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

In the doldrums

So it looks like it’s farewell to Jonathan Parry, the long serving chief executive of Southport and Ormskirk Hospital Trust.

Mr Parry has been dismissed for gross misconduct following a 15 month disciplinary process, though he plans to appeal the decision.

The trust has never disclosed the nature of the allegations about him, and is unlikely to do so while any appeal or potential employment tribunal is in the offing.

Unfortunately for the trust, it doesn’t sound as if Mr Parry is going to walk away, which means the case is set to drag out even further.

The whole process has been led by chair Sue Musson, who has probably had one of the toughest years she’s likely to have in her career.

There can’t be many NHS chairs who have sacked their chief executive, and perhaps understandably she has opted for a move to Lancashire Teaching Hospitals FT, rather than attempting to lift SOHT out of the doldrums.

So with the trust now on its third interim chief executive since Mr Parry was excluded last year, the disciplinary process set to rumble on, and the chair set to leave, the road to stability looks a long one.

On top of this, the trust must deal with multiple performance issues, the prospect of losing two key community services contracts, and deep financial problems.

Not to mention further concerns from the Care Quality Commission, which HSJ understands will publish a not very encouraging inspection report in the coming months.

Similarly to Wye Valley Trust in Herefordshire, we could see plans for SOHT to be buddied or taken over in some form by another trust.

St Helens and Knowsley Teaching Hospitals Trust looked to be one potential suitor, especially when chief executive Ann Marr took over temporary leadership at SOHT (this arrangement ended in May), but St Helens may need to secure FT status first.

So it will be interesting to see what comes up in the local sustainability and transformation plans, not least because SOHT sits awkwardly on the border between Lancashire and Merseyside.

Getting STP ready

But from the sounds of it, we won’t be seeing those STPs for a while. Full plans had to be submitted to NHS England on 21 October, and we’ve seen four published so far, but nothing so far from the North West.

It sounds as though the Cheshire-Mersey and Lancashire STPs will only publish summary documents initially, in line with NHS England’s much criticised communications strategy.

These were always going to be tricky areas, partly because of the size of the patches. Lancashire has always operated as four or five distinct health economies, which leaves the county council quite a job on its hands to feed into each of the areas.

There is scope for good progress to be made in the north, however, with the development of an “accountable care organisation” in Morecambe Bay.

This gives the council an opportunity to test out a new model, for adult social care staff to transfer into the ACO and a joint commissioning body formed with Lancashire North CCG.

Meanwhile, Cheshire and Mersey is the third largest STP, and we could well see a split into three or four areas.

Greater Manchester is a special case, of course, as its five year Taking Charge plan was published last December. It’s submission offered an update on the work.

Given the national controversy around the plans, communications chiefs for the devo project will no doubt keen to distance themselves from the STP brand.

Warrington’s last ditch attempt

Defining and delivering robust primary care services will be key to STPs, but there have been worrying questions over the future of one of pre-eminent GP enterprises in the North West.

When it was established, Warrington Health Plus was described as a “last ditch attempt to save primary care”, and has received more than £4m of national transformation funding to develop and improve services.

So news that an internal report from new chief executive John South has raised concerns over its finances, future direction and local relationships is undoubtedly a blow to the wider health system, and may drain confidence from CCG and GP leaders in other health economies.

I’m hearing Trafford is now the place to watch for primary care in terms of scaling up and new organisational forms. Hopefully more on this in the next few weeks.

End to decade long wrangle

Another significant development came from Greater Manchester last week, with Salford Royal Foundation Trust chosen as the single site for upper gastrointestinal cancer surgery.

While the choice of site is not surprising, the acceptance of the decision by the two Manchester FTs is somewhat momentous.

Efforts have been made to consolidate this service for more than a decade, with each provider previously unwilling to relinquish the service.

Early test for devolution team

Meanwhile, one of the top agenda items for the devolution leaders will be sorting out the crisis in paediatric dentistry services.

Children in Greater Manchester currently face waits of up to a year for tooth extractions under general anaesthetic, largely due to a shortage of paediatric nurses.

There are more than 1,500 children on the waiting list across all providers, with problems exacerbated by the cancellation of four lists per week at Fairfield Hospital in Bury.

Efforts between providers to manage and create spare capacity between providers have so far fallen short, leading Pennine Care FT to “escalate” the issue to national leads at NHS England.

This appears to have helped move the issue up the priority list, with devolution leaders now drawing up a detailed action plan. It will be one of the first real tests of Jon Rouse’s team.

Mental health ratings

There have long been concerns over the poor state of mental health services in Greater Manchester, and this has been borne out in the first official ratings published by NHS England.

For now, the ratings only incorporate performance against early intervention in psychosis and improving access to psychological therapies targets.

Stockport, Rochdale, Bury and Tameside were among 21 CCGs in the worst of four categories, which gives an indication of the problems at Pennine Care FT, their main provider.

I’m surprised the Manchester CCGs weren’t also in this category, given the long-standing problems at Manchester Mental Health and Social Care Trust.

Trafford and South Cheshire were among the eleven CCGs in the top category.

Tender process delayed

Meanwhile, there is increasing controversy around the breakup of Liverpool Community Health Trust, with the Liverpool Echo getting hold of leaked documents which suggest Liverpool CCG is seeking to save £5m from community services in the ongoing tender process.

With LCHT being disbanded, it’s likely that commissioners have envisioned some economies of scale.

But according to the Echo, the leaked documents warn the majority of the cuts will lead to reductions in front line services.

This puts the CCG in a tricky position, especially if they were minded to opt for the cheaper bid (from Bridgewater Community Healthcare FT), and the process has now been delayed for at least four weeks.

Good news

Congratulations to The Walton Centre, which has been given an outstanding rating from the Care Quality Commission following a recent inspection. The specialist brain and spinal trust, based in Liverpool, is only the ninth trust in England to receive the top overall rating.

North by North West takes an in-depth fortnightly 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.

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