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

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Welcome to London Eye

This is the first 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: ben.clover@emap.com.

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A tale of two trusts

Over the past fortnight news broke on two big-name trusts with very different brands but a key similarity.

To paraphrase Lady Bracknell, to lose 267 patients on a waiting list for more than a year might be counted as unfortunate, to lose 1,015 is a bit of a scandal.

But that’s what happened at Barking, Havering and Redbridge University Hospitals, which earlier this week accidentally disclosed it had four figures of year-plus waiters.

The trust hasn’t reported its elective waiting times data for two years but let slip the long waiters data in a board paper it then took down.

At a stroke this sees the trust shoot to the top of the national chart on year-plus waiters. It puts Leicester’s 267 in the shade and towers over even the national total of 748.

How did it happen?

The trust blames a lack of capacity, high levels of demand (outer north east London has one of the older populations in the capital), and data problems.

Updating a patient information system is often problematic, but two years and 1,015 patients problematic?

Despite having so far failed to lift the trust out of special measures, the new top management team at Barking is well regarded.

So the real problems are for those who regulate the system which saw this go unreported.

If just one of the nine trusts that do not report their waiting times can more than double the 52 week waiters total when their numbers are included, what is going on at the other eight? Can trusts investigate themselves to check there’s been no patient harm? (They are, I’m asking whether someone else should do it.)

None of the east London trusts – outer or inner, massive or tiny – are reporting their elective waiting times.

Barking could be in line for a fine of more than £5m on the back of this (£5,000 per patient) and I was told by someone who would know that non-reporting trusts have no incentive to start submitting their national data again. After all, they might avoid fines for long waiters they can treat whilst outside the system.

A&E is a more visible, media-friendly performance indicator for the hospital sector but referral to treatment might be the one to watch.

Meanwhile, at the expensive end of town

It emerged last week that the internationally famous Great Ormond Street Hospital for Children Foundation Trust had such an outdated patient tracking system that it didn’t know it had 9,000 patients awaiting treatment, rather than the 2,000 it thought.

The data won’t be validated until September.

It’s not often GOSH gets mentioned in the same breath as recovering basketcase Barking, Havering and Redbridge, but dramatic waiting list failures unites them.

People had known in and around GOSH for a while that there had been problems, and the trust has not reported its waiting list data nationally since July last year. But the four-fold-plus difference that came out this month shocked many.

There is no evidence so far that anyone came to harm. The trust is investigating itself.

The top team at the trust, led by recent Australian import Peter Steer, is well thought of, but as another acute trust chief executive told me, the specialism of the work at GOSH means it is medically dominated to the extent that its operational management systems are a generation behind other trusts.

A big tender for an electronic patient record system went out this week. It sounds like it is needed.

More than one problem in outer north east London

Returning to Birds of a Feather country, the agony of Barking, Havering and Redbridge’s commissioners continues at the hands of Monitor’s competition arm.

The market regulator last week delayed its decision on a competition complaint against the outer north east London boroughs by up to another month.

The case is an inversion of how people thought competition regulations would work in the NHS.

The CCGs were referred to Monitor by private firm Care UK, which complained that a process that would have seen the company’s elective orthopaedic centre taken over by Barking, Havering and Redbridge University Hospitals Trust was unjust.

Barking, Havering and Redbridge owns the site on which the centre is housed – King George Hospital – and there is some intrigue about the estates aspect.

But Care UK claims the commissioners had not shown due regard for quality, and that the trust unfairly undercut it.

During the passage through Parliament of the Health Act 2012, hand-wringers warned that increased competition would see private providers undercutting NHS incumbents on the profitable work and driving down quality.

That this challenge is going the other way – with a private sector incumbent complaining that a public provider undercut it, heedless of quality – would be an enjoyable irony if the situation didn’t threaten to cost the taxpayer a load of money by delaying the start of the contract: theatres potentially idle, the same teams of medics not knowing whose name is going to be on their payslip for the work.

London Eye hears Monitor’s competition team had found more or less in Care UK’s favour on some aspects of the complaint, but with the scope of the redress still being argued.

A decision could now come at the end of April.