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

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Welcome to North by North West

This is the third edition of HSJ’s new email briefing on the health services in the North West of England.

North by North West will take an in-depth weekly 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.

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: lawrence.dunhill@emap.com. If someone forwarded this to you, sign up to get your own copy here

A&E in the spotlight

Emergency departments in the North West have always been under severe pressure, due to higher levels of deprivation and ill-health in the population.

So with services now struggling across the country, it’s no surprise that emergency services from the Fylde Coast to the Pennine Way have started to creak.

As a general rule, when depleted local newspaper teams start picking up on problems, then it means things are bad, and there have been several reports in the last week.

Blackpool Victoria Hospital has introduced a ‘corridor nurse’ to ensure spill-over patients aren’t forgotten, while Warrington’s A&E is also in the spotlight.

Lancashire Teaching Hospitals – recognised for its efforts to hold the line on agency staff wages – was forced to breach the wage cap due to pressures in Chorley and Preston, while bosses in East Lancashire had to temporarily close a minor injury unit in Accrington so staff could help relieve pressure at the Royal Blackburn Hospital.

I’ve mentioned the problems in Greater Manchester in a previous email.

Ambulance handover times offer a good pressure gauge, and stats published by North West Ambulance Service show that average handover times in February were above the target 15 minutes at 21 of the 29 emergency departments in the region. See the numbers here.

The average handover time at Southport General Hospital was more than double the regional average, at 42 minutes.

Even at the best of times, scrutiny of emergency care is pretty intense.

But expect even greater scrutiny in 2016-17, as concerns grow among regulators and ministers that performance is taking a nosedive.

HSJ is aware of at least a couple of areas in England where executive jobs are hanging by a thread, due to A&E delays not being addressed.

Ministers will clearly see their vulnerability on NHS performance. Whether it’s 18 weeks or the four-hour standard, these are simple succeed or fail measures which could be used as a potent point of attack.

Since the Lansley reforms, the government has largely managed to duck and dodge its way out of criticism on the health service, but all this could change pretty quickly if performance tanks further.

A&E waits have of course been difficult to monitor over the winter, after NHS England stopped reporting weekly data. But there could soon be a return to regular reporting, along with the media and political scrutiny that brings with it.

In short, necks will be on the line and trust boards will be desperate to turn around “failing” A&E services. They won’t manage this on their own, of course, and will need proper acknowledgement and involvement from social services and clinical commissioning groups. It might also be worth looking at Wrightington, Wigan and Leigh Foundation Trust, one of the few trusts that met the 95 per cent target in 2015-16.

Old wounds

Old wounds have opened up in Blackpool, with NHS commissioners questioning invoices from private provider Spire Healthcare.

Blackpool CCG wants to know why Spire’s bills increased by 25 per cent, when GP referrals only increased by 3 per cent, and has brought in external auditors to investigate.

There’s a bit of history here, with Spire previously complaining to Monitor about the CCG, so it’ll be interesting to see how the audit pans out. Fylde and Wyre CCG has also queried its bills.

Suspension for nurse director

The Nursing and Midwifery Council has taken the rare step of suspending a director-level nurse, in the shape of Helen Lockett, formerly of Liverpool Community Health Trust. She was handed an interim suspension order of 18 months last week.

Should we be surprised by the length of time it has taken to investigate Ms Lockett, given that the Care Quality Commission first raised concerns about the trust’s culture and staffing in 2014?

Given the established pace of things at the NMC, probably not.