Published: 21/03/2002, Volume II2, No. 5797 Page 11 12
The chief executive is on his way and the long-running cull at University Hospitals Coventry and Warwickshire trust appears to have witnessed its final act of blood-letting.
By the time David Loughton goes, when his replacement arrives by order of the government's controversial franchising scheme, virtually all the top board will have been replaced along with other senior managers at the trust.
Mr Loughton himself leaves the trust after 16 years in the knowledge that however tarnished his reputation, he has been responsible for its university status and its much-needed£330m private finance initiative hospital when the contracts are signed next month.
Last week's Commission for Health Improvement progress report - on which the future of the trust depended - perhaps fell short of giving the trust a 'clean bill of health' as some of the trust's managers claimed that it would.
Patients will be glad to know the practice of putting a fifth bed in a four-bedded bay had come to an end. Condemned by the first CHI review team in September last year, work on the problem was already underway and has now been resolved.
'Satisfactory progress' was also made on the high death rates for non-emergency admissions. CHI said a considerable amount of work had been carried out in reviewing mortality data with the positive involvement of lead clinicians.
Frontline staff, too, were praised for the organisation of the two accident and emergency departments, although concerns were expressed that the trust still lacks a clear plan for reorganising emergency services. But the central criticism goes back to fundamentals - the relationship between managers and consultants.
CHI believes there is still considerable progress to be made.
Allegations of a breakdown in confidence between consultants and Mr Loughton is probably central to the Walsgrave story.
And with the golden halo which usually surrounds the media's coverage of doctors, central casting was always going to result in the chief executive being hired as the required Mr Nasty.
It quickly put into motion the train of events which ultimately led to his downfall. Six local MPs called for his head, his job was discussed on the floor of the Commons and suddenly he became a political issue. The wounds still bleed, as last week's HSJ's interview with Mr Loughton made clear.
It is ironic that he could take some comfort from the strongest line found in CHI's progress report: 'Limited progress has been made to address poor relationships between some consultant medical staff and senior managers and we remain concerned at this.
CHI found further evidence of two clinical service teams where there was significantly dysfunctional team-working.'
The Department of Health's best argument supporting its decision to franchise Mr Loughton's job is widespread recognition of the existence of a small minority of consultants who are still unhappy with toplevel management.
Mike O'Brien, Labour MP for North Warwickshire and one of the MPs to sign the letter calling for Mr Loughton to stand down, said: 'I think that his dictatorial approach was effective in making necessary changes. But there were too many broken relationships at the trust and I think David just stayed on too long.'
But the CHI quotation also points at something else. Gone are the references to 'aggressive' management. There is no attempt to attach blame to one side or the other. There is also that stress on a 'small' number of consultants and no mention of senior staff feeling too 'intimidated' to raise concerns.
As one manager at the trust told HSJ last week: 'Perhaps CHI finally realised that dishing out blame is never that simple when dealing with the complexities of what are messy relationships.'
There is still considerable anger within the trust at CHI for what is seen as an attempt to 'destroy' its reputation. Although strongly denied by CHI itself, some staff allege that a lack of experience led the initial review team to give undue weight to the views of a small group of consultants.
As one consultant told HSJ: 'A minority of consultants were unhappy. They accused the management team of bullying tactics.
This is hard for me to say without being misquoted, but they were widely seen as being responsible for the sort of bullying themselves which they said they saw from management.
'I am part of a multidisciplinary team, and to be honest I do not see that there is a divide between managers and clinicians. I am just as much a manager as anything else and that is not an exceptional view here at the trust.'
Even if the splits between consultants and managers have been exaggerated by a small group of doctors, the more important question for the trust now is whether franchising announced by health secretary Alan Milburn is going to bring an end to the squabbling.
The Walsgrave consultant said: 'The concern about franchising is that many of us simply do not know how It is going to work. It is creating a lot of uncertainty and the fundamental thing is that change in the right direction is already being made. Now it looks as though we are going to get new management from outside. It has been politically driven from above, and that is not good for the running of the hospital.'
Trust chair Bryan Stoten, the NHS troubleshooter brought in last November to sort out the problems at Walsgrave, disagrees: 'I think given the size of the trust and the skills needed, any new chief executive was always going to be brought in from outside.'
It is a view supported by Mr O'Brien: 'I do not think that the franchising is going to make much difference. It is only going to be the chief executive's post, rather than the entire management team, and most of that has been disappearing anyway.'
He added: 'The trust has the potential to be one of the best teaching hospitals in Europe.'
And perhaps in a tacit tribute to his old foe Mr Loughton, he added: 'We have university status and we are finally getting a PFI [hospital]. I am very optimistic.'
Coventry community health council chair Rosemary Tonkinson said she was happy to see that Mr Loughton had decided to leave. She was among the voices calling for him to go when CHI published its review findings last year. 'I would have liked to have seen him leave then, ' she said. 'To be fair to the trust, since the arrival of Bryan Stoten there have been significant improvements in our relationship with the trust.
'Certainly we are not CHI and they can ignore our reports, but we hope they will take on board our concerns.
'We were making many of the comments about the problems with the trust well before CHI's critical report came out last year which basically confirmed what we had been saying.'
The next big event will be the second set of star-ratings, due out in the summer.There will be a sense of relief that a chapter in the trust's history has closed.
But perhaps there is concern, too, that CHI - the organisation one senior manager accused of 'attempting to destroy the trust' - will decide how many stars the trust will get second time around. l