'CQC don’t want to hear about the pandemic'

Delays and uncertainty around the New Hospitals Programme are reaching the point where leaders are starting to go public with their frustrations.

Matt Makin, the medical director at North Manchester General Hospital, posts regular tweets about the difficulties of working in a former Victorian workhouse, sprinkled with clips of Boris Johnson pledging to upgrade the site.

Then, last week, Greater Manchester mayor Andy Burnham was more explicit, telling an online event: “I would fully understand how the pandemic has caused some disruptions to the new hospitals programme. Clearly, however, we are concerned about some of the delays that are entering this scheme…

“It’s now three years delay against the initial programme outlined by the Department of Health and Social Care in 2020, and already there’s a feeling the maintenance backlog, which has got worse, and inflation, have created a £100m impact on the scheme.”

He said there needs to be some new commitments made on delivery milestones and funding by the NHP.

NMGH is run by Manchester University FT, which is led by Sir Mike Deegan, who has long been close to Mr Burnham (a fellow Evertonian).

The hospital is among a group of eight projects that were originally supposed to be completed by 2025, but NHP’s demands for cheaper standardised designs, as well as inflation and rising construction costs, have led to uncertainty over the final project and the funding envelope that will be made available.

The trust’s vision, drawn up alongside the city council, is for an ambitious redevelopment that would not only provide a new hospital, but would help regenerate and bring economic growth to surrounding Crumpsall. The plans also include a new mental health unit, a ”well-being hub” with cafes and meeting places, an education facility, housing, and some commercial space.

But will this still be possible, once the final capital envelope is confirmed?

‘We don’t want to hear about the pandemic’

Leaders at the Countess of Chester Hospital FT will feel pretty aggrieved at the ”inadequate” rating they were given by the Care Quality Commission last week.

Analysis has shown the Countess was one of a handful of trusts which were disproportionately affected by the pandemic, yet this went unremarked on by the regulator.

NxNW has been told by staff that inspectors were uninterested in this context during their visit in February and March, with staff apparently being told “we don’t want to hear about the pandemic”.

The CQC clearly must judge services as they find them, but it does seem odd for the report and press release not to note this context, and perhaps acknowledge it as a mitigating factor.

Asked why this was, Ann Ford, the CQC’s director of operations in the North, said were several references in the report to examples of trust staff responding well to [general] covid pressures.

She added: “There is no doubt that the pandemic created significant challenges and an unprecedented level of pressure – something that is recognised in the press release issued alongside the report.”

This was a reference to a cursory statement in the press release which simply referred to the general pressures experienced across the health service, which read: “We recognise NHS services are under enormous pressure.”

Caesarian rates

As well as leadership at the Countess, maternity services were also rated inadequate.

An embargoed copy of the CQC report issued to media before full publication made reference to the trust’s caesarean rate being “worse” than expected – which is language now discredited by the work of Donna Ockenden, who found high caesarean rates were being used in a far too definitive way to indicate poor quality care.

After being questioned on this, the CQC said it was an error that was spotted before full publication. A spokeswoman added: “We don’t inspect against caesarean targets or view low numbers of caesarean rates as a positive indicator.”

MRI hit

The sudden closure of Rutherford Health will have some direct impact on NHS cancer services in Merseyside, as some of its MRI capacity was being subcontracted by Liverpool University Hospitals.

The trust says its subcontract with the nearby cancer centre accounted for less than 5 per cent of its activity, and thankfully, MRI scanning is not one of the tests for which there are large backlogs in Liverpool.

LUH said there would be no impact on patients, saying scans will be rearranged in house while it seeks an alternative provider. The clinical commissioning group did not have a contract with Rutherford.

There could also be an indirect impact, if the cancer centre’s private patients now seek care on the NHS instead, although maybe LUH can swoop in to recruit its staff.

The closure also leaves a significant hole in the city’s budding ”Knowledge Quarter”. The council did not respond to requests for comment on that.

Tricky dynamic

Surprisingly, for a system that was an early adopter of the integration agenda, Greater Manchester will have some catching up to do over the summer. 

The integrated care board still feels like a shell of the old devolution team, and unsure how it’s going to operate.

Chief executive Mark Fisher does not start properly in post until July, while the ICB has been slow to appoint the place directors (it’s now been confirmed the posts will be filled on a joint basis by the council CEOs in eight boroughs, with Bolton FT chief Fiona Noden taking the post on a joint basis in Bolton, and Oldham CCG’s accountable officer Mike Barker taking the Oldham post full time).

Mr Fisher, a Whitehall official who has been leading the Grenfell inquiry, could face plenty of ”that’s the way we do things here” once he arrives, particularly from a provider collaborative which has spent the last two years getting used to certain ways of working.

This will be a tricky dynamic for Mr Fisher to manage, as he’ll surely want to put his own stamp on things. His relationship with the two long established knights; Sir Mike Deegan, who leads the provider collaborative, and Sir Richard Leese, the ICB chair, looks critical.