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

Normal for north west London

There is every indication of something strange happening in north west London.

It would be perfectly normal for the accountable officer of a group of clinical commissioning groups to send a note to staff ruling herself out of applying for the role of AO across her own and a larger patch.

What was unusual about Clare Parker’s note to staff at the inner north west London CCGs was her reason, which boiled down to: there is too much to do in the day job.

To use her words: “Given the financial and performance challenges we are facing… that is what I need to concentrate on without being distracted by organisational changes.”

This is curious considering the new accountable officer will replace both her role and that of outer north west London AO Rob Larkman.

Both current accountable officers have exercised their right not to apply internally for the roles and could still apply externally (though it’s unclear why they would do this if they did want the job).

So whoever does take over the role will inherit a patch whose capital plan was knocked back by NHS Improvement and which is coterminous with an STP that wants to take out 500 beds whilst struggling with some of the worst A&E performance in the country.

Some quarters have tried to argue that the slew of senior departures from the patch is par for the course, but the churn only looks normal to a very churned up system.

Primary care trusts arrived in 2001 and lasted until around 2013. Even before their end, north west London had clustered its eight constituent statutory commissioning bodies, which was difficult for staff. When PCT abolition rolled round and CCGs and CSUs created, NWL saw further confusion in inner London as what was effectively Kensington and Chelsea CCG took over part of Westminster CCG.

Meanwhile, the PCT staff transferred to North West London Commissioning Support Unit had to be largely transferred back to the CCGs when they voted to cease using the CSU’s services in 2014. Providers complained this would lead to less uniformity across the patch as CCGs tried to vary their contracts individually.

But then STPs arrived and NWL got one of the more ambitious ones. After some toing and froing, the CCGs divided into two units whose two accountable officers – Ms Parker and Mr Larkman – replaced the eight individual ones. (Large scale provider mergers and reconfigurations were taking place at the same time, by the way; local authorities issuing judicial reviews to commissioners, etc.)

Now these eight individual statutory bodies are to have one accountable officer across them, in line with other parts of London.

The churn might explain some of the agency spending in the patch.

It’s maybe no surprise Ms Parker just wants to get on with her actual job.

Imperial succession

It’s been a rough couple of weeks for Imperial College Healthcare Trust. First the Royal Brompton announces it is looking to go over the river and take its clinical/academic/research weight and staff with it, to a landscape overseen by King’s College London, rather than Imperial.

Royal Brompton hopes all its professor-consultants will be allowed to maintain their connections to Imperial while working as part of a different academic health science partnership – but the implications for funding, research and similar have yet to be explored.

I wonder if the plans for an £800m new hospital just opposite the Houses of Parliament, built largely with the proceeds of the sale of the trust’s Chelsea site, were on Jeremy Hunt’s mind when he said the FT model needed to be scrapped (a move that puts him to the left of every health secretary of the last 25 years). Some systems might think it odd that such a significant sum of public money could be wielded outside the approval of the health minister. Other health systems with largely independent academic hospital groups, for example the Netherlands, would find it unremarkable.

But going back to Imperial’s woes, it was finally announced that Ian Dalton would be leaving the trust after a grand total of four months in the top job.

This is probably some kind of record for length of tenure, although it is perhaps merely unfortunate that the timings of the NHS Improvement chief executive came when they did. It is a bit of a slap in the face for an internationally renowned teaching institution and the kind of thing you can’t really imagine happening to, say, UCLH.

It would be interesting to know who interviewed Mr Dalton for the Imperial job and what they asked.

Either way, there is a consensus that Tracey Batten, his predecessor, left the organisation in a better position than she found it.