Essential insight into England’s biggest health economy, by Ben Clover

Sprawling governance issues

It’s been a difficult summer for managing top doctors at London hospitals.

Or rather, long running issues at two teaching hospitals came out in the open in legal proceedings.

St George’s seems to be essentially dismantling its complex cardiac surgical department in response to the strained working relationships between staff at the unit.

In recent weeks the trust and NHS Improvement have announced the suspension of complex work, the withdrawal of trainees and the appointment of an independent investigatory panel from NHS Improvement.

This is in addition to at least two separate trust led internal investigations.

The moves, which have become unusually public, come after one of the surgeons had the trust’s suspension of her overturned at the High Court.

The trust alleged the surgeon had breached an instruction not to approach a witness in one of the investigations, while her contention was that she was speaking to them about something else.

The medic in question’s own court papers said she had been the subject of 14 separate investigations over three years, after “a ruthless and unremitting” campaign of mainly anonymous complaints.

You don’t need London Eye to tell you: sprawling governance issues like this are a lot of work.

Investigating the issues, attempting to mediate, managing actual or potential conflicts of interest, organising or re-organising lists as people are suspended and then unsuspended, discharging your duty of care to employees in conflict with one another, running everything past expensive lawyers – all of this distracts from what the hospital is there to do.

The NHSI panel includes big hitters from the clinical field, law and NHS management – the latter in the shape of Sir Andrew Cash, who led Sheffield Teaching Hospitals for 16 years.

St George’s board has similar luminaries sitting as non-execs – Professor Sir Norman Williams was president of the Royal College of Surgeons, while Stephen Collier was lead counsel for the then chief executive of BMI Healthcare.

It’s hard to see both the trust’s senior management and the department still being in place in a year’s time.

Across the river

On the other side of the river, proceedings finally came to an end between two consultants at Great Ormond Street Hospital for Children.

This saw the trust lose a claim for sex discrimination. A similar claim against the private hospital that employed both doctors failed, however.

The disputes at St George’s and Great Ormond Street followed a familiar pattern of colleagues reporting one another to trust management – in one case at GOSH over whether a consultant had wrongly claimed back the £8 congestion charge fee. This particular matter was referred to the General Medical Council.

At both trusts, the legal documents revealed enmities going back at least 10 years.

You can see why management teams might shy away from confronting “dysfunctional” departments. A consultant in Nottingham recently lost an employment tribunal after spending four years suspended on full pay (£106,000).