Essential insight into England’s biggest health economy.

Mother of the Virgin Mary

Following the bad news for north west London on capital (when NHS Improvement knocked back the area’s very expensively wrought reconfiguration plans) there is good news for north central London.

The mental health trust with the second worst estate in the capital looks set to be given the go ahead from NHSI for redevelopment.

Barnet, Enfield and Haringey Mental Health Trust looks after St Ann’s Hospital in Haringey. The building is, it’s fair to say, not fit for treating patients in.

I understand the outline business case for selling some of the land to pay for making it fit for purpose has been looked upon favourably.

But some things are still unclear.

Will the scheme’s housing be offered to NHS staff first? Sir Robert Naylor’s two reviews of NHS property (one released, one not) have called for NHS employees priced out of the capital to be given first dibs on new housing and a share in the equity.

Whether that happens remains to be seen, but either way it is a big step forward for a trust traditionally considered in the bottom three of the capital.

As well as this unhappy designation, BEHMHT has lack of foundation status – in common with West London Mental Health and South West London and St George’s. More tellingly, all three have been hobbled by a terrible estate, much of it pre-WW2. SWLSTG has made significant progress on improving its facilities at Springfield Hospital, Tooting, doing more or less what BEHMHT plans to do.

Alas, St Bernard’s in West London’s fiefdom remains probably the worst estate in London.

To be fair to these organisations, they serve the boroughs with traditionally low allocations from the centre; some research suggests that even from this reduced pot they were underpaid by their local commissioners.

By the by in north central London, I understand there is a view in some quarters that there don’t need to be as many mental health providers as there are there.

There are three: BEHMHT, Tavistock and Portman Foundation Trust and Camden and Islington FT.

Tavistock is a small, specialist trust. Perhaps Camden and Islington should be worried?

Also in north London, I understand the outline business case for partial sale and redevelopment of the Whipps Cross University Hospital has been sent to NHSI. It also wants central capital, about which more below.

Toothed Godot?

I have sometimes been a bit sceptical about devolution programmes. But London’s has been so delayed it must be consequential, right?

That must be what’s holding it up – daring new powers to let the local NHS, council and third sector really tear into the issues they face?

It seems unlikely the scheme will have significant teeth.

But this much delayed announcement is now expected before the budget and raises interesting questions.

I understand the devolutioneers want to be able to retain capital receipts locally.

At an NHS estates conference recently, a GP from Gateshead asked the panel what she was supposed to do in the North East, where lower property prices meant the service couldn’t simply flog some land to fund a rebuild?

The panel said whatever form national oversight of this issue took, it could send some of the loot from London land sales to other parts of the country.

But how could it if a devolved London is allowed to keep all that money?

And in that case, why should valuably landed London get any of the national capital budget?

It’s a complicated issue with lots of players on the field. Is it a good time to introduce another in the form of a devolved London health body?

NEL trouble and finance

It remains to be seen how the latest “one accountable officer to rule them all” over an STP footprint scheme will go.

The seven clinical commissioning groups of north east London have officially appointed Jane Milligan.

Her equivalent in north central London, Helen Petterson, is well regarded and oversaw a centralisation of accountability only slightly less fraught than the one in north east London.

But Whipps Cross news aside (see above) there are some big issues with providers on Ms Milligan’s patch. Most obviously the investigation into finances at Barking, Havering and Redbridge University Hospitals Trust.

The trust’s former finance director Jeff Buggle has become finance boss for NHS Improvement London.

Across the river, King’s College Hospital FT recently saw its finance director resign.

The trust has not published any financial information since early September, which is never a great sign.

The papers then showed an organisation with serious problems paying its suppliers and with a £41.1m deficit (£18m worse than planned).

King’s has had financial problems for a while but if it became south London’s BHRUT, then we’d be seeing a real change in the London health economy.

The HSJ Strategic Estates Forum is taking place on 20 March at BMA House in London. This is a high-level strategic forum that brings together estates directors, STP estates leads and trust board leaders responsible for the estates function who are developing strategic plans for their organisations and local health economies. The focus of the forum is on issues such as the delivery vehicle for the Naylor Report, the creation of Project Phoenix, advice on establishing SEPs (Strategic Estates Partnerships) and assessing progress of STP estates plans. Sir Robert Naylor, National Adviser, NHS Property and Estates; David Williams, Director General of Finance, Department of Health and Simon Corben, Head of Profession, NHS Improvement are all confirmed as keynote speakers for the event. Register your interest for this free-to-attend event on our website: https://strategicestates.hsj.co.uk/register-your-interest-attending