Essential insight into NHS matters in the North West of England, with a particular focus on the devolution project in Greater Manchester. By Lawrence Dunhill

Welcome to North by North West

This is the fourth edition of HSJ’s new email briefing on health services in the North West of England.

North by North West will take an in-depth weekly look at one of the NHS’s most challenged and innovative regions. There will be a particular focus on the devolution experiment in Greater Manchester, but my scope will also include Merseyside, Lancashire, Cheshire and Cumbria.

Please get in touch to let me know how I can improve it, and to tip me off about stories you think I should cover: If someone forwarded this to you, sign up to get your own copy here

A handy scapegoat

Introducing a national wage cap for agency doctors and nurses was always going to have unintended consequences, and perhaps the first major impact has been felt in Lancashire.

Chorley’s accident and emergency department was downgraded at short notice on Monday, after Lancashire Teaching Hospitals Foundation Trust said it could not recruit enough doctors to staff it safely.

According to the trust, some of its regular locum doctors were enticed to work elsewhere by hospitals either breaching the cap, or offering benefits “below the radar”. Local sources tell me complaints had previously been made about medics being persuaded to work in Greater Manchester.

But beneath this, I imagine there’s more than a hint of relief among Lancashire’s health leaders, who were already bracing themselves for a bruising reconfiguration and public consultation process.

Consolidating emergency services at the Royal Preston Hospital always looked a likely option, and the national wage cap could provide a very handy scapegoat in the face of inevitable local outrage.

Suddenly that ferocious public meeting at Chorley town hall feels far more manageable.

They can stand on the stage and confidently point at national policy, recruitment difficulties, staff shortages and patient safety.

Campaigners can be told to direct their ire at the Department of Health and those naughty trusts that didn’t “hold the line” on agency pay.

If that’s the plan, regulators are unlikely to play ball, and NHS Improvement fired back on Friday by pointing out that there is a “break glass” clause which allows trusts to breach the cap if needed to ensure patient safety.

But the exact moment where it becomes appropriate to break the glass was always going to be tricky to define. It’s no surprise that a trust like Lancashire Teaching Hospitals – which has conditions on its licence due to financial concerns – feels less able to breach the cap or to get creative with the rules.

Meanwhile, I wonder if there’s some extra back-slapping at the DH as they realise that the agency cap is not only driving down costs, but is also starting to deliver much needed reconfiguration by the back door.

Where’s Hugh gone?

There is more upheaval it seems at Pennine Acute Hospitals, where the director of operations has mysteriously been replaced.

The trust announced in its board papers that chief nurse Gill Harris is now combining both roles, without saying what had happened to the Hugh Mullen.

The trust has refused to comment. Mr Mullen’s apparent replacement follows serious performance concerns, as well as an inspection by the Care Quality Commission which is expected to be critical of the trust’s emergency services.

Liverpool v Manchester

The national controversy over cardiac surgery has been largely out of the headlines since 2013, but more than two decades on from the Bristol heart scandal the issue is still a long way from being resolved.

Only four of the 11 centres in England that perform child heart surgery told HSJ that they meet the new standards being implemented by NHS England, with the others aiming to comply by 2021.

It’s widely accepted there needs to be fewer surgical centres, however, which means a difficult decision still needs to be made.

One HSJ reader complained: “Every secretary of state since Bristol has ducked the issue. Now we have NHS England doing the same. There are not enough cases for every unit to meet the proposed standards.

“Yet instead of making a decision, NHSE are going to allow units to try and meet the standards, knowing it is impossible. Interesting to note that 2021 is just after the next election.”

Alder Hey Children’s Hospital in Liverpool and Central Manchester Hospitals FT are both bidding to host a specialist site, and could be competing to be one of three centres in the north of England.