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

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Welcome to London Eye

This is the second edition of HSJ’s new email briefing on the NHS in London.

London Eye will feature a look at what’s going on in England’s biggest health economy. London has the best and worst regarded hospital trusts in the country. It has excellence and dysfunction in commissioning and primary care. I will cover all of this.

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:

In future this email will only be available to HSJ subscribers. Subscribe here.

2012 all over again?

PCT clusters are back!

Remember when Ruth Carnall proved how far ahead NHS London was by clustering PCTs ahead of the national deadline? London was divided into five sections (three in the north, two in the south).

Well, dust off the coalition government-era maps because that’s exactly the shape London’s STP footprints will be.

A sustainability and transformation plan footprint is the sack into which providers, commissioners and local authorities are being put to get along. Specifically they will pool deficits (which is quite a big deal).

Each one will be ruled by a triumvirate comprising one provider chief executive, one CCG lead and someone from a local authority. One of them will take overall responsibility for the area.

So going anticlockwise from north central London, here is a rough breakdown of who is doing what:

  • North Central London comprises well funded Camden and Islington plus traditionally financially challenged Barnet, Enfield and Haringey. The senior responsible officer for the patch is Dorothy Blundell, the chief officer for Camden. The provider lead is likely to be Royal Free London boss David Sloman. Nothing is known of the local authority chief.
  • North West London has eight CCGs and has kept a degree of continuity from the PCT clustering days thanks to its Shaping a Healthier Future programme (this is a fairly ambitious reconfiguration programme whose outcomes are being protested in some boroughs to this day).
  • Clare Parker, the chief officer for the Inner North West London CCGs, is understood to be leading this STP footprint with either Imperial’s Tracey Batten or London North West Healthcare Trust’s Jacqueline Doherty being provider lead. Nothing is known of the local authority chief – and this decision could be awkward given several of the Shaping a Healthier Future reconfigurations.
  • South West London is not as far advanced as north west or north central London, and my contacts said none of the leader roles had yet been filled. The footprint’s providers include Croydon Health Services Trust, which can sometimes find itself lumped in with south east London.
  • South East London is either more or less advanced than south west London, but definitely more secretive – no one will say anything. Leaving just north east London, which has also kept its cards close to its chest.

Whether these footprints will have a real impact remains to be seen Their configuration has proved contentious in other bits of the country with some trusts complaining about being grouped in with trusts with whom they have no real connection. In London a big issue will be the large and specialist hospitals, many of whose patients don’t come from within their STP patch anyway.

Some providers are in multiple STP patches, making the requirement to share deficits a bit interesting.

Interested to hear your thoughts on STPs within the M25 - it needn’t be attributed. Email

See the full national map here.

Good news from Barnet

Some good news in Barnet: the CCG has appointed its first substantive chief officer since the departure of John Morton.

Cathy Gritzner starts at the beginning of April and comes to an organisation that has seen significant governance problems, to say the least.

This week The Times covered HSJ’s work on the allegations about conflicts of interest made by a whistleblower shortly before he was dismissed.

The paper’s leader column called for national changes to the CCG system in order to avoid the kind of issues revealed in Barnet.

A big loss for Imperial

Imperial College Healthcare Trust is having a significant management upheaval.

The huge teaching hospital trust recently completed a consultation with staff on changes to its management structure that will see three clinical division directors report directly to the chief executive. The directors will be full members of the executive management team.

This will obviate the need for a chief operating officer, and the trust’s COO of four years (and deputy chief executive of two years) Steve MacManus is leaving.

The organisation went out of its way to sing Mr MacManus’ praises, crediting him with turning around cancer performance and establishing the clinical divisional structure.

If his next role is outside London it will be a big loss.