North by North West: Outsourcing, the Moors murderer, and £260k-a-year

Outsourcing time

Regulators’ annual instructions on how to avoid a winter crisis – by opening more acute beds - were received with an ironic handclap by many hospital leaders last week.

Those spoken to by NxNW would love to have staff available to look after more beds, or the money to pay for new recruits.

Without having more hands on deck, increasing a hospital’s bed capacity creates a risk of staff being too thinly spread. They then have less time to spend on tasks that are crucial for patient flow, such as getting medically fit patients discharged in good time.

Although agency staff could be brought in, they will obviously come at a premium - forcing many trusts to bust their budgets, and therefore miss out on incentive payments.

The main strugglers on the four-hour emergency care target (including Stockport, Mid Cheshire, Wirral and St Helens) have likely been having follow-up meetings/phone calls with Bill McCarthy’s regional directorate team – and will surely be making these points.

So, Mr McCarthy will need something to offer.

Rather than a blanket allocation of new funding across the country – as in previous years - the regulators more likely to hand some extra money (or budget loosening) at organisations that can feasibly raise capacity in a way that improves their performance.

This could mean bringing in more staff to cover the extra beds, or perhaps more likely, by outsourcing more elective activity to private providers to free up capacity.

Transformers in disguise

Alan Yates, a respected NHS-chief-executive-turned-management-consultant, has been appointed as non-executive chair of the Cheshire and Merseyside Sustainability and Transformation Partnership.

The former Mersey Care boss will have his work cut out - in a region that still looks like a Transformer Robot unable to figure out its alternative form.

Mr Yates will now oversee the appointment of a new executive lead. But will anyone want the job?

Maybe – if they can offer the sort of money received by Mr Yates’ substantive predecessor, Andrew Gibson, who received £150,000 as part-time executive chair (Mr Yates will get £60,000 as non-executive chair).

Mr Gibson’s salary equated to about £260,000 on a pro-rata basis – not bad considering the highest paid trust chief executive in the region last year (Joe Rafferty) earned around £210,000.

With many things you do get what you pay for, and Mr Gibson would no doubt point to the work he did get local leaders to accept the STP footprint (which NHS England insisted on) and to persuade local government to come to the table.

Others I’m sure would disagree, and perhaps highlight the region’s failure to make progress on the sort of collaborative projects STPs were supposed to engender, or in confronting major reconfiguration decisions.

Sharing headlines with Ian Brady

Speaking of Mersey Care, last week the trust’s chair Beatrice Fraenkel found herself splashed across the Liverpool Echo alongside Moors murderer Ian Brady, in one of the more bizarre stories of the year.

Robin Makin, who was Brady’s lawyer and will know Ms Fraenkel from his client’s time at Mersey’s Ashworth Hospital, has launched a private prosecution accusing Ms Fraenkel of misrepresenting herself as a solicitor. So far there’s just been an initial hearing at Liverpool magistrates court, with no plea entered. The next hearing is in December.

In a statement the trust told HSJ the allegation related to an admin error in last year’s annual report, which incorrectly described Ms Fraenkel, who is an industrial design engineer, as a “solicitor and notary”.

Thick skins

Lancashire Teaching Hospitals has received its fourth successive “requires improvement” rating from the Care Quality Commission.

Problems persist in the medical and emergency care at Royal Preston Hospital, but crucially for the board and senior management, the trust’s leadership has been upgraded to “good”.

Considering where LTH was 18 months ago – when four senior directors resigned in quick succession – this represents a significant achievement for chief executive Karen Partington and her senior team, who have had to develop some pretty thick skins over the last few years.

The inspectors praised the “culture” that’s been fostered across several specialties, saying staff felt respected, supported and valued, and were able to raise concerns without fear.