London Eye: Corporate whistleblowing

There keeps being more context around the departure of chairs at London hospital trusts.

It is well known that the regional director is reducing the number of independent chairs across the patch in favour of shared posts across organisations. In an integration-above-all era it makes a kind of sense.

But for good or ill, trust chairs are charged with putting their organisation, and the population they serve, first — and they can be a counter to the power of the not-at-all-democratic central NHS bodies.

Apply all this to the Whittington and it gets complicated by politics and Politics, as court papers obtained by HSJ show.

The small-ish north London hospital and community provider had agreed a strategic estates partnership with a subsidiary of Rydon — the company responsible for refurbishing Grenfell Tower.

One week after the fire, the process was paused by the trust.

The allegation from Ryhurst, the subsidiary, is that the trust backtracked on the contract under pressure from the Mayor’s office, NHS Improvement and local MPs, including Emily Thornberry and Jeremy Corbyn. Politics with a big-P.

Emails between then chair Steve Hitchins and two Whittington non-executive directors in April 2018 appear to show the effect of this, with Mr Hitchins writing there had been “a complete turnaround on the estates plan” and it was being “abandon[ed]”.

Mr Hitchins, who sadly died earlier this year, added: “The biggest reason behind this is inevitably politics with NHSI completely compromised by the possibility of any political ripples and the London Mayor’s intervention. Nothing will ever appear in writing or even be said but it has been made clear the SEP is dead!”

Harold Lasswell defined politics as “who gets what, when and how” — and the trust’s objective was to get its estate refurbished. Something that would have involved potentially selling some land to the local mental health provider. There might have been other capital works “as well as commercial developments”, the tender notice said.

Why did this have to be done through a joint venture with a private company?

As the trust put it in communications with local pressure group Defend the Whittington Hospital Coalition: “We do not have sufficient funds to develop our estate in the way that is needed.

“There is no alternative [to partnering with the private sector]. We have been trying to solve this issue for 17 years. We’ve tried every available avenue — but we’re here, now, still, trying to find a way to fund the services the community relies upon. We do not have the resources or the skills to do what is needed.

“We need to find way of funding the development of our estates which will cost near to £100m”.

Ryhurst would not have put up the £100m, but the contract covering 10 years (worth between £30m and £300m according to the contract notice) would see the firm “raising finance and investment” as well as arranging “strategic non-clinical or clinical service reconfiguration”.

We will never know where Ryhurst might have raised this “finance and investment”, but it is not fanciful to suggest it might have been part-private sector. It would seem odd to hire expensive private sector advisers to write a business case asking for NHSI money (this was all before the recent months which have seen politicians competing to pledge new public NHS capital spending).

So the populations of Islington and Haringey would have got refurbished facilities, over the next decade, through some kind of public-private tie-in.

Why was it so important to get an estates masterplan agreed?

An email from non-executive director Tony Rice to Mr Hitchins said: “Not only do we look like complete incompetents (because of the behind the scenes machinations of NHSI, local politicians and City Hall) but a backdown now may result in us never being able to effect an estates plan of any kind, a certain path to merger and possibly closure in the future.”

Ie, the populations of Haringey and Islington get less health facilities.

The Whittington has long looked like a potential target for merger and possibly closure — and it was as recently as 2007. Its independence next to large organisations like the University College London Hospital and Royal Free was never a given and it is perhaps notable that the new chair of the trust (after Mr Hitchins was told his term would not be renewed by NHSI) is UCLH chair Baroness Julia Neuberger.

The NHS response to Ryhurst’s legal complaint has been that, on reflection, the financial position was much improved and perhaps public money could be found for an estates project.

Ie, the populations of Islington and Haringey will get refurbished facilities, at some point, with no public-private tie-in.

So it appears in that case the board was doing what you might hope a trust board would do, working to secure investment for its population. It is a different question whether major capital decisions should be taken at this level.

Mr Rice’s email continues on the theme of small-p NHS politics.

The court papers quote him saying: “If we can’t reverse the direction of travel there are other actions we should consider especially re NHSI.

“We might want to consider recording the dialogue over the past two years or so and communicating it to the key players in and above the NHS to put on record the ineptitude of the centre as a form of corporate whistleblowing.”

Another NED, David Holt, said: “I am keen that, regardless of NHSI’s blocking tactics, we press on with our transformation plans, particularly the vision that a master plan will bring.”

While it seems Mr Holt’s hopes have come to naught, it is hard to disagree with Mr Rice that the whole thing could have been done a bit more openly.

Why wasn’t it?

Mr Hitchins said NHSI lacked “backbone” while Mr Holt said: “I think we need to be very clear how any change of heart on signing a [strategic estates partnership] is communicated as it would be unfortunate if it increased the power of certain lobby groups!”

He appears to be talking about the Defend Whittington Hospital Coalition. Why are they so powerful? Because they campaigned to oppose closure in the previous decade and won as well, perhaps, as their support among senior Labour figures. Part of their vociferousness came from the feeling that NHS London, sometimes remembered fondly, had not been open enough about the plan.

Mr Hitchins’ determination in the face of what some describe as the political timidity and bureaucracy of the NHS was surely a good thing.

The loss of independent chairs across London’s NHS removes a layer of local accountability.