Essential insight into England’s biggest health economy, by Ben Clover

Property is theft?

Poor old foundation trusts. Created in a blaze of reformist zeal to give organisations the freedom to innovate in the same way as, er, universities (freedom to set our own tuition fees!).

Now, with Simon Stevens foretelling the abolition of the purchaser-provider split, STPs making other trusts’ deficits your problem and Jim Mackey demoting you to a position of middle management, it’s no fun at all.

And FTs were allowed a degree of financial independence on things like investing the proceeds of their land sales.

It was that exact manoeuvre that made UCLH’s Sir Robert Naylor famous in the NHS. And it is Sir Robert whose property review will soon be identifying to the Treasury the sites that are most floggable. (I say “floggable”, I mean “used as part of an estates partnership with a private firm that can attract the investment to develop the site so that it makes more money for the NHS than a straightforward sale would”).

One rumour is that at next week’s budget the Treasury will announce plans to match NHS land sales, pound for pound. Given how popular the overspending NHS is with HMT, it wouldn’t be a surprise if that was all the capital the NHS was going to get.

What’s an FT to do if it had its own capital plans?

Well, you could try what one specialist trust did a couple of years ago, and get the local authority to designate land as “for health use only”.

We have heard more organisations have been doing this.

Clinical harm from lost patient records?

NHS IT: a confluence of acronyms with an inglorious history.

So we return to an organisation with an array of problems – St George’s University Hospitals in south London has some severe IT worries.

London Eye mentioned last week that there was no chief information officer at the trust – that’s what its risk register said – when in fact Larry Murphy has been in post nine months. They just hadn’t updated it.

We asked the trust to confirm whether the rest of the risk rating warning was accurate – that there was no deputy CIO or IT operations officer, and that this risk was “extreme” – but there was no answer.

This level of uncertainty about IT at the trust is worrying, given the rest of the risk register.

This mentions: system licences for the trust’s Windows XP computers expiring; the risk of losing data to ransomware; and an “almost certain” “catastrophic” risk of IT infrastructure failure.

There are also clinical issues pressing on the organisation, which should have a new chief executive soon.

When St George’s lost a huge amount of patient data it was forced to carry out clinical harm reviews for the patients concerned.

There are lots of these kinds of reviews when patient records get lost, and they tend to conclude that no real harm was done.

Let’s hope that is the case in SW17.

Following Manchester?

We expect news soon of further devolution for London. George Osborne announced something a bit wispy on this in December 2015 – will the coming announcement say anything more substantial?

London Eye stands to be corrected but will guess: no.

Whatever the memorandum of understanding says, can the competing power interests of more than 30 local authorities, as many CCGs, specialist trusts, DGHs, four Shelford Group members, mental health providers, the STPs, primary care providers, the community health trusts, the private community health providers, NHSI and NHSE, The Mayor’s Office, London councils, professional groups and the public be reconciled?

Obviously not.

Devo Manc looks, from down here, like an as-yet-unrealised-commissioning-superstructure that may or may not exert any influence at all on the two big providers taking over everyone else.

Maybe something small and realisable will be announced soon for London, we’ll see.

London Eye features a look at what’s going on in England’s biggest health economy. London has the best and worst regarded hospital trusts in the country. It has excellence and dysfunction in commissioning and primary care. I will cover all of this.

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