Weekly updates and essential insight into the NHS in the South West, by Will Hazell

How much should the NHS pay to turn around Kernow?

Last month NHS England announced to some fanfare a number of actions it is taking to ensure the NHS’s spending remains within its means.

This included a new financial cap on interim appointments at clinical commissioning groups, after HSJ had revealed a number of eye catching cases of interims being paid huge amounts of money.

It was a welcome move by NHS England, but unfortunately the organisation’s employees do not appear to have all been singing from the same hymn sheet.

A week after the new controls were announced, it emerged that NHS England had earlier this year waved through the appointment of an interim turnaround director at Kernow CCG at a cost of £396,000 in the current financial year.

The post has been filled by Keith Pringle, who has previously worked with CCGs in Hampshire and at Gloucestershire Hospitals Foundation Trust.

Yesterday NHS England indicated it will row back on the deal – the CCG will have to ensure the contract complies with its new cap or else apply for permission to breach it.

Kernow CCG is a troubled organisation. The group’s managing director, Joy Youart, has been suspended since the beginning of the year while an investigation takes place.

The reasons for the investigation have still not been explained. The CCG has said the suspension does not imply any wrongdoing.

In May a damning report was published which found “evidence of a culture of bullying and harassment” at the CCG. The group has been in legal directions since December 2015 after disclosing a significant and unexpected deficit, and it was recently rated “inadequate” by NHS England.

If Mr Pringle can help turn Kernow around and restore financial control, he will do a great service to the residents of Cornwall and the taxpayer.

It’s no doubt tough, demanding work, so you would expect the CCG to pay competitively. But the original financial package was beyond the bounds of acceptability; it is right that NHS England has taken a second look at it.

Yeovil rated ‘requires improvement’

The Care Quality Commission has rated Yeovil District Hospital Foundation Trust as ‘requires improvement’.

The CQC’s verdict on Yeovil is interesting for a number of reasons. As my colleague Shaun Lintern pointed out the CQC’s language in the statement released alongside the report hints at a subtle change in approach from the regulator.

In the past the CQC has scolded trusts for their lack of staffing, and it has been suggested that this has contributed to unsustainable paybill growth in some areas. Jim Mackey, NHS Improvement’s chief executive, recently said some trusts had read the CQC’s comments as an instruction to “go and employ a load of extra people”.

However, this time the CQC was more nuanced. In the statement deputy chief inspector of hospitals Professor Ted Baker said it was “for the board of the trust to determine” whether understaffing in the emergency department and intensive care unit was best addressed “through additional recruitment” or “changes to the existing model of care”.

In an interview with HSJ, Professor Baker confirmed it was a deliberate shift of emphasis. There is a recognition that in today’s financially straitened environment, trusts can’t just pile on extra staff at will.

Yeovil’s inspection report is also interesting because of the identity of its former chair. Peter Wyman chaired the trust for five years before moving on to become chair of the CQC in January 2016.

Is it a tad embarrassing, then, that despite Mr Wyman’s efforts the trust still requires improvement? Possibly – but on the other hand he can now tell hospital managers he has experience leading an organisation which is broadly in the same quality category as the majority of trusts in the country, and that he therefore truly understands the challenges and frustrations that go with that.

Mr Wyman might also be satisfied that Yeovil did not receive an inadequate rating in a single inspection domain.

For its own part, Yeovil seemed to feel it had been hard done by. Chief executive Paul Mears said the trust was “disappointed with the outcome of the report”, which did not recognise “the exceptional levels of care and service delivered by our staff every day”.

He pointedly noted that for its eight core services Yeovil had received 23 good ratings and only 15 requires improvement ratings.

Deep South

Deep South is HSJ’s email briefing on the NHS in the South West of England.

It takes an in-depth weekly look at a region which is one of the NHS’s most innovative, but also one of its most turbulent. The patch includes the cities of Bristol and Bath, through Wessex and Dorset, and all the way down the peninsular to Lizard Point.

Please get in touch with any suggestions about what you’d like to see covered and any story tips: will.hazell@emap.com