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. Contact me in confidence here, or by sending a direct message on Twitter.

Lancashire’s hospital dilemma

A difficult hospital reconfiguration has been on the cards for a while in central Lancashire, and 2018 will be the year to bite the bullet.

In any list of unsustainable NHS services, the current “hot/hot” split between the Royal Preston Hospital and Chorley and South Ribble Hospital would be close to the top.

Both are run by Lancashire Teaching Hospitals Foundation Trust, where the medical rotas have long suffered from the pull of the bigger teaching hospitals in Manchester and Liverpool.

Its workforce vulnerabilities were flushed out in 2016 when it enforced caps on agency pay and a critical number of locum doctors opted to go elsewhere.

The staffing shortages forced the trust to downgrade Chorley’s accident and emergency department, though lobbying from politicians led to its status and hours being partially restored last January.

Senior clinicians at the trust have remained firmly of the view that maintaining the two A&E departments (10 miles apart) presents a risk to patient safety and the reinstatement was always likely to be temporary.

For central Lancashire (but maybe not neighbouring regions) an ideal and more politically acceptable solution would be to replace the trust’s ageing estate with a new single site super hospital between the towns, somewhere near Bamber Bridge.

But with the current constraints on capital funding this is unlikely to be anything other than a long term ambition and the trust will need to find a quicker fix to get through the next decade.

Minutes of a trust board meeting in December said there has been good progress on redesigning out of hospital care in the area over the last year or so but it’s “clear that now is the time to focus on acute sustainability”.

The minutes said work will take place over the next few months on options development and appraisal ahead of a public consultation later this year.

It is hard to see anything other than a hot/cold split between Preston and Chorley with A&E and critical care services consolidated at Preston and electives going to Chorley. This is the type of set up that NHS England has publicly supported.

However strong the clinical case is – and the 2016 downgrade provides useful evidence – the trust and its commissioners will be very aware of the onslaught they face from campaigners in Chorley, including MP Lindsay Hoyle, who is also deputy speaker in the House of Commons.

Walk in centres

Staffing shortages and safety concerns were also behind a cut in the opening hours of Liverpool’s four walk in centres in December.

According to minutes published by Liverpool Community Health Trust, which runs them, it proposed the 5 per cent reduction in March 2017 with all the centres moving to opening times of 8am-8pm.

Initially this wasn’t supported by Liverpool Clinical Commissioning Group but it has now been approved following escalating concerns and a whistleblower contacting the Care Quality Commission.

Carillion collapse

The collapse of outsourcing giant Carillion will cause problems for the NHS across the country but there will be few organisations as heavily affected as Royal Liverpool and Broadgreen Hospital Trust.

Carillion is the main contractor on the new (private finance initiative) Royal Liverpool Hospital and the company’s liquidation is another setback for a project already delayed several times. The company also provides facilities management services at the existing hospital.

The trust says the private consortium responsible for the project, called the Hospital Company (Liverpool), has contingency plans that enable termination of existing contracts and to access insurance funds and engage a new constructor.

Facilities staff are also set to be transferred to a new company established by the PFI firm to ensure work continues and staff and suppliers are paid, the trust said.

Scandal at Wirral

It’s been an extraordinary month for Wirral University Teaching Hospital FT and its former chief executive, who stepped down last month amid serious allegations over its culture, governance and management.

When HSJ initially learned of David Allison’s sudden departure just before the Christmas break the trust said he had left for “personal reasons”.

Leaked documents then revealed senior executives at the trust had blown the whistle to NHS Improvement over Mr Allison and trust chair Michael Carr, raising concerns about the way the organisation was run and the way internal concerns were dealt with.

Mr Allison then had his offer of a secondment with NHSI withdrawn, before more leaked documents this month revealed sexual harassment and misconduct allegations against two cardiologists, as well as bullying at the trust and a disconnect between management and medical staff.

NHSI has now launched a formal investigation, while Mr Carr remains in post.

Unglamorous job

The chief executive role at Southport and Ormskirk Hospitals Trust has finally been filled on a permanent basis after more than two years.

Silas Nicholls, previously of University Hospital of South Manchester FT, has taken what I recently heard described as “the most unglamorous CEO job in the NHS”.

Maybe so, but it will certainly be a challenge. The trust is heading for a deficit of more than £20m this year on a turnover of less than £200m, while a desperately needed reconfiguration is likely to face strong opposition from one of the most effective MPs in the north west.

According to the latest board papers, the trust has sought permission from NHSI to appoint tabloid favourite Steve Leivers as financial turnaround director, to help with the finances.

Now for the deficit

The North West is set to lose one of its most widely respected chief executives later this year, after Dame Jackie Daniel announced she would be leaving University Hospitals of Morecambe Bay FT at the end of March.

Dame Jackie joined the trust in 2012 amid investigations into the high profile maternity care scandal and led it out of special measures in 2015. The trust was rated good in February 2017.

The trust’s staffing levels and quality issues have rightly been prioritised over the last few years but whoever replaces Dame Jackie is going to have to start addressing its huge structural deficit – which has grown to £60m.

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.