North by North West: Groupthink

Big hitters

Lancashire is starting to look more serious about system working and consolidation, with two big hitters drafted in to get things moving.

Sir David Dalton, recently retired from leading the Northern Care Alliance, has started meeting local providers to discuss options for provider collaboration.

This is immediately intriguing because of Sir David’s belief in hospital “groups” with shared corporate management, and his experience in implementing this in Greater Manchester.

Lancashire will need time to decide whether it’s ready for a full-blown group model (the leadership situation at Blackpool might help – see below), but the potential to standardise processes and share resources is obviously there.

The difficulty will be the absence of a clear lead provider. With the NCA, Salford Royal’s achievements made it the obvious senior partner to the “inadequate” Pennine Acute, and many of the former’s systems and processes have subsequently been rolled out across the latter.

Lancashire’s providers lack those clear distinctions, with various factors holding each one back from lead status. Although this doesn’t necessarily prevent standardisation, the lack of obvious templates to follow will make things more complicated, and perhaps competitive.

It may be that what emerges are less dramatic plans for creating networks for single services (most likely for those ending in ‘ology’).

Meanwhile, Mike Farrar, the former strategic health authority chief for the north west and former Department of Health and Social Care official, has been brought in to help develop a strategy for commissioning.

This will almost certainly result in fewer CCGs (there’s currently eight), with the configuration to be determined by April 2020, as well as some clarity on the direction of integration with local authorities.

Blackpool exodus

The board room exodus continues at Blackpool Teaching Hospitals, with medical director Mark O’Donnell the latest to announce his retirement, following the nursing director and chief executive.

The trust has attracted lots of regulatory attention since an unannounced inspection of the emergency department in January, including an improvement director being sent in.

The trust recently advertised for a new substantive chief executive, but I’m told the process was aborted after a lack of suitable candidates applied.

This will likely mean Kevin McGee, the East Lancashire Hospitals chief executive officer who is currently running Blackpool on an interim and joint basis, will be asked to stay on longer than the initially agreed six months.

If progress can be demonstrated over the rest of the financial year (the Care Quality Commission was back in during June), it could start to strengthen the case for the trusts’ leadership to be permanently joined, as well as the longer-term chances of a single management structure for all four acute trusts.

New blood for pathology project

The ongoing efforts to transform Lancashire’s pathology services prove just how difficult collaboration can be.

The partners haven’t been singing from the same hymn sheet so far, and the project has been reined back after seeming to get ahead of itself.

System leaders will hope that Mark Hindle, the former Calderstones chief executive, who has just been appointed the new managing director for the project, can help create some harmony.

Royal Liverpool and Aintree

Three people were interviewed for the most important job in the north west - chief exec of the merged Royal Liverpool and Aintree trust. Aintree University Hospital’s incumbent, Steve Warburton, got the nod.

This suggests Aintree’s recent CQC inspection went reasonably well, at least in the well-led domain.

The Royal Liverpool and Broadgreen University Hospitals Trust received its CQC downgrade last week, with the trust now rated “requires improvement” overall.

What was remarkable though, was that staff achieved an “outstanding” rating within the caring domain, in what has been a pretty demoralising 18 months since Carillion’s collapse and the problems with the building work on the new Royal that have since emerged.

Accounts published by the DHSC also revealed the trust has so far received £76m from the Treasury to buy out the private finance initiative. But how much more will be needed to finish the job?

A&E struggles

Greater Manchester is still struggling on the four-hour target, despite the formal intervention from regulators earlier this year.

A notable exception has been Tameside and Glossop, which performed better than the national average in 2018-19.

One of the reasons given for its success is the shared leadership and commissioning function across the council and clinical commissioning group, which makes it curious that Wigan and Stockport CCGs recently opted to have separate single accountable officers.

Wigan had previously gone for joint leadership with the council, but have reverted back after Donna Hall’s retirement. Wigan does at least have several other senior joint posts, such as finance and contracts boss Paul McKevitt. Stockport, which was the worst performer in Greater Manchester last year, has none.