Daily Insight: Reputation must not browbeat scrutiny

When there was an overtreatment problem in the gastroenterology department of Great Ormond Street Hospital for Children Foundation Trust it took two reviews by the royal college and quite a lot of wrangling afterwards to get anywhere near a sense that lessons had been learned.

There were issues with disclosure to the public and the regulators.

Organisations like GOSH employ some of the most talented clinicians in their field anywhere in the world.

The trust’s funding is almost as complex as its patients, with income from the NHS, charity, research, training and wealthy international private patients.

So there is a reluctance to criticise teams that are often the last chance of saving children’s lives.

But a downside of all that excellence is a clinical culture that is seen by some as “bullet proof” in the face of criticism when it is warranted.

Some upsetting cases after the gastro incidents saw the trust’s management admit fault in how it handled patient safety in a BBC documentary and call in independent investigators Verita. They found a belief in some quarters that the desire for innovation sometimes trumped safety concerns.

GOSH’s medical director Sanjiv Sharma this month outlined the safety culture improvements he hopes will avoid a repeat of these problems, including more dedicated safety managers and even employing a psychologist to look at the human factors in ensuring safe care.

One commenter on our first story about the Verita report wrote: “Your child is ill and there is the option of a Gt Ormond St team or your local paediatric unit. You decide.”

This is a perfect summary of the issue. Of course, almost everyone would opt for GOSH, but reputation and influence can, sometimes, get in the way of proper scrutiny. A good example of this is the Royal Marsden’s paediatric service in Sutton. NHS England has ruled that the current provision of service there, by the similarly prestigious trust, will not be allowed to continue.

Zeroes for heroes

Leaders could be enticed to take over struggling trusts and systems with one-off bonuses, under a draft framework being considered by ministers and NHSE.

A new very senior manager pay framework includes scope for a “non-consolidated salary uplift of up to 15 per cent”.

This also allows for local remuneration committees to determine rates within “applicable ranges,” according to the senior salaries review body who shared details of the framework in its latest report.

The SSRB stressed there should be “clear criteria” for defining challenged systems and organisations, while suggesting only a “small number of them” would exist at any one time.

It comes after former health and social care secretary Sajid Javid said more top leaders should take over struggling organisations, and be paid more for doing so, in hopes of driving standards.

This was also supported in a review he commissioned from General Sir Gordon Messenger.

The SSRB also supported the removal of “earn-back,” under which managers lose some of their salary if agreed targets are not met, and raising the salary threshold at which central approval is required.

This would increase from £150,000 to £170,000, although the SSRB still regarded this as “too low”.