Save King George Hospital: As the Chair of BHRUT resigns, there are As the Chair of BHRUT resigns, there are strong parallels with Mid-Staffs as the public, experts and local politicians are ignored by NHS authorities

Neil Zammett writes

The news last Friday 21^st February that Sir Peter Dixon has resigned as Chair of BHRUT the trust that runs Queen’s and King George is a body blow to local services and management alike.

As a former Chair of the Housing Corporation, University College Hospital and Enfield and Haringey Health Authority Sir Peter is a highly regarded and experienced public servant whose presence at BHRUT gave a calibre of leadership which it would be hard to match.

He of course follows a similarly distinguished Chair, Sir David Varney, who left the Trust after only six months in June 2010, and joins the current medical director, finance director and chief executive in departing.

Only very recently Sir Peter was heard to say at a Scrutiny meeting that he was in it “for the long term” so something significant has happened to prompt his departure.

The answer to this lies in the complex relationship between the Care Quality Commission (CQC), NHS England and a shadowy body called the National Trust Development Agency (NTDA).

The CQC ‘s last report on BHRUT made it clear that they had ran out of patience with the Trust’s inability to solve the local crisis in A&E; a crisis that had lasted for three years, not just days or months.

The NTDA, who effectively act for the Department of Health, were faced with a recommendation from CQC to put the Trust into “special measures”; they had to comply and this started the current sequence of events.

Reading between the lines it is clear that no one had worked out what “special measures” actually meant in this case. It was so unclear that the NTDA despatched an NHS grandee, Sir Ian Carruthers to the Trust to assess the situation after they had made the announcement.

But before special measures Sir Peter had already presented his assessment independently to the NTDA backed up by management consultant’s report. Again we do not know the detail but an important part of this assessment must have been a need for resources and capacity.

We can imagine that the report would have said something along the lines that: “Without the ability to source adequate capacity to support both management and clinical staff, these hospitals will continue to fail.”

Obviously Sir Peter’s arguments fell on deaf ears.

The Future

Whatever else this sad turn of events has meant it is clear that the Health4NEL plan to close A&E at King George has now run its course. There is no doubt that the management of BHRUT have done their best but the colossal projected overspend for 2013-14, the continuing dreadful performance of A&E and the departure of all the key staff all point to the same conclusion-it is simply not possible.

Even Professor Sir Mike Richards the head of the CQC has gone on record about the huge challenge facing BHRUT which he later described as “A task like Everest”.

The recently appointed turnaround director and the interim finance director are both veterans of the South London Trust and the administration regime while the new “interim” Chair Dr Maureen Dalziel has only been given a three month contract. This would run out at the end of May, around the time of the local elections.

All of this suggests that Queen’s and King George are being lined up for administration by the NTDA and local CCGs, the GP organisations that now commission hospital services. The timing of the new Chair’s contract suggests that a formal announcement will be delayed until a politically less sensitive time.

Administration carries substantial extra risks. There are already indications that the recruitment of clinical staff is being adversely affected by the “special measures” and managers are obviously not going to be rushing to join the Trust. Morale at all levels must be at an all time low. Administration would accelerate this process and could lead to “recruitment blight” as has happened at Mid-Staffs.

More serious is the fundamental difference of view between a very senior and experienced public servant like Sir Peter and the NTDA. This cannot be dismissed as a simple personality clash given the history outlined above and goes to the heart of the continuing problems at BHRUT:

· On the one hand, the NTDA, the CCGs and the Urgent Care Board (UCB) are still backing the Health4NEL plan

· On the other Sir Peter, Redbridge Council and this Blog see the need for more capacity and resources.

Without a consensus on how to move the Trust forward local people face a long period of uncertainty with failing services and an emerging crisis of confidence and leadership.

It’s just like Mid-Staffs

When things go wrong in the NHS it is difficult to find out who is responsible. At Mid-Staffs two enquiries and two massive reports gave us some clues and some recommendations about stopping this happening again. There are close parallels between Mid-Staffs and BHRUT.

In both cases, a major problem was the single minded pursuit of management objectives at the expense of patient care. At Mid-Staffs it was foundation trust status; at BHRUT it is the closure of A&E at King George.

At Mid-Staffs expert opinion from Professor Brian Jarman was disregarded; at BHRUT it is Sir Peter’s and Sir David’s from a management perspective and the evidence from this Blog from an analytical one.

Finally there are the views of the public and local politicians; again comprehensively ignored, just like Mid -Staffs. I am not suggesting the consequences are on a comparable scale but local people have had to endure a dreadful A&E service and Redbridge women have been forced against their wishes to use a sub-standard maternity service at Whipps Cross.

Who is responsible?

Although the NHS reorganisation means that many of the decision making bodies have gone, the NTDA as the controlling successor body is primarily responsible.

But the CCGs and the Urgent Care Board (UCB) although they are in a less controlling role still bear a heavy responsibility for what is happening. Without their support the NTDA could not continue with the closure plan. Surrey Downs CCG in South London has done just that; pulling out of the equivalent plan to downgrade Epsom and St Helier Hospitals.

Finally the CQC, while precipitating the current management crisis, has very little authority to influence plans as such, illustrating the weakness of accountability and regulation in market economies.

What needs to happen?

At the heart of this is the need to scrap the Health4NEL plan. It clearly has not worked, there is overwhelming evidence now that the assumptions underlying it were deeply flawed and continued efforts to implement it have created the present crisis.

Making this decision is primarily the responsibility of the NTDA. Redbridge CCG could take the lead on this, however by following the example of Surrey Downs and withdrawing from the plan. It’s up to them.

Local people need to be involved not pushed to the margins. They are supposed to be at the centre of what the NHS does, but locally their voice has been systematically ignored. The same is true for local politicians. The CCGs and the UCB need to open up and start listening to their views.

In particular there needs to be a critical review of the schemes the UCB has funded this winter and their impact on A&E performance. A central question is why the UCB has not opened up more beds to ease the pressure on A&E. This is what has precipitated the crisis.

Finally there is the issue of ignoring expert advice. There is a sense in some quarters that the NTDA and others are knowingly pushing BHRUT over the edge for whatever reasons. This is a potential charge they should be given an opportunity to answer in a way which makes them publicly accountable.

The news on Friday 21^st February that Sir Peter Dixon has resigned as Chair of BHRUT the trust that runs Queen’s and King George is a body blow to local services and management alike.