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

NHS Improvement probes Bath A&E

On Tuesday NHS Improvement announced it was investigating the Royal United Hospitals Bath Foundation Trust over its accident and emergency and elective care waiting times.

The RUH has struggled with A&E performance for some time.

When it was authorised as a foundation trust in October 2014 it agreed a set of actions to reduce waiting times, and in the last year NHS Improvement and NHS England have been working with the trust and commissioners to try to improve community provision to give the emergency department some relief.

However, the RUH’s A&E performance remains stubbornly well below target – in the last quarter of 2015-16 only 76.9 per cent of patients were treated and discharged or admitted within four hours, against the national 95 per cent target.

NHS Improvement has responded by launching an investigation of the trust to try to get under the skin of what’s driving its underperformance.

What’s going on at Bath? The answer is much the same as the rest of the country – higher admissions of increasingly frail patients without an equivalent increase in community provision so they can be swiftly discharged.

The trust has consistently argued that it does not have enough beds, but others in the local health economy have suggested to me that it has devoted too much of its attention to income generating elective work.

Whatever the cause, the RUH needs to demonstrate progress quickly. Jim Mackey, NHS Improvement’s chief executive, has identified reversing A&E performance as one of the NHS’s major short term priorities. It is widely expected that the coming “reset” moment will include an announcement about some sort of short, sharp intervention for trusts which have been consistent A&E laggards.

If that is the case, then the RUH won’t want to be on Mr Mackey’s naughty step.

Second governor resigns at Southern Health

Last week my colleague Joe Gammie reported the resignation of a governor at Southern Health Foundation Trust over the trust’s “farcical” response to the investigation into the deaths of patients in its care.

John Green is the second public governor to stand down at the trust.

In his resignation letter Mr Green said he had written to the government to express his “dismay at the farcical way” Southern Health and the NHS had managed affairs since the trust’s failiures to adequately investigate patient deaths came to light last year.

Last month Tim Smart, the trust’s interim chair, announced the findings of a review into the organisation’s leadership. He concluded that Katrina Percy, Southern Health’s chief executive, should stay on, albeit with a tweaked role, focusing more on strategy and less on operations.

Mr Green expressed his “dissatisfaction” at the decision by Mr Smart “not to censure the trust board”, which he said “appears not to address the culpability of board members for past failures”.

Southern Health’s leadership may have hoped that Mr Smart’s intervention would have steadied the ship, but if this resignation is anything to go by, its problems seem likely to rumble on.

Mental health new care models

In slightly more positive news for Southern Health, the trust is in one of the six regions selected to take on new commissioning powers for tertiary mental health services.

Southern Health is in the Oxford and Thames Valley region, but another of the pilots is in the South West, and is being led by Devon Partnership Trust.

In both cases the areas will have a remit to develop new care models for low- and medium-secure adult mental health care services, with an expectation that they will reduce admissions and lengths of stay while bringing patients located out of area closer to home.

About 480 people across the South West are currently receiving secure treatment, but more than half of them are treated outside the region. It is to be hoped that this intiative might go some way to changing that.

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