What is going on in England’s biggest health economy, by Ben Clover

Vascular problems at St George’s

Big news from HSJ’s Will Hazell this month about the suspension of the most senior vascular consultant at St George’s.

While Professor Matt Thompson is still suspended and the outcome of an investigation pending, there is some fallout that can be talked about now.

For one, it is a significant step that Guy’s and St Thomas’ have been asked to send a team in to run (possibly to help run, but probably run) vascular services in the meantime.

Guy’s and St Thomas’ is gradually expanding the branded services it offers at other sites but this is quite a dramatic version of that.

How long this team from SE1 stays in place and what it means for the way St George’s works with its larger specialist trust neighbours remains to be seen.

The Tooting trust has long had to wrestle with whether it is a major tertiary trust like the other London specialists or if it is a large regional centre, a Southampton. There is a difference of opinion within and outside the trust and we won’t know for a while how this dispute plays into it.

St George’s is an organisation with most kinds of problems you can think of (former interim chief executive Paula Vasco-Knight now faces fraud charges, it has significant cash and performance problems, governance has been so poor that the trust didn’t know how much work it had outsourced to the private sector).

There is ongoing debate about whether the new chair, Sir David Henshaw, is moving the trust in the right direction yet.

NEL surprise

London Eye wrote about the Care UK/NHS Improvement £55m mystery at some length last week (in short, when north east London clinical commissioning groups gave an elective contract to the NHS trust rather than incumbents Care UK, Care UK challenged. Ten months later, rather than NHS Improvement issue a judgement – as the process would suggest it should – a perhaps-leant-on bunch of commissioners withdrew the award and arbitrarily extended Care UK’s contract, with a strange excuse).

Since then the situation has moved on in an unexpected way.

Havering CCG – which coordinates elective care for the NEL commissioners – is about to be handed legal directions by NHS England in relation to planned care waiting times.

Being given directions isn’t being put in special measures (that’s not an actual legal term for CCGs) – it is a more significant admonishment.

Which is odd.

Havering CCG’s miraculous, belated realisation that there were waiting times issues at the local provider spared the blushes of NHS Improvement/the-centre-more-generally (this was the pretext they used for taking back the award of the contract and suddenly giving it to Care UK instead – but that issue has been well known by everyone for ages. And it could be argued the trust’s waiting times problem can only be solved by giving them the capacity at the North East London Treatment Centre).

So why has NHS England suddenly got heavy with the CCGs? Will they too claim they only just realised something that has actually been an issue for some time?

No doubt there is more to say on this in the future.

The GOSH 8,000

Talking of waiting times, when HSJ revealed in February that there were serious data issues at Great Ormond Street it wasn’t clear how deep the problems went.

What we now know is that the data validation exercise has cost the trust an astonishing £2.5m. That’s just to check the data – not treat anyone. There have been 90,000 clinical pathways checked and 8,000 patients added to the proper waiting list.

Whether children came to harm as a result of the trust’s archaic booking and tracking system is still being investigated.

GOSH’s clinical reputation goes around the world but London Eye was told a side-effect of its clinician-led management is that it never made the proper adjustments to track patient pathways.

Not closing: North Middlesex’s A&E

Edmonton is not Bexley. So The Guardian was a little overblown to talk about the idea of closingNorth Middlesex University Hospital’s A&E.

There are undoubltdly problems at the A&E, which is one of the lowest performing in the country. The trust has the same problems as everywhere else getting the staff to staff its emergency department – except a bit worse. Plus there are the problems with its junior doctors appearing not to be properly supervised.

But there are several good reasons why nothing like closing NMUH’s A&E is going to happen.

It would destabilise neighbouring units, you’d need to do a statutory consultation, and the trust has a shiny new private finance initiative (PFI) hospital to operate out of. It would make more sense to close Whipps Cross A&E and move the staff over. Which wouldn’t make much sense either, but it would make more sense than closing the unit that enabled Chase Farm’s A&E to be closed.

Staff shortages have been used to close A&Es, Queen Mary Hospital in Bexley for example, but not expensive PFI ones.

London Eye features 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 tip me off about stories you think I should cover: ben.clover@emap.com.