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

New leadership for Imperial

A new permanent chief executive will hopefully bring a period of stability at Imperial College Healthcare Trust.

The west London giant has seen significant churn at the top of the board since Tracey Batten announced her departure in January 2017.

Tim Orchard will take the reins well aware of the trust’s internal issues, as he is medical director of the medicine and integrated care divisions.

Imperial’s place in the wider health economy is a more delicate issue.

It has fallen behind neighbouring Chelsea and Westminster Hospital Foundation Trust in terms of influence in the sector. Plans for leading a potential hospital chain or integrated care system would be more likely to be led by Chelsea and Westminster than £1bn+-turnover Imperial. The planned move of Royal Brompton and Harefield FT south of the river to St Thomas’ is also potentially a blow to the north west London clinical/research system.

Chair Sir Richard Sykes is due to leave at the end of this year, having had his tenure extended by 12 months around the time Ian Dalton was poached from his role as Imperial boss to go to the top job at NHS Improvement.

London Eye was told the trust was not deluged with applicants for the chief exec job. The headhunting firm which supplied Mr Dalton first to the trust, then to NHS Improvement, worked for free to replace him – but clearly an internal candidate was ultimately the best one on offer.

Imperial faces a number of knotty estates issues as well as the finance, performance and staffing problems encountered across the NHS. Backlog maintenance is an area where it is a significant outlier. The new management team must also address the relocation of the Western Eye Hospital, negotiations around Ravenscourt Park Hospital, and the question of whether it could do something more radical with its estate altogether.

London Eye understands Sir Robert Naylor’s as-yet unpublished second report on NHS estates makes some bold suggestions around ICHT, and the Mayor’s office has recently shown it is prepared to actually get stuck in on this front.

One last thing on community services…

London Eye tries not to be too naïve about things and readers’ insights are a great help with that.

In the last column I speculated about why the Royal Marsden, a world renowned cancer specialist, would ever have wanted to get into providing community services in Sutton.

(NB: It is now, anyway, removing itself from this responsibility, with the work due to go instead to the local acute trust).

It may be that Royal Marsden’s stated ambition with this proposal – to integrate care better between the community and tertiary cancer services – was indeed the whole truth, but someone commenting on my previous piece makes an alternative suggestion.

Who ran what in community service terms was decided around 2010 to 2012, before the passage of the Health and Social Care Act. One of the things the HCSA did was liberalise the amount an FT could make from private work. The Marsden was and remains the NHS organisation with the biggest private income. The new law said a trust could earn up to 49 per cent of its income from private work but that increasing the non-NHS turnover by 5 per cent or more of total turnover required a governor vote.

Increasing the trust’s NHS income from a community services contract has the happy side effect of increasing its total income (the denominator in these calculations) – therefore increasing the sum it can earn privately (the numerator) without getting too near the 49 per cent figure, or having to call a meeting of the governors.

The 2016-17 accounts put the trust’s private income at £91.9m out of £292m.