North by North West: All change at the top

In this week’s North by North West:

• Royal Liverpool CEO’s move to Qatar
• Money flows on Merseyside
• Sir David Dalton’s replacement
• New leadership in Stockport
• Greater Manchester’s growing waiting list

Lots of Doha

Few NHS leaders have experienced a more testing year than Aidan Keogh, who was left with a half-built hospital when the contractor Carillion collapsed at the start of 2018.

Having finally managed to untangle that mess and get building work started again with a new builder, the chief executive of Royal Liverpool and Broadgreen University Hospital Trust has decided to take a job running a major hospital in Qatar.

Besides what it surely an attractive pay package in Doha, Mr Keogh says he’d reached a point where he fancied working abroad and trying something different. And with the planned merger of Aintree University Hospital Foundation Trust finally looking like it will be completed this year, he said it made sense to step aside now.

I’ve only ever heard positive things about Mr Keogh, who will be a loss to the city during what will be a crucial period of integration and change.

His departure will seemingly leave the path clear for Steve Warburton to lead the new city-wide trust, barring any objections from the regulators. This looks like it will be an important early decision for Bill McCarthy, the new regional director for the north west.

Specialist question

Clearly the merger and major programme of clinical reconfiguration will present a huge challenge for the new organisation. But the financial situation also looks particularly daunting.

Between them, the two trusts are expecting a budget deficit of £70m in 2018-19, which would be the largest acute overspend in any major city besides London.

Bringing the trusts together is expected to close some of that gap, but there will need to be realism over the size of those savings. So what else can they do?

The move towards system level financial planning will mean more questions being asked about the funding flows in Liverpool, which is unusual in having five distinct specialist trusts.

The specialists consistently report a healthy financial position (besides Liverpool Women’s FT which is already intended to be merged into the acute services), while the acute trusts have missed out on the more generous tariff revenues for these services.

For the Royal/Aintree to be sustainable under the current financial flows, it probably needs to run more of these specialist services, as its healthier counterparts do in other cities.

But with The Clatterbridge, The Walton Centre, and Liverpool Heart and Chest all rated “outstanding”, and Alder Hey and Liverpool Women’s rated “good”, that is not a straightforward case to make.

The issue could possibly be addressed in the short to medium term through a system control total which permits a large deficit in the acute trust, offset by surpluses in the specialist trusts. But are the relationships strong enough to agree that?

Big boots

When Sir David Dalton announced his departure from Salford Royal and Pennine Acute in November, there was a big hint that a replacement would be found from within.

The job was advertised externally and more than one application was received, but the trust declined to say how many were interviewed.

Staff were today told that the deputy, Raj Jain, has been promoted to chief executive.

Sir David’s boots will clearly be big ones to fill, much like those of a certain knight at a football club down the road.

Manchester United finally seem to have got their mojo back after appointing someone familiar with the club, so hopefully that’s a good omen.

Stepping in

A different but no less daunting challenge for the new chief executive of Stockport FT.

Louise Robson joined the trust earlier this month, having previously been deputy chief executive of Newcastle Upon Tyne Hospitals FT.

Hopefully she can bring some of Newcastle’s strong performance and service quality to Stepping Hill, which now looks the most troubled hospital in Greater Manchester.

External support

Jon Rouse refers to two new consultancy projects in his January report to the Greater Manchester Health and Social Care board

Cordis Bright has been commissioned to undertake evaluations of the progress made in six of the boroughs, while an unidentified external advisor will look at elective pathways across the region.

The latter will apparently look at potential productivity gains and “how to make the best use of our available capacity through mutual aid between organisations”.

At the end of November, the elective waiting list in Greater Manchester was 9 per cent higher than it was 10 months ago, which means there’s a lot of activity to get through to meet the strict new national target – for the waiting list to be no bigger in March 2019 than it was in March 2018.

A section on Mersey Care FT’s expansion has been removed and will be revisited in the next edition.