North by North West: Provider groups take the lead

The role of provider collaboratives in the emerging NHS structure remains loosely defined by the centre, and seems likely to vary widely across the country.

But for two systems in the North West, the collaboratives are starting to look like increasingly coherent and powerful bodies.

In Lancashire and South Cumbria, Kevin McGee will be confirmed as leader of the provider collaborative, alongside his appointment as chief executive of Lancashire Teaching Hospitals.

The collaborative role, and the weight it is expected to carry, means he has agreed to step down as CEO/accountable officer at East Lancashire Hospitals and Blackpool Teaching Hospitals.

Those two trusts have got used to operating without Mr McGee as a full-time CEO (with Martin Hodgson and Nicki Latham the respective deputies), and will now look to appoint people who are fully prepared to work under his oversight and leadership within the collaborative.

This does not appear to be an opportunity for a new appointment to come in with a whole new vision and strategy — and might therefore be better suited to internal candidates who are used to working with/under Mr McGee.

Organic merger

A successful provider collaborative could eventually lead to a merger of the four acute trusts in Lancashire (Morecambe Bay being the fourth), although that still feels quite a way off.

The way to get there will be to start work on the large amount of clinical reconfiguration which the system has failed to get to grips with over the last 10 years.

Specialties like stroke, vascular surgery, dermatology, and ophthalmology will be a priority, along with radiology diagnostics.

The strategy will be to gradually integrate clinical teams and create single services across the system, with some services being consolidated into fewer, more specialist, centres.

Once clinicians start to feel like they’re working for the health system, as opposed to an individual hospital (which now feels more possible with the need to recover elective services in an equitable way), then joining the trusts would be a natural next step.

Clearly all that is easier said than done, however.

GM’s dominant forum

Meanwhile, in Greater Manchester, the provider collaborative looks set to cement the position it has established during the pandemic as the region’s dominant leadership forum.

The expectation is for the GM collaborative to be assigned the bulk of the region’s acute funding (around £4bn), making it the major decision-making body in terms of how and where services are delivered.

Clearly there are plenty of fixed costs at all the existing hospital sites which will immediately account for most of that funding, but putting a joint board in charge of it will change the entire dynamic and offer new levers to start shaping the landscape.

Similarly to the situation in Lancashire, the new chief executive of the Northern Care Alliance is going to have to be satisfied working within/beneath the collaborative, which is of course led by Sir Mike Deegan of Manchester University Foundation Trust.

It will also limit the role of local NHS planners/commissioners in each borough, or ‘place’, who at the moment are theoretically responsible for the budget/pathway from primary care through to acute. 

Flexing its muscles

The collaborative is already starting to flex its muscles by moving to abandon the much-vaunted and commissioner-led Healthier Together reconfiguration of emergency general surgery.

Officially, it is commissioners that must take the decision to drop the consolidation of high-risk surgery.

But in reality, the few of them that are left are not going to oppose what the provider collaborative — driven by their consultants — wants to do.

Following up

As the review into thousands of overdue follow-ups at Aintree University Hospital continues, some serious cases of patient harm have started to be identified.

NxNW understands that, in one case, a patient is thought to have developed stage four lung cancer after a follow-up CT scan, which might have detected problems earlier, never happened.

In another, a patient with Barrett’s esophagus was supposed to have a colonoscopy scheduled, but the appointment was seemingly never made and they developed a suspicious 40cm lesion.

Another patient with a liver condition was placed in a hold file in 2016 with no further follow up scheduled, and later presented as an emergency with a probable malignant diagnosis.

Liverpool University Hospitals FT says it has apologised to the patients.

Meanwhile, NxNW understands Beverley Oates, from Wirral University Hospital, and Dave Pilsbury, from Lancashire Teaching Hospitals, have been brought in to lead the wider review of the whole situation.

There continue to be high tensions between the gastro teams at Aintree and The Royal Liverpool, as the merger of the two hospitals means the latter will need to help the former in recovering its waiting list situation.

One complaint has been that the cases being sent to The Royal are the uninteresting ones which senior clinicians don’t really want to do.

Messy.

Long waiters

Internal data seen by NxNW suggests Cheshire and Merseyside has struggled to reduce its backlog of cancer patients breaching the 62-day standard.

In mid-May, the system had around 900 patients on the GP-referral pathway who had already waited more than 62 days for treatment, which was only down by around 10 per cent from around 1,000 at the end of January.

By contrast, the national numbers had dropped by around 20 per cent by the end of March.

The C&M Cancer Alliance, hosted by The Clatterbridge, suggested higher referral numbers were driving at least part of this, adding activity has risen “well above” pre-pandemic levels.

National data shows C&M treating a higher proportion of patients within 62 days than the national average, so more priority may be needed for the longer waiters.