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

Impoverished regime

Yet more misery has emerged from HMP Liverpool, where staff continue to speak out on failings within the health services provided by Lancashire Care Foundation Trust.

In October, HSJ reported that an investigation was commissioned into quality and safety concerns, with the FT saying it would be pulling out of its five year contract.

I’ve now seen a leaked draft inspection report from HM Inspectorate of Prisons, which describes an “impoverished regime” for inpatients at the prison.

The report says mental health provision has “deteriorated significantly” since a previous visit in 2015, and highlights significant staff vacancies which are compromising services.

Staff members have also told the BBC that a lack of appropriate healthcare may have been a factor in a number of recent prisoner suicides.

Prior to Lancashire Care taking on the health contract for HMP Liverpool in 2015, the services were run by Liverpool Community Health Trust, which is now in the process of being disbanded following a wide ranging review by into care and governance failings.

Among the most troublesome findings in that Capsticks review were LCHT’s failures to act on “concerns persistently raised” after investigations into custody deaths.

When Lancashire Care took over the contract there was a clear expectation that services and oversight would improve dramatically, so suggestions within the leaked inspection report that some staff feel their concerns are not listened to or acted on will make for uncomfortable reading.

It’s clear the awful physical environment and overall prison regime has made life extremely tough for the NHS and social care staff, and it shouldn’t go unnoticed that despite the “consistent and challenging staff pressures”, nursing staff remained “caring and kind in their approach”.

The talking therapies service was also described as “an excellent beacon in an otherwise struggling service”, which is a remarkable achievement for those staff.

The fact the trust has also recently called time on its contracts for five other prisons in Lancashire should ring alarm bells about the sustainability of prison health contracts and the funding envelope offered by NHS England, which commissions them.

Salary cuts

Earlier this year, a Deloitte review commissioned by NHS England, found Liverpool Clinical Commissioning Group’s leaders were being paid “significantly higher” salaries than their peers.

This was followed by an almost total wipe out of the governing body and a second review, commissioned by the CCG, to come up with recommended salary levels.

For the chief officer role, consultancy firm Korn Ferry said Katherine Sheerin’s successor should be paid between £132,000-£143,000, instead of £155,000-£160,000, while Tom Jackson’s replacement as chief finance officer should get £104,000-£121,000, instead of £145,000-£150,000.

Taken at face value, some of the salaries paid to former lay members look more extraordinary.

The consultants recommend that lay members be paid within a band of £10,000-£15,000 for four to five sessions per month, which when compared to the £100,000-105,0000 salary received by former deputy lay chair Professor Maureen Williams, might require your eyes to be placed back in their sockets.

I understand Professor Williams was doing many more sessions than four to five a month, however, which implies the CCG had too many people attending sessions unnecessarily.

Along with an imminent bearing down on CCG “running costs”, the goings on in Liverpool will no doubt lead to much greater interest in the next iteration of NHS England’s guidance on CCGs’ governing body pay.

Unachievable timescales

Leaders at Mersey Care FT have indicated the plan to retract all services from the Calderstones Hospital site in Lancashire by 2019 will be “unachievable”.

According to board meeting minutes published at the end of November, a patient focused review of discharges has found 75 per cent of the remaining patients within the learning disability services “were very likely to not take place due to a number of individual factors”.

Within the specialist learning disabilities division there had been 16 actual discharges in the seven months to November, against the planned 54, the papers said.

The retraction timetable was set by NHS England and the minutes said a “failure to deliver against them would have negative implications for the trust, as well as significant financial ramifications for commissioners”.

Green shoots

Green shoots of collaborative working have started to emerge in Lancashire, where all four acute trusts in the STP are seriously involved in plans to consolidate pathology services.

The plan to create a “hub” at Lancaster University provides a neat way of avoiding a perceived takeover by any one trust, and the project leaders reckon it can deliver savings of 20 per cent, or £16m a year.

There’s still a way to go before this becomes reality though, because all the planning and modelling so far has been based on a project including just three of the trusts.

All the activity from East Lancashire Hospitals Trust still needs to be fed into the calculations, which could potentially throw things up in the air.

CCG sweep

The sweeping away of clinical commissioning groups gathers pace in Greater Manchester, with the leadership of several more CCGs set to be taken over by the corresponding borough council chief executive.

HSJ has learned that in Trafford, Rochdale and Oldham the council chief executive is expected to take over the CCG accountable officer role on a dual basis within the next 12 months, while Wigan CCG also confirmed its intention to merge the two roles.

Interestingly, Manchester CCG says it will not follow this model, while the others are undecided.

Delivering results

Amid all the transformation work going on in the city of Manchester, the Care Quality Commission points out the need for “greater focus on current operational delivery”.

In one of its “targeted reviews of local authority areas”, the regulator looked at how people moved through the health and social care system.

The CQC was generally impressed by the vision, ambition and “conditions for change” being created in the city, but found less to be positive about when it came to actual results.

For example, it found that in every quarter from the start of 2014-15 through to the end of 2016-17, the rate of older people attending A&E was significantly higher than the national average.

Given that the city’s big transformation projects are yet to be fully implemented, this should come as no surprise.

But it also serves as a reminder that no matter how many CCGs you merge, or multidisciplinary teams you create, it’ll mean nothing unless you deliver improved patient access and outcomes, while staying within the given budget.

Complications

I hear there are continuing difficulties in awarding the “local care organisation” contract for Manchester, which is the flagship transformation project for the city.

To the annoyance of GPs, efforts to create a distinct organisation to hold the contract have had to be put on the back burner, which means it will be held by Manchester University FT for now.

Although this is accepted, I’m told there are still issues with bringing together NHS commissioned community care with local authority commissioned social care under a single contract.

Ian Williamson, whose job title of accountable officer for Manchester Health and Care Commissioning points to a more straightforward future, said there are “still some contractual issues outstanding, but we are confident they will be addressed early in the new year”.

The contract is supposed to go live in April.

End of the revolution

The IT systems at Pennine Acute Hospitals Trust, including a system introduced in 2015 to “revolutionise” its patient records, are set to be overhauled and replaced in the new year.

It looks as though an Allscripts electronic patient record will be installed, to complement the new provider group model being developed with Salford Royal FT.

North by North West takes an in-depth fortnightly 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 also includes Merseyside, Lancashire, and Cheshire.

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@wilmingtonhealthcare.com. If someone forwarded this to you, sign up to get your own copy here.