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

Medically led

There are two big appointments where no news is potentially big news: the chief executive post at GOSH and the new regional director role at NHS I/E.

To take Great Ormond Street Hospital for Children first, incumbent Peter Steer is leaving at the end of the year. This was announced in August and job ads went out soon afterwards. But the ads have now been discontinued and no appointments made, the trust said.

The trust is coy about how many people were interviewed (if any), saying only that the process continues.

So no one wants to lead one of the world’s leading paediatric teaching and research hospitals? Or not the right people? If so, why?

Part of the answer could be that GOSH has a long history of governance nightmares, something that has historically seen a turnover of medical directors and made running the place difficult.

Recent examples include the gastroenterology scandal and the long-running dysfunction in another department.

There is some consensus that Dr Steer did a good job but that in a trust that is so medically-led there will always be difficulties of this kind.

Regional role

What of the regional director for London? The word had been that Sir David Sloman, of the Royal Free London (nee Hampstead) Foundation Trust was to take the job.

Whatever happens it will be interesting to see what they actually do.

As London Eye previously reported there was some nostalgia for the good old days of strategic health authorities at a recent King’s Fund event. But speaking to other system leaders since, there is a feeling that acute services are broadly in the right place now (the big cancer/cardiac swap has been done), so perhaps what needs sorting out now is not downgrading the Whittington and Kingston Hospital (or Ealing or King George) but actually making the cancer systems deliver properly.

There is a feeling at Guy’s and St Thomas’ that the cancer networks (much reduced by the Lansley era) are not directive enough to cancer services that are still missing access targets.

Both north and south London’s cancer networks are appointing chief operating officers to be more grippy.

GSTT, which runs a major cancer centre and has already accepted work King’s can’t cope with, believes the time has come for organisational sovereignty to be dissolved for some cancer pathways to achieve this.

The new regional director, whoever it is, will be less powerful than Ruth Carnall was as London chief executive. But this might not matter if the main jobs is persuading clinicians at different trusts they are not autonomous. It’s a less placard-prompting task.

What will be more difficult is the growing issue of London specialists refusing referrals from further out. As local trusts decide they can’t provide sub-scale specialties that they staff expensively and intermittently with locums, they increasingly refer to trusts like GSTT instead, which has prompted GSTT to prioritise south Londoners.

This is straight-up un-NHS Constitutional, and something a CCG would complain to their regional director about. This would be the same regional director who holds foundation trusts to their legal duties to governors (who are largely locals, nominally responsible to their local populations).


*This story was amended at 10.10am on October 31st because I confused an ad for chief executive of Great Ormond Street with a recruiter’s ad for chief executive of the GOSH charity. Thanks to the commenter who pointed this out