Essential insight into England’s biggest health economy, by Ben Clover
Mergers in all but name
The appointment of South West London and St George’s Mental Health Trust’s boss to the top job of the neighbouring MH provider looks like a further solidifying of a partnership spanning three organisations.
South London and Maudsley Foundation Trust is one of the best-regarded MH organisations in the world, but, like everywhere else in England, is under a fair bit of operational strain.
The “south London partnership” between three neighbours running west to east – SWLSTG, SLaM and Oxleas Foundation Trust – saw the responsibility for commissioning specialised services devolved to the providers themselves with a more formalised sharing of their caseload.
SWLSTG’s David Bradley led on some of the back-office integration of the trusts so is well-placed to run Denmark Hill.
He also has significant experience of getting capital schemes moved along, having secured a share of scarce central funding for some of SWLSTG’s work, helped as it was by having a big slug of develop-able land at its main site in Tooting.
SLaM will be looking to expand its provision of some specialised services at its Bethlem Royal site in Bromley. This will be a challenge, especially as the organisation looks to turn the promised increase in year-by-year funding from commissioners into a properly resourced community service across its four boroughs.
North East London FT is considered the best example in London of properly resourced community teams and SLaM, with its much bigger brand, is hoping to catch up over the next three to four years.
Talking of big brands, behind closed doors there is an acknowledgement that full merger between King’s College Hospital FT and its rival and not-in-special-measures neighbour Guy’s and St Thomas’ FT is the goal.
No one says this publicly but it is freely admitted by some well-informed sources.
Were it to happen, it would likely be the single biggest change effected during Sir David Sloman’s time as regional director in the capital.
The new chair of King’s is, of course, Sir Hugh Taylor, who is chair of Guy’s and St Thomas’. How on-board with a merger the new King’s chief executive Clive Kay is remains unknown.
If there is a merger, would it be one of equal partners?
In theory, the two are pretty equal, but in practice, only one of the two is in special measures and receiving substantial intervention from the centre.
Would the merger be a smooth one? The two trusts have already chosen, as independent and autonomous organisations, to share a medical school, an academic health science centre, an academic health science network, a clinical academic group structure, a part-privatised pathology provider and a four square-mile patch of inner south London.
Yet in practice, it might be pretty disruptive. The choice of metaphor of one departmental lead last time this was mooted is instructive. The senior medic (affiliation unknown) said previous attempts at collaborations had amounted to “landgrabs before the Armistice”.
Back in the NHS-as-it-is-understood-by-the public, waiting lists for planned procedures keep growing. At Sir David’s monthly meetings with providers the only performance game in town is accident and emergency waits and the number of 52-week+ waiters.
It is interesting that 52 weeks is the focus. On the latest data, London is the largest contributor to the national problem – 614 of 1,904 – with King’s, St George’s and Imperial all putting big numbers on the scoreboard.
And this is without whatever the contribution of the Royal Free would have been. Sir David’s former employer did not report its waiting times for February. The trust estimates it had roughly 89 patients to contribute to the national 52-week-plus total, but it could not validate its figures.
Of the four trusts, St George’s deserves credit for being upfront about the number of patients that came to harm as a result of the problems managing its waiting list, when it too had to stop reporting waiting times over the past two years.
- BARTS HEALTH TRUST
- British Medical Association (BMA)
- CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST
- Competition and co-operation
- GUY'S AND ST THOMAS' NHS FOUNDATION TRUST
- NHS England (Commissioning Board)
- NHS Improvement
- North East London NHS Foundation Trust
- NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST
- Public Health England
- Royal Brompton & Harefield NHS Foundation Trust
- St George’s University Hospitals NHS Foundation Trust
- Sustainability and transformation plans (STPs)
- Whittington Health NHS Trust