Essential insight into NHS matters in the North West of England, with a particular focus on the devolution project in Greater Manchester. Contact me in confidence here.

The government’s recent commitment to fund six new hospital projects, and get the ball rolling on a further 21, is hugely encouraging.

After almost a decade of cuts and deterioration, there is finally now a stream of positive news about capital resources coming from Whitehall.

More solid detail and timescales are obviously needed (we can only really judge the situation once the promised “multi-year” capital spending budgets are set out), but the mood music has become dramatically more cheerful.

However, one region that won’t feel particularly celebratory will be Cheshire and Merseyside, which was not represented at all in Boris Johnson’s recent list.

In fact, if you look at all the capital earmarked through the Sustainability and Transformation Partnership bidding rounds since 2017 as well Boris’ election preparation, C&M has received just 1 per cent (£62m) despite accounting for 4.5 per cent of England’s population.

Omission

The agreed top priority for the region has been to move Liverpool Women’s Foundation Trust from its Toxteth site to the part-built new Royal Liverpool Hospital in the city centre, to address a whole raft of clinical risks that come with operating in the country’s only standalone women’s hospital.

But much to the frustration of the trust’s chief executive Kathryn Thomson, the project, which has been recommended by the northern England clinical senate, was omitted from any of the lists.

There were several possible factors weighing against it.

The first is the new Royal Liverpool Hospital, where building work was halted after the sudden collapse of Carillion in early 2018.

The government has already invested more than £75m to buy out the Private Finance Initiative company, while problems with the structural work carried out by the former contractor means another £300m is needed to finish the job.

This will clearly eat up a big chunk of the national capital budget. But given all the circumstances, it would seem particularly harsh if this resulted in LWH being overlooked. Ongoing uncertainties around the timescales for the new Royal would surely not preclude LWH from being at least eligible for seed funding. 

Meanwhile, the case for relocation is primarily related to patient safety and clinical risk and sustainability, due to the nature of operating on a standalone site. But when it comes to assessing schemes centrally, these issues are not specifically stated in the criteria for scoring bids.

Another issue is that LWH, opened by Princess Diana in 1995, is hugely symbolic for a city which is good at remembering, having been part of the significant investment in Toxteth after the riots of 1981.

There is also nothing wrong with the current hospital building, which adds to suspicions around the motives for relocation. It just happens to be in the wrong place.

It also has some important opponents, including West Lancashire MP Rosie Cooper, who chaired LWH for nine years from 1996, and has proved highly influential when it comes to big decisions within Liverpool’s health system.

The project is frequently, and misleadingly, branded as a “closure” by protesters, who blame government cuts for the scheme being required. Ironically, it’s government cuts to the capital budget that have so far helped prevent the project.

Feedback please

What might help LWH would be to get some proper feedback from the Department of Health and Social Care or NHS England/Improvement on why they have been unsuccessful, so they can plan accordingly. But Ms Thomson says the trust has been told nothing, despite asking several times.

A few years ago there was some talk of Liverpool Council potentially providing loan funding for the project, to avoid the need to wait for national investment.

However, even if the council did loan the trust the money, national approval would still be needed for the trust to spend it. So you come back to the same old problem of the capital spending limit.

Merger complete

As expected, Liverpool’s two acute trusts merged into one at the start of October, under the leadership of Sue Musson and Steve Warburton.

The trust’s communications team will be delighted with the local media coverage given to the launch of Liverpool University Hospitals FT, which focussed on the clinical case, rather than the financial drivers.

The planned programme of reconfiguration should produce benefits on both fronts, starting with trauma and orthopaedics. Elective work is currently being centralised at Broadgreen Hospital, with all the emergency work going to Aintree.

Subsequent specialities to be looked at should include surgery; stroke care; cardiology; nephrology; radiology; haematology; dermatology; and gastroenterology.

Although the efficiency savings are likely to be well short of the 12–14 per cent previously referenced, the trust will see significant scope to make inroads into last year’s combined deficit of £85m.

One example where savings could arise is by combining the on-call arrangements across various specialties, reducing the staffing establishment that’s needed.

I’m interviewing Mr Warburton this week, so look out for that piece.

As an aside, Aintree University Hospitals FT regained its “good” rating from the Care Quality Commission last month, including in the “well led” domain, having been downgraded in early 2018. It makes you wonder whether former chair Neil Goodwin was unfairly overlooked for the job of leading the merged trust.

STP changes

There will soon be new leadership for the Cheshire and Merseyside STP, with Mel Pickup departing as ‘leader’ at the end of the month.

Interviews for a new independent chair are taking place in the next couple of weeks, and the successful applicant will then be involved in choosing Ms Pickup’s successor. She is leaving Warrington and Halton Hospitals to run Bradford’s acute trust.

Given the lack of natural coherence within this region, there will be a strong case for appointing someone to do the job full time, rather than having to run a major organisation at the same time.

I’m also told that Diane Whittingham – a former chief executive who has spent a few years supporting unstable organisations - has been brought in to provide support in the “acute sustainability” workstream. Her challenge will be to finally get things moving for the likes of Southport and Ormskirk and East Cheshire.

New dynamics

Another big appointment in the north west is that of Kevin McGee, who has been made the substantive joint chief executive of Blackpool Teaching Hospitals and East Lancashire Hospitals.

This represents a major shift in dynamics within Lancashire, which is explained in Mr McGee’s recent interview with HSJ.

Apparently Lancashire and South Cumbria is also planning to appoint an independent chair to oversee the integrated care system. A bit of challenge to Amanda Doyle and the senior team may be no bad thing.