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

Chair today, gone tomorrow

There are now a few top level vacancies in the London provider scene, and it would not be out of character for them to now be done as a job share. 

As HSJ reported last week, the Whittington’s chair Steve Hitchins resigned his post in a public board meeting, three months before the end of his term.

This is unusual.

He told members of the public that it was because NHS Improvement had told him he would not have his term renewed.

After some initial confusion, NHS Improvement’s London team contradicted him, saying that actually, no final decision had been taken.

Whoever is right on this point, the question is who will now take over at the north London integrated care trust. Despite being considerably smaller than its neighbours, the Whittington has managed to avoid being merged with any of them (although networking services has not always been pain-free).

Joint chairs are a strong current trend, especially in London and, as discussed by London Eye, are a favoured approach of the new London regional director Sir David Sloman. 

If the new chair of Whittington is to be a shared appointment, which we don’t yet know, then the questions are who and from where?

Dominic Dodd from the Royal Free and Baroness Julia Neuberger from UCLH are the obvious choices.

Mr Dodd has been chair at Sir David’s former trust since 2012 and has overseen its transformation from NHS trust to much enlarged foundation trust and hospital group leader.

Baroness Neuberger is newer to NHS provider trust leadership, taking up her role as chair in February this year, after the somewhat sudden and resented departure of Lord David Prior to chair NHS England.

Of the two organisations, Royal Free has the most form for taking over/integrating with neighbours.

Any incoming chair faces an interesting set of issues at the Whittington, not least around estates.

What do you expect?

NHS trusts have been placed in an iniquitous position by muddled policy from the centre.

That’s the only conclusion that can be drawn from HSJ’s reporting of providers being told they cannot offer services the NHS won’t fund privately.

The issue first blew up in the north west where Warrington and Halton Hospitals FT managed to make the front of the Daily Mirror for the crime of trying to balance its books by offering some private services.

Since then HSJ established that despite the restriction from NHS England (always keen to avoid people realising there is a postcode lottery on many services) many trusts continue to offer the treatments, the NHS has discontinued, citing lack of effectiveness.

The Royal Free, Chelsea and Westminster, Imperial and King’s are some of those doing this in London.

These are all organisations with a fairly mighty private income anyway, so asking them to stop doing stuff the NHS has stopped funding seems illogical.

The frustration for board leaders can be seen at North Middlesex University Hospital – a smaller trust serving an area of great deprivation with significant finance problems. It published a paper in October proposing to do exactly this, allow its medics to be paid privately for work the NHS would no longer fund as part of a desperate attempt to get the organisation anywhere near balance.

Telling them off for incidentally highlighting that NHS trusts are systemically under-compensated for the work they do – and therefore forced to find other ways – is unfair.

Outside of London

A chief executive in a non-London trust made waves this week when he said it was the duty of NHS organisations to confront racism or homophobia in the communities they serve.

Nick Hulme, formerly of Croydon Health Services Trust and now leading an organisation covering parts of Essex and Suffolk, said he had been shocked by the difference between the capital and the region.

London Eye has spoken to NHS leaders in the capital who said it would be unwise to think this is an issue that disappears inside the M25.

While maybe not as pronounced in London as elsewhere, they describe issues in community care, urgent care centres and elsewhere, involving abusive patients and their families.

Andrew Ridley, chief executive of Central London Community Healthcare Trust, raised a difficult issue for the service about how to reconcile patients’ rights to a universal health service with the right of staff not to be abused.