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
Skating close to the edge
When it was only the lawyers talking about the need for new NHS legislation, the issue could be easily ignored and left at the bottom of the to-do list.
But with health leaders now becoming increasingly vocal on the subject, the promised “review of the internal market” will be one idea from that ill fated Conservative manifesto that should remain in play.
The worry will be that bigger priorities such as Brexit and the precarious parliamentary balance may leave NHS leaders waiting years for a bill – when the dire financial situation and resulting need for transformation demands immediate action.
The NHS cannot afford to wait for new legislation, and so as Blackpool CCG’s Amanda Doyle warned recently, local leaders must dare to skate close to the edge of competition laws.
For evidence of this, just look at the single integrated care contract in Manchester – which is set to be awarded to a consortium of incumbent providers after it was the only bidder for the contract.
There was an inevitable fuss around the tendering of the £6bn contract and the potential for private bidders to come in, but judging by the tight timescales and significant involvement of incumbent providers in the contract design, it’s pretty clear there was never an intention for these services to change hands.
Albert Sanchez-Graells, a procurement expert at Bristol University’s law school, notes how the tender process appeared to simply be a formal nod to the law, rather than a real attempt to create competition, and warns the approach “potentially breaches the requirements of the principle of competition” established in the Public Contracts Regulations 2015.
Local leaders in Manchester – still full of confidence from their devolution deal and backing from NHS England – appear to have judged this as a risk worth taking and seem content to skate close to the edge.
A legal challenge seems unlikely (which arguably justifies the haste in Manchester) but as Dr Sanchez-Graells warns: it might be a good idea to hammer the legal framework into the right shape before this model is mimicked in other areas.
If the government does eventually agree to legislative changes, it will be interesting to see how they play out in Parliament, the media and with everyone else.
A move away from competition and fragmentation should surely be welcomed by the left, but they would need to resist the urge to attack the Conservatives over another NHS reorganisation.
Hopefully they will see it for what it is, and instead frame their argument around the failures of the Health and Social Care Act 2012.
The competition laws that govern NHS trust mergers are not as easy to skate around, and there will have been major relief in Manchester at the initial findings of the Competition and Markets Authority and its investigation into the planned merger of Central Manchester University Hospitals Foundation Trust and University Hospital of South Manchester FT.
Although the patient benefits must still be demonstrated, it sounds like the CMA is prepared to clear the deal.
In good news for other trusts hoping to become one, the regulator even accepts that financial pressures on the NHS have “dampened the role of competition”.
Collapse of heart surgery service
As the endless saga of reconfiguring congenital heart services in England rumbles on, the thinly stretched services at Manchester Royal Infirmary have collapsed.
The hospital’s congenital heart defect unit is one of three set to be decommissioned by NHS England (subject to consultation) and uncertainties over its future appear to have promoted staff to jump ship.
Central Manchester says the services have been withdrawn as an “interim” measure but with permanent closure on the horizon, it will clearly be difficult for the trust to recruit the staff necessary to reopen.
After almost 20 years of debate and uncertainty around these services nationally, there should be no excuses for further delays to centralisation.
Southport and Ormskirk Hospital Trust has finally revealed some details about the sacking of former chief executive Jonathan Parry, which it apportioned to governance breaches, bad behaviour towards colleagues, a breach of confidentiality and his approach to whistleblowing complaints.
The trust said Mr Parry’s right to initiate employment tribunal proceedings has expired, though he previously indicated he could challenge what he called a “vindictive” dismissal at the High Court.
Meanwhile, the future of the trust as an independent organisation remains unclear. It has struggled to meet key financial and performance targets and is subject to a “major service review” as part of the Cheshire and Merseyside STP. It is also coming up for two years since the trust had a permanent chief executive.
Lancashire was one of the health economies hit the hardest by the cyberattack in May, and on the Fylde coast it took 10 days to get all the computers back up and running.
I have been told there are serious concerns about the vulnerability of much of the county’s IT system, due to apparent difficulties in updating the machines remotely.
While the region’s STP aims to “harness the potential of digital health”, securing the existing infrastructure may need to be the priority.
The impressive turnaround of services at Calderstones Hospital – which have moved from an effective inadequate CQC rating to outstanding within three years – will not save the site from closure.
Mersey Care FT, which took over the learning disabilities hospital last year, had previously argued for retaining some low-secure units on the site. But even with the latest rating, the trust says it is now committed to reproviding the services elsewhere.
The closure will present a major opportunity for the NHS to generate capital receipts from the site, which sits within the affluent village of Whalley.
Two small areas of spare land have already been earmarked for 50 housing units, and that could be multiplied many times once the whole site is vacated.
A new job advert in Lancashire suggests its NHS trusts might just be getting serious about collaboration.
The trusts are seeking a programme director for two years to “facilitate collaborative working” across the organisations, on a salary of £100,000-£120,000.
Although they will report into Kevin McGee, chief executive of East Lancashire Hospitals Trust, they will work “collegiately” alongside the other chiefs on the county’s “provider board”.
Employing a team dedicated to transforming services is one of the key drivers of change in Greater Manchester. The region’s transformation unit now has a new director, Nigel Gloudon, who was previously NHS England’s head of finance for Cheshire and Merseyside. He will report to the unit’s chief executive, Leila Williams.
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: firstname.lastname@example.org. If someone forwarded this to you, sign up to get your own copy here.
- Acute care
- ALDER HEY CHILDREN'S FOUNDATION TRUST
- Bridgewater Community Healthcare NHS Foundation Trust
- CALDERSTONES NHS TRUST
- Care UK
- CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST
- Community services
- EAST CHESHIRE NHS TRUST
- EAST LANCASHIRE HOSPITALS NHS TRUST
- GREATER MANCHESTER WEST MENTAL HEALTH NHS FOUNDATION TRUST
- Jim Mackey
- Liverpool Community Health Trust
- Manchester devolution plan
- NHS Improvement
- North West
- PENNINE ACUTE HOSPITALS NHS TRUST
- Primary care
- Ramsay Health Care
- ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST
- SALFORD ROYAL NHS FOUNDATION TRUST
- Service design
- Seven day working
- Simon Stevens
- Sustainability and transformation plans (STPs)
- WARRINGTON AND HALTON FT