantial opposition to closing the current Crown Street site, which many in the city treasure, and this has hampered previous efforts to seal the move. Ms Douglas and leaders at the Women’s Hospital will have their work cut out in terms of public engagement, although their most effective opponent, Rosie Cooper, may have lost some influence with key decision makers, since quitting Westminster and becoming Mersey Care FT chair.

Poor outcomes

Secondly, the report takes aim at the city’s struggling emergency services, noting how patients who arrive at accident and emergency often then need to be transferred to another hospital site for specialist care, frequently causing long stays in the department, which are “associated with increased mortality and poorer outcomes”.

For one common type of heart attack, for example, it says patients are frequently admitted to Aintree or the Royal Liverpool, but then need to be transferred to Liverpool Heart and Chest Hospital, which contributes to an average length of stay for these patients which is double that of direct admissions.

To address this, the report says three joint committees and new operating models should be created between LUH and each of the Walton Centre, Clatterbridge, and Liverpool Heart and Chest (which share the Aintree, Royal, and Broadgreen sites with LUH respectively).

Those new operating models should feature three new patient pathway elements; fast-tracking of patients, so they are directly conveyed or rapidly directed to the right hospital without having to be assessed or admitted to general wards through accudent and emergencies; “passporting” for patients with a known condition to allow them to bypass A&E and be admitted directly to the right hospital; and integrated clinical teams to provide “in reach” care to patients with co-morbidities.

The authors acknowledge some of this is already happening in some specialities, but say it needs to be far more widespread.

Merge the back office

On the financial front, Carnall Farrar highlights the higher administration and corporate costs of running the six separate trusts (seven if we count Mersey Care), each with their own executive teams and back office functions.

For every £100m of income in 2020-21, the report says Liverpool Women spent £7.4m on corporate services, with the other four specialists all spending between £5.4m and £5.8m, compared to £4.5m at LUH, which is far larger.

It says HR services such as recruitment checks, finance administration and IT support should be “addressed at pace” with different models of consolidation considered, “from retaining in-house functions and hosting, to fully outsourcing services to external providers”.

That latter option could be a tricky sell in Liverpool.

The ICB has even managed to get all the providers to sign a joint supporting statement for the report, albeit a vague and uncontentious proclamation that “it’s through collaboration that we will make the biggest impact in improving outcomes”.

Acquiring mind

It’s been around 18 months since Southport and Ormskirk Hospitals Trust has been overseen by a management team from St Helens and Knowsley Teaching Hospitals Trust, and NxNW hears the planned acquisition could be nearing completion.

The remaining question is how much capital funding STHK is able to extract from the government in exchange for the takeover. At the very least, it will want to address the £25m maintenance backlog at SOHT that’s deemed “high risk” and deliver serious investment into the trust’s digital infrastructure.

Capital letter

However, we know how difficult capital funding is to come by, even where it’s already been allocated to trusts.

There are growing frustrations at Manchester University FT, for example, at the delays and uncertainty around its rebuild of North Manchester General Hospital, which is part of the New Hospitals Programme. Look out for a story on HSJ this week about a letter which the trust has sent to ministers about the consequences of the delays.

Withnell and ICB

Lancashire and South Cumbria ICB is experiencing the impressive force of a Chorley community campaign, after it picked a large-scale primary care company to take over a well-regarded GP practice.

The previous GMS contract for Withnell Health Centre was dissolved when one partner quit the practice around a year ago, with the remaining partner, Ann Robinson, given a temporary year-long deal while a tender process was arranged.

But despite the practice having excellent scores in the official GP patient survey last year, under Dr Robinson, who wanted to continue, the ICB preferred the bid of SSP Health, which runs 37 practices in the North West.

Compared to 87 per cent of respondents saying the overall experience at Withnell was “good” last year – the best in its primary care network – the average across SSP Health’s surgeries was 58 per cent.

Campaigners have also flagged concerns about SSP Health’s record in Liverpool a few years back.

The ICB has yet to properly explain the reasons for its decision.

In a statement, SSP Health said it aims to retain the current team at the practice, and its group model will remove the burden of administration, enabling staff to “continue to focus on their patients, meaning GPs don’t drown in paperwork and admin”.

The company said the patient survey data was collected around a year ago and “great strides” have been made since then. It pointed out results varied across its practices, and one in 10 are rated “outstanding” by the Care Quality Commission, compared to one in 20 nationally.