London Eye: Throwing your weight around

Royal rumble

The regional governance of the NHS has been far from clear since strategic health authorities were abolished in 2013.

This is not to say the issue concerning intensive care facilities for children sick with cancer in south London would not have happened then - the arrangements between the Royal Marsden and its neighbour trusts in south west London go back to Ruth Carnall’s time - but the channels of accountability might have been clearer.

We may never know what made Simon Stevens think the conflict of interest in appointing the chief executive of the Marsden as head of cancer services for NHS England was acceptable.

But this column reported in 2016 that the roles of provider boss and a seat in the over-arching body could be problematic for Ms Palmer.

Minutes of a meeting of the London Cancer Alliance show Ms Palmer objecting to reconfiguration proposals that might have seen her world-famous specialist trust lose urological and head and neck cancer surgery work.

The meeting in 2015 saw Ms Palmer tell the other members, who represented trusts from south and north west London, she could not support a two-site solution for urology.

She said the plans to reduce the number of sites from four to two would disadvantage the Marsden which performed smaller volumes of work but did important research.

On head and neck cancer surgery the minutes said: “CP acknowledged that the RM surgery numbers were smaller than activity at the other providers. However, if this was addressed, any change would require work to ensure that there was not a negative impact on non-surgical oncology or the current level of research.”

And: “Furthermore, CP referenced [the number of patients that surgeons treated privately] and the importance of including this when evaluating individual surgical expertise and safety. When looking at service configuration it must not be forgotten that the private patient activity makes an important financial contribution to NHS clinical practice.”

In the end, the south-east London part of the London Cancer Alliance went its own way and south west and north west parts rebranded as “RM Partners”.

You would expect a chief executive to fight their organisation’s corner. Especially if that organisation is paid more than £50m a year from private work. But as the paediatric cancer issue shows, asking that individual to combine that with a broader policy role, one that might put them in conflict with their organisation is unfair.

No one would suggest putting the chief executive of the Royal Brompton and Harefield Foundation Trust in charge of paediatric congenital cardiac surgery reconfiguration, it would be an obvious conflict of interest.

The obvious concern is that similar fudges of service configuration, fudges with patient safety implications, are happening now.

It’s hard to argue they would be easier to spot now.

As NHS England London’s former medical director’s interview with HSJ shows, it was hard enough to get accountability for publishing the review in the slightly clearer goverance situtation of 2015.

Now that the workings of the regional director’s office are almost entirely opaque – no papers, minutes or agenda published – it looks to be even harder.

Fifths-ing London?

A substantive response from senior figures at London STPs to the last London Eye in which we reported some people were thinking about – just thinking about – dividing the capital into four sub-divisions rather than four.

Both Helen Petterson’s team at North Central London and Mark Easton, who runs north west London’s clinical commissioning groups, got in touch to say there were no plans to divide NCL between its north London neighbours.

So let’s be clear, we never said it was going to happen, we said some people had mentioned it.

Meanwhile the plans for boiling down the many CCGs of London into just five. It will be interesting to see whether they do any better than their forebears in holding the sometimes over-mighty trusts to account.