North by North West: Not a good look

In this week’s North by North West:

• Controversial appointment at Alder Hey
• Objections to staff transfer in south Cumbria
• CMA back with a bang

New chair for Alder Hey

As the Department of Health and Social Care prepared to publish a major review of the fit and proper person test, one of the most high profile hospitals in England was promoting a rather controversial choice of individual to its chairmanship.

To the dismay of some observers familiar with her history, Dame Jo Williams is the new chair of Alder Hey Children’s Foundation Trust following the retirement of Sir David Henshaw. She has been a non-exec at the trust since 2016.

The concern stems from her previous chairmanship of the CQC to 2012, including an unsuccessful attempt to have a non-executive director, Kay Sheldon, sacked after she gave evidence critical of the CQC’s leadership to the Mid Staffs public inquiry.

She was also forced to apologise about comments she made about Ms Sheldon’s mental health while giving evidence in public to the Commons health committee.

In his final report Sir Robert Francis QC was highly critical of the CQC under Dame Jo’s chairmanship, suggesting there was a “pattern consistent with a negative and closed culture of the sort the CQC should be combatting rather than, however unintentionally, exemplifying”.

When Dame Jo appeared before a parliamentary committee in 2012, she suggested the issues had arisen because Ms Sheldon had breached the trust of her colleagues by raising concerns with external parties, which she should have kept and dealt with within the CQC.

This was despite the CQC regularly receiving, and acting on, whistleblowing reports from NHS staff in local organisations who had come to the regulator because they were fearful of raising concerns internally, or already exhausted this route.

None of this sits comfortably with the post-Francis consensus around the importance of openness and transparency, or the recommendations of the Kark Review into the fit and proper persons test, or with basic respect for a colleague.

The Kark review, published last week, called for a threat of “severe sanctions” against directors who seek to suppress or conceal whistleblowing or speaking up.

Regardless of whether Dame Jo’s treatment of Ms Sheldon and the concerns she raised would have crossed that threshold (which has not been tested), her promotion is not a good look.

West Lancashire MP Rosie Cooper has called the appointment “a spectacular own goal for a trust with a poor history of dealing with whistleblowers”.

In a statement, Alder Hey said a robust selection process was followed, overseen by the council of governors, and issues relating to the CQC were “fully explored and understood by the selection panels”.

But when asked for reassurance around its future approach to whistleblowers, and to confirm Dame Jo would take a different approach from the episode above to staff who feel the need to raise concerns externally, a spokesman told me there was no further comment.

The FT may now have to work doubly hard to persuade staff it is open to criticism and willing to listen. Let’s hope anyone wanting to raise concerns doesn’t think twice about it.

Transfer objections

There’s not much love going around for Lancashire Care Foundation Trust at the moment, with staff in south Cumbria now objecting to plans which would see them transfer into the organisation.

To recap, Cumbria Partnership FT is merging with North Cumbria University Hospitals Trust, uniting their community and acute services to form an integrated physical health provider. But its mental health services are due to be split between LCFT (in the south) and Northumberland Tyne and Wear FT (in the north).

Many of the staff in the south would prefer to go to the “outstanding” NTW, with some having previous experience of working for the “requires improvement” LCFT.

Structurally though, a transfer to LCFT makes more sense, as south Cumbria now falls in the Morecambe Bay commissioning area and the Lancashire integrated care system. Ultimately, the decision would rest with the commissioners, and they could point to the new leadership coming into LCFT as a selling point for unhappy staff.

I wonder if Caroline Donovan, who is due to take over the chief executive post in April, knew quite how difficult a job LCFT would be.

CMA returns

When clearing the merger that created Manchester University FT, the Competition and Markets Authority sounded as though it was retreating from its NHS regulation role.

The CMA agreed the patient benefits from consolidating services had been demonstrated, and also accepted financial pressures and a greater focus collaboration and integration had “dampened the role of competition” in the NHS. The long term plan has subsequently proposed to remove its duties altogether.

But the regulator was back with a bang last week, publishing a startling report which suggested merging hospital trusts could increase mortality rates by up to 550 per cent and cause incidents of patient harm to almost triple.

The study considered a range of typical harms such as falls, pressure ulcers and blood clots, and looks at activity covering 60 per cent of hospital admissions, rather than only narrow types of procedures. The authors controlled for a range of factors that might influence harm and mortality.

However, while the mechanics of the study are impressive, the conclusions were criticised by Nigel Edwards, chief executive of the Nuffield Trust, who said the headline findings were an overextension and ignored many other factors at play - such as the fact that cities, where there are greater concentrations of hospitals, normally benefit from richer supplies of staff and from top academic institutions.

Perhaps something for leaders in Greater Manchester and Liverpool to consider, though.