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

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King’s George’s?

It’s an understatement to say St George’s is having a difficult time at the moment – but London Eye hears talk of an old idea returning.

The south London trust, home to London’s smallest medical school, has difficulties across the board.

At the time of writing, interim chief executive Paula Vasco-Knight remains suspended, having been in place less than a month following the departure of predecessor Miles Scott.

The organisation is expected to record a deficit of £55.1m for 2015-16 and is predicting an optimistic £17m shortfall for 2016-17 – after a £17m slug of STP money.

In performance terms, the trust is missing the A&E, RTT and cancer targets.

A leaked report also shows a major disconnect between the trust’s medics and its managers, among the worst that the researchers had encountered.

Not to mention the serious procedural and organisational problems revealed in the report by PWC into how the trust managed to move from a surplus while it was trying to get authorised as an FT to a £16.8m deficit once it had been authorised as an FT. This has led to a major restructure of the finance department.

As a side note, NHS Concealment (aka NHS Improvement), the regulator responsible for St George’s, has refused to allow the release of the full report, instead only allowing journalists to look at it in the organisation’s foundation trust membership office – a nice irony given the context!

It’s actually pretty serious, the internal processes at the trust were apparently so bad that the trust did not know how much work it contracted out to the private sector in order to hit waiting times targets. This is the kind of report NHS Improvement should routinely release, but instead the Information Commissioner’s Office is going to have to make it.

Meanwhile, the trust has also seen its plans for a new private patient unit, a development that would also have housed an NHS renal facility, stalling.

Would any of these problems be solved by merging the organisation with King’s College Hospital Foundation Trust?

Probably not, but the idea is once again being talked about.

Hinted at a few years ago, London Eye was told it never went further because at the time the differing fortunes of the two trusts meant it would’ve looked like a takeover by Denmark Hill.

But with King’s now having a lower standing, the idea has re-surfaced.

Although technically a teaching hospital with specialist services like the big three in London (Imperial, GSTT and UCLH) Tooting cannot really compete with this trio. Figures in commissioning have long suggested the trust should focus on trauma, stroke, infectious diseases and its overheated DGH business, giving away some transplant work to retain more neurology.

The St George’s Medical School would, under this approach, likewise merge with King’s College London.

Nick Moberly is only recently installed at King’s and the board at St George’s is as interim-heavy as it has ever been, but it will interesting to see if this idea gains traction – especially with the range of merger-lite options currently available to decision-makers.


Over bedded

With performance seemingly doing its best to overtake finance as the biggest problem for providers, STPs, vanguards and the like can seem a bit abstract.

So it was heartening to see a bit of substance in North West London’s sustainability and transformation plan, which recently came to light.

There wasn’t lots of it but NW London, led by Ealing CCG’s Mohini Parmar, included an aspiration to take out 500 acute beds.

Of course, this was received with horror by local media but, simply put, NW London is over-bedded. Those very familiar with the area tell the London Eye that the patch has been over-bedded for some time. And that bed base is divided between many deficit-ridden trusts.

Whether services can be improved such that taking out 12 per cent of the sector’s 4,000 beds is possible is debatable. Ditto whether the changes can be sold to the public well enough to get political support.

Dr Parmar follows in the footsteps of a fellow Ealing GP Mark Spencer, who took on local politicians to make the case for safety when services were being moved out of Ealing Hospital.

When the history of the NHS is written Ealing CCG will get an honourable mention for telling their population things they didn’t want to hear, but will in all likelihood save lives.