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

Fixing a hole

The tentative merger between Liverpool’s two acute providers has begun to get serious.

Two years after deciding they are better off together, the boards of Aintree University Hospitals Foundation Trust and Royal Liverpool and Broadgreen Trust have now approved an outline business case.

Regulators are due to visit the trusts this week to review the plans, after which there will need to be a submission to the Competition and Markets Authority and a full business case approved.

If the financial estimates used to support plans are correct, the trusts could really do with moving things up a gear.

According to a recent loan application from Aintree, a report commissioning from McKinsey in 2014 reckoned that a merger and clinical reconfiguration between the trusts would release annual savings of 12-14 per cent on their combined costs of almost £900m.

Trusts with experience of mergers, or researchers who have studied them, would probably suggest savings of that order are a tad hopeful, but even a fraction of that would come in very handy.

Royal Liverpool was a long way short of its control total last year and looks set finish 2017-18 with a deficit of £14m – £10m behind plan.

Aintree posted a surplus in 2016-17, but the position is deteriorating and the trust has run out of cash to fund its £15m capital programme. A recent loan request to the Department of Health (quoting the McKinsey savings) was rejected earlier this year and it’s having to think about alternative options.

Look inside

Royal Liverpool has been reporting some terrible performance stats for diagnostics in 2017-18, with 20 per cent of cases missing the six week target in the first half of the year.

The latest numbers, for September, show the trust accounted for more than a quarter of all waits of over 13 weeks in England in September. National performance on the six week measure has been running at 2 per cent against the 1 per cent target.

The steep deterioration (the trust was at 6 per cent in 2016-17) has been almost exclusively down to delays in endoscopy testing, where there are staffing shortages and a backlog touching 2,500.

The trust has now started outsourcing tests to 18 Week Support LLP to and bring the backlog down to a manageable level (around 1,400), while trying to recruit to vacant posts and aiming for a 10 per cent reduction in referrals from GPs.

The diagnostic delays have also started affecting the overall elective waiting times with performance dipping to 85 per cent.

Boardroom instability

Yet more board shuffling at Southport and Ormskirk Hospitals Trust where Sheila Lloyd, the executive director of nursing, will depart for The Clatterbridge Cancer Centre in the spring.

Ms Lloyd joined SOHT in 2016 and is highly thought of locally, so her departure adds to concerns about the trust’s stability. She said the Clatterbridge position has “taken 17 years to come up” and she felt like she had to go for it.

The trust has been without a permanent chief executive since Jonathan Parry’s abrupt departure in 2015, and finally advertised for a substantive replacement in November. Interviews are taking place this month.

Meanwhile, executive medical director Rob Gillies remains excluded, with Professor Arpan Guha recently being appointed on an interim basis. He was previously deputy medical director at the Royal Liverpool.

Lofty ambitions

Not content with leading the next stage of NHS transformation, Greater Manchester’s devolution team have set their sights on repairing the “cracked foundations” that have been at the heart of the NHS since its inception.

In a lecture at Manchester University’s business school last week (well worth a read), chief officer Jon Rouse said the “crucial deficiency” baked into the NHS in 1948 was the split between hospital care, general practice and social services, which has led to fragmented planning and delivery ever since.

He suggests the “irreversible” first steps of the GM devo project have started to address the defects, although a broader devolution settlement, or legislative changes at a national level, will be required to fully realise some of the changes – such as a reform of social care funding.

It sounds like Greater Manchester will be knocking hard on the government’s door ahead of next year’s green paper, in the hope of providing a further test bed for dealing with the “funding misalignment” between health (free at the point of use) and social care (means tested).

There could also be choppy waters to navigate in relation to cultural tensions between the integration “imperative” and providers’ “compulsions towards competition”, Mr Rouse warns. Are the big beasts ready to give up their compulsions?

Procurement down the pan

Wirral University Teaching Hospital FT and Countess of Chester Hospital FT have abandoned their procurement process for a strategic estates partner because of the preferred bidder’s link to a contractor on Grenfell Tower.

The trusts launched a procurement process for a strategic estates partner in 2016, which resulted in estates firm Ryhurst being named as preferred bidder earlier this year.

Ryhurst is a subsidiary of the Rydon Group, which came under scrutiny for its refurbishment work on Grenfell Tower following the fire that killed 71 people in June.

It will be interesting to see whether Ryhurst tries to challenge the decision.

CQC relief

There will have been relief at Pennine Acute Hospitals Trust (or should we say the Northern Care Alliance?) after the recent inspection by the Care Quality Commission, which did not raise any immediate safety concerns.

Multiple concerns had been raised immediately after the inspection in February 2016, which were followed by an inadequate rating, so some progress has been made.

The trust has been supported and effectively taken over by Salford Royal FT since that inspection and the mortality statistics for both trusts now make for interesting reading (Salford’s are up in the last two quarters, while Pennine’s are down).

There could be several factors at play, but something to keep an eye on perhaps.

CQC disappointment

The news wasn’t so good at Warrington and Halton Hospitals Trust, which has again been rated requires improvement following an inspection in March.

According to the ratings for each department, there had been a very slight deterioration since 2015.

Concerns in the latest inspection included staffing levels and escalation plans in critical care, although among other areas, some outstanding practice was identified by the paediatric acute response team in delivering care to a health centre central Warrington.

Rising costs

Mersey Care FT has been anxiously waiting for the Treasury to approve the full business case for its £60m medium secure facility in Maghull.

According to the trust’s November board papers, the case had to be approved by 1 December to avoid an increase to the developer’s “guaranteed maximum price”.

Mersey Care was talking to NHS Improvement to try and advance order the project and secure maximum price, but the trust wouldn’t comment when asked if this had been successful.

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.