North by North West: Thousands of staff set for redeployment

Mass redeployment

Vaccinating all adults by the end of the month is quite the ask, and the prime minister has already admitted some routine services will be affected.

In the north west, it is hoped the vaccination programme can more than triple the number of doses being delivered, from just over 300,000 last week, to more than a million by next week.

Achieving this will mean redeploying thousands of staff from non-urgent elective care to help with the vaccine effort. So, we can expect some quite widespread cancellations of priority three and four cases (which are supposedly safe to defer for up to three months/at least three months, respectively).

More detailed guidance is expected to be sent to systems this afternoon.

What the waiting lists will look like come the end of winter is now anyone’s guess, especially if omicron leads to a substantial rise in hospital admissions.

Missed opportunity 

Over the last few months, leaders in Lancashire have been carrying out an engagement process around the so-far-very-vague plans to upgrade or replace two of its acute hospitals.

A long list of options was published in the summer, including to replace Royal Preston Hospital and Lancaster Royal Infirmary with one or two new-build hospitals on different sites.

In reality though, the funding envelope which the government has made available, as well as the political calculations that must be made, mean the viable options are extremely limited.

For example, there would be too much local opposition to replacing RPH and LRI with a single new super hospital halfway up the M6, between the current sites. The government’s ‘40 new hospitals’ programme is supposed to be saving the day, not provoking ‘save our hospital’ campaigns, so ministers are never going to back this option.

Two new hospitals closer to the current sites would be far more palatable, but the £1.1bn total capital allocation is unlikely to be enough for that.

The best option from a clinical and financial point of view would be to upgrade LRI on the current site, and then build a completely new hospital to replace RPH.

This could address the elephant in the room, which is the fragile Chorley and South Ribble Hospital, because its acute services could then be consolidated into the RPH’s replacement, which would ideally be sited between Preston and Chorley.

This would likely be supported by Sir Lindsay Hoyle, the MP for Chorley and House of Commons speaker, as it would not be viewed as Chorley losing services to Preston.

But with rising construction costs and the budget headroom which must be built into business cases, there seems a good chance this would breach the budget as well.

So, unless more money can be secured (very difficult, as every system in the country is competing for a limited pot of cash), we are left with upgrades on the current LRI and RPH sites (and no change to Chorley).

This would be a huge missed opportunity, as it would leave one of the ICS’s biggest headaches unresolved.

A few years ago, I was told keeping Chorley’s A&E — and all the supporting services which that requires — costs the system around £25m per year. With an underlying deficit of more than £300m, those are costs that L&SC really cannot afford.

The clinicians relied on to keep both Chorley and Preston running will also be dismayed if the current configuration is confirmed.

Shared intent

A few weeks ago, I wrote about the fragility of services at East Cheshire Trust, and how its future probably lies with a form of shared leadership, leading to merger, with Stockport FT.

The foundations of that process are now being laid, with staff at both trusts sent a “statement of intent” last week.

The memo, seen by NxNW, said: “This statement signals our intention to support clinical teams to continue working together to develop a joint clinical strategy that sets out new, single clinical pathways, as well as innovative solutions to best meet the growing care needs of our local populations.

“Initial consideration is being given to opportunities within the following services; general surgery (including endoscopy), women’s and children’s services, trauma and orthopaedics, critical care, cardiology, imaging, gastroenterology and diabetes & endocrinology…

“This is the start of a much broader conversation and whilst there are steps we need to take now, jointly, to address demand, we will be listening to our staff, patients, public and other key stakeholders to ensure they are at the heart of this work.”

Separately, according to a report to the trust’s board this month, finance director Ged Murphy is standing in as interim CEO at East Cheshire, while permanent chief John Wilbraham takes a period of planned sickness absence.

Liverpool rejected again

There was a major disappointment for health researchers and NHS leaders in Liverpool recently, with the city again missing out on national funding for a biomedical research centre.

Liverpool University Hospitals FT is the largest trusts in the country which does not host a BRC, which is seen as crucial to building the foundations of a major research hub and attracting private investment.

England has around 20 BRCs, with centres awarded that status every five years by the National Institute of Health Research, which means they share a funding pot of more than £800m. Liverpool has been trying for many years to secure some of this funding, and the all important creditation.

But the latest joint bid between LUFT and the University of Liverpool, for a BRC focussed on infectious diseases, didn’t even pass the first stage of the two-stage process.

In a joint statement, the bid team said the outcome was “extremely disappointing”.